United States Medical Licensing Examination (USMLE) Women's and Children's Health Syllabus

List the most effective reversible contraceptive methods (Tier 1, <1% failure with typical use).

Long-acting reversible contraceptives: the etonogestrel subdermal implant and intrauterine devices (levonorgestrel and copper IUDs).

What is the most effective form of emergency contraception, and within what window can it be placed?

The copper IUD is the most effective emergency contraceptive; it can be inserted up to 5 days after unprotected intercourse. Oral options include ulipristal acetate and levonorgestrel.

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

History of thromboembolism/thrombogenic mutation, smoking >=15 cigarettes/day at age >=35, migraine with aura, uncontrolled hypertension, breast cancer, active liver disease, and <21 days postpartum.

What organisms cause pelvic inflammatory disease, and what is the outpatient first-line treatment regimen?

Most commonly Neisseria gonorrhoeae and Chlamydia trachomatis (often polymicrobial). Outpatient regimen: ceftriaxone IM plus doxycycline, with metronidazole added for anaerobic coverage.

What is Fitz-Hugh-Curtis syndrome?

Perihepatitis (inflammation of the liver capsule with 'violin-string' adhesions) caused by ascending pelvic infection (chlamydia or gonorrhea), presenting with right upper quadrant pain in a patient with PID.

Compare the discharge findings of bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis.

BV: thin gray discharge, fishy odor, clue cells, pH >4.5. Trichomoniasis: frothy yellow-green discharge, 'strawberry cervix,' motile trichomonads, pH >4.5. Candidiasis: thick white 'cottage cheese' discharge, pseudohyphae, normal pH (<4.5).

What is the treatment for primary and secondary syphilis, and for the penicillin-allergic non-pregnant patient?

Single dose of benzathine penicillin G IM. Penicillin-allergic non-pregnant patients can receive doxycycline; pregnant patients must be desensitized to penicillin.

At what age and at what intervals does cervical cancer screening begin and proceed per current guidelines?

Begin at age 21. Ages 21-29: Pap cytology every 3 years. Ages 30-65: cytology every 3 years, HPV testing every 5 years, or co-testing every 5 years. Stop at 65 if adequate prior negative screening.

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

HPV 16 and 18 cause about 70% of cervical cancers (high-risk). HPV 6 and 11 cause most genital warts (low-risk).

What are the classic risk factors for endometrial carcinoma?

Unopposed estrogen exposure: obesity, nulliparity, late menopause, early menarche, chronic anovulation/PCOS, tamoxifen, estrogen-only HRT, and Lynch syndrome.

Which tumor marker is used to monitor epithelial ovarian cancer, and what is the most common histologic type?

CA-125 is the tumor marker for monitoring. Serous cystadenocarcinoma is the most common epithelial (and overall) ovarian cancer histology.

Define menopause and the typical hormonal changes seen.

Menopause is 12 consecutive months of amenorrhea (mean age ~51). Hormones: markedly elevated FSH (and LH), with low estradiol due to ovarian follicular depletion.

What are the risks associated with estrogen-only versus combined hormone replacement therapy?

Estrogen-only HRT increases endometrial cancer risk (used only in women without a uterus). Combined estrogen-progestin HRT increases risk of breast cancer, VTE, stroke, and coronary events.

Classify pelvic organ prolapse types by the organ involved.

Cystocele (anterior wall/bladder), rectocele (posterior wall/rectum), enterocele (small bowel), uterine prolapse, and vaginal vault prolapse (post-hysterectomy).

Compare stress, urge, and overflow urinary incontinence.

Stress: leakage with increased abdominal pressure (cough/sneeze), from urethral hypermobility. Urge: sudden urgency from detrusor overactivity. Overflow: continuous dribbling from incomplete emptying (detrusor underactivity or obstruction).

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

Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. Each scored 0-2; assessed at 1 and 5 minutes of life.

In neonatal resuscitation, what heart rate threshold indicates the need to begin positive pressure ventilation, and what threshold triggers chest compressions?

Begin PPV if heart rate <100 bpm (or apnea/gasping). Begin chest compressions (3:1 with ventilation) if heart rate <60 bpm despite 30 seconds of effective PPV.

Differentiate physiologic from pathologic neonatal jaundice.

Physiologic: appears after 24 hours, peaks day 3-5, unconjugated, resolves within ~1 week. Pathologic: appears within the first 24 hours, rises >5 mg/dL/day, total bilirubin >15 mg/dL, conjugated hyperbilirubinemia, or persists >2 weeks.

What is kernicterus and how is severe neonatal hyperbilirubinemia treated?

Kernicterus is bilirubin-induced neurologic damage from unconjugated bilirubin deposition in the basal ganglia. Treatment of severe hyperbilirubinemia is phototherapy; exchange transfusion is used for extreme/refractory levels.

What organisms most commonly cause early-onset neonatal sepsis, and what intrapartum prophylaxis reduces one of them?

Group B Streptococcus (S. agalactiae), E. coli, and Listeria monocytogenes. Intrapartum penicillin/ampicillin prophylaxis for GBS-positive mothers reduces early-onset GBS sepsis.

List the TORCH infections.

Toxoplasmosis, Other (syphilis, varicella, parvovirus B19, HIV), Rubella, Cytomegalovirus, and Herpes simplex virus.

What is the pathophysiology of neonatal respiratory distress syndrome and its main risk factor?

Surfactant deficiency from immature type II pneumocytes causes alveolar collapse; the main risk factor is prematurity. Chest x-ray shows diffuse ground-glass appearance with air bronchograms.

How is antenatal corticosteroid therapy used to reduce neonatal respiratory distress syndrome?

Betamethasone or dexamethasone given to mothers at risk of preterm delivery between 24 and 34 weeks accelerates fetal lung maturation/surfactant production, reducing RDS, intraventricular hemorrhage, and necrotizing enterocolitis.

What complication of prematurity presents with bloody stools, abdominal distension, and pneumatosis intestinalis on imaging?

Necrotizing enterocolitis (NEC). Pneumatosis intestinalis (air within the bowel wall) is the classic radiographic finding.

What is the newborn screening test panel commonly checking for, and name three classic conditions detected.

State-mandated heel-stick metabolic/genetic screening. Classic conditions include phenylketonuria (PKU), congenital hypothyroidism, galactosemia, sickle cell disease, and cystic fibrosis.

Differentiate the cyanotic congenital heart defects '5 Ts' and the most common one.

Truncus arteriosus, Transposition of the great arteries, Tricuspid atresia, Tetralogy of Fallot, and Total anomalous pulmonary venous return. Tetralogy of Fallot is the most common cyanotic lesion overall.

What are the four anatomic components of Tetralogy of Fallot?

Pulmonary stenosis (RV outflow obstruction), right ventricular hypertrophy, overriding aorta, and ventricular septal defect. Boot-shaped heart on x-ray; 'tet spells' relieved by squatting.

By what age should an infant double and triple their birth weight, and what is the normal head circumference growth in the first months?

Birth weight doubles by ~6 months and triples by ~12 months. Head circumference grows about 2 cm/month for the first 3 months.

List key gross motor milestones at 2, 6, 9, and 12 months.

2 months: lifts head/chest when prone. 6 months: sits unsupported, rolls both ways. 9 months: crawls, pulls to stand. 12 months: stands alone, takes first steps.

What is the recommended US childhood immunization given at birth, and which live vaccines are given at 12-15 months?

Hepatitis B vaccine is given at birth. The live MMR and varicella vaccines are first given at 12-15 months.

What organism classically causes epiglottitis and croup, and how do their presentations differ?

Epiglottitis: historically Haemophilus influenzae type b—presents with drooling, tripod position, 'thumbprint sign.' Croup: parainfluenza virus—presents with barking cough and inspiratory stridor, 'steeple sign' on x-ray.

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

Respiratory syncytial virus (RSV). Presents in infants <2 years with wheezing, tachypnea, and respiratory distress following a URI; treatment is supportive.

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

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

What is the inheritance pattern and underlying defect in cystic fibrosis?

Autosomal recessive mutation in the CFTR gene (most commonly delta F508) on chromosome 7, causing defective chloride channel function and thick secretions. Diagnosed by elevated sweat chloride.

What genetic mechanism causes Duchenne muscular dystrophy, and what is a classic clinical sign?

X-linked recessive frameshift deletion in the dystrophin gene causing absent dystrophin. Classic sign: Gower maneuver (using hands to climb up the legs to stand) and pseudohypertrophy of the calves.

Differentiate the genetic mechanisms of Down, Edwards, and Patau syndromes.

Down syndrome = trisomy 21; Edwards syndrome = trisomy 18 (clenched fists, rocker-bottom feet); Patau syndrome = trisomy 13 (cleft lip/palate, polydactyly, holoprosencephaly).

What are the components of the HEEADSSS adolescent psychosocial interview?

Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/depression, and Safety—a confidential framework for adolescent risk assessment.

What findings on physical exam should raise concern for child physical abuse?

Injuries inconsistent with the developmental stage or history, patterned bruises, posterior rib fractures, metaphyseal corner ('bucket-handle') fractures, spiral fractures in non-ambulatory infants, and retinal hemorrhages (shaken baby).

What is the recommended infant sleep position and environment to reduce SIDS risk?

Place infants supine (on their back) to sleep on a firm flat surface, in the parents' room but separate sleep surface, with no soft bedding, and avoid overheating and tobacco smoke exposure.