Ob & Gyn Form 1 by 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 mil d discomfort to severe pain. the bladder expands until it's full and then signals your brain that it's tim e 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, medicati ons and other therapies may offer relief.
symptoms; the signs and symptoms of interstitial cystitis vary from person to person. if you have interstitial c ystitis, 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.
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
o
pain or discomfort while the bladder fills and relief after urinating.
o
pain during sexual intercourse.
the severity of symptoms caused by interstitial cys titis often varies, and some people may experience periods during which symptoms disappear. although signs and symptoms of interstitial cystitis may res emble 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 uri nary 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 t o 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.)
…..23 yo ,f, breach presentation, cs, low grade fever, q10 decrease air entry bilaterally ans….a
atelectasis…most 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 ºF (38 ºC) 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
q12…67 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 f etal 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 de signed 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
i
0 –15
pre-adolescent
none
pre-adolescent
0 –15
pre-adolescent testes (≤2.5 cm)
pre-adolescent
none
pre-adolescent
ii
8 –15
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
10 –15
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
10 –15
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
1½ –16.5
further enlargement
significant enlargement, especially in diameter
increase in amount; curling
not applicable
iv
10 –17
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, 1 –3 years after thelarche
variable: 12 –17
further enlargement
further enlargement, especially in diameter
adult in type but not in distribution
development of axillary hair and some facial hair
v
12.5 –18
large breast with single contour
adult in distribution
menarche occurs in 10% of girls in stage v.
13 –18
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] ans…e
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 q19……20 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
ans…c
heamatocolpos….imperforate hymen
q21…20 yo,f,hirsutism ans…d
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
q25…17 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 müllerian defects [25,26]. Therefore, all women with müllerian defects should undergo a radiologic renal investigation, such as an intravenous pyelogram or renal ultrasound. Ipsilateral renal agenesis is invariably noted with obstructive müllerian defects
q27…..32 yo f 26wks gestation…left back pain radiate to groin ans…l
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
q29…57 yo,f,small amount of blood in her underwear ,menopuase ans…c
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 ans…c
cervical trauma
q31……42yo,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 ans…e
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 .
q34…47 yo,f,started estrogen therapy, on u/s there is mobile cystic mass ans…d
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 q38……22yrs old f ,painful urination and vaginal discharge ans…a
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]
q39……23 yo,f, 30 wk gestation ,headache, right upper quadrant pain ans…..e
severe preeclampsia [hellp syndrome]
q40…..32yo,f,20 wks gestation,u/s shows fetus with a chondroplasia ans…..a
mood of inheritance is ad.
Q41……painful vesicles ans..e
painful vesicles second attack…..herpes simplex ……normal course to disappear within one week
q42……32 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
q43……22 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
osteoporosis…regardless 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
