OBGYN Form 3 Qs Searchable

Exam Section : item 1 of 50

1.

National Board of Medical Examiners

Time 3 maining:

A 32-year-old primigravid woman comes to the physician at 30 weeks ' gestation because of a 10-day history o f decreased appetite, intermittent nausea, and generalized generalized itching. itching. She has no history history of serious illness, and her pregnancy has been otherwise uncomplicated. Her pulse is 98/min and regular, and blood pressure is 104/64 mm Hg. Examination shows excoriations on the left shoulder. The lungs are clear to auscultation. A grade 2/6 systolic murmur is heard best at the left sternal border. The uterus is consistent in size with a 3 0-week gestation. Laboratory studies show: Hemoglobin Mean corpuscular volume Leukocyte count Platelet count Red cell distribution width Serum Total bilirubin Alkaline phosphata se AST ALT

11 g/dL 86 pm3 10,200/mm3 114.000/mm3 13% (N=13%-15%) 2.1 mg/dL 206 U/L 30U/L 26 U/L

Exam Exam Section : Item 2 of 50 National Board of Medical Examiners Time Remainin Mark_____________ Mark__________________________ __________________________ __________________________ __________________________ __________________________ ______________ _ Obstetr ics & Gynecology Self-Assessment_________________ Self-Assessment_____________________________ _______________________ _______________________ ________________________ ______________ __ 4 h r 59 min 4 s m

2.

A 47-year-old woman comes to the emergency d epartment because of a 4-day history of increasing pain pain with urination. urination. Five days ago, she began treatment with a sulfonamide antibiotic by her primary physician after a phone consultation: she has not had relief of her symptom s. She has no history of serious illness, abnormal Pap smears, or sexually transmitted diseases. She currently takes no medications. She states that she has had increasing stress during the past month. Pelvic Pelvic examination shows an exquisitely tender ulcer on the lower labium minus. minus. A photograph of the lower labia is shown. Which of the following is the most likely diagnosis? A) Candidiasis B) Condyloma acuminatum

S; C) Flerpes simplex virus 1 D) Molluscum contagiosum E) Paget disease

Exam Exam Section : Item 2 of 50 National Board of Medical Examiners Time Remainin Mark_____________ Mark__________________________ __________________________ __________________________ __________________________ __________________________ ______________ _ Obstetr ics & Gynecology Self-Assessment_________________ Self-Assessment_____________________________ _______________________ _______________________ ________________________ ______________ __ 4 h r 59 min 4 s m

2.

A 47-year-old woman comes to the emergency d epartment because of a 4-day history of increasing pain pain with urination. urination. Five days ago, she began treatment with a sulfonamide antibiotic by her primary physician after a phone consultation: she has not had relief of her symptom s. She has no history of serious illness, abnormal Pap smears, or sexually transmitted diseases. She currently takes no medications. She states that she has had increasing stress during the past month. Pelvic Pelvic examination shows an exquisitely tender ulcer on the lower labium minus. minus. A photograph of the lower labia is shown. Which of the following is the most likely diagnosis? A) Candidiasis B) Condyloma acuminatum

S; C) Flerpes simplex virus 1 D) Molluscum contagiosum E) Paget disease

Exam Section : Item 3 of 50 Marb

3.

National Board of Medical Examiners Obstetrics & Gynecology Self-Assessment Self-Assessment

Time Renr 4 hr 57 m

A 21-yea r-old primigravid woma n at 10 we eks ' gestation has had severe nausea and has been unable to keep anything in her stomach for 48 hours. She has had mild mild nausea and vomiting for 6 weeks. Examination shows normal findings. Ultrasonography shows a normal 10-week gestation. Which of the following is the most appropriate next step in diagnosis? A) Com plete blood count

4 B) Measurement of serum bilirubin bilirubin concentration C) Measurement of serum glucose concentration 5 D) Measurement of urinary ketones E) Measurement of urinary protein

Exam Section : Item 4 of 50

4.

National Board of Medical Examiners Obstetrics & Gynecology Self-Assessment Self-Assessment

Time Rema 4 hr 57 min

A 23-year-o ld woman comes to the physician because of a 3-day history of pain and burning burning with with urination. Two years ago. she had similar symptoms that resolved with trimethoprim-sulfamethoxazole trimethoprim-sulfamethoxazole therapy. She is sexually sexually active and uses an oral contraceptive. Her temperature is 37°C (98 .6°F). Examination Examination shows no costovertebral angle tenderness. Urinalysis Urinalysis shows bacteria and pus. She requests advice about preventing future episodes. Which of the following is the most appropriate recommendation?

€ A) Drinking 6 ounces of c ranb erry ju ice daily € B) Voidin g im medi ately after coitus €> C) Antib iotic prophyla xis on ly af ter coitus D)

Daily trimethoprim-sulfamethoxazole prophylaxis

€ E) No preventive measu res available


____________ ________ _______ ___ Marti ________ 5.

National Board of Medical Examiners Obstetrics & Gynecology Self-Assessment

A 27-year-old woman comes to the physician because of a 4-month history of increasingly increasingly severe pain during during her menstrual menstrual periods. Menses occur at regular 28-day intervals and last 5 to 7 days with light light flow. Her last menstrual period was 25 days ago. She underwent a loop electrosurgical excision of the cervical transformation zone for cervical dysplasia 6 months ago; examination examination of the biopsy specimen showed cervical intraepithelial neoplasia (CIN) 2 with negative margins. She is sexually active and uses condoms and spermicidal foam. Pelvic examination shows a normal vagina and a small, scarred cervical os. The uterus is slightly enlarged and tender. Which of the following is the most likely cause of this patient's symptoms?

€> €> A ) C ervical stenosis € B) En dometritis # C) Premenstrual Premenstrual syndrome € D) Recurrent dysplasia € E) Thre atened abortion

Exam Section : Item 6 of 50 Mark

6.

National Board of Medical Examiners Obstetric s & Gynecology Self-Assessment

Time Remaining 4 hr 53 min 14 s

A 37-year-old woman, gravida 1. para 1. comes to the physician for a follow-up examination. Six weeks ago, a Pap smear showed low-grade intraepithelial lesions. She has had no symptoms and takes no medications. She is sexually active with one partner and uses a diaphragm for contraception. Examination shows a normal vagina, cervix, and uterus. Colposcopic examination shows an acetowhite area with punctation. The entire squamocolumnar junction cannot be visualized. A biopsy specimen o f the cervix shows cervical intraepithelial neoplasia (CIN) 3. Which of the following is the most appropriate next step in management?

€' A) Monthly Pap sm ears over th e next 3 months 4 B) Second colposcopy in 3 months 4 C) Hysteroscopy # D) Cone biopsy of the cervix 4E) Cryotherapy of the cervix

® F) Vaginal hysterectomy


7.

National Board of Medical Examiners Obstet rics & Gynecology Self-Assessment

Time Remalnin 4 hr 52 min 40

A 16-year-old girl is brought to the physician by her mother because she has never had a menstrual period. She also has had moderate low er abdominal pain during the past 5 months. She has no history of serious illness and takes no medications. She is 163 cm (5 ft 4 in) tall and weighs 52 kg (115 lb): BMI is 20 kg/m-. Breast development is Tanner stage 4. Examination shows coarse pubic and axillary hair. The external genitalia appear normal. The vaginal canal cannot be visualized. Rectal examination shows an anterior tender, central mass. Which of the following is the m ost likely explanation for these findings?

« A) Androgen insensitivity syndrome € B) C omplet e m ijlleria n agenesis ® C) Hormonally active ovarian tumor € D) Imp erfo rate hymen € E) Norm al developme nt


8.

National Board of Medical Examiners Obstetr ics & Gynecology Self-Assessment

Time Remalnir 4 hr 51 min 59

A 32-year-old woman with type 1 diabetes mellitus has had increasingly severe perineal pain over the past 3 days. Her temperature is 39°C (102.2°F). Pelvic examination shows a 5 * 5-cm tense cystic mass in the posterior right labium majus with cellulitis extending past the right pubic hairline. Which of the following is the most serious complication of this condition? A) Bartholin gland a bsce ss

€ B) Chla mydial sepsis C) Gram-positive sepsis D) Necrotizing fasciitis # E) Perirectal abscess

Exam Section : Item 9 of 50 Mori,

9.

Time 4 hr 50 min 5

A 12',4-year-old girl is brought to the physician because she has not had a menstrual period for 5 months. M enarche was at the age of 11 years, and menses had occurred at irregular 30- to 90-day intervals and lasted 1 to 5 days. She plays softball in the spring and participates in physical education class at school two tim es week ly. She is not sexually active. She is at the 60th percentile for height and 40th percentile for weight. Examination shows no abnormalities. Which of the following is the most likely diagnosis?

® A) Anorexia nervosa € B) Ath letic amenorrhea # C) Congenital adrenal hyperplasia € D) H yperth yroidism € E) Hy pothyr oidism #


F) Polycystic ovarian syndrome

# G) Prolactin-secreting tumor C H) Normal development

Exam Section : item 10 of 50 Mark __________________

10.


HUgne Renta 4 hr 50 min

An 18-year-old woman comes to the physician because of irregular menses over the past 3 months; menses occur at 14- to 40-day intervals. Menstrual flow varies from spotting to heavy cramping and bleeding; the latter symptoms have caused her to miss school. Her last menstrual period was 3 weeks ago. Menarche was at the age of 12 years, and menses had occurred at regular 28-day intervals for 6 years. She has a sedentary lifestyle. She is 165 cm (5 ft 5 in) tall and weighs 63 kg (139 lb); BMI is 23 kg/m2. Pelvic examination shows no abnormalities. A urine pregnancy test is negative. Which o f the following is the most appropriate next step in management?

