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OBGYN 2

Obgyn 2

by qamar20, Sep. 2016

Subjects: OBGYN

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206 Cards in this Set

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	A pregnant woman who has a child with down syndrome. She's concerned about having another child with down syndrome. What is the best test to rule out down syndrome in the second trimester? a. Amniotic fluid sample b. Chorionic villous sampling c. Triple investigation	Amniotic fluid sample ● Triple investigation is done between 15- 20 weeks. Its sensitivity is about 65% for trisomy 21. Patients with positive screen should be offered U/S or amniocentesis for confirmation. ● Quadruple screen can improve the detection rate for Down syndrome to about 81%. Second trimester confirmatory test: Amniotic fluid sample.
	Which of the following viruses can cross the placenta? a. Rubella b. Mumps c. HBV	Rubella - Hepatitis B transplacental infection is rare. - Diseases that can cross the placenta: ● All TORCH; Toxoplasmosis Others: e.g. Syphilis Rubella , CMV , HSV ● HIV, Chicken pox, CMV, Erythema Infectiosum (Fifth Disease), Hepatitis B.
	(long scenario) Pregnant lady in 1st trimester (12 weeks) on iron trial, complaining of fatigue and shortness of breath. CBC show: Hb = low , MCV = 70 , hematocrit = normal , reticulocyte = 10% . What is the most likely diagnosis? A. Physiological. B. Iron deficiency. C. Thalassemia.	Iron deficiency
	28 weeks pregnant (nuli), presents with generalized fatigue, BLOOD PRESSURE 162/95, 3+ protein in urine. What is your next step? a. Mgso4 b. Labetalol c. Methyldopa	Mgso4 Sever preeclampsia: >160/110, proteinuri +3 to +4, 24h urine >5, generalized edema, mental state changes, vision changes, impiered liver function. 1. Prevent eclampsia: Mgso4 2. Control BP We recommend administration of antenatal corticosteroids for all pregnant women at 23 to 34 weeks Betamethasone is given if < 34 weeks who are at increased risk of preterm delivery within the next seven days.
	Which infection has high mortality rate in pregnant? a. Toxoplasmosis b. Syphilis c. CMV	CMV Question did not specify fetal or maternal mortality. Untreated syphilis has high fetal mortality rate (40%)
	What antibiotic is safe in pregnancy? a. Ciprofloxacin b. Amoxicillin c. Chloramphenicol	Amoxicillin Some of the antibiotics that may be prescribed safely during pregnancy include: Amoxicillin, Ampicillin, Clindamycin, Erythromycin, Penicillin, Gentamicin, Ampicillin-Sulbactam, Cefoxitin, Cefotetan and Cefazolin
	Pregnant women (30 Something but definitely less than 38) with BLOOD PRESSURE baseline 80 now present with 140 or 160 (Not sure), LL edema. +2 proteinuria, no change in LFT (not sure). Admitted to the hospital. What will you give her? a. Betamethasone b. Labetalol c. Mgso4	question is not clear. The bottom line is that if the patient has severe preeclampsia give her mgso4 and antihypertensives and definitive treatment is delivery. If only mild: conservative management and delivery 36 weeks
	What is the drug of choice for eclamptic seizure? A. Phenytoin. B. Diazepam. C. Magnesium Sulfate.	Magnesium Sulfate Although the definitive treatment is delivery, and the seizure should be controlled with magnesium sulfate.
	A pregnant lady presented with flank pain. On examination there was tenderness. Labs showed leukocytosis and positive nitrate, what is the management? a. Admission to treat pyelonephritis b. Drink plenty of fluids c. Start antibiotics	Admission to treat pyelonephritis
	Which of the following is a side effect of ocps? a. Breast cancer b. Cervical cancer c. DVT	DVT
	Postmenopausal women complaining of itchy vulva and erythema of the labia majora and sometimes bleed. On examination there is a pea shaped mass. What is the diagnosis? A. Bartholin gland cyst. B. Bartholin gland carcinoma. C. Bartholin abscess.	Bartholin gland carcinoma.? It is generally recommended that women over age 40 with a Bartholin cyst or abscess undergo drainage and biopsy of the gland to exclude the possibility of an underlying carcinoma. More details are needed to answer the question. Although, old age and bleeding goes more with malignancy
	Woman pregnant 42 Gestation was given gel for induction of labor. Later she was found to have 4 cm dilated cervix and 70% effaced. However, her contractions lasted 2 minutes and fetal HR dropped from 140 to 80. What to do? a. Give Oxygen b. Immediate c-section c. Give some medication	Immediate c-section
	A patient did a PAP smear and the result showed high grade intraepithelial cells. What will you do next? a. Cone biopsy b. Total hysterectomy c. Colposcopy	Colposcopy. HSIL (high-grade squamous intraepithelial lesion) includes: moderate dysplasia, carcinoma in situ, and CIN II and III. Colposcopy and biopsy is indicated.
	What is the best treatment for premenstrual dysmorphic syndrome? a. OCP b. Fluoxetine c. Bromocriptine	Fluoxetine - Premenstrual syndrome (PMS) is characterised by cyclical physical and behavioural symptoms occurring in the luteal phase of the menstrual cycle (the time period between ovulation and onset of menstruation). Premenstrual dysphoric disorder (PMDD) is a more severe variant that includes at least 1 affective symptom. - Premenstrual syndrome (PMS) is characterised by cyclical physical and behavioural symptoms occurring in the luteal phase of the menstrual cycle (the time period between ovulation and onset of menstruation). Premenstrual dysphoric disorder (PMDD) is a more severe variant that includes at least 1 affective symptom. - The goal of treatment is to provide relief of symptoms during the luteal phase and to improve quality of life and reduce distress for women - Predominant somatic symptoms : Oral contra ceptives are convenient when contraception is a concurrent need; they may improve breast pain and bloating, but not mood symptoms. Com bined oestrogen and progestogen oral contra ception is recommended for PMS and PMDD - Predominantly behavioural symptoms and PMDDSSRIs[REF 34] [REF 35] have been shown to be equally efficacious in symptom reduction when prescribed continuously or during the luteal phase only, and are considered a first-line option in moderate to severe PMS or PMDD.
	Sexually abused child vaginally, the hymen tear will be in which position? a. 2 o'clock b. 4 o'clock c. 6 o'clock	6 o'clock Blunt penetrating trauma to the vaginal orifice produces a characteristic pattern of injury; bruising, lacerations and/or abrasions are typically seen between the 4 and 8 o'clock positions of the hymen.
	. A 19 years old white female. Weight: 52 kg & Height: 145 cm with no history of twins in the family, got spontaneously pregnant by twins. What is the risk factor in this case? A. Age B. Race C. Weight	Race they answered! - Dizygotic twins are the most common. Identifiable risk factors include IVF, newly discontinued OCP, race (e.g. Certain African regions), increased maternal age, geography, family history, or ovulation induction. - Maternal age — Advancing age is associated with an increased prevalence of twin births. - Increasing parity correlates with an increased likelihood of twin birth, even after adjustment for maternal age - Twinning appears to have a genetic component that is expressed in women, but can be inherited from either parent - Obese (BMI ≥30 kg/m2) and tall women (≥65 inches [164 cm]) are at greater risk for twin birth than underweight (BMI <20 kg/m2) and short women (<61 inches [155 cm]
	A pregnant lady 34-week gestation presents with headache, epigastric pain and blurred vision with a BLOOD PRESSURE of 163/89. What is the best course of management? a. Stabilize the general condition, magnesium sulphate, …. b. Deliver immediately c. Give magnesium sulphate, stabilize the general condition….	Stabilize the general condition, magnesium sulphate, …. ABC > mgso4 + hydralazine + Delivery
	What to do after a Pap smear show atypical changes ? a. Hysterectomy b. Guided colposcopy biopsy c. Excisional biopsy	Guided colposcopy biopsy
	What is the best investigation to establish ectopic pregnancy? a. HCG b. Laparoscopy c. Pelvic U/S	Laparoscopy Β-HCG: 85% of ectopic pregnancies demonstrate abnormal β-HCG doubling U/S: is only definitive if fetal cardiac activity is detected in the tube or uterus Laparoscopy: for definitive diagnosis but it is invasive
	40 year-old woman G3P1, history of 2 months pregnancy. Upon examination her uterus is large for gestational age. HCG: very high, U/S: no fetus or heart sounds. She was diagnosed to have cancer which is sensitive to chemotherapy and easily treated. What does she have? (She had molar or ectopic pregnancy before) a. Endometriosis b. Gestational Trophoblastic Disease. c. Ovarian CA	Gestational Trophoblastic Disease. Two main risk factors increase the likelihood for the development of GTD: 1) The woman being under 20 years of age, or over 35 years of age, and 2) previous GTD. Suspect gestational trophoblastic disease if uterine size is much larger than expected for dates, women have symptoms or signs of preeclampsia, or β-hcg levels are unexpectedly high during early pregnancy or if ultrasonographic findings suggest it.
	35 weeks of gestation, come mention she doesn't feel the baby movement. Fetus is dead. She is hypoxic with decreased DLCO (75%, Normal 80%) Blood test: Low Hct, prolonged PT and PTT. What does she have? a. Amniotic embolism b. DIC c. ITP	Amniotic embolism - Amniotic fluid embolism causes DIC and ARDS together. - Amniotic fluid embolism is a clinical syndrome of hypoxia, hypotension, and coagulopathy that results from entry of fetal antigens into the maternal circulation.
	Women 34 weeks pregnant, however fundal height is 28cm. What is the most likely cause of IUGR? a. GDM b. Oligohydramnios c. Polyhydramnios	Oligohydramnios Screening for IUGR in the general population relies on symphysis–fundal height measurements. Discrepancy of greater than 3 cm between observed and expected measurements may prompt a growth evaluation using ultrasound.
	Anovulatory female. What will you give to induce ovulation? a. Clomiphene b. Danzo c. Pulsatile push of LH	Clomiphene - The most widely prescribed drug for ovulation induction to reverse anovulation or oligoovulation. - Medical induction of ovulation: clomiphene citrate, human menopausal gonadotropins (HMG [Pergonal®]), LHRH, recombinant FSH, and metformin.
	Female with clear presentation of UTI. History of URTI. Urine analysis showed nitrate : + Esterase : +, what is the organism: A. Klebsiella pneumoniae B. E.coli C. Pseudomonas	E.coli -nitrate test is commonly used in diagnosing urinary tract infections (UTI). A positive nitrite test indicates that the cause of the UTI is a gram negative organism, most commonly Escherichia coli -A leukocyte esterase test (LE test) is a urine test for the presence of white blood cells and other abnormalities associated with infection. White blood cells in the urine usually indicate a urinary tract infection.also used to screen for gonorrhea and for amniotic fluid infections. -The combination of the LE test with the urinary nitrite test provides an excellent screen for establishing the presence of a urinary tract infection (UTI).
	A 17 yrs old girl vaginal delivery at home with perineum tear what is the injured ? A. Coccygeal B. Pubococcygeal C. Ischial...	Pubococcygeal The muscles of the anus (corrugator cutis ani, the internal anal sphincter and the external anal sphincter) * The medial muscles of the urogenital region (the superficial transverse perineal muscle, the deep transverse perineal muscle and bulbocavernosus) * The medial levator ani muscles (puborectalis and pubococcygeus * The fascia of perineum, which covers these muscles * The overlying skin and subcutaneous tissue.
	What the treatment of eclamptic seizure? A. Magnesium sulphate B. Diazolam C. Carbamazepine	Magnesium sulphate As soon as eclampsia or severe preeclampsia is diagnosed, Mg sulfate must be given to stop or prevent seizures and reduce reflex reactivity
	Diagnosis of trichomonas vaginosis? A. Yellow discharge B. White discharge C. Clue cell	Yellow discharge - Yellow-green, and frothy in trichomonas - Clue cells will be in bacterial vaginosis not in trichomonas
	Adenomyosis treatment? A. Hysterectomy B. Ocp C. Gonadotropin analogue	Hysterectomy Hysterectomy is the definitive surgical treatment First IUD (coil) may be offered, since it has been found that a low level slow release of progesterone can ease the symptoms of adenomyosis
	Pregnant with flank pain and tenderness, +nitrate and leukocytosis what is the plan A. Admission to treat pyelonephritis B. Drink plenty of fluid C. Start antibiotics	Admission to treat pyelonephritis Acute pyelonephritis is characterized by fever, flank pain, and tenderness in addition to significant bacteriuria. Positive results for nitrites, leukocyte esterase, wbcs, red blood cells (rbcs), and protein suggest Pyelonephritis.
	Severe symptoms of preeclampsia A. Abdominal pain B. High urea C. High blood pressure	Abdominal pain abdominal pain due to hepatic sub capsular swelling from edema which may develop to hematoma or Hepatic rupture even it's rare but can occur .(resource Lippincott Obs&gyne recall) the other options can occur in mild preeclampsia too. - Severe preeclampsia: Blood pressure: 160 mm Hg or higher systolic or 110 mm Hg or higher diastolic on two occasions at least six hours apart in a woman on bed rest Proteinuria: 5 g or more of protein in a 24-hour urine collection or 3+ or greater on urine dipstick testing of two random urine samples collected at least four hours apart Other features: oliguria (less than 500 ml of urine in 24 hours), cerebral or visual disturbances, pulmonary edema or cyanosis, epigastric or right upper quadrant pain, impaired liver function, thrombocytopenia, intrauterine growth restriction
	40 year old lady early pregnant, what is useful for her: A- urine dip steak. B- blood group and Rh factor C- ultrasonography	ultrasonography 8-12 weeks GA> blood group and Rh
	What to do after a Pap smear show atypical changes? A. Hysterectomy B.Guided calposcopy biopsy C.Exsional biopsy	Guided calposcopy biopsy
	When do you do US for screening of the fetus? A-early 2nd trimester B- late 2nd C-early 3rd and late 3rd	late 2nd Screening investigation: - 8-12w: dating US - 10-12: CVS - 11-14: first T screen - 11-13: truncal translucency us - 15-16 up to term: Amniocentesis - 16-18: maternal serum screen - 18-20: US for dates, structural assessment - 18-20 to term: count fetal movement - 24-28 w: 50g OGCT - 28: repeat CBC, RhIG for all Rh negative women - 36: Rh antibody screen if indicated, GBS screen * 2nd trimester US: 18-22 w to determine # of fetuses, GA, location of placenta, fetal anomalies * dating US best at 8-12w: Measurement of crown rump legth (3d margin error). Change EDC (based on LMP) to CRL if >1w descripency * NTUS at 11-14 w: Measure amount of fluid behind fetal neck Early screen for serious conganital anomalies (Down) * fetal growth and anatomy us routinely at 18-20 w (7d margin of error) .
	Complicated labor switch to C-section, when to give antibiotics? A. Before C-section B. After C. During	Before C-section, first-generation cephalosporin - All women undergoing elective or emergency Caesarean section should receive antibiotic prophylaxis. - a single dose of a first-generation cephalosporin. If the patient has a penicillin allergy, clindamycin or erythromycin can be used - 15 to 60 minutes prior to skin incision. No additional doses are recommended. - If an open abdominal procedure is lengthy (> 3 hours) or estimated blood loss is greater than 1500 ml, an additional dose of the prophylactic antibiotic may be given 3 to 4 hours after the initial dose - Prophylactic antibiotics may be considered for the reduction of infectious morbidity associated with repair of third and fourth degree perineal injury
	A pregnant in 32 weeks of gestation, she is in true labor, what to do: A. Call neonatologist, give corticosteroids, strict bed rest B. Call neonatologist, give corticosteroids, give fluids C. Call neonatologist, give antibiotics, bed rest	- A or B
	Pregnant women in 1st trimester never got chickenpox, her antibody titer is zero, what is the best management? A. Avoid exposure B. Acyclovir 3 C. Varicella vaccine	Avoid exposure It's contraindicated to take varicella vaccine during pregnancy if patient got contact there is varicella zoster immune globulin (varizig) that can help to reduce the risk of becoming infected with chickenpox. Non immune pregnant woman can take the vaccine one month prior to being pregnant or after delivery.
	Mother in labor you did vaginal examination, touched orbit ridge, nasal and chin, what is the presentation? A. Cephalic B. Brow C. Face	Face In a face presentation, the fetal head and neck are hyperextended, causing the occiput to come in contact with the upper back of the fetus while lying in a longitudinal axis. The presenting portion of the fetus is the fetal face between the orbital ridges and the chin - any presentation other than vertex is malpresentation: vertex is the area between parietal emineces and anterior and posterior fontanelles - in face presentation: the mentum is the denominator mostly mentoanterior. * deliver vaginally if mentoanterior, not if posterior. * submentobregmatic diameter is 9.5 cm * traction forceps can be used in mentoanterior
	Smoker pregnant women, what is the possible fetus complication? A. Macrosomia B. Low birth weight C. Transient tachypnea	Low birth weight Smoking during pregnancy has been associated with a host of complications, including low birth weight, premature rupture of the membranes, placenta previa, placental abruption, and preterm birth, preterm premature rupture of membranes (PPROM), ectopic pregnancy.
	30 weeks' pregnant woman, BP: 170/120, what is the proper prophylactic management in addition to blood pressure control? A. Mg sulphate and deliver B. Mg sulphate and wait till 34w C. Call anesthesia and deliver	Mg sulphate and wait till 34w -  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. - Women with suspected, mild, or diagnosed preeclampsia remote from term or labile blood pressures due to chronic hypertension and/or gestational hypertension should be hospitalized for close observation, bed rest, and frequent fe tal monitoring. - When preeclampsia develops remote from term (ie, < 34-36 weeks' gestation), attempts are often made to prolong the pregnancy to allow for further fetal growth and maturation
	Best way to avoid transmission of tetanus in pregnant lady to her baby? A. Newborn tetanus toxoid B. Neonate anti tetanus C. Give the mother early tetanus toxoid	Give the mother early tetanus toxoid ACIP recommends that providers of prenatal care implement a Tdap immunization program for all pregnant women. Health-care personnel should administer a dose of Tdap during each pregnancy, irrespective of the patient's prior history of receiving Tdap.
	The term means that increase in frequency of ( period) menstruation is: A. Polymenorrhea B. Hyper… C. Metromenorrhagia	Polymenorrhea - Menarche A menarche is another word for a first period. The average age for the beginning of menstruation is twelve or thirteen. - Premenstrual syndrome Premenstrual syndrome, (PMS) begins about a week or two before someone starts their period. Some may experi ence breast tenderness, mood swings, depression, food cravings, fatigue or insomnia, bloating, backache, headache, or cramps. - Dysmenorrhea: Dysmenorrhea is a synonym for menstrual cramps. - Menorrhagia: Menorrhagia is abnormally heavy or lengthy bleedin - Polymenorrhea: Polymenorrhea is defined as an abnormal regulation of menstrual bleeding. It occurs when the menstrual cycle is less than 21 days long. An average menstrual cycle is between 21 and 35 days between periods. - Oligomenorrhea If your periods are very light and. - Amenorrhea Like oligomenorrhea, this is also a term for infrequent periods Menopause - Menopause is the complete absence of a period for 12 months. It typically occurs after age 51.
	Patient has obesity, hirsutism, HTN, insulin resistance What is the diagnosis? A. Kallman syndrome B. Kleinfilter syndrome C. Stein leventhal syndrome	Stein leventhal syndrome Polycystic ovarian syndrome also called: o Chronic ovarian androgenism o Hyperandrogenic anovulation (HA) o Stein–Leventhal syndrome
	Lady with metromenorrhagia ( dysfunctional uterine bleeding) from 6 month ago and abdominal pain interfere with her activity, what is the best drug? A. Hysterectomy B. Oral contraceptive C. Estrogen analogous	Oral contraceptive
	Which of the following Oral contraceptive can cause hyperkalemia? A. Levonogestrel B. Norethindrone C. Yasmin	Yasmin Yasmin (ethinyl estradiol+drospirenone “progestin”) and Yaz causes hyperkalemia (rare side effect, but contraindicated in renal and adrenal insufficiency)
	Pregnant in labor cervical opening 6 cm, which stage this manifestation? A. Stage 1 B. Stage 2 C. Stage 3	Stage 1 Labour stages: -  First stage: The time of the onset of true labor until the cervix is completely dilated to 10 cm. o Early Labor Phase –The time of the onset of labor until the cervix is dilated to 3 cm. o Active Labor Phase – Continues from 3 cm. Until the cervix is dilated to 7 cm. o Transition Phase – Continues from 7 cm. Until the cervix is fully dilated to 10 cm. - Second stage: The period after the cervix is dilated to 10 cm until the baby is delivered - Third stage: Delivery of the placenta
	. A 39 weeks pregnant female .. Came with BLOOD PRESSURE 160/95 ..no proteinuria.. The previous visits the BLOOD PRESSURE was normal .. What is your diagnosis? A. Gestational hypertension B. Chronic HTN C. Preeclampsia	Gestational hypertension GESTATIONAL HYPERTENSION is diagnosed with sustained elevation BLOOD PRESSURE ≥ 140/90 mmhg after 20 weeks of pregnancy without proteinuria.
	Early pregnant , what is useful for her A. Urine dip steak B. Blood group and rh factor C. Ultrasonography	Ultrasonography First trimester ultrasonography is used to confirm the presence of an intrauterine pregnancy, estimate gestational age, diagnose and evaluate multiple gestations, confirm cardiac activity, and evaluate pelvic masses or uterine abnormalities (as an adjunct to chorionic villus sampling, embryo transfer, or localization and removal of intrauterine contraceptives). It is also useful for evaluating vaginal bleeding, suspected ectopic pregnancy, and pelvic pain.
