Ob-Gyn NBME Form 3 - Questions and Answers

Ob-Gyn NBME Form 3 - Questions and Answers 47 yo PSHx: TAH + BOS for leiomyomata uteri (6 wks ago) no hx of abnormal Paps PE: well-healing incision next step regarding future Paps? no longer indicated can stop screenin ...

Ob-Gyn NBME Form 3 - Questions and Answers 47 yo PSHx: TAH + BOS for leiomyomata uteri (6 wks ago) no hx of abnormal Paps PE: well-healing incision next step regarding future Paps? no longer indicated can stop screening at 65-70 yo, 3+ normal Pap tests in a row w/o CIN2/3 or higher in past 20 yrs, or if woman had TAH for benign indications and no hx of CIN2/3 or higher hx of CIN2/3 w/ TAH + 3 consecutive neg screening tests can stop 32 yo - 2 days of vag bleeding and lower abd cramps LMP: 7 wks ago sex active w/ 1 partner; condoms no meds PE: soft abd and lower quadrant tenderness speculum exam: mod vag bleeding; closed cervical os preg: pos transvag US: fluid-filled endometrial cavity; no gest sac b-hCG: 2500, 2800 (48 hrs) most likely dx? ectopic pregnancy b-hCG didn't double in 48 hrs > not IUP presents w/ abd pain and vag spotting/ bleeding dx: UPT (+); transvag US (empty uterus); confirm w/ serial hCG (no doubling) tx: methotrexate +/- leucovorin (if b-hCG <5000, no fetal heart tones, GS < 3.5 cm) ; salpingectomy (if ruptured); salpingostomy (no rupture) 27 yo - 2 wks after noticing tender in L.breast hx of similar smaller masses that resolved spontanelously w/in few wks no meds menses reg LMP: 3.5 wks ago vitals gucci PE: no lymphadenopathy; breast symmetric w/o skin changes exam of L.breast: 1 cm, smooth, mobile masses, and 3 cm, mobile soft, tender mass in upper outer quadrant exam of R.breast: tenderness to deep palp; small masses similar to L.breast most likely dx? fibrocystic changes of the breast MC of all benign breast conditions exaggerated stromal tissue response to hormones and growth factors findings: cysts, papillomatosis, adenosis, fibrosis, and ductal episode hyperplasia primarily affects women 30-50 yo associated w/ trauma and caffeine use features: cyclic BL mastalgia and swelling (most prominent just before menstruation); rapid fluctuation in size of masses; irregular, bumpy consistency to breast tissue dx: mammogram; US (cystic vs solid); FNA (alleviate pain; confirm cystic nature of mass); excisisonal biopsy (no fluid or bloody) tx: dietary modifications; danazol (severe pain); OCPS (dec hormonal fluctuations) 26 yo - G3P2 - 11 wks gest blood: O, Rh- received RhoGAM after 1st delivery most app test to evaluate Rh status? indirect antiglobulin (Coombs) test detects Abs to RBCS in pt's serum Kleihauer-Betke test: determine extent of any fetomaternal transfusion so appropriate amount of RhoGAM can be administered 32 yo primigravid - 30 wks gest - 10 days of dec appetite, int nausea, and gen itching no PMHx PE: excoriations on L.shoulder; lung clear; grade 2/6 sys murmur at L.sternal border uterus - consistent in size w/ 30 wks gest labs: dec Hgb, plts; MCV, WBC, red cell distribution width - WNL; inc BR, alk phos, AST, ALT abd US: gucci most likely explanation? intrahepatic cholestasis package of bile flow pregnant woman are predisposed to developing cholelithiasis cholestasis: inc alk phos and BR intrahepatic - no ductal dilation features: jaundice, gray stools, dark urine; pruritus; skin xanthomas; inc serum chol; malabsorption of fats and fat-soluble vitamins (esp vit K) 16 yo - no period mod lower abd pain during past 5 months no PMHx; no meds BMI: 20 breast - Tanner stage 4 PE: coarse pubic/ax hair; ext gen normal; vag canal can't be visualized rectal exam: ant tender, central mass most likely explanation? imperforate hymen if vag canal can't be visualized - something is clearly obstructing it results in obstruction to outflow tract of reproductive system build up of secretions in vagina behind hymen = hydrocolpos or mucocolpos if not ID at birth > dx at puberty in adolescents w/ primary amenorrhea and cyclic pelvic pain due to accumulation of menstrual flow behind hymen (hematocolpos) and uterus (hematometra) PE: absence of identifiable vag lumen, tense bulging hymen, and possibly inc lower abd girth tx: surgery 32 yo - G2P1 - 18 wks gest US: triplet gest w/o abnormalities all 3 fetuses have fetal heart tones and are app size inc risk for what complication? premature labor dx w/ US b-hCG, HPL, and MSAFP - inc complications: twin-to-twin transfusion syndrome, IUGR< preterm labor, and congenital malformations tx: multifetal reduction and selective fetal termination; antepartum fetal surveillance for IUGR; mgnt by high-risk specialist 18 yo - irregular menses last 3 months 14-40 day intervals flow varies cramping/bleeding - caused her to miss school LMP: 3 wks ago menarche: 12 yo were reg at 28 day intervals for 6 yrs sedentary BMI: 23 pelvic exam: gucci preg: neg next step in mgnt? cyclic progesterone therapy OCPs are used to regulate periods but need to contain prog withdrawal of prog > endometrium to slough = menstrual phase