GYNECOLOGY

1. Turner:
 ovarian failure with FSH higher than LH
2. Chancroid:
 painful ulcer. Gram positive rods
3. Granuloma inguinale:
 painless ulcer. Start as papule…ulcer…irregular
borders…beefy…granular base
4. Lymphogranulama: .
 painless, shallow, non specific symptoms after a month buboes
appear; elephantiasis
5. Syphilis:
 Painless, pouched out ulcer with rolled edges and painless
adenopaty
6. Infertility testing;
 first basal temperature and mid luteal level of progesterone
7. IUGR:
 First step in dg of IUGR, measure by abdominal circumference
8. Diabetes screen in pregnant more than 24 weeks:
 1h /50 g glucose tolerance test. In 1h glucose should be less
than 140. If more than 140 do 3h GT oral.
9. Mild dysplasia in Paps:
 follow with colposcopy
10. Mild granulocytosis
 is Ok after immediate postpartum
11. Raloxifen in Rx of osteoporosis
 increase the risk of thromboembolism
12. Fetal death as a clinic diagnosis
 follow with ultrasonogram in real time
13. Diabetes in less than 24 weeks:
 check fasting urine sample
14. Hypertensive lady that get pregnant:
 stop ACE and start labetalol
15. Olygohydramnios present:
 check if delivery is possible
16. Oxytocine
 can cause water retention, hyponatremia and seizures. Pt with
seizures in postpartum: check TA or think in hyponatremia due
to oxytocine. The risk is more severe if pt has diabetes or had
receive insulin
17. Clomiphene:
 anti-estrogenic in Rx of infertility when cause is increase
estrogens
18. Clomiphene
 can give intermenstrual bleeding, breast discomfort and hot
flashes
19. Kallman
  hypogonadism hypogonadotrophic. 46XX with absence of
secondary sexual characters and decrease of FSH and GnRh
20. Al l oral antidiabetics
 are teratogenic….change to insulin
21. Pregnant with HTA
 use hydralazine, metildopa and labetalol
22. Arrest in the active phase of labor:
 c section
23. Chemotherapy induce premature menopause.
 FSH high¦more than the LH showing ovarian failure
24. Estrogen therapy:
 increase requirements of tyroid hormones
25. Bacteria vaginitis:
 20% of cells ¦clue cells and ph more than 4.5
26. Testicular feminization
 is the same as androgen insensitivity syndrome
27. Due date.
 LMP less than 3 months plus seven days. If cycles are of 21
days instead to add 7 days, subtract seven days. And if periods
are more than 35 days, add 7 days more (14 )
28. SLE:
 abortion due to anti-phospholipids antibodies cause placental
infraction with decrease fetal growth . (placental thrombolytic
disease)
29. If mom does not feel the baby:
 check heart with Doppler next real time ultrasonography .if
death is confirmed do coagulation profile
30. Avoid tiazides
 in pregnant to avoid volume depletion
31. Endometriosis.
 First Rx. OCP if woman want to have family in the future.
Second: Danazol if cannot tolerate OCP or if OCP fail. Danazol
does a pseudo menopause state and can cause hirsutism, acne,
deep voice. Instead of Danazol GNRh agonist can be
used…inhibit secretion of FSH/LH…temporary castration. If
woman wants to conceive soon go for laser. If more than 40 and
does not want family go for hysterectomy or
salpingectomy/ooforectomy. If younger ablation of endometrial
spots can be done.
32. Pregnant women with HTA
 can be preeclampsia but if has a massive proteinuria or malar
rash or high ANA think in glomerulonephritis chronic OF sLE
33. Manage of Bleeding:
 If heavy bleeding: take conjugated estrogens for 25 days. If
teenager: add 10 mg of progesterone during last 10-15 days to
simulate normal cycle and allow 5 to 7 days for withdrawal
34. If heavy bleeding more than 36 y/o:
 do endometrial biopsy. Then cyclic progestin then endometrial
 ablation if fails. Obese more than 35 yo and diabetics or
hypertensive woman are a high risk.
35. Postpartum fever:
 think first in endometritis ( manipulation, prolonged labor,
rupture of membranes) prescribe clindamycin and
aminoglycosides¦if fever keep going up and up…think in pelvic
thrombophlebitis and prescribe heparin.
36. OCP:
 the cycles or hypo or anovulation ¦increase of androgens that
become estrogens ¦generate endometrial hyperplasia. Rx. With
OCP or cyclic progestin.
37. Superficial thrombophlebitis
 if it is away from junction with femoral treat with Nsaids, bed
rest. Anticoagulation is not used for superficial thrombosis.
38. Streptococcus b or agalactie
 is normal flora that can cause meningitis. Should be screened at
36-37 week with culture. If positive use Peniciline G during
labor.
39. Urgent contraception pill:
 up to 72 hours ( etinyl estradiol and levonorgestrol)
40. Daughters of women that took DEB
 are at increase risk of adenocarcinoma of vagina and cervix or
malformation if boys like adenocarcinoma of testicles and
infertility.
41. Preeclampsia criteria.
 If mild: HTA between 140/90 to 160/110. Proteinuria more than
300 and less than 5mg. If severe HTA more than 160/110.
Oliguria, alter conscious, pulmonary edema, cyanosis, alt. liver
function test, increase creatinine and RCIU
42. Scarred and fenestrated vulva and oral lesions and uveitis
 think in Bechet disease. can have also joint problems and
burning sensation. Differentials: It s not syphilis (has painless
chancre), is not herpes ( not uveitis), it is not chron ( more GI
symptoms)
43. Donovan bodies in Giemsa or Wright:
 reddish encapsulated intracellular with bipolar staining bacteria.
Treat with tetracycline 10-21 days. The ulcer start as pustule.
beefy granular with irregular borders.
44. Syphilis ulcer:
 painless…rolled edges and punched out base
45. Chancroid:
 ¦very painful…gray base and foul smelling…..painful inguinal
nodes and buboes
46. Herpes: painful vesicles ¦.burning ¦.itching
47. LGV: .painless¦.shallow¦ pay attention ¦this one has systemic
symptoms
48. Management of pre-eclampsia: Mild preeclampsia: 1. If
pregnancy at term or lung Ok proceed with delivery. 2. If pregnancy
 early and lung not Ok….bed rest, low salt, close observation,
dexametasone (24-34) then delivery. Severe preeclampsia: bed rest,
decrease salt and add hypo tensors. 1. If patient go right and fetus
maturation is ok…….delivery . 2. If pt go right and fetus
immature…..wait until mature plus dexametasone. 3. If patient go
wrong: delivery
49. Maternal or fetal deterioration¦
 delivery regardless of gestational age
50. All the time prefer vaginal¦
 just do C section if vaginal is contraindicated
51. In Hypertension use
 drugs if . 1. TA more than 160/110 or CNS start getting altered
regardless level or PA
52. Hypertension near term or in labor:
 hydralazine or labetalol.
53. Hypertension away from term:
 metyldopa. Second line are b blockers like atenolol or
metoprolol.
54. Beta blockers in fetus
 can cause bradicardia and hypoglycemia
55. Gonorrhea if nullipare:
 admit plus cefotetan or cefotaxim plus doxicilin
56. Mass in ovaries
 precous puberty¦ cell granulose (increase estrogen) If appear in
post menopause can show as bleeding
57. Disgerminomas
 tend to strangulate and do not produce hormones
58. Sertoli Leydig
 produce androgens, cause virilization and amenorrhea
59. Teratomas¦
 are benign and do not produce hormones
60. PID:
 Hospitalization requirement: More than 39 fever if nullipari,
adolescent if previous treatment fall, low socio economic status
61. PID: drugs
 cefoxetin/doxi …..cefotetan/doxi……clinda/genta
62. Overflow incontinence
 has residual volume. Due to detrusor hypotonic or acontractility
like in diabetes, MS, spinal cord injury.
 Pt taking NSAID
o make worse the incontinence. Treat with bethanecol and
intermittent catheterization
63. Glucosa in pregnangt:
 first urine dipstick¦. if positive¦ do fasting urine sample ¦ if
positive 1h glucose if positive do 3 h glucose
64. PCOD:
 LH/FSH ratio more than 2/1.Has increase of DHEA and ACTH
normal. If give ACTH to these pt can have an exaggerated
 65. Abruptio:
 If its mild and stable and fetus pretermino….tocolitics and fetal
maduration
 Abruptio: if progress and augement labor….do fast vaginal
delivery if possible
 Abruptio..if labor is an early stage and mom or fetus are
unstable…c section
69. Tricomoniasis: metronidazol .. oral. 2 gr or 250 three times a day for 7
days. If pregnant do clotrimazol 100 mg.
70. Bacteriuria asymptomatica in pregnant with more than 100 000
colonies give nitrofurantoin 7 to 10 days.
71. AFP increased: real causes: neural tube, gastroschisis, omphalocele.
False causes: multiple pregnancy, fetal dismise, wrong gestational age.
 AFP increased: do ultrasound…rule out false positive…..then
amniocentesis and measure AFP in amniotic fluid and AchE that
increase in neural tube defect
 AFP decreased, bhCG increase and UE3 drecrease¦Down
 AFP decreased, bhCG decrease and UE3 decrease…..Trysomy 18
 AFP, bhCG and UE3 are called triple test ( 16-18 weeks)
 Amnioscentesis 16-20 week
77. CVS 10 -12 week.
78. Clomiphene block the estrogen receptors in hypotalmo. Produce more
FSH and LH….ovulation
79. Danazol¦produce hot flashes, breast enlargement, bloating, uterine
bleeding. Has inhibitory effect on gonadotrophins good to treat
endometriosis, fibroids, fibroystic breast disease.
80. Magnesium sulfate: if intoxication treat with calcium gluconate
81. Status epileptic in pregnant treat with diazepam
82. AFI: less than 5¦means oligohydrmnios…. Delivery
83. Pr. Puberty…do test of GnRh stimulation with 100 mg of GnRh…that
has to increase LH, if does is a true isosexual, that means the puberty is due
to activation of pituitary- hypophisis and ovary axis.
84. Infertility: most common cause in women is peritoneal factor like
endometriosis, adherences, laparoscopy has to be done and treat with
danazol or medroxiprogesterone.
 Infertility: ovulatory factor: defect in axis, diagnose with basal
temperature and progesterone in mid lutheal phase.
 Infertility: Tubouterine factor: diagnose with histerosalpingograhy and
laparoscope
 Infertility: cervical factor, diagnose with mucus examination and
postcoital test
88. Amenorrhea: Meyer Rokitansky: Mullerian agenesia: vaginal pouch, no
uterus. Pt looks with normal Tanner with no menstruation and is 46 xx.
 Amenorrhea: Testicular feminization: or androgen resistance
syndrome. Is a 46 xy with a feminine phenotype. Due to the presence
of peripheral estrogen pt has breast but lack of axilary and pubic hair.
Intraabdominal testicles can be confused with ovaries
 Amenorrhea: Savage Sd. Or ovary resistance to FSH/LH. There is
 amenorrhea and lack of sexual characters
91. Abortion: Missed abortion: do dilation and curettage. If more than 16
weeks proceed to labor with oxitocine
 Abortion: Inevitable or incomplete…do suction curettage because the
oc is open
 Abortion: Complete require follow with bhCG for risk of
choriocarcinoma
94. All Rh negative woman should habe anti D and globuline
95. Syphilis: if pregnant is allergic do desensitization
96. Mc. Cune Albright…..cafe au lait spots…polyostosis fibrous displacia
and pr. Puberty independent of level of gonadotropic hormones
97. Pt comes to office with delay on puberty……think about Kallman
( hypogonadism hypogonadotrophic and anosmia). Congenital abscense of
GnRh with normal kariotype and eunocoid stature
98. IUGR: plus oligoamnios….think delivery
99. IUGR: if not oligoamnios…..do stress test and BPP twice a week
100. IUGR: if lungs are mature….delivery
101. Eclampsia: First cause of death is hemorrhagic stroke
102. Infertility> start to ruling out spermatic causes…then do basal body
Temp. or mid luteal progesterone level…..( lutheal defect)…means low
progesterone is produced by corpus lutheum …pt can have history of
abortion in this case……..then do endometrial biopsy….show lag in
endometrial maturation of 2 days or more.
103. Liquen : sclerous in vulva treat with high potency corticosteroids..but do
always biopsy in old lady with an itchy spot….do not assume that is liquen
without doing the biopsy
104. Tocolitis: in diabetes or heart disease not use beta 2. Ritrodina ( b2
agonist) the only tocolitic in preterm. Magnesium sulfato is the drug of choice
y tocolysis
105. HypertiroidisM. B blockers can cause placental isquemia dn IUGR. PTU
can be use but not metimazol.
Durign second trimester surgery can be anoption if medical treatment fail.
106. Amenorrhea. Until when we can wait to start to investigate? until 14 if
no sexual characters or until 16 if sexual character. are present.
107. Suspecting Sheehan….ask Gh and prolactine
108. OCP: Protection: ovarian and endometrial cancer, CUB, dysmenorrea,
ectopic pregnancy and PID.
109. OCP: can cause: depression, increase wight, increase cholesterol,
cholecystitis.
110. Most common cause of non reactive NST: sleepy baby…so do
vibroacutstic stimulation in low risk pregnancy to reassure, if not reactive do
BPP
111. NST is good if in 20 mins reach at least 2 accelerations (more than 15
beats per minute)
112. BPP; measure toe, moves (3 in 10 min), breth (30 in 10 min), AFI ( 5 to
20)…normal index is 8 to 10 for BPP
113. Clamidia in pregnant…one single dosis of azytromicine
114. Toxoplasma in mom: IgM toxoplasma. Fetal infection…do cord
blood or placentl culture ( IgM), also amniotic fluid culture, serologic,
ultrasound. Treat with spiramine if mom decide to keep the baby ( first
trimester), not pirimetamine ( contraindicated in first trimester) Durign 3th.
Trimester use sulfadiazine and pirimetmine. Sulfadiazine can cause medular
toxicity and need supplemental folinic acid.
115. MCC of hypertiroidism in pregnancy is Grave. Mom can present with
atrail fibrillation
116. If signs of hyperthyroidism in early pregnancy think also in
choriocarcinoma because bhCG has the alpha chain similar to TSH, so can
stimulate receptors
117. Other cause of atrial fibrillation in women pregnancy is mitral
stenosis….become evident with the increase of volume during pregnancy.
High frequency in asian countries.
118. MCC of PID: 1. Clamidia. 2. Gonorrhea. 3. Mycoplasma
119. PID: if abscess is present: think in E coli, Bacteroides, and Gardnerella.
Treat with cefotetan and doxycycline l….or clindamycin and
gentamycin…..or cefoxitin and doxi……if is an outpatient use ceftraxone
and doxycilin.
120. Rhogam: less than 1:6 means mom not sensitize….so Rhogam is
indicated . At 28 weeks or within 72 hours after any procedure
( delivery/abortion)… If antibodies is equal to 1:6 or greater than
1:4…..Rhogam is useless. So next pregnancy use amniotic fluid
spectrophotometry to check levels of Bb in amniotic fluid.
121. Edwards> low AFP. ;pw UE3, low bhCG
122. Gonorrhea in pregnant…treat the same as in pregnant….ceftriaxone
and erythromycine
123. ASCUS ….means inflammatory when compare with Bethseda
classification.
124. PAP is III: go for conization under colposcopy….endocervical curettage
and biopsy are equivocal or unsatisfactory.
125. Turner is a menopause before menarche. No estrogen….cause no
inhibin…so increase FSH and LH. Ovaries have just stroma and not follicles
at all. 45 xo. Diagnost is made by kariotyping. Risk of gonadoblastoma.
126. Hypothyroid patient taking HRT. Estrogen replacement require increase
dosis of thyroxin, due to increase of crom..p 450 in livear that clear T4.
127. Lithium….Ebstein anomaly
128. PCOS. Inccrease sensitivity of adrenal gland to ACTH. So if give ACTH,
increase androgens lik e DHEA..
129. Biophysical Profile (BPP): 6 and no oligohydramnios….do contraction
test…if bad….delivery…if suspicious repeat next day.