O A) Conjugated estrogen therapy ® B) Cyclic progesterone therapy ® C) Hysteroscopy 0) Endometrial biopsy E)

Dilatation and curettage


Exam Secti on : Item 11 of 50 M

Mark

The response options for the next 2 items are the same. Select one answer for each item in the set. For each patient with a fetus or newborn with abnormalities, select the maternal condition most likely associated with these findings. ® A) Alcohol use 9 B) Amphetamine use C) Cigarette smoking # D) Cocaine use E) Cystic fibrosis carrier state ® F) Folic acid deficiency G) Gametic nondisjunction

H) Heroin use I) Iodine deficiency J) Marijuana use K) Parvovirus B19 infection L) Rh sensitization M) Rubella infection N) Tay-Sachs carrier state

Time Remainii 4 hr 47 min 44

Exam Section : Item 12 of SO

For each patient with a fetus or newborn with abnormalities, select the maternal condition most likely associated with these findings. ® A) Alcohol use 9

9

H) Heroin use 1) Iodine deficiency

C) Cigarette smoking

® J) Marijuana use

D) Cocaine use

9

E) Cystic fibrosis carrier state

fa L) Rh sensitizatio n

F) Folic acid deficiency

€ M) Rubella infec tion

G) Gametic nondisjunction 12.

i

B) Amphetamine use

t

K) Parvovirus B19 infection

N) Tay-Sachs carrier state

A 19-year-old primigravid woman c omes to the em ergency department because of vaginal bleeding, abdominal pain, and lethargy for 4 hours. She has had no prenatal care. She is unable to give a history.

Exam Section : item 13 of 50 Mark

13.


Time Remaimr 4 hr 45 min 55

A 27-year-old primigravid woman at 38 week s' 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 o f 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 a rrest 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 coli infection C) Neisseria gonorrhoeae infection D) Polymicrobial infection # E) Septic pelvic thrombophlebitis

Exam Section : Item 14 of 50 Mark _________________

14.

ilme Remaining 4 hr 44 min 20 i

A 42-year-old woman with systemic lupus erythematosus comes to the physician for a follow-up examination. Two wee ks ago. prednisone therapy was begun because of a flare-up of her disease; this is her third course of prednisone during the past 18 months. Toda y, the patient is feeling well. Menses occur at regular 2 8-day intervals. Her only other medications are vitamin D and calcium. She has no other history of serious illness, and there is no family history of serious illness. She has no known allergies. She does not smoke cigarettes or drink alcohol. She is 165 cm (5 f t 5 in) tall and weighs 63 kg (140 lb); BMI is 23 kg/ m2. Her pulse is 70/min, and blood pressure is 108/64 mm Hg. Examination shows no abnormalities. Which of the following is the most appropriate pha rmacotherapy to prevent os teoporosis in this patient?

A) Alendrona te now 4 B) Calcitonin now C) Estrogen and progesterone now •


D) Estrogen alone at the onset of menopause

9 E) Raloxifene now

Exam Section : Item 15 of 50 Mart,

15.

National Board of Medical Examiners Obstet rics & Gynecolog y Self-Assessment

Time Remalr 4 hr 43 min 1

A 27-year-old nulligravid woman comes to the physician because she has been unable to conceive for 3 years. Menses occur at irregular 35- to 42-day intervals and last 8 days. Laparos copy 8 weeks ago showed spill from both fallopian tubes after methylene blue dye was instilled into the cervix: there was no evidence of endometriosis. Her husband has two children from a previous marriage. Pelvic examination shows a normal-sized uterus and no palpable masses. Postcoital test shows many motile sperm. Which of the following is the most appropriate pharmacotherapy?

© A) Clomiphene © B) Danazol C) Leuprolide G D) Levothyroxine © E) Menotropins © F) Progesterone

Exam Section : item 16 of 50 Mark

16.

National Board of Medical Examiners Time Remalnir Obstetrics & Gynecology Self-Assessment__________________________________________________________________4 hr 42 min 24

A 37-year-old woman, gravida 2, para 1, at 36 weeks' gestation is admitted to the hospital aft er she was found to have fetal growth res triction during a routine prenatal visit. She has a 6-year history of mild chronic essential hypertension controlled with p-adrenergic blocking agents that were discontinued at 8 weeks' gestation. At 10 weeks' gestation, a 24-hour urine collection shows a protein concentration of 50 mg and creatinine clearance of 110 mL/min. Ultrasonography 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 (97.8° F), pulse is 88/min, respirations are 20/min, and blood pressure is 110/70 mm Hg. Examination shows a fundal height of 30 cm. U ltrasonography 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) Determin ation of nuchal thickn ess O B) Fetal fibronectin test 9C) Glucose tolerance test

9 D) Doppler ultrasonography of the umbilical artery 9E) Determination of amniotic fluid glucose concentration


17.


Tim# Remaining 4 hr 41 min 12 s

A 32-year-old woman, gravida 3. para 2. comes to the physician for her first prenatal visit. Her last menstrual period was 17 week s ago. Examination shows a uterine fundus that is palpated midway between the pubic symphysis and umbilicus. Her serum a-fetoprotein concentration is 2.6 multiples of the median. Which of the following is the most appropriate next step in management?

A) Repea t measure ment of serum a-fe topro tein concen tration « B) Serum studies for fetal erythrocytes S C) Ultrasonography # D) Amniocentesis E)

Pregnancy termination

Exam Section : Item 18 of SO M Mark

18.

Time Remaining 4 hr 39 min 49

A 52-year-old woman comes to the physician because of a 6-month history of urinary urgency. She often has a strong urge to void but passes only a small amount of urine. Sometimes, she is unable to reach a bathroom quickly enough after feeling the sudden need to void. She says she often feels hot at night and occasionally during the day. She has not had any other symptoms. She has no history of serious illness and takes no medications. Her last menstrual period was 12 months ago. She is not sexually active. She is 168 cm (5 ft 6 in) tall and weighs 68 kg (150 lb); BMI is 24 kg/m-. Her temperature is 37 .1 X (98.7" F), pulse is 70/min, respirations are 12/min, and blood pressure is 90/50 mm Hg. Pelvic examination shows moderate tenderness and vaginal atrophy. The uterus is normal sized. There are no vulvar, vaginal, or cervical lesions or adnexal masses. The remainder of the examination, including rectal examination, shows no abnormalities. Test of the stool for occult blood is negative. A wet mount preparation o f vaginal fluid shows numerous leukocytes. Urine culture is negative. Her postvoid residual volume is 50 mL. Which of the following is the most likely underlying cause o f these findings?

9 A) Atonic bladder 9


B) Estrogen deficiency

9 C) Prolapse of the pelvic floor

0 D) Trichomoniasis E) Urinary tract infection


19.

4 hr 38 m

A 23-year- old woman, gravida 3. para 2. at 26 week s' gestation com es to the physician for a follow-up examination. She reports that her daughte r 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. Ultrasonogra phy shows polyhydram nios, fetal ascite s, and skin thickening. Infection with which of the following is the most likely cause of these findings?

9 A) Adenov irus 9 B) Coxsackievirus A 9C) Cytomegalovirus

9 D) Herpes simplex virus 9

National Board of Medical Examiners Obste trics & Gynecolo gy Self-Assessment

E) Parvovirus B19

Exam Section : item 20 of 50 Mark _________________

20.


Time Remaininj 4 hr 36 min 13 *

A 50-year-old woman, gravida 3. para 2. aborta 1, has had loss of urine with coughing, straining, or lilting since the birth of her last child 9 years ago; the sym ptom has progressively worsene d over the past 2 years. During examination, she loses urine in small spurts with coughing, but the anterior and po sterior vaginal walls appear well supported. A cotton-tippe d applicator placed in the urethra moves in an arch of 45 d egrees with the horizontal during Valsalva maneuver. Which of the following is the most likely diagnosis?

4 A) Cysto cele

4 B) Enterocele 4 C) Femoral hernia 4 D) Fourth-degree obstetric laceration 4E) Hiatal hernia 4 F) Indirect inguinal hernia 4G) Rectocele 4H) Urethrocele

Exam Section : item 21 of 50 9 Mark

21.


Tim# Remainii 4 hr 34 min 21

An otherwise healthy 27-year-old woman comes to the physician 2 weeks after noticing a tender mass in her left breast during breast s elf-examination. She has a history of similar smaller masses that resolved spontaneously within a few w eeks. She feels well and takes no medications. Menses occur at regular 28-day intervals. Her last menstrual period was 3V? weeks ago Vital signs are within normal limits. There is no lymphadenopathy. The breasts are symmetric, and there are no skin changes. Examination of the left breast shows several 1-cm. smooth, soft, mobile masses and a 3-cm. mobile, soft, tender mass in the upper outer quadrant. Examination of the right breast shows tenderness to deep palpation and small masses similar to the left breast. Which of the following is the most likely diagnosis?

# A) Abscess € B) F at necrosis # C) Fibroadenoma 4 D) Fibrocystic changes of the breast €' E) G alact ocele G F) Intraductal papilloma €> G) Lipoma

Exam Section : item 22 of 50 j Marit

22.

National Board of Medical Examiners Obste trics & Gy necology Self-A ssessment

1i"'* 3 maintr 4J ir3 3j ni n2 7

A 77-year-old woman, g ravida 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?

G A) Adenocarcinoma B) Carcinosarcoma ® C) Clear cell carcinoma € D) Papillary serous carcinom a € E) Squ amous cell car cinoma


23.

National Board of Medical Examiners Obstetric s & Gynecology Self-Assessment


A previously healthy 42-year-old woman comes to the physician because o f irregular menses during the past 7 months. She also has had intense mood changes and occasional hot flashes during this time. Her last menstrual period was 6 weeks ago. She is sexually active with one male partner, and they usually use barrier contraception. Examination, including pelvic examination, shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?

