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213 Cards in this Set

  • Front
  • Back
HCG is produced by ???
Placental syncytiotrophoblast
HCG
1. First appears in maternal blood how many days after fertilization
2. Peaks at ???
3. then Gradually falls to a plateau level at???
1. 10 days after fertilization
2. 9-10 weeks
3. 20-22 weeks
If HCG levels are excessive then D/D ???
1. Twin pregnancy
2. Hydatidiform mole
3. Choriocarcinoma
4. Embryonal carcinoma
If HCG levels are inadequate then D/D ??
1. Ectopic pregnancy
2. Missed abortion
3. Threatened abortion
Human Placental Lactogen chemically similar to which hormones ??
1. Anterior pituitary growth hormone
2. Prolactin
What are the effects of Human Placental Lactogen??
Antagonizes the cellular action of insulin, decreasing insulin utilization, thereby contributing
to the predisposition of pregnancy to glucose intolerance and diabetes
If Human Placental Lactogen levels are low then D/D ??
1. Threatened abortion
2. IUGR
Source of Progesterone production -
1. Upto 6-7 menstrual weeks
2. Between 7 and 9 weeks
3. After 9 weeks
1. Produced exclusively by the corpus luteum
2. Both the corpus luteum and the placenta produce progesterone
3. Corpus luteum declines, and progesterone production is exclusively by the placenta
Predominant estrogen hormone during the nonpregnant reproductive years ??
Estradiol
Predominant estrogen hormone during pregnancy ??
Estriol
Predominant estrogen hormone during menopause??
Estrone
Bluish or purplish discoloration of the vagina and cervix as a result of increased vascularity called ???
Chadwick sign
What happens to following in pregnancy?
1. Gastric motility
2. Emptying time
3. and why ??
1. Decreases
2. Increases
3. Progesterone effect on smooth muscle.
The only lung volume that does not decrease with pregnancy ??
Tidal Volume (Vt)
What happens to levels of total T3 and T4 in pregnancy and why ??
Increase
Coz Thyroid binding globulin (TBG) increases
What happens to levels of free T3 and free T4 in pregnancy ??
Remain unchanged.
Which hormone promotes the growth of ducts in the breast ??
Estrogen
Which hormone stimulates the development of milk producing alveolar cells ??
Progesterone
Which hormone stimulates milk production ??
Prolactin
Which hormone causes milk ejection from the lactating breast ??
Oxytocin
Which hormone antagonizes the positive effect of
prolactin on milk production ??
Estrogen
Most significant event of Post-conception week 1 is ??
Implantation of the blastocyst on the endometrium
Most significant event of Post-conception week 2 is ??
Development of the bilaminar germ disk with epiblast
and hypoblast layers
Most significant event of Post-conception week 3 is ??
Migration of cells through the primitive streak
between the epiblast and hypoblast to form the trilaminar germ disk with ectoderm, mesoderm,
and endoderm layers
The period of major teratogenic risk ??
Postconception Weeks 4-8
Derivatives of Ectoderm ??
1. Central and peripheral nervous systems
2. Sensory organs of seeing and hearing
3. Integument layers (skin, hair, and nails)
Derivatives of Mesoderm ??
1. Muscles
2. Cartilage
3. Cardiovascular system
4. Urogenital system
Derivatives of Endoderm ??
1. Lining of the gastrointestinal tracts
2. Lining of the respiratory tracts
Primordium of the female internal reproductive
system ??
Paramesonephric (Mullerian) Duct
Primordium of the male internal reproductive
system ??
Mesonephric (Wolffian) Duct
Structures formed from Urogenital sinus in Males ??
1. Prostate gland
2. Bulbourethral gland
Structures formed from Urogenital sinus in Females ??
1. Skene's glands
2. Bartholin's glands
Structures formed from Genital tubercle in Males ??
1. Glans penis
2. Corpus cavernosum and spongiosum
Structures formed from Genital tubercle in Females ??
1. Glans clitoris
2. Vestibular bulbs
Structures formed from Urogenital folds in Females ??
Labia minora
Structures formed from Urogenital folds in Males ??
Ventral shaft of penis (penile urethra)
Most common trisomy in first-trimester losses is ??
Trisomy 16
Most common trisomy at term ??
Trisomy 21
Gonadal mosaicism can result in which condition ??
Premature ovarian failure
And predispose the gonad to malignancy.
Two most common aneuploidies in miscarriages ??
1. Trisomy 16
2. Monosomy X
Neural tube closes by what period of embryonic life ??
Days 26-28 of embryonic life
Which is the most common First trimester abortion procedure in the United States ??
Vacuum curettage---Dilation and curettage (D&C)
Medical induction of abortion in First trimester by what medication ??
At what time period shoud it be given??
