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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. contamination bias
X linked recessive due to deficiency of factor VIII
10 days course of ab x immediatly
Control group gets tx or intervention - thus decreases difference between control vs tx
Acute crisis - endometritis - pyelonephritis - thromboembolic event. 46% develop complications

2. selection bias
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
Participants selected are not representative; more or less in a particular population; prevention; randomization
Intrauterine exposure to virus causing pericarditis
FSH - LH is increased at certain point of regular mens

3. What are the absolute contraindication of OCP?
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Ultrasound. since helical CT scan is contraindicated
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.

4. what body fluid exposure needs standard precautions
Decreases risk of breast and ovarian ca
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo

5. susceptibility bias
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable

6. eisenmenger syndrome
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
Lactating women
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
Primary -similar to ITP; secondary- infection - malignancy hypersplenism - ttp or DIC

7. if ultrasound neg or inconclusive in increasd AFP - next step
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1
Copper intrauterine device
Amniocentesis

8. positive GBS culture in pregnancy
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
10 days course of ab x immediatly

9. OCP
Amoxi - cephalexin - nitrofurantoin
Decreases risk of breast and ovarian ca
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
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;

10. Tx of PID
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester
Retinal hemorrahge. represents vascular damage -
FSH - LH is increased at certain point of regular mens
Most common bugs - N. gonorrhoea and chlamydia... abx should cover them cefoxitin+doxy or ceftriaxone+doxy doc; surg eval if tubo ovarian abscess

11. How to measure SAAG?
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases

12. When do we screen gestational dm
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
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
Animal studies showed an adverse effect; but no studies done in pregnant women or animals

13. When to attempt ext cephalic version?
Decreases risk of breast and ovarian ca
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
On or after 37 weeks;
Very bad. both animals and human studies showed fetal risk

14. bugs for aspiration pneumonia?
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used
Mouth flora anerobes and aerobes
Long h/o pruritus - 65-75 - vulvar lump/mass
Ca 1200mg and vitamin 400-80o IU

15. indication of cesarean section in breech?
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
Large fetus - hyperextended head - footling breech - fetal distress

16. fetus in breech presentation in 28 weeks
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
Result is influenced by observer's prior knowledge of the details of studs
Most will be in cephalic by 34-36 weeks - by 36 weeks 6% will be in breech and one third will be convert to cephalic during delivery
No.

17. congenital hypoplastic left heart; normal at birth then develop heart failure
Mother taken lithium during pregnancy
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Hypoplastic left heart syndrom
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

18. Tx of LSIL
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester
Pregnancy - contraception - STD - substance abuse - emotional illness
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%

19. copious frothy green vaginal discharge - fishy odor - vulvar and vaginal pruritus - or dysuria
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk
Male phenotype - smalle testes - gynecomastia
Decreases risk of breast and ovarian ca
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

20. When to call a pap smear unsatisfactory?
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
Copper intrauterine device
<5000 well visualized squamus cells/contain blood
Acute crisis - endometritis - pyelonephritis - thromboembolic event. 46% develop complications

21. how lactating mother will get metronidazol
2g po single dose; discontinue breast feeding for 12-24 hours
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)
Pregancy test

22. who is emancipated minor?
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties
No.
Don't give a patient with intact uterus. increases endometr hyperplasia/ca
Self sufficient - no longer living with parent. parents of children

23. what to test in perimenopause - FSH or LH
FSH - LH is increased at certain point of regular mens
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
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

24. How to dx septic abortion
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Failure of fetal shoulder to pass through maternal pelvis
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
11%; doesn't increase risk of abortion; repositioned from retroverted to anterior position at 12-16w

25. What is likelihood ratio?
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
Very bad. both animals and human studies showed fetal risk

26. breast development but no pubic/axillary hair

27. How to evaluate nephrolithiasis in pregnancy?
Control group gets tx or intervention - thus decreases difference between control vs tx
Trichomonas; petetchia in vagina and cervix
Ultrasound. since helical CT scan is contraindicated
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap

28. excessive mentrual bleeding in adolescent
DUB resulting from anovulation. anovulation means no progesterone release from C luteum--so unopposed estrogen causes excessive endometrial growth and ultimately outgrows blood supply...tear them down...cause heavy bleeding tx; ocp
Male phenotype - smalle testes - gynecomastia
Route of delivery (3% of vaginal birth and 15-30% of c-section)
Crosses placenta - cause bilat congenital deafness -

29. HRT in postmenopausal women vs younger patient with premat ovarian failure
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta

30. bacteriuria diagnosed incidentaly during pregnancy with no symptoms
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Mouth flora anerobes and aerobes
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
No.

31. when delivery is failure to progress?

32. Tx of chlamydia in pregnancy
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Fetal hyperinsulinemia and hypoglycemia and macrosomia
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used

33. Tx of complicated UTI (fever/flank pain)
On or after 37 weeks;
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
<1%; no special measure is taken if prevent transmission
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version

34. When to dx ttp?
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
Cervix hasn't dilated beyond 4 cm in 2 h
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
X linked recessive due to deficiency of factor VIII

35. What is internal podalic version
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)
10 days course of ab x immediatly

36. puppp
Giving zidovudine to pregnant and newborn; it deceased by 70%.
Retinal hemorrahge. represents vascular damage -
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities

37. when an adolescent will get care without parental consent
Carbamazepine and valproate - ask why
Pregnancy - contraception - STD - substance abuse - emotional illness
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth

38. What is most common cause of ascitis in us
Hepatic cirrhosis
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
Don't give a patient with intact uterus. increases endometr hyperplasia/ca
Platelet <50k - or develop early in pregnancy

39. most common cause of posmenopausal bleeding
Atrophic vaginitis 50-60%; endometrial ca 10%
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream
Young females - due to inadequate urethral support. incr intra abd pressure--leakage of urine; dx ask patient to give vigorous cough - leakage of urine..suggest stress incontinence
Amniocentesis

40. primary and secondary HIV thrombocytopenia and
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
If patient has positive PPD and no active TB in CXR or sputum
Primary -similar to ITP; secondary- infection - malignancy hypersplenism - ttp or DIC
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine

41. failure rate of OCP
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
Hypoplastic left heart syndrom
Mouth flora anerobes and aerobes
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%

42. Why fluoroquinoloes contraindicate in pregnancy?
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases
Cross placenta--concentrate in amniotic fluid---fetal arthopathy
Most will be in cephalic by 34-36 weeks - by 36 weeks 6% will be in breech and one third will be convert to cephalic during delivery
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used

43. indication of chorionic villous sampling
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Primary -similar to ITP; secondary- infection - malignancy hypersplenism - ttp or DIC
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down

44. emergency contraception
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
Ultrasound. since helical CT scan is contraindicated
Eqinovarus foot - amniotic fluid loss
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg

45. rec for folate supple during preg
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
0.4-4mg daily for >1m prior conception to entire first trimester
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd
Most will be in cephalic by 34-36 weeks - by 36 weeks 6% will be in breech and one third will be convert to cephalic during delivery

46. What is shoulder dystocia?
Magneisium sulphate; give antihypergensive when bp >160/105
Eqinovarus foot - amniotic fluid loss
Indinavir; it precipitate in urine and obstruct urinary flow.
Failure of fetal shoulder to pass through maternal pelvis

47. vaccine sched for infants of HepB pos mother
Don't give a patient with intact uterus. increases endometr hyperplasia/ca
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI
Intrauterine exposure to virus causing pericarditis
Long h/o pruritus - 65-75 - vulvar lump/mass

48. teratogenicity of genta
Male phenotype - smalle testes - gynecomastia
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Crosses placenta - cause bilat congenital deafness -
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination

49. differences between PMS and PMDD
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
Decreases risk of breast and ovarian ca
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.

50. can eisenmenger patient have pregnancy
Chorionic villous sampling or amniocentesis for fetal karyotyping
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis