NBME CMS OBGYN FORM 3 Q 1-10 (need help) - jjpyae

[ArchivalUser]

2...They look like the same but one is almost a plaque on anal skin, the other a patch on mucus membrane. The most important thing is clinical picture, paget is not painful and two ulcers are that much painful in genitalia, herpes and ducray. Believe me it is not paget.

[ArchivalUser]

thank you Samy

I think you are right.

short time, most often, pain -- all point to HSV


Paget is super rare, needs much longer time to develop, and has pain from scratching.

http://www.dermnetnz.org/site-age-specif...paget.html
The most common symptom is a mild to intense itching of a lesion found around the groin, genitalia, perineum or perianal area. Pain and bleeding may occur from scratching lesions that have been around for a long time. Thickened plaques may form that can become red, scaly and crusty. Although they may appear similar to eczema, they fail to clear up with topical steroid creams.

[ArchivalUser]

monter, thanx for the information.

[ArchivalUser]

regading 6....she s gravida, so shouldn't v be more conservative n do colpo n Bx every 3 months. (uw qid 4758) coz as long as its not invasive it will spontaneously regress 50%

[ArchivalUser]

sorry she s not pregnant..... my bad

[ArchivalUser]

probably a little late for this, but I can verify the following answers to definitely be correct (I got them correct on the exam).

1 is intrahepatic cholestasis

2 is HSV 1. they hint at this with the increased stress and by saying exquisitely tender ulcers.

3 is measurement of ketones. this pt is likely suffering from hyperemesis gravidarium. the inability to eat causes an increase in ketones.

4 voiding immediately after coitus. daily TMP-SMX is an option, not sure when it's indicated though, probably if voiding is not curative.

5 cervical stenosis hinted by scarred, small cervix.

6 cone biopsy of the cervix. cone biopsy or endocervical curettage is indicated after an unsatisfactory colposcopy.

7 imperforate hymen. she's having abdominal pain, a sign that menstruation is occurring. Everything on exam is normal, except the vaginal canal can't be viewed, likely an outlet obstruction.

8 necrotizing fasciitis a risk with any cellulitis

9 normal development. height and weight are normal. physical exam is normal. and it's common for menstruation to vary considerably during the first three years of onset of menstruation.

10 this is the one I got wrong. A is definitely wrong, I think B is the right answer. not sure.

[ArchivalUser]

Hello hope you guys are doing well, I was wondering if any of you got these questions right and a brief explanation. I would really appreciate it my exam is coming up soon! please any help would be extremely appreciated. Thank you have a great day.

1. A 21-year-old woman comes to the physician because of a 2-week history of a small amount of vaginal discharge and itching; her symptoms began immediately before her last menstrual period. She has had two sexual partners over the past 2 months and uses an oral contraceptive. One month ago, she had pain on urination and urinary frequency that resolved after a 7-day course of cephalexin. Examination shows a red introitus and vulva. There are erythematous vaginal walls with a normal amount of vaginal discharge. The cervix and cervical discharge are normal. Vaginal pH is 4.5. The addition of KOH to the discharge produces no odor. A wet mount preparation shows no motile organisms. Which of the following is the most likely causal organism?
A) Candida Albicans
B) Chlamydia trachomatis
C) Gardnerella vaginalis
D) Neisseria gonorrhoeae
E) Trichomonas vaginalis

8. A 77-year-old woman, gravida 2, para 2, comes to the physician because of a 1-month history of intermittent episodes of vaginal bleeding. Each episode lasts 3 to 4 days and is not associated with trauma or sexual intercourse. Menopause occurred 26 years ago, and she has never received hormone therapy. Her last gynecologic examination was 38 years ago following the birth of her youngest child. She takes no medications. She has smoked two packs of cigarettes daily for 50 years. Physical examination shows no abnormalities. Pelvic examination shows a 2-cm, exophytic lesion on the cervix. There is no enlargement of the uterus or evidence of blood in the vagina. Results of a biopsy specimen of the lesion are most likely to show which of the following?