1. Oral Mifepristone (Progesterone antagonist)
2. Oral Misoprostol (Prostaglandin E1)
3. Use is limited to first 63 days of amenorrhea
Which is the most common second-trimester abortion procedure ??
Dilation and evacuation (D&E)
We label it as Spontaneous abortion if vaginal bleeding occurs at what gestation week ??
Vaginal Bleeding that occurs before 12 weeks gestation
1. Anticardiolipin antibodies lead to what type of Abortion ??
2. What is the treatment for this ??
1. Spontaneous abortion
2. Subcutaneous Heparin
Sonogram finding of a nonviable pregnancy without vaginal bleeding, uterine cramping, or
cervical dilation indicate ??
Management ??
Missed Abortion
Management :-
1. Scheduled suction D&C, or
2. Conservative management awaiting a spontaneous completed abortion or
3. Induce contractions with misoprostol
Sonogram finding of a viable pregnancy with vaginal bleeding but no cervical dilation indicate ??
Management ??
Threatened abortion
Management :-
1. Observation
2. Half of these pregnancies will continue to term successfully
Vaginal bleeding and uterine cramping leading to cervical dilation, but no POC has yet been
passed. Indicates ??
Management ??
Inevitable abortion
Management :-
Emergency suction D&C to prevent further blood loss and anemia
Vaginal bleeding and uterine cramping leading to cervical dilation, with some, but not all, POC
having been passed ??
Management ??
Incomplete abortion
Management :-
Emergency suction D&C to prevent further blood loss and anemia
Vaginal bleeding and uterine cramping have led to all POC being passed and confirmed by a sonogram showing no intrauterine contents or debris. Dx ??
Management ??
Completed abortion
Management :-
1. Conservative if an intrauterine pregnancy had been previously confirmed
2. Otherwise, serial hCG titers should be obtained weekly until negative to ensure an ectopic pregnancy has not been missed
1. In utero death of a fetus after 20 weeks' gestation before birth ?? What we call this ??
2. Most serious consequence ??
1. FETAL DEMISE
2. DIC
How will you diagnose Unruptured ectopic
pregnancy ??
1. Beta-hCG titer > 1,500 mU
2. No intrauterine pregnancy is seen with
vaginal sonogram
If the sonogram does not reveal an IUP, but the quantitative Beta-hCG is <1,500 mlU, In this case How will you differentiate a normal IUP from an
ectopic pregnancy ??
Because Beta-hCG levels in a normal IUP double every 58 hours, the appropriate management will be to repeat the quantitative Beta-hCG and vaginal
sonogram every 2-3 days until the Beta-hCG level exceeds 1,500 mIU.
Management of unruptured ectopic pregnancy ??
1. Medical with methotrexate , or
2. Surgical with laparoscopy
Management of ruptured ectopic pregnancy ??
Immediate surgical intervention to stop the bleeding is vital, usually by Laparotomy.
4 Criterias for Methotrexate usage in treating ectopic pregnancy ??
1. Pregnancy mass <3.5 cm diameter
2. Absence of fetal heart motion
3. Beta-hCG level <6,000 mlU,
4. No history of folic supplementation
CHORIONIC VILLUS SAMPLING (CVS) :-
1. Usually performed at what time of gestation period?
2. Indication ?
1. Between 10 and 12 weeks' gestation
2. For karyotyping
AMNIOCENTESIS :-
1. Usually performed at what time of gestation period?
2. Indication ?
1. After 15 weeks
2. a) NTD (Neural tube defect) screening by detecting amniotic fluid alpha fetoprotein levels and acetylcholinesterase levels
b) For karyotyping
What is Spontaneous abortion ?
Vaginal bleeding that occurs before 12 weeks gestation.
1. What are Braxton-Hicks contractions ?
2. Palpated at what gestation period ?
1. Painless, low-intensity, long-duration contractions
2. Palpated as early as 14 weeks.
1. What is Quickening ?
2. Detected at what gestation period ?
1. Maternal awareness of fetal movement
2. 18-20 weeks in primigravidas
16-20 weeks in multigravidas.
1. What is lightening ?
2. What gestation period ?
1. Descent of the fetal head into the pelvis resulting in easier maternal breathing
2. 3rd Trimester
1. What is bloody show ?
2. What gestation period ?
1. Vaginal passage of bloody endocervical mucus, the result of cervical dilation before labor.
2. 3rd Trimester
Pre-eclampsia is a complication of Pregnancy seen in which period of gestation ?
3rd Trimester
6 immunizations which are safe during pregnancy ?
1. Influenza (all pregnant women in flu season)
2. Hepatitis B (pre- and postexposure)
3. Hepatitis A (pre- and postexposure)
4. Pneumococcus (only high-risk women)
5. Meningococcus (in unusual outbreaks)
6. Typhoid (not routinely recommended)
6 immunizations which are Unsafe during pregnancy ?
