Cisco
CompTIA
ISC
EC-Council
EXIN
Fortinet
ITIL
Juniper
Microsoft
VMware
Avaya
SAP
Google
NVIDIA
Salesforce
Amazon
Palo Alto Networks
ISC2
Splunk
ServiceNow
All Vendors
  2. Home
  3. Exams
  4. USMLE
  5. STEP3

USMLE STEP3 Exam
Step3 (Page 49 )

Updated On: 1-Feb-2026
Page 32 of 162
PDF with 804 Questions

A39-year-old woman with a long-standing history of normal pap smears undergoes a total abdominal hysterectomy for a large uterine fibroid and menorrhagia. Six months after her hysterectomy she had a negative vaginal pap smear from the vaginal apex. She presents to your clinic today for a routine physical examination. Based on the American College of Obstetricians and Gynecologists recommendations, when should this patient have pap smears?

  1. yearly
  2. every 3 years
  3. every 5 years
  4. never again
  5. only if she develops risk factors

Answer(s): E

Explanation:

This patient, who had a hysterectomy for a benign condition, no longer needs pap smear screening as long as she is monogamous and does not develop risk factors for cervical dysplasia. The incidence for vaginal dysplasia after hysterectomy for benign disease is approximately 0.13%. Invasive carcinoma of the vagina is rare, and screening for this cancer is not cost-effective. However, women who had a hysterectomy for cervical dysplasia or cancer are at increased risk for vaginal dysplasia and should continue to have vaginal pap smears. It is also reasonable to reinitiate pap smear screening in women who had a hysterectomy for benign disease if they have new sexual partners or new risk factors. Apap test is also indicated if patients present with vaginal spotting or bleeding



A 30-year-old (G2P0101) female presents to the clinic for a new obstetric visit. She has an unknown LMP. She reports that she discovered she was pregnant when she took a urine pregnancy test at home a month ago. She vaguely recalls having a period about 2 months ago, but is not sure exactly when that occurred. She reports that she is generally healthy. She had a previous delivery at 36 weeks EGA, though she reports her doctor was not really sure about her due date in that pregnancy. She reports that she had a normal spontaneous vaginal delivery in her previous pregnancy, and the child is healthy. Her postpartum course was complicated by depression, which has since resolved and not recurred. She denies history of sexually transmitted diseases or abnormal pap smears. She has no surgical history. She does not smoke, drink alcohol, or use illicit drugs. She does not have any family history of hypertension, diabetes, twins, or congenital anomalies. She does report that her mother has a history of depression

Given the patient's history of postpartum depression as well as her family history of depression, her risk of postpartum depression after this pregnancy is approximately what percentage?

  1. 50% or greater
  2. 5%
  3. 10%
  4. 20%
  5. less than 1%

Answer(s): A

Explanation:

The pelvic ultrasound is the most reliable measurement of fetal gestational age in the absence of accurate dating by LMP. A first trimester sonogram is thought to be reliable ±7 days. Given the patient's history, she is likely at least 2 months pregnant. hCG level at this gestation can be variable and is not a useful method of pregnancy dating. A pelvic examination is useful to help confirm likely dating, but is not a reliable means of determining EDD. FSH and LH levels have no role in determining pregnancy dating.

The risk of postpartum major depression is estimated at 820% in all postpartum patients. In those with a previous history of postpartum depression, the risk is thought to be 50100%. In patients who have had previous depression not associated with pregnancy, the risk of postpartum depression is 2030%. Maternity blues is a milder psychological reaction that can occur in the early postpartum period and is thought to occur in 70+ % of all postpartum patients. Patients with a history of bipolar disease have a igher risk of recurrence in the postpartum period, and these patients often present with postpartum psychosis symptoms.



A 30-year-old (G2P0101) female presents to the clinic for a new obstetric visit. She has an unknown LMP. She reports that she discovered she was pregnant when she took a urine pregnancy test at home a month ago. She vaguely recalls having a period about 2 months ago, but is not sure exactly when that occurred. She reports that she is generally healthy. She had a previous delivery at 36 weeks EGA, though she reports her doctor was not really sure about her due date in that pregnancy. She reports that she had a normal spontaneous vaginal delivery in her previous pregnancy, and the child is healthy. Her postpartum course was complicated by depression, which has since resolved and not recurred. She denies history of sexually transmitted diseases or abnormal pap smears. She has no surgical history. She does not smoke, drink alcohol, or use illicit drugs. She does not have any family history of hypertension, diabetes, twins, or congenital anomalies. She does report that her mother has a history of depression Postpartum psychosis is a serious disorder that can occur in the early postpartum period. Patients with which of the following medical conditions are at increased risk of postpartum psychosis?

  1. multiparity
  2. anxiety disorder
  3. thyroid disease
  4. bipolar disorder
  5. advanced maternal age

Answer(s): D

Explanation:

The pelvic ultrasound is the most reliable measurement of fetal gestational age in the absence of accurate dating by LMP. A first trimester sonogram is thought to be reliable ±7 days. Given the patient's history, she is likely at least 2 months pregnant. hCG level at this gestation can be variable and is not a useful method of pregnancy dating. A pelvic examination is useful to help confirm likely dating, but is not a reliable means of determining EDD. FSH and LH levels have no role in determining pregnancy dating.

The risk of postpartum major depression is estimated at 820% in all postpartum patients. In those with a previous history of postpartum depression, the risk is thought to be 50100%. In patients who have had previous depression not associated with pregnancy, the risk of postpartum depression is 2030%. Maternity blues is a milder psychological reaction that can occur in the early postpartum period and is thought to occur in 70+ % of all postpartum patients. Patients with a history of bipolar disease have a igher risk of recurrence in the postpartum period, and these patients often present with postpartum psychosis symptoms.



A 24-year-old White (G1P1001) female presents to your office 6 weeks after a normal spontaneous vaginal delivery at term. She reports that she has been unable to breast-feed her baby despite helpfrom her pediatrician and a lactation consultant. On further questioning, you elicit that she has also experienced nausea, weakness, and weight loss. In addition, she reports dizziness when getting out of bed in the morning. On your examination, she has a waxy texture to her skin and periorbital edema. You also note decreased axillary and pubic hair, which she reports is a change for her.
She most likely has which of the following diagnoses?

  1. postpartum depression
  2. normal postpartum changes
  3. Sheehan syndrome
  4. PCOS
  5. medication reaction

Answer(s): C

Explanation:

Sheehan syndrome is also known as postpartum pituitary necrosis. It is associated with severe blood loss during the early postpartum period. The patient with this syndrome may present acutely with hypotension and shock due to adrenal insufficiency, though often it presents as in this case, with the more gradual onset of symptoms. The most common initial presentation is the inability to lactate. Other symptoms may occur over months to years with the classic patient presenting with failure of lactation, rapid breast involution, amenorrhea, failure to regrow pubic and axillary hair, skin depigmentation, anorexia and nausea, lethargy, weakness, and weight loss. Signs and symptoms may present years after the event. Additionally, on physical examination, patients may have waxy skin, periorbital edema, and decreased skin pigmentation. Sheehan syndrome usually involves the anterior pituitary but can sometimes cause ischemia of the posterior pituitary. With posterior pituitary involvement, vasopressin secretion is diminished resulting in diabetes insipidus. Most cases involve the selective loss of hormone secretion of the anterior pituitary hormones, and the loss is usually incomplete. The clinical manifestation depends on the degree of deficiency and the hormones that are affected. GH deficiency is seen in the majority of patients with Sheehan syndrome followed by ACTH deficiency, hypogonadism, and hypothyroidism



A 24-year-old White (G1P1001) female presents to your office 6 weeks after a normal spontaneous vaginal delivery at term. She reports that she has been unable to breast-feed her baby despite helpfrom her pediatrician and a lactation consultant. On further questioning, you elicit that she has also experienced nausea, weakness, and weight loss. In addition, she reports dizziness when getting out of bed in the morning. On your examination, she has a waxy texture to her skin and periorbital edema. You also note decreased axillary and pubic hair, which she reports is a change for her.

This condition is most commonly associated with which of the following?

  1. obesity and increased facial hair
  2. postpartum hemorrhage
  3. acute thrombosis
  4. no specific association is known, this condition is idiopathic
  5. serotonin imbalance

Answer(s): B

Explanation:

Sheehan syndrome is also known as postpartum pituitary necrosis. It is associated with severe blood loss during the early postpartum period. The patient with this syndrome may present acutely with hypotension and shock due to adrenal insufficiency, though often it presents as in this case, with the more gradual onset of symptoms. The most common initial presentation is the inability to lactate. Other symptoms may occur over months to years with the classic patient presenting with failure of lactation, rapid breast involution, amenorrhea, failure to regrow pubic and axillary hair, skin depigmentation, anorexia and nausea, lethargy, weakness, and weight loss. Signs and symptoms may present years after the event. Additionally, on physical examination, patients may have waxy skin, periorbital edema, and decreased skin pigmentation. Sheehan syndrome usually involves the anterior pituitary but can sometimes cause ischemia of the posterior pituitary. With posterior pituitary involvement, vasopressin secretion is diminished resulting in diabetes insipidus. Most cases involve the selective loss of hormone secretion of the anterior pituitary hormones, and the loss is usually incomplete. The clinical manifestation depends on the degree of deficiency and the hormones that are affected. GH deficiency is seen in the majority of patients with Sheehan syndrome followed by ACTH deficiency, hypogonadism, and hypothyroidism



Viewing page 49 of 162
Viewing questions 241 - 245 out of 804 questions



Post your Comments and Discuss USMLE STEP3 exam prep with other Community members:

Join the STEP3 Discussion