cms gync

[Blind date18]

27 yr old female comes to the clinic as she was unable get pregnant from 1 year despite regular sexual encounter . She complains of irregular periods varying from 35- 42 days lasting for 8 days. O/e pelvis and adnexa normal , HSG reveled patent Fallopian tubes . Her husband had 2 children from the previous marriage and post coital semen analysis in normal now . What is the best treatment in this patient?

-Clomiphene
-Leuprolide
- Danazole
-Progesteron


This is one the question i got it wrong on the cms, can any one help me with this ?

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[Blind date18]

2) 30 yr old Pregnant women presents to the clinic for routine prenatal visit at 31 weaks of GA, she complains of breathing problem particularly while lying down . On u/s Amniotic fluid index 35 cm ( normal 10 - 20 cm) and rest of the examination is normal , She denies any infection's and takes only prenatal vitamins what is the best step in management ?

Diuretics
Antenatal screening
complete bed rest
weekly aminocentesis

 

[Blind date18]

Multi garvid women comes to the clinic at 40 weeks of GA d/t onset of uterine contraction's 2 hours ago .Her previous visit was 1 week ago during which the cervix is 1 cm dilated and 50 % with fetal vertex at - 2 since the onset of the contraction she reports of not loosing any water / blood from the vagina and her cervix had progressed to 6 cm and 50 % effaced with vertex still at - 2 and FHR tracing is reactive , what is the best possible thing to do ? -Amniocentesis -U/s of the pelvis -Fetal scalp electrolides -Abg of the uterine artery - C section

 

[Blind date18]

A 47 yr F, comes to the clinic with Intense mood changes, hot flashes, irregular periods for the past 7 months. Her last period was 6 weeks ago she is currently active with one male sexual partner uses barrier contraception , what is the most accurate test for diagnosis?

-S. estradiol
- S. testosterone concentration
-Endometrial biopsy
- Pergnancy test
-Tran vaginal u/s

 

[Drscopes]

A urine pregnancy test. Always rule out pregnancy in a sexually active premenopausal woman if the pt has had amenorrhea. If negative then work up for menopause.

A 47 yr F, comes to the clinic with Intense mood changes, hot flashes, irregular periods for the past 7 months. Her last period was 6 weeks ago she is currently active with one male sexual partner uses barrier contraception , what is the most accurate test for diagnosis?

-S. estradiol
- S. testosterone concentration
-Endometrial biopsy
- Pergnancy test
-Tran vaginal u/s

 

[Drscopes]

Clomiphene to induce ovulation

27 yr old female comes to the clinic as she was unable get pregnant from 1 year despite regular sexual encounter . She complains of irregular periods varying from 35- 42 days lasting for 8 days. O/e pelvis and adnexa normal , HSG reveled patent Fallopian tubes . Her husband had 2 children from the previous marriage and post coital semen analysis in normal now . What is the best treatment in this patient?

-Clomiphene
-Leuprolide
- Danazole
-Progesteron


This is one the question i got it wrong on the cms, can any one help me with this ?

 

[Drscopes]

2) 30 yr old Pregnant women presents to the clinic for routine prenatal visit at 31 weaks of GA, she complains of breathing problem particularly while lying down . On u/s Amniotic fluid index 35 cm ( normal 10 - 20 cm) and rest of the examination is normal , She denies any infection's and takes only prenatal vitamins what is the best step in management ?

Diuretics
Antenatal screening
complete bed rest
weekly aminocentesis

Antenatal screening to look for cause of impaired fetal swallow/overproduction

 

[Drscopes]

Multi garvid women comes to the clinic at 40 weeks of GA d/t onset of uterine contraction's 2 hours ago .Her previous visit was 1 week ago during which the cervix is 1 cm dilated and 50 % with fetal vertex at - 2 since the onset of the contraction she reports of not loosing any water / blood from the vagina and her cervix had progressed to 6 cm and 50 % effaced with vertex still at - 2 and FHR tracing is reactive , what is the best possible thing to do ? -Amniocentesis -U/s of the pelvis -Fetal scalp electrolides -Abg of the uterine artery - C section

USG pelvis to confirm the lie and r/o OP etc before proceeding forward to help cervical effacement and vaginal delivery

 

[Blind date18]

Clomiphene to induce ovulation

Hi thank you for you response , but i just want to ask my clomiphene we can also with leuprolide right?

 

[Blind date18]

37 Yr F, present's with intense pain in the perineal that had started 3 days ago. Her current temperature is 102 F , O/E there is tense cystic swelling posterior to labius major with cellulitis extending past the hair line what is the most feared complication in the patient?

-Necrotising facitis
-Bartholin cyst abcess
- Gram positive sepsis
-Chalamydia sepsis

 

[Drscopes]

Hi thank you for you response , but i just want to ask my clomiphene we can also with leuprolide right?

Clomiphene is considered superior when needed to induce ovulation. Leuprolide can do the job but it is difficult to maintain its pulse dosing and also has a greater side effect profile. (There was a similar uworld question, and I guess it stated this was the reason)

 

[Drscopes]

37 Yr F, present's with intense pain in the perineal that had started 3 days ago. Her current temperature is 102 F , O/E there is tense cystic swelling posterior to labius major with cellulitis extending past the hair line what is the most feared complication in the patient?

-Necrotising facitis
-Bartholin cyst abcess
- Gram positive sepsis
-Chalamydia sepsis

Should be nec fasc?

 

[Blind date18]

Should be nec fasc?

yeah nec fac, i choose B. cyst abcess . Can you please quote what made you think in terms of nec fac over b.cyst abcess?

 

[Drscopes]

yeah nec fac, i choose B. cyst abcess . Can you please quote what made you think in terms of nec fac over b.cyst abcess?

Bartholin cyst abscess is a localized infection, but this patient has cellulitis which is spreading in the subcutaneous region and has reached upto hair line, and has risk of expanding further and causing nec fasc. Groin is anyway more susceptible to such infections.
Had the patient only had a cystic mass in the labia, that would just be bartholin cyst which can get complicated into an abscess, but this is already a deeper infection.