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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. rec for folate supple during preg
<1%; no special measure is taken if prevent transmission
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
FSH - LH is increased at certain point of regular mens
0.4-4mg daily for >1m prior conception to entire first trimester

2. What are the absolute contraindication of OCP?
Amoxi - cephalexin - nitrofurantoin
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Hepatic cirrhosis

3. What is the cause infertility in PCOD
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate

4. if ultrasound neg or inconclusive in increasd AFP - next step
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
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
Amniocentesis
Intrauterine exposure to virus causing pericarditis

5. if AFP inc - next step?
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep
Ca 1200mg and vitamin 400-80o IU
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Ultrasound for detail anatomic survey

6. High anti D titre despite receiving anti-D immunoglobulin
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
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.
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down

7. what if patient has less than 2 of centor criteria
Pregnancy - contraception - STD - substance abuse - emotional illness
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Likely viral meningitis
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products

8. standard test performed in prenatal visit?
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
On or after 37 weeks;
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.
95 and 120

9. When to bact vaginosis
On or after 37 weeks;
Inherited metabolic disorders - intrauterine infections - cri du chat
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD

10. Is ocp contraindicated in migraine?
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Trichomonas; petetchia in vagina and cervix

11. what drugs are used to decrease riks of infant resp distress syndrome in cases of preterm delivery
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS
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
Betamethason - dexamethason IM

12. congenital hypoplastic left heart; normal at birth then develop heart failure
Mouth flora anerobes and aerobes
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
<5000 well visualized squamus cells/contain blood
Hypoplastic left heart syndrom

13. bugs for aspiration pneumonia?
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.
Mouth flora anerobes and aerobes
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk

14. lower lobe pneumonia- possible etiology
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
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
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS
Copper intrauterine device

15. What is perimenopause?
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women

16. vaccine sched for infants of HepB pos mother
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
Junction of squamus and glandular cells at the external cervical os
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases

17. pg I2 and throboxane A2 ratio
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
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS
Increase in pregnancy; decreases in preeclam/eclamsia

18. teratogenicity of sulphonylurea?
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
Yea. except valproate. give high dose folic acid patient is conneuing preg
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd
Fetal hyperinsulinemia and hypoglycemia and macrosomia

19. history of preeclampsia
Increase serum free T4; serum Tsh <0.01
Atrophic vaginitis 50-60%; endometrial ca 10%
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.

20. herpes gestationis or pemphigoid gestationis
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Mouth flora anerobes and aerobes
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.

21. emergency contraception
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
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep

22. What is extremely ominous sign of preecalmsia/eclampsia
X linked recessive due to deficiency of factor VIII
Retinal hemorrahge. represents vascular damage -
Junction of squamus and glandular cells at the external cervical os
Trichomonas; petetchia in vagina and cervix

23. parameters measured in subsequent visit of pregnancy?
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose
Increase in pregnancy; decreases in preeclam/eclamsia
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.

24. Tx of LSIL with unsatisfactory colpo
Carbamazepine and valproate - ask why
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
Cross placenta--concentrate in amniotic fluid---fetal arthopathy
Not encouraged; no clear study

25. When to attempt ext cephalic version?
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
On or after 37 weeks;
Mouth flora anerobes and aerobes
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.

26. does normal HbA1c eliminate need for dm screening
No.
FSH - LH is increased at certain point of regular mens
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
Control group gets tx or intervention - thus decreases difference between control vs tx

27. Estrogen

28. most common cause of posmenopausal bleeding
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
Atrophic vaginitis 50-60%; endometrial ca 10%
Participants selected are not representative; more or less in a particular population; prevention; randomization
Amniocentesis

29. Tx of complicated UTI (fever/flank pain)
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
No.
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate

30. Why fluoroquinoloes contraindicate in pregnancy?
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;
If patient doesn't improve in 48h to r/o perinephric abscess or calculi
Cross placenta--concentrate in amniotic fluid---fetal arthopathy
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

31. What is most common cause of ascitis in us
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Hepatic cirrhosis

32. straberry cervix
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate
Trichomonas; petetchia in vagina and cervix

33. association of myelomeningocele?
Indinavir; it precipitate in urine and obstruct urinary flow.
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth

34. hemophillia
X linked recessive due to deficiency of factor VIII
Trichomoniasis; tx both partners and patient - metronidazol doc 500mg po bid; this drug secrets in breast milk
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
Giving zidovudine to pregnant and newborn; it deceased by 70%.

35. most common cause of hyperthyroidism in pregnant women
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Not encouraged; no clear study
They have glycogen deposition in myocardium mostly affected inthe interventricular septum

36. Major cause of PPH
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID

37. patient with eclamsia - MOST effective strategy
Inherited metabolic disorders - intrauterine infections - cri du chat
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
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;
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose

38. vaginal disch - ph>4.5 - presence of clue cells in wet mount - foul smelling fishy odor - koh application-amine odor
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS
Large fetus - hyperextended head - footling breech - fetal distress

39. differential trichominiasis and cadiidiasis?
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
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis
Pregancy test
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.

40. ebstein anomaly or atrialized right ventricle; p/w cyanosis in infancy
Yea. except valproate. give high dose folic acid patient is conneuing preg
Mother taken lithium during pregnancy
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

41. excessive mentrual bleeding in adolescent
Animal studies showed an adverse effect; but no studies done in pregnant women or animals
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
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
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)

42. Tx of chlamydia in pregnancy
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Chorionic villous sampling or amniocentesis for fetal karyotyping
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required

43. Tx of LSIL
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)
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
Retinal hemorrahge. represents vascular damage -
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis

44. when an adolescent will get care without parental consent
Eqinovarus foot - amniotic fluid loss
Betamethason - dexamethason IM
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Pregnancy - contraception - STD - substance abuse - emotional illness

45. What is definitive dx of down syndrome?
Chorionic villous sampling or amniocentesis for fetal karyotyping
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep
If patient has positive PPD and no active TB in CXR or sputum

46. atrophic vaginitis
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream
Intrauterine exposure to virus causing pericarditis
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
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap

47. what test is absolutely necessary before treating an woman at reproductive age
Animal studies showed an adverse effect; but no studies done in pregnant women or animals
10 days course of ab x immediatly
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
Pregancy test

48. Pap shows HGSIL
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
Self sufficient - no longer living with parent. parents of children
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
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep

49. What HIV med cause crystal induced nephropathy?
Self sufficient - no longer living with parent. parents of children
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
Betamethason - dexamethason IM
Indinavir; it precipitate in urine and obstruct urinary flow.

50. pregnant women with positive FTA-ABS or treponemal tests
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
Not encouraged; no clear study
Hypoplastic left heart syndrom
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization