Exam Section : Item 1 of 50 National Board of Medical Examiners Time Remaining:

■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 59 min 57 sec

1. A 2-week-old newborn is brought for an initial examination. She was born at home to a 25-year-old primigravid woman following an
uncomplicated pregnancy. Her parents say that it takes a long time to feed the newborn, and she usually does not finish her bottle.
They are also concerned that she may be constipated. She is at the 50th percentile for length and weight and 90th percentile for
head circumference. She has a hoarse cry. Vital signs are within normal limits. Examination shows large anterior and posterior
fontanelles, a large protruding tongue, and a small umbilical hernia. The skin is dry and slightly mottled. There is mild hypotonia.
Which of the following is most likely to have predicted these findings?

Q A) Routine newborn screening

Q B) Fetal monitoring
0 C) Paternal karyotype analysis
Q D) Prenatal ultrasonography
Q E) Maternal glucose tolerance testing

~ ~ p, r,
Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 2 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 59 min 52 sec

2. A 30-year-old woman comes to the physician because of a third episode of a Bartholin gland abscess over the past 5 years. Culture
of the abscess cavity is most likely to show which of the following?

0 A) Bacteroides fragilis
Q B) Chlamydia trachomatis
Q C) 13-Hemolytic streptococcus

0 D) Neisseria gonorrhoeae

0 E) Mixed enteric and skin flora

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 3 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 59 min 48 sec

3. A 37-year-old woman comes to the physician because of a foul-smelling vaginal discharge for 10 days. She is sexually active with
one partner. She had a bilateral tubal ligation 7 years ago. Examination shows a watery vaginal discharge with vulvar irritation. Which
of the following is the most appropriate test to confirm the diagnosis?

Q A) Culture for Candida albicans

Q B) DNA probe for Chlamydia trachomatis of the cervix
Q C) Serologic testing for syphilis
Q D) Vaginal culture for Gardnerella vagina/is
Q E) Wet mount preparation

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 4 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 59 min 44 sec

4. A 25-year-old woman, gravida 1, para 1, comes to the physician because of almost continuous vaginal bleeding since delivery 5 days
ago. She underwent a cesarean delivery because of a breech presentation at 40 weeks' gestation. She has had no difficulty
breast-feeding. She is afebrile. Approximately 5 ml of old blood is visible in the vagina. The cervix is closed, and the uterus is firm
and approximately 10 cm in length. Her hematocrit is 37%. Which of the following is the most appropriate next step in management?

Q A) Observation
Q B) Coagulation profile
Q C) Administration of methylergonovine
Q D) Administration of oxytocin
Q E) Dilatation and curettage

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 5 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 59 min 40 sec

5. A 27-year-old woman at 7 weeks' gestation is admitted to the hospital for an appendectomy for a ruptured appendix. During the
operation, one ovary is inadvertently removed due to extensive adhesions from previous operative procedures. Pathologic
examination of an ovary specimen shows a corpus luteum cyst. Which of the following is the most appropriate next step in
management?

Q A) Estrogen supplementation until 10 weeks' gestation

Q B) Follicle-stimulating hormone therapy until 10 weeks' gestation
Q C) Progesterone supplementation until 10 weeks' gestation
Q D) Termination of pregnancy
Q E) No treatment is indicated

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 6 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 59 min 36 sec

6. A previously healthy 18-year-old woman comes to the physician because of a 2-day history of vulvar pain. She is sexually active with
three male partners, and they use condoms inconsistently. Examination shows a tender, nonindurated ulcer on the right labium
majus that bleeds easily when touched. Which of the following is the most likely causal organism?

0 A) Calymmatobacterium granulomatis
Q B) Chlamydia trachomatis
Q C) Haemophilus ducreyi
0 D) Human papillomavirus

0 E) Treponema pallidum

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 7 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 59 min 32 sec

7. A previously healthy 27-year-old woman is brought to the emergency department 20 minutes after the sudden onset of loss of
consciousness. She has a 1-day history of temperatures to 39.4°C (103°F), vomiting, watery diarrhea, and a rash over her face,
trunk, and arms. Her last menstrual period started 5 days ago; she routinely uses tampons. Her temperature is 39.4°C (103°F), pulse
is 125/min, respirations are 30/min, and her palpable systolic blood pressure is 70 mm Hg. Examination shows erythema of the
conjunctivae and pharynx. Pelvic examination shows 10 to 15, 0.5-cm ulcers over the vaginal mucosa. Culture of a lesion scraping
grows Staphylococcus aureus. This patient is at greatest risk for mortality from which of the following complications?

Q A) Acute respiratory distress syndrome

Q B) Hemorrhage
0 C) Hepatic failure
0 D) Pulmonary embolism
Q E) Renal failure

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 8 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 59 min 28 sec

8. A 42-year-old nulligravid woman comes to the physician because she has been unable to conceive for the past year. She also says
she has had hot flashes daily and vaginal dryness. Two years ago, she was diagnosed with cancer of the right breast; she underwent
lumpectomy, sentinel node biopsy, and four cycles of chemotherapy followed by radiation therapy. There has been no evidence of
recurrence. She has not had a menstrual period since beginning the second cycle of chemotherapy 18 months ago. She is in a
monogamous relationship with a male partner and has frequent unprotected sexual intercourse. She is 163 cm (5 ft 4 in) tall and
weighs 86 kg (190 lb); BMI is 33 kg/m 2. Her pulse is 80/min, respirations are 10/min, and blood pressure is 100/60 mm Hg.
Examination of the right breast shows a well-healed lumpectomy scar. Examination of the left breast shows no abnormalities. The
abdomen is soft and nontender. Pelvic examination shows vaginal atrophy with no vulvar, vaginal, or cervical lesions. The uterus is
normal sized , and there are no adnexal masses. Which of the following is the most likely cause of this patient's infertility?

Q A) Adrenal insufficiency
Q B) Hyperprolactinemia
Q C) Hypogonadism
Q D) Hypothalamic-pituitary dysfunction
Q E) Hypothyroidism

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item g of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 59 min 24 sec

9. A 32-year-old primigravid woman at 36 weeks' gestation comes for a routine Fetal Heart Rate (beats/min)
prenatal visit. Her blood pressure is 122/70 mm Hg. Examination shows a 210
fundus of 37 cm. Fetal heart tones are heard in the midabdomen, and the rate
is 144/min. Deep tendon reflexes are brisk, and there is no pedal edema. The
I .. I
- .•.
I
I
cervix is 50% effaced and 1 cm dilated; the vertex is at -1 station. During '
- :--:- ~- - ,-·.- -1 - - -
1:::0
pelvic examination, the patient feels a sudden, dramatic fetal movement, and - - ,- _J _ =1-
- 1
- -·-.- - =1=1-=I-==- '
-1 -; f\, - l~
1-\r·'\.. ·-=12- :-r- ...., '" v .h•: .,, ~ =4:±
- 1-1-r,±;
her membranes rupture. A large gush of clear fluid is seen. A fetal heart rate of -- N- -
144/min is heard on auscultation. Cervical examination now shows no change r ~

in dilation or effacement. She begins to have painful contractions every

6 to 8 minutes that last 45 to 60 seconds. An electronic fetal monitor with an #~~=f =+- --H-
+f-1-t- - ~ ;
-t-H--
I I I I , -~
-p
internal pressure catheter is applied. A fetal heart tracing is shown. Which of =t+-=-=-'-:~:;=i=l;: '
--'- 1-:L-..l-
- ~ ~ . I -f-1- - -:-H-}-f--
' I '

the following is the most appropriate next step in management? =l. 7- . , · - ,1- ,!.
' 30

Q A) Observation and continued monitoring

0 B) Fetal scalp blood pH sampling
O C) Administration of oxytocin
0 D) Amnioinfusion
Q E) Immediate cesarean delivery

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 10 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 59 min 20 sec

10. Four weeks after a total vaginal hysterectomy for cervical dysplasia, a 57-year-old woman comes for a follow-up visit. A pathology
report confirms the presence of cervical intraepithelial neoplasia (CIN) 3 with all surgical margins clear of disease. Which of the
following is the most appropriate recommendation for future screening for recurrent squamous cell intraepithelial neoplasia in this
patient?

Q A) Human papillomavirus testing in 3 months

Q B) Pap smears annually
Q C) Colposcopy of the vagina in 1 year
Q D) Random vaginal biopsy in 1 year
Q E) No further testing for this condition is necessary

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 11 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 59 min 16 sec

11 . A 24-year-old woman comes to the physician because of a 10-month history of breast tenderness that is worse just prior to the
onset of menses. Her menses occur at regular 28-day intervals, and she is currently on day 26 of her menstrual cycle. Examination
shows multiple, bilateral, firm cystic areas of the breasts. Which of the following is the most appropriate next step in diagnosis?

Q A) Reexamination after menses

Q B) Cytology of expressed nipple discharge
Q C) Mammography
Q D) Aspiration of the cysts
Q E) Biopsy of the cysts

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 12 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 59 min 12 sec

12. A previously healthy 47-year-old woman , gravida 3, para 3, comes to the physician because of a 2-week history of excessive
vaginal bleeding with the passage of clots. During this time, she has had to change her sanitary pad every 2 hours. She has had
occasional hot flashes during the past 6 months. Her menses previously occurred at regular 28-day intervals until 1 year ago. She
now has 2 weeks of bleeding every 2 months. She has no history of serious illness and takes no medications. Six months ago, a
Pap smear showed no abnormalities. She is 165 cm (5 ft 5 in) tall and weighs 66 kg (145 lb); BMI is 24 kg/m 2• Physical examination
shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?

Q A) Pap smear
Q B) Measurement of serum luteinizing hormone concentration
O C) Measurement of serum testosterone concentration
Q D) CT scan of the pelvis
Q E) Endometrial biopsy

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section: Item 13 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 59 min 7 sec

13. An 18-year-old woman is brought to the emergency department 2 hours after the onset of severe abdominal pain and nausea and
vomiting. During a routine visit 2 weeks ago, pelvic examination showed an 8-cm right adnexal mass. Ultrasonography showed an
8-cm, mature cystic teratoma on the right ovary. Abdominal examination today shows severe rebound tenderness with guarding in
the right lower quadrant. Which of the following is the most likely diagnosis?

0 A) Acute appendicitis
Q B) Ectopic pregnancy
Q C) Ovarian torsion
0 D) Pelvic inflammatory disease

0 E) Renal calculi

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section: Item 14 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 59 min 3 sec

14. A 27-year-old primigravid woman at 31 weeks' gestation comes to the physician because of a 3-day history of shortness of breath
at rest. She has gestational diabetes treated with diet. She measures her blood glucose concentrations four times daily; her 1-hour
postprandial concentrations have averaged 144 mg/dl. Ultrasonography at 18 weeks' gestation showed a fetus who had normal
anatomy and was consistent in size with gestational age. The patient is Rh-negative and received Rh 0 (D) immune globulin at
28 weeks' gestation; antibody screening was negative. Her pulse is 88/min, and respirations are 22/min . The lungs are clear to
auscultation and percussion. Examination shows a fundal height of 44 cm. The cervix is 4 cm dilated and 50% effaced ; the vertex is
at -2 station. Which of the following is the most likely cause of this patient's symptoms?

0 A) Anencephaly
0 B) Incorrect gestational age
0 C) Polyhydramnios
0 D) Rh isoimmunization
0 E) Twin gestation

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section: Item 15 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 58 min 59 sec

15. A 27-year-old woman, gravida 3, para 2, comes to the physician for her first prenatal visit. Her last menstrual period was 12 weeks
ago. Her previous pregnancies were uncomplicated. Examination shows a closed cervix and a uterus consistent in size with a
12-week gestation. Her blood group is AB, Rh-negative. Ultrasonography detects a fetal heart rate. Which of the following is the
most appropriate next step in management?

Q A) Glucose tolerance test

Q B) Indirect antiglobulin (Coombs) test
Q C) Measurement of hemoglobin A 1c
Q D) Determination of tJ. OD 450 in amniotic fluid
Q E) Administration of Rh 0 (D) immune globulin

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 16 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 58 min 54 sec

16. A 22-year-old woman comes to the physician for counseling prior to conception. She feels well. She is recently married, and she
and her husband wish to start a family immediately. She has a 10-year history of type 1 diabetes mellitus treated with an insulin
pump. During the past 3 years, she has been hospitalized twice for ketoacidosis. She is 163 cm (5 ft 4 in) tall and weighs 50 kg
(110 lb); BMI is 19 kg/m 2. Physical examination shows no abnormalities. Her serum glucose concentration is 180 mg/dl in the
physician's office. Which of the following measures will have the greatest impact on the success of this patient's pregnancy?

O A) Adding an oral hypoglycemic to the regimen

Q B) Exercise program
O C) Prenatal vitamin supplementation
O D) Tighter glucose control
0 E) Weight gain

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 17 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 58 min 50 sec

17. A 47-year-old woman comes for a routine health maintenance examination. She smoked one pack of cigarettes daily for 30 years,
but she quit 1 year ago. She has had one lifetime sexual partner and has not been sexually active for 3 years. Pap smear and
mammography showed normal findings 8 months ago. Her mother died of breast cancer at the age of 60 years. Physical and pelvic
examinations show no abnormalities. Which of the following is the most appropriate screening test for this patient?

0 A) Pap smear
Q B) X-ray of the chest
Q C) Mammography
0 D) Colonoscopy

0 E) No screening indicated

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 18 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 58 min 46 sec

18. A 30-year-old multigravid woman at 37 weeks' gestation is admitted in labor 6 hours after the onset of regular uterine contractions.
Her vital signs are within normal limits. Physical examination shows no abnormalities. By abdominal palpation, her fetus is thought
to be in breech presentation. Her amniotic membranes are intact. Her cervix is 2 cm long and 1 cm dilated; the presenting part is at
-3 station but is difficult to palpate. Ultrasonography shows a double footling breech presentation. During labor, this patient is at
greatest risk for which of the following complications?

0 A) Chorioamnionitis
Q B) Fetal shoulder dystocia
0 C) Hemorrhage
O D) Prolapse of the fetal umbilical cord
Q E) Uterine rupture

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 19 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 58 min 42 sec

19. A 37-year-old woman, gravida 2, para 1, at 28 weeks' gestation comes to the physician for a routine prenatal visit. She feels well,
and pregnancy has been uncomplicated. Amniocentesis for fetal karyotype at 16 weeks' gestation showed no abnormalities, and
she received Rh 0 (D) immune globulin. She has gained 8.2 kg (18 lb) during her pregnancy. Her blood pressure is 135/78 mm Hg.
Fundal height is 29 cm. The fetus is in a longitudinal lie with a cephalic presentation. The fetal heart rate is 160/min. The patient's
blood group is A, Rh-negative. Two days ago, serum anti-D antibody titer was negative. Which of the following is the most
appropriate next step in management?

