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* NBME-ob/gyn 3:
  kennychan - 12/01/17 20:45
  A 50-yo woman, G3 P2 A1, has had loss of urine with coughing, straining, or lifting since the birth of her last child 9 year ago; the symptoms has progressively worsened over the past 2 years. During examination, she loses urine in small spurts with coughing, but the anterior and posterior vaginal walls appear well supported. A cotton-tipped applicator place in the urethra does in an arch of 45 degrees with the horizontal during Valsalva maneuver. Which of the following is the most likely diagnosis?
a) Cystocele
b) Enterocele
c) Femoral hernia
d) Fourth-degree obstetric laceration
e) Hiatal hernia
F) Indirect inguinal hernia
g) Rectocele
h) Urethrocele

Which is the answer and explain. Thanks in advance!
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* Re:NBME-ob/gyn 3:
  kennychan - 12/01/17 21:16
  A 23-yo F, G3 P3, at 26 weeks’ gestation comes to the physician for a follow-up examination. She reports that her daughter had a flu-like illness 2 months ago that resolved without medical treatment. Her pregnancy has been otherwise uncomplicated, and results of prenatal laboratory studies have been within the reference ranges. Examination shows a fundal height of 34 cm. Ultrasonography shows polyhydramnios, fetal ascites, and skin thickening. Infection with which of the following is the most likely cause of these finding?
a) Adenovirus
b) Coxsackievirus A
c) CMV (wrong)
d) Herpes simplex virus
e) Parvovirus B 19

Please help!
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* Re:NBME-ob/gyn 3:
  kennychan - 12/01/17 21:26
  A 27 yo F comes to the physician because of 4-month history of increasingly severe pain during her menstrual periods. Menses occur at regular 28-day intervals and last 5 to 7 days with light flow. Her last menstrual period was 24 days ago. She underwent a loop electrosurgical excision of the cervical transformation zone for cervical dysplasia 6 months ago; examination of the biopsy specimen showed cervical intraepithelial neoplasm (CIN 2) with negative margins. She is sexually active and uses condoms and spermicidal foam. Pelvic examination shows a normal vaginal, scarred cervical os. The uterus is slightly enlarged and tender. Which of the following is the most likely cause of this patine's symptoms?
a) Cervical stenosis
b) Endometritis
c) Premenstrual syndrome (wrong)
d) Recurrent dysplasia
e) Threatened abortion

Please help!
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* Re:NBME-ob/gyn 3:
  kennychan - 12/01/17 21:42
  A 37 yo F G2P1 at 36 weeks' gestation is admitted to the hospital after she was found to have fetal growth restriction during a routine rental visit. She has a 6 year history of mild chronic essential hypertension controlled with B-adrenergic blocking agents that were discontinued at 8 weeks' gestation. At 10 week's gestation, a 24-hour urine collection shows a protein concentration of 50 mg and creatinine clearance of 110ml/min. US and amniocentesis at 18 weeks' gestation showed no abnormalities; the estimated fetal weight was at the 50th percentile. Her temperature today is 36.6 C, pulse is 88/min, RR 20/min, and BP 110/70 mm Hg. Exam shows a fundal height of 30 cm. US shows a fetal head circumference consistent in size with a 35-week gestation and an abdominal circumference consistent in size with a 30 week gestation. The estimated fetal weight is at the 9th percentile. Which of the following is the most appropriate test to determine the risk of intrauterine fetal demise?
a) Determination of nuchal thickness (wrong)
b) Fetal fibronectin test
c) Glucose tolerance test
d) Doppler US of the umbilical artery
e) Determination of amniotic fluid glucose concentration

Please help and give explanations.
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* Re:NBME-ob/gyn 3:
  kennychan - 12/01/17 21:55
  A 62 yo F comes to the physician because of two episodes of vaginal bleeding during the past 3 weeks. Menopause occurred 12 years ago. She has hypertension treated with an ACE inhibitor and type 2 DM treated with oral hypoglycemic agents. She has no history of abnormal Pap smears. BMI 25 kg/m2. Pelvic exam shows a normal cervix and uterus with blood at the cervical os. A 6=8 cm left ovarian mass is palpated. Pelvic US confirms the results of physical exam. An endometrial biopsy specimen shows atypical complex hyperplasia. Which of the following is the most likely diagnosis?
a) Brenner tumor
b) Granulosa cell tumor
c) Ovarian carcinoma
d) Ovarian fibroma (wrong)
e) Stertoli-Leydig cell tumor

Thanks for helping!
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* Re:NBME-ob/gyn 3:
  danyjoe - 12/02/17 10:58
  no 1 sounds like stress incontinence ..h
no 2 previous hx of child with illness and u/s showing polyhydraminous and others .. parvo b 19
no 3 .. sounds like cervical stenosis .. previous hx of LEE surg predisposes to cerviacl stenosis , decrsase flow etc..
no 4 ..umblical artery..fibronectine is for prematurity,nuchal thickness down syndrome ,glucose tolerance DM .
no 5; granulosa cell tumor.
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* Re:NBME-ob/gyn 3:
  kennychan - 12/02/17 13:13
  Thank You!  
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* Re:NBME-ob/gyn 3:
  nelly88 - 12/03/17 23:00
  1- Cystocele
2- Parvovirus.... remember the only one in the TORCHS that produce hydrops fetalis. Adenovirus can give hemorrhagic cystitis.
3- Cervical stenosis... She had history of LEE
4- Doppler of umbilical artery, remember nuchal thickness is tanner, fibronectine is for premature and glucose tolerance is for gestational diabetes
5-Granulosa cell tumor... Is gonna be present as a large adnexal mass. In child there's gonna be precocious puberty and in postmenopausal women would be bleeding and endometrial hyperplasia. In ovarian carcinoma there's not gonna be bleeding. Is gonna be present with shortness of breath, constipation, abdominal distention and the adnexal mass.
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* Re:NBME-ob/gyn 3:
  kennychan - 12/04/17 15:56
  Thank You!  
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* Re:NBME-ob/gyn 3:
  abarron - 12/14/17 09:59
  1. Is actually urethrocele. The q-tip test shows that the urethra is hypermobile indicating pelvic floor incompetence causing stress incontinence.  
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