 BPP: 4 withouth oligohydramnios….if lungs normal….delivery…if
lung inmature…steroid and repeat BPP in 24 hours.
 BPP: less than 4…delivery independently of maturity
132. Magnesium sulfate….no more than 4 to 6 grams.LGV: do serologic test
to confirm chlamidia. First is the ulcer and later is the lymph node. Treat with
tetraciclin or erytromicin for 3 weeks. Second choice doxicilin and sulfas
133. Cocain abusers mom: fetus with intracranial hemorrhage or newborns
with necrotizing enterocolitis.
134. Pt middle age with endometrial hyperplasia without atypia….treat
withciclic progestins and biopsy again in 3 -6 months
135. HPV infections. Vulvar papilomatosis: condiloma acuminate. Koilocitos in
microscopy. Treat with 25% ac. Cloracetic or podofiline. Do not use
podofiline in pregnancy.
136. HPV in pregnancy. Use dinitroclorobenzeno and c section.l
137. Hydantoin syndrome (due to the teratogenicity of phenytoin or
carbamazepine: hypoplasia distal phalange. Can develop
neuroblastoma.Hirsutism.
138. Vulvar hyperkeratosis. Cause of pruritus . treat with fluorinated
corticosteroids ointment. Diferentiate from squamous cell carcinoma, and
from lichen
139. Gardnerella in pregnant treat with clindamicina intravaginal cream or
metronidazol in cream. If not pregnant metronidazol oral route.
140. GINECOLOGIC HY FROM VIDEOS
141. Cancer takes from 8 to 10 years to develop from precancer
142. MC gynecologic cancer is endometrial carcinoma
143. MC cancer in woman is breast cancer
144. The highest mortality for gynecological cancer in woman is ovarian
cancer.
145. Highest mortality in woman (all groups) is lung cancer
146. Incidence of cancer in women overall is breast, lung and colon
147. Mortality overall is lung, breast and colon
148. Ovarian cancer spread or exfoliate by seeding and gives ascitis and
usually is diagnose in stage III
149. All women with ascitis has to have a differential with ovarian cancer
150. Etiology of cancer:
151. Cervical cancer link to HPV. 16. 18. 31. 35. Genital warts. 6 to 11.
152. Endometrial cancer in postmenopause if she is obese and in
premenopause who has PCOS.
153. SERM:Selective estrogen modulator like Tamoxifen
154. Raloxifen give benefit of estrogen without the risk of breast cancer.
155. SERM does not decreases the hot flashes and can increase DVT and PE
156. HRT use less estrogen than OCP. OCP has 10 times estrogen than HRT
157. OCP: two conditions increase the risk for TEP. More than 35 years old
and smoker
158. OCP: The dominant hormone in birth control pill is progesterone. The
advantage is contraception effectiveness and regulation of menses.
159. Ovarian Cancaer is linked to ovalution. The most common cancer from
ovary is epithelial because of the trauma of ovulation. That is why pregnancy
and OCP are a protection facts.
160. DUB: 10-15% of DUB in postmenopausal are due to endometrial cancer,
so always , always do endometrial sampling.
161. MCC of genital bleeding in postmenopausal is vaginal atrophy
162. Vaginal Cancer: Associated with prurite, mucoid discharge with blood.
163. Postemnopausal woman with clear discharge think in Falopian Cancer.
164. Ovarian cancer: masculinizing. Sertoli-Leydig. Hormone producing.
Estroma cell
165. Ovarian Cancer: early feminization: Teca. Is a estroma cell cancer.
166. Ovarian tumors: cistadenoma can be: mucinous, serous, and
endometroid.
167. MC cistadenoma is serous.
168. CA 125 is a marker for epithelial cancer in postmenopausal
169. Epitelial cancer present at stage III require debunking surgery plus
platinum derivatives
170. Ovarian cancer: Germ cell cancers: 1. Dysgerminoma.2. Teratoma 3.
Choriocarcinoma 4. Endodermal sinus tumor
171. Dysgerminoma: LDH. Is the most common.
172. Coriocarcinoma: HCG
173. Endodermal sinus: AFP
174. Dysgerminoma is the equivalent to seminoma in male and respond to
radiation. Is the most common of ger cell. Usually present at stage I because
they grow fast. Treat: keep uterus, ovaries out and gave chemotherapy
175. Vulvar cancer: first is squamous second is melanoma (more than 0.76
able to metastazise)
176. Vulvar melanoma is a black lesion, depth of invasion is most important
prognostic factor.
177. Clarke classification is base on histology appearance.
178. Brestlow invasion is base on mm of invasion
179. Vulvar lesion: If red can be Paget. Lesion is red with “icing†,most
of the time is just intraepithelial …different than the pagest of the breast
that is invasive
180. Paget treatment; wide excision only if it is invasive vulvectomy ( less
than 20%)
181. Paget in vulva is associated with carcinoma in breas, Gi or Gu
carcinomas.
182. Paget in vulva confirmed then do GI series and mammography
183. Mortality: Pt with cervical cancer in advance state die from renal failure,
and patients with ovarian cancer die from bowel obstruction
184. Screening; the only screen test for genital cancer is the pap test for
cervical cancer.
185. Screening: women have 3 types of screening: PAP, mammogram and
colon cancer . The detection of this cancer allows treatment and decrease
incidence.
186. Cancer: Colon cancer screening in woman: 50 years old do annual
guaiac test. 3 – 5 years a colonoscopy.
187. MC type of cancer in cervis: squamous
188. MC type of cancer in vulva: squamous
189. MC type of cancer in vagina: squamous. All related with HPV.
190. MC type of cancer in ovary: epithelial
191. MC type of cancer in endometrium: adenocarcinoma
192. Displasia can be mild, Moderate or severe.
193. Mild dysplasia affect the upper layers of epithelium, moderate dsplasia
can affect the middle third of epithelium, severe dysplasia is when also the
lower third of epitleium is affected. When this happen is call carcinoma in
situ.
194. Cervical intraepithelial neoplasia (CIN) is called I when is mild, is called
II when is moderate and is calle III when severe.
195. Always next step after abnormal PAP test is colposcopy, use acidic acid
to see cervix better.
196. Colposcopy with acid: if u see tiles…..mosaicism ( pre cancer), If you
see dots….called punctuation is precancer too, if you see white
patches….white epithelium is precancer too.
197. Pre cancer can appear as: “ mosaicism…punctuacion or white
epithelium”
198. In USA crio excision is the preferred method to destroy dysplastic
epithelium. Other methods are hot, cold, laser or wide surgical excision.
199. After treat a dysplasic epithelium do PAP every 3 moths for the next 3
years. If it come back again : threat the same way again.
200. Cone biopsy indications: 1. When the endocervical curettage is positive
for dysplastic cells. 2. When insatisfactory or inadecuade colposcopy that do
not let see the entire lesion. 3. With discrepancy between the cytology and
histology results. 4. When diagnosis of micro-invasive cervical cancer was
made in the past.
201. PAP showing severe dysplasia in a 16 week pregnant. What to do next?
Colposcopy. In pregnant do not do endocervical curetage. If the
ectocervical biopsy come back severe dysplasia the treatment Is nothing and
treat after the baby born with laser or crio. However during pregnancy has to
be followed every 3 months during pregnancy.
202. If invasive cancer is find in ultrasound in early pregnancy…finish the
pregnancy and hysterectomy, if advance pregnancy wait until baby is born.
In this case baby has to born by c section.
203. ASCUS…atypical squmos of undetermined significance…does not
have koilocitosis present. Next step repeat pap in 3 to 6 months.
204. If PAP come back saying ASCUS or HPV…do HPV typing to see HPV 6
or 11. If come back HPV 6 or 11, see the patient in 1 year. If come 16, 18,
31,32, colposcopy or biopsy.
205. In a pap report is worse to see HPV positive than see ASCUS .
206. If an endometrial sampling of a woman comes “cystic† think in
adenomatosis if it is “atypical” then is adenocarcinoma.
207. Mole. 1/12000. Snow storm. Treat with suction and curettage, then see
once a week HCG
208. Mole…after evacuation bhCG takes 10-12 weeks to goes down in 80%
cases. If keep going up do chemotherapy. Pt with mole pregnancy has to go
to strict contraception for 1 year. (oral)
209. If bhCG keeps going high next step is doing ct scan of brain, thorax,
abdomen and pelvis.
210. Choriocarcinoma has a bad prognosis if it is in liver or brain, if hCG is
more than 40 000 after curettage or more than 4 months with hcG increase
after a normal baby.
211. Choriocarcinoma is 50% after mola, 25% after ectopic pregnancy or
miscarriage, 25% after normal baby.
212. Mole..treatment: if not metastatic, metrotrexate or actinomicin. If
multiple metastasis or poor prognosis use a multiple agent like MTx plus
actinomicin D and citosin ( MAC)
213. Postcoital bleeding…..colposcopy and punch biopsy. If mass is present
do metastatic work up…if result invasive….do chemotherapy …plus
cistoscopy, sigmoidoscopy and iv pielogram, cx chest and pelvic examination
214. Gynecological cancers are surgical stage…all need pathology just the
cervix cancer can be clinically staged.
215. Emergency contraception, within 72 hours and 12 hours later
216. DES. To threatened abortion, In 1971 know is theratogenic. Daughter of
those woman has vaginal adenosis ( the most common result ) where the
vaginal columnar epithelium behave like cervix epithelium. Also can have
clear cell vaginal adenocarcinoma. Dg. Around 19 yo. With better prognosis
than squamous cell. Other severe malformations were reported.
217. Endometrial cancer risk factor: obese, nullipare, late menopause, HTA,
diabetes, breast Cancer, colon cancer, ovarian cancer, increase estrogen
levels, tamoxifen.
218. Squamous cell: main risk fact is HPV
219. Precocious puberty can be 1. Ture isosexual and 2. Pseudoisosexual.
220. Precocious puberty true isosexual when exis hiphotalamic, hypphofisis
and ovary is working in high levels.
221. Precocious puberty pseudoisosexual due to malfunction of ovary,
adrenal, exogen estrogen, hypothyroidism, mc. Cune Albright.
222. Dg. Df. Between isosexual and pseudoisosexual is GnRH stimulation
test: 100 mc Iv bolus. If LH increase is true isosexual
223. Tocolitic. The only tocolitic drug accepted in USA is Ritodrine ( b2
agonist) however, magnesium sulfate is better…and compete with calcium
to get into the cell
224. Mastitis in breast feeding. Suspend breast feeding and give doxiciline
( UW..other sources says not suspend).
225. Postpartum contraception: progestin pills
226. Syphilis diagnosis: dark field…see the spirochete
227. Contraceptives predispose to cervical ectopy and facilitate colonization
with Chlamydia
228. Precocious puberty and mass in ovary> is granulose cell tumor, with
increase estrogens
229. Granulose cell tumor also appears in postmenopausal woman, with
bleeding, myohyperplasia and good vaginal lubrication.
230. Next step after fetal dismiss is search for cause: TORCH,
anticardiolipinas, chromosome cause,
231. AFP increase need to rule out: fetal dismiss, twins, and wrong last
menstrual period date. Next step ultrasound……….. AFP is low in
Down…then amniocentesis to confirm.
232. Incontinence: real stress: is a real anatomic problem. miss urine during
valsalva maneuvers….do surgery
233. Incontinence : urge: Detrusor instability.treat with
anticholinergic…..oxibutine
234. Incontinence: differentiate between urge and real stress with cytometric
studies
235. Incontinence: overflow…like diabetes, m sclerosis…bethanecol and
alpha blockers also self catheterization
236. Constant wetness after a surgery pelvic or abdominal surgery….fistula
237. Ultrasound accuracy is +/- 5 days at 12 weeks and +/- 7 days at 12-18
weeks.
238. Ultrasound> Optimal age for detecting fetal anomaly is between 18-10
weeks. Can be so late for measurements taken.
239. Karyotype: CVS 9 – 12 weeks.
240. Amniocentesis; for kariotyping, alpha fetus protein and biochemical
studies need to be done between 15-20 weeks
241. Amniocentesis for Rh immunization do it around week 24
242. Amniocentesis for maturation do around week 34
243. PUBS: require blood from umbilical vein> useful for karyotyping,
measure of IgM, blood type. Do after 20 week
244. Fetoscopy. Do around week 18-20.
245. Trysomy: most common at abortion is trysomy 16, most common at
birth is 21.
246. Turner can have normal intelligence but urinary malformation and
coartaction are some frequent
247. Teratogenic risk: big during week 4 – 8
248. Teratogenic radiation: 20 rads
249. HCG: appears at day 10. Peak at 9-10 week. Plateau at 20-22
250. Hormones: Estradiol: the most important during reproductive years in
non pregnant women. Estriol: the most important in pregnancy. Estrone:
come from androstenendione ( fat transformation ) in menopause years
251. Murmurs: A systolic murmur due to increase in CO could be normal, a
new diastolic murmur during pregnancy is never normal.
252. Weight: during 1 trimester. 5 to 8 pounds. Up to 13 weeks.
253. Weight: during 2 trimester: ( 13 to 26 week). One pound per wek
254. Weight: during 3 trimester: 1 pound per week
255. HRT: no cv beanefits, Reduce risk of colon cancer, reduce the risk of
osteoporosis, increase risk of breast cancer some formulations, increase risk
of stroke in long term use.
256. Endometritis: after partum; anaerobes: peptostreptococus,
streptococcus, bacterioidis flagilis. Or aerobs like e coli, and enterococus.
That is why treatment is started with clinda plus ampi until culture results are
coming
257. Endometritis postpartum. 70% are caused by anaerobes, if the is
abscess think in E. coli.
258. Stages of partum: First stage from onset of labor to full dilation…can
be latent: that is slow dilation until 2 oer 3 cm is dilated and require 20 h in
nullipare and less than 14 hours to multipare...can be active: where the
dilation is faster like 1 cm per hour
259. Stages of partum: Second stage: expulsion can be from 30 minutes to 3
hours in primipara and 5 to 30 mins in multipara
260. Stages of partum: Third stage: until placental expulsion
261. Stages of partum: Fourth stage: up to 6 hours after placental expulsion:
high risk of postpartum bleeding.
262. Latente phase can be prolonged by excess of anesthesia, hiper or
hipocontraction ( ineffective)
263. Hypertonic contraction: morphine sulfate
264. Hypotonic contraction: oxitocine…if then is too much….therapeutic
rest
265. HIV: increase risk of transmission if: recently infected, with advance
disease or preterm delivery.
266. HIV risk: decrease from 25 to 8% with ZDV trough pregnancy, labor,
delivery and newborn during the first 6 weeks of baby’s life.
267. Risk for endometrial cancer: diabetes and hypertension
268. Risk for cervical cancer; young age first sexual intercourse, young first
baby, several sexual partners, smoke , low economic level.
269. Risk for breast cancer: late births and pauciparity
270. OCP: decrease risk of ovarian and endometrial cancer.
271. MCC of intravascular coagulation in pregnancy is abruption
272. Fetal dismiss; first do dopler.then Eco..then Tp and TTP, fibrin and
platelets. During the first weeks there is labor with no induction required,
between 13 to 28 weeks require induction.
273. Induction for fetal dismiss: prostaglandin suppositories are 97%
effective. After 28 weeks no Pg but oxitocine due to Pg can cause uterine
rupture.
274. More than 43 weeks, delivery is mandate.
275. AFI: more than 5 and less than 25
276. Deceleration: variable: not related with contraction…due to cord
compretion…change mom position and see
277. Deceleration: early: fetal head compression
278. Deceleration: late: utero placaental insufficiency
279. Extreme fetal tachycardia, associated with infection
280. Solid mass in ovaries during pregnancy…luteoma of
ovaries…virilization of mom and fetus can occur due to the androgens
secreted by stromal cells. Are bilateral, multinodular, solid masses, more in
African American and multiparous.
281. Low progesterone in a woman is a defect in lutheal phase, can cause
short cycles and abortion.
282. Chorionic Villious Sampling (CVS) is preferred than serum screen in
women over 35 years old where fails to detect trisomy or the results are not
concluyent. Is the best choice if antecedents of genetic disorders.
