Ob & Gyn Form 1 by Maya Ali

Q1..27 yo,f,14 week gestation,rt sided lower abdominal

pain,nausea for 24hrs ,loss of appetite,low grade fever,

lab show leukocytosis with segmented neutrophils ,wbcs in urine

but nitrates negative [so not uti],

ans..a

appendicitis

not salpingitis[no risky sexual hx ,no vaginal discharge,no hx of std]

Right lower quadrant pain is the most common symptom and occurs within a few centimeters of McBurney's point in
most pregnant women, regardless of the stage of pregnancy. In late pregnancy, pain may be the right mid or upper
quadrant. Rebound tenderness and guarding are less prominent in pregnant women, especially in the third trimester.

q2..17 yo,f, primary ammenorhea,systolic murmur heard

midsternal and radiate to the back

ans.a

turner syndrome[murmer of coarctation of aorta]

pts with turner have streak ovaries[non functioning] .fsh is high [no
negative feed back]

q3.32 yo,f, chronic pelvic pain, pain with urination, urgency,

normal urinalysis

ans..c

interstitial cystitis
is a chronic condition in which you experience bladder pressure, bladder pain and sometimes pelvic pain, ranging from mild
discomfort to severe pain.

the bladder expands until it's full and then signals your brain that it's time to urinate, communicating through the pelvic
nerves. this creates the urge to urinate for most people. with interstitial cystitis, these signals get mixed up you feel the
need to urinate more often and with smaller volumes of urine than most people.

interstitial cystitis most often affects women and can have a long-lasting impact on quality of life. although there's no
treatment that reliably eliminates interstitial cystitis, medications and other therapies may offer relief.
symptoms;
the signs and symptoms of interstitial cystitis vary from person to person. if you have interstitial cystitis, your symptoms may
also vary over time, periodically flaring in response to common triggers, such as menstruation, sitting for a long time, stress,
exercise and sexual activity.

interstitial cystitis signs and symptoms include:

o pain in your pelvis or between the vagina and anus in women or between the scrotum and anus in men (perineum).

o chronic pelvic pain.

o a persistent, urgent need to urinate.

o frequent urination, often of small amounts, throughout the day and night. people with severe interstitial cystitis may urinate
as often as 60 times a day.

o pain or discomfort while the bladder fills and relief after urinating.

o pain during sexual intercourse.

the severity of symptoms caused by interstitial cystitis often varies, and some people may experience periods during which
symptoms disappear.

although signs and symptoms of interstitial cystitis may resemble those of a chronic urinary tract infection, urine cultures are
usually free of bacteria. -however, symptoms may worsen if a person with interstitial cystitis gets a urinary tract infection.

Q4.32 yo ,f,no menses after she stopes ocps ,excessive hair

growth with male distribution pattern,scalp
boldness,musculnizaton,

ans..d

testosterone excess from ovarian tumor

Q5..27 yo,f, complaining of pulling sensation on the right side of

incision of c[s

ans.e

normal post operative course. common symptoms of incisional

seroma is swelling and leakage of clear fluid

q6 .42 yo,f,heavy period,fibroid on us

ans.d

submucosal heavy period

 q7..27 yo ,f,34 wk gestation,1 day hx of anxiety, palpitation,
thyroid diffusely enlarged not tender

ans.d

propylthiouracil. pt has some feature of thyroid storm [tm b-

blocker and propylthiouracil
For patients with life-threatening thyroid storm admitted to an ICU, we suggest propylthiouracil (PTU) (200 mg orally every
four hours) rather than methimazole as initial therapy (Grade 2B). PTU blocks T4 to T3 conversion and results in lower
serum T3 levels for the first several days of treatment. However, for severe but not life-threatening hyperthyroidism,
methimazole (20 mg every six hours) may be preferred because of its longer half life, lower risk of hepatic toxicity, and
because it ultimately restores euthyroidism more quickly than PTU.
For patients with contraindications to thionamides who require urgent correction of hyperthyroidism, surgery is the treatment
of choice. Patients who are to undergo surgery require preoperative treatment of thyrotoxicosis. We typically treat with beta
blockers (if not contraindicated, propranolol 60 to 80 mg every four to s ix hours), glucocorticoids to inhibit conversion of T4
to T3 (eg, dexamethasone, 1 to 2 mg every six hours), bile acid sequestrants (eg, cholestyramine 4 g orally four times daily),
and, in patients with Graves disease, iodine (SSKI, five drops [50 mg iodide/drop] orally every six hours, or Lugol's solution,
10 drops [8 mg iodide/iodine per drop] every eight hours). We continue treatment for up to five to seven days.

q8.32 yo,f,18 wks gestation,previous hx of premature

labour,bicornuate uterus

ans..d

previous preterm labor is risk factor for another preterm labor

beside that she has uterine anomalies

q9..32 yo,f,10 wk gestation,has nausea,vomiting

ans..e

hyperemesis
gravidarum ,,nausea, vomiting, electrolytes abnormalities and ketone
in urine,i.v hydration and antiemetics should be given and u/s should
be done to exclude molar pregnancy
A step-wise approach to treatment of nausea and vomiting of pregnancy is provided in the algorithm (algorithm 1). The steps
are based on evidence of efficacy and safety profiles. The goal is to reduce symptoms through changes in diet/environment and
by medication, correct consequences or complications of nausea and vomiting, and minimize the fetal effects of maternal
nausea and vomiting and its treatment.

Women should try to become aware of, and avoid, environmental triggers and foods which might provoke their nausea
and vomiting. (See 'Initial approach' above.)
Where available, we suggest pyridoxine-doxylamine succinate combination therapy for initial pharmacologic treatment of
nausea of pregnancy (Grade 2B). If this drug is not available, we suggest pyridoxine, adding doxylamine succinate if
pyridoxine alone is not effective.
If nausea and vomiting persists, we suggest adding diphenhydramine 25 to 50 mg orally every four to six hours
or meclizine 25 mg orally every six hours (Grade 2C). If symptoms do not improve, we suggest adding a dopamine
antagonist (prochlorperazine, metoclopramide) (Grade 2C).
For patients who require hospitalization because of dehydration, we suggest a serotonin antagonist (ondansetron)
(Grade 2C).
 Women who are dehydrated or have electrolyte abnormalities or acid-base disturbances should receive intravenous
fluids. Thiamine supplements should be added to the intravenous solution to prevent Wernicke's encephalopathy. We
suggest a short period of gut rest during hydration, followed by reintroduction of oral intake with liquids and bland, low fat
foods. We reserve use of glucocorticoids for treatment of refractory cases after the first trimester.
(See 'Glucocorticoids' above.)
The optimal timing for initiating enteral or parenteral nutrition has not been established; the decision is based upon
clinical judgment. In general, enteral nutrition is begun in women who cannot maintain their weight because of vomiting
and despite a step-wise trial of pharmacologic interventions. (See 'Enteral and parenteral nutrition' above.)
We suggest that women of child-bearing age take a multivitamin with folic acid to help prevent nausea and vomiting
during pregnancy (Grade 2C), as well as for reducing the risk of neural tube defects. (See 'Prevention' above.)

q10 ..23 yo ,f, breach presentation, cs, low grade fever,

decrease air entry bilaterally

ans.a
atelectasismost common cause of postoperative fever in first 24 hrs
Postpartum fever and infection The United States Joint Commission on Maternal Welfare defines postpartum febrile
morbidity as an oral temperature of 38.0 degrees Celsius (100.4 degrees Fahrenheit) or more on any two of the first 10
days postpartum, exclusive of the first 24 hours. The first 24 hours are excluded because low grade fever during this period
is common and often resolves spontaneously, especially after vaginal birth.
Surgical site infection Wound infection is diagnosed in 2.5 to 16 percent of patients after cesarean delivery [17], generally
four to seven days after the procedure.
Endometritis Endometritis is more common following cesarean birth than following vaginal birth. The diagnosis of
endometritis is largely based upon clinical criteria: fever; uterine tenderness; foul lochia; and leukocytosis, which develop within
five days of delivery. A temperature 100.4 F (38 C) in the absence of other causes of fever, such as pneumonia, wound
cellulitis, or urinary tract infection, is the most common sign.
Atelectasis (not causal) Atelectasis is often used as an explanation for otherwise unexplained
postoperative fever. Both atelectasis and fever occur frequently after surgery, but their concurrence is
probably coincidental rather than causal.

q11.30 yo,f,recently delivered want to take combined oral

contraceptive pills

ans..b

combined ocps affect breast milk production

q1267 yo,f,vulvar itching for two years ,o/e 1-cm white area over
labia majora

ans.e

punch biopsy to exclude squamous cell cancer which associated

with lichen scelerosis
q13.57 yo,f,q about historical greatest risk factor for breast
cancer

ans.c

hormone replacement therapy

q14.27 yo,f,36 week gestation,vaginal bleeding,rh negative,no

antibodies,next step

ans.e

administer rh immunoglobulin
All Rh(D)-negative pregnant women should undergo an antibody screen at the first prenatal visit. If the initial screen is
negative, a routine repeat screen at 28 weeks of gestation is optional.
We recommend administration of antenatal anti-D immune globulin when there is an increased risk of fetomaternal
hemorrhage (Grade 1B). Some examples include miscarriage, abortion, ectopic pregnancy, multifetal reduction,
amniocentesis, chorionic villus sampling, blunt abdominal trauma, external cephalic version, antepartum bleeding, and fetal
death. We administer 300 micrograms as soon as possible within 72 hours of the event.
Postpartum Postpartum administration of anti-D immune globulin significantly reduces the risk of maternal
alloimmunization.
alternatively: give small dose + rosette test
The rosette test [48] is a qualitative, yet sensitive, test for fetomaternal hemorrhage. We suggest performing this test as an
initial screen. A standard dose of anti-D immune globulin is given to patients with a negative test. The test is designed to
give a negative result when the amount of fetomaternal hemorrhage is small (<2 mL or 0.04 percent fetal cells) and thus will
not necessitate additional doses of anti-D immune globulin; few cases require confirmatory quantitative testing [49].

Q15 11 yo f, pubic hair tanner sage 3

ans..d

menarche is imminent

stage female male

age range breast growth pubic hair growth other changes age range testes growth penis growth pubic hair growth other changes
(years) (years)

i 015 pre-adolescent none pre-adolescent 015 pre-adolescent pre-adolescent none pre-adolescent

testes
(2.5 cm)

ii 815 breast budding long downy pubic peak growth 1015 enlargement of minimal or no long downy hair, not applicable
(thelarche); hair near the labia, velocity often testes; enlargement often appearing
areolar often appearing occurs soon after pigmentation of several months
hyperplasia with with breast stage ii scrotal sac after testicular
small amount of budding or several growth; variable
breast tissue weeks or months pattern noted
later with pubarche

iii 1015 further increase in amount menarche occurs 116.5 further significant increase in not applicable
enlargement of and pigmentation in 2% of girls late enlargement enlargement, amount; curling
breast tissue and of hair in stage iii especially in
areola, with no diameter
separation of their
contours

iv 1017 separation of adult in type but menarche occurs variable: 1217 further further adult in type but development of
contours; areola not in distribution in most girls in enlargement enlargement, not in distribution axillary hair and
and nipple form stage iv, 13 especially in some facial hair
secondary mound years after diameter
above breasts thelarche
tissue

v 12.518 large breast with adult in menarche occurs 1318 adult in size adult in size adult in body hair
single contour distribution in 10% of girls in distribution continues to
stage v. (medial aspects of grow and
thighs; linea alba) muscles continue
to increase in
size for several
months to years;
20% of boys
 reach peak
growth velocity
during this peri

Q16..22 yo,f,vaginal bleeding,positive pregnancy test,uterus 10

wk gestation, us shows no fetus but hyperechoic material[molar
pregnancy]

anse

suction curettage

q17..27 yo ,f,33 wk gestation, sle, normal fetus on us,

oligohydramnios

ans..e

uteroplacental insufficiency

q18.27 yo,f, 3 days after cs, bilaeral breast pain,low grade

fever,breast swelling,erythema and tenderness,baby is bottle fed

ans.a

breast engorgment,important word is that it is bilateral ,mastitis

usually unilateral,beside baby is bottle fed

q1920 yo f epidural anesthesia..develop tinnitus and metallic

taste

ans.c

systemic toxicity of epidural [if accidentelly injected into blood

vessels]is neurotoxicity and cardiotoxicity

neurotoxicity precedes cardiotoxicity

tinnitus and metallic taste first signs[uptodate]

q20.15 yo,severe lower abdominal pain,cyclical pain,bluish mass

protrude from cervix
 ansc

heamatocolpos.imperforate hymen

q2120 yo,f,hirsutism

ansd

pt has normal level of dehydroepiandrosterone sulfate and

testosterone ,the only explanation for hirsutism is increase activity
of alpha reductase which convert testosterone to its active form
dht.

Q22.19 yo,f,31 wk gestation, intense uterine contraction, tender

firm uterus, vaginal bleeding

ans.a

abruptio placentae

Q 23..23 yo,f,32wk gestation,irregular uterine contraction,vaginal

discharge of clear fluid[amniotic because positive nitrazine
test],low grade fever,tender uterus

ans.c

chorioamnionitis[rupture of membrane,fever,tender uterus]

not labour because irregular uterine contraction in true labor

contraction should be regular

q24.24 yo,f,three episode of uti.treated with tmp/smx.

ans..e
tmp,smx
Continuous antimicrobial prophylaxis regimens for women with recurrent urinary tract
infection
Trimethoprim-sulfamethoxazole ,Nitrofurantoin, Cefaclor, cephalexin, Norfloxacin, Ciprofloxacin
Antimicrobial prophylaxis has been demonstrated to be highly effective in reducing the risk of recurrent UTI in women.
Prophylaxis has been advocated for women who experience two or more symptomatic UTIs within six months or three or more
over 12 months. However, the degree of discomfort experienced by the woman from these infections and concerns about
antimicrobial resistance are the most important determinant of whether antimicrobial prophylaxis should be tried.
Continuous prophylaxis, postcoital prophylaxis, and intermittent self-treatment (which is not really a prophylaxis method) have all
been demonstrated to be effective in the management of recurrent uncomplicated cystitis

q2517 yo,f,pelvic pain started soon after menses bigens and

disappear 48hrs

ans..e

primary dysmenorrhea

q26..26 yo,f, hx of 3 abortions in first trimester,single left

kidney,on exam..palpable uterus and palpable left ovary

ans.b

causes of first trimesteric miscarriage is chromosomal

anomalies,inrauterine infections,uterine anomalies.
there is association between unilateral renal agenesis and bicornuate
uterus[palpable uterus]
Clinical manifestations and diagnosis of congenital anomalies of the uterus
Associated renal anomalies Renal anomalies are found in 20 to 30 percent of women with mllerian defects [25,26].
Therefore, all women with mllerian defects should undergo a radiologic renal investigation, such as an intravenous pyelogram
or renal ultrasound.

