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Flashcards in OBGYN Deck (578)
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1
Q

clue for PCOS(3)

A

acne
irregular mentrual period
hirsutism

2
Q

what hormone is high in PCOS(2)

A

testosterone

high LH/FSH ratio

3
Q

problem in PCOS causing hyperglycemia(2)

A

abnormal glucose metabolism

impaired glucose tolerance

4
Q

rx of PCOS(4)

A
oral contraceptive
or
citrate d eclomiphen
antidrogen
metformin if impaired glucose tolerance
5
Q

advantages of metformin in PCOS(4)

A

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

6
Q

normal biophysical profile

A

8-10

7
Q

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

A

delivery should be considered

8
Q

biophysical profile 6 with no oligoamnios fetus a

A

repeat BP in 24 hours

if the same delivery

9
Q

biophysical profile 6 with no oligoamnios fetus a > 37

A

delivery

10
Q

biophysical profile

A

daily monitoring

11
Q

biophysical profile 32 s

A

delivery

12
Q

what to do if BP =4 or less

A

delivery if fetus > 26 weeks of gestation

13
Q

meaning of BPP less than 2

A

fetal asphyxia

14
Q

how to assess BP

A

sonography

15
Q

elements of BP(5)

A
NST 
fetal tone
fetal movement
fetal brathing mvt
amniotic fluid volume
16
Q

NST normal

A

active

17
Q

fetal tone evaluation(2)

A

extension
or
flexion

18
Q

fetal mvts

A

at least 2 mvts in 30 mn

19
Q

fetal breathing mvts

A

at least last 20 seconds in 30 mn

20
Q

quid of amniotic fluid volume

A

single pocket more than 2 cm in vertical axis

21
Q

abnormal uterine bleeding with negative pregnancy test in young female

A

ovulation dysfunction

22
Q

cause of ovulation dysfunction in young girl

A

immature hypothalamic pituitary ovarian axis

23
Q

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

A

test de grossesse

test for blood coagulation

24
Q

first line rx in ovulation dysfunction

A

oral estrogen

25
Q

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

A

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

26
Q

quid of tranexamic acid

A

antifibrinolytic used when there is contraindication with estrogen and progesterone

27
Q

syphylis positive in pregnant women with PNC allergy next step

A

PNC desensitization

28
Q

how to desensitize a patientfor PNC allergy

A

using incremental dose of PNC

29
Q

first step in PNC allergy

A

confirm the allergy by skin testing

30
Q

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

A

allow spontaneous vaginal delivery

31
Q

when to alllow premature labor(3)

A

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

32
Q

how’s BUN and creatinine in pregnancy

A

low

33
Q

why BUN and creatinine in pregnancy(2)

A

increase of renal plasma flow
and
glomerular filtration rate

34
Q

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

A

always choose the values with low creat and low BUN

35
Q

physical exam in pelvic floor weakness(2)

A

cystocele

uterine prolapse

36
Q

passage of urine when sneezing or coughing

A

stress incontinence

37
Q

cause of stress incontinence

A

pelvic floor mx weaakness

38
Q

raik factor for stress incontinence(2)

A

high parity

older woman

39
Q

work up in stress incontinence(3)

A

urine analysis
cystometry
post void residual volume

40
Q

clue for bacterial vaginosis

A

pear shaped motile organism on wet mount

41
Q

rx of bacterial vaginosis

A

metro

42
Q

what habit must be prohibited during the rx of bacterial vaginosis

A

alcohol use

43
Q

quid of disulfuram effect(4)

A

flushing
nausea
hypotension
vomiting

44
Q

physiopatho of disulfuram effect

A

accumulation of acetaldehyde in blood stream

45
Q

next step in HGSIL

A

colposcopy

46
Q

what to do if coposcopy shows no suspicious area

A

biopsies are not required

47
Q

what to do in suspicious areasin colposcopy

A

biopsy

48
Q

finding in colposcopy plus biopsy

A

CIN 1
CIN 2
CIN 3

49
Q

quid of cIN

A

cervical intraepithelial neoplasia

50
Q

pregnant woman with HGSIL

A

repeat the pap test and colposcopy after the delivery

51
Q

why repeat the pap test and colposcopy after the delivery

A

because CIN2 et 3 and hGSIL will regress spontaneously after pregnancy

52
Q

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

A

for lesion suggestive of invasive cancer

53
Q

patient > ou egal 25 ans with HGSIL next step

A

colposcopy or loop surgical excision if no pregnancy or post menopause

54
Q

patient 21-24 ans with HGSIL

A

colposcopy

55
Q

colposcopy and biosy showing CIN 2 et 3 next step

A

manage en fonction de guidelines

56
Q

colposcopy and biopsy with no CIN2 et 3

A

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

57
Q

clue for turner(2)

A

short stature

coarctation of the aorta

58
Q

why patient with TURNER has late menstruations

A

poor ovarian function

59
Q

hormone increased in Turner and why?(2)

A

FSH

due to lack of negative feedback

60
Q

painless bleeding in pregnant women third trimester

A

placenta praevia

61
Q

dx of placenta preavia

A

ultrasonogram

62
Q

patient with vaginal bleeding what to not do?

A

pelvic examination(toucher vaginal)

63
Q

placenta praevia with stable mother and fetus a 37 semaines

A

schedule CS

64
Q

placenta praevia with stable mother and fetus

A

amniocenthesis to assess lung maturity

65
Q

placenta praevia with stable mother and fetus

A

elective CS

66
Q

unstable mother and baby in palcenta praevia

A

elective CS

67
Q

how to assess baby stability

A

if non stress test is reactive and reassuring

68
Q

clue for androgen insensitivity syndrome(4)

A

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

69
Q

karyoptype in androgen insensitivity syndrome

A

46 xy

70
Q

phenotype of androgen insensitivity syndrome(AIS)

A

female with blind vaginal pouch

71
Q

other name of IAS

A

Male pseudohermaphrodism

72
Q

risk in AIS

A

testicular carcinoma

73
Q

why AIS patietn has breast

A

because testo is converted to estrogen

74
Q

what patient AIS dont have

A

mullerian structures

75
Q

quid of mullerian structures(2)

