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Chings Notes > High YIELD ob > Flashcards

High YIELD ob Flashcards

1
Q

HTN after 20 wks

A

Gestational Hypertension

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2
Q

Evidence of Hypertension of pregnancy
HTN before 20 weeks

A

Chronic Hypertension

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3
Q

HTN after 20 wks and proteinuria (300mg/24h)
end organ dysfunction

A

Preeclampsia

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4
Q

fetal malposition
0-37 weeka

A

No intervention

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5
Q

37+ weeks
Fetal Malposition

A

Extrernal Cephalic Version

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6
Q

37+ weeks
Fetal Malposition

A

Extrernal Cephalic Version

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7
Q

Fetal Malposition
Active Labor at any time

A

C-section

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8
Q

37+ weeks with failed ECV, active labor or any contrindication to vaginal delivery

A

C-section

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9
Q

Contraindications for external Cephalic version

A

Placenta previa or abruption
Multiple gestation
Ruptured Membranes

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10
Q

Before 37 weeks

A

Preterm

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11
Q

before the onset of contractions

A

Premature

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12
Q

<34 wks, mgt?

A

Corticosteroids

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13
Q

<32 wks , PPROM, mgt?

A

Magnesium Sulfate (neuroprotective)

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14
Q

> 34 wks, PPROM, mgt?

A

Delivery

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15
Q

Multiple “grouped” ulcers, eythematous base

A

Herpes Simplex Virus

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16
Q

Severe painful ulcers with exudate + friable base
Painful inguinal lymphadenopathy with pus leakage

A

Chancroid (Haemophilus ducreyi)

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17
Q

Single painless chancre

A

Priary Syphilis (Treponema Pallidum)

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18
Q

Multiple painless ulcers
No lymphadenopathy

A

Granuloma Inguinale (Kleibsiella Granulomatis)

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19
Q

small, shallow, painless ulcers
Large, painful, inguinal ympahdenpathy

A

LLymphogranuloma Venereum

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20
Q

First growth spurt for girls

A

Bud development
(8-13 years)
areolar growth

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21
Q

White thick, cottage cheese appearance
ph : Normal <4.5
Vaginal inflammation
Treatment : Oral Fluconazole (topical Miconazole if pregnant)

A

Candidiasis

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22
Q

Off-white fishy odor
ph : Normal >4.5
No Vaginal inflammation
Treatment : Metronidazole for patient only (Clindamycin)

A

Bacterial vaginosis

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23
Q

Greenish, frothy discharge
Red spots on cervic (strawberry cervix)
vaginal inflammation
Metronidazole for patient and partner

A

Trichomonas vaginalis

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24
Q

What is the normal Ranges for AFI

A

5-24 cm
deepest pocket 2-8 cm

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25
Q

Amniotic fluid index (AFI) 24 cm or Single deepest pocket 8+ cm
enlarged uterus
inability to swallow (esophageal atresia, eA + TEF, duodenal atresia) diabetes, multiple gestation, anencephaly
Compications: PPROM, umbilical cord prolapse, Fetal Malpositionl

A

Polyhydramnios

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26
Q

AFI < 5cm or Single deepest pocket < 2 cm
Uterus is less than estiamted dates
Potter’s sequene (Pulmonnary hypoplasia, flattened face, dysmorphic limbs)
Complications: Meconium aspiration, Umbilical cord compression

A

Oligohydramnios

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27
Q

Unilateral breast erythema
Skin dimpling
warmth

A

Inflammatory Breast carcinoma

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28
Q

PCOS with post menopausal bleeding for 1 month

A

Endometrial carcinoma

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29
Q

patient with fever, RUQ pain, rebound and guarding

A

Appendicitis

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30
Q

beefy protrusion of tissue at the urethral meatus

A

Urethral Prolapse treat with topical estrogen

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31
Q

Purulent vaginal discharge
Mass at the Vaginal introitus

A

Vaginal Foreign body

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32
Q

Non-tender abdominal bulge in postpartum patient with no facial defect on palpation

A

Rectus Abdominis diastasis

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33
Q

Post menopausal bleeding, thickened endometrial stripe
ovarian mass

A

Granulosa Cell tumor

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34
Q

Amenorrhea and cyclic abdominal pain each month

A

Imperforate Hyrmen

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35
Q

History of multiple miscarriages, positive VDRL and elevated PTT

A

Antiphospholipid Antibody Syndrome

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36
Q

Pregnant woman with fever, dysuria, flank pain

A

Pyelonephritis

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37
Q

Pregnant woman at 0 weeks with uterine size larger than estimate dats
severe nausea and vomiting
BP 155/95
markedly elevated B-hG

A

Complete Hydatidiform Mole

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38
Q

Pregnant woman with severe nausea, vomiting, orthostatic hypotension, ketones in urine

A

Hyperemesis gravidarum

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39
Q

Pregnant woman with anemia, thrombocytopenia, LFTS elevated

A

HELLP Syndrome

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40
Q

Pregnant woman with severe RUQ pain, thrombocytopenia, profound hypoglycemia, elevated LFTS and DIC

A

Acute Fatty Liver of pregnancy

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41
Q

Erythematous unilateral nipple rash, itchy and refractory to steroids

A

Paget Disease of the breast

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42
Q

Pregnant patient with fever, uterine tenderness, vaginal discharge, fetal tachycardia

A

Chorioamnionitis

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43
Q

Amenorrhea, anosmia, cleft palate

A

Kallmann syndrome

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44
Q

What is the management of Lichen Planus

A

Reassurance + steroid

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45
Q

What is the management of Vulvovaginitis in Prepubertal Girls

A

Reassurance , Steroid

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46
Q

A girl deveop labial fusio past h/o of vulvovaginitis which was treated successfully. No voiding difficulties. Most approp advice?

A

Reassurance

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47
Q

Post menopausal female comes to you with enterococele prolapse and stress incotinence
What is the management

A

Pessary

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48
Q

A woman taking OCP containing 30mg estrogen now comes to you with hypertension
What is the next step?

A

POP

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49
Q

Mentally retarted girl complaining of menorrhagia
Best tx?

A

Mirena
Levonorgestrel-releasing intrauterine system

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50
Q

Young lady came for contraception advice
she feels headache
BP 130/90
What to prescribe?

A

POP

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51
Q

Girl came for repeat prescription for OCP
Some headache with visual disturbance
Best advice?

A

OCP is contraindicated

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52
Q

Girl comes with a period pain
Best treatment?

A

Mefenamic Acid

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53
Q

Newly delivered pregnant woman and is on breastfeeding
Wants to conceive as soon as possible again
What contraception you should give?

A

Progesterone Pill only

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54
Q

After delivery, breast feeding whicn contraception?

A

Levonorgestrel

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55
Q

How does the Microgynon works?

A

In the hypothalamus

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56
Q

A patient comes in asking for OCPS
She also reports that she has been experiencing migraine
What do you do?

A

Start Progesterone

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57
Q

Female using 30 mg ocp
Presents with continuing painful periods
Want to conceive after 12 to 12 months
What to advice?

A

use 50mg ocp

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58
Q

Woman with 3 kids, has otosclerosis with hearing aid
Which contraceptive is best for her?

A

IUCD

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59
Q

Lady with obesity, hirsutism and PCO
asking for contraception

A

COCP

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60
Q

A lady comes to your practice concern about her OCP compliance ont he 10th day
She missed her pill on the 7th and 8th day
She has unprotected intercourse on the 6th and 7th day
What is your management?

A

Give emergency contracptionw ith levonogestrel twice dose 12 hrs apart

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61
Q

What is the gold standard for the abnormal uterine bleeding?

A

Hysteroscopy and D and C

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62
Q

Young girl with h/o Epilepsy well controlled with Phenytoin wants to have an OCP. What will be your advice?

A

IUCD

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63
Q

Most important contraindication for prescription of OC pill in this patient?

A

Breast Cancer

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64
Q

A 20 yo woman came to you and ask for contraception advice. Mother and sister has DVT episode.
What is the next best step?

A

Do thrombophilia screening

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65
Q

A menopausal woman came with complains of hot flushes and vaginal dryness
Vaginal exam shows atopic vagnitis.
She had hysterectomy 10 years ago and she said she also has VT
What is the best treatment?

A

Low dose transdermal oestrogen

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66
Q

A 10 wk pregnant patient comes to you for her first antenatal visit
You see the strings of the IUCD. What is your next step?

A

Remove the IUCD now

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67
Q

A woman taking OCP containing 30 mg esterogen now comes to you with hypertension
What is the next step?

A

POP

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68
Q

Young lady came for contraception advice. She feels headache and her BP is 130/90. What to prescribe?

A

POP

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69
Q

Ladi with migraine, pins and needle sensation, shes asking for cotnraception. What to give?

A

POP

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70
Q

Mentally retarded girl complaining of menorrhagia, looking for best contraception.

A

COCP

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71
Q

45 yo female with menorrhagia and consultation is due in a few weeks, what can you give for the meantime?

A

NET

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72
Q

Came for contraception, mother and sister has DVT and found out to have factor V defect
What will be approp for her?

A

Progestogen only
Mirena IUD

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73
Q

Young lady comes to you on the 10th day and she missed her pill on the fay 6 , 7 and day 8 she had intercourse
She took her first pill from the new pack today
What will you advice her?

A

Emergency Contraception

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74
Q

Which would be the best option for OCP for a smoker female?

A

Norethisterone

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75
Q

HcG <2000 IU/L

A

Repeat tVS / HCg in 48-72 hrs

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76
Q

Hcg > 2000 IU/L abd TVS with no IUP
Complex adnexal mass and/or free fluid

A

High probability of ectopic pregnancy

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77
Q

hcg > 2000 IU/L and TVS with no IUP
and no abnormal findings

A

Repeat TVS /HCG in 48-72 hrs

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78
Q

Vaginal bleeding prior to 20 weeks gestation

A

Threatened Abortion

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79
Q

Passage of POC of a non-viable IUP or expected to occur imminently

A

Inevitable

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80
Q

Retention of POC od a non-viable IUP

A

Incomplete

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81
Q

Ultrasound scans diagnosis of a non-viable IUP in the absence of vaginal bleeding

A

Missed

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82
Q

Misscarriage complicated by infection

A

Septic

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83
Q

Three or more consecutive miscarriages

A

Recurrent

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84
Q

Full epulsion of POC of an IUP

A

Complete

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85
Q

HSIL

A

Refer for Colposcopy

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86
Q

Negative cytology

A

Repeat HPV test in 12 months

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87
Q

Possible lwo grade intraepithelial lesion and definite LSIL

A

Repeat HPV test in 12 months

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88
Q

Unsatisfactory cytology result

A

Repeat test in 6-12 weeks

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89
Q

Pap test
negative smear - no Endocervical cells

A

Repeat in 2 years

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90
Q

Pap Test
negative Smear - inflammatory Cells

A

Repeat test in 2 years

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91
Q

Unsatisfactory smear

A

Repeat smear in 6-12 wks

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92
Q

LSIL and definitive LSIL

A

Repeat Pap test at 12 months
If the woman is 30+ years and has no negative cytology in previous 2-3 years, refer to Colposcopy
or Repeat the test in 6 months

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93
Q

Possible HSIL and definite HSIL

A

Refer for Colposcopy

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94
Q

Glandular abnormalities

A

Refer to gynecologist

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95
Q

Invasive Squamous cell carcinoma or Adenocarcinoma

A

Refer to a gynecologist

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96
Q

Inconclusive - raising possibility of high grade disease

A

Refer for colposcopy and possible biopsy

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97
Q

Post coital bleed

A

Atrophic vaginal

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98
Q

Postmenstrual Bleeding

A

Endocervical Ca until proven otherwise

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99
Q

Post menstrual bleeding
bleeding within 1 year

A

Graaffian Follicles

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100
Q

53 yo bleeding
Postmentrual symp

A

Atrophic Vaginitis

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101
Q

postmenstrual bleeding + growth

A

Cervical Cancer

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102
Q

Intermenstrual bleeding
multiple sexual partners
no vaccine

A

Carvical Ca

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103
Q

Dysmenorrhea
1st line treatment?

A

Mefenamic Acid

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104
Q

Heavy Menstrual bleeding
1st line?

A

Mefenamic
acute flood - Tranexamic Acid

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105
Q

Young girl + OCP user + bleeding

A

Cervical Ectropion

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106
Q

Postcoital bleeding
55 years

A

Cervical CA or Atrophic Vagintis

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107
Q

Postcoital bleeding 25 years

A

Polyp or cervical ca or Ectopian

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108
Q

Abnormal uterine bleeding

A

Fibroids

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109
Q

50 years recently menopause 8 months
new onset of bleeding

A

Anovulatory cycle (Graddian follicle)

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110
Q

60 years old female with post menopausal bleeding

A

Endometrial CA

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111
Q

53 years postcoital bleeding
[ain during coitus

A

Atrophic Vaginitis (lack of estrogen)

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112
Q

58 years post coital bleeding

A

Cervical cancer

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113
Q

Mass seen in the vagina

A

Cervical cancer

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114
Q

Menopause within a year

A

Graaffian F

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115
Q

Any age group universal cancer

A

Ca of the cervix

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116
Q

clear mass

A

cancer mostly

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117
Q

bleed on touch

A

Ca polyp

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118
Q

What are teh premenstrual treatment

A

Hormone therapy
Vaginal Estrogen
Antidepressants
Gabapentin

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119
Q

T score of -2.5 or lower indicates that you have

A

Osteoporosis

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120
Q

T scoring of -1.5 to -2.5

A

Osteopenia
tx: Calcium and Vitamin D

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121
Q

T scoring of >2.6

A

Osteoporosis
tx: Alendronate / Zollindronic Acid
IV more preferable

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122
Q

Osteoporosis is known + low trauma fracture

A

DEXA first

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123
Q

T score of -2.5, Osteoporosis
tx?

A

Alendronate

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124
Q

Osteoporosis + fracture

A

DEXA

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125
Q

Osteoporosis + PUD

A

Zolindronic Acid

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126
Q

Osteoporosis + Breast Ca

A

Tamoxifen / Raloxifen

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127
Q

Severe osteoporosis + HRT for 6 years
what to give?

A

Alendronate

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128
Q

Drug of Choice for hypertension with pregnancy

A

Methyldopa

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129
Q

What must be avoided in pregnancy

A

ACEI

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130
Q

What are the other antibiotics that should be avoided in pregnancy?

A

SAFE
Sulfonamides
Aminoglycosides
Fluoroquinolones
Erythromycin

Ribavirin
Grieofulvin
Chloramphenicol

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131
Q

new onset of grand mal seizures in women with preeclampsia

A

Eclampsia

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132
Q

What are the signs of preeclampsoa

A

Persistent headache
visual disturbances
epigastric pain or RUQ pain
Vaginal bleeding due to Hypertension
hyperreflexia

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133
Q

The only cure for preeclampsia is

A

Delivery of the fetus

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134
Q

If the patient is close to term
in peeclampsia
What to do?

A

Induce Delivery

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135
Q

If the patient is far from termin preeclampsia
what to do?

A

Expectant Management

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136
Q

What is the first step to control BP in the severe preeclampsia

A

Labetalol and or hydralazine
the goal is <160/110 with DBP of 90-100 to maintain the fetal blood flow

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137
Q

What is the second step of management in severe preeclampsia

A

Prevent seizures with continuous magnesium sulfate
continue sezure prophylaxis for 24 hours postpartum

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138
Q

What is the third step in severe pre-eclampsia

A

Deliver by induction or C section

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139
Q

used to accelerate the fetal lung maturity

A

Dexamethasone given at 24th to 34th week

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140
Q

If there is seizure for the first time what is the next step?

A

Glucose Electrolytes

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141
Q

If there is seizure for 4 years and recurrent what is the next step?

A

Glucose

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142
Q

What is the first step in Eclampsia?

A

ABCs with supplemental O2

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143
Q

What is the second step of management in Eclampsia

A

Seizure control / prophylaxis with magnesium
if seizures recur then give IV diazepam

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144
Q

What is the third step of management in Eclampsia?

A

Delivery

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145
Q

What is the first sign of toxicity of magnesium sulfate

A

loss of deep tendon reflexes

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146
Q

What is the serious sign of magnesium sulfate toxicity?

A

Repiratory Depression
Comma

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147
Q

What is the treatment for the toxicity of magnesium sulfate

A

IV calcium gluconate

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148
Q

Pain + amenorrhea + vaginal bleeding

A

Ectopic Pregnancy

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149
Q

What is the most common site of ectopic pregnancy

A

Ampulla of the fallopian tube

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150
Q

What is the recurrence rate for Ectopic pregnancy?

A

10-15%

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151
Q

What are the predisposing factors for the Ectopic Pregnancy?

A

Scarring to the Fallopian tubes

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152
Q

What is the most common cause of Ectopic Pregnancy?

A

History of PID

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153
Q

Woman of reproductive age presenting with abdominal pain and vaginal bleeding
dx?

A

Ruptured Ectopic Pregnancy

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154
Q

What are the steps of management for Ruptured Ectopic Pregnancy?

A

First step: Pregnancy Test
if (-) : NO PREGNANCY
if (+) : transvaginal Ultrasound
If you find a sac in the uterus: Normal Pregnancy
Empty uterus: do Serial HcG
Doubling : Normal Pregnancy
No doubling: Ectopic

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155
Q

What is the medical treatment for ectopic pregnancy?

A

Methotrexate

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156
Q

What is the endoscopic management for the unruptured ectopic pregnancy and stable patient?

A

laparoscopy

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157
Q

How to diagnose unruptured Ectopic pregnancy?

A

B Hcg titer <1,500 mIU
No intrauterone pregnancy is seen in vaginal sonogram

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158
Q

Ectopic pregnancy is always seen in 1st trimester

A

true

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159
Q

Defined as any bleeding that occurs after 20 weeks

A

Antepartum hemorrhage

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160
Q

The most common caused of Antepartum Hemorrhage are

A

Placental abruption and placenta previa

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161
Q

Separation of the placenta from the inner wall of the uterus before the baby is delivered

A

Abruptio Placenta

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162
Q

Placenta is implanted in the lower part of the uterus obstructing vaginal birth

A

Placenta Previa

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163
Q

placenta covers the cervical os

A

Total

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164
Q

placenta extends to the margin of the os

A

Marginal

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165
Q

placenta is in close proximity to the os

A

Low-lying

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166
Q

What is the most common risk factors for placenta previa

A

Prior C section

others are:

Grand multiparity
Multiple Gestation
prior placenta previa

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167
Q

What to give if the mother is Rh D negative?

A

Anti-D prophylaxis

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168
Q

What is the most common cause of Placenta Abruption ?

A

Hypertension

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169
Q

What is the very impt cause of Placental abruption?

A

Cocaine

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170
Q

painful dark vaginal
abdominal painn + uterine contraction
on exam : Uterine tenderness
Uterine hypertonicity
fetal Distress

A

Placental Abruption

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171
Q

How to manage patient with Placental abruptio?

A

Stabilize patients
hospitalize
start IV and fetal monitoring

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172
Q

fetal vessels crossing the internal Os

A

vasa previa

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173
Q

What is the main management of Vasa previa

A

CS

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174
Q

What is the most common risk factor for placental abruption

A

Hypertension

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175
Q

What is the most common risk factor for placenta previa

A

Previous CS

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176
Q

Bleeding with placental abruption

A

Painful

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177
Q

bleeding with placenta previa

A

painless

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178
Q

Most impt sign with the placental abruption

A

Uterine tenderness

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179
Q

Main route of delivery with both of them

A

Vaginal

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180
Q

Mgt if there if fetal distressed?

A

CS

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181
Q

Main inv with placenta previa

A

US

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182
Q

Main inv with placental separation

A

US

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183
Q

The drug that causes placental infarction

A

Cocaine

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184
Q

What is the main complication with placental separation

A

DIC

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185
Q

Main risk factor for stroke

A

Hypertension

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186
Q

Main risk factor for MI

A

Hyperlipidemia

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187
Q

Main risk factor for placental separation

A

Hypertension

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188
Q

Main factor causing damage of kidney in diabetic patients

A

Hypertension

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189
Q

What is the most common cause of abdominal pain with pregnancy
in 2nd trimester
usually site is the Right side
jabbing sensation or sharp stabbing pain felt when a pregnant woman suddenly changes position

A

Round Ligament Pain

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190
Q

What is the differential diagnosis of Round ligament pain

A

Appendicitis

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191
Q

What is the tx for the round ligament pain?

A

Analgesic and Rest

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192
Q

What is the most common cause of uterine prolapse

A

Premature ruprute of the membranes

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193
Q

What are the steps of management in the Round ligament pain

A

1st step: Assess the pulsation of the umbilical cord to see if the fetus is still alive or not
2nd steo: Put patient in the knee - chest position (trendelenburg)
3rd step; Push the presenting part back ward to decrease the pressure
4th step: CS

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194
Q

jaundice and itching at the third trimester
bilirubin and ALT elevated

A

Cholestasis of Pregnancy

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195
Q

What are the risk for cholestasis of pregnancy

A

fetal distress and mortality

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196
Q

What is the inv for Cholestasis of pregnancy

A

CTG

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197
Q

What is the treatment for the Cholestasis of pregnancy?

A

Ursodeoxycholic acid

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198
Q

What is the complication of Pyenephritis with pregancy

A

Preterm delivery

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199
Q

What is the tx for the Pyelonephritis in pregnancy

A

Hospitalization
IV Ceftriaxone and Gentamycin

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200
Q

10 wks gestation with uterine bleeding, pelvic pressure and multiple episodes of non-bloody and non-bilious emesis
bleeding is like a prune juice
uterus is larger than gestational age

A

Gestattional Trophoblastic Disease

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201
Q

Snow storm
cluster of grapes
honey comb

A

Gestational trophoblastic
inv: B-hcg
chest xray if patient presents with pulmonary symptoms

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202
Q

69 XXX or XXY
missed abortion

A

Partial Mole

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203
Q

46 XX or XY
molar gestation

A

Complete mole

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204
Q

defined as a birth weight > 90 th percentile

A

fetal macrosomia

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205
Q

Most common cause of fetal macrosomia

A

DM

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206
Q

Defined as the AFI > 20 on ultrasound

A

Polyhydramnios

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207
Q

Duodenal atresia
tracheoesophageal distula
Potter Syndrome

A

Polyhydramnios

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208
Q

AFI < 5 cm on ultrasound

A

Oligohydramnios

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209
Q

what is the most common cause of polyhydramnios

A

Renal Agenesis

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210
Q

What is the risk factor for Shoulder dystocia

A

Obesity and Diabetes

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211
Q

Prolonged second stage of labor
Recoil of the perineum or turtle sign

A

Shoulder Dystocia

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212
Q

What are the treatment for Shoulder Dystocia

A

Help reposition
Episiotomy
Leg elevated (first step ( McRobert’s MAneuver)
Pressure suprapubic - s econd most important
Reach for the fetal arm

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213
Q

What are the complications of shoulder dystocia

A

Clavicle Fracture
Brachial plexus Injury

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214
Q

Most important risk factor for the shoulder dystocia

A

Diabetes Mellitus

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215
Q

What is the first step mgt in Shoulder dystocia

A

Elevation of the patient’s legs

second step: suprapubic pressure

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216
Q

What is the most common nerve injury with the shoulder dystocia

A

Brachial Plexus

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217
Q

What are the signs of clavicle fracture

A

fullness, crepitus or deformity

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218
Q

What are the roots that are affected in the Erb’s palsy?

A

C5 and C6

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219
Q

internally rotated arm, adduction (waiter tip) hand
it is associated with the diaphragmatic paralysis
resolve in 3 months

A

Erbs palsy

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220
Q

What are the roots affected in Klumps palsy
Associated with the horner Syndrome

A

C7, C8 and T1

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221
Q

rupture of membranes occuring at <37 wks gestation

A

PPROM

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222
Q

Defined as rupture > 18 hours prior to the delivery

A

Prolonged ROM

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223
Q

sudden gush of clear or blood tinged amniotic fluid

A

Rupture of membrane

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224
Q

What are the steps in diagnosing the Rupture of membranes

A

First step: Sterile Speculum ecam - pooling of amniotic fluid in the vagina
Nitrazine paper test is - when the paper turns blue - indicated that the paper is alkaline of ph amniotic fluid
Second step: ultrasound

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225
Q

What is the treatment for the Rupture of membranes?

A

Induce Labor

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226
Q

Rupture of membranes mgt if it is >34-36 wks

A

Labor induction

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227
Q

Rupture of membranes mgt if <25-32 wks gestation

A

Expectant management with bed rest
try to delay as long as possible so that the baby become more mature
a high vaginal swab is advisable

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228
Q

defined as onset of labor between 20 and 37 weeks

A

Preterm labor

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229
Q

What is the inv to confirm the preterm labor

A

Fetal fibronectin

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230
Q

1st tri pregnant woman
cervical screening test + for HPV 16 and 18
HSCIL

A

Colposcopy oc cervix ith biopsy

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231
Q

Most common symptom of endometriosis

A

Dysmenorrhea

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232
Q

If ovarian cyst is less than 5 cm in size

A

Repear Ultrasound in 4 months

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233
Q

lower abdominal pain, significant vaginal bleeding and amenorrhea

A

Ectopic pregnancy

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234
Q

Has intrauterine gestational sac (altho empty) abd b fkuid in the Pouch of Douglas
no tenderness and cervical os is closed

A

Missed abortion

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235
Q

If intrauterine pregnancy tissue is completely expelled

A

Complete miscarriage

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236
Q

Intrauterine pregnancy tissue is partially expelled

A

Incomplete miscarriage

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237
Q

three or more consecutive miscarriages

A

Recurrent Miscarriage

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238
Q

miscarriages complicated by infection

A

Septoc

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239
Q

ultrasound scans diagnosis of a non-viable IUP in the absence of vaginal bleeding

A

Missed

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240
Q

Some retention of POC (products of conception, IVP , intrauterine pregnancy) of a nonviable IUP

A

Incomplete

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241
Q

Passage of POC of a nonviable IUP occuring or expected to occur imminetly

A

Inevitablee

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242
Q

Vaginal bleeding prior to 20 wks gestation

A

Threatened

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243
Q

headache that occurs one day before the onset of menses
pain starts in the occipital area and spreads towards the left frontal region
aggravated by walking
irritable and sensitive to light

A

Menstrual headache

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244
Q

What is the most comon presentation of the ovarin cancer?

A

Abdominal mass and ascites

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245
Q

What is the screening marker for the ovarian cancer

A

CA 125
and transvaginal ultrasound

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246
Q

What is the average age group diagnosed with ovarian cancer

A

50-64

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247
Q

Carries the lowest risk in developing the ovarian cancer

A

Oral contraceptive pill

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248
Q

HPV can call all these subtypes of cancers except:

A

Cancer of cervic
cancer of oropharyngeal cavity
Squamous cell carcinima of anus, penis and agina
Cancer of the uterus

except: ESOPHAGEAL cancer

249
Q

post menopausal woman presented with mild vaginal bleeding for the last 12 hrs after the sexual acitivity

A

Atrophic Vagintis

250
Q

What are the risk factors for urinary incontinence

A

Obesity
Prenatal urinary incontinence
Constipation
Instrumental delivery
Third and fourth degree tears
Baby with a right birth weight of more than 4.0 kg

251
Q

40 yo with hx of postcoital bleeding
periods were normal and regular for the last 12 months
now she is complaining of intermenstrual bleeding for a year
she has multiple sexual partners
What to do next?

A

Cervical Screening test as well as liquid base cytology

252
Q

Asking for contraception advice
she has a family history of DVT and thrombophilia
Most appropriate contraception?

A

Levonorgestrel intrauterine device

253
Q

A petient had undergone total abdominal hysterectomy
complaint of clear fluid discharge from the vagina
Discharge is continuous in nature but without any odor or itching.
What is the most likely cause of her symptoms?

A

Reactionary fluid from vaginal wall

254
Q

A middle age woman presented with peristsent lower back pai and sensation of heaviness in the vagina
A bulge protruding out of the vagina is noted on the examination
What is the responsible for this?

A

Uterosacral ligament
- patient developed uterine prolapse - weakening of the uterosacral ligament

255
Q

1st line contraceptive choice for women with epilepsy using enzyme inducing antiepileptic drug

A

Levonorgestrel-releasing intrauterine contraceptive device

256
Q

OCPS increase the incidence of

A

Cervical Cancer

257
Q

What is the investigation of choice for the earlier diagnosis of endometriosis

A

Diagnostic laparoscopy with histopathology

258
Q

Breast tender, swollen and painful
not sexuallya ctive and not planning to have any relationship in the future
mgt?

A

Primrose oil
- mastalgia

259
Q

premenstrual women
simple ovarian cyst <5cm

A

Do not require follow up
Reassurance no further action required

260
Q

premenstrual women
simple ovarian cyst 5-7cm

A

Repeat Ultrasound

261
Q

premenstrual women
simple ovarian cyst >7cm

A

Refer to gynecologist

262
Q

Postmenopausal women
simple ovarian cyst <5cm and low risk of malignancy

A

Manafe conservatively
it will resolve in 3 months

263
Q

Postmenopausal women
simple ovarian cyst 2-5 cm

A

should be rescanned 3-4 months

264
Q

This contraception is contraindicated in pregnancy, breast cancer and undiagnosed vaginal bleeding

A

Progestgen only

265
Q

contraceptive use with a past medical history in hypertension

A

Progestogen only pills

266
Q

Which outcome has the most sutiable outcome to the treatment of infertility?

A

Stein-Leventhal Syndrome or PCOS

267
Q

Postmenopausal woman with frequent hot flushes had a hx of oestrogen dependent breast cancer ten years ago
What is the mgt?

A

Paroxetine

268
Q

mestrual irregularities and hirsutism

A

PCOS

269
Q

Woman inability to conceive last 12 months
Pelvic USG shows 3-4 follicles in both ovaries. Blood test low estrogen and elevated FSH and LC
Keen to get pregnant
Mgt?

A

In vitro fertilization

270
Q

Danazol for endometrisos treatment
Side effects?

A

Lighter or absent menstruation, since danazol causes endometrial atrophy

271
Q

Best emergency contraception

A

Copper intrauterine contraceptive device
next is Ulipristal Acetate and Levonorgestrel

272
Q

Invasive squalous cell carcinoma was diagnosed
What is the nest step?

A

refer to a gynecologist at tertiart hospital

273
Q

Nulliparous woman presents onset of painful menstrual irregular bleeding
bleeding isheavy and erratic with 25-37 day cycle. She is sexually active and no history of hyspareunia or postcoital bleeding.
The couple doesnt want to have children in the future
Mgt?

A

Endometrial Ablation

274
Q

Risk factor for the development of ovarian cancer

A

Increased body mass index

275
Q

Which of the ff is the advantage of using progestogen implant over the contraceptive options?

A

It provides contraception for three years and is easily reversible

276
Q

HPV non 16 and 18 and Low grade Intraepithelial lesion o reflex liquid basec cytology

A

Repeast Cervical screening test in 12 months

277
Q

Gray vachinal discharge with burning and itching

A

Gardenerella vaginali

278
Q

History of vaginal bleeding after sexial interourse
She has a mucupurlent cervical discharge
What to do

A

Vaginal swab for chlamydia and gonorrhea

279
Q

64 yo woman with painless vaginal bleeding lasted for 2 months
TV shows endometrial thickness of 6mm
Associated with increased risk of endometrial cancer?

A

PCOS associated with Chronic Anovulation

280
Q

Not correct regarding the peri-menopause stage

A

Decrease in FSH

281
Q

She never had a sexual activity with a male
She is a lesbian and has a gf
she prefers a lesbian friendly health care provider
What is the approp advice?

A

Refer to a lesbian friendly clinic in the area

282
Q

diffuse pelvic pain and vaginal bleeding
painw ith defecation, dyspareunia and dysmenorrhea
dx?

A

Endometriosis

283
Q

c/o urinary incontinence
Suggestive of urge incontinence
urinarylysis is negative
mgt?

A

Instruct her to eliminate excess water and caffeine from her daily fluid intake

284
Q

Gradual onset of bilateral pain associated with fever, vaginal discharge and mild dysuria
Adnexal and cervical motion tenderness
Cause of the pain?

A

PID

285
Q

free fluid within the abdominal cavity
abdominal pain and vaginal bleeding

A

Ruptured Ectopic pregnancy

286
Q

amenorrhea came to hospital with massive per vaginal bleeding

A

Urine Pregnancy test

287
Q

PMS symptoms - depression and emotional symptoms
Tx?

A

Fluoxetine

288
Q

Treatment for hirsutism and facial acne

A

OCPS

289
Q

Pap smaer: test result: HGSIL
Coposcopy confirms the presence of a cervical lesion consistent with cervical dysplasia (CIN III)
Which of the ff type of HPV confirms this type of lesion

A

HPV 16

290
Q

1 hr acute onset of progressively worsening pain in her RLQ

A

Immediate laparoscopic surgery

291
Q

Increasing hair growth in her face, chest and abdomen
coarse, dark hair on her face and abdomen
enlarged clitoris
7cm left adnexal mass
What type of ovarian tumor?

A

Sertoli Leydig Cell

292
Q

Occasional abdominal cramping associated with bleeding without passage of fetal products
closed cervical os
dx?

A

Threatened abortion

293
Q

9 cm right ovarian mass
Shows the evidence of glial tissue and immature cerebellar and cortical tissue
dx?

A

Immature teratoma

294
Q

KOH prep - fishy odor

tx?

A

Metronidazole

295
Q

Small amount of urine when sneezing

A

Stress incontinence

296
Q

She has cyclic pain during premenstrual period and during her menses
inv?

A

MRI

297
Q

Biopsies show chronic cervicitis but no evidence of dysplasia
mgt?

A

Conization of the cervix

298
Q

Post op total vaginal hysterectomy 2 wks ago
also had the Burch procedure for uterine prolapse and stres urinary incontinence
she complains a constant loss of urine throughout a day
denies any urgency or dysuria
dx?

A

Vesicovaginal Fistula

299
Q

Postmenopausal had cancer 5 years ago
complains of mood swings, disturbed sleep and hot flushes
mgt?

A

Paroxetine

300
Q

highly suggestive of pCOS

A

Elevared LH

301
Q

Least likely site for Endometriosis

A

Cervix

302
Q

Planning to conceive. Labtest results are LH low, FSH low, TSH Low and Prolactin is high
mgt?

A

Bromocriptine

303
Q

Pre-menstrual period has bloating, headached, reduced libido and reduced concentration and anger management
symptoms get worse 1 week before the menses
Mgt

A

Sertraline

304
Q

50yo with history of hysterectomy and DVT
with hot flushes
mgt?

A

Osterogen Dermal Patch

305
Q

history of smoking and asking for contraception

A

Progesterone only pills

306
Q

Best option for the treatment of endometriosis

A

Danazol

307
Q

Ovulatory dysfunctional uterine bleeding
Mgt?

A

Tranexamic Acid

308
Q

INCORRECT regarding menopause

A

Decresed FSH level

309
Q

Fishy, offensive gray vaginal discharge
Clue cells are present
mgt?

A

Clindamycin
- Bacterial Vaginosis

310
Q

Asking for contraceptive advice
She had hx of DVT and currently on treatment with anti-coagulants
She is on combined oral Contraceptive Pill
Mgt?

A

Progesterone only pill

311
Q

purulent lochial dischage

A

Endometriosis

312
Q

Best invt to establish ectopic pregnancy

A

Transvaginal Ultrasound

313
Q

1st line of inv for Ectopic Pregnancy

A

B-Hcg

314
Q

NOT A risk factor for cervical cancer

A

Alcohol

315
Q

Absolutw contraindication to use the progestogen only pills

A

Rifampicin

316
Q

Which is correct regarding continuous used of combined hormone replacement therapy

A

It increases the risk of breast cancer

317
Q

Next choice of investigation to predict ovualtion

A

Serum progresterone

318
Q

She has high grade abnormality on cervical screening test
She has colposcopy and has higher abnormal cells in the cervical canal
mgt?

A

Cone Biopsy

319
Q

Gold standarc choice of investigation for the diagnosis of abnormal uterine bleeding

A

Hysteroscopy along with Dilatation and curettage

320
Q

Vaginal itching and discharge
Red vulva and whitish discharge
tx?

A

Clotrimazole

321
Q

Risk factpr for endometrial hyperplasia

A

Early menarche

322
Q

Correct description of hysterosalpingogram

A

Unilateral hydrosalpinx with a normal uterine cavity

323
Q

Most common type of cervical cancer in Australia

A

Squamous cell carcinoma

324
Q

irregular bleeding for the past 5 months
period were reguklar
pap smear norma

A

Anovulatory cycles

325
Q

episodes of painless vaginal bleeding
What is the cause of teh postcoital bleeding

A

Cervical ectropion
- Chlamydia cervicitis a cervical polyp or cervical carcinoma

326
Q

Tx for severe mastalgia

A

Danazol

327
Q

test to evaluate amenorrhea

A

LH and FSH levels

328
Q

Troublesome urinary leakage
What is the first step of evaluation?

A

urinarlysis and culture

329
Q

FSH and LH high
not started her period, no brest budding, no pubic hair
has cervix and uterus
What is the cause of her delayed puberty and sexual infantilism ?

A

Gonadal Dysgenesis

330
Q

Signet cells

A

Krukenberg tumor

331
Q

Normal breast and pubic hair development
Uterus and Vagina are absent
dx?

A

Mullerian Agenesis

332
Q

One sided pain that is diffuse and dull, occasionally sharp
menses are normal
Smooth mobile andexal mass on the Right side
What is the cause of the pain?

A

Ovarian Cyst

333
Q

23F presented amenorrhea for 6 wks
Which of the ff will make you decide to proceed for emergency intervention?

A

Shoulter tip pain

334
Q

complainet of amenorrhea for one year duration
what may be the cause of the amenorrhea?

A

Hormonal dysfunction

335
Q

CIN2
mgt?

A

Colposcopy

336
Q

Absoulute contraindication of COCPs

A

her premenstrual headaches

337
Q

multiple fibroids, pakpabkle up to the umbilicus

A

GnRH analogues for 3 months followed by myomectomy

338
Q

Treatment for the urge incontinence

A

bladder training

339
Q

Vaginal discharge and gush of clear fluid
rupture of membranes and cervix is closed
most approp treatment?

A

Systemic Steroids

340
Q

salpped cheek

A

Parvovirus B19

341
Q

most frequently responsible for septic shock in Obstettric and gynecology

A

Escherichia coli

342
Q

Whixh of the followig is correct regarding cesarian section delivery

A

Increased rick of adhesions

343
Q

Uterine bleeding in the presence of closed cervix

A

Trhreatened abortion

344
Q

Indicaated for the treatment of Chlamydia; urtehritis in pregnancy

A

Azithromycin 1 g single dose

345
Q

DOC for the treatment of bacterial vaginosis in pregnant woman

A

Clindamycin

346
Q

12wks gestation
persistent nause and vomiting
mgt

A

Pyridoxine - treatment for hyperemesis gravidarum

347
Q

Recommended suppllement for pregnancy

A

Folic Acid 5mg daily 12 wks befoe conception
150 mg micrograms of Iodine

348
Q

Planning to conceive in the next 3 months
DM well controlled
current HBA1c is 6%
Supplement needed?

A

Folic Acid

349
Q

Not a complication of obesity in pregnancy

A

ncreased risk of postpartum psychosis

350
Q

NOT associated with Oligohydramnios

A

Gestational Diabetes

351
Q

Not a contraindication to Tocolysis

A

Materanal Hypothyroidism

352
Q

Not a risk factor for isolated spontaneous abortion

A

Retroverted Uterus

353
Q

32 wks gestation
Diagnosed with breech postion
Not in labour and is still breech position in the pelvic examination
appro step?

A

Pelvic ultrasoud

354
Q

38 wks gestation with labor pains since 8 hrs ago
Vaginal examinatio shows 7cm dilated and fully effaced
On Amniotomy - greenish vaginal fluid
140 bpm with accelarations and variable deceleration
beat to beat variability with good contractions
Next step?

A

Fetal Scalp blood sampling

355
Q

20 wks pregnant and have found to have thyrotoxicosis and mild enlargement of the thyroid gland
inv?

A

Ultrasound thyroid gland

356
Q

Which of the ff can reduce the risk of [pre-eclampsia during the pregnancy

A

Calcium 1000 mg daily

357
Q

Most common feature of pre-eclampsia

A

Proteinuria

358
Q

DOES NOT increase the risk of postnatal depression

A

Elective cesarian section

359
Q

Most likely the cause of oligohydramnios in the second trimester of pregnancy

A

Renal Agenesis

360
Q

best negative predictor of imminent birth within the next 7 days
she is at 34wks of gestation

A

The absence of fetal fibronectin in cervical secretions

361
Q

Woman who developed epilepsy and has been stable on Lamotrigine
Planning to conceive and is concerned about the medications that can harm her baby
Which of the ff measure would reduce the incidence of neural tube defects?

A

High dose of folic acid for one month befoe conception and during the first trimester

362
Q

Which of the ff is correct regarding the shoulder dystocia

A

Erb is common fetal injury

363
Q

32 female diagnosed with DVT of calf beins at the 20th week of pregnancy
best mgt?

A

Therapeutic dose of low molecular weight heparin for 3 months

364
Q

Which of the dd if present can lead to death during the pregnancy

A

Mitral Stenosis

365
Q

Folic acid 0.4 mg is usually recommended one month before conception til 12 wks of gestation. A higher dose of folic acid 5mg daily is recommended in all of the ff situations except

A

Body mass index of 24

366
Q

20f Asian with hx of Pulmonary hypertension. What would you advice?

A

Pregnancy is contraindicated in her condition

367
Q

Most common method of termination of pregnancy before 20 wks in Australia

A

suction and curettage

368
Q

30yo woman decides to conceive and is stable on lithium fir the severe relpasing bipolar disorder
Lithim is continued after discussion witht he aptient
Which one of the ff will be essential during pregnancy

A

High Resolution of ultrasound 18-20 wks of pregnancy

369
Q

Hemolysis , relevated liver enzymes, and low platelet levels

A

HELLP Syndrome

370
Q

Stool microscopy showed human roundworm infestation
First line option for treatment

A

Pyrantel

371
Q

Not elevated in the rhid trimester pf pregnancy

A

Serum free T4

372
Q

Which od the ff vaccine is recommened to use during pregnancy

A

Influenza vaccine

373
Q

Not a complication related to smoking during pregnancy

A

less likely to die of sudden infant death syndrome

374
Q

Which of the ff condition would require intrapartum antibitic prophylaxis

A

A previous infatn with Grp B strep disease regardless of present culture

375
Q

Which of the ff is a contraindication to pregnancy
BMI 40
Absence of retinopaty
Age of 38
Absence of nephropathy
history of type 2 DM with HBA1c above 10

A

history of type 2 DM with HBA1c above 10

376
Q

Indication to perform cervical cerclage at 14 wks of gestation

A

2 or more consecutive prior second trimester pregnancy losses

377
Q

Aboriginal woman have a rubella IgM and IgG positive during routine antenatal screening
What is the approp mgt?

A

Repeat Rubella serology

378
Q

24f delivered a baby at 35wks has a
Diagnosed with gestattional hypertension at 22 wks
BP 170/100
Motivated to bresfeed her baby
medication to treat her bp which s safe to both mother and the baby

A

Metoprolol

379
Q

24 Aboriginal lady presents at antenatal clinic at 19 wks of gestation
Best time for which of theff

A

Ultrasound

380
Q

Ultrasound for identification of phyical abnormalities including neural tube defects is best performed at what age of gestation

A

18-20 wks of gestation

381
Q

Maternal Serum screening for Down Syndrome is best performed at what age of gestation

A

15-17 wks of gestation

382
Q

Amniocentesis is best perfomed during

A

between 16-18 wks of gestation

383
Q

Chronic villus sampling is best perfoemd between
this is accurate for diagnosis of chromosomal anomalies

A

10-12 wks of gestation

384
Q

Rubella screen is best perfoem

A

before conception and not during pregnancy

385
Q

Sudden onset of severe abdominal pain, vaginal bleeding and cesation of contractions after 28 hrs of active ushing at home
Abdomen is distended
Fetal heart sounds not audible

A

Uterine rupture

386
Q

Vaginal bleeding at 16 wks of gestation
RH negative and her baby is Rh positive
Cervix is dilated and product of condeption are visible
Pelvic usg - spontaneous abortion
What will you do regarding anti-D administration?

A

Give anti-D now

387
Q

At which weeks of gestation should the gestational diabetes status be checked

A

28 wks

388
Q

20 wks pregnant woman has developed palpitatins, sweating of palms and increased nervousness
What other investigations should be done with TSH

A

Free T4

389
Q

Purulent lochia discharge noticed on vaginal examination 3 days after cesarean section

A

Gentamicin and clindamycin - postpartum endometritis

390
Q

Nausea and vomiting during pregnancy and headache
Past medical history of migraine
Most approp management to prescribe for 1 wk

A

Codein and promethiazine - dx severe migraine

391
Q

36 wks of pregnancy presents with BP 40/95, proteinuria, headache and mild upper abdominal pain
Most approp management?

A

Immediate vaginal delivery - severe preeclampsia management

392
Q

Right iliac fossa pain esp when she tried to stand up or cough
had a history of appendectomy 12 yrs ago
Mild tenderness in the Right iliac fossa no rebound tenderness and there is no guarding
Diagnosis?

A

Round ligament pain

393
Q

Young mothers have a higher risk of several pregnancy complications including which of the ff

A

Low birthweight infants

394
Q

Complications of Warfarin use

A

Warfarin is contraindicated in the
First trimester - it will cause fetal chondrodysplasia punctata
if used in second or third trimester - fetal optic atrophy and mental retardation

395
Q

involves the vaginal mucosa or perineal ski byt not the underlyig tissue
what type of vaginal delivery tear?

