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OBGYN 1

Obgyn 1

by qamar20, Sep. 2016

Subjects: OBGYN

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	Long scenario of pregnant in 1st trimester whilr chick up she had high blood pressure in next visit high blood pressure but lower than the 1st visit, diagnosis?	Chronic hypertension - BP decrease and reach nadi at 24-28 w, them gradually start to increase but never to prepregnancy. D >S 15mmhg - gestational: sustained >140/90 after 20 w without protinurea, return to normal postpartum. Needs close observation as outpt. - chronic: <20 w or prepregnancy, sustained >140/90, +/- proteinueria - good prognosis if <180/109 and no organ damage. Poor if cardiac (LVH) renal (C >1.4) or retinal problems are present. Worst if uncontrolled HTN before conception or w/superimposed preeclampsia. * superimposed: chronic HTN w/ worsening BP or proteinurea - meds: only in severe HTN and drug of choice Methyldopa. BBs--> IUGR, ACE--> oligohydrominos, renal faliure, hypocalvaria, Diuretics--> plasma volume reduction * serial sonogram after 30w+ serial BP and urine proteine. Induce labour at 39 w
	A pregnant lady with pneumonia develops igg, what type of of immunity will the baby acquire?	Passive neutral Passive immunity is the transfer of active immunity, in the form of readymade antibodies, from one individual to another. Passive immunity can occur naturally, when maternal antibodies are transferred to the fetus through the placenta, and can also be induced artificially, when high levels of human (or horse) antibodies specific for a pathogen or toxin are transferred to non-immune individuals.
	Breastfeeding mother with HCV treated with interferon more than one year what the risk of breastfeeding on infant?	Nipple cracking Hepatitis C is not transmitted through breast milk. However, the Centers for Disease Control recommends that mothers with HCV infection should consider abstaining from breastfeeding if their nipples are cracked or bleeding
	A married lady presented with periumbilical abdominal pain, guarding, sever pain on rectal exam and low grade fever. What is the most likely diagnosis? A. Ovarian torsion B. Ectopic pregnancy C. Appendicitis D. Cholecystitis	Ectopic pregnancy In appendicitis there will be a clear discerption of shifting of pain mcburney's point since all other symptoms are similar?
	Premature birth, the woman at risk for it if cervical effacement is? A. 10mm B. 20mm C. 30mm D. 40mm	< 25 mm. C? USMLE step 2 CK (page 69): Risk factors of preterm labor: short trans-vaginal cervical length of < 25 mm In OBGYN clinic: < 3 cm (30 mm)
	Pap smear found epithelial cells? A. Hiv B. Hpv C. Hsv1 D. Hsv2	I think the question means dysplastic epithelial cells which are caused by HPV infection.
	OCP effects on liver: A. Hepatoma B. Adenoma C. HCC D. Hepatic hyperplasia	Hepatoma
	Most common site of gonococcus in female: A. Cervix B. Urethra C. Pharnix D. Rectum	Cervix - caused by N.gonorrhea, gram negative diplococcus. - long term: pelvic adhesion causing chronic pain and infertility. - active infection--> acute PID - sx: lower genital tract infection leat to vulvovaginal discharge (mucoperilent seen on speculum), itching, burning w/dysurea or rectal discomfort. Cervical motion tenderness * Bartholin abscess (obstruction in gland duct) --> incision and drainage Upper genital tract infection lead bilateral abdominal pelvic pain. Systemic: dermatitis,polyarthalgia, tenosynovitis. - dx: nucleic acid amplification test of discharge or urine. - tx: single dose of IM ceftriaxone + single oral dose azithromycine (chlamydia)
	Pregnant lady with daily symptom of cough and wheeze and nocturnal once a week She's on albuterol What's the management? A. Short with inhaled steroid B. Short with oral steroid C. Long with inhaled steroid D. Long with inhaled steroid again	A or B (Depends on stepwise management or severity) I think A -
	- Female after menarche at what age the bone will stop growing? A. 6 months B. 12 years C. 24 years D. 36 years - What is the best place to take a cervical sample for Pap smear?	- 12y Girls will usually stop growing earlier than boys, around age 11 or 12. - Transformation The transformation zone is the site of origin for most cervical neoplasia and should be the focus of cytology specimen collection
	Adenomyosis diagnosed by : A. MRI B. US C. Endometrial specimen D. Uterine biopsy by hysterectomy	Uterine biopsy by hysterectomy Adenomyosis refers to a disorder in which endometrial glands and stroma are present within the uterine musculature (uterine adenomyomatosis). The ectopic endometrial tissue appears to induce hypertrophy and hyperplasia of the surrounding myometrium, which results in a diffusely enlarged uterus (often termed "globular" enlargement) analogous to the concentric enlargement of the pregnant uterus. Most common presentation is diffuse involvement. If focal :adenomyomz - Heavy menstrual bleeding and painful menstruation are the major symptoms of adenomyosis. Uterus 12w size, globular soft and tender. - A definitive diagnosis of adenomyosis can only be made from histological examination of a hys terectomy specimen - The only guaranteed treatment for adenomyosis is total hysterectomy. Medical is IUS
	Best antibiotic for breast feeding is? A. Chloramphenicol B. Azithromycin C. Cimetidine D. Ciprofloxacin	Azithromycin
	48 Y Women with fibroid 5 or 6 cm asymptomatic:	Regular follow up yearly - fibroid (leiomyoma): Benign smooth muscle growth of myometrium, most common benign tumor. Most common is intramural. Submucosal cause abnormal vaginal bleeding/anemia. Subserosal cause firm nontender asymmetry, cause P on bladder, rectum or ureturs. - most fibroids are small slow groing. - rapid growth due to high estrogen usually during pregnancy, carneous degeneration: red degeneration that cause extreme acute pain. - shrinkage: at menopause or w/GnRH agonist suppressing FSH. Dx: clinically by pelvic exam--> enlarged asymmetric non tender uterus. Defintive dx: histology of excised tissue. Saline infusion US/hystroscopy used for submucosal. - tx: 1) observation: most, FU w/pelvic exam 2) presurgical shrinkage: 3-6 m decrease size 70% but regrowth. 3) myomectomy vs hysterectomy 4) embolization
	Multigravida in labor with 60% effacement and dilated cervix (5 cm). After 1 hour she still has 60% effacement but the cervix dilates to 6 cm. What will you do for her? A. Expectant management B. Oxytocin C. Cervix ripening D. Artificial rupture of membranes	Expectant management Prolongation of active phase is diagnosed if cervical dilation is <1.2 cm/h in a primipara or <1.5 cm/h in a multipara. Arrest is diagnosed if cervical dilation has not changed for >2 h. However, treatment is directed at assessment of uterine contraction quality. If hypotonic give oxytocin.
	42 years old female complaining of amenorrhea, night sweat and flushing for the last 6 months. What is the most likely diagnosis? A. Hypothyroid B. Hyperprolactinemia C. Congenital adrenal Hyperplasia D. Pheochromocytoma	Hyperprolactinemia Secondary amenorrhea: 3 m if regular, 6 if irregular 1) pregnancy: beta hCG. Most common cause 2) Anovulation (unopposed estrogen): physiologic: 13y, normal ht and wt. chronic: 33y, obese and HTN. Charachter: amenorrhe--> irregular unpredictable. Cause: PCOS, incrase prolactin, pitutiry adenoma, hypothiroidism. 3) estrogen deficincy: absence ovarian follicle or hypothalamic pitutiry insufficincy. 4) outflow obstruction. Dx: 1. Pregnancy test. 2. TSH (elevated prolactin a.w elevated TRH) 3. Prolactin level: increased due to drugs (anti-dopamine like antidepressent/psychotic), tumor (<1cm: bromocriptin) (>1cm: surgical), idiopathic: bromocriptin. 4. PCT: bleeding (positive)--> anovulation, tx: MPA prevent hyperplasia, clomiphene for pregnancy. No bleeding (negative) go to next step. 5. EPCT: bleeding (positive)--> FSH Increased: ovarian failure--> karyotype, low: HTP insufficiency--> imaging, hormonal replacement No bleeding (negative): Asherman syndrome--> HSG.
	21 years old Female with negative pap smear. You should advise her to repeat pap smear every: A. 6 months B. 12 months C. 18 months D. No repeat	3y?! - Cervical cancer screening guidelines: Age <21: no screening REGARDLESS of sexual activity Age 21: Start Pap test with cytology alone without HPV testing. - Frequency of screening: Age 21-29: repeat Pap every 3 years (no HPV testing for this group) Age 30-65: repeat Pap smear every 3 years OR repeat Pap every 5 years if both cytology and HPV testing (the latter is the preferred method of screening in this age group) - Stop screening: After age 65 if negative Pap smear for past 10 years AND no history of CIN 3 or more severe diagnosis.
	How ectopic pregnancy occurs at the cellular level? A. Disappearance of zona pellucida. B. Fertilization at ampulla tube. C. Persistence of Zona pellucida. D. Fast division of blastomere.	they answered A
	Nursing mom wants to conceive but not in the coming two years. What will you recommend for her? A. Vaginal ring B. Combined OCP C. Progestin injection D. Patch	Progestin injection Progestin only: For breast feeding - pill: need to be taken daily and continuously. SE: break through bleeding - injectable: IM DMPA every 3m. Best for epilepsy pt and sicklers. SE: break through bleeding, prolonged time for fertility regain, decrease bone density (osteoporosis), wt gain, depression. - subcutaneous implant: for 3y. SE: break through bleeding. - morning after pill: 2 tablets 12h apart.
	A patient with ectopic pregnancy of 2.5*3.0 size. Hcg is 5000. The patient is stable. What will you do? A. Wait and watch B. Laparotomy C. Laparoscopy D. D & C	Laparoscopy - most common site is distal Ampulla of fallopian tube, biggest RF: previous episods. PID is most predisposing. - secondary amenorrhea, unilateral abdominal/pelvic pain, vaginal bleeding. Sign: motion tenderness. - dx: beta hCG quantitative serum titer>1.500 and No intrauterine pregnancy seen on vaginal US (5w gestation). * progesterone if >25 normal IUP. <5 abnormal -tx: 1) ruptured (unstable)--> laprotomy 2) intrauterine pregnancy (hydatidiform mole)--> S/C and FU weekly beta hCG. 3) possible ectopic (<1500 but no IUP)--> repeat beta hCG every 2-3d until exceeds 1500. 4) unruptured: a. Methotrexate (folate antagonist) if mass <3.5cm, no heart motion, beta hCG <6000, no folic supplement. FU beta hCG, give RhoGAM b. Laparoscopy--> salpingostomy. FU beta hCG, give RhoGAM c. Salpingectomy--> if ruptured or no desire for fertility.
	A couple came to your clinic. They are trying to conceive for the last 3 months with no success. The girl had appendectomy before marriage. She also has an aunt who is her uncle's wife (not blood related) with down syndrome. What should be done? A. Try some more B. Clomiphene C. Laparoscopy D. Semen analysis	Try some more
	A 50 years old lady came with signs and symptoms of menopause. What picture describes his report best? A. Increased LH and FSH B. Decreased FSH and LH C. Increased FSH decrease LH D. Increase LH decrease FSH	Increased LH and FSH - 12m amenorrhea. A.w elvation in LH and FSH. Mean age 51, smoking 2y earlier. Premature: before 40 mostly idiopathic. Premature ovarian faliure: <30 (increase FSH) a.w autoimmune disease or Y chromosome mosaicism. - dx: serial elevation of gonadotropin (3m FSH) - etiology: lack of estrogen. Shorten follicular phase, luteal phase not changed. - Amenorrhea, hot flashes (less in obese), vaginal atrophy, osteoporosis, CAD (cause of mortality). -
	A long scenario of a lady with vaginal infection, has strawberry cervix. What is the organism? A. Trachomatis B. Bacterial vaginosis C. Gonorrhea D. Trichomonas vaginalis	Trichomonas vaginalis - an STD, vaginal discharge frothey and green PH >4.5, itching and burning, strwaberry cervix. Pain w/intercourse. - flagellated pear- shaped protozoan - dx: wet Mount microscope reveals motile trichomondas. WBC seen - tx: tx pt and sexual partner w/oral mitronidazole. Safe in pregnancy 1st T.
	What is the role of metformin in PCOS? A. Decrease glucose level B. Decrease insulin resistance C. Anti-androgenic D. Menstrual regulation	Decrease insulin resistance The hallmark mark of PCOS is insulin resistance. - chronic anovulation and infertility. Sx: hairsutisim, obesity, irregular vaginal bleeding. - include: HyperAndrogenism, Insulin Resistance and Acanthosis Nigricans. - dx: LH:FSH ratio of 3:1 (normal 1.5-1) - tx: OCP: stop irregular bleeding + prevent hyperplasia (progestin) + hairsutisim (Also use spironolacton). Clomiphene for pregnancy. Metphormine increase insulin sensitivity and enhance ovulation.
	Hormonal replacement therapy prevents which of the following? A. Postmenopausal symptoms B. Osteoporosis C. Coronary artery disease D. Stroke	Postmenopausal symptoms Indications of HRT: primary indication is treatment of menopausal symptoms (short-term). HRT is not used to treat osteoporosis, although if used they decrease risk of osteoporotic fractures - Estrogen/ progestin for vasomotor sx (hot flushes), vaginal atrophy and dyspareunia - Estrogen/ progestin may prevent osteoporosis but not used as 1st line. Both increase risk of stroke. - progestine: increase risk of breast cancer and CAD. - contraindication: vaginal bleeding, breast/endometrium cancer, thrombosis, liver disease. - if a woman has uterus give combine (prevent hyperplasia) if not estrogen only. - estrogen alternatives: No effect on hot flashes or sweat. Tamoxifen (breast antagonist--> prevent cancer) But endometrial and bone agonist. Raloxifene: bone agonist but endometrial antagonist --> decrease breast and uterine cancer
	46 years old woman comes with amenorrhea for 6 months and flushes at night that disturbs her sleep. What is the best investigation to make your diagnosis? A. LH B. FSH C. Estrogen D. Progesterone	FSH
	Premature menopause starts before...?	40
	A pregnant lady with gestational diabetes. What medication will you prescribe for her?	Insuline For pt w/overt DM: At 1st visit: HemA1C , 24 h urine, fundoscopy - HemA1C increase: malformation risk - anomalies: NTD, CHD, sacral agenesis. - prevention: euoglycemia preconception, Folate 4mg Anomaly screen: 1. 15-20 w: triple screen --> NTD 2. 18-20 w: targeted Sono --> spina bifida, ancephaly 3. 22-24 w: Fetal echo if elevated hemA1C * anomalies not a.w GDM (after 20w gestation) Age of delivery: not >40 w Complications: Arrest of labor, sholder dystocia, PPH - fetal surveillance: weekly NST and AFI at 32 if (take insuline, macrosmic, HTN, previous demis) or 26 if small vessel disease - DM1: IUGR, DM2: macrosmia - fetal demis RF: needs insulin, HTN, previous - neonatal complications: hypoglycemia, hypocalcemia, polycithemia, high bilirubin, RDS
	A pregnant lady had a child with 3500 grams with the use of forceps, presented to you 20 days postpartum with whitish vaginal discharge but with no itching or cervical tenderness. On examination cervix is pink. Microscopic examination reveals epithelial cells with leukocytes. What would you do for your patient?	Reassure Presence of epithelial cells and few numbers of wbcs is normal. Also, a normal discharge does not have an offensive odor and is not associated with vaginal irritation, itching, or burning.
	A pregnant lady with a positive OGTT, what is your action? A. Repeat the test B. Check hga1c C. Start insulin D. Do a random blood glucose	Start insulin One abnormal OGTT is enough to diagnose GDM and the treatment is diet and exercise. If diabetes is not controlled, insulin is initiated. Who to screen? Every pt 24-48h or at 1st visit if has RF - screen test: 1hr 50g glucose (not fasting), positive if 140 or > - if positive do: 3hr 100g OGTT Fasting Dx: 2 of 4: FBG (>95), 1h (>180), 2h (155), 3h (140) * Impaired glucose tolerance dx if only one value abnormal. * if FBG >125 dont give glucose load (overt DM) or if screen value 200 or > - RF: obesity, >30y, Fhx, macrosmic baby Tx: 1) ADA diet: spread cal evenly, encourge complex CHD * target glu monitoring: FBS<90, 1h <140 2) SC insulin: type 1, 2 and uncontrolled (glu out of range) GDM * dose based on T: BW x 0.8 T1, 1 T2, 1.2 T3. * 2/3 NPH and 1/3 regular morning * 1/2 NPH and 1/2 regular night. * no hypoglycemic--> fetal hypoglycemia
	- Pregnant G1P0 who has a history of travelling 1 year ago, came for check up. Result shows HIV +ve. What is the action in this case ? A. Acyclovir for the mother during 1 week. B. (something) given to the baby after delivery. C. (something) given to the mother and baby after delivery. D. Acyclovir is contraindicated. - Pregnant female is HIV positive. What is the most likely mode of transmission to the baby?	- zidovudine for mother and baby - By breast feeding In an HIV-infected pregnant woman who has never been exposed to antiretroviral medication, HAART should be started as soon as possible, including during the first trimester. Combination antiretroviral therapy should be offered in all cases. As zidovudine (ZDV) is the only agent specifically shown to reduce perinatal transmission, it should be used whenever possible as part of the highly active antiretroviral therapy (HAART) regimen. All HIV-exposed infants should receive zidovudine - ZDV start at 14w gestation. - CS without amniocentesis if viral load 1000 copies or more.
	What is Adenomyosis?	Presence of endometrial tissue and gland in Uterine Muscle It occurs when endometrial tissue, which normally lines the uterus, exists within and grows into the muscular wall of the uterus.
	What is the most common sign and symptom in placental abruption? A. Vaginal bleeding B. Uterine tenderness C. Uterine contractions D. Fetal distress	Vaginal bleeding Placental abruption is mainly a clinical diagnosis with all the above findings. The most common symptom is dark red vaginal bleeding with pain during the third trimester of pregnancy (80%) and abdominal or uterine tenderness (70%). Bleeding may occur at various times in pregnancy: Bleeding in the first trimester of pregnancy is quite common and may be due to the following: miscarriage (pregnancy loss) ectopic pregnancy (pregnancy in the fallopian tube) Bleeding in late pregnancy (after about 20 weeks) may be due to the following: placenta previa or placental abruption. -
	- female patient with bacterial vaginosis. What is the most appropriate treatment? A. Ceftriaxone. B. Clindamycin. C. Ampicillin. D. Fluconazole. - Best way to diagnose bacterial vaginosis?	Clindamycin - gram stain Gram's stain of vaginal discharge is the gold standard for diagnosis of BV BV can be diagnosed by the use of clinical criteria (i.e., Amsel's Diagnostic Criteria) Demonstration of clue cells on a saline smear is the most specific criterion for diagnosing BV. Obtaining routine vaginal cultures in patients with BV has no utility, because this is a polymicrobial infection and some women may have asymptomatic carriage of G vaginalis organisms. - vaginal discharge ph >4.5, Fishy odor, clue cells, thin grayish, no inflammation. - most common cause of vaginal complaints. - lactobacilli are replaced by massive increase in concentration of anaerobic species and faculative aerobes. - positive whiff test w/KOH--> fishy odor. - wet mount: clue cells - tx: metronidazole/clindamycin.
	34-year-old lady pregnant, complaining of amenorrhea, bleeding, and abdominal pain. B-hcg done showed levels of 1600, she was given methotrexate. One week later she still has abdominal pain despite analgesia. B-hcg done showed 6000 units. What is the best management? A. Continue methotrexate. B. Exploratory laparoscopy. C. Salpingectomy D. Salpingostomy	Exploratory laparoscopy.
	A mother delivered her first baby with cleft lip and palate. What is the percentage of recurrence for her next pregnancy?	4%
	Pregnant lady, everything was normal except hemoglobin was low. What is the next step?	Iron Iron supplementation is almost universally recommended during pregnancy to correct or prevent iron deficiency Iron deficiency anemia accounts for 75-95% of the cases of anemia in pregnant women. While folate deficiency is much less common than iron deficiency. A woman who is pregnant often has insufficient iron stores to meet the demands of pregnancy. Encourage pregnant women to supplement their diet with 60 mg of elemental iron daily. The clinical consequences of iron deficiency anemia include preterm delivery, perinatal mortality, and postpartum depression. Fetal and neonatal consequences include low birth weight and poor mental and psychomotor performance. - Hbg<10g, MCV <80, RDW >15% - decrease serum iron w/ increased TIBC - pregnant woman needs 800 mg. - tx: FeSO4 325 oral. Prevention: iron 30mg/d
	Cervical insufficiency: the canal is less than A. 10 mm B. 20 mm C. C-30 mm D. D- 40 mm	20 mm We make a diagnosis of cervical insufficiency in women with one or two prior second-trimester pregnancy losses or preterm births and cervical length <25 mm on TVU examination or advanced cervical changes on physical examination before 24 weeks of gestation. Risk factors for cervical insufficiency support the diagnosis - pregnant 18-22w, painless cervical dilation, delivery of previable fetus. No labor contraction - tx: elective cerclage at 13-14w if cervical legth <25 mm. Preterm birth (remove at 36-37) .
	What is the best drug given to prevent postoperative thromboembolism?	Uf heparin?! Unfractionated heparin (UFH) may be preferred if the patient is likely to have immediate surgery because of its shorter half-life and reversibility with protamine compared with LMWH * I think LMWH
	30 years old female has 1 child ,Want to delay pregnancy 3 years later, she didn't want OCCP nor intravaginal Device. Doctor advise her for transdermal patch, What is the best advice to tell the patient about the patch? A- decrease compliance B- increase blood clot C- less effective than OCCP (same effect ) D- less skin complication (causes skin irritation )	Increase blood clot Combination modalities: contain both hormones, daily w/on and off (withdrawal bleeding). Regular predictable menses. Best for dysmenorrhea, ovarian cyst, endometriosis. - oral: reduce severe PMS sx (fluid retention and acne). - vaginal ring: for 3w and 1 w removed to allow bleed. Stable constant hormone levels. - skin patch: replaced every 3 w (3w on and 1 w allow bleed). Contain 60% higher steroid than oral.
	Pregnant woman with significant edema in his hand and foot, Blood pressure 160/110, what will you do? A. Give him diuretic B. Low diet salt C. Labetalol D. Observation in hospital	Labetalol - If a pregnant woman's blood pressure is sustained greater than 160 mm Hg systolic and/or 110 mm Hg diastolic at any time, lowering the blood pressure quickly with rapid-acting agents is indicated for maternal safety. - Anticonvulsant therapy may be undertaken in the setting of severe preeclampsia (primary prophylaxis) or in the setting of eclamptic seizures (secondary prophylaxis). The most effective agent is IV magnesium sulfate; phenytoin is an alternative, although less effective, therapy. - Labetalol has a more rapid onset of action, may be given orally or parenterally, and is generally preferred as a first-line agent.
	Prolong labor. She might have post partum hemorrhage, How to asses this patient? A. Visual blood loss B. Hematocrit count C. Pulse D. Hemoglobin level	- A or C?! - vaginal delivery blood loss 500 ml or > or CS blood loss 1000 ml or > * Uterine atony the most common cause of PPH - PPH is best defined and diagnosed clinically as excessive bleeding that makes the patient symptomatic (eg, pallor, lightheadedness, weakness, palpitations, diaphoresis, restlessness, confusion, air hunger, syncope) and/or results in signs of hypovolemia (eg, hypotension, tachycardia, oliguria, low oxygen saturation [<95 percent]. - Vaginal bleeding is usually noted, but may not be present in cases where hemorrhage is related to abdominal bleeding broad ligament hematoma after a sulcus laceration - PPH is also defined as primary or secondary: primary PPH occurs within 24 hours after delivery (also called early PPH) and secondary PPH occurs 24 hours to 12 weeks after delivery (also called late PPH) - Women with a prior PPH have as much as a 10 percent risk of recurrence in a subsequent pregnancy - For secondary postpartum hemorrhage, we suggest administration of uterotonic agents and/or antibiotics. If unsuccessful, we suggest suction curettage to evacuate potential retained products of conception. - Atony: soft uterus (dough) above umblical, due to rapid or protracted labor commonly. Tx: massage, uterotonics. - laceration: surgical tx - retained placenta: accecory placental lobe, contracted uterus but missing cotyledons, tx: manual removal or curettage - DIC: mostly due to Abruptio placenta. Preeclampsia, AF embolisim, dead fetus. Oozinf from IV siets. Remove tissue, ICU, blood products - uterine inversion: due to myometrial weakness, beefy appearing bleeding mass in vagina, uterus not palpable in abdomen. Tx: replace with vaginal fornices and IV oxytocin - persistent unexplained bleeding: ligate vessels or hysterectomy.
	Pregnant woman in 3rd trimester have high blood glucose level despite close observation What is the suspect cause? A. Neonate hyperglycemia B. Neonate hypoglycemia C. Mother hyperglycemia D. Mother hypoglycemia	Mother hyperglycemia This woman complaining of gestational diabetes mellitus Similar question in alqassim Booklet but they were asking about the complication (Answer: Fetal Hypoglycemia)
	Pregnant on labor, on pelvic examination you fell the orbital margin and the nose, what is the presentation of this fetus? A. Mento anterior B. Mento posterior C. Lateral mento-transvers D. Medial mento-transvers	Mento posterior - Face presentations are classified according to the position of the chin (mentum):  Left Mento-Anterior (LMA), Left Mento-Posterior (LMP), Left Mento-Transverse (LMT)  Mento anterior is the most common presentation.
