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Flashcards in OBGYN Deck (578):
1

clue for PCOS(3)

acne
irregular mentrual period
hirsutism

2

what hormone is high in PCOS(2)

testosterone
high LH/FSH ratio

3

problem in PCOS causing hyperglycemia(2)

abnormal glucose metabolism
impaired glucose tolerance

4

rx of PCOS(4)

oral contraceptive
or
citrate d eclomiphen
antidrogen
metformin if impaired glucose tolerance

5

advantages of metformin in PCOS(4)

prevention of diabetes
helps losing weight
ovulation in conjoction with citrate de clomiphene
modest effect in suppressing androgen to correct hirsutism

6

normal biophysical profile

8-10

7

what to do if biophysical profile at 8 and decreased amniotic fluid

delivery should be considered

8

biophysical profile 6 with no oligoamnios fetus a

repeat BP in 24 hours
if the same delivery

9

biophysical profile 6 with no oligoamnios fetus a > 37

delivery

10

biophysical profile

daily monitoring

11

biophysical profile 32 s

delivery

12

what to do if BP =4 or less

delivery if fetus > 26 weeks of gestation

13

meaning of BPP less than 2

fetal asphyxia

14

how to assess BP

sonography

15

elements of BP(5)

NST
fetal tone
fetal movement
fetal brathing mvt
amniotic fluid volume

16

NST normal

active

17

fetal tone evaluation(2)

extension
or
flexion

18

fetal mvts

at least 2 mvts in 30 mn

19

fetal breathing mvts

at least last 20 seconds in 30 mn

20

quid of amniotic fluid volume

single pocket more than 2 cm in vertical axis

21

abnormal uterine bleeding with negative pregnancy test in young female

ovulation dysfunction

22

cause of ovulation dysfunction in young girl

immature hypothalamic pituitary ovarian axis

23

what to do in young adolescent with positive bleeding(2)

test de grossesse
test for blood coagulation

24

first line rx in ovulation dysfunction

oral estrogen

25

modality of rx in aptient with abnormal uterine bleeding (4)

high dose of oral estrogen
or high dose of combined contraceptive pills
or high dose progestin
or tranexamic acid

26

quid of tranexamic acid

antifibrinolytic used when there is contraindication with estrogen and progesterone

27

syphylis positive in pregnant women with PNC allergy next step

PNC desensitization

28

how to desensitize a patientfor PNC allergy

using incremental dose of PNC

29

first step in PNC allergy

confirm the allergy by skin testing

30

mother at 28 weeks of gestation sono confirms a dx of bilateral agenesis in mother passing clear fluid form vagina next step

allow spontaneous vaginal delivery

31

when to alllow premature labor(3)

severe pulmonary hypoplasia
bilateral renal agenesis
any sever congenital anomaly incompatible with life

32

how's BUN and creatinine in pregnancy

low

33

why BUN and creatinine in pregnancy(2)

increase of renal plasma flow
and
glomerular filtration rate

34

in vignette patient at 18 semaine choose set of creat and BUN

always choose the values with low creat and low BUN

35

physical exam in pelvic floor weakness(2)

cystocele
uterine prolapse

36

passage of urine when sneezing or coughing

stress incontinence

37

cause of stress incontinence

pelvic floor mx weaakness

38

raik factor for stress incontinence(2)

high parity
older woman

39

work up in stress incontinence(3)

urine analysis
cystometry
post void residual volume

40

clue for bacterial vaginosis

pear shaped motile organism on wet mount

41

rx of bacterial vaginosis

metro

42

what habit must be prohibited during the rx of bacterial vaginosis

alcohol use

43

quid of disulfuram effect(4)

flushing
nausea
hypotension
vomiting

44

physiopatho of disulfuram effect

accumulation of acetaldehyde in blood stream

45

next step in HGSIL

colposcopy

46

what to do if coposcopy shows no suspicious area

biopsies are not required

47

what to do in suspicious areasin colposcopy

biopsy

48

finding in colposcopy plus biopsy

CIN 1
CIN 2
CIN 3

49

quid of cIN

cervical intraepithelial neoplasia

50

pregnant woman with HGSIL

repeat the pap test and colposcopy after the delivery

51

why repeat the pap test and colposcopy after the delivery

because CIN2 et 3 and hGSIL will regress spontaneously after pregnancy

52

when cervical biopsy and electrosurgical excision are indicated in HGSIL in pregnancy

for lesion suggestive of invasive cancer

53

patient > ou egal 25 ans with HGSIL next step

colposcopy or loop surgical excision if no pregnancy or post menopause

54

patient 21-24 ans with HGSIL

colposcopy

55

colposcopy and biosy showing CIN 2 et 3 next step

manage en fonction de guidelines

56

colposcopy and biopsy with no CIN2 et 3

repeat pap test and coploscopy at 6 months for up to 2 years

57

clue for turner(2)

short stature
coarctation of the aorta

58

why patient with TURNER has late menstruations

poor ovarian function

59

hormone increased in Turner and why?(2)

FSH
due to lack of negative feedback

60

painless bleeding in pregnant women third trimester

placenta praevia

61

dx of placenta preavia

ultrasonogram

62

patient with vaginal bleeding what to not do?

pelvic examination(toucher vaginal)

63

placenta praevia with stable mother and fetus a 37 semaines

schedule CS

64

placenta praevia with stable mother and fetus

amniocenthesis to assess lung maturity

65

placenta praevia with stable mother and fetus

elective CS

66

unstable mother and baby in palcenta praevia

elective CS

67

how to assess baby stability

if non stress test is reactive and reassuring

68

clue for androgen insensitivity syndrome(4)

primary amenorrhea
bilateral inguinal mass
breast development
but no axillary and pubic hair

69

karyoptype in androgen insensitivity syndrome

46 xy

70

phenotype of androgen insensitivity syndrome(AIS)

female with blind vaginal pouch

71

other name of IAS

Male pseudohermaphrodism

72

risk in AIS

testicular carcinoma

73

why AIS patietn has breast

because testo is converted to estrogen

74

what patient AIS dont have

mullerian structures

75

quid of mullerian structures(2)

uterus
fallopian tubes

76

cause of AIS

mutation in androgen receptor gene

77

consequence of mutation in AIS

peripheral tissue become unresponsive to androgens

78

risk in PCOS

endometrial carcinoma

79

cyst important to see in dx PCOS(2)

no
cwith only symptom you can have the dx

80

why patient with PCOS has difficulty having kid

anovulation cycle

81

cause of ENDOMETRIAL CARCINOMA in PCOS

unbalanced estrogen

82

painless genital ulcer(2)

syphylis
granulome inguinale

83

painfull ulcer(2)

chancroid
herpes

84

differentiate syphilis from granulome inguinale

in granulome inguinal ulcers doen't go without antibiotic

85

bug causing granulome inguinale

callymatobacterium granulomatis

86

other name for granulome inguinale

donovanose

87

cuase of chancroid

hemophilus ducreyi

88

screening test for syphilis

non treponemal test

89

quid of non treponemal test(2)

VDRL
RPR

90

confirmation test for syphilis

FTAabs

91

quid of FTA abs

treponemal serologic test

92

quid of dark field

method to identify T pallidum

93

indication of Tzanck smear(3)

to dx Herpes
CMV
varicella

94

quid of premature rupture of membrane PROM

leakage of amniotic fluid before onset of labor

95

immature lung assessment

ratio lecithin/sphingomyelin

96

PROM in 24 a 34 semaines next step?

corticosteroid

97

prom with contractions next step entre 24 a 24 semaines(2)

corticosteroid
plus
tocolysis

98

critical point to say yes we have immature lungs

99

when to give HPV vaccines(2)

all girls 9-26 ans regardless HPV status or sexual activity
boys 9-21 ans

100

when can you begin screening for cancer du col

21 yo

101

patient entre 21 a 29 ans screening for ca du col

cytology q 3 ans

102

patient entre 30 a 65 ans screening for ca du col(2)

cytology q 3 ans
cytologie plus HPV serology q 5 ans

103

screening of cervical cancer > 65 ans

no screening

104

screening of cervical cancer

no screening

105

patietn with hysterectomy when cervical cancer screening is indicated(2)

history of precancerous lesion cervical cancer
exposure to diethylstylbestrol

106

screening of ca du col in immunocompromised patient(2)

2 times aucours de la premiere annee
and then annualy

107

how to beginscreening of ca du col in immunocompromised patient

onset of sexual intercourse

108

dx test for chlamydia and gonorrhea

nucleic acid amplification

109

CAT if NAA is positive for chlamidial but not for gonorrhea

single dose of azythromycin

110

screening test for chlamydia

NAA

111

patietn at 9 semaines de gestation comes with nausea and worsening vomiting .what shuold be done

quantitative B HCG level

112

next step is b hcg is elevated

rule out gestationnal throphoblastic disease

113

quid of gestationnal trophoblastic disease(2)

mole hydatiforme
chorio carcinome

114

red flag for GTD

severe vomiting

115

triad of mole hydatiform(3)

enlarged uterus
hyperemesis
BHCG > 100 000

116

severe vomiting with normal BHCG

hyperemesis gravidarum

117

in the vignette patient is vomiting severely,amylase and lipase are high why

because they are from salivary gland

118

significance of mild increase of ALT/AST cause(4)

50% of hospitalised patient has increase
ALT,AST
lipase
bilirubin
amylase

119

HELLP SYNDROME patient TA at 130/80 is this possible

yes it's

120

quid of HELLP syndrome(4)

hemolysis
elevated liver enzymes
low platelet

121

cause of RUQ pain in HELLP syndrome

distension of liver capsule

122

how's ALP in pregnancy

elevated

123

pregnant woman with hemolysis,low platelet,increase liver enzymes 2 f de la normale and low platlet Dx

HELLP SYNDROME

124

Anemia in HELLP syndrome

hemolysis caused by microangiopathic anemia

125

clue for microangiopathic anemia

schistocytes

126

patient with HELPP syndrome develops difficulty breathing and decrease arterial oxygen saturation

pulmonary edema

127

what can cause pilmonary edema in preecclampsia(4)

decrease albumin
decreased renal function
endothelial damage causing increase permeability
congestive heart failure

128

cause of congestive heart failure in preecclampsia(2)

arterial vasospasm
increased vascular resistance----> decrease cardiac output

129

physiopatho of precclampsia

general arterial vasospasm leading to increased systemic vx resistance with increased cardiac afterload

130

why increased ventricular contraction in preecclampsia

because afterload is increased

131

clue for midcycle pain(3)

LLQ pain occcuring two weeks after menstruation
unilateral
no fever

132

other of midcycle pain

mittelschmerz

133

cause of fetal hydantoin syndrome(3)

phenytoin
carbamazepine
during pregnancy

134

clue for hydantoin syndrome

mid facial hypoplasia
microcephaly
cleft lip or palate
digital hypoplasia
hirsutism and developmental delay

135

body of hydantoin

small body

136

in USMLE intense uterine contraction and bleeding

painfull bleeding

137

cause of painfull bleeding

abruptio placentae

138

stable mother and fetus with abruptio placentae ,labor started next step

let the labor,icrease labor if necessary

139

indication of CS in abruptio placentae

rapid deterioration of mother and fetus

140

quid of placenta praevia

abnormal insertion of placenta causing internal cervica os to be partially or totally obstructed

141

painless third trimester bleeding

preavia

142

why lactation is not considered as a reliable form of contraception

ovulation can occur

143

contraptives method during lactation(4)

progestin
barrier methods
sterilisation
intrauterine devices

144

why progestin is the best method to use in lactating woman

because volume and composition of the milk does not change

145

risk with combination pills

risk of DVT

146

why amenorrhea during lactation

prolactin inhibits GNRH release from hypothalamus

147

clue for intrauterine fetal demise(2)

no mvt
no cardiac activities in fetus

148

best time to confirm intrauterine fetal demise

real time ultrasonogram

149

finding in real time sonogram in case of intrauterine fetal demise(2)

absence of fetal mvt
no cardiac activity

150

quid of fetal demise intra uterine

death of fetus occurring after 20 weeks and before onset of labor

151

next step after delivery of intra uterine fetal demise

autopsy of the fetus and placenta with permission of the parents

152

cause of intrauterine fetal demise(6)

hypertensive disorders
diabetes
placental and cord complication
congenital anomalies
TORCH
listeriosis

