USMLE STEP 2 CK OBGYN" AND SECRETS UPDATED STUDY
GUIDE QUESTIONS AND CORRECT ANSWERS
C
Embryologic origin of uterus Fusion of the 2 Mullerian ducts
When is transvaginal transducer ultrasound used? Transvaginal transducer: ("pie shaped image")
Transabdominal transducer? - lower pelvic masses
- not influenced by thickness of maternal abdominal wall
Transabdominal transducer:
- entire pelvis as well as abdomen imaging
Ultrasound works best when adjacent tissues have differing echodensities,
particularly fluid/tissue interfaces
Average age range of menarche? Thelarche? menarche: 10-16.5y
thelarche: breast development; 8~11y
What is the average age for Tanner II stage of breast Tanner II: Breast development
development? Presentation? - 8-13 yrs
- Breast buds begin
ASCUS? Atypical Squamous Cells of Uncertain Significance
misreadings on Pap smears due to mechanical errors (drying, etc.)
Major structures of the uterus (3) Corpus (body)
- Cornu (uterus join with fallopian tubes)
Isthmus
Cervix
Describe satisfactory colposcopy vs. unsatisfactory Satisfactory colposcopy
colposcopy 1. T-zone does NOT extend into the endocervical canal
2. No lesions visualized within T-zone
Unsatisfactory is the opposite..
Tanner stages: Pubic Hair Male + Female
Tanner I: None (prepubertal state)
Tanner II: small amount of long, downy hair with slight pigmentation on the
labia majora
Tanner III: hair becomes more coarse and curly and begins to extend laterally
Tanner IV: adult-like hair quality, extending across pubis but sparing medial
thighs
Tanner V: hair extends to medial surface of the thighs
,What are the risks of cone biopsy? (3) 1. incompetent cervix (cutting too much)
2. cervical stenosis (can cause amenorrhea)
3. preterm birth
Traditional Pap vs. Liquid-based Pap Traditional Pap:
- spatula for ectocervix*
- cyto-brush for endocervical canal* (rotating in 1 direction 360°)
- both specimens are smeared onto a glass slide, fixed with formalin, then
stained
Potential problems
- ASCUS (atypical squamous cells of uncertain significance) cannot be
diagnosed
- insufficient smearing, air-drying artifacts if process is delayed, mechanical
problems makes traditional technique obsolete
Liquid-based Pap:
- cervical broom* to collect specimens (rotated 5 times in same direction)
- broom is placed into "formalin" solution and rotated 10 times to release
collected material
- this method is more preferred vs. traditional Pap due to absence of
mechanical errors
- ASCUS can also be used for HPV-DNA typing
What is special about Tanner IV stage of breast Papilla and areola forms a 2' mound not contour with surrounding breast
development?
, LEEP (loop electrosurgical excision procedure) A thin low-voltaged loop cuts out abnormal cervical tissue identified with
description, procedure, followup, risks colposcopy
advantage: visual confirmation lesions have been removed; no anesthesia
needed
followup Pap smear every 3-6 months for 2 years to ensure dysplastic changes
to not return
long-term risks of LEEP include
- cervical stenosis
- cervical insufficiency
What type of blood supply do oviducts receive? From Dual blood supply*
where?
Receives blood from the uterine artery and ovarian artery
What is the average age range for Tanner V stage of Tanner V: Breast development
breast development? - 12.5~18.5 yrs
- development is complete
What does the ovarian stroma produce? androgen
Important for libido after menopause
Dilation and Curettage (D&C) procedure under anesthesia
examines histology of endometrial lesions
similar to endometrial biopsy; dilation of cervix is required to introduce curette
can collect large amounts of endometrial tissue (>endometrial biopsy)
What are the 4 segments of the oviducts? Proximal → Distal "INTERcourse IS AMP and FUN"
1. Interstitium
2. Isthmus
3. Ampulla
4. Infundibulum
American Cancer Society recommendations 1. initial study at age 34 if there are risk factors (breast cancer in first degree
relative, BRCA genes, etc.)
2. routine screening at age 40 if there are no risk factors
Explain the formation of the T-zone at puberty the vaginal pH falls (due to estrogen dominance)
the "native" columnar epithelium goes through metaplasia and becomes the
transformation zone; normal-appearing "metaplastic" stratified squamous
epithelium
Old→New squamocolumnar junction (outer-to-inner)
Procedure associated with assessment of Asherman's HSG
syndrome
hysterosalpingogram
GUIDE QUESTIONS AND CORRECT ANSWERS
C
Embryologic origin of uterus Fusion of the 2 Mullerian ducts
When is transvaginal transducer ultrasound used? Transvaginal transducer: ("pie shaped image")
Transabdominal transducer? - lower pelvic masses
- not influenced by thickness of maternal abdominal wall
Transabdominal transducer:
- entire pelvis as well as abdomen imaging
Ultrasound works best when adjacent tissues have differing echodensities,
particularly fluid/tissue interfaces
Average age range of menarche? Thelarche? menarche: 10-16.5y
thelarche: breast development; 8~11y
What is the average age for Tanner II stage of breast Tanner II: Breast development
development? Presentation? - 8-13 yrs
- Breast buds begin
ASCUS? Atypical Squamous Cells of Uncertain Significance
misreadings on Pap smears due to mechanical errors (drying, etc.)
Major structures of the uterus (3) Corpus (body)
- Cornu (uterus join with fallopian tubes)
Isthmus
Cervix
Describe satisfactory colposcopy vs. unsatisfactory Satisfactory colposcopy
colposcopy 1. T-zone does NOT extend into the endocervical canal
2. No lesions visualized within T-zone
Unsatisfactory is the opposite..
Tanner stages: Pubic Hair Male + Female
Tanner I: None (prepubertal state)
Tanner II: small amount of long, downy hair with slight pigmentation on the
labia majora
Tanner III: hair becomes more coarse and curly and begins to extend laterally
Tanner IV: adult-like hair quality, extending across pubis but sparing medial
thighs
Tanner V: hair extends to medial surface of the thighs
,What are the risks of cone biopsy? (3) 1. incompetent cervix (cutting too much)
2. cervical stenosis (can cause amenorrhea)
3. preterm birth
Traditional Pap vs. Liquid-based Pap Traditional Pap:
- spatula for ectocervix*
- cyto-brush for endocervical canal* (rotating in 1 direction 360°)
- both specimens are smeared onto a glass slide, fixed with formalin, then
stained
Potential problems
- ASCUS (atypical squamous cells of uncertain significance) cannot be
diagnosed
- insufficient smearing, air-drying artifacts if process is delayed, mechanical
problems makes traditional technique obsolete
Liquid-based Pap:
- cervical broom* to collect specimens (rotated 5 times in same direction)
- broom is placed into "formalin" solution and rotated 10 times to release
collected material
- this method is more preferred vs. traditional Pap due to absence of
mechanical errors
- ASCUS can also be used for HPV-DNA typing
What is special about Tanner IV stage of breast Papilla and areola forms a 2' mound not contour with surrounding breast
development?
, LEEP (loop electrosurgical excision procedure) A thin low-voltaged loop cuts out abnormal cervical tissue identified with
description, procedure, followup, risks colposcopy
advantage: visual confirmation lesions have been removed; no anesthesia
needed
followup Pap smear every 3-6 months for 2 years to ensure dysplastic changes
to not return
long-term risks of LEEP include
- cervical stenosis
- cervical insufficiency
What type of blood supply do oviducts receive? From Dual blood supply*
where?
Receives blood from the uterine artery and ovarian artery
What is the average age range for Tanner V stage of Tanner V: Breast development
breast development? - 12.5~18.5 yrs
- development is complete
What does the ovarian stroma produce? androgen
Important for libido after menopause
Dilation and Curettage (D&C) procedure under anesthesia
examines histology of endometrial lesions
similar to endometrial biopsy; dilation of cervix is required to introduce curette
can collect large amounts of endometrial tissue (>endometrial biopsy)
What are the 4 segments of the oviducts? Proximal → Distal "INTERcourse IS AMP and FUN"
1. Interstitium
2. Isthmus
3. Ampulla
4. Infundibulum
American Cancer Society recommendations 1. initial study at age 34 if there are risk factors (breast cancer in first degree
relative, BRCA genes, etc.)
2. routine screening at age 40 if there are no risk factors
Explain the formation of the T-zone at puberty the vaginal pH falls (due to estrogen dominance)
the "native" columnar epithelium goes through metaplasia and becomes the
transformation zone; normal-appearing "metaplastic" stratified squamous
epithelium
Old→New squamocolumnar junction (outer-to-inner)
Procedure associated with assessment of Asherman's HSG
syndrome
hysterosalpingogram
