USMLE Step3 Gynecology Obstetrics

Instructions:

• Answer 50 questions in 15 minutes.
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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. Tx of UTI in pregnancy
Amoxi - cephalexin - nitrofurantoin
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
Crosses placenta - cause bilat congenital deafness -
Betamethason - dexamethason IM


2. what body fluid exposure needs standard precautions
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
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
FSH - LH is increased at certain point of regular mens
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo


3. When to dx gestational thrombocytopenia?
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth
Amniocentesis
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities


4. pregnant women with positive FTA-ABS or treponemal tests
Intrauterine exposure to virus causing pericarditis
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
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization


5. eisenmenger syndrome
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
Pregnancy - contraception - STD - substance abuse - emotional illness
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


6. What is the cause infertility in PCOD
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate
Mouth flora anerobes and aerobes
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur


7. How to dx septic abortion
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
Amniocentesis
No.
Hypoplastic left heart syndrom


8. risks of maternal DM
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID
Participants selected are not representative; more or less in a particular population; prevention; randomization
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S


9. can eisenmenger patient have pregnancy
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties
Route of delivery (3% of vaginal birth and 15-30% of c-section)
Pregnancy - contraception - STD - substance abuse - emotional illness


10. what component of cervix has greatest risk for neoplasia?
Junction of squamus and glandular cells at the external cervical os
Platelet <50k - or develop early in pregnancy
Pregnancy - contraception - STD - substance abuse - emotional illness
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks


11. When to renal US in complicated UTI in preg


12. What is likelihood ratio?
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
Decreases risk of breast and ovarian ca


13. What is perimenopause?
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
RCT shows no fetal risk or possiblity
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms


14. when endometrial bx indicated in perimenopause?
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
Ultrasound. since helical CT scan is contraindicated
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%


15. When to dx ITP?
Ultrasound. since helical CT scan is contraindicated
Mouth flora anerobes and aerobes
Platelet <50k - or develop early in pregnancy
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo


16. selection bias
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
Participants selected are not representative; more or less in a particular population; prevention; randomization
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc


17. ASCUS on pap smear
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
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
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities
No.


18. Tx of chlamydia
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth
Ca 1200mg and vitamin 400-80o IU
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.
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


19. pregnant adolescent
Incr perinatal mortality - pretem delivery - premature and LBW
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
Amniocentesis


20. Is ocp contraindicated in migraine?
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
Bacterial vaginosis; 5-60 women and 10-29% pregnant women


21. When to give INH prophylaxis
If patient has positive PPD and no active TB in CXR or sputum
Retinal hemorrahge. represents vascular damage -
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk


22. budd chiairi syndrom
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1
<5000 well visualized squamus cells/contain blood
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Copper intrauterine device


23. Tx of PID
Most common bugs - N. gonorrhoea and chlamydia... abx should cover them cefoxitin+doxy or ceftriaxone+doxy doc; surg eval if tubo ovarian abscess
Clue cells in the vaginal smear
Eqinovarus foot - amniotic fluid loss
Male phenotype - smalle testes - gynecomastia


24. retroverted uterus


25. What is internal podalic version
Amoxi - cephalexin - nitrofurantoin
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Mouth flora anerobes and aerobes
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version


26. How to dx stress incontinence?
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
Platelet <50k - or develop early in pregnancy
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


27. bacteriuria diagnosed incidentaly during pregnancy with no symptoms
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Amoxi - cephalexin - nitrofurantoin
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy


28. differential trichominiasis and cadiidiasis?
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine


29. most common cause of hyperthyroidism in pregnant women
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester
0.4-4mg daily for >1m prior conception to entire first trimester
Self sufficient - no longer living with parent. parents of children


30. observer bias


31. atrophic vaginitis
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI


32. SAAG <1.1
Mouth flora anerobes and aerobes
Fetal hyperinsulinemia and hypoglycemia and macrosomia
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
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis


33. what to test in perimenopause - FSH or LH
Cervix hasn't dilated beyond 4 cm in 2 h
Platelet <50k - or develop early in pregnancy
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties
FSH - LH is increased at certain point of regular mens


34. Tx of complicated UTI (fever/flank pain)
Increase serum free T4; serum Tsh <0.01
Not encouraged; no clear study
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene


35. Tx of HELLP syndrome micorangi hem anemia - inc LFT - dec platelet
Magneisium sulphate; give antihypergensive when bp >160/105
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties
Indinavir; it precipitate in urine and obstruct urinary flow.


36. most common cause of posmenopausal bleeding
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
Atrophic vaginitis 50-60%; endometrial ca 10%
10 days course of ab x immediatly
Very bad. both animals and human studies showed fetal risk


37. How to dx neural tube defects on baby
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
Animal studies showed an adverse effect; but no studies done in pregnant women or animals
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream


38. rec for folate supple during preg
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S
0.4-4mg daily for >1m prior conception to entire first trimester
Low risk women with satisfactory pap and negative cytology result
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation


39. bilateraal breast discharge
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy


40. what if patient has less than 2 of centor criteria
Clue cells in the vaginal smear
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
Likely viral meningitis
RCT shows no fetal risk or possiblity


41. emergency contraception after 120 hours
Likely viral meningitis
95 and 120
Copper intrauterine device
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc


42. susceptibility bias
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
Nitrofurantoin-first gen cephalosporn
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
Betamethason - dexamethason IM


43. When to attempt ext cephalic version?
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
On or after 37 weeks;
FSH - LH is increased at certain point of regular mens


44. pruritus in pregnancy
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Result is influenced by observer's prior knowledge of the details of studs


45. Tx of LSIL
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m


46. vulvar ca
Long h/o pruritus - 65-75 - vulvar lump/mass
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
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo


47. parameters measured in subsequent visit of pregnancy?
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate
Route of delivery (3% of vaginal birth and 15-30% of c-section)
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose


48. Estrogen


49. fetus in breech presentation in 28 weeks
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
If patient doesn't improve in 48h to r/o perinephric abscess or calculi
Fetal hyperinsulinemia and hypoglycemia and macrosomia
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF


50. when delivery is failure to progress?