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USMLE Step3 Gynecology Obstetrics

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. How to dx anogenital warts (condyloma acuminata)
Mouth flora anerobes and aerobes
Hypoplastic left heart syndrom
Crosses placenta - cause bilat congenital deafness -
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

2. ASCUS on pap smear
Hepatic cirrhosis
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
Long h/o pruritus - 65-75 - vulvar lump/mass
95 and 120

3. does normal HbA1c eliminate need for dm screening
Retinal hemorrahge. represents vascular damage -
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
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
No.

4. How to dx septic abortion
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
Pregancy test
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women

5. atrophic vaginitis
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
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
If patient has positive PPD and no active TB in CXR or sputum
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream

6. pregnancy risk category A
Self sufficient - no longer living with parent. parents of children
Yea. except valproate. give high dose folic acid patient is conneuing preg
RCT shows no fetal risk or possiblity
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID

7. straberry cervix
Trichomonas; petetchia in vagina and cervix
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy
Amoxi - cephalexin - nitrofurantoin
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth

8. What contraception is best for sickle cell patient
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
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases
Ca 1200mg and vitamin 400-80o IU
Mouth flora anerobes and aerobes

9. Who uses progesterone only pills or mini pill
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Cross placenta--concentrate in amniotic fluid---fetal arthopathy
Lactating women
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene

10. what test is absolutely necessary before treating an woman at reproductive age
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Pregancy test
Long h/o pruritus - 65-75 - vulvar lump/mass
Amniocentesis

11. what anti-TB drugs are contraindicated in pregnancy?
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
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli

12. pregnancy category X
Animal studies showed an adverse effect; but no studies done in pregnant women or animals
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli
Very bad. both animals and human studies showed fetal risk
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided

13. what body fluid exposure needs standard precautions
Control group gets tx or intervention - thus decreases difference between control vs tx
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
X linked recessive due to deficiency of factor VIII

14. history of preeclampsia
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
Ultrasound for detail anatomic survey
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.

15. what if patient has less than 2 of centor criteria
<5000 well visualized squamus cells/contain blood
Likely viral meningitis
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI
Control group gets tx or intervention - thus decreases difference between control vs tx

16. pruritus in pregnancy
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Likely viral meningitis
If patient has positive PPD and no active TB in CXR or sputum
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.

17. rate of transmission of HPV from anogenital wart during delivery
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
<1%; no special measure is taken if prevent transmission
Increase serum free T4; serum Tsh <0.01
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.

18. what to test in perimenopause - FSH or LH
Mouth flora anerobes and aerobes
FSH - LH is increased at certain point of regular mens
If patient doesn't improve in 48h to r/o perinephric abscess or calculi
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo

19. should patient continue antiepileptic during pregnancy?
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used
Yea. except valproate. give high dose folic acid patient is conneuing preg
Very bad. both animals and human studies showed fetal risk
Ca 1200mg and vitamin 400-80o IU

20. indication of chorionic villous sampling
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
Ultrasound. since helical CT scan is contraindicated
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down

21. Why fluoroquinoloes contraindicate in pregnancy?
Cross placenta--concentrate in amniotic fluid---fetal arthopathy
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
Nitrofurantoin-first gen cephalosporn

22. criteria of hyperthyroidism in pregnancy?
<5000 well visualized squamus cells/contain blood
Giving zidovudine to pregnant and newborn; it deceased by 70%.
Increase serum free T4; serum Tsh <0.01
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%

23. Can patient with sickle cell disesase get ocp?
Not encouraged; no clear study
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
Cervix hasn't dilated beyond 4 cm in 2 h
<1%; no special measure is taken if prevent transmission

24. observer bias

25. What is most frequent vaginal infecton
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo
Bacterial vaginosis; 5-60 women and 10-29% pregnant women
Participants selected are not representative; more or less in a particular population; prevention; randomization

26. What is centor's criteria?
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
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo

27. What is the recommendation for Ca and vitamin supplement >50yrs women
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Ca 1200mg and vitamin 400-80o IU
Cross placenta--concentrate in amniotic fluid---fetal arthopathy
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version

28. laser cone biopsy for CIN and hx of spont abortion
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
Pregnancy - contraception - STD - substance abuse - emotional illness
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
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;

29. failure rate of OCP
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate
Platelet <50k - or develop early in pregnancy
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep

30. When to renal US in complicated UTI in preg

31. when an adolescent will get care without parental consent
Pregnancy - contraception - STD - substance abuse - emotional illness
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases
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
Route of delivery (3% of vaginal birth and 15-30% of c-section)

32. What is extremely ominous sign of preecalmsia/eclampsia
Retinal hemorrahge. represents vascular damage -
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S

33. What is definitive dx of down syndrome?
Chorionic villous sampling or amniocentesis for fetal karyotyping
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation

34. pg I2 and throboxane A2 ratio
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S
Increase in pregnancy; decreases in preeclam/eclamsia

35. time of last tetanus booster <10 yrs
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Self sufficient - no longer living with parent. parents of children
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
Cross placenta--concentrate in amniotic fluid---fetal arthopathy

36. emergency contraception
Lactating women
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
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate

37. teratogenicity of sulphonylurea?
Fetal hyperinsulinemia and hypoglycemia and macrosomia
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
Male phenotype - smalle testes - gynecomastia
Result is influenced by observer's prior knowledge of the details of studs

38. OCP
Decreases risk of breast and ovarian ca
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
Don't give a patient with intact uterus. increases endometr hyperplasia/ca
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present

39. breast feeding with anti-epileptic drugs?
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)
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
Betamethason - dexamethason IM

40. if ultrasound neg or inconclusive in increasd AFP - next step
Amniocentesis
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)

41. what drugs used to tx UTI in pregnacy
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
Nitrofurantoin-first gen cephalosporn

42. most common cause of hyperthyroidism in pregnant women
10 days course of ab x immediatly
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester

43. When to repeat pap in 12 months
Self sufficient - no longer living with parent. parents of children
Low risk women with satisfactory pap and negative cytology result
Indinavir; it precipitate in urine and obstruct urinary flow.
Decreases risk of breast and ovarian ca

44. emergency contraception after 120 hours
Copper intrauterine device
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
95 and 120

45. patient with eclamsia - MOST effective strategy
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;
80% develop psychiatric illness - depression
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose
Decreases risk of breast and ovarian ca

46. positive GBS culture in pregnancy
10 days course of ab x immediatly
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester
Copper intrauterine device
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow

47. Tx of LSIL
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
Mother taken lithium during pregnancy
Acute crisis - endometritis - pyelonephritis - thromboembolic event. 46% develop complications
Incr perinatal mortality - pretem delivery - premature and LBW

48. congenital hypoplastic left heart; normal at birth then develop heart failure
Male phenotype - smalle testes - gynecomastia
Not encouraged; no clear study
If patient has positive PPD and no active TB in CXR or sputum
Hypoplastic left heart syndrom

49. How HIV risk of transmission to newborn is decreased
Control group gets tx or intervention - thus decreases difference between control vs tx
Mother taken lithium during pregnancy
80% develop psychiatric illness - depression
Giving zidovudine to pregnant and newborn; it deceased by 70%.

50. if AFP inc - next step?
Ultrasound for detail anatomic survey
X linked recessive due to deficiency of factor VIII
Failure of fetal shoulder to pass through maternal pelvis
Increase serum free T4; serum Tsh <0.01