1.Measles
2. Mumps
3. Polio
4. Rubella
5. Yellow fever
6. Varicella
The most reliable predictor of true anemia in Pregnancy ?
MCV
Can Anti-TB drugs be given in Pregnancy ??
YESSSSSSS!!!!
Differental dx's Of increased Maternal Serum alpha Fetoprotein (MS-AFP) levels ?
1. Open neural tube defect [NTD]
2. Ventral wall defects
3. Twin pregnancy
4. Placental bleeding
5. Fetal renal disease
6. Sacrococcygeal teratoma.
Maternal serum alpha Fetoprotein (MS-AFP) testing is performed at what gestation period ?
Performed within a gestational window of
15-20 weeks
Differental dx's Of DECREASED Maternal Serum alpha Fetoprotein (MS-AFP) levels
1. Down's syndrome
The most common cause of an elevated MS-AFP ??
Dating error
What is the next step in management of high positive value of MS-AFP ??
Obtain an obstetric ultrasound to confirm gestational dating
Elevated levels of __________________________are specific to open NTD ?
AF acetylcholinesterase activity
With elevated MS-AFP, Normal Sonogram and normal AF-AFP,
What should be thought of ??
Pregnancy is statistically at risk for :-
1. Intrauterine growth restriction (IUGR),
2. Stillbirth,
3. Pre-eclampsia
1. For Low MS-AFP positive low value is
2. For High MS-AFP positive high value is
1. <0.85 MoM
2. >2.5 MoM
Triple marker screen for trisomy is performed at what gestation period ?
Performed within a gestational window of
15-20 weeks
In Down syndrome, levels for
1. MS-AFP ___________________
2. Estriol ___________________
3. hCG ____________________
1. Decreased
2. Decreased
3. Increased
In Edward syndrome, levels for
1. MS-AFP ___________________
2. Estriol ___________________
3. hCG ____________________
1. Decreased
2. Decreased
3. Decreased
Levels of Inhibin-A in
1. Down Syndrome _____________
2. Edward syndrome ____________
1. Increase
2. Normal
1. Screening test for diabetes in pregnancy ??
2. Normal value??
3. Gestation period during which it is done ??
1. 1-h 50-g Glucose challenge test
2. <140 mgldL
3. Between 24 and 28 weeks' gestation
What is the definitive test for glucose intolerance in pregnancy??
3-h 100-g OGTT
1. If abnormal 1-h 50-g Glucose challenge test, Whats the next step?
2. And the what's the criteria to further differentiate between Gestational DM and Impaired glucose tolerance ??
Administer a 100-g glucose load, followed by glucose levels at 1, 2, and 3 h.
Normal values are
Fasting blood glucose level < 95 mg/dl
1 h <180 mg/dL,
2 h <155 mg/dL,
3 h <140 mg/dL.
Gestational diabetes is diagnosed if two or more values are abnormal.
Impaired glucose intolerance is diagnosed if only one value is abnormal
1. Test for anemia should be performed at what gestation in pregnancy ??
2. Below what level considered anemic ?
1. Between 24 and 28 weeks' gestation
2. <10 g/dL
Most common cause of painful late-trimester
bleeding ??
Abruptio placenta
Cocaine use leads to which of the following conditions?
a) Placenta previa
b) Abruptio placenta
c) Placenta accreta
d) Vasa previa
Abruptio placenta
Presence of painless late-trimester vaginal bleeding with an obstetric ultrasound showing placental implantation over the lower uterine segment ??
Diagnosis ??
Placenta previa
The classic triad of rupture of membranes and painless vaginal bleeding,followed by fetal bradycardia indicate diagnosis of which condition??
Vasa previa
The findings in a 34 weeks pregnant are vaginal bleeding, fetal bradycardia , abdominal pain, and loss of station of fetal head. Diagnosis ??
UTERINE RUPTURE
Early onset infection, occurring within a few hours to days of birth, and characterized by fulminant pneumonia and sepsis. Whats the diagnosis ??
GROUP B Beta-HEMOLYTIC STREPTOCOCCI (GBS)`
Which antibiotics are used to treat a known infection of Toxoplasmosis ??
Pyrimethamine and sulfadiazine
Which antibiotics are used to prevent vertical transmission of toxoplasmosis from the mother to the fetus ??
Spiramycin
The neonate presents with "zigzag" skin lesions, micropthalmia, cataracts, chorioretinitis, extremity hypoplasia, and motor and sensory defects. Whats the diagnosis ??
