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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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1. does normal HbA1c eliminate need for dm screening
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties
No.
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m

2. dx postpartum endometritis
Result is influenced by observer's prior knowledge of the details of studs
Increase serum free T4; serum Tsh <0.01
10 days course of ab x immediatly
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta

3. What is most frequent vaginal infecton
Bacterial vaginosis; 5-60 women and 10-29% pregnant women
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS
Pseudohyphe in candida and motile trichomonas and abundance of wbc in trichomoniasis
Acute crisis - endometritis - pyelonephritis - thromboembolic event. 46% develop complications

4. How to dx down syndrom?
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)
X linked recessive due to deficiency of factor VIII
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Symptomatic tx pessary. - definitive tex ; surgical repair posterior colporrhaphy

5. differences between PMS and PMDD
Ca 1200mg and vitamin 400-80o IU
Incr perinatal mortality - pretem delivery - premature and LBW
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present

6. lower lobe pneumonia- possible etiology
Animal studies showed an adverse effect; but no studies done in pregnant women or animals
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Route of delivery (3% of vaginal birth and 15-30% of c-section)

7. failure rate of OCP
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
RCT shows no fetal risk or possiblity
Clue cells in the vaginal smear
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS

8. What is extremely ominous sign of preecalmsia/eclampsia
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
Retinal hemorrahge. represents vascular damage -
Cervix hasn't dilated beyond 4 cm in 2 h
Acute crisis - endometritis - pyelonephritis - thromboembolic event. 46% develop complications

9. breast development but no pubic/axillary hair

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10. When to dx ttp?
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.
Self sufficient - no longer living with parent. parents of children
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization

11. pregnancy risk category B drugs
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Pregancy test
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women

12. should patient continue antiepileptic during pregnancy?
<1%; no special measure is taken if prevent transmission
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli
Indinavir; it precipitate in urine and obstruct urinary flow.
Yea. except valproate. give high dose folic acid patient is conneuing preg

13. when an adolescent will get care without parental consent
On or after 37 weeks;
Primary -similar to ITP; secondary- infection - malignancy hypersplenism - ttp or DIC
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Pregnancy - contraception - STD - substance abuse - emotional illness

14. How to dx septic abortion
Nitrofurantoin-first gen cephalosporn
Animal studies showed an adverse effect; but no studies done in pregnant women or animals
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1

15. laser cone biopsy for CIN and hx of spont abortion
Foul smelling vagianl disch - fever - uterine tenderness - leukocytosis tx; cefriaxone/levo and metro - in breastfeeding women - clinda and genta
Frequent cervical exam in 2nd trimester - place cerclage at 13-17 weeks gestation if required
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx

16. What is internal podalic version
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Decreases risk of breast and ovarian ca
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
Inherited metabolic disorders - intrauterine infections - cri du chat

17. pg I2 and throboxane A2 ratio
Male phenotype - smalle testes - gynecomastia
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Increase in pregnancy; decreases in preeclam/eclamsia
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream

18. When to attempt ext cephalic version?
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
Retinal hemorrahge. represents vascular damage -
On or after 37 weeks;
If >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx

19. OCP
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
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
Carbamazepine and valproate - ask why

20. What contraception is best for sickle cell patient
Intermediate acting NPH insulin qhs. efficacy of long acting glargine not known.
Not encouraged; no clear study
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases

21. complication of sickle cell during pregnancy
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S
Acute crisis - endometritis - pyelonephritis - thromboembolic event. 46% develop complications
Hypoplastic left heart syndrom

22. Can patient with sickle cell disesase get ocp?
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
Not encouraged; no clear study
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate

23. most common cause of posmenopausal bleeding
Amoxi - cephalexin - nitrofurantoin
Atrophic vaginitis 50-60%; endometrial ca 10%
Decreases pulsatile secretion of LH - dec GnRH---estrogen definition---infertility - osetoporo - vaginal atrophy - breast atrophy
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate

24. SAAG <1.1
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.
2g po single dose; discontinue breast feeding for 12-24 hours
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.
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis

25. if ultrasound neg or inconclusive in increasd AFP - next step
11%; doesn't increase risk of abortion; repositioned from retroverted to anterior position at 12-16w
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.
Amniocentesis
Mouth flora anerobes and aerobes

26. emergency contraception after 120 hours
Copper intrauterine device
Two to eight years before menopause and one year after last mens; normal ovulatory cycle interpersed with anovulatory cycles
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
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

27. 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.
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
Betamethason - dexamethason IM

28. when delivery is failure to progress?

