Excisional procedure (LEEP or cold knife cone). For CIN 2-3, observation is not recommended in a non-pregnant adult. If margins involved → repeat excision or follow-up.
Preeclampsia without severe features. Definitive treatment is delivery (after stabilization and corticosteroid administration for fetal lung maturity if <34 weeks). Magnesium sulfate is given for seizure prophylaxis.
Stress urinary incontinence (SUI). Exam finding: positive cough stress test (instant leakage with cough when bladder is full) and possibly urethral hypermobility (Q-tip test >30 degrees). First-line treatment: pelvic floor muscle therapy, weight loss. Surgical: mid-urethral sling.
A 10-question screening tool for postpartum depression. Used at the postpartum visit (or earlier if symptoms). Score ≥10 suggests possible depression; ≥13 indicates high likelihood. It is not diagnostic but prompts further evaluation. Section 4: Gynecology – Abnormal Bleeding & Fibroids Q12: A 45-year-old with heavy, regular periods every 24 days lasting 10 days. No intermenstrual bleeding. Exam: normal. What is the PALM-COEIN classification for this condition? obstetrics and gynaecology questions and answers pdf
Digital cervical examination. This can provoke catastrophic hemorrhage. Management is C-section.
Section 1: Obstetrics (Antepartum) Q1: A 28-year-old G2P1 at 28 weeks gestation presents with new-onset hypertension (BP 150/95) and proteinuria (300 mg/24h). What is the diagnosis, and what is the definitive treatment?
AUB-O (Ovulatory dysfunction) – but in a 45-year-old, must rule out structural causes. Actually, this describes menorrhagia (heavy menstrual bleeding) with regular cycles. PALM-COEIN: AUB-O if anovulatory; AUB-L (leiomyoma) if fibroids present. Workup: endometrial biopsy, pelvic ultrasound. Excisional procedure (LEEP or cold knife cone)
Endometrial biopsy (office) or dilation and curettage (D&C) with hysteroscopy. Thickened stripe (>4-5 mm postmenopausal) + bleeding requires tissue diagnosis to rule out endometrial cancer.
Letrozole (aromatase inhibitor) – now preferred over clomiphene due to higher live birth rates and lower multiple pregnancy risk. Dose 2.5-7.5 mg days 3-7 of cycle. Section 7: Urogynecology Q20: What is the difference between a cystocele, rectocele, and enterocele?
Threatened preterm labor. First-line tocolytic is nifedipine (calcium channel blocker). Also administer antenatal corticosteroids (betamethasone) to accelerate fetal lung maturity. Section 2: Intrapartum Q5: Describe the components of the Bishop score and its purpose. Preeclampsia without severe features
Administer Rh(D) immune globulin (300 mcg IM) . Also give after any potentially sensitizing event (e.g., abortion, amniocentesis, trauma) and within 72 hours of delivery of an Rh-positive newborn.
Arrest disorder: Active phase arrest. Next step: amniotomy if membranes intact, followed by oxytocin augmentation if no progress after 2-4 hours. If still no change → C-section.
Endomyometritis. Broad-spectrum IV antibiotics: Gentamicin + clindamycin (or ampicillin-sulbactam). Switch to oral when afebrile for 24-48 hours.
Vesicovaginal fistula. Initial test: tampon test (place tampon, instill blue dye into bladder – if tampon stains blue, confirms fistula). Confirmatory: cystoscopy, CT urogram. Treatment: surgical repair (usually delayed 3-6 months). Section 8: Quick Review – Must-Know Facts | Condition | Key Feature | Next Step | |-----------|-------------|------------| | Ectopic pregnancy | Adnexal mass + β-hCG >1500 with empty uterus | Methotrexate or salpingectomy | | Hydatidiform mole | "Snowstorm" on US, very high β-hCG, vaginal bleeding | Suction D&C; follow β-hCG weekly | | Placental abruption | Painful, dark bleeding + uterine tenderness + fetal distress | Immediate delivery (often C-section) | | Ovarian torsion | Sudden severe pain + nausea + enlarged ovary on Doppler (absent flow) | Surgical detorsion (within 6-8 hours) | | PID | Cervical motion tenderness + adnexal tenderness + fever | Doxycycline + ceftriaxone | This PDF is for educational purposes. Always correlate with clinical judgment and local protocols.