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 < 37(2)
repeat BP in 24 hours
if the same delivery
biophysical profile 6 with no oligoamnios fetus a > 37
delivery
biophysical profile < 6 and fetus < 32 s
daily monitoring
biophysical profile < 6 and fetus > 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 < 37 semaines
amniocenthesis to assess lung maturity
placenta praevia with stable mother and fetus < 37 semaines and mature lung
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 < 2
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
<34 semaines
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 <21
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 < 100 000
RUQ pain or epigastric pain
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
fibrinogen in coagulopathy
160 mg/dl is considerd as low
whta to do in front of inttra uterine fetal demise
induce labor
risk for precocious puberty(2)
epiphyseal plate fusion
short stature
after amniotomy baby develops decrease of heart beat with late deceration ?
ruptured fetal ombilical vessel
clue for ruptured fetal ombilical vessel during amniotomy
tachycardia puis bradycardia to a sinusoidal pattern
during ruptured fetal ombilical vessel how to say the blood is not from the mother
by the APT test
rx of rupture fetal ombilical vessel
crash CS
quid of vasa preavia
fetal blood vessel traverse the lower segment between the baby and the internal cervical os
clue vasa preavia bleeding
normal vitals for mother during bleeding
in pregnant women when to consider urine culture positive
> 100 000 colonois forming unit/ml for a single organism
risk for asymptomatic bacteriuria
pyelonephritis
rx for bacteruiria asymptomatic(4)
amox
or ampicilllin
or nitrofurantoin
or cephalexin
complication of pyelonephritis(3)
low birth weight baby
septicemia
pretem babies
HTA in pregnant women < 20 weeks with no protein in urine
chronic HTA
hta in pregnant women < 20 weeks(2)
mole hydatiform
chronic HTA
why you can have hypokaliemia and hypernatremia in pregnant woman
because of hyperaldosteronism
risk in chronic HTA
abruptio placentae
abruption placenta risk for the mother
bleeding
abruption placenta risk for the baby
interruption of placental perfusion
SLE and abruptio placenta
lupus anticoagulant
most comon risk factor for abruptio
HTA
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
when to give RHOGAM in RH - patient(2)
28 e semaines
after delivery
patient with history of abruptio placenta rh - develops antirh antibody what can cause that
low dose of antiglobulin in post partum
what ‘s rosette test in abruptio in rh -
determine the amount of fetal maternal transfusion
next step if rosette test is negative
give the standard dose of anti D immune globulin
rosette test positif next step
perform kleihauer betke stain or fetal red blood cell using flow cytometry
next step after kleihauer betke stain test
anti D immune globulin should be corrected accordingly
quid of preterm labor
labor occuring between 20 a 37 weeks of gestation
before 37 ,after 20 weeks
clue for good contractions during labor(2)
in labor 4 contractions q 20 mn or more
cervical changes
complication of preterm labor(5)
respiratory distress syndrome intra ventricular hemorrage sepsis necrotizing enterocolitis kernicterus
best thing to do in preterm labor(2)
tocolysis
corticosteroid pendant 48 h < 34 semaines
in preterm labor what’s the goal of tocloysis
ammener la grossessede 34 a 36 semaines of gestation
young woman with breast lump what to do
ask her to return shortky after menstrual period
young woman with breast lump ,regeression after menstrual period dx
it’s benign
clue for kalman syndrome(3)
primary amenorrhea
absent of sexual characteristics
hypoosmia or anosmia
karyotype in kallman syndrome
46XX
what about internal organ in kallman
Normal
phenotype in kallman syndrome
girl
karyotype in klinefelter
47XXY
karyotype in turner
45X0
threatened abortion
any vaginal bleeding occuring before 20 semaines with a live fetusand closed cervix
standard care for threatened abortion(3)
reassurance
outpatient follow up
bed rest no sex
why bed rest and no sex during threatened abortion
to avoid guilt in parents
cause of anovulation in PCOS(2)
imbalance in FSH and LH
insulin resistance
tetrad of PCOS(4)
anovulation
androgen excess
male pattern growth
ovarian cyst
testicular feminisation syndrome karyotype
46 XY
testicular feminisation syndrome phenotype
girl
why absence of internal reproductive organ in testicular feminisation
presence of mullerian inhibiting factor(MIF)
why MIF is present
because testis are present and form MIF
role of MIF
prevent formation in internal organ in female in case of testiculer feminisation
rx of testicular feminisation(2)
gonadectomy in puberty
creation of neovagina
young girl with amenorrhea,hypoestrogenism,high gonadotrophin levels dx
primary ovarian failure
diseases associated with primary ovarian failure(5)
autoimmune disorder hashimoto addisson diabete type 1 pernicious anemia
cause of premature destruction of follicles(4)
mumps
radiation
oophoritis
chemo
clue for rimary ovarian failure(2)
high FSH /LH
low estrogen
how to deal with infertility in patient with primary ovarian failure
in vitro fertilization with donor oocytes
symptom assciated with pathologic leucorrhea(3)
pruritus
burning
malodorous discharge
physical exam of pathologic leucorrhea(3)
erythema and edema
tenderness of cervix
green and curdlike vaginal discharge
quid of physiologic leucorrhea(4)
yellow or white
non malodorous
absence of associated symptom
normal physical exam
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
quid of clue cells
vaginal epithelial cell with adherent cocobaccilus on wet mount
KOH test
amine like odor (fishy) when KOH is added to vaginal discharge
AMSEL criteria to dx vagise bacterienne
3 sur 4
patient taking OCP complaining of weight gain what to say
reassure the patient that the weight gain is not related to oral contraceptives pills
why oCP is no longer associated to weight gain
because new OCP are lower dosed
most common side effect of combined OCP
breakthrough bleeding
side effect of combined oCP(6)
HTA increased risk cervical ca DVT amenorrhea high triglycerides hepatic adenoma
advantage of combined OCP
lower risk of endometrial and ovarian cancer
chronic HTA in pregnancy rx(2)
labetalol
@ methyl dopa
ACE and ARB s in pregnancy(2)
teratogenic
fetal kidneys damage
after amniocentesis patient develops sudden respiratory failure seizures ,purpuric rash cardiogenic
amniotic fluid embolism
next step after amniotic fluid embolism(2)
intubation
mechanical ventilation
meaning of purpura in amniotic fluid embolism
DIC is developing
test to confirm premature rupture of membranes(3)
positive nitrazine test
positive pooling tes
positive ferning test
first thing to do in case of PROM
give PNC
Why PNC in GBM
to prevent GBS infection
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
drugs used in GBS prophylaxis(4)
ampicillin
cephazolin
clindamycin
vancomycin
clue for lichen sclerosis(2)
vulvar itching in elderly
dicomfort
quid of porcelain white atrophy
vulvar skin thin dry white in color
next step in front of lichen sclerosis
vulvar punch biopsy
risk in lichen sclerosis
vulvar squamous cell carcinoma
first line rx in lichen sclerosis
high potency topical steroids
normal fibrinogen
150-450
risk of DIC in intra uterine fetal demise
low fibrinogen
quid of abortion(2)
fetal demise before 20 weeks or
fetus weight <500 g
what to do in fetal demise in patietnwith fibrinogen 480
discuss the need for delivery and review options of vaginal/CS
thyroid pattern in pregnant woman(2)
increase total T4,T3
normal TSH
how’s TBG in pregnancy
high
how are free T3 T4 TSH IN PREGNANCY
normal
incontinence in woman after C/S
epidural anesthesia
causing bladder denervation
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
rx of incontinence after CS
intermittent catherisation
clue for endometriosis(4)
chronic pelvic pain
dyspareunia
infertility
bladder or bowel problems
characteristic of pain in endometriosis
worse with menses
complication of endometriosis(2)
bowel bladder obstruction
rupture of endometrioma or torsion
dx or rx of endometriosis
laparoscopy
indication of laparoscopic rx in endometriosis(2)
complicated case
failure with medical rx
medical rx of endometriosis
NSAIDS plus combined OCP
next step if first line medical rx fails in rx of endometriosis(3)
progestin
plus
GNRH agonist
plus addback therapy
3 D of endometriosis
dyspareunia
dysmenorrhea
dyschezia
dyschezia quid
pain during defecation
complication of endometriosis
infertility 30 %
goal in rx endometriosis
suppress ovulation
quid of progestin
medroxyprogesterone acetate
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
clue for endometrial hyperplasia(2)
intermenstrual bleeding
heavy menses
Dx of endometrial hyperplasia
biopsy
type of endometrial hyperplasia(4)
simple
complex
simple atypical
complex atypical
risk to progress to endometrial cancer in simple endometrial hyperplasia
1%
risk to progress to endometrial cancer in complex endometrial hyperplasia
3 %
risk to progress to endometrial cancer in simple atypical endometrial hyperplasia
8 %
risk to progress to endometrial cancer in complex atypical endometrial hyperplasia
29%
rx of simple or complex without atypia
cyclic progestins
rx of complex hyperplasia atypia
hysterectomy
med contraindicated in hyperplasia de l’endometre and why?(2)
estrogen
it will agravate the case
chronic pelvic pain low sacral back pain worse during menses dx a eliminer
endometriosis
how’s sonogram in endometriosis
can be normal
physical exam in endometriosis(2)
pain uterus motion with finger
patient will experience rectovaginal tenderness
gold standard to DX endometriosis
laparoscopy
woman in labor with active genital herpes
immediate C section
why woman with active genital herpes should undergo CS
risk of neonatal HSV
post partum woman with breast pain
breast engorgement
rx of breast engorgement(2)
cool compresses
acetaminophen and NSAIDS
peak for breast engorgement(2)
3 a 5 jours
beginning 24 a 72 h
quid of endometriosis
endometrial and stromial tissue outside uterus
most common affected site for endometriosis(4)
ovary
peritoneal surfaces of the cul de sac
broad and uterosacral ligaments
rectovaginal septum
patient with chronic infertility ,pelvic pain and mass in the left adnexae
endometriosis
indication of surgery in placentae praevia(2)
unstable mother with vital signs
unreassuring fetal haert rates
patient with SLE develops acne why(2)
prednisone taking
steroid induced folliculitis
clue for acne in steroid
no comedones
early decelerations quid?
peak of contraction postive deflection corresponds to valley (nadir)in heart deceleration
cause of early deceleration(2)
fetal head compression
or could be normal
quid of late deceleration
nadir of deceleration (negative deflection) occurs after uterine contraction (positive deflection)
cause of late decelration
uteroplacental insufficiency
quid of variable deceleration
can be or not associated with contraction
cause of variable deceleration(3)
cord compression
oligoamnios
cord proplapse
management of reccurent variable decelerations(3)
change maternal position
o2 administration
rescucitative measures
after motor vehicle accident patient of 34 weeks come with hypotension and late deceleration of the baby dx
uterine rupture
in uterine rupture type of deceleration
late deceleration
patient with schizophrenia develops milk in why
risperidone taking
action of risperidone
dopamine and serotonin antagonist
urinalysis in pregnant woman develops > 100 000 bacteria
bacteriuria asymptomatic
first line rx of asymptomatic bacteriuria(2)
nitrofurantoin for 7 days or amox or cephalosporin first generation
bug in cause of aymptomatic bacteriuria
E coli
work up of adrenal mass(2)
US
ca-125 antigen
suspicscious failure in US(4)
mass > 10 cm
nodular or pelvic fixed mass
ascites
metastasis
when rx conservatively(3)
simple cyst in sonogram
normal ca 125
mass < 10 cm
patient on lithium for bipolar disorder and isotretinoin becomes pregnant(2)
stop isotretinoin
wean lithium
why wean lithium in case of pregnancy
you should slow taper lithium to prevent relapse
congenital anomaly associated with lithium
ebstein anomaly
congenital anomaly associated with isotretinoin(3)
craniofacial dysmorphism
heart defect
deafness
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
could we use inhaled steroid in pregnancy
yes
false labor when it occurs
in the late 4-8 weeks of pregnancy
clue for false labor(2)
no cervical changes during pregnancy
relieved by sedation
rx for false labor
nothing
low grade fever following 24 h post partum and high leucocytes(2)
it’s normal
reassurrance
lochia in post partum rubra(2)
first few days
rouge
lochia in post partum serosa (2)
3 a 4 jours
pale
lochia in post partum alba
white or yellow
foul smelling lochia
endometritis
why evaluation of mucus should be part of infertility work up
because hostile cervical mucous can dialoow penetration of spermato into uterus
normal aspect of cervical mucus during ovulation(4)
profuse
clear and thin
stretch approximately 6 cm
exhibit fening on microscopic slide smear preparation
35 young patietn with dyspareunia and tense vagina dx
vagisnismus
rx of vagisnismus(3)
kegel exercice
gradual dilation with finger
relaxation
preecclampsia and SLE(3)
both has HTA
both proteinuria
edema
clue for glomerulonephritis in SLE during pregnancy(4)
massive proteinuria 8g 24 h
RB cast
malar rash
ANA +
could pregnancy cause ANA positive
yes
quid of malar rash
macular eruptions on the cheek bones
premature ovarian failure clue(2)
high FSH LH
FSH/LH>1
Cause amenorrhea(3)
ovarian failure
turner
fragile x syndrome
in premature ovarian failure the greatest elevation LH or FSH
FSH
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
symmetrical pitting edema in pregnant woman with normal TA next step(2)
reassurrance
normal follow up
patietn at 36 weeks seen with increased abdominal pain and bleeding clue for abruptio placenta
firm and tender uterus
why contraction in AP
blood seems to have uterotonic action
can you have absence of vaginal bleeding in AP
if you have a retroplacental hemmorage dans 20% des cas
VEAL IN deceleration(4)
variable
early
accelerated
late
cause of deceleration CHO=VEAL(4)
Cord compression or prolapse,oligoamnios=V
head compession =E
okay= accelerated
Placental insufficiency=late deceleration
two types of bleeding in AP(2)
concealed
visible
masculinisation in pregnant mother resolving after delivery
aromatase deficiency in baby
why masculinisation certain pregnant women
placenta is unable to make estrogen in utero
clue for aromatase deficiency(4)
absent estrogen
increasd testosterone and estrogen
increase LH and FSH
polycystic avaries
genital organs in patietn with aromatase deficiency(2)
normal internal organs
cliteromegaly(ambiguous)
dx of aromatase deficiency(2)
high FSH LH
low estrogen
PID coplicated with vomiting next step(2)
hospitalize the patient
give cefotaxin and dox
genital organs in patietn with aromatase deficiency(2)
normal internal organs
cliteromegaly(ambiguous)
dx of aromatase deficiency(2)
high FSH LH
low estrogen
PID coplicated with vomiting next step(2)
hospitalize the patient
give cefotaxin and dox
complication of PID(5)
tubo ovarian abcess abcess rupture pelvic peritonitis sepsis infertility
outpatient rx of PID(2)
ceftriaxone or cefoxitin
plus
dox
cause of PID(3)
neisseria gonerrhea
chlanydia
genital mycoplasma
poor surgical candidate with tumor size < 2cm
radiation
rx of squamous cell carcinoma of vagima stage 1 et 2 with no metastasis or extension to pelvic wall size < 2cm
surgical excision
rx of squamous cell carcinoma of vagima stage 1 et 2 with no metastasis or extension to pelvic wall size > 2cm
radiation
first step in patient with secondary amenorhea
BHCG
secondary amenorhee with negative BHCG and high testoterone
PCOS
why TSH in secondary amenorrhea
to rule out hypothyroidism
secondary amenorhee with negative BHCG and high TSH and low t4
hypothyroidism
next step in Secondary amenorrhea with high prolactin(3)
check TSH
check medication
check creat
next step in Secondary amenorrhea with high prolactin with normal TSH ,no history of medication and normal creat
MRI of the brain
clue for asherman syndrome(2)
intrautrauterine adhesions
secondary amenorrhea
dx for asherman syndrome(2)
hysteroscopy
or
hysterosalpingography
patietn seen with no fetal mvts next step
profile biophysique
patient with solid ovarian mass during pregnancy
all ovarian masses are malignant except during pregnancy
during pregnancy patient develops facial hair and acne next step
ultrasonogram
sonogram shows bilateral adrenal masses in pregnant woman with facial hair and acne dx
luteoma
next step in dx of luteoma during pregnancy(2)
reassurrance
follow up with U/S
people at risk for luteoma(2)
african american
30’s 40’s
grand mal seizures in pregnancy
ecclampsia
stable patietn with preeclampsia 37 semaines de grossese
induction labor
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
acid base status in pregnancy(3)
respiratory alkalosis
low co2 pressure
high o2 pressure
why respiratory alkalosis in pregnancy(3)
progesterone stimulates respiratory center in the brain and causes hyperventilation
increase minute ventilation
increase volume tidal
why HCO3 is low during pregnancy
to compensate metabolic alkalosis
patietn having serial ablation after LEEP what could be the greatest complication
cervical insufficiency
risk factir for cervical insufficiency(6)
cone bioopsy DES exposure multiple gestation mullerian anomalies preterm birth second trimester pregnancy loss
best test to Dx cervical insufficiency
transvaginal US
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
premenstrual syndrome
symptoms occuring 1-2 weeks before menses and regress around the time of menstrual flow
Symptom of premenstrual syndrome(4)PMS
bloating
headaches
breast tenderness anxiety
mood disturbance
what to do when tyou suspect premenstrial syndrome
menstrual diary for 2 a 3 months to see exact time of symptom appearance
quid premenstrual dysphoric syndrome(2)
variant of PMS
irritability and anger predomines
rx of PMS
SSRI fluoxetine first line
quid of sheehan syndrome(3)
hemmorage of post partum
problem of lactation
anterior hypophyse necrosis
clue trichomonas vaginalis
PH 5.0-6,0
consequence of sheehan syndrome
prolactin deficiency
microscopy in Trichomonas vaginitis
flagellated motile norganisms
difference between trichomonas vaginalis and vaginose bacterienne
vaginose bacterienne does not cause inflammation
exam image of choice to detect gynecologic tumor
pelvic U/S
quid of pretem labor
occuring < 20 semainees de gestation and before 37 semaines
quid of labor(2)
uterine contraction at a rate of 4 per 2o mn or more
cervical changes
what the goal in term of preterm labor
reach 34 36 semaines
what to in preterm labor(2)
bed rest
tocolysis
different types of abortion(5)
missed inevitable incomplete threatened septic
quid of missed abortion(2)
light vaginal bleeding
pregnancy symptom can become prominent
best test to dx missed abortion(2)
US
non viable fetus
quid inevitable abortion(2)
vaginal bleeding and open cervix
US fetus with possible heart beat
incomplete abortion (3)
vaginal bleeding with passage of large clots
cervix open
US products of conception often in cervix
threatened abortion(2)
vaginal bleeding with close cervix
US viable pregnancy
septic abortions(3)
sign of sepsis
cervix open
US retained products of conception
1 cause of septic abortion(2)
induced abortion
spontaneous rarely causes sepsis
best test to dx abortion
US pelvic
3 ways to rx missed abortion(3)
abortion
medical using prostaglandin
expectant management
patient with vaginal bleeding last menstrual period 5 weeks ago BHCH 1000 next step
repeat BHCG in 48 hours
postive pregnancy test but no evidence of intra uterine or extrauterine pregnancy dx (3)
ectopic
nonviable intrauterine pregnancy
early viable pregnancy
when will you see fetus in pelvic U/S
BHCG 1500-2000 ml
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
early pregnancy with spotting trans abdomen US negative next step
transvaginal US
when can you gestationnal sac in trans abdominal US
when BHCG is greater than 6500
when can you gestationnal sac in trans vaginal US
a partir de 1500
patient with spotting and intra uterine sac in transvaginal US dx
no ectopic
adnexial sac or no sac intra uterine in transvaginal US
ectopic
patient with spotting and transvaginal US douteux
serial BHCG measurement
tendancy for BHCG
doubles every 48 h
when to perform transvaginal US in pregnancy
when BHCG 1500-6500
next step in decreaser of fetal mvts perceived by mother
nonstress test
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
abnormal NST
< 2 deceleration
most common cause of non reactive stress test
fetal sleep cycle
post menopausal women with vaginal dryness burning and dysuria and dyspareunia
atrophic vaginitis
rx of atrophic vaginitis
vaginal estrogen replacement
what to do if you suspect atrophic vaginitis
rule out UTI
mild atrophic vaginitis rx(2)
moisturizers
lubricants
moderate to severe atrophic vaginitis rx
low dose of vaginal estrogen
clue for ruptured ectopic pregnancy(3)
diffuse abdominal pain
cervical and adrenal tenderness
hypotension
differenciation between PID and ectopic pregnancy ruptured
no hypotension in PID
risk for ectopic(6)
tubal pathology tubal surgery current IVD PID multiple partners DES and infertility rx
dx of ectopic pregnancy ruptured(2)
transvaginal US
BHCG
image in trans vaginal US in ectopic pregnancy(2)
adrenal mass
free intraperitoneal fluid
cause of cervical motion tenderness(2)
ectopic
PID
Med rx of ectopic
metotrexate
dx ddifferentiel of acute pelvic pain(5)
Mittelscmerz syndrome ectopic ovarian torsion ruptured ovarian cyst PID
US in ovarian torsion(2)
enlarged ovary
decreased flow in ovary
risk factor for ovarian ruptured cyst
strenous or sexual activity
US in ovarian ruptured cyst
free fluid near ovarian cyst
clue of ruptured ovarian cyst in vignette
cystic ovarian mass with a moderate amount of free fluid
how to measure blood flow in ovary
doppler velocitometry
importance of transvaginal US in PID
to rule out tuboovarian abcess
free fluid in the context of pelvic pain in US
ruptured ovarian cyst
major side effect of low dose combination pills
worsening HTA
associated risk with estrogen progestin combined rx(4)
DVT
HTA
Hepatic adenoma
stroke and MI
woman with uncontrolled HTA end organ damage ,smoker and 35 ans ou plus wants a contraceptive method
no estrogen in contraception
best benefit of OCP’s(2)
reduced risk of endometrial cancer
reduced risk of ovarian cancer
risk # 1 for tamoxifen
endometrial carcinoma
quid of tamoxifen
selective receptor estrogen modulator
action of tamoxifen
agonist of estrogen receptors in the breast
why tamoxifen is used in the rx of breast cancer
it’s an agonist of estrogen receptors in the breast
quid of early deceleration
contraction of uterus =positive deflection
occurs at the same time as negative deflection( deceleration)
what to do before giving MMR vaccine
test for immunity with IGG antibody titers
what to do after receiving varicella and MMR
avoid contraception for at least 4 weeks after the vaccination
vaccine you can give during pregnancy(5)
MMR Varicella smallpox HPV live attenuated intra nasal influenza vaccines
can you give Hep B during pregnancy
yes
