OBGYN Review Flashcards
Inv of choice :
If secondary sexual characteristics exist
If NO 2ry sexual characteristics
US
FSH and LH
If XX»>
Manag:
mullerian agenesis.
elongation of vagina.
If XY»>
Manag:
androgen insensitivity $. removal of testis after puberty.
1ry amenorrhea, +ve uterus, no breast.. next step:
karyotyping.
If XX»>
TTT
HPO failure.
: GnRH; pulsatile form.
If XO»
Manag:
turner $(gonadal dysgenesis). hormonal replacement after puberty.
1ry amenorrhea, abd. Pain at the middle of the month»
imperforate hymen
Physical findings in imperforate hymen»
bluish discoloration.
TTT of imperforate hymen»>
surgery under anesthesia.
1st step with 2ry amenorrhea:
pregnancy test.
MC site of fibroid
intra-mural
Fibroid that causes subfertility and recurrent abortion
sub mucosal
TTT of fibroid:
myomectomy… give GnRH 3-6ms b4 operation.
Pregnant with H/O fibroid has abd. Pain and fever……… Dx
TTT:
red degeneration of the fibroid….
Analgesic.
Pain with menstruation with no underlying pathology
1ry dysmenorrhea.
TTT of 1ry dysmenorrhea 1st line
2nd line
1st line: NSAIDs
2nd line: OCPs.
Infertility + dysmenorrhea, dysuria, dyschezia, dyspareunia… Dx
endometriosis
MC site of endometriosis:
ovary (chocolate cyst)… the cause of infertility.
Inv. Of choice of endometriosis
laparoscopy (surgery)
TTT of endometriosis
OCPs or encourage pregnancy.
TTT of severe cases of endometriosis:
GnRH analogue or leuprolide (androgen).
TTT of severe cases of endometriosis in old age:
TAH, BSO
Endometrial gland in myometrium
adenomyosis.
CP of adenomyosis
menorrhagia and dysmenorrhea
TTT of adenomyosis:
OCPs.. if failed: TAH, BSO.
Obese female with infertility, irregular bleeding, acne& hirsutism..Dx
PCOS
Cause of infertility in PCOS
anovulation.
Most imp. Inv. Of PCO:
testosterone (free & total). elevated
TTT of PCO
clomiphene citrate for infertility,
OCPs for irregular bleeding
The most imp. Advice for PCO pts
Wt loss
MCC of hirsutism
TTT:
idiopathic hirsutism.
Aldosterone.
Female in 3rd decade with signs of menopause; Dx
premature ovarian failure.
Most imp inv. Of premature ovarian failure
increased FSH.
OCPs are for?
for sexually active and those who don’t need kids
HRT»
for those who aren’t sexually active and want kids
IVF with egg donation»
for those who want to get pregnant
Foul smelling vaginal discharge, clue Cells under nicroscope; Dx
B.vaginosis
Causative organism of B. vaginosis
gardenella vaginalis.
TTT of B. vaginosis
oral metronidazole (safe in pregnancy)+ no need for partner TTT.
strawberry cervix, motile flagellated organism under microscope; Dx
Trichomonas vaginalis.
TTT of trichomans vaginalis
oral metronidazole(u must treat partner as well)
Thick, cheesy, odorless, pseudohyphae under microscope, Dx
candida vaginalis.
TTT of candida vaginalis
oral fluconazole(if pregnant: fluconazole cream) and no need for partner TTT.
Cause of cyclic vulvovaginitis
candida vaginalis
TTT of recurrent vulvovaginitis
oral fluconazole
Post-menopause with long standing H/O of vulvar itching; 1st step
punch biopsy
TTT of lichen sclerosus
cortisone cream(but, bunch biopsy 1st to exclude malignancy)
Screening test of Chlamydia
all sexually active female from 15-29 yrs every year
Offer the girl “opportunistic screening” in each visit
MCC of cervical muco-purulent discharge in female
chlamydia
Recurrent subclinical cervicitis due to Chlamydia> adhesion> leads to?
infertility
TTT of Chlamydia
azithromycin+ ceftriaxone (treat both Chlamydia and gonorrhea)
Partner tracing is very important.
After TTTof Chlamydia
search for other STDs(e.g. ELISA for HIV, VLDL for syph.)
Chlamydia outbreak(e.g. in high school)
Education first. give condoms(recently, lecture about safe sex is the right answer even if condom is found in answers)
Screening of cervical cancer (pap smear):
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
(pap smear) Lesbians, HPV vaccine»
screen
(pap smear) Virgin»
No screening.
Pap smear interpretation:
Abnormal result in presence of infection
repeat screening after TTT of inf.
LSIL
repeat after 12ms; if still LSIL: colposcocy
LSIL for those >30 yrs old
colposcopy
HSIL
colposcopy
Give HPV to all female»_space;
from 9-45 Ys.(max. benefit: b4 starting intercourse)
Vaccine can be given for those
sexually active females, previous genital warts,
Previous abnormal cytology and lactating females.
Vaccine can’t be given to»
immuocompromised & pregnant females
MC risk factor of endometrial cancer
obesity.
Best inv. For suspected endometrial cancer
hystrescopy and biopsy.
Female with +ve BRCA1, BRCA2 mutation, are risk for what 2 cancers?» BO?
Breast and Ovarian Cancer
Screening of ovarian cancer»
is no longer recommended even in high risk Pts
Ovarian cyst in US of an old female; next step
CA125 even if the cyst is simple.
Urinary incontinence with increase intra-abdominal pressure (e.g. coughing, laughing)
= stress incontinence (MCC of incontinence in females).
Inv. Of choice of stress incontinence
urodynamics
1st line: tx for stress incontinence?
kegel exercise.
If no response to exercise:
surgery (TAH or vaginal hysterectomy)
If old pt (can do neither exercise nor operation) in stress incontinence, then what to use?
pessaries.
Urinary incontinence in all the time, position.. Dx
Total incontinence
MCC of total incontinence
TTT:
fistula…
surgery.
Strong unexpected urge to void not related to position
= urge incontinence.
Inv of choice of urge Incont.
UA. urine analysis
TTT of urge; 1st line
if failed?
bladder training.
If failed: anticholenergic or TCA
Urinary incontinence in pt with long standing DM»
overflow incontinence
TTT of overflow incontinence
intermittent cath.
Main ligament supporting the uterus is»
utero-sacral ligament
2nd MC site of endometriosis
utero-sacral ligament
MCC of PID
Chlamydia and 2nd MC organism: gonorrhea.
Adult with painful ulcer on genitalia
has HSV until proven otherwise.
Adult with painless ulcer on genitalia
has syph. until proven otherwise
MC type of ovarian cyst
follicular cyst
Ovarian cyst>6cm
laparoscopical removal.
Ovarian cyst<6cm
OCPs and repeat US in 6-8Ws.. if persist: laparoscopy.
Most imp to be evaluated for female puberty assessment
breast budding
Mother worry as her daughter have no menses yet»
look for breast budding
Time from breast budding to menarche:
about 2 Yrs.
2ry sexual characteristic<8 Ys in females
= precocious puberty
1st step in manag. Of precocious puberty»
x-ray to determine bone age.
Breast development<3ys only with no other 2ry sexual characteristics..Dx»
management:
premature thelarche…
reassure only.
Ethics of abortion in Australia:
Process of abortion»>
1st: counseling,
2nd: get informed consent
& then do the abortion
Who can give informed consent»>
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.
Who should do the abortion?
only the physician.
Where the abortion should be done?
only in 3ry hospital howeverr far is it
Is abortion legally allowed?
Abortion is legally allowed at any time during pregnancy
Can a physician refuse to do abortion?
U can refuse to do abortion… u should refer to another physician.
Inv. Of choice for Dx of osteoporosis:
DEXA scan.
DEXA scan interpretation:
a. (-1:-2.5): osteopenia. b. (>-2.5
When to say osteoporosis??
1-T-score less than 2.5 2- minimatrauma fracture
Inv. Of choice for suspected osteoporotic bone fracture?
X-ray.
Prevention of osteoporosis»>
Ca &; vit.D
TTT of osteoporosis»>
bisphosphonate (even if ca&vit.D are present in MCQ)
TTT of osteoporosis in pt with H/O breast cancer»
raloxifen (SERM).
Inv. Of choice for menopause:
FSH (increased).
MC symptom of menopause, MC indication for HRT in menopause:
hot flushing.
MC symptom to be improved after HRT:
hot flashing.
Can menopause and HRT cause depression?
Depression is neither a part of normal menopause nor responds to HRT.
MCC of dysfunction bleeding at the beginning of
puberty:
anovulation
MCC of dysfunction bleeding near menopause:
anovulation.
Menopause + irregular bleeding
= cancer endometrium until proven
otherwise……….. next step: hysteroscopy & biopsy.
MCC of post- menopausal bleeding»>
atrophic vaginitis.
Menopause + bleeding in the 1st year»>
follicular activation
Menopause+ bleeding+ pain during sex
= vaginal atrophy
Menopause+ bleeding+ no pain during sex
= endometrial cancer.
Menopause+ brownish discharge
= endometrial cancer.
Menopause+ green, yellow or gray discharge
= infection
Indication of HRT:
hot flushes, osteoporosis.
Duration of HRT»>
not >5 Yrs
Types of HRT:
Continuous……….
Cyclic…
……….for menopausal women
……for perimenopause.
Female on HRT develop unpredictable bleeding.. mode of HRT:
continuous form.
Post-menopausal with H/O hysterectomy:
give estrogen only.
Post-menopause with H/O DVT need HRT:
no estrogen should be given & if you have to give estrogen: give estrogen patches.
Post-menopausal with H/O breast cancer:
give paroxitine(SSRI).then clonidine
Post-menopausal with atrophic vaginitis only:
give estrogen cream.
Post-menopausal on HRT for 5Yrs:
trial of stoppage
Pt on anti-epileptic need OCPs:
give high dose estrogen (microgynon 30-50).
Pt on OCPs, recently started anti-epileptic mededications…. next step:
increase estrogen dos.
lamitrogen acts the other way
Contra-indication of OCPS other than DVT& estrogen-dependent tumour»
migraine with aura is an absolute contra-indication of OCPs use.
2 imp. Indications of POPs:
Lactating pt and pt with migraine.
Wt to give for emergency contraception:
levonorgestrel 750mg.
When to give emergency contraception?
condom rupture, unplanned pregnancy.
Complications of IUCD:
bleeding, infection.
Most sensitive method of natural contraception:
increase cervical secretions.
Tubal ligation consent
taken from the female only.
OCPs with lactation what to give?
POP is the best, start 6 Ws after delivery, never estrogen.
Pt on OCPs develops chloasma, what to do?
stop estrogen.
Pt on OCPs develops HTN; next step:
stop OCPs 1st and then check response.
Pt on OCPs develops headache; next step:
stop OCPs 1st & then check response.
MC indication of OCPs after delivery:
low frequency of breast feeding
Most benefit of Yasmine:
wt loss.
1st step in evaluation of infertile couple:
semen analysis.
MCC of decreased sperm count:
alcohol.
+ve progesterone withdrawal test (i.e. withdrawal bleeding)
= anovulation.
Infertile couple, male has no offspring and; female in 40s with 2 offspring.. cause of infertility in this couple:
female (anovulation DT aging).
Old female not easy to get pregnant
bad quality and quantity of the ova
Female near menopause want to get pregnant:
IVF.
Cause of infertility in male with CF»
absence of vas deference.
Cause of infertility in those undergone any uterine procedure:
Asherman’s $
Metastasis from GIT to ovary; 1st MC:& 2nd MC:
stomach
colon.
Physical & psychological distress few Ds b4 menstruation:
premenstrual $.
Best way to diagnose premenstrual $:
menstrual dairy.
1st line TTT of premenstrual $:
relaxation therapy.
2nd line TTT of premenstrual b$:
SSRI.
1st line TTT of severe menstrual $ affecting, pt relations:
SSRI.
1st step in management of excessive menstrual bleeding:
TSH.
If TSH is normal; next step:
TVS.
Young female with solid & cystic mass in US.. Dx:
dermoid cyst.
MC site of dermoid cyst:
ovary.
9 yrs kid started menstruation
normal puberty
2 yrs kid started menstruation:
precocious puberty
2 yrs kid with breast enlargement only:
thelarche
Main site of action of pop( low dose):
cervix
Main site of action of pop ( normal dose):
ovary
Main site of action of combined oral contraceptive:
hypothalamo pituitary ovarian axis
Site of sample in female with vaginal discharge
endocervical
Most common cause of infertility in female with normal examination
tube adhesion
Most common cause of infertility in couple with normal investigations
tube adhesion
Most common cause of infertility in couple who had a kid before
tube adhesion
Imp Inv. for Old age + fracture before discharge from the hospital:
bone scan
Best inv. for Chlamydia:
PCR 1st catch urine
Most common malignancy in PCOS
endometrium
does haloperidol cause pin point pupil?
No
In a patient with Hx of DVT, what contraceptive should we avoid?
Estrogen
cervical screening should start when?
2 years after sexual intercourse
how does OCP affect anti seizure meds?
increase metabolism, there increase Antiseixure meds when giving OCP
Treatment of yeast(candida)
Clotrimazole (Antifungal)
warfarin causes what in 1st trimester?
chondrodyplasia punctata (fetal)
warfarin causes what in 2nd and 3rd trimester?
Optic neuropathy (fetal)
Levels of Estrogen/LH/FSH in menopause
decreased/increased/increased
what reduces the risk of preclampsia during pregnancy?
Calcium….1000mg daily
1st inv in 1ry amenorrhea:……
If secondary sexual characteristics exist………
If NO 2ry sexual characteristics………….
US…
FSH and LH
Most impoartant risk factor for developing endomitritis?
Csection
pt with hx of ectopic pregnancy, can not use for ….ocp?
POP
Salbutamol can be used as tocolytic in what type of DM
NIDDM
which contraceptive is indicated for breast feeding mother?
POP
COP can be used once stop breastfeeding, it reduces breast milk supply if used while breast feeding
nerve involved in saturday night palsy
Radial nerve (saturday nites, we play Raggae)
Most appropriate test to detect ovulation is ?
serum progesterone
MC reason for csection in Aus?
Previous csection
MC symptom in Endomitriosis?
Dysmenorrhea
Prefered methos of abortion <20 weeks in Aus?
Suction and Curettage
which subtsance is elevated during pregnancy?
ALP
mc feature of turner syndrome?
short stature
tx of cyclic mastalgia 1.medical
2. Non medical
Danazol if analgesics failed
primrose oil
Complications of severe preclampsia that overlaps with Fatty liver of pregnancy?
HELLP
What to do about OCP with Hx of smoking, Breastfeeding, post/peri menopausal?
Avoid Estrogen
in pregnancy,1. levels of protein c and s
2. levels of factors V and VII?
- c see u later low
2. high
how long does postpartum blues last for?
2 weeks
1st line tx for menorrhagia
Tranexamic acid
1st line tx of BV in pregnancy is?
Clindamycin
what to do if pt infected with acute rubella in 1st trimester?
terminate pregnancy
Most likely cause of oligohydraminos in 2nd trimester?
Renal Agenesis
presence or absence of fetal fibronectin is an indicator of birth within 7 days?
Absence
fetal fibronectin glues moter to baby,,,ig gone, baby comes out!
First line contraceptive choice for women on enzyme inducing anti epileptic drugs?
SCRAP GP
Levonorgestrel IUD
sulphonyureas Carbamezapine Rifampin Alcohol Phenytoin Griseofluvin Phenobarb
which contraceptive is absolutely contraindicated with the use of anit epileptics?
POP
Hep C pt with cracked nipples and bleeding breastfeeding, what to tell her?
Avoid breastfeeding until cracked nipples heal
Migraine in pregnancy, what to give?
codeine and metoclopramide
Which valvular defect can lead to death during pregnancy?
MS……can develop afib
In pt with Pulmonary HTN during delivery, avoid?
CSection………go for vaginal delivery which is less stressful
old woman with osteoporosis and Hx of breast cancer, wat to use
bisphosphonates
Tx of DVT in pregnancy? how long?
Therapeutic dose of LMWH
3 months
Hormone levels in menopause?
low estrogen,,,,,,,increased LH and FSH
when to start pap smear?
2 years after intercourse or 25 yrs which ever comes first
most useful to blood test to evaluate for osteoporosis
25 hydroxy vitamin D
Most important endocrine test to assess for male infertility?
Serum FSH (it is high when infertile 2.5 times normal)
Anti epileptic drugs that do not affect OCP
Gabas/valproate/leventis
Pregnant pt with positive CMV IgM, what to do?
Check if fetus has been infected
