OBGYN Flashcards
clue for PCOS(3)
acne
irregular mentrual period
hirsutism
what hormone is high in PCOS(2)
testosterone
high LH/FSH ratio
problem in PCOS causing hyperglycemia(2)
abnormal glucose metabolism
impaired glucose tolerance
rx of PCOS(4)
oral contraceptive or citrate d eclomiphen antidrogen metformin if impaired glucose tolerance
advantages of metformin in PCOS(4)
prevention of diabetes
helps losing weight
ovulation in conjoction with citrate de clomiphene
modest effect in suppressing androgen to correct hirsutism
normal biophysical profile
8-10
what to do if biophysical profile at 8 and decreased amniotic fluid
delivery should be considered
biophysical profile 6 with no oligoamnios fetus a
repeat BP in 24 hours
if the same delivery
biophysical profile 6 with no oligoamnios fetus a > 37
delivery
biophysical profile
daily monitoring
biophysical profile 32 s
delivery
what to do if BP =4 or less
delivery if fetus > 26 weeks of gestation
meaning of BPP less than 2
fetal asphyxia
how to assess BP
sonography
elements of BP(5)
NST fetal tone fetal movement fetal brathing mvt amniotic fluid volume
NST normal
active
fetal tone evaluation(2)
extension
or
flexion
fetal mvts
at least 2 mvts in 30 mn
fetal breathing mvts
at least last 20 seconds in 30 mn
quid of amniotic fluid volume
single pocket more than 2 cm in vertical axis
abnormal uterine bleeding with negative pregnancy test in young female
ovulation dysfunction
cause of ovulation dysfunction in young girl
immature hypothalamic pituitary ovarian axis
what to do in young adolescent with positive bleeding(2)
test de grossesse
test for blood coagulation
first line rx in ovulation dysfunction
oral estrogen
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
quid of tranexamic acid
antifibrinolytic used when there is contraindication with estrogen and progesterone
syphylis positive in pregnant women with PNC allergy next step
PNC desensitization
how to desensitize a patientfor PNC allergy
using incremental dose of PNC
first step in PNC allergy
confirm the allergy by skin testing
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
when to alllow premature labor(3)
severe pulmonary hypoplasia
bilateral renal agenesis
any sever congenital anomaly incompatible with life
how’s BUN and creatinine in pregnancy
low
why BUN and creatinine in pregnancy(2)
increase of renal plasma flow
and
glomerular filtration rate
in vignette patient at 18 semaine choose set of creat and BUN
always choose the values with low creat and low BUN
physical exam in pelvic floor weakness(2)
cystocele
uterine prolapse
passage of urine when sneezing or coughing
stress incontinence
cause of stress incontinence
pelvic floor mx weaakness
raik factor for stress incontinence(2)
high parity
older woman
work up in stress incontinence(3)
urine analysis
cystometry
post void residual volume
clue for bacterial vaginosis
pear shaped motile organism on wet mount
rx of bacterial vaginosis
metro
what habit must be prohibited during the rx of bacterial vaginosis
alcohol use
quid of disulfuram effect(4)
flushing
nausea
hypotension
vomiting
physiopatho of disulfuram effect
accumulation of acetaldehyde in blood stream
next step in HGSIL
colposcopy
what to do if coposcopy shows no suspicious area
biopsies are not required
what to do in suspicious areasin colposcopy
biopsy
finding in colposcopy plus biopsy
CIN 1
CIN 2
CIN 3
quid of cIN
cervical intraepithelial neoplasia
pregnant woman with HGSIL
repeat the pap test and colposcopy after the delivery
why repeat the pap test and colposcopy after the delivery
because CIN2 et 3 and hGSIL will regress spontaneously after pregnancy
when cervical biopsy and electrosurgical excision are indicated in HGSIL in pregnancy
for lesion suggestive of invasive cancer
patient > ou egal 25 ans with HGSIL next step
colposcopy or loop surgical excision if no pregnancy or post menopause
patient 21-24 ans with HGSIL
colposcopy
colposcopy and biosy showing CIN 2 et 3 next step
manage en fonction de guidelines
colposcopy and biopsy with no CIN2 et 3
repeat pap test and coploscopy at 6 months for up to 2 years
clue for turner(2)
short stature
coarctation of the aorta
why patient with TURNER has late menstruations
poor ovarian function
hormone increased in Turner and why?(2)
FSH
due to lack of negative feedback
painless bleeding in pregnant women third trimester
placenta praevia
dx of placenta preavia
ultrasonogram
patient with vaginal bleeding what to not do?