Q A) Repeat serum anti-D antibody titer in 2 to 4 weeks

Q B) Kleihauer-Betke (acid elution) test
Q C) Administration of Rh 0 (D) immune globulin
Q D) Amniocentesis for measurement of bilirubin concentration
Q E) Cordocentesis for measurement of fetal hemoglobin concentration

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 20 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 58 min 38 sec

20. A 27-year-old woman at 22 weeks' gestation is admitted to the hospital because of fractures of right ribs 4-10 sustained in a motor
vehicle collision. She is intubated. Her blood pressure is 120/80 mm Hg, and urine output is 50 mUh. Fetal monitoring shows no
fetal heart tones. Laboratory studies show:
Hematocrit 30%
Leukocyte count 9500/mm 3
Platelet count 70,000/mm 3
Prothrombin time 16 sec
Partial thromboplastin time >100 sec
Plasma fibrinogen 50 mg/dL (N=200-400)

Fibrin split products are present in the serum at a 1: 160 dilutional titer. Ultrasonography of the abdomen shows free fluid. Which of
the following is the most appropriate next step?

Q A) CT scan of the abdomen

Q B) Exchange transfusion
Q C) Platelet transfusion
Q D) Transfusion of packed red blood cells
Q E) Cesarean removal of the fetus

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 21 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 58 min 34 sec

21 . A 32-year-old primigravid woman at 26 weeks' gestation comes to the emergency department because of an 8-hour history of
moderate abdominal pain and cramping. She has no history of serious illness or operative procedures. Her pregnancy had been
uncomplicated. Vital signs are within normal limits. On pelvic examination, the cervix is 6 cm dilated and 100% effaced; the
presenting part is at +1 station. Ultrasonography shows a fetus in a breech presentation and consistent in size with a 26-week
gestation. The patient undergoes an emergent cesarean delivery. Twenty-four hours after delivery, the patient's temperature is
41 °C (105.8°F), pulse is 130/min, respirations are 30/min, and blood pressure is 80/40 mm Hg. Cardiopulmonary examination
shows no abnormalities. Abdominal examination shows moderate tenderness to palpation over the uterus. Urinalysis shows 2+
RBCs and trace leukocyte esterase. Which of the following is the most likely diagnosis?

0 A) Pneumonia
0 B) Puerperal sepsis
0 C) Pyelonephritis
O D) Retained placental fragments
0 E) Septic pelvic thrombophlebitis

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 22 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 58 min 29 sec

22. A 62-year-old woman comes to the physician because of urinary incontinence for 4 weeks. Sometimes she is unable to reach a
bathroom quickly enough after feeling the need to void. She recalls falling on wet grass 3 weeks ago but did not notice any injuries.
She has gastroesophageal reflux disease and hypertension. Her medications include hydrochlorothiazide and famotidine. She
stopped taking hydrochlorothiazide 7 days ago because she thought it was causing the incontinence, but the symptoms have
continued. She takes no other medications. Her blood pressure is 137/92 mm Hg. Examination, including pelvic examination,
shows no abnormalities. Which of the following is the most likely explanation for her incontinence?

Q A) Adverse effect of medication

Q B) Loss of progesterone effect on the bladder mucosa
O C) Obstruction of the bladder outlet
0 D) Spinal cord injury
Q E) Uninhibited bladder contractions

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 23 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 58 min 26 sec

23. A27-year-old woman, gravida 4, para 1, aborta 3, comes to the physician with her 31-year-old husband because of three
first-trimester spontaneous abortions during the past 15 months. The patient received the diagnosis of each pregnancy by serum
~-hCG testing and ultrasonography. After diagnosis, there was no evidence of embryonic viability on ultrasonography, and
spontaneous abortion occurred at 7 weeks' gestation. Seven years ago, she had deep venous thrombosis of the left lower extremity
while taking an oral contraceptive and was treated with anticoagulation therapy for 6 months. Physical examination of the patient
and her husband shows no abnormalities. Which of the following is most likely to establish the cause of recurrent spontaneous
abortion in this patient?

O A) Karyotype analysis of the patient and her husband

O B) Karyotype analysis of subsequent abortus material
0 C) Serum antiphospholipid antibody assay
0 D) Hysterosalpingography
O E) Endometrial biopsy during the luteal phase

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 24 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 58 min 21 sec

24. A 32-year-old woman, gravida 1, para 1, is brought to the emergency department because of headaches for 4 days and slurred
speech for 3 hours. She also has had fatigue and intermittent vaginal bleeding since delivering a healthy newborn at term 4 months
ago; the bleeding has been heavy at times. Her blood pressure is 110/70 mm Hg. Examination shows a closed cervical os.
Ultrasonography shows a slightly enlarged uterus with a small clot in the endometrial cavity. There are bilateral, 8-cm, cystic,
ovarian masses. Neurologic examination shows right-sided weakness. Her hematocrit is 28%, and serum ~-hCG concentration is
530,000 mlU/mL. Which of the following is the most likely diagnosis?

