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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.
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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. what if patient has less than 2 of centor criteria
Hepatic cirrhosis
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties
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
Likely viral meningitis

2. Estrogen

3. association of myelomeningocele?
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
Received inadequate dose post partum in the events of fetomaternal hemorrhage; rosette test-qualiatively detemine and Kleihauer-Betke use cytometry of fetal red cells; dose of anti-D should adjusted based on KB test.
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Not encouraged; no clear study

4. what drugs are used to decrease riks of infant resp distress syndrome in cases of preterm delivery
Betamethason - dexamethason IM
Acute crisis - endometritis - pyelonephritis - thromboembolic event. 46% develop complications
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS

5. What is the recommendation for Ca and vitamin supplement >50yrs women
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Ca 1200mg and vitamin 400-80o IU
Clue cells in the vaginal smear
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow

6. How to evaluate nephrolithiasis in pregnancy?
<5000 well visualized squamus cells/contain blood
Intrauterine exposure to virus causing pericarditis
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
Ultrasound. since helical CT scan is contraindicated

7. Can patient with sickle cell disesase get ocp?
Pregancy test
Decreases risk of breast and ovarian ca
Not encouraged; no clear study
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose

8. patient on ocp - How to adjust levothyroxine dose?
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd
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
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women

9. Tx of chlamydia
Likely viral meningitis
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth
Nitrofurantoin-first gen cephalosporn
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.

10. pregnant women with positive FTA-ABS or treponemal tests
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream
95 and 120
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID

11. ASCUS on pap smear
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
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
Eqinovarus foot - amniotic fluid loss
10 days course of ab x immediatly

12. does normal HbA1c eliminate need for dm screening
10 days course of ab x immediatly
Chorionic villous sampling or amniocentesis for fetal karyotyping
Amoxi - cephalexin - nitrofurantoin
No.

13. What is the cause infertility in PCOD
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth
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;
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate

14. Tx of PMS/PMDD

15. What is internal podalic version
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
Intrauterine exposure to virus causing pericarditis
Bacterial vaginosis; 5-60 women and 10-29% pregnant women

16. parameters measured in subsequent visit of pregnancy?
Likely viral meningitis
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)
Giving zidovudine to pregnant and newborn; it deceased by 70%.
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose

17. congenital dilated cardiomyopathy
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
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
Retinal hemorrahge. represents vascular damage -
Inherited metabolic disorders - intrauterine infections - cri du chat

18. what insulin is given in pregnancy?
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
Likely viral meningitis

19. congenital constrictive pericarditis in children
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Lactating women
Intrauterine exposure to virus causing pericarditis
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg

20. pregnancy category D drugs
Betamethason - dexamethason IM
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
Animal studies showed an adverse effect; but no studies done in pregnant women or animals

21. rate of transmission of HPV from anogenital wart during delivery
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc
<1%; no special measure is taken if prevent transmission
95 and 120

22. How to dx down syndrom?
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
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)

23. emergency contraception
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
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
Most common bugs - N. gonorrhoea and chlamydia... abx should cover them cefoxitin+doxy or ceftriaxone+doxy doc; surg eval if tubo ovarian abscess

24. susceptibility bias
Result is influenced by observer's prior knowledge of the details of studs
Hypoplastic left heart syndrom
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap

25. hemophillia
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Magneisium sulphate; give antihypergensive when bp >160/105
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties
X linked recessive due to deficiency of factor VIII

26. When to call a pap smear unsatisfactory?
Result is influenced by observer's prior knowledge of the details of studs
Participants selected are not representative; more or less in a particular population; prevention; randomization
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

27. teratogenicity of sulphonylurea?
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
Fetal hyperinsulinemia and hypoglycemia and macrosomia

28. complication of amniocentesis?
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream
Eqinovarus foot - amniotic fluid loss
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Nitrofurantoin-first gen cephalosporn

29. When to dx ITP?
Chorionic villous sampling or amniocentesis for fetal karyotyping
Platelet <50k - or develop early in pregnancy
Participants selected are not representative; more or less in a particular population; prevention; randomization
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m

30. When to dx ttp?
Hepatic cirrhosis
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
Inherited metabolic disorders - intrauterine infections - cri du chat

31. What is extremely ominous sign of preecalmsia/eclampsia
10 days course of ab x immediatly
Male phenotype - smalle testes - gynecomastia
Retinal hemorrahge. represents vascular damage -
Most common bugs - N. gonorrhoea and chlamydia... abx should cover them cefoxitin+doxy or ceftriaxone+doxy doc; surg eval if tubo ovarian abscess

32. stress incontinence
Indinavir; it precipitate in urine and obstruct urinary flow.
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine
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
Cervix hasn't dilated beyond 4 cm in 2 h

33. How to measure SAAG?
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
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
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products

34. How to dx anogenital warts (condyloma acuminata)
Ultrasound for detail anatomic survey
No.
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
FSH - LH is increased at certain point of regular mens

35. when endometrial bx indicated in perimenopause?
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
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

36. if AFP inc - next step?
Decreases risk of breast and ovarian ca
Likely viral meningitis
Increase in pregnancy; decreases in preeclam/eclamsia
Ultrasound for detail anatomic survey

37. history of preeclampsia
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
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
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF

38. selection bias
Decreases risk of breast and ovarian ca
Participants selected are not representative; more or less in a particular population; prevention; randomization
Result is influenced by observer's prior knowledge of the details of studs
Pregnancy - contraception - STD - substance abuse - emotional illness

39. hemophillia- mom carrier and dad healthy
Very bad. both animals and human studies showed fetal risk
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms

40. HRT in postmenopausal women vs younger patient with premat ovarian failure
Low risk women with satisfactory pap and negative cytology result
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Participants selected are not representative; more or less in a particular population; prevention; randomization
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk

41. congenital hypoplastic left heart; normal at birth then develop heart failure
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
Hypoplastic left heart syndrom
Incr perinatal mortality - pretem delivery - premature and LBW
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m

42. criteria of hyperthyroidism in pregnancy?
Increase serum free T4; serum Tsh <0.01
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
Yea. except valproate. give high dose folic acid patient is conneuing preg

43. SAAG <1.1
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd
Ultrasound for detail anatomic survey

44. Tx of LSIL with unsatisfactory colpo
Atrophic vaginitis 50-60%; endometrial ca 10%
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
FSH - LH is increased at certain point of regular mens
Chorionic villous sampling or amniocentesis for fetal karyotyping

45. time of last tetanus booster >10 or unknown
<1%; no special measure is taken if prevent transmission
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID

46. primary and secondary HIV thrombocytopenia and
Primary -similar to ITP; secondary- infection - malignancy hypersplenism - ttp or DIC
Animal studies showed an adverse effect; but no studies done in pregnant women or animals
On or after 37 weeks;
Low risk women with satisfactory pap and negative cytology result

47. Tx of complicated UTI (fever/flank pain)
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
Not encouraged; no clear study
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
Result is influenced by observer's prior knowledge of the details of studs

48. Should women continue HAART during pregnancy?
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
Not encouraged; no clear study
Received inadequate dose post partum in the events of fetomaternal hemorrhage; rosette test-qualiatively detemine and Kleihauer-Betke use cytometry of fetal red cells; dose of anti-D should adjusted based on KB test.
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided

49. pregnancy category X
Copper intrauterine device
Very bad. both animals and human studies showed fetal risk
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Mother taken lithium during pregnancy

50. pregnancy risk category B drugs
Chorionic villous sampling or amniocentesis for fetal karyotyping
Likely viral meningitis
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth