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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. long term prognosis of congenital HOCM
Large fetus - hyperextended head - footling breech - fetal distress
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg

2. when endometrial bx indicated in perimenopause?
Ultrasound for detail anatomic survey
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
Very bad. both animals and human studies showed fetal risk
Don't give a patient with intact uterus. increases endometr hyperplasia/ca

3. vaccine sched for infants of HepB pos mother
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI
X linked recessive due to deficiency of factor VIII
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD
If patient has positive PPD and no active TB in CXR or sputum

4. How to confirm bacterial vaginosis
Clue cells in the vaginal smear
<1%; no special measure is taken if prevent transmission
Chorionic villous sampling or amniocentesis for fetal karyotyping
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities

5. When to renal US in complicated UTI in preg

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6. How to measure SAAG?
Ultrasound for detail anatomic survey
Amniocentesis
Carbamazepine and valproate - ask why
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S

7. should patient continue antiepileptic during pregnancy?
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD
Yea. except valproate. give high dose folic acid patient is conneuing preg
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP

8. Tx of HELLP syndrome micorangi hem anemia - inc LFT - dec platelet
Magneisium sulphate; give antihypergensive when bp >160/105
Crosses placenta - cause bilat congenital deafness -
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli
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;

9. ASCUS on pap smear
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
<5000 well visualized squamus cells/contain blood
Atrophic vaginitis 50-60%; endometrial ca 10%
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow

10. differences between PMS and PMDD
Low risk women with satisfactory pap and negative cytology result
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
If patient doesn't improve in 48h to r/o perinephric abscess or calculi
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present

11. pruritus in pregnancy
Mother taken lithium during pregnancy
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Nitrofurantoin-first gen cephalosporn
Ultrasound for detail anatomic survey

12. how maternal dm cause HOCM in infants
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy
They have glycogen deposition in myocardium mostly affected inthe interventricular septum
X linked recessive due to deficiency of factor VIII
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation

13. What is extremely ominous sign of preecalmsia/eclampsia
Long h/o pruritus - 65-75 - vulvar lump/mass
Retinal hemorrahge. represents vascular damage -
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine

14. teratogenicity of genta
If patient has positive PPD and no active TB in CXR or sputum
Crosses placenta - cause bilat congenital deafness -
Copper intrauterine device
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID

15. How to dx overflow incontinence?
Result is influenced by observer's prior knowledge of the details of studs
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester

16. How to dx down syndrom?
Primary -similar to ITP; secondary- infection - malignancy hypersplenism - ttp or DIC
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)
Mouth flora anerobes and aerobes
Clue cells in the vaginal smear

17. what if patient has less than 2 of centor criteria
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;
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
Likely viral meningitis
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis

18. does normal HbA1c eliminate need for dm screening
Animal studies showed an adverse effect; but no studies done in pregnant women or animals
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
Eqinovarus foot - amniotic fluid loss
No.

19. observer bias

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20. what insulin is given in pregnancy?
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
No.
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present
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

21. teratogenicity of sulphonylurea?
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc
Fetal hyperinsulinemia and hypoglycemia and macrosomia
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
Eqinovarus foot - amniotic fluid loss

22. bacteriuria diagnosed incidentaly during pregnancy with no symptoms
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
Very bad. both animals and human studies showed fetal risk

23. How to tx anogenital warts

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24. can eisenmenger patient have pregnancy
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Mother taken lithium during pregnancy
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Amoxi - cephalexin - nitrofurantoin

25. eisenmenger syndrome
Male phenotype - smalle testes - gynecomastia
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
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd

26. most common cause of posmenopausal bleeding
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Atrophic vaginitis 50-60%; endometrial ca 10%
Carbamazepine and valproate - ask why
Ultrasound for detail anatomic survey

27. When to give INH prophylaxis
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used
If patient has positive PPD and no active TB in CXR or sputum
If patient doesn't improve in 48h to r/o perinephric abscess or calculi

28. When to dx ITP?
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy
Platelet <50k - or develop early in pregnancy
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
Lactating women

29. pregnancy category D drugs
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1
Most common bugs - N. gonorrhoea and chlamydia... abx should cover them cefoxitin+doxy or ceftriaxone+doxy doc; surg eval if tubo ovarian abscess
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF

30. patient with eclamsia - MOST effective strategy
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD
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;
Large fetus - hyperextended head - footling breech - fetal distress

31. atrophic vaginitis
10 days course of ab x immediatly
Ultrasound. since helical CT scan is contraindicated
Crosses placenta - cause bilat congenital deafness -
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream

32. history of preeclampsia
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
FSH - LH is increased at certain point of regular mens
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products

33. rec for folate supple during preg
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose
0.4-4mg daily for >1m prior conception to entire first trimester
Result is influenced by observer's prior knowledge of the details of studs

34. Is ocp contraindicated in migraine?
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli

35. dysmenorrhoea after years of painless menstruation
X linked recessive due to deficiency of factor VIII
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
On or after 37 weeks;
Retinal hemorrahge. represents vascular damage -

36. hemophillia- mom carrier and dad healthy
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
On or after 37 weeks;
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur

37. Tx of chlamydia
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used
X linked recessive due to deficiency of factor VIII
Ultrasound for detail anatomic survey
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.

38. laser cone biopsy for CIN and hx of spont abortion
Fetal hyperinsulinemia and hypoglycemia and macrosomia
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities

39. When to dx gestational thrombocytopenia?
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth
Acute crisis - endometritis - pyelonephritis - thromboembolic event. 46% develop complications
Likely viral meningitis
Participants selected are not representative; more or less in a particular population; prevention; randomization

40. Tx of PID
Most common bugs - N. gonorrhoea and chlamydia... abx should cover them cefoxitin+doxy or ceftriaxone+doxy doc; surg eval if tubo ovarian abscess
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Likely viral meningitis
Decreases risk of breast and ovarian ca

41. when an adolescent will get care without parental consent
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Route of delivery (3% of vaginal birth and 15-30% of c-section)
Pregnancy - contraception - STD - substance abuse - emotional illness
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;

42. What is shoulder dystocia?
Ultrasound. since helical CT scan is contraindicated
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Decreases risk of breast and ovarian ca
Failure of fetal shoulder to pass through maternal pelvis

43. What is likelihood ratio?
Junction of squamus and glandular cells at the external cervical os
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)

44. pregnancy risk category B drugs
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
Route of delivery (3% of vaginal birth and 15-30% of c-section)

45. How to dx septic abortion
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
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
Amniocentesis
Very bad. both animals and human studies showed fetal risk

46. What is the cause infertility in PCOD
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD

47. budd chiairi syndrom
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Intrauterine exposure to virus causing pericarditis
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1
Male phenotype - smalle testes - gynecomastia

48. Tx of UTI in pregnancy
Ultrasound for detail anatomic survey
Amoxi - cephalexin - nitrofurantoin
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
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

49. what test is absolutely necessary before treating an woman at reproductive age
Male phenotype - smalle testes - gynecomastia
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
Pregancy test
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream

50. complication of sickle cell during pregnancy
Acute crisis - endometritis - pyelonephritis - thromboembolic event. 46% develop complications
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
RCT shows no fetal risk or possiblity