OBGYN Flashcards
1
Q
clue for PCOS(3)
A
acne
irregular mentrual period
hirsutism
2
Q
what hormone is high in PCOS(2)
A
testosterone
high LH/FSH ratio
3
Q
problem in PCOS causing hyperglycemia(2)
A
abnormal glucose metabolism
impaired glucose tolerance
4
Q
rx of PCOS(4)
A
oral contraceptive or citrate d eclomiphen antidrogen metformin if impaired glucose tolerance
5
Q
advantages of metformin in PCOS(4)
A
prevention of diabetes
helps losing weight
ovulation in conjoction with citrate de clomiphene
modest effect in suppressing androgen to correct hirsutism
6
Q
normal biophysical profile
A
8-10
7
Q
what to do if biophysical profile at 8 and decreased amniotic fluid
A
delivery should be considered
8
Q
biophysical profile 6 with no oligoamnios fetus a < 37(2)
A
repeat BP in 24 hours
if the same delivery
9
Q
biophysical profile 6 with no oligoamnios fetus a > 37
A
delivery
10
Q
biophysical profile < 6 and fetus < 32 s
A
daily monitoring
11
Q
biophysical profile < 6 and fetus > 32 s
A
delivery
12
Q
what to do if BP =4 or less
A
delivery if fetus > 26 weeks of gestation
13
Q
meaning of BPP less than 2
A
fetal asphyxia
14
Q
how to assess BP
A
sonography
15
Q
elements of BP(5)
A
NST fetal tone fetal movement fetal brathing mvt amniotic fluid volume
16
Q
NST normal
A
active
17
Q
fetal tone evaluation(2)
A
extension
or
flexion
18
Q
fetal mvts
A
at least 2 mvts in 30 mn
19
Q
fetal breathing mvts
A
at least last 20 seconds in 30 mn
20
Q
quid of amniotic fluid volume
A
single pocket more than 2 cm in vertical axis
21
Q
abnormal uterine bleeding with negative pregnancy test in young female
A
ovulation dysfunction
22
Q
cause of ovulation dysfunction in young girl
A
immature hypothalamic pituitary ovarian axis
23
Q
what to do in young adolescent with positive bleeding(2)
A
test de grossesse
test for blood coagulation
24
Q
first line rx in ovulation dysfunction
A
oral estrogen
25
modality of rx in aptient with abnormal uterine bleeding (4)
high dose of oral estrogen
or high dose of combined contraceptive pills
or high dose progestin
or tranexamic acid
26
quid of tranexamic acid
antifibrinolytic used when there is contraindication with estrogen and progesterone
27
syphylis positive in pregnant women with PNC allergy next step
PNC desensitization
28
how to desensitize a patientfor PNC allergy
using incremental dose of PNC
29
first step in PNC allergy
confirm the allergy by skin testing
30
mother at 28 weeks of gestation sono confirms a dx of bilateral agenesis in mother passing clear fluid form vagina next step
allow spontaneous vaginal delivery
31
when to alllow premature labor(3)
severe pulmonary hypoplasia
bilateral renal agenesis
any sever congenital anomaly incompatible with life
32
how's BUN and creatinine in pregnancy
low
33
why BUN and creatinine in pregnancy(2)
increase of renal plasma flow
and
glomerular filtration rate
34
in vignette patient at 18 semaine choose set of creat and BUN
always choose the values with low creat and low BUN
35
physical exam in pelvic floor weakness(2)
cystocele
| uterine prolapse
36
passage of urine when sneezing or coughing
stress incontinence
37
cause of stress incontinence
pelvic floor mx weaakness
38
raik factor for stress incontinence(2)
high parity
| older woman
39
work up in stress incontinence(3)
urine analysis
cystometry
post void residual volume
40
clue for bacterial vaginosis
pear shaped motile organism on wet mount
41
rx of bacterial vaginosis
metro
42
what habit must be prohibited during the rx of bacterial vaginosis
alcohol use
43
quid of disulfuram effect(4)
flushing
nausea
hypotension
vomiting
44
physiopatho of disulfuram effect
accumulation of acetaldehyde in blood stream
45
next step in HGSIL
colposcopy
46
what to do if coposcopy shows no suspicious area
biopsies are not required
47
what to do in suspicious areasin colposcopy
biopsy
48
finding in colposcopy plus biopsy
CIN 1
CIN 2
CIN 3
49
quid of cIN
cervical intraepithelial neoplasia
50
pregnant woman with HGSIL
repeat the pap test and colposcopy after the delivery
51
why repeat the pap test and colposcopy after the delivery
because CIN2 et 3 and hGSIL will regress spontaneously after pregnancy
52
when cervical biopsy and electrosurgical excision are indicated in HGSIL in pregnancy
for lesion suggestive of invasive cancer
53
patient > ou egal 25 ans with HGSIL next step
colposcopy or loop surgical excision if no pregnancy or post menopause
54
patient 21-24 ans with HGSIL
colposcopy
55
colposcopy and biosy showing CIN 2 et 3 next step
manage en fonction de guidelines
56
colposcopy and biopsy with no CIN2 et 3
repeat pap test and coploscopy at 6 months for up to 2 years
57
clue for turner(2)
short stature
| coarctation of the aorta
58
why patient with TURNER has late menstruations
poor ovarian function
59
hormone increased in Turner and why?(2)
FSH
| due to lack of negative feedback
60
painless bleeding in pregnant women third trimester
placenta praevia
61
dx of placenta preavia
ultrasonogram
62
patient with vaginal bleeding what to not do?