283. Culdoscentesis, if suspect of ectopic pregnancy that is bleeding, but
always after to measure a HCG and do transvaginal ultrasound.
284. Do not do abdominal ultrasound, because US do not see if HCG is less
than 1500 or 2000
285. FSH more than LH is patognomonic of ovarian failure. FSH has to be
blocked by inhibin
286. Chemotherapy can cause failure of follicular cells, with decrease of
estrogens and inhibin….causing increase of FSH and LJ.
287. Differentials in a women with puerperal fever: pelvic tromboflebitis,
pelvic abscess, septic shot, endometritis ( 2 or 3 days post partum)
288. Endometritis is more common after C section or instrumentation
289. DOC in endometritis is clinda and aminoglucoside or ampiciline
290. Fever during the first 24 hours post partum….athelectasias.
291. Type of delivery in vasa previa: c section
292. Pt with history of distention of abdomen and heaviness that suddenly
develops peritonitis…think in pseudomyxoma peritonei due to rupture of
mucinous cystadenoma. Ovarian neoplasma with slow growing pattern.
293. An ovarian mass that appears during first week of gestation, unilateral
and disappear at the second trimester is a classic corpus luteum cyst of
pregnancy, that resolved whtn placenta took over function of progesterone
production
294. Girl that is showing changes of breast development and vaginal bleeding
with an ovarian mass unilateral in sonogram…is classical of granulose cell
tumor that is causing isosexual precious puberty due to increase of
estrogens.
295. Postmenopausal woman with temporal balding clitoromegaly, and facial
hair with unilateral pelvic mass: is a Sertoly Leydig cell tumor that is
hormonally functional producing androgens.
296. Asymptomatic unilateral mass solid, cystic and calcification components
in a young women can be assumed until proven otherwise as benign cystic
teratoma.
297. A young infertile nulligravida with history of dysmenorrheal and pain
with intercourse and bowel movements, …endometriosis.
298. Douching is a risk factor for tubo-ovarian abscess
299. Intrauterine devices are risk factors for PID and tubo-ovarian abscess
300. Gonadoblastoma are tumors that occurs in patient that have intersex
disorders. The mc presentation ins amenorrhea following puberty. Pt in risk
are male pseudohermaphroditism, mixed gonadal digenesis, and turners.

1) Timeline: prenatal testing @ 6-8wks, Triple Screen @ 15-18, Ultrasound,

18-20wk GBS culture @ 35-37wk RhoGAM @ 28wk (if +, treat at 28 wks and
72 hrs postportum Diabetes checkup @ 26-28wks (high risk pt @ prenatal
visit), Chorionic Villous Sampling @ 9-12wks
2) What tests makeup a normal prenatal visit? CBC, UA, Rubella, RPR, HBV,
Rh typing, sickle cell prep and if pt is a teenager then do gonorrhea and
chlamyida
3) What are the weeks of utmost teratogenicity in the fetus? 3-8 weeks
4) Where is progesterone made? 0-6 wks at chorionic villus, 6-9 weeks
between chorionic villus and placenta and then >9 weeks placenta alone
5) What do you do NEXT if hCG or AFP levels comes back too high or too
low? always recheck the dates with an ultrasound (vaginal is best)
6) What are some causes of HIGH hCG? Low hCG? For high hCG (remember
H C G: Hydatidiform mole, Choriocarcinoma and Gestations multiple (twins
and stuff), but also due to Downs syndrome and embryonal cancer). Low
hCG includes incorrect dates, ectopic and missed abortions)
7) What are some causes of High AFP? Low AFP? High AFP includes gatrocele,
omphalocele, NTD, incorrect dates. Low AFP includes Downs synd., Edwards
syndrome, incorrect dates.
8) Mom says she doesnt feel the baby move anymore, what is the next step?
U/S
9) Ultrasound does not pick up fetal heart tones, what is the next step? Real-
time U/S
10) In fetal demise, at what weeks do you do D&C? 16wks
11) Mom does not feel the baby move and after an ultrasound is done, fetal
heart tones are heard, what is the next step? NST
12) NST comes back nonreactive, what is the next step? do FAS, after that
repeat NST. If its reactive, thast good (means the baby was sleeping). if its
still nonreactive do BPP.
13) BPP comes back 8-10, what is the next step? Repeat in 4 days. What
about 4-6? Do stress test. What about 0-2? Emergency delivery
14) At what amniotic fluid level do you consider oligohydramnios? 15
15) A stress test comes back c late decelerations, what does that mean?
uteroplacental insufficiency. What about early decelerations? Head
compression. What about variable decelerations? Cord compression
16) A stress test comes back with any type of deceleration, what is the next
step in management? 1st D/C oxytocin, 2nd O2 and fluids, 3rd put pt on L
lateral decubitus postion, 4th get scalp pH (normal is 7.25-7.4, if pH 500?
Only continue AZT throughout 2nd and 3rd TM and 6 weeks postpartum.
26) What is the 1st test you use to diagnose HIV in a child less than 6 weeks
old? PCR (not ELISA)
27) What are the 4 major causes of 1st TM bleeding (for USMLE purposes of
course)? Mole, Incomplete abortion, Ectopic, Threatened abortion. What
about the 4 major causes of 3rd TM bleeding? Placenta previa, vasa previa,
abruptio placenta, uterine rupture.
28) A woman comes with vaginal bleeding in the 1st TM, what is the next
step in management? Speculum exam
29) If her cervical os is open and she had vaginal bleeding, what is the
diagnosis and tx? Incomplete abortion, do D&C
30) If her cervical os is closed and she had vaginal bleeding, what is the next
step in management? Vaginal U/S and b-hCG levels
31) If her cervical os is closed and you see a snowstorm pattern on u/s, what
is your dx and tx? Mole. what if the u/s showed an intrauterine pregnancy?
Threatened abortion. What if it showed no intrauterine pregnancy? Ectopic
32) If you narrowed it down to a mole, and you decide to do a D&C , but her
hCG levels stay very high (>100,000) and dont fall, what is your diagnosis?
Choriocarcinoma. What is your next step in management? Get CT of
chest/abdo/pelvis. What is your treatment? If no metastasis to brain/liver,
give MTX. If + METS, give radiation and MAC (MTX, adrenomycin, cytotoxin)
and then hysterectomy.
33) If you narrowed it down to an ectopic, and the woman is stable and does
not want surgery, what is your treatment? MTX. What if she is unstable and
does not want surgery? Surgery. What if she is unstable and just wants to be
treated, what is the best treatment then?? Surgery
34) A pt comes in with vaginal bleeding in her 3rd TM, what is your next step
in management? Ultrasound. What are you trying to rule OUT? Placenta
previa.
35) How will a woman with a placenta previa present? painless vaginal
bleeding. If it was preterm and it was mild how will you treat? hydration bed
rest. if she was preterm and it was serious how will you treat? c/s. What type
of delivery are you expected to do? c/s.
36) How will a woman with abruptio placenta present? painful bleeding.
Same questions as above? If mild then observe. If mod-severe, then vaginal
delivery if possible, otherwise c/s.
37) How will a woman with Vasa previa present? What type of delivery
should you do? painless vaginal bleeding, ROM and fetal bradycardia. C/s
38) How will a woman with uterine rupture present? how can you
differentiate it from a ruptured placenta? Sudden painful bleeding with
abnormal fetal heart rate. Ruptured placenta wont have abnormal fetal heart
rate (normal is 110-160)
39) If mom already has (+) Rh antibodies because of failed RhoGAM
administration in the past and she now presents to you, what will you do?
dont give rhogam, just get titers, if >1:8 then get spectrophotometry to
assess degree of hemolysis.
40) If mom has PROM, how can you confirm its correct? Fern + Nitrazine +.
What is the next step in management? Get cultures and start ampicillin +
gentamycin while waiting for results. Do you wait for results to start
treatment? No. What do you do if she has an infection? Deliver. What do you
do if there is no fever and child is between 24-35 weeks gestational age?
prophylactic Abx, steroids, hydration. What about >24wks? outcome is
dismal, induce labor.
41) A woman comes in with labor contractions, how will you be certain she is
in preterm labor and that the contractions are not Braxton-Hicks? Look for
cervical dilitation. What do you do next if you confirm that it is preterm
labor? 1st L lateral decubitus postion c O2 and IVF, 2nd start tocolytics.
Would you use tocolytics, if so which one? In this instance, B-adrenergic
tocolytics are preferred.
42) Give the 4 known tocolytics, and their adverse effect? MgSO4 (causes
hypotension, decrease DTRs and even coma), B-adrenergics (not given to DM
and Cardiac Disease), Calcium blockers (not given if hypotensive),
Prostaglandins (not given 40 weeks in gestation, what is the next step you
do? Check the dates. What do you do if the cervix is favorable? Induce labor
unfavorable? Wait until 42 weeks and then induce.
44) How do you know when its chronic HTN from gestational HTN? Chronic
HTN is HTN before 20 weeks gestation. what is the best drugs for HTN in
pregnancy? Hydralazine, Lobetolol. What is contraindicated? ACEI
45) How do you manage preeclampsia? hydrate and send home. severe
preeclampsia? MgSO4 and deliver. eclampsia? MgSO4 and deliver. Do yo do
vaginal or C/Sxn? Vaginal unless mom is unstable then C/S.
46) How do you manage prolonged latent phase? bed-rest. prolonged active
phase? oxytocin, then C-sxn. prolonged 2nd stage? If head is engaged, do
vaccuum. If head is not engaged, do C/S. If prolonged 3rd stage? manual
placental removal, then currettage. prolonged 4th stage? massage, 2nd
pitocin, 3rd PGE, 4th Methergin, 5th hysterectomy
47) What is the MCC of prolonged 4th stage? Uterine Atony. What are some
other causes? Lacerations, retained placenta (send for ex-lap if you cant get
it out), DIC and uterine inversion.
48) How do you manage shoulder distocia? McRoberts maneuver (maternal
thigh flexion and push on the suprapubic area)
49) Post-partum fever, what cause are you suspecting at days 0-1?
Atelactasis. 2-3? Endometritis. 1 week later? Septic thrombophlebitis
50) How do you treat endometritis? Ampicillin, Gentamycin and
Metronidazole. what do you suspect if that treatment does not stop the
fevers? Septic Thrombophlebitis. how do you manage that? Heparin
51) How do you manage mastitis? Dicloxacillin and continued breast feeding
from same breast
52) Mom does not want to breastfeed, what do you tell her? Ice-packs and
tight bra
53) Mom wants OCPs while breastfeeding, which one do you give her?
Progesin only (minipill)
54) How do you manage amniotic fluid embolism? Supportive care (oxygen
and intubation if needed, do not use heparin/warfarin as this is not a blood
clot).
55) How do you manage acute fatty liver of pregnancy in the emergent
setting? IVF, IV glucose and FFPs.