when to give pneumococcus during pregnancy
2 et 3 e trimestre
can you give Hi flu during pregnancy
yes in asplenic patient
routine vaccines in pregnancy(2)
TDAp
inactivated influenza vaccines
patient with bilateral pale grey discharge
galactorrhea
quid of galactorrhea
lactation in women who are breastfeeding or in men
clue for physiologic galactorrhea
it’s bilateral
clue for pathologic galactorrhea(2)
unilateral
breast cancer
color of galactorrhea(4)
white green
gray
yellow
brown
most common cause of physiologic galactorrhea
hyperprolactinemia
cause of hyperprolactinemia(7)
prolactinoma risperidone opiods hypothyroidism pregnancy oral contraceptive pills chest wall or nipple stimulation
cause of chest wall stimulation(3)
surgery
trauma
shingles
first test to do in galactorrhea
guaic test in fluid from breast
first test to do if galactorhhea is non bloody and bilateral(3)
serum prolactin
TSH
brain MRI
galactorrhea and palpable mass in the breast(3)
mammogram
US of breast
surgical evaluation
investigation of breast mass
mammogram
US of breast
surgical evaluation
indication to investigate breast mass in galactorhea
unilateral galactorrhea
bloody galactorrhea
patient with history of formula feeding of baby after hemorragic delivery
sheehan syndrome
physiopatho of sheehan syndrome
ischemic necrosis
hypopituitarism in post partum(2)
sheehan syndrome
lynphocytic hypophysitis
can you have insipidus diabetes in sheehan
it’s uncommon
clue for hypopituitarism(2)
hypogonadism
hypothyroidism
rx of asymptomatic bacteriuria in pregnancy(4)
nitrofurantoin
amox
augmentin
cephalexin
antibio contrindicated in pregnancy(3)
cyclines
fluoroquinolones
TMS
what to do in rx of hypothyroidism in pregnancy
increase levothyroxin dose
when to check TSH in pregnancy
every 2-3 months
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
when can you give influenza in pregnancy
n’importe quand
test to ask in specifci risk in pregnancy(5)
lead level TB HB electrophoresis if MCV < 80 toxo thyroid function
when to ask thyroid fuction test in pregnancy(2)
if symptomatic
or associated conditions like diabetes
pregnant woman with paresthesia in hand
carpal tunnel syndrome
why carpal tunnel syndrome in pregnancy
because estrogen mediates depolarisation of ground substance causing hand edema
rx of carpal tunnel syndrome in pregnancy(2)
wrist splinting
put the wrist in neutral position and NSAIDS
failure with wrist splinting during carpal tunnel syndrome
local corticosteroid
rx of carpal tunnel syndrome when conservative disorder fails
surgical decompression
pregnant woman with increased pruritus soles and palms and increased transaminases and elevated bile salts dx
intra hepatic cholestasis of pregnancy
pregnant woman with RUQ pain with hemolysis low platelet and moderately high transaminase
HELLP syndrome
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
complication of acute fatty liver disease
liver failure
red papules with striae in the periombilical region in 3e trimestre > ou egal a 25 ans
pruritic urticarial papules and plaques of pregnancy
quid of ASC-VS
atypical squamous cell of undetermined significance
how can you dx ASC-VS
pap test
next step if you found it ASC-VS in pap test in woman > ou egal a 25 ans
HPV serology
HPV+ plus ASC-VS next step in woman > ou egal a 25 ans
colposcopy
HPV- plus ASC-VS next step
repeat pap test and HPV in 3 years
ASC-VS in woman 21-24 years old or LSIL
repeat pap smear in 1 year
young woman in AFIB and pulmonary edema dx causal
mitral stenosis
why mitral stenosis can become worse during pregnancy
increased blood flow
risk factor for mitral stenosis
strep pyogenes infection
G2 patient with RH - next step
RH D abtibody testing
when to perform RH antibody testing(2)
first visit
repeat at 24-28 semaines
first visit of rh- mother(2)
rh typing
antibody with RHD
if alloimmunization is noted next step(2)
anti immune globulin at 28 semaines
at delivery