pelvic examination(toucher vaginal)
placenta praevia with stable mother and fetus a 37 semaines
schedule CS
placenta praevia with stable mother and fetus
amniocenthesis to assess lung maturity
placenta praevia with stable mother and fetus
elective CS
unstable mother and baby in palcenta praevia
elective CS
how to assess baby stability
if non stress test is reactive and reassuring
clue for androgen insensitivity syndrome(4)
primary amenorrhea
bilateral inguinal mass
breast development
but no axillary and pubic hair
karyoptype in androgen insensitivity syndrome
46 xy
phenotype of androgen insensitivity syndrome(AIS)
female with blind vaginal pouch
other name of IAS
Male pseudohermaphrodism
risk in AIS
testicular carcinoma
why AIS patietn has breast
because testo is converted to estrogen
what patient AIS dont have
mullerian structures
quid of mullerian structures(2)
uterus
fallopian tubes
cause of AIS
mutation in androgen receptor gene
consequence of mutation in AIS
peripheral tissue become unresponsive to androgens
risk in PCOS
endometrial carcinoma
cyst important to see in dx PCOS(2)
no
cwith only symptom you can have the dx
why patient with PCOS has difficulty having kid
anovulation cycle
cause of ENDOMETRIAL CARCINOMA in PCOS
unbalanced estrogen
painless genital ulcer(2)
syphylis
granulome inguinale
painfull ulcer(2)
chancroid
herpes
differentiate syphilis from granulome inguinale
in granulome inguinal ulcers doen’t go without antibiotic
bug causing granulome inguinale
callymatobacterium granulomatis
other name for granulome inguinale
donovanose
cuase of chancroid
hemophilus ducreyi
screening test for syphilis
non treponemal test
quid of non treponemal test(2)
VDRL
RPR
confirmation test for syphilis
FTAabs
quid of FTA abs
treponemal serologic test
quid of dark field
method to identify T pallidum
indication of Tzanck smear(3)
to dx Herpes
CMV
varicella
quid of premature rupture of membrane PROM
leakage of amniotic fluid before onset of labor
immature lung assessment
ratio lecithin/sphingomyelin
PROM in 24 a 34 semaines next step?
corticosteroid
prom with contractions next step entre 24 a 24 semaines(2)
corticosteroid
plus
tocolysis
critical point to say yes we have immature lungs
when to give HPV vaccines(2)
all girls 9-26 ans regardless HPV status or sexual activity
boys 9-21 ans
when can you begin screening for cancer du col
21 yo
patient entre 21 a 29 ans screening for ca du col
cytology q 3 ans
patient entre 30 a 65 ans screening for ca du col(2)
cytology q 3 ans
cytologie plus HPV serology q 5 ans
screening of cervical cancer > 65 ans
no screening
screening of cervical cancer
no screening
patietn with hysterectomy when cervical cancer screening is indicated(2)
history of precancerous lesion cervical cancer
exposure to diethylstylbestrol
screening of ca du col in immunocompromised patient(2)
2 times aucours de la premiere annee
and then annualy
how to beginscreening of ca du col in immunocompromised patient
onset of sexual intercourse
dx test for chlamydia and gonorrhea
nucleic acid amplification
CAT if NAA is positive for chlamidial but not for gonorrhea
single dose of azythromycin
screening test for chlamydia
NAA
patietn at 9 semaines de gestation comes with nausea and worsening vomiting .what shuold be done
quantitative B HCG level
next step is b hcg is elevated
rule out gestationnal throphoblastic disease
quid of gestationnal trophoblastic disease(2)
mole hydatiforme
chorio carcinome
red flag for GTD
severe vomiting
triad of mole hydatiform(3)
enlarged uterus
hyperemesis
BHCG > 100 000
severe vomiting with normal BHCG
hyperemesis gravidarum
in the vignette patient is vomiting severely,amylase and lipase are high why
because they are from salivary gland
significance of mild increase of ALT/AST cause(4)
50% of hospitalised patient has increase ALT,AST lipase bilirubin amylase
HELLP SYNDROME patient TA at 130/80 is this possible
yes it’s
quid of HELLP syndrome(4)
hemolysis
elevated liver enzymes
low platelet
cause of RUQ pain in HELLP syndrome
distension of liver capsule
how’s ALP in pregnancy
elevated
pregnant woman with hemolysis,low platelet,increase liver enzymes 2 f de la normale and low platlet Dx
HELLP SYNDROME
Anemia in HELLP syndrome
hemolysis caused by microangiopathic anemia
clue for microangiopathic anemia
schistocytes
patient with HELPP syndrome develops difficulty breathing and decrease arterial oxygen saturation
pulmonary edema
what can cause pilmonary edema in preecclampsia(4)
decrease albumin
decreased renal function
endothelial damage causing increase permeability
congestive heart failure
cause of congestive heart failure in preecclampsia(2)
arterial vasospasm
increased vascular resistance—-> decrease cardiac output
physiopatho of precclampsia
general arterial vasospasm leading to increased systemic vx resistance with increased cardiac afterload
why increased ventricular contraction in preecclampsia
because afterload is increased
clue for midcycle pain(3)
LLQ pain occcuring two weeks after menstruation
unilateral
no fever
other of midcycle pain
mittelschmerz
cause of fetal hydantoin syndrome(3)
phenytoin
carbamazepine
during pregnancy
clue for hydantoin syndrome
mid facial hypoplasia microcephaly cleft lip or palate digital hypoplasia hirsutism and developmental delay
body of hydantoin
small body
in USMLE intense uterine contraction and bleeding
painfull bleeding
cause of painfull bleeding
abruptio placentae
stable mother and fetus with abruptio placentae ,labor started next step
let the labor,icrease labor if necessary
indication of CS in abruptio placentae
rapid deterioration of mother and fetus
quid of placenta praevia
abnormal insertion of placenta causing internal cervica os to be partially or totally obstructed
painless third trimester bleeding
preavia
why lactation is not considered as a reliable form of contraception
ovulation can occur
contraptives method during lactation(4)
progestin
barrier methods
sterilisation
intrauterine devices
why progestin is the best method to use in lactating woman
because volume and composition of the milk does not change
risk with combination pills
risk of DVT
why amenorrhea during lactation
prolactin inhibits GNRH release from hypothalamus
clue for intrauterine fetal demise(2)
no mvt
no cardiac activities in fetus
best time to confirm intrauterine fetal demise
real time ultrasonogram
finding in real time sonogram in case of intrauterine fetal demise(2)
absence of fetal mvt
no cardiac activity
quid of fetal demise intra uterine
death of fetus occurring after 20 weeks and before onset of labor
next step after delivery of intra uterine fetal demise
autopsy of the fetus and placenta with permission of the parents
cause of intrauterine fetal demise(6)
hypertensive disorders diabetes placental and cord complication congenital anomalies TORCH listeriosis
devant abruptio placenta first indicator to watch
TA
complication of abruptio placentae(2)
DIC
hemorrage
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
risk factor for torsion(3)
pregnancy
ovulation induction
ovarian masses >5 cm
first to do devant lower abdominal pain in woman and why(2)
BHCG
to rule out ectopic
best to Dx torsion of ovary
ultra sonogram(pelvic colr doppler)
management of ovary torsion
detorsion laparoscopic
indication of salpin oophorectomy in ovary torsion(2)
necrosis of adnexae
suspected ovarian malignancy
complication of ovarian torsion(3)
peritonitis and sepsis
infertility and chronic pain
hemorrage
why right side torsion is more common(2)
because of lenght of tubo ovarian ligament
because of rectosigmoid occupies space around the left ovary
clue in sonogram for down
increase fetal nuchal fold lucency
best test to rule out down or chromosomal abnormality
chorionic villus sampling
when to perform chronic villus sampling
10 a 12 semaines
indication of chorionic villus sampling
any woman of > 35 ans pregnant
risk of chorionic villus sampling procedure(2)
fetal death
limb reduction defects
when you have the greatest risk for complication using chorionic villus sampling
before nine to 10 weeks
clue for vaginal candidiasis(2)
thick white discharge
cottage cheese appearrance
rx for vaginal candidiasis
oral fluconazole
image of pseudohyphae
image tankou ti branch bwa
pseudohyphae meaning
candidiasis
should you treat the partner in vaginal candidiasis