pelvic examination(toucher vaginal)
63
placenta praevia with stable mother and fetus a 37 semaines
schedule CS
64
placenta praevia with stable mother and fetus < 37 semaines
amniocenthesis to assess lung maturity
65
placenta praevia with stable mother and fetus < 37 semaines and mature lung
elective CS
66
unstable mother and baby in palcenta praevia
elective CS
67
how to assess baby stability
if non stress test is reactive and reassuring
68
clue for androgen insensitivity syndrome(4)
primary amenorrhea
bilateral inguinal mass
breast development
but no axillary and pubic hair
69
karyoptype in androgen insensitivity syndrome
46 xy
70
phenotype of androgen insensitivity syndrome(AIS)
female with blind vaginal pouch
71
other name of IAS
Male pseudohermaphrodism
72
risk in AIS
testicular carcinoma
73
why AIS patietn has breast
because testo is converted to estrogen
74
what patient AIS dont have
mullerian structures
75
quid of mullerian structures(2)
uterus
| fallopian tubes
76
cause of AIS
mutation in androgen receptor gene
77
consequence of mutation in AIS
peripheral tissue become unresponsive to androgens
78
risk in PCOS
endometrial carcinoma
79
cyst important to see in dx PCOS(2)
no
| cwith only symptom you can have the dx
80
why patient with PCOS has difficulty having kid
anovulation cycle
81
cause of ENDOMETRIAL CARCINOMA in PCOS
unbalanced estrogen
82
painless genital ulcer(2)
syphylis
| granulome inguinale
83
painfull ulcer(2)
chancroid
| herpes
84
differentiate syphilis from granulome inguinale
in granulome inguinal ulcers doen't go without antibiotic
85
bug causing granulome inguinale
callymatobacterium granulomatis
86
other name for granulome inguinale
donovanose
87
cuase of chancroid
hemophilus ducreyi
88
screening test for syphilis
non treponemal test
89
quid of non treponemal test(2)
VDRL
| RPR
90
confirmation test for syphilis
FTAabs
91
quid of FTA abs
treponemal serologic test
92
quid of dark field
method to identify T pallidum
93
indication of Tzanck smear(3)
to dx Herpes
CMV
varicella
94
quid of premature rupture of membrane PROM
leakage of amniotic fluid before onset of labor
95
immature lung assessment
ratio lecithin/sphingomyelin < 2
96
PROM in 24 a 34 semaines next step?
corticosteroid
97
prom with contractions next step entre 24 a 24 semaines(2)
corticosteroid
plus
tocolysis
98
critical point to say yes we have immature lungs
<34 semaines
99
when to give HPV vaccines(2)
all girls 9-26 ans regardless HPV status or sexual activity
| boys 9-21 ans
100
when can you begin screening for cancer du col
21 yo
101
patient entre 21 a 29 ans screening for ca du col
cytology q 3 ans
102
patient entre 30 a 65 ans screening for ca du col(2)
cytology q 3 ans
| cytologie plus HPV serology q 5 ans
103
screening of cervical cancer > 65 ans
no screening
104
screening of cervical cancer <21
no screening
105
patietn with hysterectomy when cervical cancer screening is indicated(2)
history of precancerous lesion cervical cancer
| exposure to diethylstylbestrol
106
screening of ca du col in immunocompromised patient(2)
2 times aucours de la premiere annee
| and then annualy
107
how to beginscreening of ca du col in immunocompromised patient
onset of sexual intercourse
108
dx test for chlamydia and gonorrhea
nucleic acid amplification
109
CAT if NAA is positive for chlamidial but not for gonorrhea
single dose of azythromycin
110
screening test for chlamydia
NAA
111
patietn at 9 semaines de gestation comes with nausea and worsening vomiting .what shuold be done
quantitative B HCG level
112
next step is b hcg is elevated
rule out gestationnal throphoblastic disease
113
quid of gestationnal trophoblastic disease(2)
mole hydatiforme
| chorio carcinome
114
red flag for GTD
severe vomiting
115
triad of mole hydatiform(3)
enlarged uterus
hyperemesis
BHCG > 100 000
116
severe vomiting with normal BHCG
hyperemesis gravidarum
117
in the vignette patient is vomiting severely,amylase and lipase are high why
because they are from salivary gland
118
significance of mild increase of ALT/AST cause(4)
```
50% of hospitalised patient has increase
ALT,AST
lipase
bilirubin
amylase
```
119
HELLP SYNDROME patient TA at 130/80 is this possible
yes it's
120
quid of HELLP syndrome(4)
hemolysis
elevated liver enzymes
low platelet < 100 000
RUQ pain or epigastric pain
121
cause of RUQ pain in HELLP syndrome
distension of liver capsule
122
how's ALP in pregnancy
elevated
123
pregnant woman with hemolysis,low platelet,increase liver enzymes 2 f de la normale and low platlet Dx
HELLP SYNDROME
124
Anemia in HELLP syndrome
hemolysis caused by microangiopathic anemia
125
clue for microangiopathic anemia
schistocytes
126
patient with HELPP syndrome develops difficulty breathing and decrease arterial oxygen saturation
pulmonary edema
127
what can cause pilmonary edema in preecclampsia(4)
decrease albumin
decreased renal function
endothelial damage causing increase permeability
congestive heart failure
128
cause of congestive heart failure in preecclampsia(2)
arterial vasospasm
| increased vascular resistance----> decrease cardiac output
129
physiopatho of precclampsia
general arterial vasospasm leading to increased systemic vx resistance with increased cardiac afterload
130
why increased ventricular contraction in preecclampsia
because afterload is increased
131
clue for midcycle pain(3)
LLQ pain occcuring two weeks after menstruation
unilateral
no fever
132
other of midcycle pain
mittelschmerz
133
cause of fetal hydantoin syndrome(3)
phenytoin
carbamazepine
during pregnancy
134
clue for hydantoin syndrome
```
mid facial hypoplasia
microcephaly
cleft lip or palate
digital hypoplasia
hirsutism and developmental delay
```
135
body of hydantoin
small body
136
in USMLE intense uterine contraction and bleeding
painfull bleeding
137
cause of painfull bleeding
abruptio placentae
138
stable mother and fetus with abruptio placentae ,labor started next step
let the labor,icrease labor if necessary
139
indication of CS in abruptio placentae
rapid deterioration of mother and fetus
140
quid of placenta praevia
abnormal insertion of placenta causing internal cervica os to be partially or totally obstructed
141
painless third trimester bleeding
preavia
142
why lactation is not considered as a reliable form of contraception
ovulation can occur
143
contraptives method during lactation(4)
progestin
barrier methods
sterilisation
intrauterine devices
144
why progestin is the best method to use in lactating woman
because volume and composition of the milk does not change
145
risk with combination pills
risk of DVT
146
why amenorrhea during lactation
prolactin inhibits GNRH release from hypothalamus
147
clue for intrauterine fetal demise(2)
no mvt
| no cardiac activities in fetus
148
best time to confirm intrauterine fetal demise
real time ultrasonogram
149
finding in real time sonogram in case of intrauterine fetal demise(2)
absence of fetal mvt
| no cardiac activity
150
quid of fetal demise intra uterine
death of fetus occurring after 20 weeks and before onset of labor
151
next step after delivery of intra uterine fetal demise
