Test your basic knowledge |

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. complication of sickle cell during pregnancy
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate
Acute crisis - endometritis - pyelonephritis - thromboembolic event. 46% develop complications
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
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;

2. if AFP inc - next step?
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used
Ultrasound for detail anatomic survey
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
Platelet <50k - or develop early in pregnancy

3. eisenmenger syndrome
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
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
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine

4. positive GBS culture in pregnancy
10 days course of ab x immediatly
Nitrofurantoin-first gen cephalosporn
Decreases risk of breast and ovarian ca
Mouth flora anerobes and aerobes

5. What is centor's criteria?
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep
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

6. What is the cause infertility in PCOD
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo
95 and 120
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate

7. pregnant adolescent
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
Bacterial vaginosis; 5-60 women and 10-29% pregnant women
Incr perinatal mortality - pretem delivery - premature and LBW

8. pg I2 and throboxane A2 ratio
Increase in pregnancy; decreases in preeclam/eclamsia
Result is influenced by observer's prior knowledge of the details of studs
Retinal hemorrahge. represents vascular damage -
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta

9. How to dx anogenital warts (condyloma acuminata)
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
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
Ultrasound for detail anatomic survey
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms

10. emergency contraception
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Copper intrauterine device

11. Tx of UTI in pregnancy
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
RCT shows no fetal risk or possiblity
Amoxi - cephalexin - nitrofurantoin
If patient has positive PPD and no active TB in CXR or sputum

12. rate of transmission of HPV from anogenital wart during delivery
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
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
<1%; no special measure is taken if prevent transmission
Ultrasound for detail anatomic survey

13. when young female can develop osteoporosis?
Magneisium sulphate; give antihypergensive when bp >160/105
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
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
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)

14. selection bias
Carbamazepine and valproate - ask why
Participants selected are not representative; more or less in a particular population; prevention; randomization
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo
11%; doesn't increase risk of abortion; repositioned from retroverted to anterior position at 12-16w

15. What HIV med cause crystal induced nephropathy?
Route of delivery (3% of vaginal birth and 15-30% of c-section)
Ca 1200mg and vitamin 400-80o IU
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI
Indinavir; it precipitate in urine and obstruct urinary flow.

16. when delivery is failure to progress?

17. What is cdc recommendation for chlamydia screen in pregnancy
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Increase in pregnancy; decreases in preeclam/eclamsia
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
Chorionic villous sampling or amniocentesis for fetal karyotyping

18. Who uses progesterone only pills or mini pill
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
Lactating women

19. stress incontinence
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities
Likely viral meningitis
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine
Bacterial vaginosis; 5-60 women and 10-29% pregnant women

20. pregnant women with positive FTA-ABS or treponemal tests
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
Primary -similar to ITP; secondary- infection - malignancy hypersplenism - ttp or DIC
Acute crisis - endometritis - pyelonephritis - thromboembolic event. 46% develop complications
Copper intrauterine device

21. primary and secondary HIV thrombocytopenia and
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate
Primary -similar to ITP; secondary- infection - malignancy hypersplenism - ttp or DIC

22. How to dx septic abortion
11%; doesn't increase risk of abortion; repositioned from retroverted to anterior position at 12-16w
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate

23. unilateral breast discharges
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities
Ca 1200mg and vitamin 400-80o IU
Copper intrauterine device

24. How to measure SAAG?
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S
If patient has positive PPD and no active TB in CXR or sputum
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
Junction of squamus and glandular cells at the external cervical os

25. Is ocp contraindicated in migraine?
Nitrofurantoin-first gen cephalosporn
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo

26. How to dx stress incontinence?
80% develop psychiatric illness - depression
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
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd
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

27. congenital hypoplastic left heart; normal at birth then develop heart failure
Large fetus - hyperextended head - footling breech - fetal distress
Ultrasound for detail anatomic survey
Hypoplastic left heart syndrom
0.4-4mg daily for >1m prior conception to entire first trimester

28. long term prognosis of congenital HOCM
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
They have glycogen deposition in myocardium mostly affected inthe interventricular septum
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously

29. OCP
Decreases risk of breast and ovarian ca
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
Increase in pregnancy; decreases in preeclam/eclamsia
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI

30. How to evaluate nephrolithiasis in pregnancy?
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Ultrasound. since helical CT scan is contraindicated
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine
Magneisium sulphate; give antihypergensive when bp >160/105

31. dysmenorrhoea after years of painless menstruation
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
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
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg

32. fetus in breech presentation in 28 weeks
Low risk women with satisfactory pap and negative cytology result
Hepatic cirrhosis
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
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

33. teratogenicity of sulphonylurea?
Fetal hyperinsulinemia and hypoglycemia and macrosomia
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
Male phenotype - smalle testes - gynecomastia
Incr perinatal mortality - pretem delivery - premature and LBW

34. Can patient with sickle cell disesase get ocp?
Not encouraged; no clear study
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided

35. 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
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
Ultrasound for detail anatomic survey
2g po single dose; discontinue breast feeding for 12-24 hours

36. what body fluid exposure needs standard precautions
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)
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

37. copious frothy green vaginal discharge - fishy odor - vulvar and vaginal pruritus - or dysuria
10 days course of ab x immediatly
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk
Self sufficient - no longer living with parent. parents of children
Mother taken lithium during pregnancy

38. indication of chorionic villous sampling
Betamethason - dexamethason IM
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS

39. Estrogen

40. 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
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
Atrophic vaginitis 50-60%; endometrial ca 10%

41. most common cause of posmenopausal bleeding
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
10 days course of ab x immediatly
Participants selected are not representative; more or less in a particular population; prevention; randomization
Atrophic vaginitis 50-60%; endometrial ca 10%

42. complications of PMS?
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
Amniocentesis
80% develop psychiatric illness - depression

43. Should women continue HAART during pregnancy?
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
FSH - LH is increased at certain point of regular mens
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
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient

44. Tx of complicated UTI (fever/flank pain)
Clue cells in the vaginal smear
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)

45. Tx of PID
Route of delivery (3% of vaginal birth and 15-30% of c-section)
Most common bugs - N. gonorrhoea and chlamydia... abx should cover them cefoxitin+doxy or ceftriaxone+doxy doc; surg eval if tubo ovarian abscess
They have glycogen deposition in myocardium mostly affected inthe interventricular septum
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)

46. When to dx ttp?
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli

47. bacteriuria diagnosed incidentaly during pregnancy with no symptoms
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
Retinal hemorrahge. represents vascular damage -

48. When to give INH prophylaxis
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
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.
If patient has positive PPD and no active TB in CXR or sputum
Indinavir; it precipitate in urine and obstruct urinary flow.

49. vulvar ca
Long h/o pruritus - 65-75 - vulvar lump/mass
They have glycogen deposition in myocardium mostly affected inthe interventricular septum
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
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.

50. Tx of LSIL with unsatisfactory colpo
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
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
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