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MCCQE1 ** > OBGYN > Flashcards

OBGYN Flashcards

1
Q

Define: Secondary Amenorrhea

A

The absence of menses for three months in a woman with previously normal menstruation or nine months for women with a history of Oliogomenorrhea.

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2
Q

Patient with sweating bouts, lethargy, dyspareunia, skin hyperpigmentation, normal thyroid function, decreased cortisol levels, decreased estrogen, increased gonadotropin, + adrenal cytoplasmic antibodies.
Dx?

A

Premature ovarian failure (POF) due to an autoimmune disorder.

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3
Q

Is there an immunosuprressive therapy for POF?

A

No known therapy for POF has been proven safe and effective.

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4
Q

why shoud all women with POF recieve cyclical hormone treatement with estrogens and progestins?

A

To relieve the symptoms of estrogen deficiency and maintain bone density. BUT this wouldn’t restore patient’s ovulation.

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5
Q

What should be given to POF women who are hypothyroid?

A

Levothyroxine.

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6
Q

T/F: Surgical treatment given to all amenorrhea patients?

A

False.

It would be given if amenorrhea is caused by pituitary tumors. It isn’t necessary in patient with autoimmune oophoritis.

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7
Q

Define: primary amenorrhea?

A

absence of menstruation by age 14 in women without secondary sexual charachteristics OR absence of menstruation by age 16 in women with secondary charachteristics.

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8
Q

Patient has no secondary sexual charachteristics, FSH and LH levels were low. Dx?

A

Hypogonadotropic hypogonadism.

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9
Q

Patient has no secondary sexual charachteristics, FSH and LH levels were elevated. next step?

A

Karyotype analysis.

Hypergondatropic hypogonadism.

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10
Q

49 y/o woman: abnormal vaginal bleeding, heavy periods, intermenstrual bleeding, parous cervis w dark blood. BP is normal, hemoglobin is 115 g/L, preg test is -
next step?

A

Endometrial biopsy.

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11
Q

Initial evaluation of abnormal uterine bleeding (AUB) in reproductive age women?

A

human chorionic gonadotropin to exclude pregnancy, CBC, hemoglobin to assess anemia.

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12
Q

Evaluation for (blank) is recommended for any non pregnant reproductive age women with frequent AUB.

A

Endomentrial hyperplasia or endomentrial cancer by endometrial biopsy.

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13
Q

22 y/o woman with complaints of AUB. takes combined oral contraceptive pill.

exam shows: no lesions, no polyps, - preg test and reduced hemoglobin.
Tx?

A

NSAIDs and/or supplemental estrogen.

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14
Q

AUB between periods in women who use OCPs is known as what?

A

Breakthrough bleeding & associated with insufficient estrogens.

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15
Q

30 y/o woman: type 1 diabetic, non offensive vaginal discharge (white & curdy), itching, swollen genital area.

Test and findings?

A

Wet mount test.

Pseudohyphae and Spores.

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16
Q

31 y/o woman: vaginal discharge, odor, itching.

Examination reveals: yellow discharge, vulvar & vaginal erythema, strawberry cervix.

Dx?

A

Trichomonal vaginitis.

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17
Q

Painless bumps outside of vagina with some discomfort in sex & itching.

Tx?

A

Cryotherapy.

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18
Q

How to confirm condyloma acuminatum?

A

Acetowhitening & colposcopy.

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19
Q

T/F: treatment of genital warts may weaken condoms.

A

True

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20
Q

Ointment Tx of genital warts?

A

Sinecatechin.

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21
Q

Maximum duration of use of Sinecatechins?

A

16 weeks

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22
Q

Pelvic inflammatory disease can lead to what condition?

A

Fitz-Hugh-Curtis syndrome.

(Spreading infection to peritoneum causing inflammation & formation of scar tissue on external surface of the liver

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23
Q

T/F: Sheehan syndrome is a complication of PID

A

False.
It is characterised by decreased functioning of the pituitary gland, caused by ischemic necrosis due to blood loss & hypovolemic shock during & after childbirth.

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24
Q

Known complications of untreated PID:

A 
Ectopic pregnancy
Tubal factor infertility
Tubo-ovarian abscesses
Pyosalpinx
Chronic pelvic pain
Peritonitis
Adhesions
Bacteremia
Septic arthritis
Fitz-Hugh-Curtis syndrome
Endocarditis
25
Q

T/F: Cervical neoplasia is a complication of PID

A

False

26
Q

40 y/o asymptomatic woman with 10 weeks sized irregular uterus. Next step?

A

Ultrasonography & reexamination in 6 months

27
Q

What is CIN 1, CIN 2, CIN3?

A

CIN (cervical intraepithelial neoplasia)

CIN1: displays dysplastic changes in appx 1/3 of the thickness of the epithelium

CIN2:1/2 - 1/3

CIN: full thickness involvement

28
Q

Next step CIN 1

A

Follow up without Tx by doing pap smear at 6 months or colposcopy

29
Q

Next step CIN2

A

Colposcopy at 6 months & at 12 months

30
Q

CIN3 next step

A

Conization of the cervix

loop electrosurgical excision

31
Q

When is HSIL cytology is preceded with HSIL (CIN2,3), what is Tx?

A

Diagnostic excisional procedure

32
Q

Women with subtotal hysterectomy OR total one for malignant cause (or benign cause but HPV positive) need what?

A

Routine swab of cervix or vaginal vault

33
Q

36 y/o woman has atypical glandular cells of undetermined significance. Next step?

A

Colposcopy with endocervical curettage

34
Q

When should women be tested for HPV DNA

A

When a pap smear shows ASCUS in women under 30 y/o

35
Q

If ASCUS is found:

A

HPV test OR repeat cytology in 6 months

HPV - = repeat cytology in 12 months
HPV + = colpo

If cytology is chosen instead of test:
ASCUS = colpo
- = repeat cytology again in 6 months

36
Q

Tx for Lichen sclerosus?

A

Fluorinated corticosteroid

37
Q

Ulcers in sexually active person denote one of:

A 
HSV
Primary syphilis
Chancroid
Lymphogranuloma venereum
Granuloma inguinale
38
Q

HSV cytology:

A

Multinucleated giant cells.

Epithelial cells containing nuclear inclusion bodies

39
Q

30 y/o woman: type 1 diabetic, non offensive vaginal discharge, itching, red and swollen genital area.
test and result?

A

Wet mount test: pseudohyphae and spores.

40
Q

Most common species causing candidiasis?

A

C. albicans

41
Q

31 y/o woman: vaginal discharge, odor, itching, yellow discharge, vulvar and vaginal erythema, strawberry cervix.
Dx?

A

Trichomonal vaginitis.

42
Q

Once ovarian torsion is confirmed, what should be done?

A

Conserve ovary via a speedy detorsion

43
Q

Suspicions of PCOS as patient displays risks for it. What screening test to do?

A

Lipid levels

HbA1C

44
Q

How to prevent congenital rubella syndrome

A

Ensuring a patient’s rubella antibody titre is greater than 10 IU/ml. If she is non reactive, immunization should be deferred until after delivery due to inability of rubella vaccine virus to cross placenta and infect the fetus

45
Q

When should high risk pregnant patients be screened for DM

A

If they test negative in initial screening, they should be screened again towards the end of second trimester between 24th & 28th weeks

46
Q

T/F: Amlodipine & Lisinopril are safe for HTN

A

False

Methyldopa is safe

47
Q

Pregnant woman with mild preeclampsia at 37 weeks gestation. Next step?

A

Vaginal examination and calc of Bishop score.
Bishop score 6: labour should be induced
Lower score: cervix should be ripened first

48
Q

Late decelerations are consistent with what?

A

Uteroplacental insufficiency.

Management should include intrauterine resuscitation first. If no improvement, delivery.

49
Q

3rd stage of labour?

A

Delivery of placenta. If placenta isnt delivered by 30 mins, Dx of retained placenta.

Mgm of Retained placenta: uterotonics + watchful waiting and/or cord traction for 15 mins.
In case of hemorrhage: immediate manual removal of placenta. If it cant be removed, Dx of placenta accreta is made and hysterectomy is done.

50
Q

Tx of women in pre term labour

A

1- tocolytic agent (CCB) IF they are having contractions
2- Glucocorticoid to avoid RDS in neonate
3- Antibiotics to avoid GBS

51
Q

How is Tocolytic therapy useful?

A

In delaying delivery up to 48h in situations of pre term labour with contractions to allow max benefit of glucocorticoids to avoid RDS in neonates. In pts in pre term labour <30 weeks, prostaglandin synthetase inhibitors i.e. indomethacin are 1st line tocolytics

52
Q

One major risk for Abruption?

A

HTN

53
Q

Patient is breastfeeding, best contraception?

A

Oral progesterone pill
Any contraception that includes estrogen isnt recommended since estrogen reduces breast milk production.

Note: sex is to be discourages for the first 6 weeks post partum for pelvic rest.

54
Q

Indications of CSXN:

A

Maternal:

  • Eclampsia
  • Prior uterine surgery
  • Prior classic CSXN
  • Cardiac Dx
  • Birth canal obstruction
  • Maternal death
  • Cervical cancer
  • Active genital herpes
  • HIV viral load > 1000

Fetal:

  • Acute fetal distress
  • Malpresentation
  • Cord prolapse
  • Macrosomia
  • Placental abruption
  • Placenta previa
  • Passenger pelvic disproportion
55
Q

Oligohydramnios is associated with which fetal condition?

A

Talipes equinovarus (club foot)

56
Q

Diagnostic test of ICP?

A

Elevated serum bile acids (NOT bilirubin)

Note: ICP classically presents in 3rd trimester as severe pruritis

57
Q

Define spontaneous abortion

A

Expulsion of an embryo or fetus weighing 500g or less. This is usually 20 to 22 weeks or less

58
Q

Classification of spontaneous abortions?

A

1- Threatened: presents with vaginal bleeding +/- cramping, cervix is closed, Ultra sound shows viable fetus

2- Inevitable: Vaginal bleeding, crampy pelvic pain, cervix is dilated.

3- Incomplete: extremely heavy bleeding & cramping. Passage of tissues may have been noticed, cervix is open.

4- Complete: history of bleeding & cramping, passage of placenta & sac, resolution of Sx, cervix is closed

5- Missed: no Sx, fetus died in utero, cervix is closed. U/S shows too small fetus & no fetal heart rate

6- Habitual: > 3 consecutive spontaneous abortions

7- Septic: infection of contents of uterus

MCCQE1 ** (5 decks)

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