NBME Exams

Question 1

Classic clinical presentation of ashmermans syndrome

Answer 1

Prior pregnancy and d&c presenting with secondary amenorrhea or hypomenorrhea

Question 2

37 yo G1P1 w. LSIL, colpo biopsy reveals CINIII.

Next step?

Answer 2

Cone biopsy (which is the same thing as a LEEP…)

Question 3

Mechanism by which obesity increases the risk of endometrial cancer

Answer 3

Adipose tissue contains enzyme (aromatase) that allows peripheral conversion of androstenedione to estrone

Question 4

23 yo F w/ acute onset of intense, RLQ pain x18 hrs

• initially intermittent, now constant for 3 hrs
• LMP 6 wks ago
• 5x5x4 mass in right adnexa found 3 wks ago
• afebrile
• RLQ tenderness w/ rebound and guarding

Dx

Answer 4

Torsion of ovarian cyst

-intermittent pain (as blood supply cut off)

Question 5

Clinical presentation of imperforate hyman

Answer 5

Primary amenorrhea with cyclic pelvic pain

-otherwise normal development

Question 6

Buzzword: uterosacral nodularity

Answer 6

Endometriosis

Question 7

27 yo w. Dysparenuria and dysmenorrhea x2 yrs

• anexa normal size but tender
• nodularity over the uterosacral area

Next step

Answer 7

Laparoscopy

-Dx endometriosis

Question 8

21 yo F presents at 40 weeks at 5/10/?
-Leopold maneuver shows fetus in transverse lie w. Back towards the pelvis

Next step

Answer 8

C section

Question 9

25 yo G1P0 at 36 wks w. Sudden onset excruciating abdominal pain and vaginal bleeding
-BP 160/110, HR 118
PE: firm, distended tender uterus
FHT: 108 baseline w. No variability

Dx

Answer 9

Premature placental separation = abruptio placentae

Wouldn’t be vasa previa bc that wouldn’t cause such a hypertonic tender uterus or maternal hypertension

Question 10

26 yo G3P2 at 11 wks gestation s/p Rhogam during second pregnancy. Best way to evaluate her Rh status?

Answer 10

Indirect antiglobulin (Coombs) test
-wouldn't do kleihauer betke test bc that would only tell you the current presence of fetal RBC in maternal blood, not the current status of Rh+ antibodies

Question 11

24 yo F presents in labor w. GBs status pending.

• 5/80/1
• ROM x12 hours, contractions every 12 minutes

Next step to prevent GBS sepsis In the newborn

Answer 11

Give abx if delivery has not occurred within 18 hrs after rupture of membranes

Question 12

24 yo at 42 wks gestation admitted for induction of labor

• normal VS and reactive NSt
• closed, posterior cervix
• AFI 3.2

Next step

Answer 12

Administer prostaglandins

• wouldn’t send her home (even if she wasn’t olgio)
• no indication for emergent C sxn

Question 13

32 yo G3P2 at 30 wks p/w pain. RLQ tenderness. febrile to 101.3, white count 14
US: fluid in the right paracolic gutter

Next step

Answer 13

Surgical exploration

-ruptured appendicitis

Question 14

24 yo G3P3 presenting w. Amenorrhea x13 mo. Had a vaginal delivery 13 mo ago complicated by hemorrhage requiring d&c.
-progestin challenge shows no withdrawal bleed

Dx

Answer 14

Asherman syndrome = adhesions/fibrosis of the myometrium