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USMLE Step3 Gynecology Obstetrics

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. Klinefelter
Pregnancy - contraception - STD - substance abuse - emotional illness
Male phenotype - smalle testes - gynecomastia
Hypoplastic left heart syndrom
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down

2. unilateral breast discharges
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
Male phenotype - smalle testes - gynecomastia
1-2% chance of cervical ca already occured; do colposcopy with endo cervial currettage - if unsatisfactory - LEEP/cone - if satisfactory - cin 2/3 - cryotherapy; other cases-leep/cone or coloposcopy at 6m
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy

3. long term prognosis of congenital HOCM
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis
80% develop psychiatric illness - depression
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Long h/o pruritus - 65-75 - vulvar lump/mass

4. copious frothy green vaginal discharge - fishy odor - vulvar and vaginal pruritus - or dysuria
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Crosses placenta - cause bilat congenital deafness -
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc

5. patient with eclamsia - MOST effective strategy
Crosses placenta - cause bilat congenital deafness -
Giving zidovudine to pregnant and newborn; it deceased by 70%.
Nitrofurantoin-first gen cephalosporn
Speed vaginal delivery - nothing as effective as this. if they ask What is the next step answer is mag suplph - hydralazin/labetolol for bp control;

6. hemophillia- mom carrier and dad healthy
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
RCT shows no fetal risk or possiblity
Crosses placenta - cause bilat congenital deafness -
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%

7. When to bact vaginosis
If patient has positive PPD and no active TB in CXR or sputum
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI

8. emergency contraception after 120 hours
Male phenotype - smalle testes - gynecomastia
Betamethason - dexamethason IM
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
Copper intrauterine device

9. How to evaluate nephrolithiasis in pregnancy?
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities
Ultrasound. since helical CT scan is contraindicated
Don't give a patient with intact uterus. increases endometr hyperplasia/ca
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID

10. eisenmenger syndrome
Junction of squamus and glandular cells at the external cervical os
Congenital L to R shunt (VSD/PDA/ASD) untreated for long; pulmonary vascular resistance exceed systemic vascular system--reversal of shunt (R to L) and cyanosis
If patient has positive PPD and no active TB in CXR or sputum
Women with low body weight develop amenorrhoea if they engaged in sports/physical activity; exercise ---dec pulsatile secretion of LH---dec estrogen---osteopenia/osteoporosis/amenorrhoea

11. bacteriuria diagnosed incidentaly during pregnancy with no symptoms
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk
Copper intrauterine device
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common

12. criteria for gestational transient thyrotoxicosis?
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID
Large fetus - hyperextended head - footling breech - fetal distress
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine

13. vulvar ca
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Long h/o pruritus - 65-75 - vulvar lump/mass
They have glycogen deposition in myocardium mostly affected inthe interventricular septum
Amoxi - cephalexin - nitrofurantoin

14. What is the complication of chorionic villous sampling
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
Long h/o pruritus - 65-75 - vulvar lump/mass
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd

15. What HIV med cause crystal induced nephropathy?
Indinavir; it precipitate in urine and obstruct urinary flow.
Ultrasound. since helical CT scan is contraindicated
11%; doesn't increase risk of abortion; repositioned from retroverted to anterior position at 12-16w
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.

16. budd chiairi syndrom
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy
Yea. except valproate. give high dose folic acid patient is conneuing preg

17. What is perimenopause?
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
95 and 120

18. most common cause of hyperthyroidism in pregnant women
Clue cells in the vaginal smear
Self sufficient - no longer living with parent. parents of children
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1

19. Tx of complicated UTI (fever/flank pain)
Lactating women
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
No.

20. selection bias
Participants selected are not representative; more or less in a particular population; prevention; randomization
Symptomatic tx pessary. - definitive tex ; surgical repair posterior colporrhaphy
Chorionic villous sampling or amniocentesis for fetal karyotyping
24-28w; screeing at first with 50g GTT - >140 BG after 1h - should have 3h GTT with 100gm on a fasting state. measure at 0 -1 -2 -3 hr; values more than 95 - 180 - 155 - 140 are abnormal; more than 2 values diagnostic

21. How to dx down syndrom?
Amniocentesis
If patient has positive PPD and no active TB in CXR or sputum
Prenatal screening; us at 10 weeks for measurement of nuchal translucency; serum markers first trimester (papp-A); and 2nd trimester (alpha feto protein - hcg - unconjugated estriol - dimeric inhibin-A)
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S

22. Should women continue HAART during pregnancy?
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
Junction of squamus and glandular cells at the external cervical os

23. when an adolescent will get care without parental consent
Pregnancy - contraception - STD - substance abuse - emotional illness
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S
<5000 well visualized squamus cells/contain blood
Route of delivery (3% of vaginal birth and 15-30% of c-section)

24. positive GBS culture in pregnancy
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Magneisium sulphate; give antihypergensive when bp >160/105
10 days course of ab x immediatly
Ultrasound. since helical CT scan is contraindicated

25. stress incontinence
Increase in pregnancy; decreases in preeclam/eclamsia
They have glycogen deposition in myocardium mostly affected inthe interventricular septum
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine
Yea. except valproate. give high dose folic acid patient is conneuing preg

26. if ultrasound neg or inconclusive in increasd AFP - next step
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S
Amniocentesis
Magneisium sulphate; give antihypergensive when bp >160/105

27. How to dx neural tube defects on baby
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.
Bacterial vaginosis; 5-60 women and 10-29% pregnant women
Measure tsh levels 12 weeks after ocp - increase levo dose accordingly - estrogen component of levo increases TBG - increases in total t4 and decrease in free t4. hypothyroid unable to produce more hormone in response to low free t4. levo dose needs
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur

28. can eisenmenger patient have pregnancy
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases
0.4-4mg daily for >1m prior conception to entire first trimester
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required

29. What are the absolute contraindication of OCP?
Incr perinatal mortality - pretem delivery - premature and LBW
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Failure of fetal shoulder to pass through maternal pelvis
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy

30. straberry cervix
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Hepatic cirrhosis
Trichomonas; petetchia in vagina and cervix
Cervix hasn't dilated beyond 4 cm in 2 h

31. What is most common cause of ascitis in us
Indinavir; it precipitate in urine and obstruct urinary flow.
Hepatic cirrhosis
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present
Large fetus - hyperextended head - footling breech - fetal distress

32. history of preeclampsia
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
Carbamazepine and valproate - ask why
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID

33. How to dx septic abortion
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
Participants selected are not representative; more or less in a particular population; prevention; randomization
Mouth flora anerobes and aerobes
Mother taken lithium during pregnancy

34. pregnant women with positive FTA-ABS or treponemal tests
Trichomonas; petetchia in vagina and cervix
11%; doesn't increase risk of abortion; repositioned from retroverted to anterior position at 12-16w
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
Speed vaginal delivery - nothing as effective as this. if they ask What is the next step answer is mag suplph - hydralazin/labetolol for bp control;

35. atrophic vaginitis
Fetal hyperinsulinemia and hypoglycemia and macrosomia
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream
Junction of squamus and glandular cells at the external cervical os
On or after 37 weeks;

36. hemophillia
Androgen insensitvity due to mutation of AR gene; 46xy but testosterone doesn't work and converted to estrogen. female phenotype - pw amenorrhoes - inguinal mass (testes) - bind vaginal pouch
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID
X linked recessive due to deficiency of factor VIII

37. emergency contraception
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles

38. congenital dilated cardiomyopathy
Don't give a patient with intact uterus. increases endometr hyperplasia/ca
Trichomonas; petetchia in vagina and cervix
Inherited metabolic disorders - intrauterine infections - cri du chat
RCT shows no fetal risk or possiblity

39. parameters measured in subsequent visit of pregnancy?
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Chorionic villous sampling or amniocentesis for fetal karyotyping

40. differential trichominiasis and cadiidiasis?
Control group gets tx or intervention - thus decreases difference between control vs tx
Junction of squamus and glandular cells at the external cervical os
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis

41. what component of cervix has greatest risk for neoplasia?
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
Fetal hyperinsulinemia and hypoglycemia and macrosomia
Junction of squamus and glandular cells at the external cervical os

42. pruritus in pregnancy
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.
Large fetus - hyperextended head - footling breech - fetal distress
Mother taken lithium during pregnancy
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient

43. teratogenicity of sulphonylurea?
Fetal hyperinsulinemia and hypoglycemia and macrosomia
2g po single dose; discontinue breast feeding for 12-24 hours
Warty projection in vaginal or ana area; p/w pruritus - bleeding -burning - tenderness - vaginal disch and pain. large lession can p/w difficulty in defecation - intercourse; apply acetic acid to lesion - if it turns white - confirms dx
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow

44. standard test performed in prenatal visit?
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
X linked recessive due to deficiency of factor VIII
Do hpv testing --if neg - routine f/you every year - if positive colposcopy---cin2/cin3--tx; if CIN1--repeat pap in 6/12 months---two negative smear--- f/you routine screening - if ASCUS again--colposcopy
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation

45. first step in shoulder dystocia?

46. failure rate of OCP
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
Cross placenta--concentrate in amniotic fluid---fetal arthopathy
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women

47. how lactating mother will get metronidazol
Pregancy test
2g po single dose; discontinue breast feeding for 12-24 hours
Yea. except valproate. give high dose folic acid patient is conneuing preg
Androgen insensitvity due to mutation of AR gene; 46xy but testosterone doesn't work and converted to estrogen. female phenotype - pw amenorrhoes - inguinal mass (testes) - bind vaginal pouch

48. risks of maternal DM
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
Hepatic cirrhosis
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
Lactating women

49. time of last tetanus booster >10 or unknown
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
Speed vaginal delivery - nothing as effective as this. if they ask What is the next step answer is mag suplph - hydralazin/labetolol for bp control;
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy

50. How to dx overflow incontinence?
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis