Posted on January 9, 2015 by Archer USMLE Reviews
Your patient is a gravida 1 para 0, 19 year old female at 33 weeks gestation that presents with a complaint of heavy vaginal bleeding and severe abdominal pain for an hour. Her pregnancy has been uneventful, and she is in good health, although she continues to smoke cigarettes, admitting to one pack per day.
Blood pressure is 110/80 with a heart rate of 110. The patient is afebrile, with respirations of 20/minute. Examination reveals a contracted uterus with a closed cervical os. The patient expels a large amount of blood from her closed cervix during the examination. Fetal heart rate monitoring reveals severe late decelerations. What is the best treatment option for this patient?
A. Expectant management with bed resT
B. Terbutaline
C. Oxytocin
D. Magnesium sulfate
E. Caesarean section delivery
Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: Archer Gynecology, archer obstetrics, archer ostetrics and gynecology, obstetrics, usmle step 3 gynecology and obstetrics | 8 Comments »
Posted on January 9, 2015 by Archer USMLE Reviews
Your patient is a gravida 2 para 2 female with a complaint of a vaginal discharge, vulvar irritation, and dysuria. Her symptoms have recurred 4 times within the past year. She had a recent urinary tract infection that was treated with ciprofloxacin, but is in otherwise good health. She is afebrile with normal vital signs, and pelvic examination reveals vulvar and vaginal erythema with a thick white discharge in the vaginal vault. KOH prep reveals pseudo hyphae. Which of the following treatments is most appropriate for this patient?
a. Oral fluconazole 150 mg x 1
b. Probiotic lactobacilli
c. No treatment is necessary
d. Oral Fluconozole induction followed by maintenance.
e. Topical miconazole x 7 days
Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: Archer Gynecology, archer ostetrics and gynecology, usmle step 3 gynecology | 11 Comments »
Posted on April 22, 2012 by Archer USMLE Reviews
394) A 36 year old woman with Type I diabetes mellitus presents to your office because she just learned that she is pregnant. She is excited and seeks your advise. Her home blood sugars are well controlled on a basal-bolus regimen of Glargine and Lispro insulin. Her other medications include Atorvastatin and aspirin. Her most recent HgbA1C was 6.0%. Her records also reveal that her most recent fasting lipid profile met the therapeutic goals at LDL of 80mg% and Non-HDL cholesterol of 100mg%. On examination, she is comfortable. Vitals are stable and reminder of the examination is unremarkable. An office based serum pregnancy test is positive. A repeat fasting lipid profile reveals Total Cholesterol : 250 mg% LDL cholesterol (calculated) 140mg%, HDL – cholesterol 40 mg%, Triglycerides 350mg%. Liver function tests , Serum electrolytes, Creatinine and Complete blood count are within normal limitsWhich of the following is the most appropriate next step?
A) Therapeutic Abortion
B) Add Niacin to her Lipid Regimen
C) Discontinue Statin and Start Niacin
D) Discontinue Statin and advise Diet modification alone
E) Increase Atorvastatin
Filed under: Uncategorized, USMLE Test Prep | Tagged: approach to hyperlipidemia, Archer cardiology, archer ostetrics and gynecology, archer preventive medicine, choosing hyperlipidemia therapy, Goals in treating hyperlipidemia, Hyperlipdemia Drugs and effects, hyperlipidemia in pregnancy, USMLE STEP 3 CARDIOLOGY, usmle step 3 gynecology and obstetrics, usmle step 3 preventive medicine | 8 Comments »
Posted on January 9, 2012 by Archer USMLE Reviews
308) A 76-year-old man presented with a 4-month history of recurrent vertigo. He reports feeling a sensation of spinning dizziness on turning the neck to his left. He also reports left sided headaches and decreased hearing on the left. Each episode lasted about 15 to 20 minutes and occurred when he turned his head to the left. He denies any ringing sensation in ears, nausea or vomiting. He denies any chest-pain, shortness of breath or palpitations. His past medical history is significant for hypertension and diet controlled diabetes. His medications include hydrochlorothiazide and enalapril. He also has history chronic neck pain due to cervical spondylosis for which he uses tylenol. On examination, his blood pressure in supine position is 140/88 mmHg and blood pressure on standing is is 130/86. Tympanic membranes are visible and there is some cerumen in the left ear. Using a 512Hz tuning fork , bone conduction is found to be better than air conduction on the left and Weber test shows lateralization to the left. Dix-Hallpike’s and Lhermitte’s signs are negative. There are no other neurological deficits. Gait is normal. Range of motion of the neck is limited on lateral movements and neck pain is elicited by turning to left side. An X-ray of cervical spine shows severe spondylosis with discopathy and osteophytes from C2 to C4 vertebrae. Which of the following is the most likely explanation for his Vertigo?
A) Orthostatic Hypotension
B) Vertebral artery occlusion from cervical spondylosis
C) Cerumen Impaction
D) Meniere’s disease
E) Labyrinthitis
Filed under: Uncategorized, USMLE Test Prep | Tagged: archer neurology, archer obstetrics, archer ostetrics and gynecology, archer preventive medicine, neurology mcqs, neurology usmle mcqs, usmle step 3 gynecology and obstetrics, usmle step 3 neurology, usmle step 3 obstetrics, usmle step 3 preventive medicine, vaccinations usmle step 3, vertigo | 7 Comments »
Posted on January 6, 2012 by Archer USMLE Reviews
307) A 35 year old woman is evaluated in your office during an antenatal visit. Her last menstrual period was 8 weeks ago. She tells you that 2 weeks after she missed her regular menstrual period she checked herself with home pregnancy kit and tested positive. She works in a day-care center. She is concerned now because she received Rubella vaccination 4 weeks ago after an exposure to a sick child without knowing that she was pregnant. She read about the dangers to fetus on the internet and is very worried. Physical examination is benign.
Which of the following is the most appropriate course of action?
A. Refer her to medical termination of pregnancy
B. Tell her that there is a high established risk to fetus and she should strongly consider termination of pregnancy
C. Counsel her about theoretical risk to fetus and continue pregnancy care
D. Administer Rubella immunoglobulin
E. Reassure her that there is no risk to fetus.
Filed under: Uncategorized, USMLE Test Prep | Tagged: archer obstetrics, archer ostetrics and gynecology, archer preventive medicine, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics, usmle step 3 preventive medicine, vaccinations usmle step 3 | 6 Comments »
Posted on June 26, 2011 by Archer USMLE Reviews
207) A 30 year old pregnant woman with 32 week gestation presents with severe itching that is present through out the day and interferes with her sleep at night. The itching is more on palms and soles. She had a similar problem during her previous pregnancy. She denies any history of eczema or liver disease in the past. Physical examination reveals excoriations on the skin. There are no papules, wheals or plaques. There is no scleral icterus. Laboratory investigations reveal an elevated Asparate aminotransferase ( AST) 140u/l , Alanine Aminotransferase (ALT) 150u/l, alkaline phosphatase at 280U/L ( Normal 40 to 120U/L) and Total bilirubin 2.2mg%. Complete blood count is with in normal limits. Hepatitis profile is negative. Which of the following is the most common complication associated with this entity:
A) Hepatic Failure
B) Fetal Prematurity
C) Renal Failure
D) Disseminated Intravascular Coagulation
E) Severe Post-Partum Hemorrhage
Filed under: USMLE Test Prep | Tagged: Archer Gynecology, archer obstetrics, archer ostetrics and gynecology, obstetrics, usmle step 3 gynecology, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics | 6 Comments »
Posted on June 26, 2011 by Archer USMLE Reviews
206) A 30 year old pregnant woman with 32 week gestation presents with severe itching that is present through out the day and interferes with her sleep at night. The itching is more on palms and soles. She had a similar problem during her previous pregnancy. She denies any history of eczema or liver disease in the past. Physical examination reveals excoriations on the skin. There are no papules, wheals or plaques. There is no scleral icterus. Laboratory investigations reveal an elevated Asparate aminotransferase ( AST) 140u/l , Alanine Aminotransferase (ALT) 150u/l, alkaline phosphatase at 280U/L ( Normal 40 to 120U/L) and Total bilirubin 2.2mg%. Complete blood count is with in normal limits. Hepatitis profile is negative. The most appropriate next step in managing this patient?