autopsy of the fetus and placenta with permission of the parents
152
cause of intrauterine fetal demise(6)
```
hypertensive disorders
diabetes
placental and cord complication
congenital anomalies
TORCH
listeriosis
```
153
devant abruptio placenta first indicator to watch
TA
154
complication of abruptio placentae(2)
DIC
| hemorrage
155
clue for ovarian torsion(4)
no fever or low grade fever
pain in lower abdomen
history of ovary cystic mass
can also have nausea and vomiting
156
risk factor for torsion(3)
pregnancy
ovulation induction
ovarian masses >5 cm
157
first to do devant lower abdominal pain in woman and why(2)
BHCG
| to rule out ectopic
158
best to Dx torsion of ovary
ultra sonogram(pelvic colr doppler)
159
management of ovary torsion
detorsion laparoscopic
160
indication of salpin oophorectomy in ovary torsion(2)
necrosis of adnexae
| suspected ovarian malignancy
161
complication of ovarian torsion(3)
peritonitis and sepsis
infertility and chronic pain
hemorrage
162
why right side torsion is more common(2)
because of lenght of tubo ovarian ligament
| because of rectosigmoid occupies space around the left ovary
163
clue in sonogram for down
increase fetal nuchal fold lucency
164
best test to rule out down or chromosomal abnormality
chorionic villus sampling
165
when to perform chronic villus sampling
10 a 12 semaines
166
indication of chorionic villus sampling
any woman of > 35 ans pregnant
167
risk of chorionic villus sampling procedure(2)
fetal death
| limb reduction defects
168
when you have the greatest risk for complication using chorionic villus sampling
before nine to 10 weeks
169
clue for vaginal candidiasis(2)
thick white discharge
| cottage cheese appearrance
170
rx for vaginal candidiasis
oral fluconazole
171
image of pseudohyphae
image tankou ti branch bwa
172
pseudohyphae meaning
candidiasis
173
should you treat the partner in vaginal candidiasis
sometimes you have too
174
patietn with night sweats,insomnia,irregular menses middle aged woman dxs
hyperthyroidism
| menopause
175
patietn with night sweats,insomnia,irregular menses middle aged woman test to perform(2)
FSH
| LH
176
dx of septic abortion
ultrasonogram
177
echo finding in septic abortion(3)
thick endometrial stripe
echogenic material
increase vascularity
178
what will you see in echo
retained products of conception
179
rx of septic abortion(3)
curretage and succion
IV fluid and cultures
empiric antibio en attendant cultures
180
quid of septic abortion
medical emergency
181
fever after abortion
septic abortion
182
risk factor for abruptio(7)
```
maternal HTA
polyhydramnios
abdo trauma
prior placental abruptio
cocaine /tobacco use
chorio amniotitis
PROM
```
183
fond de contracture in USMLE
tender hypertonic uterus
184
why U/S in abruption(2)
to rule out preavia
| not for DX
185
patient with involontary loss of urine after sneezing,laughing dx
stress incontinence
186
rx of stress incontinence
kegel exercices
187
failure for kegel exercices
urethropexy
188
quid of inevitable abortion or incomplete
dialted cervix with visible products of conception
189
next step in case of inevitable abortion(2)
iv fluids
| succion curettage
190
abortion RH -
give rhogam
191
why you give rhigam in negative RH patient
to prevent formation of antibody from the mother
192
complication of abortion
hemorrage
sepsis
DIC
193
vaginal bleeding in mother G5 after de,ivery of a baby of 4.5 kg why bleeding
uterus atony
194
first cause of vaginal bleeding within 24 hours of delivery
uterine atony
195
rx of uterine atony
oxytocin infusion
196
general measure in post partum hemorrage(4)
fundal or bimanual massage
iv access plus uterotonic agent
crystalloid to keep TAsystolic > 90 mm de hg
notification of blood bank for packed red blood cells
197
risk for uterine atony(3)
hydraamnios
multiple gestation
increased parity
198
quid of uterine agent used in atony uterine(3)
oxytocin
methylergonovine
carboprost
199
patietn with morbid obesity with amenorrhea cause
anovulation cycle
200
how 's FSH LH in morbid obesity
normal level
201
quid of infertility
failure to conceive after 12 months of unprotcted sexual intercourse
202
first test to do in patient with infertility and proof of ovulation
hysterosalpingogram
203
cause of infertility in girl(4)
PID
endometriosis
DES exposure
congenital malformation
204
devant tout patietn devant infertility first question to ask
ask about PID
205
quid of severe preecclampsia(10)
```
TA 10/110 with one of the folllowing
oliguria
altered consciousness headche and scotoma
pulmonary edema
epigastric pain and cyanosis
significant thrombocytopenia
microangiopathic hemolysis
alterd liver function
increased creat
IUGR or oligoamnios
```
206
role of MGSO4 in pregnancy
prevent seizures
207
ten weeks of pregnancy with vaginal bleeding and lower abdominal pain ckue for complete abortion(3)
close cervix
vacant uterine cavity in US
contraction can subside
208
amenorrhea in female athletes causee
estrogen deficiency
209
consequence of estrogen deficiency in female athlete(4)
osteopenia
infertility
breast atrophy
vaginal atrophy
210
patietn in labor with sudden abdominal intense pain with vaginal bleeding and loss of fetal station
uterine rupture
211
red flag for uterine rupture
loss of fetal station
212
risk for uterine rupture(3)
uterine scar
abdominal trauma
ant de CS
213
physiologic for ovulation(3)
pulsatile GNRH from hypothalamus
release of LH and FSH by anrt pituitary gland
ovulation
214
clue for puberte precoce
7 yo girl with pubic and axillary hair
215
cause fo puberte precoce
early activation of hypothalamic pituatary ovarian axis
216
quid of precocious puberty(2)
secondary sex characteristics before 8 in girl
| before 9 in boys
217
quid of peripheral precocious puberty
low FSH and LH level
218
cause of peripheral precocious puberty
gonadal or adrenal excess release of androgen
219
clue central precocious puberty
high FSH and LH
220
next step in patient with central precocious puberty
CT or MRI of the brain
221
rx of central precocious puberty
GNRH analog
222
the most prevalent preventable cause of fetal growth restriction
smoking cessation
223
the most common tumor in reproductive aged woman
leiyomyoma
224
dx test for myoma
US
225
symptom of leiyomyoma(3)
constipation
back pain
urinary retention or frequency
226
first step in intrauterine fetal demise
coagulation profile
227
why coagulation profile in intrauterine fetal demise
to rule out DIC
228
what can happen in intrauterine fetal demise
retention of deasdd fetus can cause chronic consumption coagulopathy
229
why coagulopathy in intrauterine fetal demise
release of thromboplastin from placenta into the maternal circulation
230
early indicator of intra uterine fetal demise(2)
low fibrinogen
| low platelet
231
how s fibrinogen in pregnancy
high
232
fibrinogen in coagulopathy
160 mg/dl is considerd as low
233
whta to do in front of inttra uterine fetal demise
induce labor
234
risk for precocious puberty(2)
epiphyseal plate fusion
| short stature
235
after amniotomy baby develops decrease of heart beat with late deceration ?
