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AMC MCQ - Key points > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Describe the most common risk factor for uterine fibroids (leiomyomas)

A

Race, specifically Black race

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2
Q

Define primary dysmenorrhea

A

Lower crampy abdominal pain during menstruation in young females

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3
Q

How can endometriosis be diagnosed?

A

Laparoscopy is the investigation of choice

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4
Q

What is the first-line treatment for primary dysmenorrhea?

A

NSAIDs

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5
Q

Do young patients with adenomyosis benefit from oral contraceptive pills (OCP)?

A

Yes, they can be treated with OCPs

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6
Q

Describe the presentation of Mullerian agenesis

A

Normal female secondary development, no uterus, blind end vagina

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7
Q

What is the treatment for Androgen Insensitivity Syndrome after puberty?

A

Removal of testes

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8
Q

How is Turner syndrome characterized genetically?

A

45 XO karyotype

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9
Q

Describe the clinical features of Turner syndrome.

A

Short stature, low IQ, webbed neck, wide spaced nipples, congenital lymphedema, horseshoe kidney, cubitus valgus, and certain heart defects like coarctation of the aorta and bicuspid aortic valve.

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10
Q

What are the causes of hypothalamic pituitary failure?

A

Causes include anorexia, strenuous exercise, severe stress, and congenital conditions like Kallman syndrome.

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11
Q

Define Kallman syndrome and its clinical presentation.

A

Kallman syndrome is characterized by low GnRH, low FSH and LH levels, resulting in low estrogen and progesterone. It presents with anosmia and imperforate hymen.

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12
Q

How is imperforate hymen diagnosed and treated?

A

Diagnosed by cyclic abdominal pain, bulging bluish hymen on exam, and ultrasound showing a distended vagina and uterus. Treatment involves surgery under anesthesia.

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13
Q

Describe the clinical features and causes of secondary amenorrhea.

A

Clinical features include absence of menstruation, normal breasts, and a distended abdomen. Causes include obesity, excessive exercise, low body fat, anxiety, hyperprolactinemia, and other medical conditions.

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14
Q

What are the clinical features and investigations for polycystic ovarian syndrome (PCOS)?

A

Clinical features include irregular bleeding, obesity, acne, hirsutism, and infertility. Investigations show increased androgens, testosterone, LH, and a reversed LH: FSH ratio on blood tests, and a necklace appearance on ultrasound.

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15
Q

How is PCOS managed?

A

Management includes weight loss advice, OCPs for irregular bleeding and hirsutism, and clomiphene or gonadotropins for infertility. Metformin can be used for insulin resistance.

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16
Q

Describe the clinical features and treatment of congenital adrenal hyperplasia.

A

Features include salt-losing crisis in infancy, masculinized external genitalia in females, hirsutism, acne, and irregular cycles in adults. Treatment involves cortisone replacement.

Palpable gonads:
-Pelvic ultrasound
-Testosterone and dihydrotestosterone (DHT) ratio.
-LH and FSH.
-ACTH stimulation test.
-hCG stimulation test

No palpable gonads:
- markedly elevated 17-hydroxyprogesterone 90%
-Serum electrolytes.
-Plasma renin activity

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17
Q

What is the most common cause of idiopathic hirsutism and its treatment?

A

Idiopathic hirsutism is the most common cause of hirsutism without virilization. It is treated with spironolactone. Premature ovarian failure is characterized by menopausal symptoms before age 30 with a positive family history.

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18
Q

Describe the treatment approach for a patient with increased FSH who wants to have kids.

A

Hormone replacement therapy (HRT)

In Women:
Menopause:

During menopause, the ovaries reduce their production of estrogen and progesterone. In response, the pituitary gland releases more FSH to stimulate the ovaries, leading to high FSH levels.
Primary Ovarian Insufficiency (POI):

Also known as premature ovarian failure, POI is characterized by the loss of normal ovarian function before age 40. High FSH levels indicate the ovaries are not responding adequately to stimulation.
Polycystic Ovary Syndrome (PCOS):

Women with PCOS may have higher levels of FSH as part of the hormonal imbalances associated with the condition, though elevated LH (luteinizing hormone) is more common.

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19
Q

What is the recommended treatment for a patient with increased FSH who does not want to have kids and is sexually active?

A

Oral contraceptive pills (OCP)

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20
Q

How would you manage vaginal discharge in a female neonate with bloody discharge a few days after delivery?

A

Reassure

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21
Q

Define physiologic leucorrhea.

A

Clear or thin whitish discharge with no offensive odor or itching

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22
Q

What is the most common cause of bacterial vaginosis?

A

Gardnerella vaginalis

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23
Q

Describe the clinical presentation of bacterial vaginosis.

A

Thin, grayish-white discharge with a fishy odor

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24
Q

What is the drug of choice for treating bacterial vaginosis?

A

Metronidazole

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25
Q

How would you manage a patient with trichomonas vaginalis infection during pregnancy?

A

Metronidazole

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26
Q

Do you need to treat the partner of a patient with trichomonas vaginalis infection?

A

Yes, it is necessary

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27
Q

Define candida and list some risk factors for its occurrence.

A

A non-sexually transmitted infection; Risk factors include diabetes, immunodeficiency, prolonged antibiotic use, and pregnancy

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28
Q

What is the recommended treatment for candida infection with recurrent vulvovaginitis?

A

Oral fluconazole

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29
Q

How would you manage a cervical polyp presenting with bleeding after sexual intercourse?

A

Twisting

Finger liks projections

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30
Q

Describe the clinical presentation of cervicitis.

A

Mucopurulent cervical discharge

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31
Q

What are the most common causative organisms of cervicitis?

A

Chlamydia and gonorrhea

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32
Q

How should you approach the treatment of Chlamydia and gonorrhea in a patient with cervicitis?

A

Treat both infections simultaneously

33
Q

Describe the complications associated with untreated chlamydia infection.

A

Complications include acute PID, infertility, and ectopic pregnancy.

34
Q

What is the drug of choice for treating chlamydia?

A

Azithromycin.

35
Q

How often should sexually active females aged 15-29 be screened for chlamydia?

A

Every 12 months.

36
Q

Define Cervical Intraepithelial Neoplasia (CIN) 1 and 2.

A

CIN 1 and 2 are precancerous changes in the cervix.

High grade

37
Q

What is the recommended treatment for CIN 1 and 2?

A

Results
Negative
LSIL
HSIL/glandular changes Unsatisfactory
Action
Repeat smear 2 years Repeat smear 12 months Colposcopy
Repeat 6–12 weeks

Cancer Council
https://www.cancer.org.au › treatm…
Colposcopy and treatment
Treatment should be reserved for women with histologically confirmed HSIL (CIN2/3) or AIS, except for women requiring diagnostic excisional biopsy. Consensus- …
Missing: racgp ‎| Show results with: racgp

38
Q

Do all partners of a patient with chlamydia need to be traced, tested, and treated?

A

Yes, all partners should undergo this process.

39
Q

How should cervical cancer screening be done?

A

Through a pap smear, sampling the ectocervix and endocervix.

The National Cervical Screening Program changed on 1 December 2017. The Pap smear test has been replaced by a new HPV cervical screening test with reflex liquid-based cytology (LBC) for oncogenic HPV positive samples.
https://www.racgp.org.au › preven…
Prevention and early detection of cervical cancer - RACGP

40
Q

Describe the screening frequency for cervical cancer.

A

Screening

Asymptomatic women aged 25–69 years who have ever been sexually active
Offer cervical screening test (HPV) from age 25 years (or two years after commencing sexual activity, whichever is later) regardless of whether HPV vaccination has been given

Note: As of 1 December 2017, Pap smears are no longer recommended as a screening test for cervical cancer

Every five years racgp

41
Q

What is the most common site for cervical neoplasia?

A

Transformation zone.

42
Q

What are the risk factors associated with cervical neoplasia?

A

HPV infection (16, 18, 31, 33, 35), early sexual activity, multiple partners, prostitution, and smoking.

43
Q

How should CIN 1 and 2 be managed?

A

Usually observation or minor interventions.

44
Q

How many doses of Gardasil vaccine are recommended?

A

3

A two-dose schedule with an interval of 6–12 months between doses is appropriate for those aged ≤14 years at the time of first dose. Older individuals and those who are immunocompromised should continue to receive the three-dose schedule at zero, two and six months.
https://www1.racgp.org.au › …PDF
Human papillomavirus vaccination update - RACGP

45
Q

What is the maximum age for females to receive the HPV vaccine?

A

45

Can I get the HPV vaccine at 40 in Australia?
The HPV vaccine is approved for use in Australia for females aged 9 to 45 years and males aged 9 to 26 years, however the vaccine is only free for those aged 12-25 …

https://www.hpvvaccine.org.au › ab…
About the HPV vaccine
Cervarix® (GlaxoSmithKline) is a bivalent VLP HPV vaccine (2vHPV; types 16 and 18) registered in Australia for use in females aged 10–45 years.

https://www.ncirs.org.au › …
Human papillomavirus (HPV) vaccines for Australians - NCIRS fact sheet

46
Q

What is the most common gynecological cancer?

A

Endometrial cancer

47
Q

What are the risk factors for endometrial cancer?

A

Unopposed estrogen, obesity, hypertension, diabetes, nulliparity, late menopause, PCOS, chronic anovulation

48
Q

What is the main treatment for ovarian cancer?

A

Debulking operation

Risk‑reducing surgery with bilateral salpingo‑oophorectomy is recommended for women at high risk of developing ovarian cancer. Ovarian cancer treatment still centres on surgery and chemotherapy, with aggressive cytoreductive techniques and intraperitoneal treatments being evaluated in advanced disease.

Advances in epithelial ovarian cancer - RACGP

49
Q

What is the most common cause of postmenopausal bleeding until proven otherwise?

A

Vaginal atrophy

50
Q

What are the risk factors for pelvic organ prolapse?

A

Vaginal birth, advancing age, pelvic surgery

51
Q

What is the most common type of incontinence characterized by uncontrolled loss at all times and in all positions?

A

Total incontinence

52
Q

What is the first-line treatment for pelvic organ prolapse in older patients?

A

Kegel exercises

53
Q

What is the most common surgical procedure for pelvic organ prolapse?

A

Vaginal or abdominal hysterectomy

54
Q

Describe stress incontinence

A

Involuntary leakage of urine due to increased intra-abdominal pressure, commonly seen in multiparous women or after pelvic surgery.

55
Q

What is the most common cause of detrusor hyperreflexia (urge incontinence)?

A

Inflammatory conditions or neurogenic disorders of the bladder.

56
Q

Define overflow incontinence

A

Chronic urinary retention leading to a distended bladder and dribbling of urine due to intravesical pressure exceeding outlet resistance.

57
Q

How is detrusor hyperreflexia (urge incontinence) typically managed as a first-line treatment?

A

Bladder training is the first-line treatment, and if unsuccessful, anticholinergic or tricyclic antidepressants may be used.

58
Q

Describe pelvic inflammatory disease

A

An infection of the female reproductive organs, often caused by sexually transmitted organisms like chlamydia and gonorrhea, presenting with symptoms like lower abdominal pain, fever, and cervical discharge.

59
Q

What is the main ligament supporting the uterus?

A

Uterosacral ligament.

60
Q

Do functional ovarian cysts commonly present with abdominal pain and uterine bleeding?

A

Yes, functional ovarian cysts can present with abdominal pain and uterine bleeding.

61
Q

How are small Bartholin cysts typically managed?

A

Small Bartholin cysts are usually left untreated.

  1. History and Examination:
    • Assess the size, location, and symptoms of the cyst.
    • Look for signs of infection (redness, warmth, pain, fever).
  1. Asymptomatic Cysts:
    • Often do not require treatment.
    • Regular monitoring and self-care advice (good hygiene, warm baths).
  2. Symptomatic or Infected Cysts:
    • Incision and Drainage: For abscesses, make a small cut to drain the pus.
    • Marsupialization: Create a permanent opening to prevent recurrence. Typically done for recurrent cysts or abscesses.
    • Word Catheter: Insert a small balloon catheter to keep the duct open for several weeks, allowing drainage and healing.
  3. Antibiotics:
    • Prescribed if there is evidence of infection.
    • Common choices include trimethoprim-sulfamethoxazole or clindamycin.
  4. Pain Management:
    • NSAIDs or acetaminophen to manage pain and inflammation.
  5. Referral:
    • Refer to a gynecologist if the cyst is recurrent, complicated, or does not respond to initial treatment.

For more detailed guidelines, refer to the RACGP resource on managing vulval conditions and Bartholin cysts: RACGP - Common vulval dermatoses

62
Q

Define Marsupialization in the context of Bartholin cysts

A

A surgical procedure where the cyst is opened and sutured to the edges of the wound to create a permanent opening.

63
Q

What is the management approach for functional ovarian cysts smaller than 6 cm in size?

A

Rescan after 6-8 weeks and consider giving oral contraceptive pills.

64
Q

Describe the complications associated with functional ovarian cysts

A

Complications can include torsion leading to severe abdominal pain and rupture causing an acute abdomen.

65
Q

Describe the characteristics of a complex cyst that may indicate the need for laparotomy if ruptured.

A

More than 6 cm in size, persistent after 2 months, suspected in old age, and if complex.

66
Q

What is Toxic Shock Syndrome (TSS) and what is its common cause?

A

A condition caused by S. aureus toxin (TSST-1) often associated with tampon use.

67
Q

What are the common signs and symptoms of Toxic Shock Syndrome (TSS)?

A

Abrupt onset of fever, vomiting, watery diarrhea, diffuse rash, and desquamation, especially on palms and soles.

68
Q

How is Toxic Shock Syndrome (TSS) treated?

A

Rapid rehydration is a key part of the treatment.

69
Q

Define the normal stages of puberty in females.

A

Thelarche (breast budding), pubarche (pubic hair growth), increase in growth velocity, and menstruation (menarche).

70
Q

What is the most important question to ask a female with delayed menstruation?

A

Timing of breast budding, as menstruation usually occurs 2 years after breast budding.

71
Q

Describe the signs of precocious puberty in females.

A

Development of secondary sexual characteristics before the age of 8, such as breast development and vaginal bleeding.

72
Q

What is the first step in diagnosing precocious puberty?

A

Obtaining an x-ray of the wrist and hand to determine bone age.

73
Q

How is central precocious puberty differentiated from peripheral precocious puberty?

A

Central precocious puberty results from early activation of hypothalamic GnRH production, while peripheral precocious puberty is due to nonhypothalamic GnRH production.

74
Q

What is the treatment approach for central precocious puberty?

A

Leuprolide is the first-line treatment.

75
Q

Describe premature thelarche in girls.

A

Breast development in girls under 3 years old, often caused by maternal estrogens with no other signs of puberty.

76
Q

What should be done for a 9-year-old who starts menstruating?

A

Considered normal puberty.

77
Q

What does it indicate if a 7-year-old starts menstruating?

A

Indicates precocious puberty.

78
Q

What does breast enlargement in a 2-year-old without other signs of puberty suggest?

A

Premature thelarche.

AMC MCQ - Key points (49 decks)

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