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29. pregnant adolescent
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate
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
Incr perinatal mortality - pretem delivery - premature and LBW
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate

30. Tx of UTI in pregnancy
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Likely viral meningitis
Amoxi - cephalexin - nitrofurantoin
Doxy - fluoroquonolones - and erythromycin contraindicated - only azithro can be used

31. congenital constrictive pericarditis in children
Intrauterine exposure to virus causing pericarditis
Atrophic vaginitis 50-60%; endometrial ca 10%
Ultrasound for detail anatomic survey
Nitrofurantoin-first gen cephalosporn

32. pregnancy category C drugs
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc
Animal studies showed an adverse effect; but no studies done in pregnant women or animals
Route of delivery (3% of vaginal birth and 15-30% of c-section)
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep

33. for what drugs do you need supplementation of high dose folic acid during pregnancy
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Carbamazepine and valproate - ask why
Junction of squamus and glandular cells at the external cervical os

34. unilateral breast discharges
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
Ca 1200mg and vitamin 400-80o IU
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
Betamethason - dexamethason IM

35. susceptibility bias
Atrophic vaginitis 50-60%; endometrial ca 10%
Experimental and control groups are different in susceptibilty to tx/intervention due to confounding variable
Low risk women with satisfactory pap and negative cytology result
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%

36. What is definitive dx of down syndrome?
Increase in pregnancy; decreases in preeclam/eclamsia
Malignancy until proven otherwise; screen with mammogram - if mass found - do need aspiration or open breast biopsy
Chorionic villous sampling or amniocentesis for fetal karyotyping
Mild and asymptomatc - late in pregnancy - no hx blood disorder - resolved after child birth

37. High anti D titre despite receiving anti-D immunoglobulin
Serum albumin - ascitic fluid albumin; >1.1 high albumin gradient ascitic fluid or portal htn; S
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
Hypoplastic left heart syndrom
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.

38. What is the cause infertility in PCOD
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate
10 days course of ab x immediatly
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
X linked recessive due to deficiency of factor VIII

39. what anti-TB drugs are contraindicated in pregnancy?
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
Chorionic villous sampling or amniocentesis for fetal karyotyping
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF

40. What is the complication of chorionic villous sampling
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Yea. except valproate. give high dose folic acid patient is conneuing preg
PMS tension - sleep disturbance -othe s/s one week before period resolve with mens bleeding; PMDD when anger and irritability present

41. How to dx neural tube defects on baby
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
Betamethason - dexamethason IM
Retinal hemorrahge. represents vascular damage -
AFP at 16-20 weeks. however low pos predictive value - also measure acetylecholinsterase level - present in neural tissue/blood cells/ muscle.

42. How to evaluate nephrolithiasis in pregnancy?
Ultrasound. since helical CT scan is contraindicated
Scalp anus - vulva - abdomen; cause-dermographism or urticaria; tx topical steroid - antihistamin - oatmeal bath - emolient
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
Pregnancy - contraception - STD - substance abuse - emotional illness

43. Klinefelter
Eqinovarus foot - amniotic fluid loss
Male phenotype - smalle testes - gynecomastia
Self sufficient - no longer living with parent. parents of children
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out

44. pregnancy category X
Inherited metabolic disorders - intrauterine infections - cri du chat
Very bad. both animals and human studies showed fetal risk
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester
If patient doesn't improve in 48h to r/o perinephric abscess or calculi

45. retroverted uterus

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46. When to bact vaginosis
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
Route of delivery (3% of vaginal birth and 15-30% of c-section)

47. indication of cesarean section in breech?
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Eqinovarus foot - amniotic fluid loss
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS
Large fetus - hyperextended head - footling breech - fetal distress

48. When to call a pap smear unsatisfactory?
If patient doesn't improve in 48h to r/o perinephric abscess or calculi
<5000 well visualized squamus cells/contain blood
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Ask mother not to push - then do McRoberts; two people grab mother's legs and flex thigh against abdomen. 42% success rate

49. How to dx stress incontinence?
Ultrasound. since helical CT scan is contraindicated
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
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

50. selection bias
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
If patient has positive PPD and no active TB in CXR or sputum
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine
Participants selected are not representative; more or less in a particular population; prevention; randomization

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USMLE Step3 Gynecology Obstetrics

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