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247 Cards in this Set
- Front
- Back
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What to see under microscope in bacterial vaginosis
A) Cell with multiple inclusion B) Giant cell |
Demonstration of clue cells on a saline smear is the most specific criterion for diagnosing BV. Clue cells are vaginal epithelial cells that have bacteria adherent to their surfaces. The edges of the squamous epithelial cells, which normally have a sharply defined cell border, become studded with bacteria. The epithelial cells appear to be peppered with coccobacilli.
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40 year-old female, completed her family. She has endometrioma. Presented complaining of mild dysmenorrhea and severe pain during intercourse. What is the most appropriate management? A. Removal of the cyst and ablation of the endometriosis lesions B. TAH + BSO |
TAH + BSO
Definitive surgery — Definitive surgery involves hysterectomy, with or without removal of the fallopian tubes and ovaries. Definitive, rather than conservative, surgery for treatment of endometriosis should be considered when (1) incapacitating symptoms persist following conservative surgery and medical therapy, (2) moderate to severe disease is present and future pregnan cy is not desired, or (3) hysterectomy is indicated for coexisting pelvic pathology [ 1 ]. The decision to perform a definitive procedure is primarily dependent upon the patient's interest in maintaining child-bearing potential. |
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Postmenopausal women with bone metastasis, BMD T score -3. Came with vertebral fractures. What is your appropriate management?
A. Estrogen B. Bisphosphonate |
Bisphosphonate
postmenopausal with fragility fracture or DXA T-score <-2.5 bisphosphoates calcium and vitamin D supplementation raloxifine or denosumab |
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A 14 years female, with 6 month history of lower mid abdominal pain , the pain is colicky radiate to the back and upper thigh, begin with onset of manse and last for 2-4 days, , physical examination of abdomen and pelvis normal, normal secondary sex development, what is the most likely diagnosis?
A) Primary dysmenorrhea B) Secondary dysmenorrhea. |
Primary dysmenorrhea
Primary dysmenorrhea refers to the presence of recurrent, crampy, lower abdominal pain that occurs during menses in the absence of demonstrable disease that could account for these symptoms. Secondary dysmenorrhea has the same clinical features, but occurs in women with a disorder that could account for their symptoms, such as endometriosis, adenomyosis, or uterine fibroids. |
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Premenstrual syndrome :
A) More in the first half of menses B) More in the 2nd half of menses |
More in the 2nd half of menses
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Patient with odorless vaginal disch, grey-white. Spores on wet mount.
A-Candida B-Othet opts |
Candida
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Pregnant woman..what type of fibroid will put her in high risk of Miscarriage? A. Submucosa B. Intramural
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???? They answered intramural - Intramural fibroids, the most common, grow in the wall of the uterus. ● Subserosal fibroids grow on the outside of the uterus. As they grow larger, they can cause pain due to their size or pressure put on nearby organs. - Submucosal fibroids grow just underneath the uterine lining and can crowd into the uterus cavity and lead to heavy bleeding and other more serious complications. - Pedunculated fibroids grow on small stalks inside or outside the uterus. It's possible to have more than one type of fibroid. Early spontaneous miscarriage happens more often when the fibroids are in the main body of the uterus when compared with fibroids being in the lower segment of the uterus or those fibroids which are intramural or submucosal. It is not known exactly how fibroids cause miscarriage. Possible mechanisms include: increased irritability of the uterus, mechanical compression by the fibroid and/or damage to the blood supply to the growing placenta or foetus. |
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Nulli pregnant Decrease amount of urine, SOB? A) Acute amniotic emboli- B) acute glomerulonephritis
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acute glomerulonephritis
Only reasonable answers from choices above - incomplete question |
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Regards cervical cancer Wt true ?
A)Pap smear decrease incidence dramatically B)CIN start as low grade then high grade |
BOTH!! |
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Radio sensitive tumor:
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seminomas << yolk sac embryonl carcinoma
Radiosensitive tumours are tumours which respond well to radiotherapy. Radiotherapy may be effective alone, or may require the addition of cytotoxic chemotherapy as in the more advanced stages of a wilm's tumour and hodgkin's disease. This group includes: Malignant lymphomas Seminomas Medulloblastoma Neuroblastoma Wilm's tumour Early cervical carcinoma Vaginal carcinoma Most head and neck |
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How to differentiate a large ovarian cyst from ascites?
A. Dull anteriorly and resonant laterally B. Resonant anteriorly and dull laterally |
a (midabdominal dullness and lateral tympany)
- Ascitis displace the small intestine centrally producing a tympanic percussion note in midabdomen and dullness in flanks. - with ovarian cyst the intestines are pushed laterally so there is midabdominal dullness and lateral tympany. - ovarian cyst never produce a fluid wave. You can palpate the aorta pulsation. |
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woman with recurrent uti , why ?
A. because it cleans itself of the from anus to vulva |
cervical cap usage
Recurrent urinary tract infection (uti) refers to ≥2 infections in six months or ≥3 infections in one year. Risk factors for recurrent uti the frequency of sexual intercourse ( strong rf ) •spermicide use ( strong rf ) - women with recurrent uti have been shown to have an increased susceptibility to vaginal colo nization with uropathogens compared with women without a history of recurrences. •pelvic anatomy may predispose to recurrent uti in some women, with a shorter distance from the urethra to the anus being associated with in creased risk. - among postmenopausal women, mechanical, and/or physiological factors that affect bladder emptying are associated with recurrent uti. |
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what is hellp syndrome?
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Hellp syndrome, named for 3 features of the disease (hemolysis, elevated liver enzyme levels, and low platelet levels), is a life-threatening condition that can potentially complicate pregnancy. It is considered as complication of severe preeclampsia (hypertension and proteinuria after 20 weeks gestation).
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female pt diagnosed with pid on ceftriaxon with no benefit what is the organism?
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the answer is chlamydia.
Chlamydia & gonorrhea are the most common causative organisms causing pid. Ceftriaxone is used for gonorrhea tx. (chlamydia can be treated with azithromycin or doxycycline) erythromycin is safe in pregnancy for chlamydia) |
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DVT in pregnant. What will you do?
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Compression ultrasound
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Ascites Bilateral ovarian mass, what is the most likely tumor?
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??? Check page 149 |
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A 34-week pregnant lady is known to have HIV on antiviral medication. Her viral load is low what do you do regarding her pregnancy?
A. Continue with antiviral medication and elective CS |
Antiretroviral medications should be used throughout pregnancy along with intrapartum zidovudine for the baby. As for mode of delivery it depends on viral load. If viral load is high -above 1000/µl- CS is performed. The question & answer are not clear regarding viral load.
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What is the adenomyosis?
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Adenomyosis refers to a disorder in which endometrial glands and stroma are present within the uterine musculature (uterine adenomyomatosis). The ectopic endometrial tissue appears to induce hypertrophy and hyperplasia of the surrounding myometrium, which results in a diffusely enlarged uterus (often termed "globular" enlargement) analogous to the concentric enlargement of the pregnant uterus. However, some women have only small areas of diffuse disease that are only apparent by microscopy, whereas others develop nodules (termed adenomyomas), which clinically resemble leiomyomas. The uterus only rarely exceeds the size of a pregnant uterus at 12 weeks of gestation.
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Treatment of Endometriosis?
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Endometriosis, which is characterized by endometrial implants outside of the endometrial cavity, is a chronic disease that requires a lifelong management plan. According to the Practice Committee of the American Society for Reproductive Medicine, “Endometriosis should be viewed as a chronic disease that requires a lifelong management plan with the goal of maximizing the use of medical treatment and avoiding
repeated surgical procedures. Despite extensive research, the optimal management of endometriosis and its related symptoms is unclear. - Clinical manifestations fall into 3 categories: pelvic pain, infertility, pelvic mass. - The goal of therapy is to relieve these symptoms. Treatment individualized based on many factors. Options include: Expectant management, analgesia, hormonal medical therapy, cyclic or continuous estrogen -progestin oral contraceptives, gnrh agonists, progestins, Danazol, aromatase inhibitors, surgical interventions. |
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60 years old female with vague Sx Labs : ALP high , DEXA scan showed mild osteoporosis , what to give ?
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Bisphosphonate
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Hirsutism obese female and irregular menses:
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PCOS |
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Asymptomatic female has 7 cm cyst in ovary the period is normal
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Follicular cyst
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On Lateral side upon vaginal examination, what structure do you feel?
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Ovary |
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Gray Virginal discharge what can u see in microscpy ( there is no clue cell or hyphee in the answer )
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Gray vaginal discharge is more indicative of bacterial vaginosis which characterized by clue cells in microscopy. Clue cell is epithiail cell covered or surrounded by bacteria giving it that stippled appearance
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Pregnant with n. N. Gonhorea Tt
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Ceftrixone +azthromycn or doxcyclin (due to co infection of chlamedia)
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Vaginal discharge fishy odor.??
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Bacterial vaginosis
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Tamoxifen SE or Complications?
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Uterine Bleeding
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Pregenat healthy come to prenatal follup every thing is normal Lab show : nitrat +ve , WBC increase , what is the dignosis ?
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Asymptomaic bacturia
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Pregenat , has +ve protein in urin and i think hypertention , she recevid mg sulphate , what is prevent ( or treat ) :
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Seizure
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Which of the following muscles will be affected in perineal tear during normal vaginal delivery? Answer: ?
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it depends on the degree of the perineal tear
- 1st degree: vaginal mucosa affected only - 2nd degree: involvement of perineal body muscles which includes: ● Bulbocavernous ● Superficial transverse perineal muscle ● Pubococcygeus muscles - 3rd degree: involvement of the external anal sphincter and/ internal anal sphincter. - 4th degree: extent through the anal mucosa. |
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What is the most common cause of vaginal bleed?
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Anovulation The most common specific causes in adult women who are not known to be pregnant are: ● Anovulatory (dysfunctional uterine) bleeding > most common ● Complications of an early, undiagnosed pregnancy ● Submucous myoma |
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In polycystic ovarian syndrome, which of the following will be found on blood test?
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FSH:LH 1:3
Other findings (increased DHEA-S, androstenedione and free testosterone (most sensitive)) |
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Mom wants to know if her baby is having thalassemia or not. How you will investigate her antenatally?
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Screening tests for high risk population: CBC (MCV and MCH), Hb electrophoresis or high performance liquid chromatography (HPLC)
Confirmatory tests: Chorionic villus sampling (CVS): between 10-12 weeks, Amniocentesis: between 15 weeks to term. |
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Woman with endometriosis. What is the best way to diagnose?
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Laparoscopy |
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Pregnant with monochorionic twins in week 27. One of them died, what to do?
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They answered deliver!! If fetal assessment after 26 weeks of gestation suggests impending death rather than demise of one twin of a monochorionic pair, we suggest prompt delivery of both twins rather than expectant management given the high risk of neurologic impairment in the surviving co-twin. http://www.uptodate.com/contents/twin-pregnancy-prenatalissues?Source=search_result&search=monochorionic+twins+one+f+them+die&selectedtitle=1%7E150#H24 |
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Pregnant lady with UTI, which Antibiotic is contraindicated?
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Tetracycline
- Certain antibiotics should be avoided during pregnancy. For example, tetracyclines — such as doxycycline and minocycline — can damage a pregnant woman's liver and discolor a developing baby's teeth. ➢ Antibiotics generally considered safe during pregnancy: Amoxicillin, Ampicillin, Clindamycin, Erythromycin, Penicillin and Nitrofurantoin. |
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Patient known case of PCOS and wants to get pregnant.
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Clomiphene citrate
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Which of the following is equally effective to laparoscopy in a patient with unruptured small ectopic pregnancy?
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Methotrexate
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Megaloblastic anemia in pregnant.
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Folate |
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Female patient came with signs and symptoms of PCOS. Lab results: FSH= 1.5, LH= 10. What is the most likely Diagnosis?
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PCOS |
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Which of the following is an absolute contraindication for breastfeeding?
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Active HIV
Contraindicated if mother: ● Is receiving chemotherapy or radioactive compounds: ● Has HIV/AIDS, active untreated TB, herpes in breast region: ● Is using >0.5 g/kg/d alcohol or illicit drugs ● Is taking medications known to cross to breast milk |
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A patient presented to the ER with severe RLQ pain and positive B-HCG. What is the Diagnosis?
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Ruptured ectopic pregnancy.
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63 years old female. Pap smear showed atypical squamous cells of undetermined significance (ASCUS). You gave her local estrogen and after one week pap smear results still showing ASCUS. What will be your next step?
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colposcopy + biopsy
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What is the most common cause of secondary amenorrhea?
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Pregnancy |
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Typical case of PCOS. Biopsy showed Endometrial hyperplasia. What is the cause?
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Unopposed estrogen
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Multipara, 38 weeks pregnant. Cervical os is 7 cm with cord prolapse?
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CS
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Diabetic female complaining of itchy vaginal discharge?
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Candidiasis
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A female patient presented with green vaginal discharge and pruritus?
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Trichomonas |
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A female patient can't get pregnant for 3 years. Recently she developed breast milk. What is the most likely diagnosis?
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Hyperprolactinemia |
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30-year-old lady having whitish vaginal discharge, odorless and labial erythema. What is the most likely cause?
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Candida vulvovaginitis: Erythematous, excoriated vulva/vagina with thick white discharge without odor.
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What is the best time to estimate the chorionicity of the twins on ultrasound?
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10-13 weeks.
Assessment of chorionicity: Ultrasonography is an effective prenatal tool for determining amnionicity and chorionicity. The optimal time for performing the ultrasound examination is in the first trimester after 7 weeks (sensitivity ≥98 percent), with lower but acceptable accuracy in the early second trimester. |
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The most common cause of postpartum hemorrhage(PPH) is...?
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Uterine atony
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20 years old female, presented with amenorrhea, short stature and webbed neck. Which hormone will be affected?
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Decreased estrogen |
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A pregnant during labor. Her cervical opening is 6 cm. Which stage?
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Active Phase
First Stage of Labor: The first stage of labor is the longest and involves three phases: Early Labor Phase –The time of the onset of labor until the cervix is dilated to 3 cm. Active Labor Phase – Continues from 3 cm. Until the cervix is dilated to 7 cm. Transition Phase – Continues from 7 cm. Until the cervix is fully dilated to 10 cm. |
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Women with itchy, whitish vaginal discharge. KOH shows pseudohyphae. What is the treatment?
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Ointment Miconazole
Candidal vaginitis: Vaginal vulvar pruritus, burning, or irritation (which may be worse during intercourse) and dyspareunia are common signs, as is a thick, white, cottage cheese–like vaginal discharge that adheres to the vaginal walls. |
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Women developed itchy rash with whitish vaginal discharge after nitrofurantoin course for UTI. How will you treat this patient?
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Miconazole |
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Calculate day of delivery.
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EDC using Naegle's Rule: ƒ 1st day of LMP + 7 d – 3 mo ƒ e.g. LMP = 1 Apr 2013, EDC = 8 Jan 2014 (modify if cycle >28 d by adding number of d >28)
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Woman with bilateral ovarian abscess, what is the diagnosis?
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Pelvic inflammatory disease
The major complication of pelvic inflammatory disease are tuboovarian abscess,chronic pelvic pain,infertility and ectopic pregnancy |
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Yellow secretion pv with pmn >10 ?
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trichomonas
Symptoms range from none to copious, yellow-green, frothy vaginal discharge with soreness of the vulva and perineum, dyspareunia, and dysuria. If trichomoniasis is present in microscopic examination, numerous neutrophils are also present. |
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DVT prophylaxis for pregnant woman?
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heparin
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Pregnant in 38th week .. By examination .. The fetus in breech position .. The cervix is closed. What is the next step?
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Deliver her by c/s
Criteria for vaginal breech delivery: - frank or complete breech, GA >36 w - EFW 2,500- 3,800 g - fetal head flexed |
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Risk factor of recurrent UTI in females
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whipping from back to front
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Tubal ligation then c/o vginal spotting after 6 wk of amenorrhea:
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Answer?? Menstrual changes? Delayed complications of laparoscopic tubal ligation include the following: • Failure • Filshie clip complications • Regret • Ectopic pregnancy • Menstrual changes • Hysterectomy • Sexual function |
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Pregnant lady with lobar pneumonia what is the type of immune the baby will have?
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there are no choices but the answer is “passive immunity”
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Typical case of PCOS what is skin manifestation associated with?
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Acanthosis nigricans |
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Female try to get pregnant for one year she is healthy and her husband is known to be healthy what to do 1st ?
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Semen analysis
Since the woman is healthy we should investigate man, most common factor for this is semen abnormalities, therefore, semen analysis and culture. |
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A female postpartum with upper lateral quadrant mass, redness, tenderness,with +ve lymph nodes:
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Mastitis
During lactation, enlarged intramammary and/or axillary lymph nodes may be seen. The hyperplastic nodes are felt to be related to the bacterial seeding of the nipple by the infant during breastfeeding. These nodes are typically seen in the upper outer quadrant of the breast and axilla. Benign entities include galactocele, fibroadenoma, obstructed milk duct, mastitis with or without abscess, hyperplastic intramammary and/or axillary lymph nodes, and granulomatous mastitis. Malignant diseases include pregnancy-associated breast cancer and metastatic disease. |
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Patient present at 10 week with painless bleeding not part of conception, cervix closed, what is the diagnosis?
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They answered threatened - threatened: cervix closed, viable fetus: watch/wait - invitable: external os open, viable fetus: watch/wait, misoprostol, D and C - incomplete: passage of tissue, cervix open: watch/wait, misoprostol, D and C - complete: complete passage of sac and placenta, cervix open: no D and C only expectant tx (FU beta hcg). - missed: fetal death in utero, cervix closed: watch/wait, misoprostol, D and C. If recurent > 3 evaluate - septic: D and C, IV Abx |
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Patient with pelvic inflammatory disease, didn't respond to antibiotic after 3 days' examination revealed fluctuating mass, how to manage?
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Laparoscopy
minimally invasive drainage or laparoscopy, depend on choices! - A case of tubo-ovarian abscess 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 |
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Hormonal changes at menopause in estrogen, LH, FSH.
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Follicle-stimulating hormone (FSH) levels are higher than luteinizing hormone (LH) levels, and both rise to even higher values than those seen in the surge during the menstrual cycle. FSH is the diagnostic marker for ovarian failure. Estrogen levels begin to fall.
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Pregnant lady no symptoms UTI, no frequency no urgency no dysuria, Positive urine culture, Diagnosis?
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Asymptomatic bacteriuria
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With heavy menses each 2 weeks, what to do?
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Endometrial biopsy??
Investigations: CBC, serum ferritin Β-hcg TSH, free T4 Coagulation profile (especially in adolescents): rule out von Willebrand's disease Prolactin if amenorrheic FSH, LH Serum androgens (especially free testosterone) Day 21 (luteal phase) progesterone to confirm ovulation Pap test Pelvic U/S: detect polyps, fibroids; measure en dometrial thickness (postmenopausal) SHG: very sensitive for intrauterine pathology (polyps, submucous fibroids) HSG Endometrial biopsy: consider biopsy in women >40 yr Must do endometrial biopsy in all women pre senting with postmenopausal bleeding to ex clude endometrial cancer D&C: not for treatment; diagnosis only (usually with hysteroscopy) |
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Female in 12 weeks' gestation age develop UTI treated, then at 27 weeks again had another UTI what you will do?
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You will treat even if asymptomatic
Any asymptomatic UTI in pregnant women should be treated |
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Female in 12 wk gestation develop UTI treated then at 27 wk again had UTI what you will do ? E. Coli >100000 -you will
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Asymptomatic bacteriuria in pregnancy is more likely to lead to cystitis and pyelonephritis
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What you should look for in case of gonorrhea?
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Chlamydia trachomatis
Because chlamydia is also frequently found in conjunction with Neisseria gonorrhoeae infection, any patient with known or suspected gonorrhea infection should also be evaluated for chlamydia. |
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About old female with recurrent fracture ..
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Estrogen Def
Estrogen affects the development of cortical and trabecular bone, although the effect on the latter is more pronounced. Bone density diminishes at the rate of approximately 1% to 2% per year in postmenopausal women, compared with approximately 0.5% per year in perimenopausal women. |
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63-Married female Patient with white vaginal discharge, odorless, Wet test was negative, KOH test showed Psudohyphae, what is the diagnosis?
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Vaginal candidiasis.
Vulvovaginal candidiasis is caused by ubiquitous airborne fungi. Approximately 90% of these infections are caused by Candida albicans. The most common presenting complaint for women with candidiasis is itching, although up to 20% of women may be asymptomatic. Burning, external dysuria, and dyspareunia are also common. The vulva and vaginal tissues are often bright red in color, and excoriation is not uncommon in severe cases. A thick, adherent “cottage cheese” discharge with a ph of 4 to 5 is generally found. This discharge is odorless. Diagnosis requires either visualization of blastospores or pseudohyphae on saline, or 10% KOH microscopy, or a positive culture in a symptomatic woman. |
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Patient present at 10 week with painless bleeding not part of conception cervix closed what is ?
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Threatened abortion
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with heavy menses each 2 wk what to do
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CBC count, Iron studies, Coagulation factors, Human chorionic gonadotropin, Thyroid function tests and prolactin level, Liver function and/or renal function tests, Hormone assays, pap smear, and cervical specimen.
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Pregnant women at 14 weeks with splenomegaly low platelet what is diagnosis ?
