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USMLE Step3 Gynecology Obstetrics

Subjects : health-sciences, usmle-step-3

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. breast development but no pubic/axillary hair

2. what component of cervix has greatest risk for neoplasia?
Junction of squamus and glandular cells at the external cervical os
X linked recessive due to deficiency of factor VIII
Copper intrauterine device
95 and 120

3. breast feeding with anti-epileptic drugs?
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID
Very bad. both animals and human studies showed fetal risk
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
Fetal hyperinsulinemia and hypoglycemia and macrosomia

4. indication of chorionic villous sampling
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth
Trichomonas; petetchia in vagina and cervix
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation

5. criteria for gestational transient thyrotoxicosis?
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties
Magneisium sulphate; give antihypergensive when bp >160/105
Don't give a patient with intact uterus. increases endometr hyperplasia/ca
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream

6. should patient continue antiepileptic during pregnancy?
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
Yea. except valproate. give high dose folic acid patient is conneuing preg
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties

7. OCP
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Decreases risk of breast and ovarian ca
0.4-4mg daily for >1m prior conception to entire first trimester

8. pregnancy category C drugs
If patient has positive PPD and no active TB in CXR or sputum
Animal studies showed an adverse effect; but no studies done in pregnant women or animals
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
Retinal hemorrahge. represents vascular damage -

9. how lactating mother will get metronidazol
2g po single dose; discontinue breast feeding for 12-24 hours
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Atrophic vaginitis 50-60%; endometrial ca 10%
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd

10. who is emancipated minor?
Hypoplastic left heart syndrom
Self sufficient - no longer living with parent. parents of children
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx

11. What is perimenopause?
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Low risk women with satisfactory pap and negative cytology result

12. complication of sickle cell during pregnancy
Very bad. both animals and human studies showed fetal risk
Hepatic cirrhosis
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Acute crisis - endometritis - pyelonephritis - thromboembolic event. 46% develop complications

13. How to dx down syndrom?
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)
They have glycogen deposition in myocardium mostly affected inthe interventricular septum
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version

14. what anti-TB drugs are contraindicated in pregnancy?
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
RCT shows no fetal risk or possiblity
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;

15. Can patient with sickle cell disesase get ocp?
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Not encouraged; no clear study
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI

16. Tx of PMS/PMDD

17. Should women continue HAART during pregnancy?
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
Route of delivery (3% of vaginal birth and 15-30% of c-section)
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
Amniocentesis

18. What are the recommended FBS and 2h posprandial BG in pregnant?
2g po single dose; discontinue breast feeding for 12-24 hours
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)
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
95 and 120

19. differential dx of increased AFP in pregnant mom?
Mouth flora anerobes and aerobes
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%

20. When to give INH prophylaxis
Very bad. both animals and human studies showed fetal risk
Crosses placenta - cause bilat congenital deafness -
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream
If patient has positive PPD and no active TB in CXR or sputum

21. What is shoulder dystocia?
Pregnancy - contraception - STD - substance abuse - emotional illness
Failure of fetal shoulder to pass through maternal pelvis
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
Result is influenced by observer's prior knowledge of the details of studs

22. What is the cause infertility in PCOD
If patient doesn't improve in 48h to r/o perinephric abscess or calculi
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate
Hypoplastic left heart syndrom
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.

23. standard test performed in prenatal visit?
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate
Decreases risk of breast and ovarian ca
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester

24. parameters measured in subsequent visit of pregnancy?
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine

25. teratogenicity of genta
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Crosses placenta - cause bilat congenital deafness -

26. Tx of chlamydia in pregnancy
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;
Trichomonas; petetchia in vagina and cervix
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common

27. What are the absolute contraindication of OCP?
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate
Male phenotype - smalle testes - gynecomastia
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%

28. rectocele
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
Hypoplastic left heart syndrom
Symptomatic tx pessary. - definitive tex ; surgical repair posterior colporrhaphy
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis

29. positive GBS culture in pregnancy
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
Mother taken lithium during pregnancy
Amniocentesis

30. When to dx ITP?
Platelet <50k - or develop early in pregnancy
Hypoplastic left heart syndrom
Giving zidovudine to pregnant and newborn; it deceased by 70%.
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

31. What is likelihood ratio?
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
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
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided

32. what body fluid exposure needs standard precautions
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine
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
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep

33. 6 cm cervical dilation - no improv in 2 h -fetus in zero station
Atrophic vaginitis 50-60%; endometrial ca 10%
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;
Junction of squamus and glandular cells at the external cervical os

34. indication of cesarean section in breech?
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose
Mother taken lithium during pregnancy
Large fetus - hyperextended head - footling breech - fetal distress
Animal studies showed an adverse effect; but no studies done in pregnant women or animals

35. if ultrasound neg or inconclusive in increasd AFP - next step
Amniocentesis
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
10 days course of ab x immediatly
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.

36. How to evaluate nephrolithiasis in pregnancy?
Carbamazepine and valproate - ask why
<5000 well visualized squamus cells/contain blood
Ultrasound. since helical CT scan is contraindicated
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI

37. association of myelomeningocele?
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Increase serum free T4; serum Tsh <0.01
Amoxi - cephalexin - nitrofurantoin

38. Tx of complicated UTI (fever/flank pain)
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)
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester

39. what test is absolutely necessary before treating an woman at reproductive age
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Pregancy test
Long h/o pruritus - 65-75 - vulvar lump/mass
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli

40. what to test in perimenopause - FSH or LH
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose
FSH - LH is increased at certain point of regular mens
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP

41. What is most common cause of ascitis in us
Hepatic cirrhosis
Long h/o pruritus - 65-75 - vulvar lump/mass
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI

42. rate of transmission of HPV from anogenital wart during delivery
Not encouraged; no clear study
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)
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD
<1%; no special measure is taken if prevent transmission

43. What is internal podalic version
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version

44. 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;
Ca 1200mg and vitamin 400-80o IU
Ultrasound. since helical CT scan is contraindicated
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks

45. failure rate of OCP
Cervix hasn't dilated beyond 4 cm in 2 h
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep
Participants selected are not representative; more or less in a particular population; prevention; randomization

46. Is ocp contraindicated in migraine?
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP

47. When to dx gestational thrombocytopenia?
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
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
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth

48. primary and secondary HIV thrombocytopenia and
Primary -similar to ITP; secondary- infection - malignancy hypersplenism - ttp or DIC
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used

49. how ppd works?
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
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
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out

50. susceptibility bias
2g po single dose; discontinue breast feeding for 12-24 hours
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
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