Inicet Flashcards by 193-Shanice Monica Bethel

Definition of primary amenorrhea

Absence of menses by 13 years and no secondary sexual characteristics
OR
Absence of menses by 15 years but secondary sexual characters present

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Investigations for primary amenorrhea

1 step-Local examinaton
Ist Inv-USG(look for presence and absence of uterus , ovaries)

2nd Inv-FSH levels

IOC- karyotype

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Primary amenorrhea with high FSH means

Gonadal dysgenesis,Ex:Turners syndrome

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Primary amenorrhea with low FSH seen in

Kallman syndrome

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Primary amenorrhea with normal FSH

Mullerian agenesis

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Cancer caused by DES

Clear cell cancer vagina

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Diseases caused by DES

T shaped uterus
CIN
Cervical collar
Cervical hood
Clear cell cancer of vagina
Vaginal adenosis

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Most common finding in DES

Hypoplastic uterus

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Min no of AN visits by WHO and Indian std

8&4

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Calorie requirement throughout pregnancy

Extra 350 kcal

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Methods of first trimester abortì on

Misoprostol / Migeprestone-upto 9 weeks

Manual vaccum aspiration-60 ml-660 mmHg-double valve vasculation syringe

Suction and Evacuation -600 mmHg

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Therapeutic level of MgSO4

4-7 mEq/L

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Knee jerk is lost at,Resp distress,resp arrest at

7-10
>10
>12

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Uses of MgSO4

Weak tocolytic drug
Prevention of seizures and it’s recurrence
Neuroprotective <32 weeks

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Define and give cause for late deceleration

Gradual,wide symmetrical starts at the peak of contraction and always ends just after contraction

Cause - uteroplacental insufficiency

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What is category 3 FHR and what is its management

Late deceleration/Variable deceleration with absent BTBV

Absent BTBV with Bradycardia

Rx-urgent CS
NEVER INDUCTION OF LABOR

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What part of HPV virus is used to make vaccine

L1 capsid protein make virus like particles

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How does HPV cause malignant transformation of cells

E6-knocks out P53 gene
E7-knocks out RB
E1 and E2 cause replication of virus

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Cancers caused by HPV and characteristic HPE finding

Cancers of vulva,vagina,penile,anal,oro pharyngeal

Epitheliotropic(affects squamous epithelium,lies between basal and para basal cells)

HPE - koilocytosis

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Vulval cancer most common age group

Type 2(non HPV)>Type 1

Type 2-55-65 years,related to non inflammatory conditions like lichen sclerosis

Type 1- HPV related,smoking RF,HPV 16 most common ,seen in younger women

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Most common site and presentation of vulval cancer

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Labia majors>minora

Vulval lesion(maybe with pruritis)

Components of BPP
Another name of BPP

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Amniotic fluid (SDP>2cm - +2)
NST
Fetal tone
Fetal breathing movement
Gross body movements

Mannings score

Modified NST

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BPP+Amniotic fluid

When is Chronionic villous sampling done,complications?

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11–13 weeks
Fetal limb defects
Fastest results

When is amniocentesis done,what is early amniocentesis

16-18 weeks Early-11-14 weeks

When is fetal blood sampling done

Aka cordocentesis At >18 weeks

When and why is fetoscopy done

In T2,T3 TTTS-for laser ablation of vessels

What is the treatment of mild to moderate anemia according to anemia mukt bharat

Mild to moderate—7-10.9% If POG<34 weeks-oral iron 1 Tab twice a day-check Hb after 1 month If persisting-consider non compliance,non tolerance,malabsorption-give injectable iron If POG>34 weeks—injectable iron sucrose 200 mg(max)/day-2-3 times/week OR carboxymaltose 1000mg

Treatment of severe anemia

If Hb<5%,irrespective ofPOG-blood transfusion If Hb—5-6.9%~if POG>34 weeks-blood transfusion,if POG<34 weeks—injectable iron If pt has signs and symptoms of heart failure,irrespective of Hb and POG-blood transfusion (packed cells)

What causes non immune hy drops,how to diagnose

TORCH infections,especially syphillis(NOT HIV) Anemia Trisomies and structural abnormalities DIGNOSIS C/f- pleural effusion,pericardial effusion,ascites,subcutaneous edema USG-placentomegaly,polyhydramnios If Hb<5%,Hct<15%—hydrops fetalis

HCG is structurally and functionally similar to

LH Alpha-LH,FSH,TSH Beta-LH

Vagitus uterinus ?

Cry of unborn baby,before ROM,not a sign of fetal distress

F/o Turner’s syndrome

Webbed neck,short 4th metacarpal,low posterior hairline ,cubitus valgus 45 XO,no Barr body High FSH,LH(hypergonadotropic hypergonadism) MC type of gonadal dysgenesis

How to diagnose and treat lichen sclerosis

It is a white thinned out area on perineum/vulva Appears as figure of 8 ,if near perinatal area-keyhole like lesion Aka lichen atrophicus Asso with pruritus,hyperkeratosis Localised to labia minora Dx-Biopsy-loss of rete pegs,significant thinning Rx-topical steroid-clobetazol

What is fetal to placental ratio at birth When does fetal weight becomes equal to placental weight

6:1 17 weeks

Which umbilical vein disappears

Right

Single best criteria to calculate POG

Crown Rump Length(7-10 weeks,upto 14 weeks)

Goodle sign??Seen at pog

Softening of cervix 6th week

Hegars sign??Seen at?

Softening of isthmus Seen at 6th week

Signs seen at 8th week of gestation

Osianders sign,Chadwick’s sign,Palmers sign,Piscaceks sign

When is lightening seen

3rd trimester

Which hormones influence fetal growth

Estrogen,Glucocorticoids(for tissue differentiation),Insulin,IGF,Progesterone,TSH

Abnormalities caused by I sotretinoin,chloramphenicol,warfarin,thalidomide,tetracycline,misoprostol

~Microtia,anotia ~Grey baby syndrome ~Depressed nasal bridge,chondrodysplasia punctata ~Phocomelia ~discoloration of teeth -Moebius syndrome-underdevelopment of 6th and 7th cranial nerve

Teratogenic effects of valorate,phenytoin,benzodiazepines,ACE inh

Neural tube defects CVS defects Cleft lip,cleft palate Renal agenesis,Craniofacial abnormalities

Fetal Alcohol Syndrome

Microcephaly,growth restriction,typical facial features

Risk factors for uterine dysfunction

Multifetal pregnancy Macrosomia Overdistension of abdomen Obesity Maternal exhaustion Abnormal fetal presentation Shoulder dystocia

When and where is perimortem CS done

When there are signs of collapse Perform CPR Upper segment

SSRIs in pregnancy causes

Low APGAR score Persistent Pulmonary Hypertension Delayed motor development ADHD

In ovarian cancer who is consider as platinum sensitve ,resistent, refractory

If cancer recurs beyond 6 months—platinum sensitive—rx:Carboplatin +gemcitabin/paclitaxel If recurs within 6 months of treatment with platinum compounds-platinum resistant-rx:gemcitabin/paclitaxel/topotecan If cancer continues to grow on platinum trt-platinum refractory—rx:give non platinum drugs

Hormone levels in menopause

E2-low-10-20pg/ml E1-30-70 PG/ml E2/E1<1 Urine FSH>40IU/L

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