0 A) Choriocarcinoma
0 B) Ectopic pregnancy
Q C) Germ cell ovarian tumor
Q D) Hydatidiform mole
Q E) Threatened abortion

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 25 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 58 min 17 sec

25. A 37-year-old woman with a 2-week history of urinary frequency, urgency, and burning comes to the physician for a follow-up
examination. One week ago, urinalysis showed 20-50 WBC/hpf with no protein, glucose, bacteria, ketones, or crystals. Urine
dipstick showed trace blood. Her symptoms have not improved with 1 week of trimethoprim-sulfamethoxazole therapy. Pelvic
examination shows urethral tenderness. The remainder of the examination shows no abnormalities. Urinalysis remains unchanged.
In addition to urine culture, which of the following is the most appropriate next step in diagnosis?

Q A) Cytologic examination of suprapubic urine aspirate

Q B) Gram stain of the cervical mucus
Q C) PPD skin test
0 D) Throat culture
Q E) Urethral culture for chlamydia

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 26 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 58 min 14 sec

26. A 30-year-old woman, gravida 1, para 1, has had fever and lower abdominal pain for 24 hours. Two days ago, she underwent a low
transverse cesarean delivery because of failure to progress in labor after 18 hours. Her temperature is 39°C (102.2°F}. The lungs
are clear to auscultation. The incision is mildly tender and pink. The fundus is near the umbilicus and extremely tender. Which of the
following organisms is the most likely cause of this infection?

0 A) Gram-negative aerobes
Q B) Gram-negative anaerobes
Q C) Gram-positive aerobes
0 D) Gram-positive anaerobes

0 E) Mixed aerobes and anaerobes

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 27 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 58 min 10 sec

27. A 37-year-old primigravid woman comes to the physician for a routine prenatal visit. She conceived 17 weeks ago by in vitro
fertilization. Pregnancy has been uncomplicated. Physical examination shows no abnormalities. The uterus is consistent in size with
a 17-week gestation. Her maternal serum a-fetoprotein concentration is 7.3 multiples of the median. Which of the following is the
most likely fetal abnormality?

0 A) Cystic fibrosis
Q B) Down syndrome
Q C) Myelomeningocele
0 D) Tay-Sachs disease

0 E) Ventricular septal defect

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 28 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 58 min 6 sec

28. Immediately after cesarean delivery because of abruptio placentae, a 25-year-old woman loses consciousness. She had an
estimated blood loss of 1200 ml. Her pregnancy was uncomplicated. Her temperature is 37°C (98.6°F), pulse is 120/min,
respirations are 26/min, and blood pressure is 60/40 mm Hg. Examination shows frothy pink sputum. Bilateral wheezes are heard
on auscultation. The fundus is firm. Laboratory studies show:
Hemoglobin 7 g/dL
Leukocyte count 8000/mm 3
Platelet count 60,000/mm 3
Bleeding time 9 min
Prothrombin time 20 sec (INR=2)
Partial thromboplastin time 55 sec
Thrombin time 5 sec
Plasma fibrinogen 100 mg/dL (N=200-400)
Fibrin split products 80 µg/mL (N<10)

An x-ray of the chest shows pulmonary edema. An ECG shows tachycardia. Which of the following is the most likely diagnosis?

0 A) Amniotic fluid embolism

O B) Eclampsia
0 C) Hypovolemic shock
0 D) Pulmonary embolism
0 E) Septic shock

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 29 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 58 min 1 sec

29. A 39-year-old woman, gravida 1, para 1, comes for a routine health maintenance examination. Menses have occurred at irregular
intervals since menarche at the age of 14 years. Her last menstrual period occurred 6 months ago and was extremely heavy. She
has declined to take hormones to regulate menses because she does not want to have a monthly menstrual period. Her only child
was conceived 8 years ago after she was treated with clomiphene. She has had mild hirsutism since adolescence. Which of the
following serum concentrations is most likely to be increased?

Q A) Follicle-stimulating hormone
0 B) Progesterone
0 C) Testosterone
O D) Thyroid-stimulating hormone
Q E) Thyroxine (T 4)

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 30 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 57 min 57 sec

30. A 16-year-old girl is brought to the physician by her mother because of an 18-month history of increasingly severe menstrual
cramps associated with diarrhea and vomiting. The symptoms cause her to miss 2 days of school each month, and her school
performance is beginning to decline. Menarche was at the age of 13 years. Menses occur at regular 28-day intervals. She is not
sexually active. She is 165 cm (5 ft 5 in) tall and weighs 57 kg (125 lb); BMI is 21 kg/m 2. Physical examination shows no
abnormalities. Pelvic examination shows normal-appearing external genitalia, vagina, and cervix. The uterus is small, mobile, and
nontender. There are no adnexal masses or nodularity. Which of the following is the most likely cause of this patient's symptoms?

0 A) Adenomyosis
0 B) Endometrial polyps
Q C) Endometriosis
Q D) Leiomyomata uteri
Q E) Primary dysmenorrhea

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 31 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 57 min 53 sec

31 . A previously healthy 23-year-old primigravid woman at 10 weeks' gestation has had nausea and vomiting for 4 weeks. She can
tolerate small amounts of food intermittently but usually vomits 3 to 4 times daily. She is 157 cm (5 ft 2 in) tall; she has lost
1.8 kg (4 lb) and currently weighs 54 kg (119 lb). Ultrasonography shows a viable fetus consistent with a 10-week gestation. Which
of the following is the most likely effect of her condition on the fetus?

