HIGH YIELD SMLE NOTES

Obstetrics and Gynecology

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HIGH YIELD SMLE NOTES

Infections

□Vaginitis;

□Trichomans vaginalis; strawberry cervix, green, flagellates cell, Tx; metronidazole

for both (patient + partner)
□Bacterial vaginosis; gray vaginal discharge, fishy smell, clue cells (granular epithelial
cells), Whiff’s test positive, Tx; metronidazole
□Candida vulvovaginitis; white, thick (cottage cheese like) discharge, pseudohyphae
on KOH, Tx; oral fluconazole, if pregnant; topical imidazole

□Gonorrhoea Tx; ceftriaxone, dx;

●in Female; Endocervical swab or lower vaginal swab
●In Male; urethra

□Chalmydia, Tx; Doxycycline, if not there; Azithromycin

□Bilateral tubo ovarian abscess tx; IV antibiotics

□UTI:

□Post coital UTI Tx; post coital antibiotic prophylaxis

□Recurrent UTI in pregnancy, Next; prophylactic antibiotics and urine culture or
cystoscopy
□If pyelonephritis in pregnancy; do ultrasound, if not in the options; choose septic
screening

□Antibiotic contraindicated in pregnancy;

●All trimesters; Ciprofloxacin
●C/I in 1st trimester only; Trimethoprim/sulfamethoxazole
●C/I in 1st and 3rd trimester; nitrofurantoin
□If UTI in 3rd trimester; give amoxicillin, if in 26 weeks GA; give nitrofurantoin

HIGH YIELD SMLE NOTES

Gynecology :

□Indicate ovulation; progesterone at day 21

□Time of ovulation; 72hrs after LH surge

□Monophasic basal temperature; anovulation

□Amenorrhea in young female, high FSH, LH, future increase risk of; osteoporosis +

ovarian insufficiency

□Cervical motion tenderness (tender fornices); Pelvic inflammatory disease

(Salpingitis)

□Stress Urinary incontinence, Dx; cough stress test, if positive then; Bonny test

□Lady came to Gyn clinic, highest dx value; History then digital pelvic Exam

□Overactive blabber syndrome: First; urine analysis and culture, Then; post voidal

residual volume

□Cystorectocele, Mx; Ant&post colpoperineorrhaphy,

□Cystorectocele + uterine prolapse, Mx; Fothergill’s operation (Manchester repair)

□ Pelvic organ prolapse (POP), cause;

●If history of pelvic surgery; Enterocoele

●If no history of pelvic surgery; cystocele

□Pelvic organ prolapse (POP), Dx by; speculum

□Management of POP;
●in elderly or pregnant woman; pessary
●in women with hysterectomy; abdominal sacrocolpopexy (sacrospinous fixation)

HIGH YIELD SMLE NOTES

□Fundus mass, Lymph Node drainage; para-aortic LN

□40y.o with stress urinary incontinence (hyper mobile urethra), Tx;

●Initial; pelvic floor exercise
●Definitive; mid urethral sling (tension free vaginal tape)

□Urge incontinence, most appropriate Mx; oxybutynin and kegel exercise, if not in

the options; choose oxybutynin

□PCOS = stein-leventhal syndrome, Tx;

●For ovulation; Letrizole or clomophine
●For regulating cycles; OCP

□Urine out of the vagina:

●If during micturition; urethro-vaginal fistula
●If continuous leak; vesico- vaginal fistula (if hysterectomy), other gynecological
procedures; uretrovaginal fistula

□Picture (labia minora), ulcer with raised edges + necrotic center, Dx; Chancroid

□Picture (urethra), minimal bleeding when touch the urethra; urethral caruncle

□Urethral diverticulum; 3Ds; dysuria, dyspareunia, dribbling

□Follicular Cyst; Most common ovarian mass in women of reproductive age

□Corpus Luteal Cyst; Failure of corpus luteum to regress after ovum release, most
common pelvic mass within 1st trimester of pregnancy

□Mass on a vagina with a history of repeated unprotected sexual intercourse with

multiple partners, examination shows wart in the vagina, the causative agent is;
Treponemma pallidum

HIGH YIELD SMLE NOTES

infertility:

□Infertile lady, Hx of Pelvic inflammatory disease, next; Hysterosalpingography (HSG)

□Cause of infertility;

●if 35 Y.O and more; age,

●If less than 35; smoking

□Female wants to conceive but she couldn’t, semen analysis is normal, induction of

ovulation by clomiphene citrate was done, Next; IUI

Antenatal:

□Worst outcome in pregnancy; mitral stenosis (one of indications of using forceps)

□Type of estrogen:

●in pregnancy; estriol

●in post menopause; estrone

●in young; estradiol

□Physiological cause of iron loss; pregnancy

□Expected day of delivery; First day of last menstrual period Plus 7 days, Months

plus 9 or minus 3

□Minimal time to get pregnant;

●After hernia repair; 12 months

●After breast cancer treatment; 2 years

●After retionic acid (isotertoin); 1 months, if not there; 3 months

HIGH YIELD SMLE NOTES

Puberty Disorders:

□14 Y.O with irregular bleeding, next; reassure, cause; hormonal problem or

hypothalamic-pituitary-gonadal (HPG) axis maturation (endocrine cause)

□Athletic and tanner stage 5, no menses; Hypothalamic hypogonadotropic

hypogonadism

□Female with dysmenorrhea, important to ask; menstrual history

□Primary dysmenorrhea:

●Dx by; clinical symptoms

●Managed by; NSAID (first), if failed or not tolerated; OCP,

-If respond to NSAID; Advice for life style modification

□Premenstrual syndrome + behavior changes:

●Dx; premenstrual dysphoric disorder "clinical diagnosis"

●Tx; NSIADs then OCPs then SSRI

□Breast bud; tanner stage 2

Vs.
□if breast bud with separated aerola; tanner stage 3

□Primary amenorrhea, normal testosterone; mullerian agenesis ( Mayer–

Rokitansky–Küster–Hauser syndrome (MRKH syndrome))
Vs.
□Primary amenorrhea, high testosterone; complete androgen insensitivity

HIGH YIELD SMLE NOTES

Abnormal Uterine Bleeding:

□Patient with intermenstrual bleeding, next; US

□Any Female complain of abnormal uterine bleeding or lower abdominal pain or 2ry

amenorrhea, investigation; B-HCG, if not there; choose transvaginal ultrasound

□Acute AUB management;

●If unstable; ABC (Fluid and blood)

●If heavy or severe; dilation and curettage (D/C)

●If none of the above; IV estrogen, OCP, Oral progestin, Tranexamic acid

□Chronic AUB management; Mirena, OCP, progestin, tranexamic acid, NSAID

(mefenamic acid), GnRH agonist

Contraception:

□Contraceptive method for any comorbidity (IHD, stroke, PE) or using warfarin; IUD

□Mechanism of action of emergency contraceptive pills; prevent ovulation

□Injectable progesterone; reversible decrease in bone mineral density

□Breastfeeding, Contraception for 2y; depo provers injection (Medroxyprogesterone

acetate)

□OCP for; Menorrhagia and dysmenorrhea, uterine fibroid

□Estrogen patch; if did total hysterectomy with bilateral salpingo-oophorectomy

HIGH YIELD SMLE NOTES

□Ovarian cyst;
●Want contraception; IUD if not there; OCP
●Tx of ovarian cyst;
-If more than 10cm in pregnancy; cystectomy
-If less; reassure

□Absolute contraindication for IUD;

●Endometritis (active (within 3 months) not previous infection)
●Genital bleeding
●Sever distortion of uterus
●Known or suspected pregnancy

Vaccination in Pregnancy:

□Vaccine before conception to reduce stillbirth; rubella

●If got pregnant and did not take rubella vaccine; give the vaccine postpartum
●Outcome If got pregnant after 3 week of receiving rubella vaccine; not affected
(favorable pregnancy)
□Influenza vaccine for; pregnant in winter, given at 1st visit, at 1st or 2nd trimester
(dtap in third trimester)
□Pregnant took high androgenic progesterone, complication to her daughter;
masculinization

Abortion:

□Pregnant with bleeding, US shows no sac intrauterine or extra;

●Dx; pregnancy of unknown location
●What to do; US after 2 day
Vs.
□If sac intrauterine but anembryoonic, Dx; pregnancy of unknown viability

HIGH YIELD SMLE NOTES

□Pregnant with IUFD and smoker; smoking 10 cigarettes per day increase the risk of

abortion and stillbirth (IUFD) by 50 %

□Pregnant with 4 first trimester abortions, highest diagnostic value; karyotyping

□Incomplete, inventible, missed abortions Mx;

●If unstable or severe (heavy) bleeding; D/C
●If stable;
-If ≤13 weeks GA; expectant management
-If 14 to 20 weeks GA; medical Mx (mifepristone, misoprostol)

□Percentage of recurrent abortion:

●After 1 spontaneous abortion; 10-15%
●After 2 abortions; 25%

Ectopic Pregnancy:

□Risk of recurrent ectopic:

●After 1 ectopic; 10%
●After 2 ectopic or more; 25%

□Ectopic pregnancy defect in; implantation (in Fallopian tube)

□Fluid in Douglas pouch; ruptured ectopic pregnancy (if fluid 1-2mm; Normal
pregnancy)

□Indication of surgical intervention in ectopic pregnancy;

●unstable vital signs then home distance
●failure of medical treatment
●severe abdominal pain despite analgesia (rupture)

HIGH YIELD SMLE NOTES

□Contraindications of medical treatment of ectopic pregnancy;
●bHCG more than 5000
●size more than 4 cm
●detectable cardiac activity
●low blood pressure
●home is far away from hospital

□If bHCG decrease less than 15% or plateau or increase; second dose of
methotrexate
□If decrease more than 15% (between day 4 to day 7) after methotrexate; follow up
weekly until undetectable

□Follow up after slapingostomy; follow up weekly until undetectable

□Follow up after salpingectomy; need one bhcg level to confirm decline

□Salpingectomy;
●By Laparoscopy; if stable
●By laparotomy; if unstable

Molar pregnancy:

□Fundal height more than gestational age, very high BHCG; Molar pregnancy,
●Tx; suction and evacuation

□Complication of suction and evacuation; perforation (immediate), infection (after

the procedure)
Vs.
□Complication of hysteroscopy; perforation then bleeding

□Molar follow up of hCG levels; weekly (3 consecutive negative) then monthly for 6
months
□Snow storm; complete molar; highly malignant
□If hemoptysis; staging (chest Xray )

□Postpartum, something protrude from cervix; test for metastasis

HIGH YIELD SMLE NOTES

Cervical Insufficiency:

□Cervical cerclage indication:

□History indications;

●one or more second trimester loses

●or prior cerclage due to painless cervical dilatation in second trimester

(Do cerclage at 13,14 weeks GA)

-if came early (before 13w GA); serial exam

-If came late (after 14w GA); progesterone

□Exam indications;

●painless cervical dilation in second trimester

●or cervical length by US; less than 25 mm

(Do cerclage at 24w GA)

-If came late (after 24w GA); progesterone

Preeclampsia:

●Proteinuria(0.3g/day) + HTN: 140/90 after 20 weeks; Preeclampsia

□Risk factor of preeclampsia; twins and nulliparous

□Decrease risk of preeclampsia; aspirin

□Decrease risk of eclampsia; mg sulfate, to prevent; seizure

□Mg sulfate side effects; respiratory depression, absence of tendon reflex, absence

of variability in CTG

□Mx of Mg sulfate toxicity; Stop Mg sulfate then Ca gluconate

HIGH YIELD SMLE NOTES

□Indication of severe preeclampsia; high creatinine, Severe HTN (160/110)
□Significantly decrease in preeclampsia; platelet, if not there; plasma volume

□HTN drugs; (to prevent maternal complication(stroke));

●if Chronic (oral); Labetalol, nifedipine
●if Urgent (IV); Labetalol, hydralzine

Management;
-HTN or preeclampsia without severe features;
●If less than 37 w GA; expectant and anti-HTN drug
●If 37 w GA and more; IOL and anti-HTN drug

-Preeclampsia with severe features;

●If less than 34 w GA; admission and corticosteroid and magnesium sulfate and IV
labetalol
●If 34 w GA and more; IOL and magnesium sulfate and IV Labetalol

-Eclampsia;
●Delivery after stabilization

-HELLP; platelet less than 100,000;

●Delivery after stabilization

DM & Gestational Diabetes Mellitus:

□DM at 1st trimester (less than 22 GA), risk of; Congenital malformation
□GDM associated with; preeclampsia
□Screen GDM at; 24w GA
□Pregnant k/c DM with hypoglycemia, which route safe; peripherals venous
□Pregnant with uncontrolled DM, complication to baby; respiratory distress
syndrome, Mx; change mother position

HIGH YIELD SMLE NOTES

Fetal Conditions and Abnormalities:

□Decrease fetal movement and CTG normal; discharge with fetal kick chart
□No fetal movement and CTG normal and BPP is 8; repeat BPP at 1 week
□32 gestational age, baby stopped movement; non stress test, if reactive; US

□Reversed end diastolic flow:

●If 32 weeks GA and above; delivery
●If less than 32w GA; non stress test

□Anti D dose; 300 micor/30ml or 100micro/10ml

□Anti D 300 micro cover; 30 ml of whole fetal blood or 15 ml of fetal RBC
□Fetal weight intrapartum; Abdominal Circumference

□Delivering a boy with single umbilical artery,

●associated with; DM
●higher risk for; major malformation (20-30%)

Pregnancy Related Medical and Surgical Conditions:

□Confirm diagnosis of hyperemesis gravidarum; urine ketone

□Green amniotic fluid, cause; feral distress
□Fetal hydrops; antikell antibody
□Asthma exacerbation in pregnancy; spirometry

□Hyperthyroidism in 15mg carbimazole, still symptomatic; increase to 20mg

□Pregnant lady has hypothyroidism, how much do you have to increase
levothyroxine dose; 30%

□Polyhydramnios causes; anencephaly, duodenal atresia, down syndrome(tri 21)

□Oligohydramnios causes; Renal problem, uteroplacental vascular insufficiency

HIGH YIELD SMLE NOTES

□Pregnant with wart; cryotherapy
□Pregnant with cervical lesion; colposcopy

□RUQ pain, most common cause;

●if late trimester (more than 20 weeks GA); Appendicitis
●if earlier; Acute cholecystitis

Pregnancy Related Hematological Problems:

□Antenatal complication associated with Pregnant with sickle cell disease or taking
atenolol or smoking; IUGR
□Antenatal complication associated with sickle cell trait; UTI
□Rh isoimmunization; maternal antibodies against fetal RBC (maternal
autoantibodies in ABO incompatibility)

□Anti D given at;

●28w GA, 36w GA
●Postpartum if fetus is RH+ve (within 72hrs of delivery to mother)
●In any known event causing Fetomaternal hemorrhage (if only spotting; discharge)

Investigations and Screening Tests During Pregnancy:

□Increase nuchal translucency; congenital cardiac malformation

□12w pregnant, blood test; low creatinine
□Pregnant with high BHCG; Cause depression of TSH,TRH (not elevation)

□Screen for Asymptomatic bacteruria; 12-16 weeks GA

□Indicate chromosomal abnormalities at; 16-18 weeks GA
□Detailed anatomy scan; 18-20 weeks GA
□GBS swab; 35-37 weeks GA

HIGH YIELD SMLE NOTES

□Physiological changes;
●During pregnancy; increase 40-45% of blood volume
●During 1st trimester; increase 20-25% of blood volume

□Pregnant folic acid; 0.4 or 0.8 or 1 mg/3 months

●If high risk (hx of neural tube defects); 4mg/3 months
●If k/c of sickle cell anemia; 5 mg till birth

Abnormal Placenta Implantation:

□Attached deeply; Placenta Accrete: chorionic villi Attach to the myometrium.

(Uterine wall), risk factor; enter uterine cavity during myomectomy
□Placenta in implanted in the uterine wall; Placenta Increta; chorionic villi Invade
into the myometrium. (Uterine muscle)
□Placenta Percreta: chorionic villi Penetrate though the myometrium, penetrate the
serosa

Antepartum Hemorrhage:

□Artificial ruptures of membrane then painless bleeding and fetal bradycardia, Dx;
vasa previa
□Stop in uterine contractions, Dx; uterine rupture, Mx; immediate delivery

□32 week GA with bleeding and contractions and dilation; intrapartum hemorrhage
□32 week GA with bleeding, no contractions or dilation; antepartum hemorrhage

□Highest risk factor for placenta abruption; HTN then smoking

□Highest risk factor for placenta previa; Twins and smoking

HIGH YIELD SMLE NOTES

□When to do C/S in placenta previa; 36-37 week GA (Same time of delivery in
preeclampsia without severe features)
□Placenta abruption delivery; 34w GA (Same time of delivery in preeclampsia with
severe features)

□Abruptio placenta and bleeding stopped; remain in hospital

□Most common condition cause DIC; placenta abruption

□Placenta previa and continuous bleeding; hospitalization
□Pregnant unbooked presented with vaginal bleeding, no abd pain, fundal height 34;
US and admit
□APH investigation; US, if US showed placenta previa, next step; CTG

Labor and CTG monitoring:

CTG categories:
□Category 1;
(If FHR 110-160 and moderate variability and acceleration and early deceleration)
●Management; regular surveillance

□Category 3;
(If absent variability with recurrent late deceleration
Or absent variability with recurrent variable deceleration
Or absent variability with bradycardia
Or sinusoidal pattern)
●Management; emergency C/S

□Category 2;
(If not under category 1 and 3)
●Management; Left lateral position then O2 then IVF then stop oxytocin then give
tocolytic

HIGH YIELD SMLE NOTES

□Prolonged latent phase (cervical dilation less than 6 cm);
●Nulliparous; 20 hours
●Multiparous; 14 hours
●Mx; If less than 20/14 h; wait

□Prolonged active phase (≥ 6 cm cervical dilation- No rupture of membrane);

●Adequate contractions; ≥4 hours
●Inadequate contractions; ≥6 hours

●Mx;
●For hypotonic contractions; Augmentation with oxytocin (with cervical ripening for
unfavorable cervix 6cm or less)
●For good contractions; Amniotomy (rupture of membrane)

□Arrested active phase (≥ 6 cm cervical dilation- with rupture of membrane);

●Adequate contractions; ≥4 hours
●Inadequate contractions; ≥6 hours
●Mx; Cesarean Section (C/S)

□Prolonged second stage (Arrest of fetal descent);

●Multiparous; More than 2 hours (add 1hr if epidural)
●Nulliparous; More than 3 hours (add 1hr if epidural)
●Mx; linstrumental delivery; if station +2 and above
♦ If less than +2 or 3 attempts of instrumental; C/S

□Prolonged 3rd stage; Placenta not delivered within 30 minutes; manual removal

HIGH YIELD SMLE NOTES

□DIC in Pregnancy:
●In Hemodynamically unstable mother OR fetal distress OR contraindication to
vaginal delivery; Cesarean delivery
●In Hemodynamically stable mother with dead or nonviable fetus; Induction of
Labor
●In Hemodynamically stable mother with a viable fetus and reassuring fetal status;
reassure and find the cause

□Management of DIC in hemodynamically unstable patients

●For patients with heavy bleeding; order a minimum of 6 units of packed red blood
cells (pRBCs), 6 units of fresh frozen plasma (FFP), 1 dose of, and 10 bags of
cryoprecipitate (two pools of 5 units), and begin transfusion of blood products prior
to receiving initial laboratory results
●For Patients with serious bleeding or need for urgent/emergent surgery and a
platelet count <50,000/microL; platelet transfusions

□GDM delivery:
●at 39w GA; if well controlled
●at 36w to 39w GA; if poorly controlled
□Elective C/S; full term, if not there, choose 39w GA

□Pregnant 41 weeks GA;

●if she has any problem; induction of labor
●if she is healthy; observe

Vs.

□Pregnant 42 weeks GA; induction of labor

□Cord prolapse; cause bradycardia; C/S

□Induction of labor with prostaglandin then fetal bradycardia; terbutaline, if not
there; remove prostaglandin pessary

HIGH YIELD SMLE NOTES

□Full term in labor, retraction ring, Dx; obstructed labor
□Degrees of laceration; SMSM; 1;skin, 2;muscle, 3;sphincter, 4;rectal mucous
□Make 4th degree perianal tear; Restrained legs with forceps Then unrestrained legs
and in chair.
□Bleeding when closing the caesarean incision; spleen aneurysm
□Contraindications of ECV; variable deceleration, bicornuate uterus, placenta previa

□Retroverted uterus location; fundus

□Shoulder dystocia case, cause of delay in delivery; fundal pressure (one of active
Mx of third stage of labour)

□Sparing in epidural anesthesia; Rectum

□Epidural CTG finding; prolonged deceleration

Vs.
□Mg sulfate CTG finding; absent variability

Preterm labor,(PROM) and (PPROM):

□Confirm preterm labor; cervical dilatation through pelvic examination

□24w-34w GA; give steroid to prevent RDS
□24w-32w GA; give Mg sulfate to prevent cerebral palsy

□Tocolysis choice in preterm labor:

●32w - 34w GA; Nifedipine
●24w - 32w GA; Indomethacin

□Tocolysis and even steroid are C/I if there is non-reassuring fetal status (variable
deceleration)
□No tocolysis if closed cervix (or even less than 2cm)
□Tocolytic side effects; Palpitation
□Most common complication to an image (twins); Preterm

HIGH YIELD SMLE NOTES

Postpartum Hemorrhage (PPH):

□Cause of PPH;
●if hx of prolonged use of oxytocin, high parity, multiple gestation, polyhydramnios
macrosomia; uterine atony
●if hx of succenturiate placenta, previous uterine surgery, incomplete placenta at
delivery; retained part of placenta
●if hx of operative vaginal delivery, precipitous delivery; genital tract trauma
●if hx of abnormal bruising, placental abruption, current thromboembolism Tx ;
coagulopathy

□Risk factors of PPH;

●multi gravid if ≥6 previous deliveries,
●precipitate labor if less 3 hours,
●macrosomia if fetal weight more than 4000 gram
●prolonged labor if ≥14h in multi, ≥20h in nulli

□DIC + respiratory symptoms; amniotic fluid embolism

□Hypovolemic shock VS. PPH; high pulse pressure
□how to assess PPH; visual
□Maternal death due to PPH; 20%

□Female with placenta previa had severe hemorrhage. outcome post-delivery;

Absence of menstrual cycle (Sheehan)
Vs.
□Asherman’s Syndrome: Multiple D&C, basalis layer removed

□PPH Mx;
●Oxytocin (20units with 500ml D5)
●Then methylergonovine (contraindicated in HTN)
●Then carboprost (contraindicated in asthma )
●Then misoprostol

□PPH with failed manual compression;

●If unstable; ligation then hysterectomy
●If stable;
-During C/S; B-lynch
-During Vaginal delivery; Bakri balloon

□Bleeding in delivery, ligation of; internal iliac artery

HIGH YIELD SMLE NOTES

Multiple pregnancy
□Monozygotic twins;
●Dichorionic and Diamniotic; 1-3 days
●monochorionic/diamniotic; 4-8 days
●Monochorionic and monoamniotic; 8-13 days
Vs.
□Dizygotic twins;
●Dichorionic and Diamniotic regardless of the sex

Endometriosis
□Severe dysmenorrhea or Uterosacral nodularity; Endometriosis:
●Initial (acceptable); US
●Gold standard (best); laparoscopy
□If took NSAID, but not improved; OCP
□If want to preserve family; ablation (fulguration)
□High risk for endometriosis; Family history, DM, Early menarche and late
menopause
□Endometriosis related to; ovarian cancer

□Post-menopausal dyschezia; depo provea injection

□Post- menopausal dyspareunia; Estrogen cream

Adenomyosis
□Enlarged and tender uterus or
□Abnormal uterine bleeding with previous Hx of surgery (myomectomy);
adenomyosis:
●Dx; initial; US, then MRI, definitive; Histopathology
●Tx:
-If old; hysterectomy
-If young; OCP

HIGH YIELD SMLE NOTES

Uterine Fibroids
□firm fundal mass; Fibroid
□heavy bleeding; sub mucosal fibroid
□most common or felt on pelvic exam; intra mural
□Diagnoses; next; US, Best; MR
□Submucosal fibroid, Mx,
●If old; hysterectomy
●If young; hysteroscopic resection (laparoscopic resection for intramural, subserosal
fibroid)

□Incidental findings of fibroid (asymptomatic); observation or US every year

●Fibroid; hypoechoic (black in colour)
VS.
●polyp; hyperechoic (white in colour)

□Medication given to decrease fibroid size before surgery; GNRH agonist

□34 gestational age with fever and abdominal pain,2 cm cervical dilatation, Dx; Red
degeneration, Next; observe

Cervical cancer screening;

If routine cervical smear shows:

□Unsatisfactory;
●More than 30 y.o and HPV-positive; colposcopy
●Others; repeat 2-4 months

□Undermined significant;
●21-24 y.o; repeat 12 months
●More than 24 y.o; HPV testing

HIGH YIELD SMLE NOTES

□Low-grade squamous intraepithelial lesion (LSIL);
●21-24 y.o; repeat 12 months
●25-29 y.o; colposcopy
●30 y.o and more; HPV testing

□High grade squamous intraepithelial lesion (HSIL); colposcopy

□Cervical lesion found in examination;

●next step; colposcopy
●highest dx; biopsy

□Pregnant with suspicious cervical lesion; colposcopy

□HISL then biopsy showed carcinoma in situ, want conserve her family; LEEP

□Start Pap smear (from transformation zone); 21 y.o

●21-29 Y; pap every 3 years
●30-65 Y; pap every 3 years or every 5 years with HPV

□Start HPV screening; 30-34 y.o

□HPV vaccine;
●9-14y; 2 doses(0, 6-12 months)
●15-26y; 3 doses(0,1-2 months, 6 months)

□Invasive cervical cancer; clinical staging

Vs.
□Ovarian tumor; surgery and chemo

□Bleeding location:
●if profuse; uterus
●if after sexual intercourse; cervix (next step; Pap test)

HIGH YIELD SMLE NOTES

Endometrial Hyperplasia and Carcinoma:

□Elderly with endometrial polyp, endometrial lining was 19mm;

●Initially; hysteroscopy with polypectomy
●Definitive; laparoscopic hysterectomy

□56 years with uterine cancer, what the most appropriate treatment at this age;
laparoscopic hysterectomy (less invasive than laparotomy)

□Endometrial hyperplasia Mx:

●If wants preserve fertility; progesterone
●If post-menopausal; hysterectomy

□Risk factors of endometrial cancer; PCOS Then age, DM, nulliparity and Tamoxifen

□When to do Endometrial biopsy;

●Post-menopausal bleeding
●45 Y to menopause; if bleeding is heavy, prolonged, frequent or intermenustral
●Less than 45 Y; if BMI ≥30, PCOS

□Post menopause blood and itchy, pea size mass confined to valvular (SCC); wide
local excision

□Most common ovarian cancer; Epithelial

□Most common valvular cancer; Squamous cell carcinoma

□Vulvar lesion at 5 o'clock or 7, inflammatory changes up to cervix, red, unilateral,

tender, edematous fluctuant mass was noticed just outside the introits in the rt
vulva; Bartholin abscess
□Small mass in the vulva, jelly-like secretions; vulvar mucinous cyst

HIGH YIELD SMLE NOTES

□Sudden onset of unilateral, lower abdominal pain, often following strenuous
physical activity, sometimes hemorrhagic shock; Ruptured Ovarian Cyst

□US done showed Solitary with cystic component complex left ovarian cyst measure
7x8 cm; Tumor markers (CA -125)

□75-year-old female presented with left abdominal pain, by US there is

multiloculates, hard left adnexal mass, CA125 normal, Most app Mx; Refer to
gynecology oncology center

□Ovarian cyst 6 cm with high ca125, u/s showed multi Loculated, cystic something,
Which of the following is the most appropriate management; oopherctomy

HIGH YIELD SMLE NOTES