153

devant abruptio placenta first indicator to watch

TA

154

complication of abruptio placentae(2)

DIC
hemorrage

155

clue for ovarian torsion(4)

no fever or low grade fever
pain in lower abdomen
history of ovary cystic mass
can also have nausea and vomiting

156

risk factor for torsion(3)

pregnancy
ovulation induction
ovarian masses >5 cm

157

first to do devant lower abdominal pain in woman and why(2)

BHCG
to rule out ectopic

158

best to Dx torsion of ovary

ultra sonogram(pelvic colr doppler)

159

management of ovary torsion

detorsion laparoscopic

160

indication of salpin oophorectomy in ovary torsion(2)

necrosis of adnexae
suspected ovarian malignancy

161

complication of ovarian torsion(3)

peritonitis and sepsis
infertility and chronic pain
hemorrage

162

why right side torsion is more common(2)

because of lenght of tubo ovarian ligament
because of rectosigmoid occupies space around the left ovary

163

clue in sonogram for down

increase fetal nuchal fold lucency

164

best test to rule out down or chromosomal abnormality

chorionic villus sampling

165

when to perform chronic villus sampling

10 a 12 semaines

166

indication of chorionic villus sampling

any woman of > 35 ans pregnant

167

risk of chorionic villus sampling procedure(2)

fetal death
limb reduction defects

168

when you have the greatest risk for complication using chorionic villus sampling

before nine to 10 weeks

169

clue for vaginal candidiasis(2)

thick white discharge
cottage cheese appearrance

170

rx for vaginal candidiasis

oral fluconazole

171

image of pseudohyphae

image tankou ti branch bwa

172

pseudohyphae meaning

candidiasis

173

should you treat the partner in vaginal candidiasis

sometimes you have too

174

patietn with night sweats,insomnia,irregular menses middle aged woman dxs

hyperthyroidism
menopause

175

patietn with night sweats,insomnia,irregular menses middle aged woman test to perform(2)

FSH
LH

176

dx of septic abortion

ultrasonogram

177

echo finding in septic abortion(3)

thick endometrial stripe
echogenic material
increase vascularity

178

what will you see in echo

retained products of conception

179

rx of septic abortion(3)

curretage and succion
IV fluid and cultures
empiric antibio en attendant cultures

180

quid of septic abortion

medical emergency

181

fever after abortion

septic abortion

182

risk factor for abruptio(7)

maternal HTA
polyhydramnios
abdo trauma
prior placental abruptio
cocaine /tobacco use
chorio amniotitis
PROM

183

fond de contracture in USMLE

tender hypertonic uterus

184

why U/S in abruption(2)

to rule out preavia
not for DX

185

patient with involontary loss of urine after sneezing,laughing dx

stress incontinence

186

rx of stress incontinence

kegel exercices

187

failure for kegel exercices

urethropexy

188

quid of inevitable abortion or incomplete

dialted cervix with visible products of conception

189

next step in case of inevitable abortion(2)

iv fluids
succion curettage

190

abortion RH -

give rhogam

191

why you give rhigam in negative RH patient

to prevent formation of antibody from the mother

192

complication of abortion

hemorrage
sepsis
DIC

193

vaginal bleeding in mother G5 after de,ivery of a baby of 4.5 kg why bleeding

uterus atony

194

first cause of vaginal bleeding within 24 hours of delivery

uterine atony

195

rx of uterine atony

oxytocin infusion

196

general measure in post partum hemorrage(4)

fundal or bimanual massage
iv access plus uterotonic agent
crystalloid to keep TAsystolic > 90 mm de hg
notification of blood bank for packed red blood cells

197

risk for uterine atony(3)

hydraamnios
multiple gestation
increased parity

198

quid of uterine agent used in atony uterine(3)

oxytocin
methylergonovine
carboprost

199

patietn with morbid obesity with amenorrhea cause

anovulation cycle

200

how 's FSH LH in morbid obesity

normal level

201

quid of infertility

failure to conceive after 12 months of unprotcted sexual intercourse

202

first test to do in patient with infertility and proof of ovulation

hysterosalpingogram

203

cause of infertility in girl(4)

PID
endometriosis
DES exposure
congenital malformation

204

devant tout patietn devant infertility first question to ask

ask about PID

205

quid of severe preecclampsia(10)

TA 10/110 with one of the folllowing
oliguria
altered consciousness headche and scotoma
pulmonary edema
epigastric pain and cyanosis
significant thrombocytopenia
microangiopathic hemolysis
alterd liver function
increased creat
IUGR or oligoamnios

206

role of MGSO4 in pregnancy

prevent seizures

207

ten weeks of pregnancy with vaginal bleeding and lower abdominal pain ckue for complete abortion(3)

close cervix
vacant uterine cavity in US
contraction can subside

208

amenorrhea in female athletes causee

estrogen deficiency

209

consequence of estrogen deficiency in female athlete(4)

osteopenia
infertility
breast atrophy
vaginal atrophy

210

patietn in labor with sudden abdominal intense pain with vaginal bleeding and loss of fetal station

uterine rupture

211

red flag for uterine rupture

loss of fetal station

212

risk for uterine rupture(3)

uterine scar
abdominal trauma
ant de CS

213

physiologic for ovulation(3)

pulsatile GNRH from hypothalamus
release of LH and FSH by anrt pituitary gland
ovulation

214

clue for puberte precoce

7 yo girl with pubic and axillary hair

215

cause fo puberte precoce

early activation of hypothalamic pituatary ovarian axis

216

quid of precocious puberty(2)

secondary sex characteristics before 8 in girl
before 9 in boys

217

quid of peripheral precocious puberty

low FSH and LH level

218

cause of peripheral precocious puberty

gonadal or adrenal excess release of androgen

219

clue central precocious puberty

high FSH and LH

220

next step in patient with central precocious puberty

CT or MRI of the brain

221

rx of central precocious puberty

GNRH analog

222

the most prevalent preventable cause of fetal growth restriction

smoking cessation

223

the most common tumor in reproductive aged woman

leiyomyoma

224

dx test for myoma

US

225

symptom of leiyomyoma(3)

constipation
back pain
urinary retention or frequency

226

first step in intrauterine fetal demise

coagulation profile

227

why coagulation profile in intrauterine fetal demise

to rule out DIC

228

what can happen in intrauterine fetal demise

retention of deasdd fetus can cause chronic consumption coagulopathy

229

why coagulopathy in intrauterine fetal demise

release of thromboplastin from placenta into the maternal circulation

230

early indicator of intra uterine fetal demise(2)

low fibrinogen
low platelet

231

how s fibrinogen in pregnancy

high

232

fibrinogen in coagulopathy

160 mg/dl is considerd as low

233

whta to do in front of inttra uterine fetal demise

induce labor

234

risk for precocious puberty(2)

epiphyseal plate fusion
short stature

235

after amniotomy baby develops decrease of heart beat with late deceration ?

ruptured fetal ombilical vessel

236

clue for ruptured fetal ombilical vessel during amniotomy

tachycardia puis bradycardia to a sinusoidal pattern

237

during ruptured fetal ombilical vessel how to say the blood is not from the mother

by the APT test

238

rx of rupture fetal ombilical vessel

crash CS

239

quid of vasa preavia

fetal blood vessel traverse the lower segment between the baby and the internal cervical os

240

clue vasa preavia bleeding

normal vitals for mother during bleeding

241

in pregnant women when to consider urine culture positive

> 100 000 colonois forming unit/ml for a single organism

242

risk for asymptomatic bacteriuria

pyelonephritis

243

rx for bacteruiria asymptomatic(4)

amox
or ampicilllin
or nitrofurantoin
or cephalexin

244

complication of pyelonephritis(3)

low birth weight baby
septicemia
pretem babies

245

HTA in pregnant women

chronic HTA

246

hta in pregnant women

mole hydatiform
chronic HTA

247

why you can have hypokaliemia and hypernatremia in pregnant woman

because of hyperaldosteronism

248

risk in chronic HTA

abruptio placentae

249

abruption placenta risk for the mother

bleeding

250

abruption placenta risk for the baby

interruption of placental perfusion

251

SLE and abruptio placenta

lupus anticoagulant

252

most comon risk factor for abruptio

HTA

253

what if for any reason you dont want to perform an abortion what to do

refer the patient to another physician who can and will do it

254

when to give RHOGAM in RH - patient(2)

28 e semaines
after delivery

255

patient with history of abruptio placenta rh - develops antirh antibody what can cause that

low dose of antiglobulin in post partum

256

what 's rosette test in abruptio in rh -

determine the amount of fetal maternal transfusion

257

next step if rosette test is negative

give the standard dose of anti D immune globulin

258

rosette test positif next step

perform kleihauer betke stain or fetal red blood cell using flow cytometry

259

next step after kleihauer betke stain test

anti D immune globulin should be corrected accordingly

260

quid of preterm labor

labor occuring between 20 a 37 weeks of gestation
before 37 ,after 20 weeks

261

clue for good contractions during labor(2)

in labor 4 contractions q 20 mn or more
cervical changes

262

complication of preterm labor(5)

respiratory distress syndrome
intra ventricular hemorrage
sepsis
necrotizing enterocolitis
kernicterus

263

best thing to do in preterm labor(2)

tocolysis
corticosteroid pendant 48 h

264

in preterm labor what's the goal of tocloysis

ammener la grossessede 34 a 36 semaines of gestation

265

young woman with breast lump what to do

ask her to return shortky after menstrual period

266

young woman with breast lump ,regeression after menstrual period dx

it's benign

267

clue for kalman syndrome(3)

primary amenorrhea
absent of sexual characteristics
hypoosmia or anosmia

268

karyotype in kallman syndrome

46XX

269

what about internal organ in kallman

Normal

270

phenotype in kallman syndrome

girl

271

karyotype in klinefelter

47XXY

272

karyotype in turner

45X0

273

threatened abortion

any vaginal bleeding occuring before 20 semaines with a live fetusand closed cervix

274

standard care for threatened abortion(3)

reassurance
outpatient follow up
bed rest no sex

275

why bed rest and no sex during threatened abortion

to avoid guilt in parents

276

cause of anovulation in PCOS(2)

imbalance in FSH and LH
insulin resistance

277

tetrad of PCOS(4)

anovulation
androgen excess
male pattern growth
ovarian cyst

278

testicular feminisation syndrome karyotype

46 XY

279

testicular feminisation syndrome phenotype

girl

280

why absence of internal reproductive organ in testicular feminisation

presence of mullerian inhibiting factor(MIF)

281

why MIF is present

because testis are present and form MIF

282

role of MIF

prevent formation in internal organ in female in case of testiculer feminisation

283

rx of testicular feminisation(2)

gonadectomy in puberty
creation of neovagina

284

young girl with amenorrhea,hypoestrogenism,high gonadotrophin levels dx

primary ovarian failure

285

diseases associated with primary ovarian failure(5)

autoimmune disorder
hashimoto
addisson
diabete type 1
pernicious anemia

286

cause of premature destruction of follicles(4)

mumps
radiation
oophoritis
chemo

287

clue for rimary ovarian failure(2)

high FSH /LH
low estrogen

288

how to deal with infertility in patient with primary ovarian failure

in vitro fertilization with donor oocytes

289

symptom assciated with pathologic leucorrhea(3)

pruritus
burning
malodorous discharge

290

physical exam of pathologic leucorrhea(3)

erythema and edema
tenderness of cervix
green and curdlike vaginal discharge

291

quid of physiologic leucorrhea(4)

yellow or white
non malodorous
absence of associated symptom
normal physical exam

292

clue for bacterial vaginosis(4) AMSEL criteria

thin gray white vaginal discharge
vaginal PH>4,5
positive whift test upon addition of KOH to the vaginal discharge
clue cells

293

quid of clue cells

vaginal epithelial cell with adherent cocobaccilus on wet mount

294

KOH test

amine like odor (fishy) when KOH is added to vaginal discharge

295

AMSEL criteria to dx vagise bacterienne

3 sur 4

296

patient taking OCP complaining of weight gain what to say

reassure the patient that the weight gain is not related to oral contraceptives pills

297

why oCP is no longer associated to weight gain

because new OCP are lower dosed

298

most common side effect of combined OCP

breakthrough bleeding

299

side effect of combined oCP(6)

