NBME Obstetrics and Gynecology 4

Question 1

A 25-year-old at 6 weeks amenorrhea presents with vaginal bleeding and left lower quadrant pain. β-hCG is 2,400 mIU/mL; transvaginal ultrasound shows no intrauterine pregnancy and a small left adnexal mass without cardiac activity. She is hemodynamically stable. Most appropriate next step?

Accepted Answer

Single-dose intramuscular methotrexate

Answer

A hemodynamically stable patient with presumed ectopic pregnancy, β-hCG <5,000 mIU/mL, adnexal mass without cardiac activity, and no contraindications is a candidate for single-dose methotrexate.

Question 2

A 30-year-old woman with 3 consecutive first-trimester spontaneous abortions is found to have antiphospholipid antibody syndrome. What is the recommended treatment during her next pregnancy?

Accepted Answer

Low molecular weight heparin plus low-dose aspirin

Answer

Antiphospholipid syndrome causing recurrent pregnancy loss is treated with LMWH plus low-dose aspirin throughout pregnancy, as warfarin is teratogenic.

Question 3

A 28-year-old woman with primary infertility undergoes hysterosalpingography showing bilateral tubal occlusion. Her partner's semen analysis is normal. What is the most likely cause of her tubal pathology?

Accepted Answer

Prior Chlamydia trachomatis pelvic infection

Answer

Prior Chlamydia trachomatis infection causing pelvic inflammatory disease is the most common cause of tubal factor infertility due to tubal scarring and occlusion.

Question 4

A 36-year-old woman with hypertension well-controlled on lisinopril asks about contraception. Which method is CONTRAINDICATED in this patient?

Accepted Answer

Combined estrogen-progestin oral contraceptives

Answer

Combined oral contraceptives are contraindicated in women with hypertension due to increased risk of stroke and myocardial infarction, especially over age 35.

Question 5

A 32-year-old woman undergoing IVF achieves a positive β-hCG two weeks after embryo transfer. She presents with severe abdominal distension, dyspnea, and 6 kg weight gain over 5 days. What is the most likely diagnosis?

Accepted Answer

Ovarian hyperstimulation syndrome (OHSS)

Answer

OHSS is a complication of ovarian stimulation characterized by massive fluid shifts, ascites, weight gain, and dyspnea, worsened by the rise in hCG from an established pregnancy.

NBME Practice Test

NBME Practice Test

NBME Obstetrics and Gynecology 4