Congenital varicella syndrome
Communicability of Varicella infection
1. Begins ________________________ ??
2. Lasts until _____________________??
1. 1-2 days before the appearance of vesicles
2. All vesicles are crusted over
What is the major route of vertical transmission in case of HIV infection ??
Contact with infected genital secretions at the time of vaginal delivery.
A Woman had a preterm delivery at 34 weeks' gestation of a male neonate who died within the first day of life. She states that at delivery the baby
was swollen with skin lesions and that the placenta was very large. She was treated with antibiotics but she does not remember the name or other details.
Whats the diagnosis ??
Congenital syphilis
The VDRL or RPR test will first come out to be positive in which stage of syphilis ??
Secondary syphilis
What should be done of the pregnant mother with syphilis is penicillin allergic ??
if the gravida is penicillin allergic, she should still be given a full penicillin dose using an oral desensitization regimen under controlled conditions.
1. What is the treatment for syphilis in a pregnant mother ??
2. Why we cant give any other antibiotic ??
1. Benzathine penicillin 2.4 million units IM x 1
2. Other antibiotics do not cross the placenta well
What is perinatal transmission risk of Hepatitis B Virus if the mother is positive for HBV surface antibodies but negative for HBV surface antigen ??
NONEEEEEEEEEEE!!!!!!!!!!
If Active immunization for Hepatitis
B Virus safe in pregnancy ??
YeSSSSS
The agent is a killed virus
McDonald cerclage vs Shirodkar cerclage ??
1. McDonald cerclage places a removable suture in the cervix. The benefit is that vaginal delivery can be allowed to take place, avoiding a cesarean.
2. Shirodkar cerclage utilizes a submucosal placement of the suture that is buried beneath the mucosa and left in place. Cesarean delivery is performed at term.
•
Chorionicity and amnionicity of the twin pregnancies depending on the duration of time from fertilization to cleavage :-
1. Up to 72 hours (separation up to the morula stage)
Twins are dichorionic, diamnionic
Chorionicity and amnionicity of the twin pregnancies depending on the duration of time from fertilization to cleavage :-
Between 4 and 8 days (separation at the blastocyst stage)
Twins are monochorionic, diamnionic.
Chorionicity and amnionicity of the twin pregnancies depending on the duration of time from fertilization to cleavage :-
1. Between 9 and 12 days (splitting of the embryonic disk)
2. >12 days
1. Twins are monochorionic, monoamnionic.
2. Conjoined twins
Route of delivery in case of Twin pregnancies ??
1. Vaginal delivery if both are cephalic presentation (50%);
2. Cesarean delivery if first twin in noncephalic presentation;
3. Route of delivery is controversial if first twin is cephalic and second twin is noncephalic.
When is RhoGAM given to Rh(D)-negative mothers ??
1. Routinely at 28 weeks
2. Within 72 h of chorionic villus sampling (CVS), amniocentesis, or D&C
3. Within 72 h of delivery of an Rh(D)-positive infant
What is Kleihauer-Betke test ??
1. Test quantitates the volume of fetal RBCs in the maternal circulation by differential staining of fetal and maternal RBCs on a peripheral smear.
2. This can assess whether more than one vial of RhoGAM needs to be given when large volumes
of fetal-maternal bleed may occur.
What are the 3 criteria that need to be met to diagnose Pre-Term labour ??
1. Gestational age-pregnancy duration :-
>20 weeks, but <37 weeks.
2. Uterine contractions-
at least three contractions in 30 min.
3. Cervical change-
Serial examinations show a change in dilation or effacement, or a single examination shows cervical dilation of >2 cm.
Criteria for diagnosing of PROM ??
1. Posterior vaginal fornix pooling
2. Fluid is Nitrazine (phenaphthazine) (+)
3. Glass slide drying :- fern(+)
Patient is at 32 weeks gestation, On examination her blood pressure (BP) is 155/95, which is persistent on repeat BP check 10 minutes later. A spot urine dipstick is negative. Most likely diagnosis ??
GESTATIONAL HYPERTENSION
Patient is at 32 weeks gestation, On examination her blood pressure (BP) is 155/95, which is persistent on repeat BP check 10 minutes later.
She denies headache, epigastric pain, or visual disturbances. She has 2+ pedal edema, and her fingers appear swollen. A spot urine dipstick shows 2+ protein. Most likely diagnosis ??
MILD PREECLAMPSIA
Patient is at 32 weeks gestation, On examination her blood pressure (BP) is 165/115. Severe, unremitting occipital headache, and midepigastric pain not relieved by acetaminophen, and she has also seen light flashes and spots in her vision. She has 2+ pedal edema, and her fingers appear swollen. A spot urine dipstick shows 4+ protein. Most likely diagnosis ??
SEVERE PREECLAMPSIA
Evidence of DIC and hepatocellular injury associated with Hypertension in a pregnant female indicates ??
