Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) Women's Health, Pediatrics, and the Lifecycle Syllabus

What is the most effective reversible form of contraception, and how do hormonal vs copper IUDs differ in duration?

LARC (IUDs and implants) are most effective; levonorgestrel IUDs last 3-8 years depending on type, and the copper IUD lasts up to 10 years and is non-hormonal.

What are the absolute contraindications to combined estrogen-containing oral contraceptives?

History of VTE/clotting disorder, smoker >=35 years old (>=15 cigarettes/day), migraine with aura, uncontrolled hypertension, active breast cancer, and history of stroke or CAD.

Which emergency contraception is most effective and what is the time window for options?

Copper IUD is most effective (within 5 days); ulipristal acetate works up to 5 days; levonorgestrel (Plan B) is best within 72 hours.

What organisms cause bacterial vaginosis, and what are the Amsel criteria findings?

BV is a polymicrobial overgrowth (Gardnerella vaginalis); Amsel: thin gray discharge, pH >4.5, positive whiff (amine) test with KOH, and clue cells on microscopy.

Differentiate the discharge of trichomoniasis, candidiasis, and bacterial vaginosis.

Trichomonas: frothy yellow-green, motile flagellates, strawberry cervix; candidiasis: thick white 'cottage cheese,' itching, normal pH; BV: thin gray, fishy odor, clue cells.

What HPV types most commonly cause cervical cancer and which cause genital warts?

HPV 16 and 18 cause ~70% of cervical cancers; HPV 6 and 11 cause most genital warts.

What is the most common gynecologic malignancy in the US and its cardinal symptom?

Endometrial (uterine) cancer; the cardinal symptom is postmenopausal bleeding.

Why is ovarian cancer often diagnosed late, and what tumor marker is associated with epithelial ovarian cancer?

Symptoms are vague (bloating, early satiety, pelvic pain), so it presents at an advanced stage; CA-125 is the associated marker (epithelial type).

Define menopause and the typical hormonal changes.

Permanent cessation of menses confirmed after 12 consecutive months of amenorrhea (average age ~51); FSH is elevated and estrogen (estradiol) is low.

What are the classic vasomotor and urogenital symptoms of menopause, and the main treatment?

Hot flashes, night sweats, vaginal atrophy/dryness, and dyspareunia; systemic hormone therapy is most effective for vasomotor symptoms (add progestin if uterus present).

What are the degrees of pelvic organ prolapse described by the term cystocele, rectocele, and uterine prolapse?

Cystocele = bladder herniates into the anterior vaginal wall; rectocele = rectum into the posterior wall; uterine prolapse = descent of the uterus into the vaginal canal.

What are the components of the APGAR score and when is it assessed?

Appearance (color), Pulse (heart rate), Grimace (reflex), Activity (tone), Respiration; scored 0-2 each at 1 and 5 minutes after birth.

What is the differential mechanism of physiologic vs pathologic neonatal jaundice timing?

Physiologic jaundice appears after 24 hours and peaks days 3-5; jaundice within the first 24 hours of life is pathologic (e.g., hemolysis) until proven otherwise.

What is the most common cause of pathologic unconjugated hyperbilirubinemia leading to kernicterus, and how is it treated?

Hemolytic disease (e.g., ABO/Rh incompatibility, G6PD deficiency); treated with phototherapy and, if severe, exchange transfusion.

Name the routine newborn screening prophylaxis given at birth.

Erythromycin eye ointment (gonococcal prophylaxis), intramuscular vitamin K (hemorrhagic disease prevention), and hepatitis B vaccine.

At what ages should an infant's birth weight double and triple?

Birth weight doubles by ~4-6 months and triples by ~12 months.

List key gross motor milestones at 6, 9, 12, and 18 months.

6 months: sits with support/rolls; 9 months: sits unsupported, crawls, pulls to stand; 12 months: stands alone, first steps; 18 months: walks well, runs.

What is the most common cause of bronchiolitis in infants and its hallmark presentation?

Respiratory syncytial virus (RSV); presents with wheezing, cough, tachypnea, and respiratory distress, usually in infants under 2 years.

What organism causes croup and what is its classic clinical sign and radiographic sign?

Parainfluenza virus; barking 'seal-like' cough and inspiratory stridor, with the 'steeple sign' (subglottic narrowing) on neck X-ray.

How do croup and epiglottitis differ in onset and posture?

Croup: gradual onset, barking cough, low fever; epiglottitis: rapid onset, high fever, drooling, tripod positioning, no cough (a medical emergency, classically H. influenzae type b).

What is the most common cause of acute otitis media, and the first-line antibiotic?

Streptococcus pneumoniae (also nontypeable H. influenzae and M. catarrhalis); first-line is high-dose amoxicillin.

What is intussusception's classic triad and characteristic stool finding in infants?

Triad: intermittent colicky abdominal pain, a sausage-shaped abdominal mass, and 'currant jelly' (bloody, mucoid) stools.

What electrolyte/acid-base abnormality is classic for pyloric stenosis, and the classic exam finding?

Hypochloremic, hypokalemic metabolic alkalosis; a palpable 'olive' mass with projectile non-bilious vomiting in a 3-6 week old.

What are the diagnostic criteria for Kawasaki disease and its feared complication?

Fever >=5 days plus 4 of 5: bilateral conjunctivitis, oral changes (strawberry tongue/cracked lips), cervical lymphadenopathy, polymorphous rash, extremity changes; feared complication is coronary artery aneurysm (treat with IVIG and aspirin).

Name the chromosomal abnormality and key features of Down syndrome.

Trisomy 21; features include hypotonia, flat facial profile, upslanting palpebral fissures, single palmar crease, and increased risk of congenital heart defects (AV septal defect) and duodenal atresia.

Differentiate Turner syndrome from Klinefelter syndrome by karyotype and key features.

Turner (45,X): short stature, webbed neck, ovarian dysgenesis, coarctation of the aorta; Klinefelter (47,XXY): tall, gynecomastia, small testes, infertility.

What are the Tanner stages used to assess, and what is the first sign of puberty in girls vs boys?

Tanner stages assess sexual maturity (breast/pubic hair in girls, genital/pubic hair in boys); first sign is breast budding (thelarche) in girls and testicular enlargement in boys.

What is the leading cause of death in adolescents, and what screening tool assesses adolescent psychosocial risk?

Unintentional injuries (motor vehicle accidents); the HEEADSSS assessment (Home, Education, Eating, Activities, Drugs, Sexuality, Suicide/depression, Safety) screens psychosocial risk.

What is the recommended STI screening for sexually active adolescents and young women under 25?

Annual screening for chlamydia and gonorrhea (and HIV testing); routine cervical cancer screening (Pap) begins at age 21 regardless of activity.

What are the four osteopathic tenets, and how is OMT used in pregnancy?

The body is a unit; structure and function are interrelated; the body has self-regulation/self-healing; rational treatment is based on these principles. OMT in pregnancy addresses low back pain, edema, and pelvic alignment using gentle techniques (e.g., soft tissue, myofascial, counterstrain), avoiding high-velocity thrusts on unstable joints.

Which gentle osteopathic technique is commonly used to treat otitis media and improve eustachian tube drainage in children?

The Galbreath technique (mandibular drainage) and auricular drainage, used to promote lymphatic/eustachian tube drainage as adjunctive care.