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1.

Ulipristal Acetate --> selective progesterone receptor modulator

2. Meigs syndrome
a. Pleural effusion
b. Ascites
c. Fibroma (pelvic mass)

3. Clexane dose and pre-op for a 80kg woman


a. Dose --> 1 mg/kg SC
b. Prophylaxis --> D/C 12 hours pre-op
c. Therapeutic --> D/C 24 hours pre-op

4. Pap smear screening


a. 43 year old married woman; last screening was 6 times in 10 years and last result is
normal
b. When to tell her to resume?
i. 3 years after last test
c. ACOG guidelines
i. Begin at age 21 years
ii. 21-29 --> Pap smear every 3 years
iii. 30-64 --> pap smear ALONE every 3 years OR every 5 years for Pap smear + HPV
testing
iv. >65 --> stop screening

5. Malodorous vaginal discharge + burning. Green frothy discharge + multiple sexual partners
a. Trichomoniasis Vaginalis = protozoan
b. Ping pong infection (need to Rx partner as well)
c. Presentation
i. Green frothy discharge, malodorous
ii. Strawberry cervix
iii. Dx --> wet mount (discharge + normal Saline and examine under microscope =
motile protozoa swimming around
iv. Rx --> metronidazole 400mg po tds or tinidazole

6. IUCD + pap smear showing Sulphur Granules


a. Most likely organism is Actinomyces Israelli
b. Actinomyces Israelii
i. Implicated in PID
ii. Causes infection of IUCD esp with non-copper left insitu for > 2 years

7. Uterine Prolapse - ligamentous support


a. Secondary support
i. Endopelvic fascia + Ligaments
 Cardinal ligaments (transverse cervical ligament) gives most support
followed by suspensory support from
 Broad ligament
 Uterosacrals
8. Ectopic Pregnancy
- Adnexal mass
- Adnexal tenderness
- Cervical excitation tenderness

Open cervical os
- Incomplete miscarriage

Closed cervical os
- Silent miscarriage
- Threatened miscarriage
- Complete miscarriage

9. Oncogenes for HPV 16 & 18 cause 70% of cervical cancer

10. Ovulation occurs 14 days prior to end of cycle


a. Confirmation of ovulation
i. Low FSH/LH values
ii. Elevated day 21 progesterone >10ng/ml
 Due to corpus luteum formation after follicle erupts from graafian follicle.
Corpus luteum produces progesterone & if fertilization does not occur, it
involutes which stops progesterone production
iii. Elevated Basal Body Temperature

11. Semen Analysis


a. Liquefaction time - within 60 minutes
b. pH > 7.2
c. Sperm count > 20 million/ml
d. Total sperm count > 40 million/ml
e. Motility > 60% forward progression
f. Morphology > 15%
g. Vitality > 75% alive
h. WBC < 1 million/ml

12. Rx for Chlamydia infection = Doxycycline

13. COCP
a. Risk of cancer
i. Increased risk Breast cancer (due to estrogen component)
b. Decreased risk of
i. Endometrial cancer
ii. Ovarian cancer
Due to progesterone component (antagonizes estrogen!!)

14. Congenital Adrenal Hyperplasia


a. 16 year old girl with primary amenorrhea, 148cm tall, BMI is 24.7 + breast development
+ pubic hair sparse
b. Cubitus valgus

15. Reduce risk of cervical Ca by screening regularly!

17. Cervical cancer management - Stage 1b1


a. Stage 1b1 = cervical tumor < 4cm diameter
b. Management option -->
i. Radical Hysterectomy (Wertheim's hysterectomy) + pelvic radiotherapy
ii. Radical vaginal/abdominal Trachelectomy + bilateral pelvic lymphadenectomy for
future fertility plans!
 Increased risk of miscarriage --> 25%

18. Endometrial hyperplasia


a. Atypical hyerplasia
i. Increased # of endometrial glands lined by cells displaying cytological atypia with
complex glandular pattern
ii. Highest premalignant potential (25%)
iii. Cases of adenocarcinoma of endometrium can co-exist with atypical hyperplasia
iv. Progression to endometrial carcinoma from atypical hyperplasia occurs in 2-4
years
 Compare w 10 years for cystic hyperplasia!
v. Rx
 25% = progress to endometrial cancer in 2-4 years
 Medical
 Medroxyprogesterone acetate 20-40mg po od 6months
 Depo-Provera 150mg IM monthly
 Mirena
 Surgical
 TAH + BSO (completion of family, recurrent or resistant cases of
atypical hyperplasia

25. USS findings of suspicious ovarian malignancy


a. Single loculated cyst > 7cm diameter
b. Features of malignant ovarian cyst
i. Straw-colored ascites
ii. Large ovarian cyst > 6cm diameter
iii. Bilateral ovarian cysts
iv. Solid areas in cyst
v. Peritubal and periovarian adhesions
vi. Excrescences
vii. Peritoneal seedings
viii. Omental deposits

26. Ovarian carcinoma


a. Most are epithelial in origin
b. Peak age 50-70 years
c. Poor prognosis since Dx made late
d. Risk factors --> CAT Funny Bone
i. Caucasian
ii. Age 50-70
iii. Tamoxifen
iv. Family Hx breast, endometrial, colon cancer, ovarian cancer
v. BRCA 1 and 2
e. Protective
i. COCP
ii. Smoking

27. FIGO classification of Fibroid

30. Benefits of OCP


1. protection against benign breast disease and benign ovarian disease
2. reduced risk of ovarian and endometrial cancer
3. reduced menstrual flow
4. menorrhagia and anemia resolves!
5. lower risk of fibroid, endometriosis, PID and ectopic pregnancy

Contraindications of COCP
1. severe DM + HTN
2. Hx of TE
3. idiopathic jaundice
4. breast/endometrial cancer
5. pregnancy
6. undiagnosed AUB
7. MI
48. Complication of HELLP syndrome
a. Acute renal failure
b. Hepatic rupture
c. Placental abruption
d. Subcapsular liver hematoma
e. According to system
i. Hematologic --> DIC, bleeding, hematoma
ii. Cardiac --> cardiac arrest, MI
iii. Pulmonary --> pulmonary edema, respiratory failure, PE, ARDS
iv. CNS --> hemorrhage/stroke, edema, central venous thrombosis, seizures, retinal
detachment
v. Renal --> acute renal failure, chronic renal failure
vi. Hepatic --> subcapsular hematoma, rupture, ascites, nephrogenic diabetes
insipidus
vii. Infection
viii. Neonatal --> prematurity, IUGR, thrombocytopenia

49. Maternal mortality definition


a. "death of a woman while pregnant or within 42 days of termination of pregnancy
irrespective of site and duraition of pregnancy from any cause related to or aggravated
by pregnancy or its management but NOT from accidental or incidental causes."
b. CDC extended the definition up to 1 year post-partum regardless of outcome

50. Full anticoagulation Rx in pregnancy


a. SLE --> antepartum administration of prophylactic LMWH + low dose aspirin
b. Recurrent pregnancy loss --> screen for antiphospholipid antibodies (no anticoagulation
required bc T2 miscarriages can be due to cervical incompetence, genetics etc)
c. Pulmonary embolism in prior pregnancy --> 6 weeks postpartum prophylaxis with
LMWH
d. ASD --> no
e. Obese primigravida --> no

51. PPH --> initial management


a. Uterine massage + 20 units oxytocin in 500ml NS

52. Successful conception --> embryonic disc forms 3 weeks after fertilization

53. Multiple pregnancy is NOT a risk factor for DM

54. IDA --> iron studies


a. Low ferritin
b. Low transferrin
c. High TIBC

55. HIV transmission


a. Without Rx --> 25%
b. With Rx (HAART) --> reduced from 25% to 1-2%

56. Mitral stenosis --> not given ergometrine routinely after 3rd stage labor
57. Polyhydramnios
a. Causes
i. Maternal DM
ii. Multiple pregnancy
iii. Neuromuscular fetal conditions
iv. Fetal anomalies (esophageal atresia), duodenal atresia
v. Congenital cardiac rhythm anomalies
vi. Chromosomal abnormalities
vii. Fetal akinesia syndrome
viii. TORCH infections
b. NOT a cause
i. Post-maturity
 Oligohydramnios is a feature of postterm pregnancy
 Liquor volume peaks at 37 weeks and reduces after this 33% reduction in
liquor volume per week after EDD