A

uterus

fallopian tubes

76
Q

cause of AIS

A

mutation in androgen receptor gene

77
Q

consequence of mutation in AIS

A

peripheral tissue become unresponsive to androgens

78
Q

risk in PCOS

A

endometrial carcinoma

79
Q

cyst important to see in dx PCOS(2)

A

no

cwith only symptom you can have the dx

80
Q

why patient with PCOS has difficulty having kid

A

anovulation cycle

81
Q

cause of ENDOMETRIAL CARCINOMA in PCOS

A

unbalanced estrogen

82
Q

painless genital ulcer(2)

A

syphylis

granulome inguinale

83
Q

painfull ulcer(2)

A

chancroid

herpes

84
Q

differentiate syphilis from granulome inguinale

A

in granulome inguinal ulcers doen’t go without antibiotic

85
Q

bug causing granulome inguinale

A

callymatobacterium granulomatis

86
Q

other name for granulome inguinale

A

donovanose

87
Q

cuase of chancroid

A

hemophilus ducreyi

88
Q

screening test for syphilis

A

non treponemal test

89
Q

quid of non treponemal test(2)

A

VDRL

RPR

90
Q

confirmation test for syphilis

A

FTAabs

91
Q

quid of FTA abs

A

treponemal serologic test

92
Q

quid of dark field

A

method to identify T pallidum

93
Q

indication of Tzanck smear(3)

A

to dx Herpes
CMV
varicella

94
Q

quid of premature rupture of membrane PROM

A

leakage of amniotic fluid before onset of labor

95
Q

immature lung assessment

A

ratio lecithin/sphingomyelin

96
Q

PROM in 24 a 34 semaines next step?

A

corticosteroid

97
Q

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

A

corticosteroid
plus
tocolysis

98
Q

critical point to say yes we have immature lungs

A
99
Q

when to give HPV vaccines(2)

A

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

boys 9-21 ans

100
Q

when can you begin screening for cancer du col

A

21 yo

101
Q

patient entre 21 a 29 ans screening for ca du col

A

cytology q 3 ans

102
Q

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

A

cytology q 3 ans

cytologie plus HPV serology q 5 ans

103
Q

screening of cervical cancer > 65 ans

A

no screening

104
Q

screening of cervical cancer

A

no screening

105
Q

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

A

history of precancerous lesion cervical cancer

exposure to diethylstylbestrol

106
Q

screening of ca du col in immunocompromised patient(2)

A

2 times aucours de la premiere annee

and then annualy

107
Q

how to beginscreening of ca du col in immunocompromised patient

A

onset of sexual intercourse

108
Q

dx test for chlamydia and gonorrhea

A

nucleic acid amplification

109
Q

CAT if NAA is positive for chlamidial but not for gonorrhea

A

single dose of azythromycin

110
Q

screening test for chlamydia

A

NAA

111
Q

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

A

quantitative B HCG level

112
Q

next step is b hcg is elevated

A

rule out gestationnal throphoblastic disease

113
Q

quid of gestationnal trophoblastic disease(2)

A

mole hydatiforme

chorio carcinome

114
Q

red flag for GTD

A

severe vomiting

115
Q

triad of mole hydatiform(3)

A

enlarged uterus
hyperemesis
BHCG > 100 000

116
Q

severe vomiting with normal BHCG

A

hyperemesis gravidarum

117
Q

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

A

because they are from salivary gland

118
Q

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

A
50% of hospitalised patient has increase 
ALT,AST
lipase 
bilirubin
amylase
119
Q

HELLP SYNDROME patient TA at 130/80 is this possible

A

yes it’s

120
Q

quid of HELLP syndrome(4)

A

hemolysis
elevated liver enzymes
low platelet

121
Q

cause of RUQ pain in HELLP syndrome

A

distension of liver capsule

122
Q

how’s ALP in pregnancy

A

elevated

123
Q

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

A

HELLP SYNDROME

124
Q

Anemia in HELLP syndrome

A

hemolysis caused by microangiopathic anemia

125
Q

clue for microangiopathic anemia

A

schistocytes

126
Q

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

A

pulmonary edema

127
Q

what can cause pilmonary edema in preecclampsia(4)

A

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

128
Q

cause of congestive heart failure in preecclampsia(2)

A

arterial vasospasm

increased vascular resistance—-> decrease cardiac output

129
Q

physiopatho of precclampsia

A

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

130
Q

why increased ventricular contraction in preecclampsia

A

because afterload is increased

131
Q

clue for midcycle pain(3)

A

LLQ pain occcuring two weeks after menstruation
unilateral
no fever

132
Q

other of midcycle pain

A

mittelschmerz

133
Q

cause of fetal hydantoin syndrome(3)

A

phenytoin
carbamazepine
during pregnancy

134
Q

clue for hydantoin syndrome

A
mid facial hypoplasia
microcephaly
cleft lip or palate
digital hypoplasia
hirsutism and developmental delay
135
Q

body of hydantoin

A

small body

136
Q

in USMLE intense uterine contraction and bleeding

A

painfull bleeding

137
Q

cause of painfull bleeding

A

abruptio placentae

138
Q

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

A

let the labor,icrease labor if necessary

139
Q

indication of CS in abruptio placentae

A

rapid deterioration of mother and fetus

140
Q

quid of placenta praevia

A

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

141
Q

painless third trimester bleeding

A

preavia

142
Q

why lactation is not considered as a reliable form of contraception

A

ovulation can occur

143
Q

contraptives method during lactation(4)

A

progestin
barrier methods
sterilisation
intrauterine devices

144
Q

why progestin is the best method to use in lactating woman

A

because volume and composition of the milk does not change

145
Q

risk with combination pills

A

risk of DVT

146
Q

why amenorrhea during lactation

A

prolactin inhibits GNRH release from hypothalamus

147
Q

clue for intrauterine fetal demise(2)

A

no mvt

no cardiac activities in fetus

148
Q

best time to confirm intrauterine fetal demise

A

real time ultrasonogram

149
Q

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

A

absence of fetal mvt

no cardiac activity

150
Q

quid of fetal demise intra uterine

A

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

151
Q

next step after delivery of intra uterine fetal demise

A

autopsy of the fetus and placenta with permission of the parents

152
Q

cause of intrauterine fetal demise(6)

A
hypertensive disorders
diabetes
placental and cord complication
congenital anomalies
TORCH
listeriosis
153
Q

devant abruptio placenta first indicator to watch

A

TA

154
Q

complication of abruptio placentae(2)

A

DIC

hemorrage

155
Q

clue for ovarian torsion(4)

A

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

156
Q

risk factor for torsion(3)

A

pregnancy
ovulation induction
ovarian masses >5 cm

157
Q

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

A

BHCG

to rule out ectopic

158
Q

best to Dx torsion of ovary

A

ultra sonogram(pelvic colr doppler)

159
Q

management of ovary torsion

A

detorsion laparoscopic

160
Q

indication of salpin oophorectomy in ovary torsion(2)

A

necrosis of adnexae

suspected ovarian malignancy

161
Q

complication of ovarian torsion(3)

A

peritonitis and sepsis
infertility and chronic pain
hemorrage

162
Q

why right side torsion is more common(2)

A

because of lenght of tubo ovarian ligament

because of rectosigmoid occupies space around the left ovary

163
Q

clue in sonogram for down

A

increase fetal nuchal fold lucency

164
Q

best test to rule out down or chromosomal abnormality

A

chorionic villus sampling

165
Q

when to perform chronic villus sampling

A

10 a 12 semaines

166
Q

indication of chorionic villus sampling

A

any woman of > 35 ans pregnant

167
Q

risk of chorionic villus sampling procedure(2)

A

fetal death

limb reduction defects

168
Q

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

A

before nine to 10 weeks

169
Q

clue for vaginal candidiasis(2)

A

thick white discharge

cottage cheese appearrance

170
Q

rx for vaginal candidiasis

A

oral fluconazole

171
Q

image of pseudohyphae

A

image tankou ti branch bwa

172
Q

pseudohyphae meaning

A

candidiasis

173
Q

should you treat the partner in vaginal candidiasis

A

sometimes you have too

174
Q

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

A

hyperthyroidism

menopause

175
Q

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

A

FSH

LH

176
Q

dx of septic abortion

A

ultrasonogram

177
Q

echo finding in septic abortion(3)

A

thick endometrial stripe
echogenic material
increase vascularity

178
Q

what will you see in echo

A

retained products of conception

179
Q

rx of septic abortion(3)

A

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

180
Q

quid of septic abortion

A

medical emergency

181
Q

fever after abortion

A

septic abortion

182
Q

risk factor for abruptio(7)

A
maternal HTA
polyhydramnios
abdo trauma
prior placental abruptio
cocaine /tobacco use
chorio amniotitis
PROM
183
Q

fond de contracture in USMLE

A

tender hypertonic uterus

184
Q

why U/S in abruption(2)

A

to rule out preavia

not for DX

185
Q

patient with involontary loss of urine after sneezing,laughing dx

A

stress incontinence

186
Q

rx of stress incontinence

A

kegel exercices

187
Q

failure for kegel exercices

A

urethropexy

188
Q

quid of inevitable abortion or incomplete

A

dialted cervix with visible products of conception

189
Q

next step in case of inevitable abortion(2)

A

iv fluids

succion curettage

190
Q

abortion RH -

A

give rhogam

191
Q

why you give rhigam in negative RH patient

A

to prevent formation of antibody from the mother

192
Q

complication of abortion

A

hemorrage
sepsis
DIC

193
Q

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

A

uterus atony

194
Q

first cause of vaginal bleeding within 24 hours of delivery

A

uterine atony

195
Q

rx of uterine atony

A

oxytocin infusion

196
Q

general measure in post partum hemorrage(4)

A

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
Q

risk for uterine atony(3)

A

hydraamnios
multiple gestation
increased parity

198
Q

quid of uterine agent used in atony uterine(3)

A

oxytocin
methylergonovine
carboprost

199
Q

patietn with morbid obesity with amenorrhea cause

A

anovulation cycle

200
Q

how ‘s FSH LH in morbid obesity

A

normal level

201
Q

quid of infertility

A

failure to conceive after 12 months of unprotcted sexual intercourse

202
Q

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

A

hysterosalpingogram

203
Q

cause of infertility in girl(4)

A

PID
endometriosis
DES exposure
congenital malformation

204
Q

devant tout patietn devant infertility first question to ask

A

ask about PID

205
Q

quid of severe preecclampsia(10)

A
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
Q

role of MGSO4 in pregnancy

A

prevent seizures

207
Q

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

A

close cervix
vacant uterine cavity in US
contraction can subside

208
Q

amenorrhea in female athletes causee

A

estrogen deficiency

209
Q

consequence of estrogen deficiency in female athlete(4)

A

osteopenia
infertility
breast atrophy
vaginal atrophy

210
Q

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

A

uterine rupture

211
Q

red flag for uterine rupture

A

loss of fetal station

212
Q

risk for uterine rupture(3)

A

uterine scar
abdominal trauma
ant de CS

213
Q

physiologic for ovulation(3)

A

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

214
Q

clue for puberte precoce

A

7 yo girl with pubic and axillary hair

215
Q

cause fo puberte precoce

A

early activation of hypothalamic pituatary ovarian axis

216
Q

quid of precocious puberty(2)

A

secondary sex characteristics before 8 in girl

before 9 in boys

217
Q

quid of peripheral precocious puberty

A

low FSH and LH level

218
Q

cause of peripheral precocious puberty

A

gonadal or adrenal excess release of androgen

219
Q

clue central precocious puberty

A

high FSH and LH

220
Q

next step in patient with central precocious puberty

A

CT or MRI of the brain

221
Q

rx of central precocious puberty

A

GNRH analog

222
Q

the most prevalent preventable cause of fetal growth restriction

A

smoking cessation

223
Q

the most common tumor in reproductive aged woman

A

leiyomyoma

224
Q

dx test for myoma

A

US

225
Q

symptom of leiyomyoma(3)

A

constipation
back pain
urinary retention or frequency

226
Q

first step in intrauterine fetal demise

A

coagulation profile

227
Q

why coagulation profile in intrauterine fetal demise

A

to rule out DIC

228
Q

what can happen in intrauterine fetal demise

A

retention of deasdd fetus can cause chronic consumption coagulopathy

229
Q

why coagulopathy in intrauterine fetal demise

A

release of thromboplastin from placenta into the maternal circulation

230
Q

early indicator of intra uterine fetal demise(2)

A

low fibrinogen

low platelet

231
Q

how s fibrinogen in pregnancy

A

high

232
Q

fibrinogen in coagulopathy

A

160 mg/dl is considerd as low

233
Q

whta to do in front of inttra uterine fetal demise

A

induce labor

234
Q

risk for precocious puberty(2)

A

epiphyseal plate fusion

short stature

235
Q

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

A

ruptured fetal ombilical vessel

236
Q

clue for ruptured fetal ombilical vessel during amniotomy

A

tachycardia puis bradycardia to a sinusoidal pattern

237
Q

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

A

by the APT test

238
Q

rx of rupture fetal ombilical vessel

A

crash CS

239
Q

quid of vasa preavia

A

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

240
Q

clue vasa preavia bleeding

A

normal vitals for mother during bleeding

241
Q

in pregnant women when to consider urine culture positive

A

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

242
Q

risk for asymptomatic bacteriuria

A

pyelonephritis

243
Q

rx for bacteruiria asymptomatic(4)

A

amox
or ampicilllin
or nitrofurantoin
or cephalexin

244
Q

complication of pyelonephritis(3)

A

low birth weight baby
septicemia
pretem babies

245
Q

HTA in pregnant women

A

chronic HTA

246
Q

hta in pregnant women

A

mole hydatiform

chronic HTA

247
Q

why you can have hypokaliemia and hypernatremia in pregnant woman

A

because of hyperaldosteronism

248
Q

risk in chronic HTA

A

abruptio placentae

249
Q

abruption placenta risk for the mother

A

bleeding

250
Q

abruption placenta risk for the baby

A

interruption of placental perfusion

251
Q

SLE and abruptio placenta

A

lupus anticoagulant

252
Q

most comon risk factor for abruptio

A

HTA

253
Q

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

A

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

254
Q

when to give RHOGAM in RH - patient(2)

A

28 e semaines

after delivery

255
Q

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

A

low dose of antiglobulin in post partum

256
Q

what ‘s rosette test in abruptio in rh -

A

determine the amount of fetal maternal transfusion

257
Q

next step if rosette test is negative

A

give the standard dose of anti D immune globulin

258
Q

rosette test positif next step

A

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

259
Q

next step after kleihauer betke stain test

A

anti D immune globulin should be corrected accordingly

260
Q

quid of preterm labor

A

labor occuring between 20 a 37 weeks of gestation

before 37 ,after 20 weeks

261
Q

clue for good contractions during labor(2)

A

in labor 4 contractions q 20 mn or more

cervical changes

262
Q

complication of preterm labor(5)

A
respiratory distress syndrome
intra ventricular hemorrage
sepsis
necrotizing enterocolitis
kernicterus
263
Q

best thing to do in preterm labor(2)

A

tocolysis

corticosteroid pendant 48 h

264
Q

in preterm labor what’s the goal of tocloysis

A

ammener la grossessede 34 a 36 semaines of gestation

265
Q

young woman with breast lump what to do

A

ask her to return shortky after menstrual period

266
Q

young woman with breast lump ,regeression after menstrual period dx

A

it’s benign

267
Q

clue for kalman syndrome(3)

A

primary amenorrhea
absent of sexual characteristics
hypoosmia or anosmia

268
Q

karyotype in kallman syndrome

A

46XX

269
Q

what about internal organ in kallman

A

Normal

270
Q

phenotype in kallman syndrome

A

girl

271
Q

karyotype in klinefelter

A

47XXY

272
Q

karyotype in turner

A

45X0

273
Q

threatened abortion

A

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

274
Q

standard care for threatened abortion(3)

A

reassurance
outpatient follow up
bed rest no sex

275
Q

why bed rest and no sex during threatened abortion

A

to avoid guilt in parents

276
Q

cause of anovulation in PCOS(2)

A

imbalance in FSH and LH

insulin resistance

277
Q

tetrad of PCOS(4)

A

anovulation
androgen excess
male pattern growth
ovarian cyst

278
Q

testicular feminisation syndrome karyotype

A

46 XY

279
Q

testicular feminisation syndrome phenotype

A

girl

280
Q

why absence of internal reproductive organ in testicular feminisation

A

presence of mullerian inhibiting factor(MIF)

281
Q

why MIF is present

A

because testis are present and form MIF

282
Q

role of MIF

A

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

283
Q

rx of testicular feminisation(2)

A

gonadectomy in puberty

creation of neovagina

284
Q

young girl with amenorrhea,hypoestrogenism,high gonadotrophin levels dx

A

primary ovarian failure

285
Q

diseases associated with primary ovarian failure(5)

A
autoimmune disorder
hashimoto
addisson
diabete type 1
pernicious anemia
286
Q

cause of premature destruction of follicles(4)

A

mumps
radiation
oophoritis
chemo

287
Q

clue for rimary ovarian failure(2)

A

high FSH /LH

low estrogen

288
Q

how to deal with infertility in patient with primary ovarian failure

A

in vitro fertilization with donor oocytes

289
Q

symptom assciated with pathologic leucorrhea(3)

A

pruritus
burning
malodorous discharge

290
Q

physical exam of pathologic leucorrhea(3)

A

erythema and edema
tenderness of cervix
green and curdlike vaginal discharge

291
Q

quid of physiologic leucorrhea(4)

A

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

292
Q

clue for bacterial vaginosis(4) AMSEL criteria

A

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

293
Q

quid of clue cells

A

vaginal epithelial cell with adherent cocobaccilus on wet mount

294
Q

KOH test

A

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

295
Q

AMSEL criteria to dx vagise bacterienne

A

3 sur 4

296
Q

patient taking OCP complaining of weight gain what to say

A

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

297
Q

why oCP is no longer associated to weight gain

A

because new OCP are lower dosed

298
Q

most common side effect of combined OCP

A

breakthrough bleeding

299
Q

side effect of combined oCP(6)

A
HTA
increased risk cervical ca
DVT
amenorrhea
high triglycerides
hepatic adenoma
300
Q

advantage of combined OCP

A

lower risk of endometrial and ovarian cancer

301
Q

chronic HTA in pregnancy rx(2)

A

labetalol

@ methyl dopa

302
Q

ACE and ARB s in pregnancy(2)

A

teratogenic

fetal kidneys damage

303
Q

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

A

amniotic fluid embolism

304
Q

next step after amniotic fluid embolism(2)

A

intubation

mechanical ventilation

305
Q

meaning of purpura in amniotic fluid embolism

A

DIC is developing

306
Q

test to confirm premature rupture of membranes(3)

A

positive nitrazine test
positive pooling tes
positive ferning test

307
Q

first thing to do in case of PROM

A

give PNC

308
Q

Why PNC in GBM

A

to prevent GBS infection

309
Q

indication of GBS prophylaxis(5)

A

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

310
Q

drugs used in GBS prophylaxis(4)

A

ampicillin
cephazolin
clindamycin
vancomycin

311
Q

clue for lichen sclerosis(2)

A

vulvar itching in elderly

dicomfort

312
Q

quid of porcelain white atrophy

A

vulvar skin thin dry white in color

313
Q

next step in front of lichen sclerosis

A

vulvar punch biopsy

314
Q

risk in lichen sclerosis

A

vulvar squamous cell carcinoma

315
Q

first line rx in lichen sclerosis

A

high potency topical steroids

316
Q

normal fibrinogen

A

150-450

317
Q

risk of DIC in intra uterine fetal demise

A

low fibrinogen

318
Q

quid of abortion(2)

A

fetal demise before 20 weeks or

fetus weight

319
Q

what to do in fetal demise in patietnwith fibrinogen 480

A

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

320
Q

thyroid pattern in pregnant woman(2)

A

increase total T4,T3

normal TSH

321
Q

how’s TBG in pregnancy

A

high

322
Q

how are free T3 T4 TSH IN PREGNANCY

A

normal

323
Q

incontinence in woman after C/S

A

epidural anesthesia

causing bladder denervation

324
Q

why urinary incontinence after epidural anesthesia(4)

A

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

325
Q

rx of incontinence after CS

A

intermittent catherisation

326
Q

clue for endometriosis(4)

A

chronic pelvic pain
dyspareunia
infertility
bladder or bowel problems

327
Q

characteristic of pain in endometriosis

A

worse with menses

328
Q

complication of endometriosis(2)

A

bowel bladder obstruction

rupture of endometrioma or torsion

329
Q

dx or rx of endometriosis

A

laparoscopy

330
Q

indication of laparoscopic rx in endometriosis(2)

A

complicated case

failure with medical rx

331
Q

medical rx of endometriosis

A

NSAIDS plus combined OCP

332
Q

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

A

progestin
plus
GNRH agonist
plus addback therapy

333
Q

3 D of endometriosis

A

dyspareunia
dysmenorrhea
dyschezia

334
Q

dyschezia quid

A

pain during defecation

335
Q

complication of endometriosis

A

infertility 30 %

336
Q

goal in rx endometriosis

A

suppress ovulation

337
Q

quid of progestin

A

medroxyprogesterone acetate

338
Q

indication of surgery in endometriosis(7)

A

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
Q

clue for endometrial hyperplasia(2)

A

intermenstrual bleeding

heavy menses

340
Q

Dx of endometrial hyperplasia

A

biopsy

341
Q

type of endometrial hyperplasia(4)

A

simple
complex
simple atypical
complex atypical

342
Q

risk to progress to endometrial cancer in simple endometrial hyperplasia

A

1%

343
Q

risk to progress to endometrial cancer in complex endometrial hyperplasia

A

3 %

344
Q

risk to progress to endometrial cancer in simple atypical endometrial hyperplasia

A

8 %

345
Q

risk to progress to endometrial cancer in complex atypical endometrial hyperplasia

A

29%

346
Q

rx of simple or complex without atypia

A

cyclic progestins

347
Q

rx of complex hyperplasia atypia

A

hysterectomy

348
Q

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

A

estrogen

it will agravate the case

349
Q

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

A

endometriosis

350
Q

how’s sonogram in endometriosis

A

can be normal

351
Q

physical exam in endometriosis(2)

A

pain uterus motion with finger

patient will experience rectovaginal tenderness

352
Q

gold standard to DX endometriosis

A

laparoscopy

353
Q

woman in labor with active genital herpes

A

immediate C section

354
Q

why woman with active genital herpes should undergo CS

A

risk of neonatal HSV

355
Q

post partum woman with breast pain

A

breast engorgement

356
Q

rx of breast engorgement(2)

A

cool compresses

acetaminophen and NSAIDS

357
Q

peak for breast engorgement(2)

A

3 a 5 jours

beginning 24 a 72 h

358
Q

quid of endometriosis

A

endometrial and stromial tissue outside uterus

359
Q

most common affected site for endometriosis(4)

A

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

360
Q

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

A

endometriosis

361
Q

indication of surgery in placentae praevia(2)

A

unstable mother with vital signs

unreassuring fetal haert rates

362
Q

patient with SLE develops acne why(2)

A

prednisone taking

steroid induced folliculitis

363
Q

clue for acne in steroid

A

no comedones

364
Q

early decelerations quid?

