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Step 2 CK (primary set) > OBGYN > Flashcards

OBGYN Flashcards

1
Q

clue for PCOS(3)

A

acne
irregular mentrual period
hirsutism

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2
Q

what hormone is high in PCOS(2)

A

testosterone

high LH/FSH ratio

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3
Q

problem in PCOS causing hyperglycemia(2)

A

abnormal glucose metabolism

impaired glucose tolerance

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4
Q

rx of PCOS(4)

A 
oral contraceptive
or
citrate d eclomiphen
antidrogen
metformin if impaired glucose tolerance
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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

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6
Q

normal biophysical profile

A

8-10

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7
Q

what to do if biophysical profile at 8 and decreased amniotic fluid

A

delivery should be considered

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8
Q

biophysical profile 6 with no oligoamnios fetus a < 37(2)

A

repeat BP in 24 hours

if the same delivery

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9
Q

biophysical profile 6 with no oligoamnios fetus a > 37

A

delivery

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10
Q

biophysical profile < 6 and fetus < 32 s

A

daily monitoring

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11
Q

biophysical profile < 6 and fetus > 32 s

A

delivery

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12
Q

what to do if BP =4 or less

A

delivery if fetus > 26 weeks of gestation

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13
Q

meaning of BPP less than 2

A

fetal asphyxia

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14
Q

how to assess BP

A

sonography

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15
Q

elements of BP(5)

A 
NST 
fetal tone
fetal movement
fetal brathing mvt
amniotic fluid volume
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16
Q

NST normal

A

active

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17
Q

fetal tone evaluation(2)

A

extension
or
flexion

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18
Q

fetal mvts

A

at least 2 mvts in 30 mn

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19
Q

fetal breathing mvts

A

at least last 20 seconds in 30 mn

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20
Q

quid of amniotic fluid volume

A

single pocket more than 2 cm in vertical axis

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21
Q

abnormal uterine bleeding with negative pregnancy test in young female

A

ovulation dysfunction

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22
Q

cause of ovulation dysfunction in young girl

A

immature hypothalamic pituitary ovarian axis

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23
Q

what to do in young adolescent with positive bleeding(2)

A

test de grossesse

test for blood coagulation

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24
Q

first line rx in ovulation dysfunction

A

oral estrogen

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25
Q

modality of rx in aptient with abnormal uterine bleeding (4)

A

high dose of oral estrogen
or high dose of combined contraceptive pills
or high dose progestin
or tranexamic acid

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26
Q

quid of tranexamic acid

A

antifibrinolytic used when there is contraindication with estrogen and progesterone

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27
Q

syphylis positive in pregnant women with PNC allergy next step

A

PNC desensitization

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28
Q

how to desensitize a patientfor PNC allergy

A

using incremental dose of PNC

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29
Q

first step in PNC allergy

A

confirm the allergy by skin testing

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30
Q

mother at 28 weeks of gestation sono confirms a dx of bilateral agenesis in mother passing clear fluid form vagina next step

A

allow spontaneous vaginal delivery

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31
Q

when to alllow premature labor(3)

A

severe pulmonary hypoplasia
bilateral renal agenesis
any sever congenital anomaly incompatible with life

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32
Q

how’s BUN and creatinine in pregnancy

A

low

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33
Q

why BUN and creatinine in pregnancy(2)

A

increase of renal plasma flow
and
glomerular filtration rate

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34
Q

in vignette patient at 18 semaine choose set of creat and BUN

A

always choose the values with low creat and low BUN

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35
Q

physical exam in pelvic floor weakness(2)

A

cystocele

uterine prolapse

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36
Q

passage of urine when sneezing or coughing

A

stress incontinence

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37
Q

cause of stress incontinence

A

pelvic floor mx weaakness

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38
Q

raik factor for stress incontinence(2)

A

high parity

older woman

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39
Q

work up in stress incontinence(3)

A

urine analysis
cystometry
post void residual volume

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40
Q

clue for bacterial vaginosis

A

pear shaped motile organism on wet mount

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41
Q

rx of bacterial vaginosis

A

metro

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42
Q

what habit must be prohibited during the rx of bacterial vaginosis

A

alcohol use

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43
Q

quid of disulfuram effect(4)

A

flushing
nausea
hypotension
vomiting

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44
Q

physiopatho of disulfuram effect

A

accumulation of acetaldehyde in blood stream

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45
Q

next step in HGSIL

A

colposcopy

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46
Q

what to do if coposcopy shows no suspicious area

A

biopsies are not required

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47
Q

what to do in suspicious areasin colposcopy

A

biopsy

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48
Q

finding in colposcopy plus biopsy

A

CIN 1
CIN 2
CIN 3

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49
Q

quid of cIN

A

cervical intraepithelial neoplasia

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50
Q

pregnant woman with HGSIL

A

repeat the pap test and colposcopy after the delivery

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51
Q

why repeat the pap test and colposcopy after the delivery

A

because CIN2 et 3 and hGSIL will regress spontaneously after pregnancy

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52
Q

when cervical biopsy and electrosurgical excision are indicated in HGSIL in pregnancy

A

for lesion suggestive of invasive cancer

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53
Q

patient > ou egal 25 ans with HGSIL next step

A

colposcopy or loop surgical excision if no pregnancy or post menopause

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54
Q

patient 21-24 ans with HGSIL

A

colposcopy

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55
Q

colposcopy and biosy showing CIN 2 et 3 next step

A

manage en fonction de guidelines

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56
Q

colposcopy and biopsy with no CIN2 et 3

A

repeat pap test and coploscopy at 6 months for up to 2 years

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57
Q

clue for turner(2)

A

short stature

coarctation of the aorta

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58
Q

why patient with TURNER has late menstruations

A

poor ovarian function

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59
Q

hormone increased in Turner and why?(2)

A

FSH

due to lack of negative feedback

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60
Q

painless bleeding in pregnant women third trimester

A

placenta praevia

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61
Q

dx of placenta preavia

A

ultrasonogram

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62
Q

patient with vaginal bleeding what to not do?

A

pelvic examination(toucher vaginal)

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63
Q

placenta praevia with stable mother and fetus a 37 semaines

A

schedule CS

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64
Q

placenta praevia with stable mother and fetus < 37 semaines

A

amniocenthesis to assess lung maturity

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65
Q

placenta praevia with stable mother and fetus < 37 semaines and mature lung

A

elective CS

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66
Q

unstable mother and baby in palcenta praevia

A

elective CS

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67
Q

how to assess baby stability

A

if non stress test is reactive and reassuring

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68
Q

clue for androgen insensitivity syndrome(4)

A

primary amenorrhea
bilateral inguinal mass
breast development
but no axillary and pubic hair

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69
Q

karyoptype in androgen insensitivity syndrome

A

46 xy

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70
Q

phenotype of androgen insensitivity syndrome(AIS)

A

female with blind vaginal pouch

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71
Q

other name of IAS

A

Male pseudohermaphrodism

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72
Q

risk in AIS

A

testicular carcinoma

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73
Q

why AIS patietn has breast

A

because testo is converted to estrogen

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74
Q

what patient AIS dont have

A

mullerian structures

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75
Q

quid of mullerian structures(2)

A

uterus

fallopian tubes

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76
Q

cause of AIS

A

mutation in androgen receptor gene

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77
Q

consequence of mutation in AIS

A

peripheral tissue become unresponsive to androgens

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78
Q

risk in PCOS

A

endometrial carcinoma

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79
Q

cyst important to see in dx PCOS(2)

A

no

cwith only symptom you can have the dx

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80
Q

why patient with PCOS has difficulty having kid

A

anovulation cycle

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81
Q

cause of ENDOMETRIAL CARCINOMA in PCOS

A

unbalanced estrogen

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82
Q

painless genital ulcer(2)

A

syphylis

granulome inguinale

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83
Q

painfull ulcer(2)

A

chancroid

herpes

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84
Q

differentiate syphilis from granulome inguinale

A

in granulome inguinal ulcers doen’t go without antibiotic

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85
Q

bug causing granulome inguinale

A

callymatobacterium granulomatis

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86
Q

other name for granulome inguinale

A

donovanose

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87
Q

cuase of chancroid

A

hemophilus ducreyi

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88
Q

screening test for syphilis

A

non treponemal test

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89
Q

quid of non treponemal test(2)

A

VDRL

RPR

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90
Q

confirmation test for syphilis

A

FTAabs

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91
Q

quid of FTA abs

A

treponemal serologic test

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92
Q

quid of dark field

A

method to identify T pallidum

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93
Q

indication of Tzanck smear(3)

A

to dx Herpes
CMV
varicella

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94
Q

quid of premature rupture of membrane PROM

A

leakage of amniotic fluid before onset of labor

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95
Q

immature lung assessment

A

ratio lecithin/sphingomyelin < 2

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96
Q

PROM in 24 a 34 semaines next step?

A

corticosteroid

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97
Q

prom with contractions next step entre 24 a 24 semaines(2)

A

corticosteroid
plus
tocolysis

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98
Q

critical point to say yes we have immature lungs

A

<34 semaines

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99
Q

when to give HPV vaccines(2)

A

all girls 9-26 ans regardless HPV status or sexual activity

boys 9-21 ans

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100
Q

when can you begin screening for cancer du col

A

21 yo

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101
Q

patient entre 21 a 29 ans screening for ca du col

A

cytology q 3 ans

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102
Q

patient entre 30 a 65 ans screening for ca du col(2)

A

cytology q 3 ans

cytologie plus HPV serology q 5 ans

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103
Q

screening of cervical cancer > 65 ans

A

no screening

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104
Q

screening of cervical cancer <21

A

no screening

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105
Q

patietn with hysterectomy when cervical cancer screening is indicated(2)

A

history of precancerous lesion cervical cancer

exposure to diethylstylbestrol

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106
Q

screening of ca du col in immunocompromised patient(2)

A

2 times aucours de la premiere annee

and then annualy

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107
Q

how to beginscreening of ca du col in immunocompromised patient

A

onset of sexual intercourse

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108
Q

dx test for chlamydia and gonorrhea

A

nucleic acid amplification

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109
Q

CAT if NAA is positive for chlamidial but not for gonorrhea

A

single dose of azythromycin

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110
Q

screening test for chlamydia

A

NAA

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111
Q

patietn at 9 semaines de gestation comes with nausea and worsening vomiting .what shuold be done

A

quantitative B HCG level

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112
Q

next step is b hcg is elevated

A

rule out gestationnal throphoblastic disease

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113
Q

quid of gestationnal trophoblastic disease(2)

A

mole hydatiforme

chorio carcinome

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114
Q

red flag for GTD

A

severe vomiting

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115
Q

triad of mole hydatiform(3)

A

enlarged uterus
hyperemesis
BHCG > 100 000

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116
Q

severe vomiting with normal BHCG

A

hyperemesis gravidarum

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117
Q

in the vignette patient is vomiting severely,amylase and lipase are high why

A

because they are from salivary gland

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118
Q

significance of mild increase of ALT/AST cause(4)

A 
50% of hospitalised patient has increase 
ALT,AST
lipase 
bilirubin
amylase
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119
Q

HELLP SYNDROME patient TA at 130/80 is this possible

A

yes it’s

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120
Q

quid of HELLP syndrome(4)

A

hemolysis
elevated liver enzymes
low platelet < 100 000
RUQ pain or epigastric pain

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121
Q

cause of RUQ pain in HELLP syndrome

A

distension of liver capsule

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122
Q

how’s ALP in pregnancy

A

elevated

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123
Q

pregnant woman with hemolysis,low platelet,increase liver enzymes 2 f de la normale and low platlet Dx

A

HELLP SYNDROME

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124
Q

Anemia in HELLP syndrome

A

hemolysis caused by microangiopathic anemia

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125
Q

clue for microangiopathic anemia

A

schistocytes

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126
Q

patient with HELPP syndrome develops difficulty breathing and decrease arterial oxygen saturation

A

pulmonary edema

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127
Q

what can cause pilmonary edema in preecclampsia(4)

A

decrease albumin
decreased renal function
endothelial damage causing increase permeability
congestive heart failure

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128
Q

cause of congestive heart failure in preecclampsia(2)

A

arterial vasospasm

increased vascular resistance—-> decrease cardiac output

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129
Q

physiopatho of precclampsia

A

general arterial vasospasm leading to increased systemic vx resistance with increased cardiac afterload

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130
Q

why increased ventricular contraction in preecclampsia

A

because afterload is increased

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131
Q

clue for midcycle pain(3)

A

LLQ pain occcuring two weeks after menstruation
unilateral
no fever

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132
Q

other of midcycle pain

A

mittelschmerz

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133
Q

cause of fetal hydantoin syndrome(3)

A

phenytoin
carbamazepine
during pregnancy

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134
Q

clue for hydantoin syndrome

A 
mid facial hypoplasia
microcephaly
cleft lip or palate
digital hypoplasia
hirsutism and developmental delay
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135
Q

body of hydantoin

A

small body

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136
Q

in USMLE intense uterine contraction and bleeding

A

painfull bleeding

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137
Q

cause of painfull bleeding

A

abruptio placentae

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138
Q

stable mother and fetus with abruptio placentae ,labor started next step

A

let the labor,icrease labor if necessary

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139
Q

indication of CS in abruptio placentae

A

rapid deterioration of mother and fetus

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140
Q

quid of placenta praevia

A

abnormal insertion of placenta causing internal cervica os to be partially or totally obstructed

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141
Q

painless third trimester bleeding

A

preavia

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142
Q

why lactation is not considered as a reliable form of contraception

A

ovulation can occur

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143
Q

contraptives method during lactation(4)

A

progestin
barrier methods
sterilisation
intrauterine devices

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144
Q

why progestin is the best method to use in lactating woman

A

because volume and composition of the milk does not change

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145
Q

risk with combination pills

A

risk of DVT

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146
Q

why amenorrhea during lactation

A

prolactin inhibits GNRH release from hypothalamus

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147
Q

clue for intrauterine fetal demise(2)

A

no mvt

no cardiac activities in fetus

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148
Q

best time to confirm intrauterine fetal demise

A

real time ultrasonogram

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149
Q

finding in real time sonogram in case of intrauterine fetal demise(2)

A

absence of fetal mvt

no cardiac activity

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150
Q

quid of fetal demise intra uterine

A

death of fetus occurring after 20 weeks and before onset of labor

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151
Q

next step after delivery of intra uterine fetal demise

A

autopsy of the fetus and placenta with permission of the parents

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152
Q

cause of intrauterine fetal demise(6)

A 
hypertensive disorders
diabetes
placental and cord complication
congenital anomalies
TORCH
listeriosis
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153
Q

devant abruptio placenta first indicator to watch

A

TA

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154
Q

complication of abruptio placentae(2)

A

DIC

hemorrage

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155
Q

clue for ovarian torsion(4)

A

no fever or low grade fever
pain in lower abdomen
history of ovary cystic mass
can also have nausea and vomiting

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156
Q

risk factor for torsion(3)

A

pregnancy
ovulation induction
ovarian masses >5 cm

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157
Q

first to do devant lower abdominal pain in woman and why(2)

A

BHCG

to rule out ectopic

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158
Q

best to Dx torsion of ovary

A

ultra sonogram(pelvic colr doppler)

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159
Q

management of ovary torsion

A

detorsion laparoscopic

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160
Q

indication of salpin oophorectomy in ovary torsion(2)

A

necrosis of adnexae

suspected ovarian malignancy

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161
Q

complication of ovarian torsion(3)

A

peritonitis and sepsis
infertility and chronic pain
hemorrage

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162
Q

why right side torsion is more common(2)

A

because of lenght of tubo ovarian ligament

because of rectosigmoid occupies space around the left ovary

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163
Q

clue in sonogram for down

A

increase fetal nuchal fold lucency

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164
Q

best test to rule out down or chromosomal abnormality

A

chorionic villus sampling

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165
Q

when to perform chronic villus sampling

A

10 a 12 semaines

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166
Q

indication of chorionic villus sampling

A

any woman of > 35 ans pregnant

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167
Q

risk of chorionic villus sampling procedure(2)

A

fetal death

limb reduction defects

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168
Q

when you have the greatest risk for complication using chorionic villus sampling

A

before nine to 10 weeks

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169
Q

clue for vaginal candidiasis(2)

A

thick white discharge

cottage cheese appearrance

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170
Q

rx for vaginal candidiasis

A

oral fluconazole

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171
Q

image of pseudohyphae

A

image tankou ti branch bwa

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172
Q

pseudohyphae meaning

A

candidiasis

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173
Q

should you treat the partner in vaginal candidiasis

A

sometimes you have too

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174
Q

patietn with night sweats,insomnia,irregular menses middle aged woman dxs

A

hyperthyroidism

menopause

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175
Q

patietn with night sweats,insomnia,irregular menses middle aged woman test to perform(2)

A

FSH

LH

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176
Q

dx of septic abortion

A

ultrasonogram

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177
Q

echo finding in septic abortion(3)

A

thick endometrial stripe
echogenic material
increase vascularity

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178
Q

what will you see in echo

A

retained products of conception

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179
Q

rx of septic abortion(3)

A

curretage and succion
IV fluid and cultures
empiric antibio en attendant cultures

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180
Q

quid of septic abortion

A

medical emergency

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181
Q

fever after abortion

A

septic abortion

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182
Q

risk factor for abruptio(7)

A 
maternal HTA
polyhydramnios
abdo trauma
prior placental abruptio
cocaine /tobacco use
chorio amniotitis
PROM
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183
Q

fond de contracture in USMLE

A

tender hypertonic uterus

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184
Q

why U/S in abruption(2)

A

to rule out preavia

not for DX

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185
Q

patient with involontary loss of urine after sneezing,laughing dx

A

stress incontinence

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186
Q

rx of stress incontinence

A

kegel exercices

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187
Q

failure for kegel exercices

A

urethropexy

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188
Q

quid of inevitable abortion or incomplete

A

dialted cervix with visible products of conception

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189
Q

next step in case of inevitable abortion(2)

A

iv fluids

succion curettage

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190
Q

abortion RH -

A

give rhogam

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191
Q

why you give rhigam in negative RH patient

A

to prevent formation of antibody from the mother

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192
Q

complication of abortion

A

hemorrage
sepsis
DIC

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193
Q

vaginal bleeding in mother G5 after de,ivery of a baby of 4.5 kg why bleeding

A

uterus atony

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194
Q

first cause of vaginal bleeding within 24 hours of delivery

A

uterine atony

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195
Q

rx of uterine atony

A

oxytocin infusion

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196
Q

general measure in post partum hemorrage(4)

A

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

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197
Q

risk for uterine atony(3)

A

hydraamnios
multiple gestation
increased parity

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198
Q

quid of uterine agent used in atony uterine(3)

A

oxytocin
methylergonovine
carboprost

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199
Q

patietn with morbid obesity with amenorrhea cause

A

anovulation cycle

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200
Q

how ‘s FSH LH in morbid obesity

A

normal level

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201
Q

quid of infertility

A

failure to conceive after 12 months of unprotcted sexual intercourse

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202
Q

first test to do in patient with infertility and proof of ovulation

A

hysterosalpingogram

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203
Q

cause of infertility in girl(4)

A

PID
endometriosis
DES exposure
congenital malformation

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204
Q

devant tout patietn devant infertility first question to ask

A

ask about PID

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205
Q

quid of severe preecclampsia(10)

A 
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
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206
Q

role of MGSO4 in pregnancy

A

prevent seizures

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207
Q

ten weeks of pregnancy with vaginal bleeding and lower abdominal pain ckue for complete abortion(3)

A

close cervix
vacant uterine cavity in US
contraction can subside

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208
Q

amenorrhea in female athletes causee

A

estrogen deficiency

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209
Q

consequence of estrogen deficiency in female athlete(4)

A

osteopenia
infertility
breast atrophy
vaginal atrophy

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210
Q

patietn in labor with sudden abdominal intense pain with vaginal bleeding and loss of fetal station

A

uterine rupture

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211
Q

red flag for uterine rupture

A

loss of fetal station

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212
Q

risk for uterine rupture(3)

A

uterine scar
abdominal trauma
ant de CS

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213
Q

physiologic for ovulation(3)

A

pulsatile GNRH from hypothalamus
release of LH and FSH by anrt pituitary gland
ovulation

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214
Q

clue for puberte precoce

A

7 yo girl with pubic and axillary hair

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215
Q

cause fo puberte precoce

A

early activation of hypothalamic pituatary ovarian axis

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216
Q

quid of precocious puberty(2)

A

secondary sex characteristics before 8 in girl

before 9 in boys

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217
Q

quid of peripheral precocious puberty

A

low FSH and LH level

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218
Q

cause of peripheral precocious puberty

A

gonadal or adrenal excess release of androgen

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219
Q

clue central precocious puberty

A

high FSH and LH

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220
Q

next step in patient with central precocious puberty

A

CT or MRI of the brain

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221
Q

rx of central precocious puberty

A

GNRH analog

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222
Q

the most prevalent preventable cause of fetal growth restriction

A

smoking cessation

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223
Q

the most common tumor in reproductive aged woman

A

leiyomyoma

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224
Q

dx test for myoma

A

US

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225
Q

symptom of leiyomyoma(3)

