NBME

Question 1

atelectasis

Answer 1

partial collapse of lung

Question 2

septic pelvic thrombophlebitis

Answer 2

sequela of endometritis that can lead to local invasion and infection of the pelvic walls causing intimal damage and thrombosis

symptoms: pelvic pain, fever, persistently febrile despite antibiotic treatment for endometritis

Question 3

In pregnancy TBG is _______, and HCG also _________

Answer 3

TBG is increased, creating increased circulations of T4 and T3, Hcg also stimulate the thyroid gland acting like TSH

Question 4

In pregnancy some one with hyperthyroidism should be evaluated with which lab?

Treatment?

Answer 4

Free thyroxine (T4) NOT triioodothyronine (T3)

1rst trimester propylthiouracil (PR for Pre, given 1rst)
2nd/3rd trimester methimazole

Betablockers until thyroid hormone syn is controlled with propylthiouravcil or methimazole

Question 5

Treatment for DIC

Answer 5

fresh frozen plasma

Question 6

ecclampsia during pregnancy treatment

Answer 6

• stabilize with mg and induce for labor if at least 34wks GA
• <34weeks C-section

Question 7

PCOS Pathophysiology
what hormone is measured/ elevated?

Answer 7

GrRh pulsatility increases, causing more LH to be produced in respect to FSH
- ovulation does not occur due to lack of follicle maturity
- LH triggers more androgen production from theca lutein cells
- lack of progesterone from lack of ovulation,corpus luteum formation causes uninhibited LH release
- estrone production from adipose production further suppresses FSH
- See insulin resistance and hyperandrogenism

-measure testosterone ( elevated)
-LH:FSH ratio is increased but levels themseleves can be normal

Question 8

the baby with this fetal heart tracing is most likely experiencing

Answer 8

metabolic acidosis form hypoxemia as seen by later decelerations

• babies in utero can’t breath so they cannot develop a respiratory acid-base disorder

Question 9

verruca plantaris is

Answer 9

a plantar wart

Question 10

enterocele

Answer 10

when instestines herniate through the pelvic floor and impress upon the vaginal canal

Question 11

cystocele

Answer 11

bladder prolapses through the anterior vaginal wall

PE: bulge on anterior vaginal wall, urethral hypermobility, stress urinary incontince, urinary retention of incomplete bladder emptying

Question 12

indirect inguinal hernia

Answer 12

loop of bowel or omentum exits the the inguinal ring

Question 13

femoral hernia

Answer 13

portion of intestin or imentum proturudes through the femoral ring

Question 14

urethrocele

Answer 14

prolapse of urethra into the anterior wall of the vagina

common cause of stress urinary incontinence

Question 15

baby who is constipated, lethargy, hoarse cry, hypotonia, large fontanelle, dry skin, poor feeding most likely has , screeneed with

Answer 15

congenital hypothyroidism , routine newborn screening

Question 16

ureteral calculus

Answer 16

colicky unilateral flank pain radiating to the groin, with gross microscopic hematuria
NO fever, dysuria or pyuria (WBC in urine)
UA: RBC without casts

Question 17

osteoperosis risk is high in ( race/ gender)
- risk is lowered by use of (meds)

Answer 17

white women
antihypertensive meds ie beta blockers

Question 18

ureteral transection (cut)

Answer 18

urine leaking into abdominal cavity resulting in nausea,, vomiting, fever, abscess formation, and sepsis

Question 19

complication of surgery that presents as anuria, oliguria, abdominal pain, difficulty urinating, feeling of incomplete bladder emptying, and palpable suprapubic mass

Answer 19

urinary retention

Question 20

glucose tolerance test is performed when in pregnancy?

Answer 20

at 24-28 weeks

Question 21

fetal fibronectin

Answer 21

glues amniotic sac to uterus wall
- positive test means increase risk for preterm labor

Question 22

What initial evaluation should be conducted in pregnant patient that has complaints about fluid leaking from her vagina

Answer 22

sterile speculum examination of the vagina

Question 23

dehiscence

Answer 23

partial or total separation of approximated wound edges

• can see serosanguinous drainage
  -treatmentL operative exploration of the wound site

Question 24

evisceration

Answer 24

internal abdominopelvic organs are expelled from the surgical site

surgical emergency!

Question 25

In a patient with sudden onset of vaginal bleeding, post delivery with a placenta with a non-tapering vessel that extends the membrane

most likely has a

Answer 25

succenturiate placenta lobe

Question 26

unilateral facial paralysis following forceps delivery most likely results form

Answer 26

facial nerve injury

cerebral palsy would not occur immediately at birth

Question 27

polyhydramnios causes

Answer 27

• maternal diabetes, fetal infection with parvovirus, twin-twin transfusion syndrome , fetal chromosomal or structural abnormality (ancephaly, duodenal atresia)

Question 28

renal agenesis causes poly/oligohydramnios?

Answer 28

oligohydramnios ( no fetal urine production)

Question 29

medication of choice for mastitis
most concerning bug

Answer 29

dicloxacillin
-beta lactamse produceing bacteria ie staph aureus

less common: strep a, step b, E coli, H influenzae

Question 30

axillary lymphadenopathy with adenocarcinoma is most likely due to

Answer 30

breast cancer , even if x-ray and mammography is unremarkable

adenocarcinoma- cancer of glandular tissue,

Question 31

STIs that cause painless genital ulcer

Answer 31

Question 32

functional ovarian cyst

Answer 32

occurs when egg is not released form the follicle and would not present as a echogenic mass

Question 33

hypogonadophic hypogonadism

Answer 33

low gnRH, low FSH/LH, low sex steroids

Question 34

hypergonadotropic hypogonadism

Answer 34

high gNRH => high LH, FSH, => no steroid no negative feedback so LH and FSH are high

• ex Turner syndrome

Question 35

things that increase osteoporosis risk the most

Answer 35

white female
family history