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).

chronic pelvic pain.

a persistent, urgent need to urinate.

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.

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 bblocker 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
(years)

breast growth

pubic hair growth

other changes

age range
(years)

testes growth

penis growth

pubic hair growth

other changes

015

pre-adolescent

none

pre-adolescent

015

pre-adolescent
testes
(2.5 cm)

pre-adolescent

none

pre-adolescent

ii

815

breast budding
(thelarche);
areolar
hyperplasia with
small amount of
breast tissue

long downy pubic

hair near the labia,
often appearing
with breast
budding or several
weeks or months
later

peak growth
velocity often
occurs soon after
stage ii

1015

enlargement of
testes;
pigmentation of
scrotal sac

minimal or no
enlargement

long downy hair,

often appearing
several months
after testicular
growth; variable
pattern noted
with pubarche

not applicable

iii

1015

further
enlargement of
breast tissue and
areola, with no
separation of their
contours

increase in amount
and pigmentation
of hair

menarche occurs
in 2% of girls late
in stage iii

116.5

further
enlargement

significant
enlargement,
especially in
diameter

increase in
amount; curling

not applicable

iv

1017

separation of
contours; areola
and nipple form
secondary mound
above breasts
tissue

adult in type but

not in distribution

menarche occurs
in most girls in
stage iv, 13
years after
thelarche

variable: 1217

further
enlargement

further
enlargement,
especially in
diameter

adult in type but

not in distribution

development of
axillary hair and
some facial hair

12.518

large breast with

single contour

adult in
distribution

menarche occurs
in 10% of girls in
stage v.

1318

adult in size

adult in size

adult in
distribution
(medial aspects of
thighs; linea alba)

body hair
continues to
grow and
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