All q Flashcards
Old patient, parkinsonism , visual hallucinations
Lewy body dementia
Young male patient, DM has UTI + mrsa , which medication?
Vancomycin
Most nephrotoxic anti tb
Rifampicin
Most hepatotoxic anti tb
Inh
Soldier go south region, what malaria prophylaxis to give?
Atovaquone/ proguanil
Case of chronic diarrhea, blood culture shows c.diff
Oral vancomycin
Pt with Htn and progressive memory lost and decrease cognitive function. MRI shows hyperintense lesion.
Vascular dementia
Sharp, shooting pain of neck radiating to shoulder and jaw, what’s the diagnosis?
Cervical disk prolapse
16 year old girl with acute migraine headache and nausea and aura. What’s the acute management?
Triptans
Headache that is throbbing and unilateral aggravating with light and movement
Migraines
Extraintestinal symptom of crohn disease
Erythema nodosum
Interstitial pneumonitis causes
Viral pneumonia
NF1 mode of inheritance?
AD
Parameter that indicate LV function?
Bnp
40 year old, diabetic female. Hx pruritis, vulva erythematous with white - grey odourless discharge. What’s the likely diagnosis?
Candida albicans
In iron deficiency anemia which of the following will be high
TIBC( total iron binding capacity)
Osteoporosis screening
65
In another Q,
Answer is 65-69
Child throws ball at you, draws a straight line and stacks few cubes on each other. What is the age?
24 months
child that can raise his head slightly when prone and
smiles. He turns his head
180 degrees and has head lag when you pull him to sit. How old is
he?
8 weeks
Child can sit without support, cruises around furniture,
uses chair to stand, say
dada, crawl stairs. What is the age of this child ?
10 months
baby can smile at which age
2 months
child ride tricycle, but can’t copy square what is the age
3 years
child can know color but with difculty in making
square
3 year
Baby wave his hand bye bye which developmental
milestone reflect ???
9 month
what is the age of child should be know few word ?
12month/ 1 year
child can support his head when sit and loving when
stare to him or cooing
4 months
Developmental milestones 5 words, hop on one leg ?
48 month/4 years
Milestone, baby pull him self to stand crawl without
difficulty, which age
10 months
ER Child can roll over, sit triploid, attempt to take
object
Which month?
6 month
Child tells stories runs and plays father -role.. What’s
the age?
4 years
Baby setting in mother’s lap unsupported, when the
doctor spoke the baby turned
around and laughed and babbled to the doctor, baby’s age?
6 month
18 months baby says baba mama what you will do for
him
Developmental assessment
Baby can walk when he held by one hand and good
pincer grasp but he can not put things in the bottle What is his age:
12 months
milestone baby can hold his head and when he looks
at his flying hand he laughs and coos ?
4 months
milestone said baba and walk holding furniture and a
lot of other features
12 month
infant sit in tripod position , role from prone to supine ,
reach object
6 month
Can’t sit without support , coos and laughs
3 months
child can Know the color when you point at them, ride
tricycle but cannot copy
square what is his age ?
3 years
4 month child which developmental milestone ?
A- try to crawling
B- roll over from side to side
C- sit without support
✨ D- complete fixation of the head
development child walk alone & build three cup ?
18 month/1.5 year
Child say few words what age
12 months
child etc … Can Not take the object in 2 fingers .. How
old is he?
6 month
milestone baby can hold his head and when he looks
at his flying hand he laughs
and coos
4 months
milestone said baba and walk holding furniture and a lot
of other features
10 months / 12/ not sure
4 y.o child , language development
Tell a story
child in the hospital play and come to his parents say
stories , draw head and hands
and legsط what is the age of this
child:
4 years or 5?
Child can walk without support ,crawling ,build 3
cubes point to something he interested in , so what is the age of the child ?
15 months
Say few words at the age of which ?
12 month
milestone > baby healthy run to the doctor play a role
model as his father can’t
complete a sentence can’t eat with spoon
Run so should be more than 15 months?
child sit and support his head , laughing and cooing :
4 months or 6 , NS
baby sit briefly, crawl , move object from hand to hand ,
but no pencil grasp.
7 month
baby said hi when he entered the clinic, imitates his
mother, feeds his doll, refers to
himself “ME” and say “eye”:
18 months
A child that can raise his head slightly when prone
and smiles . He turns his head
180 degrees and has head lag when you pull him to sit. How many
old is he?
8 weeks?
Pencil grasp develops at
9 months
4 month child with developmental milestone ?
roll over from side to side
baby can sit roll from prone to supine and back play
handle object but can’t pick things b/2 fingersage
6 months
Child can roll over ,sit tripod ,attempt to take object
Which month?
6 month
Milestone at 6 months
Rolls prone to supine
Smoking increase risk of ischemia by/
Risk of MI in a smoker compared to a non-smoker
2 times
Physical activity in adult
1/2 hour in 5 days
Rheumatic fever prophylaxis
carditis prophylaxis is for 10 years or until 21 years old whichever is longer
Lipid goal
Total cholesterol < 200 Triglycerides < 150 LDL < 100 HDL ≥ 60
Daily requirement of vit D
400 IU/ml
Mammogram can detect breast cancer before clinical examination by how many years
2
Smoking withdrawal peak
3-5 days
Colon cancer screen recommended grad A which age group
50 - 75
Colon cancer screen recommended grad A which age group
50 - 75
Colon cancer screen recommended grad A which age group
50 - 75
Colon cancer screen recommended grad A which age group
50 - 75
Colon cancer screen recommended grad A which age group
50 - 75
COPD O2 indications
SO 2 <90% or Pao2 ≤ 55 mm Hg
Brucellosis treatment duration →
6-8 weeks
Neurobrucellosis treatment duration →
6 months
Cancer of lung in smoker →
20-37 folds
screening of the uveitis in JIA
+ve ANA > 3 months. N.B: -ve > 6 months.
Best time to examine red reflex
birth or 6 weeks
HCV genotype in KSA
4
Intercostal space
Tension pneumothorax: 2nd mid clavicular line (using NEEDLE THORACOSTOMY)
® Chest tube: 5th
® Live need biopsy: 7th
® Thoracentesis: 8th-10th mid axillary line.
What are the sleeping hours associated with obesity→
< 5H or less 6 hours?
What is the percentage of smokers in Saudi Arabia
37% All, M only 21 %.
After colectomy due to colorectal cancer, how many months you follow up
3 m
Post-partum hemorrhage →
vaginal more than 500 → CS more then 1000
Ulcerative colitis when will do colonoscopy →
8y after diagnosis
Fecal incontinence which level is affected
Below T12
The degree of obesity in women based on the BMI, height 154cm weight 150kg
Obese grade 3
Confirm the h pylori eradication →
4 weeks
How long does a whooping cough vaccine last for →
10 years
Steeping reflex for baby disappears →
2 months
Overall deaths percentage due to postpartum hemorrhage →
25%
Blood bank storage →
Whole blood at 1°- 6°C (4°C). Platelet 20°-24°C (22°C).
Minimum volume of blood to do a culture is →
10 -20 ml
Peutz-Jegher syndrome (PJS) Familial adenomatous polyposis or Gardner syndrome
(FAP) screening time?
FAP annually → PJS start at age of 8 and every 3 years
HTN when to do screening at what age →
18 years
For how long you avoid airplane in Postural hypotension that caused by BB
2 weeks
Apgar score, at which score do you do resuscitation→
0-3
Pregnant women on chemo, at which age the child can get vaccination →
6 months
Infantile colic onset
Start at 6 weeks of age and goes away by 6 months of age
What time taken for patches on x ray of Lobar pneumonia to disappear →
6 weeks
What is the best time to do US to confirm GA →
11/14 or 14/16
How long should meningitis patient stay in isolation after antibiotics started →
12 hours
How long do you follow up an old patient with appendicular mass which was treated
Colonoscopy 6 weeks
When to screen for hyperlipidemia in low risk males →
low risk male 35, female 45.
→ High risk both gender 25.
Lung cancer risk increases with smokers for how many folds→
20
Boy has genital hair + scrotal darkening, what type of tanner stage →
4
Learn stages from gallery
Incidence of Down Syndrome with maternal age
® 40 ∼ 1:100
® 45 ∼ 1:30
® 50 ∼ 1:6
Vaccine at birth
- BCG
- Hepatitis B
BaBy
Vaccination at 2 months
- Hepatitis B
- Dtap
- Rota
- Hib
- IPV
- PCV
BIRD PH 2
Vaccination at 4 months
- Hepatitis B
- Dtap
- Rota
- Hib
- IPV
- PCV
BIRDPH 4
6 months
- Hepatitis B
- Dtap
- OPV
- Hib
- IPV
- PCV
BODHIP
9 months
- Measles
- MCV 4
M&M
12 months
- PCV
- OPV
- MMR
- MCV4
POMM 1 year
Vaccination at 18 months
- Hib
- OPV
- Varicella
- MMR
- Hepatitis A
- Dtap
HOVMAD
Vaccine at 2 years
- Hepatitis A
It’s just A
Vaccine at 4 - 6 years
- Varicella
- MMR
- OPV
- DTap
VMOD
Live attenuated vaccine
Varicella
BCG
Rota
MMR
OPV
Very Big RoOM
Killed attenuated vaccine
Hepatitis A
DTaP
Hepatitis B
Hib
PCV
PH BAD
Best test for critical limb ischemia/ best to confirm ischemic arterial disease
- CT angio
Pt with picture of pcos what could be the cause for infertility?
Increased testosterone
Ovulatory dysfunction
Female pt came with pancreatitis picture then she was treated few days later she came with palpable epigastric mass (pseudocyst) what is the Mx?
- observation
- drainage
Least risk factor for gallstones
Nulliparity
Picture of trichomonalis infection how to treat?
Metronidazole
Couples came for fertility work up female has regular period what test you want to do?
21 progesterone
Picture of Turner syndrome with amenorrhea , the mother asks for simple test to do ?
LH/FSH
In the middle of an operation (do not remember but I think colon) pt started to bleed the surgeon called vascular surgery and he clamped an artery to stop the bleeding which artery?
Infrarenal
which of the following is an absolute contraindications for thrombolytic therapy?
-intracranial hemorrhage in the past 2 years
which of the following is contraindicated for Dtap vaccine?
- seizure
- encephalopathy
The site of thoracocentesis?
8th to 10th mid axillary line
Female pt with picture of preeclampsia which of the following would increase her risk for fetal
growth restriction?
GDM
pt with preeclampsia developed seizure what is the next step?
MgSO4
Pt with preeclampsia which of the following is a complication?
Fetal growth restriction
A female who is divorced had sickle cell child from first marriage, She is getting married what is the next step in premarital screening?
-Hb electrophoresis for the mother
-Hb electrophoresis for the husband
-Genetic testing for the mother
Pregnant smoker , best method for smoking cessation?
-Behavioral therapy/CBT
What is the most common cause of biliary colic?
Gallbladder stone
Farmer came to ER with severe abdominal pain and have green discharge after being hit by a wooden stick with . What is the most appropriate management?
Abdomen CT
Pic of sole hand spots and said in the q also he have same in sole of foot ask about the diagnosis?
Palmoplantar pustulosis
18 month have cystic fibrosis confirmed and the doctor suggest that he needs intubation, the family refused but other doctors suggest same.
Intubate
Same other q , but boy should be put in the?
Pedia care unit
Vaginal yellow discharge diagnosis?
Trichomoniasis
Female diabetic, what’s the most probably vaginal infection?
Candida
Pregnant delivered at home, the newborn have some ecchymosis
Neonatal hemorrhagic dis
When the rooting reflex disappear?
4 month
66 y old male with low grade yof esophagus
Follow up after 6m + ppi
TTl with 32000 PLT, what’s the management?
Plasma exchange
Pt with go to surgery and he has 85000 ply count , normal others like PT, Patti, INR what to do before surgery?
Give hydration only
The most indicative of systemic perfusion?
Central line
What could make the condition of cystic fibrosis worsening?
Post pertussis infection
Female planning to be pregnant this winter, what vaccine should take?
Influenza
Rubella before conception
Obgyne infections( Candida, tricho, BV , Chlamydia, gonorrhea)
Learnnn
Large abscess, PID case, how to manage?
Antibiotics
Lots of pedo surgery qns
Learn intussuception, duodenal atrecia , hirshprung
Young man wants to be soldier came with bilateral inguinale hernia
Laparoscopic with mesh
Girl she have headache tight like bands?
Tension
Child have asthma and father smoker
Inform father smoking effect in child
On other q, parents refuses to listen about quitting smoking - inform child protection
Hydatid cyst treatment but no albendazol in answers
Surgical resection
Refer notes rn
Hydatid cyst:
5 cm or less 👉🏻 metro or albenazole
More than 5 cm 👉🏻puncture aspiration injection re-aspiration
Large with daughter cells 👉🏻 surgical deroofing
Large calcified 👉🏻 observe
Ebola patient wants to go out of hospital and refuse to stay?
Call security
Turner syndrome
Webbed neck, daughter 17 no period
SLE with UTI, drug contraindicated?
Sulfamethoxazole
SLE on Hydroxychloroquine Gtt and indirect high, AST: 700 ALT: 700 AlP: high Bright
echogenicity Liver, They did a Biopsy and they find (interface hepatitis with plasma cell)
what is management?
Prednisolone
Criteria of SLE
Autoimmune hemolytic anemia
Pregnant abdominal pain and vaginal bleeding on ex abdomen tender , uterus not palpable?
Missed abortion
Ns
Retrosternal and epigastric pain and regurgitation and heart burn did barium x-ray showed dilation of esophagus and lower esophagus stenosis, and there is multiple contraction in it, no esophageal movement was the diagnosis?
Achalasia cardia
Aspiration conium treatment?
Surfactant
Known case of polymyalgia rheumatic presents with malignancy symptoms (weight loss and other non specific constitutional symptoms) Labs showed anemia, low platelets and increase WBC lymphocytes.
What is the diagnosis?
CLL
12 yard old male with testicular pain (horizontally lined, mildly elevated no swelling or erythema of Scratoum)
What to do next?
Pediatric, 11 yo male, came to the ER with severe scrotal pain , swelling , redness , absent cremasteric reflex
, light exam showed transillumination and something about cremasteric reflex. What is your next step ??
Surgical exploration
5 years old child found to have 1 testes in the scrotum and other in the inguinal area what to do?
5 Y/O boy, his parents noticed that he has
undescended testis, on P/E unilateral
descended testis, the other was in the
inguinal, management?
Orchiopexy
What indicates adequate systemic perfusion?
Mixed venous O2 saturation
Crohn disease with fistula in steroids and pentosa, what tt?
Infliximab
Rapid progressive glomerulonephritis, what’s pathophysiology?
Crescent formation in bowman’s capsule
Side effects of chemotherapy in electrolytes?
Find answer
Man with jaundice came to doctor to discuss the normal blood test he said it was abnormal in bilirubin in last previous test what’s your diagnosis?
Healthy man came with icterus , indirect bilirubin high dx?
Gilbert’s syndrome
Vaccine contraindicated for pregnancy
Zoster
Rubella
Old women vaginal fish smell tt?
Metronidazole
Aedes aegyptu, which can carry dengue fever, when is the favourite time for this mosquito to bite?
Early morning
Clear case of malaria in sudan, what’s the treatment?
Artemisinin combination therapy
What gives the highest diagnostic value in asthma?
Methacholine challenge test
Atypical complex endometrial hyperplasia tx?
Oral progestin
If she is postmenopausal then it should be TAH & BSO
Hx abortion + DVT, Dx?
Anti phospholipid syndrome
Sick patient low O2, despite 100% O2
Adult respiratory distress syndrome
Bilateral scrotal redness and swelling, non tender , dx?
Idiopathic scrotal edema
Additional precaution for meningitis belt countries other than quadruple vaccine
Oral ciprofloxacin chemoprophylaxis
Acute pancreatitis dx
US
Old PT came with sudden severe lower back pain started coughing, x-ray showed lumbar compression fracture, next step?
Start iv acetaminophen
Came by ambulance from a burning building, semi confused o/e aligned nasal hair, otherwise stable, what to do?
Elective intubation
Female had a previous history of varicose veins, came now c/0 painful cord like. What is the initial Mx?
NSAID
Diarrhea for 5 days, vomiting 3 days and in PT in hypovolemic state, what lab abdnormality do you expect?
Hypernatremia
Trauma patient, came to ER after RTA , he was driving 130 and wearing his seat belt , he was alert, conscious, what is the next step?
US abdomen
Diabetic patient with central chest pain occur after exercise and last 15 minutes relieved by rest. ECG was given with depressed ST segment in lead v1 and V3?
Refer to cardiologist
Common valvular heart disease in down syndrome
Endocardial cushion defect
Investigation of down syndrome
High bhcg, high inhipin ,low AFP , low estradiol
HBI , LAE
Slanting eyes , short fingers , single crease palm of hand , dx?
Down syndrome
Prominence occipital, rocker bottom feet, cardiac
Edwards syndrome
17 years old hypertensive not menstruating heat at clinic by her parents, she is short stature , short neck. Most appropriate diagnosis /
16 yo F short stature< 5th percentile, short neck, low hairline and hypertension, both parents short, what’s the dx?
Turner syndrome
Child 9yrs old came with his mother because she thinks he is short stature. mother is short. When hand bone examined revealed age of 7 years Investigation All normal including
growth hormone. Except insulin like growth hormone was 18 low, What is diagnosis?
Growth hormone deficiency
Pediatric with egg allergy contraindication and needs to be referred to an immunologist before given?
Yellow fever
Kawasaki case asking about which of the following is one of the criteria:
Injection conjunctivitis with no exudate
child took tablets, came with black vomiting, most likely material ingested?
Iron
child ingest iron tablets and come with symptoms=
IV deferoxamine
Face Rash with conjunctivitis spread later to the trunk:
Rubella
Developmental milestones q: 5 words, hop on one leg
48 months/ 4 years
Picture of intussusception : nausea and vomiting Which statement regarding
Diagnosis
Presence of sausage shape in palpation
Baby 3 hours of life. His brother died of immune condition
Do not give bcg and only give hepatitis vaccine
Child with strabismus
Cover eye test
home delivery baby with umbilical bleeding after day 5, dx:
Factor x deficiency
Beriberi
Vit b1 deficiency
Honey crust lesion ask about diagnosis?
Impetigo
Google pictures
Case of child studies given microcytic anemia he has high Hba2 on electrophoresis
what type of anemia
Beta thalassemia minor
pediatric patient have meningitis, with close contact to his brother recently, Asking for
what to give to his brother
Rifampicin
Other question, younger brother, give oral rifampicin
34 years old nulliparity with previous hx of DVT, drugs will give this patient?
No need treatment
-Young female presented with dyspnoea, low grade fever and arthralgia. On examination there was tender erythematous nodules on her shin. And on auscultation basal crackles. Whaic is best nexts step in management?
Chest Xray
29years old woman complaining of dysuria and urgency , allergic to penicillin, shell fish and TMX . What to give
Nitrofurantoin
Case of gun shot, raised JVP and no heart sounds , best appropriate management?
Pericardiocentesis
Another Q, If it is cardiac tamponade , initially give IV fluids
Stab wound in chest. Came with weak thread pulse , raised JVP even what’s the diagnosis?
Cardiac tamponade
Child with stab wound in the lower right chest, he is hypotensive and tachycardias, what is the most appropriate thing to do?
Thoracotomy
Pt with CHF and afib. What will you use to control his cardiac rhythm?
Amiodarone
Rate control- BB, CCB or digoxin
Rhythm control - amiodarone, sotalll, flacinide
18 Y has ALL. 17 days after chemo he develops fever around 38.7 C. No focus of infection found. Labs shows: low WBC 0.6 (normal was 4-10x..), Neutrophil level 60% (normal 40-60%), i’m not sure if he has low platelets as well, what you’ll do:
Blood, urine, … Culture and Iv abx
IBS patient advice
Avoid lentils
Which if the following is true regarding intussuception
Shock is the most common complication
which one of the dipeptidyl peptidase-4 inhibitors used without limitation
Linagliptin( can be given without monitoring in CKD)
Patient you suspect chronic thromboembolic what’s the highest diagnostic test ?
Spiral CT with contrast
- 28 years old male presented with attacks of bloody stool for 2 months. Colonoscopy shows diffuse polyps in rectum and colon. Multiple biopsies were taken.
Familial adenomatous polyposis
Honey coloured crusts on face and extremities ( impetigo), asking about the organism
Group A streptococcus
Revise other causative organism
A baby with recurrent vomiting in between and after feeding, wheezing, cough, dystonic neck posturing( he described sandifer syndrome), dx or cause?
GERD
Pediatric Girl 4-5 years with uncomplicated cystitis , Mx?
Oral amoxicillin,
Rest of options were IV
Pt with bronchogenic carcinoma, presented with progressive SOB, on P/E
there’s elevated jvp, clear lung and quiet heart sounds. What will confirm your
dx:
ECHO
Dx is cardiac tamponade
Mode of inheritance of neurofibromatosis
Autosomal dominant inheritance
4 year old child with a morning limb and knee arthritis and (-) ANA.When should see the ophthalmologist to check for uveitis?
6 months
Dx: juvenile idiopathic arthritis
when do you recommend mammography for female patients aged between 50-75
annually
Every 2 years
Case scenario describes pertussis presentation , ask about the diagnostic test :
Nasopharyngeal sample culture
Learn pertussis symptoms
1 year old boy is brought to the clinic for failure to thrive, recurrent oral thrust and hepatosplenomegaly, he had a brother who died at the age of 3 years old with sever infection and septic shock, which of the following vaccine must be avoided until a diagnosis is made?
Varicella
celiac diseasel lost follow up , has bossing , distal phalanges erosion , what diagnostic for the condition:
X-ray hand cupping
Pt with humeral and ulnar fracture of the left arm, surgery done and after surgery cant extend forearm, wrist and fingers
Which nerve is affected :
Radial nerve at spiral groove
Child had a viral illness 2 weeks ago, has symmetric weakness in the extremities and face. Reflexes in lower limbs absent. Ascending paralysis. Also has fluctuations in respiratory effort, sometimes becoming tachypneic. Whatʼs the diagnosis?
GBS
A scenario of a boy with recurrent infections. His brother died when he was 3 years old. He has 2 sisters who are alive and well. Previous investigations done at an outside clinic show low levels of all immune markers except for T cells which are normal What does he have?
X linked agammaglobulinemia
Residents have order from consultant that he should proscribed penicillin but the pharmacy told the pt have allergy from this the consultant insist:
Refuse to give gently
Known case of polymyalgia rheumatic presents with malignancy symptoms (weight loss and other non specific constitutional symptoms) Labs showed anemia, low platelets and increase WBC lymphocytes.
What is the diagnosis?
Chronic lymphocytic leukemia
Anal fissure with skin tag Mx?
Internal lateral sphincterotomy
How to effectively decrease the risk of children intoxication?
Advice about legalization of strong cap of hazardous medication
PTH high, ca high phosphate 1.2 slightly low treatment?
Hydration, diuretic with bisphosphonate ✅
Case about patient with cancer on chemotherapy asking about Side effect in electrolytes ?
Hypocalcemia
Ectopic pregnancy presentation, what is the source of bleeding?
Fallopian tube
What’s the most commonly occured minor side effects after DTap vaccination?
Local erythema
pediatric patient with umbilical hernia, bulging out when he cries, and reduced when he is sleeping, whats your managment:
Observation
child has attention problem at school , day dreaming , starting brief sudden lapses of consciousness “seizure” (less than 30 seconds) , EEG (generalized 3-Hz spike-and-wave activity Treatment :
Ethosuxamide(absence seizure)
Asymptomatic child scheduled for a dental procedure, on examination found to have a murmur that changes with position, what to do?
Innocent murmur
2 months old baby wakes at night and cries for 1-2 hrs was happening several times he’s fine and growing well the mother concerned how to assures her ?
Infantile colic
Pt did CT with contrast and develop AKI few days later.. What is the mechanism?
Acute tubular necrosis
Elderly (70s) patient with progressive hand tremors, she was unable to feed herself by spoon + unable to write Now she started to notice her voice is changed.
Propranolol
Q about when ovulation happen? ( With pic)
36 hrs after LH peak
36 hrs after LH surge
Ask about role of Metformin in PCOS
Decrease insulin resistance
couple came to infertility clinic the wife had PID 2 year ago and got traded , the husband semen was normal . what is the appropriate step?
?
Couples came to infertility clinic the wife had PID 2 years ago with chlamydia inf and got treated
the husband semen was normal what is the appropriate step
IVF
Child can sit without support, cruises around furniture
10 month
pregnant with twins. One twin is breech, and other cephalic , US show bicornate uterus . what is CI for ECV?
Bicornuate uterus
asthma on albuterol, complained of symptoms and 2/week night symptoms . the most appropriate mx?
Long action beta 2 agonist and ics
COPD
Smoking cessation
Pt was found to have cavity on x-ray in upper lobe
Airborne
Abruption of placenta , what is the mx?
A reassurance
B call multi disciplinary team and rrt
Answer not known
smoker has chronic GERD, endoscopy done show high grade dysplasia. What is mx?
Endoscopic mucosal resection
Impetigo ask about Mx?
Abx
feral with breech presentation flexion hip and knee :
Complete breech
baby 3 hrs of life. His brother died of immune condition ?
Don’t give bcg
Drugs should be avoided in pregnancy?
Ciprofloxacin
female G3p2 had previous C/S due to breach and one vaginal delivery. Shes at 34
weeks and fetus is breach, she wants to do ECV. US: anterior low lying placenta and amniotic fluid
of 4 Digital exam: “normal” Whats the contraindication for ECV?
Us findings
Contraindication of IUFD(intra uterine fetal demise)
Child death due to IUFD
Per vaginal examination/ digital vaginal exam is contraindicated in
Placenta previa
Def- abnormal implantation of placenta over the internal cervical os
Dx- transabdominal us , then transvaginal us ( confirmatory test)
Contraindications vaccine during pregnancy
Live vaccines
Which of the following is an absolute contraindication for thrombolytic therapy?
Intracerebral hemorrhage 2 years ago
?Pregnant in her 38 week and 2 weeks ago she was admitted and ECV was done for her.
Currently the fetus position is in linear (or lateral not sure) with amniotic fluid index 12. What’s the
contraindication for ECV in her condition?
Fetal position
Women diabetic controlled developed dysuria and frequency urine analysis nitrate, creatinine
high. Which drug is contraindicated?
Septrin
Pregnant UTI which drug contraindicated?
Ciprofloxacin
pt came to clinic want to get pregnant she has a history of epilepsy 6 years and not compliance
on medication what best initial management?
Review all medication
ECV in 34 weeks pregnant absolute contraindication?
Ultrasound finding of low lying placenta( type of placenta previa)
Low lying placenta
Def- placenta that is implanted in the lower segments of the uterus but not covering the internal cervical os( more than 0 cm but less than 2 cm away)
Contraindication to external cephalic version
Bicornate uterus
Female use paroxetine with history of suicidal attempts and depressions pregnant what to do
Discontinue
SSRIs are generally considered an option
during pregnancy, including citalopram , fluoxetine and sertraline .?
Some studies have indicated using paroxetine during pregnancy may increase your risk for
miscarriage. In addition, there may be an increased risk of your newborn experiencing heart
defects if you use Paxil while pregnant.
Preeclampsia management in mild BP> 140/ 90mm Hg
At term - induce delivery
Preterm
1. Betamethasone - mature fetus lungs
2. Magnesium sulphate- seizure prophylaxis
Preeclampsia management in severe BP> 160/110
- Prevent eclampsia - magnesium sulphate
- Control BP- Labetalol, hydralazine
- Delivery- Term
- For preterm delivery- give betamethasone for mature fetus lungs and magnesium sulphate for seizure prophylaxis
Pregnant with blurred vision, headache and … BP 170/ What to do ?
stabilize and give MG and deliver
Mgso4 toxicity ?
Discontinue MGso4
Primigravida 32 came with mild headache with no abdominal pain, or visual disturbance, Blood
pressure 150/90, urine analysis +3 protien, appropriate management?
Admission and observe
Pregnant 32 GA, with 150/90 BP and protinuria +3. Whats next
Admit and observe
Pregnant , 10 weeks with HTN never went to doctor before (chronic HTN) what is the complication?
Preeclampsia
Pregnant present in 38 weeks in labor , BP 150/90 and elevated proteins /creatinine ratio.
Preeclampsia
Preeclampsia presentation
Without severe features
HT > 140/ 90
Proteinuria dipstick+1, +2 ; 24h urine > 300 mg
With severe features
HT> 160/110
Proteinuria not necessary
Mental status changes present
Vision changes present
Ruq pain present( due to swelling if Glisson capsule)
39 week, women with proteinuria Bp 140/90 , ur action:
Labour induction
Pregnant with pre-eclampsia mild 140/40 with abdominal pain .platelet and, uricaerd what
indicate severity
Abdominal pain
Case of preeclampsia on labetalol she’s 32 weeks, fundal height 28. what will commonly occur with IUGR:
Oligohydramnios
IUGR( intra uterine growth restriction ), witch one of the following can be the cause?
Oligohydramnios
about Pre-eclampsia : 32 weeks other case ; 34wks has hypertension and proteinuria, management?
Admit and observe
Delivery is the only cure for preeclampsia.
Patients with preeclampsia without severe features are induced after 37 weeks’ gestation. Before this, the patient is usually hospitalized and monitored carefully for the development of
worsening preeclampsia or complications of preeclampsia, and the immature fetus is treated with
expectant management with corticosteroids to accelerate lung maturity in preparation for early
delivery.
In patients with preeclampsia with severe features, induction of delivery should be considered
after 34 weeks’ gestation. In these cases, the severity of disease must be weighed against the risks of infant prematurity. In the emergency setting, control of BP and seizures should be priorities.
?Pregnant 34 week with preeclampsia, high BP 170 /100 what to give ?
Stabilize , MgSo4 and admistion
?preeclampsia what drug to give to prevent convulsions
MgSo4
?Pregnant 34 wx, vaginal bleeding open cervix 6, preeclampsia Fetal bradycardia:
MgS04 and deliver
pregnant in 32 weeks with pre eclampsia what to do?
Admit to observation
?34 wk pre eclamsia pt came with epigastric pain, headache, bullerd vision .. non stress test
reassuring mx ?
MgS04 and delivery
?Magnisium sulfate given to HTN pregnant to
Prevent the attack eclampsia
Pregnant, now bp 140/90, platelets 90, hx of previously severe preeclampsia. What indication here of severe preeclampsia?
Platelets
?Preganat c/o sever abd pain and uterine cotractions she was given 6mg Mg sulfate and the e
contractions become normal then decrease the dose to 4mg Then complained of shortness of
breath What to do
after stop Mg sulfate give the Ca gluconate✅
Case of preeclampsia with very low plt and high urea what indicators that is preeclampsia:
Low platelets
pregnant with seizure take 6 .. mg sulphate then decrease to 4 , There is
absent deep tendon reflex
Stop mg sulphate > THEN GIVE CA GLUCONATE
Patient on oxytocin and MgS04, preeclampsia. Her CTG: absence variability. What’s the cause?
Another question CTG of child is non reactive
MgSO4 toxicity
pt at 32 week presented with seizure and high blood pressure, what is the next
appropriate ‘There was no medication for seizure
magnesium sulfate
Severe preeclampsia, acute management of HTN drug?
Hydralazine
GDM type F with nephritis + and controlled HTN, She is pregnant now what’s most
complications will occur ?
Pre eclampsia
pathophysiology of GDM
Placental hormones(lactogene)
Human placental lactogene(HPL) aka somatomammotropin is a hormone produced by placenta, peaks at 24 - 28 week and decrease maternal insulin sensitivity
When is ultrasound done to confirm gestational age best done?
14-16 week
Another Q 11-13 week
Pt with preterm symptoms ( contractions and cervical changes before 34 wks) the best test to
confirm your diagnosis is
Continues CTG
Gestational diabetes at what week screening?
Gestational age diabetes screening?
24 weeks
24 - 28 weeks
K/c of cervical incompetence came for antenatal care. When to do surgery?
12 to 14 weeks
Cervical incompetence do not have a hx of contractions , but painless dilation if cervix
married women came to routine antenatal care most important thing?
most significant examination in gyne for general check up in newly married women:
Pelvic examination
What’s the minimum number of days should do muscle strengthening activities
Secondary pregnancy
55 years old female done mammogram now, when to do it again
Other q, 50 y women no family Hx of breast ca , mammogram normal When to do next mammogram ?
After 2 years/ every other year
Screening of breast Ca - 50 to 74
Mammography screening for 50 yr
Every 2 year
Less than 50 year old, every 1 year
solid mass of ovary+ca125 high
Gynaecologist oncology referral
pregnant 1st visit at 10 weeks what is the most important to be done on 1st visit
CBC for anemia
Pic of anembryonic pregnancy and asks about the Dx an embryonic tx:
Follow up to 4 week
Pic will show empty fluid-filled structure, called a gestational sac, with no embryo inside it.
Pregnant at 22 weeks gestational age oral glucose challenge test after one hr high after 2 hrs high
after three hrs high.. What is next?
HgA1c✅✅✅
Female came with left leg pain and swelling with red streak, what is the causative organisms?
Streptococcus pyogenes
Female used herbal cream in vagina then started to have Redness and itching :
Contact dermatitis
Female pt with her husband for fertility counselling. BMI and All labs are good, Regular menses.
Your advice:
Eat less fast food
Couple came to OBGYN clinic, need to check infertility, what to assess first?
General appearance
General appearance of the couple might help you to reach diagnosis, for example:
*Hirsutism on the female supports , Lymphadenopathy or parotid enlargement in male
Couple come by infertility after investigation done show bilateral fallopian tube obstruction
what will do
Tell couple
Infertility and cysts in ovary what is the problem?
Ovulation
couple seeking infertility clinic after 3 months what is ur advise?
Try more
After how many months you will start call a couple infertile?12 months
Wife with down syndrome husband try to conceive for 3m? try more and come back after
complete 1 year✅
Couple present with 3months infertility, next step: nothing
Couple after 2 years failed to get pregnant, husband sperm normal what is the cause of infertility
after excluding male factors we should look for ovulation cuases✅
Female complain of infertility since 2 years, regular period, normal semen analysis, monophasic
basal body temperature. What the cause of her infertility?
Anovulation
woman in her 30s with irregular cycles and anovulatory cycles since several years endometrial
biopsy was done and showed atypical hyperplasia what is the best treatment
Oral progestin
Management of endometrial hyperplasia includes surveillance, progestin therapy or hysterectomy
Couple present to infertility clinic everything normal after taking history and doing examination
which first investigation to start?
Serum analysis
Female with regular menses come for infertility evaluation?
21 progesterone
Couple came to you, with infertility issues. Upon investigation, wife has bilateral tubal
blockage (not sure). Who should you inform?
Both
Couples present with infertility for 3y, what you will order:
Sperm analysis
Pt came to infertility clinic, wife ha ha of PID everything else is normal, what to do?
Hysterosalpingogram
pregnant lady, G4p3 ,35yo, 34GA came complaining of bleeding 2hours ago, what question will
you ask next?
Intercourse
F Hx of chlamydia infection, wants to get pregnant, best next step?
Hysterosalpingography
Woman had adhesion in pelvis and peritoneum and signs of obstruction what is the organism?
Chlamydia
Ttt : azithro + doxy
Pt with history of PID (pelvic infection dis) and treated for it is now coming in the clinic because of
infertility despite regular sexual activity what investigation will you do first:
Hysterosalpingography (adhesions)
came with feature of PID what is the investigation: Hysterosalpingo
Which bacterial infection is associated with intrauterine device in PID ?
Actinomycosis
most common cause of ectoplc pregnancy ( no hx of anything )
PID
Most common risk factor of ectopic is PID
Most significant factor is previous ectopic
Couples use condom which type of infection - PID
Chlamdiya + pregnant woman, what is the most commonly infected part of the neonate:
Eyes
Ophthalmia neonatorum
Pelvic adhesion causes
Chlamydia
Strawberry cervix with yellowish to grey discharge
Trichomonas vaginalis
Ttt metronidazole for both?
case of 20 yrs old with GTD ( grossly abnormal mass on cervical examination) with
hemoptysis, What is the next in management ?
Admitted for staging and chemo
Vaginal discharge under microscope flagellate what dx ?
Trichomonas vaginalis
Yellow green vaginal discharge
Trichomoniasis
Vaginal discharge pseudohyphae cell under microscope what treatment?
Fluconazole
A woman with smiley vaginal discharge and itching..her husband has a Hx of
urethral discharge, asking about ttt?
Ceftriaxine
Female her previous pregnancy is stellbirth and now she want to pregnant and ask the doctor
about all the vaccines that she is need before consumption and
.reduce the stillbirth
Rubella
vaginal infection that can cause incompetency
Bacterial vaginitis
Patients with sx of bacterial vaginitis. What’s the test?
Gram stain
Fish like odor discharge without pruritus
Clinical scenario of (painless genital ulcer + skin rash). What is the dx?
Secondary syphilis
1⁰ syphilis- painless genital ulcer with healed up indurated edges
2⁰ syphilis - rash( palms & soles, alopecia areata, mucous patches, condylomata Lata
3⁰ syphilis - neurosyphilis, aortitis , gummas( bone & skin lesions)
Dx: dark field microscopy
FTA or MHA- TP( confirmatory)
Tx: single dose of intramuscular benzathine penicillin
Doxycycline if penicillin allergic
Post - op fever
0-2days: atelectasis or pneumonia.
3-5 days> UTI
5-7 days > DVT / thrombophlebitis of the IV access lines
7 day - wound infection / cellulitis
8 -15 day - drug fever or deep abscess
Pregnant came because his son has infection, What to give her? .
Influenza
Vaccine in pregnancy
Influenza, Dtap
Pregnant with Rh-negative blood type her baby have Rh-positive blood type present with
jaundice ask about Pathophysiology
autoantibodies against fetal RBCs (Mother’s
antibodies attack fetus RBCs?
Mother A negative Newborn o positive, what to do ?
Give Rh
Anti rhesus, Rh immunoglobulin
?when to give inti D? if mother rh ve- and child rh ve+.
?Pregnant 28 wk primigravida came for routine check up and she mentioned that
she is -RH and her husband is +RH what next
Give her anti D in this visit
Femal has cottage like vaginal white discharge, what could this Pt suffer from?
DM