	Pregnant lady, had an outbreak asking for all vaccination can be given, what you will give? A. Influenza B. MMR C. Rubella D. Varicella	Influenza Two vaccines are routinely recommended during pregnancy: o Flu (influenza) shot. o Tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine Given If indicated: HBV, HAV, meningiococcal, pneumococcal Certain vaccines should generally be avoided during pregnancy, including: o Varicella (chickenpox) o Human papillomavirus o Measles, mumps and rubella o Zoster
	A G3P0 female with 3 recurrent abortions, on investigating the last abortion you found an aneuploidy 45X. What are the chances of having this abnormality in her next pregnancies? A. 30% B. 40% C. 50% D. 60%	30% Turner syndrome (45X) is frequently observed and is the most common chromosomal abnormality observed in spontaneous abortions. Turner syndrome accounts for 20-25% of cytogenetically abnormal abortuses. - The likelihood for an SAB increases with each successive miscarriage. Data from various studies indicate that after 1 SAB, the baseline risk of a couple having another SAB is approximately 15%. However, if 2 SABs occur, the subsequent risk increases to approximately 30%. - Most spontaneous miscarriages are caused by an abnormal (aneuploid) karyotype of the embryo. At least 50% of all first-trimester SABs are cytogenetically abnormal.
	Pregnant Women with hypotension and low platelet what is type of anesthesia you prefer ?	General anesthesia is indicated for maternal with medical condition like thrombocytopenia. While one of the complications of epidural and spinal is hypotension Epidural SE: hypotention (IV fluid, IV epi), CNS bleeding or infection, spinal headache (IV hydration, caffeine, or blood patch. General anesthesia indications: blood dyscrasia, thrombocytopenia, rapid emergency delivery.
	MMR vaccine in breastfeeding : - A. Harm to baby B. Safe to baby C. Delayed feeding 72 hours D. Live attended vaccine	Live attended vaccine
	Female pregnant with twins , in her 34 week ( she had some complication I forget it ) the doctor said that she needs emergency CS cuc the presentation of twin A might result in fetal complications , what is the presentation of twin	Breech-cephalic In general, if the first (presenting) twin is in the cephalic (vertex) presentation, labor is allowed to progress to vaginal delivery, whereas if the presenting twin is in a position other than cephalic, cesarean delivery is often performed. Twin gestations in which the first twin is in the breech presentation (20% of all twin deliveries) are most often delivered via cesarean delivery
	Female pregnant in her 24 week , came to you for her first prenatal visit , lab are provided all were normal except that the Hgb is slightly low ( I think it was 10) , what will you do ?	Iron Anemia in pregnancy is generally defined as an Hct less than 30% or a hemoglobin of less than 11g/d during any time in pregnancy. (10.5 lower limit). * anemia defined as a value less than the fifth percentile is a hemoglobin level of 11 g/dL or less in the first trimester, 10.5 g/dL or less in the second trimester, and 11 g/dL or less in the third trimester. - physiological anemia is normal in pregnancy due to hemodilution from volume expansion. Esp. In Second T - 80% is iron deficiency.
	Patient with Invasive Cervical Cancer, you want to stage her cancer, which of the following tests you should perform?	Proctoscopy, cystoscopy, hysteroscopy Cervical cancer: double peak: 40-44 and 70-47 y. - squamous cell tumors are 90-95% - sx: abnormal bleeding (intermenstrual and postcoital). - RF: early age of first intercourse, high # of sexual partner (or partner w/prostatic or penile cancer), HPV, smoking, lower socioeconomic - suspicious features by colposcopy: intense acetowhite, pale on iodine staine, mosaicism and punctuation atypical vessels, raised or ulcerated surface. - staging: investigations: 1) cone biopsy to assess depth of invasion. 2) CXR, IVU, Cystoscopy, sigmoidoscopy or MRI to look for bladder/bowel involvement. - stage 1 and 2a: surgery/radio - other stages: radio. - distance metastasis: palliative
	Single Female came to your clinic one day after condom rupture during vaginal intercourse, she is worried about becoming pregnant. What you will do? A.Pregnancy test B.Wait and arrange for appointment after one week C.Give post-coital contraception D.Give progesterone only contraception	Give post-coital contraception - EMERGENCY CONTRACEPTION • hormonal EC (Yuzpe® or Plan B®, usually 2 doses taken 12 h apart) or post-coital IUD insertion • hormonal EC is effective if taken within 72 h of unprotected intercourse (reduces chance Of pregnancy by 75-85%), most effective if taken within 24 h, does not affect an established Pregnancy • post-coital iuds inserted within 5 d of unprotected intercourse are significantly more effective Than hormonal EC (reduces chance of pregnancy by ~99%) Yuzpe® method = 98% (within 24 h), decreases by 30% at 72 h “Plan B” levonorgestrel only= 98% (within 24 h), decreases by 70% at 72 h
	Postpartum patient with bilateral breast engorgement and tenderness, what is the management? A. Hot compression and continue breastfeed B. Cold compression and stop breastfeed C. Oral Dicloxacillin and continue breastfeed D. Oral Dicloxacillin and pump the milk into bag and discard it	Hot compression and continue breastfeed
	Increase in frequency of menses: A. Metrorrhagia B. Hypermenorrhea C. Metrorrhagia D. Polymenorrhea	- Hypermenorrhea : abnormally heavy or prolonged menstruation; can be a symptom of uterine tumors and can lead to anemia if prolonged - Metrorrhagia: is uterine bleeding at irregular intervals, particularly between the expected menstrual periods - Polymenorrhea is the medical term for cycles with intervals of 21 days or fewer. - Oligomenorrhea is the medical term for infre quent, often light menstrual periods (intervals exceeding 35 days). - Menometrorrhagia (meno = prolonged, metro = uterine, rrhagia = excessive flow/discharge) may be diagnosed. Causes may be due to abnormal blood clotting, disruption of normal hormonal regulation of periods or disorders of the en dometrial lining of the uterus .
	Patient pelvic inflammatory d with salpingitis , On ceftriaxone and no improvement , What is the cause?!	N gonorrhea: - The organisms most commonly isolated in cases of acute PID are N gonorrhoeae and C trachomatis. Ceftriaxone is used for Neisseria Tx. - PID is acute bacterial infection OR adhesions from old inflamation - most common RF: female sexual activity in adolecence w/multiple partners. - PID increase in the m after insertion of IUD 1) cervicitis: no sx only mucoperilent discharge.--> WBC/ESR normal--> single dose cefixime and azithro 2) Acute salpingio-oopheraitis: after menses: bi lateral abdominal pelvic pain, cervical motion tenderness, mucoperilent discharge. WBC/ESR elevated, laparoscopy, cultures--> IM ceftriaxoe + (doxycycline for 14d). 3) abscess: pt septic w/sevre rectal, back or bow el movement pain. N/V. Septic and peritonial signs--> bilareal complex pelvic masses--> IV clindamycine and gentamicin. Drainage maybe needed. 4) chronic PID: bilateral abdominal pelvic pain, cervical motion tenderness, no discharge. Hx of infertility--> Sonography show bilateral cystic pelvic masses consistent w/hydrosalpinges. , laparoscopic visualization of adhesion--> analgesia, adhesion lysis.
	Best time to check chorionicity and amnionicity of twins? A. Early 2nd trimester B. Late 2nd trimester C. Early 3rd trimester D. Late 3rd trimester	Early 2nd trimester It is easiest to determine chorionicity and amnionicity in the first trimester. - dizygotic twins are most common and has RFs like oval induction, monozygotic no RFs. - dx: Sonogram - lowest risk: Dizygotic (2 eggs), Dichorionic, Diamniotic: same gender or unknown w/2placenta - The number of placentas and amniotic sacs in a monozygotic twin pair depends on when division of the zygote occurs relative to formation of the chorion and amnion. * di-di: Morula (0-3), Monochorionic (1placenta w/septum)-di: blastocyst 4-8d-->TTTS, mono-moni: embryonic disk--> cords entangled, conjoined: Embryo >12d. - dizygotic is always Di-Di - complications : anemia, pre-eclampsia, preterm labor, malpresentation, CS, PPH, thromboembolism, malpresentation. - sx: hyperemesis gravidarum. Higher BhCG and AFP
	When does a pregnant patient do GDM ? A. 12 weeks B. 16 weeks C. 20 weeks D. 28 weeks	24-28 w
	Definition of postpartum hemorrhage: A. More than 500 ml post SVD B. Less than 500 ml post CS C. More than 500 ml post CS D. Less than 500 ml post SVD	More than 500 ml post SVD Postpartum hemorrhage is bleeding of 500 ml post spontaneous vaginal delivery and 1000 ml post CS
	Nullipara with diabetes gestational diet. Normal contraction. During labor she full extension and one nurse push the baby from fundus and the other nurse push the above symphysis pubis with no labor thin the doctor do episiotomy. What response for delayed labor A. Full extension B. Pushing the fundus C. Pushing symphysis pubic D. Episiotomy	Pushing the fundus
	Seven weeks pregnant lady c/o vaginal bleeding with tissue. Her cervix was open and you can see some product of conception. Her fundal height is equal to 7 to 8 weeks. A. Threatened abortion B. Incomplete abortion C. Missed abortion D. Molar pregnancy	Incomplete abortion Incomplete abortion is a pregnancy that is associated with vaginal bleeding, dilatation of the cervical canal, and passage of products of conception. Usually, the cramps are intense, and the vaginal bleeding is heavy. Patients may describe passage of tissue, or the examiner may observe evidence of tissue passage within the vagina. Ultrasound may show that some of the products of conception are still present in the uterus - dilated cervix is seen in Inevitable and incomplete abortion. *Inevitable: No POC has yet been passed. D and C if bleeding is heavy vs expectant tx (if fetal cardiac activity present). - if cervical OS is closed: threatened abortion which is a sonogram finding of viable pregnancy and no cervical dilation.--> observation - Complete: all POC passed, OS closed. Confirmed by sonography (no content) --> conservative, FU BhCG to exclude ectopic. Missed: nonviable, no bleeding, no dilation, no POC --> suction D and C.
	Fibroid was found in a healthy asymptomatic 52 year old woman, it was 5x6cm, what will you do? A. Follow up every two months with ultrasound and CBC B. Follow up regularly C. Immediate myomectomy D. Immediate hysterectomy	Follow up regularly Conservative treatment if: minimal or asymptomatic, <6-8 cm or stable in size, not submucosal, currently pregnant We perform annual pelvic exams and, in patients with anemia or menorrhagia, check a complete blood count
	Wiff test positive what to do to confirm the diagnosis ( bacterial vaginosis) A. Serology B. Gram stain C. Fungal culture D. PH	Gram stain Demonstration of clue cells on a saline smear is the most specific criterion for diagnosing BV. Clue cells are vaginal epithelial cells that have bacteria adherent to their surfaces.
	How to assess progress in labour: A. Severity of uterine contraction B. Descending of presenting part C. Molding of head D. Duration of contraction	Descending of presenting part Vaginal examinations have become a routine intervention in labour as a means of assessing labour progress( affecment , dilatation,desnding of baby)
	26 year old female with three months history of bilateral clear fluid coming out of her breasts, it was obvious on physical examination. Normal menstrual cycle. What investigation you would like to do? A. Neuroimaging. B. Mammogram. C. Prolactin assay. D. ACTH.	Prolactin assay - Hyperprolactinemia in premenopausal women causes hypogonadism, manifested by infertility, oligomenorrhea, or amenorrhea and less often by galactorrhea. - Excluding pregnancy, hyperprolactinemia accounts for approximately 10 to 20 percent of cases of amenorrhea - Mild hyperprolactinemia can cause infertility even when there is no abnormality of the menstrual cycle, serum prolactin values of 20 to 50 ng/mL (20 to 50 mcg/L SI units), may cause only insufficient progesterone secretion, and therefore, a short luteal phase of the menstrual cycle (anovulation) - serum prolactin values above 200 ng/mL usually indicate the presence of a lactotroph adenoma - search for the cause of the hyperprolactinemia should begin with the history. One should inquire about pregnancy (nonpathologic hyperprolactinemia) and medications that can cause hyperprolactinemia (such as estrogen, neuroleptic drugs, metoclopramide, antidepressant drugs, cimetidine, methyldopa, reserpine, verapamil, and risperidone). One should also inquire about headache, visual symptoms, symptoms of hypothyroidism, and a history of renal disease. - The physical examination should be directed toward testing for a chiasmal syndrome (eg, bitemporal field loss), and looking for chest wall injury and signs of hypothyroidism or hypogonadism.
	The most accurate diagnostic investigation For ectopic pregnancy: A. Culdocentesis B. Pelvic U/S C. Endometrial biopsy D. Serial B-HCG E. Laparoscopy	Combined transvaginal ultrasonography and serial quantitative beta-hcg measurements are aproximately 96 percent sensitive and 97 percent specific for diagnosing ectopic pregnancy. Therefore, transvaginal ultrasonography followed by quantitative beta-hcg testing is the optimal and most cost-effective strategy for diagnosing ectopic pregnancy. - TVUS is the most useful test for determining the location of a pregnancy. If the imaging study is nondiagnostic, it may be because the gestation is too early to be visualized on ultrasound. If so, serial measurements of the serum human chorionic gonadotropin (hCG) concentration should be taken until the hCG discriminatory zone is reached - Pelvic ultrasound may be performed using one or both of 2 methods:Transabdominal (through the abdomen). A transducer is placed on the abdomen using the conductive gelTransvaginal (through the vagina). A long, thin transducer is covered with the conducting gel and a plastic/latex sheath and is inserted into the vagina
	24 years old G1P0 , she has gestational diabetes which is controled by diet only, and no other medical problems. She is in the 2nd stage of labor which last more than 2 hours, normal uterine contractions, baby's head comes down with eatch contraction and go back when uterus is relaxed, the mother's hip is maximally flexed, one nurse is apllying suprapubic pressure, other nurse applying fundus pressure, the doctor decided to d o episiotomy and deliver the posterior shoulder. Which of the following will cause delay in delivery?	fundus pressure
	G8P7 in 36 weeks of gestation, with past medical history of postpartum hemorrhage in each previous delivery that required blood transfusion. What should be done regarding this delivery?	Perform active management of 3rd stage of labor. Third stage of labor: from the delivery of fetus till the delivery of placenta Active management of the third stage: (1) Uterotonic medication administered within one minute after delivery of baby after ruling out presence of another fetus; (2) controlled umbilical cord traction and counter traction to support the uterus until separation and delivery of the placenta; (3) uterine massage after delivery of the placenta The best preventive strategy is active management of the third stage of labor
	What is the most common cause for postpartum hemorrhage? A. Uterine atony B. Multiparity C. Multiple gestation D. Macrosomia	Uterine atony
	A girl with bilateral ovarian abscess with fever ? A. Immediate laparotomy B. Laparoscopic C. Trans us drain D. Antibiotic	Hospitalization, IV antibiotics, if not improved after 48 hr: First-line therapy typically uses a second generation cephalosporin with anti-anaerobic activity and it is still inconclusive whether additional anti-anaerobic coverage is needed above and beyond the second-generation cephalosporing, cefoxitin or cefotetan, plus doxycycline , proceed to trans US drain. - A tuboovarian abscess (TOA) is an inflammatory mass involving the fallopian tube, ovary and, occasionally, other adjacent pelvic organs (eg, bowel, bladder) [1]. These abscesses are found most commonly in reproductive age women and typically result from upper genital tract infection. * type 3 PID - Antibiotics are the mainstay of treatment for TOA. - The choice of antibiotic therapy alone or in combination with drainage or surgery depends upon the status of the patient and characteristics of the abscess. - We suggest antibiotic therapy alone for women with the following characteristics:Hemodynamically stable with no signs of a ruptured TOA (acute abdomen, sepsis)Abscess <9 cm in diameterAdequate response to antibiotic therapyPremenopausal - Rupture of a TOA occurs in approximately 15 percent of cases. Women suspected of having a ruptured TOA or who present with signs of sepsis require immediate surgical exploration. Laparotomy appears to be the best route in these emergent cases
	Self breast examination decrease breast cancer by years ? A. 1 year B. 2year C. 3 year D. 4year	Recommend CBE be performed at least every 3 years starting between ages 20 and 39 and annually starting at age 40. The ACOG,[14] ACR,[28]and AMA[29] recommend starting CBE at age 40 and annually thereafter.
	Patient has a 3 years infertility and have breast milk the lab show Hight WBC and hight prolactine what visual field will be Affected:	- If it's a pituitary adenoma it will present with bitemporal hemianopsia.”Loss in peripheral visual field” due to pressure on optic chiasm
	Mother after ROM came to ER the patient give history of herpes infection 2 years back OE doctor see inactive H.simplex what will do: A. Cs B. Instrumental delivery C. Sterile speculum examination D. Give acyclovir	It has been recommended that a cesarean section should be performed if active lesions are present at the onset of labour - spread by mucocutaneous contact, most common rout for fetal infection is dirct lesion contact during a recurent HSV episode. most result of HSV2, defintive dx is culture from ruptured vedicle. PCR is more sensitive and detect shedding. - fetal infection (transplacental): abortion, IUGT symmetric, microcephaly, cerebral calcifications. - neonatal infection: meningoencephalitis, juandice, mental retardation, petechia, pneumonia, hepatosplenomegaly * only primary herpes cause fetal infection, recurrent cause infection if lesion at birth canal. Prevention: SC if lesion present, if membrane is ruptured >8-12 h no SC Tx: Acyclovir
	Delivery can feel nose chin mouth what kind of presentation A. Face presentation B. Cephalic presentation C. Breech presentation D. Brow presentation	Face presentation
	Sign of fetal distress? A. Blood loss B. Early decelerations C. Late decelerations D. Various decelerations	Late decelerations
	Mother G2 p 1 with Rh + and father - the last baby + and what is % the baby will have - : A. 50% B. 25% C. 100% D. 0%"	50%
	34 yo Female after examination with Pap smear you found ASCUS what is your next step: A. Cone biopsy B. Colposcopy C. Repeat later D. Do HPV test	C or D?!
	I don't remember the scenario exactly,Female while giving birth full dilatation and effacement the child heartbeat decrease from baseline what is the best analgesic: . A - pudendal B - paracervical C - general D - narcotic anesthesia	General?
	Gynecologist see atypical invasive cell on colposcopy , Otherwise the patient is fine . What is the initial management for her? A. Clinical staging B. Conization C. And ? D. Surgical	Atypical squamous cells of undetermined signifi cance (ASCUS):Three options:1. Repeat Pap every 6 months until two consecutive negative smears.2. Perform colposcopy.3. Perform HPV testing. If positive, will need to proceed with colposcopy.?Atypical squamous cells, cannot exclude high-grade squamous intra-epithelial lesion (ASC-H) - answer: Conization?! Because we need biopsy
	24) year old mother presented with her child who is diagnosed with Down syndrome CLINICALLY, she's asking about the risk of down in her next child, what is the best investigation: A. Karyotype this child B. Karyotype the mother and child C. Do US next pregnancy D. Do amniocentesis next pregnancy	- ?? We have to screen first then to diagnose. US is a screening test while amniocentesis is a diagnostic test.
	A patient with blood only noticed when she wipes with toilet paper, where is the bleeding ? A. Urethra B. Vulva C. Uterine body D. Uterine cervix	Valva?
	Vulvar carcinoma will present as a unifocal, ulcerative and lesion in : A. Labia Majora B. Clitoris C. Mons pubis D. Perineum	Labia Majora
	Multipara pregnant. Medically free.. She is term.. Effacement 90% .. 4 cm.. Regular contractions.. Spontaneous rupture of membrane.. Suddenly baby is stress from 140 to 80 beats.. Which type of anesthesia would you use: A. General anesthesia B. Narcotics C. Pudendal n D. Upper utrian?	General?!
	10 week pregnant with DM Nephropathy and HTN. BLOOD PRESSURE is high (162/141) and +3 protein in urine. What to do? A. ACEI B. Bed rest C. Termination of pregnancy D. Observation	?? ACE inhibitors have been designated by the FDA as category D drugs -- meaning that they carry known fetal risks
	Long case Pregnant lady -almost at labour I think-with breech presentation . Face flexed, the lichoer is fair the baby found to be small and the pelvis of mother has ??? Somthing I forgot but sure they didn't mention the type of pelvis Which of the following will prevent you from trying Ecv ? A. Small baby B. Fair lichor C. Pelvic D. Flexed face of baby	Small baby???? Absolute contraindication to external cephalic version : If cesarean delivery is indicated for reasons other than breech presentation Placenta previa or abruptio placentae Nonreassuring fetal status, Intrauterine growth restriction in association with abnormal umbilical artery Doppler index 5-isoimmunization 6-severe preeclampsia 7-recent vaginal bleeding 8-significant fetal or uterine anomalies 9-ruptured membranes, 10- fetus with a hyperextended head, 11- multiple gestations Relative contraindications: Relative contraindications include maternal obesity, small for gestational age fetus (less than 10%), and oligohydramnios because they make successful ECV less likely. [24] Previous uterine scar from cesarean delivery or myomectomy may also be a relative contraindication for ECV.
	14 ys girl menarche at age of 12 she suffering from sever dysmenorrhea with normal amount what is the appropriate action : A- NSAID B- acetaminophen C- OCP D- progesterone	NSAID Most patients with primary dysmenorrhea show subjective improvement with NSAID treatment ( first choice). Primary dysmenorrhea: Menstrual pain in absence of organic disease begins 6 mo-2 yr after menarche (once ovulatory cycles established)
	Case was clear of bacterial vaginosis treatment is	metronidazol Bacterial Vaginosis: Gray, thin, diffuse dischare with fishy odor and usually asymptomatic. No treatment if non-pregnant and asymptomatic, unless scheduled for pelvic surgery or procedur
	Pregnant female in her 34 week , cervix is affect 80% and 1 cm dilated , fetal position I is + 1 , what type of Anastasia will give ? A-Pedundale nerve block B-GA C-Narcotic D-Epidural	Narcotics In 1st stage: 1- oxygen/NO2 inhaled for 20-30 sec doesn't relieve pain 2- Pethidine IM, give w/antiemetic. If baby developed respiratory depression give naloxone In 2nd stage: 1- pudendal block: S2,3,4 infiltraltion w/lidocain Used before operative delivery 2- epidural: bupivicain at L3-4 (1st or 2nd stage, CS). Complete pain relief, bolus every 3-4h or infusion. 3- spinal anasthesia: for any operative delivery or manual removal of placenta. SE: respiratory depression.
	62 years old came with vaginal bleeding. What is the most common benign cause of bleeding in this age? A. Cervical erosion B. Cervical polyps C. Atrophic vaginitis D. Endometrial Hyperplasia	Atrophic vaginitis But you need rule out other serious causes. Such as uterine cancer
	Pregnant at 1st trimester, which is of the following medication is contraindication; A. Erythromycin B. Nitrofurantoin C. Tetracycline D. Gentamicin	Tetracycline It causes abnormal tooth discoloration off the baby.
	Women in phenobarbital what you will do while breastfeeding: A. Stop drug B. Continue drug C. Ween child 3 week before starting breastfeeding. D. Stop it one month before starting breastfeeding.	Continue drug During breastfeeding the baby will, however, continue to be exposed to the AED in varying concentrations depending on the prescribed AED. If mothers receiving ethosuximide, phenobarbital or primidone choose to breastfeed, they should exercise caution and closely monitor the infant for sedation, lethargy and any significant clinical findings.
	43 year old female with irregular menses 3 months back & 1-2 days spotting, what next to do next ? A. FSH B. LH C. HCG D. US	FSH
	45 yrs female came to the primary healthcare and found to have this result Hga1c > 7.8, Random blood sugar ( elevated ) labs indicating that she has diabetes what labs you will request: A. LFT B. Fasting blood sugar C. Full blood count D. Urinalysis	Urinalysis
	Post cautery now complain if post coital bleeding. What is the source of bleeding? A. Vulva. B. Vagina. C. Uterine cervix. D. Uterine body	uterine Cervix
	Women deliver baby (down syndrome) and she want to know about future pregnancy? A. Aminocenthesis in next pregnancy B. Keryotype of infant C. Keryotype infant and mother D. U/s in next pregnancy	Keryotype of infant Recurrence rate depends on type of down syndrome which is determined by karyotyping
	Lady on cervical exam you visualize mass 00*00 cm what to do? A. Cone biopsy B. Excision C. Reassure D. Take sample for histopathology (or something like this )	Take sample for histopathology???
	A 43 year-old female undergone for a mammogram, and the result was negative, when do you advise her to get tested again: A. After 1 year.? B. After 3 year. C. After 5 year. D. Other choices I cannot remember	After 1y
	DVT in a pregnant woman what to do ? a. Duplex U/S +bed rest +LMWH(low molecular weight heparin) b. Venography +bed rest +LMWH(low molecular weight heparin) c. Plethysmography +bed rest +LMWH(low molecular weight heparin) d. Plethysmography +bed rest +LMWH(low molecular weight heparin)+warfarin	Venography +bed rest +LMWH(low molecular weight heparin)
	A lady delivered a macrosomic baby, what is the reliable method of diagnosing postpartum hemorrhage? A. Visual assessment of blood loss B. Maternal pulse C. Hemoglobin D. Creatinine	Maternal pulse Important organ systems to assess include the cardiovascular (heart murmur, tachycardia, strength of peripheral pulses) the pulmonary system (evidence of pulmonary edema), and neurological systems (mental status changes from hypovolemia). The hemoglobin and hematocrit are helpful in estimating blood losses. However, in a patient with acute hemorrhage, several hours may pass before these levels change to reflect the blood loss and platelet count.
	A 42-year-old female complaining of amenorrhea, night sweat and flushing for the last 6 months. What is the most likely diagnosis? A. Hypothyroid B. Hypoprolactinemia >> new choices C. Congenital adrenal Hyperplasia D. Pheochromocytoma	Hypothyroid Primary hypothyroidism will lead to decreased level of T3, T4 and increase level of TSH. TSH and FSH both of them have the same alpha unit, so when level of TSH is increased it will go and attach to FSH receptor and will work like FSH, this will lead to appear of menopause symptoms.
	When does a pregnant patient do GDM ? A. 12 weeks B. 16 weeks C. 20 weeks D. 28 weeks	24-28 w
	Mean age of menopause A. 48 B. 51 C. 53 D. 59	51
	G5P5 women , has chlymedia and herpes , on examination she has cervical dysplasia , what is the most likely cause : A- HPV B- herpes C- chlymedia D- multiparity	HPV Worldwide, the human papillomavirus (HPV) has been detected in more than 90% of cervical carcinomas and in as many as 99.7% of cervical neoplasias. Almost all precancerous and cancer lesions are associated with long-term, persistent HPV infection.
	Pregnant women her amniotic fluid >2000 , atresia on which part cause that : A- renal B- ureteric C- tracheal D- esophageal	Esophageal Fetal anomalies, including esophageal atresia (usually associated with a tracheoesophageal fistula), tracheal agenesis, duodenal atresia, and other intestinal atresias. Renal agenesis is associated with oligohydromnios
	Which of these agents can aggrevate the primary dysmenorrhea? A- copper iud B- levo IUD C- magnesum D- CCB	copper iud Copper intra-uterine devices may cause painful and heavy periods.
	Hydrops fetalis in thalasemia case:	Normal 2 beta abnormal 4 alpha
	A pregnant lady in labor. Multipara and gravida, after presentation to you she had spontaneous rapture of amniotic membrane. In examination she is 5 cm dilated with 100% effacement of the cervix with station zero . After three hours still the same and no change. What is your management: A. Expectant management B. Oxytocin C. Prostaglandin E2(or I2 not sure) D. CS	Oxytocin
	After vaginal delivery the patient is complaining of urine coming out of the vagina during the micturition what is your diagnosis: A.viscovaginal fistula B.urterovaginal fistula C.uretherovainal fistula D.rectovaginal fistula	uretherovainal fistula Continuous inconteinence = vesico or uretero Just during micturition URTHERO
	Women after hystrectomy she will receive : A. Continuos estrogen and progesterone B. Cyclic estrogen and progestron C. Levonorgestrel D. Estrogen only	Estrogen only Treating menopausal symptoms with estrogen alone is known as estrogen therapy (ET). ET improves the symptoms of menopause, but it increases the risk of cancer of the uterus (endometrial cancer). Because of this, ET is only safe for women who don't have a uterus (such as those who have had a hysterectomy).
	Women post intercourse bleeding: A. Uterine cervix B. Uterine body C. Valve D. Vagina	Uterine cervix In premenopausal women, the source of vaginal bleeding after sex is usually the cervix. In postmenopausal women, vaginal bleeding after sex may arise from the opening of the bladder (urethral meatus), the outer opening of the vagina (labia) or the uterus, as well as the cervix.
	A woman who had spontaneous rupture of membranes came to the hospital stating that the fluid that came out was clear. O/E her temp. 38.4 c and there's Pain score was 8 out of 10. On palpation of uterus when not in contraction, there's tenderness. How to manage? a. Give antipyretic b. Give antibiotics while in labor c. Don't do anesthesia d. Do immediate CS.	Give antibiotics while in labor? Once the decision to manage a patient expectantly has been made, the institution of broad-spectrum antibiotics should be considered. However if there is no sign of infection the management of PROM depends on the gestational age (go back to Kaplan notes) - Ruptured fetal membrane before labor onset (term/preterm). Posterior fornix pooling, fluid is nitrazine +, fernning on glass slide drying. - most RF: ascending infection. Cigarettes and local infection. -sx: fluig guch from vagina, clear. Oligohydramnios Dx: sterile speculum * Chorioamnionitis: maternal fever and uterine tenderness in presence of PROM but no URTI/UTI. Tx: 1) if uterine contraction: Never Tocolysis 2) if Chorioamnionitis: take cervical culture, give IV Abx, initiate delivery 3) if no infection: <24w: induce labor or bed rest If 24-33: conservative (in hospital bed rest, IM betamethasone, cervical culture, 7d Ampicillin and erythromycin. If >34 initiate delivery
	CML associated with which translocation : A- t (14; 18) B- t ( 11;14) C- t (8; 14) D- t (9; 22).	t (9; 22) CML is almost invariably associated with an abnormal chromosome 22 known as the Philadelphia chromosome, often abbreviated as Ph, Ph(1), or Ph1[1,2]. The Philadelphia chromosome t(9;22)(q34;q11) results in the formation of a unique gene product (BCR-ABL1)
	. A pregnant women exposed to MMR and she is Not vaccinated against MMR before ...what you have to give her ? a. MMR vaccine b. Immunoglobulin c. No treatment. d. IV immunoglobulin	IV immunoglobulin MMR vaccine should not be given to a pregnant lady
	A women came with vaginal discharge and strawberry cervix and blood spots and other details what is the organism ? a. Chlamydia trachomatis b. Gonorrhea infections c. Trichomonas d. Bacterial vaginosis	Trichomonas
	Women came with pruritus and itching … no discharge ,culture is negative , what to do A. Give empirical therapy AB B. Reassurance and no follow up C. Reevaluation when symptoms come with consideration other inflammatory process D. Referral to STD clinic	Reevaluation when symptoms come with consideration other inflammatory process
	Vaginal discharge with fishy odor and other details what is the treatment ?	Metronidazole This is bacterial vaginosis ( Clue cells, fishy odor and PH>4.5). Metronidazole or clindamycin are used to treat BV. Metronidazole is safe in pregnancy.
	Pregnant came for evaluation, TSH was low what are you going to give her: a. Methinazole a. Ptu b. Radio active iodine c. Thyroidectomy	depending on the trimester Methinazole and ptu can be used in pregnancy but Methinazole should not be used in the first trimester. PTU has a risk of developing liver failure (rare) thus is should be limited to the first trimester. Radio active iodine is contraindicated in pregnancy. Thyroidectomy could be used after the failure of medical therapy. Hyper: - etiology may be gravis ( decrease TSH, increase T4, TSHR-Ab)most common. Other: toxic nodular (plummer), hydatidi form mole, toxic diffuse goiter. - if uncontrolled: IUGR, premature, abortion - storm: pyrexia, severe dehydration and tachycardia. Tx: PTU, BBs, steroids, iodine. - antithyroid meds: first line tx but can cross placenta cause hypothiroidism. Hypo: - mostly a primary thiroid defect, result in anovulation and infertility. Related to sponteniously abortion. Increase suplemental thyroid hormone 30%
	A patient with breast mass the become large with menses came to you asking for diagnosis FNA shows yellowish secretion and it disappear after it what is diagnosis : a. Galactocele b. Ductasia [Duct ectasia] c. Normal variant d. Anovulatory	-
	Pregnant , full term, fully dilated , station +2 ,cephalic presentation, well rotation of the head, fetal bradycardia: A. Ventouse B. CS C. Forceps D. Nothing	A and C Both of them can be used?! ^ to use instruments: cervix fully dilated, head at/below ischial spine, known fetal position, no caput or molding. Ventouse: Usefule in fetal malposition, but not used before 34 w gestation. - should be completed within 15m Indicated: if delay in 2nd stage due to maternal exhaustion or fetal malposition (occipito posteri or/transverse). Or if CTG abnormality. - require maternal effort and adequate contractions * instruments should not be used if head is above ischial spine--> CS - ventous can cause chignon (edema) or cephalhematoma. Forceps: simpson (traction non rotation, Keilland (rotational) - indication: if the mother has a medical condi tion complecating labor like CVD, unconscious (not able to assist w/pushing), or if fetus age <34w, Face presentation, fetal bleeding disorder, breech, at CS. * neeed empty blader to use forceps. - forceps can cause brusing, facial palsy, depression skull fx.
	RLQ pain 9 out of 10 , mass felt tender on examination , US mass 6cm: a. Ectopic pregnancy b. Cystic rupture c. Appendicitis d. Cystic torsion	Cystic torsion Sudden and severe lower abdominal pain associated with adnexal mass is presumptive evidence of ovarian torsion Common causes of abdominal pain in pregnant women include appendicitis, acute chole-cystitis, ovarian torsion, placental abruption, and ectopic pregnancy. Often, it isdifficult to differentiate from among these different etiologies, but a careful his-tory and physical and reexamination are the most important steps. * Appendicitis: Any trimester, RLQ, N/V anorexia leukocytosis fever, treatment surgery * Cholecystitis: After first trimester, RUQ, N/V anorexia leukocytosis, Fever, treatment surgery. * Torsion: 14 weeks gestation or post delivery, unilateral abdominal or pelvic, N/V, treatment surgery. * placental abruption: second and third trimester, midline persistent uterine, vaginal bleeding and abnormal fetal heart tracing, delivery * ectopic pregnancy: first trimester, unilateral abdominal or pelvic, N/V syncope spotting, surgical or medical
	Women in her 30s , multipara 40 week with breach presentation ECV done 2 weeks ago , amniotic fluid index 12, now the baby is on lateral position , why it is contraindicated ECV ? A. Age of the patient B. Previous ECV C. Her AFI D. Position of the fetus	- ?? ECV: repositioning of fetus within uterus under U/S guidance. Contraindications: previous T3 bleed, prior classical C/S, previous myomectomy, oligohydramnios, PROM, placenta previa, abnormal U/S, suspected IUGR, HTN, uteroplacental insufficiency, nuchal cord. In this case there is no contraindication to repeat the ECV
	Which of these cardiac diseases female fit for pregnancy: a. MS 1cm b. Sever MR c. Eisenmenger d. 20% ejection fracture	MS 1cm The most common acquired lesion in pregnancy is rheumatic heart disease and the most common of which is MS - I think its sever MR! PPSS: Prolapse good in pregnancy Stenosis sick in pregnancy Most common rheumatic heart disease. Main problem is inadequate diastolic flow from left atrium to left ventricle. § ↑ preload due to normal ↑ in blood volume results in left atrial over-load.↑ pressure in the left atrium is transmitted into the lungs, resulting in pulmonary hypertension (HTN). § Tachycardia associated with labor and delivery exacerbates the pulmonary HTN because of decreased filling time. May lead to pulmonary edema. § Twenty-five percent of women with mitral stenosis have cardiac failure for the first time during pregnancy. § Ballon valvuloplasty may need to be performed as a last resort. § Fetus is at risk for growth restriction. § Peripartum period is the most hazardous time. - ASD, VSD are tolerated well as are any reguritation lesions. - severe MS is <2 w/maternal mortality 5-15%
	Lactating women with seizure , on phenobarbital what is your advice regarding breast feeding? a. Stop breast feed 8 hour after medication . b. Stop breast feeding immediately c. Continue breast feeding d. Something for 3 weeks	Continue breast feeding mothers receiving ethosuximide, phenobarbital or primidone choose to breastfeed, they should exercise caution and closely monitor the infant for sedation, lethargy and any significant clinical findings.
	What is the best antibiotic for breast feeding is? A. Chloramphenicol → enters breast milk; discontinue drug or do not nurse B. Azithromycin →Unknown whether drug is excreted into breast milk; use with caution C. Cimetidine → not antibiotic & does enter breast milk D. Ciprofloxacin → drug enters breast milk; use not recommended (American Academy of Pediatrics Committee states that drug is compatible with nursing	None of the choices is “SAFE”. There could have been a 4th choice instead of cimetidine In general, according to Mayo clinic, the following are safe during pregnancy  Amoxicillin  Ampicillin( all beta lactames are safe according to Kaplan)  Clindamycin  Erythromycin  Penicillin  Nitrofurantoin
	48 year-old asymptomatic woman has 5-6 cm fibroid 5 or 6. What is the treatment? A. Hysterectomy B. Myomectomy C. Regular follow up yearly D. Follow up and CBC every 2 month	Regular follow up yearly For asymptomatic patients and those that elect non-surgical treatment or no treatment at all, annual pelvic examination should suffice to document stability in size and growth
	27 weeks pregnant lady with history of UTI treated with antibiotics on week 12. Now she has symptoms of UTI and stat abx (?), what is the best management? A. Referral to cystoscopy B. Start antibiotics if patient asymptomatic C. Continue antibiotics then do culture D. Referral to surgery	Their answer: I believe B is wrong because I think the question is meant to be “if patient is symptomatic” to make sense. If so, B would be wrong because bacteriuria/UTI in pregnant patients should be treated promptly even if she is “asymptomatic” due to the increased risk of pyelonephritis and other complications. C is right because pregnant patients with UTI treatment success depends on complete eradication of the bacteria. Patients should be followed up with culture after antibiotics course to insure that. - asymptomatic bacteriuria is most common UTI in pregnancy. If untx will develop acute pyelonephritis - acute pyelonephritis lead to: preterm labor, sepsis, anemia, pulmonary dysfunction IV ceftriaxone
	. Patient with Resistant slapingitis what is the organism? A. Gonerra B. Chlamydia C. Strepto D. E.coli	Gonoria
	20 year-old pregnant lady was exposed to rubella virus 3 days ago. She was never vaccinated against rubella mumps or measles, what's the best thing to do? A. Give IG B. Vaccine C. Do nothing D. Terminate the pregnancy	They answered C?? I think its A, Use of immune globulin — Intramuscular immune serum globulin can prevent or diminish the severity of disease if administered to susceptible individuals within six days of exposure. Administration of immune serum globulin may be especially warranted in exposed individuals for whom the risk of complications of measles is increased, such as pregnant women, individuals less than one year of age, and immunocompromised hosts.
	Presentation of malignant vulvar lesion? A. Perineum B. Labia major C. Clitoris D. Labia minor	Labia major The cancer can appear anywhere on the vulva, although about three fourths arise primarily on the labia
	Pregnant with history of DVT, how to manage? A. Heparin B. Enoxaparin C. Warfarin D. No anticoagulant	Enoxaparin Subcutaneous low molecular weight heparin (LMWH) is the preferred treatment for most patients acute DVT. The most commonly used LMWH is enoxapari - IV to increase PTT by 1.5-2.5 then SC heparine.
	Which is at risk in uterine artery ligation A. Pudendal n B. Ovarian a C. Vagina D. Ureter	Ureter Ureters pass under uterine artery and under ductus deferens (retroperitoneal).“Water (ureters) under the bridge (uterine artery, vas deferens).”Gynecologic procedures involving ligation of the uterine vessels may damage the ureter.
	24 year-old was married for 9 month with regular heavy menses and pain. On examination, there is a nodule in cervix and tenderness. What is the cause? A. Fibroid B. Endometriosis C. Cervical cancer D. Vaginal cancer	- cervical cancer?
	A lady complained of vuvula vesicle that tender , no vaginal discharge? A. Chancer B. Syphilis C. Hsv D. Postherptic leison	They answered A?! - Lesions (chancres) usually begin as solitary, raised, firm, red papules that can be several centimeters in diameter. The chancre erodes to create an ulcerative crater within the papule, with slightly elevated edges around the central ulcer (see the images below). It usually heals within 4-8 weeks, with or without therapy. - painful ulcer: HSV
	80% effecment , 4 cm dilated cervix on IV oxytocin, she is stable on CTG showingg variable acceleration? A. Stop oxytocin B. Give terbutaline C. Change mother position D. Expectant delivery	Expectant delivery?!
	Best to confirm menopause? A. FSH B. LSH (not sure if this choice is correct! I think it should be LH) C. Estrogen D. Progesterone	FSH (FSH) levels are higher than (LH) levels, and both rise to even higher values than those seen in the surge during the menstrual cycle. The FSH rise precedes the LH rise. FSH is the diagnostic marker for ovarian failure. LH is not necessary to make the diagnosis.
	27 Gestation pregnant with monoamniotic twin, one of them died? A. Give steroid and deliver B. Wait to 34 then deliver C. Wait 37 then deliver D. Wait until SVD	A or B? Once choosing a conservative management, one should be aware, however, to the natural history of approximately 90 % deliveries within 3 weeks from the time of diagnosis. Preterm delivery is therefore common and steroid prophylaxis for lung maturity enhancement should be given. - For gestations at 32 to 34 weeks, administering a course of corticosteroids to enhance fetal maturity and delivery 48 hours later is an option; however, there are no data showing that this is beneficial to the survivor. Before 32 weeks, it is probably best to allow the pregnancy to continue. The risk of cerebral palsy in the surviving cotwin may be as high as 20 percent
	70 year old with yellow discharge, foul smell not itching not sexually active: A. Atrophic vaginitis B. Candida C. Bacterial vaginosis D. Trhomanis	Atrophic vaginitis This is due to estrogen deficiency in postmenopausal women.
	Breastfeeding mother haven't received MMR (rubella vaccine) what are you going to tell her? A. MMR well hurt the baby B. MMR is live attenuated bacteria C. MMR can be received while breastfeeding D. Stop breastfeeding for 48-72	MMR can be received while breastfeeding MMR vaccine can be given to breast-feeding mothers without any risk to their baby. Very occasionally rubella vaccine virus has been found in breast milk but this has not caused any symptoms in the baby.
	80% effacement, 4 cm dilated cervix on IV oxytocin, she is stable, CTG variable deceleration? A. Stop oxytocin B. Give terbutaline C. Change mother position D. Expectant delivery	Stop oxytocin?! If CTG is non-reassuring start 1 or more conservative measures: Encourage the woman to change position and avoid being supine, offer oral or intravenous fluids, reduce contraction frequency by stopping oxytocin if being used and/or offering tocolysis. - Variable decelerations occur when the umbilical cord is compressed. Intermittent variable decelerations (associated with <50 percent of contractions) are frequently observed in labor tracings and are not usually associated with adverse consequences, presumably because transient cord compression is well tolerated by the fetus [37]. Thus, they do not require intervention. - recurrent variable decelerations (>50 percent of contractions) require a greater degree of surveillance. The treatment of variable decelerations is generally aimed at resolving cord compression. Change of maternal position is a reasonable first treatment option [39]. Amnioinfusion can be useful in resolving persistent variable decelerations. (See "Amnioinfusion: Indications and outcome" and "Amnioinfusion: Technique".) Adjunctive measures to improve fetal oxygenation (oxygen supplementation, intravenous fluid bolus, reduce uterine contraction frequency) may be useful. In addition, scalp stimulation should be performed to provoke fetal heart rate acceleration, which is a sign that the fetus is not acidotic. Delivery is indicated if the tracing does not improve and acidemia is suspected.
	What prevent fracture in post menopause a. Daily vitamin D supplements b. Weight baring exercise c. Decrease obesity	Weight baring exercise
	Increase risk of dysmenorrhea? a. Copper releasing hormone b. Levonorgestrel releasing hormone c. Magnesium d. Nifedipine	Copper releasing hormone
	Pregnant with DVT previously, what to do: a. Aspirin b. Enoxaparin c. Heparin d. No anticoagulant	Enoxaparin
	What is the mean age of menopause in normal women? a. 48.4 b. 51.4 c. 53.4 d. 55.4	51.4
	62 years old came with vaginal bleeding. What is the most common benign cause of bleeding in this age? a. Cervical erosion b. Cervical polyps c. Atrophic vaginitis d. Endometrial Hyperplasia	Atrophic vaginitis Atrophy account for (59%) of all postmenopausal bleeding histopathology
	Primi gravida, Diet controls GDM, on prolonged second stage of labor. She did full flexion of her hip. The head of the baby descent during contraction and going up during relaxation, One nurse applied pressure on fundus, while another nurse applied pressure on the supra pubic area. What is the cause of her delayed labor? a. Full flexion of the hip. b. Apply pressure on the fundus c. Apply pressure on the supra pubic area d. Something irrelevant.	Apply pressure on the fundus Can further exacerbate nerve injury
	Pregnant woman worries from tetanus for her baby. How will you advise her regarding vaccine? A. Give to mother and child after delivery B. Give to baby after delivery C. Give as early as possible or before pregnancy D. Give to mother after delivery	Give as early as possible
	Pregnant lady (7th week) presented with RLQ pain, febrile (38.5) with tachycardia and hypotention. Labs: normal CBC (no leukocytosis) UA: Normal Diagnosis? A. Ruptured appendix B. Ruptured Ectopic Pregnancy C. Ruptured Ovarian Cyst	Ruptured ectopic pregnancy Clinical manifestations of ectopic pregnancy typically appear six to eight weeks after the last normal menstrual period. The classic symptoms of ectopic pregnancy are: pelvic\lower Abdominal pain, Amenorrhea, Vaginal bleeding. These symptoms can occur in both ruptured and un-ruptured cases. Rupture may be present as sudden, severe pain, followed by syncope or by symptoms and signs of hemorrhagic shock or peritonitis.
	For pap smear? A. Three specimen from endocervix B. 2 specimen from two different areas C. One specimen from endocervix D. One specimen from cervical os	They answered: A or C couldn't find a reference for the # of the specimens But I found in kaplan: should include cytologic specimen from 2 areas: Stratified squamous epithelium of TZ of ectocervix and could lumnar epithelium of endocervical canal. - ectocervix: screen for SCC w/scrapping - endocervical canal: screen for Adenocarcinoma w/cytobrush
	2*3 cm ampulla ectopic pregnancy, patient is hemodynamically stable. Management? A. Laproscopy B. Medical C. Laprotomy D. Observe	Medical
	What structure you will feel laterally in p.v? A. Ovaries B. Pernial body C. Ureter D. Rectum	Ovaries The purpose of the bimanual examination is to determine the size and nature of the uterus and the presence or absence of adnexal masses.
	Pregnant lady 24 weeks GA, thyroid function test as the following: TBG High, TSH Normal, TOTAL T4 high and Free T4 low A) Pregnancy B) Oral contraceptives use C) Compensated euthyroid D) Hyperthyroidism	A major contribution to the increased TBG concentration during pregnancy is the reduced plasma clearance of the protein caused by changes in TBG glycosylation induced by estrogen. Total thyroxine (TT4) and total triiodothyronine (TT3) concentration increase in the setting of pregnancy-induced increases in serum TBG concentrations. Free T3 (FT3) and free T4 (FT4) levels are slightly lower in the second and third trimesters. TSH levels are low-normal in the first trimester, with normalization by the second trimester.
	Vaginal discharge. Treatment? A. Metronidazole cream 4times 7days B. Metronidazole tablet C. Clindamycin tablet D. Clindamycin cream	Metronidazole tablet
	High d-dimer.acute case. What would you give this pregnant woman? A. Infractionated heparin and warfrin B. LMWH C. Warfarin D. Aspirin	LMWH
	Dew drops on rose petals vaginal lesions, dx: A- Herpes simplex B- Syphilis C_ chanchroid lesion D- herpangia	Herpes simplex Herpes simplex and varicella zoster both cause this type of rash. The skin lesions are characteristic for this disease. There are maculopapules, vesicles and scabs in various stages of evolution. This is shown in the figure below. - There is shifting from maculopapules to vesicles over hours to days. Usually the trunk and face is affected and this shifts to other regions of the body. The base of these vesicles are erythematous and they appear in crops i.e. Some are still developing while others are healing. The classical sequence is macules, papules, clear vesicles, pustules, central umbilication and eventually crust formation. The classical description of the lesion is a 'dew drop on rose petal' appearance. The rose petal refers to the reddish irregular papule and the clear vesicle on it is the dew drop.
	When to swap for GBS in pregnant ladies: A-25 wks B-30 wks C-35 wks D-40 wks	35w GBS: neonatal sepsis: Newborn sepsis withinhours of birth (bilateral diffuse pnemonia) - early onset: fulminant bilateral diffuse pneumonia and sepsis-->IV penicillin G prophylaxis intrapartum Prophylaxis for: 1) all women w/+ culture or pre baby affected 2) positive screen culture in 3rd T (35-37w) rectovaginal. 3) RF w/no culture: preterm <37w, ROM >18h, maternal fever - late onset: after 1st w of life, hospital acquired: meningitis - key words: 35w (preterm) w/active labour, posi tive urine culture, previous baby w/GBS pneumonia - 30% have asymptomatic vaginal colonization, majority are transiant carriers. -
	. What it the Side effect of post-menopausal hormonal therapy A. Breast cancer B. Uterine cancer C.DVT D. STROKE	DVT - Although studies have been inconsistent, an emerging consensus appears to suggest that HT may slightly increase the risk for breast cancer. This risk is similar to that associated with natural late menopause, and it comes into effect after at least 5 years of continuous HT. - evidence from randomized controlled studies showed a definite association between HT and uterine hyperplasia and cancer. HT based on unopposed estrogen is associated with this observed risk, which is unlike the increased risk of breast cancer linked with combined rather than unopposed HT. Continuous combined regimens have not been associated with an increased risk. However, cyclical regimens—even ones involving 10-14 days of progestogens per month—do increase the risk after 5 years of usage. - combined HT increased the risk of venous thrombosis and pulmonary embolism, The risk of venous thrombosis increased for women given an estrogen-only regimen
	Pregnant lady 24 weeks GA, thyroid function test as the following: TBG High TSH Normal TOTAL T4 high Free T4 low A. Pregnancy B. Oral contraceptives use C. Compensated euthyroid D. Hyperthyroidism	Pregnancy In pregnancy: Free T3 (FT3) and free T4 (FT4) levels are slightly lower in the second and third trimesters. Thyroid-stimulating hormone (TSH) levels are low-normal in the first trimester, with normalization by the second trimester.
	22 year old lady healthy present to check up she only complain of breast tenderness 3 days before menses /she never had sexual contact and wish to be pregnant in next 2 year what is the best thing to do for screening? A. Breast US B.HPV C. Pap smear D. Colposcopy	Pap smear She is most likely having premenstrual syndrome. No need for further testing regarding her breast tenderness. Pap smear should be done at this age even if she is still virgin because it can be transmitted without intercourse.
	Contraindication for breastfeeding? A- HCV B- HIV C- Herpes zoster D- Wart	HIV Contraindication of breast feeding: human immunodeficiency virus (HIV) , antiretroviral medications, active tuberculosis, human T-cell lymphotropic virus type I or type II , cancer chemotherapy agents , radiation therapy
	24 married for 9 months with regular heavy menses and pain, on examination there is a nodule in cervix and tenderness, what is the cause? A- Fibroid B- Endometriosis C- Cervical cancer D- Vaginal cancer	Fibroid Http://www.merckmanuals.com/professional/gynecology-and-obstetrics/uterine-fibroids/uterine-fibroids
	Pregnant type DM1 class f w/ nephrotic complication and control HYPERTENSION what is likely complication? A) Preeclampsia B) Stillbirth C) Shoulder dystocia D) Large for GA	Preeclampsia Pregestational diabetes mellitus, as seen with T1DM patients, is a well-known risk factor for preeclampsia. The risk of developing preeclampsia in gravid T1DM patients is between 12% to 15%, compared with 5% to 7% in the general population. In patients with preexisting nephropathy the risk rises to as much as 50%. Choice C and D are more common in type 2 DM.
	Pregnant woman, if not allergic, by which antibiotics you treat UTI? A. Ampicillin B. Sulfametha C. Nitrofurantoin D. I think ciprofloxacin	Nitrofurantoin ➤ The most common cause of cystitis is E coli. ➤ Bacteriuria caused by group B streptococcus in pregnancy necessitatesthe use of intravenou penicillin or ampicillin in labor to decrease the riskof neonatal GBS sepsis. ➤ Pyelonephritis presents with flank tenderness and fever. Pregnant women with pyelonephritis should be hospitalized and treated with intravenous antibiotics, such as ampicillin and gentamicin, or a cephalosporin, such as cefazolin, cefotetan, or ceftriaxone. ➤ Urethritis,commonly caused by ChlamydiaorN gonorrhea,should be sus-pected with negative urine cultures and symptoms of a UTI. ➤ Asymptomatic bacteriuria has a high inci dence in women with sickle cell trait - cystitis: Trimethoprim/sulfa (Bactrim), nitrofurantoin, norfloxacin, ciprofloxacin, and cephalosporins, such as cephalothin, are effective. Ampicillin is generally not used due to the widespread resistance of E coli.
	G3P2+0. Her first visit was on the 20th week of gestation. She has history of two premature deliveries. Her cervical length was 30 mm. What is your appropriate management? A. Strict bed rest B. Terminate her pregnancy C. Immediate cerclage D. Inject her with progesterone	I think C Several studies have indicated that the likelihood of preterm delivery increases with decreasing cervical length. A cervical length of 25–30 mm before 32 weeks gestation seems to increase the risk of preterm delivery. If examination and ultrasound show that you have an abnormally short cervix, and you're less than 24 weeks pregnant, your practitioner may recommend “cerclage”, a procedure in which she stitches a band of strong thread around your cervix to reinforce it and help hold it closed. However, there's a lot of controversy about whether cerclage should be used in this situation."
	The most accurate diagnostic investigation For ectopic pregnancy ? A-Culdocentesis B. Pelvic U/S C. Endometrial biopsy D. Serial B-HCG E. Laparoscopy	Laparoscopy remains the criterion standard for diagnosis; however, its routine use on all patients suspected of ectopic pregnancy, However initial diagnosis of ectopic pregnancy is a clinical diagnosis made based upon serial serum human chorionic gonadotropin (hcg) testing and transvaginal ultrasound (TVUS).
	Patient g2p1 with twins GA41 weeks , +ve GBS management ? A. C/s with AROM B. Acyclovir C. Prepare forceps for delivery D. Abx	Abx Mother must be given Abx to minimize risk of transmission to baby According to the CDC, if you have tested positive and are not high risk, your chances of delivering a baby with GBS are: 1 in 200 if antibiotics are not given 1 in 4000 if antibiotics are given To help protect their babies from infection, pregnant women who test positive for group B strep bacteria in the current pregnancy should receive antibiotics through the vein (IV) during labor. Antibiotics help to kill some of the group B strep bacteria that are dangerous to the baby during birth. The antibiotics help during labor only — they cannot be taken before labor, because the bacteria can grow back quickly. Penicillin is the most common antibiotic that is given, but women who are severely allergic to penicillin can be given other antibiotics. Penicillin is very safe and effective at preventing the spread of group B strep bacteria to newborns during birth. There can be side effects from penicillin for the mother, including a mild reaction to penicillin (in about 1 out of every 10 women).
	OCP: A. Decrease the risk of ovarian cancer B. Increase the risk of breast cancer C. Decrease endometrial cancer D. Increase risk of ectopic pregnancy	Decrease the risk of ovarian cancer combined oral contraceptive (COC) decrease the risk of ovarian cancer, endometrial cancer and colorectal cancer It also increase the risk of cancers of the breast, cervix and liver.
	34 years old lady, in 27 weeks pregnant present with upper and lower extremity edema her Blood pressure was 150/90 admitted for further investigation What your management: A. Low salt diet B. BB C. Reassure D. Continue investing	This could be preeclampsia: - Mild preeclampsia is defined as the presence of hypertension (BLOOD PRESSURE ≥140/90 mm Hg) on 2 occasions, at least 6 hours apart, but without evidence of end-organ damage, in a woman who was normotensive before 20 weeks' gestation. All women who present with new-onset hypertension should have the following tests: CBC, ALT and AST levels, Serum creatinine, Uric acid ! 24-hour urine collection for protein and creatinine (criterion standard) or urine dipstick - Management: O Delivery is the only cure for preeclampsia. Patients with mild preeclampsia are often induced after 37 weeks' gestation. O Before this, the patient is usually hospitalized and monitored carefully for the development of worsening preeclampsia or complications of preeclampsia, and the immature fetus is treated with expectant management with corticosteroids to accelerate lung maturity in preparation for early delivery. In patients with severe preeclampsia, induction of delivery should be considered after 34 weeks' gestation. In these cases, the severity of disease must be weighed against the risks of infant prematurity. In the emergency setting, control of BLOOD PRESSURE (Hydralazine, Labetalol, Nifedipine, Sodium nitroprusside) and seizures (ABC, Magnesium sulfate is the first-line, Lorazepam and phenytoin may be used as second-line).
	Patient in 39 week gestation come with contraction every 3-4 mints and continue for the last 2 hour, the cervix is dilated 2 cm she is pregnant by twin the doctor cannot palpable the presenting part he think that because the the position of the twin A. What could be the presentation (twin A-B): A. Cephalic-breach B. Transfer-cephalic C. Breach -cephalic D. Cephalic-cephalic	?? - Vertex-vertex twins — This presentation accounts for approximately 42 percent of twins [50]. The general consensus is that a trial of labor with the goal of a vaginal delivery of vertex-vertex twins is appropriate at any gestational age - cesarean delivery when the first twin is not in the vertex presentation - Vertex-nonvertex twins comprise 38 percent of twins; the nonvertex twin may be breech (26 percent), transverse (11 percent), or oblique (1 percent). Options for delivery include cesarean delivery of both twins, vaginal delivery with cephalic version of the second twin, or vaginal delivery with breech extraction of the second twin. - I think answer is C!
	Approach to vulvar carcinoma is ?? A) Clinical then ask about HPV B) Histopatholgically then biopsy C) Radiologically D) Hematologically then tumor marker	Histopatholgically then biopsy
	Pregnant frequent abortions hx of recurrent herpes but NOW No lesions in vulva , Membranes ruptured one hour ago Clear & thin Wt to do? A. CS B. Instrumental C. Give acyclovir D. Speculum	CS
	To perform instrumental delivery you should first exclude what? A. Cephalopelvic disproportion B. Placental rupture C. Breech presentation D. Uterine rupture	Cephalopelvic disproportion - Any contraindication to vaginal delivery - Refusal of the patient to verbally consent to the procedure - Cervix not fully dilated or retracted - Inability to determine the presentation and fetal head position - Inadequate pelvic size - Confirmed cephalopelvic disproportion - Unsuccessful trial of vacuum extraction (rela tive contraindication) - Absence of adequate anesthesia/analgesia - Inadequate facilities and support staff - Inexperienced operator
	What is the mean age of menopause in normal women? A. 48.4 B. 51.4 C. 53.4 D. 55.4	51.4 In perimenopausal period: - hypothalamic pitutiry activity (raised FSH, later LH) - decrease/absent progesterone - unopposed estrogen These changes result in dysfunctional uterine bleeding (anovulatory), with time insufficient follicles develop with inadequate estrogen to stimulate endometrium and menses cease. Short term sx: vasomotor sx, end organ atrophy, psychological sx. Long term sx: osteoporosis, cardiovascular disease
	Old lady did hysterectomy and bilateral oophorectomy histology showed Ovarian germ cell theca something What other findings : A. chronic salpingitis B. endometrial hyperplasia C. uterine navus D. Cervical something	Endometrial hyperplasia - Many patients with granuloma theca cell tumor present with manifestations of hyperestrogenism. most common endocrine manifestation of GCTs in postmenopausal women is abnormal uterine bleeding. This is caused by resumption of endometrial proliferation due to estrogen production by the tumor. For this reason, endometrial hyperplasia and/or endometrial adenocarcinoma may be a concomitant finding in women with GCT.
	Case about infertility, what's the initial evaluation A. Temperature chart B. Semen analysis C. Refer to reproductive clinic	Semen analysis It depends on the case at hand. But most commonly, after taking proper Hx & Px, the first lab evaluation should be semen analysis. - conception occur in the 4d aroud ovulation - hx: heavy period (fibroids), painful period (endometreosis/Asherman: both cause adhesions), irregular/prolonged period (anovulation), dyspareunia (PID/endometreosis). Previous chlamydial infection, IUCD, ectopic pregnancy. - enlarged uterus: fibroid, immobile: PID/ endometreosis Investigations: 1- semen analysis: v 1.5-5ml, count >20m/ml, progression >50%, normal form >30% 2- progesterone: level at 7d before the next period (21 if 28cycle, 28 if 35cycle). If >32 ovulation + 3- screen for chlamedya before doing hysterosalpingogram or laparoscopy (worsen) 4- tubal patency: in the 1st half of cycle (not pregnant): HSG is tset of choice unless pelvic assessment needed do laparoscopy under anasthesia (for ex. PID/endometreosis adhesions) 5- us: presence of uterus/ovaries, conganital abnormalities, bulky ovaries w/periphral follicles in PCOS, HYDROSALPINX * TSH, prolactine, LH/FSH: if irregular cycle * prolactine: galactorrhea * karyotype: secondary sexual characteristics absent * testosterone: if man hypoadrogenic or woman over hirsutism * Antisperm antibody: not a significant predictor * Hysteroscopy: if US show abnormality; adhesions, polyp, fibroid. (Submucosal fibroid a.w infertility)
	Patient post hystrectomy and oophorectomy to be started on HRT how you gonna give? A- Cyclic estrogen & progestrone B- Continuous estrogen & progesterone C- Estrogen alone	Estrogen alone Post-Hysterectomy pts have no uteri so no point in giving PROGESTERON to prevent endometrial hyperplasia.
	Post coital bleeding + vaginal discharge (no special color or odor was mentioned) A- C. Trachomatis B- Vaginosis C- Candida	C.trachomatis Postcoital bleeding: The most common etiology is chlamydial infection(cervicitis), 2nd most common cause is Bacterial vaginosis.
	38 years old female had amenorrhea for two months after 1 year of irregularity of the menstrual cycle. She is a mother of 3 children, she has one history of dilatation and curettage after Cesarean section. She has thinning in the vaginal secretion labs were done and shows normal finding except high FSH & LH, low estrogen radiology revealed normal uterus and cervix what is the diagnosis? A- Premature failure of the ovary B- Asherman's syndrome C- Androgenic cause	Premature failure of the ovary In Primary ovarian insufficiency, ovaries do not regularly release eggs and do not produce enough sex hormones despite high levels of circulating gonadotropins (especially follicle-stimulating hormone [FSH]) in women < 40. Diagnosis is confirmed by high FSH and low estradiol levels. Typically, treatment is with combined estrogen/progestogen therapy.
	50 years old Menopausal woman, high risk of breast cancer, with osteoporosis, what is the treatment of osteoporosis here? A. Vit D supplementation B. Estrogen C. Biphosphonate	Biphosphonate Estrogen is contraindicated. All patients should have (risk factor modification, diet including daily supplementation of elemental Ca and Vit D, exercise). Pharmacologic treatment bisphosphonates are first line drugs. - estrogen mediate trabecular bone maintenance. Most common site in vertebral body follwed by hip and wrist. - most common dx: DEXA, and most common method to assess Ca loss is 24h urine hydroxyproline or NTX - RFs: Fhx, thin white female, steroid, low ca, sedentry life, smok/alcohol. - BMD test: all >65, postmenopausal w/RF: other than F white, or postmenopausal w/fx - above -1 is normal, -1/-2,5 osteopenia, under -2.5 osteoporosis - bisphosphoates (alendronate,risedronate): inhibit osteoclast activity. Selective estrogen receptor modulators (raloxifene): increase bone density, no breast/uterine SE. These are 1st line - estrogen replacement is highly effective it should not be used due to SE.
	Treatment of gestational diabetes: A. Insulin B. Metformin C. Glipizide	Insulin
	34 weeks gestation fetus with decreased fetal movements. What will you do? A. Non stress test B. Biophysical profile C. Stress test	NST The nonstress test (NST) provides immediate reassurance of fetal viability and well-being. We suggest the basic evaluation of pregnancies complicated by decreased fetal movement include review of the prenatal record and a nonstress test. Even in the setting of a reactive nonstress test, we suggest obtaining an ultrasound examination within 24 to 48 hours if not recently performed.
	Which OCP will cause hypertension? A. Estradiol levonorgesterel B. Estradiol progesterone C. Estradiol depressing....	Estradiol levonorgesterel SE of COCP: mainly thromboembolism and CVD, exacerbated by: Age, obesity, smoking, DM, HTN, hyperlipidemia Other SE: wt gain, decrease libido, breast discomfort, mood disturbance, breakthrough bleeding. - increase cervical interaepthelial neoplasia and cancer. - discontinued 4w before surgery (R of DVT). Absolute contraindication: pregnancy, DVT, liver disease, vaginal bleeding, estrogen dependent tumor, recent hydatidiform mole. Relative: migraine, HTN - its use decrease dysmenorrhea, menorrhagia, PMS, reduce insidance of ovarian/endometrial cancer. Control functional ovarian cyst.
	When you can diagnose the dichorionic twins by ultrasound? A. Early 2nd trimester B. Late 2nd trimester C. 3 rd trimester	Early 2nd T Accuracy is improved when the assessment of chorionicity is undertaken before 14 weeks' gestation rather than after 14 weeks. The twin peak sign (lambda sign) alone in the second trimester can accurately identify the chorionicity in many cases, but that may not be sufficient. In the second trimester, the twin peak sign becomes more difficult to visualize, and it disappears in about 7% of dichorionic pregnancies.
	A patient has a breast mass. It is not related to cyclic pain. On exam, it is mobile. What is the most likely diagnosis? A. Fibro-adenoma B. Fibrocystic change C. Intraductal papilloma (IDC)	Fibroadenoma - most common in adolecence and young a multiple lesions, discrete, smoothly contoured, rubbery non tender, freely moveable, mostly UOQ * IDC presents as nipple discharge, and is the most common cause of spontaneous unilateral bloody nipple discharge - fibrocystic changes: cyclic premenstrual mastalgia, palpable madd. FNA: complete cyst drainage w/collapse of cyst wall.
	A patient presented to the gynecology clinic with malodorous vaginal discharge. What is the most likely diagnosis? A. Trichomonas vaginitis (TV) B. Gonorrhea C. Chlamydia	Trichomonas vaginitis (TV) TV is the most common cause of vaginal complains worldwide. It is mainly characterized by diffuse malodorous yellow-green discharge with vulvar irritation and characteristic strawberry cervix. Gonorrhea and chlamydia are sexually transmitted disease that has mucopurulent discharge
	Case of vaginal prolapse. How to examine? A. Speculum B. US C. Upright position	Speculum Pelvic Organ Prolapse is diagnosed with a pelvic examination. A medical history is also important to elicit prolapse-associated symptoms, since treatment is generally indicated only for symptomatic prolapse. Examination components: Physical examination of women with POP includes the following components: Visual inspection Speculum examination Bimanual pelvic examination Rectovaginal examination Neuromuscular examination
	Women at 20 w gestation with 2 previous premature births, what to do to prevent recurrence for this fetus? A. Cerclage at 20 wk B. Aspirin C. Strict bed rest until full term	Cerclage at 20 wk Interventions to prevent preterm delivery:  Singleton pregnancy: a. Weekly IM 17-hydroxyprogesterone caproate (17-OH-P) if cervical length >= 25 mm with prior spontaneous PTB b. Weekly IM 17-OH-P plus cervical cerclage placement if cervical length < 25 mm before 24 weeks with prior PTB c. Daily vaginal progesterone if cervical length < 20 mm before 24 weeks but No prior PTB  Twin pregnancy: no interventions shown to have benefit
	Hysterectomy granulosa theca tumor , what else to find ? A. Condylomata acuiminata B. Mole in uterus C. Endometrial hyperplasia	Endometrial hyperplasia Granulosa theca tumors are associated with elevated estrogen levels produced by the tumor, which will lead to endometrial hyperplasia.
	When is the appropriate time to give rhogam to an Rh “-“ pregnant lady? A. Before pregnancy and as soon as she knows she's pregnant B. 3 days within delivery C. At delivery and 2 weeks after	3 days within delivery Rhogam should be given on 28 weeks gestation and 3 days within delivery. * also given if chorionic villus sampling, amniocentesis, or DandC. - Rhogam is ant D IgG given IM - 300 mcg of rhoGAM will naturalize 15ml of fetal RBCs or 30 ml of whole body. - Rosette test: qualitative screen test for detecting feto-maternal hemorrhage >10ml - Kleihauer-betke test: quantities volume of fetal RBCs in maternal circulation by differential staining. Fetal cells appear brighter.
	Palpation of posterior vaginal fornix. What will you feel laterally? A. Perineal body B. Ovaries C. Rectum	Ovaries
	13 yo girl with normal second sexual character with absent uterus and vagina what's the cause: A. Muller agenesis B. Gonadal agenesis C. Turner syndrome	Muller agenesis Primary amenorrhe is dx w/absence of menses at 14 without secondary sexual development or at 16 with secondary sexual development. 1) anatomical: vaginal agenesis/septum, imperforate hymen, Mullerian agenesis. 2) hormonal: complete androgen insensitivity, gonadal dysgenesis (turner), HTP insufficincy Presence of breast= presence of Estrogen If breast present and uterus is absent: A) Mullerian agenesis 46 xx: idiopathic, estrogen from ovaries, pubic hair present, testosterone of a female. Tx: no hormone, only create vagina, pregnancy: surrogate. B) Androgen insensitivity 46 xy: Mullerian inhebitors factor lead to absent uterus, estrogen from testes, pubic hair absent, and testosterone level of male. Tx: estrogen, creat vagina, remove testes.
	Can use for pregnant women "? A. Paracetamol B. Aspirin C. Ibuprofen	Paracetamol
	Women with mastitis A. Stop breast feeding B. Clean nipple with alcohol C. Surgical drainage	THE ANSWER MAY BE MISSED OPTION CONTINUE BREAST FEEDING - lactational nipple trauma leading to nipple craking and S.aures infection. - fever of variable degree w/unilateral breast tenderness, erythema, edema. - tx: oral Cloxacillin or dicloxscillin for 7-10 d. Continue breat feeding - if not responding, US to exclude abcess
	How can stimulate breast feeding secretion ? A. Breast feeding B. Increase fluid intake C. Increase caloric intake	Breast feeding - estrogen from follicle--> duct growth - progesterone from corpus luteum-->development of milk producing alveolar cells - prolactin--> milk production - oxytocin: milk ejection in responce to succkling. - estrogen antagonize the positive effect of prolactine on milk production.
	Primigravida week 16. She is RH negative. What is your next step? a. US b. Anti-D Rh immunoglobulin c. Rh antibody titer	Rh antibody titer - Rh antibody titer during the initial prenatal visit if she's RH - Unsensitized patients do not yet have antibodies to Rh positive blood. The goal is to keep it that way: ● So any time that fetal blood cells may cross the placenta, anti-D Rh immunoglobulin (rhogam) are given. ● Prenatal antibody screening is done at 28 and 35 weeks. Patients who continue to be unsensitized at 28 weeks should receive anti-D Rh immunoglobulin prophylaxis. ● At delivery, if the baby is Rh positive, the mother should be given anti-D Rh immunoglobu lin again. The patient is considered sensitized if she has a titer level more than 1:4. ● If the titer is less than 1:16, no further treat ment is necessary. ● If it reaches 1:16 at any point during the preg nancy, serial amniocentesis should be done. Ser ial amniocentesis allows for evaluation of the fe tal bilirubin level.
	Multigravida 34 week, her baby is breech, what you will do for her? a. Expectant delivery b. CS c. External Cephalic Version	Expectant delivery Expectant delivery until 36 week. You should not perform ECV before 36 weeks, because the baby can turn into cephalic spontaneously.
	Which of the following non hormonal supplements will decrease the hot flashes in postmenopausal women? a. Black Cohosh b. Paroxetine c. Bromocriptine	Paroxitine * FDA approved Paroxitine mesylate (Brisdelle) as the first nonhormonal therapy for vasomotor symptoms (VMS) (hot flashes) associated with menopause. SSRI in general venlafaxine, gabapentin, propranolol, clonidine
	Why postmenopausal women develop osteoporosis? a. Decrease progestin b. Increase FSH c. Decrease Estrogen	Decrease Estrogen
	Young female complaining of whitish grey vaginal discharge. KOH test and clue test were positive. What is the diagnosis? A. Gonorrhea B. Bacterial Vaginosis C. Trichomonas Vaginalis	Bacterial Vaginosis Amsel criteria 3 out of 4 is diagnostic  Ph >4.5  Positive clue cells  Discharge is thin, grey and homogenous  Whiff test positive (KOH mount)
	20 years old sedentary female complaining of amenorrhea for the last 6 months and her BMI is 20. A. Prolactinoma B. Anorexia C. Depression	Depression?! * menstrual irregularities or oligo since minarche--> PCOS (obesity,hairsutisim) * pitutiry faliure after massive postpartum hemorrhage (shrehan) * early pregnancy loss w/curettage--> Ashermann * hypothalamus: wt loss (stress, athletic), tumors, Kallmann (impaired sence of smell). * drugs: phenothiazine, chemo/radio * normal breast but no hair: androgen insensitivity * heamatocolpos: blue bulge at introitus.
	Lactating lady who didn't take the MMR. What will you advise her to do? A. Take the vaccine and stop feeding for 72 hour B. It is harmful for the baby C. She can take the vaccine	She can take the vaccine
	A girl who hit puberty few months back and complains of spotting in between her periods. What will you tell her? a. She has PCOS b. She needs to take ocps c. If tests were normal it's not a disease	If tests were normal it's not a disease
	A patient with cervical carcinoma. What viruses are thought to be major culprits? a. HPV 43 and 44 b. HPV 16 and 18 c. HPV 6 and 11	HPV 16 and 18
	A woman with vaginal infection that grows gram negative diplococci. What is the organism involved? a. N.gonorrhoeae b. HSV c. Candida	N.gonorrhoeae
	What is the best way to know the date of pregnancy? a. LMP b. Ultrasound c. Fundal height	Ultrasound The 3 basic methods used to help estimate gestational age (GA) are menstrual history, clinical examination, and ultrasonography Early (first trimester) ultrasound is the most accurate way to determine gestational age. The first 2 are subject to considerable error and should only be used when ultrasonography facilities are not available - fundal ht in cm correspond to GA from 20-34 w. Do US if discrepancy of 3cm - hegar sign: softening of junction between corpus and cervix.

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