Severe preeclampsia.
Does a primary seizure disorder predispose a pregnant woman to eclampsia ??
NOOOOOOOOOOOOOOOOOO!!!!!
Which complication can result with Eclampsia ??
Intracerebral hemorrhage can occur with even death resulting.
When is screening for diabetes done in a pregnant woman ??
Between 24 and 28 weeks' gestation when the anti-insulin effect of hPL is maximal.
29 year old primagravida is at 33 weeks' gestation, becoming mentally confused, experiencing nausea and vomiting, lack of appetite, BP is 150/95 mm Hg.
Random blood glucose is 52 mg/dl. Platelet count is 75,000. PTI is prolonged at 64.7 seconds. Creatinine is 2.1 mg/dl. Uric acid is 11.9 mg/dl, lactic dehydrogenase is 1063 U/I, ALT is 220 U/I, AST is 350 U/I, total bilirubin is 8.4 mgldl. Serum ammonia is elevated. Urine protein dipstick is 3+.
Most likely Diagnosis ??
Acute Fatty Liver
Is Warfarin safe during breast feeding ??
YESSSSSS!!!!!
Fetus with estimated fetal weight (EFW) >90-95th percentile for gestational age. Birth weight <4,000-4,500 grams. Diagnosis ??
Macrosmia
Fetus with estimated fetal weight (EFW) < 5-lOth percentile for gestational age.Birth weight <2,500 grams. Diagnosis ??
IUGR
Amniotic fluid index :-
1. Normal ??
2. Oligohydraminos ??
3. Polyhydraminos ??
1. 9-25 cms
2. <5 cms
3. >25 cms
Cervical dilatation accelerates to a maximum rate in which phase of labour ??
Active phase of labour
Signs of 3rd stage of labour ??
1. Gush of blood vaginally,
2. Change of the uterus from long to globular,
3. "Lengthening" of the umbilical cord.
Duration may be up to 30 min in all women.
Duration of 2nd stage of labour ??
< 2 hrs in a Primipara
< 1 hr in a Multipara
Duration of latent phase in the 1st stage of labor ??
<20 hours in primipara
<14 hours in multipara
Management of prolonged latent phase in the 1st Stage of labor ??
Therapeutic rest and sedation
Names of cardinal movements of labour in exact sequence ??
1. Engagement
2. Decent
3. Flexion
4. Internal Rotation
5. Extension
6. External Rotation
7. Expulsion
Management of Prolonged or Arrested Active Phase in the 1st Stage of labor ??
1. Assessment of uterine contraction quality.
2. Contractions should occur every 2-3 min, last 45-60 s with 50 mm Hg intensity.
3. If contractions are hypotonic, IV oxytocin is administered
4. If contractions are hypertonic, give morphine sedation.
5. If contractions are adequate, proceed to emergency cesarean section.
Management of Prolonged 2nd stage of labor ??
1. Assessment of uterine contractions and maternal pushing efforts.
2. Use IV oxytocin or enhanced coaching as needed. 3. If they are both adequate, assess whether the
fetal head is engaged.
4. If the head is not engaged, proceed to emergency cesarean.
5. If the head is engaged, consider a trial of either obstetric forceps or a vacuum extractor delivery
Management of Prolonged 3rd stage of labor ??
1. Manual placental removal
2. Rarely even hysterectomy
Management of prolapsed Umbilical Cord ??
1. Do not hold the cord or try to push it back into the uterus.
2. Place the patient in knee-chest position,
3. Elevate the presenting part,
4. Avoid palpating the cord,
5. Perform immediate cesarean delivery.
Management of Shoulder Dystocia ??
1. Suprapubic pressure,
2. Maternal thigh flexion (McRobert's maneuver),
3. Internal rotation of the fetal shoulders to the oblique plane (Wood's "corkscrew" maneuver),
4. Manual delivery of the posterior arm,
5. Zavanelli maneuver (cephalic replacement)
Possible indication for Episiotomy ??
1, Shoulder dystocia,
2. Non-reassuring fetal monitor tracing,
3. Forceps or vacuum extractor vaginal delivery,
4. Vaginal breech delivery,
5. Narrow birth canal.
Pudendal Block administered in which stage of labor ?
Second stage
Normal Value of Fetal Heart rate ??
Between 110 and 160 beats/min
Bradycardia is diagnosed in fetus when FHR is
<110 beats/min
Criteria for Reassuring FHR Tracing ??
1. Baseline rate is between 110 and 160 beats/min.
2. Accelerations are present.
3. Decelerations are absent.
4. Variability is present.
Late decelerations occur in response to ??
Uteroplacental insufficiency and are non reassuring and maybe associated with fetal acidosis
Indications for Obstetrics Forceps ??