# A) Measurement of serum estradiol concentration € B) M easurem ent of serum t esto stero ne concentra tion ® C) Pregnancy test € D) Transv aginal ultrasonog raphy # E) Endometrial biopsy

Exam Section : Item 23 of 50 National Board of Medical Examiners j Mark_______________________________________________________________________________ Obstet rics & Gyne cology Self-Assessment____________________________________________________________________ (RleaselWai :

24.

A 32-yea r-old woman, gravida 3. para 2. at 30 wee ks' gestation is brought to the emergency departm ent because o f pain in the right mid abdomen for 12 hours; she has had one episode of diarrhea since that time. Her tempe rature is 38.5"C (1 01 ,3‘ F). Physical examination shows diffuse tenderness in the right lower quadrant o f the abdomen with minimal guarding. Rectal and pelvic examinations show right sided tenderness. Her leukocyte count is 14,000/mm3with a shift to the left. Ultrasonography of the abdomen shows fluid in the right paracolic gutter: the appendix cannot be visualized. Which of the following is the most appropriate next step in management?

$ A) Cultures of the stool € B) Barium enema ® C) Broad-spectrum antibiotic therapy and observation S D) Sigmoidoscopy € E) Surgica l explora tion

Exam Section : Item 25 of 50 Mari,

25.

National Board of Medical Examiners Obstetr ics & Gynecology Self-Assessment

4 hr 30 min 4

One month after an uncomplicated vaginal delivery of a 3400-g (7-lb 8-oz) newborn, a 32-year-old woman, gravida 2, para 2, comes to the physician because of a 7-day history o f a tender mass in her left breast. Her pregnancy had been complicated by abdominal trauma sustained in a motor vehicle collision. A second-degree midline vaginal laceration was repaired without difficulty after delivery. She is breast-feeding. Her temperature is 37°C (98.6'F). Examination shows a 3 x 3-cm. fluctuant mass in the lateral aspect of the left breast. The mass is mildly tender to palpation. The breast is not warm or erythematous. The breasts are symmetric. Which of the following is the most likely diagnosis?

4 A) Abscess € B) B reast engorgem ent # C) Galactocele 6 D) Mastitis 4 E) Supernumerary breast

Exam Section : Item 26 of SO Mart,

26.


f ly 4 hr 28 min 6 s

A 24-year-old primigravid woman at 42 wee ks' gestation is admitted to t he 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, poste rior 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 1w eek € B) Ad ministe r b etamethas one ® C) Administer a prostaglandin € D) Begin amnioinfusion G E) Perform an immediate cesarean delivery


27.



A 32-year-old woman, gravida 2. para 1. at 18 weeks ' gestation comes for a routine prenatal visit. Ultrasonography shows a triplet gestation with no abnormalities. All three fetuses have fetal heart tones and are appropriate in size for gestational age. For which of the following complications is this patient at increased risk?

€ A) Abrupt io p lacentae € B) Oligo hydramn ios $ C) Placenta previa € D) Polyhydram nios E) Premature labor

Exam Section : item 28 of 50 B Mark____________________________________________________________________________

28.

National Board of Medical Examiners Obstet rics & Gynecology S e l f - A

s

s

e

s

s

m

e

n

Time Remaining t _______________________________________ 4 hr 26 min 42 s

A 37-year-old woman, gravida 7, para 4. aborta 2, at 40 weeks ' gestation is admitted to the hospital in labor. Spontaneous rupture of membranes along with severe abdominal pain occurred 4 hours ago. The pain is constant and sharp, unlike the labor pains of her previous pregnancies. Her pregnancy had been uncomplicated. Her last pregnancy ended in cesarean delivery at term for breech presentation. Her temperature is 37°C (98.6 'F). pulse is 80/min, respirations are 17/min, and blood pressure is 122/68 mm Hg. The fundal height is 28 cm. Leopold maneuvers show fetal small parts above the fundus. External monitoring shows fetal tachycardia with late decelerations and loss of beat-to-beat variability. Which of the following is the most likely diagnosis?

# A) Abruptio placentae « B) Chorioamnionitis ® C) Placenta previa 6 D) Umbilical cord prolapse ® E) Uterine rupture

Exam Section : item 29 of SO Mark__________________

29.


Time Rema 4 hr 25 min

A previously healthy 32-year-old woman comes to the physician because of a 2-day history of vaginal bleeding and lower abdominal cramps. H er last menstrual period was 7 weeks ago. She is sexually active with one partner, and they use condoms for contraception consistently. She takes no medications. Her pulse is 90/min, and blood pressure is 100/65 mm Hg. Physical examination shows a soft abdomen and lower quadrant tenderness. Speculum examination shows moderate vaginal bleeding and a closed cervical os. A pregnancy test is positive. Transvaginal ultrasonography shows a fluid-filled endometrial cavity and no gestational sac. Her quantitative serum (3-hCG concentration is 2500 mlU/mL. Forty-eight hours later, a second measurement of quantitative serum |3-hCG concentration is 2800 mlU/mL. Which of the following is the most likely diagnosis?