0 A) Developmental delay
Q B) Premature birth
Q C) Pulmonary hypoplasia
0 D) Spontaneous abortion

0 E) No significant adverse effect

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 32 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 57 min 49 sec

32. A 27-year-old primigravid woman at 8 weeks' gestation comes to the physician because of a 1-day history of a migraine. She has a
history of migraines treated with sumatriptan. She reports that she has not taken any pain relief medication for her headache
because of concern regarding possible harm to her fetus. Vital signs are within normal limits. Physical examination shows a uterus
consistent in size with an 8-week gestation. Which of the following is the most appropriate pharmacotherapy?

0 A) Acetaminophen
Q B) Butalbital
Q C) Ergotamine
0 D) Meperidine

0 E) Sumatriptan

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 33 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 57 min 46 sec

33. A 17-year-old primigravid patient has been in labor for 15 hours; she has made no progress for the past 3 hours. The cervix is 5 cm
dilated and 80% effaced; the vertex is at +2 station. Contractions occur every 5 minutes. Assuming a normal-sized full-term fetus
and a clinically adequate pelvis, which of the following is the most appropriate next step?

Q A) Augmentation of labor with oxytocin

Q B) Cesarean delivery for failure to progress
Q C) Intramuscular sedation for 2 hours of rest
Q D) Intravenous hydration
Q E) X-ray pelvimetry

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 34 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 57 min 39 sec

34. A 23-year-old woman, gravida 1, para 1, comes to the physician because of increasingly severe pain of the left breast over the past
3 days. She now describes the pain as excruciating. Five days ago, she delivered a 3700-g (8-lb 3-oz) newborn vaginally after an
uncomplicated labor. Her pregnancy was complicated by oligohydramnios, and labor was induced at 39 weeks' gestation. Her
postpartum course has been uncomplicated. She is breast-feeding. Her temperature is 37.5°C (99.5°F). Examination shows a
tender, edematous area on the lateral aspect of the left breast that is not erythematous or warm. Which of the following is the most
appropriate next step in management?

Q A) Application of heat to the area

Q B) Aminoglycoside therapy
0 C) Dicloxacillin therapy
Q D) Needle aspiration and culture
Q E) Incision and drainage

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 35 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 57 min 35 sec

35. A previously healthy 4 7-year-old woman comes to the physician 3 weeks after she noted a lump in her right breast during
self-examination. Physical examination shows a 3-cm mass in the upper outer quadrant of the right breast. Mammography shows
no abnormalities. Ultrasonography shows a cystic component; fine-needle aspiration biopsy yields cloudy straw-colored fluid. The
mass is still present after aspiration. Which of the following is the most appropriate next step in management?

0 A) Observation
Q B) Repeat examination in 6 weeks
Q C) Repeat examination in 1 year
0 D) Repeat mammography

0 E) Thermography

0 F) Biopsy of the mass

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 36 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 57 min 31 sec

36. A 23-year-old woman, gravida 2, para 1, is admitted in labor at term. Her pregnancy has been uncomplicated. The cervix is 4 cm
dilated and 75% effaced; the vertex is at -1 station. Two hours later, the cervix is 5 cm dilated and 75% effaced; the vertex is at
0 station. Fetal heart rate is 140/min. Four hours later, the cervix is 6 cm dilated; the rest of the examination is unchanged. Which of
the following is the most likely diagnosis?

0 A) Prolonged latent phase of labor

Q B) Prolonged second stage of labor
Q C) Protracted active phase of labor
0 D) Protraction of descent

0 E) Normal labor

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 37 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 57 min 27 sec

37. A 32-year-old woman, gravida 4, para 3, at 38 weeks' gestation is admitted to the hospital 8 hours after premature rupture of
membranes. Pregnancy had been uncomplicated. Previous pregnancies were uncomplicated with spontaneous vaginal delivery of
3430-g (7-lb 9-oz), 3629-g (8-lb), and 3770-g (8-lb 5-oz) newborns at 37 to 39 weeks' gestation. She has no history of serious
illness. Her only medication is a prenatal vitamin. Her temperature is 37.2°C (99°F), pulse is 80/min, respirations are 16/min, and
blood pressure is 112/65 mm Hg. The cervix is 1 cm dilated and 80% effaced. Labor augmentation with oxytocin is begun and
results in contractions 2 to 3 minutes apart. The cervix is now 8 cm dilated and 100% effaced; the vertex is at +2 station. Her
temperature now is 39°C (102.2°F), pulse is 110/min, respirations are 22/min, and blood pressure is 105/58 mm Hg. The baseline
fetal heart rate is 175/min with mild variable decelerations. The uterus is tender. Which of the following is the most appropriate next
step in management?

