Usmle Step 3 Mtb Gyn, Peds, Neuro, Preventive Med

Front 1

Normal AFI

Oligo-

Poly-

Back 1

Normal AFI - 8 - 15cm

Oligo- < 5 cm

Poly-> 25 cm

Front 2

Bartholin’s cyst/abscess rx

Back 2

Incision and drainage

Front 3

HTN drugs for preg. pts.

Back 3

Labetelol, Methyldopa (Aldomet), Nefidipine

Front 4

Benign ovarian tumors

Back 4

- Serous cystadenoma - most common

- Mucinous cystadenoma

- Endometrioma/Endometriosis

- Teratoma/dermoid cyst - can have thyroid tissue

- Brenner tumor - looks like bladder, coffee bean nucei on H&E

- Fibroma

- Thecoma - makes estrogen

Front 5

Malignant ovarian tumors

Back 5

- Granulosa cell tumor - most common malignant stromal tumor. women in 50s. makes estrogena and progesterone, postmeno bleeding, breast tenderness. Call-Exner cell.

- Serous cystadenocarcinoma - most common

- Mucinous cystadenocarcinoma

- immature teratoma. Dx after menopause

- dysgerminoma - girls and young women

- yolk sac - young children

- krukenberg

Front 6

Meigs syndm

Back 6

Meigs syndrome—triad of ovarian fibroma, ascites,hydrothorax. “Pulling” sensation in groin.

Front 7

dysgerminoma - tumor marker

Back 7

hCG, LDH

Front 8

yolk sac tumor - tumor marker

Back 8

AFP

Front 9

Drugs causing gynecomastia

Back 9

Spironolactone, Hormones,

Cimetidine, Ketoconazole

Front 10

Loop electrosurgical excison procedure (LEEP)/ cone biopsy - indication

Back 10

+ ECC

Colposcopy inadequate - border/transformation one is not recognized

Discrepancy between pap smear and biopsy

Microinvasive cervical cancer < 3mm

Front 11

OCP - contraindication

Back 11

smokers > 35 years old ( risk of cardiovascular events),

patients with risk ofcardiovascular disease (including history of venous thromboembolism, coronary artery disease,stroke),

migraine (especially with aura),

breast cancer

Liver disease

Front 12

False positive VDRL

Back 12

Viral infection (eg, EBV, hepatitis)

Drugs

Rheumatic fever

Lupus and leprosy

Front 13

neural tube defect - maternal serum screening

Back 13

incr. AFP,

incr. acetylcholinesterase (AChE)

Spina bifida occulta - normal

Front 14

downs sydm - maternal serum screening

Back 14

low α-fetoprotein, low estriol,

high inhibin A, high β-hCG

Front 15

Edward - serum screening

Back 15

ALL LOW

α-fetoprotein, β-hCG, estriol, or normal inhibin A.

Front 16

Patau - serum sreening

Back 16

both low

freeβ-hCG, PAPP-A.

Front 17

what is the newborn given on birth.

What should you give the newborn before discharging?

Back 17

- IM Vit. K

- Erythromycin ophthalmic ointment

- Hep B vaccine if mom is HBsAg -ve

Hep B IVIG if mom is +ve

- hearing test

- Neonatal screening tests

PKU

Galactosemia

Hypothyroidism

Front 18

new born with eye drainage. next step?

Back 18

Gram stain, culture. PCR for N. gono. and chlamydia

Front 19

N. gono ophthalmia rx?

Back 19

slver nitrate eye drops

Front 20

newborn with no eye drainage but crying with bulging eyes

Back 20

urgent ophthalmologist referral. suspect glaucoma

Front 21

Infant, child or aldolesent with red eye - no penetrating injury. Rx?

Back 21

examine and irrigate

Front 22

Infant, child or aldolesent with red eye- H/O trauma

Back 22

- Examine with topical anesthetic

- fluorescein with wood lamb exam - corneal abrasion will show up as green

- topical antibiotic

- Patch

Front 23

periorbital cellulitis vs. orbital cellulitis

Back 23

periorbital cellulitis:

eyeball can move

PO/IV Antibiotics

orbital cellulitis

eyeball may not move

MRI/CT to see extent

ophthal and sx consult

IV Antibiotics

Front 24

Hypospadias - ass. anomaly and mngt?

Back 24

undescended testes or inguinal hernia

- do not circumcise

- further genetic and endocrine evaluation for hermaphroditism

Front 25

Epispadias - ass. anomaly and mngt?

Back 25

Urinary incontinence

- surgical evaluation for bladder exstrophy

Front 26

infant of diabetic mother - lab findings?

Back 26

hypoglycemia

hyPO calcemia, magnesemia

hyPER bilirubinemia

POLYcythemia

Front 27

Neonate with resp. distress sydm. Mngt.? Tests?

Back 27

Tests: ABG, Blood culture, Blood glucose, urine culture, CBC, elec, CXR, Pulse oximetry, cranial U/S

Check L/S ratio if done on amnotic fluid prior to birth.

Mngt: Nasal CPAP with 100% O2 - target O2 sat 93-96%

cardiac and resp. monitor

umbilical vein catheter with fluids

consider empiric antibiotics

? exogenous surfactant

if baby doesnt improve look for cardiac causes. do echo.

Front 28

exogenous surfactant- name of the drug

Back 28

Lucinactant

Front 29

possible complications of neonatal RDS

Back 29

retinopathy of prematurity

bronchopulmonary dysplasia

Intraventricular hemorrhage

Front 30

transient tachypnea of newborm Rx?

Back 30

O2

rapid improvement within hours to days

Front 31

Meconium aspiration - newborn in severe resp. distress. what will the Xray show?

Back 31

patchy infiltrates

increased AP diameter (barrel chest)

flattening of diaphragm

Front 32

Meconium aspiration Rx

Back 32

Positive pressure ventilation

high frequency ventilation

nitric oxide therapy

extracorporeal membrane oxygenation

Front 33

meconium plugs are seen in which conditions?

Back 33

small left colon in infants of diabetic mothers

cystic fibrosis - can also have meconium ileus

Hirschsprung disease

maternal drug abuse

Front 34

necrotizin enterocolitis (NEC) - features

Back 34

medical emergency.

- premature infants with low APGAR score

- bloody stool

- apnea and lethargy on feeding

Front 35

NEC - Dx test

Back 35

Abd Xray

Front 36

NEC Rx

Back 36

NPO

decompress the gut - NG tube?

antibiotics

surgical resection

Front 37

when is hyperbilirubinemia pathologic?

Back 37

- occurs on first or after 2nd week

- bilirubin > 12

- bili rises at 5 mg/day

- direct >2

Front 38

jaundice in newborn - direct. DDx?

Back 38

Infection: Sepsis/TORCH/

Endo: hypothyroidism

galactosemia, tyrosinemia

cystic fibrosis

Front 39

jaundice in newborn - indirect. next step?

Back 39

Do Coombs, CBC and ret count

Front 40

jaundice in newborn - indirect. Coombs -ve, high Hb. DDx?

Back 40

Polycythemia

twin-twin transfusion

IUGR

delayed cord clamping

infant of diabetic mother

Front 41

jaundice in newborn - indirect. Coombs -ve, low/normal Hb. DDx?

Back 41

spherocytosis

G6PD def

Pyruvate kinase

Front 42

Breast milk jaundice Rx?

Back 42

no rx needed

Front 43

Breast feeding jaundice

Back 43

fluids - rehydrate

phototherapy

Front 44

neotal sepsis Rx?

Back 44

EMPIRIC ampicillin and gentamicin until 48-72 hrs cutures are negative

if meningitis - ADD cefotaxime

Front 45

neotal sepsis tests

Back 45

CBC with diff., U/A, urine culture, blood culture,

CXR BEFORE antibiotics

Front 46

List of notifiable diseases

Back 46

Hep A, B, C

HIV

Syphilis

Gonorrhea

MMR

Varicella

TB

Salmonella

Shigella

Diphtheria

Front 47

Croup Mngt?

Back 47

Humidified O2

neb epinephrine and corticosteroids

dont give antitussive, decongestants or antibiotic

Front 48

epiglottitis tests?

Back 48

- tests: Neck xray

- blood cultures

- nasopharyngoscopy in the OR

- epiglottic swab

Front 49

epiglottitis mngt?

Back 49

- mngt:transfer to ORconsult

- ENT and anesthesia

- intubategive antibiotics (ceftriaxone) and steroids

- rifampin proflyx to household IF H. influenza +ve

Front 50

retropharyngeal abscess pt. presentation

Back 50

pt. is drooling and difficulty swallowing

Front 51

pertussis features

Back 51

unimmunizated child

cough for 1-2 wks with whoop and spells of cough (paroxysms)

Front 52

best prevention for bronchiolitis

Back 52

breastfeeding - IgA

Front 53

Peds - mngt of pneumonia

Back 53

outpatient: Amox/cefuroxime

Inpatient: IV cefuroxime (if S. aureus ad Vanc.)

Chlamydia or Mycoplasma - Erythromycin

Front 54

peds - viral pneumonia

Back 54

URI symptoms

low grade fever

tachypnea (imp finding)

Front 55

peds - bacterial pneumonia

Back 55

sudden onset chills

high fever

cough

chest pain

decr. breath sounds with dullness to percussion

Front 56

peds - chlamydia pneumonia

Back 56

NO fever or wheezing (vs. RSV) with or without conjunctivitis at birth

Staccato cough and peripheral eosinophilia

Front 57

pyloric stenosis elec imbalance

Back 57

low K and Cl

Front 58

peds - rx of diarrhea

Back 58

hydration with fluids and electrolyte replacement

do not use anti-diarrheal

Front 59

hemolytic uremic syndrome (HUS) - symptoms and mngt

Back 59

- NEVER give antibiotics

- pallor, weakness, oliguria, acute renal insuffieciency or acute renal failure, anemia, low platelets, hematuria, proteinuria

mngt:

supportive

treat HTN

early dialysis

monitor BP for 5 years

monitor renal function for 2-3 years after HUS

Front 60

MCC of ARF in children

Back 60

HUS

Front 61

infection that causes chronic diarrhea in children. test?

Back 61

giardia

duodenal aspirate or biopsyor immunoassay

Front 62

after surgery to correct pyloric stenosis. what to follow

Back 62

follow electrolyte and replace losses

Front 63

meckel diverticulum. features and test.

Back 63

intermittent, painless rectal bleeding

Ma - Tc-99m pertechneate scan

Front 64

Peds - Cystitis and pyelonephritis - Rx?

Back 64

cystitis - oral Amox

pyelo - IV ceftrixone or ampicillin and gentamicin

Front 65

Peds - Cystitis and pyelonephritis F/U

Back 65

do urine culture 1 week after stopping antibiotics o confirm sterile urine. and reassess periodically for next 2-3 years

VUGr - according to case

Front 66

peds - hemautria - imp. tests

Back 66

U/A

U/C

C3 level

BP

BUN/Cr

Front 67

beta thalassemia - tests and rx

Back 67

test:

- hemoglobin electrophoresis - HbF, no or low HbA (thalessemia minor HbA2 will be high)

- iron studies

- CBC etc.

Rx:

transfusion to maintain hb >9

iron chelation - deferoxamine

splenectomy

routine: folate supplementation

vaccine: pneumococcal, hep B, daily oenicillin proflyx

growth hormone - excess iron related to reduced GH

bone marrow transplantation

Front 68

significance of ristocetin cofactor assay

Back 68

vWF disease. ristocetin = pseudo vWF

Front 69

significance of mixing study

Back 69

factor deficiency

Front 70

west sydm. (infantile spasm) Rx?

Back 70

ACTH

prednisone

pyridoxine

Front 71

cerbral palsy test

Back 71

brain MRI

serum CK to rule out muscular dystrophy

Front 72

by the age of 1 year. HIV positive babies should get which vaccines:

Back 72

Hib

Heb B

DTP

IPV

all are inactivated vaccines

DO NOT GIVE ANY LIVE ATTENUATED VACCINE - MMR

Front 73

live attenuated vaccines?

Back 73

Live attenuated: smallpox, yellow fever,rotavirus, chickenpox (VZV), Sabin poliovirus, MMR, Influenza (intranasal).

Front 74

killed vaccines?

Back 74

Rabies, Influenza (injected), Salk Polio, andHAV vaccines. Killed/inactivated vaccinesinduce only humoral immunity but are stable.

Front 75

after which angle do you need to do ortho surgical consult for scoliosis

Back 75

25 degrees.

less than that only monitor

Front 76

when do you admit anoexia nervosa pts.

Back 76

when their weight drops to 80% of their ideal wt.

Front 77

heat stroke vs. heat exhaustion - symptoms

Back 77

heat stroke - dry skin, alter mental status. temp >40 C

heat exhaustion - excessive sweating, nausea vomiting 37-39 C

Front 78

heat stroke vs. heat exhaustion management

Back 78

heat stroke - spraying with water, ice packs/bath, large amount of IV fluids

heat exhaustion - NS IV and move to cold environment

Front 79

how can you induce absent seizure in a office setting

Back 79

hyperventilation

Front 80

otitis media with effusion (OME) - effusion that can occur after OM - feature and mngt

Back 80

(A retracted tympanic membrane with an effusion in the middle ear and mild hearin gloss suggests that the eustachian tube is blocked.)

follow the pt. for 4-6 months without treatment. if effusion does not then ENT consult for tympanostomy tube

Front 81

in rickets. alk. phos. is high or low and why?

Back 81

Alkaline phosphatase is high in all forms of rickets, indicating increased osteoblast activity.

Front 82

RDW in thalassemia

Back 82

normal

Front 83

when do you give endocarditis proflx if pt. is to under go dental procedure

Back 83

amox 50mg one dose, one hour before procedure

Front 84

ADHD presents before the age of..?

Back 84

seven

Front 85

Fanconi syndrome

Back 85

hyperchloremia

hyperphosphotemia

aminoaciduria

Front 86

duchenne muscuar dystrophy - caused by?

Back 86

defective dystrophin gene

Front 87

duchenne muscular dystrophy - muscle biopsy

Back 87

muscle biopsy shows atrophic and hyper-trophic muscle fibers

- enlarged calfs

- high CK

Front 88

Kawasaki diagnostic criteria

Back 88

To meet the criteria for classic Kawasaki disease, there should be evidence of fever for at least 5 days plus four of the followingfive criteria:

1) bulbar conjunctival injection without exudates,

2) mucosal changes such as dry, fissured lips; strawberry tongue or injected pharynx,

3) unilateral cervical lymphadenopathy,usually, greater than 1.5 cm

4) induration or edema of the hands and feet, and

5) generalized erythematous rash, which can vary from maculopapular to one resembling erythema multiforme.

Front 89

amblyopia - rx nd f/u?

Back 89

Patch the normal eye

for younger children weeks = their age

eg: 4 months old, f/u after no more than 4 wks

older children - 3 months

Front 90

Stroke initial tests

Back 90

Head CT without contrast

MRA

Front 91

Stroke Rx

Back 91

- tPA if <3hrs. If more than 3 hrs, give aspirin

- Aspirin/Clopidogrel/aspirin with dipyridamole

- if pt. is already on aspirin then add dipyridimole or switch to clopidogrel

- statins - for all nonhemorrhagic stroke goal < 100

Front 92

Stroke - after initial mngt and pt. stabilization, what is further mngt?

Back 92

Echocardiogram - Anticoag. if clots

Carotid doppler - endarterectomy if stenosis > 70%

EKG or Holter monitor

Control HTM, DM, hyperlipidemia, no smoking, physical and stretch therapy

Front 93

Young pt. <50 with stroke, no significant medical history. tests?

Back 93

VDRL

ANA, dsDNA

ESR

Protein C, protein S, factor V leiden mutation, antiphospholipid sydm

Front 94

Mulltiple Sclerosis Rx

Back 94

- STEROIDS - best initial

- Disease modifying agents - beta-interferon..etc

- symptomatic - amantadine, baclofen

Front 95

Huntington's Rx

Back 95

Tetrabenazine for movement disorder

Antipsychotics

Front 96

do not give -triptans to pts. with..

Back 96

pregnancy

HTN

coronary disease

- causes vasodilation

Front 97

migraine - when should you do head CT/MRI

Back 97

- sudden/severe onset, or getting worse

- onset age >40

- associated focal neuro. findings

Front 98

migraine Rx and proflx

Back 98

Bi - sumatriptan or ergotamine

Proflx if > 4 episodes per month - several weeks for effect - propranolol, CCBs, TCAs or SSRIs

Front 99

Benign positional vertigo/Vestibular neurtis/Labyrinthitis Rx?

Back 99

Meclizine

labyrinthitis - meclizine and steroids

Front 100

acoustic neuroma - test and Rx

Back 100

Test - MRI of the internal audiory canal

Rx - Surgical resection

Front 101

Meningitis - initial mngt.

Back 101

Empiric - IV ceftriaxone, IV vanc, IV dexamethasone

add Ampicillin if risk of Listeria (HIV, older pts, steroid use)

Front 102

Meningitis - imp. thing to remember before ordering tests

Back 102

if pt. has papilledema, focal neurologic symptoms, seizures, confusion - ORDER HEAD CT BEFORE LP

Front 103

large intracranial hemorrhage with mass effect - mngt.

Back 103

- Admit to ICU

- maintain systolic >100

- Intubate/hyperventilate - to decrease ICP. Decrease pCO2 to 28-32, which will constrict blood vessels.

- IV mannitol

- Surgical evacuation - neurosurgical consultaation

Front 104

SAH - do you need to do LP if Head CT shows bleed?

Back 104

No.

Do LP (Ma test) only if CT doesn't show bleed.

LP - Xanthochromia

Front 105

SAH - Mngt?

Back 105

- Angiography

- Embolize site of bleeding

- Insert a Ventriculoperitoneal shunt if hydrocephalus develops

- Oral Nimodipine

Front 106

spinal cord compression -mngt

Back 106

usually due to tumor.

first give steroids

Front 107

epidural abscess - spine - mngt

Back 107

- MRI spine

- Oxacilling/Nafcillin

- surgical decomp.

Front 108

spinal stenosis - features and mngt

Back 108

- seems like Peripheral artery disease but pulses are normal.

- pain is worse on going downhill, but improves on going uphill

- MRI

- surgical decomp.

Front 109

Restless leg sydm. Rx?

Back 109

Pramipexole or ropinirole.

Front 110

Myasthenia gravis. Rx?

Back 110

Bi - Pyridostigmine or neostigmine

- if fails, thymectomy (if age < 60)

- if fails, Prednisone

Front 111

Phenytoin toxicity - symptoms

Back 111

- vertical nystagmus NOT horizontal

- ataxia

- dysarthria

Front 112

Breast ca. screening should be done between __ and __ ages

Back 112

Start at age 50.

50-75

Front 113

BRCA is ass. with increased risk of?

Back 113

familial breast ca. and ovarian ca.

not a routine screening test

Front 114

colon cancer screening

Back 114

- Colonoscopy age 50, then every 10 years.

- Occult blood testing age 50, then every year.

Front 115

lung ca. resection cannot be performed if..

Back 115

- B/L disease

- Metastases

- Malignant pleural effusion

- Involvement of aorta, vena cava, heart

- Lesions within 1-2cm of the carina

Front 116

cervical ca. screening age

Back 116

start at age 21, every 2-3 years till age 65

OR every 5 years with Pap and HPV test

Front 117

HPV vaccine

Back 117

all females ages 13-26

Front 118

meningococcal vaccination is given at what age?

Back 118

all at age 11. earlier for asplenic pts. and those with terminal complement deficiency

Front 119

osteoporosis screening
Ag
e

Back 119

from age 65

Front 120

Abd. aortic aneurysm screening

Back 120

all men age 65 and with h/o smoking. screen once with U/S

Front 121

Hyperlipidemia screening

Back 121

men > 35 and women > 45

Front 122

Pregnancy F/U return visits and complications to remember in each visit

Back 122

every 4 weeks up to 28 weeks (7 mos) - few comp.

every 2 wks up to 36 weeks (final 2 months) - GDM, anemia, preclampsia, SPROM, IUGR

every 1 week until delivery - more comp.

Front 123

Rh negative mom. When should you give RhoGAM

Back 123

28 weeks after first rescreening for absence of anti-D antibodies.

give RhoGAM after any procedure (CVS, amniocentesis) and after delivery.

Front 124

second trimester optional tests

Back 124

triple marker screen

MS-AFP

beta-hCG

Estriol

Add inhibin in high-risk women

Front 125

when MS-AFP is high or low - after date confirmation - next step?

Back 125

High MS-AFP --> amniocentesis for amniotic fluid AFP (AF-AFP) and acetylcholinesterase activity

Low MS-AFP --> Amniocentesis for karyotyping

Genetic counseling, genetic sonogram before amniocentesis

Front 126

3rd trimester routine tests

Back 126

OGTT - 1 hr 50 g

CBC

Indirect Coombs

GBS - vaginal and rectal culture

Front 127

preg. woman - positive GBS - Rx

Back 127

INTRAPARTUM

IV Penicillin or

IV clindamycin/erythromycin if penicillin allergy

give the treatment if previous delivery was complicated by GBS - even if GBS is negative in this delivery

Front 128

N&V in Preg. - meds that can be given

Back 128

Doxylamine

Metoclopramide

Odansetron

Promethazine

Pyridoxine

Front 129

CCS: mngt of late preg. bleeding

Back 129

Get Vitals

Place external fetal monitor

start IVFs with NS

lab tests:
CBC

DIC workup (PT, PTT, fibrinogen, D-dimer)

Blood type and cross-match

Obstetric U/S to rule out placenta previa - Must do this before vaginal exam

further:

blood transfusion if large blood loss

Foley's to measure urine output

Vaginal exam - to rule out laceration

? schedule delivery

Front 130

triad of vasa previa

next step?

Back 130

rupture of memebranes

painless vaginal bleeding

fetal bradycardia

emergency c-section

Front 131

varicella - greatest risk for the fetus?

Back 131

if the rash appears in the mother between 5 days antepartum and 2 days postpartum

Front 132

congenita varicella features

Back 132

zigzag lesions on skin, limb hypoplasia, microcephaly, microphthalmia, choriorenitis and cataracts

Front 133

prevention of congenital varicella

Back 133

live attenuated vaccine to NONpreg. women

Front 134

congenital varicella- post exposure proflyx. Mom unimmunized

Back 134

VariZIG wthin 10days of exposure

Front 135

uncomplicated maternal varicella Rx

Back 135

Oral acyclovir to mother

VariZIG to mom and neonate

Front 136

congenital varicella Rx

Back 136

VariZIG and IV acyclovir to neonate

Front 137

Rubella - (has no postexposure Rx) - congenital rubella features

Back 137

congenital deafness

congenital heart disease - PDA
cataracts

mental retardation

hepatosplenomegaly

thrombocytopenia

blueberry muffin rash

Front 138

HIV positive mother - steps for prevention of transmission to baby

Back 138

triple-drug therapy (must have ZDV)

give infant proflyx - 6 wks of ZDV

DO NOT BREASTFEED

schedule c-section at 38 wks unless viral load <1000

avoid invasive procedures - fetal scalp electrodes, artificial ROM

Front 139

preeclampsia and eclampsia mngt (lab etc)

Back 139

labs:
U/A, Urine tox, CBC, BUN, Cr, Uric acid, PT, PTT, AST, ALT

only HTN: conservative mngt, repeat BP in 15-20 min
mild preclampsia: Hospitalize and observe
Don't treat until BP> 160/100 (goal - 140-150 and 90-100)
1st line- methyldopa, labetalol
2nd line - nifedipine
- if seizure -MgSO4 bolus
- protect pt. airway and tongue

Monitor:
serial sonograms
serial BP monitoring and urine protein

labor:
< 34 wks - Im betamethasone
> 36 wks - mild preclampsia - attempt vag. with IV oxytocin
severe preclampsia or seizures - prompt delivery irrespective of fetal age
- give intrapartum IV MgSO4 and hydralazine/labetelol - continue Mg So4 24 hrs after delivery

Front 140

eclampsia pt. given mgso4, has resp. depression. next step?

Back 140

stop mgso4 and give IV calcium gluconate and O2

Front 141

when does HELLP usually occur

Back 141

3rd trimester

2 days after delivery

Front 142

HELLP mngt

Back 142

- delivery - any gest. age

- if platelet < 100,000 - give IV corticosteroids ante- and post-partum. continue till platelets and LFTs normalize

- platelet transfusion if count < 20,000 or <50,000 for C-section

- IV mgso4 proflyx

- ? steroids - lung maturity

Front 143

preg. grave's disease Rx

Back 143

PTU in 1st trimester

Methimazole in 2nd and 3rd

Front 144

gest. DM. Mngt

Back 144

initial:

diet and exercise

diabetic counseling

home glucose monitoring

weekly F/U

U/S

if still uncontrolled:

insulin therapy

2x/week fetal surveillence - NST, AFI, BPP

Front 145

abortion before 13 wks

Back 145

D&C

Front 146

medical abortion

Back 146

oral mifepristone (progesterone antagonist) AND oral misoprostol (prostaglandin)

first 63 days of amenorrhea

Front 147

When do you do elective c-section in macrosomia - EFW

Back 147

if EFW > 4500 g in diabetic mother or

> 5000 g in nondiabetic mother

Front 148

normal fetal heart rate

Back 148

110-160

Front 149

umbilical cord prolapse mngt

Back 149

High flow O2 by mask

Never attempt to replace the cord

place pt in knee-chest position, elevate presenting part, give terbutaline

immediate c-section

Front 150

early decelerations

Back 150

mirror images

normal

due to head compression

Front 151

variable decelerations

Back 151

due to umbilical cord compression

fetal acidosis

rapid drop and rise.

last 60secs - FHR drops by 60

Front 152

late decelerations

Back 152

uteroplacental insufficiency

FHR - check --tachycardia

fetal acidosis

urgent help

Front 153

nonreassuring fetal monitoring pattern mngt

Back 153

check for factors like - drugs, sleep etc.

- ensure IV assess 16 gauge needle

- stop oxytocin, give terbutaline

- give 500ml bolus RL

- give 8-10 L O2 by face mask

- change pt's position

- digital vag. exam to rule out prolapsed cord

- perform digital scalp stimulation to observe for accelerations

fetal scalp pH - normal >7.2

if all fails - prepare for delivery

Front 154

trial of vaginal birth after c-section

Back 154

when the previous c-section was a low segment uterine incision

Front 155

uterine inversion - Rx

Back 155

uterine replacement

then IV oxytocin

Front 156

only contraception that can be used during breastfeeding

Back 156

progestin

Front 157

diaphragm or IUD use after birth

Back 157

not until 6 weeks later

Front 158

OCP use after birth

Back 158

not for 3 weeks post partum

Front 159

contraceptive use and breastfeeding

Back 159

can be deferred for 3 months

Front 160

breast ca. preinvasive - ductal carcinoma in situ. next step?

Back 160

schedule surgical resection with clear margin (lumpectomy i.e. breast conserving sx). Then radiation and tamoxifen for 5 years.

Front 161

breast ca. preinvasive - lobular carcinoma in situ. next step?

Back 161

tamoxifen alone for 5 years

Front 162

tamoxifen ass. with risk of

Back 162

endometrial ca.

thromboebmolism

Front 163

when to test for BRCA1 and BRCA2?

Back 163

- Family h/o early onset (<50) breast or varian ca.

- family h/o mae breast ca.

- breast and/or ovarian ca. in same person

- ashkenazi Jew

Front 164

invasive breast ca. Rx

Back 164

size <5 lumpectomy, + radiotherapy + adjuvant therapy +chemo

size > and metastatic disease - systemic therapy

Front 165

tamoxifen - agonist and antagonist action

Back 165

antagonist at breast

agonist at bone

Front 166

tamoxifen MOA

Back 166

competitively binds estrogen receptors

Front 167

anastrozole, exemestane, letrozole MOA

Back 167

aromatase inhibitor. block peripheral production of estrogen

Front 168

aromatase inhibitor side effects

Back 168

do not cause menopausal symptoms

but increase risk of osteoporosis

Front 169

h/o tamoxifen use and now vag. bleeding. next step?

Back 169

endometrial biopsy

Front 170

invasive breast ca.

HR -ve, pre- or postmenopausal woman

Back 170

chemo +/- Radiation alone

Front 171

invasive breast ca.

HR +ve, pre-menopausal woman

Back 171

chemo +/- RT and Tamoxifen

Front 172

invasive breast ca.

HR +ve, postmenopausal woman

Back 172

chemo +/- RT and aromatase inhibitor

Front 173

uterus - soft, symmetric, globular with menorrhagia and dysmenorrhea

Back 173

adenomyosis

Front 174

adenomyosis Rx

Back 174

no Rx really.

levonorgestrel intrauterine system (IUD), may decrease heavy mens. bleeding

Front 175

uterine prolapse degrees

Back 175

2nd degree - prolapse till introtus

3rd degree - past introtus

Front 176

uterine prolapse Rx nonpreg women

Back 176

prolapse - total vaginal hysterectomy (ccs: Laparatomy)

cystocele - anterior vag. wall repair

rectocele - anterior vag. wall repair

if sx. not possible - Pessary

Front 177

postmenopausal women endometrial thickness ?mm

Back 177

< 5mm

Front 178

postmenopausal women, biopsy +ve for endometrial ca. next step?

Back 178

+ve adenocarcinoma

perform surgery staging - TAH&BSO, paraaotic lymphadenectomy, peritoneal washing

if lymph node mets -radiation

if mets - chemo

Front 179

postmenopausal women, biopsy +ve for endometrial HYPERPLASIA. next step?

Back 179

simple hyperplasia - progestin

complex hyperplasia - progestin

complex hyperplasiawith atypia - progestinwith hysterectomy

Front 180

ovarian cyst - simple cyst mngt

Back 180

transvaginal or tranabd U/S to assess.

asymptomatic and <7 cm - observe - F/U 6-8 wks

if >7cm or h/o previous steroid contraception (estrogen/progesterone)

then laparascopic removal

Front 181

cause of death in ovarian mass

Back 181

recurrent bowel obstruction

Front 182

post meno. woman with ovarian mass. dx? and order which markers?

Back 182

most likely epithelial tumor.

CA-125, CEA

Front 183

young women (can be kid) with ovarian mass. dx? and order which markers?

Back 183

most likely germ cell tumor - dysgerminoma.

LDH, b-hcg, AFP

Front 184

post meno. woman with ovarian mass and endometrial hyperplasia. dx? and order which markers?

Back 184

granulosa theca (stromal tumor).

estrogen

Front 185

woman with ovarian mass and facial hair and deeping voice . dx? and order which markers?

Back 185

sertoli leydig cell - stromal tumor.

testosterone

Front 186

krukenberg tumor marker?

Back 186

CEA

Front 187

drug for prevention of genital warts in males

Back 187

gardasil (quadriavalent HPV recombinant vaccine)

Front 188

acute salpingo-oophoritis - similar to PID + lower pelvic pain after menses. Rx

Back 188

out pt. - one dose IM ceftriaxone and PO doxy

in pt. -IV cefotetan/cefoxitin and PO doxy

Front 189

tubo-ovarian abscess. Rx

Back 189

admit

IV cefoxitin and doxy (IV?)

if fails/no response for 72 hrs or rupture then exploratory laparatomy +/- TAH and BSO or percutaneous drainage

Front 190

endometriosis Rx

Back 190

1st line - OCPs

2nd - danazol (testostrone derivative) or Leurolide (GnRH analog)

Front 191

vulvar itching and lesion. next step?

Back 191

biopsy

Front 192

vulvar squamous hyperplasia - benign

Back 192

Fluorinated

corticosteroid cream

Front 193

lichen sclerosis (atrophy)

Back 193

clobestasol cream

Front 194

condylomata acuminata/wart

Back 194

podophyllin

TCA acid

imquimod

laser

cryo

Front 195

vulvar ca.

Back 195

radical vulvectomy

Front 196

premenarchal vag. bleeding work up

Back 196

pelic exam under sedation

CT/MRI of pituitary, abd, pelvis for tumor

if -ve, diagnosis - idiopathic precocious puberty

Front 197

bromocriptin MOA

Back 197

dopamine agonist

Front 198

LH:FSH in PCOs

Back 198

3:1 (normal 1.5:1)

Front 199

PCOs Rx

Back 199

OCPs

Clomiphene citrate or human menopausal gonadotropin - if preg. is desired

spironolactone

metformin

check serum lipids and fasting blood glucose

Front 200

Dx of menopause

Back 200

2 high FSH levels - 2 wks apart. (CCS routine takes 3 days)

FSH >50

Front 201

menopause mngt

Back 201

counseling

? HRT

PO conjugated estrogen

PO medroxyprogesterone acetate (estrogen progesterone combined)

F/U 3 mos

Front 202

gestational trophoblastic disease - symptoms

Back 202

bleeding < 16 wks gestation

passages of vesicles

fundus larger than dates

Front 203

gestational trophoblastic disease - Rx

Back 203

Baseline quantitative beta-hCG titer

CXR

Suction D&C

OCPs for 1 year

Front 204

chemo for small cell lung cancer

Back 204

Etoposide and cisplatin

Front 205

chemo for epithelial ovarian ca.

Back 205

Taxol and carboplatin

Front 206

milk production hormone

Back 206

prolactin

Front 207

milk let down hormone

Back 207

oxytocin

Front 208

misoprostol (prostaglandin) contraindication

Back 208

asthma and glaucoma

Front 209

mgso4 symptoms as dose increases

Back 209

EKG changes --> loss of DTRs --> warmth and flushing --> somnolence and slurry speech --> paralysis or resp. depression

Front 210

MC pathogen in mastitis and breast abscess

Back 210

S. areus

Front 211

where does squamous cell carcinoma of vagina mostly occur

Back 211

upper 1/3rd of vagina

-drained my internal and common iliac nodes

Front 212

ass. with bicornuate uterus

Back 212

Premature labor, second-trimester abortions,and fetal malpresentation (i.e., breech or trans-verse lie

Front 213

choroid plexus cysts ass. with

Back 213

trisomy 18

Front 214

osteosarcoma (malignant) on xray. lab.

Back 214

sunburstcodman triangleAlk phos incr. and LDH incr.

Front 215

osteogenesis imperfecta IP

Back 215

AD

Front 216

Osteogenesis imperfecta - features.

Back 216

Blue sclerae, hearing loss, recurrent fractures, and opalescent teeth. Patients with osteogenesis imperfecta have normal intelligence.

Front 217

Choledochal cysts.

Back 217

Choledochal cysts are congenital abnormalities of the biliary tree characterized by dilatation of the intra and/or extra hepatic biliary ducts.

Front 218

An immediate anaphylactic reaction, an encephalopathy, or any CNS complication within 7 days of administration of the DTP vaccine. Cause?

Back 218

pertussis component of the vaccine.DT should be substituted for DTaP.

Front 219

Meckel's diverticulum. Cause and features.

Back 219

most common congenital abnormality of the small intestine. It results from incomplete obliteration of the omphalomesenteric duct and usually contains ectopic pancreatic or gastric tissue. 2 yrs old. painless bleeding.

Front 220

Choanal atresia. Features, test to confirm. Rx.

Back 220

Cyanosis that is aggravated by feeding and relieved by crying.Failure to pass catheter through nose.CT scan with intranasal contrast - narrowing at the level of the pterygoid.Rx: place oral airway, lavage feeding. surgery for repair.

Front 221

cephaloma hematoma vs. caput succedaneum.

Back 221

Cephalohematoma - subperiosteal hemorrhage, limited to the surface of one cranial bone, no discoloration Caput succedaneum - diffuse, sometimes ecchymotic, swelling of the scalp. It may extend across the midline and across suture lines.

Front 222

Chlamydia pneumonia Rx

Back 222

Oral Erythromycin

Front 223

myotonic muscular dystropy. features.

Back 223

temporal wasting, thin cheeks, and an upper lip in the shape of an inverted V. Pertinent physical findings include emaciated extremities, atrophy of the thenar and hypothenar eminences, proximal muscle weakness, positive Gowers sign, winged scapula, and myotonia. Myotonia is defined as delayed muscle relaxation, and the classic example is the inability to release the hand after a handshake. In addition, abnormalities of the endocrine, immunologic, and nervous systems occur. Endocrine manifestations include diabetes mellitus, testicular atrophy, frontal baldness and hypothyroidism.

Front 224

TCA toxicity.

Back 224

seizure, hypotension, and prolonged QRS complexes on EKG

Front 225

Skull x-rays, taken after the age of 2 years, reveal gyriform intracranial calcifications that resemble a tramline. - Disease?

Back 225

Sturge-Weber syndrome.

Front 226

Osgood-Schlatter disease

Back 226

is a traction apophysitis of the tibial tubercle. Radiographic findings include anterior soft tissue swelling, lifting of tubercle from the shaft, and irregularity or fragmentation of the tubercle.

Front 227

Erythema toxicum

Back 227

is a benign, self-limited condition in newborns characterized by an evanescent rash with red haloes, and eosinophils in the skin lesions.

Front 228

Varicella zoster infection - describe rash

Back 228

- Pruritic rash - later develops into teardrop vesicles, which then ruptures to leave scabs.

- Several stages of lesions (macules, papules, vesicles etc.) are present at the same time.

Front 229

normal newborn wt.

Back 229

2.5kg-4kg

Front 230

Lesch-Nyhan syndrome IP

Back 230

X R - all pts. are male

Front 231

Diamond-Blackfan anemia (DBA) - features

Back 231

- congenital pure red cell aplasia

- first 3 months of life

- pallor and poor feeding

- normocytic or macrocytic anemia with reticulocytopenia. Normal WBC and platelet counts.

Front 232

Lesch-Nyhan syndrome - enzyme deficiency and mech. of disease.

Back 232

Hypoxanthine-guanine phosphoribosyl transferase (HPRT)enzyme involved in purine metabolism.This deficiency results in increased levels of uric acid and accumulation in peripheral tissue.

Front 233

Lesch-Nyhan syndrome - features

Back 233

- age 6 months with hypotonia and persistent vomiting.

- mental retardation, choreoathetosis, spasticity, dysarthric speech, dystonia and compulsive self-injury, especially biting of the upper extremities.

- uric acid deposits

- gouty arthritis, tophus formation and obstructive nephropathy.

Front 234

young boy with gout - which disease should you think of?

Back 234

Lesch-Nyhan

Front 235

Lesch-Nyhan - few points about mngt.

Back 235

- Allopurinol is used to reduce the uric acid levels.- Patients should be advised to take adequate intake of fluids.

Front 236

Crigler-Najjar syndrome and Gilbert syndrome - which enzyme defect?

Back 236

uridine diphosphoglucuronic acid glucuronosyltransferase (UDPGA)

Front 237

Biliary atresia - features

Back 237

- conjugated hyperbilirubinemia 1–6 weeks after birth- clay-colored stools, dark urine, and an enlarged liver.

Front 238

Side effects of hydroxyurea

Back 238

- suppresses the bone marrow.- Leukopenia, anemia, and thrombocytopenia may occur

Front 239

Dry and wet beri beri

Back 239

- dry - peripheral neuropathy

- wet - peripheral neuropathy + cardiac involvement

Front 240

Glioblastoma multiforme

Back 240

- adult brain tumor

- highly malignant

- cereberal hemisphere, can cross corpus callosum "butterfly glioma"

- “Pseudopalisading” pleomorphic tumor cells —border central areas of necrosis and hemorrhage.

- Stain astrocytes for GFAP.

Front 241

Meningioma

Back 241

- adult brain tumor

- parasagittal region

- Spindle cells concentrically arranged in a whorled pattern; psammoma bodies (laminated calcifications).

Front 242

Hemangioblastoma

Back 242

- adult brain tumor

- cerebellar

- Associated with von Hippel-Lindau syndrome when found with retinalangiomas.

- Can produce erythropoietin

Front 243

Schwannoma

Back 243

- adult brain tumor

- cerebellopontine angle

- Often localized to CN VIII vestibular schwannoma.

- If B/L NF-2.

- Resection or stereotactic radiosurgery.

- Schwann cell origin S-100 positive

Front 244

Oligodendroglioma

Back 244

- adult brain tumor

- very rare- frontal lobe

- "fried-egg" pattern

Front 245

Pituitary adenoma

Back 245

- adult brain tumor

- prolactinoma - can be hyper or hypo pituitarism- bitemporal hemianopia - due to pressure on optic chiasm

Front 246

Craniopharyngioma

Back 246

- childhood brain tumor

- bitemporal hemianopia

- supratentorial- derived from Rathke's pouch

- calcification or cholesterol crystals in fluid tumor "motor-oil"

Front 247

Pinealoma

Back 247

- childhood brain tumor

- parinaud sydm - verticle gaze palsy

- obstructive hydrocephalus

- precocious puberty - b-hCG

Front 248

Pilocytic astrocytoma

Back 248

- childhood brain tumor

- posterior fosa/supratentorial

- GFAP +ve

- benign with good prognosis

- cystic + solid

- Rosenthal fibers - eosinophilic corkscrew fibers

Front 249

Medulloblastoma

Back 249

- childhood brain tumor

- highly malignant

- can compress 4th ventricle - noncommunicating hydrocephalus

- can send mets. through spinal cord- Homer-Wright rosettes, small blue cells

Front 250

Ependymoma

Back 250

- childhood brain tumor

- mostly in 4th ventricle

- hydrocephalus

- poor prognosis

Front 251

Trachoma - features, Dx test and Rx

Back 251

- follicular conjunctivitis

- pannus (neovascularization) formation in the cornea

- nasal discharge

- major cause of blindness worldwide

- caused by Chlamydia trachomatis serotype A-C

- Repeated infections can lead to scarring of the cornea.

- Dx - Giemsa stain examination of conjunctival scrapings

- Rx - Topical tetracycline or oral azithromycin should be started immediately.

Front 252

most common cause of polycythemia in term infants

Back 252

- delayed clamping of the umbilical cord

Front 253

manifestations of polycythemia in newborns

Back 253

- respiratory distress

- poor feeding

- neurologic manifestations.

Front 254

Granuloma inguinale (Donovanosis) - features

Back 254

- painless genital ulcers

- a red, beefy base and there is no associated adenopathy

- does not resolve without antibiotic treatment.

Front 255

pregnancy and thyroid

Back 255

Pregnancy is associated with an increase in TBG (due to estrogen), resulting in

- increased total T4 and T3

- normal free T4 and T3, and a normal TSH.

Front 256

Turner's - LH and estrogen level

Back 256

FSH high

Estrogen low - ovarian agenesis

Front 257

BUN and Creatinine in pregnant pts.

Back 257

Serum BUN and creatinine are usually decreased in pregnant patients due to an increase in renal plasma flow and glomerular filtration rate.

Front 258

Raloxifene- mech and contraindication

Back 258

- mixed agonist/antagonist of estrogen receptors. In breast and vaginal tissue, it is an antagonist, whereas in bone tissue, it is an agonist.

- It is a first-line agent for the prevention of osteoporosis, and it decreases breast cancer risk.

- It increases the risk of thromboembolism.- contra - DVT

Front 259

PCOS - ass. with increased risk of which cancer

Back 259

is characterized by an unbalanced estrogen secretion that may result in endometrial hyperplasia and carcinoma.

Front 260

complex hyperplasia (endometrium) WITH atypia - Rx

Back 260

hyterectomy.

if want to preserve fertility - cyclic progestins

Front 261

RhoGAM and maternal titer

Back 261

If a mother is not sensitized (or has a VERY weak titer, as in this case 1:4) anti-D immunoglobulin is indicated. If a mother is already sensitized (antibody titers ≥ 1:6), administration of RhoGAM is not helpful and close fetal monitoring for hemolytic disease is required.

Front 262

Postterm pregnancies should be monitored for..?

Back 262

oligohydramnios twice weekly.

Front 263

Reason for anovulation and amenorrhea in lactating mothers.

Back 263

Elevated prolactin levels suppress GnRH release thereby suppressing LH and FSH production and ovulation.

Front 264

most effective parameter for estimation of fetal weight in cases of suspected FGR.

Back 264

Abdominal circumference

Front 265

squamous cell carcinoma (SCC) vagina - symptoms

Back 265

vaginal bleeding and malodorous vaginal discharge

Front 266

squamous cell carcinoma (SCC) - Treatment

Back 266

- Stage I and II tumors (no extension to the pelvic wall and no metastases) which are less than 2 cm in size may be removed surgically.

- Stage I and II tumors which are greater than 2 cm in size are treated with radiation therapy.

- Combination chemotherapy is used for Stage III and IV tumors

Front 267

Asymptomatic patients with cervical swab +ve for chlamydia, -ve for gono. Next step?

Back 267

single dose of azithromycin or a 7-day course of doxycycline

Front 268

HIV +ve mother - how would you reduce transmission to baby?

Back 268

zidovudine throughout pregnancy and labor, and treating the newborn for the first 6 weeks of life

Front 269

PID Rx

Back 269

Outpt: IM Ceftriaxone and Oral doxy

Inpt.: IV Cefoxitin and IV doxy or IV Clindamycin and IV gentamicin

Front 270

when is corticosteroid for fetal lung maturity useful?

Back 270

period between 24 and 34 weeks

Front 271

fetal heart changes progressing from tachycardia to bradycardia and finally to a sinusoidal pattern occurring suddenly after rupture of membranes - Dx?

Back 271

An antepartum hemorrhage - vasa previa

If fetal bleeding is suspected, an Apt test - which differentiates maternal from fetal blood - can be performed to confirm the diagnosis.

Front 272

postpartum bleeding - initial mngt

Back 272

Initial treatment includes bimanual uterine massage, fluid resuscitation, uterotonic agents (oxytocin, methylergonovine, carboprost), and blood transfusion as needed.

Front 273

how is penicillin desensitization done?

Back 273

first confirm penicillin allergy using skin test.

then desensitize - accomplished using incremental doses of oral penicillin V.

Front 274

Ovarian torsion - features

Back 274

- medical emergency.

- suddn-onset lower quadrant abdominal pain that radiates to the groin or back and is accompanied by nausea and vomiting. An adnexal mass is usually present.