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Flashcard

Medicine Part 1
Medicine Part 2
Gynecology & Obstetrics
Surgery
Pediatrics Part 1
Pediatrics Part 2
Ethics

Gynecology & Obstetrics

General Gynae and Obs1. Antidepressants Safe in Pregnancy
Fluoxetine & Citalopram
General Gynae and Obs2. Antidepressant Contraindicated in Pregnancy
Paroxetine
General Gynae and Obs3. Steps of Treatment for Uterine Atony
Uterine massage
Oxytocin
Prostaglandins or surgery
General Gynae and Obs4. Gestational Diabetes
Screening at 24 weeks
General Gynae and Obs5. Cervical Incompetence Surgery
12-14 weeks
General Gynae and Obs6. Most Important Antenatal Visit Activity
Pelvic examination
General Gynae and Obs7. Screening with Mammogram
50-74 years: Every 2 years
50 years: Annually
General Gynae and Obs8. Solid Ovarian Mass + High Ca 125
Oncology referral
General Gynae and Obs9. Best Time to Confirm Gestational Age via Ultrasound
11-13 weeks
General Gynae and Obs10. Most Important Investigation in the 1st Pregnancy Visit
CBC
General Gynae and Obs11. Diagnosis of Embryonic Pregnancy
Follow-up for 4 weeks
General Gynae and Obs12. Pregnant Before 24 Weeks + High Glucose
Do HbA1c
General Gynae and Obs13. Cervical Mass + Hemoptysis
Possible malignancy
General Gynae and Obs14. Safe Vaccine in Pregnancy
Influenza
General Gynae and Obs15. Risky Vaccine in Pregnancy
Rubella
General Gynae and Obs16. Vaccine to Reduce Stillbirth
Rubella (pre-pregnancy)
General Gynae and Obs17. Painless Genital Ulcer + Rash
Secondary syphilis
General Gynae and Obs18. Postoperative Fever Causes
0-2 days: Atelectasis/pneumonia
3-5 days: UTI
5-7 days: DVT
>7 days: Wound infection
General Gynae and Obs19. Jaundice in Newborn (Rh - Mother, Rh + Baby)
Auto-antibodies against fetal RBCs
General Gynae and Obs20. Mother Rh -ve and Baby (or Husband) Rh +ve
Give Anti-Rh
General Gynae and Obs21. Painful Genital Ulcer + Rash + Conjunctivitis
Gonorrhea
General Gynae and Obs22. HBV Husband
Wear condom
General Gynae and Obs23. Pregnant with HBV
Secondary prevention
General Gynae and Obs24. Baby of HBV Mother (First 12 Hours)
HBV vaccine + Ig
General Gynae and Obs25. Rupture of Membranes with History of Herpes Before
Speculum examination → Start Acyclovir if confirmed
General Gynae and Obs26. Recurrent Genital Herpes (Painful Vesicles)
Give Acyclovir
General Gynae and Obs27. Active Herpes Before Labour
Caesarian section
General Gynae and Obs28. Dyspareunia + Bleeding After Intercourse
Bleeding from cervix or uterus
General Gynae and Obs29. Treatment of Valvular Wart in Pregnancy
Cryotherapy
General Gynae and Obs30. Organism Causing Wart
HPV 6-11
General Gynae and Obs31. Multiple Sexual Partners + Valvular Lesion
Condyloma lata → Treponema pallidum
General Gynae and Obs32. Multiple Sexual Partners + Small Papule with Central Pitting
Molluscum contagiosum
General Gynae and Obs33. Immunity Baby Gets from Mother
Passive natural
General Gynae and Obs34. Hyperthyroidism in Pregnancy Up to 12 Weeks
Propyl thiouracil
General Gynae and Obs35. Hyperthyroidism in Pregnancy After 12 Weeks
Carbimazole
General Gynae and Obs36. Hydroxychloroquine
Safe in pregnancy but reduced efficacy with smoking
General Gynae and Obs37. Asthma in Pregnancy
Safe to take all medications
General Gynae and Obs38. Uterotonic Agent Contraindicated in Asthma
Carboprost F2 alpha
General Gynae and Obs39. Prevent Hypercalciuria Stone
Thiazide diuretics
General Gynae and Obs40. Previous Preterm Labour + Cervix >25 mm
Progesterone
General Gynae and Obs41. Previous Preterm Labour + Cervix <25 mm
Cervical cerclage
General Gynae and Obs42. Previous Preterm Labour ≥3 Times
Cervical cerclage
General Gynae and Obs43. Vitamin Deficiency Associated with Polished Rice
Vitamin B1
General Gynae and Obs44. Essential Supplement for Pregnancy
Folic acid
General Gynae and Obs45. Most Important Drug in Epileptic Pregnant Woman
Folic acid
General Gynae and Obs46. Asthma in Pregnancy (Treatment Steps)
Short-acting B-agonist → Inhaled steroid → Long-acting B-agonist + Steroid
General Gynae and Obs47. Atypical Endometrial Hyperplasia
Trial oral progesterone → If failed → Surgery
General Gynae and Obs48. UTI in 1st and 2nd Trimester
Nitrofurantoin
General Gynae and Obs49. UTI in 3rd Trimester
Amoxicillin or Cephalexin
General Gynae and Obs50. Anti-Thyroid Drugs in Pregnancy
Usually will need to increase the dose
General Gynae and Obs51. Antidote of MgSO4
Calcium gluconate
General Gynae and Obs52. Bleeding Due to Ovulatory Dysfunction
Give OCP
General Gynae and Obs53. Estrogens in Females
No specific detail provided
General Gynae and Obs54. Drugs to Avoid in Familial Mediterranean Fever in Pregnancy
Macrolides + Verapamil
General Gynae and Obs55. Newly Married Female Without Cycles for 2 Months + Bleeding
Source of bleeding is the tube (Ectopic pregnancy)
General Gynae and Obs56. Ectopic Pregnancy Refusing Surgery
Medical treatment + consent
General Gynae and Obs57. Post-Delivery with Exclusive Breastfeeding Asking for Long-Term Contraception
Depo-Provera injection
General Gynae and Obs58. Treatment of Hepatic Adenoma Caused by OCP
<5 cm: Stop OCP
>5 cm: Surgical excision
General Gynae and Obs59. Most Common Site of Post-Coital Bleeding
Cervix
General Gynae and Obs60. Post-Coital Bleeding
Examine vagina + cervix
General Gynae and Obs61. Post-Coital Bleeding + Cervical Mass
Do cone biopsy
General Gynae and Obs62. Urine Leaks During Intercourse and After Micturation
Urethral diverticulosis
General Gynae and Obs63. Triad of Dysuria + Dyspareunia + Incontinence
Urethral diverticulosis
General Gynae and Obs64. Irregular Menses + Abnormal Uterine Bleeding
Give Medroxyprogesterone
General Gynae and Obs65. Amenorrhea After Menarche
Give Medroxyprogesterone
General Gynae and Obs66. Abnormal Uterine Bleeding or Irregular Menses
Give Medroxyprogesterone
General Gynae and Obs67. Most Important Ig in Breast Milk
IgA
General Gynae and Obs68. Instructions to HIV Mother on HIV Medications
No lactation but treatment decreases transmission rate to baby
General Gynae and Obs69. TB Mother Lactation Status
No lactation but treatment decreases transmission rate to baby
General Gynae and Obs70. HBV Mother Lactation Status
Allowed
General Gynae and Obs71. No Milk After Delivery
Sheehan syndrome
General Gynae and Obs72. Most Important Risk Factor for Breast Cancer
Age
General Gynae and Obs73. Amenorrhea + Delayed Breast Development
Hypogonadotrophic hypogonadism
General Gynae and Obs74. Amenorrhea + No Pubic or Axillary Hair
Androgen insensitivity
General Gynae and Obs75. Amenorrhea + Pubic and Axillary Hair + High Testosterone
Mullerian agenesis
General Gynae and Obs76. Breast Mass + Positive Family History of Cancer
Do BRCA gene testing
General Gynae and Obs77. Inflamed Breast Mass in Lactating Mother
Abscess needs drainage
General Gynae and Obs78. Inflamed Breast WITHOUT Mass
Mastitis → Needs antibiotics only
General Gynae and Obs79. Unilateral Breast Mass (1st Investigation)
Bilateral breast ultrasound
General Gynae and Obs80. Bilateral Breast Lumps Painful Before Menses
Breast ultrasound
General Gynae and Obs81. Breast Mass with Suspected Malignancy
Mammography (NOT ultrasound)
General Gynae and Obs82. Best Advice to Pregnant Smoker
Smoking cessation
General Gynae and Obs83. Cracked Nipple
Breastfeeding is contraindicated
General Gynae and Obs84. Cystosarcoma Phyllodes
Wide local excision
General Gynae and Obs85. Breastfeeding Mother with Inverted Slit-Like Nipple
Duct ectasia
General Gynae and ObsDuct ectasia 86. Best Timing for Breastfeeding Counseling
Before pregnancy
General Gynae and Obs87. Breastfeeding Mother Developed Breast Abscess
Continue breastfeeding from the other breast
General Gynae and Obs88. Common Sources of Vaginal Bleeding
Married: Cervix
Suspected Pregnancy: Ectopic in the tubes
Elderly: Uterus
General Gynae and Obs89. Child with Breast Development but No Secondary Sexual Features
Early breast development NOT puberty
General Gynae and Obs90. Endometrial Hyperplasia Consent
Verbal
General Gynae and Obs91. Fibroid Management
Laparoscopic myomectomy
General Gynae and Obs92. Fibroid Increased in Size Suddenly
Malignant transformation (Leiomyosarcoma)
General Gynae and Obs93. Fever + Recurrent Bleeding Post-Labour (Especially CS)
Endometritis
General Gynae and Obs94. Most Characteristic Feature of Endometrial Bleeding
Heavy bleeding
General Gynae and Obs95. Multiple Small Masses Around the Areola in Pregnancy
Lactiferous ducts
General Gynae and Obs96. Risk Factor for Endometrial Cancer
Nulliparity
General Gynae and Obs97. Treatment of Epithelial Ovarian Cancer
Surgery then chemotherapy
General Gynae and Obs98. Cancer in Labia Majora Treatment of Epithelial Ovarian Cancer
SCC
General Gynae and Obs99. Most Important Step After Diagnosing Malignant Phylloid Tumour
CT-chest
General Gynae and Obs100. Best Investigation in Family History of Breast Cancer
BRCA gene testing
General Gynae and Obs101. Differentiating Normal from Malignant Ovarian Cyst
Malignant is hypoechoic
General Gynae and Obs102. Risk Factors for Ovarian Cancer
Infertility, nulliparity, early menarche, late menopause
General Gynae and Obs103. High CA 125
High suspicion of ovarian cancer
General Gynae and Obs104. High LH + High FSH + Low Estrogen
High risk of osteoporosis
General Gynae and Obs105. Simple Test for Turner Patient with Amenorrhea
FSH/LH
General Gynae and Obs106. First Test in Amenorrhea
Pregnancy test
General Gynae and Obs107. Amenorrhea + Pregnancy Test -ve
FSH/LH
General Gynae and Obs108. Deeply Implanted Placenta
Placenta increta
General Gynae and Obs109. Most Common Morbidity in Multiparity
Prematurity
General Gynae and Obs110. Which Ig Crosses the Placenta?
IgG
General Gynae and Obs111. Testing for Risk of Chromosomal Anomalies
Nuchal translucency test at 11-13 weeks
General Gynae and Obs112. Management of Placenta Previa Before 37 Weeks
Mother and fetus stable: Admission and conservative treatment
Mother and fetus not stable: CS
General Gynae and Obs113. Management of Placenta Previa After 37 Weeks
CS
General Gynae and Obs114. Placenta Implanted in the Uterine Wall
Placenta creta
General Gynae and Obs115. IVC Compression by the Uterus
Hypotension
General Gynae and Obs115. IVC Compression by the Uterus
Hypotension
General Gynae and Obs116. Confirmation of Labour
Examination every 2 hours
General Gynae and Obs117. Fetal Bradycardia + Painless Vaginal Bleeding + Amniotomy
Vasa previa (Fetal blood vessels near the internal os)
General Gynae and Obs118. Normal Cervical Length Before Pregnancy
4-5 cm
General Gynae and Obs119. Normal Cervical Length During Pregnancy
>3 cm
General Gynae and Obs120. Cervical Length During Pregnancy <3 cm
Risk of preterm labour → Give progesterone
General Gynae and Obs121. Lymphatic Drainage of Uterine Fundus
Para-aortic LN
General Gynae and Obs122. DVT or PE in Pregnancy Treatment
Enoxaparin
General Gynae and Obs123. Pregnant + History of Previous DVT
Enoxaparin
General Gynae and Obs124. Risk Factor for DVT
OCP
General Gynae and Obs125. Supplementation for Planning or Early Pregnancy
Folate
General Gynae and Obs126. Fetal Death
Induce labour
General Gynae and Obs127. Lab Findings in DIC
Prolonged PT, PTT + Low platelets + Low fibrinogen
General Gynae and Obs128. Recurrent Miscarriage ± PE or DVT
Suspect anti-phospholipid syndrome
General Gynae and Obs129. Recurrent Spontaneous Abortion
Suspect anti-phospholipid syndrome
General Gynae and Obs130. Bleeding + Everything is Normal
Threatened abortion (Mostly before 20 weeks) → Bed rest
General Gynae and Obs131. Bleeding + Os Closed + No Fetus
Complete abortion → No treatment (Fetus already passed)
General Gynae and Obs132. Bleeding + Passage of Tissues + Os Opened
Incomplete abortion → D&C + IV fluids
General Gynae and Obs133. Bleeding + No Passage of Tissues + POC at the Cervix
Inevitable abortion
General Gynae and Obs134. Swelling in the Vulva
Bartholin cyst
General Gynae and Obs135. 0 O’clock Lesion at the Vulva with Pus Discharge
Bartholin duct abscess
General Gynae and Obs136. Vaginal Bleeding After RTA
Check for pregnancy
General Gynae and Obs137. Supra-Pubic Pain + Itching in Vulva in Newly Married Female
Honeymoon syndrome
General Gynae and Obs138. Meigs Syndrome Management
Histopathology
General Gynae and Obs139. Severe Menorrhagia
Medroxyprogesterone
General Gynae and Obs140. Large Ovarian Cyst
Laparoscopic or open surgery
General Gynae and Obs141. Vulvar Itching After Using Local Cream
Allergic dermatitis
General Gynae and Obs142. Young Female (e.g., 13 Years Old) with Recurrent Weekly Bleeding
Irregular menses (common in the first few months)
General Gynae and Obs143. Tanner Scale
For determining puberty and sexual development grade
General Gynae and Obs144. Secondary Sexual Characters + No Menses
Look for imperforate hymen
General Gynae and Obs145. First Test in Case of Delayed or No Menses
Pregnancy test
General Gynae and Obs146. Irregular Cycles + Amenorrhea + Spotting
Pregnancy test
General Gynae and Obs147. LMP 5 Months Ago
Pregnancy test
General Gynae and Obs148. First Screening Test Before Any Pregnancy
HPV screening
General Gynae and Obs149. 9-Month-Old Girl with Asymmetrical Breast Enlargement
Do pelvic US
General Gynae and Obs150. 6-Year-Old Girl with Vulvar Itching + Bleeding + Offensive Smell
Foreign body
General Gynae and Obs151. Urge Incontinence Treatment
Kegel exercises
General Gynae and Obs152. Urge on Coughing or Sneezing + Urge to Go to the Bathroom
Mixed incontinence
General Gynae and Obs153. What Prevents the Uterus from Prolapse
Uterosacral ligament
General Gynae and Obs154. Mechanism of Action of OCP
Inhibition of gonadotropins
General Gynae and Obs155. Galactorrhea ± Irregular Menses
Do prolactin level
General Gynae and Obs156. High Prolactin Level
MRI brain to view sella turcica
General Gynae and Obs157. Infertility + Headache + High Prolactin + High TSH
Do Brain MRI
General Gynae and Obs158. Determine the Expected Date of Delivery
Ultrasound
General Gynae and Obs159. Dysmenorrhea in Young Females Without Other Symptoms
Normal (Primary dysmenorrhea)
General Gynae and Obs160. Timing of Tubal Ligation
After menstruation
General Gynae and Obs161. What to Do for Unbooked Women
Ultrasound to determine gestational age
General Gynae and Obs162. Turner Syndrome with Amenorrhea
Do FSH
General Gynae and Obs163. Turner Syndrome Association
Coarctation of aorta
General Gynae and Obs164. Probability of Turner Syndrome in Next Pregnancy
30%
General Gynae and Obs165. 15-Year-Old with Short Stature and Webbed Neck
Look for chromosomal disorders
General Gynae and Obs166. Screening Test for Down Syndrome
Quadruple test = Quad screen test (AFP, hCG, Estriol, Inhibin-A) at 2nd trimester
General Gynae and Obs167. Most Sensitive Marker for Down Syndrome in 2nd Trimester
High hCG
General Gynae and Obs168. Diagnostic Test of Pregnancy
Serum B-HCG
General Gynae and Obs169. Treatment of Primary Dysmenorrhea
NSAIDs
General Gynae and Obs170. Dysmenorrhea Not Responding to NSAIDs
Exercise + Relaxation → If not responding, give OCP
General Gynae and Obs171. Menorrhagia
OCP
General Gynae and Obs172. Adnexal Mass Felt in Mid-Cycle in Healthy Female
Follicular cyst
General Gynae and Obs173. Vaginal Discharge and All Investigations Normal
Physiological discharge
General Gynae and Obs174. Mother of Sickle Cell Child Wants to Marry Again
Do Hb electrophoresis for the husband
General Gynae and Obs175. Relation Between LH Peak and Ovulation
Ovulation occurs after 36 hours of LH peak
General Gynae and Obs176. GERD in Pregnancy
1st step is lifestyle modifications
General Gynae and Obs177. Acid-Base Disorder in Fetal Asphyxia
Metabolic acidosis
General Gynae and Obs178. Who Should Decide Contraception?