A) Serum Bile Acid level
B) Liver Biopsy
C) Ursodeoxycholic acid
D) Immediate delivery
E) Long-chain 3-hydroxyacyl CoA dehydrogenase (LCHAD) mutation testing
Filed under: USMLE Test Prep | Tagged: Archer Gynecology, archer obstetrics, archer ostetrics and gynecology, obstetrics, usmle step 3 gynecology, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics | 8 Comments »
Posted on June 26, 2011 by Archer USMLE Reviews
205) A 27 year old woman, primigravida at 35 week gestation is evaluated in your office for extreme itching associated with rash. The rash and itching first started on her abdomen but now spread to her buttocks and legs as well. She denies similar complaints in any of her family members. On physical examination, an eruption consisting of small erythematous wheals is noted mostly in the abdominal striae with sparing of the peri-umbilical skin. Some rash is also noted on her lower extremities. There is no involvement of palms and soles. A picture of her abdomen is shown below:
Most likely diagnosis:
A) Scabies
B) Pemphigoid Gestationis
C) Intahepatic Cholestasis of Pregnancy (ICP)
D) Pruritic Urticarial Papules of Pregnancy (PUPP)
E) Pruritic folliculitis of Pregnancy
Filed under: USMLE Test Prep | Tagged: archer dermatology, Archer Gynecology, archer obstetrics, archer ostetrics and gynecology, obstetrics, USMLE STEP 3 DERMATOLOGY, usmle step 3 dermatology images, usmle step 3 gynecology, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics | 5 Comments »
Posted on June 25, 2011 by Archer USMLE Reviews
200) A 26 year old pregnant woman is evaluated in the emergency Room for severe weakness and dehydration from persistent vomiting. She is a primigravida at 9 weeks gestation. She reports that her nausea and vomiting started at 5 weeks of pregnancy and have progressively become worse. She denies any abdominal pain or vaginal bleeding. She denies any headache. Her bowel movements are normal. Her past medical history is unremarkable. Her pre-pregnancy weight was 60lbs but now she weighs about 55lbs. Physical examination reveals dry oral mucosa. Laboratory tests reveal Serum sodium 140 meq/l, potassium 3.2meq/L, Chloride 102meq/l, Bicarbonate 34meq/L. hematocrit of 52 (normal = 36 to 46%). Urine reveals ketonuria. The most appropriate next step in investigating this patient:
A) Hemoglobin A1C level
B) Serum Uric acid
C) Urine for total protein
D) Ultrasound Pelvis
E) Plain X-Ray abdomen
Filed under: USMLE Test Prep | Tagged: Archer Gynecology, archer obstetrics, archer ostetrics and gynecology, obstetrics, usmle step 3 gynecology, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics | 8 Comments »
Posted on June 25, 2011 by Archer USMLE Reviews
199) A 32 year old pregnant woman with 32 week gestation is evaluated in your office during a regular follow up visit. She denies any abdominal pain or vomiting or vaginal bleeding or headache. She denies any headache or pruritis. She feels healthy and is hoping for a normal delivery. Physical examination is consistent with 32 week gestation. Extremities do not reveal any edema. Laboratory investigations reveal a mild anemia at 12.0gm%. Rest of the lab results are normal except for elevated alkaline phosphatase at 280U/L ( Normal 40 to 120U/L) . The patient is very concerned. Most appropriate next step in managing this patient?
A) Ultrasound of the liver and gall bladder
B) Immediate Delivery
C) Ursodeoxycholic acid
D) Reassurance
E) Obtain Peripheral Smear
Filed under: USMLE Test Prep | Tagged: Archer Gynecology, archer obstetrics, archer ostetrics and gynecology, obstetrics, usmle step 3 gynecology, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics | 4 Comments »
Posted on June 25, 2011 by Archer USMLE Reviews
198) A 26 year old pregnant woman is evaluated in the emergency Room for severe weakness and dehydration from persistent vomiting. She is a primigravida at 9 weeks gestation. She reports that her nausea and vomiting started at 5 weeks of pregnancy and have progressively become worse. She denies any abdominal pain or vaginal bleeding. She denies any headache. Her bowel movements are normal. Her past medical history is unremarkable. Her pre-pregnancy weight was 60lbs but now she weighs about 55lbs. Physical examination reveals dry oral mucosa. Laboratory tests reveal Serum sodium 140 meq/l, potassium 3.2meq/L, Chloride 102meq/l, Bicarbonate 34meq/L. hematocrit of 52 (normal = 36 to 46%); Total bilirubin of 2mg/dl; ALT of 160U/L and AST of 140U/L. Urine is positive for ketones. Ultrasound reveals normal fetus appropriate for 9 week gestation. Which of the following explains her jaundice and elevated liver function tests:
A) Acute pancreatitis
B) Acute Fatty Liver of pregnancy
C) Cholestatis of Pregnancy
D) Hyperemesis Gravidarum
E) HELLP Syndrome
Filed under: USMLE Test Prep | Tagged: Archer Gynecology, archer obstetrics, archer ostetrics and gynecology, obstetrics, usmle step 3 gynecology, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics | 6 Comments »
Posted on June 25, 2011 by Archer USMLE Reviews
197) A 26 year old pregnant woman is evaluated in the emergency Room for severe weakness and dehydration from persistent vomiting. She is a primigravida at 9 weeks gestation. She reports that her nausea and vomiting started at 5 weeks of pregnancy and have progressively become worse. She denies any abdominal pain or vaginal bleeding. She denies any headache. Her bowel movements are normal. Her past medical history is unremarkable. Her pre-pregnancy weight was 60lbs but now she weighs about 55lbs. Physical examination reveals dry oral mucosa. Laboratory tests reveal hematocrit of 52 ( normal = 36 to 46%) ; Total bilirubin of 2mg/dl; ALT of 160U/L and AST of 140U/L . Urine is positive for ketones. Ultrasound reveals normal fetus appropriate for 9 week gestation. The most likely diagnosis:
A) Diabetic Ketoacidosis
B) Acute Pancreatitis
C) Hyperemesis Gravidarum
D) Cholestasis of Pregnancy
E) Morning Sickness
Filed under: USMLE Test Prep | Tagged: Archer Gynecology, archer obstetrics, archer ostetrics and gynecology, obstetrics, usmle step 3 gynecology, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics | 2 Comments »
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