A

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

365
Q

cause of early deceleration(2)

A

fetal head compression

or could be normal

366
Q

quid of late deceleration

A

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

367
Q

cause of late decelration

A

uteroplacental insufficiency

368
Q

quid of variable deceleration

A

can be or not associated with contraction

369
Q

cause of variable deceleration(3)

A

cord compression
oligoamnios
cord proplapse

370
Q

management of reccurent variable decelerations(3)

A

change maternal position
o2 administration
rescucitative measures

371
Q

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

A

uterine rupture

372
Q

in uterine rupture type of deceleration

A

late deceleration

373
Q

patient with schizophrenia develops milk in why

A

risperidone taking

374
Q

action of risperidone

A

dopamine and serotonin antagonist

375
Q

urinalysis in pregnant woman develops > 100 000 bacteria

A

bacteriuria asymptomatic

376
Q

first line rx of asymptomatic bacteriuria(2)

A
nitrofurantoin for 7 days
or
amox
or
cephalosporin first generation
377
Q

bug in cause of aymptomatic bacteriuria

A

E coli

378
Q

work up of adrenal mass(2)

A

US

ca-125 antigen

379
Q

suspicscious failure in US(4)

A

mass > 10 cm
nodular or pelvic fixed mass
ascites
metastasis

380
Q

when rx conservatively(3)

A

simple cyst in sonogram
normal ca 125
mass

381
Q

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

A

stop isotretinoin

wean lithium

382
Q

why wean lithium in case of pregnancy

A

you should slow taper lithium to prevent relapse

383
Q

congenital anomaly associated with lithium

A

ebstein anomaly

384
Q

congenital anomaly associated with isotretinoin(3)

A

craniofacial dysmorphism
heart defect
deafness

385
Q

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

A

use contraception at least one month before beginning

pregnancy test befor rx

386
Q

could we use inhaled steroid in pregnancy

A

yes

387
Q

false labor when it occurs

A

in the late 4-8 weeks of pregnancy

388
Q

clue for false labor(2)

A

no cervical changes during pregnancy

relieved by sedation

389
Q

rx for false labor

A

nothing

390
Q

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

A

it’s normal

reassurrance

391
Q

lochia in post partum rubra(2)

A

first few days

rouge

392
Q

lochia in post partum serosa (2)

A

3 a 4 jours

pale

393
Q

lochia in post partum alba

A

white or yellow

394
Q

foul smelling lochia

A

endometritis

395
Q

why evaluation of mucus should be part of infertility work up

A

because hostile cervical mucous can dialoow penetration of spermato into uterus

396
Q

normal aspect of cervical mucus during ovulation(4)

A

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

397
Q

35 young patietn with dyspareunia and tense vagina dx

A

vagisnismus

398
Q

rx of vagisnismus(3)

A

kegel exercice
gradual dilation with finger
relaxation

399
Q

preecclampsia and SLE(3)

A

both has HTA
both proteinuria
edema

400
Q

clue for glomerulonephritis in SLE during pregnancy(4)

A

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

401
Q

could pregnancy cause ANA positive

A

yes

402
Q

quid of malar rash

A

macular eruptions on the cheek bones

403
Q

premature ovarian failure clue(2)

A

high FSH LH

FSH/LH>1

404
Q

Cause amenorrhea(3)

A

ovarian failure
turner
fragile x syndrome

405
Q

in premature ovarian failure the greatest elevation LH or FSH

A

FSH

406
Q

Dx of confirmation of pramature ovarian failure

A

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

407
Q

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

A

reassurrance

normal follow up

408
Q

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

A

firm and tender uterus

409
Q

why contraction in AP

A

blood seems to have uterotonic action

410
Q

can you have absence of vaginal bleeding in AP

A

if you have a retroplacental hemmorage dans 20% des cas

411
Q

VEAL IN deceleration(4)

A

variable
early
accelerated
late

412
Q

cause of deceleration CHO=VEAL(4)

A

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

413
Q

two types of bleeding in AP(2)

A

concealed

visible

414
Q

masculinisation in pregnant mother resolving after delivery

A

aromatase deficiency in baby

415
Q

why masculinisation certain pregnant women

A

placenta is unable to make estrogen in utero

416
Q

clue for aromatase deficiency(4)

A

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

417
Q

genital organs in patietn with aromatase deficiency(2)

A

normal internal organs

cliteromegaly(ambiguous)

418
Q

dx of aromatase deficiency(2)

A

high FSH LH

low estrogen

419
Q

PID coplicated with vomiting next step(2)

A

hospitalize the patient

give cefotaxin and dox

420
Q

genital organs in patietn with aromatase deficiency(2)

A

normal internal organs

cliteromegaly(ambiguous)

421
Q

dx of aromatase deficiency(2)

A

high FSH LH

low estrogen

422
Q

PID coplicated with vomiting next step(2)

A

hospitalize the patient

give cefotaxin and dox

423
Q

complication of PID(5)

A
tubo ovarian abcess
abcess rupture
pelvic peritonitis
sepsis
infertility
424
Q

outpatient rx of PID(2)

A

ceftriaxone or cefoxitin
plus
dox

425
Q

cause of PID(3)

A

neisseria gonerrhea
chlanydia
genital mycoplasma

426
Q

poor surgical candidate with tumor size

A

radiation

427
Q

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

A

surgical excision

428
Q

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

A

radiation

429
Q

first step in patient with secondary amenorhea

A

BHCG

430
Q

secondary amenorhee with negative BHCG and high testoterone

A

PCOS

431
Q

why TSH in secondary amenorrhea

A

to rule out hypothyroidism

432
Q

secondary amenorhee with negative BHCG and high TSH and low t4

A

hypothyroidism

433
Q

next step in Secondary amenorrhea with high prolactin(3)

A

check TSH
check medication
check creat

434
Q

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

A

MRI of the brain

435
Q

clue for asherman syndrome(2)

A

intrautrauterine adhesions

secondary amenorrhea

436
Q

dx for asherman syndrome(2)

A

hysteroscopy
or
hysterosalpingography

437
Q

patietn seen with no fetal mvts next step

A

profile biophysique

438
Q

patient with solid ovarian mass during pregnancy

A

all ovarian masses are malignant except during pregnancy

439
Q

during pregnancy patient develops facial hair and acne next step

A

ultrasonogram

440
Q

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

A

luteoma

441
Q

next step in dx of luteoma during pregnancy(2)

