USMLE Step 2 CK-OB/GYN Exam Study Questions 2022/23 COMPLETE SOLUTION

Document Content and Description Below

USMLE Step 2 CK-OB/GYN Exam Study Questions 2022/23 COMPLETE SOLUTION What is Nagele's rule? - ✔✔due date = LMP + 9 months + seven days What is developmental age? - ✔✔number of weeks and da... ys since fertilization. typically used only in research, as the exact date of fertilization is not commonly known What is gestational age? - ✔✔number of wks and days measured from the first day of the LMP. How else can gestational age be determined? - ✔✔Fundal height: at 20wks, uterus is at the umbilicus and grows approx 1 cm/wk Quickening, or appreciation of fetal movt: typically occurs at 17-18 wks Fetal heart tones: can be heard at 10-12 wks by Doppler Ultrasound: measures fetal crown-rump length (CRL) at 5-12wks and measured biparietal diameter (BPD), femur length (FL), and abd circumference (AC) from 13 wks. U/S measurement of GA is most reliable during the first trimester How does renal flow change in pregnancy? - ✔✔increases 25-50% How does glomerular filtration rate change in pregnancy? - ✔✔increases early, then plateaus How does uterine weight change in pregnancy? - ✔✔increases from about 60-70g to about 900-1200g How does body weight change in pregnancy? - ✔✔average 11kg (25lb) increase What is the standard for diagnosing pregnancy? - ✔✔B-hCG - produced by placenta; peaks at 100,000 mIU/mL by 10wks of gestation - decreases throughout the second trimester; levels off in the third trimester - hCG levels double approx every 48hrs during early pregnancy. This is often used to diagnose ectopic pregnancy when doubling is abnormal What is a quantitative B-hCG used for? - ✔✔- to diagnose and follow ectopic pregnancy - to monitor trophoblastic disease - to screen for fetal aneuploidy What is a quad screen? - ✔✔1) Maternal serum alpha-fetoprotein - produced by the fetus, crosses the placenta in small amounts and enters the maternal circulation - Elevated: assoc w/ open neural tube defects (anencephaly, spina bifida), abd wall defects (gastroschisis, omphalocele), multiple gestation, incorrect gestational dating, fetal death, and placental abnormalities (e.g. placental abruption) - Decreased: assoc w/ trisomy 21 and 18, fetal demise, and inaccurate gestational dating. 2) inhibin A 3) estriol 4) B-hCG What quad screen results suggest Trisomy 18? - ✔✔ALL four decreased What quad screen results suggest Trisomy 21 - ✔✔decreased AFP and estriol Increased B-hCG and inhibin A How does heart rate change in pregnancy? - ✔✔gradually increases 20% How does blood pressure change in pregnancy? - ✔✔gradually decreases 10% by 34 wks, then increases to prepregnancy values How does stroke volume change in pregnancy? - ✔✔increases to maximum at 19wks, then plateaus How does cardiac output change in pregnancy? - ✔✔rises rapidly by 20%, then gradually increases an additional 10% by 28wks How does peripheral venous distention change in pregnancy? - ✔✔progressive increase to term How does peripheral vascular resistance change in pregnancy? - ✔✔progressive decrease to term How does respiratory rate change in pregnancy? - ✔✔unchanged How does tidal volume change in pregnancy? - ✔✔increases by 30-40% How does expiratory reserve change in pregnancy? - ✔✔gradual decrease How does vital capacity change in pregnancy? - ✔✔unchanged How does respiratory minute volume change in pregnancy? - ✔✔increases by 40% How does blood volume change in pregnancy? - ✔✔increases by 50% in second trimester How does hematocrit change in pregnancy? - ✔✔decreases slightly How does fibrinogen change in pregnancy? - ✔✔increases How do electrolytes change in pregnancy? - ✔✔unchanged How does sphincter tone change in pregnancy? - ✔✔decreases How does gastric emptying time change in pregnancy? - ✔✔increases What is the recommended amount of weight women should gain in pregnancy? - ✔✔an additional 100- 300 kcal/day; 500 kcal/day during breastfeeding Excessive gain: >1.5kg/mo Inadequate gain: <1 kg/mo What are the nutritional guidelines for pregnancy? - ✔✔folic acid supplements (decrease neural tube defects for all reproductive-age women): 0.4 mg/day Iron: 30mg/day of elemental iron Calcium: 1300 mg/day for women <19yo; 1000mg/day >19yo Vitamin D: 10ug or 400IU/day Vitamin B12: 2ug/day What is PAPP-A? - ✔✔pregnancy-assoc plasma protein A recommended at wks 9-14 to detect Down Syndrome and Trisomy 18 risk combined with ultrasound-determined nuchal transparency (fluid in the fetal neck) + B-hCG What is CVS? - ✔✔chorionic villus sampling recommended at wks 10-12 involves transcervical or transabd aspiration of placental (chorionic villi) tissue What are the advantages and disadvantages of CVS? - ✔✔Ads - diagnostic accuracy comparable to that of amnio, available at 10-12wks Disads - carries risk of fetal loss (1-2%); cannot detect open neural tube defects What are complications of CVS? - ✔✔limb defects have been assoc w/ CVS performed </= 9wks How often should prenatal visits occur? - ✔✔Wks 0-28: every four wks Wks 29-35: every 2 wks Wks 36-birth: every wk What kind of testing should be completed at the initial prenatal visit? - ✔✔Heme: CBC, Rh factor, type and screen ID: UA and culture, rubella ab titer, HBsAg, RPR/VDRL, cervical gonorrhea and chlamydia, PPD, HIV, Pap smear (to check for dysplasia) If indicated: HbA1c, sickle cell screening Discuss genetic screening: Tay-Sachs, CF What kind of prenatal testing should be completed at 9-14wks? - ✔✔offer Triple Screen - PAPP-A - nuchal transparency - free B-hCG +/- CVS What kind of prenatal testing should be completed at 15-20wks? - ✔✔Offer Quad Screen - AFP - estriol - B-hCG - inhibin A +/- amniocentesis What kind of prenatal testing should be completed at 18-20wks? - ✔✔ultrasound for full anatomic screen What kind of prenatal testing should be completed at 24-28 wks? - ✔✔1hr glu challenge test for gestational diabetes screen What kind of prenatal testing should be completed at 28-30 wks? - ✔✔RhoGAM for Rh (-) women (after ab screen) What kind of prenatal testing should be completed at 32-36wks? - ✔✔GBS; repeat CBC What kind of prenatal testing should be compeleted at 34-40wks? - ✔✔cervical chlamydia and gonorrhea cultures, HIV, RPR in high-risk pts What is an amniocentesis? - ✔✔recommended 15-20wks consists of transabdominal aspiration of amniotic fluid using an ultrasound guided needle and eval of fetal cells for genetic studies What are the advantages and disadvantages of an amniocentesis? - ✔✔Ads - detects ~80% of open neural tube defects, ~85% of cases of Down syndrome, and ~60% of cases of trisomy 18 Disads - risks: premature rupture of membranes, chorioamnionitis, and fetal-maternal hemorrhage, which can result in fetal loss (0.5%) When is an amniocentesis indicated? - ✔✔- women wh [Show More]

Last updated: 2 years ago

Preview 1 out of 87 pages