NBME OBGYN Form 6 - Answers & Explanations

Updated: Jul 28, 2020

Authors: Luke Carlson

Editor: Miriam Andrusier

1) Mixed enteric and skin flora

• Bartholin cyst gland abscess – mixed enteric and skin flora

2) Puerperal sepsis

• Patient is demonstrating signs and symptoms of septic shock: fever >38C (41C), tachycardia (130/min), tachypnea (30/min), and hypotension

• Puerperium = period of ~6 weeks after childbirth, during which, the mother’s reproductive organs return to their original non-pregnant condition

3) Protracted active phase of labor

• Out of date answer (should be normal labor); new guidelines set active phase at 6cm, however older guidelines had 4cm as active phase

• The cervix should dilate at a rate of ≥1cm every 2 hours during the active phase of labor (6-10 cm cervical dilation)

• Protracted active phase is when you have < 1cm dilation over 2 hours

4) Augmentation of labor with oxytocin

• Out of date answer (active labor should be at 6cm)

• If patient was 6cm dilated (active phase), augmentation of labor with oxytocin to increase strength and frequency of contractions

• Protracted active phase of labor

5) Enterocele

• Pelvic organ prolapse

• “Something moving” = peristalsis, stool

6) Synchronization of the endometrium

• Hormonal imbalance → menometrorrhagia (irregular and heavy bleeding)

• OCPs promote regular menses – cause synchronization of the endometrium by providing progesterone that will cause endometrial shedding and oppose estrogen-induced endometrial hyperplasia

7) Observation and continued monitoring

• This fetal heart rate tracing is normal with moderate variability although no accelerations makes it non-reactive, there is nothing more to do here

8) Observation

• Hematocrit of 37% is within normal limits

• Lochia – normal bleeding postpartum, up 2-6 weeks, both vaginal or cesarean delivery

9) Progesterone supplementation until 10 weeks’ gestation

• Corpus luteum is responsible for producing progesterone during the first 6-12 weeks of gestation

• Placenta takes over progesterone production around 8-12 weeks

• Providing progesterone supplementation until 10 weeks would provide adequate time for placenta to take over production

10) Acetaminophen

• Acetaminophen is safe for use in pregnancy & is first line tx for headache in pregnancy

• NSAIDs are second line tx for abortive migraine treatment during pregnancy

• Butalbital, ergotamine not recommended during pregnancy

• Sumatriptan – abortive

• Meperidine – opioid, risk of withdrawal syndrome if used in excess

11) Hypogonadism

• Chemotherapy-induced premature ovarian failure → menopause-like symptoms

12) Application of heat to the area

• Plugged duct - afebrile breastfeeding mother, tender edematous area (can be lateral aspect as in this patient)

○ Tx: warm compress

• Galactocele - afebrile breastfeeding mother with a non-tender mass

• Mastitis would be treated with antibiotics (eg, dicloxacillin and continued breastfeeding)

13) Endometrial biopsy

• Endometrial biopsy indicated in women >45 with postmenopausal or abnormal uterine bleeding

14) Sexual assault

• Elderly patient with dementia has a lateral 3cm laceration and erythematous, edematous vaginal perineal body = trauma (unlikely she did this to herself)

15) Wet mount preparation

Gardenerella vaginalis (bacterial vaginosis) and Trichomonas vaginalis (trachomoniasis) have foul-smelling, watery vaginal discharge – wet mount preparation can help differentiate between the two

16) Fetal ultrasonography

• Fetus at 32 weeks should be ~32 cm fundal height

• U/S to identify possible fetal growth restriction - whenever there is a size-date discrepancy, its best to do an ultrasound

17) Testosterone

• ↑ testosterone → Hirsutism + irregular menses

● PCOS has elevated testosterone and LH:FSH at least >2:1

18) Mixed aerobes and anaerobe

• Postpartum endometritis – cesarean delivery, purulent lochia, uterine fundal tenderness, fever >24 hours

• Tx: clindamycin and gentamicin

19) Antibiotic therapy

• Maternal fever + fetal tachycardia = suspicious for chorioamnionitis

• Management: broad-spectrum antibiotics (ampicillin + gentamicin) then delivery (cesarean delivery is not done in chorioamnionitis unless there is another indication eg, breech)

20. Haemophilus ducreyi

• Chancroid - painful, large deep ulcer with yellow/grey exudates, well-demarcated borders, and soft, friable base (bleeds easily)

• You “do cry” with ducreyi = painful

21) Acute respiratory distress syndrome

• Toxic shock syndrome secondary to Staphylococcus aureus

• Presents with fever, hypotension, diffuse red macular rash – systemic illness due to exotoxin release (TSS toxin-1)

• Common cause of morbidity/mortality in TSS is ARDS

22) Ovarian torsion

• One complication of cystic teratoma is ovarian torsion

• Variable mass densities cause intrinsically unstable suspension across the infundibulopelvic ligaments (cystic teratomas are large and their weight is not balanced causing them to rotate and cause torsion)

23) Indirect antiglobulin (Coombs) test

• Rh-negative mothers screened with Rh (D) type antibody test at initial prenatal visit (to make sure she doesn’t have Rh antibodies)