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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. who is emancipated minor?
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
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
Self sufficient - no longer living with parent. parents of children
Mother taken lithium during pregnancy

2. What is centor's criteria?
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
<5000 well visualized squamus cells/contain blood
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

3. pregnancy category C drugs
Animal studies showed an adverse effect; but no studies done in pregnant women or animals
95 and 120
Eqinovarus foot - amniotic fluid loss
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version

4. breast development but no pubic/axillary hair

5. rec for folate supple during preg
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
Mother taken lithium during pregnancy
0.4-4mg daily for >1m prior conception to entire first trimester
Indinavir; it precipitate in urine and obstruct urinary flow.

6. herpes gestationis or pemphigoid gestationis
Carbamazepine and valproate - ask why
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
Magneisium sulphate; give antihypergensive when bp >160/105
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.

7. if AFP inc - next step?
FSH - LH is increased at certain point of regular mens
Ultrasound for detail anatomic survey
0.4-4mg daily for >1m prior conception to entire first trimester
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1

8. What are the absolute contraindication of OCP?
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Inherited metabolic disorders - intrauterine infections - cri du chat
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1

9. congenital hypoplastic left heart; normal at birth then develop heart failure
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;
Eqinovarus foot - amniotic fluid loss
Hypoplastic left heart syndrom
Amoxi - cephalexin - nitrofurantoin

10. Major cause of PPH
Platelet <50k - or develop early in pregnancy
Amoxi - cephalexin - nitrofurantoin
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
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products

11. complications of PMS?
Amoxi - cephalexin - nitrofurantoin
80% develop psychiatric illness - depression
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
Incr perinatal mortality - pretem delivery - premature and LBW

12. what drugs are used to decrease riks of infant resp distress syndrome in cases of preterm delivery
Betamethason - dexamethason IM
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S

13. excessive mentrual bleeding in adolescent
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
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
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

14. ebstein anomaly or atrialized right ventricle; p/w cyanosis in infancy
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth
Mother taken lithium during pregnancy
<1%; no special measure is taken if prevent transmission
X linked recessive due to deficiency of factor VIII

15. vulvar ca
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
Long h/o pruritus - 65-75 - vulvar lump/mass
<1%; no special measure is taken if prevent transmission

16. Can patient with sickle cell disesase get ocp?
Not encouraged; no clear study
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD
Atrophic vaginitis 50-60%; endometrial ca 10%

17. pruritus in pregnancy
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth
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
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
No.

18. What is the cause infertility in PCOD
Increase in pregnancy; decreases in preeclam/eclamsia
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
2g po single dose; discontinue breast feeding for 12-24 hours

19. contamination bias
Control group gets tx or intervention - thus decreases difference between control vs tx
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Large fetus - hyperextended head - footling breech - fetal distress

20. vaccine sched for infants of HepB pos mother
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
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)
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;

21. bacteriuria diagnosed incidentaly during pregnancy with no symptoms
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Junction of squamus and glandular cells at the external cervical os
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common

22. What is extremely ominous sign of preecalmsia/eclampsia
Retinal hemorrahge. represents vascular damage -
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
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
Increase serum free T4; serum Tsh <0.01

23. dysmenorrhoea after years of painless menstruation
Ultrasound. since helical CT scan is contraindicated
X linked recessive due to deficiency of factor VIII
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant

24. should patient continue antiepileptic during pregnancy?
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
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
Giving zidovudine to pregnant and newborn; it deceased by 70%.

25. How to measure SAAG?
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc

26. differential trichominiasis and cadiidiasis?
X linked recessive due to deficiency of factor VIII
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis
Long h/o pruritus - 65-75 - vulvar lump/mass
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;

27. pregnancy category D drugs
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
Ca 1200mg and vitamin 400-80o IU
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
Cervix hasn't dilated beyond 4 cm in 2 h

28. When to call a pap smear unsatisfactory?
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.
<5000 well visualized squamus cells/contain blood

29. When to bact vaginosis
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD
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;
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx

30. What is perimenopause?
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
0.4-4mg daily for >1m prior conception to entire first trimester
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles

31. When to attempt ext cephalic version?
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
2g po single dose; discontinue breast feeding for 12-24 hours
Ca 1200mg and vitamin 400-80o IU
On or after 37 weeks;

32. what component of cervix has greatest risk for neoplasia?
Amoxi - cephalexin - nitrofurantoin
Cross placenta--concentrate in amniotic fluid---fetal arthopathy
Control group gets tx or intervention - thus decreases difference between control vs tx
Junction of squamus and glandular cells at the external cervical os

33. can eisenmenger patient have pregnancy
10 days course of ab x immediatly
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.

34. Tx of UTI in pregnancy
Symptomatic tx pessary. - definitive tex ; surgical repair posterior colporrhaphy
Amoxi - cephalexin - nitrofurantoin
Animal studies showed an adverse effect; but no studies done in pregnant women or animals
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks

35. Tx of PID
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
Atrophic vaginitis 50-60%; endometrial ca 10%
Most common bugs - N. gonorrhoea and chlamydia... abx should cover them cefoxitin+doxy or ceftriaxone+doxy doc; surg eval if tubo ovarian abscess

36. atrophic vaginitis
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth

37. When to dx gestational thrombocytopenia?
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
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
Decreases risk of breast and ovarian ca
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth

38. Tx of LSIL with unsatisfactory colpo
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
Magneisium sulphate; give antihypergensive when bp >160/105
If patient doesn't improve in 48h to r/o perinephric abscess or calculi
Fetal hyperinsulinemia and hypoglycemia and macrosomia

39. when young female can develop osteoporosis?
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
Yea. except valproate. give high dose folic acid patient is conneuing preg
X linked recessive due to deficiency of factor VIII
Increase serum free T4; serum Tsh <0.01

40. if ultrasound neg or inconclusive in increasd AFP - next step
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Don't give a patient with intact uterus. increases endometr hyperplasia/ca
Amniocentesis
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk

41. Tx of HELLP syndrome micorangi hem anemia - inc LFT - dec platelet
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
Magneisium sulphate; give antihypergensive when bp >160/105
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down

42. how ppd works?
Ultrasound for detail anatomic survey
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
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth

43. 6 cm cervical dilation - no improv in 2 h -fetus in zero station
Junction of squamus and glandular cells at the external cervical os
Indinavir; it precipitate in urine and obstruct urinary flow.
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;
Retinal hemorrahge. represents vascular damage -

44. breast feeding with anti-epileptic drugs?
Increase serum free T4; serum Tsh <0.01
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.

45. when delivery is failure to progress?

46. Is ocp contraindicated in migraine?
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd
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
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
10 days course of ab x immediatly

47. risks of maternal DM
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
<1%; no special measure is taken if prevent transmission
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow

48. Tx of chlamydia
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
No.
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.
Male phenotype - smalle testes - gynecomastia

49. pregnancy risk category B drugs
Increase serum free T4; serum Tsh <0.01
Inherited metabolic disorders - intrauterine infections - cri du chat
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
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

50. What is cdc recommendation for chlamydia screen in pregnancy
Pregnancy - contraception - STD - substance abuse - emotional illness
Increase serum free T4; serum Tsh <0.01
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate