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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.
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 bact vaginosis
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD
Incr perinatal mortality - pretem delivery - premature and LBW
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.

2. congenital dilated cardiomyopathy
Inherited metabolic disorders - intrauterine infections - cri du chat
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.
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
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg

3. What is the complication of chorionic villous sampling
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
On or after 37 weeks;

4. hemophillia
X linked recessive due to deficiency of factor VIII
Self sufficient - no longer living with parent. parents of children
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Amniocentesis

5. How to dx stress incontinence?
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
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
Hypoplastic left heart syndrom
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided

6. Klinefelter
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
Yea. except valproate. give high dose folic acid patient is conneuing preg
Increase serum free T4; serum Tsh <0.01
Male phenotype - smalle testes - gynecomastia

7. positive GBS culture in pregnancy
10 days course of ab x immediatly
Lactating women
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
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles

8. When to dx ITP?
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
Platelet <50k - or develop early in pregnancy
Amniocentesis
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common

9. pregnant women with positive FTA-ABS or treponemal tests
Male phenotype - smalle testes - gynecomastia
Long h/o pruritus - 65-75 - vulvar lump/mass
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version

10. Estrogen

11. Tx of LSIL
Yea. except valproate. give high dose folic acid patient is conneuing preg
Decreases risk of breast and ovarian ca
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m

12. When to give INH prophylaxis
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
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
80% develop psychiatric illness - depression
If patient has positive PPD and no active TB in CXR or sputum

13. dx postpartum endometritis
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
2g po single dose; discontinue breast feeding for 12-24 hours
Result is influenced by observer's prior knowledge of the details of studs

14. When to dx gestational thrombocytopenia?
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth
Eqinovarus foot - amniotic fluid loss
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
Crosses placenta - cause bilat congenital deafness -

15. Why fluoroquinoloes contraindicate in pregnancy?
Cross placenta--concentrate in amniotic fluid---fetal arthopathy
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.
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
<1%; no special measure is taken if prevent transmission

16. history of preeclampsia
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
Intrauterine exposure to virus causing pericarditis
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth

17. congenital hypoplastic left heart; normal at birth then develop heart failure
Giving zidovudine to pregnant and newborn; it deceased by 70%.
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID
Hypoplastic left heart syndrom
Chorionic villous sampling or amniocentesis for fetal karyotyping

18. herpes gestationis or pemphigoid gestationis
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.
10 days course of ab x immediatly
Cervix hasn't dilated beyond 4 cm in 2 h

19. does normal HbA1c eliminate need for dm screening
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
No.
Atrophic vaginitis 50-60%; endometrial ca 10%
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.

20. most common cause of posmenopausal bleeding
Atrophic vaginitis 50-60%; endometrial ca 10%
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
Platelet <50k - or develop early in pregnancy
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)

21. pg I2 and throboxane A2 ratio
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
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities
Increase in pregnancy; decreases in preeclam/eclamsia

22. pregnancy category D drugs
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI
2g po single dose; discontinue breast feeding for 12-24 hours
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk

23. how maternal dm cause HOCM in infants
Cross placenta--concentrate in amniotic fluid---fetal arthopathy
They have glycogen deposition in myocardium mostly affected inthe interventricular septum
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
FSH - LH is increased at certain point of regular mens

24. how lactating mother will get metronidazol
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
2g po single dose; discontinue breast feeding for 12-24 hours

25. if ultrasound neg or inconclusive in increasd AFP - next step
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
Result is influenced by observer's prior knowledge of the details of studs
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy
Amniocentesis

26. What is most frequent vaginal infecton
11%; doesn't increase risk of abortion; repositioned from retroverted to anterior position at 12-16w
<5000 well visualized squamus cells/contain blood
Control group gets tx or intervention - thus decreases difference between control vs tx
Bacterial vaginosis; 5-60 women and 10-29% pregnant women

27. when delivery is failure to progress?

28. what drugs used to tx UTI in pregnacy
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
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
FSH - LH is increased at certain point of regular mens
Nitrofurantoin-first gen cephalosporn

29. What is internal podalic version
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
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
11%; doesn't increase risk of abortion; repositioned from retroverted to anterior position at 12-16w
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI

30. How to evaluate nephrolithiasis in pregnancy?
Route of delivery (3% of vaginal birth and 15-30% of c-section)
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Ultrasound. since helical CT scan is contraindicated
Chorionic villous sampling or amniocentesis for fetal karyotyping

31. What are the absolute contraindication of OCP?
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
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)
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI

32. contamination bias
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
Control group gets tx or intervention - thus decreases difference between control vs tx
Magneisium sulphate; give antihypergensive when bp >160/105
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis

33. differential trichominiasis and cadiidiasis?
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester
Hypoplastic left heart syndrom
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis
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

34. rec for folate supple during preg
0.4-4mg daily for >1m prior conception to entire first trimester
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)
Pregnancy - contraception - STD - substance abuse - emotional illness
Self sufficient - no longer living with parent. parents of children

35. differential dx of increased AFP in pregnant mom?
No.
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version

36. patient on ocp - How to adjust levothyroxine dose?
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
Hepatic cirrhosis
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep
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

37. what test is absolutely necessary before treating an woman at reproductive age
Clue cells in the vaginal smear
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
Pregancy test

38. Tx of complicated UTI (fever/flank pain)
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
Ultrasound. since helical CT scan is contraindicated

39. risks of maternal DM
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
95 and 120
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester
Animal studies showed an adverse effect; but no studies done in pregnant women or animals

40. time of last tetanus booster >10 or unknown
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester
Very bad. both animals and human studies showed fetal risk

41. what if patient has less than 2 of centor criteria
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Participants selected are not representative; more or less in a particular population; prevention; randomization
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
Likely viral meningitis

42. pruritus in pregnancy
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI
Cervix hasn't dilated beyond 4 cm in 2 h
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Don't give a patient with intact uterus. increases endometr hyperplasia/ca

43. standard test performed in prenatal visit?
Don't give a patient with intact uterus. increases endometr hyperplasia/ca
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Hepatic cirrhosis

44. vaginal disch - ph>4.5 - presence of clue cells in wet mount - foul smelling fishy odor - koh application-amine odor
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women

45. Should women continue HAART during pregnancy?
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
10 days course of ab x immediatly
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
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

46. laser cone biopsy for CIN and hx of spont abortion
10 days course of ab x immediatly
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI
Cervix hasn't dilated beyond 4 cm in 2 h

47. ebstein anomaly or atrialized right ventricle; p/w cyanosis in infancy
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
Mother taken lithium during pregnancy
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Crosses placenta - cause bilat congenital deafness -

48. budd chiairi syndrom
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1
RCT shows no fetal risk or possiblity

49. vulvar ca
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
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present
Long h/o pruritus - 65-75 - vulvar lump/mass
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI

50. 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
Giving zidovudine to pregnant and newborn; it deceased by 70%.
Control group gets tx or intervention - thus decreases difference between control vs tx
11%; doesn't increase risk of abortion; repositioned from retroverted to anterior position at 12-16w