ruptured fetal ombilical vessel
236
clue for ruptured fetal ombilical vessel during amniotomy
tachycardia puis bradycardia to a sinusoidal pattern
237
during ruptured fetal ombilical vessel how to say the blood is not from the mother
by the APT test
238
rx of rupture fetal ombilical vessel
crash CS
239
quid of vasa preavia
fetal blood vessel traverse the lower segment between the baby and the internal cervical os
240
clue vasa preavia bleeding
normal vitals for mother during bleeding
241
in pregnant women when to consider urine culture positive
> 100 000 colonois forming unit/ml for a single organism
242
risk for asymptomatic bacteriuria
pyelonephritis
243
rx for bacteruiria asymptomatic(4)
amox
or ampicilllin
or nitrofurantoin
or cephalexin
244
complication of pyelonephritis(3)
low birth weight baby
septicemia
pretem babies
245
HTA in pregnant women < 20 weeks with no protein in urine
chronic HTA
246
hta in pregnant women < 20 weeks(2)
mole hydatiform
| chronic HTA
247
why you can have hypokaliemia and hypernatremia in pregnant woman
because of hyperaldosteronism
248
risk in chronic HTA
abruptio placentae
249
abruption placenta risk for the mother
bleeding
250
abruption placenta risk for the baby
interruption of placental perfusion
251
SLE and abruptio placenta
lupus anticoagulant
252
most comon risk factor for abruptio
HTA
253
what if for any reason you dont want to perform an abortion what to do
refer the patient to another physician who can and will do it
254
when to give RHOGAM in RH - patient(2)
28 e semaines
| after delivery
255
patient with history of abruptio placenta rh - develops antirh antibody what can cause that
low dose of antiglobulin in post partum
256
what 's rosette test in abruptio in rh -
determine the amount of fetal maternal transfusion
257
next step if rosette test is negative
give the standard dose of anti D immune globulin
258
rosette test positif next step
perform kleihauer betke stain or fetal red blood cell using flow cytometry
259
next step after kleihauer betke stain test
anti D immune globulin should be corrected accordingly
260
quid of preterm labor
labor occuring between 20 a 37 weeks of gestation
| before 37 ,after 20 weeks
261
clue for good contractions during labor(2)
in labor 4 contractions q 20 mn or more
| cervical changes
262
complication of preterm labor(5)
```
respiratory distress syndrome
intra ventricular hemorrage
sepsis
necrotizing enterocolitis
kernicterus
```
263
best thing to do in preterm labor(2)
tocolysis
| corticosteroid pendant 48 h < 34 semaines
264
in preterm labor what's the goal of tocloysis
ammener la grossessede 34 a 36 semaines of gestation
265
young woman with breast lump what to do
ask her to return shortky after menstrual period
266
young woman with breast lump ,regeression after menstrual period dx
it's benign
267
clue for kalman syndrome(3)
primary amenorrhea
absent of sexual characteristics
hypoosmia or anosmia
268
karyotype in kallman syndrome
46XX
269
what about internal organ in kallman
Normal
270
phenotype in kallman syndrome
girl
271
karyotype in klinefelter
47XXY
272
karyotype in turner
45X0
273
threatened abortion
any vaginal bleeding occuring before 20 semaines with a live fetusand closed cervix
274
standard care for threatened abortion(3)
reassurance
outpatient follow up
bed rest no sex
275
why bed rest and no sex during threatened abortion
to avoid guilt in parents
276
cause of anovulation in PCOS(2)
imbalance in FSH and LH
| insulin resistance
277
tetrad of PCOS(4)
anovulation
androgen excess
male pattern growth
ovarian cyst
278
testicular feminisation syndrome karyotype
46 XY
279
testicular feminisation syndrome phenotype
girl
280
why absence of internal reproductive organ in testicular feminisation
presence of mullerian inhibiting factor(MIF)
281
why MIF is present
because testis are present and form MIF
282
role of MIF
prevent formation in internal organ in female in case of testiculer feminisation
283
rx of testicular feminisation(2)
gonadectomy in puberty
| creation of neovagina
284
young girl with amenorrhea,hypoestrogenism,high gonadotrophin levels dx
primary ovarian failure
285
diseases associated with primary ovarian failure(5)
```
autoimmune disorder
hashimoto
addisson
diabete type 1
pernicious anemia
```
286
cause of premature destruction of follicles(4)
mumps
radiation
oophoritis
chemo
287
clue for rimary ovarian failure(2)
high FSH /LH
| low estrogen
288
how to deal with infertility in patient with primary ovarian failure
in vitro fertilization with donor oocytes
289
symptom assciated with pathologic leucorrhea(3)
pruritus
burning
malodorous discharge
290
physical exam of pathologic leucorrhea(3)
erythema and edema
tenderness of cervix
green and curdlike vaginal discharge
291
quid of physiologic leucorrhea(4)
yellow or white
non malodorous
absence of associated symptom
normal physical exam
292
clue for bacterial vaginosis(4) AMSEL criteria
thin gray white vaginal discharge
vaginal PH>4,5
positive whift test upon addition of KOH to the vaginal discharge
clue cells
293
quid of clue cells
vaginal epithelial cell with adherent cocobaccilus on wet mount
294
KOH test
amine like odor (fishy) when KOH is added to vaginal discharge
295
AMSEL criteria to dx vagise bacterienne
3 sur 4
296
patient taking OCP complaining of weight gain what to say
reassure the patient that the weight gain is not related to oral contraceptives pills
297
why oCP is no longer associated to weight gain