A)

Blighted ovum

4 B) Complete spontaneous abortion C) Ectopic pregnancy 4 D) Hydatidiform mole E) Normal intrauterine pregnancy


30.



A 47-year-old wom an has had increasing fatigue, constipation, night sweats, anxiety, and mood lability over the past year; she has had a 2.3-kg (5-lb) weight gain during this period. Her last menstrual period was 6 months ago. Her blood pressure is 130/80 mm Hg. Physical and pelvic examinations show normal findings. Which of the following serum concentrations is most likely to be increased?

A)

ACTH

C B) Follicle-stimulating hormone ® C) Parathyroid hormone # D) Thyroid-stimulating hormone E) Thyrotropin-releasing hormone

Exam Section : item 31 of 50 ■

M a rk

31.

Time Remall 4 hr 21 min

A 62-year-old woma n comes to the physician because of two episod es of vaginal bleeding during the past 3 weeks. Menopause occurred 12 years ago. She has hypertension treat ed with an ACE inhibitor and type 2 diabetes mellitus treated with oral hypogly cemic 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/ m2. Pelvic examination shows a normal cervix and uterus with blood at the cervical os. A 6 x 8-cm left 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 A) Brenne r tum or B)

Granulosa cell tumor

A C) Ovarian carcinoma

f i D) Ovarian fibroma €

National Board of Medical Examiners Obstetrics & G ynecology Self-Assessment

E) S erto li-Ley dig cell tu mor


32.

Nationa l Board of Medical Examiners Obstetrics & Gynecology Self-Assessment

Tim® Re 4 hr 19 r

A 26-year-o ld woma n, gravida 3. para 2. comes for her first pren atal visit at 11 weeks ' gestation. Her previous pregnancies and deliveries were uncomplica ted. Her blood type is O, Rh-negative. She received R ht(D) immune globulin after her first delivery. Which of the following is the most appropriate t est to evaluate her Rh status? A)

Dete rmina tion of husba nd's Rh g enoty pe

$ B) Measurement of fetal hemoglobin concentration C)

Measurem ent of serum bilirubin concentration

€ D) Indir ect antiglo bulin (Co om bs) tes t E) Kleihauer-Betke acid elution test


M a rk

33.


Time Remaining 4 hr 18 min 20

A 21 -year-old woman co mes to the physician because of a 2-week history of a small amount of vaginal discharge and itching; her symptoms began immediately before h er 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 o f 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 9 C ) Gardnerella vaginalis D) Neisseria gonorrhoeae E) Trichomonas vaginalis

Exam Section : Item 34 of 50 Mark m

34.


Time Remainir 4 hr 16min 10

A 37-year-old woman, gravida 5, para 3, aborta 1, at 40 weeks' gestation is admitted in labor. Contractions began 2 hours ago. She has not had vaginal bleeding or loss of fluid. Her pregnancy has been uncomplicated. Her last child was delivered vaginally at term and weighed 4300 g (9 lb 8 oz). At her last prenatal visit 1 week ago, the cervix was 50% effaced and 1 cm dilated, and the vertex was at -2 station. Examination now shows contractions that occur every 5 minutes. The cervix is 50% effaced and 6 cm dilated: no presenting part can be felt. A fetal heart tracing shows no abnormalities. Which of the following is the most appropriate next step in management? A) Arter ial blood gas analysis of t he umbilical arte ry B) Fetal sc alp stimulation C) Ultrasonography of the pelvis

O' D) Amniotomy ® E) Cesarean delivery


M a rk

35.


Time Rer 4 hr 15 rr

At 37 wee ks' gestation, a 28-year-o ld woman with gestational diabetes delivers a 4500-g (10-lb ) newborn who develops hyaline membrane disease. The mother had postprandial serum glucose concentrations of 180-200 mg/dL during the last half of pregnancy. The macrosomia and pulmonary disease are most closely related to an increased serum concentration of which of the following in the fetus?

® A) Cortisol B)

Grow th hormone

S C) Human placental lactogen S D) Insulin S E) Reverse triiodothyronine (rTj)

Exam Section : item 36 of 50 Mark __________________

36.


Time Remain 4 hr 9 min 51

A 17-year-old girl is brought to the physician by her mother because she has never had a menstrual period. She is otherwise healthy. Both of her older sisters had normal pubertal development. Examination shows absent breast development and scant pubic hair. Her serum follicle-stimulating hormone concentration is 105 mlU/mL. Which of the following is the most appropriate next step in diagnosis?

A) Gonad otrop in-rel easin g ho rmone stimulation tes t 4 B) Karyotype analysis C)

Measurement of serum electrolyte concentrations

« D) Measurement of serum luteinizing hormone concentration E) Measurement of serum thyroid-stimulating hormone concentration

Exam Section : item 37 of 50 MgrL

37.


