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Test your basic knowledge |
USMLE Step3 Gynecology Obstetrics
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Subjects
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health-sciences
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usmle-step-3
Instructions:
Answer 50 questions in 15 minutes.
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study here
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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. What contraception is best for sickle cell patient
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases
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
Magneisium sulphate; give antihypergensive when bp >160/105
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
2. When to dx ttp?
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.
Mother taken lithium during pregnancy
Indinavir; it precipitate in urine and obstruct urinary flow.
3. what insulin is given in pregnancy?
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk
Bacterial vaginosis; 5-60 women and 10-29% pregnant women
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
4. copious frothy green vaginal discharge - fishy odor - vulvar and vaginal pruritus - or dysuria
Lactating women
X linked recessive due to deficiency of factor VIII
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk
Hypoplastic left heart syndrom
5. HRT in postmenopausal women vs younger patient with premat ovarian failure
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Intrauterine exposure to virus causing pericarditis
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Don't give a patient with intact uterus. increases endometr hyperplasia/ca
6. congenital hypoplastic left heart; normal at birth then develop heart failure
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
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)
Hypoplastic left heart syndrom
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
7. bugs for aspiration pneumonia?
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
Mouth flora anerobes and aerobes
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
10 days course of ab x immediatly
8. Tx of UTI in pregnancy
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
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
Amoxi - cephalexin - nitrofurantoin
Long h/o pruritus - 65-75 - vulvar lump/mass
9. what body fluid exposure needs standard precautions
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo
Giving zidovudine to pregnant and newborn; it deceased by 70%.
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.
10. When do we screen gestational dm
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
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
Animal studies showed an adverse effect; but no studies done in pregnant women or animals
Mouth flora anerobes and aerobes
11. Tx of chlamydia
Atrophic vaginitis 50-60%; endometrial ca 10%
Control group gets tx or intervention - thus decreases difference between control vs tx
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.
12. hemophillia
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
Lactating women
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
X linked recessive due to deficiency of factor VIII
13. risks of maternal DM
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
0.4-4mg daily for >1m prior conception to entire first trimester
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
14. 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.
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Long h/o pruritus - 65-75 - vulvar lump/mass
On or after 37 weeks;
15. What is likelihood ratio?
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
Yea. except valproate. give high dose folic acid patient is conneuing preg
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)
16. what anti-TB drugs are contraindicated in pregnancy?
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)
Retinal hemorrahge. represents vascular damage -
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
10 days course of ab x immediatly
17. ebstein anomaly or atrialized right ventricle; p/w cyanosis in infancy
Mother taken lithium during pregnancy
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used
Cervix hasn't dilated beyond 4 cm in 2 h
18. What HIV med cause crystal induced nephropathy?
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
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present
Indinavir; it precipitate in urine and obstruct urinary flow.
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream
19. unilateral breast discharges
RCT shows no fetal risk or possiblity
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
20. Tx of HELLP syndrome micorangi hem anemia - inc LFT - dec platelet
Amniocentesis
FSH - LH is increased at certain point of regular mens
Magneisium sulphate; give antihypergensive when bp >160/105
Incr perinatal mortality - pretem delivery - premature and LBW
21. What is the complication of chorionic villous sampling
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
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)
80% develop psychiatric illness - depression
22. what to test in perimenopause - FSH or LH
Retinal hemorrahge. represents vascular damage -
FSH - LH is increased at certain point of regular mens
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
Increase in pregnancy; decreases in preeclam/eclamsia
23. differential dx of increased AFP in pregnant mom?
Increase in pregnancy; decreases in preeclam/eclamsia
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
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
24. if AFP inc - next step?
80% develop psychiatric illness - depression
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd
Ultrasound for detail anatomic survey
Decreases risk of breast and ovarian ca
25. How to dx neural tube defects on baby
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate
Magneisium sulphate; give antihypergensive when bp >160/105
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
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.
26. When to give INH prophylaxis
Chorionic villous sampling or amniocentesis for fetal karyotyping
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
If patient has positive PPD and no active TB in CXR or sputum
27. Major cause of PPH
Nitrofurantoin-first gen cephalosporn
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
28. who is emancipated minor?
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate
Crosses placenta - cause bilat congenital deafness -
Self sufficient - no longer living with parent. parents of children
29. can eisenmenger patient have pregnancy
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
95 and 120
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
30. Tx of PMS/PMDD
31. Why fluoroquinoloes contraindicate in pregnancy?
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine
Cross placenta--concentrate in amniotic fluid---fetal arthopathy
X linked recessive due to deficiency of factor VIII
32. bilateraal breast discharge
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
Pregnancy - contraception - STD - substance abuse - emotional illness
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)
33. herpes gestationis or pemphigoid gestationis
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
<1%; no special measure is taken if prevent transmission
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.
0.4-4mg daily for >1m prior conception to entire first trimester
34. how lactating mother will get metronidazol
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used
2g po single dose; discontinue breast feeding for 12-24 hours
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;
35. differences between PMS and PMDD
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present
Increase serum free T4; serum Tsh <0.01
36. parameters measured in subsequent visit of pregnancy?
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis
37. 6 cm cervical dilation - no improv in 2 h -fetus in zero station
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
Cervix hasn't dilated beyond 4 cm in 2 h
Trichomonas; petetchia in vagina and cervix
38. How to dx overflow incontinence?
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy
Junction of squamus and glandular cells at the external cervical os
39. ASCUS on pap smear
Giving zidovudine to pregnant and newborn; it deceased by 70%.
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
RCT shows no fetal risk or possiblity
Increase serum free T4; serum Tsh <0.01
40. What is cdc recommendation for chlamydia screen in pregnancy
Hepatic cirrhosis
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
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.
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
41. What is shoulder dystocia?
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
Ca 1200mg and vitamin 400-80o IU
Retinal hemorrahge. represents vascular damage -
Failure of fetal shoulder to pass through maternal pelvis
42. when an adolescent will get care without parental consent
Platelet <50k - or develop early in pregnancy
Don't give a patient with intact uterus. increases endometr hyperplasia/ca
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy
Pregnancy - contraception - STD - substance abuse - emotional illness
43. hemophillia- mom carrier and dad healthy
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
44. When to bact vaginosis
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
On or after 37 weeks;
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;
45. criteria for gestational transient thyrotoxicosis?
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
Likely viral meningitis
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties
Very bad. both animals and human studies showed fetal risk
46. How HIV risk of transmission to newborn is decreased
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
Magneisium sulphate; give antihypergensive when bp >160/105
Giving zidovudine to pregnant and newborn; it deceased by 70%.
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
47. vulvar ca
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.
Mouth flora anerobes and aerobes
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
Long h/o pruritus - 65-75 - vulvar lump/mass
48. Who uses progesterone only pills or mini pill
Pregancy test
Not encouraged; no clear study
Result is influenced by observer's prior knowledge of the details of studs
Lactating women
49. time of last tetanus booster >10 or unknown
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID
50. What are the absolute contraindication of OCP?
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
RCT shows no fetal risk or possiblity
Result is influenced by observer's prior knowledge of the details of studs
Copper intrauterine device