Kaplan USMLE Step 3 prep: Women’s health drives these 7 stumpers

Over the years, the AMA has run dozens of example questions from Kaplan Medical. If you’re preparing for the United States Medical Licensing Examination^® (USMLE^®) Step 3 exam, you might want to know which questions are most often missed by test-prep takers. We’ve compiled seven cases from Kaplan Medical involving women’s health. Each question comes with an expert explanation of the answer. You can check out all posts in this series.

The AMA and Kaplan have teamed up to support you in reaching your goal of passing the USMLE® or COMLEX-USA®. If you're looking for additional resources, Kaplan provides free access to tools for pre-clinical studies, including Kaplan’s Lecture Notes series, Integrated Vignettes, Shelf Prep and more.

Think you can answer these questions involving women’s health? Find out now.

1. What to do next in difficult delivery?

   1. A 34-year-old G1P0 woman at 39 weeks presents for rupture of membranes. The patient felt a gush of fluid one-hour ago, denies vaginal bleeding and is feeling contractions every three to four minutes. She feels the baby moving. The patient's prenatal course has been complicated by gestational diabetes for which she is following a special diet but no medication. She progressed to fully dilated and began pushing 90 minutes ago. The fetal head was delivered 30 seconds ago, and anterior shoulder has not been able to be delivered. The nurses are applying suprapubic pressure. What is the next step in the management of this patient?

2. How to manage pregnant woman’s lab result?

   1. A 24-year-old G2P1 woman with intrauterine pregnancy at 17 weeks presents for routine prenatal visit. The patient denies contractions, vaginal bleeding, or leakage of fluid. The patient states that she feels the baby moving. On physical exam the patient's fundal height is 15 cm and a fetal heartbeat is heard. Routine labs are done and the maternal serum alpha-fetoprotein returns low. Which is the next step in the management of this patient?

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3. Headache hits 10 of 10 on pain scale

   1. You are seeing a 34-year-old woman in the emergency department who is now 10 days post emergent C-section for preeclampsia at 29 weeks and presents with a three-day history of a headache. She describes it as “pain starting at the right temple and shooting through the head to the left temple.” There is some associated photophobia and phonophobia. At its worst, the headache is a 10 of 10 on the pain scale, with 10 being the worst pain that she ever felt in her life. What’s the next step in management of this patient?

4. What is the woman’s electrolyte abnormality?

   1. An 82-year-old woman with a history of Alzheimer dementia is brought to the emergency department by her family. Her home health attendant found her collapsed on the floor of her apartment. The patient gradually becomes more alert and conversant after administration of intravenous normal saline for two days. Attempts to feed her orally are unsuccessful, as she has evidence of defective swallowing. The decision is made to place a percutaneous gastrostomy tube to ensure proper nutrition and protect against aspiration. Which is the most likely electrolyte abnormality in this patient?

5. Manage this pregnancy complication

   1. A 26-year-old G1P0 woman who is eight weeks pregnant presents with vaginal bleeding for the past three days. She denies any passage of blood clots and has no abdominal or pelvic pain. Vital signs and physical examination are normal. Transvaginal ultrasound demonstrates a gestational sac containing a fetal pole and a yolk sac. The fetal heart motion is detected, and crown rump length measurements are consistent with an eight week gestation. There is a small crescent-shaped hypoechoic area next to the gestational sac. What is the next step in management of this patient?

6. Woman has frequent kidney stones

   1. A 38-year-old woman with systemic lupus erythematosus (SLE) and hypertension presents with frequent nephrolithiasis. Her stones are composed of calcium oxalate. Her SLE has been managed with immunosuppressive therapy, with no recent flares. She also takes hydrochlorothiazide for her hypertension. Her blood pressure is 142/68 mm Hg and her pulse is 77 beats per minute. On physical examination, there is mild tenderness and warmth of the knee joints; the remainder of the exam is unremarkable. A chest X-ray is normal. What is the most appropriate treatment for this patient's nephrolithiasis?

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7. Next step for woman with hip pain

   1. A 45-year-old woman with a five-year history of systemic lupus erythematosus comes to the emergency department complaining of hip pain. She rates the pain as a 10 on a pain scale of one to 10. She describes the pain as deep aching in quality and increasing over the last several weeks. The pain is persistent at rest and during physical activity. She denies any history of trauma. What is the most appropriate next step in the management of this patient?

For more prep questions on USMLE Steps 1, 2 and 3, view other posts in this series.