Time Remaining 4 hr 9 min 15 se

A 47-year-old nulligravid woman comes to the physician because of heavy menstrual flow during the past 3 months. Previous menses were normal with regard to flow. She has mild hypertension treated with diuretics and type 2 diabe tes mellitus treat ed with oral hyp oglycem ics. She has no history of abnormal Pap sm ears. She is 160 cm (5 ft 3 in) tall and weighs 95 kg (210 lb); BMI is 37 kg /m2. Her blood pressure is 146/86 mm Hg. Physical examination shows no other abnormalities. A Pap smear is reported as atypical glandular cells. Colposcopy show s no abnormalities. Endocervical curettage shows benign cells. Which of the following is the most appropriate next step in diagnosis?

9 A) Second Pap smear in 6 months B)

Human papillomavi rus testing

$ C) Pelvic ultrasonography 9 D) Endometrial biopsy 4 E) Loop electrosurgical excision of the cervical transformation zone

Exam Section : Item 38 of 50 ■

M a rk

National Board of Medical Examiners Obstetrics & G ynecology Self-Assessment

Time Rem 4 hr 7 min

38. A 28-year-o ld woman, gravida 1. para 1. has been amenorrheic and has had hot flashes for the past 6 months. She takes thyroid medication for chronic lymphocytic thyroiditis (Hashimoto disea se). Alte r using an oral contraceptive for 2 years, she discontinued taking it 3 years ago. Serum studies show: Follicle-stimulating hormone Estradiol Thyroid-stimulating hormone Prolactin Which of the following is the most likely cause of this patient's condition? O A) Autoimmune ovarian failure B) Hypothalamic dysfunction ® C) Inadequate control of hypothyroidism

62 mlU/mL 15 pg/mL (N=20-60> 1.5 pU/mL 5 ng/mL

Exam Section : item 39 of 50 *

M ar k __________________________

39.

Time Remaii 4 hr 4 min 1

A 27-year-old woman comes to the physician because of painful vulvar swelling for 2 days. She has had three episodes of Neisseria gonorrhoeae infection treated successfully with oral antibiotics over the past 5 years. Examination shows a 4-cm, tender, f luctuant mass of the labium majus. Which of the following is the most likely diagnosis?

# A) Bacterial vaginosis €


B) Ba rtholin duct absc ess

® C) Human papillomavirus infection € D) Lichen scleros us E) Urethral diverticulum F) Vulvar vestibulitis

txa m Section : item 40 of 50 B

M a rk

40.


Time Remainin 4 hr 3 min 31 s

A 20-year-old woman, gravida 2, para 1, at 42 weeks' gestation is admitted to the hospital in labor. She reports severe abdominal pain. She has received no prenatal care. She has no history of serious illness and takes no medications. Leopold maneuvers indicate a fetus at term. The cervix is 10 cm dilated and 100% effaced; the vertex is at +2 station. After pushing for 3 hours, low-forceps-assisted delivery is performed because of nonreassuring fetal heart tones, severe variable decelerations, and maternal exhaustion. The operative vaginal delivery of a 4200-g (9.3-lb) newborn is complicated by shoulder dystocia that requires 8 minutes to reduce. On examination, the newborn does not move the right arm. The forearm is pronated, and the arm is adducted and internally rotated at the shoulder, Which of the following is the most likely cause of these findings in this newborn?

O A) Fracture of the clavicle 6 B) Hypoxic injury to the motor area of the precentral gyrus C)

Injury to the eighth cervical root and first thoracic root

4 D) Injury to the fifth and sixth cervical roots € E) P artial dislocation of the elbow

Exam Section : Item 40 of 50 Marti __________________


Exam Section : Item 42 of 50 National Board of Medical Examiners Time Remaminj B Mart, ______________________________________________________________________________ Obstet rics & G ynecology Self-Assessment__________________________________________________________________ 4 hr 1 min 8 sei

42.

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 fo r 3 years but discontinued it 8 wee ks ago on advice of her oncologist and began using condoms. Since discontinuing oral contraceptive therapy, she has had one menstrual period tha t lasted 4 days. Previously, menses oc curred at regul ar 28-day interva ls 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)

Progest in-only oral c ontrace ptive

€ B) D iaphragm ® C) Placement of a copper IUD ® D) Depot medroxyprogesterone E) Etonogestrel implant

Exam Section : Item 43 of 50 National Board of Medical Examiners Time Remaining: B Mark_______________________________________________________________________________Obstetrics & Gynecology Self-Assessment_________________________________________________________________3 hr 59 min 23 si

43.

A 35-year-old woman, gravida 2. para 1. with chronic hypertension has spontaneous onset of labor at 39 weeks ' gestation. After 4 hours of regular contractions and a second stage of 5 minutes, she spontaneously delivers a 3650-g (8-lb 1-oz) newborn under epidural anesthesia. Approximately 2 minutes afte r separation o f the placenta, she develops apnea, cyanosis, and severe hypotension. During the unsuccessful resuscitation, the patient develops bleeding from the vagina and venipuncture sites. Which of the following is the most likely diagnosis?

