USMLE Step3 Gynecology Obstetrics

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. When to attempt ext cephalic version?
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
On or after 37 weeks;


2. What is the complication of chorionic villous sampling
Eqinovarus foot - amniotic fluid loss
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
Indinavir; it precipitate in urine and obstruct urinary flow.


3. when an adolescent will get care without parental consent
Junction of squamus and glandular cells at the external cervical os
Pregnancy - contraception - STD - substance abuse - emotional illness
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis


4. breast development but no pubic/axillary hair

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5. herpes gestationis or pemphigoid gestationis
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.
If patient doesn't improve in 48h to r/o perinephric abscess or calculi
No.
Incr perinatal mortality - pretem delivery - premature and LBW


6. differential trichominiasis and cadiidiasis?
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis
Primary -similar to ITP; secondary- infection - malignancy hypersplenism - ttp or DIC
Nitrofurantoin-first gen cephalosporn
Control group gets tx or intervention - thus decreases difference between control vs tx


7. What is the recommendation for Ca and vitamin supplement >50yrs women
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
Ca 1200mg and vitamin 400-80o IU
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd


8. pregnant adolescent
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
Incr perinatal mortality - pretem delivery - premature and LBW
2g po single dose; discontinue breast feeding for 12-24 hours
Failure of fetal shoulder to pass through maternal pelvis


9. straberry cervix
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk
Trichomonas; petetchia in vagina and cervix
Nitrofurantoin-first gen cephalosporn
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


10. hemophillia- mom carrier and dad healthy
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
<5000 well visualized squamus cells/contain blood
Magneisium sulphate; give antihypergensive when bp >160/105
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.


11. what insulin is given in pregnancy?
Nitrofurantoin-first gen cephalosporn
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
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
Amoxi - cephalexin - nitrofurantoin


12. How to dx stress incontinence?
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
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1
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
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.


13. when endometrial bx indicated in perimenopause?
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
Ultrasound for detail anatomic survey
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously


14. When to give INH prophylaxis
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present
If patient has positive PPD and no active TB in CXR or sputum
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version


15. what drugs are used to decrease riks of infant resp distress syndrome in cases of preterm delivery
Ultrasound for detail anatomic survey
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Betamethason - dexamethason IM
Cross placenta--concentrate in amniotic fluid---fetal arthopathy


16. congenital hypoplastic left heart; normal at birth then develop heart failure
Inherited metabolic disorders - intrauterine infections - cri du chat
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI
Hypoplastic left heart syndrom
Bacterial vaginosis; 5-60 women and 10-29% pregnant women


17. When to renal US in complicated UTI in preg

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18. What is likelihood ratio?
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
Intrauterine exposure to virus causing pericarditis


19. criteria of hyperthyroidism in pregnancy?
FSH - LH is increased at certain point of regular mens
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1
Increase serum free T4; serum Tsh <0.01


20. What is cdc recommendation for chlamydia screen in pregnancy
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities
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
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester


21. should patient continue antiepileptic during pregnancy?
Incr perinatal mortality - pretem delivery - premature and LBW
Yea. except valproate. give high dose folic acid patient is conneuing preg
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common


22. What are the absolute contraindication of OCP?
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;
Amniocentesis
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Large fetus - hyperextended head - footling breech - fetal distress


23. How to tx anogenital warts

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24. time of last tetanus booster >10 or unknown
<1%; no special measure is taken if prevent transmission
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;
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


25. puppp
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
If patient doesn't improve in 48h to r/o perinephric abscess or calculi
Clue cells in the vaginal smear


26. when young female can develop osteoporosis?
Fetal hyperinsulinemia and hypoglycemia and macrosomia
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
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. complication of amniocentesis?
Eqinovarus foot - amniotic fluid loss
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles


28. when delivery is failure to progress?

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29. Pap shows HGSIL
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
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
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
95 and 120


30. Tx of LSIL with unsatisfactory colpo
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
Very bad. both animals and human studies showed fetal risk
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


31. bugs for aspiration pneumonia?
Lactating women
Route of delivery (3% of vaginal birth and 15-30% of c-section)
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S
Mouth flora anerobes and aerobes


32. observer bias

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33. What is most common cause of ascitis in us
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
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
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Hepatic cirrhosis


34. What is the cause infertility in PCOD
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;
Not encouraged; no clear study
10 days course of ab x immediatly
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate


35. pregnancy risk category A
Copper intrauterine device
X linked recessive due to deficiency of factor VIII
Decreases risk of breast and ovarian ca
RCT shows no fetal risk or possiblity


36. What HIV med cause crystal induced nephropathy?
No.
If patient doesn't improve in 48h to r/o perinephric abscess or calculi
Amniocentesis
Indinavir; it precipitate in urine and obstruct urinary flow.


37. history of preeclampsia
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
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
Copper intrauterine device
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.


38. Tx of UTI in pregnancy
Amoxi - cephalexin - nitrofurantoin
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present
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
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


39. excessive mentrual bleeding in adolescent
Primary -similar to ITP; secondary- infection - malignancy hypersplenism - ttp or DIC
Cross placenta--concentrate in amniotic fluid---fetal arthopathy
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
Failure of fetal shoulder to pass through maternal pelvis


40. atrophic vaginitis
<1%; no special measure is taken if prevent transmission
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream
If patient doesn't improve in 48h to r/o perinephric abscess or calculi


41. eisenmenger syndrome
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester
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


42. pruritus in pregnancy
Hepatic cirrhosis
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient


43. what anti-TB drugs are contraindicated in pregnancy?
Hypoplastic left heart syndrom
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
If patient doesn't improve in 48h to r/o perinephric abscess or calculi


44. long term prognosis of congenital HOCM
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Inherited metabolic disorders - intrauterine infections - cri du chat
Carbamazepine and valproate - ask why
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk


45. differential dx of increased AFP in pregnant mom?
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.
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
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
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


46. time of last tetanus booster <10 yrs
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;


47. emergency contraception
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate
80% develop psychiatric illness - depression
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate


48. How to dx down syndrom?
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
Betamethason - dexamethason IM
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)
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS


49. patient with eclamsia - MOST effective strategy
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester
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
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;
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


50. When to dx ITP?
Platelet <50k - or develop early in pregnancy
Copper intrauterine device
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI