Inicet Flashcards
Definition of primary amenorrhea
Absence of menses by 13 years and no secondary sexual characteristics
OR
Absence of menses by 15 years but secondary sexual characters present
Investigations for primary amenorrhea
1 step-Local examinaton
Ist Inv-USG(look for presence and absence of uterus , ovaries)
2nd Inv-FSH levels
IOC- karyotype
Primary amenorrhea with high FSH means
Gonadal dysgenesis,Ex:Turners syndrome
Primary amenorrhea with low FSH seen in
Kallman syndrome
Primary amenorrhea with normal FSH
Mullerian agenesis
Cancer caused by DES
Clear cell cancer vagina
Diseases caused by DES
T shaped uterus
CIN
Cervical collar
Cervical hood
Clear cell cancer of vagina
Vaginal adenosis
Most common finding in DES
Hypoplastic uterus
Min no of AN visits by WHO and Indian std
8&4
Calorie requirement throughout pregnancy
Extra 350 kcal
Methods of first trimester abortì on
Misoprostol / Migeprestone-upto 9 weeks
Manual vaccum aspiration-60 ml-660 mmHg-double valve vasculation syringe
Suction and Evacuation -600 mmHg
Therapeutic level of MgSO4
4-7 mEq/L
Knee jerk is lost at,Resp distress,resp arrest at
7-10
>10
>12
Uses of MgSO4
Weak tocolytic drug
Prevention of seizures and it’s recurrence
Neuroprotective <32 weeks
Define and give cause for late deceleration
Gradual,wide symmetrical starts at the peak of contraction and always ends just after contraction
Cause - uteroplacental insufficiency
What is category 3 FHR and what is its management
Late deceleration/Variable deceleration with absent BTBV
Absent BTBV with Bradycardia
Rx-urgent CS
NEVER INDUCTION OF LABOR
What part of HPV virus is used to make vaccine
L1 capsid protein make virus like particles
How does HPV cause malignant transformation of cells
E6-knocks out P53 gene
E7-knocks out RB
E1 and E2 cause replication of virus
Cancers caused by HPV and characteristic HPE finding
Cancers of vulva,vagina,penile,anal,oro pharyngeal
Epitheliotropic(affects squamous epithelium,lies between basal and para basal cells)
HPE - koilocytosis
Vulval cancer most common age group
Type 2(non HPV)>Type 1
Type 2-55-65 years,related to non inflammatory conditions like lichen sclerosis
Type 1- HPV related,smoking RF,HPV 16 most common ,seen in younger women
Most common site and presentation of vulval cancer
Labia majors>minora
Vulval lesion(maybe with pruritis)
Components of BPP
Another name of BPP
Amniotic fluid (SDP>2cm - +2)
NST
Fetal tone
Fetal breathing movement
Gross body movements
Mannings score
Modified NST
BPP+Amniotic fluid
When is Chronionic villous sampling done,complications?
11–13 weeks
Fetal limb defects
Fastest results
When is amniocentesis done,what is early amniocentesis
16-18 weeks
Early-11-14 weeks
When is fetal blood sampling done
Aka cordocentesis
At >18 weeks
When and why is fetoscopy done
In T2,T3
TTTS-for laser ablation of vessels
What is the treatment of mild to moderate anemia according to anemia mukt bharat
Mild to moderate—7-10.9%
If POG<34 weeks-oral iron 1 Tab twice a day-check Hb after 1 month
If persisting-consider non compliance,non tolerance,malabsorption-give injectable iron
If POG>34 weeks—injectable iron sucrose 200 mg(max)/day-2-3 times/week OR carboxymaltose 1000mg
Treatment of severe anemia
If Hb<5%,irrespective ofPOG-blood transfusion
If Hb—5-6.9%~if POG>34 weeks-blood transfusion,if POG<34 weeks—injectable iron
If pt has signs and symptoms of heart failure,irrespective of Hb and POG-blood transfusion (packed cells)
What causes non immune hy drops,how to diagnose
TORCH infections,especially syphillis(NOT HIV)
Anemia
Trisomies and structural abnormalities
DIGNOSIS
C/f- pleural effusion,pericardial effusion,ascites,subcutaneous edema
USG-placentomegaly,polyhydramnios
If Hb<5%,Hct<15%—hydrops fetalis
HCG is structurally and functionally similar to
LH
Alpha-LH,FSH,TSH
Beta-LH
Vagitus uterinus ?
Cry of unborn baby,before ROM,not a sign of fetal distress
F/o Turner’s syndrome
Webbed neck,short 4th metacarpal,low posterior hairline ,cubitus valgus
45 XO,no Barr body
High FSH,LH(hypergonadotropic hypergonadism)
MC type of gonadal dysgenesis
How to diagnose and treat lichen sclerosis
It is a white thinned out area on perineum/vulva
Appears as figure of 8 ,if near perinatal area-keyhole like lesion
Aka lichen atrophicus
Asso with pruritus,hyperkeratosis
Localised to labia minora
Dx-Biopsy-loss of rete pegs,significant thinning
Rx-topical steroid-clobetazol
What is fetal to placental ratio at birth
When does fetal weight becomes equal to placental weight
6:1
17 weeks
Which umbilical vein disappears
Right
Single best criteria to calculate POG
Crown Rump Length(7-10 weeks,upto 14 weeks)
Goodle sign??Seen at pog
Softening of cervix
6th week
Hegars sign??Seen at?
Softening of isthmus
Seen at 6th week
Signs seen at 8th week of gestation
Osianders sign,Chadwick’s sign,Palmers sign,Piscaceks sign
When is lightening seen
3rd trimester
Which hormones influence fetal growth
Estrogen,Glucocorticoids(for tissue differentiation),Insulin,IGF,Progesterone,TSH
Abnormalities caused by I sotretinoin,chloramphenicol,warfarin,thalidomide,tetracycline,misoprostol
~Microtia,anotia
~Grey baby syndrome
~Depressed nasal bridge,chondrodysplasia punctata
~Phocomelia
~discoloration of teeth
-Moebius syndrome-underdevelopment of 6th and 7th cranial nerve
Teratogenic effects of valorate,phenytoin,benzodiazepines,ACE inh
Neural tube defects
CVS defects
Cleft lip,cleft palate
Renal agenesis,Craniofacial abnormalities
Fetal Alcohol Syndrome
Microcephaly,growth restriction,typical facial features
Risk factors for uterine dysfunction
Multifetal pregnancy
Macrosomia
Overdistension of abdomen
Obesity
Maternal exhaustion
Abnormal fetal presentation
Shoulder dystocia
When and where is perimortem CS done
When there are signs of collapse
Perform CPR
Upper segment
SSRIs in pregnancy causes
Low APGAR score
Persistent Pulmonary Hypertension
Delayed motor development
ADHD
In ovarian cancer who is consider as platinum sensitve ,resistent, refractory
If cancer recurs beyond 6 months—platinum sensitive—rx:Carboplatin +gemcitabin/paclitaxel
If recurs within 6 months of treatment with platinum compounds-platinum resistant-rx:gemcitabin/paclitaxel/topotecan
If cancer continues to grow on platinum trt-platinum refractory—rx:give non platinum drugs
Hormone levels in menopause
E2-low-10-20pg/ml
E1-30-70 PG/ml
E2/E1<1
Urine FSH>40IU/L