A

constipation
back pain
urinary retention or frequency

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226
Q

first step in intrauterine fetal demise

A

coagulation profile

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227
Q

why coagulation profile in intrauterine fetal demise

A

to rule out DIC

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228
Q

what can happen in intrauterine fetal demise

A

retention of deasdd fetus can cause chronic consumption coagulopathy

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229
Q

why coagulopathy in intrauterine fetal demise

A

release of thromboplastin from placenta into the maternal circulation

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230
Q

early indicator of intra uterine fetal demise(2)

A

low fibrinogen

low platelet

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231
Q

how s fibrinogen in pregnancy

A

high

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232
Q

fibrinogen in coagulopathy

A

160 mg/dl is considerd as low

233
Q

whta to do in front of inttra uterine fetal demise

A

induce labor

234
Q

risk for precocious puberty(2)

A

epiphyseal plate fusion

short stature

235
Q

after amniotomy baby develops decrease of heart beat with late deceration ?

A

ruptured fetal ombilical vessel

236
Q

clue for ruptured fetal ombilical vessel during amniotomy

A

tachycardia puis bradycardia to a sinusoidal pattern

237
Q

during ruptured fetal ombilical vessel how to say the blood is not from the mother

A

by the APT test

238
Q

rx of rupture fetal ombilical vessel

A

crash CS

239
Q

quid of vasa preavia

A

fetal blood vessel traverse the lower segment between the baby and the internal cervical os

240
Q

clue vasa preavia bleeding

A

normal vitals for mother during bleeding

241
Q

in pregnant women when to consider urine culture positive

A

> 100 000 colonois forming unit/ml for a single organism

242
Q

risk for asymptomatic bacteriuria

A

pyelonephritis

243
Q

rx for bacteruiria asymptomatic(4)

A

amox
or ampicilllin
or nitrofurantoin
or cephalexin

244
Q

complication of pyelonephritis(3)

A

low birth weight baby
septicemia
pretem babies

245
Q

HTA in pregnant women < 20 weeks with no protein in urine

A

chronic HTA

246
Q

hta in pregnant women < 20 weeks(2)

A

mole hydatiform

chronic HTA

247
Q

why you can have hypokaliemia and hypernatremia in pregnant woman

A

because of hyperaldosteronism

248
Q

risk in chronic HTA

A

abruptio placentae

249
Q

abruption placenta risk for the mother

A

bleeding

250
Q

abruption placenta risk for the baby

A

interruption of placental perfusion

251
Q

SLE and abruptio placenta

A

lupus anticoagulant

252
Q

most comon risk factor for abruptio

A

HTA

253
Q

what if for any reason you dont want to perform an abortion what to do

A

refer the patient to another physician who can and will do it

254
Q

when to give RHOGAM in RH - patient(2)

A

28 e semaines

after delivery

255
Q

patient with history of abruptio placenta rh - develops antirh antibody what can cause that

A

low dose of antiglobulin in post partum

256
Q

what ‘s rosette test in abruptio in rh -

A

determine the amount of fetal maternal transfusion

257
Q

next step if rosette test is negative

A

give the standard dose of anti D immune globulin

258
Q

rosette test positif next step

A

perform kleihauer betke stain or fetal red blood cell using flow cytometry

259
Q

next step after kleihauer betke stain test

A

anti D immune globulin should be corrected accordingly

260
Q

quid of preterm labor

A

labor occuring between 20 a 37 weeks of gestation

before 37 ,after 20 weeks

261
Q

clue for good contractions during labor(2)

A

in labor 4 contractions q 20 mn or more

cervical changes

262
Q

complication of preterm labor(5)

A 
respiratory distress syndrome
intra ventricular hemorrage
sepsis
necrotizing enterocolitis
kernicterus
263
Q

best thing to do in preterm labor(2)

A

tocolysis

corticosteroid pendant 48 h < 34 semaines

264
Q

in preterm labor what’s the goal of tocloysis

A

ammener la grossessede 34 a 36 semaines of gestation

265
Q

young woman with breast lump what to do

A

ask her to return shortky after menstrual period

266
Q

young woman with breast lump ,regeression after menstrual period dx

A

it’s benign

267
Q

clue for kalman syndrome(3)

A

primary amenorrhea
absent of sexual characteristics
hypoosmia or anosmia

268
Q

karyotype in kallman syndrome

A

46XX

269
Q

what about internal organ in kallman

A

Normal

270
Q

phenotype in kallman syndrome

A

girl

271
Q

karyotype in klinefelter

A

47XXY

272
Q

karyotype in turner

A

45X0

273
Q

threatened abortion

A

any vaginal bleeding occuring before 20 semaines with a live fetusand closed cervix

274
Q

standard care for threatened abortion(3)

A

reassurance
outpatient follow up
bed rest no sex

275
Q

why bed rest and no sex during threatened abortion

A

to avoid guilt in parents

276
Q

cause of anovulation in PCOS(2)

A

imbalance in FSH and LH

insulin resistance

277
Q

tetrad of PCOS(4)

A

anovulation
androgen excess
male pattern growth
ovarian cyst

278
Q

testicular feminisation syndrome karyotype

A

46 XY

279
Q

testicular feminisation syndrome phenotype

A

girl

280
Q

why absence of internal reproductive organ in testicular feminisation

A

presence of mullerian inhibiting factor(MIF)

281
Q

why MIF is present

A

because testis are present and form MIF

282
Q

role of MIF

A

prevent formation in internal organ in female in case of testiculer feminisation

283
Q

rx of testicular feminisation(2)

A

gonadectomy in puberty

creation of neovagina

284
Q

young girl with amenorrhea,hypoestrogenism,high gonadotrophin levels dx

A

primary ovarian failure

285
Q

diseases associated with primary ovarian failure(5)

A 
autoimmune disorder
hashimoto
addisson
diabete type 1
pernicious anemia
286
Q

cause of premature destruction of follicles(4)

A

mumps
radiation
oophoritis
chemo

287
Q

clue for rimary ovarian failure(2)

A

high FSH /LH

low estrogen

288
Q

how to deal with infertility in patient with primary ovarian failure

A

in vitro fertilization with donor oocytes

289
Q

symptom assciated with pathologic leucorrhea(3)

A

pruritus
burning
malodorous discharge

290
Q

physical exam of pathologic leucorrhea(3)

A

erythema and edema
tenderness of cervix
green and curdlike vaginal discharge

291
Q

quid of physiologic leucorrhea(4)

A

yellow or white
non malodorous
absence of associated symptom
normal physical exam

292
Q

clue for bacterial vaginosis(4) AMSEL criteria

A

thin gray white vaginal discharge
vaginal PH>4,5
positive whift test upon addition of KOH to the vaginal discharge
clue cells

293
Q

quid of clue cells

A

vaginal epithelial cell with adherent cocobaccilus on wet mount

294
Q

KOH test

A

amine like odor (fishy) when KOH is added to vaginal discharge

295
Q

AMSEL criteria to dx vagise bacterienne

A

3 sur 4

296
Q

patient taking OCP complaining of weight gain what to say

A

reassure the patient that the weight gain is not related to oral contraceptives pills

297
Q

why oCP is no longer associated to weight gain

A

because new OCP are lower dosed

298
Q

most common side effect of combined OCP

A

breakthrough bleeding

299
Q

side effect of combined oCP(6)

A 
HTA
increased risk cervical ca
DVT
amenorrhea
high triglycerides
hepatic adenoma
300
Q

advantage of combined OCP

A

lower risk of endometrial and ovarian cancer

301
Q

chronic HTA in pregnancy rx(2)

A

labetalol

@ methyl dopa

302
Q

ACE and ARB s in pregnancy(2)

A

teratogenic

fetal kidneys damage

303
Q

after amniocentesis patient develops sudden respiratory failure seizures ,purpuric rash cardiogenic

A

amniotic fluid embolism

304
Q

next step after amniotic fluid embolism(2)

A

intubation

mechanical ventilation

305
Q

meaning of purpura in amniotic fluid embolism

A

DIC is developing

306
Q

test to confirm premature rupture of membranes(3)

A

positive nitrazine test
positive pooling tes
positive ferning test

307
Q

first thing to do in case of PROM

A

give PNC

308
Q

Why PNC in GBM

A

to prevent GBS infection

309
Q

indication of GBS prophylaxis(5)

A 
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
Q

drugs used in GBS prophylaxis(4)

A

ampicillin
cephazolin
clindamycin
vancomycin

311
Q

clue for lichen sclerosis(2)

A

vulvar itching in elderly

dicomfort

312
Q

quid of porcelain white atrophy

A

vulvar skin thin dry white in color

313
Q

next step in front of lichen sclerosis

A

vulvar punch biopsy

314
Q

risk in lichen sclerosis

A

vulvar squamous cell carcinoma

315
Q

first line rx in lichen sclerosis

A

high potency topical steroids

316
Q

normal fibrinogen

A

150-450

317
Q

risk of DIC in intra uterine fetal demise

A

low fibrinogen

318
Q

quid of abortion(2)

A

fetal demise before 20 weeks or

fetus weight <500 g

319
Q

what to do in fetal demise in patietnwith fibrinogen 480

A

discuss the need for delivery and review options of vaginal/CS

320
Q

thyroid pattern in pregnant woman(2)

A

increase total T4,T3

normal TSH

321
Q

how’s TBG in pregnancy

A

high

322
Q

how are free T3 T4 TSH IN PREGNANCY

A

normal

323
Q

incontinence in woman after C/S

A

epidural anesthesia

causing bladder denervation

324
Q

why urinary incontinence after epidural anesthesia(4)

A

patient is unable to feel full bladder
when bladder overdistends,bladder pressure becomes > to uretral pressure
patient voids unvoluntary until pressure equalizes

325
Q

rx of incontinence after CS

A

intermittent catherisation

326
Q

clue for endometriosis(4)

A

chronic pelvic pain
dyspareunia
infertility
bladder or bowel problems

327
Q

characteristic of pain in endometriosis

A

worse with menses

328
Q

complication of endometriosis(2)

A

bowel bladder obstruction

rupture of endometrioma or torsion

329
Q

dx or rx of endometriosis

A

laparoscopy

330
Q

indication of laparoscopic rx in endometriosis(2)

A

complicated case

failure with medical rx

331
Q

medical rx of endometriosis

A

NSAIDS plus combined OCP

332
Q

next step if first line medical rx fails in rx of endometriosis(3)

A

progestin
plus
GNRH agonist
plus addback therapy

333
Q

3 D of endometriosis

A

dyspareunia
dysmenorrhea
dyschezia

334
Q

dyschezia quid

A

pain during defecation

335
Q

complication of endometriosis

A

infertility 30 %

336
Q

goal in rx endometriosis

A

suppress ovulation

337
Q

quid of progestin

A

medroxyprogesterone acetate

338
Q

indication of surgery in endometriosis(7)

A

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
Q

clue for endometrial hyperplasia(2)

A

intermenstrual bleeding

heavy menses

340
Q

Dx of endometrial hyperplasia

A

biopsy

341
Q

type of endometrial hyperplasia(4)

A

simple
complex
simple atypical
complex atypical

342
Q

risk to progress to endometrial cancer in simple endometrial hyperplasia

A

1%

343
Q

risk to progress to endometrial cancer in complex endometrial hyperplasia

A

3 %

344
Q

risk to progress to endometrial cancer in simple atypical endometrial hyperplasia

A

8 %

345
Q

risk to progress to endometrial cancer in complex atypical endometrial hyperplasia

A

29%

346
Q

rx of simple or complex without atypia

A

cyclic progestins

347
Q

rx of complex hyperplasia atypia

A

hysterectomy

348
Q

med contraindicated in hyperplasia de l’endometre and why?(2)

A

estrogen

it will agravate the case

349
Q

chronic pelvic pain low sacral back pain worse during menses dx a eliminer

A

endometriosis

350
Q

how’s sonogram in endometriosis

A

can be normal

351
Q

physical exam in endometriosis(2)

A

pain uterus motion with finger

patient will experience rectovaginal tenderness

352
Q

gold standard to DX endometriosis

A

laparoscopy

353
Q

woman in labor with active genital herpes

A

immediate C section

354
Q

why woman with active genital herpes should undergo CS

A

risk of neonatal HSV

355
Q

post partum woman with breast pain

A

breast engorgement

356
Q

rx of breast engorgement(2)

A

cool compresses

acetaminophen and NSAIDS

357
Q

peak for breast engorgement(2)

A

3 a 5 jours

beginning 24 a 72 h

358
Q

quid of endometriosis

A

endometrial and stromial tissue outside uterus

359
Q

most common affected site for endometriosis(4)

A

ovary
peritoneal surfaces of the cul de sac
broad and uterosacral ligaments
rectovaginal septum

360
Q

patient with chronic infertility ,pelvic pain and mass in the left adnexae

A

endometriosis

361
Q

indication of surgery in placentae praevia(2)

A

unstable mother with vital signs

unreassuring fetal haert rates

362
Q

patient with SLE develops acne why(2)

A

prednisone taking

steroid induced folliculitis

363
Q

clue for acne in steroid

A

no comedones

364
Q

early decelerations quid?

A

peak of contraction postive deflection corresponds to valley (nadir)in heart deceleration

365
Q

cause of early deceleration(2)

A

fetal head compression

or could be normal

366
Q

quid of late deceleration

A

nadir of deceleration (negative deflection) occurs after uterine contraction (positive deflection)

367
Q

cause of late decelration

A

uteroplacental insufficiency

368
Q

quid of variable deceleration

A

can be or not associated with contraction

369
Q

cause of variable deceleration(3)

A

cord compression
oligoamnios
cord proplapse

370
Q

management of reccurent variable decelerations(3)

A

change maternal position
o2 administration
rescucitative measures

371
Q

after motor vehicle accident patient of 34 weeks come with hypotension and late deceleration of the baby dx

A

uterine rupture

372
Q

in uterine rupture type of deceleration

A

late deceleration

373
Q

patient with schizophrenia develops milk in why

A

risperidone taking

374
Q

action of risperidone

A

dopamine and serotonin antagonist

375
Q

urinalysis in pregnant woman develops > 100 000 bacteria

A

bacteriuria asymptomatic

376
Q

first line rx of asymptomatic bacteriuria(2)

A 
nitrofurantoin for 7 days
or
amox
or
cephalosporin first generation
377
Q

bug in cause of aymptomatic bacteriuria

A

E coli

378
Q

work up of adrenal mass(2)

A

US

ca-125 antigen

379
Q

suspicscious failure in US(4)

A

mass > 10 cm
nodular or pelvic fixed mass
ascites
metastasis

380
Q

when rx conservatively(3)

A

simple cyst in sonogram
normal ca 125
mass < 10 cm

381
Q

patient on lithium for bipolar disorder and isotretinoin becomes pregnant(2)

A

stop isotretinoin

wean lithium

382
Q

why wean lithium in case of pregnancy

A

you should slow taper lithium to prevent relapse

383
Q

congenital anomaly associated with lithium

A

ebstein anomaly

384
Q

congenital anomaly associated with isotretinoin(3)

A

craniofacial dysmorphism
heart defect
deafness

385
Q

what to do if you plan to begin isotretinoin in reproductive age(2)

A

use contraception at least one month before beginning

pregnancy test befor rx

386
Q

could we use inhaled steroid in pregnancy

A

yes

387
Q

false labor when it occurs

A

in the late 4-8 weeks of pregnancy

388
Q

clue for false labor(2)

A

no cervical changes during pregnancy

relieved by sedation

389
Q

rx for false labor

A

nothing

390
Q

low grade fever following 24 h post partum and high leucocytes(2)

A

it’s normal

reassurrance

391
Q

lochia in post partum rubra(2)

A

first few days

rouge

392
Q

lochia in post partum serosa (2)

A

3 a 4 jours

pale

393
Q

lochia in post partum alba

A

white or yellow

394
Q

foul smelling lochia

A

endometritis

395
Q

why evaluation of mucus should be part of infertility work up

A

because hostile cervical mucous can dialoow penetration of spermato into uterus

396
Q

normal aspect of cervical mucus during ovulation(4)

A

profuse
clear and thin
stretch approximately 6 cm
exhibit fening on microscopic slide smear preparation

397
Q

35 young patietn with dyspareunia and tense vagina dx

A

vagisnismus

398
Q

rx of vagisnismus(3)

A

kegel exercice
gradual dilation with finger
relaxation

399
Q

preecclampsia and SLE(3)

A

both has HTA
both proteinuria
edema

400
Q

clue for glomerulonephritis in SLE during pregnancy(4)

A

massive proteinuria 8g 24 h
RB cast
malar rash
ANA +

401
Q

could pregnancy cause ANA positive

A

yes

402
Q

quid of malar rash

A

macular eruptions on the cheek bones

403
Q

premature ovarian failure clue(2)

A

high FSH LH

FSH/LH>1

404
Q

Cause amenorrhea(3)

A

ovarian failure
turner
fragile x syndrome

405
Q

in premature ovarian failure the greatest elevation LH or FSH

A

FSH

406
Q

Dx of confirmation of pramature ovarian failure

A

elevation of FSH in the setting of more than 3 months of amenorrhea in a woman under 40 ans

407
Q

symmetrical pitting edema in pregnant woman with normal TA next step(2)

A

reassurrance

normal follow up

408
Q

patietn at 36 weeks seen with increased abdominal pain and bleeding clue for abruptio placenta

A

firm and tender uterus

409
Q

why contraction in AP

A

blood seems to have uterotonic action

410
Q

can you have absence of vaginal bleeding in AP

A

if you have a retroplacental hemmorage dans 20% des cas

411
Q

VEAL IN deceleration(4)

A

variable
early
accelerated
late

412
Q

cause of deceleration CHO=VEAL(4)

A

Cord compression or prolapse,oligoamnios=V
head compession =E
okay= accelerated
Placental insufficiency=late deceleration

413
Q

two types of bleeding in AP(2)

A

concealed

visible

414
Q

masculinisation in pregnant mother resolving after delivery

A

aromatase deficiency in baby

415
Q

why masculinisation certain pregnant women

A

placenta is unable to make estrogen in utero

416
Q

clue for aromatase deficiency(4)

A

absent estrogen
increasd testosterone and estrogen
increase LH and FSH
polycystic avaries

417
Q

genital organs in patietn with aromatase deficiency(2)

A

normal internal organs

cliteromegaly(ambiguous)

418
Q

dx of aromatase deficiency(2)

A

high FSH LH

low estrogen

419
Q

PID coplicated with vomiting next step(2)

A

hospitalize the patient

give cefotaxin and dox

420
Q

genital organs in patietn with aromatase deficiency(2)

A

normal internal organs

cliteromegaly(ambiguous)

421
Q

dx of aromatase deficiency(2)

A

high FSH LH

low estrogen

422
Q

PID coplicated with vomiting next step(2)

A

hospitalize the patient

give cefotaxin and dox

423
Q

complication of PID(5)

A 
tubo ovarian abcess
abcess rupture
pelvic peritonitis
sepsis
infertility
424
Q

outpatient rx of PID(2)

A

ceftriaxone or cefoxitin
plus
dox

425
Q

cause of PID(3)

A

neisseria gonerrhea
chlanydia
genital mycoplasma

426
Q

poor surgical candidate with tumor size < 2cm

A

radiation

427
Q

rx of squamous cell carcinoma of vagima stage 1 et 2 with no metastasis or extension to pelvic wall size < 2cm

A

surgical excision

428
Q

rx of squamous cell carcinoma of vagima stage 1 et 2 with no metastasis or extension to pelvic wall size > 2cm

A

radiation

429
Q

first step in patient with secondary amenorhea

A

BHCG

430
Q

secondary amenorhee with negative BHCG and high testoterone

A

PCOS

431
Q

why TSH in secondary amenorrhea

A

to rule out hypothyroidism

432
Q

secondary amenorhee with negative BHCG and high TSH and low t4

A

hypothyroidism

433
Q

next step in Secondary amenorrhea with high prolactin(3)

A

check TSH
check medication
check creat

434
Q

next step in Secondary amenorrhea with high prolactin with normal TSH ,no history of medication and normal creat

A

MRI of the brain

435
Q

clue for asherman syndrome(2)

A

intrautrauterine adhesions

secondary amenorrhea

436
Q

dx for asherman syndrome(2)

A

hysteroscopy
or
hysterosalpingography

437
Q

patietn seen with no fetal mvts next step

A

profile biophysique

438
Q

patient with solid ovarian mass during pregnancy

A

all ovarian masses are malignant except during pregnancy

439
Q

during pregnancy patient develops facial hair and acne next step

A

ultrasonogram

440
Q

sonogram shows bilateral adrenal masses in pregnant woman with facial hair and acne dx

A

luteoma

441
Q

next step in dx of luteoma during pregnancy(2)

A

reassurrance

follow up with U/S

442
Q

people at risk for luteoma(2)

A

african american

30’s 40’s

443
Q

grand mal seizures in pregnancy

A

ecclampsia

444
Q

stable patietn with preeclampsia 37 semaines de grossese

A

induction labor

445
Q

management of ecclampsia(4)

A

prevent ,maternal hypoxia and trauma
prevent seizures with MGSO4
prevent stroke using labetalol or hydralazine
delivery by induction of labor or CS

446
Q

acid base status in pregnancy(3)

A

respiratory alkalosis
low co2 pressure
high o2 pressure

447
Q

why respiratory alkalosis in pregnancy(3)

A

progesterone stimulates respiratory center in the brain and causes hyperventilation
increase minute ventilation
increase volume tidal

448
Q

why HCO3 is low during pregnancy

A

to compensate metabolic alkalosis

449
Q

patietn having serial ablation after LEEP what could be the greatest complication

A

cervical insufficiency

450
Q

risk factir for cervical insufficiency(6)

A 
cone bioopsy
DES exposure
multiple gestation
mullerian anomalies
preterm birth
second trimester pregnancy loss
451
Q

best test to Dx cervical insufficiency

A

transvaginal US

452
Q

quid of short cervix(2)

A

cervical lenght below the 10 th percentile for gestationnal age
cervical lenght less than 25 mm at gestationnal age 23-28 weeks

453
Q

premenstrual syndrome

A

symptoms occuring 1-2 weeks before menses and regress around the time of menstrual flow

454
Q

Symptom of premenstrual syndrome(4)PMS

A

bloating
headaches
breast tenderness anxiety
mood disturbance

455
Q

what to do when tyou suspect premenstrial syndrome

A

menstrual diary for 2 a 3 months to see exact time of symptom appearance

456
Q

quid premenstrual dysphoric syndrome(2)

A

variant of PMS

irritability and anger predomines

457
Q

rx of PMS

A

SSRI fluoxetine first line

458
Q

quid of sheehan syndrome(3)

A

hemmorage of post partum
problem of lactation
anterior hypophyse necrosis

459
Q

clue trichomonas vaginalis

A

PH 5.0-6,0

460
Q

consequence of sheehan syndrome

A

prolactin deficiency

461
Q

microscopy in Trichomonas vaginitis

A

flagellated motile norganisms

462
Q

difference between trichomonas vaginalis and vaginose bacterienne

A

vaginose bacterienne does not cause inflammation

463
Q

exam image of choice to detect gynecologic tumor

A

pelvic U/S

464
Q

quid of pretem labor

A

occuring < 20 semainees de gestation and before 37 semaines

465
Q

quid of labor(2)

A

uterine contraction at a rate of 4 per 2o mn or more

cervical changes

466
Q

what the goal in term of preterm labor

A

reach 34 36 semaines

467
Q

what to in preterm labor(2)

A

bed rest

tocolysis

468
Q

different types of abortion(5)

A 
missed
inevitable
incomplete
threatened
septic
469
Q

quid of missed abortion(2)

A

light vaginal bleeding

pregnancy symptom can become prominent

470
Q

best test to dx missed abortion(2)

A

US

non viable fetus

471
Q

quid inevitable abortion(2)

A

vaginal bleeding and open cervix

US fetus with possible heart beat

472
Q

incomplete abortion (3)

A

vaginal bleeding with passage of large clots
cervix open
US products of conception often in cervix

473
Q

threatened abortion(2)

A

vaginal bleeding with close cervix

US viable pregnancy

474
Q

septic abortions(3)

A

sign of sepsis
cervix open
US retained products of conception

475
Q

1 cause of septic abortion(2)

A

induced abortion

spontaneous rarely causes sepsis

476
Q

best test to dx abortion

A

US pelvic

477
Q

3 ways to rx missed abortion(3)

A

abortion
medical using prostaglandin
expectant management

478
Q

patient with vaginal bleeding last menstrual period 5 weeks ago BHCH 1000 next step

A

repeat BHCG in 48 hours

479
Q

postive pregnancy test but no evidence of intra uterine or extrauterine pregnancy dx (3)

A

ectopic
nonviable intrauterine pregnancy
early viable pregnancy

480
Q

when will you see fetus in pelvic U/S

A

BHCG 1500-2000 ml

481
Q

in the vignette why repeat HCG in 48 h

A

because in case of viable pregnancy BHCG will double as the opposite of ectopic or complete abortion

482
Q

early pregnancy with spotting trans abdomen US negative next step

A

transvaginal US

483
Q

when can you gestationnal sac in trans abdominal US

A

when BHCG is greater than 6500

484
Q

when can you gestationnal sac in trans vaginal US

A

a partir de 1500

485
Q

patient with spotting and intra uterine sac in transvaginal US dx

A

no ectopic

486
Q

adnexial sac or no sac intra uterine in transvaginal US

A

ectopic

487
Q

patient with spotting and transvaginal US douteux

A

serial BHCG measurement

488
Q

tendancy for BHCG

A

doubles every 48 h

489
Q

when to perform transvaginal US in pregnancy

A

when BHCG 1500-6500

490
Q

next step in decreaser of fetal mvts perceived by mother

A

nonstress test

491
Q

normal non stress test

A

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
Q

abnormal NST

A

< 2 deceleration

493
Q

most common cause of non reactive stress test

A

fetal sleep cycle

494
Q

post menopausal women with vaginal dryness burning and dysuria and dyspareunia

A

atrophic vaginitis

495
Q

rx of atrophic vaginitis

A

vaginal estrogen replacement

496
Q

what to do if you suspect atrophic vaginitis

A

rule out UTI

497
Q

mild atrophic vaginitis rx(2)

A

moisturizers

lubricants

498
Q

moderate to severe atrophic vaginitis rx

A

low dose of vaginal estrogen

499
Q

clue for ruptured ectopic pregnancy(3)

A

diffuse abdominal pain
cervical and adrenal tenderness
hypotension

500
Q

differenciation between PID and ectopic pregnancy ruptured

A

no hypotension in PID

501
Q

risk for ectopic(6)

A 
tubal pathology
tubal surgery
current IVD
PID
multiple partners
DES and infertility rx
502
Q

dx of ectopic pregnancy ruptured(2)

A

transvaginal US

BHCG

503
Q

image in trans vaginal US in ectopic pregnancy(2)

A

adrenal mass

free intraperitoneal fluid

504
Q

cause of cervical motion tenderness(2)

A

ectopic

PID

505
Q

Med rx of ectopic

A

metotrexate

506
Q

dx ddifferentiel of acute pelvic pain(5)

A 
Mittelscmerz syndrome
ectopic
ovarian torsion
ruptured ovarian cyst
PID
507
Q

US in ovarian torsion(2)