sometimes you have too
patietn with night sweats,insomnia,irregular menses middle aged woman dxs
hyperthyroidism
menopause
patietn with night sweats,insomnia,irregular menses middle aged woman test to perform(2)
FSH
LH
dx of septic abortion
ultrasonogram
echo finding in septic abortion(3)
thick endometrial stripe
echogenic material
increase vascularity
what will you see in echo
retained products of conception
rx of septic abortion(3)
curretage and succion
IV fluid and cultures
empiric antibio en attendant cultures
quid of septic abortion
medical emergency
fever after abortion
septic abortion
risk factor for abruptio(7)
maternal HTA polyhydramnios abdo trauma prior placental abruptio cocaine /tobacco use chorio amniotitis PROM
fond de contracture in USMLE
tender hypertonic uterus
why U/S in abruption(2)
to rule out preavia
not for DX
patient with involontary loss of urine after sneezing,laughing dx
stress incontinence
rx of stress incontinence
kegel exercices
failure for kegel exercices
urethropexy
quid of inevitable abortion or incomplete
dialted cervix with visible products of conception
next step in case of inevitable abortion(2)
iv fluids
succion curettage
abortion RH -
give rhogam
why you give rhigam in negative RH patient
to prevent formation of antibody from the mother
complication of abortion
hemorrage
sepsis
DIC
vaginal bleeding in mother G5 after de,ivery of a baby of 4.5 kg why bleeding
uterus atony
first cause of vaginal bleeding within 24 hours of delivery
uterine atony
rx of uterine atony
oxytocin infusion
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
risk for uterine atony(3)
hydraamnios
multiple gestation
increased parity
quid of uterine agent used in atony uterine(3)
oxytocin
methylergonovine
carboprost
patietn with morbid obesity with amenorrhea cause
anovulation cycle
how ‘s FSH LH in morbid obesity
normal level
quid of infertility
failure to conceive after 12 months of unprotcted sexual intercourse
first test to do in patient with infertility and proof of ovulation
hysterosalpingogram
cause of infertility in girl(4)
PID
endometriosis
DES exposure
congenital malformation
devant tout patietn devant infertility first question to ask
ask about PID
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
role of MGSO4 in pregnancy
prevent seizures
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
amenorrhea in female athletes causee
estrogen deficiency
consequence of estrogen deficiency in female athlete(4)
osteopenia
infertility
breast atrophy
vaginal atrophy
patietn in labor with sudden abdominal intense pain with vaginal bleeding and loss of fetal station
uterine rupture
red flag for uterine rupture
loss of fetal station
risk for uterine rupture(3)
uterine scar
abdominal trauma
ant de CS
physiologic for ovulation(3)
pulsatile GNRH from hypothalamus
release of LH and FSH by anrt pituitary gland
ovulation
clue for puberte precoce
7 yo girl with pubic and axillary hair
cause fo puberte precoce
early activation of hypothalamic pituatary ovarian axis
quid of precocious puberty(2)
secondary sex characteristics before 8 in girl
before 9 in boys
quid of peripheral precocious puberty
low FSH and LH level
cause of peripheral precocious puberty
gonadal or adrenal excess release of androgen
clue central precocious puberty
high FSH and LH
next step in patient with central precocious puberty
CT or MRI of the brain
rx of central precocious puberty
GNRH analog
the most prevalent preventable cause of fetal growth restriction
smoking cessation
the most common tumor in reproductive aged woman
leiyomyoma
dx test for myoma
US
symptom of leiyomyoma(3)
constipation
back pain
urinary retention or frequency
first step in intrauterine fetal demise
coagulation profile
why coagulation profile in intrauterine fetal demise
to rule out DIC
what can happen in intrauterine fetal demise
retention of deasdd fetus can cause chronic consumption coagulopathy
why coagulopathy in intrauterine fetal demise
release of thromboplastin from placenta into the maternal circulation
early indicator of intra uterine fetal demise(2)
low fibrinogen
low platelet
how s fibrinogen in pregnancy
high