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*low platelet count (<150000/mm 3 ) is most likely indicative to gestational thrombocytopenia (Kaplan page 39)
* Splenomegaly with pregnancy should be considered as a high risk pregnancy and it is to be dealt under the supervision of senior obstetrician in a tertiary care centre because it can complicate the maternal and fetal outcome |
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Follicular cell of ovary what it is orign embryologically???
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The outer ovarian cortex consists of follicles embedded in a connective tissue stroma. Embryologically, this stroma is the medulla that originated as the gonadal ridge, while the cortex originated as coelomic epithelium. The medulla contains smooth muscle fibers, blood vessels, nerves, and lymphatics.
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Questions about the contraindications of external cephalic version
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ECV is recommended by several national organizations for all women with an uncomplicated singleton fetus in breech presentation at term to improve their chances of having a cephalic vaginal birth.
- Clearly, if cesarean delivery is indicated for reasons other than breech presentation, ECV is contraindicated: Placenta previa or abruptio placentae, nonreassuring fetal status, intrauterine growth restriction in association with abnormal umbilical artery Doppler index, isoimmunization, severe preeclampsia, recent vaginal bleeding, and significant fetal or uterine anomalies are also contraindications for ECV. - Other contraindications to ECV include ruptured membranes, fetus with a hyperextended head, and multiple gestations, although ECV may be considered for a second twin after delivery of the first. - Relative contraindications include maternal obesity, small for gestational age fetus (less than 10%), and oligohydramnios because they make successful ECV less likely.[24] Previous uterine scar from cesarean delivery or myomectomy may also be a relative contraindication for ECV. |
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Endometriosis best management ? And treatment ..
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- Clinical manifestations of endometriosis fall into three general categories: pelvic pain, infertility, and pelvic mass. - The goal of therapy is to relieve these symptoms. There is no high quality evidence that one medical therapy is superior to another for managing pelvic pain due to endometriosis, or that any type of medical treatment will affect future fertility. - Expectant management - Analgesia - Hormonal medical therapy o Estrogen-progestin oral contraceptives, cyclic or continuous o Gonadotropin-releasing hormone (gnrh) ago nists o Progestins, given by an oral, parenteral, or in trauterine route o Danazol o Aromatase inhibitors - Surgical intervention, which may be conservative (retain uterus and ovarian tissue) or definitive (removal of the uterus and possibly the ovaries) Combination therapy in which medical therapy is given before and/or after surgery |
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Questions about cervical cancer (staging, biopsy)
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- Stage I is carcinoma strictly confined to the cervix; extension to the uterine corpus should be disregarded.
o Stage IA: Invasive cancer identified only microscopically o Stage IB: Clinical lesions confined to the cervix or preclinical lesions greater than stage IA Stage II is carcinoma that extends beyond the cervix but has not extended onto the pelvic wall. The carcinoma involves the vagina but not as far as the lower third section. o Stage IIA: No obvious parametrial involvement. Involvement of as much as the upper two thirds of the vagina o Stage IIB: Obvious parametrial involvement, but not onto the pelvic sidewall Stage III is carcinoma that has extended onto the pelvic sidewall and/or involves the lower third of the vagina. o Stage IIIA: No extension onto the pelvic sidewall, but involvement of the lower third of the vagina o Stage IIIB: Extension onto the pelvic sidewall or hydronephrosis or nonfunctioning kidney Stage IV is carcinoma that has extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum. o Stage IVA: Spread of the tumor onto adjacent pelvic organs o Stage IVB: Spread to distant organs |
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Group B strep positive pregnancy and she is in her 24 weeks , when to give prophylactic antibiotic ?
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during labour
All women who are GBS positive by rectovaginal culture should receive antibiotic prophylaxis in labor or with rupture of membranes. |
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Pregnant lady no symptoms UTI, no frequency no urgency no dysuria Positive urine culture? Diagnosis?
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Asymptomatic bacteriuria
A urine culture is obtained at the onset of prenatal care and patients with asymptomatic bacteriuria are treated with ampicillin, cephalexin or nitrofurantoin. |
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isotretinoin most feared complication -birth defect
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- (FDA) approved the drug isotretinoin (Accutane) for use in the treatment of severe recalcitrant nodular acne - adverse reproductive outcomes among women taking isotretinoin during the first trimester of pregnancy: spontaneous miscarriage, fetal isotretinoin syndrome. - retinoic acid embryopathy, also known as Accutane embryopathy or fetal isotretinoin syndrome, consists of a set of malformations involving the central nervous system, head and face, and heart. (derivatives of pharyngeal arch). - facial asymmetry; serious external ear abnormalities, including microtia (small ear), anotia (no ear), or stenosis of the external ear canal; micrognathia (small jaw); flat depressed nasal bridge; and ocular hypertelorism (widely spaced eyes). The cardiovascular abnormalities commonly seen include conotruncal malformations, such as transposition of the great vessels and tetralogy of Fallot. Effects on the CNS can lead to hydrocephalus and microcephaly as well as to an IQ in the subnormal range and learning disabilities. Thymic aplasia and parathyroid abnormalities can also be part of this syndrome. - Isotretinoin is teratogenic, causes birth defects, and is Category X, meaning that there is no indication for its usage during pregnancy. In addition, it should not be taken while nursing.Patients should take 2 pregnancy tests before starting isotretinoin and take a monthly pregnancy test while on the medication. - isotretinoin a drug used to treat skin disorders, is stored in fat beneath the skin and is released slowly. Isotretinoin can cause birth defects if women become pregnant within 2 weeks after the drug is stopped. Therefore, women are advised to wait at least 3 to 4 weeks after the drug is stopped before they become pregnant. |
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Pregnant in the third trimester with history of recurrent herpes simplex, she is in labour, during exam no lesions what to do?
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1) CS IV acyclovir 2) Do specular exam before
??? In the absence of active lesions or prodromal symptoms, vaginal delivery should be allowed. |
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Primary amenorrhea , what is the next investigation ?
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Thyroid-stimulating hormone (TSH), b-HCG, prolactin, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) measurements are always the first line of testing. If hirsutism is predominant upon examination, include androgen testing: measure testosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, and 17-OH progesterone to determine the organ of cause (eg, ovary vs adrenal gland).
Primary amenorrhea: 2ndry sexual characteristics present? (Breast)? * if yes--> do karyotype: 46 xx--> if no uterus (mullerian) or other anatomic problems (imperforate hymen,...) 46 xy--> androgen insensitivity * if no--> FSH/LH high--> hypogonadotropic (gonadal dysgenesis 45 x) No estrogen due to no overian follicles Low--> HP axis faliure 46 xx. No estrogen because follicles not stimulated. |
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Pregnant lady with vaginal discharge and + KOH , what is Diagnosis :
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bacterial vaginisis
Diagnosis is usually established by vaginal ph greater than 4.5, presence of clue cells (vaginal epithelial cells with borders that are covered with small bacteria), examining the discharge microscopically; may show clue cells. A positive whiff test after adding a drop of KOH to some of the discharge on a microscopic slide suggests bacterial vaginosis. |
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Type of fibroid cause abortion :
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submucosal Fibroids that bulge into the uterine cavity (submucous) or are within the cavity (intracavitary) may sometimes cause miscarriages. The fertilized egg comes down the fallopian tube and takes hold in the lining of the uterus. If a submucosal fibroid happens to be nearby, it can thin out the lining and decreases the blood supply to the developing embryo. The fibroid may also cause some inflammation in the lining directly above it. The fetus cannot develop properly, and miscarriage may result.
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Postmenopausal with osteoporosis and high Alkaline phosphatase ,What will you give :
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Bisphosphonate “DISCUSSION: Bisphosphonate treatment lowered ALP levels, and this decrease was strongly correlated with a decrease in BAP. Among blood test data, the decrease in BAP had the strongest correlation with the ALP decrease. CONCLUSION: For treatment of osteoporosis, ALP is an acceptable alternative to BAP. Elevated ALP in postmenopausal women is mainly caused by high bone turnover.”
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Female with ductal carcinoma Doctor want treat her, what is the gene responsible for that cancer? (No BRCA1 in options)
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Tp53 Most breast cancers are associated with BRCA 1 & BRCA 2 mutations, but inherited changes in the TP53 gene greatly increase the risk of developing breast cancer, as well as several other forms of cancer, as part of a rare cancer syndrome called Li-Fraumeni syndrome (described below). These mutations are thought to account for only a small fraction of all breast cancer cases. Noninherited (somatic) mutations in the TP53 gene are much more common than inherited mutations, occurring in 20 to 40 percent of all breast cancers |
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What is the antithyroid used in pregnancy? |
Propylthiouracil
PTU Because of the risk of fetal abnormalities associated with methimazole, propylthiouracil may be the treatment of choice when an antithyroid drug is indicated during or just prior to the first trimester of pregnancy. |
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Contraindication of external cephalic version?
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Contraindications include multiple pregnancy, severe fetal anomaly, ruptured membranes, significant third-trimester bleeding, and other indications for caesarean section (e.g., placenta praevia or uterine malformation).
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Ovarian cancer tumor marker
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CA125 CA125 levels >35 U/ml in post-menopausal women warrant concern for ovarian cancer. In the pre-menopausal patient this serum marker yields little because elevated levels are associated with many benign conditions, such as uterine fibroids, PID, endometriosis, adenomyosis, pregnancy, and menstruation. Levels >200 U/ml in pre-menopausal women warrant a referral to a gynaecological oncologist for further evaluation. - |
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Mother close to delivery developed respiratory symptoms + fetal distress :
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Amniotic fluid embolism
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Long scenario of patient with symptoms of dysfunctional uterine bleeding; you diagnosed her what medication you'll prescribe:
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OCP
Progestogens are first-line treatment for DUB, particularly when associated with anovulation. It Can also be delivered through progesterone-containing iuds and contraceptive implants. |
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Mother after delivery sees snakes crawling into her baby bed :
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Postpartum psychosis
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12 week pregnant w high blood pressure:
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pre-existing hypertension
Women who had high blood pressure before pregnancy – or are diagnosed with it before 20 weeks – have chronic hypertension. |
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Pregnant works under sun, developed patches over the forehead and cheeks :
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cholasma
Melasma also known as Chloasma faciei is thought to be the stimulation of melanocytes (cells in the epidermal layer of skin that produce a pigment called melanin) by the female sex hormones estrogen and progesterone to produce more melanin pigments when the skin is exposed to sun. |
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Causes of fetal distress:
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1- cord prolapse
2-placenta abruption 3-anemia 4-oligo/polyhydramnios 5-DM/PET 6-IUGR 7-post term |
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Endometriosis typical case presentation and asking about the diagnosis
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Gold standard is laparoscopy
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30*A female presenting with hirsutism, acne, and irregular menstruation. What is the most probable finding?
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High androgen PCO ( 1- high androgen , insulin resistance, acanthosis nigra) To diagnosed PCO 1- US 2- lab ( high: testosterone , androgen, insulin. Low : progesterone , increase ratio LH/FSH > 2:1 |
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A pregnant lady in her first trimester did not have any vaccination for rubella what to do?
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No choices MMR vaccine unsafe during pregnancy so if patient not immunized give MMR vaccine after delivary |
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Pregnant in labor cervical opening 6 cm, which stage?
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First Stage: Latent>> 3-4cm dilation Active>> from 4cm to 10cm
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Definition of leiomyoma?
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Leiomyoma: A benign tumor of smooth muscle, the type of muscle that is found in the heart and uterus. A leiomyoma of the uterus is commonly called a fibroid.
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Treatment of community acquired pneumonia in pregnancy?
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For pregnant women:
➢ Community acquired pneumonia and no features of severe disease: antipneumococcal beta-lactam (ceftriaxone, cefotaxime, ampicillin-sulbactam) plus azithromycin ➢ Allergic reactions to cephalosporins: clindamycin plus aztreonam, unless they have severe pneumonia. ➢ Severe pneumonia and past reactions to cephalosporins: vancomycin plus azithromycin plus aztreonam. |
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Vaginal infection lead to neonatal conjunctivitis
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The most common bacteria that can cause serious eye damage are gonorrhea and chlamydia. These can be passed from mother to child during birth.
Time of onset: Nisseria gonorrhoeae: Delivery of the baby until 5 days post-birth (Early onset) Chlamydia trachomatis: 5 days post-birth to 2 weeks (Late onset - C.trachomatis has longer incubation period) |
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Pregnant early, low appetite nausea fatigue. Blood: low Hb, high MCV, MCHC, high TIBC: whats the reason
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macrocytic anemia( high MCV, High MCHC ) due to vitamin b12 or folate deficiency . While High TIBC is due to pregnancy
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Missed period 2 months , high bhcg , examination show 16 weeks GA ,U/S show fetus small for data ? Dx?
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1- choriocarcinoma (raising or plateau HCG )
2- hydatidiform (large for date and BHCG>100,000) 3- placenta in site trophoblastic tumor(low BHCG) - Hydatidiform molesLesions are considered part of benign gestational trophoblastic disease, and arise from placental abnormalities.Includes complete hydatidiform mole, partial hydatidiform mole, and invasive mole.Complete moles carry higher risk of malignancy than partial moles.Malignant transformation set apart by failure of serum beta hCG to return to normal levels after treatment of the mole. - The most common presenting symptom is vaginal bleeding. Uterine size is greater than expected for gestational age. Pelvic ultrasound is the mainstay of diagnosis. Typical ultrasound findings for a complete molar pregnancy include a diffuse echogenic pattern described as a snow-storm pattern, which is created by intermingling of hydropic villi and blood clots. abnormal placenta with partial fetal development, without fetal cardiac activity, is characteristic of a partial molar pregnancy. abnormal placenta with partial fetal development, without fetal cardiac activity, is characteristic of a partial molar pregnancy. Complete is most common (empty egg 46 xx) and more chance to become malignant. * molar: pregnancy <20w, HTN, proteinuria, no FHT, vaginal passage of vesicles. Tx: no chemo, suction D and C, fu beta hcg to 0. OCP for 1y RF: extreme of age, folate deficincy, previous * CXR to exclude lung metastasis - Gestational trophoblastic neoplasiaInvasive malignancies that can metastasise.Includes choriocarcinoma, placental site trophoblastic tumour, and epithelioid trophoblastic tumour. |
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Woman with IUD and came with vaginal pain and discharge, (what organism)?
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Actinomyces infections in association with IUD use have been reported. And PID ( Actinmuces ) is the most common infection associated with IUD
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Patient complain of scanty pubic hair and primary amenorrhea & secondary sexual character & develop breast with bilateral growing swelling what is the diagnosis ?
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ANDROGEN INSUFFICIENCY ?
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Endometriosis (Presentation, investigations, treatment)
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http://emedicine.medscape.com/article/271899-overview
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Patient with BPH+HYPERTENSION what TTT? (best management)
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alpha blocker
Alpha-blockers are medicines that are mainly used to treat high blood pressure (hypertension) and problems with passing urine in men who have enlargement of the prostate gland. |
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Female with 3 months meses loss what is best action :
A- reassurance |
incomplete question
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Pregnant lady with hypertension. You're mostly concerned about:
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IUGR |
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Q about the polycystic ovarian Investigation ?
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- 1st tests to order : serum total and free testosterone, serum dehydroepiandrosterone sulfate (DHEAS), serum 17-hydroxyprogesteroneserum, prolactin, serum TSH, oral glucose tolerance test, fasting lipid panel - Tests to considerserum : androstenedione, pelvic ultrasound, basal body temperature monitoring, luteal phase progesterone measurementserum LH and FSH |
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Pap smear in old postmenopausal lady, showed ASCUS, was given estrogen cream, FU PAP showed ASCUS again. What's your next step?
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Colposcopy |
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She had to go for CS , epidural anesthesia is not possible if the cervix is dilated more than 5 cm. (confirmed by student get full mark in Oby/Gyne )
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-? |
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Same weight for 6 months , amenorrhea :
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Eating disorder ?
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Which part of the female urethra is more susceptible to be damaged ( in an intervention I can't remember what)
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Answer :??
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A patient who's 36 weeks pregnant started having contractions lasting 30 secs. CTG was done and was good. What to do ?
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Is there cervical dilation! If pt has preterm labor (contraction and cervical dilation). If 34-37 (2,500g): deliver If 24-33 (<2,500): betamethasone and Tocolytcis |
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If a Pap smear shows HPV, the cytology will show what:
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- ??? |
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HYPERTENSION in third tri >> only
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gast hypertension
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Pregnant patient came with high blood pressure was given magnisum sulfate, which of the following is sign of low maginsum in the body ? ( sizure wasn't included)
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Symptoms of magnesium deficiency include hyperexcitability, muscular symptoms (cramps, tremor, fasciculations, spasms, tetany, weakness), fatigue, loss of appetite, apathy, confusion, insomnia, irritability, poor memory, and reduced ability to learn. Moderate to severe magnesium deficiency can cause tingling or numbness, heart changes, rapid heartbeat, continued muscle contractions, nausea, vomiting, personality changes, delirium, hallucinations, low calcium levels, low serum potassium levels, retention of sodium, low circulating levels of parathyroid hormone (PTH),[4] and potentially death from heart failure.[5] Magnesium plays an important role in carbohydrate metabolism and its deficiency may worsen insulin resistance, a condition that often precedes diabetes, or may be a consequence of insulin resistance.
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Pregnent lady in 3 trimester suddenly she developed LL swilling from hip to toes best investigation is
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Dopplex , because it is above the knee
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Which vaccination cant give to pregnant woman?
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all live vaccines (measles, mumps, polio, rubella yellow fever, and varicella )
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When a couple should seek help regarding infertility ?
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Infertility: inability to conceive or carry to term a pregnancy after 1 yr of regular, unprotected intercourse.
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Diabetic female c/o itchy vaginal discharge ?
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Candidiasis Candidiasis: Predisposing factors include:
• Immunosuppressed host (DM, AIDS, etc.) • Recent antibiotic use • Increased estrogen levels (e.g. Pregnancy, OCP) |
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Pregnant lady in labor she has preeclampsia ,she already given magnesium sulphate after that she had respiratory distress with tachypnea(I think side effects of Mg sulphate) , what you are going to give ?
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Ca gluconate (antidote)
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18 year-old married missed her period for two months, came with rt sided abd pain wts thedx:
what's the test to order: |
Ruptured ectopic
Urine hcg |
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Vaginal bleeding week 10 fundus 15cm closed os what is the diagnosis
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Threatened abortion.?!
Vaginal bleeding in early pregnancy: Fetal cardiac activity: |
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Patient hirsutism, obese x-ray shows cystic ovary, she wants to conceive, best Treatment?!
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Clomiphene citrate It is most probably a PCOS case, so for them to pregnant if infertile they need clomiphene and metformin.
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Pregnant women with UTI what is the best drug:
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Nitrofurantoin
Nitrofurantoin is an antibiotic that is used for treating urinary tract infections caused by several types of bacteria. It is effective against E. Coli, Enterobacter cystitis, Enterococcus, Klebsiella, and Staphylococcus aureus. Pregnancy category: B; contraindicated at term. |
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Pregnant lady, fall from stairs, and started to have vaginal bleeding, Diagnosis?
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Placenta abruption
is a complication of pregnancy, wherein the placental lining has separated from the uterus of the mother Prior to delivery. It is the most common pathological cause of late pregnancy bleeding |
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Female had vaginitis coming with fever & rash.
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Toxic shock should be considered in any individual who presents with sudden onset of fever, rash, hypotension, renal or respiratory failure, and changes in mental status. STSS (Streptococcal Toxic Shock Syndrome) most commonly occurs in women, usually those who are using tampons, TSS develops within 5 days after the onset of menstruation.
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Minimal investigation for Monitor pre-eclampsia.
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Hypertension plus one or more of the following after the 20th week of pregnancy:
Proteinuria Thrombocytopenia Impaired liver function Signs of kidney trouble other than protein in the urine Pulmonary edema New-onset headaches Visual disturbances |
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Female with severe pain during her period and heavy bleeding on examination nodules in uterosacral ligament:
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Endometriosis
Signs and symptoms of Endometriosis: Cyclic pelvic pain, abnormal heavy bleeding and nodular uterus or adnexal masses. Diagnosis: laparoscopy (dark brown clusters of lesions called Endometrioma “Chocolate Cyst”) Treatment: nsaids, ocps, Danazol “androgen derivative”, leuprolide acetate “leupron” both are used to decrease FSH & LH. |
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25 years old female with 2 cm mass in upper right breast movable and firm –negative family history, for 2 months:
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Fibroadenoma
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Child take overdose of isoniazid and toxicity symptoms?
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seizure include status epilepticus
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25 years old lady presented with severe abdominal pain and regular menstruation, in US mass in the ovary with hair, what is the next step?
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dermoid cyst--> laparoscopy
Benign cystic teratomas: These tumors are also called dermoid cysts because although derived from all 3 germ cell layers, they consist mainly of ectodermal tissue. * Most functional cysts and benign tumors are asymptomatic. Sometimes they cause menstrual abnormalities. Hemorrhagic corpus luteum cysts may cause pain or signs of peritonitis, particularly when they rupture. Occasionally, severe abdominal pain results from adnexal torsion of a cyst or mass, usually > 4 cm. Ascites and rarely pleural effusion may accompany fibromas. * Masses with radiographic characteristics of cancer (eg, cystic and solid components, surface excrescences, multilocular appearance, irregular shape) require excision. * Most ovarian cysts < 8 cm resolve without treatment; serial ultrasonography is done to document resolution. If technically feasible, cyst removal from the ovary (ovarian cystectomy) via laparoscopy or laparotomy may be necessary for the following: Most cysts that are ≥ 10 cm and that persist for > 3 menstrual cycles Cystic teratomas < 10 cm Hemorrhagic corpus luteum cysts with peritonitis Fibromas and other solid tumors |
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25 year-old c/o lower abdomen. Cramp, 6 weeks from the last normal period. She has vaginal bleeding but no passage of tissue. Diagnosis?
