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OBGYN USMLE Step 3 > Section 1: Obstetrics 1 > Flashcards

Section 1: Obstetrics 1 Flashcards

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USMLE® Step 1 flashcards
1
Q

Define:

  1. Embryo
  2. Fetus
  3. Infant
A
  1. Embryo: fertilization to eight weeks
  2. Fetus: eight weeks to birth
  3. Infant: birth to one year old

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 441). Kaplan Medical Test Prep. Kindle Edition.

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2
Q

A 27-year-old woman presents with nausea and vomiting for the past 2 weeks. Symptoms are worse in the morning, but can occur at any time during the day.
She has a decrease in appetite. Her last menstrual period (LMP) was 6 weeks ago. Physical examination is unremarkable. Which of the following is the best next step in the management of this patient?
a. Complete blood count
b. Beta-HCG
c. HIDA scan
d. Comprehensive metabolic panel
e. Urinanaylsis

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 441). Kaplan Medical Test Prep. Kindle Edition.

A

B. A pregnancy test should be done first in all symptomatic women of childbearing age. Her LMP occurred 6 weeks ago and the patient is experiencing
“morning sickness.” Morning sickness is caused by an increase in beta-HCG produced by the placenta. This can occur until the 12th to 14th week of pregnancy.
A complete blood count (CBC), comprehensive metabolic panel (CMP), and urinalysis are used to evaluate the severity of dehydration, not the etiology. A HIDA scan is done in patients with suspected cholecystitis.

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 441). Kaplan Medical Test Prep. Kindle Edition.

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3
Q

Dating Methods:

  1. Define developmental age (DA)
  2. Define gestational age (GA)
  3. What is Nägele rule
  4. What is the estimated date of delivery in a woman with an LMP of July 1, 2010?
A
  1. Number of days since fertilization
  2. Number of days/weeks since the last menstrual period (usually 2 weeks longer than DA)
  3. Estimation of the day of delivery by taking the last menstrualperiod, subtracting 3 months, and adding 7 days. LMP - 3 months + 7 days
  4. April 8, 2011

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 442). Kaplan Medical Test Prep. Kindle Edition.

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4
Q

Define:

  1. First trimester
  2. Second trimester
  3. Third trimester
A
  1. Fertilization until 12 weeks (DA) or 14 weeks (GA)
  2. 12(DA)/14(GA) weeks until the 24 week (DA) or 26 week (GA)
  3. 24(DA)/26(GA) weeks until delivery

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 442). Kaplan Medical Test Prep. Kindle Edition.

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5
Q

When is the fetus deifned as

  1. Pre-viable
  2. Preterm
  3. Term
  4. Postterm
A
  1. Fetus born before 24 weeks
  2. Fetus born between 25 and 37 weeks
  3. Fetus born between 38 and 42 weeks
  4. Fetus born after 42 weeks

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 442). Kaplan Medical Test Prep. Kindle Edition.

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6
Q

Gravidity is the number of times a patient has been pregnant. Parity is what happens to the pregnancy. This is broken down into 4 numbers:
1. Full-term births
2. Preterm births
3. Abortions (both spontaneous and induced)
4. Living children (if a patient has a multiple gestation pregnancy, one birth
results in 2 living children)

Write the conventional notation for a 35-year-old woman presents to the office for her sixth pregnancy. She has had 2 abortions, 2 children born at term, and a set of twins born preterm.

A

G6P2124

Use: Full-term birth (F); Preterm birth (P); Abortions (A); Living children (L) = F-PAL

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 442). Kaplan Medical Test Prep. Kindle Edition.

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7
Q

A 20-year-old woman presents to the office because she believes that she is pregnant. Her sexual partner usually pulls out, but did not do so 2 weeks ago. She is
now 4 weeks late for her menstruation. Which of the following is one of the first signs of pregnancy found on physical exam?
a. Quickening
b. Goodell sign
c. Ladin sign
d. Linea nigra
e. Chloasma

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 443). Kaplan Medical Test Prep. Kindle Edition.

A

B. One of the first signs of pregnancy that is seen on physical exam is the Goodell sign, softening of the cervix that is felt first at 4 weeks. Quickening is the first
time the mother feels fetal movement.

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 443). Kaplan Medical Test Prep. Kindle Edition.

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8
Q

Based on the following physical signs, list the sign (name of sign) and the time form conception when it is seen

  1. Softening of the cervix
  2. Softening of the midline of the uterus
  3. Blue discoloration of vagina and cervix
  4. Small blood vessels/reddening of the palms
  5. The “mask of pregnancy” is a hyperpigmentation of the face most commonly on forehead, nose, and cheeks; it can worsen with sun exposure
  6. A line of hyperpigmentation that can extend from xiphoid process to pubic symphysis

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 444). Kaplan Medical Test Prep. Kindle Edition.

A
  1. Goodell sign; 4 weeks (first trimester)
  2. Ladin sign; 6 weeks (first trimester)
  3. Chadwick sign; 6–8 weeks (first trimester)
  4. Telangiectasias/palmar erythema; First trimester
  5. Chloasma; 16 weeks (second trimester)
  6. Linea nigra; Second trimester

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 444). Kaplan Medical Test Prep. Kindle Edition.

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9
Q
  1. Best initial test when pregnancy is suspected
  2. When is the gestational sac detected on ultrasound
A
  1. Beta-HCG
  2. Beta-HCG > 1500 or 5 weeks
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10
Q

First trimester prenatal care:

  1. How often is the pregnant patient seen?
  2. When is ultrasund used to confirm GA and check for nuchal translucency
  3. A thickened or enlarged nuchal translucency indicates what condition?
A
  1. Every 4-6 weeks
  2. Between 11 and 14 weeks
  3. Down syndrome
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11
Q

A 17-year-old woman presents for a routine prenatal checkup at 12 weeks. Which of the following is the most accurate method to establish gestational age?

a. Ultrasound
b. Beta-HCG
c. Pelvic exam
d. Fundal height
e. LMP

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 445). Kaplan Medical Test Prep. Kindle Edition.

A

A. Ultrasound is the most accurate way of establishing gestational age at 11 to 14 weeks. Beta-HCG is unreliable in confirming dates, as the levels can be increased in twins or decreased in early abortions. Pelvic exam and fundal height are not the most
accurate methods to confirm dates because they may change with multiple gestations. A patient’s account of LMP is often unreliable because histories are inaccurately remembered.

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 446). Kaplan Medical Test Prep. Kindle Edition.

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12
Q

Second trimester prenatal care:

  1. When is the “triple” or “quad” screen done
  2. True or False: auscultation for the fetal heart is done now
  3. When is quickening felt
  4. When is routine ultrasound for fetal malformation done?
A
  1. At 15 to 20 weeks
  2. True
  3. At 16 to 20 weeks
  4. At 18 to 20 weeks

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 446). Kaplan Medical Test Prep. Kindle Edition.

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13
Q

What does an increase in MSAFP may indicate?

A
  • A dating error
  • Neural tube defect
  • Abdominal wall defect

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 446). Kaplan Medical Test Prep. Kindle Edition.

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14
Q
  1. List the components of the “triple” screen
  2. List the components of the “quad” screen
A
  1. A triple screen includes:
    • Maternal serum alpha fetoprotein (MSAFP)
    • BetaHCG
    • Estriol.
  2. The quad screen adds inhibin A to the triple screen.

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 446). Kaplan Medical Test Prep. Kindle Edition.

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15
Q

Third trimester prenatal care:

  1. Frequency of visits in 3rd timester
  2. Frequency of visit after 36 weeks
  3. What to do next if patient has continued Braxton-Hicks contraction?
A
  1. Every 2 to 3 weeks until 36 weeks
  2. Every week
  3. Check the cervix to rule out preterm labor before 37 weeks

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 446). Kaplan Medical Test Prep. Kindle Edition.

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16
Q

List the third trimester tests and the appropriate actions conducted at the following GA:

  1. 27 weeks
  2. 24-28 weeks
  3. 36 weeks
A
  1. 27 weeks:
    • Complete blood count
    • If hemoglobin <11, replace iron orally
  2. 24–28 weeks:
    • Glucose load If glucose >140 at one hour, perform oral glucose tolerance test
  3. 36 weeks:
    • Cervical cultures for Chlamydia and gonorrhea; Rectovaginal culture for group B Streptococcus
    • Treatment if positive; Prophylactic antibiotics

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 446). Kaplan Medical Test Prep. Kindle Edition.

17
Q

Glucose tolerance test in pregnancy:

  1. Describe the glucose loading test
  2. Describe glucose tolerance test in pregnancy
A
  1. Fasting or nonfasting ingestion of 50g of glucose, and serum glucose check 1 hour later
  2. Fasting serum glucose, ingestion of 100g of glucose, serum glucose check at 1, 2, and 3 hours. Elevated glucose during any two of these tests is gestational diabetes
18
Q

True or False:

Stool softeners should be given with iron supplementation. Why?

A

True

Iron causes or worsens constipation

19
Q

Chorionic Villus Sampling:

  1. When is it done and for whom?
  2. What it show?
  3. How is it done?
A
  1. Done at 10 to 13 weeks in advanced maternal age or known genetic disease in parent
  2. Obtains fetal karyotype
  3. Catheter into intrauterine cavity to aspirate chorionic villi from placenta (can be done transabdominally or transvaginally)

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 447). Kaplan Medical Test Prep. Kindle Edition.

20
Q

Amniocentesis:

  1. When is it done and for whom?
  2. What it show?
  3. How is it done?
A
  1. Done after 11 to 14 weeks for advanced maternal age or known genetic disease in parent
  2. Obtains fetal karyotype (advanced maternal age)
  3. Needle transabdominally into the amniotic sac and withdraw amniotic fluid

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 447). Kaplan Medical Test Prep. Kindle Edition.

21
Q

Fetal Blood Sampling:

  1. When is it done and for whom?
  2. What it show?
  3. How is it done?
A
  1. Percutaneous umbilical blood sample
  2. Done in patients with Rh isoimmunization and when a fetal CBC is needed
  3. Needle transabdominally into the uterus to get blood from the umbilical cord

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 447). Kaplan Medical Test Prep. Kindle Edition.

22
Q

A 29-year-old woman with a past medical history of chlamydia presents with left lower quadrant abdominal pain for the past eight hours. She also states that she
has some abnormal vaginal bleeding. Her LMP was 6 weeks ago. On physical exam the patient’s temperature is 99°F, heart rate is 100 bpm, blood pressure is 130/80
mm Hg, and respiratory rate is 13 per minute.
Which of the following is the most likely diagnosis?
a. Ectopic pregnancy
b. Menstrual cramps
c. Diverticulitis
d. Ovarian torsion
e. Ovarian cyst

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 447). Kaplan Medical Test Prep. Kindle Edition.

A

A. See the following section on ectopic pregnancy. Diverticulitis causes left lower quadrant abdominal pain and rectal bleeding, not vaginal bleeding. The age
range of the patients has almost no overlap between ectopic pregnancy and diverticulitis. Ovarian torsion and ovarian cysts do not cause vaginal bleeding. Menstrual cramps are not associated with an altered menstrual pattern.

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 448). Kaplan Medical Test Prep. Kindle Edition.

23
Q

List the risk factors of ectopic pregnancy

A
  • Pelvic inflammatory disease (PID)
  • Intrauterine devices (IUD)
  • Previous ectopic pregnancies (strongest risk factor)

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 448). Kaplan Medical Test Prep. Kindle Edition.

24
Q

List the diagnostic tests in ectopic pregnancy

A
  • Beta-HCG: done to confirm the presence of a pregnancy
  • Ultrasound: to locate the site of implantation of the ectopic pregnancy
  • Laparoscopy: invasive test and treatment to visualize the ectopic pregnancy

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 448). Kaplan Medical Test Prep. Kindle Edition.

25
Q

Outline the management algorithm in ectopic pregnancy

A

Below is the management algorithm for ectopic pregnancy. Unstable patients (low BP, high HR) should be given fluids and sent to surgery immediately.

26
Q

Diagramatically outline the medical Rx outline for ectopic pregnancy

A

Medical Rx outline for ectopic pregnancy

27
Q

Methotrexate is the drug of choice fo the medical Rx of ectopic pregnancy. List the baseline tests to be done before starting Rx with methotrexate.

A
  • CBC to monitor for anemia
  • Blood type/screen
  • Transaminases to detect changes indicating hepatotoxicity from the medications (e.g., methotrexate)
  • Beta-HCG to assess for success of treatment via a decrease in beta-HCG

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 449). Kaplan Medical Test Prep. Kindle Edition.

28
Q

For how long is the patient followed to observe for a 15% decrease in the patient’s beta-hCG

A

4 to 7 days

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 449). Kaplan Medical Test Prep. Kindle Edition.

29
Q

Exclusion criteria for medical Rx of ectopic pregnancy

A

Exclusion Criteria for Methotrexate

  • Immunodeficiency: Avoid methotrexate, which is an immunosuppressive drug
  • Noncompliant patients: Who knows if they will follow up? Patients need to return for evaluation to know if the treatment worked and if they need a second dose or surgery
  • Liver disease: Hepatotoxicity is a serious side effect of methotrexate. Baseline liver disease increases the risk of subsequent toxicity.
  • Ectopic is 3.5 cm or larger: The larger the ectopic, the greater the risk of treatment failure with methotrexate
  • Fetal heartbeat auscultated: A pregnancy developed enough to have a heartbeat detectable by auscultation has an increased risk of failure with methotrexate.

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 449). Kaplan Medical Test Prep. Kindle Edition.

30
Q

Ectopic Pregnancy:

  1. Surgery done to preserve the Fallopian tube
  2. Surgery that removes the Fallopian tube
  3. True or False: Mothers who are Rh negative should also receive anti-D Rh immunoglobulin
A
  1. Salpingostomy
  2. Salpingectomy
  3. True

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 449). Kaplan Medical Test Prep. Kindle Edition.

31
Q

A 20-year-old woman presents to the emergency department for vaginal bleeding and lower abdominal pain for one day. She states that she is 15 weeks pregnant. Vital signs include temperature 99.0°F, heart rate 100 bpm, blood pressure 110/75 mm Hg, and respiratory rate 12 per minute. On pelvic exam, there is blood present in the vault. Ultrasound shows intrauterine bleeding, products of conception,
and a dilated cervix. Which of the following is the most likely diagnosis in this patient?
a. Complete abortion
b. Incomplete abortion
c. Inevitable abortion
d. Threatened abortion
e. Septic abortion

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 450). Kaplan Medical Test Prep. Kindle Edition.

A

C. An inevitable abortion is characterized by intrauterine bleeding with a dilated cervix. (See table “Types of Abortions” for explanation of other answer choices.)

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 450). Kaplan Medical Test Prep. Kindle Edition.

32
Q

Abortion is defined as a pregnancy that ends before 20 weeks gestation or a fetus less than 500 grams. Almost 80% of spontaneous abortions occur prior to 12 weeks gestation. Chromosomal abnormalities in the fetus account for 60% to 80% of spontaneous abortions. However, certain maternal factors increase the risk of abortion. List them.

A
  • Anatomic abnormalities
  • Infections (STDs)
  • Immunological factors (antiphospholipid syndrome)
  • Endocrinological factors (uncontrolled hyperthyroidism or diabetes)
  • Malnutrition
  • Trauma
  • Rh isoimmunization

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 450). Kaplan Medical Test Prep. Kindle Edition.

33
Q

List the diagnostic tests in the management of abortion and the rationale for such tests

A
  • CBC to evaluate blood loss and need for transfusion
  • Blood type and Rh screen: should blood need to be transfused, and evaluation of need for anti-D Rh immunoglobulin
  • Ultrasound to distinguish between the types of abortions

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 451). Kaplan Medical Test Prep. Kindle Edition.

34
Q

Based on the following ultrasound findings state the diagnosis and Rx for the following abortion presentations:

  1. No products of conception found
  2. Some products of conception found
  3. Products of conception intact,
    but intrauterine bleeding
    present and dilation of cervix
  4. Products of conception intact, intrauterine bleeding, no dilation of cervix
  5. Death of fetus, but all products of conception present in the uterus
  6. Infection of the uterus and the
    surrounding areas
A
  1. Complete abortion; Follow up in office
  2. Incomplete abortion; Dilation and curettage (D&C)/medical
  3. Inevitable abortion; D&C/medical
  4. Threatened abortion; Bed rest, pelvic rest
  5. Missed abortion; D&C/medical
  6. Septic abortion; D&C and IV antibiotics,such as levofloxacin and metronidazole

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 451). Kaplan Medical Test Prep. Kindle Edition.

35
Q
  1. What agents are used for the medical Rx of abortion?
  2. True or False: Mothers who are Rh negative should also receive anti-D Rh immunoglobulin at this time.
A
  1. Misoprostol (a prostaglandin E1analog). These agents help open the cervix and expulse the fetus
  2. True

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 451). Kaplan Medical Test Prep. Kindle Edition.

36
Q

List the complications of multiple gestation

A
  • Spontaneous abortion of one fetus
  • Premature labor and delivery
  • Placenta previa
  • Anemia

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 452). Kaplan Medical Test Prep. Kindle Edition.

37
Q

List the normal pregnancy weight gain recommendations for the following women based on their BMIs

  1. BMI < 24.9 kg/m2
  2. BMI 25-29.9 kg/m2
  3. BMI > 30 kg/m2
A
  1. 14.4-15.9 kg (25-35 lb)
  2. 6.8-11.4 kg (15-25 lb)
  3. < 6.8 kg (< 15 lb)

Patients should never diet or lose weight during pregnancy

QMax3

38
Q

Which of the following factors is associated with an increased risk of first-trimester loss?

  1. a. Chlamydia trachomatis
  2. Consuming > 5 cups of coffee per day
  3. Folate deficiency
  4. Herpes simplex infection
  5. Uterine myomas
A

B. Excessive caffeine consumption during pregnancy increases the risk of miscarriage

OBGYN USMLE Step 3 (7 decks)

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