A) Adenocarcinoma
B) Carcinosarcoma
C) Clear cell carcinoma
D) Papillary serous carcinoma
E) Squamous cell carcinoma


19. A 37-year-old woman, gravida 1, para 1, with recently diagnosed breast cancer comes to the physician for advice regarding contraception. She will begin chemotherapy and radiation therapy in 6 weeks. She had been using a combination oral contraceptive for 3 years but discontinued it 8 weeks ago on advice of her oncologist and began using condoms. Since discontinuing oral contraceptive therapy, she has had one menstrual period that lasted 4 days. Previously, menses occurred at regular 28-day intervals and lasted 3 to 4 days. She delivered her first child 18 months ago and wishes to have another child in the future. She has no other history of serious illness and takes no other medications. Her blood pressure is 115/72 mm Hg. Pelvic examination shows no abnormalities. Which of the following is the most appropriate recommendation regarding contraception for this patient?
A) Progestin-only oral contraceptive
B) Diaphragm
C) Placement of a copper IUD
D) Depot medroxyprogesterone
E) Etonogestrel implant

29. A 62-year-old woman 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 diabetes mellitus treated with oral hypoglycemic agents. She has no history of abnormal annual Pap smears. She is 163 cm (5 ft 4 in) tall and weighs 66 kg (145 lb); BMI is 25 kg/m 2. Pelvic examination shows a normal cervix and uterus with blood at the cervical os. A 6 x 8-cm left t ovarian mass is palpated. Pelvic ultrasonography confirms the results of physical examination. 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
E) Sertoli-Leydig cell tumor

34. A 37-year-old primigravid woman at 31 weeks' gestation comes to the physician for a routine prenatal visit. She reports a 4-day history of mild difficulty breathing, especially when in the reclining position. She has no history of serious illness; her only medication is a prenatal vitamin. Her temperature is 37°C (98.6°F), pulse is 90/min, respirations are 18/min, and blood pressure is 130/80 mm Hg. The fundal height is 37 cm. Pelvic examination shows no cervical dilation or effacement. Ultrasonography shows a normal-appearing fetus. The amniotic fluid index is 35 cm (N=10-20). Which of the following is the most appropriate next step in management?
A) Complete bed rest until delivery
B) Recommendation to limit dietary sodium intake
C) Antenatal testing
D) Diuretic therapy
E) Weekly amniocentesis for removal of fluid


41 A 24-year-old primigravid woman at 42 weeks' gestation is admitted to the hospital for labor induction. Her pregnancy has been uncomplicated. She has no history of serious illness. On admission, her temperature is 36.9°C (98.5°F), pulse is 64/min, and blood pressure is 130/72 mm Hg. Fetal nonstress testing is reactive. Pelvic examination shows a closed, long, posterior cervix. The amniotic fluid index is 3.2 cm (N=9-31). Which of the following is the most appropriate next step in management?
A) Discharge home and readmit in 1 week
B) Administer betamethasone
C) Administer a prostaglandin
D) Begin amnioinfusion
E) Perform an immediate cesarean delivery

[ArchivalUser]

1 . A having itching and ph 4.5
8 . E
19 . C This is best contraception with no hormonal side effect
29. B estrogen producing tumor having endometrial hyperplasia
34. C
41. C
plz let me know if i m wrong

[ArchivalUser]

@Anagh thank you so much for your fast reply! sorry I took a bit long.

All your answers above were correct, I did it online and those questions weren't on my wrong list anymore. Thank you so much!!

The question below I believe the answer is E Septic Pelvic Thrombophlebitis, I think in another forum someone said N gonorrhea infection but after doing it online thats not the right answer, if you have any input it would be greatly appreciated

13. A 27-year-old primigravid woman at 38 weeks' gestation is admitted to the hospital in labor. She had spontaneous rupture of membranes 2 days ago. On arrival, her temperature is 39.1°C (102.3°F). The cervix is 100% effaced and 4 cm dilated; the vertex is at +1 station. Abdominal examination shows exquisite tenderness of the uterine fundus. Pelvic examination shows mucopurulent cervical discharge. The fetal heart rate is 180/min with good variability. Treatment with intravenous ampicillin and gentamicin is begun. Two hours after admission, the cervix remains 4 cm dilated. She undergoes cesarean delivery for arrest of active phase and delivers a healthy newborn. Six hours after delivery, the patient's temperature is 38.9°C (102°F). Which of the following is the most likely cause of this patient's fever?
A) Chlamydia trachomatis infection
B) Escherichia coil infection
C) Neisseria gonorrhoeae infection
D) Polymicrobial infection
E) Septic pelvic thrombophlebitis

[ArchivalUser]

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