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AMC MCQ > OBGYN Review > Flashcards

OBGYN Review Flashcards

1
Q

Inv of choice :
If secondary sexual characteristics exist
If NO 2ry sexual characteristics

A

US

FSH and LH

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2
Q

If XX»>

Manag:

A

mullerian agenesis.

elongation of vagina.

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3
Q

If XY»>

Manag:

A

androgen insensitivity $. removal of testis after puberty.

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4
Q

1ry amenorrhea, +ve uterus, no breast.. next step:

A

karyotyping.

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5
Q

If XX»>

TTT

A

HPO failure.

: GnRH; pulsatile form.

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6
Q

If XO»

Manag:

A

turner $(gonadal dysgenesis). hormonal replacement after puberty.

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7
Q

1ry amenorrhea, abd. Pain at the middle of the month»

A

imperforate hymen

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8
Q

Physical findings in imperforate hymen»

A

bluish discoloration.

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9
Q

TTT of imperforate hymen»>

A

surgery under anesthesia.

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10
Q

1st step with 2ry amenorrhea:

A

pregnancy test.

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11
Q

MC site of fibroid

A

intra-mural

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12
Q

Fibroid that causes subfertility and recurrent abortion

A

sub mucosal

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13
Q

TTT of fibroid:

A

myomectomy… give GnRH 3-6ms b4 operation.

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14
Q

Pregnant with H/O fibroid has abd. Pain and fever……… Dx

TTT:

A

red degeneration of the fibroid….

Analgesic.

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15
Q

Pain with menstruation with no underlying pathology

A

1ry dysmenorrhea.

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16
Q

TTT of 1ry dysmenorrhea 1st line

2nd line

A

1st line: NSAIDs

2nd line: OCPs.

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17
Q

Infertility + dysmenorrhea, dysuria, dyschezia, dyspareunia… Dx

A

endometriosis

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18
Q

MC site of endometriosis:

A

ovary (chocolate cyst)… the cause of infertility.

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19
Q

Inv. Of choice of endometriosis

A

laparoscopy (surgery)

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20
Q

TTT of endometriosis

A

OCPs or encourage pregnancy.

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21
Q

TTT of severe cases of endometriosis:

A

GnRH analogue or leuprolide (androgen).

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22
Q

TTT of severe cases of endometriosis in old age:

A

TAH, BSO

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23
Q

Endometrial gland in myometrium

A

adenomyosis.

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24
Q

CP of adenomyosis

A

menorrhagia and dysmenorrhea

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25
Q

TTT of adenomyosis:

A

OCPs.. if failed: TAH, BSO.

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26
Q

Obese female with infertility, irregular bleeding, acne& hirsutism..Dx

A

PCOS

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27
Q

Cause of infertility in PCOS

A

anovulation.

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28
Q

Most imp. Inv. Of PCO:

A

testosterone (free & total). elevated

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29
Q

TTT of PCO

A

clomiphene citrate for infertility,

OCPs for irregular bleeding

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30
Q

The most imp. Advice for PCO pts

A

Wt loss

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31
Q

MCC of hirsutism

TTT:

A

idiopathic hirsutism.

Aldosterone.

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32
Q

Female in 3rd decade with signs of menopause; Dx

A

premature ovarian failure.

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33
Q

Most imp inv. Of premature ovarian failure

A

increased FSH.

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34
Q

OCPs are for?

A

for sexually active and those who don’t need kids

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35
Q

HRT»

A

for those who aren’t sexually active and want kids

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36
Q

IVF with egg donation»

A

for those who want to get pregnant

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37
Q

Foul smelling vaginal discharge, clue Cells under nicroscope; Dx

A

B.vaginosis

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38
Q

Causative organism of B. vaginosis

A

gardenella vaginalis.

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39
Q

TTT of B. vaginosis

A

oral metronidazole (safe in pregnancy)+ no need for partner TTT.

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40
Q

strawberry cervix, motile flagellated organism under microscope; Dx

A

Trichomonas vaginalis.

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41
Q

TTT of trichomans vaginalis

A

oral metronidazole(u must treat partner as well)

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42
Q

Thick, cheesy, odorless, pseudohyphae under microscope, Dx

A

candida vaginalis.

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43
Q

TTT of candida vaginalis

A

oral fluconazole(if pregnant: fluconazole cream) and no need for partner TTT.

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44
Q

Cause of cyclic vulvovaginitis

A

candida vaginalis

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45
Q

TTT of recurrent vulvovaginitis

A

oral fluconazole

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46
Q

Post-menopause with long standing H/O of vulvar itching; 1st step

A

punch biopsy

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47
Q

TTT of lichen sclerosus

A

cortisone cream(but, bunch biopsy 1st to exclude malignancy)

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48
Q

Screening test of Chlamydia

A

all sexually active female from 15-29 yrs every year

Offer the girl “opportunistic screening” in each visit

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49
Q

MCC of cervical muco-purulent discharge in female

A

chlamydia

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50
Q

Recurrent subclinical cervicitis due to Chlamydia> adhesion> leads to?

A

infertility

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51
Q

TTT of Chlamydia

A

azithromycin+ ceftriaxone (treat both Chlamydia and gonorrhea)
Partner tracing is very important.

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52
Q

After TTTof Chlamydia

A

search for other STDs(e.g. ELISA for HIV, VLDL for syph.)

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53
Q

Chlamydia outbreak(e.g. in high school)

A

Education first. give condoms(recently, lecture about safe sex is the right answer even if condom is found in answers)

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54
Q

Screening of cervical cancer (pap smear):

A

Start 2 Yrs after starting intercourse or >18Ys regardless of sexual activity.
Do pap smear every 2Yrs
Stop it in those>70Ys with previous normal test and those undergone hysterectomy

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55
Q

(pap smear) Lesbians, HPV vaccine»

A

screen

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56
Q

(pap smear) Virgin»

A

No screening.

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57
Q

Pap smear interpretation:

Abnormal result in presence of infection

A

repeat screening after TTT of inf.

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58
Q

LSIL

A

repeat after 12ms; if still LSIL: colposcocy

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59
Q

LSIL for those >30 yrs old

A

colposcopy

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60
Q

HSIL

A

colposcopy

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61
Q

Give HPV to all female&raquo_space;

A

from 9-45 Ys.(max. benefit: b4 starting intercourse)

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62
Q

Vaccine can be given for those

A

sexually active females, previous genital warts,

Previous abnormal cytology and lactating females.

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63
Q

Vaccine can’t be given to»

A

immuocompromised & pregnant females

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64
Q

MC risk factor of endometrial cancer

A

obesity.

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65
Q

Best inv. For suspected endometrial cancer

A

hystrescopy and biopsy.

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66
Q

Female with +ve BRCA1, BRCA2 mutation, are risk for what 2 cancers?» BO?

A

Breast and Ovarian Cancer

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67
Q

Screening of ovarian cancer»

A

is no longer recommended even in high risk Pts

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68
Q

Ovarian cyst in US of an old female; next step

A

CA125 even if the cyst is simple.

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69
Q

Urinary incontinence with increase intra-abdominal pressure (e.g. coughing, laughing)

A

= stress incontinence (MCC of incontinence in females).

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70
Q

Inv. Of choice of stress incontinence

A

urodynamics

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71
Q

1st line: tx for stress incontinence?

A

kegel exercise.
If no response to exercise:
surgery (TAH or vaginal hysterectomy)

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72
Q

If old pt (can do neither exercise nor operation) in stress incontinence, then what to use?

A

pessaries.

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73
Q

Urinary incontinence in all the time, position.. Dx

A

Total incontinence

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74
Q

MCC of total incontinence

TTT:

A

fistula…

surgery.

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75
Q

Strong unexpected urge to void not related to position

A

= urge incontinence.

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76
Q

Inv of choice of urge Incont.

A

UA. urine analysis

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77
Q

TTT of urge; 1st line

if failed?

A

bladder training.

If failed: anticholenergic or TCA

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78
Q

Urinary incontinence in pt with long standing DM»

A

overflow incontinence

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79
Q

TTT of overflow incontinence

A

intermittent cath.

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80
Q

Main ligament supporting the uterus is»

A

utero-sacral ligament

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81
Q

2nd MC site of endometriosis

A

utero-sacral ligament

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82
Q

MCC of PID

A

Chlamydia and 2nd MC organism: gonorrhea.

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83
Q

Adult with painful ulcer on genitalia

A

has HSV until proven otherwise.

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84
Q

Adult with painless ulcer on genitalia

A

has syph. until proven otherwise

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85
Q

MC type of ovarian cyst

A

follicular cyst

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86
Q

Ovarian cyst>6cm

A

laparoscopical removal.

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87
Q

Ovarian cyst<6cm

A

OCPs and repeat US in 6-8Ws.. if persist: laparoscopy.

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88
Q

Most imp to be evaluated for female puberty assessment

A

breast budding

89
Q

Mother worry as her daughter have no menses yet»

A

look for breast budding

90
Q

Time from breast budding to menarche:

A

about 2 Yrs.

91
Q

2ry sexual characteristic<8 Ys in females

A

= precocious puberty

92
Q

1st step in manag. Of precocious puberty»

A

x-ray to determine bone age.

93
Q

Breast development<3ys only with no other 2ry sexual characteristics..Dx»
management:

A

premature thelarche…

reassure only.

94
Q

Ethics of abortion in Australia:

Process of abortion»>

A

1st: counseling,
2nd: get informed consent
& then do the abortion

95
Q

Who can give informed consent»>

A

Competent pt are those >16 ys and those who are>14 but independent.
Parents or guardian…. For those who are <14.
Sexual assault authorities… for those<14 who exposed to rape.

96
Q

Who should do the abortion?

A

only the physician.

97
Q

Where the abortion should be done?

A

only in 3ry hospital howeverr far is it

98
Q

Is abortion legally allowed?

A

Abortion is legally allowed at any time during pregnancy

99
Q

Can a physician refuse to do abortion?

A

U can refuse to do abortion… u should refer to another physician.

100
Q

Inv. Of choice for Dx of osteoporosis:

A

DEXA scan.

101
Q

DEXA scan interpretation:

A

a. (-1:-2.5): osteopenia. b. (>-2.5

102
Q

When to say osteoporosis??

A

1-T-score less than 2.5 2- minimatrauma fracture

103
Q

Inv. Of choice for suspected osteoporotic bone fracture?

A

X-ray.

104
Q

Prevention of osteoporosis»>

A

Ca &; vit.D

105
Q

TTT of osteoporosis»>

A

bisphosphonate (even if ca&vit.D are present in MCQ)

106
Q

TTT of osteoporosis in pt with H/O breast cancer»

A

raloxifen (SERM).

107
Q

Inv. Of choice for menopause:

A

FSH (increased).

108
Q

MC symptom of menopause, MC indication for HRT in menopause:

A

hot flushing.

109
Q

MC symptom to be improved after HRT:

A

hot flashing.

110
Q

Can menopause and HRT cause depression?

A

Depression is neither a part of normal menopause nor responds to HRT.

111
Q

MCC of dysfunction bleeding at the beginning of

puberty:

A

anovulation

112
Q

MCC of dysfunction bleeding near menopause:

A

anovulation.

113
Q

Menopause + irregular bleeding

A

= cancer endometrium until proven

otherwise……….. next step: hysteroscopy & biopsy.

114
Q

MCC of post- menopausal bleeding»>

A

atrophic vaginitis.

115
Q

Menopause + bleeding in the 1st year»>

A

follicular activation

116
Q

Menopause+ bleeding+ pain during sex

A

= vaginal atrophy

117
Q

Menopause+ bleeding+ no pain during sex

A

= endometrial cancer.

118
Q

Menopause+ brownish discharge

A

= endometrial cancer.

119
Q

Menopause+ green, yellow or gray discharge

A

= infection

120
Q

Indication of HRT:

A

hot flushes, osteoporosis.

121
Q

Duration of HRT»>

A

not >5 Yrs

122
Q

Types of HRT:
Continuous……….
Cyclic…

A

……….for menopausal women

……for perimenopause.

123
Q

Female on HRT develop unpredictable bleeding.. mode of HRT:

A

continuous form.

124
Q

Post-menopausal with H/O hysterectomy:

A

give estrogen only.

125
Q

Post-menopause with H/O DVT need HRT:

A

no estrogen should be given & if you have to give estrogen: give estrogen patches.

126
Q

Post-menopausal with H/O breast cancer:

A

give paroxitine(SSRI).then clonidine

127
Q

Post-menopausal with atrophic vaginitis only:

A

give estrogen cream.

128
Q

Post-menopausal on HRT for 5Yrs:

A

trial of stoppage

129
Q

Pt on anti-epileptic need OCPs:

A

give high dose estrogen (microgynon 30-50).

130
Q

Pt on OCPs, recently started anti-epileptic mededications…. next step:

A

increase estrogen dos.

lamitrogen acts the other way

131
Q

Contra-indication of OCPS other than DVT& estrogen-dependent tumour»

A

migraine with aura is an absolute contra-indication of OCPs use.

132
Q

2 imp. Indications of POPs:

A

Lactating pt and pt with migraine.

133
Q

Wt to give for emergency contraception:

A

levonorgestrel 750mg.

134
Q

When to give emergency contraception?

A

condom rupture, unplanned pregnancy.

135
Q

Complications of IUCD:

A

bleeding, infection.

136
Q

Most sensitive method of natural contraception:

A

increase cervical secretions.

137
Q

Tubal ligation consent

A

taken from the female only.

138
Q

OCPs with lactation what to give?

A

POP is the best, start 6 Ws after delivery, never estrogen.

139
Q

Pt on OCPs develops chloasma, what to do?

A

stop estrogen.

140
Q

Pt on OCPs develops HTN; next step:

A

stop OCPs 1st and then check response.

141
Q

Pt on OCPs develops headache; next step:

A

stop OCPs 1st & then check response.

142
Q

MC indication of OCPs after delivery:

A

low frequency of breast feeding

143
Q

Most benefit of Yasmine:

A

wt loss.

144
Q

1st step in evaluation of infertile couple:

A

semen analysis.

145
Q

MCC of decreased sperm count:

A

alcohol.

146
Q

+ve progesterone withdrawal test (i.e. withdrawal bleeding)

A

= anovulation.

147
Q

Infertile couple, male has no offspring and; female in 40s with 2 offspring.. cause of infertility in this couple:

A

female (anovulation DT aging).

148
Q

Old female not easy to get pregnant

A

bad quality and quantity of the ova

149
Q

Female near menopause want to get pregnant:

A

IVF.

150
Q

Cause of infertility in male with CF»

A

absence of vas deference.

151
Q

Cause of infertility in those undergone any uterine procedure:

A

Asherman’s $

152
Q

Metastasis from GIT to ovary; 1st MC:& 2nd MC:

A

stomach

colon.

153
Q

Physical & psychological distress few Ds b4 menstruation:

A

premenstrual $.

154
Q

Best way to diagnose premenstrual $:

A

menstrual dairy.

155
Q

1st line TTT of premenstrual $:

A

relaxation therapy.

156
Q

2nd line TTT of premenstrual b$:

A

SSRI.

157
Q

1st line TTT of severe menstrual $ affecting, pt relations:

A

SSRI.

158
Q

1st step in management of excessive menstrual bleeding:

A

TSH.

159
Q

If TSH is normal; next step:

A

TVS.

160
Q

Young female with solid & cystic mass in US.. Dx:

A

dermoid cyst.

161
Q

MC site of dermoid cyst:

A

ovary.

162
Q

9 yrs kid started menstruation

A

normal puberty

163
Q

2 yrs kid started menstruation:

A

precocious puberty

164
Q

2 yrs kid with breast enlargement only:

A

thelarche

165
Q

Main site of action of pop( low dose):

A

cervix

166
Q

Main site of action of pop ( normal dose):

A

ovary

167
Q

Main site of action of combined oral contraceptive:

A

hypothalamo pituitary ovarian axis

168
Q

Site of sample in female with vaginal discharge

A

endocervical

169
Q

Most common cause of infertility in female with normal examination

A

tube adhesion

170
Q

Most common cause of infertility in couple with normal investigations

A

tube adhesion

171
Q

Most common cause of infertility in couple who had a kid before

A

tube adhesion

172
Q

Imp Inv. for Old age + fracture before discharge from the hospital:

A

bone scan

173
Q

Best inv. for Chlamydia:

A

PCR 1st catch urine

174
Q

Most common malignancy in PCOS

A

endometrium

175
Q

does haloperidol cause pin point pupil?

A

No

176
Q

In a patient with Hx of DVT, what contraceptive should we avoid?

A

Estrogen

177
Q

cervical screening should start when?

A

2 years after sexual intercourse

178
Q

how does OCP affect anti seizure meds?

A

increase metabolism, there increase Antiseixure meds when giving OCP

179
Q

Treatment of yeast(candida)

A

Clotrimazole (Antifungal)

180
Q

warfarin causes what in 1st trimester?

A

chondrodyplasia punctata (fetal)

181
Q

warfarin causes what in 2nd and 3rd trimester?

A

Optic neuropathy (fetal)

182
Q

Levels of Estrogen/LH/FSH in menopause

A

decreased/increased/increased

183
Q

what reduces the risk of preclampsia during pregnancy?

A

Calcium….1000mg daily

184
Q

1st inv in 1ry amenorrhea:……
If secondary sexual characteristics exist………
If NO 2ry sexual characteristics………….

A

US…

FSH and LH

185
Q

Most impoartant risk factor for developing endomitritis?

A

Csection

186
Q

pt with hx of ectopic pregnancy, can not use for ….ocp?

A

POP

187
Q

Salbutamol can be used as tocolytic in what type of DM

A

NIDDM

188
Q

which contraceptive is indicated for breast feeding mother?

A

POP

COP can be used once stop breastfeeding, it reduces breast milk supply if used while breast feeding

189
Q

nerve involved in saturday night palsy

A

Radial nerve (saturday nites, we play Raggae)

190
Q

Most appropriate test to detect ovulation is ?

A

serum progesterone

191
Q

MC reason for csection in Aus?

A

Previous csection

192
Q

MC symptom in Endomitriosis?

A

Dysmenorrhea

193
Q

Prefered methos of abortion <20 weeks in Aus?

A

Suction and Curettage

194
Q

which subtsance is elevated during pregnancy?

A

ALP

195
Q

mc feature of turner syndrome?

A

short stature

196
Q

tx of cyclic mastalgia 1.medical

2. Non medical

A

Danazol if analgesics failed

primrose oil

197
Q

Complications of severe preclampsia that overlaps with Fatty liver of pregnancy?

A

HELLP

198
Q

What to do about OCP with Hx of smoking, Breastfeeding, post/peri menopausal?

A

Avoid Estrogen

199
Q

in pregnancy,1. levels of protein c and s

2. levels of factors V and VII?

A
  1. c see u later low

2. high

200
Q

how long does postpartum blues last for?

A

2 weeks

201
Q

1st line tx for menorrhagia

A

Tranexamic acid

202
Q

1st line tx of BV in pregnancy is?

A

Clindamycin

203
Q

what to do if pt infected with acute rubella in 1st trimester?

A

terminate pregnancy

204
Q

Most likely cause of oligohydraminos in 2nd trimester?

A

Renal Agenesis

205
Q

presence or absence of fetal fibronectin is an indicator of birth within 7 days?

A

Absence

fetal fibronectin glues moter to baby,,,ig gone, baby comes out!

206
Q

First line contraceptive choice for women on enzyme inducing anti epileptic drugs?
SCRAP GP

A

Levonorgestrel IUD

sulphonyureas
Carbamezapine
Rifampin
Alcohol
Phenytoin
Griseofluvin
Phenobarb
207
Q

which contraceptive is absolutely contraindicated with the use of anit epileptics?

A

POP

208
Q

Hep C pt with cracked nipples and bleeding breastfeeding, what to tell her?

A

Avoid breastfeeding until cracked nipples heal

209
Q

Migraine in pregnancy, what to give?

A

codeine and metoclopramide

210
Q

Which valvular defect can lead to death during pregnancy?

A

MS……can develop afib

211
Q

In pt with Pulmonary HTN during delivery, avoid?

A

CSection………go for vaginal delivery which is less stressful

212
Q

old woman with osteoporosis and Hx of breast cancer, wat to use

A

bisphosphonates

213
Q

Tx of DVT in pregnancy? how long?

A

Therapeutic dose of LMWH

3 months

214
Q

Hormone levels in menopause?

A

low estrogen,,,,,,,increased LH and FSH

215
Q

when to start pap smear?

A

2 years after intercourse or 25 yrs which ever comes first

216
Q

most useful to blood test to evaluate for osteoporosis

A

25 hydroxy vitamin D

217
Q

Most important endocrine test to assess for male infertility?

A

Serum FSH (it is high when infertile 2.5 times normal)

218
Q

Anti epileptic drugs that do not affect OCP

A

Gabas/valproate/leventis

219
Q

Pregnant pt with positive CMV IgM, what to do?

A

Check if fetus has been infected

AMC MCQ (14 decks)

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