HTA
increased risk cervical ca
DVT
amenorrhea
high triglycerides
hepatic adenoma

300

advantage of combined OCP

lower risk of endometrial and ovarian cancer

301

chronic HTA in pregnancy rx(2)

labetalol
@ methyl dopa

302

ACE and ARB s in pregnancy(2)

teratogenic
fetal kidneys damage

303

after amniocentesis patient develops sudden respiratory failure seizures ,purpuric rash cardiogenic

amniotic fluid embolism

304

next step after amniotic fluid embolism(2)

intubation
mechanical ventilation

305

meaning of purpura in amniotic fluid embolism

DIC is developing

306

test to confirm premature rupture of membranes(3)

positive nitrazine test
positive pooling tes
positive ferning test

307

first thing to do in case of PROM

give PNC

308

Why PNC in GBM

to prevent GBS infection

309

indication of GBS prophylaxis(5)

delivery ou egal a 18 h
GBS bacteriuria during current pregnancy
prior GBS sepsis during delivery
GBS status unknown

310

drugs used in GBS prophylaxis(4)

ampicillin
cephazolin
clindamycin
vancomycin

311

clue for lichen sclerosis(2)

vulvar itching in elderly
dicomfort

312

quid of porcelain white atrophy

vulvar skin thin dry white in color

313

next step in front of lichen sclerosis

vulvar punch biopsy

314

risk in lichen sclerosis

vulvar squamous cell carcinoma

315

first line rx in lichen sclerosis

high potency topical steroids

316

normal fibrinogen

150-450

317

risk of DIC in intra uterine fetal demise

low fibrinogen

318

quid of abortion(2)

fetal demise before 20 weeks or
fetus weight

319

what to do in fetal demise in patietnwith fibrinogen 480

discuss the need for delivery and review options of vaginal/CS

320

thyroid pattern in pregnant woman(2)

increase total T4,T3
normal TSH

321

how's TBG in pregnancy

high

322

how are free T3 T4 TSH IN PREGNANCY

normal

323

incontinence in woman after C/S

epidural anesthesia
causing bladder denervation

324

why urinary incontinence after epidural anesthesia(4)

patient is unable to feel full bladder
when bladder overdistends,bladder pressure becomes > to uretral pressure
patient voids unvoluntary until pressure equalizes

325

rx of incontinence after CS

intermittent catherisation

326

clue for endometriosis(4)

chronic pelvic pain
dyspareunia
infertility
bladder or bowel problems

327

characteristic of pain in endometriosis

worse with menses

328

complication of endometriosis(2)

bowel bladder obstruction
rupture of endometrioma or torsion

329

dx or rx of endometriosis

laparoscopy

330

indication of laparoscopic rx in endometriosis(2)

complicated case
failure with medical rx

331

medical rx of endometriosis

NSAIDS plus combined OCP

332

next step if first line medical rx fails in rx of endometriosis(3)

progestin
plus
GNRH agonist
plus addback therapy

333

3 D of endometriosis

dyspareunia
dysmenorrhea
dyschezia

334

dyschezia quid

pain during defecation

335

complication of endometriosis

infertility 30 %

336

goal in rx endometriosis

suppress ovulation

337

quid of progestin

medroxyprogesterone acetate

338

indication of surgery in endometriosis(7)

symptom intolerable ou refractaire a medical rx
severe incapacitating pain
need to exclude malignancy or adnexal mass
need fertility rx
evidence of complication
contrindication of medical rx
need definitive dx of endometriosis

339

clue for endometrial hyperplasia(2)

intermenstrual bleeding
heavy menses

340

Dx of endometrial hyperplasia

biopsy

341

type of endometrial hyperplasia(4)

simple
complex
simple atypical
complex atypical

342

risk to progress to endometrial cancer in simple endometrial hyperplasia

1%

343

risk to progress to endometrial cancer in complex endometrial hyperplasia

3 %

344

risk to progress to endometrial cancer in simple atypical endometrial hyperplasia

8 %

345

risk to progress to endometrial cancer in complex atypical endometrial hyperplasia

29%

346

rx of simple or complex without atypia

cyclic progestins

347

rx of complex hyperplasia atypia

hysterectomy

348

med contraindicated in hyperplasia de l'endometre and why?(2)

estrogen
it will agravate the case

349

chronic pelvic pain low sacral back pain worse during menses dx a eliminer

endometriosis

350

how's sonogram in endometriosis

can be normal

351

physical exam in endometriosis(2)

pain uterus motion with finger
patient will experience rectovaginal tenderness

352

gold standard to DX endometriosis

laparoscopy

353

woman in labor with active genital herpes

immediate C section

354

why woman with active genital herpes should undergo CS

risk of neonatal HSV

355

post partum woman with breast pain

breast engorgement

356

rx of breast engorgement(2)

cool compresses
acetaminophen and NSAIDS

357

peak for breast engorgement(2)

3 a 5 jours
beginning 24 a 72 h

358

quid of endometriosis

endometrial and stromial tissue outside uterus

359

most common affected site for endometriosis(4)

ovary
peritoneal surfaces of the cul de sac
broad and uterosacral ligaments
rectovaginal septum

360

patient with chronic infertility ,pelvic pain and mass in the left adnexae

endometriosis

361

indication of surgery in placentae praevia(2)

unstable mother with vital signs
unreassuring fetal haert rates

362

patient with SLE develops acne why(2)

prednisone taking
steroid induced folliculitis

363

clue for acne in steroid

no comedones

364

early decelerations quid?

peak of contraction postive deflection corresponds to valley (nadir)in heart deceleration

365

cause of early deceleration(2)

fetal head compression
or could be normal

366

quid of late deceleration

nadir of deceleration (negative deflection) occurs after uterine contraction (positive deflection)

