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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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1. pregnancy risk category A
RCT shows no fetal risk or possiblity
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)
Lactating women
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP

2. What are the absolute contraindication of OCP?
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S
Mouth flora anerobes and aerobes
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI

3. cause of amenorrhoea in athelet
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy
Ultrasound. since helical CT scan is contraindicated

4. pregnancy category X
Very bad. both animals and human studies showed fetal risk
Result is influenced by observer's prior knowledge of the details of studs
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks

5. complications of PMS?
80% develop psychiatric illness - depression
Participants selected are not representative; more or less in a particular population; prevention; randomization
Amoxi - cephalexin - nitrofurantoin
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. failure rate of OCP
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Yea. except valproate. give high dose folic acid patient is conneuing preg
FSH - LH is increased at certain point of regular mens

7. most common cause of posmenopausal bleeding
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc
Atrophic vaginitis 50-60%; endometrial ca 10%
Bacterial vaginosis; 5-60 women and 10-29% pregnant women
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties

8. 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
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
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

9. What is internal podalic version
Likely viral meningitis
Giving zidovudine to pregnant and newborn; it deceased by 70%.
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version

10. How HIV risk of transmission to newborn is decreased
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
Giving zidovudine to pregnant and newborn; it deceased by 70%.
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene

11. What is the recommendation for Ca and vitamin supplement >50yrs women
Platelet <50k - or develop early in pregnancy
If patient has positive PPD and no active TB in CXR or sputum
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
Ca 1200mg and vitamin 400-80o IU

12. vaginal disch - ph>4.5 - presence of clue cells in wet mount - foul smelling fishy odor - koh application-amine odor
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli
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
Carbamazepine and valproate - ask why

13. breast feeding with anti-epileptic drugs?
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
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
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate

14. congenital hypoplastic left heart; normal at birth then develop heart failure
Hypoplastic left heart syndrom
Atrophic vaginitis 50-60%; endometrial ca 10%
Yea. except valproate. give high dose folic acid patient is conneuing preg
Likely viral meningitis

15. parameters measured in subsequent visit of pregnancy?
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Inherited metabolic disorders - intrauterine infections - cri du chat
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties

16. can eisenmenger patient have pregnancy
Symptomatic tx pessary. - definitive tex ; surgical repair posterior colporrhaphy
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination

17. what anti-TB drugs are contraindicated in pregnancy?
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used
80% develop psychiatric illness - depression

18. what insulin is given in pregnancy?
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
Ultrasound for detail anatomic survey
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

19. Tx of chlamydia
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Increase serum free T4; serum Tsh <0.01
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.

20. differential trichominiasis and cadiidiasis?
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.
Hypoplastic left heart syndrom
Crosses placenta - cause bilat congenital deafness -
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis

21. pg I2 and throboxane A2 ratio
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Increase in pregnancy; decreases in preeclam/eclamsia

22. Tx of chlamydia in pregnancy
Amoxi - cephalexin - nitrofurantoin
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used

23. Major cause of PPH
Pregnancy - contraception - STD - substance abuse - emotional illness
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis

24. eisenmenger syndrome
Mouth flora anerobes and aerobes
2g po single dose; discontinue breast feeding for 12-24 hours
95 and 120
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

25. pruritus in pregnancy
Increase serum free T4; serum Tsh <0.01
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
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
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta

26. does normal HbA1c eliminate need for dm screening
Self sufficient - no longer living with parent. parents of children
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
No.
0.4-4mg daily for >1m prior conception to entire first trimester

27. hemophillia
X linked recessive due to deficiency of factor VIII
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Mother taken lithium during pregnancy
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required

28. emergency contraception
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
Amniocentesis

29. should patient continue antiepileptic during pregnancy?
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate
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
Yea. except valproate. give high dose folic acid patient is conneuing preg
Very bad. both animals and human studies showed fetal risk

30. How to measure SAAG?
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S
Junction of squamus and glandular cells at the external cervical os
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation

31. what to test in perimenopause - FSH or LH
On or after 37 weeks;
Result is influenced by observer's prior knowledge of the details of studs
FSH - LH is increased at certain point of regular mens
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable

32. SAAG <1.1
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
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.
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used
10 days course of ab x immediatly

33. lower lobe pneumonia- possible etiology
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
Pregancy test
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities

34. criteria for gestational transient thyrotoxicosis?
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties
No.
Amoxi - cephalexin - nitrofurantoin

35. What is likelihood ratio?
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine

36. OCP
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis
Inherited metabolic disorders - intrauterine infections - cri du chat
Magneisium sulphate; give antihypergensive when bp >160/105
Decreases risk of breast and ovarian ca

37. complication of sickle cell during pregnancy
Acute crisis - endometritis - pyelonephritis - thromboembolic event. 46% develop complications
They have glycogen deposition in myocardium mostly affected inthe interventricular septum
Betamethason - dexamethason IM
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep

38. How to dx septic abortion
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
Self sufficient - no longer living with parent. parents of children
Giving zidovudine to pregnant and newborn; it deceased by 70%.

39. if ultrasound neg or inconclusive in increasd AFP - next step
Amniocentesis
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
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
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.

40. complication of amniocentesis?
Eqinovarus foot - amniotic fluid loss
Atrophic vaginitis 50-60%; endometrial ca 10%
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
0.4-4mg daily for >1m prior conception to entire first trimester

41. time of last tetanus booster >10 or unknown
RCT shows no fetal risk or possiblity
Low risk women with satisfactory pap and negative cytology result
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID

42. herpes gestationis or pemphigoid gestationis
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI
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
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.
Eqinovarus foot - amniotic fluid loss

43. Klinefelter
Male phenotype - smalle testes - gynecomastia
Betamethason - dexamethason IM
Likely viral meningitis
Mouth flora anerobes and aerobes

44. how maternal dm cause HOCM in infants
They have glycogen deposition in myocardium mostly affected inthe interventricular septum
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
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
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF

45. What is definitive dx of down syndrome?
Cervix hasn't dilated beyond 4 cm in 2 h
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.
Chorionic villous sampling or amniocentesis for fetal karyotyping
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli

46. What is the cause infertility in PCOD
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate
Crosses placenta - cause bilat congenital deafness -
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
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

47. congenital constrictive pericarditis in children
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Intrauterine exposure to virus causing pericarditis
Amoxi - cephalexin - nitrofurantoin

48. selection bias
2g po single dose; discontinue breast feeding for 12-24 hours
Trichomonas; petetchia in vagina and cervix
Participants selected are not representative; more or less in a particular population; prevention; randomization
<1%; no special measure is taken if prevent transmission

49. positive GBS culture in pregnancy
Bacterial vaginosis; 5-60 women and 10-29% pregnant women
Participants selected are not representative; more or less in a particular population; prevention; randomization
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
10 days course of ab x immediatly

50. dx postpartum endometritis
Magneisium sulphate; give antihypergensive when bp >160/105
On or after 37 weeks;
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Low risk women with satisfactory pap and negative cytology result