Both the husband and the wife
General Gynae and Obs179. Refusing Intervention in Life-Threatening Situation
Take consent from the husband
General Gynae and Obs180. Cervical Polyp
Removal in the clinic
General Gynae and Obs181. Soft Tissue Projection During Hysteroscopy
Endometrial polyp, not fibroids
General Gynae and Obs182. Breast Pain During Menses + US Breast Shows Multiple Cysts
Fibrocystic disease of the breast
Infertility and PID183. Infertility with Regular Periods and Monophasic Basal Body Temperature
Anovulation (Temperature should increase with ovulation)
Infertility and PID184. When to Consider a Couple Infertile?
12 months
Infertility and PID185. Cause of Infertility in Polycystic Ovary
Anovulation
Infertility and PID186. First Thing to Look for in Case of Infertility
General look
Infertility and PID187. First Investigation to Order in Case of Infertility
Semen analysis
Infertility and PID188. Most Significant Examination in Newly Married Woman
Pelvic examination
Infertility and PID189. Best Advice to Prevent Infertility
Eat less fatty food
Infertility and PID190. Irregular Cycles + Anovulation + Atypical Endometrial Hyperplasia
Give oral progesterone
Infertility and PID191. First Test in Case of Regular Cycles with Infertility
LH/FSH ratio
Infertility and PID192. Who to Inform in Bilateral Tubal Blockage?
Both partners
Infertility and PID193. Bleeding in Late Pregnancy
Ask about intercourse
Infertility and PID194. PID → Adhesions → Bilateral Tubal Blockage → Infertility
Pelvic inflammatory disease (PID)
Infertility and PID195. Organism Causing PID and Adhesions
Chlamydia
Infertility and PID196. Infertility Secondary to PID
Hysterosalpingography
Infertility and PID197. Cause of Infected IUD
Actinomycosis
Infertility and PID198. Chlamydia in Pregnancy Affects Which Part of the Infant
Eye
Infertility and PID199. Strawberry Cervix with Yellowish to Grey Discharge
Chlamydia trachomatis
Infertility and PID200. Treatment of Infertility Caused by Chlamydia PID
IVF
PAP smear and colposcopy201. Screening for Cervical Cancer Using PAP Smear
Below 30: Screening every 3 years starting from age 21
If ASCUS: Repeat after 1 year (mostly resolves).
Above 30: Screening every 3 years
If ASCUS: Do HPV → Positive: Colposcopy; Negative: Screening every 3 years.
PAP smear and colposcopy202. HGSIL (High-Grade Squamous Intraepithelial Lesion) in PAP Smear
Do colposcopy (20% may progress to cancer)
PAP smear and colposcopy203. Breast Tenderness Before Periods
PAP smear
PAP smear and colposcopy204. Last PAP 3 Years Ago or More
Repeat PAP smear
PAP smear and colposcopy205. Previous Genital Wart
Do PAP smear
PAP smear and colposcopy206. Cervical Lesion with Irregular Borders
Excision
PAP smear and colposcopy207. Female with Atypical Hyperplasia Many Years Ago
Repeat PAP smear
PAP smear and colposcopy208. Suspicious Lesion on the Cervix
Do PAP smear
PAP smear and colposcopy209. Postmenopausal with ASCUS
Local estrogen → Reassess after 1 month → If not resolved: Colposcopy
PAP smear and colposcopy210. How to Do PAP Smear
From the transformation zone (endocervix)
PAP smear and colposcopy211. First Step After Diagnosing Invasive Cervical Carcinoma on Colposcopy
Staging
PAP smear and colposcopy212. Postpartum Clear Discharge Positive for Leucocytes and Epithelial Cells
Normal
PAP smear and colposcopy213. Fever After a Few Days of Delivery (Up to 6 Weeks)
Endometritis
PAP smear and colposcopy214. Antibiotic for Mastitis
Ceftriaxone
PAP smear and colposcopy215. C. Difficile Infection
Vancomycin (oral)
PAP smear and colposcopy216. Vaginal Bleeding and Brown Discharge in Early Pregnancy
Normal
PAP smear and colposcopy217. Positive PAP Smear + Inconclusive Colposcopy
Do cone biopsy
PAP smear and colposcopy218. Post-Coital Bleeding + Cervical Mass
Excision in the clinic
PAP smear and colposcopy219. Uterine Mass Increases During Pregnancy Without Malignant Features
Polyp → Monitor and reassess after delivery
PAP smear and colposcopy220. Vulvar Tumour in Situ (Benign or Malignant)
Local superficial excision
PAP smear and colposcopy221. Vulvar Mass Translucent and Filled with Mucus
Vulvar mucinous cyst
PAP smear and colposcopy222. Lichen Planus in the Vulva
SCC
PAP smear and colposcopy223. Tumour Causing Meigs Syndrome (Ascites + Pleural Effusion Resolves After Excision)
Benign solid ovarian tumour (Sex cord-stromal tumour)
PAP smear and colposcopy224. Best Diagnostic Test in Suspected Cervical Cancer
Biopsy
PAP smear and colposcopy225. Risk Factor for All Malignancies
Smoking
Pre-eclampsia226. Diagnosis
BP >140/80 + Proteinuria