	Pregnant woman in third trimester she is in airline about 18 hours and developed of sudden chest pain , with dyspnea, what is the cause ? A. Pulmonary hypertension B. .pulmonary embolism C. Myocardial ischemia	pulmonary embolism Sob and chest pain symptoms of PE Clinical signs and symptoms of PE are nonspecific. The classic symptoms of PE are dyspnea (82%), abrupt onset chest pain (49%), and cough (20%)
	Young patient with 4 weeks amenorrhea , presented with abdominal pain and severe vaginal bleeding , the bleeding from ? A-Ovary B-Fallopian tube C-Cervix	Fallopian tube The classic symptoms associated with ectopic pregnancy are amenorrhea followed by vaginal bleeding and abdominal pain on the affected side
	Complicated labor switch to c-section when to give antibiotics ? A. Before c-section B. After C. During	Before c-section Single dose prophylactic antibiotic should be used (e.g. Cefazolin 1-2g).
	Pregnant lady miss pregnant symptom since 1 week and started complain of spot bleeding the most valuable investigation in this condition is : A. Hcg B. Alpha feto C. Us	Us US to distinguish between types of abortion, to identify the different types of placenta previa or placenta abruption
	You performed a pudendal nerve block on a woman in labor, which of the following structures will be fully sensitive and not blocked by the anesthesias? A. Perineal body B. Urogenital diaphragm C. Rectum	Rectum The sensory and motor innervation of the perineum is derived from the pudendal nerve, which is composed of the anterior primary divisions of the second, third, and fourth sacral nerves. The pudendal nerve's 3 branches include the following: 1. Dorsal nerve of clitoris, which innervates the clitoris 2. Perineal branch, which innervates the muscles of the perineum, the skin of the labia majora and labia minora, and the vestibule 3. Inferior hemorrhoidal nerve, which innervates the external anal sphincter and the perianal skin The anal canal also has differing nervous innervations above and below the line. Above the pectinate line, the nerve supply is visceral, com ing from the inferior hypogastric plexus. As is it visceral, this part of the anal canal is only sensitive to stretch. Below the pectinate line, the nerve supply is somatic, receiving its supply from the inferior rectal nerves (branches of the pu dendal). As it is somatically innervated, it is sensitive to pain, temperature, and touch. They answered C but I Think its B if its urogenital triangle. from medscape: Pudendal nerve block does not abolish sensation to the anterior part of the perineum, as the perineum is supplied by branches of the ilioinguinal and genitofemoral nerves.
	Pregnant in the third trimester with history of recurrent herpes simplex, she is in labour, during exam no lesions what to do? A. CS B. IV acyclovir C. Do specular exam before	IV acyclovir - Transmission of herpes simplex virus (HSV) to neonates usually occurs during labor and delivery as a result of direct contact with virus shed from infected sites (vulva, vagina, cervix, perianal area). Importantly, viral shedding can occur when maternal symptoms and lesions are absent - Suppressive antiviral therapy is suggested at 36 weeks of gestation through delivery for women with a history of recurrent genital herpes to reduce the risk of lesions at the time of delivery - Suppressive therapy reduces the risk of clinical recurrence of HSV and asymptomatic viral shedding at delivery, and thus the need for cesarean delivery. However, the clinical impact on neonatal HSV is unknown.
	Pregnant women has GGT diagnostic what is your action ? A. Do hga1c B. Start insulin C. Do Random blood Glucose	Start insulin Definitive diagnosis is based on OGTT if it is positive start insulin
	About the side effect of OCP ? A. Breast cancer B. Cervical cancer C. DVT	DVT Serious complications (such as venous thrombosis, pulmonary embolism, cholestasis and gallbladder disease, stroke, and myocardial infarction) are more likely for women using high-dose formulations. However, these complications also can occur occasionally in patients taking low-dose formulations. Hepatic tumors have also been associated with the use of high-dose oral contraceptives.
	Female with no sexual hx presented with amenorrhea and thyroid disease has been excluded what first investigation will you do ? A. Pregnancy test B. TSH C. Prolactin	Prolactin First rule out pregnancy (no sexual hx) & then TSH (thyroid disease excluded in question) The definitive method to identify hypothalamic–pituitary dysfunction is to measure FSH, LH, and prolactin levels in the blood. In these conditions, FSH and LH levels are in the low range. The prolactin level is normal in most conditions, but is elevated in prolactin-secreting pituitary adenomas.
	Pregnant women in 1st trimester never got chickenpox her antibody titer is zero what is the best management ? A. A-avoid exposure B. B-acyclovir C. C -Varicella vaccine	avoid exposure Because the effects of the varicella virus on the fetus are unknown, pregnant women should not be vaccinated. Nonpregnant women who are vaccinated should avoid becoming pregnant for 1 month after each injection
	What cross the placenta? A. A-rubella B. B –mumps C. C -HBV	rubella Neonates with rubella may have a "blueberry muffin" appearance caused by purpuric skin lesions that result from extramedullary hematopoiesis. Heart defects in these infants include ventricular septal defects, patent ductus arteriosus, pulmonary stenosis, and coarctation of the aorta. The presentation of rubella at birth varies greatly. Most of these complications develop in infants born to mothers who acquire rubella infection during the first 16 weeks of pregnancy. Ninety percent of infants present with some finding of congenital rubella if infection occurs within the first 12 weeks, and 20% present with congenital disease if the infection occurs between weeks 12 and 16
	Mother in labor you did vaginal examination, touched orbit ridge, nasal and chin What is the presentation? A. Cephalic B. Brow C. Face	Face In a face presentation, the fetal head and neck are hyperextended, causing the occiput to come in contact with the upper back of the fetus while lying in a longitudinal axis. The presenting portion of the fetus is the fetal face between the orbital ridges and the chin.
	Pregnant with HIV on medication, used to have 400 copies and now 200 copies on labor A. A.Spontaneous Vaginal delivery B. B.Forceps delivery C. C.CS	Spontaneous Vaginal delivery Awareness of maternal HIV status can help guide management of labor and delivery to minimize risk of transmission to the fetus. Use of episiotomy or vacuum extraction or forceps may potentially increase risk of transmission by increasing exposure to maternal blood and genital secretions. Cesarean delivery performed before the onset of labor and rupture of membranes significantly reduces the risk of perinatal HIV transmission. Planned cesarean delivery at 38 weeks of gestation to prevent perinatal transmission of HIV is recommended for women who have a viral load >1000 copies/ml
	Women with negative pregnancy test have vaginal bleeding, Hgb 9 mangement? A. Blood transfusion B. Progesterone C. Conjugated Estrogen	Progesterone The primary goal of treatment of anovulatory uterine bleeding is to ensure regular shedding of the endometrium and consequent regulation of uterine bleeding. If ovulation is achieved, conversion of the proliferative endometrium into secretory endometrium will result in predictable uterine withdrawal bleeding. A progestational agent may be administered for a minimum of 10 days. The most commonly used agent is medroxyprogesterone acetate. When the progestational agent is discontinued, uterine withdrawal bleeding ensues, thereby mimicking physiologic withdrawal of progesterone
	Contraindicated antibiotic in pregnancy? A. A.Nitrofurantoin B. Erythromycin C. Tetracycline	Tetracycline Antibiotics contraindicated in pregnancy“MCAT” • M – Metronidazole • C – Chloramphenicol • A – Aminoglycoside • T – Tetracyclines
	Missed period 2 months , high ah BCG , examination show 16 weeks GA .. US show fetus small for data ? Dx: A. Choriocarcinoma B. Hydatidiform C. Placenta in site trophoblastic tumor	Placenta in site trophoblastic tumor The placenta is critical for nutrient regulation and transportation from mother to fetus. Abnormalities in placentation or defective trophoblast invasion and remodeling may contribute to fetal growth restriction as well as other disorders of pregnancy. In addition, uterine anomalies (uterine septum or fibroids) may limit placental implantation and development and, consequently, nutrient transport, resulting in inadequate nutrition for the developing fetus. Finally, the genetic composition of the placenta is important and abnormalities such as confined placental mosaicism are associated with growth delay.
	35 year old female P3+0 with amenorrhea for 6 months, thinning and dryness of vaginal mucosa, she underwent D & C 3 years ago due to retained placental tissue following one of his deliveries. On examination: normal cervical canal, normal uterus with non-palpable ovaries. Her hormonal profile is: (numbers was given with the normal range) FSH: high LH: high TSH: normal Estradiol: low What is the diagnosis? A. Asherman's syndrome. B. Turner syndrome. C. Ovarian failure.	Ovarian failure In ovarian failure, the ovarian follicles are either exhausted or are resistant to stimulation by pituitary FSH and LH. As the ovaries cease functioning, blood concentrations of FSH and LH increase. Women with ovarian failure experience the symptoms and signs of estrogen deficiency
	Postmenopausal women has hot flushes what altered enzyme is the reason behind her symptoms ? A. TSH B. Estrogen C. Progenstron	Estrogen The hot flush is the most common symptom of decreased estrogen production and is considered one of the hallmark signs of perimenopause.
	Female with ovarian mass, hysterectomy was done, specimen showed thecal cell tumor, what other things you would find in the specimen? A. Moles in the uterus B. Endometrial hyperplasia C. Others	Endometrial hyperplasia The leading role in the pathogenesis of endometrial hyperplasia is given relative or absolute hyperestrogenic, the absence of antiestrogenic effects of progesterone or insufficient effect. Causes of hyperestrogenic: anovulation caused by the persistence or atresia of follicles, hyperplastic processes in the ovaries or hormoneproducing tumor of ovary (stromal hyperplasia, tecomates, granulosa tumor, theca cell tumor, etc)
	Pregnent lady miss pregnant symptom since 1 week and started complain of spot bleeding the most valuable investigation in this condition is : A)HCG B)alpha feto C)us .....	us
	Post menopose women pallor vagina and week what is the Treatment: A)estrogen B)proges C)diet	estrogen The therapeutic standard for moderate to severe vaginal atrophy is estrogen therapy, administered either vaginally at a low dose or systemically. There has been a relative lack of randomized controlled trials performed to date, but they have shown that low-dose, local vaginal estrogen delivery is effective and well tolerated for treating vaginal atrophy.
	During pv exam you found cervical mass 10×12mm what you will do : A) Reassure. B) Biopsy. C) Test for human papilloma virus	They answered C I think B
	Girl 15 never had mensis Examination breast bed ,fine hair >n After 1 year come e increase height >6cm And gain kilograms: A) Primary amenorrhea B) amenorrhea Precocious puberty C) Constitutional	Primary amenorrhea Primary amenorrhea is the failure of menses to occur by age 16 years, in the presence of normal growth and secondary sexual characteristics. If by age 13 menses has not occurred and the onset of puberty, such as breast development, is absent, a workup for primary amenorrhea should start.
	Mother breastfeeding, needs MMR vaccine A -Give the vaccine B - Give and stop breastfeeding for 72 hours C -MMR is harmful to the baby	Give the vaccine Breast feeding does not interfere with the response to MMR vaccine, and your baby will not be affected by the vaccine through your breast milk.
	Old lady postmenopausal with osteoarthritis and risk for osteoporosis , what you will do : A. Calcium , TSH , dihydroxy vit D B. Bisphosphonate , vit D , calcium C .DEXA scan	Bisphosphonate , vit D , calcium Bisphosphonates are first-line pharmacological therapy for postmenopausal women and men. In postmenopausal women ,oestrogenis considered only for those at high risk for whom non-oestrogen medicines are inappropriate.
	Pregnant female in 24 weeks gestation, known case of chronic DM type 2 and chronic HTN, fundal height is 25 cm, which one of the following is a complication of her pregnancy? A. Preeclampsia. B. Shoulder dystocia. C. Large infant for gestational age.	Preeclampsia Hypertension/preeclampsia (especially if pre-existing nephropathy/ proteinuria): insulin resistance is implicated in etiology of hypertension
	Patient don't want to get pregnant for years. What will you give her? A. Estrogen B. Androgen C. Estrogen and androgen	??? Methods of long acting reversible contraception: Available LARC methods include iuds and the subdermal implant: 1- Hormonal intrauterine device (Mirena - also known as IUC or IUS) 2- Nonhormonal intrauterine device with copper (US -paragard) 3- Subdermal contraceptive implant (US -Nexplanon/Implanon NXT; internationally -Nor plant/Jadelle) 4- Some shorter-acting methods are sometimes considered LARC: - Depot medroxyprogesterone acetate injection (DMPA; US - - Depo Provera shot) - Combined injectable contraceptive
	. Patient with amenorrhea and discharge from her breast with high prolactin level what to do next: A - check estrogen level B - exclude pituitary lesion C - TSH level	exclude pituitary lesion Patients with hyperprolactinaemia or those diagnosed with hypogonadotrophic hypogonadism and neurological symptoms should undergo neuroimaging to rule out an intracranial neoplasm. Serum prolactin: elevated levels of circulating prolactin (hyperprolactinaemia), whether idiopathic or due to a pituitary adenoma, result in hypogonadotrophic hypogonadism. For persistently elevated levels, neuroimaging is indicated to rule out intracranial neoplasm
	Pregnant lady presenting lower limb swelling, HYPERTENSION and mild proteinuria, what will you give her? A-Methyldopa B-ACEI C-ARB	Methyldopa? The answer depend of the BLOOD PRESSURE reading and other details to distinguish b.w mild and severe pre-eclampsia. Anyhow we gonna discuss the treatment for both. - Mild preeclampsia: • < 37 weeks, expectant Rx in the hospital with no need for antihypertensive or mgso4 + close monitoring for both fetus and mother. • > 37 weeks, prompt delivery is the choice - Severe preeclampsia: • Antihypertensive; labetalol or hydralazine • Mgso4 • Prompt delivery regardless the gestational age
	Had history of HPV when she was young, you did Pap test and found nothing what to do now: A - do nothing B - repeat every 5 years C - repeat annually	repeat annually Women with a negative Pap smear and a positive HPV test should have both tests repeated at 12 months. If both tests are negative at that time, they can be returned to routine screening. If the HPV test remains positive, women should be referred for colposcopy. For women with an abnormal Pap smear, irrespective of HPV testing status, appropriate evaluation should be undertaken. It is important to note that women should continue to have cytological screening even if they have been immunised for HPV
	Nulliparous Patient came to ER with heavy bleeding 18 month history of heavy bleeding and trying to conceive for 1 year Vitals given Hgb= 10 Pregnancy test -ve; what to give: A. Blood transfusion B. Progesterone C. Estrogen	Progesterone The right answer is progesterone the medication called duphastone Or because she wants to get pregnant - Clomiphene if there's (pt anovulatory and want to get pregnant)
	Pregnant lady 11 weeks GA , come to weird about infectious disease outbreak in the school of her child that may affect her pregnancy . What is the appropriate vaccine at that time? A-rubella B-varicella C-influenza	influenza Varicella & rubella vaccines are contraindicated during pregnancy
	Women had yellow watery foul smelling vaginal discharge A- bacterial vaginosis B- trichominus vaginalis C- atrophic vaginitis	trichominus vaginalis
	Patient in labour and has pre-eclampsia. Mgso4 and hydralazine were given. Respiratory rate was 12. What do you give? A- Narcan B- Naloxone C- Atropine	She has magnesium sulphate toxicity > respiratory depression so Calcium gluconate Is the antidote for magnesium sulphate
	What changes will occur during pregnancy A) Increase tidal volume B) Increase total lung capacity C) Increase residual capacity	Increase tidal volume The volume of air moves in and out of lungs at rest. Increase to 40%. The only lung volume that does not decrease w/pregnancy. - increase in Vt produce a respiratory alkalosis but compansated w/alkalotic urine (loss bicarb)
	Patient complaint progressive wrist pain since 2 months and increased in the passed 1month , give history of cesarean delivery on exam therenumbness and normal range of motion What is the Rx? A. Thumb cast B. Whole are cast C. Surgical decompression	Symptoms usually resolve over period of week after delivery We recommend nocturnal wrist splint, surgical decompression rarely done Carpal tunnel syndrome (CTS) refers to the complex of symptoms and signs brought on by compression of the median nerve as it travels through the carpal tunnel. Patients commonly experience pain, paresthesia, and less common ly, weakness in the median nerve distribution. CTS is the most common compressive focal mononeuropathy seen in clinical practice. * clinical diagnosis of CTS without EMG confir mation, or pregnant women : wrist splint * mild or moderate based on EMG findings (non- pregnant): wrist splint, hydrochlorothiazide, non- steroidal anti-inflammatory drugs (NSAIDs), cor ticosteroid injection + wrist splint, * severe based on EMG findings (non-pregnant)surgical release
	Pregnant is in her 38 weeks gestation with a blood pressure of 140 over 90. No proteinuria and completely asymptomatic what will you do? A-Immediate delivery b-Antihypertensives c-Observation (frequently)	Observation (frequently) This case consider as gestational hypertention ( bp<150/90 and no proteinuria) Ttt: close blood pressure monitoring
	Best treatment for premenstrual dysmorphic syndrome: A- OCP B- Flouxitine C- Bromocriptin	Flouxitine SSRI like ( fluxitine) first line treatment of PMDD
	Non hormonal treatment for postmenopausal symptoms: A- Black cohosh B- Paroxitine C- Phytoestrogen	Paroxitine
	Post menpose women pallor vagina and week what is the TREATMENT - a) Estrogen - b) Proges r c) Diet or.	Estrogen
	Adenomyosis treatment? A-hystroectomy B-ocp C-gonadotropin analogue	hystroectomy
	Female patient known to have Bicornuate uterus present in labor , give History of kicking in lower abdomen and on Examination there is round object in fundus on auscultation the heart positive in the umbilicus of his mother , what is the most likely presentation ? A-Face b-Vertex c-Breach	Breach
	Young female with whitish grey vaginal discharge KOH test? Smell fish like, what is thediagnosis? A-Gonorrhea b-Bacterial Vaginosis c-traichomanousvaginalis	Bacterial Vaginosis
	Lady with menses every 15 days a-Menometrorrhea b-Polymenorhea c-Hypermenorhea	Polymenorhea
	Common cause of pregnant lady mortality : a-Syphilis b-Toxoplasmosis c-CMV	CMV
	Pregnant with past history of depression on Paroxitine for long time. She is asking the physician if she can use this medication or not while she is pregnant. What you have to tell her ? A. It is not safe because the risk of cardiac congenital malformation * [NOT SURE 100%] B. It is not safe ... C. It is safe ...	It is not safe because the risk of cardiac congenital malformation * Paroxetine — Paroxetine has been associated with an increase in congenital heart defects, particularly ventricular septal defects, but these findings have not been consisten
	Lady with metromenorrhagia, from 6 month ago and abdominal pain interfere with her activity , what is the best drug ? A- hysterectomy B- OCP C- estrogen analogous	?? -NSAID used for relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which is responsible for prostaglandin synthesis. Acute bleeding (stabilize and IV estrogen or d&c) Chronic bleeding: - (anatomical or organic problem>>IV estrogen or d&c if no response after 24 hrs. -(ocps -long progestin -NSAID)
	Pregnant in labour with 6 cm dilation and 1+ effacement and spontaneous rupture of membrane, which analgesic to give A. Pudendal B. Cervical C. General	Para cervical ?? Active phase (stage 1) begins with cervical dilation acceleration, usually by 6 cm of dilation, ending with complete cervical dilation. (Kaplan page 116) Paracervical block is administered in the “active phase” of labor. (Kaplan page 123)
	Q about Ocp side effects on the liver ? A. Hepatocellular carcinoma B. Sinusoidal diletation C. Hepatic adenoma	Hepatic adenoma Hepatocellular adenomas occur mostly in women of childbearing age and are strongly associated with the use of oral contraceptive pills (ocps) and other estrogens (
	About pregnant lady with twins on 24 weeks and you discover one fetal death what to do? A. Delivery + dexamethasone B. Wait until 34 weeks C. Wait until 37 weeks	Wait until 34 weeks
	Pregnant lady come to you with splenomegaly and platelet = 50 and uterus on the level of symphysis pubic , what is Diagnosis : A- idiopathic thrombocytopenic purpura B- gestational thrombocytopenia C- thromboembolic disease	??? - Thrombocytopenia can be defined as platelet count less than 150,000/μL - Any pregnant patient with a platelet count of less than 100,000/μL should undergo further clinical and laboratory assessment. - The most common causes of thrombocytopenia in pregnancy are as follows:Gestational thrombocytopenia (70%)Preeclampsia (21%)Immune thrombocytopenic purpura (3%)Other (6%) -
	Female last delivery with forceps what is complicate : A- primary postpartum hemorrhage B- secondary postpartum hemorrhage C- uterine inversion	A primary PPH which occurs within the first 24 PP
	Old female with endometrial biopsy showing: high grade hyperplasia with atypia. What is the best management? a) • Trial of OCP. b) • Total abdominal hysterectomy. c) • Cauterization.	Total abdominal hysterectomy.
	On examination: her cervix is dilated by 3 cm and effaced by 70% and fetal presenting part at 0 station. After 6 hours or so, her cervix is dilated by 7 cm and effaced by 80%, but she is complaining of tenderness when palpated the uterus, her temperature is 38. What is the best management? a) • Give intrapartum antibiotics. b) • Emergency CS. c) • Wait for spontaneous delivery.	Give intrapartum antibiotics.
	Pregnant in 3rd trimester with pain and bleeding, CTG showed late deceleration. Uterus is distended. What is the diagnosis? A. Placenta previa. B. Vasa previa. C. Abruptio placenta.	- APH is vaginal bleeding from 24w gestation. Majority of bleeding is unexplained - risk of mortality and PPH - presence of abdominal pain distinguish placental abruption from placenta praevia. - avoid digital examination unless placenta previa is excluded - a kleihaure test should be done if abruption - in placent previa/abruption blood is from the mother. 1) placenta previa: low attatchment, a.w increase in age/parity, multiple pregnancy, C-S, succenturiate lobe, smoking. Uterus soft non tender, cephalic presentation not ingaged or malpresentation. Transvaginal us. Inpatient management in 3rd T, C-S if severe compramise or within 2cm of Cervical os. Placenta accreta, is a complication. 2) placental abruption: a.w HTN/pre-eclampsia, trauma, smoking, cocaine, ECV. Unprovoked pain, uterine contractions, concealed Hemorhage, uterus tender hard, CTG: sinusoidal pattern. Bradycardia and late decelerations if severe. Complication: DIC and renal faliure, coulvelair uterus, PPH. 3) vasa previa: velamenous insertion of the cord, so vessels lie over internal os. Fetal blood, so must be deliverd C-S urgently before exsan guination. Usually bleeding after AROM, painless bleeding, and fetal bradycardia. 4)
	Epithelial cell source in female sample: A. Chlamydia urethritis B. Vulva contamination C. Renal stones	Vulva contamination
	Pregnant woman with chronic HYPERTENSION and uncontrolled DM she is on week 10 of gestation what is the best action A- bed rest B- ACE inhibitor C- termination of pregnancy	bed rest?!
	Pregnant with vag bleeding she delivered normal baby but she bleeding from nose , gum and IV line A-factor v liden B-DIC C- protine s c def	DIC
	Patient G1P0 27ws came sick with high blood pressure was admitted in ICU for observation Dr. Was prescribe magnesium sulphate what is the indication of such drug A- prevent the seizer B- control of high BP C- something for renal management	prevent the seizer Risk of seizure is highest in the 1st 24 hours post-partum -continue mgso4 for 12-24 hours after delivery
	Patient in routine checkup during pregnancy discover high Blood pressure in 3 time 160/... You will start : A- methyl dopa B- atenolol C- labetalol ( not sure if it was within choices)	A or C?! Prefered antihypertensive agents during pregnancy :Labetalol , Nifedipine, a-methyldopa. But for severe HYPERTENSION (BLOOD PRESSURE >160/110), give one of labetalol, nifedipine, or hydralazine. ACEI , ARB, atenolol , prazosin are all contraindicated during pregnancy.
	Pregnant with chest infection : A. Trimethoprim/sulphamethaxazol B. Augmentin C. Ceftraioxon	- Trimethoprim/sulphamethaxazol is used for UTI and is category D. - Augmentin : Amoxicillin-clavulanate has been assigned to pregnancy category B by the FDA. Animal studies failed to reveal any evidence of teratogenicity. Augmentin is used to treat many different infections caused by bacteria, such as sinusitis, pneumonia, ear infections, bronchitis, urinary tract infections, and infections of the skin. - ceftriaxone : Pregnancy category: B, acute bacterial otitis media, lower respiratory tract, UTIs, skin and skin structure, bone and joint, pelvic inflammatory disease (PID), intraabdominal infections, meningitis, uncomplicated gonorrhea. Surgical prophylaxis
	Patient has history of gonoreheai think came with complain of infertility hystroscopy done with result of normal uterus but dye cant be seen freely from tubes ( tubal block) what is the best way for lady to conceive : A. In vitro fertilization and embryo transplant B.induction of ovulation C. Clomophen	In vitro fertilization and embryo transplant
	Lady came with history of infertility. She has BMI of 30 ( and other features of PCO) which of the following will help her to conceive : A) wt reduction B) in utero fertilization C) Clomophine	Clomophine Clomiphene citrate, human menopausal gonadotropins, LHRH, recombinant FSH, and metformin. Toronto notes Induction
	25 ys old female came to ER with sever Rt lower abdominal pain she has history of aminorrhea for 2 month what is the diagnosis : A. Rupture tubal pregnancy. B. Acute appendicitis C. Diverticulitis	Rupture tubal pregnancy.
	Pregnant woman diagnosed with gestational diabetes what is the treatment should be started A) Insulin B) Metformin C) Sulphanylurea	Insulin First line is management through diet modification and increased physical activity and initiate insulin therapy if glycemic targets not achieved within 2 wk of lifestyle modification alone
	Female pregnant lady with hyperthyroidism but not symptomatic what is the management? I DON"T KNOW A) MMI theantithyroid B) PTU the antithyroid C) b blocker	PTU recommended in 1st trimester, MMI during 2nd and 3rd trimester. Symptomatic treatment with β-blockers.
	Female patient she's 30 yers old she did pap smear yearly for 9 years ,, all normal ,, this time pap smear showed low grade …. What is your management A) remove the lision by electrical something B) repeat after 1 year C) colposcopy	colposcopy
	65 years old female patient at night she wake up and want to urinate but she urinate before arrive to path A-urgency B-overflow	urgency URGE INCONTINENCE: urine loss associated with an abrupt, sudden urge to void
	18 year-old girl presented to the clinic complained of amenorrhea for almost 2 consecutive months. She denied the pelvic examination. What is your next step ? A. TRH, TSH, T4, T3 B. Brain MRI C. B-Hcg Urine Test	B-Hcg Urine Test
	Best way to diagnose Adenomyosis ? A. Histology section of hysterectomy B. Endometrial Biopsy C. Pelvic MRI	Histology section of hysterectomy The only definitive diagnosis is by histologic confirmation of the surgically excised tissu
	Menopause lady came with vaginal spotting , on examination there was cystic nodule ir )cervix examination showed tumor what to do? A. -cone biopsy B. -Directed biopsy C. -Pap smear	-
	pregnant lady with hypotension, what type of anesthesia you will give her: A- pedundal. B- epidural. C- general.	general
	Young lady came to clinic complained of not being pregnant for 2 years. She has dysmenorrhea. What is your diagnosis ? A. Endometriosis B. Endometritis C. Leiomyoma	Endometriosis - functional endometrium outside uterine cavity. - occuring in myometrium: adenomyosis. - most common sites for development of endometreosis are ovaries and uterosacral ligaments. - cyclical pain a.w/ menstruation. - neural/intracranial endometreosis cause continuous pain. - rupture of ovarian endometerioma cause acute severe lower abdominal pain. Release of irritant chocolate material from cyst cause pertonism. - dense adhesions and tubal/ovarian damage and distortion lead to infertility - sx: secondary dysmenorrhea (start prior to period and exacerbated by flow), deep dyspareunia, pelvic pain, infertility - pelvic examination may reveal tender,retroverted retroflexed, fixed uterus w/thickening of cardinal or uterosacral ligaments. - nodules pslpable in posterior vaginal fornix or overian endometerioma on bimanual exam. - pain elicited on moving cerbix anteriorly - adenomyosis: uterus smoothly enlarged globular and tender. - dx: laparoscopy: powder burn lesion, white or red. - tricycling the COCP is the gold standered maintenance therapy but mirena IUS can be used. * tx mimick pregnancy (progestogens) or menopause (Danazole, gestrinone, GnRH analouges). * surgical: conservative or radical
	Female abdominal pain examination tender nodular retroverted uterus what investigation? A. Laparoscopy B. Hysteroscopy C. Hysterosalpengiogram	Laparoscopy
	80 years' women had yellow watery foul smelling vaginal discharge: A. Bacterial vaginosis B. Trichomonas vaginalis C. Atrophic vaginitis	Trichomonas vaginalis Trichomoniasis is a sexually transmitted infection (STI) caused by the motile parasitic protozoan Trichomonas vaginalis. Women with trichomoniasis may be asymptomatic or may experience various symptoms, including a frothy yellow-green vaginal discharge and vulvar irritation. Men with trichomoniasis may experience nongonococcal urethritis but are frequently asymptomatic. I think it is atrophic vaginitis: postmenopausal; itching, burning, discomfort, dyspareunia, yellowish malodorous vaginal discharge, or vaginal bleeding
	Multiparous with cervical dysplasia, has chlamydia and HSV 2, what is the cause of her dysplasia ? A. Chlamydia B. HSV C. HPV	HPV Human papillomavirus (HPV) is the major etiologic agent of cervical precancer and cancer. ●Low-oncogenic-risk HPV subtypes, such as HPV 6 and 11, do not integrate into the host genome and only cause low-grade lesions (eg, low-grade SIL and CIN 1) and benign genital warts ●High-oncogenic-risk HPV subtypes, such as 16 and 18, are strongly associated with high-grade lesions, persistence, and progression to invasive cancer, but also cause low-grade lesions.
	Recurrent Bartholin gland cysts after incision & catheter placement, how to manage: A. I&D B. Incision & catheterization C. Marsupialization	Marsupialization This procedure is reserved for recurrent abscesses. The acute abscess is drained prior to marsupialization. This procedure consists of a wide incision of the mass followed by suturing the inner edge of the incision to external mucosa. This complicated procedure is usually performed by a gynecologist or urologist in the OR.
	Pregnant lady at 34 weeks present with regular contractions, dilated cervix 3 cm, fetal station .., US reveals a back toward the cervix in transverse lie with echo lucent area behind the placenta , what to do ? A. Tocolytic B. Induce labor C. CS	- transverse lie: empty pelvis, head palpated in lateral abdomen, fundal ht low. Exclude placenta praevia. - complication: cord prolapse, a.w ROM • INTACT membrane: -Before and early labor: ECV at 38-39 weeks follows by artificial rupture of membrane If ECV unsuccessful ~> CS - active labor: CS • Ruptured membrane: - >= 34 CS - < 34 expectant management • Second twin transverse: internal podalic ver sion to breech then deliver while membrane is still intact •Preterm labor: regular contractions (2 in 10 min) • cervix >2 cm dilated, 80% effaced, or documented change in cervix • Tocolytics: requirements (all must be satisfied) ƒ .preterm labor ƒ .live, .immature fetus, .intact membranes, .cervical dilatation of <4 cm ƒ .absence of maternal or fetal contraindications.
	Pregnant in labor, about 80% effacement, 4 cm dilation, +1 fetal station, rupture of membrane, (they give lab values which was low Hb & low platelet) what type of anesthesia? A. General anesthesia B. Para cervical C. Pudendal	Pudendal Transvaginal pudendal nerve block indications: - Analgesia for the second stage of labor - Repair of an episiotomy or perineal laceration - Outlet instrument delivery (to assist with pelvic floor relaxation) - Used in the past as an alternative to neuroaxial analgesia in assisted twin and breech deliveries - Minor surgeries of the lower vagina and per ineum * Pudendal nerve block does not abolish sensation to the anterior part of the perineum, as the perineum is supplied by branches of the ilioinguinal and genitofemoral nerves. * Pudendal block does not abolish the pain of uterine contractions and cervical dilatation; this sensation is transmitted by the sympathetic fibers derived from the spinal levels of T10-L2.
	Best diagnostic test for ectopic pregnancy; A. US B. B Hcg C. Laparoscopy	TVUS: first step, Laparoscopy: gold standard
	Epithelial cells in female urine sample; A. Chlamydial urethritis B. Outer vulva contamination C. From the cervix	Epithelial cells that may be found in the urinary sediment include squamous epithelial cells (from the external urethra) and transitional epithelial cells (from the bladder). Generally 15-20 squamous epithelial cells/hpf or more indicates that the urinary specimen is contaminated. Mostly none of the choices above is true because such a finding usually found if the disease in the upper urologic system.
	Pap shows ASCUS, estrogen trial for some duration, Pap again show ASCUS; what is next A. Colposcopy B. Hysterectomy C. F/U in next year	Colposcopy If the patient had a pap smear with ASCUS then repeated after 4-6 months with the same result do colposcopy.
	Scenario, about a female has bright red spots what's the source of this blood?! A. Uterine B. Cervix C. Vulva	?? • heavy bleeding: uterus • staining, spotting, light bleeding: genital tract • brown: uterus, cervix, upper vagina • red: genital tract • postcoital: cervical
	Case of Premature Preterm Rupture of Membranes at 32 weeks what to do? A. Sterile speculum exam B. Vaginal exam C. Chemical investigation of liquor	If the presentation of this patient gush of fluid or leakage (American Associated Family Medicine) NCBI Answer: A Preterm PROM is largely a clinical diagnosis. It is typically suggested by a history of watery vaginal discharge and confirmed on sterile speculum examination. The traditional minimally invasive gold standard for the diagnosis of ROM relies on clinician ability to document 3 clinical signs on sterile speculum examination: (1) visual pooling of clear fluid in the posterior fornix of the vagina or leakage of fluid from the cervical os; (2) an alkaline ph of the cervicovaginal discharge, which is typically demonstrated by seeing whether the discharge turns yellow nitrazine paper to blue (nitrazine test); and/or (3) microscopic ferning of the cervicovaginal discharge on drying.
	HELLP syndromes: A. Hypertension,........, low enzyme B. Hypertension, ,....., high enzyme C. Hemolysis , Elevate liver enzyme, low platelet	Hemolysis , Elevate liver enzyme, low platelet
	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	Incomplete abortion - Complete abortion: no product of conception found. - Incomplete abortion: some product of conception found - Inevitable abortion: product of conception intact, dilated cervix, vaginal bleeding. - Threatened abortion: product of conception intact, no cervix dilatation, intrauterine bleeding. - Missed abortion: death of fetus, but all prod ucts of conception present in uterus. - Septic abortion: infection of the uterus and sur rounding area
	Old lady postmenopausal with osteoarthritis and risk for osteoporosis, what you will do: A. Calcium ,TSH ,dihydroxy vit D B. Bisphosphonate, vit D, calcium C. DEXA scan	C??? Previously answered B! We recommend pharmacologic therapy for postmenopausal women with a history of fragility fracture or with osteoporosis based upon bone mineral density (BMD) measurement (T-score ≤-2.5)
	Patient with polyhydramnios what atresia? A. Kidney B. Esophagus C. Duodenal	Esophagus
	Lady atypical cervical cell, the doctor can't see cervix well in colposcopy, what the appropriate next: A. Repeated pap smear B. Repeated colposcopy C. Cone biopsy	D or C I think C
	Female with DM well controlled, she wants to get pregnant, to avoid the complication, DM control should be… A. Started before pregnancy B. 1st trimester C. 2nd trimester	Started before pregnancy
	Pregnant lady in the 8 weeks gestation came with history of bleeding for the last 12 hours + abdominal pain, she passed tissue. On Examination, os is opened, uterus is 7-8 weeks in size, Diagnosis? A. Incomplete abortion. B. Threatened abortion. C. Molar pregnancy.	Incomplete abortion.
	Pregnant women is Rh +ve and her baby is Rh -ve .what will happen to the mother? A. No reaction. B. Mild hemolysis. C. Hydrops fetalis.	No reaction.  It's due to Rh- mother and Rh+ baby..  Rh disease is also called erythroblastosis fetalis during pregnancy. In the newborn, the resulting condition is called hemolytic disease of the newborn (HDN).  Some of the more common complications of Rh disease for the fetus and newborn baby include the following: o Anemia: (in some cases, the anemia is severe with enlargement of the liver and spleen) o Jaundice: yellowing of the skin, eyes, and mucous membranes. o Severe anemia with enlargement of the liver and spleen o Hydrops fetalis: this occurs as the fetal organs are unable to handle the anemia. The heart be gins to fail and large amounts of fluid build up in the fetal tissues and organs. A fetus with hydrops fetalis is at great risk of being stillborn.
	Female after delivery started to develop pelvic pain, fever, & vaginal discharge -, There's test mentioned in the Q . What's the diagnosis? A. PID B. Bacterial vaginosis C. Vaginal yeast	?? >20% clue cells = squamous epithelial cells dotted with coccobacilli (Gardnerella) • Paucity of WBC • paucity of lactobacilli • Positive whiff test: fishy odor with addition of KOH to slide (due to formation of amines) # Endometritis is an ascending polymicrobial infection. The causative agents are usually normal vaginal flora or enteric bacteria. - day 1 or 2 most frequently is caused by group A streptococci. If the infection develops on day 3 or 4, the causative organism is frequently enteric bacteria, most commonly E coli, or anaerobic bacteria. Endometritis that develops more than 7 days after delivery is most frequently caused by Chlamydia trachomatis - patient may report any of the following symptoms: fever, chills, lower abdominal pain, malodorous lochia, increased vaginal bleeding, anorexia, and malaise.
	Pregnant lady in her 8 week of gestation came and complain that she loss pregnancy sensation & there is vaginal spotting. What to do to establish the diagnosis A. Mother serum AFP B. Trans vaginal US C. Serum b HCG	Trans vaginal US
	Which of the following use in judgment on progression of delivery? A. Frequency of the contraction B. Strong of contraction C. Descent of the baby	Descent of the baby
	Which of the following is contraindicated for assistant delivery by forceps? A. Breach presentation B. Face presentation C. Cephalopelvic disproportion	Cephalopelvic disproportion
	Pregnant lady in her 41 wk of gestation admitted for delivery induction. After oxytocin was given she start having contraction and there is 4 cm dilation & 60 % effacement. After one hour there is 8 cm dilatation of the cervix & 80% effacement. Baby pulse is 120-140, also there is acceleration & variability. What is the correct action to do A. Expectant delivery B. Stop oxytocin C. Go immediately for CS	Expectant delivery
	Which of the following drug safe during pregnancy A. Erythromycin B. Cephalosporin C. Warfarin surgery	Erythromycin
	Patient presented with lower diffuse abdominal pain , the cervix was normal during P/E there was chandelier sign positive (Cervical motion tenderness) , what is the most likely diagnosis ? A. Pelvic inflammatory disease B. Uterine abnormality C. Ectopic pregnancy	PID Cervical motion tenderness is more common with PID In cases of ectopic pregnancy Typically presents with RLQ pain. PID can exist concurrently with ectopic pregnancy. Positive pregnancy test will guide search for ectopic pregnancy: hcg hormone level is high in serum and urine.Ultrasound reveals an empty uterus and may show a mass in the fallopian tubes.
	Lady presenting with lower abdominal pain when you did U/S you found tubuloovarian abscess , so what you will do ? a. Emergent laparotomy b. Aspiration of the abscess by laparoscopy C. CT guided aspiration d. IV antibiotic	CT guided aspiration I think D, uptodate: Antibiotics are the mainstay of treatment for TOA. In some women, antimicrobial therapy must be combined with a minimally invasive drainage procedure or surgical treatment.
	What is the complication of a pregnant woman Gestational Age 24 hypertensive controlled on medication but controlled on medication and have DM type 1 on insuline when you examining her you found that the fundus was 25 cm ? a. Preeclampsia b. Large for Gestational age c. Shoulder dystocia	Preeclampsia
	Pregnant in 2nd trimester hx of tiredness in first now she is ok all labs normal ex hemoglobin level 10 so management: A. Iron B. Folic acid C. None	Answer: A
	Young female has severe attack of headache anxiety and palpitation she also have lost weight and her skin looks (i forgot the word) which test will order: a. Brain MRI b. Urine catecholamine c. TSH	TSH?!
	Pregnant is in her 38 weeks gestation with a blood pressure of 140 over 90. No proteinuria and completely asymptomatic what will you do: a. Immediate delivery b. Antihypertensives c. Observation (frequently)	Pre eclampsia case At >36 weeks' gestation: delivery is the most sensible approach. I think C! No proteinurea and no sx is gestational HTN not pre-eclampsia!!
	Lady with lower abdominal pain. Vaginal examination reveals suprapubic and fornices tenderness with purulent vaginal discharge? A. Acute cervitis B. Acute salpingitis C. Acute appendicitis	Acute salpingitis Explanation: PID is an upper genital tract infection most commonly caused by chlamydia and gonorrhea The initial infection is acute cervicitis which has no symptoms. However, vaginal exam reveals signs most commonly as mucopurulent cervical discharge or a friable cervix. Acute salpingo-oophritis: patient complains of bilateral abdominal/pelvic pain often after menses. On examination: there is mucopurulent discharge and cervical motion tenderness. Reference: Kaplan OB/GYN step2 lecture notes
	During delivery the cord is before the fetal head, management? A. C/S. B. Vacuum. C. Forceps.	C/S The gold Standard obstetrical management of cord prolapse in the setting of a viable pregnancy typically involves immediate delivery by the quickest and safest route possible. This usually requires cesarean section, especially if the woman is in early labor to avoid fetal compromise or death from compression of the cord. However, vaginal delivery may be a reasonable option in select cases when delivery is imminent.
	Small for gastitional date us show storm form appearance: A- Complete hydatiform B- Partial hydatiform C- Something ca	Complete hydatiform U/S findings in molar pregnancies: if complete: no fetus (classic “snow storm” due to swelling of villi (. If partial: molar degeneration of placenta ± fetal anomalies, multiple echogenic regions corresponding to hydropic villi, and focal intrauterine hemorrhage
	18 yrs old girl c/o amenorrhea for 2 months .she is not sexually active,she refuse examination. What should u do first? A- urine pregnancy test, B- pelvic US, C- hormonal test .	urine pregnancy test Pregnancy is the most common cause of secondary amenorrhea. A pregnancy test is recommended as a first step in evaluation of a secondary amenorrhea.