0 A) Antibiotic therapy
Q B) Increased oxytocin therapy
Q C) Forceps delivery
0 D) Vacuum extraction

0 E) Immediate cesarean delivery

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 38 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 57 min 23 sec

38. A 67-year-old woman, gravida 3, para 3, comes to the physician because of a 1-month history of a rapidly increasing lower
abdominal mass. Twenty years ago, she underwent radiation therapy of the pelvis for early cervical cancer; the uterus was not
removed. She has been receiving estrogen and progesterone replacement therapy since then. She has smoked two packs of
cigarettes daily for 40 years. Examination shows a normal-appearing vulva, vagina, and cervix. The uterus measures 16 cm. She
undergoes exploratory laparotomy, total abdominal hysterectomy, and bilateral salpingo-oophorectomy. Pathologic evaluation
shows a uterine sarcoma. Which of the following is the most likely underlying cause of this pathologic finding?

Q A) Cigarette smoking
Q B) Excessive estrogen
0 C) Genetic predisposition
Q D) Human papillomavirus infection
Q E) Pelvic radiation therapy

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 39 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 57 min 18 sec

39. A 77-year-old woman, gravida 7, para 5, aborta 2, comes to the physician because of a mass protruding from the vagina for
1 week; she feels something moving within the mass. She has also had severe low back pain for 6 months. Eight years ago, she
underwent a vaginal hysterectomy and anterior and posterior colporrhaphy for treatment of uterovaginal prolapse. Which of the
following is the most likely diagnosis?

0 A) Cystocele
Q B) Enterocele
Q C) Femoral hernia
0 D) Indirect inguinal hernia

0 E) Sigmoid intussusception

0 F) Urethrocele

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 40 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 57 min 14 sec

40. A healthy 27-year-old woman , gravida 3, para 2, at 32 weeks' gestation comes to the physician for a routine prenatal visit. She says
that she feels well and has not had any uterine contractions. She reports that the baby has been very active. The patient has had a
1-kg (2-lb) weight gain since her last visit 2 weeks ago. She does not drink alcohol and quit smoking after she learned she was
pregnant. She works as a bartender. Her blood pressure is 120/70 mm Hg. Examination shows a fundal height of 28 cm. Fetal heart
tones are 150/min. Leopold maneuvers confirm a cephalic presentation. Which of the following is the most appropriate next step
in management?

Q A) Follow-up visit in 2 weeks

Q B) Fetal ultrasonography
0 C) Induction of labor
Q D) Percutaneous umbilical blood sampling
Q E) Amniocentesis
0 F) Cesarean delivery

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section: Item 41 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 57 min 8 sec

~
or
~ ·2i
~ 99·0- MCNSTRUAL
~ B
~ . t
6LEE:OING

~ ·6 )( )(
~ ·'t X

....... ·2
~
~ 98·0 -
<::5 ~1-.-1-.-1-,--1---.-1---.-1-.-1--..--1~ - - ~1-
o 4 8 12 16 20 24 28 32 36 40
-D~~s

41 . The basal body temperature graph shown was obtained from a 22-year-old nulligravid woman who has been unable to conceive for
18 months. Menses occur at regular 28-day intervals. Which of the following hormones is the most likely cause of the increase in
basal body temperature on the 15th day?

0 A) Estrogen
Q B) Follicle-stimulating hormone
Q C) Human chorionic gonadotropin
0 D) Luteinizing hormone

0 E) Progesterone

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 42 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 57 min 4 sec

42. A 32-year-old woman comes to the physician for a follow-up examination 4 months after beginning a trial of oral contraceptive
therapy for menometrorrhagia. Her symptoms have improved. Menses now occur at regular 28- to 30-day intervals and last 3 days.
Her last menstrual period was 2 weeks ago. She is otherwise healthy and takes no other medications. Physical examination,
including pelvic examination, shows no abnormalities. Which of the following is the most likely explanation for the improvement in
this patient's bleeding?

Q A) Enhanced progesterone secretion by the corpus luteum

Q B) Increased luteinizing hormone concentration
0 C) Suppression of uterine adenomyosis
O D) Synchronization of the endometrium
Q E) Thickening of the cervical mucus

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 43 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 57 min O sec

43. A 66-year-old woman is admitted to the hospital because of a 2-day history of decreased level of consciousness and dyspnea. Two
years ago, she was diagnosed with stage IV epithelial ovarian cancer. The patient initially responded to surgical debulking and
chemotherapy, but she has not responded to the past three chemotherapy regimens. Her last CT scan of the abdomen showed an
increase in peritoneal tumor burden. The patient does not have an advance directive. She appears thin and is in moderate
respiratory distress. She is unconscious and does not respond to verbal stimuli. Her temperature is 37.7°C (99.9°F), pulse is
110/min, respirations are 24/min, and blood pressure is 80/50 mm Hg. Breathing is labored, and breath sounds are decreased in
the lower lung fields bilaterally. Her serum CA 125 concentration is 1236 U/ml (N<35); 1 month ago, it was 247 U/ml. The
physician requests a family meeting with her two daughters. Which of the following is the most appropriate initial statement by the
physician?

Q A) "Do you want your mother to be an organ donor?"

Q B) "What do you think is happening with your mother?"
Q C) "Who is in charge of making decisions about your mother's care?"
Q D) "Would you like your mother to be put on life support?"
Q E) "Your mother will not live through the night."

