Important for Mcq
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Transcript of Important for Mcq
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IMPORTANT : Number-dependant and number-including questions represent at least
30% of the total questions of a Gynecology&Obstetrics exam , numbers include
(doses,periods,percentages ..etc) ,, most of us don't pay attention to numbers , most of
them are confusing , here is a brief including the main im...portant numbers in Obst.
Curriculum of end of round exam (which are in red): ((Numbers are copied from thedepartment Book))
**********************OBSTETRICS******************
********
*Age of viability = 28 weeks gestation
*30% of women experience slight bleeding in the first trimester
*15-20% of all pregnancies end in spontaneous abortion
*80% of all abortions occur in the 1st. Trimester & 20% in the 2nd trimester
*Chromosomal anomalies count for >50% of cases of spontaneous abortion
*50% or more of cases of threatened abortion will continue normally
*Surgical evacuation of the uterus is done only if the uterus is less than 12 weeks
gestation in size
*Spontaneous expulsion of missed 2nd trimesteric abortion occurs within 2-4 weeks
*Incidence of recurrent abortion = 1-2% of all pregnancies
*Incidence of isthmic incompetence = 0.5-1 %
*Isthmic incompetence surgery is done between 12-14 w. Gestation
*Success rate of McDonald's operation = 75-80%
*Disturbance of pregnancy in a rudimentary horn occurs at 4th or 5th m.
*Tubal ectopic represents 99% of all ectopic pregnancies
*Intrauterine gestational sac is seen by abdominal US at serum hCG level of 5000-5000
miu/ml and by vaginal US at 1000-2000 miu/ml
*Theca-leutin cysts are present in about 50% of gestational trophoblastic diseases
*Incidence of vesicular mole is < 1% of all pregnancies
*Recurrence rate of vesicular mole = 1-2%
*Prophylactic chemotherapy in acase of mole is indicated only with high risk
pregnancies at hCG level of > 100,000 miu/ml & theca-leutin cysts of >6 cm in diameter
*Malignant change of vesicular mole counts for 20% of all mole cases
*Follow up by serum hCG level in a vesicular mole is done as :
Weekly for 3 consecutive weeks then,
Monthly for 3 consecutive months then,
Every 2 months for a total 1 year
*After normal pregnancy serum hCG level declines in 6 w. , however in vesicular mole
it usually declines in about 9 weeks
*Suspicion of melagnancy in a vesicular mole is present when serum hCG level doesn't
dec. After 12 w. Or returns after decline*Incidence of Acc. Hge. = 1%
*Incidence of placenta previa = 1/300-1/500 of all pregnancies
*Normal CVP = 4-8 cmH2O
*Perinatal mortality in concealed acc. Hge. =95% , but in revealed = 50%
*Hypertensive disorders(in general) complicates 5-10% of all preg.
*Incidence of PE superimposing chronic htn. = 20-25%
*Chronic hypertension(not related to preg.) persists after preg. By > 12w.
*Hypertension of preeclampsia resolves after pregnancy by 6 w.
*Proteinuria of PE = >300mg/24h.
*Proteinuria of severe PE = 5gm/24h.
*Eclampsia complicates 1-2% of all cases of PE*HELLP syndrome complicates 2-4% of cases of PE
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Average amount = 30-50 cc
Average interval = 24 32 d. (28d.)
*Female ovary at time of puberty contains about 400,000 primordial follicles
*Follicular phase = 14 d. (variable)
*Luteal phase = 14 d. (constant)
*Life span of CL = 9 d.*Ovulation takes place 36 h. after LH surge & 12 h. after LH peak
*Placenta starts steroidogenesis at 8th w. gestation
*Decidua basalis represents 25% of the endometrial thickening
*Normal Spinbarkeit test (cervical mucus threads 7-10 cm.)
* PrimaryAmenorrhea:
Absence of menses with 2ry sexual ch. at 16y.
Absence of menses without 2ry sexual ch. at 14y.
*Secondary Amenorrhea is cessation of menses for > 6m.
*Incidence of Imperforate hymen = 0.1%
*Complete or partial Mullerian agenesis(Rokitansky syndrome) is 44XX
*Testicular feminization genotype is 44XY
*Y-containing gonads in testicular feminization carries 20% risk of
malignancy(gonadoblastoma)
*Complete Turner is 45XO
*Mosaic Turner is 46XX or 45XO
*In premature ovarian failure FSH level is >40 ng/ml
*Pituitary microadenomas are < 10mm. in diameter
*Pituitary macroadenomas are >10mm. in diameter
*Infantile uterus, body/cervix ratio = 1/1
*Adult uterus, body/cervix ratio = 2/1
*Doses of drugs used in ttt of hyperprolactinemia :
Bromocryptine = 1-2 tablets daily(4-6 weeks)
Cabergoline = 1/2 tablet twice weekly for 2weeks*Normal Prolactin level = 2.9-29 ng/ml
*Prolactinomas are responsible for >90% of pituitary causes of anovulation &
amenorrhea
*PCO has LH/FSH = 2/1 (which is abnormal)
*Rise in temp. in the 2nd half an ovulatory mens. Cycle = 0.2-0.3
*Midluteal serum progesterone is done 7 days after ovulation (at day 21 of the cycle)
*PEB is done 2-3 d. before menstruation
*Dose of CC = 50mg oral tablets twice daily for 5 d. starting from 5th day of the cycle
*Success rate of CC in induction of ovulation = 85%
*Dose of Tamoxifen : 10-40mg daily orally for 5 d. starting from the 2nd day of the cycle
*HMG contains 75IU FSH + 75IU LH*Purified FSH contains 75IU FSH + 1IU LH
*hCG is given as 2 ampoules 5000 m/IU each as a single IM inj.
*Incidence of PCOS = 5-10% of women in the reproductive age
*In LPD the luteal phase of the cycle is shortened to be < 11 d.
* Levels of P,E2,Prolactin,T,FSH,LH are all calculated in (ng)
*MPHG is sometimes associated with small ovarian follicular cyst < 5cm in diameter
*A cut-off value for endometrial thickness in menopause > 5mm is suspicious for
hyperplasia, and that > 10mm is suspicious for malignancy
*Anaerobes:Aerobes among vaginal flora = 10:1
*Normal vaginal pH = 3.8-4.5
*pH of vagina in BV = 4.7-7*50% of cases of BV are asymptomatic
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*Gardnerella Vaginalis may grow normally in the vagina of over than 50% of normal
women
*30% of cases of BV recur after treatment within 3 m.
*CDC regimen of BV :Metronidazole(tablets) 500 mg
Clindamycin(tablets) 300 mg
Metronidazole(gel) 5 g
Clindamycin(cream) 5 g
*About 30% of women have candidal colonization in their vagina with no symptoms
*Budding yeast under microscope is seen in 50-70% of yeast infected women
*CDC regimen of CV :
Topical : butaconazole 5g (3d.)-miconazole 5g(7d.)-nystatin(100,000 U)(14d.)
Oral : Fluconazole single oral dose(150mg)-Ketoconazole(in recurrent cases)
*Metronidazole in ttt of trichomoniasis is given 1 g orally
*Male sexual partner should be treated by metronidazole,otherwise he will be
reinfected by 25%
*Risk of prolapse increases by 1.2 times with each vaginal delivery
*Incidence = 20% of women over the age of 30 (1 in every 5 women)
*Corporeal fibroids represent 96% _ Cervical 4 %
*Sarcomatous in change of a myoma occurs in 0.2-0.5 % of cases
*30% of case of fibroid present with menorrhagia
*Small myoma gives a uterine size of < 12 w.,if more it indicates degeneration
*Medical ttt of fibroid is indicated when the uterus is < 12 w. , however surgical
management is indicated when it becomes > 14 w.
*Incidence of Endometriosis = 20 % of women in the childbearing period
*In mild cases of fibroid, but with severe symptoms, pseudopregnancy orpseudomenopause is created along a duration of 6m. to 2y.
*Male factor represents 30-40% of causes of infertility
*Female factor represents 40-50% of causes of infertility
*The cause of infertility is unexplained in 10-15% of cases
*Normal Semen parameters :
Vol. = 2-5 ml
Conc./ml = >20 million sperms/ml
Total spermatic count = >40 million/ml
Progression >50%
Motility >50%
Morphology >30% normal forms(oval head&single head)
WBC's < 1 milloion/ml
*Ovarian factor is the commonest cause of female infertility 30-40%
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*Decreased ovarian reserve is detected by high FSH level on dat 3 of the cycle
(>10ng/ml)
*HSG is performed 2-3 days after menses
*Post Coital Test is done 6-10 hours after intercourse
*Cu-T may be 380 or 200(Nova-T)
*Cu-T IUD is changed every 6-8 years*Mirena IUD is changed every 3-4 years
*IUD is inserted on the last day of menses,4-6 weeks after delivery & 3-4 weeks after
abortion
*IUD threads are cut 2 cm. from the ext. os
*Failure rate of IUD = 0.5/HWY
*Cu-IUD inc. blood loss by 35%
*Mirena dec. blood loss by 70%
*Abortion rate in pregnancy on IUD = 50% if threads are not seen & 25% if threads are
seen and IUD is removed
*COC monophasic pills are given on day 3 or 4 of menstruation for 21 d. followed by 7
d. free period , shedding occurs 3-4 d. after stopping COC
*Vaginal ring is applied on day 3-4 of menstruation for 21 d. followed by 7 d. ring free
period to allow withdrawal
*Contraceptive patches are given on day 3-4 of menstruation for 21 d. (changed every
one week) followed by 7 d. patch free period to allow withdrawal
*Failure rate of hormonal contraceptive method = 0.1-1/HWY
*Progestin only injectables are given every 3 m. IM
*Subdermal progestin Implants give 3 y. contraception
*During lactation 40-60% of women will experience amenorrhea&anovulation in the first
few months
*IUD is inserted post-coitaly for emergency contraception within 24-48 h.
*POP are given post-coital immediately as 1st dose followed by 2nd dose after 12 h.
*POP or COC are given within 72 h. after coitus for emergency contraception
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