1. Prolonged second stage of labor
2. Nonreassuring EFM strip
3. To avoid maternal pushing :- variety of conditions in which pushing efforts may be hazardous to the parturient, e.g., cardiac, pulmonary, or neurologic disorders.
4. Breech presentation :- Shorten the time to deliver the head of a vaginal breech fetus.
Most important risk factor associated with uterine rupture ??
Classical incision in Cesarean Section
Indications for Primary Cesarean Section ??
1. Cephalopelvic disproportion (CPD)
2. Fetal malpresentation :- Most commonly breech presentation, but also means any fetal orientation other than cephalic.
3. Nonreassuring EFM strip :- The fetus may not be tolerating labor, but commonly this is a false-positive finding.
Optimized time of External Cephalic version ??
37 weeks' gestation
RhoGAM Adminstration :-
1. Dosage ??
2. Route ??
3. Time of administration ??
1. 300 μg of RhoGAM
2. IM
3. Within 72 hours of delivery
List of causes of PPH ??
1. Uterine Atony (50%)
2. Laceration (20%)
3. Retained placenta (10%)
4. DIC
5. Uterine inversion
Rx for infectious mastitis??
Oral Cloxacillin
The ligaments attached to the uterus ??
1, Broad ligament
2. Uterosacral ligaments
3. Cardinal ligaments
4. Round ligaments
Attachments of the ovaries ??
1. Attached by the ovarian ligament to the uterine fundus,
2 . By the suspensory ligaments to the pelvic side wall, 3. By the mesovarium to the broad ligament.
Lymphatic drainage of the ovaries ??
Through :-
1. Pelvic nodes
2. Para-aortic lymph nodes
What is the screening test for premalignant
cervical changes ??
Cervical Pap smear
An outpatient technique that is used for both diagnosing and treating cervical dysplasia ??
LEEP
1. Indication for Radical hysterectomy ??
2. What all parts are removed ??
1. Performed for early-stage cervical carcinoma
2. Following parts removed :-
a) Uterine corpus
b) Cervix
c) Proximal vagina
d) Broad ligaments
Gynaecological indication of D&C ??
Diagnostic test that examines the histology of endometrial lesions.
Grades of Uterine Prolapse ??
Grade I : Cervix descends half way to the introitus.
Grade II: Cervix descends to the introitus.
Grade III: Cervix extends outside the introitus.
Grade IV or procidentia: The entire uterus, as well as the anterior and posterior vaginal walls, extends outside the introitus.
Types of Urinary incontinence ??
1. Sensory Irritative Incontinence
2. Genuine Stress Incontinence
3. Motor Urge (Hypertonic) Incontinence
4. Overflow (Hypotonic) Incontinence
5. Bypass Fistula
Involuntary rises in bladder pressure occur owing to detrusor contractions stimulated by irritation from any of the following bladder conditions: infection, stone,tumor, or a foreign body. ?? Diagnosis ??
Sensory Irritative Incontinence
What is the most common form of true urinary incontinence ??
Genuine Stress Incontinence
1. Loss of urine occurs in small spurts simultaneously with coughing or sneezing. It does not take place when the patient is sleeping. What is the diagnosis ??
2. Mechanism ??
1. Genuine Stress Incontinence
2. Rises in bladder pressure because of intraabdominal pressure increases (e.g.,coughing and sneezing) are not transmitted to the proximal urethra because it is no longer a pelvic structure owing to loss of support from pelvic relaxation.
Q tip test is positive.
1. What do u understand by that ??
2, What does it indicate ??
3. What is the diagnosis ??
1. The Q-tip angle generally exceeds 30 degrees from the horizontal.
2. Inadequate bladder neck support
3. Stress incontinence
Management of Stress Incontinence ??
1. Medical therapy :-
a) Kegel exercises
b) Estrogen replacement in postmenopausal women.
Surgical therapy :-
1. Aims to elevate the urethral sphincter so that
it is again an intraabdominal location (urethropexy). - Done by attachment of the sphincter to the symphysis pubis, using the Burch procedure as well as the MarshallMarchetti- Kranz (MMK) procedure.
2. A minimally invasive surgical procedure is the tension-free vaginal tape procedure in which a mesh tape is placed transcutaneously around and under the mid urethra. It does not elevate the urethra but forms a resistant platform against
intraabdominal pressure.
What type of urinary incontinence is caused by denervated bladder (e.g., diabetic neuropathy, multiple sclerosis) or systemic medications (e.g.,
ganglionic blockers, anticholinergics ??
Overflow (Hypotonic) Incontinence
Following findings are seen in what type of urinary incontinence ??
- Markedly increased residual volume
- No involuntary detrusor contractions
Overflow (Hypotonic) Incontinence
Postmenopausal woman coming with the complaint of thin greyish white vaginal discharge with fishy odour. No itching or burning is there. On examination vaginal pH found to be >4.5 . and a positive whiff test.
Clue cells seen on wet mount. Diagnosis ??
Bacterial Vaginosis
Treatment of bacterial vaginosis ??
1. Metronidazole orally or vaginally
2. Clindamycin orally or vaginally
Can metronidazole be given to pregnant woman in the first trimester ??
Yesssss!!!!!!
STD in a woman presenting with complaints of itching, burning, and pain with intercourse. On examination vaginal discharge is typically frothy and green, Characteristic strawberry appearance of cervix, with vaginal pH > 5. ?? Diagnosis??
Trichomonas Vaginitis
Management of physiological discharge ??
Steroid contraception with progestins, which will
convert the thin, watery, estrogen-dominant cervical discharge to a thick, sticky progestin dominant
mucus.
The most common HPV types associated with premalignant and cancerous lesions of the cervix ??
HPV 16, 18, 31, 33, and 35
The most common HPV types associated with benign condyloma acuminata ??
HPV 6 and 11
Best screening test for premalignant lesions of
cervix ??
The Pap test
The most common site for cervical dysplasia ??
The transformation zone (T-zone)
When should pap smear test be started ??
1. 3 years after the onset of sexual activity
2. Or Age 21 whichever occurs first
Pap smear classification ??
Bethesda system
The only gynecologic cancer that is staged
clinically ??
Invasive Cervical Cancer
The most active chemotherapeutic agent for cervical cancer ??
Cisplatinum
1. In case of cervical cancer in pregnant woman which diagnostic procedure is not performed ??
2. And why ??
1. ECC (Endocervical curettage) is not performed during pregnancy.
2. Owing to increased cervical vascularity,
How will you manage invasive carcinoma of cervix in pregnant woman ??
1. If the punch biopsy of the cervix reveals frankly invasive carcinoma, then treatment is based on the gestational age.

2. If a diagnosis of invasive carcinoma is made before 24 weeks of pregnancy, the patient should receive definitive treatment (e.g., radical hysterectomy or radiation therapy).

3. If the diagnosis is made after 24 weeks of pregnancy, then conservative management up to about 32-33 weeks can be done to allow for fetal maturity to be achieved, at which time cesarean delivery is performed and definite treatment begun.
Saline infusion sonography is helpful for identifying which type of leiomyoma ??
Submucosal myomas
Differential diagnosis of postmenopausal bleeding ??
1. Vaginal or Endometrial atrophy
2. Endometrial carcinoma
3. Postmenopausal hormonal replacement therapy.
65-year-old patient with vaginal bleeding for 3 months. She has not taken any hormone replacement. Diagnosed with type 2 diabetes 20 years ago and was treated with oral hypoglycemic agents. She has chronic hypertension, for which she is treated with oral antihypertensives. She weighs 200 lb. On examination, normal-sized uterus and with no vulvar, vaginal, or cervical lesions. Most likely diagnosis ??
ENDOMETRIAL NEOPLASIA
If sonography shows a complex adnexal mass in a girl or teenager, Whats the differential diagnosis ??
Germ cell tumor of the ovary
Serum tumor marker for dysgerminoma ??
Lactate dehydrogenase (LDH)
Serum tumor marker for choriocarcinoma ??
Beta-hCG
Serum tumor marker for endodermal sinus tumor ??
alpha-fetoprotein
28-year-old woman complaining of lower abdominal discomfort the last 5 days. No history of steroid contraceptive use. Pelvic exam today shows a 7-cm, mobile, painless right adnexal mass. An endovaginal sonogram in the emergency department confirms a 7-cm, mobile, irregular complex mass with prominent calcifications. Diagnosis ??
Dermoid cyst or benign cystic teratoma
Sudden onset of severe lower abdominal pain in the presence of an adnexal mass in a woman of reproductive age ?? Diagnosis ??
Ovarian torsion
70-year-old woman complains of lower
abdominal discomfort. No weight loss or abdominal distention. On pelvic examination you find a nontender, 6-cm, solid, irregular, fixed, left
adnexal mass. Diagnosis ??
Ovarian Cancer
The current screening test for ovarian cancer ??
Bimanual pelvic examination
The most common gynecologic cancer leading to death ??
Ovarian Cancer
Serum tumor marker for Ovarian epithelial cancer ??
1. CA-125
2. CEA
24-year-old Filipino nurse is 14 weeks pregnant by dates, vaginal bleeding, severe nausea and vomiting, Uterus extends to her umbilicus but no fetal heart tones can be heard. Blood pressure is 150/95. Dipstick urine shows 2+ proteinuria. Diagnosis ??
Hydatidiform Mole
Outpatient treatment for Acute salpingo-oophoritis ??
1. Criteria
2. Medications
1. Criteria include a certain diagnosis and no evidence of systemic infection or pelvic abscess.
2. Medications:
a) Ofloxacin bid for 14 days AND
b) Metronidazole bid for 14 days.
Inpatient treatment for Acute salpingo-oophoritis ??
1. Criteria
2. Medications
1. Criteria include uncertain diagnosis, nulligravida, adolescent, outpatient treatment failure, IUD in place, evidence of pelvic abscess, and temperature
>39°C or 102.2°F.
2. Medications: IV cefoxitin or cefotetan plus IV doxycycline or IV clindamycin plus gentamicin.
19-year-old nulligravida with bilateral lower abdominal pelvic pain. Onset of pain was 24 hours ago after she had just finished her menstrual period. Sexually active but using no contraception. Mucopurulent cervical discharge, bilateral adnexal tenderness and cervical motion tenderness. Urinary P-hCG test is negative. Complete blood cell
count (CBQ shows a WBC of 14,000. ESR is elevated. Diagnosis ??
PID (Acute salpingo-oophoritis)
The most common initial organisms responsible for PID ??
Chlamydia and Gonorrhea.
A 34-year-old woman complains of dysmenorrhea, dyspareunia, and infertility for 2 years. She had used combination oral contraceptive pills from age 25 to 30. Pelvic examination reveals a tender, 5-cm cul-de-sac mass, along with tenderness and
nodularity of the uterosacral ligaments. Diagnosis??
Endometriosis
Management of Chancroid ??
1. A single oral dose of Azithromycin,
2. A single IM dose of ceftriaxone,
3. Or oral erythromycin base for 7 days.
classic clinical lesion of a double genitocrural fold, the "groove sign" Seen in which condition ??
Lymphogranuloma Venereum (LGV)
Management of Lymphogranuloma Venereum (LGV) ??
1. Oral doxycycline for 3 weeks OR
2. Oral erythromycin for 3 weeks.
Management of Granuloma lnguinale (Donovanosis) ??
1. Oral doxycycline for 3 weeks OR
2. Trimethoprim-sulfamethoxazole for 3 weeks
Management of Condyloma Acuminatum ??
1. Small lesions are treated topically with podophyllin, trichloroacetic acid, or imiquimod.
2. Larger lesions are ablated with cryotherapy, laser vaporization, or surgical excision
Diagnosis of Chlamydia ??
Nucleic acid amplification tests (NAAT) of either cervical discharge or urine.
Management of Chlamydia ??
1. Single oral dose of azithromycin OR
2. Oral doxycycline for 7 days
Management of Neisseria gonorrhea ??
1. Dual therapy for gonococcus and chlamydia
2. Single dose of cefixime for Gonococcus PLUS
3. Single oral dose of azithromycin.
Treatment of PMDD ??
Oral contraceptive (YAZ) containing :-
1. Ethynyl estradiol
2. New progestin - Drospirenone
The dosing is 24 days of active pills, following by 7 days of placebo.
Management of PCOS ??
1. Irregular bleeding :-
OCPs will normalize her bleeding. The progestin component will prevent endometrial hyperplasia.
2. Hirsutism :-
a) Excess male-pattern hair growth can be suppressed two ways. OCPs will lower testosterone production by suppressing LH stimulation of the ovarian follicle theca cells. OCPs will also increase SHBG, thus decreasing free testosterone levels.
b) Spironolactone suppresses hair follicle 5-a
reductase enzyme conversion of androstenedione
and testosterone to the more potent dihydrotestosterone.
3. Infertility :-
a) If she desires pregnancy, ovulation induction can be achieved through clomiphene citrate (Clomid) or human menopausal gonadotropin (HMG; Pergonal).
b) Metformin, a hypoglycemic agent that increases insulin sensitivity, can enhance the likelihood of ovulation both with and without clomiphene.
What procedure used for fertilization in case of Minimally abnormal sperm analysis ??
Intrauterine insemination (IUI)
What procedure used for fertilization in case of Severely abnormal sperm analysis ??
Intracytoplasmic sperm injection (ICSI) may be used in conjunction with in vitro fertilization (IVF) and embryo transfer
What procedure used for fertilization in case of No viable sperm ??
Artificial insemination by donor (AID)
1. Drug used for Ovulation induction ??
2. Timing of its administration ??
1. Clomiphene citrate
2. Administered orally for 5 days beginning on day 5 of the menstrual cycle
At what time of menstrual cycle should HSG investigation should be done ??
Scheduled during the week after the end of menses after prophylactic antibiotics to prevent causing
a recurrent acute salpingitis
Bloody nipple discharge indicate which pathology ??
Intraductal Papilloma