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Obstetrics & Gynecology Flashcards

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USMLE® Step 1 flashcards
1
Q

غربالگری کنسر سرویکس

A

توصیه نمی‌شود

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2
Q

غربالگری کنسر سرویکس ۲۱-۲۹
روش؟
هر چند سال؟

A

روش بررسی پاتولوژیک پاپ اسمیر (سایتولوژی)
تکرار هر سه سال

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3
Q

غربالگری کنسر سرویکس ۳۰-۶۵

A

تست ترکیبی سایتولوژی + بررسی سوش‌های خطرناک HPV
تکرار هر ۵ سال
سایتولوژی تنها هم قابل انجام

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4
Q

غربالگری کنسر سرویکس > ۶۵

A

توقف اگر
هیچ وقت ضایعات CIN=> 2 نداشته
و اگر داشته بیشتر از ۲۰ سال گذشته باشه
و
منفی به اندازه کافی داشته باشه ۳تا سایتولوژی منفی طی ۱۰ سال گذشته یا ۲ تا گزارش ترکیبی منفی در طی ۱۰ سال گذشته که جدیدترینش ۵ سال پیش باشد

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5
Q

غربالگری کنسر سرویکس در کسی که توتال هیسترکتومی

A

توقف

اگر هیچ وقت ضایعات CIN=> 2 نداشته
و اگر داشته بیشتر از ۲۰ سال گذشته باشه

اگر داشته باشد تا ۲۰ سال ادامه غربالگری

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6
Q

غربالگری کانسر سرویکس با توالی بیشتر چه زمانى لازم است؟ (۳ تا)

A

دی استیل استرول زمان جنینی
نقص ایمنی HIV
سرطان , CIN 2 , 3

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7
Q

Mammo screening فواصل
45-54 y 55 y

A

1 y 2 y

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8
Q

Dysmenorrhea ttt

A

NSAID

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9
Q

Fundus of uterus wich lymph node drain

A

Para Aortic

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10
Q

Most common cause of hereditary breast and ovarian cancers

A

BRCA mutation

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11
Q

Most common site of breast cancer

A

Upper outer quadrant

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12
Q

Bilateral breast cancer

A

Lobular carcinoma

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13
Q

Tamoxifen (for breast cancer) SE

A

Increase risk Endometrial cancer

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14
Q

Reconstruction of breast with ? muscle, the ? artery maybe injured

A

Rectus muscle
Inferior epigastric artery

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15
Q

Postmenopausal symptoms reach to diagnosis?

A

FSH

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16
Q

After delivery unable to breast feed, no milk at all Dx?

A

Sheehan synd

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17
Q

Intermittent bloody nipple discharge
Most likely Dx

A

Intraductal papilloma

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18
Q

Self breast exam فواصل

A

Every month

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19
Q

Suspecting intraductal papilloma
next step?

A

Excision

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20
Q

Intermittant bloody discharge from one nippel SECOND common cause

A

Intraductal carcinoma

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21
Q

G P Ab Lc

A

Gravid چندمين باردارى

Para چندمين زايمان

Abbortion تعداد سقط

Living child تعداد بچه‌های زنده

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22
Q

Pap smear frequency

A

Every 3 years
Women between 21-65

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23
Q

TVUS

A

Trans vaginal ultrasound

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24
Q

AFI

A

Doctors commonly measure the depth of the fluid in four quadrants in the uterus and add them up. This method of measuring amniotic fluid is referred to as the amniotic fluid index (AFI). If the amniotic fluid depth measures less than 5 centimeters, the pregnant woman has oligohydramnios (or polyhydramnios).

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25
Q

ECV

A

External cephalic version, or ECV, is a maneuver your doctor may use when your unborn baby is set up to come out bottom first or feet first. Those positions are called a breech birth, and they can make a vaginal birth more difficult

اگر شکم بیمار ساعت باشد ساعد گرد می‌چرخانیم

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26
Q

ROM

A

Tearing or rupture of membranes (ROM) normally occurs during labor. Premature rupture of membranes (PROM) is defined as rupture of membranes before the onset of labor. Membrane rupture that occurs before 37 weeks of gestation is referred to as preterm PROM (PPROM)

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27
Q

CTG

A

Cardiotocography (CTG) measures your baby’s heart rate. At the same time it also monitors the contractions in the womb (uterus). CTG is used both before birth (antenatally) and during labour, to monitor the baby for any signs of distress

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28
Q

Effaced ?!

A

When it is 50 percent effaced, it is about two centimeters long. When it is 100 percent effaced, it is “paper-thin.

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29
Q

Chocolate cyst in ovary suggest?

A

Endometriosis

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30
Q

FHS

A

Fetal Heart Sound

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31
Q

Choloasma

A

Also known as melasma or the “mask of pregnancy,” is a pigmentation disorder of the skin characterized by darker skin patches that primarily affect the face and other sun-exposed areas.

Depending on the person, melasma may go away on its own, it may be permanent, or it may respond to treatment within a few months. Most cases of melasma will fade away with time and especially with good protection from sunlight and other sources of light.

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32
Q

Perineal tear

A

A laceration of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tears mainly occur in women as a result of vaginal childbirth, which strains the perineum. It is the most common form of obstetric injury.

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33
Q

CPD

A

Cephalopelvic disproportion (CPD) is a medical issue that can arise during childbirth. It occurs when a baby is having trouble getting through the birth canal. The baby may be very large or in a difficult delivery position, or the mom’s pelvis may be too small for the baby to pass safely

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34
Q

Bishop score

A

Bishop’s score or cervix score, is a pre-labor scoring system to assist in predicting whether induction of labor will be required. It has also been used to assess the likelihood of spontaneous preterm delivery.

A Bishop score of 8 or greater is considered to be favorable for induction, or the chance of a vaginal delivery with induction is similar to spontaneous labor. A score of 6 or less is considered to be unfavorable if an induction is indicated cervical ripening agents may be utilized

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35
Q

BPP

A

A biophysical profile (BPP) is a prenatal ultrasound evaluation of fetal well-being involving a scoring system, with the score being termed Manning’s score. It is often done when a non-stress test (NST) is non reactive, or for other obstetrical indications.

The test combines fetal heart rate monitoring (nonstress test) and fetal ultrasound to evaluate a baby’s heart rate, breathing, movements, muscle tone and amniotic fluid level.

A score of 6/8 or 8/8 is normal. Most fetuses that score ≤ 6/8 need additional monitoring. A complete BPP includes the addition of electronic fetal monitoring (nonstress test) for a total score of 10 points. A score of 8/10 or 10/10 is considered normal. A score of 6/10 is equivocal and ≤ 4/10 is abnormal

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36
Q

Pregnant woman, vaginal itching, whitish vag discharge ttt?

A

Fluconazole

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37
Q

Vaccine should be given in preconception

A

Rubella

38
Q

Forceps indication

A

Prolonged second stage: This includes nulliparous woman with failure to deliver after 2 hours without, and 3 hours with, conduction anesthesia. It also includes multiparous woman with failure to deliver after 1 hour without, and 2 hours with, conduction anesthesia.

Suspicion of immediate or potential fetal compromise in the second stage of labor.

Shortening of the second stage for maternal benefits: Maternal indications include, but are not limited to, exhaustion, bleeding, cardiac or pulmonary disease, and history of spontaneous pneumothorax.

In skilled hands, fetal malpositions, including the after-coming head in breech vaginal delivery, can be indications for forceps delivery.

39
Q

Vaccine CI during pregnancy

A

MMR
Varicella
Live influenza vaccine
BCG

HPV vaccine is not recommended for pregnant women

40
Q

CI of methotrexate for abortion

A

Vital sign

41
Q

Trichomonas ttt

A

A single 2-g dose of metronidazole, tinidazole, or secnidazole

A schedule of 500 mg of metronidazole, taken twice daily for 7 days

42
Q

IUFD

A

Intrauterine fetal demise (مرگ داخل رحمی جنین) is an unpredictable and challenging obstetric complication. Its etiology is multifactorial with more than 60% attributed to the placental cause

The two most common options for women with IUFD are labor induction or removal of the pregnancy (using Dilation and Evacuation, or D&E). In some rare cases, cesarean delivery can be performed

43
Q

Cystocele

A

is a condition in which supportive tissues around the bladder and vaginal wall weaken and stretch, allowing the bladder and vaginal wall to fall into the vaginal canal. Usually, the muscles and connective tissues that support the vaginal wall hold the bladder in place

44
Q

Kegel exercise

A

strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum.

Make sure your bladder is empty, then sit or lie down.
Tighten your pelvic floor muscles. Hold tight and count 3 to 5 seconds.
Relax the muscles and count 3 to 5 seconds.
Repeat 10 times, 3 times a day (morning, afternoon, and night).

45
Q

When pregnancy after varicella vaccine

A

1-3 months

46
Q

SI transdermal contraceptive compare IUCD and OCP

A

Because the patch contains a higher dose of hormones than the pill, the side effects may be more intense than with the pill.
It predisposes to coagulation more

47
Q

What copper IUD side effects (5)

A

spotting between periods.
irregular periods.
heavier or longer periods.
more or worse cramping during your periods.
pain when your IUD is put in, and cramping or back aches for a few days after.

48
Q

OCP benefit

A

it does not interrupt sex
it usually makes your bleeds regular, lighter and less painful
it reduces your risk of cancer of the ovaries, womb and colon
it can reduce symptoms of PMS (premenstrual syndrome)
it can sometimes reduce acne
it may protect against pelvic inflammatory disease
it may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease

49
Q

Adverse Magnesium sulfate toxicity on pre eclampsia pt

A

Calcium gluconate

50
Q

Pounch of douglas

A

The rectouterine pouch, pouch of Douglas, or rectovaginal pouch is the extension of the peritoneum between the rectum and the posterior wall of the uterus in the human female. Its anterior boundary is formed by the posterior fornix of the vagina.

51
Q

Culdocentesis

A

Culdocentesis is a procedure that checks for abnormal fluid in the space just behind the vagina. This area is called the cul-de-sac. During a culdocentesis a long thin needle is inserted through the vaginal wall just below the uterus and a sample is taken of the fluid within the abdominal cavity.

52
Q

Clamydia pregnancy ttt

A

Erythromycin

53
Q

Bartholin’s cyst

A

also called a Bartholin’s duct cyst, is a small fluid-filled sac just inside the opening of the vagina

Experts believe that the cause of a Bartholin’s cyst is a backup of fluid. Fluid may accumulate when the opening of the gland (duct) becomes obstructed, perhaps caused by infection or injury. A Bartholin’s cyst can become infected, forming an abscess

54
Q

Safe analgesia during pregnancy

A

Paracetamol

55
Q

What instrument is used for D&C

A

In a dilation and curettage, your provider uses small instruments or a medication to open (dilate) the lower, narrow part of your uterus (cervix). Your provider then uses a surgical instrument called a curette, which can be a sharp instrument or suction device, to remove uterine tissue

Curate: a surgical instrument that has a scoop, ring, or loop at the tip and is used in performing curettage. curette. verb. variants: or less commonly curet. curetted; curetting

56
Q

Post partum psychosis

A

Postpartum psychosis is a serious mental health illness that can affect someone soon after having a baby. It affects around 1 in 500 mothers after giving birth. Many people who have given birth will experience mild mood changes after having a baby, known as the “baby blues”

Postpartum psychosis requires immediate treatment, usually in the hospital. Treatment may include: Medication. Treatment may require a combination of medications — such as antipsychotic medications, mood stabilizers and benzodiazepines — to control your signs and symptoms.

57
Q

Most common cause of postmenopausal benign bleeding

A

Atrophic vaginitis

58
Q

Colostrum

A

Colostrum is the first form of milk produced by the mammary glands of mammals immediately following delivery of the newborn. Most species will begin to generate colostrum just prior to giving birth

Your body produces colostrum for up to about five days after your baby is born. It changes to transitional milk around this time, then changes again to mature milk after about 14 days. Traces of colostrum are present in your breast milk for up to six weeks.

59
Q

Gestational DM may develope to

A

DM 2

60
Q

Drinking alchohol during pregnancy

A

Drinking alcohol during pregnancy increases the risk of miscarriage, premature birth and your baby having a low birthweight. It can also affect your baby after they’re born. Drinking during pregnancy can cause your baby to develop a serious condition called **foetal alcohol spectrum disorder (FASD

61
Q

Secondry amenorrhea first check? Second check?

A

Bhcg pregnancy
Prolactin level

62
Q

Hypothalamic amenorrhea

A

is a condition in which menstruation stops for several months due to a problem involving the hypothalamus. The hypothalamus is in the center of the brain, controls reproduction, and produces gonadotropin-releasing hormone (GnRH).

Hypothalamic amenorrhea is a condition that causes your period to stop and can lead to health problems. Stress, disordered eating, being underweight, and too much exercise are the main causes of hypothalamic amenorrhea

63
Q

Cervical incompitence

A

Cerclage last of first trimester 11-13 week before 14 week

64
Q

Prolapse uterus

A

Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken and no longer provide enough support for the uterus. As a result, the uterus slips down into or protrudes out of the vagina. Uterine prolapse can occur in women of any age

A diagnosis of uterine prolapse generally occurs during a pelvic exam. During the pelvic exam your doctor is likely to ask you: To bear down as if having a bowel movement. Bearing down can help your doctor assess how far the uterus has slipped into the vagina. Clinical examination

65
Q

The only true contraindications to breastfeeding are the following

A

infants with classic galactosemia (galactose 1-phosphate uridyltransferase deficiency) mothers, in the US, who are infected with human immunodeficiency virus (HIV).

66
Q

Gestational HTN

A

Gestational hypertension is a form of high blood pressure in pregnancy. It occurs in about 6 percent of all pregnancies. Another type of high blood pressure is chronic hypertension–high blood pressure that is present before pregnancy begins. Gestational hypertension can develop into preeclampsia
It occurs in about 3 in 50 pregnancies

Chronic hypertension in pregnancy is defined by the American College of Obstetrics and Gynecology (ACOG) as blood pressure ≥140 mm Hg systolic and/or 90 mm Hg diastolic before pregnancy or, in recognition that many women seek medical care only once pregnant, before 20 weeks of gestation, use of antihypertensive

67
Q

How can one get pregnant with a tubal blockage?

A

If tubal damage or blockages cannot be corrected through surgery or tubal cannulation, which involves a doctor clearing the blockage with a medical instrument, a woman may still be able to get pregnant through in vitro fertilization (IVF).

68
Q

Preneal tears degrees

A

First-degree
Small tears affecting only the skin which usually heal quickly and without treatment.

Second-degree
Tears affecting the muscle of the perineum and the skin. These usually require stitches.

Third- and fourth-degree tears
For some women (3.5 out of 100) the tear may be deeper. Third- or fourth- degree tears, also known as obstetric anal sphincter injuries (OASI), extend into the muscle that controls the anus (anal sphincter). These deeper tears need repair in an operating theatre.
3-partial anal sphincter involvemant
4-complete tear of anal sphincter involveing bowel lining

69
Q

Lamp in breast what does indicate mass is cystic and no need for reevaluation

A

Clear fluid on FNA aspiration and disappearace of the mass after

70
Q

Mastitis ttt

A

Mastitis is an inflammation of breast tissue that sometimes involves an infection. The inflammation results in breast pain, swelling, warmth and redness. You might also have fever and chills. Mastitis most commonly affects women who are breast-feeding (lactation mastitis)

Using the other breast and startingantibiotics

For simple mastitis without an abscess, oral antibiotics are prescribed. Cephalexin (Keflex) and dicloxacillin (Dycill) are two of the most common antibiotics chosen, but a number of others are available

The beta lactamase-resistant penicillins have been recommended in the treatment of mastitis. These include cloxacillin, dicloxacillin, or flucloxacillin.

71
Q

ECV CI

A

An ECV isn’t right for you if you’re expecting more than one baby or you need a C-section. It also works best on women with a pear-shaped womb and not those with a heart-shaped womb, called a bicornuate uterus

Placenta previa or abruptio placentae, nonreassuring fetal status, intrauterine growth restriction in association with abnormal umbilical artery Doppler index, isoimmunization, severe preeclampsia, recent vaginal bleeding, and significant fetal or uterine anomalies are also contraindications for ECV

72
Q

What is the most important thing to check before instrumental delivery?

A

Head pelvic disproportion

73
Q

Adenomyosis

A

occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus. The displaced tissue continues to act normally — thickening, breaking down and bleeding — during each menstrual cycle.
Adenomyosis is considered a benign (not life-threatening) condition, the frequent pain and heavy bleeding associated with it can have a negative impact on a woman’s quality of life.

Heavy or prolonged menstrual bleeding.
Severe cramping or sharp, knifelike pelvic pain during menstruation (dysmenorrhea)
Chronic pelvic pain.
Painful intercourse (dyspareunia)

Pelvic imaging such as ultrasound and MRI can detect signs of adenomyosis, but the only way to confirm it is to examine the uterus after hysterectomy.

74
Q

Vaginal discharge with fishy odour

A

it may be caused by a bacterial infection

To treat bacterial vaginosis, your doctor may prescribe one of the following medications: Metronidazole (Flagyl, Metrogel-Vaginal, others). This medicine may be taken as a pill by mouth (orally). Metronidazole is also available as a topical gel that you insert into your vagina

75
Q

Trichomoniasis

A

Trichomoniasis is a common sexually transmitted infection caused by a parasite. In women, trichomoniasis can cause a foul-smelling vaginal discharge, genital itching and painful urination. Men who have trichomoniasis typically have no symptoms

Trichomoniasis is caused by a parasite called Trichomonas vaginalis. In women, this parasite mainly infects the vagina and the urethra

Green, yellow, gray, frothy, and/or bad-smelling vaginal discharge.
Blood in your vaginal discharge.
Itching and irritation in and around your vagina.
Swelling around your genitals.
Pain during sex.

76
Q

When is cholecystectomy done in pregnancy?

A

Indications for this procedure should include stringent criteria such as unrelenting biliary tract symptoms or the complications of cholelithiasis. If at all possible, when laparoscopic cholecystectomy is indicated, it should be performed either in the second trimester or early in the third

77
Q

screening for gestational diabetes in pregnancy

A

Testing for gestational diabetes usually occurs between 24 and 28 weeks of pregnancy. If you have an increased chance of developing gestational diabetes, your doctor may test for diabetes during the first visit after you become pregnant.

The screening test is called an oral glucose tolerance test (OGTT), which takes about 2 hours. It involves having a blood test in the morning, when you have not had any food or drink for 8 to 10 hours (though you can usually drink water, but check with the hospital if you’re unsure).

78
Q

First sign of puberty female

A

Thelarce

79
Q

Thelarche
Adernarche
Pubarache
Menarche

A

the beginning of adult breast development, marks the onset of puberty in the majority of white women and occurs at a mean age of 10 years

the awakening of the adrenal gland.” The adrenal gland is responsible for making hormones including androgens—sex hormones that cause changes such as the development of pubic hair, oily skin, oily hair and body odor. There is one adrenal gland on top of each kidney.

Pubarche is the appearance of sexual hair

Menarche is defined as the first menstrual period in a female adolescent. Menarche typically occurs between the ages of 10 and 16

80
Q

Postpartum “blues”

A

are defined as low mood and mild depressive symptoms that are transient and self-limited. [1] The depressive symptoms include sadness, crying, exhaustion, irritability, anxiety, decreased sleep, decreased concentration, and labile mood

Most people experience baby blues 2 to 3 days after the baby is born. They can last up to 2 weeks. They usually go away on their own, and you don’t need any treatment. If you have sad feelings that last longer than 2 weeks, tell your health care provider

81
Q

Salphingitis

A

Salpingitis is inflammation of the fallopian tubes, caused by bacterial infection. Common causes of salpingitis include sexually transmitted diseases such as gonorrhoea and chlamydia. Salpingitis is a common cause of female infertility because it can damage the fallopian tube. Treatment options include antibiotics

Common symptoms include fever, unusual vaginal discharge, frequent urination, nausea, vomiting, lower back pain, pelvic pain, as well as pain during menstruation and sexual intercourse. In order to diagnose salpingitis, one will usually undergo clinical and physical examination

Blocked fallopian tubes does not cause irregular menses

82
Q

How common is death from postpartum hemorrhage?

A

Globally, postpartum hemorrhage is the leading cause of maternal mortality. The condition is responsible for 25% of delivery-associated deaths, and this figure is as high as 60% in some countries

83
Q

What causes intrauterine growth restriction?

A

high blood pressure.
chronic kidney disease.
advanced diabetes.
heart or respiratory disease.
malnutrition, anemia.
infection.
substance abuse (alcohol, drugs)
cigarette smoking.

Chronic hypertension is the most common cause of IUGR. Moreover, the infants of hypertensive mothers have a three-fold increase in perinatal mortality compared with infants with IUGR who are born of normotensive mothers

Pregnancies that have any of the following conditions may be at a greater risk at developing IUGR: Maternal weight less than 100 pounds. Poor nutrition during pregnancy. Birth defects or chromosomal abnormalities.

Often, IUGR happens because the fetus doesn’t get enough nutrients and nourishment. This can happen if there is a problem with: the placenta, the tissue that brings nutrients and oxygen to the developing baby. the blood flow in the umbilical cord, which connects the baby to the placenta.

84
Q

Which Ig can cross the placenta

A

Immunoglobulin G (IgG), although it has a high molecular weight, is the only class of immunoglobulins able to cross the placenta and to reach the fetal circulation

85
Q

Mole

A

Complete mole is the most common type and does not contain fetal parts, whereas in a partial mole there might be identifiable fetal residues. Complete moles are typically diploid, whereas partial moles are triploid

Complete hydatidiform moles (CHM) are abnormal pregnancies with no fetal development resulting from having two paternal genomes with no maternal contribution. It is important to distinguish CHM from partial hydatidiform moles, and non-molar abortuses, due to the increased risk of gestational trophoblastic neoplasia

They are usually slow growing and benign, although there is a chance a mole can become cancerous. A complete molar pregnancy is much more likely to become cancerous than a partial molar pregnancy

Treatment usually consists of one or more of the following steps: Dilation and curettage (D&C). To treat a molar pregnancy, your doctor will remove the molar tissue from your uterus with a procedure called dilation and curettage ( D&C ). A D&C is usually done as an outpatient procedure in a hospital

86
Q

Pregnant
1. Painful vaginal bleeding
2. Bleeding with os closed
3. Bleeding with os open
4. Bleeding with os closed + US no fetus

A

Placenta abortion
Threatent abortion bed rest
Invitable abortion
Compelete abortion

87
Q

First trimester, second trimester abortion due to

A

Chromosomal abnormality
Cervical incompetence

88
Q

Stillbirth

A

A stillbirth is the death of a fetus in the uterus after week 20 of pregnancy. The reasons go unexplained for 1 in 3 cases. The rest may be caused by problems with the placenta or umbilical cord, high blood pressure, infections, birth defects, or lifestyle choices

89
Q

Pt hysterectomy has hot flash after surgery ttt

A

Transdermal estrogen only

90
Q

Ep treatment

A

To prevent complications, treatment is needed. In the early stages, medications may be sufficient. Later stages require surgery.

Medication. An early ectopic pregnancy without unstable bleeding is most often treated with a medication called methotrexate, which stops cell growth and dissolves existing cells. The medication is given by injection

Medical procedure
Vacuum aspiration and Dilation and evacuation

Surgery
Laparoscopic surgery

91
Q

What is the best shape of hip for a woman to deliver her babay

A

Gynecoid pelvis
So a woman who’s described as having childbearing hips likely has a gynecoid shaped pelvis, which was thought to be most favorable for labor and delivery. Gynecoid happens to be a common pelvic shape, too

Medical (22 decks)

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