367

cause of late decelration

uteroplacental insufficiency

368

quid of variable deceleration

can be or not associated with contraction

369

cause of variable deceleration(3)

cord compression
oligoamnios
cord proplapse

370

management of reccurent variable decelerations(3)

change maternal position
o2 administration
rescucitative measures

371

after motor vehicle accident patient of 34 weeks come with hypotension and late deceleration of the baby dx

uterine rupture

372

in uterine rupture type of deceleration

late deceleration

373

patient with schizophrenia develops milk in why

risperidone taking

374

action of risperidone

dopamine and serotonin antagonist

375

urinalysis in pregnant woman develops > 100 000 bacteria

bacteriuria asymptomatic

376

first line rx of asymptomatic bacteriuria(2)

nitrofurantoin for 7 days
or
amox
or
cephalosporin first generation

377

bug in cause of aymptomatic bacteriuria

E coli

378

work up of adrenal mass(2)

US
ca-125 antigen

379

suspicscious failure in US(4)

mass > 10 cm
nodular or pelvic fixed mass
ascites
metastasis

380

when rx conservatively(3)

simple cyst in sonogram
normal ca 125
mass

381

patient on lithium for bipolar disorder and isotretinoin becomes pregnant(2)

stop isotretinoin
wean lithium

382

why wean lithium in case of pregnancy

you should slow taper lithium to prevent relapse

383

congenital anomaly associated with lithium

ebstein anomaly

384

congenital anomaly associated with isotretinoin(3)

craniofacial dysmorphism
heart defect
deafness

385

what to do if you plan to begin isotretinoin in reproductive age(2)

use contraception at least one month before beginning
pregnancy test befor rx

386

could we use inhaled steroid in pregnancy

yes

387

false labor when it occurs

in the late 4-8 weeks of pregnancy

388

clue for false labor(2)

no cervical changes during pregnancy
relieved by sedation

389

rx for false labor

nothing

390

low grade fever following 24 h post partum and high leucocytes(2)

it's normal
reassurrance

391

lochia in post partum rubra(2)

first few days
rouge

392

lochia in post partum serosa (2)

3 a 4 jours
pale

393

lochia in post partum alba

white or yellow

394

foul smelling lochia

endometritis

395

why evaluation of mucus should be part of infertility work up

because hostile cervical mucous can dialoow penetration of spermato into uterus

396

normal aspect of cervical mucus during ovulation(4)

profuse
clear and thin
stretch approximately 6 cm
exhibit fening on microscopic slide smear preparation

397

35 young patietn with dyspareunia and tense vagina dx

vagisnismus

398

rx of vagisnismus(3)

kegel exercice
gradual dilation with finger
relaxation

399

preecclampsia and SLE(3)

both has HTA
both proteinuria
edema

400

clue for glomerulonephritis in SLE during pregnancy(4)

massive proteinuria 8g 24 h
RB cast
malar rash
ANA +

401

could pregnancy cause ANA positive

yes

402

quid of malar rash

macular eruptions on the cheek bones

403

premature ovarian failure clue(2)

high FSH LH
FSH/LH>1

404

Cause amenorrhea(3)

ovarian failure
turner
fragile x syndrome

405

in premature ovarian failure the greatest elevation LH or FSH

FSH

406

Dx of confirmation of pramature ovarian failure

elevation of FSH in the setting of more than 3 months of amenorrhea in a woman under 40 ans

407

symmetrical pitting edema in pregnant woman with normal TA next step(2)

reassurrance
normal follow up

408

patietn at 36 weeks seen with increased abdominal pain and bleeding clue for abruptio placenta

firm and tender uterus

409

why contraction in AP

blood seems to have uterotonic action

410

can you have absence of vaginal bleeding in AP

if you have a retroplacental hemmorage dans 20% des cas

411

VEAL IN deceleration(4)

variable
early
accelerated
late

412

cause of deceleration CHO=VEAL(4)

Cord compression or prolapse,oligoamnios=V
head compession =E
okay= accelerated
Placental insufficiency=late deceleration

413

two types of bleeding in AP(2)

concealed
visible

414

masculinisation in pregnant mother resolving after delivery

aromatase deficiency in baby

415

why masculinisation certain pregnant women

placenta is unable to make estrogen in utero

416

clue for aromatase deficiency(4)

absent estrogen
increasd testosterone and estrogen
increase LH and FSH
polycystic avaries

417

genital organs in patietn with aromatase deficiency(2)

normal internal organs
cliteromegaly(ambiguous)

418

dx of aromatase deficiency(2)

high FSH LH
low estrogen

419

PID coplicated with vomiting next step(2)

hospitalize the patient
give cefotaxin and dox

420

genital organs in patietn with aromatase deficiency(2)

normal internal organs
cliteromegaly(ambiguous)

421

dx of aromatase deficiency(2)

high FSH LH
low estrogen

422

PID coplicated with vomiting next step(2)

hospitalize the patient
give cefotaxin and dox

423

complication of PID(5)

tubo ovarian abcess
abcess rupture
pelvic peritonitis
sepsis
infertility

424

outpatient rx of PID(2)

ceftriaxone or cefoxitin
plus
dox

425

cause of PID(3)

neisseria gonerrhea
chlanydia
genital mycoplasma

426

poor surgical candidate with tumor size

radiation

427

rx of squamous cell carcinoma of vagima stage 1 et 2 with no metastasis or extension to pelvic wall size

surgical excision

428

rx of squamous cell carcinoma of vagima stage 1 et 2 with no metastasis or extension to pelvic wall size > 2cm

radiation

429

first step in patient with secondary amenorhea

BHCG

430

secondary amenorhee with negative BHCG and high testoterone

PCOS

431

why TSH in secondary amenorrhea

to rule out hypothyroidism

432

secondary amenorhee with negative BHCG and high TSH and low t4

hypothyroidism

433

next step in Secondary amenorrhea with high prolactin(3)

check TSH
check medication
check creat

434

next step in Secondary amenorrhea with high prolactin with normal TSH ,no history of medication and normal creat

MRI of the brain

435

clue for asherman syndrome(2)

intrautrauterine adhesions
secondary amenorrhea

436

dx for asherman syndrome(2)

hysteroscopy
or
hysterosalpingography

437

patietn seen with no fetal mvts next step

profile biophysique

438

patient with solid ovarian mass during pregnancy

all ovarian masses are malignant except during pregnancy

439

during pregnancy patient develops facial hair and acne next step

ultrasonogram

440

sonogram shows bilateral adrenal masses in pregnant woman with facial hair and acne dx

luteoma

441

next step in dx of luteoma during pregnancy(2)

reassurrance
follow up with U/S

442

people at risk for luteoma(2)

african american
30's 40's

443

grand mal seizures in pregnancy

ecclampsia

444

stable patietn with preeclampsia 37 semaines de grossese

induction labor

445

management of ecclampsia(4)

prevent ,maternal hypoxia and trauma
prevent seizures with MGSO4
prevent stroke using labetalol or hydralazine
delivery by induction of labor or CS

446

acid base status in pregnancy(3)

respiratory alkalosis
low co2 pressure
high o2 pressure

447

why respiratory alkalosis in pregnancy(3)

progesterone stimulates respiratory center in the brain and causes hyperventilation
increase minute ventilation
increase volume tidal

448

why HCO3 is low during pregnancy

to compensate metabolic alkalosis

449

patietn having serial ablation after LEEP what could be the greatest complication

cervical insufficiency

450

risk factir for cervical insufficiency(6)

cone bioopsy
DES exposure
multiple gestation
mullerian anomalies
preterm birth
second trimester pregnancy loss

451

best test to Dx cervical insufficiency

transvaginal US

452

quid of short cervix(2)

cervical lenght below the 10 th percentile for gestationnal age
cervical lenght less than 25 mm at gestationnal age 23-28 weeks

453

premenstrual syndrome

symptoms occuring 1-2 weeks before menses and regress around the time of menstrual flow

454

Symptom of premenstrual syndrome(4)PMS

bloating
headaches
breast tenderness anxiety
mood disturbance

455

what to do when tyou suspect premenstrial syndrome

menstrual diary for 2 a 3 months to see exact time of symptom appearance

456

quid premenstrual dysphoric syndrome(2)

variant of PMS
irritability and anger predomines

457

rx of PMS

SSRI fluoxetine first line

458

quid of sheehan syndrome(3)

hemmorage of post partum
problem of lactation
anterior hypophyse necrosis

459

clue trichomonas vaginalis

PH 5.0-6,0

460

consequence of sheehan syndrome

prolactin deficiency

461

microscopy in Trichomonas vaginitis

flagellated motile norganisms

462

difference between trichomonas vaginalis and vaginose bacterienne

vaginose bacterienne does not cause inflammation

463

exam image of choice to detect gynecologic tumor

pelvic U/S

464

quid of pretem labor

occuring

465

quid of labor(2)

uterine contraction at a rate of 4 per 2o mn or more
cervical changes

466

what the goal in term of preterm labor

reach 34 36 semaines

467

what to in preterm labor(2)

bed rest
tocolysis

468

different types of abortion(5)

missed
inevitable
incomplete
threatened
septic

469

quid of missed abortion(2)

light vaginal bleeding
pregnancy symptom can become prominent

470

best test to dx missed abortion(2)

US
non viable fetus

471

quid inevitable abortion(2)

vaginal bleeding and open cervix
US fetus with possible heart beat

472

incomplete abortion (3)

vaginal bleeding with passage of large clots
cervix open
US products of conception often in cervix

473

threatened abortion(2)

vaginal bleeding with close cervix
US viable pregnancy

474

septic abortions(3)

sign of sepsis
cervix open
US retained products of conception

475

# 1 cause of septic abortion(2)

induced abortion
spontaneous rarely causes sepsis

476

best test to dx abortion

US pelvic

477

3 ways to rx missed abortion(3)

abortion
medical using prostaglandin
expectant management

478

patient with vaginal bleeding last menstrual period 5 weeks ago BHCH 1000 next step

repeat BHCG in 48 hours

479

postive pregnancy test but no evidence of intra uterine or extrauterine pregnancy dx (3)

ectopic
nonviable intrauterine pregnancy
early viable pregnancy

480

when will you see fetus in pelvic U/S

BHCG 1500-2000 ml

481

in the vignette why repeat HCG in 48 h

because in case of viable pregnancy BHCG will double as the opposite of ectopic or complete abortion

482

early pregnancy with spotting trans abdomen US negative next step

transvaginal US

483

when can you gestationnal sac in trans abdominal US

when BHCG is greater than 6500

484

when can you gestationnal sac in trans vaginal US

a partir de 1500

485

patient with spotting and intra uterine sac in transvaginal US dx

no ectopic

486

adnexial sac or no sac intra uterine in transvaginal US

ectopic

487

patient with spotting and transvaginal US douteux

serial BHCG measurement

488

tendancy for BHCG

doubles every 48 h

489

when to perform transvaginal US in pregnancy

when BHCG 1500-6500

490

next step in decreaser of fetal mvts perceived by mother

nonstress test

491

normal non stress test

in 20 mn you have at least 2 accelerations of the fetal heart rate of at least 15 beats/mn above the baseline and lasts at least 15 s each

492

abnormal NST

493

most common cause of non reactive stress test

fetal sleep cycle

494

post menopausal women with vaginal dryness burning and dysuria and dyspareunia

atrophic vaginitis

495

rx of atrophic vaginitis

vaginal estrogen replacement

496

what to do if you suspect atrophic vaginitis

rule out UTI

497

mild atrophic vaginitis rx(2)

moisturizers
lubricants

498

moderate to severe atrophic vaginitis rx

low dose of vaginal estrogen

499

clue for ruptured ectopic pregnancy(3)

diffuse abdominal pain
cervical and adrenal tenderness
hypotension

500

differenciation between PID and ectopic pregnancy ruptured

no hypotension in PID

501

risk for ectopic(6)

tubal pathology
tubal surgery
current IVD
PID
multiple partners
DES and infertility rx

502

dx of ectopic pregnancy ruptured(2)

transvaginal US
BHCG

503

image in trans vaginal US in ectopic pregnancy(2)

adrenal mass
free intraperitoneal fluid

504

cause of cervical motion tenderness(2)

ectopic
PID

505

Med rx of ectopic

metotrexate

506

dx ddifferentiel of acute pelvic pain(5)