A

First degree

396
Q

it involves the underlying subcutaneous tissue byt not the rectal sphincter or the rectal mucosa

A

Second degree

397
Q

The rectal sphincter is affected

A

third degree

398
Q

extends up to the rectal mucosa

A

fourth degree

399
Q

Biophysical profile revealed severe oligohydramnios
Evaluation of the infant for the ff should be included

A

Renal Agenesis

400
Q

It promotes lung maturity and decreases the risk of resp syndrome

A

Bethamethasone

401
Q

Contraindication for tocolysis

A

Suspected placental abruption

402
Q

Best management for Staph saprophyticus

A

Augmentin

403
Q

Explusion of all fetal and placental tissue from the uterine cavity at 10 wks gestation

A

Complete abortion

404
Q

Major predisposing factors in the developmentEctopic pregnancy

A

PID

Any opetarive procedure on the fallopian tube may increase the risk
- Tubal sterilization with laparoscopic fulguration

405
Q

Used in prevention of recurrent eclamptic seizure

A

Magnesium Sulfate

406
Q

Pregnant patient at 29 wks developed flu like symptoms - runny nose, mild headache and feels achy.
She is at higher risk of giving birth to a newborn with ?

A

Wide Pulse Pressure (PDA due to Rubella)

407
Q

11 wks gestation, uterus is palpable between the symphysis pubis and the umbilicus
No fetal heart tones are audible
mgt?

A

Shceule an ultrasounf as soon as possible to determine the gestational age and viability of the fetus

408
Q

Prenatal CMV infections may produce which retinal disturbance

A

Chorioretinitis

409
Q

Which of the ff is a reactivation and therefore not a risk to the fetus

A

Shingles

410
Q

3 recurrent miscarriages during the first trimester in the last 12 months
inv?

A

Antiphospholipid antibodies

411
Q

After delivery, a woman develops lower abdominal pain and uterine tenderness. Large gram negative rods suggestive of clostridia are seen in the smear of the cervix.

Which of the ff is most likely to proceed with hysterectomy

A

Gas gangre

412
Q

Which of the ff explanation for the patient’s decreased fundal height

A

Fetal growth retsriction

413
Q

What are the tests included in the first trimester

A

Hepatitis B, HIV and Scrren

the 1 hr glucose tolerance test should be perfomed between 24-28 wks of gestation.

414
Q

Most appropriare intial management of Hypertension

A

Methyldopa

415
Q

Grp B strep infxn in pregnant woman
What is the treatment

A

Amoxicillin for 3 days

416
Q

Which of the ff malpositons would require a cesarean section n the absence of fetomaternal distress and cephalopelvic disproportion?

A

Face presentation

417
Q

Diagnose with primary genital herpetic lesions at multiple sites iin the genital area
What is the most approp management?

A

Suppressive antiviral until delvery

418
Q

Pregnant lady presented with exposure to rubella
never been vaccinated against rubella
What will you do next?

A

Check serum IgM and IgG for rubella

419
Q

Most single warning sign of diminishing blood volume withinn the first 4 hours post partum?

A

Tachycardia

420
Q

Not a complication of gestational trophoblastic disease

A

Infertility

421
Q

Gestational trophoblastic disease can cause complications including

A

Uterine infection
haemorrhagic shock
Sepsis
Pre-eclampsia
Metastasis to the lungs

422
Q

True statement regarding the mgt of DVT in pregnancy

A

Warafarin therapy is CONTRAINDICATED throughout pregnancy but safe during breast feeding

423
Q

Complication of severe pre-eclampsia that overlaps with acute fatty liver in pregnancy

A

HELLP syndrome

424
Q

Abdominal pain and genital bleeding, pregnant woman at 40wks gestation loss 400ml of blood
Vital signs normal and as tender abdomen, no fetal heart sounds
Nesxt step?

A

Amniotomy

425
Q

Most approp stepfor the estimation of the fetal gestational age?

A

Transvaginal ultrasound at 8 wks

426
Q

28wks pregnant with sudden gush of clear fluid
Premature rupture of membranes with closed cervic
mgt while transferring the patient to the tertiary care?

A

Bethamethasone

427
Q

What is contraindicated regarding the Hepatitis C transmission

A

Fetal scalp blood sampling

Breastfeeding is not contraindicated in Hepatitis C.

428
Q

Breech presentation at 32 wks, had gestational diabetes and macrosomia, breech presentation for her baby
Most appop advice?

A

Elective cesarean section

429
Q

16 wks gestation with a history of lower vaginal pressure, vaginal spotting and lower back pain.
TVS shows cervical shortening of 2 cm, cervical dilation and protrusion of fetal membranes into the cervical canal.
Developed symptoms of cervical insufficiency that may lead to premature delivery.
Most approp treatment?

A

Reinforcement of the cervicak ring with nonabsorbable suture material

430
Q

Symptomatic and asymptomatic urinary tract infection in pregnancy
tx?

A

oral amoxicillin with clavulanate or oral cephalexin for 7 days

431
Q

Diagnosed with DVT at 18th wks of pregnancy
Best mgt?

A

Therapeutic dose of LMW heparin for 6 months

432
Q

Most common cause of cesarean section delivery in Australia

A

Previous cesearn section

433
Q

Reason for the Rh sensitizatiom of the patient

A

Blood transfusion

434
Q

UNLIKELY Predisposing factors for postpartum Hemorrhage

A

Oligohydramnios

435
Q

Risk factor for recurrent pregnancy loss

A

Antiphospholipid syndrome

436
Q

Best management for DVT in pregnant patients

A

LMW heparin

437
Q

Not a contraindication for tocolysis

A

Asthma

438
Q

Can be used in the screening test in both first and second trimester of pregnancy to detect Down Sydnrome

A

Free beta Hcg level

439
Q

37wks gestation, sudden gush of clear fluid
apart from giving antibiotics
What’s next?

A

Induce labor now

440
Q

Contraindication to the vagiinal delivery for breech presentation?

A

Clinically inadequate pelvis

441
Q

Gestational diabetes taking Metformin but was ceased after the birth of the baby four weeks ago
What will you do?

A

Oral glucose tolerance test at 6-12 wks postpartum

442
Q

Antenatal Advice
Aside from folic acid, what else should be given to the pregnant lady

A

Iodine

443
Q

Weight loss
Moderate to severe dehydration
ketosis
Electrolyte abnormalities

A

Hyperemesis Gravidarum

444
Q

Most common cause of post-partum hemorrhage

A

Uterine Atony

445
Q

Most common cause of post-partum hemorrhage

A

Uterine Atony

446
Q

Risk Factors for uterine atony:

A

Multiple pregnancy
Polyhydramnios
Macrosomia
Prolonged labour
Multiparity

447
Q

Other causes of post-partum hemorrhage

A

Laceration of genital tract
Uterine rupture
Uterine inversin
Coagulopathy

448
Q

Most common cause of postpartum hemorrhage requiring hysterectomy

A

Placenta accreta

449
Q

DOES Not increase the risk for dveeloping postpartum endometriosis

A

Advanced maternal age

450
Q

A 34 yo woman who has been using oral contraceptive pills for the last 3 years. She is planning to conceive this year. Drinks regular alcohol.
What is the most approp advice?

A

Stop Alcohol now

451
Q

Which one of the ff would not increase the risk for cord prolapse during delivery?

A

Anemia

452
Q

Not associated with maternal Vitamin D deficiency in pregnancy

A

Large for gestational Age

453
Q

Maternal Vitamin D deficiency is associated with

A

Hypocalcemia in newborn
Rickets
Defective tooth enamel
Small for gestational duet to effect in skeletal growth
Fetal convulsions or seizures due to hypocalcemia

454
Q

Rheumatoid arthritis pregnancy

A

STOP METHOTREXATE and continue SULFASALAZINE

455
Q

Klympls palsy

A

C7, C8 and T1

456
Q

hand and wrist paralysis
Associated with Horner Syndrome

A

KLUMPLS PALSY

457
Q

Rupture of membranes occurring < 37 wks gestation

A

PPROM

458
Q

Defined as a rupture >18 hrss prior to delivery

A

Prolonged ROM

459
Q

How to diagnose Rupture of membranes

A

A sterile speculum exam
Nitrazine paper test - paper turns blue, indicating alkaline ph of amniotic fluid

Second step: Ultrasound
Never perform digital Vaginal exam

460
Q

What is the treatment for premature rupture of membrane?

A

Depends on GA and fetal lung maturity

If it is term: Induce labor
>34-36 wks gestation: Labor induction may be considered
<25-32 wks - Expectant management with bed rest

Try to delay as long as possible so that he baby become more mature. A high vaginal swab is advisabe.

Lung maturity -> mother -> steroid

AntibioticsL Given to prevent infection
Antenatal corticosteroids: BETHAMETHASONE or DEXAMETHASONE 48 hrs - promote lung maturity
If there are signs of infection or fetal distress develop - Antibiotics and induce labor

461
Q

Onset of labor between 20 and 37 wks gestation

A

Preterm Labor

462
Q

Menstrual like cramps
Low back pain, pelvic pressure
Or new vaginal discharge or bleeding

A

Preterm Labor

463
Q

How to diagnose preterm labor

A

Regular uterine contractions
Concurrent cervical change
Fetal fibronectin to confirm

Sterile speculum exam to rule out PROM
Ultrasound

464
Q

What is the treatment for Preterm Labor

A

Hydration and bed rest
1st step - Unless contraindicated begin tocolytic therapy - B-Agonist, MgSO4, CCBs, PGIs

Steroids - to accelerate fetal lung maturity

465
Q

What are the contraindications to tocolysis

A

Infection - nonreassuring fetal testing, placental abruption, no contractions
Fetus is older than 34 wks gestation
Fetus weighs less than 2500 grams or has inrauterine growth restriction (IUGR) or placental insufficiency
Lethal congenital or chromosomal abnormalities
Cervical dilation is greater than 4 cm
Chorioamnionitis or intrauterine infection is present
Other cause of fetal distress or fetal death

466
Q

What is the prophylaxis for GBS

A

Penicillin or Ampicillin

467
Q

Sudden gush of fluid

A

PRO

468
Q

Uterine contraction and dilatation of cervix

A

PRETERM LABOR

469
Q

Most impt drug to the PROM

A

Dexamethasone

470
Q

Important drug to preterm labor

A

Tocolytics

471
Q

Most absolute contraindication to tocolytics

A

Chorioamnionitis

472
Q

Key word of Chorioamnionitis

A

Maternal fever

473
Q

Once chorioamnionitis occured

A

Sampling and antibiotics

474
Q

Tocolytic drugs that are used in the clinical practice

A

Calcium antagonist - Nifedipine
Oxytocin -receptor antagonists - Atosiban
Inhibitors od prostaglandin synthesis - Indomethacin
NO donors - Nitroglycerin
Betamimetics - Fenoterol, Terbutaline, Ritrodrine
Magnesium

475
Q

Most common fetal malpresentation

A

Prematurity

476
Q

Most common malpresentation

A

Occipito Posterior

477
Q

The thighs are flexed, and the knees are extended

A

Frank Breech (50-75%)

478
Q

One or both legs are extended below the buttocks

A

Footling breech (20%)

479
Q

The thighs are flexed and the knees are extended

A

Frank Breech

480
Q

One or both legs are extended below the buttocks

A

Footling breech

481
Q

The thighs and knees aee flexed

A

Complete breech (5-10%)

482
Q

Attempt only if delivery is imminent

A

Trial of breech vaginal delivery

483
Q

Most common indication for CS

A

Previous CS

484
Q

Most common cause of Priary C-section

A

Cephalopelvic disproportion

485
Q

Prior classical C-section

A

Never to try vaginal delivery - UTERINE RUPTURE

486
Q

What type of Episiotomy is the easy one

A

Midline

487
Q

Which type of episiotomy is the hardest one

A

Mediolateral

488
Q

Uterine shifts from midline
Fetal body part more prominent
Less bleeding more shock.

A

Uterine Rupture

489
Q

Loss of > 500 ml blood for vaginal delivery or >1000 ml for C-section

A

Postpartum hemorrhage

490
Q

Most common cause of Postpartum Hemorrhage

A

Uterine Atony

491
Q

What are the other causes of Postpartum Hemorrhage

A

Genital Tract Trauma
Retained Placental Tissue

492
Q

Most common cause of postpartum hemorrhage

A

Uterine Atony

493
Q

Palpation of a soft, enlarged, “Boggy” uterus

A

Postpartum Hemorrhage

494
Q

What is the first step of treatment in Uterine Atony

A

Bimanual uterine Massage

495
Q

What is the second step in Uterine Atony

A

Oxytocin Infusion

496
Q

Puerperal fever is defined as raised temperature of >38 C from day 1 to day 10. If fever think of the 3cs - birth cana;, breast, bladder.

A

Postpartum infections

497
Q

Characterized by:
Temperature > 38 Deg C
Uterine tenderness
Offensive Lochia

Timing : usually 2nd day or 3rd day

A

Postpartum Infections

498
Q

What is the most common risk factor for Postpartum infections

A

C-section

499
Q

Postpartum with amenorrhea can’t breast-fed her baby.
What is the diagnosis?

A

Pituitary Necrosis or Sheehan’s Syndrome (Postpartum Pituitary Necrosis)

500
Q

Anterior pituitary insufficiency secondary to

A

Massive obstetric Hemorrhage and Shock - Sheehan’s Syndrome (Postpartum Pituitary Necrosis)

501
Q

What is the most common presenting syndrome

A

Failure to lactate due to decrease prolactin levels

502
Q

Weakness, lethargy, cold insensitivity

A

Decreased TSH

503
Q

Genital Atrophy and Menstrual Disorders

A

Decreased FSH and LH

504
Q

What are the treatment options for pituitary tumours?

A

Usually surgery in most cases except for Prolactinoma

505
Q

Early breast milk
Very rich in protein, fat,secretory IA and minerals

A

Colostrum

506
Q

The 6Ws of postpartum fever

A

Wind (atelectasis) - first day
Water (UTI) - 2nd -3rd day
Womb (endomyometritis) - 2nd or 3rd
Walk (DVT, Pulmonary Embolism) - after 5 days
Wound ( incision, episiotomy) - After one week
Weaning (breast engorgement, absecess, mastitis) - usually more than 10 days

507
Q

A female postpartum presents with blood pressure 80/50 and pulse 120 with 400 ml blood loss. on examination there was deviated uterus. What is the cause?

A

Broad Ligament Hematoma
- patient after labor with hypotension + contracted uterus + deviated uterus

508
Q

The time of the onset of true labor until the ervix is completely dilated to 10cm

A

First Stage

509
Q

The period after the cervic is dilated to 10 cm until the baby is delivered.

A

Second Stage

510
Q

Delivery of the placenta

A

Third Stage

511
Q

It is the longest and involves two phases

A

First Stage

512
Q

The time of the onset of labor until the cervix is dilated to 4cm

A

Latent Phase

513
Q

Continues from 4 cm until the cervix is dilated to 10 cm

A

Active Labor Phase

514
Q

Early labor will last approx 8-12 hrs
Cervix will efface and dilate to 4c,
Contractions will last about 30-45 seconds, giving you 5-30 minutes of rest between contractions

A

Early Labor Phase

515
Q

Active Labor will last about 3-5 hrs
Cervix will dilate from 4 cm to 10 cm
Contractions during this phase will las about 45-60 seconds with 3 -5 minutes rest in between

A

Active Labor Phase

516
Q

Second stage of labor starts with ___ and ends with _____ with a total duration of ______

A

Starts with COMPLETE CERVICAL DILATATON and ends with the BABY DELIVERY and with the duration of 1 -3 hours.

517
Q

The Third stage of labor starts with ____ and ends with _____ and the duration of _____.

A

Starts with the delivery fof the baby and ends with the delivery of the placenta and duration of Half an hour.

518
Q

What is the treatment of prolonged Latent Phase

A

Sedation and rest

519
Q

Cervix dilatation is around 2 cm with regular contraction

A

Prolonged Latent Phase

520
Q

Cervix is dilated around 7cm and 2 cm change in 4 hrs
Regular contractions

A

Prolonged Active Phase

521
Q

Dilated around 7 cm with regular contractions

A

Arrested Active Phase

522
Q

What is the treatment if HYPOTONIC

A

Oxytocin

523
Q

What is the treatment if it is Hypertonic

A

SEDATION

524
Q

What if it is Adequate

A

CS

525
Q

Regular contraction
Fully dilated cervix
No descent in 3 hrs

A

Second Stage of Arrest

526
Q

If the contraction is weak what is the management

A

Oxytocin

527
Q

If the head is not engaged in Arrest of labor, what is the management?

A

CS

528
Q

If teh head is engaged in Arrest of Labor, what is the management?

A

FORCEPS (nonrotating)

529
Q

Increase FHR above the base line
Less than 2 minutes
Not related to contraction
Always reassure

A

ACCELERATION

530
Q

Fluctuation in the FHR
Normally occurs (6-25 mins)
If absent —- Abnormal
if marked reliability —– Fetal distress

A

Variability

531
Q

Normal range of Fetal Heart Rate

A

110 - 160

532
Q

If less than 110

A

Bradycardia

533
Q

If more than 160

A

Tachycardia

534
Q

Most common cause of fetal Bradycardia

A

Sleeping baby

535
Q

Most common cause of Fetal Tachycardia

A

Maternal Fever

536
Q

Normal Fetal Ph

A

7.25-7.35

537
Q

Gradual Drop in the FHR
Gradual increase in the FHR
Mirror image of the contraction
Cause : fetal Head Compression

A

Early Deceleration

538
Q

Gradual drop in FHR
Gradual increase in the FHR
Delay in relation to contraction
Cause is : fetal hypoxia or Fetal Acidosis
First Step is FETAL SCALP PH

A

Late Deceleration

539
Q

Sudden drop in the FHR
Sudden increase in FHR
Severe if FHR is less than 60 —-CS
Cause —- CORD COMPRESSION

A

Variable Deceleration

540
Q

When to say it is Normal Labor

A

Baseline 110-160
Acceleration and Variability is present
Deceleration is absent

541
Q

Less than 110 or more than 160
Absent acceleration
Variability Absent
Late or Variable devceleration is present

A

ABNORMAL LABOR

542
Q

Lowest point after onset of an early or late deceleration
and variable

A

NADIR

543
Q

VEAL CHOP

A

Variable
Early
Acceleration
Late
Cord Compression
Head Compression
Okay or Mild Hypoxia
Placenta Insufficiency

544
Q

The degree of acidemia can be detected through

A

Sampling the fetalscalp blood to measure either scalp ph or scalp lactate

545
Q

What is the Fetal Movement assessment

A

32-34 wks

Normally 10 or more fetal movements in 2 hours

546
Q

What is the first step in the abnormal fetal movements

A

History and Examination

547
Q

First inv for the Abnormal Fetal movements

A

Fetal Heart doppler

548
Q

Mgt if fetal heart rate is detected in Abnormal Fetal movements

A

CTG

549
Q

If CTG is not available in the abormal Fetal movements

A

Refer to the hospital

550
Q

If recurrent abnormal Fetal Heart movements, Near Term

A

Induction of labor

551
Q

If recurrent abnormal FHM, away from term

A

Continuous CTG

552
Q

Performed with the mother resting in the Lateral Tilt position
FHR is monitored externally by Doppler

A

Nonstress Test (NST)

553
Q

two accelerations of > 15 bpm above baseline lasting for at least 15 secons over a 20 minute

A

REACTIVE (normal response)

554
Q

Fewer than two accelerations over a 20-minute period

A

NONREACTIVE

555
Q

Uses a real time ultrasound to assign a score of
2 (normal) or O (abnormal) to five parameters
fetal tone
Breathing
Movement
Amniotic fluid volume
NST

A

Biophysical profile (BPP)

556
Q

Scoring is as follows for BPP
8-10 ?

A

Reassuring for fetal well-being

557
Q

Scoring for BPP
6?

A

Considered equivocal. Term pregnancies are usually delivered

558
Q

Scoring for BPP
0-4

A

Strong consideration should be given to immediate delivery

559
Q

Fetal hips are flexed and the knees extended (pike position)

A

Frank breech

560
Q

The fetus seems to be sitting with hips amd knees flexed

A

Complete breech

561
Q

One or both legs are completely extended and present before the buttocks.

A

Footling Breech

562
Q

One or both legs are completely extended and present before the buttocks.

A

Footling Breech

563
Q

The baby is in a kneeling position, with one or both legs extended at the hips and flexed at the knees.

A

Kneeling Position

564
Q

Is a transverse lie if the fetal long axis is oblique or perpendicular rather than parallel to the maternal long axis

A

Fetal Position

565
Q

Oligohydramnios first diagnosed in the third trimester is often associated with

A

PPROM or with Uteroplacentak Insufficiency due to conditions such as Preeclampsia or other maternal Vascular diseases.

566
Q

5

A
567
Q

Management of gestational Diabetes

A

75g oRal Glucose tolerance test performed 6-8 wks after delivery

568
Q

Right iliac fossa pain on getting up the chair and has been coughing and sneezing
No Mass palpable and no rebound tenderness
What is the cause?

A

Round Ligament Strain

569
Q

Tx for UTI in pregnancy

A

Cephalexin

(Co-Amoxiclav and Nitrofurantoin can be used safely in pregnancy)

570
Q

Safest treament for Acute Migraine causing headache and vomiting

A

Paracetamol and metoclopramide

571
Q

TVS shows cervical shortening to 2 cm, cervical dilation, and protrusion of fetal membranes into the cervical canal.
What is the most likely diagnosis?

A

Cervical Insufficiency

572
Q

Contraindication to Vagina delivery in breech presentation at term

A

Anemia

573
Q

Cervical os is closed
Endometrial thickness of 2mm and an empty uterus
Adnexa are clear and there is no fluid in the pouch of Douglas

A

Complete Abortion

574
Q

Most serious diagnosis of hyperemesis gravidarum

A

Hypokalemia

575
Q

Which of the ff complications develop if Warfarin is used in second trimester of pregnancy?

A

Fetal Optic Atrophy

576
Q

What food should be avoided during pregnany

A

Soft cheese

577
Q

Abnormalities not seen in a pregnant woman with hyperemesis gravidarum

A

Hypothyroidism

578
Q

Dilated cervic as well a progressive uterine bleeding and painful uterine bleeding contractions
The gestational tissue often can be felt or seen through the cervical os and passage of this tissue typically ocurs within a short time.

A

Inevitable abortion

579
Q

Membranes may have ruptured and the conception products may have pastly passed, but significant amounts of placental tissue is still left in the uterus.
Cervical os is open, uterine is not well contraccted.
Gestational tissue is observed int he cervix.
Uterine size is ssmall than expected

A

Incomplete abortion

580
Q

Refers to o utero death of the embryo or fetus prior to 20 wks gestation
Women feel that they dont feel pregnant anymore
Vaginal bleeding may occur and the cerix usually remains closed.

A

Missed abortion

581
Q

Miscarriage occurs before the 12 wks and the entire contents of the uterus is expelled.
Uterus is small on PE and well contracted with an open or closed cervix.
Scant vahinal bleeding and only mild cramping
Ultrasound will reveal an empty uterus and no extra-uterine pregnancy

A

Complete Abortion

582
Q

Screening markers used for both first and second trimester for screening for Down Syndrome

A

Free Beta HcG level

583
Q

Increased in size but not blood supply
Total T3 and T4 increased
Free T3 nd T4 is normal

A

Sheehan Syndrome

584
Q

Loss of products of conception before 20th week of pregnancy

A

Abortion

585
Q

What is the most common cause of Abortion?

A

Chromosomal Abnormalities

586
Q

Inhertied thrombophilies associated with abortion

A

Factor V leiden

587
Q

No POC is expelled
Uterine bleeding +/- Abdominal pain
Closed os +
Intact membranes + fetal cardiac motion on ultrasound

A

Threatened Abortion

588
Q

What is the treatment of Threatened Abortion?

A

Pelvic rest for 24-48 hrs
No sexual relationships
Progesterone

589
Q

Completely expelled
No pain
No bleeding
Closed os
Emty uterus on ultrasound

A

Complete Abortion

590
Q

Expelled some POC
There is bleeding and pain
Open os
Ultrasound shows retained Fetal tissue
Manual uterine Aspiration or D and C

A

Incomplete

591
Q

No POC is expelled
Uterine Bleeding
There is Pain
Open OS.
Ultrasound shows retained fetal tissue.
Manual uterine Aspiration or D and C

A

Incomplete

592
Q

No POC is expelled
No fetal cardicac motion
No uterine bleeding
No pain
Closed os
No detal cardiac activity
retained fetal tissue on ultrasound

A

Missed Abortion

593
Q

Endometritis leading to septicemia

A

Septic Abortion

594
Q

Main Treatment of septic arthritis

A

Antibiotics then curettage

595
Q

What is the main risk with curettage of Septic Abortion

A

Perforation of Uterus

596
Q

Main treatment of Threatened abortion

A

Rest

597
Q

Most common cause of Abortion

A

Chromosomal

598
Q

What is the timing of abortion with chromosomal disorders

A

First Trimester

599
Q

What is the TTT of abortion in first trimester

A

Dilataion and Curettage

600
Q

What is the TTT of abortion in second trimester

A

Dilatation and Evacuation

601
Q

What is the best way to assess the gestational age in the first trimester

A

US

602
Q

Nonviable pregnancy without vaginal bleeding, uterine cramping or cervical dilation

A

Missed abortion
Mgt: Scheduled suction D & C
Conservative management or induce cotnrations with Misoprostol

603
Q

Viable pregnancy with vaginal bleeding but no cervical dilation

A

Threatened Abortion
Mgt: PFten the cause is Implantation bleeding

604
Q

Vaginal bleeding and uterine cramping leading to Cervical dilation but not POC has yet been passed.

A

Inevitable Abortion
Mgt: Emergency Suction
D&C if bleeding is heavy to prevent further blood loss and anemia
Misoprostol

605
Q

Vaginal bleeding and uterine cramping leading to cervical dilation with some but not all, POC having been passed.

A

Incomplete Abortion
Mgt: Emergency Suction D & C
Cytotec or Misoprostol - inuce contractions

606
Q

all POC being passed

A

Conpleted Abortion
Confirmed by USG
B-HCG should be obtained weekly

607
Q

Most common cause of fetal demise

A

Idiopathic

608
Q

What is the risk of Fetal Demise

A

DIC

609
Q

Condition of intrauterine fetal growth slowing
Caused bu infant nutrition and general life support
Intrinsic factors in the fetus itself

A

Intrauterine Growth Retardation (IUGR)

610
Q

It is caused by Placental Insufficiency

A

Asymmetric IUGR

611
Q

recurrent abortion and IUGR
Second trimester
Antibodies: Antiphospholipic, Anticardiolipin
Most commen congenital abnormaltyL Heart Block

A

SLE with pregnancy

612
Q

What is the treatment needed for SLE with prenancy

A

Low dose Aspirin
Low Dose Heparin (LMWH)

613
Q

Painless dilation of the cervix
Delivery of Normal baby who quickly dies (premature delivery)
Timing: Second trimester
Painless leakage of amniotic fluid in second trimester often diagnosed with USG

A

Incompetent Cervix

614
Q

What are the causes of Incompetent Cervix

A

History of conization
LEEP
Diethystilbestrol Exposure

615
Q

What is the ultrasound findings for the incompetent cervix?

A

Shortening of cervix
Herniation of Fetal Membranes

616
Q

What is the TTT of Incompetent Cervix

A

Cerclage

617
Q

Large ketonuria
Weight Loss
Electrolyte disturbances
Ptyalism (excess salivation)

A

Hyperemesis Gravidarum

618
Q

What are the risk factors for Hyperemesis Gravidarum

A

Molar Pregnancies
Multiple Gestations
UTI

Chings Notes (39 decks)

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