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OBGYN USMLE Step 3 > Section 7: Gynecology 3 > Flashcards

Section 7: Gynecology 3 Flashcards

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USMLE® Step 1 flashcards
1
Q
  1. Define hirsutism
  2. The two major causes of hirsutism
  3. What must be excluded in the workup of hirsutism?
A
  1. Excessive male-pattern hair growth in a woman
  2. PCOS or idiopathic
  3. Androgen-secreting tumors

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14612-14634). Kaplan Publishing. Kindle Edition.

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2
Q

Define virilization

A

Excessive male-pattern hair growth in a woman plus other masculinizing signs, such as clitoromegaly, baldness, lowering of voice, increasing muscle mass, and loss of female body contours

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14612-14634). Kaplan Publishing. Kindle Edition.

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3
Q

List the initial workup for hirsutism/virilization

A
  • Testosterone
  • DHEAS
  • LH/ FSH
  • 17-hydroxyprogesterone

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14612-14634). Kaplan Publishing. Kindle Edition.

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4
Q
  • Gradual-onset hirsutism
  • Obesity
  • Acne
  • Irregular bleeding
  • Infertility. There are chronic anovulatory cycles and infertility
  1. Diagnosis?
  2. How is the diagnosis confirmed?
  3. Pelvic ultasound and exam finding?
A
  1. Polycystic Ovarian Syndrome (PCOS)
  2. An elevated LH/ FSH ratio
  3. Bilaterally enlarged ovaries

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14612-14634). Kaplan Publishing. Kindle Edition.

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5
Q

List the differentials of the following classic presentation

  • Anovulation
  • A history of amenorrhea followed by
  • Unpredictable bleeding
A
  • Polycystic ovary syndrome (PCOS)
  • Hypothyroidism
  • Pituitary adenoma
  • Elevated prolactin
  • Medications (e.g., antipsychotics, antidepressants)

(prolonged unopposed estrogen stimulates the endometrium)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14634-14657). Kaplan Publishing. Kindle Edition.

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6
Q

How does anovulation leads to irregular bleeing and predispose to endometrial cancer?

A

Anovulation → no corpus luteum production of progesterone → unopposed estrogen → hyperplastic endometrium and irregular bleeding → predisposition to endometrial cancer.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14612-14634). Kaplan Publishing. Kindle Edition.

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7
Q
  1. Explain the pathphysiology of increased testosterone in PCOS
  2. Explain the pathogenesis of ovarian enlargement in PCOS
A
  1. ↑ LH levels → ↑ theca cell production of androgens → hepatic production of SHBG is suppressed → ↑ total testosterone and ↑ free testosterone
  2. ↑ androgens → multiple follicles in various stages of development, stromal hyperplasia, and a thickened ovarian capsule → bilaterally enlarged ovaries

Ultrasound shows a necklacelike pattern of multiple peripheral cysts (20– 100 cystic follicles in each ovary)

SHBG=Sex Hormone Binding Globulin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14634-14657). Kaplan Publishing. Kindle Edition.

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8
Q
  1. Beyond the history and exam findings, list the diagnostic findings in PCOS
  2. Mgnt of PCOS
A
  1. Diagnostic Testing
    • LH:FSH ratio = 3: 1 (normal is 1.5: 1)
    • Testosterone level is mildly elevated
    • Pelvic ultrasound shows bilaterally enlarged ovaries with multiple subcapsular small follicles and increased stromal echogenicity
  2. Treatment
    • Oral contraceptive pill treats irregular bleeding and hirsutism. The progestin component prevents endometrial hyperplasia
    • Spironolactone may also be used to suppress hair follicles
    • Clomiphene citrate or human menopausal gonadotropin (HMG) is the treatment of choice for infertility
    • Metformin enhances ovulation and manages insulin resistance.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14634-14657). Kaplan Publishing. Kindle Edition.

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9
Q
  1. Diagnosis: Rapid onset hirsutism and virilization without a family history. DHEAS is markedly elevated.
  2. Diagnosis: Rapid onset hirsutism and virilization without a family history. Testosterone is markedly elevated.
  3. Rx of (1)
  4. Rx of (2)
A
  1. Adrenal Tumor
  2. Ovarian Tumor
  3. Surgical removal of tumor
  4. Surgical removal of tumor

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14658-14716). Kaplan Publishing. Kindle Edition.

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10
Q
  1. Diagnosis: Gradual-onset hirsutism without virilization in the second or third decade that is associated with menstrual irregularities and anovulation. Serum 17-hydroxyprogesterone level is markedly elevated. Precocious puberty with short stature is common. Family history may be positive.
  2. Management?
A
  1. Congenital Adrenal Hyperplasia (21-Hydroxyolase Deficiency)
  2. Corticosteroid replacement, which will arrest the signs of androgenicity and restore ovulatory cycles

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14658-14716). Kaplan Publishing. Kindle Edition.

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11
Q
  • Hirsutism
  • No virilization
  • All lab tests are normal
  1. Diagnosis?
  2. Management?
A
  1. Idiopathic Hirsutism. It is the most common cause of hirsutism.
  2. Treatment:
    • Spironolactone is the treatment of choice
    • Eflornithine (Vaniqa) is the first-line topical drug for the treatment of unwanted facial and chin hair.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14658-14716). Kaplan Publishing. Kindle Edition.

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12
Q

Fill in the levels of the following lab values indicating whether thay are elevated. decreased or normal for PCOS, CAH, ovarian tumor or adrenal tumor. The lab tests are testosterone, DHEAS, LH/FSH and 17-OHP. Also indicate the next step in managment

A

See result in table.

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13
Q
  1. Define menopause
  2. Mean age of menopause
  3. True or False: Smokers experience menopause up to 2 years earlier
  4. How is the diagnosis of menopause made?
  5. Menopause occurring between 30 and 40 years of age.
  6. Causes of (5)
  7. Menopause before age 30
  8. Causes of (7)
A
  1. 12 months of amenorrhea with elevation of FSH and LH
  2. 51 years
  3. True
  4. With serial levels of elevated gonadotropins (FSH > 50 IU/ mL)
  5. Early menopause
  6. Causes of early monopause:
    • Idiopathic (most often)
    • Radiation therapy
    • Surgical oophorectomy
  7. Premature ovarian failure
  8. Causes of Premature ovarian failure:
    • Autoimmune disease
    • Y chromosome mosaicism

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14716-14739). Kaplan Publishing. Kindle Edition.

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14
Q

List and explain the menopausal symptoms due to estrogen

A

Amenorrhea: Menses become anovulatory and decrease in the 3– to 5-year period known as perimenopause

Hot flashes: This is unpredictable, profuse sweating and heat that occurs in 75 percent of women. Obese women are less likely to undergo hot flashes (due to peripheral conversion of androgens to estrone)

Reproductive tract: Decreased vaginal lubrication*, *increased vaginal pH, and increased vaginal infections can occur

Urinary tract: Increased urgency*, *frequency*, *nocturia, and urge incontinence can occur

Psychic: Depressed mood,* *emotional lability,* and *sleep disorders can occur

Cardiovascular disease: This is the most common cause of mortality (50 percent) in postmenopausal women

Osteoporosis

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14716-14739). Kaplan Publishing. Kindle Edition.

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15
Q

Common sites for osteoporosis in postmenopausal women

A
  1. Vertebral bodies, leading to crush fractures, kyphosis, and decreased height
  2. Hip and wrist fractures are the next most frequent sites

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14739-14765). Kaplan Publishing. Kindle Edition.

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16
Q

Risk factors for osteoporosis

A
  1. Positive family history in a thin, white female (most common)
  2. Steroid use,
  3. Low calcium intake
  4. Sedentary lifestyle,
  5. Smoking
  6. Alcohol

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14739-14765). Kaplan Publishing. Kindle Edition.

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17
Q

How to prevent osteoporosis?

A
  • Calcium and vitamin D supplementation
  • Weight-bearing exercise
  • Smoking cessation
  • Alcohol cessation

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14739-14765). Kaplan Publishing. Kindle Edition.

18
Q

How is the diagnosis of osteoporosis made?

A

Bone density is assessed with a DEXA scan (dual-energy x-ray absorptiometry). The results are reported as a T-score: T-score ≥ –2.5 indicates the presence of osteoporosis

  • T-score –1.5 to –2.5 = osteopenia
  • T-score ≥ –2.5 = osteoporosis

Calcium loss is assessed with a 24-hour urine hydroxyproline or NTX (N-telopeptide, a bone breakdown product)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14739-14765). Kaplan Publishing. Kindle Edition.

19
Q

Outline the management of osteoporosis

A
  1. First-line therapy is bisphosphonates and SERMs
    • Bisphosphates (e.g., alendronate, risedronate) inhibit osteoclastic activity
    • Selective estrogen receptor modulators (SERMs) increase bone density
    • SERMs are protective against the heart and bones but are not effective for vasomotor symptoms of menopause
    • Tamoxifen (Nolvadex) has endometrial and bone agonist effects but breast antagonist effects
    • Raloxifene (Evista) has bone agonist effects but endometrial antagonist effects
  2. Calcitonin, denosumab, and teriparatide are second-line therapy. Teriparatide is a PTH analog that is used when biphosphates fail
  3. Estrogen is never the primary treatment of osteoporosis because of associated risks of clots and endometrial cancer

Denosumab is a RANKL inhibitor that inhibits osteoclast function

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14765-14802). Kaplan Publishing. Kindle Edition.

20
Q
  1. Rx indications of hormone replacement therapy (HRT)
  2. Contraindications of HRT
  3. True or False: HRT is used in the Rx of osteoporosis
A
  1. Rx indications of HRT
    • Menopausal vasomotor symptoms (hot flashes)
    • Genitourinary atrophy
    • Dyspareunia
  2. Contraindications of HRT
    • Estrogen-sensitive cancer (breast or endometrial)
    • Liver disease
    • Active thrombosis
    • Unexplained vaginal bleeding
  3. False

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14765-14802). Kaplan Publishing. Kindle Edition.

21
Q
  1. List the benefits of HRT
  2. List the risks of HRT
  3. True or False: Women without a uterus can be given continuous estrogen
  4. True or False: All women with a uterus must also receive progestin therapy. Why?
A
  1. Benefits of HRT
    • ↓ Rate of osteoporotic fractures
    • ↓ Rate of colorectal cancer
  2. Risks of HRT
    • ↑ Risk of DVT
    • ↑ Risk of heart attacks
    • ↑ Risk of breast cancer in combination therapy. Risk of breast cancer is only associated with therapy > 4 yrs
  3. True
  4. True. Prevents endometrial hyperplasia

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14765-14802). Kaplan Publishing. Kindle Edition.

22
Q

List the guidelines for HRT

A
  • Only start HRT for vasomotor symptoms
  • Never give HRT for the prevention of cardiovascular disease
  • Use the lowest dose of HRT to treat symptoms
  • Use the shortest duration of HRT to treat symptoms; reevaluate annually
  • Do not exceed 4 years of therapy (increased risk of breast cancer after 4 years of therapy)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14804-14858). Kaplan Publishing. Kindle Edition.

23
Q

True or False: Low-dose contraceptive pills do not increase the risk of cancer, heart disease, or thromboembolic events in women with no associated risk factors (hypertension, diabetes, or smoking)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14804-14858). Kaplan Publishing. Kindle Edition.

A

True

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14804-14858). Kaplan Publishing. Kindle Edition.

24
Q

List (1) examples, (2) absolute contraindications, (3) relative contraindications and (4) benefits of barrier methods of contraception

A
  1. Condoms, Vaginal diaphragm, ± spermicides
  2. N/ A
  3. N/ A
  4. Protective against STDs

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14804-14858). Kaplan Publishing. Kindle Edition.

25
Q

List (1) examples, (2) absolute contraindications, (3) relative contraindications and (4) benefits of intrauterine device

A
  1. Examples:
    • Combination (estrogen + progesterone)
    • Progestin only (OCP called “mini-pill”, injectable, implant, morning after pill)
  2. Absolute Contraindication – Pregnancy – Acute liver disease – Vascular disease (e.g., thromboembolism, DVT, CVA, SLE) – Hormone dependent cancer (e.g., breast CA) – Smoker > 35 – Uncontrolled hypertension – Migraines with aura – DM with vascular disease – Thrombophilia
  3. Relative Contraindication – Migraines – Depression – DM – Chronic HTN – Hyperlipidemia
  4. Benefits:
    • ↓ ovarian and endometrial CA
    • ↓ dysmenorrhea
    • ↓ dysfunctional uterine bleeding
    • ↓ ectopic pregnancy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14804-14858). Kaplan Publishing. Kindle Edition.

26
Q

List (1) examples, (2) absolute contraindications, (3) relative contraindications and (4) benefits of intrauterine device

A
  1. Examples:
    • Levonorgestrel-impregnated
    • Copper-banded
  2. Absolute contraindications:
    • – Pregnancy – Pelvic malignancy – Salpingitis
  3. Relative contraindications:
    • Abnormal uterine size or shape
    • Immune suppression (including steroid therapy)
    • Nulligravidity
    • Abnormal Pap smears
    • History of ectopic pregnancy
  4. Benefits: Effective and avoids side effects of hormonal therapy
27
Q

A 35-year-old woman comes to the gynecologist’s office complaining of infertility for 1 year. She and her husband have been trying to achieve pregnancy for > 1 year and have been unsuccessful. There is no previous history of pelvic inflammatory disease, and she had used oral contraception medication for 6 years. The pelvic examination is normal. Semen analysis is low volume and shows decreased sperm density and low motility. What is the next step in management?

a. Administer testosterone
b. Measure serum testosterone
c. Measure thyroid hormone
d. Repeat semen analysis
e. Refer for intrauterine insemination

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14860-14905). Kaplan Publishing. Kindle Edition.

A

D. Because semen samples are variable, an abnormal semen analysis is repeated in 4– 6 weeks to confirm findings

. Infertility is defined as inability to achieve pregnancy after 12 months of unprotected and frequent intercourse. Steps in workup for infertility: 1. The first step is semen analysis. 2. If semen analysis is normal, work up for anovulation. 3. If semen analysis is normal and ovulation is confirmed, work up for fallopian tube abnormalities. Step Diagnosis Management 1. Semen Analysis Normal values: • Volume > 2 mL; pH 7.2– 7.8; sperm density > 20 million/ mL; sperm motility > 50%; and sperm morphology > 50% normal. • If values are abnormal, repeat the semen analysis in 4– 6 weeks. • Abnormal semen analysis: Intrauterine insemination, intracytoplasmic sperm injection (ICSI), and in vitro fertilization (IVF) are fertility options. • No viable sperm: Artificial insemination by donor may be used. 2. Anovulation • Basal body temperature (BBT) chart: NO midcycle temperature elevation • Progesterone: Low • Endometrial biopsy: Proliferative histology • Hypothyroidism or hyperprolactinemia are causes of anovulation that can be treated. • Ovulation induction: – Clomiphene citrate is the agent of choice. – Human menopausal gonadotrophin (hMG) is used if clomiphene fails – Most common side effect = ovarian hyperstimulation. Ovarian size must

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14860-14905). Kaplan Publishing. Kindle Edition.

28
Q

Infertility is defined as inability to achieve pregnancy after 12 months of unprotected and frequent intercourse

List the steps in the workup of infertility

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14860-14905). Kaplan Publishing. Kindle Edition.

A
  1. Semen analysis (first step)
  2. If semen analysis is normal, work up for anovulation
  3. If semen analysis is normal and ovulation is confirmed, work up for fallopian tube abnormalities

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14860-14905). Kaplan Publishing. Kindle Edition.

29
Q

State the normal values for semen analysis:

  1. Volume
  2. pH
  3. Sperm density
  4. Sperm motility
  5. Sperm morphology
A
  1. > 2 mL
  2. 7.2– 7.8
  3. > 20 million/ mL
  4. > 50%
  5. > 50% normal

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14860-14905). Kaplan Publishing. Kindle Edition.

30
Q

Management of abnormal semen analysis:

  1. Next best step following an abnormal semen analysis
  2. Next step if (1) fails
  3. Rx of no viable sperm
A
  1. Repeat the semen analysis in 4– 6 weeks
  2. Abnormal semen analysis:
    • Intrauterine insemination
    • Intracytoplasmic sperm injection (ICSI)
    • In vitro fertilization (IVF)
  3. Artificial insemination by donor may be used

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14860-14905). Kaplan Publishing. Kindle Edition.

31
Q

Anovulation:

  1. Diagnosis
  2. List treatable causes of anovulation
  3. Rx for ovulation induction
  4. Most common side effect of ovulation induction
A
  1. Diagnosis
  • Basal body temperature (BBT) chart: NO midcycle temperature elevation
  • Progesterone: Low
  • Endometrial biopsy: Proliferative histology
  1. Hypothyroidism or hyperprolactinemia a
  2. Ovulation induction:
  • Clomiphene citrate (is the agent of choice)
  • Human menopausal gonadotrophin (hMG) is used if clomiphene fails
  1. Ovarian hyperstimulation. Ovarian size must be monitored during induction

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14860-14905). Kaplan Publishing. Kindle Edition.

32
Q

Tubo abnormalities:

  1. Diagnosis
  2. How to rule out Chlamydia infection-induced tubal adhesions
  3. True or False: No further testing is performed if the Hysterosalpingogram (HSG) shows normal anatomy
  4. True or False: Laparoscopy: Performed with an abnormal HSG to visualize the oviducts and attempt reconstruction (tuboplasty)
  5. Rx for severe tubal damage
A
  1. Diagnosis:
  • Hysterosalpingogram and
  • Laparoscopy
  1. Chlamydia Antibody: A negative IgG antibody test for chlamydia rules out infection-induced tubal adhesions
  2. True
  3. True
  4. IVF

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14905-14933). Kaplan Publishing. Kindle Edition.

33
Q
  • Normal semen analysis
  • Ovulation confirmed
  • Patent oviducts
  1. Diagnosis
  2. Rx of (1)
A
  1. Unexplained Infertility
  2. No treatment is indicated, and approximately 60 percent of patients with unexplained infertility will achieve a spontaneous pregnancy within the next 3 years

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14905-14933). Kaplan Publishing. Kindle Edition.

34
Q

Outline the steps in in-vitro fertilization

A
  1. Eggs are aspirated from the ovarian follicles using an ultrasound-guided transvaginal approach
  2. They are fertilized with sperm in the laboratory, resulting in the formation of embryos
  3. Multiple embryos are transferred into the uterine cavity with a cumulative pregnancy rate of 55 percent after 4 IVF cycles

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14905-14933). Kaplan Publishing. Kindle Edition.

35
Q

Gestational Trophoblastic Disease (GTN)

This is an abnormal proliferation of placental tissue involving both the cytotrophoblast and/ or syncytiotrophoblast. It can be either benign or malignant.

  1. Risk factors for GTN
  2. Symptoms of GTN
  3. Signs of GTN
  4. Most common site of distance metastasis
A
  1. Risk factors for GTN
  • From Taiwan and the Philippines (most common)
  • Maternal age extremes (< 20 years old, > 35 years old)
  • Folate deficiency
  1. Symptoms of GTN:
  • Bleeding < 16 weeks gestation and passage of vesicles from the vagina (most common)
  • Hypertension
  • Hyperthyroidism
  • Hyperemesis gravidarum
  • No fetal heart tones appreciated
  1. Signs of GNT
  • Fundus larger than dates
  • Absence of fetal heart tones
  • Bilateral cystic enlargements of the ovary (theca-lutein cysts)
  1. Lungs

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14933-14984). Kaplan Publishing. Kindle Edition.

36
Q

Compare the complete and incomplete moles

A

Complete and incomplete moles compared

37
Q

List and compare the different types of malignant moles

A

Malignant moles

38
Q

A 32-year-old Filipino woman is 15 weeks’ pregnant by dates. She presents with painless vaginal bleeding associated with severe nausea and vomiting. Her uterus extends to her umbilicus but no fetal heart tones can be heard. Her blood pressure is 162/ 98 mm Hg. A dipstick urine shows 2 + proteinuria. Which of the following is the most likely diagnosis?

a. Chronic hypertension
b. Chronic hypertension with superimposed preeclampsia
c. Eclampsia
d. Molar pregnancy
e. Preeclampsia

A

D. This patients presentation is typical for a molar pregnancy. Absence of fetal heart tones eliminates the other options

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14933-14984). Kaplan Publishing. Kindle Edition.

39
Q

Outline the diagnosis and management of GTN

A

Diagnostic Testing

Sonogram reveals homogenous intrauterine echoes without a gestational sac or fetal parts (“snowstorm” ultrasound)

Management

  • Baseline quantitative β-hCG titer
  • Chest x-ray (rule out lung metastasis)
  • Suction dilation and curettage (D& C) (to evacuate the uterine contents)
  • Place the patient on effective contraception (oral contraceptive pills) toensure no confusion between rising β-hCG titers from recurrent disease and normal pregnancy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14984-14985). Kaplan Publishing. Kindle Edition.

40
Q

Exercise-induced amenorrhea is due to a decrease in the pulsatile secretion of LH, which leads to a decline in estrogen production.

List the consequences of exercise-induced amenorrhea

A
  • Osteopenia
  • Ostoporosis
  • Breast atrophy
  • Vaginal atrophy
  • Mild hypercholesterolemia
  • Infertility

OBGYN USMLE Step 3 (7 decks)

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