	Pregnant on 16 weeks ,Rh (-) what u will do ?? A- amniocentesis B- give her rh antibody C- coombs test	C?? for RH incompatibility, routine screening with indirect Coombs test at first visit for blood group, Rh status, and antibodies. - Key diagnostic factors : Prior hx of maternal sensitisation to RhD or hydrops, multiparity, maternal RhD-negative status, invasive fetal procedures, placental trauma, and abortion (threat ened, spontaneous, or induced). - 1st tests to order: maternal blood type (if Rh-negative) then test for maternal serum Rh antibody screen ( positive screen) - the indirect Coombs test detects the presence of anti-Rh antibodies in a pregnant woman's blood serum. - If titres are greater than or equal to 1:16, fetal middle cerebral artery (MCA) blood flow is measured at intervals of 1 to 2 weeks to detect high output cardiac failure.
	Women c/o vesicles of vulva and cervix ? What is organism ? A- herpes simplex B- gonorrhea C- trichomonas	herpes simplex Herpes simplex present with painful vesicular lesions on the vulva and cervix. Gonorrhea and trichomonas do not cause ulcers.
	Women in postpartum , she said that she complete her family and ask about contraception . She is exclusively breast feeding her newborn .and she said that the menses in previous came at 10th month postpartum ? A- give her OCP B- progestrone injection C- wait as previous until 10month	progestrone injection for breast feeding women current evidence indicates that progestin-only contraceptives do not appear to have an adverse effect on breast milk volume during the first 6 weeks postpartum and also have no adverse effect on infant growth and development throughout the duration of their use. Generally recommended that breastfeeding mothers not use hormonal methods that contain estrogen.
	Contraindications to do instrumental delivery a. Placenta abruption! b. Face presentation! c. Breech presentation	Placenta abruption!
	Case of gonorrhea, what are you going to give his close contacts: A. Rifampin chemoprophylaxis B. Isolate all contacts for 4 weeks C. Meningiococal vaccine	Isolate all contacts for 4 weeks ??
	80 years women had yellow watery foul smelling vaginal discharge: A. Bacterial vaginosis B. Trichominus vaginalis C. Atrophic vaginitis	Atrophic vaginitis The thinned endometrium and increased vaginal ph level induced by estrogen deficiency predispose the vagina and urinary tract to infection and mechanical weakness. The earliest symptoms are decreased vaginal lubrication, followed by other vaginal and urinary symptoms that may be exacerbated by superimposed infection. Once other causes of symptoms have been eliminated, treatment usually depends on estrogen replacement.
	Most common complication after hystrectomy: a. Bleeding b. Bladder injury C. Ureter injury	Bleeding Bleeding 1-3%, Bladder injury 2%, Ureter injury 1.6% The most serious postoperative complication of hysterectomy is hemorrhage, which occurs in 1% to 3% of patients. Ureteral injuries are common, the incidence is reported to be 0.5% for hysterectomy performed for benign disease and up to 1.6% for laparoscopically-assisted hysterectomy. Bladder injuries occur in up to 2% of hysterectomy cases.
	Pap shows ASCUS, estrogen trial for some duration , Pap again show ASCUS ; what is next a. Colposcopy b. Hysterectomy c. F/U in next year	Colposcopy
	Pregnant lady at 34 weeks present with regular contractions , dilated cervix 3 cm, fetal station .., US reveals a back toward the cervix in transverse lie with echo leucent area behind the placenta , what to do ? A. Tocolytic B. Induce labor C. CS	CS
	Pregnant in labor, about 80% effacement, 4 cm dilation, +1 fetal station, rupture of membrane, (they give lab values which was low Hb & low platelet) what type of anesthesia? A. General anesthesia B. Para cervical C. Pudendal	General anesthesia??
	Female e DM well controlled , she wants to get pregnant, to avoid the complication dm control should be ,,,, a. Started before pregnancy b. St trimester c. 2nd trimester	Started before pregnancy Preconception anomaly prevention: euglycemia, maintaining glucose values at a normal levels reduces anomaly risk close to that of non-diabetes; start 3 months prior to discontinuing contraception
	46 year old woman G2P2 expressed that she want to get pregnant again, but she had amenorrhea since 7 months now. What will consider before you can tell her wither she can or can't get pregnant? a. LH and FSH Level b. Estrogen level c. Prolactin level	LH and FSH Level Maybe based on the age the patient can have peri -menopause but she's not considered menopause until loss of menses for 12 months?
	During delivery the cord is before the fetal head, management? A- C/S. B- Vacuum. C- Forceps.	C/S The gold Standard obstetrical management of cord prolapse in the setting of a viable pregnancy typically involves immediate delivery by the quickest and safest route possible This usually requires cesarean section, especially if the woman is in early labor and to avoid fetal compromise or death from compression of the cord. However, vaginal delivery may be a reasonable option in select cases when delivery is imminent.
	Pregnant lady with nausea and vomiting and abdominal pain, what's your first priority in management? A- IV fluids B- Pain management C- IV Antibiotics	IV fluids
	Pregnant women in labor pain her abdomen distended to xyphoid process US show breach presentation ,intact membrane , fully dilated and effaced , station 0 what is the best management of the case a. Cesearion section b. Amniotomy c. Extension breach delivery	?? Criteria for Vaginal Breech Delivery : Frank or complete breech, GA >36 wk • EFW 2,500-3,800 g based on clinical and U/S assessment (5.5–8.5 lb) • Fetal head flexed • Continuous fetal monitoring • 2 experienced obstetricians, assistant, and anesthetist present • Ability to perform emergency C/S within 30 min if required C/S recommended if: the breech has not descended to the perineum in the second stage of labor a er 2 h, in the absence of active pushing, or if vaginal delivery is not imminent a er 1 h of active pushing Contraindications to vaginal breech delivery:cord presentation,clinically inadequate maternal pelvis, fetal factors incompatible with vaginal delivery
	Best modality in diagnosis DVT in pregnancy a. D-dimer b. Doppler US c. Impedance Plethysmography	B or C In pregnancy, compression US should be performed with the patient in the left lateral decubitus position and with Doppler analysis of flow variation during respiration to maximize the studies ability to diagnose pelvic DVT. D-dimer increases progressively throughout gestation,[38] adding to the difficulty in selecting an appropriate cut off value for reasonable specificity in pregnancy. Impedance plethysmography is both sensitive and specific for the diagnosis of proximal deep vein thrombosis in symptomatic patients when venography is the reference standard.In contrast, impedance plethysmography is not sensitive for the detection of proximal deep vein thrombi in asymptomatic high-risk patients such as patients who have recently undergone hip arthroplasty or stabilization of hip fracture. - Ascending contrast venography is considered the gold standard for the diagnosis of lower extremity DVT in both the pregnant and the non-pregnant populations - We recommend compression venous color Doppler ultrasound as the initial test in pregnant women with suspected DVT. The test should be performed in advanced pregnancy with the patient in the left lateral decubitus position. All tests positive for proximal DVT should prompt immediate treatment
	Minimal test to check in preeclampsia : A. Creatinine , liver enzymes , platelet B. Creatinine, liver enzyme , Htc -platelet, uric acid , liver enzymes C. Platelet , uric acid , creatinine	Creatinine, liver enzyme , Htc -platelet, uric acid , liver enzymes Elevation in hemoconsentration is shown by elevation of Hb, HCT, BUN, serum ceraitnine and serum uric acid.
	7 weeks gastation woman c/o bleeding associated with tissue passage, cervix is open: A) Inevitable abortion B) Threatened abortion C) Incomplete	Incomplete
	Malodourous vaginal discharge watery mucopurulent no itching with clue cell dx: A) Trichomonas B) Bacterial vaginosis C) Atrophic vaginitis	Bacterial vaginosis Clue cells are a medical sign of bacterial vaginosis, particularly that caused by Gardenerella vaginalis.
	Monozygot twin presentation (twin A/twin B)will dengioras in : A) Cephalic. Cephalic B) ransver. Cephalic C) Breach. Cephalic	A???? According to Mudaliar and Menon's Clinical Obstetric book, 10th edition, page 184: The most common presentation is Cephalic-Cephalic then Cephalic-Breech
	Pregnant women (38 w) her BLOOD PRESSURE is 140/90, no proteinuria ... What is the appropriate treatment? A) Do CS B) Observation C) Some thing	Observation Therefore, pregnant patients should be started on antihypertensive therapy if the SBP is greater than 160 mm Hg or the DBP is greater than 100-105 mmhg."
	Lady e atypical cervical cell, the doctor can't see cervix well in colposcopy, what is the appropriate next step: A) Repeated pap smear B) Repeated colposcopy C) Cone biopsy	Cone biopsy
	Pregnant women has HIV the CD was 400 and now it is CD200 how to dliver the pt.: A) CS B) Spontaneous vaginal delivery C) Scheduled CS	- spontaneous vaginal delivery - at 39w - avoid amniotomy as long as possible, dont use forceps, vacume ectractor or scalp electrode. Use gentle newborn resusitation - Scheduled cesarean delivery at 38 w without amniocentesis should be discussed and recommended for women with viral loads greater than 1000 copies/mL, whether or not they are taking antiretroviral therapy.
	What's true regarding cervical cancer? A. Most of the lesion progress to malignancy B. CIN requires months to progress to malignancy C. Pap smear decrease its incidence (my answer)	I think B?!
	Mother want to screen her fetus for thalassemia : A- chorionic villus sampling at 16 week B- amniotic fluid with something at 15 week C- amniotic fluid with 2 other things at 16 week	Answer: Choices incomplete Explanation: screening for thalassemia can be done using either chorionic villus sampling or amniotic fluid. However chorionic villus sampling is done between 10-12 weeks which makes A wrong. Amniotic fluid can be done at 15 weeks or more so B or C can be correct depending on the missing information in each choice. To limit the possibility of misdiagnosis, we analyse chorionic villous DNA with two different procedures: i.e. RDB hybridisation and primer-specific amplification, using distinct couples of primers.
	A patient 39 week in labor. You ran a reactive cardiotocography (CTG), on examination you feel orbital margin nose and chin. How will you manage her? A. Delivered her in operating room B. Emergency c/s C. Oxytocin	- Oxytocin - According to the question, it is a FACE Presentation. - Continuous electronic fetal heart rate monitoring is considered mandatory because of the increased incidence of abnormal fetal heart rate patterns and/or nonreassuring fetal heart rate patterns. - Fetuses with face presentation can be deliv ered vaginally with overall success rates of 60- 70% - Cesarean delivery is performed only for the usual obstetrical indications. - Oxytocin can be used to augment labor - Forceps may be used if the mentum is anterior
	Pregnant 8 week of gestation presented with severe abdominal pain followed by heavy bleeding. Examination revealed tense abdomen. What is most likely diagnosis? A. Threatened abortion B. Ectopic pregnancy C. Ovarian failure	Ectopic pregnancy Ectopic pregnancy: A fertilized ovum implanting and maturing outside of the uterine endometrial cavity. The most common site being the fallopian tube (Oviduct-Distal Ampulla) - EP Triad: Secondary amenorrhea + Unilateral abdominal or pelvic pain + Vaginal bleeding - Symptoms generally appear 6 to 8 weeks after the last normal menstrual period, but they can occur much later in cases of non-tubal ectopic pregnancy - To confirm the diagnosis: B-hcg titer > 1500 miu + No intrauterine pregnancy is seen with vaginal sonogram
	Patient with preterm symptoms. Cephalic presentation. CTG done showed contraction every 10 min vaginal exam showed 1 cm -3 station managed with hydration and steroid. What is the best next step to confirm the diagnosis? A. Vaginal exam B. CTG C. Lung maturation	Vaginal exam Sterile speculum examination Preterm labor triad (used to confirm the diagnosis): Pregnancy 20-36 weeks + 3 or more contractions in 30 min + cervical dilation of 2 cm or more. Other common symptoms: abdominal pain\ low back pain\ vaginal bleeding
	Which of these medications is safe for pregnant women? A. Paracetamol B. Aspirin C. Ibuprofen	Paracetamol Paracetamol (Acetaminophen) is safe to use in all stages of pregnancy short term.
	25 year-old female was diagnosed with pelvic inflammatory disease 3 years ago which was completely resolved. She presented with inability to conceive for 3 months of trying. Investigation were normal, and semen analysis was normal as well  Her BMI is 35  LH and FSH were low How will you manage her? A. Induction ovulation and IVF B. Induction ovulation and normal conceive C. Advice here to reduce Her BMI to 23 and trying to get pregnant	C (NOT SURE) Since this patient has high. Women with elevated baseline weight or body mass index (BMI) greater than 27 kg/m2 and anovulatory infertility should be advised to lose weight But LH and FSH low!
	A case of pregnant lady whose baby was breech and small in size. She came at 38 weeks of gestation for external cephalic version. Upon US, bicornuate uterus was discovered, baby's head is flexed. Doctor decided to do CS, why? A. Bicornuate uterus B. Baby's head flexed C. Size of baby	Bicornuate uterus Maybe answer not written!
	A case of pregnant lady who's complaining of severe pain and bleeding. US was done and showed fibroid and viable fetus, what to do? A. Hysterectomy B. Termination of pregnancy C. Analgesia	Analgesia  Fibroid pain during pregnancy is usually managed conservatively by bed rest, hydration, and analgesics. Use nsaids with caution. Rarely, severe pain may necessitate additional pain medication (narcotic analgesia), epidural analgesia, or surgical management (myomectomy). -  It is rare for fibroids to be treated surgically in the first half of pregnancy. If necessary, however, several studies have reported that antepartum myomectomy can be safely performed in the first and second trimester of pregnancy.
	A female cannot get pregnant, and tried for 3 months and she is normal, regular menstrual cycle, and husband is normal what to do? A. Try more B. Semen analysis C. Genetic study	Try more Infertility is defined as not being able to get pregnant (conceive) after one year of unprotected sex. Women who do not have regular menstrual cycles, or are older than 35 years and have not conceived during a 6-month period of trying, should consider making an appointment with a reproductive endocrinologist—an infertility specialist.
	A pregnant lady in her 3 rd trimester is complaining of swelling in her lower limbs. What will you do? A. Venogram heparin B. Doppler, bed rest >heparin C. Clinical, bed rest < warfarin	B. Doppler, bed rest >heparin DVT risk factors is as follows: Age, immobilization longer than 3 days, pregnancy and the postpartum period…etc . The American Academy of Family Physicians (AAFP)/American College of Physicians (ACP) recommendations for workup of patients with probable DVT. In patients with intermediate to high pretest probability of lower-extremity DVT, ultrasonography is recommended
	Site of fibroid that cause abortion? A. Submucosal B. Intramural C. Serosal	Submucosal Affect implantation lead to miscarriage A recent systematic review found the spontaneous miscarriage rate to be higher in women with submucosal and intramural fibroids (in descending order) undergoing IVF, compared with women with no fibroids; however, only 11 controlled studies were analysed (Klatsky et al., 2008)."
	3 months pregnant woman scenario of Bacterial vaginosis what to give? A. Oral metronidazole B. Ceftriaxon C. Cream	Oral metronidazole Bacterial vaginosis is a clinical syndrome caused by excessive growth of bacteria that may normally be present in the vagina, The etiology is polymicrobial in nature; with a ph of more than 4.5, Gardnerella vaginalis and anaerobes become the prominent associated organisms. Treat BV occurring in pregnant women to reduce the risk of pregnancy-associated complications related to infection (premature labor unresponsive to tocolytic therapy). Oral metronidazole or clindamycin is recommended; clindamycin cream should be avoided during the second half of pregnancy
	Pregnant with asthma scenario came with SOB, what to do? A. Chest X-ray B. Spirometry C. CT	Spirometry Lung function tests, such as spirometry, are useful for distinguishing the shortness of breath associated with a worsening of asthma from the normal shortness of breath that many women experience during pregnancy.
	Lady with lower abdominal pain. Vaginal examination: fornices tenderness, suprapubic tenderness and purulent vaginal discharge. What is the diagnosis ? A. Acute cervicitis B. Acute salpingitis C. Acute appendicitis	Acute salpingitis Salpingitis is an infection and inflammation in the fallopian tubes. It is often used synonymously with pelvic inflammatory disease (PID) Symptoms: (1) Lower abdominal pain is usually present. The pain is typically described as dull, aching or crampy, bilateral, and constant; it begins a few days after the onset of the last menstrual period and tends to be accentuated by motion, exercise, or coitus (2) Abnormal vaginal discharge is present in approximately 75% of cases. (3) Unanticipated vaginal bleeding. Physical signs: (1) Cervical motion tenderness (2) Uterine tenderness (3) Adnexal tenderness
	Assessment of delivery by? A. Number of contractions B. Force of contractions. C. Fetal station.	Fetal station. Evaluation of status of labor, including a description of uterine activity, cervical dilation and effacement, and fetal station and presentation, unless vaginal exam deferred; evaluation of fetal status, including interpretation of auscultation or electronic fetal monitoring strips.
	36 weeks gestational age experiencing uterine contraction every 3 minute, each contraction lasting 30 second, hypertensive (BLOOD PRESSURE 160\ 100). What will you do: A. CS B. Induce labor C. Tocolytic	CS
	Massive bleeding 2 hours after delivery. What is the management A. Ringer lactate B. Blood transfusion C. Methergine	Blood transfusion
	Most accurate sign for placental abrupto: A. Uterine tenderness with back pain B. Fetal distress C. Vaginal bleeding	I think A The uterus is frequently tender to palpation and may feel hard, with the consistency of wood. Key diagnostic factors : vaginal bleedingabdominal painuterine contractionsuterine tenderness Other diagnostic factors: lower back painfetal death
	Lactating women with mastitis? A. Continue breastfeeding B. Draining C. Antibiotic	Continue breastfeeding Supportive treatment includes the use of analgesics and warm compresses. Breasts should be frequently emptied of milk through continued nursing or pumping (should be initiated with the uninfected breast). If symptoms are not improving within 12-24 hours or if the woman is acutely ill, antibiotics should be started. If an abscess develops, consider irrigation and debridement along with IV antibiotics.
	Pregnant lady with DVT what is the best investigation to diagnose? A. D-dimer B. Duplex to calf muscle C. CT-angio	Duplex to calf muscle
	Female after birth was experiencing excessive crying for short period then resolved. A. Maternal blues B. Postnatal depression C. Postpartum psychosis	Maternal blues blues: Symptoms peak on the 4-5 day after delivery and last for several days, spontaneously remit within the first 2 postpartum weeks depression: > 2 wks, develops most frequently in the first 4 months following delivery but can occur anytime in the first year.
	Pregnant lady came to the clinic at 10 week with 2 hr bleeding, examination revealed close Os, the fundus is palpable ? Cm above symphysis pubis. What is the cause? A. Rupture cyst B. Inferiorly located placenta C. Ectopic pregnancy	ectopic preg.: early pregnancy bleeding, pelvic pain, adnexal tenderness or mass, uterus may be slightly enlarged (but less than anticipated based on date of LMP or # of weeks) Could be abortion (threatened) because there is no cervical dilation.
	G7P0 Gave birth to 4 Kg Baby, blood loss was 800 ml A- primary hemorrhage B- secondary hemorrhage C- tertiary hemorrhage	primary hemorrhage bleeding that occurs within the intra-operative period.
	Pregnant lady has asthma, before pregnancy she used to have 3 attacks/ week using salbutamol, now she is 30 weeks pregnant and her symptoms relieved spontaneously, why does her asthma improve with pregnancy? A- Increase TV B- Progesterone effect on smooth muscles C- improve expiratory I dnk what	Increase TV
	The doctor convert to Caesarean Section, what is the case to do CS? A- Age of fetus B- Presentation C- Rupture of membrane	Presentation Indications for CS: Possible indications include: - Cephalopelvic disproportion - Malpresentation - eg, breech, transverse lie. - Multiple pregnancy. - Severe hypertensive disease in pregnancy. - Fetal conditions: distress, iso-immunisation, very low birth weight. - Failed induction of labour. - Repeat caesarean section. - Pelvic cyst or fibroid. - Maternal infection (eg, herpes, HIV) .
	Which of the following tests are minimum requirements for screening of pre-eclampsia: A-Platelets count, creatinine level & liver enzymes B- HCT, 24 urine protein & liver enzymes C- HCT, creatinine level & liver enzymes	A?? In a patient with new-onset hypertension without proteinuria, the new onset of any of the following is diagnostic of preeclampsia: - Platelet count below 100,000/μl - Serum creatinine level above 1.1 mg/dl or doubling of serum creatinine in the absence of other renal disease - Liver transaminase levels at least twice the normal concentrations - Pulmonary edema - Cerebral or visual symptoms Diagnostic tests 1st tests to order : urinalysisfetal ultrasoundfetal cardiotocographyfetal biometryumbilical artery Doppler velocimetryamniotic fluid assessment Tests to consider : FBCLFTsserum creatininecoagulation screen
	Pregnant g3p2 in labor, cervical dilatation 3cm, effacement 100% membrane rupture, after 3 hours still 3 cm, A. C-section B. Oxytocin C. Waiting	Waiting?? She still in latent phase (less than 4 cm), so wait but should not exceed 14 hours the phase - A prolonged latent phase is defined as ≥20 hours for the nullipara and ≥14 hours for the multiparous woman - The average duration of latent phase in nulliparous and multiparous women is 6.4 and 4.8 hours, respectively - The active phase is defined as the period when changes in cervical dilation accelerate to at least 1 to 2 cm per hour and the fetus descends into the birth canal.

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