Mittelscmerz syndrome
ectopic
ovarian torsion
ruptured ovarian cyst
PID

507

US in ovarian torsion(2)

enlarged ovary
decreased flow in ovary

508

risk factor for ovarian ruptured cyst

strenous or sexual activity

509

US in ovarian ruptured cyst

free fluid near ovarian cyst

510

clue of ruptured ovarian cyst in vignette

cystic ovarian mass with a moderate amount of free fluid

511

how to measure blood flow in ovary

doppler velocitometry

512

importance of transvaginal US in PID

to rule out tuboovarian abcess

513

free fluid in the context of pelvic pain in US

ruptured ovarian cyst

514

major side effect of low dose combination pills

worsening HTA

515

associated risk with estrogen progestin combined rx(4)

DVT
HTA
Hepatic adenoma
stroke and MI

516

woman with uncontrolled HTA end organ damage ,smoker and 35 ans ou plus wants a contraceptive method

no estrogen in contraception

517

best benefit of OCP's(2)

reduced risk of endometrial cancer
reduced risk of ovarian cancer

518

risk # 1 for tamoxifen

endometrial carcinoma

519

quid of tamoxifen

selective receptor estrogen modulator

520

action of tamoxifen

agonist of estrogen receptors in the breast

521

why tamoxifen is used in the rx of breast cancer

it's an agonist of estrogen receptors in the breast

522

quid of early deceleration

contraction of uterus =positive deflection
occurs at the same time as negative deflection( deceleration)

523

what to do before giving MMR vaccine

test for immunity with IGG antibody titers

524

what to do after receiving varicella and MMR

avoid contraception for at least 4 weeks after the vaccination

525

vaccine you can give during pregnancy(5)

MMR
Varicella
smallpox
HPV
live attenuated intra nasal influenza vaccines

526

can you give Hep B during pregnancy

yes

527

when to give pneumococcus during pregnancy

2 et 3 e trimestre

528

can you give Hi flu during pregnancy

yes in asplenic patient

529

routine vaccines in pregnancy(2)

TDAp
inactivated influenza vaccines

530

patient with bilateral pale grey discharge

galactorrhea

531

quid of galactorrhea

lactation in women who are breastfeeding or in men

532

clue for physiologic galactorrhea

it's bilateral

533

clue for pathologic galactorrhea(2)

unilateral
breast cancer

534

color of galactorrhea(4)

white green
gray
yellow
brown

535

most common cause of physiologic galactorrhea

hyperprolactinemia

536

cause of hyperprolactinemia(7)

prolactinoma
risperidone
opiods
hypothyroidism
pregnancy
oral contraceptive pills
chest wall or nipple stimulation

537

cause of chest wall stimulation(3)

surgery
trauma
shingles

538

first test to do in galactorrhea

guaic test in fluid from breast

539

first test to do if galactorhhea is non bloody and bilateral(3)

serum prolactin
TSH
brain MRI

540

galactorrhea and palpable mass in the breast(3)

mammogram
US of breast
surgical evaluation

541

investigation of breast mass

mammogram
US of breast
surgical evaluation

542

indication to investigate breast mass in galactorhea

unilateral galactorrhea
bloody galactorrhea

543

patient with history of formula feeding of baby after hemorragic delivery

sheehan syndrome

544

physiopatho of sheehan syndrome

ischemic necrosis

545

hypopituitarism in post partum(2)

sheehan syndrome
lynphocytic hypophysitis

546

can you have insipidus diabetes in sheehan

it's uncommon

547

clue for hypopituitarism(2)

hypogonadism
hypothyroidism

548

rx of asymptomatic bacteriuria in pregnancy(4)

nitrofurantoin
amox
augmentin
cephalexin

549

antibio contrindicated in pregnancy(3)

cyclines
fluoroquinolones
TMS

550

what to do in rx of hypothyroidism in pregnancy

increase levothyroxin dose

551

when to check TSH in pregnancy

every 2-3 months

552

first prenatal visit what to ask(13)

cervical cytology
rhesus and antibody screening
HMG,MCV
rubella immunity
varicella immunity
urine culture
hiv
syphilis
hep B
chlamydia
influenza vaccine during flu season
genetic screening of cystic fibrosis
down testing syndrome

553

when can you give influenza in pregnancy

n'importe quand

554

test to ask in specifci risk in pregnancy(5)

lead level
TB
HB electrophoresis if MCV

555

when to ask thyroid fuction test in pregnancy(2)

if symptomatic
or associated conditions like diabetes

556

pregnant woman with paresthesia in hand

carpal tunnel syndrome

557

why carpal tunnel syndrome in pregnancy

because estrogen mediates depolarisation of ground substance causing hand edema

558

rx of carpal tunnel syndrome in pregnancy(2)

wrist splinting
put the wrist in neutral position and NSAIDS

559

failure with wrist splinting during carpal tunnel syndrome

local corticosteroid

560

rx of carpal tunnel syndrome when conservative disorder fails

surgical decompression

561

pregnant woman with increased pruritus soles and palms and increased transaminases and elevated bile salts dx

intra hepatic cholestasis of pregnancy

562

pregnant woman with RUQ pain with hemolysis low platelet and moderately high transaminase

HELLP syndrome

563

pregnant woman with hypoglycemia,RUQ pain elevated blirubin mildly elevated transaminase elevated bilirubin and possible DIC in 3 e trimestre

acute fatty liver disease of pregnancy

564

complication of acute fatty liver disease

liver failure

565

red papules with striae in the periombilical region in 3e trimestre > ou egal a 25 ans

pruritic urticarial papules and plaques of pregnancy

566

quid of ASC-VS

atypical squamous cell of undetermined significance

567

how can you dx ASC-VS

pap test

568

next step if you found it ASC-VS in pap test in woman > ou egal a 25 ans

HPV serology

569

HPV+ plus ASC-VS next step in woman > ou egal a 25 ans

colposcopy

570

HPV- plus ASC-VS next step

repeat pap test and HPV in 3 years

571

ASC-VS in woman 21-24 years old or LSIL

repeat pap smear in 1 year

572

young woman in AFIB and pulmonary edema dx causal

mitral stenosis

573

why mitral stenosis can become worse during pregnancy

increased blood flow

574

risk factor for mitral stenosis

strep pyogenes infection

575

G2 patient with RH - next step

RH D abtibody testing

576

when to perform RH antibody testing(2)

first visit
repeat at 24-28 semaines

577

first visit of rh- mother(2)

rh typing
antibody with RHD

578

if alloimmunization is noted next step(2)

anti immune globulin at 28 semaines
at delivery