NBME OBGYN Form 5 - Answers & Explanations

Updated: Nov 16, 2019

Authors: Luke Carlson

Editor: Jordan Abrams

1) Hemorrhagic shock

• Active, prolonged vaginal bleeding

2) Endometriosis

• Ectopic implantation of endometrial glands

• Clinical features: dysmenorrhea, dyspareunia, dyschezia, infertility

3) Dicloxacillin

• Lactational mastitis – tenderness of unilateral breast in lactating patient

• Clinical Features: erythema, tenderness, fever, fissures of nipple

• Pathogenesis – skin flora (eg, Staphylococcus aureus) → clogged, inflamed milk ducts

• Tx: frequent breastfeeding, antibiotics (cover for MSSA – penicillin, penicillinase-resistant)

4) Dehiscence

• Disruption or breakdown of a wound, serosanguineous drainage

• Diabetes mellitus → delayed wound healing → ↑ risk of dehiscence

5) ↓ACTH, ↓TSH, ↓LH, ↓FSH, ↓GH

• Sheehan syndrome: obstetric hemorrhage → hypotension → postpartum pituitary infarction

• Clinical features:

• Anorexia, weight loss, hypotension (↓ ACTH)

• Fatigue, dry skin, constipation, cold intolerance (↓ TSH)

• Amenorrhea, hot flashes, vaginal atrophy (↓ FSH, LH)

• ↓ lean body mass (↓ GH)

• Lactation failure (↓ prolactin)

6) Kell typing of the father’s blood

• Kell antigen system – group of antigens found on RBC surface; help determine blood type

• Anti-Kell antibodies (IgG) – transplacental hemolytic disease of newborn

• Mother tested positive for anti-K, therefore father needs to be tested to determine the risk of fetal K antigen

7) Hepatitis B

• Recommended vaccinations during pregnancy for high-risk patients (eg, multiple STDs)

• Hepatitis B, Hepatitis A, Pneumococcus, Haemophilus influenzae, Meningococcus,

Varicella-zoster immunoglobulin

• ⊖ Hepatitis B surface antigen assay = no Hep B exposure

• Live-attenuated vaccine are contraindicated in pregnancy (eg, MMR, live attenuated influenza, varicella)

8) Influenza virus

• Yearly routine health maintenance examination with all childhood vaccinations no high-risk behavior

9) Ectopic pregnancy

• ⊕ pregnancy test with adnexal mass, vaginal spotting and unilateral abdominal pain

10) Gonadal dysgenesis 45,X (Turner syndrome)

• Primary amenorrhea due to small, non-functioning ovaries (streak ovaries)

• Typical short stature, webbed neck, “shield chest” ( minimal breast development - tanner 3)

11) Vaginal miconazole

• Candida vaginitis tx: antifungal (eg, fluconazole)

• Mild erythema and excoriation (pruritus), no vaginal bleeding or discharge

• Microscopy reveals pseudohyphae

12) Urinary retention

• Inefficient detrusor muscle activity → hypotonic bladder (common postoperative complication)

• Soft symmetric mass extending 25cm above symphysis = distended bladder

• ↑ BUN & creatinine

13) Induction of labor

• Intrauterine fetal demise = fetal death ≥ 20 weeks

• Absence of fetal cardiac activity on US

• Management:

• 20-23 weeks: Dilation and evacuation OR vaginal delivery

• 24 weeks or greater: vaginal delivery

• Complication: coagulopathy after several weeks of fetal retention

• Hb 11g/dL, Hematocrit 32%, Platelets 90,000/mm3

• Missed abortion: no vaginal bleeding, closed cervical os, no fetal cardiac activity

14) Fibroadenoma

• Solitary, well-circumscribed, mobile mass

• Most common cause of breast mass in an adolescent (versus a breast cyst, which is most common after age 30)

• Size & tenderness fluctuate with estrogen exposure → cyclic premenstrual tenderness

15) Herpes simplex virus

• Small, painful vesicles or ulcers on erythematous base (can coalesce), mild lymphadenopathy