# A) Amniotic fluid embolism € B) Asp iration # C) Cerebral infarction € D) Myoc ardial infarction € E) Se ptic shock


44.


Time Remalnini 3 hr 58 min 18

A 47-year-old woman comes to the physician for a follow-up examination. Six weeks ago, she underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for leiomyomata uteri. She has no history of abnormal Pap smears. Examination today shows a well-healing incision. Which of the following is the most approp riate next step regarding future Pap smears fo r this patient?

G A) Annually

$ B) Annually for 3 years and then every 3 years €> C ) Every 3 year s € D) In 1 yea r and then no longe r indic ated # E) No longer indicated

Exam Section : Item 45 of 50 Mart,

45.

vTI|Aa;RMrt 3 hr 57 mi

A 26-year-old nulligravid woman has had infertility for 2 years. M enses occur at regular 25-day intervals. Serum progesterone concentration is 8 ng/mL (N>5) on menstrual day 21. An endometrial biopsy specimen on menstrual day 24 is most likely to show which of the following in this patient? A) Atrop hic endome trium

€ B) Decidual endome trium *

National Board of Medical Examiners Obste trics & Gynecolo gy Self-Assessment

C) Hyperplasia of endometrium

€ D) Prolif erati ve endome trium E) Secretory endometrium

Exam Secti on : Item 46 of 50 Marb

46.

Nationa l Board of Medical Examiner s Obstetrics & Gynecology Self-Assessment

Time Remaining 3 hr 56 min 5 sc

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 histor y of serious illness; her only medication is a prenatal vitamin. Her temperat ure is 37“ C (98.6” F). pulse is 90/min, respirati ons are 18/min. and blood pres sure is 130/8 0 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 o f the following is the most appropriate next s tep in management?

# A) Complete bed rest until delivery B) Recommendation to limit d ietary sodium intake C) Antenatal testing S’ D) Diuretic therapy C E) Weekly amniocentesis for removal of fluid


47.

A)

Abrup tio placen tae

$ C) Incompetent cervix # D) Placenta previa % E) Premature labor

® F) Premature rupture of the membranes ® G ) Prolapsed cord ®

Time Remi 3 hr 53 mil

A 22-year- old primigravid woman at 24 wee ks' gesta tion has had fullness in the lowe r pelvic area for 12 hours. She has no contractions. Fundal height is 20 cm. Fetal heart tones are good. Examination shows the fetus in a breech presentation in the vagina. No cervix is palpated. Which of the following is the most likely diagnosis?

$ B) Cervical carcinoma

•


H) Vaginal varicose veins I) Normal labor

Exam Section : Item 48 of SO National Board of Medical Examiners Time Remain j Mark________________________________________________________________________________Obstetric s & Gynecology Self-Assessment __________________________________________________________________ 3 hr 52 min 2

48.

A 27-year-old woman, gravida 2, para 1. at 30 weeks' g estation comes to the physician because of chronic fatigue for 2 months; she has had a 4.5-kg (10-lb) weight loss during this period. She has had no prenatal care. She has a history of alcoholism and drug abuse. She is 168 cm (5 ft 6 in) tall and weighs 59 kg (130 lb); BMI is 21 kg/m-. She appears chronically ill. Examination shows pallor. The uterine fundal height is 28 cm. The fetal heart rate is 140/min. Laboratory studies show: Hemoglobin Mean corpuscular hemoglobin Mean corpuscular volume Leukocyte count Reticulocyte count Platelet count Prothrombin time Serum Bilirubin (total)

6.0 g/dL 30 pg/cell 101 pm3 ASOO/mm’ 0.1% 130,000/mm3 13 sec 1.0 mg/dL

Exam Section : ■ M a rk ________

49.



A 19-year-old primigravid woman comes to the emergency department because of a 1-week history of nausea and persistent vomiting. Her last menstrual period was 15 weeks ago. but she has had daily vaginal bleeding for the past month. She has not received prenatal care. Her temperat ure is 37”C (9 8.6"F), pulse is 80/min, respirations are 20/min, and blood pressure is 140/90 mm Hg. Examination shows pedal edema. Pelvic examination shows a uterus consistent in size with a 20-week gestation: there is no adnexal tenderness. A serum pregnancy test is positive. U rinalysis shows 1+ protein. Ultrasonography shows bilateral multilocular ovarian cysts and echogenic structures in the uterus. Which of the following is the most likely diagnosis?

4' A) Combined ectopic and intrauterine pregnancy € B) Hy datidifo rm mole €> C) M ultiple gestation # D) Ovarian hyperstimulation syndrome S' E) Placenta accreta S> F) Polyhydramnios

OBGYN Form 3 Qs Searchable

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