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 44 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 56 min 56 sec

44. An 82-year-old woman with dementia, Alzheimer type, is brought to the physician by her daughter because of blood on her
underwear. The patient is confused and smells of urine. She is not oriented to place or time, but she knows her name. Pelvic
examination shows severe vaginal atrophy. There is a 3-cm, tender laceration and an erythematous, edematous vaginal perinea!
body. Which of the following is the most likely cause of these findings?

0 A) Acute allergic reaction

Q B) Lichen planus
Q C) Sexual assault
0 D) Squamous cell carcinoma in situ

0 E) Urinary incontinence

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 45 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 56 min 52 sec

45. A 30-year-old woman comes to the physician for a routine pelvic examination. She has had multiple sex partners. Perianal
examination shows two venereal warts. Cervical examination shows no abnormalities. A Pap smear shows epithelial cells with an
irregular nuclear contour and a distinct halo around the nucleus with a dense outer rim of cytoplasm. Which of the following is the
most likely cause of the cytologic abnormalities?

Q A) Infection with Chlamydia trachomatis

Q B) Infection with cytomegalovirus
Q C) Infection with herpes simplex virus 2
Q D) Infection with human papillomavirus
Q E) Invasive cervical carcinoma

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 46 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 56 min 48 sec

46. Three days after a moderately difficult forceps delivery, a 27-year-old woman , gravida 1, para 1, comes to the physician because of
a 3-day history of numbness and tingling of the anterior lower right leg. She also has had buckling of the right knee when she
attempts to walk. Epidural anesthesia was administered during labor. After 4 hours of pushing in stirrups during the second stage of
labor, spinal anesthesia was administered for the forceps delivery. Examination shows decreased sensation along the anterior,
anteromedial, and medial aspect of the right thigh , knee, and upper leg. There is some weakness of the quadriceps femoris muscle.
Which of the following is the most likely explanation for these findings?

Q A) Adverse effect of epidural anesthesia

Q B) Adverse effect of spinal anesthesia
0 C) Injury to the femoral nerve
Q D) Injury to the genitofemoral nerve
Q E) Injury to the lateral femoral cutaneous nerve

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 47 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 56 min 44 sec

4 7. A 28-year-old nulligravid woman has had increasingly severe pelvic pain and dyspareunia over the past 8 months; during menses,
the pain worsens and she has occasional episodes of diarrhea. Pelvic examination shows a normal vagina and cervix with no
suspicious lesions. The uterus is normal-sized, retroverted, and fixed, and there is induration and nodularity of the posterior wall of
the uterus and cul-de-sac. There are no palpable adnexal masses. Which of the following is the most appropriate diagnostic test?

Q A) Measurement of serum CA 125 concentration

Q B) Barium enema
Q C) CT scan of the pelvis
Q D) MRI of the pelvis
Q E) Laparoscopy

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 48 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 56 min 40 sec

48. A previously healthy, asymptomatic 25-year-old woman comes to the physician for contraceptive advice. She takes no medications.
Menses occur at regular 28-day intervals and last approximately 5 days. Her last menstrual period was 20 days ago. Pelvic
examination shows a 5-cm mobile mass in the right adnexa; the mass is moderately painful to palpation. Which of the following is
the most likely diagnosis?

0 A) Adenocarcinoma of the gastrointestinal tract

Q B) Adenocarcinoma of the ovary
Q C) Distended urinary bladder
0 D) Diverticulitis

0 E) Ectopic pregnancy
Q F) Endometrioma
Q G) Hemorrhagic corpus luteum cyst
0 H) Lymphoma

0 I) Tuba-ovarian abscess

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 49 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 56 min 36 sec

49. A 24-year-old primigravid woman at 12 weeks' gestation comes to the physician for her first prenatal visit. She has immune
thrombocytopenic purpura and wants to know whether this condition will affect her baby. Examination shows a uterus consistent in
size with a 12-week gestation. This patient's fetus is at increased risk for which of the following?

Q A) Chronic maternal anemia

Q B) Fetal platelet destruction
Q C) Fetal renal infarction
Q D) Maternal hypertension causing uteroplacental insufficiency
Q E) Placental infarction

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause
Exam Section : Item 50 of 50 National Board of Medical Examiners Time Remaining:
■ Mark Obstetrics and Gynecology Self-Assessment 4 hr 56 min 32 sec

50. A 27-year-old woman, gravida 2, para 2, comes to the physician because she is concerned that she may be pregnant. She was
sexually active with her husband 2 days ago, and they did not use contraception. She wants to prevent an unintended pregnancy.
She is breast-feeding their ?-month-old infant. Menses occur at regular 28-day intervals. Her last menstrual period was 1 week ago.
She has a 5-year history of migraines and a history of hepatitis B. She was treated for Chlamydia trachomatis infection at the age of
17 years. She takes no medications and has no known drug allergies. Vital signs are within normal limits. Physical examination,
including pelvic examination, shows no abnormalities. A urine pregnancy test is negative. Which of the following is a
contraindication for the use of levonorgestrel as emergency contraception in this patient?

0 A) Breast-feeding
O B) History of Chlamydia trachomatis infection
0 C) History of hepatitis B
0 D) History of migraines
O E) There are no contraindications

r ~ ~ p, r,
Previous Next
https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause