NBME OBGYN2 6 Wrong With Answers Searchable (2)

Thursday, January 15,201512:22AM Exam Sect1on : Item 1 of 50 National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment ~Mark Time Remammg: 2 hr 49 min 39 sec 1. A 12-year-old girl is brought to the physician because of a 1-year history of progressive facial hair growth and acne. The mother reports that her daughter has grown 4 inches during the past 4 months. Breast development is Tanner stage 1, and axillary and pubic hair development are Tanner stage 3. Physical examination shows dark hair over the upper lip, cheeks, and chin. There is acne vulgaris over the cheeks. Pelvic examination shows a 2-cm vaginal canal, significant clitoromegaly, posterior labioscrotal fusion, and no cervix or palpable uterus. Abdominal ultrasonography shows bilateral gonads without follicles; there is no uterus. Chromosomal analysis is most likely to show which of the following karyotypes? Q A) ~ 0 8 ) 46,XX @ C) 46,XY Q D) ~ Q E) ~ 1/15/201512:22 AM· Screen dipping NBME 2 OBGYN Page 1 Thursday, January 15,2015 12:22AM Exam Section : Item 2 of 50 Nat1onal Board of Medical Examiners Obstetrics and Gynecology Self-Assessment ~Mark Time Remaining: 2 hr 49 min 23 sec 2. A 27-year-old nulligravid woman comes to the physician because of dyspareunia and dysmenorrhea for 2 years. Menses occur at regular 28-day intervals. Pelvic examination shows nodularity over the uterosacral area. The uterus is retroverted . Both adnexa are normal-sized but tender. Which of the following is the most appropriate next step in diagnosis? 0 0 0 0 A) Measurement of serum CA 125 concentration B) Measurement of serum a-fetoprotein concentration C) CT scan of the abdomen D) MRI of the pelvis @ E) Laparoscopy 1/15/201512:22 AM - Screen dipping NBME 2 OBGYN Page 2 Thursday, January 15,2015 12:22AM Exam Section : Item 3 of 50 1!'.1 Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 49 min 17 sec 3. A 57-year-old woman , gravida 2, para 2, comes to the physician because of pelvic pressure and a feeling of a mass in the vagina for 2 months. These symptoms are worse while standing for long periods of time and are relieved by lying down. She had a vaginal hysterectomy 10 years ago. She has no urinary tract symptoms and no difficulty with her bowel movements. Examination shows no anterior vag inal relaxation. Valsalva maneuver produces a bulging posterior vaginal mass that has its origin high in the vaginal vau lt. Which of the following is the most likely diagnosis? 0 A) Cervical tumor 0 B) Cystocele @ C) Enterocele 0 D) Ureterocele 0 E) Urge incontinence 0 F) Urinary tract infection 0 G) Uterine prolapse 1/15/201512:22 AM- Screen Gipping NBME 2 OBGYN Page 3 4 Dates Thursday, January 15, 2015 12:22 AM Exam Section: Item 4 of 50 ~Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 49 min 12 sec 4. A 22-year-old woman, gravida 3, para 1, aborta 1, at 33 weeks' gestation comes to the physician for a routine prenatal visit. Pregnancy has been uncomplicated, and she has received prenatal care since 7 weeks' gestation . Ultrasonography at 24 weeks' gestation showed no abnormalities. She has type 1 diabetes mellitus, and her postprandial serum glucose concentration was 95 mg/dl at 28 weeks' gestation. Her blood pressure is 110/72 mm Hg. Fundal height is 38 em. Her blood group is A, Rh-positive. Which of the following is the most likely diagnosis? -::QJ 0 0 0 A) Error in gestational age B) Multiple gestation C) Pelvic tumor D) Polyhydramnios )fJ E) Normal pregnancy variation of fundal height 1/15/2015 12:22 AM- Screen Clipping Likely D -7 diabetes type 1 -7 polyhydramnios Any diabetes is associated with polyhdramnios, and polydhydram nios can cause increased f undal height NBME 2 OBGYN Page 4 Thursday, January 15,2015 12:22AM Exam Section : Item 5 of 50 • Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 49 min 8 sec 5. A healthy 24-year-old primigravid African American woman at 11 weeks' gestation comes to the physician for a routine prenatal visit. Her only medication is prenatal vitamins. Her blood pressure is 120/70 mm Hg. Examination shows no peripheral edema. The fetal heart rate is 150/min. At her first prenatal visit 4 weeks ago, laboratory studies showed: Hemoglobin Mean corpuscular hemoglobin Mean corpuscular volume 10.2g/dl 20 pg/cell Leukocyte count 10,900/mm3 140,000/mm3 Platelet count Hemoglobin electrophoresis Hemoglobin A 72 J..lm 3 95% Urinalysis today shows no glucose, protein, or ketones. Which of the following is the most likely cause of these laboratory findings? 0 A) Folic acid deficiency @ B) Iron deficiency 0 C) Physiologic dilution of pregnancy 0 D) Sickle cell disease 0 E) Vitamin 8 12 (cobalamin) deficiency 1/15/201512:22 AM- Screen Gipping NBME 2 OBGYN Page 5 Screen dipping NOT A or E.6 arrest descent Thursday. A 28-year-old woman . a 4540-g (10-lb) .. gestational diabetes? NBME 2 OBGYN Page 6 . During this pregnancy. Big baby.male newborn. Her last menstrual period was 10 weeks ago. was born by cesarean delivery because of an arrest of descent.)<.2015 12:23AM Exam Sect1on : Item 6 of 50 L'!ll Mark Nat1onal Board of Med1cal Exammers Obstetrics and Gynecology Self-Assessment Time Remaming: 2 hr 49 min 3 sec 6. para 1. January 15. Her first child. comes to the physician for her first prenatal visit. she is at increased risk for which of the following? @ A) Abruptio placentae 0 0 0 0 B) Gestational diabetes C) Polyhydramnios D) Preeclampsia E) Premature rupture of the membranes 1/15/201512:23 AM. gravida 2. January 15. A previously healthy 57-year-old woman comes to the physician because of a 2-month history of vulvar itching. Menopause occurred 7 years ago. Examination shows a 1 x 1:. She has not been sexually active for 10 years. There is no inguinal adenopathy. Which of the following is the most likely diagnosis? 0 0 0 0 A) Herpes simplex B) Hypertrophic vulvar dystrophy C) Lichen sclerosus D) Primary syphilis @ E) Vulvar carcinoma 0 F) ¥W¥ar: condylomata acuminata 1/15/201512:23 AM· Screen Oipping NBME 2 OBGYN Page 7 . no other lesions are noted.2015 12:23AM Exam Section : Item 7 of 50 ~ Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 48 min 58 sec ' 7.--2-cm ulcerated lesion on the inner right labium majus surrounded by mild erythema. She is otherwise asymptomatic and takes no medications.7 vulvar carcinoma Thursday. She uses an oral contraceptive. A Pap smear shows low-grade squamous intraepithelial lesions. crusty papules on the posterior fourchette. She has been sexually active with one partner for 2 years.25-cm raised.2015 12:23AM Exam Section : Item 8 of 50 ~ Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 48 min 53 sec ' 8. A previously healthy 22-year-old woman comes to the physician because of a bump on her vulva for 1 week. Which of the following is the most likely diagnosis? 0 A) Chancroid 0 B) Chlamydia trachomatis infection @ C) Condylomata acuminata 0 D) Herpes genitalis 0 E) Lymphogranuloma venereum 0 F) Molluscum contagiosum 1/15/201512:23 AM.Thursday.Screen dipping NBME 2 OBGYN Page 8 . January 15. Examination shows multiple 0. Physical examination. January 15. Pelvic ultrasonography shows a 3-cm. Wh ich of the following is the most likely cause of this patient's incontinence? @ A) Detrusor instability 0 0 0 0 B) Leiomyoma uteri C) Urethral hypermobility D) Urinary retention with overflow E) Urinary tract infection 1/15/2015 12:23 AM ·Screen Clipping NBME 2 OBGYN Page 9 . shows no abnormalities. uterine mass consistent with a benign leiomyoma uteri.6°F). A previously healthy 57-year-old woman comes to the physician because of a 6-month history of urinary urgency and loss of urine that requires the use of an absorbent pad. including pelvic examination. She typically awakens once each night to void. 2015 12:23AM Exam Sect1on : Item 9 of 50 • Mark Nat1onal Board of Med1cal Exammers Obstetrics and Gynecology Self-Assessment Time Remainmg: 2 hr 48 min 49 sec 9. Urinalysis shows no abnormalities. She has not had fever. Her temperature is 3JOC (98. She says her urine stream is normal. anterior. or blood in her urine.Thursday. She rarely leaves her house because she is afraid of having loss of urine in public. pain with urination. Which of the following is the most likely cause of this problem? 0 A) Ductal ectasia 0 B) Fibrocystic changes of the breast 0 C) Intraductal carcinoma @ D) Intraductal papilloma 0 E) Recurrent periareolar duct infection 1/15/201512:23 AM· Screen Gipping NBME 2 OBGYN Page 10 . For the past 4 months. Screening mammography is within normal limits. a perimenopausal 48-year-old woman has had a spontaneous intermittent serosanguineous discharge from the nipple of the left breast. No mass is palpable. January 15.1 Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaming: 2 hr 48 min 44 sec 10.2015 12:23AM Exam Section : Item 10 of 50 1!'.Thursday. A 32-year-old woman. delivers a 4111-g (9-lb 1-oz) newborn at term following a 2-hour second stage of labor assisted by a medial episiotomy. January 15. Her pulse is 60/min. para 2. On abdominal examination. a firm pale mass is noted in the lower vagina .Thursday. gravida 3.2015 12:23AM Exam Sect1on: Item 11 of 50 Nat1onal Board of Med1cal Exammers Obstetrics and Gynecology Self-Assessment ~Mark Time Remammg: 2 hr 48 min 40 sec 11. and blood pressure is 60/40 mm Hg. the uterus cannot be palpated. there is moderate vaginal bleeding_The patient develops shortness of breath.Screen dipping NBME 2 OBGYN Page 11 . The placenta delivers 12 minutes later using gentle umbilical cord traction. Following delivery of the placenta. Which of the following is the most likely diagnosis? 0 A) Placenta accreta 0 B) Retained placental fragments 0 C) Uterine atony @ D) Uterine inversion 0 E) Uterine rupture 1/15/201512:23 AM . Treatment with intravenous saline does not improve her symptoms. orn/u spstf/u spschol. January 15. She uses an oral contraceptive. Her 36-year-old brother has type 2 diabetes mellitus. usp reven tiveservicestaskforce. She has smoked one pack of cigarettes daily for 6 years.12 USPTF Thursday. select the most appropriate screening test.2015 12:23AM Exam Section : Item 12 of 50 • Mark Nat1onal Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 48 min 35 sec The response options for the next 2 items are the same. She is 157 em (5 ft 2 in) tall and weighs 95 kg (210 lb). Her last office visit was 5 years ago. BMI is 38 kgf m2 1/15/201512:23 AM. A 30-year-old woman comes to the physician for a routine examination. 0 A) ECG 0 B) Mammography 0 C) Measurement of serum CA 125 concentration @ D) Measurement of serum cholesterol concentration 0 E) Measurement of serum follicle-stimulating hormone concentration 0 0 0 0 0 F) Test of the stool for occult blood G) Testing for Chlamydia trachomatis H) Thyroid function studies I) Ultrasonography of the pelvis J) X-ray of the chest 12.Screen dipping Women 20-45 at Increased Risk for CHD From <http ://www.h tm> NBME 2 OBGYN Page 12 . Her mother had breast cancer at the age of 58 years. Her father died of a myocardial infarction at the age of 39 years. Select one answer for each item in the set. For each patient. they occasionally use condoms for contraception.2015 12:23AM Exam Section: Item 13 of 50 1!2 Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 48 min 30 sec For each patient.Thursday. 0 0 0 0 0 A) ECG B) Mammography 0 F) Test of the stool for occult blood @ G) Testing for Chlamydia trachomatis C) Measurement of serum CA 125 concentration 0 0 0 D) Measurement of serum cholesterol concentration E) Measurement of serum follicle-stimulating hormone concentration H) Thyroid function studies I) Ultrasonography of the pelvis J) X-ray of the chest 13. January 15. select the most appropriate screening test. Pelvic examination shows normal findings. Nonsteroidal anti-inflammatory drugs have only partially relieved the pain. Menarche was at the age of 12 years. A healthy 16-year-old girl comes to the physician because of painful menses for 3 years. She is sexually active and has had one male partner. Oral contraceptive therapy is suggested. 1/15/201512:23 AM· Screen dipping NBME 2 OBGYN Page 13 . She does not smoke cigarettes. Thursday. she underwent two loop electrosurgical excisions of the cervical transformation zone for carcinoma in situ. Pelvic ultrasonography confirms uterine size and shows a funneled lower uterine segment. Pelvic examination shows a closed cervix that is flush against the upper vagina and measures 2 em in diameter. the internal cervical os measures 2 em. A 32-year-old primigravid woman at 14 weeks' gestation comes to the physician because of fever. lower pelvic pressure. Three years ago. The uterus is consistent in size with a 14-week gestation. and vaginal spotting for 7 days. Which of the following is the most likely cause of this patient's vaginal bleeding? 0 A) Abruptio placentae 0 B) Cervical cancer @ C) Cervical incompetence 0 D) Incomplete abortion 0 E) Subchorionic hemorrhage 1/15/201512:23 AM· Screen Oipping NBME 2 OBGYN Page 14 . January 15.2015 12:23AM Exam Sect1on : Item 14 of 50 • Mark Nat1onal Board of Med1cal Exammers Obstetrics and Gynecology Self-Assessment Time Remammg: 2 hr 48 min 26 sec 14. Screen Oipping NBME 2 OBGYN Page 15 . Pelvic ultrasonography shows no uterus. January 15. Which of the following is the most likely diagnosis? 0 A) Adrenal insufficiency @ B) Androgen insensitivity syndrome 0 C) Imperforate hymen 0 D) Paramesonephric (mOIIerian) duct agenesis 0 E) Premature ovarian failure 1/15/201512:23 AM.Thursday. Pelvic examination shows a vagina that is 2 em in length. She is 175 em (5 ft 9 in) tall and weighs 61 kg (135 lb). She is otherwise healthy. A 16-year-old girl is brought to the physician by her mother because she has never had a menstrual period.2015 12:23AM Exam Section : Item 15 of 50 • Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaming: 2 hr 48 min 22 sec 15. Breast development is Tanner stage 3. there is no axillary or pubic hair. Screen Gipping NBME 2 OBGYN Page 16 .Thursday. Which of the following is the most appropriate next step in management? 0 A) Second PPD skin test in 2 months 0 B) Second PPD skin test after delivery 0 C) Culture of sputum for acid-fast bacilli @ D) X-ray of the chest 0 E) Spiral CT scan of the chest 1/15/201512:23 AM. An 18-year-old primigravid woman at 10 weeks' gestation comes to the physician for a follow-up examination. the lungs are clear to auscultation and percussion. January 15. On examination today. serum HIV antibody testing was positive.2015 12:23AM Exam Section : Item 16 of 50 ~ Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 48 min 17 sec ' 16. A PPD skin test shows 9 mm of induration at 48 hours. At her first prenatal visit 2 weeks ago. There is no axillary or cervical lymphadenopathy. She is sexually active and does not use contraception. Physical examination shows bilateral lower abdominal tenderness and peritoneal signs. and blood pressure is 110/75 mm Hg.7"C (103. and lower abdominal pain for 4 days.Thursday.2015 12:23AM Exam Section : Item 17 of 50 National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment ~Mark Time Remaining: 2 hr 48 min 13 sec ' 17.5°F). Pelvic examination shows copious yellow cervical discharge and exquisite uterine tenderness. pulse is 105/min.Screen Oipping NBME 2 OBGYN Page 17 0 0 0 0 0 G) Discharge with oral and intramuscular antibiotic therapy H) Limited-stay observation and evaluation I) MRI of the pelvis J) Uterine evacuation in the emergency department K) Uterine evacuation in the operating room . Her last menstrual period was 9 days ago. Which of the following is the most appropriate next step in management? @ A) Admission to the hospital for intravenous antibiotic therapy 0 0 0 0 0 B) Admission to the hospital for laparoscopy C) Admission to the hospital for laparotomy D) CT scan of the pelvis E) Discharge with analgesic therapy F) Discharge with oral antibiotic therapy only 1/15/201512:23 AM. January 15. Her temperature is 39. vomiting. A 15-year-old girl is brought to the emergency department because of nausea. 2015 12:24 AM ------------------------------------------------------------------------------------------------------------------------------------- Exam Section : Item 18 of 50 National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment ~Mark Time Remaining: 2 hr 48 min 8 sec 18. Nitrazine testing of the fluid is positive.9°C (98. After administration of intramuscular corticosteroids and intravenous antibiotics. B) Intravenous administration of oxytocin 0 C) External cephalic version 0 D) Amniocentesis ~ E) Immediate cesarean delivery/ ' 1/15/2015 12:24 AM -Screen Clipping A) Betamethasone is given a s two shots. 24 hours apart. and blood pressure is 110/60 mm Hg. A 24-year-old primigravid woman at 28 weeks' gestation is brought to the emergency department 4 hours after she felt a sudden gush of fluid from her vagina. Her pregnancy had been uncomplicated.5°F). Her temperature is 36.18 next step Thursday. External fetal monitoring shows a fetal heart rate of 150/min with moderate variability. The fetus is in a breech presentation. Pelvic ultrasonography shows an amniotic fluid index of 5 em (N=8-24). which of the following is the most appropriate next step in management? 0 A) Second administration of corticosteroids in 24 hours _j). She is concerned that her membranes have ruptured. She has no history of medical or gynecologic illness or abnormal Pap smears. Sterile speculum examination shows pooling of fluid in the vagina and a closed cervix. January 15. pulse is 64/min. and she has had good fetal movement and no contractions. There are no uterine contractions. The fundal height is 28 em. {12mg given intramuscularly 24 hours apart) NOT BORE NBME 2 OBGYN Page 18 . The uterus is nontender to palpation. and ferning is seen under the microscope. 19 Pulmonary hypoplasia Thursday.2015 12:24AM Exam Section : Item 19 of 50 1!2 Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 48 min 3 sec 19. or edema. Pregnancy was complicated by premature rupture of the membranes at 25 weeks' gestation. NBME 2 OBGYN Page 19 . Hydrops fetal is is a condition in the fetus characterized by an accumulation of fluid. January 15. respectively. A 27-year-old primigravid woman at 30 weeks' gestation delivers a 1530-g (3-lb 6-oz) newborn.X (Turner syndrome) E) Hydrops @ F) Pulmonary hypoplasia 1/15/201512:24 AM· Screen Gipping Little amnioticfluid -7 pulmonary hypoplasia. in at least two fetal compartments. observation prior to spontaneous labor showed little to absent amniotic fluid. Which of the following is the most likely explanation for the neonatal condition? 0 0 0 0 0 A) Anemia B) Down syndrome C) Fetal growth restriction D) Gonadal dysgenesis 45. Apgar scores are 3 and 1 at 1 and 5 minutes. The uterine fundus is 15 em above the symphysis. The fetal heart rate is 160/min. Which of the following is the most appropriate next step in management? 0 A) Schedule a routine return visit 0 B) Glucose tolerance test 0 C) Urine culture @ D) Ultrasonography 0 E) Amniocentesis 1/15/201512:24 AM· Screen dipping NBME 2 OBGYN Page 20 . A 47-year-old primigravid woman at 10 weeks' gestation comes to the physician for a routine prenatal visit.2015 12:24AM Exam Section : Item 20 of 50 • Mark Nat1onal Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaming: 2 hr 47 min 59 sec 20. Menopause was 3 years ago. and blood pressure is 123/78 mm Hg. January 15. Her pulse is 78/min. She conceived following oocyte donation from her 32-year-old sister.Thursday. Growth restriction Good fetal movement with no contraction= check a nonstress test to make sure baby is reactive. Seems like PPROM(?) with some vaginal bleeding. She is 152 em (5 ft) tall and has gained 4. I meant to say NO contraction. maybe due to the cigs. Examination shows a fundal height of 30 em. A 17-year-old primigravid patient at 34 weeks' gestation comes to the physician for a routine prenatal visit. Mom's BP is 100/55 which is fine. Her blood pressure is 100/55 mm Hg. She has smoked two packs of cigarettes daily for 3 years and has continued to smoke throughout pregnancy. vaginal bleeding.2015 12:24AM Exam Section : Item 21 of 50 National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment ~Mark Time Remaining: 2 hr 47 min 55 sec 21 . January 15. l agree its A though. She notes good fetal movement and no contractions. Growth restriction is seensogotta make sure baby is OK NBME 2 OBGYN Page 21 . She missed her last appointment 2 weeks ago. She does not drink alcohol or use illicit drugs.Thursday. NO bleeding. The fetal heart rate is 150/min.5 kg (10 lb) during her pregnancy. NO loss offluid. Which of the following is the most appropriate next step in diagnosis? @ A) Nonstress test 0 B) Fetal fibronectin test 0 C) Amniocentesis for Gram stain and culture 0 D) Amniocentesis for measurement of bilirubin concentration 0 E) Cordocentesis for measurement of fetal hemoglobin concentration 1/15/201512:24 AM· Screen Oipping FUNDAL HEIGHT IS TOO LOW. or loss of vaginal fluid. Pregnancy has been uncomplicated. .. para 2.2015 12:24AM Exam Section : Item 22 of 50 National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment ~Mark Time Remaining: 2 hr 47 min 50 sec 22. the vertex is at . A 32-year-old woman .Thursday.2 station. January 15. respirations are 20/min. Contractions have occurred every 3 minutes for the past 8 hours. and blood pressure is 120/80 mm Hg. The fetal heart rate decreases to 90/min. Her temperature is 37"C (98.Screen Oipping pelvic exam. pulse is 80/min. at term is admitted to the hospital in labor. yielding a large amount of clear fluid . The cervix is 100% effaced and 4 em dilated. check for prolapsed cord. gravida 3. The membranes suddenly rupture.6°F). then do emergency C-section NBME 2 OBGYN Page 22 . Which of the following is the most appropriate next step in management? @ A) Pelvic examination 0 0 0 0 0 B) External cephalic version of the fetus C) Internal podalic version of the fetus D) Atropine therapy E) Oxytocin therapy F) Forceps delivery 1/15/201512:24 AM. She is 173 em (5 ft 8 in) tall and weighs 90 kg (198 lb).Thursday.2015 12:24AM Exam Section : Item 23 of 50 ~ Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 47 min 46 sec ' 23. A 32-year-old nulligravid woman comes to the physician because she has been unable to conceive for 3 years. Examination shows normal hair distribution and velvety pigmented skin over the axillae. There are no adnexal masses.Screen Oipping NBME 2 OBGYN Page 23 . She is otherwise healthy and takes no medications. January 15. This patient is at increased risk for which of the following conditions? 0 0 0 0 0 A) Hypercalcemia B) Hypercortisolism C) Hyperthyroidism D) Hypothyroidism E) Premature ovarian failure @ F) Type 2 diabetes mellitus 1/15/201512:24 AM. She has had irregular menses during this time. Her last menstrual period was 11 weeks ago. BMI is 30 kgJm2 Her blood pressure is 128/70 mm Hg. Examination today shows no abnormalities. She is currently receiving antiretroviral therapy.1 Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 47 min 42 sec 24. 2015 I 12:24AM Exam Section : Item 24 of 50 1r. Which of the following is the most appropriate screening test for this patient? @ A) Pap smear 0 B) Serum lipid studies 0 C) X-ray of the chest 0 D) ECG 0 E) Mammography 1/15/201512:24AM -Screen Clipping NBME 2 OBGYN Page 24 . Her CD4+ T-lymphocyte count 2 weel<s ago was 425/mm 3 (Normal<::500). January 15. plasma HIV viral load was undetectable. Her last visit 8 months ago showed normal find ings.Thursday. A Pap smear 2 years ago showed no abnormalities. Serum lipid studies were within normal limits 3 years ago. An asymptomatic 37-year-old woman with a 5-year history of HIV infection comes for a routine follow-up examination. or other signs of trauma. He reports that she has been rubbing and scratching her genital area for the past 5 days and that the irritation has progressed despite treatment with topical vitamin A & D and warm baths. she says that she has had a foul-smelling discharge and burning and itching in the area. A wet mount preparation of the discharge shows occasional erythrocytes and numerous leukocytes. absolutely worth rememberin3 as a similar question appeared nearly verbatim on my actual shelfexam) NBME 2 OBGYN Page 25 .6°F). Which of the following is the most likely cause of these symptoms? 0 0 0 0 A) Gastroenteritis B) Inoculation from an upper respiratory tract infection C) Sarcoma botryoides D) Urinary tract infection @ E) Vaginal foreign body 1/15/201512:24 AM· Screen Gipping v~inal forei$n body (MCC of3reen valj"inal discharlj"C. She also has had a runny nose during this period. The hymen appears intact. January 15.2015 12:24AM Exam Section : Item 25 of 50 • Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 47 min 37 sec 25. ecchymoses. Her temperature is 37"C (98. There are no lacerations. She has not had fever and has no history of serious illness. Culture of the discharge shows a polymicrobial infection. bumin3 and itchin3 in a youl1lj" child= forei$n body such as toiletpaper or feces. On questioning. which is worse when she urinates. Examination shows green vaginal discharge and diffuse inflammation of the vulva. A 5-year-old girl is brought to the physician by her father 1 day after he noticed some blood on her underpants.25 foreign body Thursday. or use illicit drugs.Thursday. 45. She has no history of serious illness and takes no medications.Screen dipping NBME 2 OBGYN Page 26 . Menarche was at the age of 13 years.to 90-day intervals until she eventually became amenorrheic. Physical examination shows no abnormalities. January 15. She is not currently sexually active. drink alcohol. Measurement of serum hormone concentrations is most likely to show which of the following? @ A) Decreased estrogen and follicle-stimulating hormone (FSH) concentrations 0 0 0 0 B) Decreased estrogen and increased FSH concentrations C) Normal estrogen and decreased FSH concentrations D) Normal estrogen and increased FSH concentrations E) Normal estrogen and increased prolactin concentrations 1/15/201512:24 AM. She runs 7 miles daily and has completed three marathons in the past year. She is 165 em (5 ft 5 in) tall and weighs 45 kg (100 lb). menses began occurring at irregular. A 25-year-old nulligravid woman comes to the physician because she has not had a menstrual period for 1 year. BM I is 17 kgfm 2. Two years ago. She does not smoke cigarettes.2015 12:24AM Exam Sect1on : Item 26 of 50 • Mark National Board of Med1cal Exammers Obstetrics and Gynecology Self-Assessment Time Remammg: 2 hr 47 min 33 sec 26. and menses initially occurred at regular 28-day intervals. her last examination.Thursday. Her last menstrual period was 1 week ago. One year ago. 2015 12:24AM Exam Section : Item 27 of 50 • Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 47 min 29 sec 27. She has had multiple sexual partners and has used condoms inconsistently. HIV antibody testing and cultures for Neisseria gonorrhoeae and Chlamydia trachomatis are negative. An 18-year-old nulligravid woman comes to the physician for a routine health maintenance examination. Serologic testing for VORL is positive at 1:4 . including laboratory studies. Which of the following is the most appropriate next step in diagnosis? 0 A) Antinuclear antibody assay @ B) Fluorescent treponema! antibody absorption test 0 C) Rapid plasma reagin 0 D) Second VORL in 6 weeks 0 E) Lumbar puncture for VORL 1/15/2015 12:24AM ·Screen Clipping NBME 2 OBGYN Page 27 . Physical and pelvic examinations show no abnormalities. January 15. showed no abnormalities. . A 37-year-old woman .:md ""''Tum~ :Jnd ~mprcu the ilix: \-elo. h\'dnJtJrdc::r• .C. Bimanual and rectal examinations show an 8-cm mass of the upper cervix and right parametrium.. ·n u: .. extending & obstructing the ureter.~.cd (t...nblc rriJd ..Thursday..... NBME 2 OBGYN Page 28 . January 15..m... comes to the emergency department because of increasing vaginal bleeding over the past 5 hours.) l<s $\\\'!ling.... cervical cancer.tl (~l)(cr jo. gravida 8. No ovary is palpated separately.. very common test presentation.. Abdominal examination shows no abnormalities. . 1ncnt .. ki:ltte bade. para 8. of..2015 12:24AM Exam Section : Item 28 of 50 ~ Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 47 min 24 sec ' 28..pain.".ld. Which of the following is the most likely diagnosis? 0 A) Adenocarcinoma of the endometrium 0 B) Ovarian epithelial carcinoma 0 C) Peritoneal mesothelioma @ D) Squamous cell carcinoma of the cervix 0 E) Transitional cell carcinoma of the bladder 1/15/201512:24 AM..'C'\ k.Screen dipping squamous cell carcinoma of the cervix associated with benign retroperitoneal fibrosis and hydroureters is reported. ACT scan shows a right hydroureter above the level of the mass. January 15. NBME 2 OBGYN Page 29 . a 22-year-old woman has abdominal cramping and nausea and vomiting.8°F). dry. Her temperature is 38. The incision is clean .Thursday. and blood pressure is 110/64 mm Hg. Her leukocyte count is 15.8°C (101. pulse is 98/min. A urinary catheter is in place. Thirty-six hours after cesarean delivery because of prolonged labor. that**** is traumatic and irritating the epithelium. Which of the following is the most appropriate next step in management? 0 A) CT scan of the pelvis 0 B) Intramuscular administration of methylergonovine @ C) Intravenous administration of ampicillin and gentamicin 0 D) Dilatation and curettage 0 E) Surgical exploration 1/15/201512:24 AM· Screen dipping Give ABX.000/mm 3. and intact. urinalysis shows multiple RBCs.2015 12:24AM Exam Sect1on : Item 29 of 50 L'!ll Mark Nat1onal Board of Med1cal Exammers Obstetrics and Gynecology Self-Assessment Time Remaming: 2 hr 47 min 20 sec 29. RBCs in the urine is normal with a catheter. Uterine tenderness+ fever this close post op is endometritis until proven otherwise. Examination shows diffuse lower abdominal tenderness with some voluntary guarding but no rebound. A 19-year-old primigravid woman at term has been in labor for 16 hours. Her temperature is 38.Thursday. January 15.4°C (101. pulse is 90/min. A fetal heart tracing is shown.2015 12:2SAM Exam Section : Item 30 of 50 • Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 47 m in 7 sec lAO 1- 30. Her membranes have been ruptured for 11 hours. and she has had nine vaginal examinations. and blood pressure is 120/80 mm Hg.1 oF). Which of the following is most likely responsible for the results shown in the tracing? 0 0 A) Fetal anemia B) Fetal head compression @ C) Maternal fever D) Umbilical cord compression E) Uteroplacental insufficiency 0 0 1/15/201512:25 AM· Screen dipping NBME 2 OBGYN Page 30 . respirations are 20/min. Endovaginal examination shows a viable twin gestation consistent in size with an 8-week gestation. January 15. A 27-year-old primigravid woman at 14 weeks' gestation comes to the physician for an initial prenatal visit.!:.Screen Oipping Could have been monochroionic with two yolk sacs but would be thin dividing membrane. An ultrasound is shown. Features supporting a DCDA pregnancy: presence of t w o gestational sacs with a thick echogenic chorion surrounding each embryo a thick inter twin membrane twin peak sign two yolk sacs may be seen (this however does not differentiate a DCDA pregnancy from a monochorionic dia mniotic ( MCDA) pregnancy) NBME 2 OBGYN Page 31 .31 Thursday.2015 12:2SAM Exam Sect1on : Item 31 of 50 1. There are two yolk sacs and a thick dividing membrane. This patient most likely has which of the following types of twin gestation? 0 A) Conjoined @ B) Dichorionic 0 C) Monochorionic 0 D) Monochorionic-monoamniotic 0 E) Findings are inconclusive at this gestational age 1/15/201512:25 AM.iJ Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaimng: 2 hr 47 min 0 sec 31. Thursday. NBME 2 OBGYN Page 32 .2015 I 12:2SAM Exam Section : Item 32 of 50 • Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 46 min 53 sec 32. Leopold maneuvers show the fetus in a transverse lie presentation with the back toward the pelvis. A 21-year-old primigravid woman at 40 weeks' gestation is admitted in labor. The cervix is 100% effaced and 5 em dilated. January 15. Which of the following is the most appropriate next step in management? 0 0 0 0 A) Await spontaneous vaginal delivery B) Administration of oxytocin C) Tocolytic therapy D) Internal version and breech extraction @ E) Cesarean delivery 1/15/201512:25 AM.Screen Oipping Could try external version if not in labor. respirations are 12/min. A 47-year-old woman comes to the physician for a routine health maintenance examination. Which of the following is the most appropriate next step in diagnosis? 0 A) Complete blood count 0 B) Measurement of serum follicle-stimulating hormone concentration @ C) Measurement of serum 13-hCG concentration 0 D) Measurement of serum prolactin concentration 0 E) Measurement of serum thyroid-stimulating hormone concentration 1/15/201512:25 AM. Her last menstrual period was 4 months ago. January 15. BMI is 24 kgfm2 Her temperature is 37.2015 12:2SAM Exam Section : Item 33 of 50 • Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaming: 2 hr 46 min 47 sec 33. She is sexually active with one male partner. She has moderate discomfort during the pelvic examination because of vaginal dryness. She has not had any other symptoms. She is 168 em (5 ft 6 in) tall and weighs 68 kg (150 Ib). vaginal. The uterus is enlarged and mildly boggy.7"F).1 oc (98.Thursday. She has no history of serious illness and takes no medications. and blood pressure is 90/50 mm Hg. There are no vulvar. She says that she sometimes feels hot at night and occasionally during the day. or cervical lesions or adnexal masses.Screen Oipping NBME 2 OBGYN Page 33 . The remainder of the examination shows no abnormalities. and they do not use contraception. Test of the stool for occult blood is negative. pulse is 70/min. January 15.2015 12:2SAM Exam Section : Item 34 of 50 1. She has not been screened for group B streptococcal infection. the vertex is at +1 station.Screen dipping NBME 2 OBGYN Page 34 . Which of the following is the most appropriate next step regard ing prevention of group B streptococcal sepsis in the newborn? @ A) Antibiotic therapy if delivery has not occurred 18 hours after rupture of membranes 0 B) Antibiotic therapy if the fetal heart rate exceeds 180/min 0 C) Antibiotic therapy if Gram stain of amniotic fluid is positive 0 D) Forceps delivery if second stage of labor exceeds 2 hours 0 E) Cesarean delivery because lesions are present 1/15/201512:25 AM.34 Thursday. Examination shows areas of vag inal erythema.!11 Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 46 min 43 sec 34. The cervix is 80% effaced and 5 em dilated. Contractions occur every 10 minutes. The membranes ruptured 12 hours ago. Pregnancy has been uncomplicated. A 24-year-old primigravid woman at term is admitted to the hospital in labor. Cultures for group B streptococcal infection are pending. Her blood pressure is 160/90 mm Hg. Pelvic examination shows no abnormalities.to 3-month intervals and last 10 days. A 47-year-old woman . Which of the following is the most appropriate next step in management of this patient's irregular menstrual periods? 0 A) Bromocriptine therapy 0 B) Combination oral contraceptive therapy @ C) Cyclic progestin therapy 0 0 0 0 D) Estrogen replacement therapy E) Laparoscopy F) Dilatation and curettage G) Myomectomy 1/15/201512:25 AM. para 2.Screen dipping NBME 2 OBGYN Page 35 . She has smoked two packs of cigarettes daily for 30 years. Results of an endometrial biopsy specimen show proliferative endometrium.Thursday. gravida 2. January 15.2015 12:2SAM Exam Section : Item 35 of 50 Nat1onal Board of Medical Examiners Obstetrics and Gynecology Self-Assessment ~Mark Time Remaming: 2 hr 46 min 39 sec 35. She has hypertension. Menses now occur at 2. comes to the physician because of a 9-month history of irregular menstrual periods and bleeding between menses. l Mark Nat1onal Board of Medical Exammers Obstetrics and Gynecology Self-Assessment Time Remaming: 2 hr 46 min 34 sec 36. Her pregnancy was complicated by a small amount of vaginal bleeding during the first trimester that resolved spontaneously. Her sister recently had a child who was diagnosed with cystic fibrosis soon after delivery.Thursday. She appears well. January 15. Which of the following is the most likely cause of the fetal hydrops? 0 A) Cytomegalovirus 0 B) Fetal cystic fibrosis @ C) Fetal parvovirus 819 infection 0 D) Maternal Chlamydia trachomatis infection 0 E) Rh sensitization 1/15/201512:25 AM· Screen dipping NBME 2 OBGYN Page 36 . A 20-year-old primigravid woman at 20 weeks' gestation comes for a routine prenatal visit. Her blood group is A. Laboratory studies are within normal limits. Rh-negative. no structural abnormalities are noted.2015 12:2SAM Exam Section : Item 36 of 50 L!. She works in a day-care center. Ultrasonography shows a single intrauterine pregnancy with fetal hydrops. Antibody screening is negative. Examination shows a nontender uterus consistent in size with a 20-week gestation. Which of the following is the most appropriate next step in diagnosis? 0 A) Endometrial biopsy @ B) Hysterosalpingography 0 C) Karyotype analysis 0 D) Laparoscopy 0 E) Measurement of serum follicle-stimulating hormone concentration 1/15/201512:25 AM· Screen Oipping NBME 2 OBGYN Page 37 0 0 0 0 0 F) Measurement of serum luteinizing hormone concentration G) Measurement of serum progesterone concentration H) Postcoital test I) Progesterone challenge test J) Sperm antibody testing . Pelvic examination shows no abnormalities. Cervical cultures are negative. Menarche was at the age of 12 years. She used an oral contraceptive for 3 years. A 32-year-old nulligravid woman comes to the physician with her 34-year-old husband because she has been unable to conceive for 3 years. She has had multiple sexual partners.Thursday. Her husband's semen analysis is within normal limits. and menses occur at regular 28-day intervals.2015 12:2SAM Exam Section : Item 37 of 50 National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment ~Mark Time Remaining: 2 hr 46 min 29 sec 37. January 15. 4) 35 sec 1 sec 300 mg/dL (N =200-400) <10 IJg/mL (N<10) Arterial blood gas analysis on room air shows: 7. and blood pressure is 60/40 mm Hg. pulse is 120/min. January 15. Three days after cesarean delivery because of fetal distress.26 28 mm Hg 60 mm Hg A blood smear shows no abnormalities. An ECG shows tachycardia with cor pulmonale. She is 163 em (5 ft 4 in) tall and weighs 82 kg (180 Ib). The fundus is firm.4°F). Pleural rub is sign of pulmonary embolism NOT AOR i NBME 2 OBGYN Page 38 . Bilateral wheezing is heard on auscultation. An x-ray of the chest shows atelectasis. Her temperature is 38°C (100. Laboratory studies show: Hemoglobin Leukocyte count Platelet count Bleeding time Prothrombin time Partial thromboplastin t ime Thrombin time Plasma fibrinogen Fibrin split products 11 g/dL 8000/mm3 175. BMI is 31 kgfm2. Which of the following is the most likely diagnosis? 1/15/201512:26 AM· Screen Oipping ~ @ A) Amniotic fluid embolism 0 B) Cardiac arrhythmia 0 C) Cerebral hemorrhage 0 0 0 D) Congestive heart failure E) Eclampsia F) Hypovolemic shock 0 0 ~ 0 0 0 G) Pneumonitis H) Pneumothorax I) Pulmonary acid aspiration syndrome J) Pulmonary embolism K) Seizure disorder L) Septic shock PUlMONARY EMBOliSM most likely.000/mm3 5 min 14 sec (INR=1.2015 12:26 AM Exam Section : Item 38 of 50 • Mark Nat1onal Board of Medical Exammers Obstetrics and Gynecology Self-Assessment Time Remaming: 2 hr 46 min 7 sec ("'38. respirations are 26/min. a hospitalized 42-year-old woman is found unconscious. Cardiac examination shows a pleural friction rub.38 Friction rub Thursday. Laboratory studies show: Leukocyte count Segmented neutrophils Eosinophils Lymphocytes Monocytes Urine WBC Which of the following is the most likely cause of this patient's fever? 0 0 0 0 0 A) Appendicitis B) Calculous cholecystitis C) Diverticular abscess D) Pneumonia E) Postpartum endometritis 0 0 0 0 F) Pyelonephritis G) Septic pelvic thrombophlebitis H) Urinary tract infection I) Viral gastroenteritis @ J) Wound infection 1/15/201512:26 AM.800/mm3 87% 3% 5% 5% 5. The abdomen is soft without rebound.2015 12:26AM Exam Section : Item 39 of 50 • Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaming: 2 hr 45 min 47 sec 39.1 °F). There is minimal tenderness of the uterus on palpation and no costovertebral angle tenderness. She has no cough.Thursday. Examination of the incision shows erythema and induration. Her labor lasted 18 hours. January 15. shortness of breath. or dysuria. a 27-year-old woman has a temperature of 38.Screen dipping NBME 2 OBGYN Page 39 14. urinary frequency or urgency. The lungs are clear to auscultation.4°C (1 01. Three days after a cesarean delivery because of cephalopelvic disproportion.10/hpf . measure serum hCG level weekly until it is undetectable.8 g/dl. NBME 2 OBGYN Page 40 . She had an abortion. January 15. Afte r abortion. her hemoglobin concentration is 11 . Which of the following is 1he most appropriate next step in management? 0 A) Third measurement of serum ~-hCG concentration in 1 week @ B) Administration of methotrexate 0 C) Progesterone suppositories 0 D) Admission to the hospital 0 E) Endometrial biopsy -1-- 1/15/2015 12:26 AM· Screen Clipping A) Third measurement of serum·B·HCG in 1 week.40 Ectopic? Thursday. She was seen in the emergency department 1 week ago with similar symptoms. her pulse is 80/min.hCG concentration was 450 miU/mL. There are no palpable adnexal masses. and serum 13-hCG concentration is 90 miU/mL. Her serum ~. A 32-year-old primigravid woman at 6 weeks' gestation comes to the physician because of a 3-day history of moderate vaginal bleeding. Today. 2015 12:26AM Exam Sect1on : Item 40 of 50 Nat1onal Board of Med1cal Exammers Obstetrics and Gynecology Self-Assessment ~Mark Time Remainmg: 2 hr 45 min 42 sec 40. Today. Pelvic ultrasonography at that time showed a thickened endometrial stripe and no fetal pole. Pelvic examination shows a closed cervix and a nontender uterus consistent in size with a 6-week gestation. and blood pressure is 110/60 mm Hg. Physical examination shows no abnormalities.Thursday. Her symptoms are well controlled with valproic acid. there is no pressured speech or flight of ideas.Screen Oipping NBME 2 OBGYN Page 41 .2015 12:26AM Exam Section : Item 41 of 50 • Mark Nat1onal Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 45 min 37 sec 41 . and she does not want to discontinue her medication. January 15. her affect is full. Her future child will be at greatest risk for developing which of the following abnormalities if she continues to take valproic acid throughout pregnancy? 0 A) Cleft palate @ B) Neural tube defects 0 C) Retinitis pigmentosa 0 D) Syringomyelia 0 E) Tetralogy of Fallot 1/15/201512:26 AM. A 32-year-old nulligravid woman with bipolar disorder comes to the physician for preconceptional counseling. On mental status examination. A 24-year-old woman . Delivery was complicated by postpartum hemorrhage requiring dilatation and curettage. abdominal. A progestin challenge test shows no withdrawal bleeding. Her temperature is 36. Qualitative serum ~-hCG testing is negative.9°C (98. She breast-fed the infant for 4 months. gravida 3. 2015 12:26 AM ------------------------------------------------------------------------------------------------------------------------------------- Exam Section : Item 42 of 50 • Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 45 min 33 sec 42.Thursday. Which of the following is the most likely diagnosis? @ A) Asherman syndrome 0 B) Hyperprolactinemia 0 C) Hypothalamic-pituitary dysfunction 0 D) Pregnancy 0 E) Premature ovarian failure 1/15/2015 12:26 AM· Screen Clipping NBME 2 OBGYN Page 42 . She has a long-standing history of bloating and mood changes with menses. and pelvic examinations show no abnormalities. Breast. She has no other history of serious illness. She is 165 em (5 ft 5 in) tall and weighs 75 kg (165 lb). January 15. para 3. and prolactin concentrations are within the reference range. She is sexually active with her husband and uses condoms for contraception. Her serum thyroid-stimulating hormone. Examination shows a normal-sized thyroid.5°F). BMI is 28 kgfm2. and blood pressure is 120/70 mm Hg. pulse is 64/min.. foll iclestimulating hormone. comes to the physician because she has not had a menstrual period since the birth of her third child 13 months ago by vaginal delivery. comes to the physician for contraceptive advice. high blood pressure. and they currently use condoms but would like to switch to another contraceptive method. She has smoked one pack of cigarettes daily for 20 years. A healthy 37-year-old woman. para 2.l Mark Nat1onal Board of Medical Exammers Obstetrics and Gynecology Self-Assessment Time Remaming: 2 hr 45 min 28 sec 43. venous thromboembolism.Thursday. or depression. She has no history of sexually transmitted diseases.2015 12:26AM Exam Section : Item 43 of 50 L!. headaches. Which of the following contraceptive methods is contraindicated in this patient? 0 0 0 0 0 A) Copper IUD B) Depot medroxyprogesterone C) Diaphragm D) Norethindrone pills E) Progesterone IUD @ F) Triphasic oral contraceptives 1/15/201512:26 AM· Screen Oipping NBME 2 OBGYN Page 43 . January 15. She is sexually active with her husband. Testing for Neisseria gonorrhoeae and Chlamydia trachomatis is negative. gravida 2. frothy green discharge in the vaginal vault. Which of the following is the most appropriate next step? 0 A) Reassurance and fol low-up visit in 4 months 0 B) Culture of the vaginal fluid 0 C) Cytologic examination of the vaginal fluid @ D) Wet mount preparation of the vaginal fluid 0 E) Cervical biopsy 0 F) Vaginal wall biopsy 1/15/201512:26 AM· Screen dipping NBME 2 OBGYN Page 44 . and adnexa are normal. There is a large ectropion on the cervix. or use illicit drugs. drink alcohol. The external genitalia. Abdominal examination shows no masses or tenderness.6°F).2015 12:26AM Exam Section : Item 44 of 50 Nat1onal Board of Medical Examiners Obstetrics and Gynecology Self-Assessment ~Mark Time Remaming: 2 hr 45 min 25 sec 44. and abundant. foul-smelling. She does not smoke cigarettes. uterus. pulse is 78/min. no foreign body can be visualized. January 15. Pelvic examination shows petechiae on the vag inal mucosa. She takes no medications and has no known drug allergies. Menarche was at the age of 12 years. foul-smelling vaginal discharge. and blood pressure is 98/54 mm Hg. She recently has had several unexcused absences from school.Thursday. Her last menstrual period was 3 weeks ago. green. Her temperature is 3JOC (98. and menses occur at regular 28-day intervals. Breast and pubic hair development are Tanner stage 3. An otherwise healthy 14-year-old girl is brought to the physician by her mother because of a 10-day history of profuse. Her temperature is 38°C (1 00. She has no history of serious illness or surgical procedures.4°F). Menses occur at irregular 45-day intervals. A 27-year-old woman who recently emigrated from Uganda comes to the physician 14 days after she noticed a painful sore in her vagina.2015 12:27 AM Exam Section : Item 45 of 50 L!. deep. She had been sexually active with multiple partners and uses depot medroxyprogesterone. Which of the following is the most likely causal organism? 0 0 A) Calymmatobacterium granulomatis 0 D) Treponema pallidum 0 E) Trichomonas vagina/is B) Chlamydia trachomatis @ C) Haemophi/us ducreyi 1/15/201512:27 AM. exquisitely tender ulcer at the introitus with an uneven base and inflamed undermined margins. Her last menstrual period was 20 days ago. January 15.Screen Gipping NBME 2 OBGYN Page 45 .l Mark Nat1onal Board of Medical Exammers Obstetrics and Gynecology Self-Assessment Time Remaming: 2 hr 45 min 19 sec 45. Pelvic examination shows a raw.Thursday. A 17-year-old primigravid patient at 41 weeks' gestation comes to the physician for a routine prenatal visit. She is accompanied by the father of the child. and benefits of the recommended testing and induction. Examination shows a uterus consistent in size with a 41-week gestation. Pregnancy has been uncomplicated. The physician recommends initiating twice weekly nonstress testing with planned induction of labor at 42 weeks' gestation to prevent fetal morbidity and mortality. January 15. risks.Screen Oipping NBME 2 OBGYN Page 46 .Thursday. After discussing the indications. Which of the following is the most appropriate response? 0 A) Ask the father if he agrees with the patient's decision 0 B) Obtain informed consent from the patient's parents for induction of labor at 42 weeks' gestation 0 C) Obtain psychiatric assessment to determine the patient's decision-making capacity @ D) Respect the patient's wishes and schedule a follow-up visit in 1 week 0 E) Transfer the patient to a physician who feels comfortable with her decision 1/15/201512:27 AM. the patient refuses the recommendations.2015 12:27 AM Exam Section : Item 46 of 50 L!.l Mark Nat1onal Board of Medical Exammers Obstetrics and Gynecology Self-Assessment Time Remaming: 2 hr 45 min 15 sec 46. All congenital adrenal enzyme deficiencies are characterized by an enlargement of both adrenal glands due to increased ACTH stimulation (due to decreased cortisol). At birth . A 42-year-old woman undergoes amniocentesis and is informed that the fetal karyotype is 46.XX. the full-term newborn has a phallus and scrotum. January 15. Which of )(-' the following is the most likely explanation for the discrepancy between the amniocentesis finding and the physical finding? 0 A) ACTH oversecretion 0 B) Androgen insensitivity syndrome 0 C) Fusion of two monozygotes @ D) Lyonization of gene expression 1/15/201512:27 AM· Screen dipping Congenital adrenal hyperplasia.2015 12:27 AM Exam Section : Item 47 of 50 National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment ~Mark Time Remaining: 2 hr 45 min 11 sec 47. NOT CORD NBME 2 OBGYN Page 4 7 . Also get acth over secretion.47 Thursday. During the past 2 weeks. Which of the following is the most likely cause of the fetal growth restriction? 0 A) Gestational diabetes 0 B) Maternal hypothyroidism 0 C) Maternal malnutrition 0 D) Umbilical cord compression @ E) Uteroplacental insufficiency 1/15/201512:27 AM.Thursday. January 15. but it is a diagnosis of exclusion. Four weeks ago at her last examination. fundal height was lagging.Screen Oipping Primary placental insufficiency may be the most common cause of IUGR. She has hypertension treated with nifedipine and hypothyroidism controlled with levothyroxine. and blood pressure is 160/96 mm Hg. Ultrasonography shows an estimated fetal weight at the 5th percentile for 32 weeks' gestation. She is 157 em (5 ft 2 in) tall.2015 12:27 AM Exam Section : Item 48 of 50 L'!'J Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 45 min 7 sec 48. NBME 2 OBGYN Page 48 . Her pulse is 92/min. A 32-year-old primigravid woman at 32 weeks' gestation comes to the physician for a routine prenatal visit. her blood glucose concentrations have been less than 120 mg/dl 1 hour after meals. She was started on an 1800-calorie diet after results of a 3-hour glucose tolerance test showed abnormalities. She has had a 9-kg (20-lb) weight gain during her pregnancy. Examination shows a fundal height of 27 em. respirations are 18/min. She has not been sexually active for 6 months. NBME 2 OBGYN Page 49 . the pain was initially intermittent but has been constant for 3 hours. Her last menstrual period was 6 weeks ago. Ultrasonography of the abdomen shows a 10 x 8 x 7-em right-sided mass with cystic and solid components.8°C (100°F).2015 12:27 AM Exam Section : Item 49 of 50 1!2 Mark National Board of Medical Examiners Obstetrics and Gynecology Self-Assessment Time Remaining: 2 hr 45 min 2 sec 49. and blood pressure is 138/92 mm Hg.Screen dipping Ultrasonography doesn't show ruptured cyst (ultrasound doesn't show fluid in the pelvis?). Her temperature is 37. A 5 x 5 x 4-cm mass in the right adnexa was found after a mild episode of pain 3 weeks ago.49 Thursday. right-sided lower abdominal pain for 18 hours.to 50-day intervals. A 23-year-old woman comes to the emergency department because of the acute onset of intense. Pelvic examination cannot be performed because of discomfort. pulse is 100/min. Abdominal examination shows tenderness in the right lower quadrant with rebound and guarding. Menses occur at irregular 32. January 15. Which of the following is the most likely diagnosis? 0 A) Appendiceal abscess 0 B) Chronic ectopic pregnancy 0 C) Ruptured ovarian cyst @ D) Torsion of an ovarian cyst 0 E) Tube-ovarian abscess 1/15/201512:27 AM. January 15. She is 163 em (5 ft 4 in) tall and weighs 91 kg (200 lb). Her risk for endometrial cancer is increased due to peripheral conversion of which of the following? 0 A) Aldosterone to diethylstilbestrol @ B) Androstenedione to estrone 0 C) Androstened ione to mestranol 0 D) Pregnenolone to progesterone 0 E) Progesterone to estradiol 1/15/201512:27 AM· Screen dipping NBME 2 OBGYN Page 50 .Thursday. Menopause occurred at the ag:e of 49 years. BM I is 34 kgfm2. An asymptomatic 59-year-old woman comes for a routine health maintenance examination.2015 12:27 AM Exam Sect1on : Item 50 of 50 • Mark National Board of Med1cal Exammers Obstetrics and Gynecology Self-Assessment Time Remammg: 2 hr 44 min 57 sec 50. 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