Pre-eclampsia227. 34 Weeks or More
Delivery + MgSO4
Pre-eclampsia228. Before 34 Weeks and Stable
Admit for observation + MgSO4
Pre-eclampsia229. Before 34 Weeks and Unstable
Delivery + Steroids (for immature lungs)
Pre-eclampsia230. MgSO4 Toxicity (Absent Deep Tendon Reflexes, Dyspnea, or Non-Reactive CTG)
Stop immediately + Calcium gluconate
Pre-eclampsia231. HTN Before Pregnancy Increases Risk Of
Pre-eclampsia
Pre-eclampsia232. Common Cause of IUGR
Oligohydramnios
Pre-eclampsia233. Prevention of Convulsions in Pre-Eclampsia
MgSO4
Pre-eclampsia234. Indicator of Severe Pre-Eclampsia
Low platelets
Pre-eclampsia235. Treatment of HTN in Pre-Eclampsia
Hydralazine (emergency) + Methyldopa (not in emergency)
Pre-eclampsia236. Gestational DM + Nephritis + HTN at Risk Of
Pre-eclampsia
Vaginitis237. Fishy Smell, Foul Smell, Grey Discharge, Epithelial Cells, Clue Cells
Bacterial vaginitis → Metronidazole
Vaginitis238. Yellow-Green Discharge, Flagellate
Trichomonas vaginalis → Metronidazole
Vaginitis239. Odourless Vaginal Discharge, White Grey, Budding Yeast Cells, Pseudohyphae, Hyphae
Candidiasis → Fluconazole or Itraconazole
Vaginitis240. Female Vaginal Discharge + Husband Has Discharge
Gonorrhea → Ceftriaxone
Vaginitis241. Common Predisposing Factor to Candidiasis
Diabetes Mellitus (DM)
Vaginitis242. When to Treat the Male Partner
Trichomonas only
Vaginitis243. Vaginal Infection Causing Incompetence
Bacterial
Vaginitis244. Testing for Bacterial Vaginitis
Gram stain
Menopause245. Postmenopausal Bleeding Commonest Cause
Cancer endometrium until proved otherwise
Menopause246. Dexa Scan Result 1.5 – 2.4
Osteopenia
Menopause247. Dexa Scan Result 2.5 or More
Osteoporosis
Menopause248. High LH + High FSH
Ovarian failure (early menopause) → Low estrogen → Risk of osteoporosis
Menopause249. Diagnosis of Premenopausal Syndrome
FSH
Menopause250. Incontinence in Postmenopausal Women
Pelvic muscle exercises for 8 weeks
Menopause251. What Is Hot Flushes?
Increase in core body temperature due to hormones
Menopause252. Pathogenesis of Postmenopausal Hot Flushes
Cutaneous thermoregulators or low estrogen
Menopause253. Postmenopausal Asks for HRT
Refuse
Menopause254. Postmenopausal C/O Itching in Vulva + Watery Discharge + Scaly Vulva
Atrophic vaginitis
Menopause255. Postmenopausal Bleeding + Shiny Vulva Which Bleeds on Touch + Dryness
Atrophic vaginitis
Menopause256. Treatment of Atrophic Vaginitis
Topical estrogen
Menopause257. Carcinoma in Situ in the Vulva
Wide local excision OR superficial vulvectomy
Menopause258. How to Confirm Psoriasis of the Vulva
Biopsy
Menopause259. Change of Skin Color of Vulva to Brown or Black That Bleeds on Touch
Skin tag
Menopause260. Postmenopausal Bleeding + Endometrial Hyperplasia
Think of cancer
Menopause261. Tamoxifen + Postmenopausal Bleeding
Endometrial cancer
Menopause262. Breast Cancer on Tamoxifen Developed Postmenopausal Bleeding
Do biopsy
Menopause263. Hypoechoic Lesion in the Uterus
Endometrial cancer
Menopause264. Postmenopausal Bleeding + Endometrial Hyperplasia ± Atypia
Hysterectomy
Menopause265. Post Total Hysterectomy + Bilateral Oophorectomy
Give estrogen only
Menopause266. Commonest Source of Postmenopausal Bleeding
Uterus
Menopause267. Most Important Investigation for Postmenopausal Bleeding
Endometrial biopsy
Menopause268. Postmenopausal with Bilateral Ovarian Tumour
Refer to gynecology oncologist
Endometriosis 269. Classic Triad of Endometriosis
Dyspareunia + Dysmenorrhea + Dyschezia
Endometriosis 270. Other Presentations
Dysuria + Inter-menstrual bleeding + Infertility
Endometriosis 271. Complications
Infertility
Endometriosis 273. US Uterus Showed Ground Glass Appearance
Endometriosis
Endometriosis 274. Dysmenorrhea Not Relieved by Analgesics
Suspect endometriosis
Endometriosis 275. Suspected Endometriosis
Do laparoscopic exploration
Endometriosis 276. Endometriosis Cancer Risk
Epithelial ovarian tumour
Endometriosis 277. Heavy Menses + Infertility
Suspect endometriosis
Endometriosis 278. Severe Dysmenorrhea
Suspect endometriosis
Postpartum hemorrhage279. First Step in Management
Uterine massage
Postpartum hemorrhage280. Most Important Medication for PPH (Highest Success Rate)
Oxytocin
Postpartum hemorrhage281. Primary PPH
First 24 hours
Postpartum hemorrhage282. Secondary PPH
After 24 hours and before 6 weeks
Postpartum hemorrhage283. Prevention of Recurrent PPH
Reduce maternal stress + Reduce labour duration + Fundus massage
Postpartum hemorrhage284. PPH Due to Macrosomic Baby
Oxytocin
Postpartum hemorrhage285. PPH Not Responding to Massage and Medications (Next Step)
B-Lynch suture of the uterus
Postpartum hemorrhage286. Death Rate from PPH
25%
PCOS (Polycystic ovary)287. Pathophysiology
Increased testosterone level
PCOS (Polycystic ovary)288. Symptoms
Hirsutism + Acne + Irregular menses or amenorrhea + Weight gain + Obesity
PCOS (Polycystic ovary)289. Main Lines of Treatment
Metformin + Weight loss + Clomiphene
PCOS (Polycystic ovary)290. Treatment of Infertility in PCOS
Clomiphene
PCOS (Polycystic ovary)291. PCOS Doesn’t Want Pregnancy
Estrogen + Progesterone
PCOS (Polycystic ovary)292. PCOS + Obese
Metformin (Decreases insulin resistance → Prevents diabetes)
PCOS (Polycystic ovary)293. FSH/LH Ratio in PCOS
1:3
PCOS (Polycystic ovary)294. Irregular Menses + Increased LH + Increased Testosterone
Do Glucose tolerance test + Lipid profile
PCOS (Polycystic ovary)295. Blood Test for Hirsutism
Testosterone level
PCOS (Polycystic ovary)296. Cause of Endometrial Hyperplasia in PCOS
Unopposed estrogen
PCOS (Polycystic ovary)297. PCOS + Endometrial Hyperplasia
Induction of 3-monthly withdrawal bleeds with progesterone
PCOS (Polycystic ovary)298. Amenorrhea + High Testosterone
Complete androgen insensitivity (No hirsutism)
PCOS (Polycystic ovary)299. Amenorrhea + High Testosterone + Normal Breast Development + Hirsutism
Mayer Rokitansky Küster Hauser syndrome
Adenomyosis300. Definition
Invasion of endometrial glands into the myometrium
Adenomyosis301. Age
35-50
Adenomyosis302. Risk Factors
35-50Fibroids + Endometriosis>
Adenomyosis303. Symptoms
35-50Fibroids + Endometriosis>
Adenomyosis304. Keyword
35-50Fibroids + Endometriosis>Bulky or large uterus (± tender abdomen) OR Menorrhagia with previous uterine surgery
Adenomyosis305. Diagnosis
Bulky or large uterus (± tender abdomen) OR Menorrhagia with previous uterine surgery
Adenomyosis306. Treatment
Hysterectomy
Pregnancy diseases307. Pregnancy + Jaundice + Itching
Pregnancy cholelithiasis
Pregnancy diseases308. Midsystolic Murmur in Pregnancy
Physiologic
Pregnancy diseases309. Systolic Murmur Radiating to the Carotid
Aortic stenosis (AS)
Pregnancy diseases310. How to Assist a Mitral Stenosis Patient During Labour
Use forceps (to avoid straining)
Pregnancy diseases311. Brown Spots in Pregnancy
Chloasma of pregnancy
Pregnancy diseases312. What Is Dizygotic?
Di-chorionic + Di-amniotic
Pregnancy diseases313. Right Lower Abdominal Pain Without Pregnancy-Related Cause
Suspect appendicitis
Pregnancy diseases313. Right Lower Abdominal Pain Without Pregnancy-Related Cause
Divarication of recti
Pregnancy diseases315. Fate of Divarication of Recti
Resolves after delivery → If not, refer to surgery
Pregnancy diseases316. Early Pregnancy + Vomiting After Every Meal + Weight Loss + Fatigue
Hyperemesis gravidarum
Pregnancy diseases317. Os Closed + No Abortion + US Shows Empty Sac
Anembryonic pregnancy → Follow up after 4 weeks
Pregnancy diseases318. How to Stop Heavy Bleeding
High dose conjugated estrogen only (not OCP)
Pregnancy diseases319. Clinical Confirmation of Pregnancy
Uterus just above symphysis pubis (not higher)
Pregnancy diseases320. Incontinence in Multipara
Do Kegel exercises for 6 weeks and reassess
Pregnancy diseases321. When to Do Cholecystectomy in Pregnancy?
2nd trimester (Most safe for any operation)
1st trimester: Risk of abortion
3rd trimester: Risk of preterm labour
Pregnancy diseases 322. Symptomatic Biliary Colic in Pregnancy
Laparoscopic cholecystectomy in 2nd trimester
Pregnancy diseases323. Next Step After Salpingotomy for Ectopic Pregnancy
B-HCG weekly
Pregnancy diseasesB-HCG weekly 324. Why Do Medio-Lateral Episiotomy?
Prevent 4th-degree perineal tear
Pregnancy diseases325. Which Fetal Presentation Causes 3rd and 4th Degree Perineal Tear?
Occipitoposterior position
Pregnancy diseases326. Which Perineal Tear Affects Rectal Mucosa?
4th degree
Pregnancy diseases327. Swelling in Episiotomy After Few Hours
Sitz bath + dressing
Pregnancy diseases328. Management of Bleeding from Lacerations After Delivery
Prostaglandin F2
Pregnancy diseases329. Prognostic Lab Result for DM in Pregnancy
HbA1C
Pregnancy diseases330. No Bleeding in Menses After D&C
Removal of the stratum basalis layer of the endometrium
Pregnancy diseases331. Abortion More Than 3 Times (Anatomical Cause)
1st Trimester: Septate uterus
2nd Trimester: Arcuate uterus
Pregnancy diseasesTell the patient
Tell the patient
Pregnancy diseases333. HTN Before 20 Weeks
Primary HTN
Pregnancy diseases334. HTN After 20 Weeks
Pregnancy-induced HTN
Pregnancy diseases335. Pregnancy-Induced HTN - Medication to Start
Methyldopa
Pregnancy diseases336. Common Complication of Pregnancy-Induced HTN
IUGR
Pregnancy diseases337. Anti-HTN in Pregnancy
Methyldopa (1st line) + Labetalol (2nd line) + Hydralazine + Nifedipine
Pregnancy diseases338. ACEIs in Pregnancy
Absolutely contraindicated
Pregnancy diseases338. ACEIs in Pregnancy
Absolutely contraindicated
Pregnancy diseases339. Pigmentation Over Body Folds (Neck, Axilla, Groin)
Acanthosis nigricans
Pregnancy diseases340. Treatment of DM in Pregnancy
Insulin
Pregnancy diseases341. Safest Route of Glucose Administration to DM Pregnant Mother with Hypoglycemia
Peripheral venous
Pregnancy diseases342. Abnormal Glucose Tolerance Test (GTT) in Pregnancy
Repeat the test before any action
Pregnancy diseases343. Uncontrolled DM Before Pregnancy
Tight control of DM is advised before pregnancy
Pregnancy diseases344. Repeated Vomiting in Pregnancy
Check for ketones in urine
Placenta abruption345. Painful Bleeding in Pregnancy
Placental abruption
Placenta abruption346. Painless Bleeding in Pregnancy
Placenta previa
Placenta abruption347. Bleeding + Pain + Rapid Uterine Contractions + Uterine Tenderness + Fetal Heart Rate Abnormalities
Placental abruption
Placenta abruption348. Smoker with Painful Bleeding
Placental abruption
Placenta abruption349. Abdominal Trauma + Painful Bleeding
Placental abruption
Placenta abruption350. What Improves Mortality in Baby with Acidemia Due to Placental Abruption
Mild hypothermia
Placenta abruption351. DIC + Severe Bleeding + Placental Abruption
Call multidisciplinary team + Rapid response team
Placenta abruption352. Placental Abruption + Stable Fetus
Normal delivery
Placenta abruption353. Placental Abruption + Unstable FetusPlacental Abruption + Stable Fetus
Cesarean section (CS)
Placenta abruption354. Placental Abruption + Unstable Mother
Cesarean section (CS)
Placenta abruption355. Placental Abruption + Contraindication to Vaginal Delivery
Cesarean section (CS)
Placenta abruption356. Mechanism of DIC in Placental Abruption
Excessive arterial bleeding → Consumption and loss of coagulation factors
Placenta abruption357. First Investigation in Vaginal Bleeding in Pregnancy
Ultrasound (US) abdomen
Placenta abruption358. Massive Bleeding from Placental Abruption
2 peripheral IV cannulae + Blood transfusion
Cardiotocogram (CTG) 359. Decreased Fetal Movement
Do CTG
Cardiotocogram (CTG) 360. Early Deceleration (At the Beginning of Uterine Contractions)
Head compression
Cardiotocogram (CTG) 361. Variable Deceleration Causes
MgSO4, Cord compression
Cardiotocogram (CTG) 362. Late Deceleration (At the End of Uterine Contractions)
Uteroplacental insufficiency → Fetal hypoxia or asphyxia → Metabolic acidosis
Cardiotocogram (CTG) 363. CTG Indications for Stopping Oxytocin
Late deceleration, Decreased or absent contractions
Cardiotocogram (CTG) 364. Contraindications to ECV (External Cephalic Version)
CTG variable deceleration, Oligohydramnios
Cardiotocogram (CTG) 366. Fetal Bradycardia
Change mother’s position
Cardiotocogram (CTG) 367. Common Complications of Epidural Anaesthesia
Hypotension, Fetal bradycardia
Cardiotocogram (CTG) 367. Common Complications of Epidural Anaesthesia
Hypotension, Fetal bradycardia
Cardiotocogram (CTG) 368. Reduced Variability in CTG
MgSO4
Cardiotocogram (CTG) 369. Decreased Uterine Contractions
Fetal distress
Cardiotocogram (CTG) 370. No Contractions in CTG During Labour + Dilated Effaced Cervix
Wait and check in 2 hours
Cardiotocogram (CTG) 371. Prolonged Labour
Indication to use vacuum extraction
Cardiotocogram (CTG) 372. Key Points
Epidural anaesthesia → Prolonged decelerations
Fetal bradycardia → Prolonged decelerations
MgSO4 → Decreased variability
Oxytocin → Late decelerations
Cord compression → Variable decelerations
Head compression or inappropriate position → Early deceleration
Placental insufficiency or abruption → Late deceleration
Cardiotocogram (CTG) 373. Sinusoidal Pattern in CTG
Fetal anemia
Cardiotocogram (CTG) 374. Biophysical Profile (10/10)
8-10 → Normal
6-7 → Equivocal
<6 → Abnormal
Cardiotocogram (CTG) 375. Flat Fetal Heart in CTG
Stop MgSO4
Cardiotocogram (CTG) 376. Fetal Bradycardia in CTG After PROM in Polyhydramnios
Cord prolapse
Cardiotocogram (CTG) 377. CTG of Fetal Distress + Sudden Stopping of Uterine Contractions in Stable Mother
Change mother’s position
PROM (Premature rupture of membranes) 378. PROM at 34 Weeks or More
Antibiotics → Then delivery
PROM (Premature rupture of membranes) 379. PROM Before 34 Weeks
Antibiotics + Steroids → Delivery at 34 weeks
PROM (Premature rupture of membranes) 380. When to Deliver PROM Before 34 Weeks?
In labour
Intra-amniotic infection
Cord prolapse
Significant abruption of placenta
Non-reassuring fetal heart tracing
Delivery381. When to Give Antibiotics for CS
Preoperative
Delivery382. HTN + Seizures Not Responding to MgSO4
Eclampsia → Immediate CS
Delivery383. IUFD (Intrauterine Fetal Death) + Previous CS
Ask her opinion about CS or vaginal delivery
Delivery384. Placenta Previa
CS
Delivery385. Face Presentation
CS
Delivery386. Prolonged Vaginal Delivery + Fetal Distress
CS
Delivery387. Occipito-Anterior Presentation
Vaginal delivery
Delivery388. Occipito-Posterior Presentation
CS
Delivery389. Exhaustion During Normal Labour
CS
Delivery390. Herniation of Fetal Tissues in Early Pregnancy Without Symptoms
Cervical incompetence
Delivery391. Previous Preterm + Cervix Opened in Early Pregnancy
Progesterone
Delivery392. Prolonged Labour in Primi-Gravida
Allow more time before CS if mother and fetus are stable
Delivery393. IUFD in DIC + Opened Cervix
Vaginal delivery
Delivery394. Prolonged First Stage + CTG Reassuring
Recheck after 2 hours
Delivery395. Incompletely Dilated Cervix + Mother and Fetus Stable
Recheck every 2 hours
Delivery396. When to Use Oxytocin in Normal Labour
Opened effaced cervix with weak or no contractions
Delivery397. Feeling Uterine Contractions + Closed Cervix + No Effacement + No Bleeding
False labour
Delivery398. Yellowish Odourless Vaginal Discharge During Puerperium
Normal
Delivery399. Blue Vaginal Swelling After Vaginal Delivery and Episiotomy
Small: Rest, Ice, Compression, Elevation (RICE)
Large: Surgical drainage
Delivery400. Vaginal Swelling Increases When Standing + Needs Manual Evacuation of Urine
Cystocele
Delivery401. Multipara Feeling Vaginal Mass
Cystocele
Delivery402. Urine Passing from the Vagina
Vesico-vaginal fistula
Delivery403. Stool Incontinence + Flatus from the Vagina
Recto-vaginal fistula
Delivery404. Benefit of Episiotomy
Decreases incidence of perineal tear
Delivery405. Vaginal Tear + Profuse Bleeding from Above
Examine the uterus
Delivery406. Most Important Thing to Look for Before Instrumental Delivery
Cephalopelvic disproportion
Delivery407. Risk Factors for 4th Degree Perineal Tear
Legs restrain + Use of metallic instruments + Squatting position
Delivery408. Prolonged Second Stage of Labour (Fully Dilated Effaced Cervix + Good Uterine Contractions)
Use ventose
Delivery409. Prolonged Second Stage of Labour (Fully Dilated Effaced Cervix + Weak Uterine Contractions)
Use Oxytocin
Delivery410. Mouth and Nose Felt During Vaginal Examination
Face presentation
Delivery411. Best Twin Position for SVD (Spontaneous Vaginal Delivery)
Cephalic-Cephalic
Delivery412. Breech Presentation Flexing the Hips and Knees
Complete breech
Delivery413. Fetal Heart at the Level of the Mother’s Umbilicus
Breech presentation
Delivery414. Contraindication to ECV (External Cephalic Version)Fetal Heart at the Level of the Mother’s Umbilicus
Bicornuate uterus
Delivery415. Management of Breech Presentation
Trial of ECV if no contraindication → If failed, do CS
Ovarian torsion416. Sudden Onset of UNILATERAL Lower Abdominal Pain + Nausea and Vomiting + Tenderness + Adnexal Mass
Ovarian torsion
Ovarian torsion417. BILATERAL Lower Abdominal Pain + Fever + Tenderness
Salpingitis
Ovarian torsion418. Fever + Suprapubic Pain + Vaginal Discharge (Suppurative)
Salpingitis
Ovarian torsion419. Torsion Refusing Surgery
Explain, then document → Respect her wish
Uterine tumours420. Uterine Leiomyoma
Fibroid = Benign
Uterine tumours421. Uterine Leiomyosarcoma
Malignant
Uterine tumours422. Asymptomatic Fibroid
Follow up after 1 year
Uterine tumours423. Small Fibroids
Follow up after 1 year
Uterine tumours424. Large Fibroids
Surgical removal due to risk of malignant transformation
Uterine tumours425. Commonest Race for Fibroids
Africans
Uterine tumours426. Fibroid Increases in Size After Menopause
Leiomyosarcoma
Uterine tumours427. Endometrial Thickening Over Fibroid
Suspect leiomyosarcoma
Ectopic pregnancy428. Commonest Site
Fallopian tube
Ectopic pregnancy429. Predisposing Factor
PID (Pelvic Inflammatory Disease)
Ectopic pregnancy430. Defect in Which Step
Implantation
Ectopic pregnancy431. Unilateral Lower Abdominal Pain + Vaginal Bleeding
Ectopic pregnancy
Ectopic pregnancy432. Unilateral Lower Abdominal Pain + Vaginal Bleeding + Peritoneal Irritation
Ruptured ectopic pregnancy (Medical emergency)
Ectopic pregnancy433. Diagnostic Tests
B-HCG + US ± Laparoscopy
Ectopic pregnancy434. Treatment of Stable Patients
Methotrexate for 4+7 days → Reassess B-HCG → If not decreased, give second dose and reassess weekly → Target B-HCG is ZERO → If no response, refer to surgery
Ectopic pregnancy435. Increasing B-HCG Without Cause
Suspect ectopic pregnancy
Ectopic pregnancy436. Creating an Opening in Fallopian Tube (e.g., Removing Ectopic Pregnancy)
Salpingostomy
Ectopic pregnancy437. Removing the Fallopian Tube (e.g., Ruptured Fallopian Tube Due to Ectopic Pregnancy)
Salpingectomy
Ectopic pregnancy438. First Question Before Starting Medical Treatment
Accessibility to the hospital
Ectopic pregnancy439. Lower Abdominal Pain + Absent or Sluggish Bowel Sounds (Peritonitis)
Ruptured ovarian cyst OR ruptured ectopic pregnancy
Ectopic pregnancy440. Source of Bleeding in Ectopic Pregnancy
Fallopian tubes
Ectopic pregnancy441. Commonest Contraindication to IUD
Previous ectopic pregnancy on IUD
Asherman syndrome442. Cause
Adhesions (scarring) inside the uterine walls caused by recurrent D&C
Asherman syndrome443. Presentations
Recurrent abortions (No space for the fetus)
Amenorrhea (Destroyed endometrium)
Bleeding during pregnancy (Beginning of abortion)
UTI in pregnancy444. Antibiotic for UTI in 1st + 2nd Trimester
Nitrofurantoin
UTI in pregnancy445. Antibiotic for UTI in 3rd Trimester
Cephalexin
UTI in pregnancy446. Antibiotic for Pyelonephritis
Ceftriaxone
UTI in pregnancy447. Asymptomatic UTI in Pregnancy
Must be treated as it can cause abortion or preterm labour
UTI in pregnancy448. UTI During Lactation
Nitrofurantoin
UTI in pregnancy449. Gram-Negative Bacteremia Post-Operatively
UTI

The Saudi Medical License Exam (SMLE) is a standardized test required for doctors to obtain a medical license to practice in Saudi Arabia. It is conducted by the Saudi Commission for Health Specialties (SCFHS).

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