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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. When to repeat pap in 12 months
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
Low risk women with satisfactory pap and negative cytology result
Increase serum free T4; serum Tsh <0.01

2. complication of amniocentesis?
Lactating women
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Eqinovarus foot - amniotic fluid loss
Clue cells in the vaginal smear

3. congenital constrictive pericarditis in children
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
Intrauterine exposure to virus causing pericarditis
Participants selected are not representative; more or less in a particular population; prevention; randomization
Retinal hemorrahge. represents vascular damage -

4. Can patient with sickle cell disesase get ocp?
Not encouraged; no clear study
Lactating women
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
Atrophic vaginitis 50-60%; endometrial ca 10%

5. Tx of PID
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
Failure of fetal shoulder to pass through maternal pelvis
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases
Most common bugs - N. gonorrhoea and chlamydia... abx should cover them cefoxitin+doxy or ceftriaxone+doxy doc; surg eval if tubo ovarian abscess

6. failure rate of OCP
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Pregancy test

7. When to renal US in complicated UTI in preg

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8. pregnancy category C drugs
Animal studies showed an adverse effect; but no studies done in pregnant women or animals
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
Route of delivery (3% of vaginal birth and 15-30% of c-section)
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.

9. What is cdc recommendation for chlamydia screen in pregnancy
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
Ultrasound for detail anatomic survey
Magneisium sulphate; give antihypergensive when bp >160/105

10. puppp
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
Male phenotype - smalle testes - gynecomastia
If patient doesn't improve in 48h to r/o perinephric abscess or calculi
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities

11. What are the recommended FBS and 2h posprandial BG in pregnant?
X linked recessive due to deficiency of factor VIII
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
95 and 120

12. what insulin is given in pregnancy?
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
Retinal hemorrahge. represents vascular damage -
Likely viral meningitis
95 and 120

13. Why fluoroquinoloes contraindicate in pregnancy?
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep
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.
Cross placenta--concentrate in amniotic fluid---fetal arthopathy
Junction of squamus and glandular cells at the external cervical os

14. Tx of complicated UTI (fever/flank pain)
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
Yea. except valproate. give high dose folic acid patient is conneuing preg
Symptomatic tx pessary. - definitive tex ; surgical repair posterior colporrhaphy
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg

15. pg I2 and throboxane A2 ratio
If patient doesn't improve in 48h to r/o perinephric abscess or calculi
Fetal hyperinsulinemia and hypoglycemia and macrosomia
Increase in pregnancy; decreases in preeclam/eclamsia
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version

16. Tx of LSIL with unsatisfactory colpo
Atrophic vaginitis 50-60%; endometrial ca 10%
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
Ca 1200mg and vitamin 400-80o IU
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg

17. pregnancy category X
Very bad. both animals and human studies showed fetal risk
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
Symptomatic tx pessary. - definitive tex ; surgical repair posterior colporrhaphy

18. most common cause of posmenopausal bleeding
Atrophic vaginitis 50-60%; endometrial ca 10%
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
Bacterial vaginosis; 5-60 women and 10-29% pregnant women
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur

19. pruritus in pregnancy
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
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
Control group gets tx or intervention - thus decreases difference between control vs tx

20. criteria of hyperthyroidism in pregnancy?
Increase serum free T4; serum Tsh <0.01
Betamethason - dexamethason IM
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;
Atrophic vaginitis 50-60%; endometrial ca 10%

21. When to dx ITP?
Cross placenta--concentrate in amniotic fluid---fetal arthopathy
Junction of squamus and glandular cells at the external cervical os
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)
Platelet <50k - or develop early in pregnancy

22. when delivery is failure to progress?

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23. teratogenicity of sulphonylurea?
Fetal hyperinsulinemia and hypoglycemia and macrosomia
Crosses placenta - cause bilat congenital deafness -
Participants selected are not representative; more or less in a particular population; prevention; randomization
Retinal hemorrahge. represents vascular damage -

24. what component of cervix has greatest risk for neoplasia?
Ultrasound for detail anatomic survey
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
Junction of squamus and glandular cells at the external cervical os
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)

25. how ppd works?
Route of delivery (3% of vaginal birth and 15-30% of c-section)
FSH - LH is increased at certain point of regular mens
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow

26. retroverted uterus

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27. What contraception is best for sickle cell patient
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
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
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases

28. What are the absolute contraindication of OCP?
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Primary -similar to ITP; secondary- infection - malignancy hypersplenism - ttp or DIC
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS
Mother taken lithium during pregnancy

29. What is the cause infertility in PCOD
Yea. except valproate. give high dose folic acid patient is conneuing preg
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
Chorionic villous sampling or amniocentesis for fetal karyotyping

30. breast development but no pubic/axillary hair

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31. How to confirm bacterial vaginosis
Incr perinatal mortality - pretem delivery - premature and LBW
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis
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
Clue cells in the vaginal smear

32. most common cause of hyperthyroidism in pregnant women
Likely viral meningitis
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester
They have glycogen deposition in myocardium mostly affected inthe interventricular septum
If patient doesn't improve in 48h to r/o perinephric abscess or calculi

33. time of last tetanus booster >10 or unknown
Primary -similar to ITP; secondary- infection - malignancy hypersplenism - ttp or DIC
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
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID

34. complications of PMS?
80% develop psychiatric illness - depression
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
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%

35. history of preeclampsia
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy
Clue cells in the vaginal smear
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women

36. pregnancy risk category B drugs
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
Clue cells in the vaginal smear

37. When do we screen gestational dm
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
Not encouraged; no clear study
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
Amniocentesis

38. time of last tetanus booster <10 yrs
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
Long h/o pruritus - 65-75 - vulvar lump/mass
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Cross placenta--concentrate in amniotic fluid---fetal arthopathy

39. Major cause of PPH
Cross placenta--concentrate in amniotic fluid---fetal arthopathy
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep
Large fetus - hyperextended head - footling breech - fetal distress
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products

40. ASCUS on pap smear
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
Self sufficient - no longer living with parent. parents of children
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
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;

41. rectocele
Ultrasound for detail anatomic survey
Decreases risk of breast and ovarian ca
Symptomatic tx pessary. - definitive tex ; surgical repair posterior colporrhaphy
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate

42. how maternal dm cause HOCM in infants
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
Ultrasound. since helical CT scan is contraindicated
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present
They have glycogen deposition in myocardium mostly affected inthe interventricular septum

43. indication of chorionic villous sampling
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)
Yea. except valproate. give high dose folic acid patient is conneuing preg

44. bugs for aspiration pneumonia?
Mouth flora anerobes and aerobes
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
95 and 120
Inherited metabolic disorders - intrauterine infections - cri du chat

45. rec for folate supple during preg
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
Most common bugs - N. gonorrhoea and chlamydia... abx should cover them cefoxitin+doxy or ceftriaxone+doxy doc; surg eval if tubo ovarian abscess
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
0.4-4mg daily for >1m prior conception to entire first trimester

46. what drugs used to tx UTI in pregnacy
Bacterial vaginosis; 5-60 women and 10-29% pregnant women
Carbamazepine and valproate - ask why
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
Nitrofurantoin-first gen cephalosporn

47. What is most common cause of ascitis in us
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
Hepatic cirrhosis
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.

48. if ultrasound neg or inconclusive in increasd AFP - next step
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
Amniocentesis
Retinal hemorrahge. represents vascular damage -

49. straberry cervix
Trichomonas; petetchia in vagina and cervix
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
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy

50. What is extremely ominous sign of preecalmsia/eclampsia
Retinal hemorrahge. represents vascular damage -
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF