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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.
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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. rec for folate supple during preg
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli
0.4-4mg daily for >1m prior conception to entire first trimester
Giving zidovudine to pregnant and newborn; it deceased by 70%.
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg

2. when young female can develop osteoporosis?
Large fetus - hyperextended head - footling breech - fetal distress
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
Transverse limb anomaly; risk depends on age of gestation; the risk greatest <9 wks - lowest if >11wks
Amniocentesis

3. 6 cm cervical dilation - no improv in 2 h -fetus in zero station
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Cross placenta--concentrate in amniotic fluid---fetal arthopathy

4. How to dx anogenital warts (condyloma acuminata)
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
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Failure of fetal shoulder to pass through maternal pelvis

5. what component of cervix has greatest risk for neoplasia?
Junction of squamus and glandular cells at the external cervical os
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
<5000 well visualized squamus cells/contain blood
Bacterial vaginosis; imbalance between normal vaginal flora and decrease in hydrogen peroxide producing lactobacilli

6. What are the absolute contraindication of OCP?
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
Lactating women

7. most common cause of hyperthyroidism in pregnant women
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Graves disease; 0.2% - present during first trimester - less common and milder in last trimester
Trichomonas; petetchia in vagina and cervix

8. When to dx ttp?
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms
Self sufficient - no longer living with parent. parents of children
Mouth flora anerobes and aerobes
<1%; no special measure is taken if prevent transmission

9. Tx of LSIL
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version

10. What is most common cause of ascitis in us
Hepatic cirrhosis
Bladder US; postvoid residual >200 cc ---detrusor muscle weakness/obstruction--bladder overflow
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
Once a person is infected his body develop a cell medicated immune response - this is detected by ppd

11. How to dx septic abortion
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m
Purulent vaginal disch - dilated cervix - weeks of gestation; tx; clinda - genta - ampi or single therapy of pipercillin/or imipene
Large fetus - hyperextended head - footling breech - fetal distress
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization

12. Major cause of PPH
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
Don't give a patient with intact uterus. increases endometr hyperplasia/ca
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
Papular urticarial papules and plaques in pregnancy (PUPPP) pruritic erythematous papules within stria gravidarum - may spread to extremities

13. time of last tetanus booster <10 yrs
Trichloroacetic acid - repeated use - if doesn't improve electrocautery/surgery; don't use podophyllin to mucosal surface or in pregnanc
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
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;
Not encouraged; no clear study

14. HRT in postmenopausal women vs younger patient with premat ovarian failure
Minor/clean wound; only tetanus vaccine and dirty wound both vaccine +TID
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1

15. Klinefelter
Male phenotype - smalle testes - gynecomastia
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Mother taken lithium during pregnancy
Thrombosis of hepatic vein/suprahepatic venacava----portal htn - SAAG >1.1

16. should patient continue antiepileptic during pregnancy?
Yea. except valproate. give high dose folic acid patient is conneuing preg
Hepatic cirrhosis
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate
Failure of fetal shoulder to pass through maternal pelvis

17. parameters measured in subsequent visit of pregnancy?
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose
Progestin releasing IUD not copper IUD; dec menstual loss; but copper IUD increases
Giving zidovudine to pregnant and newborn; it deceased by 70%.

18. most common cause of posmenopausal bleeding
They have glycogen deposition in myocardium mostly affected inthe interventricular septum
Atrophic vaginitis 50-60%; endometrial ca 10%
Amniocentesis
Long h/o pruritus - 65-75 - vulvar lump/mass

19. risk factor for postpartum endometritis
Ca 1200mg and vitamin 400-80o IU
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Route of delivery (3% of vaginal birth and 15-30% of c-section)
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.

20. Tx of PMS/PMDD

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21. ebstein anomaly or atrialized right ventricle; p/w cyanosis in infancy
Mother taken lithium during pregnancy
Lactating women
Weight height - uterine fundal height - fetal hear sound - fetal presentaion - urine glucose
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)

22. long term prognosis of congenital HOCM
Excessive glycogen within myocardium deplete and the defect resolve spontnaeously
Offspring male 50% will have disease. chance of having male 50%. so chance of having a hemophillia child 25%
Pyrizinamide-no data; streptomycin-ototoxicity to fetus;
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth

23. indication of chorionic villous sampling
Low risk women with satisfactory pap and negative cytology result
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Uterine atony-80%; tx fundal massage-stimulate atonic uterus; and oxytocin - other causes: perineal lac - uterine rupture - retained products
Only symptomatic patient needs tx; not necessary to treat sexual partner; not STD

24. stress incontinence
Indinavir; it precipitate in urine and obstruct urinary flow.
Loss of vaginal support due to pelvic floor trauma--urethral hypermobility tx; pelvic muscle exercise - if fails alpha adrenoceptor agonist/amitryptaline/imipramine
Cervix hasn't dilated beyond 4 cm in 2 h
Expectant mangeent if colpo satisafaory. most regresses spontaneously. repeat pap in 6-12m and HPD DNA testing in 12m

25. 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.
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
Large fetus - hyperextended head - footling breech - fetal distress
Magneisium sulphate; give antihypergensive when bp >160/105

26. How HIV risk of transmission to newborn is decreased
Ablation with cryo or laser surgery; excision with knife or laser conizatio or LEEP
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI
Giving zidovudine to pregnant and newborn; it deceased by 70%.
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap

27. bacteriuria diagnosed incidentaly during pregnancy with no symptoms
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
All pregnany women - in their first prenatal visit - high risk women should have repeat testing at third trimester

28. Why fluoroquinoloes contraindicate in pregnancy?
<1%; no special measure is taken if prevent transmission
Don't give a patient with intact uterus. increases endometr hyperplasia/ca
Eqinovarus foot - amniotic fluid loss
Cross placenta--concentrate in amniotic fluid---fetal arthopathy

29. High anti D titre despite receiving anti-D immunoglobulin
There is evidence of fetal risk but the benefits from use in pregnant women may be acceptable despite risk
Levonorgestrol; efficacy within 48 hours (max at 12h) but can be give within 120 hours of intercourse. can prevent 85% of unexpected preg
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.
Intrauterine exposure to virus causing pericarditis

30. SAAG <1.1
Endomtriosis; endometrial tissu in ovaries - fallopian tubes - or other abnormal sites; dx laparoscopy; tx ocp/GnRH analog; severe cases hysterectomy
Platelet <50k - or develop early in pregnancy
Peritoneal carcinomatosis - peritoneal tv - nephrotic syndrom - pancreatitis - serositis
Should be considered infected until proven otherwise; tx penicillin if allergic desensitization

31. what to test in perimenopause - FSH or LH
Junction of squamus and glandular cells at the external cervical os
Decreases risk of breast and ovarian ca
Animal studies showed an adverse effect but it wasn;t confirmed in controlled studies in pregnant women
FSH - LH is increased at certain point of regular mens

32. What is centor's criteria?
Symptomatic tx pessary. - definitive tex ; surgical repair posterior colporrhaphy
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep
Hypoplastic left heart syndrom
Blistering dermatosis in 2nd and 3rd trimester. p/w abd pruritus - localized around umbilicus - contrary to its name not caused by virus - autoimmune.

33. patient with eclamsia - MOST effective strategy
X linked recessive due to deficiency of factor VIII
Control group gets tx or intervention - thus decreases difference between control vs tx
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 >6 months of irregular menses - heavy breakthrough bleeding - like DUB; do US if endometrial thickness >4mm do bx

34. criteria for gestational transient thyrotoxicosis?
Failure of fetal shoulder to pass through maternal pelvis
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate
Midley inc free t4 - slightly dec tsh; cause; presents in 8-11 - cause incr beta hcg which has mild thyroid stimulation properties
Symptomatic tx pessary. - definitive tex ; surgical repair posterior colporrhaphy

35. how maternal dm cause HOCM in infants
Macrosomia - hypocalcemia - hypoglycemia - hypertrophic cardiomyopathy - CCF
A proocedure in which physician manipulates the fetus inside the uterine cavity from breech to cephalic version
They have glycogen deposition in myocardium mostly affected inthe interventricular septum
Perfect user (never misses a pill) 99.9 % ; user who misses pill 5%

36. pregnant adolescent
Treat immediately. this may complicate cystitis and pyelonephritis - bugs; e coli most common
Minor wound; nothing - dirty wound-vaccine if <5yrs; no exceptions for pregnant
Mother taken lithium during pregnancy
Incr perinatal mortality - pretem delivery - premature and LBW

37. positive GBS culture in pregnancy
10 days course of ab x immediatly
On or after 37 weeks;
Biopsy of placenta for dna or karyotyping; to dx genetic disorders e g. down
Pregancy test

38. What is shoulder dystocia?
Intrauterine exposure to virus causing pericarditis
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
Failure of fetal shoulder to pass through maternal pelvis
Stroke - Liver disease - h/o estrogen dependent tumor - pregnancy -heavy smoking; age >35 relative CI

39. what body fluid exposure needs standard precautions
Yes. zido - lami and saquinavir are not teratogenic; efavirenz and delavirdine should be avoided
Tonsillar exudate - tender ant cervical lymhadenopathy - fever - no cough; presence of 3/4 of these critera have 50% ppd for diagnosis of strep
Semen - vaginal fluid - any fluids contain visible vlood; not applicable to urine - sweat - tears - sptum - vomitus - nasal secretio - feces with no visible lboo
Arrest in delivery - if nuliparus- hypotonia-give oxytocin and amniotomy if fetus ok;

40. How to tx anogenital warts

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41. standard test performed in prenatal visit?
Increases risk of MI - DVT - Strokes - breast ca in postmenopausal but not premat ova failur
Male phenotype - smalle testes - gynecomastia
Cervix hasn't dilated beyond 4 cm in 2 h
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap

42. Who uses progesterone only pills or mini pill
2g po single dose; discontinue breast feeding for 12-24 hours
<1%; no special measure is taken if prevent transmission
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
Lactating women

43. What is the cause infertility in PCOD
Anencephaly - spina bifida - congenital nephrosis - vent wall defects - dermato disorder - tumor - multiple gestation
Increase serum free T4; serum Tsh <0.01
The probability of a given test result to occur; >10= strong evidente to rule in <0.1= strong evidence to rule out
Anovulation due to decrease androgen production; tx weight reduction-restores infertility - if fails clomiphene citrate

44. what test is absolutely necessary before treating an woman at reproductive age
Pregancy test
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
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
Purpura - microangiopathic hemolytic anemia - renal failure - fever - neurologicas symptoms

45. atrophic vaginitis
Vaginal dryness - burining - dysparunia - dec secretion - labial fullness - pallor vaginal epithelium tx HRT - transvaginal estrogen cream
SSRI ...fluoxetine - 15% patient don't respond. give them alprazolam if still no improvment - give ovulation suppresing agents GnRH and Danazol (s/e acne)
<5000 well visualized squamus cells/contain blood
0 1 6 ; test immunity at 9m; if anti-HBS then immune to HepB - if HBsAg +ve refer GI

46. Is ocp contraindicated in migraine?
Bacterial vaginosis; 5-60 women and 10-29% pregnant women
Yes - it increases risk of stroke; which exacerbated by ocp; also it increases intensity of migraine
Inherited metabolic disorders - intrauterine infections - cri du chat
Aspiration; look for hx of nausea vomiting - dysphagia - swallowing abnormalitites - bronch - endosopcy - intubation - AMS

47. does normal HbA1c eliminate need for dm screening
No.
Blood type - cbc - bmp - rubulla titer - screening symphilis - chlamysdia - HIV - hepatitis panel - lipid panel - urine - pap
Route of delivery (3% of vaginal birth and 15-30% of c-section)
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.

48. bilateraal breast discharge
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
Budd chiari and hydrocehalus; tx; surgical closure 24-48h after birth
Endocrine eg. prolactinoma or medication indcued or phsyiological eg pregnancy
Symptomatic tx pessary. - definitive tex ; surgical repair posterior colporrhaphy

49. What is extremely ominous sign of preecalmsia/eclampsia
Result is influenced by observer's prior knowledge of the details of studs
Retinal hemorrahge. represents vascular damage -
No. the syndrome associated with 30-40% mortality. all patient with cyanotic HD asked for elective termination
Incr perinatal mortality - pretem delivery - premature and LBW

50. history of preeclampsia
RCT shows no fetal risk or possiblity
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
<5000 well visualized squamus cells/contain blood
7 times increased risk in susequent pregnancy; 15 times if previous episode id before 33 weeks.