Ob-Gyn NBME Form 1 - Questions and Answers 42 yo - G3P3 menses irregular at 2-3 month intervals, last 7-21 days LMP: 6 wks ago PMHx: T2DM (metformin) BMI: 32 PE: no other abnormalities pelvic exam: irregular enlarged uterus (12x8x6 cm) endometrial biopsy: atypical complex hyperplasia strongest pr...
Ob-Gyn NBME Form 1 42 yo - G3P3 menses irregular at 2 -3 month intervals, last 7 -21 days LMP: 6 wks ago PMHx: T2DM (metformin) BMI: 32 PE: no other abnormalities pelvic exam: irregular enlarged uterus (12x8x6 cm) endometrial biopsy: atypical complex hyperplasia strongest predisposing factor for this pt's condition? anovulation endometrial proliferation is normal part of menstrual cycle BMI: 32 aka this woman is obese > excess adipose tissue = inc peripheral conversion of androgens to estrogens by arom atase in adipocytes excess estrogen > stimulates overgrowth of endometrium > endometrial hyperplasia (and sometimes cancer) risk factors: obesity , nulliparity, late menopause, and exogenous estrogen use w/o progesterone; chronic anovulation , PCOS, and estr ogen -producing tumors; HTN and DM; tamoxifen 15 yo - 1 wk constant severe abd pain past yr - 10 episodes of cramps; last 3 -5 days no PMHx, no meds never had menarche sex active w/ 1 partner - no contraception 100F P - 120/min BP - 90/50 mmHg Tanner stage 5 abd exam: mod tenderness PE: mass palpated in suprapubic region at midline pelvic exam: normal ext genitalia and lower vagina cervix can't be visualized due to bluish bulging bag tissue that obscures upper vagina preg test neg most likely dx? hematocolp os when the vagina fills w/ menstrual blood ddx: usually due to an imperforate hymen ddx: vaginal atresia (agenesis of lower vag) lower vag replaced by fibrous tissue but ovaries, uterus, cervix, and upper vag are normal primary amenorrhea and cyclic pelvi c pain PE: absence of introitus and presence of vaginal dimple tx: vaginal pull -through procedure ddx: transverse vag septum 32 yo - G2P1 - 26 wks gest - ED bc awakened by worst pain she's ever had started on L.side of back > radiated into L.inguinal are a and L.labium sweating, nausea, and several episodes of vomiting felt faint while trying to urinate - couldn't completely empty bladder only comfortable when ambulating P: 122/min PE: mod tenderness in L.back/flank no gross hematuria most likely dx? urete rolithiasis colicky flank pain that radiates to groin and N/V not in the kidney but in the ureter instead dx: UA; US (since pregnant) UA: no casts and microscopic hematuria 32 yo primigravid - 10 wks gest - 5 days of N/V and dec appetite can't keep solid s/liquids down no F/C, sweating, abd pain, or vag bleeding NKDA PE: uterus consistent in size w/ 10 wks gest CBC: dec Hgb CMP: dec Na, K; inc HCO3 - UA: ketones + serum studies of TSH and free thyroxine - pending next step in mgnt? admission to the hospital for IV hydration and parenteral antiemetic therapy 20 yo primigravid - 40 wks gest - labor cervix - 4 cm dilated vertex - 0 station 2L LR sln administered epidural catheter placed - test dose of lidocaine and Epi injected immediately has tinnitus and metallic taste in her mouth P: 110/min BP: 140/100 mmHg most likely cause? IV injection of anesthetic when anesthetics are supposed to be given epidural form but are given IV instead > cause toxicity (tinnitus, metallic taste, etc.) 23 yo - f/u 3 wks after being dx w/ UTI tx: TMP -SMX 3rd UTI over past yr no PMHx SHx: married 3 months ago PE: no abd/flank tenderness UA: gucci daily administration of what is most appropriate ppx against recurrence? TMP -SMX UTIs are recurrent: 2+ in 6 months or 3+ in 1 yr other choices: > phenazopyridine - relieves symptoms of UTIs > propantheline - anti-musc agent; can be used to tx excessive sweating, cramping/spasms of stomach/intestines/urinary tract, and involuntary urination > dicloxacillin and PCN - these not used for E. coli tx 27 yo - G2P1 - 36 wks gest - 2 hr hx of intermittent vag bleeding no prenatal care fundal height 35 cm fetal HR: 135/min PE of lower genital tract and cervix: bleeding of uterine origin blood: O,Rh - w/o Abs fetal NST: reactive BPP: 8/8 next step in mgnt? administration of Rho(D) immune globulin ALL RH -NEG PREGNANT WOMEN ESP THOSE W/ VAG BLEEDING DURING PREGNANCY SHOULD RECEIVE RHOGAM TO PREVENT ISOIMMUNIZATION 42 yo - 6 months of inc heavy menstrual periods and 2 months of prolonged flow PE: slightly enlarged, irregular, smooth, freely mobile uterus abd US: 4 -cm leiomyoma uteri most likely type of leiomyoma? submucosal uterine leiomyomas = fibroids or uterine myxomas = benign proliferations of smooth muscle cells of myometrium MC type: intramu ral MC associated w/ heavy or prolonged bleeding: submucosal submucosal and subserosal may become pedunculate parasitic = pedunculate fibroid; attached to pelvic viscera or omentum; develops own blood supply
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