because new OCP are lower dosed
298
most common side effect of combined OCP
breakthrough bleeding
299
side effect of combined oCP(6)
```
HTA
increased risk cervical ca
DVT
amenorrhea
high triglycerides
hepatic adenoma
```
300
advantage of combined OCP
lower risk of endometrial and ovarian cancer
301
chronic HTA in pregnancy rx(2)
labetalol
| @ methyl dopa
302
ACE and ARB s in pregnancy(2)
teratogenic
| fetal kidneys damage
303
after amniocentesis patient develops sudden respiratory failure seizures ,purpuric rash cardiogenic
amniotic fluid embolism
304
next step after amniotic fluid embolism(2)
intubation
| mechanical ventilation
305
meaning of purpura in amniotic fluid embolism
DIC is developing
306
test to confirm premature rupture of membranes(3)
positive nitrazine test
positive pooling tes
positive ferning test
307
first thing to do in case of PROM
give PNC
308
Why PNC in GBM
to prevent GBS infection
309
indication of GBS prophylaxis(5)
```
delivery < 37 semaines
duration of membrane s rupture > ou egal a 18 h
GBS bacteriuria during current pregnancy
prior GBS sepsis during delivery
GBS status unknown
```
310
drugs used in GBS prophylaxis(4)
ampicillin
cephazolin
clindamycin
vancomycin
311
clue for lichen sclerosis(2)
vulvar itching in elderly
| dicomfort
312
quid of porcelain white atrophy
vulvar skin thin dry white in color
313
next step in front of lichen sclerosis
vulvar punch biopsy
314
risk in lichen sclerosis
vulvar squamous cell carcinoma
315
first line rx in lichen sclerosis
high potency topical steroids
316
normal fibrinogen
150-450
317
risk of DIC in intra uterine fetal demise
low fibrinogen
318
quid of abortion(2)
fetal demise before 20 weeks or
| fetus weight <500 g
319
what to do in fetal demise in patietnwith fibrinogen 480
discuss the need for delivery and review options of vaginal/CS
320
thyroid pattern in pregnant woman(2)
increase total T4,T3
| normal TSH
321
how's TBG in pregnancy
high
322
how are free T3 T4 TSH IN PREGNANCY
normal
323
incontinence in woman after C/S
epidural anesthesia
| causing bladder denervation
324
why urinary incontinence after epidural anesthesia(4)
patient is unable to feel full bladder
when bladder overdistends,bladder pressure becomes > to uretral pressure
patient voids unvoluntary until pressure equalizes
325
rx of incontinence after CS
intermittent catherisation
326
clue for endometriosis(4)
chronic pelvic pain
dyspareunia
infertility
bladder or bowel problems
327
characteristic of pain in endometriosis
worse with menses
328
complication of endometriosis(2)
bowel bladder obstruction
| rupture of endometrioma or torsion
329
dx or rx of endometriosis
laparoscopy
330
indication of laparoscopic rx in endometriosis(2)
complicated case
| failure with medical rx
331
medical rx of endometriosis
NSAIDS plus combined OCP
332
next step if first line medical rx fails in rx of endometriosis(3)
progestin
plus
GNRH agonist
plus addback therapy
333
3 D of endometriosis
dyspareunia
dysmenorrhea
dyschezia
334
dyschezia quid
pain during defecation
335
complication of endometriosis
infertility 30 %
336
goal in rx endometriosis
suppress ovulation
337
quid of progestin
medroxyprogesterone acetate
338
indication of surgery in endometriosis(7)
symptom intolerable ou refractaire a medical rx
severe incapacitating pain
need to exclude malignancy or adnexal mass
need fertility rx
evidence of complication
contrindication of medical rx
need definitive dx of endometriosis
339
clue for endometrial hyperplasia(2)
intermenstrual bleeding
| heavy menses
340
Dx of endometrial hyperplasia
biopsy
341
type of endometrial hyperplasia(4)
simple
complex
simple atypical
complex atypical
342
risk to progress to endometrial cancer in simple endometrial hyperplasia
1%
343
risk to progress to endometrial cancer in complex endometrial hyperplasia
3 %
344
risk to progress to endometrial cancer in simple atypical endometrial hyperplasia
8 %
345
risk to progress to endometrial cancer in complex atypical endometrial hyperplasia
29%
346
rx of simple or complex without atypia
cyclic progestins
347
rx of complex hyperplasia atypia
hysterectomy
348
med contraindicated in hyperplasia de l'endometre and why?(2)
estrogen
| it will agravate the case
349
chronic pelvic pain low sacral back pain worse during menses dx a eliminer
endometriosis
350
how's sonogram in endometriosis
can be normal
351
physical exam in endometriosis(2)
pain uterus motion with finger
| patient will experience rectovaginal tenderness
352
gold standard to DX endometriosis
laparoscopy
353
woman in labor with active genital herpes
immediate C section
354
why woman with active genital herpes should undergo CS
risk of neonatal HSV
355
post partum woman with breast pain
breast engorgement
356
rx of breast engorgement(2)
cool compresses
| acetaminophen and NSAIDS
357
peak for breast engorgement(2)
3 a 5 jours
| beginning 24 a 72 h
358
quid of endometriosis
endometrial and stromial tissue outside uterus
359
most common affected site for endometriosis(4)
ovary
peritoneal surfaces of the cul de sac
broad and uterosacral ligaments
rectovaginal septum
360
patient with chronic infertility ,pelvic pain and mass in the left adnexae
endometriosis
361
indication of surgery in placentae praevia(2)
unstable mother with vital signs
| unreassuring fetal haert rates
362
patient with SLE develops acne why(2)
prednisone taking
| steroid induced folliculitis
363
clue for acne in steroid
no comedones
364
early decelerations quid?
peak of contraction postive deflection corresponds to valley (nadir)in heart deceleration
365
cause of early deceleration(2)
fetal head compression
| or could be normal
366
quid of late deceleration
nadir of deceleration (negative deflection) occurs after uterine contraction (positive deflection)
367
cause of late decelration
uteroplacental insufficiency
368
quid of variable deceleration
can be or not associated with contraction
369
cause of variable deceleration(3)
cord compression
oligoamnios
cord proplapse
370
management of reccurent variable decelerations(3)
change maternal position
o2 administration
rescucitative measures
371
after motor vehicle accident patient of 34 weeks come with hypotension and late deceleration of the baby dx
uterine rupture
372
in uterine rupture type of deceleration
late deceleration
373
patient with schizophrenia develops milk in why
risperidone taking
374
action of risperidone
dopamine and serotonin antagonist
375
urinalysis in pregnant woman develops > 100 000 bacteria
bacteriuria asymptomatic
376
first line rx of asymptomatic bacteriuria(2)
```
nitrofurantoin for 7 days
or
amox
or
cephalosporin first generation
```
377
bug in cause of aymptomatic bacteriuria
E coli
378
work up of adrenal mass(2)
US
| ca-125 antigen
379
suspicscious failure in US(4)
mass > 10 cm
nodular or pelvic fixed mass
ascites
metastasis
380
when rx conservatively(3)
simple cyst in sonogram
normal ca 125
mass < 10 cm
381
patient on lithium for bipolar disorder and isotretinoin becomes pregnant(2)
stop isotretinoin
| wean lithium
382
why wean lithium in case of pregnancy
you should slow taper lithium to prevent relapse
383
congenital anomaly associated with lithium
ebstein anomaly
384
congenital anomaly associated with isotretinoin(3)
craniofacial dysmorphism
heart defect
deafness
385
what to do if you plan to begin isotretinoin in reproductive age(2)
use contraception at least one month before beginning
| pregnancy test befor rx
386
could we use inhaled steroid in pregnancy
yes
387
false labor when it occurs
in the late 4-8 weeks of pregnancy
388
clue for false labor(2)
no cervical changes during pregnancy
| relieved by sedation
389
rx for false labor
nothing
390
low grade fever following 24 h post partum and high leucocytes(2)
it's normal
| reassurrance
391
lochia in post partum rubra(2)
first few days
| rouge
392
lochia in post partum serosa (2)
3 a 4 jours
| pale
393
lochia in post partum alba
white or yellow
394
foul smelling lochia
endometritis
395
why evaluation of mucus should be part of infertility work up
because hostile cervical mucous can dialoow penetration of spermato into uterus
396
normal aspect of cervical mucus during ovulation(4)
profuse
clear and thin
stretch approximately 6 cm
exhibit fening on microscopic slide smear preparation
397
35 young patietn with dyspareunia and tense vagina dx
vagisnismus
398
rx of vagisnismus(3)
kegel exercice
gradual dilation with finger
relaxation
399
preecclampsia and SLE(3)
both has HTA
both proteinuria
edema
400
clue for glomerulonephritis in SLE during pregnancy(4)
massive proteinuria 8g 24 h
RB cast
malar rash
ANA +
401
could pregnancy cause ANA positive
yes
402
quid of malar rash
macular eruptions on the cheek bones
403
premature ovarian failure clue(2)
high FSH LH
| FSH/LH>1
404
Cause amenorrhea(3)
ovarian failure
turner
fragile x syndrome
405
in premature ovarian failure the greatest elevation LH or FSH
FSH
406
Dx of confirmation of pramature ovarian failure
elevation of FSH in the setting of more than 3 months of amenorrhea in a woman under 40 ans
407
symmetrical pitting edema in pregnant woman with normal TA next step(2)
reassurrance
| normal follow up
408
patietn at 36 weeks seen with increased abdominal pain and bleeding clue for abruptio placenta
firm and tender uterus
409
why contraction in AP
blood seems to have uterotonic action
410
can you have absence of vaginal bleeding in AP
if you have a retroplacental hemmorage dans 20% des cas
411
VEAL IN deceleration(4)
variable
early
accelerated
late
412
cause of deceleration CHO=VEAL(4)
Cord compression or prolapse,oligoamnios=V
head compession =E
okay= accelerated
Placental insufficiency=late deceleration
413
two types of bleeding in AP(2)
concealed
| visible
414
masculinisation in pregnant mother resolving after delivery
aromatase deficiency in baby
415
why masculinisation certain pregnant women
placenta is unable to make estrogen in utero
416
clue for aromatase deficiency(4)
absent estrogen
increasd testosterone and estrogen
increase LH and FSH
polycystic avaries
417
genital organs in patietn with aromatase deficiency(2)
normal internal organs
| cliteromegaly(ambiguous)
418
dx of aromatase deficiency(2)
high FSH LH
| low estrogen
419
PID coplicated with vomiting next step(2)
hospitalize the patient
| give cefotaxin and dox
420
genital organs in patietn with aromatase deficiency(2)
normal internal organs
| cliteromegaly(ambiguous)
421
dx of aromatase deficiency(2)
high FSH LH
| low estrogen
422
PID coplicated with vomiting next step(2)
hospitalize the patient
| give cefotaxin and dox
423
complication of PID(5)
```
tubo ovarian abcess
abcess rupture
pelvic peritonitis
sepsis
infertility
```
424
outpatient rx of PID(2)
ceftriaxone or cefoxitin
plus
dox
425
cause of PID(3)
neisseria gonerrhea
chlanydia
genital mycoplasma
426
poor surgical candidate with tumor size < 2cm
radiation
427
rx of squamous cell carcinoma of vagima stage 1 et 2 with no metastasis or extension to pelvic wall size < 2cm
surgical excision
428
rx of squamous cell carcinoma of vagima stage 1 et 2 with no metastasis or extension to pelvic wall size > 2cm
radiation
429
first step in patient with secondary amenorhea
BHCG
430
secondary amenorhee with negative BHCG and high testoterone
PCOS
431
why TSH in secondary amenorrhea
to rule out hypothyroidism
432
secondary amenorhee with negative BHCG and high TSH and low t4
hypothyroidism
433
next step in Secondary amenorrhea with high prolactin(3)
check TSH
check medication
check creat
434
next step in Secondary amenorrhea with high prolactin with normal TSH ,no history of medication and normal creat
MRI of the brain
435
clue for asherman syndrome(2)
intrautrauterine adhesions
| secondary amenorrhea
436
dx for asherman syndrome(2)
hysteroscopy
or
hysterosalpingography
437
patietn seen with no fetal mvts next step
profile biophysique
438
patient with solid ovarian mass during pregnancy
all ovarian masses are malignant except during pregnancy
439
during pregnancy patient develops facial hair and acne next step
ultrasonogram
440
sonogram shows bilateral adrenal masses in pregnant woman with facial hair and acne dx
luteoma
441
next step in dx of luteoma during pregnancy(2)
reassurrance
| follow up with U/S
442
people at risk for luteoma(2)
african american
| 30's 40's
443
grand mal seizures in pregnancy
ecclampsia
444
stable patietn with preeclampsia 37 semaines de grossese
induction labor
445
management of ecclampsia(4)
prevent ,maternal hypoxia and trauma
prevent seizures with MGSO4
prevent stroke using labetalol or hydralazine
delivery by induction of labor or CS
446
acid base status in pregnancy(3)
respiratory alkalosis
low co2 pressure
high o2 pressure
447
why respiratory alkalosis in pregnancy(3)
progesterone stimulates respiratory center in the brain and causes hyperventilation
increase minute ventilation
increase volume tidal
448
why HCO3 is low during pregnancy
to compensate metabolic alkalosis
449
patietn having serial ablation after LEEP what could be the greatest complication
cervical insufficiency
450
risk factir for cervical insufficiency(6)
```
cone bioopsy
DES exposure
multiple gestation
mullerian anomalies
preterm birth
second trimester pregnancy loss
```
451
best test to Dx cervical insufficiency
transvaginal US
452
quid of short cervix(2)
cervical lenght below the 10 th percentile for gestationnal age
cervical lenght less than 25 mm at gestationnal age 23-28 weeks
453
premenstrual syndrome
symptoms occuring 1-2 weeks before menses and regress around the time of menstrual flow
454
Symptom of premenstrual syndrome(4)PMS
bloating
headaches
breast tenderness anxiety
mood disturbance
455
what to do when tyou suspect premenstrial syndrome
menstrual diary for 2 a 3 months to see exact time of symptom appearance
456
quid premenstrual dysphoric syndrome(2)
variant of PMS
| irritability and anger predomines
457
rx of PMS
SSRI fluoxetine first line
458
quid of sheehan syndrome(3)
hemmorage of post partum
problem of lactation
anterior hypophyse necrosis
459
clue trichomonas vaginalis
PH 5.0-6,0
460
consequence of sheehan syndrome
prolactin deficiency
461
microscopy in Trichomonas vaginitis
flagellated motile norganisms
462
difference between trichomonas vaginalis and vaginose bacterienne
vaginose bacterienne does not cause inflammation
463
exam image of choice to detect gynecologic tumor
pelvic U/S
464
quid of pretem labor
occuring < 20 semainees de gestation and before 37 semaines
465
quid of labor(2)
uterine contraction at a rate of 4 per 2o mn or more
| cervical changes
466
what the goal in term of preterm labor
reach 34 36 semaines
467
what to in preterm labor(2)
bed rest
| tocolysis
468
different types of abortion(5)
```
missed
inevitable
incomplete
threatened
septic
```
469
quid of missed abortion(2)
light vaginal bleeding
| pregnancy symptom can become prominent
470
best test to dx missed abortion(2)
US
| non viable fetus
471
quid inevitable abortion(2)
vaginal bleeding and open cervix
| US fetus with possible heart beat
472
incomplete abortion (3)
vaginal bleeding with passage of large clots
cervix open
US products of conception often in cervix
473
threatened abortion(2)
vaginal bleeding with close cervix
| US viable pregnancy
474
septic abortions(3)
sign of sepsis
cervix open
US retained products of conception
475
1 cause of septic abortion(2)
induced abortion
| spontaneous rarely causes sepsis
476
best test to dx abortion
US pelvic
477
3 ways to rx missed abortion(3)
abortion
medical using prostaglandin
expectant management
478
patient with vaginal bleeding last menstrual period 5 weeks ago BHCH 1000 next step
repeat BHCG in 48 hours
479
postive pregnancy test but no evidence of intra uterine or extrauterine pregnancy dx (3)
ectopic
nonviable intrauterine pregnancy
early viable pregnancy
480
when will you see fetus in pelvic U/S
BHCG 1500-2000 ml
481
in the vignette why repeat HCG in 48 h
because in case of viable pregnancy BHCG will double as the opposite of ectopic or complete abortion
482
early pregnancy with spotting trans abdomen US negative next step
transvaginal US
483
when can you gestationnal sac in trans abdominal US
when BHCG is greater than 6500
484
when can you gestationnal sac in trans vaginal US
a partir de 1500
485
patient with spotting and intra uterine sac in transvaginal US dx
no ectopic
486
adnexial sac or no sac intra uterine in transvaginal US
ectopic
487
patient with spotting and transvaginal US douteux
serial BHCG measurement
488
tendancy for BHCG
doubles every 48 h
489
when to perform transvaginal US in pregnancy
when BHCG 1500-6500
490
next step in decreaser of fetal mvts perceived by mother
nonstress test
491
normal non stress test
in 20 mn you have at least 2 accelerations of the fetal heart rate of at least 15 beats/mn above the baseline and lasts at least 15 s each
492
abnormal NST
< 2 deceleration
493
most common cause of non reactive stress test
fetal sleep cycle
494
post menopausal women with vaginal dryness burning and dysuria and dyspareunia
atrophic vaginitis
495
rx of atrophic vaginitis
vaginal estrogen replacement
496
what to do if you suspect atrophic vaginitis
rule out UTI
497
mild atrophic vaginitis rx(2)
moisturizers
| lubricants
498
moderate to severe atrophic vaginitis rx
low dose of vaginal estrogen
499
clue for ruptured ectopic pregnancy(3)
diffuse abdominal pain
cervical and adrenal tenderness
hypotension
500
differenciation between PID and ectopic pregnancy ruptured
no hypotension in PID
501
risk for ectopic(6)
```
tubal pathology
tubal surgery
current IVD
PID
multiple partners
DES and infertility rx
```
502
dx of ectopic pregnancy ruptured(2)
transvaginal US
| BHCG
503
image in trans vaginal US in ectopic pregnancy(2)
adrenal mass
| free intraperitoneal fluid
504
cause of cervical motion tenderness(2)
ectopic
| PID
505
Med rx of ectopic
metotrexate
506
dx ddifferentiel of acute pelvic pain(5)
```
Mittelscmerz syndrome
ectopic
ovarian torsion
ruptured ovarian cyst
PID
```
507
US in ovarian torsion(2)
enlarged ovary
| decreased flow in ovary
508
risk factor for ovarian ruptured cyst
strenous or sexual activity
509
US in ovarian ruptured cyst
free fluid near ovarian cyst
510
clue of ruptured ovarian cyst in vignette
cystic ovarian mass with a moderate amount of free fluid
511
how to measure blood flow in ovary
doppler velocitometry
512
importance of transvaginal US in PID
to rule out tuboovarian abcess
513
free fluid in the context of pelvic pain in US
ruptured ovarian cyst
514
major side effect of low dose combination pills
worsening HTA
515
associated risk with estrogen progestin combined rx(4)
DVT
HTA
Hepatic adenoma
stroke and MI
516
woman with uncontrolled HTA end organ damage ,smoker and 35 ans ou plus wants a contraceptive method
no estrogen in contraception
517
best benefit of OCP's(2)
reduced risk of endometrial cancer
| reduced risk of ovarian cancer
518
risk # 1 for tamoxifen
endometrial carcinoma
519
quid of tamoxifen
selective receptor estrogen modulator
520
action of tamoxifen
agonist of estrogen receptors in the breast
521
why tamoxifen is used in the rx of breast cancer
it's an agonist of estrogen receptors in the breast
522
quid of early deceleration
contraction of uterus =positive deflection
| occurs at the same time as negative deflection( deceleration)
523
what to do before giving MMR vaccine
test for immunity with IGG antibody titers
524
what to do after receiving varicella and MMR
avoid contraception for at least 4 weeks after the vaccination
525
vaccine you can give during pregnancy(5)
```
MMR
Varicella
smallpox
HPV
live attenuated intra nasal influenza vaccines
```
526
can you give Hep B during pregnancy
yes
527
when to give pneumococcus during pregnancy
2 et 3 e trimestre
528
can you give Hi flu during pregnancy
yes in asplenic patient
529
routine vaccines in pregnancy(2)
TDAp
| inactivated influenza vaccines
530
patient with bilateral pale grey discharge
galactorrhea
531
quid of galactorrhea
lactation in women who are breastfeeding or in men
532
clue for physiologic galactorrhea
it's bilateral
533
clue for pathologic galactorrhea(2)
unilateral
| breast cancer
534
color of galactorrhea(4)
white green
gray
yellow
brown
535
most common cause of physiologic galactorrhea
hyperprolactinemia
536
cause of hyperprolactinemia(7)
```
prolactinoma
risperidone
opiods
hypothyroidism
pregnancy
oral contraceptive pills
chest wall or nipple stimulation
```
537
cause of chest wall stimulation(3)
surgery
trauma
shingles
538
first test to do in galactorrhea
guaic test in fluid from breast
539
first test to do if galactorhhea is non bloody and bilateral(3)
serum prolactin
TSH
brain MRI
540
galactorrhea and palpable mass in the breast(3)
mammogram
US of breast
surgical evaluation
541
investigation of breast mass
mammogram
US of breast
surgical evaluation
542
indication to investigate breast mass in galactorhea
unilateral galactorrhea
| bloody galactorrhea
543
patient with history of formula feeding of baby after hemorragic delivery
sheehan syndrome
544
physiopatho of sheehan syndrome
ischemic necrosis
545
hypopituitarism in post partum(2)
sheehan syndrome
| lynphocytic hypophysitis
546
can you have insipidus diabetes in sheehan
it's uncommon
547
clue for hypopituitarism(2)
hypogonadism
| hypothyroidism
548
rx of asymptomatic bacteriuria in pregnancy(4)
nitrofurantoin
amox
augmentin
cephalexin
549
antibio contrindicated in pregnancy(3)
cyclines
fluoroquinolones
TMS
550
what to do in rx of hypothyroidism in pregnancy
increase levothyroxin dose
551
when to check TSH in pregnancy
every 2-3 months
552
first prenatal visit what to ask(13)
```
cervical cytology
rhesus and antibody screening
HMG,MCV
rubella immunity
varicella immunity
urine culture
hiv
syphilis
hep B
chlamydia
influenza vaccine during flu season
genetic screening of cystic fibrosis
down testing syndrome
```
553
when can you give influenza in pregnancy
n'importe quand
554
test to ask in specifci risk in pregnancy(5)
```
lead level
TB
HB electrophoresis if MCV < 80
toxo
thyroid function
```
555
when to ask thyroid fuction test in pregnancy(2)
if symptomatic
| or associated conditions like diabetes
556
pregnant woman with paresthesia in hand
carpal tunnel syndrome
557
why carpal tunnel syndrome in pregnancy
because estrogen mediates depolarisation of ground substance causing hand edema
558
rx of carpal tunnel syndrome in pregnancy(2)
wrist splinting
| put the wrist in neutral position and NSAIDS
559
failure with wrist splinting during carpal tunnel syndrome
local corticosteroid
560
rx of carpal tunnel syndrome when conservative disorder fails
surgical decompression
561
pregnant woman with increased pruritus soles and palms and increased transaminases and elevated bile salts dx
intra hepatic cholestasis of pregnancy
562
pregnant woman with RUQ pain with hemolysis low platelet and moderately high transaminase
HELLP syndrome
563
pregnant woman with hypoglycemia,RUQ pain elevated blirubin mildly elevated transaminase elevated bilirubin and possible DIC in 3 e trimestre
acute fatty liver disease of pregnancy
564
complication of acute fatty liver disease
liver failure
565
red papules with striae in the periombilical region in 3e trimestre > ou egal a 25 ans
pruritic urticarial papules and plaques of pregnancy
566
quid of ASC-VS
atypical squamous cell of undetermined significance
567
how can you dx ASC-VS
pap test
568
next step if you found it ASC-VS in pap test in woman > ou egal a 25 ans
HPV serology
569
HPV+ plus ASC-VS next step in woman > ou egal a 25 ans
colposcopy
570
HPV- plus ASC-VS next step
repeat pap test and HPV in 3 years
571
ASC-VS in woman 21-24 years old or LSIL
repeat pap smear in 1 year
572
young woman in AFIB and pulmonary edema dx causal
mitral stenosis
573
why mitral stenosis can become worse during pregnancy
increased blood flow
574
risk factor for mitral stenosis
strep pyogenes infection
575
G2 patient with RH - next step
RH D abtibody testing
576
when to perform RH antibody testing(2)
first visit
| repeat at 24-28 semaines
577
first visit of rh- mother(2)
rh typing
| antibody with RHD
578
if alloimmunization is noted next step(2)
anti immune globulin at 28 semaines
| at delivery