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• complete abortion: bleeding + complete passage of tissue • incomplete abortion: extremely heavy bleeding, cramps, passage of tissue noticed • missed: no bleeding • threatened: vaginal bleeding +- cramps • inevitable: Increasing bleeding and cramps ± rupture of membranes US must be done to decide the type. |
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12-week pregnant w high blood pressure?
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Pre-existing htn (chronic) |
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RH -ve mother and +ve baby what is the complecation at dlivery
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Hemolytic disease of the newborn (HDN)
- Rh incompatibility not a problem in 1st pregnancy. Its a problem when fetal RBCs cross the placenta into mothers bloodstream and she makes antibodies against Rh positive blood. --> second baby hemolytic disease of the newborn. - hymolytic disease of newborn: fetal anemia and extramedullar production of RBCs (liver,spleen) : bilirubin neurotoxicity, erythroblastosis fetalis (high fetal cardiac output). # during initial prenatal visit: screen the mother for Rh antibody: Rh - or + - if positive: no further screen - if negative: check antibody titer (has antibodies = sensitized --> monitor) (no antibodies= Unsensitized--> repeat at 28 w and give Rhogam as indicated). * if pt Unsensitized we want to keep it that way: give pt Rhogam after: amniocentesis, abortion, vaginal bleeding, placental abruption, delivery. At 28w give Unsensitized pt Rhogam prophylaxis And give it again after delivery if baby is Rh + * if sensitized: if pt is Rh - and has antibodies--> do antibody titer by indirect antiglobulin test. Sensitized = 1:4 If 1:16 --> serial amniocentesis to detect fetal bilirubin level starting at 16-20 w. --> spectrophotometer: - low: repeat 2-3 w - medium: repeat 1-2 w - high: baby anemic do umblical blood sample, if htc low do intrauterine transfusion. |
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Early Pregnat varicella vaccine:
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Avoid exposure
Neither inactivated nor live-virus vaccines administered to a lactating woman affect the safety of breastfeeding for women or their infants |
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1- Female present with oligomenorrhea. She had 3 periods in the last year" she had acne, hirsutism, Body wt 60 , pv normal,dx? 2- Scenario about PCOS - they asked what invx u will screen for? |
1- PCOS Diagnosis of PCOS requires fulfillment of two of the following three (Rotterdam Criteria): - Polycystic Ovaries (via US . - Oligo- and\or anovulation. - Clinical and\or biochemical evidence of hyperandrogenism. 2- Glucose Tolerance & Lipid Profile. Women with PCOS are at increased risk for the following: DM2: Acanthosis nigricans. Metabolic Syndrome: Insulin Resistance, atherogenic dyslipidemia, and HTN. |
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Patient with history of amenorrhea for 6 weeks presented with abdominal pain. On Examination, there's fluid in Douglas pouch, what's the Diagnosis?
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Ectopic Pregnancy.
The classic triad of unruptured ectopic pregnancy: o Amenorrhea. o Vaginal bleeding. o Unilateral pelvic\abdominal pain. Ruptured ectopic pregnancy is associated with intraperitoneal bleeding and irritation. |
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Breech presentation at 34 weeks,,?!
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ECV at 36 wks??
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Female present with defemenization "breast atrophy & deeping of voice" they found to have ovarian cancer, diagnosis?
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Sertoli Leydig Cell
Sex cord stromal ovarian tumor: 1) Fibroma (thecoma): benign Non functional, a.w meigs syndrome: benign ovarian tumor+ ascitis+ plural effusion Firm round tumor w/fibrocytes 2) granulosa theca cell: benign or malignant (calexner bodies) Tumor marker: inhibin. A.w endometrial hyperplasia. Estrogen producing--> feminizing (precutious puberity, menorrhagia, postmenopausal bleed) 3) striol lyding cell: benign or malignant Tumor marker: Increased androgen Androgen producing--> virilizing effect (hairsutisim, deep voice, lost hair in front hairline). |
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Mother worry about radiation from microwave if exposed to her child, what to tell her?
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Not all radiation is dangerous & microwave is one of them
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Young female with recurrent UTI what you should do to reduce the recurrence:
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Educate patient not to wipe from back to front
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Grey Virginal discharge what can u see in microscpy ( there is no clue cell or hyphee in the answer
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Intrepithelium ???
Note: Clue cells: vaginal squamous epithelial cells |
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Pregnant with N.gonorrhea what is the Rx:
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Single dose of ceftriaxone 250 mg IM plus single dose of azithromycin 1g PO or doxycycline 100 mg PO bid for 7d
If pregnant: above regimen or alternate cephalosporin, or single dose of azithromycin 2 g PO |
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6 months post-partum irritable intolerance to heat :
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Post-partum thyroiditis
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36 yr old female use condom as contraceptive. She complains of nausea & amenorrhea. What is first investigation to do?
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Beta HCG
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If screening for breast cancer is limited only to postmenoupse women. Which young women carrying the following gene will be missed from the screening:
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BRCA 1
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Female can't conceive, had symptoms and signs of PID , what to do
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Hysterosalpingogram
Pelvic inflammatory disease affects the tube, and the best investigation for tubal factors is hysterosalpingogram (it can be therapeutic) |
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A pregnant lady in her first trimester did not have any vaccination for rubella what to do?
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Don't give Rubella vaccine during pregnancy
Not to give: Hepatitis A, Pneumococcal, MMR, OPV\IPV, Varicella, HPV Vaccine May give: Hepatitis B, Influenza (Inactivated), Tdap |
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Which OCP cause Hyperkalemia?
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- Drospirenone - Drospirenone is a novel synthetic progestin approved in combination with ethinyl estradiol as an oral contraceptive (OC). Marketed as Yasmin - Drospirenone is a fourth generation OC and it possesses antimineralocorticoid effects not present in previous generations of OCs. Its antimineralocorticoid potency is approximately eight times greater than spironolactone - This activity enhances sodium, chloride, and water excretion, while reducing the excretion of potassium, ammonium, and phosphate |
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40 years c/o heavy bleeding & intercyclic bleeding , not pregnant not using ocp. & not sexual active from a year, dx?!
a. Anovulatory cycle |
Abnormal uterine bleeding (formerly, dysfunctional uterine bleeding [DUB] [1] ) is irregular uterine bleeding that occurs in the absence of recognizable pelvic pathology, general medical disease, or pregnancy. It reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining.
Dysfinctional Uterine Bleeding: If the pregnancy is negative, there are no anatomic causes for bleeding and coagulopathy is ruled out, then the diagnosis of hormonal imbalance should be considered. Mechanism: the most common cause of DUB is anovulation. Anovulation results due to unopposed estrogen. With unopposed estrogen, there is continous stimulation of the endometrium with no secretory phases. # Anovulation cycle: Irregular intervals, no ovulatory pain, serum P4< 3 (2nd half cycle), monophasic BBT, serum LH < 25 |
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Female present e oligomeorrhea " she had 3 periods in the last year" she had acne $ histirusim Body wt 60 , pv normal,dx?!
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PCOS
The diagnostic criteria for PCOS should include two of the following three criteria: chronic anovulation, hyperandrogenism (clinical/biologic), and polycystic ovaries |
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Scenario about PCOS they asked what investigation u will screen for?!
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Glucose tolerance+ lipid profile
Women with PCOS are at increased risk for the following: Type 2 DM Inslulin resistance Infertility Metabolic syndrome- insulin resistance, obesity, atherogenic dyslipidemia, and HTN Evaluate for metabolic abnormalities : 2hr glucose tolerance test Fasting lipid and lipoprotein levels (total cholesterol, HDL, LDL,triglycerides) |
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Female present e defemenization " breast atrophy & deeping of voice" they found to have ovarian cancer , dx?!
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Sertoli leyding cell
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Increase amniotic fluid:
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Duodenal atresia
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You're a gynecologist in clinic, a lady come to you with profuse vaginal discharge, diagnosis?
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Master the Boards
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What is the most common complication of HYPERTENSION in pregnancy?
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IUGR Causes: Maternal:(Asymmetric) HTN Small vessel disease (SLE) Malnutrition Tobacco Alcohol Placental:(Asymmetric) Infarction Abruption TTTS Fetal:(symmetric) Infection Aneuploidy Structural anomalies |
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During labor patient complain of severe pain in right thigh relief after labor what's the nerve?
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Cutaneous branch of femoral nerve
The lateral femoral cutaneous nerve exits the pelvis under the inguinal ligament and then passes medial and inferior to the anterior superior iliac spine. It is a pure sensory nerve which supplies the anterolateral thigh. Injury to the lateral femoral cutaneous nerve causes burning, pain, or numbness of the anterolateral thigh, known as meralgia paresthetica syndrome.4 The lateral femoral cutaneous nerve is at risk of injury during prolonged pushing with hip flexion as the nerve is compressed under the inguinal ligament. |
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Case of threaten abortion how will you manage?
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Repeated US until viability of the fetus confirmed
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Female with history of lichen sclerosis present with lesion what will you do?
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Take biopsy
In non-neoplastic disorders of vulvar epithelium biopsy is necessary to make diagnosis and/or rule out malignancy. In lichen sclerosis subepithelial fat becomes diminished; labia become thin, atrophic, with membrane-like epithelium and labial fusion causing pruritus, dyspareunia, burning. |
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Pregnant primi 34w didn't gain weight the doctor start to think of preeclampsia what finding support that:
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Elevated BP
One of the risk factors of preeclampsia is nulliparity. The classic symptoms of pre-eclampsia include a frontal headache, visual disturbance and epigastric pain. However, the majority of women with pre-eclampsia are asymptomatic. Hypertension is usually the first sign.Rapidly progressive oedema of the face and hands may suggest pre-eclampsia. |
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Woman with abdominal pain they perform laparotomy then a dark blood when they open (I don't remember if there's bilateral adnexal mass or not) What is the Dx:
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Chocolate hemorrhagic cyst ???
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Treatment of dysmenorrhea
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NSAIDS |
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RH -ve mother and +ve baby what is the complication at delivery
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Acute hemolysis
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Early Pregnant varicella vaccine:
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Avoid exposure |
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Lady ,12 month trying to conceive, regular menstruation , her husband > normal semen analysis & temperature is normal What is the cause?
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Tubal disease? HSG, laparoscopy Initial investigations: BBT, semen analysis, HSG Assessment of fallopian tube is next step if semen analysis normal and ovulation is confirmed - HSG: schaduled 1 w after menses. Give prophylaxis Abx. If abnormal results--> Do laparoscopy for potentially correctable tubal disease. * tubal blockage due to PID--> IVF |
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Pregnant in last trimester or in labour couldn't remember anyhow she was presented with vaginal bleeding , baby was delivered with no complication but mother developed bleeding from nose and mouth ?
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DIC is the most likely answer, especially if the bleeding was in the third trimester and was due to abruptio placenta. The most common cause of DIC in pregnancy is abruptio placenta. In DIC, typically there is a history of blood loss through bleeding in areas such the gingivae and the gastrointestinal (GI) system
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40 years old women , her period regular , no intercourse for 1 year , well till 3 months when she had heavy period and intermenstrual bleeding : Sorry I forgot the choices :/ but I think they were asking about what to do next
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Their answer: under the topic of menorrhagia in Medscape, Exclusion of pregnancy (the most common cause of irregular bleeding in women of reproductive age and the first diagnosis that should be excluded before further testing or drug therapy). |
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Female on tamoxifene for her breast cancer , and progesterone for 5 years , she stop the progesterone , she was having fibroid that is 2*3 befor 5 years and now become 5*6 with increased homogenous thickness of the endomertium Sorry for the unorganized senior but it was like that and again I forgot the choices :/ but most probably they were asking about the diagnosis
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Tamoxifen has pro-estrogenic effects on the endometrium and is associated with a number of pathologies. It is associated with an increased prevalence of endometrial hyperplasia (1-20%), endometrial polyps (8-36%), endometrial carcinoma, cystic endometrial atrophy
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. Fast division of blastomere.
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As cilia degenerate , the amount of time it takes for the fertilized egg to reach the uterus will increase. If the fertilized egg doesn t reach the uterus in time, it will hatch from the non-adhesive zona pellucida and implant itself inside the fallopian tube, thus causing the ectopic pregnancy.
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How to confirm Down syndrome?
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Chorionic villus sampling (CVS) is performed at 10-13 weeks' gestation; earlier testing is thought to be associated with a 1 in 300-1000 risk of fetal transverse limb deficiency, a small risk of maternal cell contamination, and a 0.5-1% risk of a fetal loss after the procedure. The accuracy of CVS (96-98%) is less than that of midtrimester amniocentesis, because of confined placental mosaicism and maternal-cell contamination.
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Pregnant at 36 weeks gestational age presented with painless vaginal bleeding. Examination revealed closed cervical os without contractions. What would you see on US?
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Low lying placenta
Placenta Previa (PP) is defined as the placenta overlying the cervical OS. PP triad: 1. Late trimester bleeding 2. Lower segment placental implantation (seen in US) 3. NO Pain |
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40 year-old with irregular menses for 3 months presented with bleeding between menses. What is the diagnosis?
|
Anovulatory bleeding (chronic)?!!
- Anovulatory Bleeding Triad: 1- Irregular, Unpredictable vaginal bleeding 2- 30s – early 40s -year-old woman 3- Obese, hypertension |
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Melanocyte stimulating hormone released from?
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Intermediate lobe of pituitary
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Asymptomatic female has 7 cm cyst in her ovary. Her period is normal
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- follicular * Functional varieties, such as corpus luteum cysts, follicular cysts, and theca lutein cysts, arise in response to normal or increased hormonal action. Thus, extrinsic gonadotrophin and progesterone administration can influence cyst development and persistence * Most functional cysts are < 1.5 cm in diameter; few exceed 5 cm. Functional cysts usually resolve spontaneously over days to weeks. Functional cysts are uncommon after menopause. * thin walled and unilocularusually range around 3 to 8 cm in sizeby definition, if <3 cm it is an ovarian follicle rather than an ovarian follicular cystthere is typically posterior acoustic enhancement and an absence of internal echoesthere should be no colour flow, nodules or or any solid components. |
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Lateral vaginal examination what you feel?
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Ovary
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24 year-old lady presented with bright red bleeding, breast tenderness, and bad mood. Β-HCG is negative. No abnormality on examination. What to do
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- The initial approach to evaluation of non-pregnant reproductive-age women with abnormal uterine bleeding (AUB) is to confirm that the source of bleeding is the uterus, exclude pregnancy, and confirm that the patient is premenopausal.
- Most reproductive-age women with AUB should be evaluated initially with: human chorionic gonadotropin (hcg), CBC, hemoglobin and/or hematocrit, HORMONAL TESTING (i.e., thyroid, prolactin. FSH/LH, estrogen), bleeding disorders testing. - Pelvic imaging is useful if a structural lesion (e.g., endometrial polyps) is suspected; it is not required in every woman with AUB. Pelvic ultrasound is the first-line study. |
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Most common cause of post-partum hemorrhage?
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Uterine atony
PPH has many potential causes, but the most common, by a wide margin, is uterine atony, ie, failure of the uterus to contract and retract following delivery of the baby. |
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Pregnant have pyelonephritis:
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nitrofurantoin
Pyelonephritis is the most common urinary tract complication in pregnant women, occurring in approximately 2% of all pregnancies. Acute pyelonephritis is characterized by fever, flank pain, and tenderness in addition to significant bacteriuria. |
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Vaginal discharge with falgellated cell on microscopy?
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trichomonas vaginalis
Humans are the only known host of T vaginalis. Transmission occurs predominantly via sexual intercourse. The organism is most commonly isolated from vaginal secretions in women and urethral secretions in men. Women with trichomoniasis may be asymptomatic or may experience various symptoms, including a frothy yellow-green vaginal discharge and vulvar irritation. |
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Patient on paroxetine and is stable, she got pregnant what you will do ?
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Paroxetine is a selective serotonin reuptake inhibitor (SSRI), used for the treatment of depression and anxiety disorders. Exposures to paroxetine in early pregnancy, indicated an increased risk (also 2%) of cardiovascular defects of relatively mild types after maternal use of paroxetine
- Psychiatrically stable women who prefer to stay on medication may be able to do so after consul tation between their psychiatrist and ob-gyn to discuss risks and benefits. - Women who would like to discontinue medica tion may attempt medication tapering and dis continuation if they are not experiencing symp toms, depending on their psychiatric history. - Women with a history of recurrent depression are at a high risk of relapse if medication is dis continued. - Women with recurrent depression or who have symptoms despite their medication may benefit from psychotherapy to replace or augment medication. - Women with severe depression (with suicide at tempts, functional incapacitation, or weight loss) should remain on medication. If a patient refus es medication, alternative treatment and moni toring should be in place, preferably before dis continuation. |
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Lady with cyclic abdominal pain, heavy bleeding, not on contraceptive, trying to conceive, what is the investigation:
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Laparoscopy
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Women treated in the past for pelvic Inflammatory disease. Now her US showed bilateral ovarian cyst.. During surgery dark blood come from ovaries.. Dx?
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Chocolate cysts (Ovarian endometriosis)
Chocolate cysts are affecting women during their reproductive period and may cause chronic pelvic pain associated with menstrual periods (menstrual cramps, endometriosis). The chocolate cyst is the cyst of the ovary with intracavitary hemorrhage and formation of a hematoma containing old brown blood. |
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Ovarian cancer marker?
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CA125
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Mass out of vagina with coughing and defecation?
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Transabdominal US OR Transvaginal US or MRI.
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Mass out of vagina with coughing and defecation?
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Uterine prolapse?
Due to increase in intra-abdominal pressure (chronic obstructive airway disease, straining, constipation, heavy lifting, and hard physical activity) can lead to pelvic organ prolapse (POP). |
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Anti diabetic drug taken by ladies with PCOS
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Metformin
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Elevated in menopause lady?
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FSH Serum estrone |
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Vulvar cancer cause and treatment?
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Human papillomavirus (HPV) may be a cause of some vulvar malignancies. Treatment options for vulvar cancer depend on the type and cancer stage - Surgery :(excision) (partial vulvectomy)(radical vulvectomy). Extensive surgery for advanced cancer: called pelvic exenteration. Reconstructive surgery. Surgery to remove nearby lymph nodes - Radiation therapy , Chemotherapy |
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Urge incontinence how to diagnose? Tx??
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- Stress incontinence - involuntary leakage on effort, exertion, sneezing, or coughing - Urge incontinence - involuntary leakage accompanied by or immediately preceded by urgency - Overflow incontinence - urinary leakage from an over-distended bladder; - Over-active bladder (detrusor over-activity) - urgency with or without urge incontinence; usually with frequency and nocturia in the absence of an underlying metabolic or pathological condition. - Urge: day and night, pelvic examination shows normal anatomy. - UA and culture: negative, cystometric studies: normal residual volume, but involuntary detrouser muscle contraction even w/small urine volume. - tx: 1st line >behavioural approaches plus lifestyle change: Anticholinergic medications (oxybutynin, NSAIDS), TCAs, CCBs. |
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Female with Tubo-ovarian abscess what is the treatment?
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Treatment typically involves drainage of the abscess. The antibiotic regimen should include broad coverage against gram-negative rods, enterococci, and anaerobes(clindamycin or metronidazole should be used with doxycycline as this provides better anaerobic coverage than doxycycline alone
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Rupture of membrane during pregnancy when to give antibiotics?
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The American College of Obstetricians and Gynecologists (ACOG) recommends a seven-day course of intravenous ampicillin and erythromycin followed by oral amoxicillin and erythromycin if watchful waiting is attempted before 34 weeks. [2] Amoxicillin-clavulanic acid increases the risk of fetal bowel death (necrotizing enterocolitis) and should be avoided in pregnancy.
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DM pregnant her oral glucose tolerance test came positive what to do next.
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Diagnose with GDM: nternational Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria (endorsed by the American Diabetes Association [ADA]) recommended that all women not known to have diabetes should undergo a 75-gram OGTT at 24 to 28 weeks of gestation, with diagnosis of GDM based upon the finding of 1 abnormality. Management 1st : diet, exercise + glucose monitoring if uncontrolled with dietary therapy, or marked initial hyperglycaemia plus insulin therapy, then at 32 to 34 weeks' gestation start antepartum fetal monitoring.
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Fibroid during pregnancy does it Degenerate or stays asymptomatic Or what ?
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Degenerative changes : Usually presents during pregnancy with acute abdominal pain with significant local tenderness over the site of the mass. Most common type of degeneration during pregnancy is red type, believed to occur due to rapid fibroid cellular growth that exceeds the blood supply. Usually requires admission to the hospital for pain therapy, usually with non-steroidal anti-inflammatory drugs (nsaids). However, these drugs should be used with caution to avoid fetal problems, such as premature closure of the ductus arteriosus. OR pregnancy loss: There exist a number of hypotheses regarding the mechanism of action of spontaneous abortion in patient with uterine fibroids including altered uterine contractility, altered uterine vasculature, and/or supporting extracellular matrix
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Pregnant lady in her 27 th gestational week has mono chorionic twin. One of them died, what will be your next step?
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expectant delivery
(do nothing) In all circumstances, the use of steroids and magnesium sulfate should be considered for fetal lung maturity and neuroprotection respectively. If the live twin is leading, well grown and is in a cephalic presentation, then vaginal delivery may be considered. If the live twin is malpresenting or is growth restricted, or if the dead twin is leading, caesarean section is preferred |
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Post-menopausal with dysuria, frequency and supra pubic tenderness?
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Interstitial cystitis
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Female has itching, white cheesy discharge?
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Candida |
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Which oral contraceptive causes hyperkalemia?Candida
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Estradiol Drospirenone (from google and was in the choices)
Yasmin®: 30 μg ethinyl estradiol + 3 mg drospirenone (a new progestin) • Yaz®: 20 μg ethinyl estradiol+ 3 mg drospirenone – 24/4-d pill (4 d pill free interval) • Drospirenone has antimineralocorticoid activity and antiandrogenic effects |
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Typical of polycystic ovarian syndrome diagnosis
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- serum total and free testosterone: elevated - serum dehydroepiandrosterone sulfate (DHEAS): elevated - serum 17-hydroxyprogesterone: normal. Performed to exclude 21-hydroxylase-deficient - serum prolactin : elevation may suggest prolactinoma - serum TSH: abnormal in thyroid disease - oral glucose tolerance test - fasting lipid panel: elevated total cholesterol, LDL-cholesterol, triglycerides; low HDL-cholesterol |
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Etiology of Postpartum Pyrexia:
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B-5W
Breast: engorgement, mastitis . Day 7-21 : dicloxscillin for 7-10 d Wind: atelectasis, pneumonia --> day 0 : Ambulation, pulmonary exercise Water: UTI , pylonephritis --> day 1-2 : single IV Abx Womb: endometritis --> day 2-3 : IV genta/clinda Wound: episiotomy, C/S site infection --> day 5-6 : wet to dry pack Walking: DVT, septic thrombophlebitis "picket fence" --> day 5-6 : heparinization Pelvic mass day 5-6 percutaneous drainage Pharyngitis, Gastroenteritis |
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Gravida 1 para 1, came with history of severe abdominal pain and vaginal bleeding with passing some fetal tissues, by examination the cervix was open with some tissues protruding What is the conventional management?
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Dilatation and curettage
In missed, incomplete, or inevitable abortion present before 13 weeks' gestation, the standard therapy has been suction D&C. |
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Girl with depression in first 2 days of menstruation what dx? Mood swings, depression?!
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PMS |
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Patient has hx of PID came with adnexal mass what next step?
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Pelvic ultrasound is the first line imaging study for the evaluation of an adnexal mass
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Transmission of HIV
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Through breast feeding
MODES OF TRANSMISSION DRIVING THE EPIDEMIC — The major modes of acquiring HIV infection are - Sexual transmission, including via heterosexual and homosexual contact - Parenteral transmission, predominantly among injection drug users (IDU) - Perinatal transmission Mother-to-child transmission — With high levels of HIV infection among young women, the potential exists for large numbers of infected children, since infants can become infected in utero, at birth, or during breastfeeding. Such mother-to-child transmission accounts for 90 percent of infection among children worldwide. In the most affected countries in the world, such as in sub-Saharan Africa, 20 to 40 percent of pregnant women are HIV-infected, and one-third of their babies become infected. Although antiretroviral use during pregnancy, at the time of delivery, and during breastfeeding can largely prevent this, only a minority (25 percent or less) of affected mothers are able to access such antiretroviral prophylaxis |
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Pathogenesis of jaundice in newborn From a mother has - blood group and the newborn has +o.
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- Individuals are classified as Rh negative or positive based upon the expression of the major D antigen on the erythrocyte. The original description of HDFN was due to Rh(D) incompatibility, which is associated with the most severe form of the disease (hydrops fetalis). - PATHOGENESIS AND CONSEQUENCES OF ALLOIMMUNIZATION — By 30 days of gestation, the Rh(D) antigen is expressed as part of the red blood cell (RBC) membrane, and, in contrast to most other antigens (eg, A,B,M,N), Rh(D) is only present on rbcs. Maternal Rh(D) alloimmunization develops as a result of maternal immune system exposure to Rh(D)-positive rbcs. Once anti-D igg antibodies are present in the pregnant woman's circulation, they can cross the placenta and opsonize fetal rbcs, which are then phagocytized by macrophages in the fetal spleen. Events that can cause maternal alloimmunization include: |
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- 18 year-old married missed her period for two months, came with rt sided abd pain what is the dx:
- Similar question but what's the test to order |
- ruptured ectopic
- Urine hcg The most common clinical presentation of ectopic pregnancy is first trimester vaginal bleeding and/or abdominal pain. Ectopic pregnancy may also be asymptomatic. Normal pregnancy discomforts (eg, breast tenderness, frequent urination, nausea) are sometimes present in addition to the symptoms specifically associated with ectopic pregnancy. There may be a lower likelihood of early pregnancy symptoms, because progesterone, estradiol, and human chorionic gonadotropin (hcg) may be lower in ectopic pregnancy than in normal pregnancy. - He pain associated with ectopic pregnancy is usually located in the pelvic area. It may be diffuse or localized to one side. In cases in which there is intraperitoneal blood that reaches the upper abdomen or in rare cases of abdominal pregnancy, the pain may be in the middle or upper abdomen. If there is sufficient intraabdominal bleeding to reach the diaphragm, there may be referred pain that is felt in the shoulder. Blood pooling in the posterior cul-de-sac (pouch of Douglas) may cause an urge to defecate. The timing, character, and severity of abdominal pain vary, and there is no pain pattern that is pathognomonic for ectopic pregnancy. The onset of the pain may be abrupt or slow, and the pain may be continuous or intermittent. The pain may be dull or sharp; it is generally not crampy. The pain may be mild or severe. Tubal rupture may be associated with an abrupt onset of severe pain, but rupture may also present with mild or intermittent pain. 1. Confirm that the patient is pregnant a. Measurement of hcg is performed initially to diagnose pregnancy and then followed to assess for ectopic pregnancy. For follow-up, hcg is measured serially (every 48 to 72 hours) to determine whether the increase is consistent with an abnormal pregnancy. A single hcg measurement alone cannot confirm the diagnosis of ectopic or normal pregnancy. b. The initial test to diagnose pregnancy may be either a urine or serum hcg. Once a pregnancy is confirmed, if ectopic pregnancy is suspected, the serum hcg is then repeated serially (typically every two days) to assess whether the increase in concentration is consistent with an abnormal pregnancy 2. Determine whether the pregnancy is intrauterine or ectopic. Determine the site of the ectopic pregnancy. 3. Determine whether the structure in which the pregnancy is implanted (most commonly, the fallopian tube) has ruptured and whether the patient is hemodynamically stable. Failure to diag nose ectopic pregnancy before tubal rupture limits the treatment options and increases maternal morbidity and mortality. 4. Perform additional testing to guide further management (eg, blood type and antibody screen, pre-treatment testing for methotrexate therapy). |
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Pregnant lady 39 weeks presented with high blood pressure for the first time. No proteinurea or seizures, wts her dx:
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Gestational hypertension if it was not stated that it was present before pregnancy (before the 20 th week) and/or persists after pregnancy for more than 12 weeks postpartum
There are four major hypertensive disorders that occur in pregnant women: Preeclampsia-eclampsia – Preeclampsia refers to the syndrome of new onset of hypertension and either proteinuria or end-organ dysfunction most often after 20 weeks of gestation in a previously normotensive woman.. Eclampsia is diagnosed when seizures have occurred. Chronic (preexisting) hypertension – Chronic hypertension is defined as systolic pressure ≥140 mmhg and/or diastolic pressure ≥90 mmhg that antedates pregnancy, is present before the 20th week of pregnancy, or persists longer than 12 weeks postpartum. Preeclampsia-eclampsia superimposed upon chronic hypertension – Preeclampsia-eclampsia superimposed upon chronic hypertension is diagnosed when a woman with chronic hypertension develops worsening hypertension with new onset proteinuria or other features of preeclampsia (eg, elevated liver enzymes, low platelet count). Gestational hypertension – Gestational hypertension refers to elevated blood pressure first detected after 20 weeks of gestation in the absence of proteinuria or other diagnostic features of preeclampsia. Over time, some patients with gestational hypertension will develop proteinuria or end-organ dysfunction characteristic of preeclampsia and be considered preeclamptic, while others will be diagnosed with preexisting hypertension because of persistent blood pressure elevation postpartum |
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Patient with odorless vaginal disch, grey-white. Spores on wet mount.
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The diagnosis of vulvovaginal candidiasis is based on the presence of Candida on wet mount, Gram's stain, or culture of vaginal discharge in a woman with characteristic clinical findings (eg, vulvovaginal pruritus, burning, erythema, edema, and/or curd like discharge attached to the vaginal sidewall) and no other pathogens to account for her symptoms. The vaginal ph in women with Candida infection is typically normal (4 to 4.5), which distinguishes candidiasis from trichomoniasis or bacterial vaginosis. Candida species can be seen on a wet mount of the discharge; adding 10 percent potassium hydroxide destroys the cellular elements and facilitates recognition of budding yeast, pseudohyphae, and hyphae
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Patient with foul vaginal disch, greenish color. Microscopy flagellate organisms. What's the treatment:
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Oral metronidazole
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Patient with dyspareunia and sever dysmenorrhea on examination post fornix nodule. What is the management?
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endometriosis specifically post-vaginal endometriosis: - Medical interventions do not improve fertility, diminish endometriomas, or treat complications of deep endometriosis such as ureteral obstruction. 1. Nsaids: nsaids are be considered the first-line treatment for pelvic pain, including endometriosis-related pain. However, there are no high-quality data reporting NSAID efficacy in treating pain due to endometriosis, nor have nsaids been shown to be superior to other agents or to placebo 2. Combined (estrogen and progestin) contraceptives are the first-line treatment for most women with endometriosis-related pain because they can be used long-term, are well-tolerated, are relatively inexpensive and easy to use, and provide contraception and additional benefits including decreasing the risk of ovarian and endometrial cancers. 3. Progestin-only therapy is another treatment option. The progestins most commonly used for the treatment of endometriosis-related pain include medroxyprogesterone acetate (MPA) or the 19-nortestosterone derivatives norethindrone acetate and dienogest 4. Gonadotropin-releasing hormone (gnrh) agonists — gnrh agonists include nafarelin, leuprolide, buserelin, goserelin, and triptorelin. Gnrh agonists bind to receptors in the pituitary gland. Because gnrh agonists have a longer half-life than native gnrh, the pituitary-ovarian axis is down-regulated and hypoestrogenism results. Endometriosis-related pain is likely treated by the induction of amenorrhea and progressive endometrial atrophy. The hypoestrogenic state is the main source of adverse effects, including hot flushes, vaginal dryness, decreased libido, mood swings, headache, and decreased bone density. Negative effects can be reduced by add-back therapy, typically with oral norethindrone acetate or a combination of estrogen and progestin (ie, COC pill) 5. Danzol: Danazol is a derivative of 17 alpha-ethinyltestosterone. It primarily inhibits the luteinizing hormone surge and steroidogenesis, and increases free testosterone levels. Its mechanisms of action include inhibition of pituitary gonadotropin secretion, direct inhibition of ovarian enzymes responsible for estrogen production, and inhibition of endometriotic implant growth. While danazol is effective at treating endometriosis-related pain, it is not commonly used because of androgenic side effects. 6- Aromatase inhibitors — We reserve aromatase inhibitor (AI) treatment for women with severe, refractory endometriosis-related pain [49,50]. We inform women that treatment of endometriosis is an off-label use of these medications. Typical treatments include oral anastrozole 1 mg once daily or oral letrozole 2.5 mg once daily. These agents appear to regulate local estrogen formation within the endometriotic lesions themselves, in addition to inhibiting estrogen production in the ovary, brain, and periphery (eg, adipose tissue). Disadvantages of ais include bone loss with prolonged use and ovarian follicular cyst development. |
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Best medication for gestational diabetes mellitus is?
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Insulin |
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Pregnant female present with bleeding and abdominal contractions started at night has history of mild hypertension. Diagnosis?
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Placental abruption
http://emedicine.medscape.com/article/252810-overview |
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Idiopathic anovulation, drug to enhance ovulation?
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Clomiphene is a weak estrogen-like hormone that acts on the hypothalamus, pituitary gland, and ovary to increase levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH, which is also important in the process of ovulation).
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Patient with foul vaginal discharge, greenish color. Microscopy flagellate organisms. What's the treatment: (trach vaginitis)
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A 5-nitroimidazole drugs — The 5-nitroimidazole drugs ( metronidazole or tinidazole ) are the only class of drugs that provide curative therapy of trichomoniasis.
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Pregnant lady 39 weeks presented with high blood pressure for the first time. No proteinuria or seizures, wts her dx:
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Gestational hypertension
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Snowstorm appearance in pregnant what's the Dx?
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seen in complete hydatidiform mole
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Postmenopausal lady taking tamoxofin, which of the following u will carefully assess?
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vaginal bleeding
Because it may increase the risk of uterine malignancy Tamoxifen may increase the risk of the following, particularly in women over age 50 years: Cancer of the uterus (endometrial cancer and sarcoma). Blood clots within deep veins (deep vein thrombosis), usually in the legs, which can travel to the lungs (pulmonary embolism). Reference: |
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Endometriosis definition ?
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The presence of tissue that normally grows inside the uterus (womb) in an abnormal anatomical location. Endometriosis is very common and may not produce symptoms, or it may lead to painful menstruation. It has also been associated with infertility. Endometriosis occurs most commonly within the Fallopian tubes and on the outside of the tubes and ovaries, the outer surface of the uterus and intestines, and anywhere on the surface of the pelvic cavity. It can also be found, less often, on the surface of the liver, in old surgery scars or, very rarely, in the lung or brain. Endometriosis occurs in the reproductive years. The average age at diagnosis is 25-30.Endometriosis may be suspected by during a physical examination; it is confirmed by surgery, usually laparoscopy; available treatments include medication for pain, hormone therapy, and surgery
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Pregnant 10wks has bleeding and fetus delivered , os is opened and still some remnants ? What to do ?
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With missed, incomplete, or inevitable abortion present before 13 weeks' gestation, the standard therapy has been suction D&C
Women with an incomplete, inevitable, or missed abortion can be managed surgically, with medication, or expectantly. All three management approaches are effective, but treatment is completed more quickly with surgical management and involves fewer medical visits. The choice of method is typically based upon patient preference |
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Question about Mayer-Rokitansky-Küster-Hauser syndrome (Mullerian agenesis)
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This condition causes the vagina and uterus to be underdeveloped or absent. Affected women usually do not have menstrual periods due to the absent uterus. Often, the first noticeable sign of MRKH syndrome is that menstruation does not begin by age 16 (primary amenorrhea). Women with MRKH syndrome have a female chromosome pattern (46,XX) and normally functioning ovaries.
They also have normal female external genitalia and normal breast and pubic hair development. Women with MRKH syndrome may also have abnormalities in other parts of the body. The kidneys may be abnormally formed or positioned, or one kidney may fail to develop (unilateral renal agenesis). Affected individuals commonly develop skeletal abnormalities, particularly of the spinal bones (vertebrae). Females with MRKH syndrome may also have hearing loss or heart defects. |
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What is the treatment of gonorrhea?
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This disease is caused by Neisseria Gonorrhoeae, a Gram- negative diplococcus
- Symptoms: lower genital tract infection → vulvovaginal discharge and itching. Upper genital tract infection → bilateral abdominal and pelvic pain - Disseminated gonorrhea is characterized by: dermatitis, polyarthralgia and tenosynovitis - Diagnosis: Nucleic acid amplification test (NAAT) of either cervical discharge or urine - Treatment: single dose of IM ceftriaxone + single dose of Azithromycin. In case of Bartholin ab scess, it needs to undergo incision and drainage with Word catheter |
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A lady in labor with 6 cm dilatation was given epidural anesthesia. The pain came back, so they gave her (venylphantanile?) Baby started to be in distress. She was given fluids without improvement. What to give her next?
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no choices Ephedrine?? Is it antidote?
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Characteristic for premenstrual syndrome. Which phase or behavioral or symptomatic abnormality?
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Premenstrual syndrome (PMS) is a recurrent luteal-phase condition characterized by physical, psychological, and behavioral changes of sufficient severity to result in deterioration of interpersonal relationships and normal activity.
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Case of vaginal watery brown discharge.
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There are many causes for brown vaginal discharge but differentials depend on accompanying symptoms and clinical presentation. More on brown vaginal discharge: http://www.newhealthadvisor.com/Light-Brown-Discharge.html
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Typical case of PCO. Diagnosis ?
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Stein–Leventhal syndrome(other name) Stein and Leventhal were the first to recognize an association between the presence of polycystic ovaries and signs of hirsutism and amenorrhea (eg, oligomenorrhea, obesity). PCO diagnostic criteria:
- At least 2 of the following 3 features are required for PCOS to be diagnosed: Oligo-ovulation or anovulation manifested as oligomenorrhea or amenorrhea Hyperandrogenism (clinical evidence of andro gen excess) or hyperandrogenemia (biochemical evidence of androgen excess) Polycystic ovaries (as defined on ultrasonography): 12 or more follicles in at least 1 ovary—measuring 2-9 mm in diameter—or a total ovarian volume greater than 10 cm 3 . |
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What is most stimulus factor for milk secretion?
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Prolcatin: production of milk Oxytocin: via suckling reflex, cause ejection of milk from nipples * estrogen antagonize the positive effect of prolactin on milk production. |
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A drug that interferes with OCP?
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Anti-epileptic? Not sure
Http://www.mckinley.illinois.edu/handouts/pill_interactions_drugs.html |
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Case of incomplete abortion
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One of the common complications of pregnancy is spontaneous miscarriage, which occurs in an estimated 5-15% of pregnancies. Spontaneous miscarriages are categorized as threatened, inevitable, incomplete, complete, or missed. Signs of incomplete miscarriage include the following: The cervix may appear dilated and effaced, or it may be closed, Bimanual examination may reveal an enlarged and soft uterus. On pelvic examination, products of conception may be partially present in the uterus, may protrude from the external os, or may be present in the vagina. Bleeding and cramping usually persist.
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Pregnant G3P2 in labor, cervical dilatation 3cm ,, effacement 100% membrane rupture , after 3 hr still 3 cm ,, /(( c/s,, oxytocin , waiting ) .
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- ?? |
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Embryonal alveolar from what?
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Sacule?? |
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A female has dyspareunia, dysmenorrhea in examination we found a cyst in the posterior fornix what your management?
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danazol
This is probably endometriosis. Signs & symptoms of endometriosis typically reflect the area of involvement, they include: Dysmenorrhea, Heavy or irregular bleeding, Pelvic pain, Lower abdominal or back pain, Dyspareunia, Dyschezia (pain on defecation) - Often with cycles of diarrhea and constipation, Inguinal pain, … Laparoscopy is considered the primary diagnostic modality for endometriosis. The most common sites in descending order: Ovaries, Posterior cul-de-sac, Broad ligament. Treatment: Medical: Combination oral contraceptive pills (cocps), Danazol..etc ● Danazol: a derivative of the synthetic steroid ethisterone that suppresses the production of gonadotropins and has some weak androgenic effects. Danazol exhibits hypoestrogenic, hyperandrogenic effects that cause atrophy of the endometrium, which can alleviate the symptoms of endometriosis. Surgical: classified into: ● Conservative surgery: Drainage and laparoscopic cystectomy, Ablation, ● Semi Conservative surgery: hysterectomy and cytoreduction of pelvic endometriosis. ● Radical surgery: TAH-BSO |
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CH16 where u find?(pcos,...)
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?? |
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Ovarian tumor post hysterectomy what you will find in biopsy?
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endomaterial hyperplasia
Reference: http://www.cancer.org/cancer/endometrialcancer/detailedguide/endometrial-uterine-cancer-risk-factors |
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Most common cause of Leukorrhea?
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Estrogen imbalance Leukorrhea is a thick, whitish or yellowish vaginal discharge.There are many causes of leukorrhea, the usual one being estrogen imbalance. The amount of discharge may increase due to vaginal infection or stds, and also it may disappear and reappear from time to time, this discharge can keep occurring for years in which case it becomes more yellow and foul-smelling; it is usually a non-pathological symptom secondary to inflammatory conditions of vagina or cervix. |
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Ovarian follicular cell origenate from ??
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OVARIAN Follicular cells (granulosa cells) develop from the secondary SEX CORD (which develops in gonadal ridge).
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A female patient with ovarian cancer and high CA125. What is the type of cancer?
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Germinoma? Epithelial tumors represent the most common histology (90%) of ovarian tumors. Five main histologic subtypes: Serous (from fallopian tube), endometrioid (endometrium), Mucinous (cervix), Clear cell (mesonephros), Brenner
http://emedicine.medscape.com/article/255771-workup#c9 |
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2 weeks infant came for routine check up the doctor exam the baby and he looks well , but when the doctor ask the mother about her baby she told somthing else she said the baby is not well he is confused and he has evil power or somthing like that What does the mother have
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Postpartum psychosis
- Postpartum psychosis has a dramatic onset, emerging as early as the first 48-72 hours after delivery. In most women, symptoms develop within the first 2 postpartum weeks The mother may have delusional beliefs that relate to the infant (eg, the baby is defective or dying, the infant is Satan or God), or she may have auditory hallucinations that instruct her to harm herself or her infant. - Postpartum depression develops most frequently in the first 4 months following delivery but can occur anytime in the first year and it in terferes with the mother's ability to care for herself or her child - Postpartum blues: Symptoms peak on the fourth or fifth day after delivery and last for sev eral days, but they are generally time-limited and spontaneously remit within the first 2 postpartum weeks |
