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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. dx postpartum endometritis
Trichomonas; petetchia in vagina and cervix
2g po single dose; discontinue breast feeding for 12-24 hours
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant

2. teratogenicity of sulphonylurea?
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
Fetal hyperinsulinemia and hypoglycemia and macrosomia
Amniocentesis
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc

3. unilateral breast discharges
<1%; no special measure is taken if prevent transmission
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy

4. How to dx overflow incontinence?
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
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

5. pregnancy risk category A
RCT shows no fetal risk or possiblity
Intrauterine exposure to virus causing pericarditis
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
Hypoplastic left heart syndrom

6. how maternal dm cause HOCM in infants
Mouth flora anerobes and aerobes
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD
Junction of squamus and glandular cells at the external cervical os
They have glycogen deposition in myocardium mostly affected inthe interventricular septum

7. What is extremely ominous sign of preecalmsia/eclampsia
Platelet <50k - or develop early in pregnancy
Retinal hemorrahge. represents vascular damage -
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.

8. What is perimenopause?
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
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
Hospitalize and give IV abx like ceftriaxone or ampi+genta until afebrile for 24h; po abx for remainder of preg
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

9. When to repeat pap in 12 months
Copper intrauterine device
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream
Low risk women with satisfactory pap and negative cytology result

10. What HIV med cause crystal induced nephropathy?
Fetal hyperinsulinemia and hypoglycemia and macrosomia
Indinavir; it precipitate in urine and obstruct urinary flow.
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable

11. pregnant women with positive FTA-ABS or treponemal tests
Route of delivery (3% of vaginal birth and 15-30% of c-section)
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
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

12. What contraception is best for sickle cell patient
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
80% develop psychiatric illness - depression
Hepatic cirrhosis
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases

13. vaginal disch - ph>4.5 - presence of clue cells in wet mount - foul smelling fishy odor - koh application-amine odor
Junction of squamus and glandular cells at the external cervical os
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
If patient doesn't improve in 48h to r/o perinephric abscess or calculi
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli

14. rec for folate supple during preg
<1%; no special measure is taken if prevent transmission
10 days course of ab x immediatly
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
0.4-4mg daily for >1m prior conception to entire first trimester

15. Tx of LSIL with unsatisfactory colpo
If patient doesn't improve in 48h to r/o perinephric abscess or calculi
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd

16. if AFP inc - next step?
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Ultrasound for detail anatomic survey
Very bad. both animals and human studies showed fetal risk
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

17. criteria of hyperthyroidism in pregnancy?
2g po single dose; discontinue breast feeding for 12-24 hours
Increase serum free T4; serum Tsh <0.01
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
Platelet <50k - or develop early in pregnancy

18. parameters measured in subsequent visit of pregnancy?
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%

19. eisenmenger syndrome
Amniocentesis
Route of delivery (3% of vaginal birth and 15-30% of c-section)
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.
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

20. When to dx gestational thrombocytopenia?
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo
Ultrasound for detail anatomic survey
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

21. congenital constrictive pericarditis in children
<1%; no special measure is taken if prevent transmission
Intrauterine exposure to virus causing pericarditis
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
FSH - LH is increased at certain point of regular mens

22. selection bias
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
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
Participants selected are not representative; more or less in a particular population; prevention; randomization
Ultrasound. since helical CT scan is contraindicated

23. vulvar ca
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
Long h/o pruritus - 65-75 - vulvar lump/mass

24. what insulin is given in pregnancy?
Ca 1200mg and vitamin 400-80o IU
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
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

25. How to tx anogenital warts

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26. How to confirm bacterial vaginosis
Clue cells in the vaginal smear
If patient doesn't improve in 48h to r/o perinephric abscess or calculi
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
95 and 120

27. failure rate of OCP
Amniocentesis
Likely viral meningitis
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)
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%

28. Tx of chlamydia in pregnancy
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.

29. Pap shows HGSIL
No.
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
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common

30. pregnant adolescent
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis
Incr perinatal mortality - pretem delivery - premature and LBW

31. rate of transmission of HPV from anogenital wart during delivery
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
Clue cells in the vaginal smear
<1%; no special measure is taken if prevent transmission
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required

32. What are the recommended FBS and 2h posprandial BG in pregnant?
95 and 120
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID
Not encouraged; no clear study

33. What is the recommendation for Ca and vitamin supplement >50yrs women
RCT shows no fetal risk or possiblity
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
Ca 1200mg and vitamin 400-80o IU
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene

34. when delivery is failure to progress?

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35. congenital hypoplastic left heart; normal at birth then develop heart failure
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
Hypoplastic left heart syndrom
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Mouth flora anerobes and aerobes

36. bugs for aspiration pneumonia?
Self sufficient - no longer living with parent. parents of children
Mouth flora anerobes and aerobes
X linked recessive due to deficiency of factor VIII
Mother taken lithium during pregnancy

37. susceptibility bias
Mouth flora anerobes and aerobes
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable

38. SAAG <1.1
<5000 well visualized squamus cells/contain blood
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis

39. When to give INH prophylaxis
Male phenotype - smalle testes - gynecomastia
Azithromycin 1gm po single or doxy 100mg po bidx7d - rarely ofloxicin - levofloxacin - erythromycin may be used.
If patient has positive PPD and no active TB in CXR or sputum
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m

40. excessive mentrual bleeding in adolescent
Chorionic villous sampling or amniocentesis for fetal karyotyping
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
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
Route of delivery (3% of vaginal birth and 15-30% of c-section)

41. pregnancy category D drugs
Bacterial vaginosis; 5-60 women and 10-29% pregnant women
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
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
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.

42. breast feeding with anti-epileptic drugs?
Encouraged although antiepileptis secrets through breast milk. benzo and phenobarb can sometime cause the child to become irritable and sleepy.
Incr perinatal mortality - pretem delivery - premature and LBW
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. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided

43. complication of amniocentesis?
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases
Decreases risk of breast and ovarian ca
Eqinovarus foot - amniotic fluid loss
Control group gets tx or intervention - thus decreases difference between control vs tx

44. When to renal US in complicated UTI in preg

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45. vaccine sched for infants of HepB pos mother
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
Betamethason - dexamethason IM
Decreases risk of breast and ovarian ca
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI

46. Can patient with sickle cell disesase get ocp?
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used
Not encouraged; no clear study
Primary -similar to ITP; secondary- infection - malignancy hypersplenism - ttp or DIC

47. emergency contraception after 120 hours
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli
Not encouraged; no clear study
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;
Copper intrauterine device

48. dysmenorrhoea after years of painless menstruation
Mouth flora anerobes and aerobes
Nitrofurantoin-first gen cephalosporn
Junction of squamus and glandular cells at the external cervical os
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy

49. risk factor for postpartum endometritis
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
Likely viral meningitis
Route of delivery (3% of vaginal birth and 15-30% of c-section)
10 days course of ab x immediatly

50. who is emancipated minor?
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.
Pregancy test
Chorionic villous sampling or amniocentesis for fetal karyotyping
Self sufficient - no longer living with parent. parents of children