A

reassurrance

follow up with U/S

442
Q

people at risk for luteoma(2)

A

african american

30’s 40’s

443
Q

grand mal seizures in pregnancy

A

ecclampsia

444
Q

stable patietn with preeclampsia 37 semaines de grossese

A

induction labor

445
Q

management of ecclampsia(4)

A

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

446
Q

acid base status in pregnancy(3)

A

respiratory alkalosis
low co2 pressure
high o2 pressure

447
Q

why respiratory alkalosis in pregnancy(3)

A

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

448
Q

why HCO3 is low during pregnancy

A

to compensate metabolic alkalosis

449
Q

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

A

cervical insufficiency

450
Q

risk factir for cervical insufficiency(6)

A
cone bioopsy
DES exposure
multiple gestation
mullerian anomalies
preterm birth
second trimester pregnancy loss
451
Q

best test to Dx cervical insufficiency

A

transvaginal US

452
Q

quid of short cervix(2)

A

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

453
Q

premenstrual syndrome

A

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

454
Q

Symptom of premenstrual syndrome(4)PMS

A

bloating
headaches
breast tenderness anxiety
mood disturbance

455
Q

what to do when tyou suspect premenstrial syndrome

A

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

456
Q

quid premenstrual dysphoric syndrome(2)

A

variant of PMS

irritability and anger predomines

457
Q

rx of PMS

A

SSRI fluoxetine first line

458
Q

quid of sheehan syndrome(3)

A

hemmorage of post partum
problem of lactation
anterior hypophyse necrosis

459
Q

clue trichomonas vaginalis

A

PH 5.0-6,0

460
Q

consequence of sheehan syndrome

A

prolactin deficiency

461
Q

microscopy in Trichomonas vaginitis

A

flagellated motile norganisms

462
Q

difference between trichomonas vaginalis and vaginose bacterienne

A

vaginose bacterienne does not cause inflammation

463
Q

exam image of choice to detect gynecologic tumor

A

pelvic U/S

464
Q

quid of pretem labor

A

occuring

465
Q

quid of labor(2)

A

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

cervical changes

466
Q

what the goal in term of preterm labor

A

reach 34 36 semaines

467
Q

what to in preterm labor(2)

A

bed rest

tocolysis

468
Q

different types of abortion(5)

A
missed
inevitable
incomplete
threatened
septic
469
Q

quid of missed abortion(2)

A

light vaginal bleeding

pregnancy symptom can become prominent

470
Q

best test to dx missed abortion(2)

A

US

non viable fetus

471
Q

quid inevitable abortion(2)

A

vaginal bleeding and open cervix

US fetus with possible heart beat

472
Q

incomplete abortion (3)

A

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

473
Q

threatened abortion(2)

A

vaginal bleeding with close cervix

US viable pregnancy

474
Q

septic abortions(3)

A

sign of sepsis
cervix open
US retained products of conception

475
Q

1 cause of septic abortion(2)

A

induced abortion

spontaneous rarely causes sepsis

476
Q

best test to dx abortion

A

US pelvic

477
Q

3 ways to rx missed abortion(3)

A

abortion
medical using prostaglandin
expectant management

478
Q

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

A

repeat BHCG in 48 hours

479
Q

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

A

ectopic
nonviable intrauterine pregnancy
early viable pregnancy

480
Q

when will you see fetus in pelvic U/S

A

BHCG 1500-2000 ml

481
Q

in the vignette why repeat HCG in 48 h

A

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

482
Q

early pregnancy with spotting trans abdomen US negative next step

A

transvaginal US

483
Q

when can you gestationnal sac in trans abdominal US

A

when BHCG is greater than 6500

484
Q

when can you gestationnal sac in trans vaginal US

A

a partir de 1500

485
Q

patient with spotting and intra uterine sac in transvaginal US dx

A

no ectopic

486
Q

adnexial sac or no sac intra uterine in transvaginal US

A

ectopic

487
Q

patient with spotting and transvaginal US douteux

A

serial BHCG measurement

488
Q

tendancy for BHCG

A

doubles every 48 h

489
Q

when to perform transvaginal US in pregnancy

A

when BHCG 1500-6500

490
Q

next step in decreaser of fetal mvts perceived by mother

A

nonstress test

491
Q

normal non stress test

A

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
Q

abnormal NST

A
493
Q

most common cause of non reactive stress test

A

fetal sleep cycle

494
Q

post menopausal women with vaginal dryness burning and dysuria and dyspareunia

A

atrophic vaginitis

495
Q

rx of atrophic vaginitis

A

vaginal estrogen replacement

496
Q

what to do if you suspect atrophic vaginitis

A

rule out UTI

497
Q

mild atrophic vaginitis rx(2)

A

moisturizers

lubricants

498
Q

moderate to severe atrophic vaginitis rx

A

low dose of vaginal estrogen

499
Q

clue for ruptured ectopic pregnancy(3)

A

diffuse abdominal pain
cervical and adrenal tenderness
hypotension

500
Q

differenciation between PID and ectopic pregnancy ruptured

A

no hypotension in PID

501
Q

risk for ectopic(6)

A
tubal pathology
tubal surgery
current IVD
PID
multiple partners
DES and infertility rx
502
Q

dx of ectopic pregnancy ruptured(2)

A

transvaginal US

BHCG

503
Q

image in trans vaginal US in ectopic pregnancy(2)

A

adrenal mass

free intraperitoneal fluid

504
Q

cause of cervical motion tenderness(2)

A

ectopic

PID

505
Q

Med rx of ectopic

A

metotrexate

506
Q

dx ddifferentiel of acute pelvic pain(5)

A
Mittelscmerz syndrome
ectopic
ovarian torsion
ruptured ovarian cyst
PID
507
Q

US in ovarian torsion(2)

A

enlarged ovary

decreased flow in ovary

508
Q

risk factor for ovarian ruptured cyst

A

strenous or sexual activity

509
Q

US in ovarian ruptured cyst

A

free fluid near ovarian cyst

510
Q

clue of ruptured ovarian cyst in vignette

A

cystic ovarian mass with a moderate amount of free fluid

511
Q

how to measure blood flow in ovary

A

doppler velocitometry

512
Q

importance of transvaginal US in PID

A

to rule out tuboovarian abcess

513
Q

free fluid in the context of pelvic pain in US

A

ruptured ovarian cyst

514
Q

major side effect of low dose combination pills

A

worsening HTA

515
Q

associated risk with estrogen progestin combined rx(4)

A

DVT
HTA
Hepatic adenoma
stroke and MI

516
Q

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

A

no estrogen in contraception

517
Q

best benefit of OCP’s(2)

A

reduced risk of endometrial cancer

reduced risk of ovarian cancer

518
Q

risk # 1 for tamoxifen

A

endometrial carcinoma

519
Q

quid of tamoxifen

A

selective receptor estrogen modulator

520
Q

action of tamoxifen

A

agonist of estrogen receptors in the breast

521
Q

why tamoxifen is used in the rx of breast cancer

A

it’s an agonist of estrogen receptors in the breast

522
Q

quid of early deceleration

A

contraction of uterus =positive deflection

occurs at the same time as negative deflection( deceleration)

523
Q

what to do before giving MMR vaccine

A

test for immunity with IGG antibody titers

524
Q

what to do after receiving varicella and MMR

A

avoid contraception for at least 4 weeks after the vaccination

525
Q

vaccine you can give during pregnancy(5)

A
MMR
Varicella
smallpox
HPV
live attenuated  intra nasal influenza vaccines
526
Q

can you give Hep B during pregnancy

A

yes

527
Q

when to give pneumococcus during pregnancy

A

2 et 3 e trimestre

528
Q

can you give Hi flu during pregnancy

A

yes in asplenic patient

529
Q

routine vaccines in pregnancy(2)

A

TDAp

inactivated influenza vaccines

530
Q

patient with bilateral pale grey discharge

A

galactorrhea

531
Q

quid of galactorrhea

A

lactation in women who are breastfeeding or in men

532
Q

clue for physiologic galactorrhea

A

it’s bilateral

533
Q

clue for pathologic galactorrhea(2)

A

unilateral

breast cancer

534
Q

color of galactorrhea(4)

A

white green
gray
yellow
brown

535
Q

most common cause of physiologic galactorrhea

A

hyperprolactinemia

536
Q

cause of hyperprolactinemia(7)

A
prolactinoma
risperidone 
opiods
hypothyroidism
pregnancy
oral contraceptive pills
chest wall or nipple stimulation
537
Q

cause of chest wall stimulation(3)

A

surgery
trauma
shingles

538
Q

first test to do in galactorrhea

A

guaic test in fluid from breast

539
Q

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

A

serum prolactin
TSH
brain MRI

540
Q

galactorrhea and palpable mass in the breast(3)

A

mammogram
US of breast
surgical evaluation

541
Q

investigation of breast mass

A

mammogram
US of breast
surgical evaluation

542
Q

indication to investigate breast mass in galactorhea

A

unilateral galactorrhea

bloody galactorrhea

543
Q

patient with history of formula feeding of baby after hemorragic delivery

A

sheehan syndrome

544
Q

physiopatho of sheehan syndrome

A

ischemic necrosis

545
Q

hypopituitarism in post partum(2)

A

sheehan syndrome

lynphocytic hypophysitis

546
Q

can you have insipidus diabetes in sheehan

A

it’s uncommon

547
Q

clue for hypopituitarism(2)

A

hypogonadism

hypothyroidism

548
Q

rx of asymptomatic bacteriuria in pregnancy(4)

A

nitrofurantoin
amox
augmentin
cephalexin

549
Q

antibio contrindicated in pregnancy(3)

A

cyclines
fluoroquinolones
TMS

550
Q

what to do in rx of hypothyroidism in pregnancy

A

increase levothyroxin dose

551
Q

when to check TSH in pregnancy

A

every 2-3 months

552
Q

first prenatal visit what to ask(13)

A
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
Q

when can you give influenza in pregnancy

A

n’importe quand

554
Q

test to ask in specifci risk in pregnancy(5)

A

lead level
TB
HB electrophoresis if MCV

555
Q

when to ask thyroid fuction test in pregnancy(2)

A

if symptomatic

or associated conditions like diabetes

556
Q

pregnant woman with paresthesia in hand

A

carpal tunnel syndrome

557
Q

why carpal tunnel syndrome in pregnancy

A

because estrogen mediates depolarisation of ground substance causing hand edema

558
Q

rx of carpal tunnel syndrome in pregnancy(2)

A

wrist splinting

put the wrist in neutral position and NSAIDS

559
Q

failure with wrist splinting during carpal tunnel syndrome

A

local corticosteroid

560
Q

rx of carpal tunnel syndrome when conservative disorder fails

A

surgical decompression

561
Q

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

A

intra hepatic cholestasis of pregnancy

562
Q

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

A

HELLP syndrome

563
Q

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

A

acute fatty liver disease of pregnancy

564
Q

complication of acute fatty liver disease

A

liver failure

565
Q

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

A

pruritic urticarial papules and plaques of pregnancy

566
Q

quid of ASC-VS

A

atypical squamous cell of undetermined significance

567
Q

how can you dx ASC-VS

A

pap test

568
Q

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

A

HPV serology

569
Q

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

A

colposcopy

570
Q

HPV- plus ASC-VS next step

A

repeat pap test and HPV in 3 years

571
Q

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

A

repeat pap smear in 1 year

572
Q

young woman in AFIB and pulmonary edema dx causal

A

mitral stenosis

573
Q

why mitral stenosis can become worse during pregnancy

A

increased blood flow

574
Q

risk factor for mitral stenosis

A

strep pyogenes infection

575
Q

G2 patient with RH - next step

A

RH D abtibody testing

576
Q

when to perform RH antibody testing(2)

A

first visit

repeat at 24-28 semaines

577
Q

first visit of rh- mother(2)

A

rh typing

antibody with RHD

578
Q

if alloimmunization is noted next step(2)

A

anti immune globulin at 28 semaines

at delivery