A

enlarged ovary

decreased flow in ovary

508
Q

risk factor for ovarian ruptured cyst

A

strenous or sexual activity

509
Q

US in ovarian ruptured cyst

A

free fluid near ovarian cyst

510
Q

clue of ruptured ovarian cyst in vignette

A

cystic ovarian mass with a moderate amount of free fluid

511
Q

how to measure blood flow in ovary

A

doppler velocitometry

512
Q

importance of transvaginal US in PID

A

to rule out tuboovarian abcess

513
Q

free fluid in the context of pelvic pain in US

A

ruptured ovarian cyst

514
Q

major side effect of low dose combination pills

A

worsening HTA

515
Q

associated risk with estrogen progestin combined rx(4)

A

DVT
HTA
Hepatic adenoma
stroke and MI

516
Q

woman with uncontrolled HTA end organ damage ,smoker and 35 ans ou plus wants a contraceptive method

A

no estrogen in contraception

517
Q

best benefit of OCP’s(2)

A

reduced risk of endometrial cancer

reduced risk of ovarian cancer

518
Q

risk # 1 for tamoxifen

A

endometrial carcinoma

519
Q

quid of tamoxifen

A

selective receptor estrogen modulator

520
Q

action of tamoxifen

A

agonist of estrogen receptors in the breast

521
Q

why tamoxifen is used in the rx of breast cancer

A

it’s an agonist of estrogen receptors in the breast

522
Q

quid of early deceleration

A

contraction of uterus =positive deflection

occurs at the same time as negative deflection( deceleration)

523
Q

what to do before giving MMR vaccine

A

test for immunity with IGG antibody titers

524
Q

what to do after receiving varicella and MMR

A

avoid contraception for at least 4 weeks after the vaccination

525
Q

vaccine you can give during pregnancy(5)

A 
MMR
Varicella
smallpox
HPV
live attenuated  intra nasal influenza vaccines
526
Q

can you give Hep B during pregnancy

A

yes

527
Q

when to give pneumococcus during pregnancy

A

2 et 3 e trimestre

528
Q

can you give Hi flu during pregnancy

A

yes in asplenic patient

529
Q

routine vaccines in pregnancy(2)

A

TDAp

inactivated influenza vaccines

530
Q

patient with bilateral pale grey discharge

A

galactorrhea

531
Q

quid of galactorrhea

A

lactation in women who are breastfeeding or in men

532
Q

clue for physiologic galactorrhea

A

it’s bilateral

533
Q

clue for pathologic galactorrhea(2)

A

unilateral

breast cancer

534
Q

color of galactorrhea(4)

A

white green
gray
yellow
brown

535
Q

most common cause of physiologic galactorrhea

A

hyperprolactinemia

536
Q

cause of hyperprolactinemia(7)

A 
prolactinoma
risperidone 
opiods
hypothyroidism
pregnancy
oral contraceptive pills
chest wall or nipple stimulation
537
Q

cause of chest wall stimulation(3)

A

surgery
trauma
shingles

538
Q

first test to do in galactorrhea

A

guaic test in fluid from breast

539
Q

first test to do if galactorhhea is non bloody and bilateral(3)

A

serum prolactin
TSH
brain MRI

540
Q

galactorrhea and palpable mass in the breast(3)

A

mammogram
US of breast
surgical evaluation

541
Q

investigation of breast mass

A

mammogram
US of breast
surgical evaluation

542
Q

indication to investigate breast mass in galactorhea

A

unilateral galactorrhea

bloody galactorrhea

543
Q

patient with history of formula feeding of baby after hemorragic delivery

A

sheehan syndrome

544
Q

physiopatho of sheehan syndrome

A

ischemic necrosis

545
Q

hypopituitarism in post partum(2)

A

sheehan syndrome

lynphocytic hypophysitis

546
Q

can you have insipidus diabetes in sheehan

A

it’s uncommon

547
Q

clue for hypopituitarism(2)

A

hypogonadism

hypothyroidism

548
Q

rx of asymptomatic bacteriuria in pregnancy(4)

A

nitrofurantoin
amox
augmentin
cephalexin

549
Q

antibio contrindicated in pregnancy(3)

A

cyclines
fluoroquinolones
TMS

550
Q

what to do in rx of hypothyroidism in pregnancy

A

increase levothyroxin dose

551
Q

when to check TSH in pregnancy

A

every 2-3 months

552
Q

first prenatal visit what to ask(13)

A 
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
Q

when can you give influenza in pregnancy

A

n’importe quand

554
Q

test to ask in specifci risk in pregnancy(5)

A 
lead level
TB
HB electrophoresis if MCV < 80
toxo
thyroid function
555
Q

when to ask thyroid fuction test in pregnancy(2)

A

if symptomatic

or associated conditions like diabetes

556
Q

pregnant woman with paresthesia in hand

A

carpal tunnel syndrome

557
Q

why carpal tunnel syndrome in pregnancy

A

because estrogen mediates depolarisation of ground substance causing hand edema

558
Q

rx of carpal tunnel syndrome in pregnancy(2)

A

wrist splinting

put the wrist in neutral position and NSAIDS

559
Q

failure with wrist splinting during carpal tunnel syndrome

A

local corticosteroid

560
Q

rx of carpal tunnel syndrome when conservative disorder fails

A

surgical decompression

561
Q

pregnant woman with increased pruritus soles and palms and increased transaminases and elevated bile salts dx

A

intra hepatic cholestasis of pregnancy

562
Q

pregnant woman with RUQ pain with hemolysis low platelet and moderately high transaminase

A

HELLP syndrome

563
Q

pregnant woman with hypoglycemia,RUQ pain elevated blirubin mildly elevated transaminase elevated bilirubin and possible DIC in 3 e trimestre

A

acute fatty liver disease of pregnancy

564
Q

complication of acute fatty liver disease

A

liver failure

565
Q

red papules with striae in the periombilical region in 3e trimestre > ou egal a 25 ans

A

pruritic urticarial papules and plaques of pregnancy

566
Q

quid of ASC-VS

A

atypical squamous cell of undetermined significance

567
Q

how can you dx ASC-VS

A

pap test

568
Q

next step if you found it ASC-VS in pap test in woman > ou egal a 25 ans

A

HPV serology

569
Q

HPV+ plus ASC-VS next step in woman > ou egal a 25 ans

A

colposcopy

570
Q

HPV- plus ASC-VS next step

A

repeat pap test and HPV in 3 years

571
Q

ASC-VS in woman 21-24 years old or LSIL

A

repeat pap smear in 1 year

572
Q

young woman in AFIB and pulmonary edema dx causal

A

mitral stenosis

573
Q

why mitral stenosis can become worse during pregnancy

A

increased blood flow

574
Q

risk factor for mitral stenosis

A

strep pyogenes infection

575
Q

G2 patient with RH - next step

A

RH D abtibody testing

576
Q

when to perform RH antibody testing(2)

A

first visit

repeat at 24-28 semaines

577
Q

first visit of rh- mother(2)

A

rh typing

antibody with RHD

578
Q

if alloimmunization is noted next step(2)

A

anti immune globulin at 28 semaines

at delivery

Step 2 CK (primary set) (22 decks)

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