Ipsilateral renal agenesis is invariably noted with obstructive mllerian defects

q27..32 yo f 26wks gestationleft back pain radiate to groin

ansl

ureterolithiasis[typical pain description]

q28 27 yo,f,10,week gestation, anemia for 15 years ,no response to

ion supplement

ans..b

anemia not responded to ion supplement next step hb

electrophoresis
 q2957 yo,f,small amount of blood in her underwear ,menopuase

ansc
hypoestrogenic state
Increased exposure to estrogen such as early menarche or late menopause, is a risk factor for developing breast
cancer
See table.

q30.24 yo,f, 30 wks gestation ,vaginal bleeding after intercourse,

u/s shows fundal placenta, no uterine tenderness

ansc
cervical trauma

q3142yo,f,irreguler menses,irregular enlarged uterus,atypical

complex hyperplasia

ans.b

risk factor of endometrial hyperplasia same for the

cancer[uptodate] as follows;

..50-70

unopposed estrogen therapy

tamoxifin

early menarche

pcos[chronic anovulation]

and others

q32.18 yo, f,fever ,nausea,rash,bp 90+60,uses tampoons

anse

toxic shock syndrome ..staph

Q.33 yo,f,rt sided pelvic pain increase with menses, us shows

simple cyst

ans.b

oral contraception and pelvic exam in 6 wks

simple cyst in premenopausal women producing pain increases

with menses most likely follicular cyst ,usually resolve by its self .

q3447 yo,f,started estrogen therapy, on u/s there is mobile cystic

mass

ansd

fna of cyst

q35..18 yo f, pain in adnexal region in day 13 and 14 of the cycle

ans.a

reassurance.midcycle pain

q36.21 yo ,f, vaginal discharge ,histology pic

ans.e
neisseria gonorrhoeae[gram negative dipploccoci within
polymorphonuclear leukocytes]

q37.25 yo ,f,hiv positive,thin clear vaginal discharge ,lmp 6 wks

ago,use condom sometimes, friable cervix

ans H..pregnancy

q3822yrs old f ,painful urination and vaginal discharge

ansa

vulva and vaginal redness[vulvovaginitis+ description of vaginal

discharge[gray fishy discharge with ph >4.5].the most important
thing is frothy and itching which goes with trichomonas
vaginalis[flagellated protozoa]

q3923 yo,f, 30 wk gestation ,headache, right upper quadrant

pain

ans..e

severe preeclampsia [hellp syndrome<heamolysis indicated by high

ldh ,elevated liver enzymes, low platelet count>]

q40..32yo,f,20 wks gestation,u/s shows fetus with a

chondroplasia

ans..a

mood of inheritance is ad.

Q41painful vesicles

ans..e
painful vesicles second attack..herpes simplex normal course
to disappear within one week

q4232 yo ,f ,21 week gestation ,vaginal bleeding

ans..c

causes of second trimesteric bleeding after 20 weeks is similer to

causes of third trimester bleeding[uptodate]

so after excluding local causes ,next step is u/s to exclude placenta

previa

q4322 yo,f,20 wks gestation,fetus with abdominal organs seen

outside abdominal cavity without covering membrane

ans.c

gastroschisis

q44.42 yo,f,42 wk gestation come in labour,partogram shows

variable deceleration[no relation to contraction some times come
before ,sometimes come after contraction]

ans.e

umbilical cord compression

q45..18 yo f no period for last year

ans.e

osteoporosisregardless of what she has ,absent or low estrogen

[no withdrawal bleeding after medroxyprogesteron chalenge
test]for ten years is risk factor for osteoporosis
q46.67 yo,f,c/o vulvar itching resistant to over the counter
medication, has dm, koh shows candida

ans.d

dm.lower the pt immunity

q47..32 yo,has dm type 11,presented in labour cervix fully

dilated, efficient uterine contraction,cephalic presentation,station -
1

ans..a

arrested second stage of labour due to cephalopelvic

disproportion[pt has dm most likely fetus has macrosomia
presented wih station -1 and head fails to be fully engaged]

q48..87 yo,f,has stress incontenince

ans..a

decreased external urethral sphincter tone

q49.32 yo, f, fever and rt breast tenderness

ans.f

mastitis.area of redness nonfluctuant*abscess usually fluctuant]

q50 27 yo, f, bright red vaginal bleeding,lmp..8weeks, signs of

pregnancy

ans..k

normal pregnancy