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.
Endomyometritis. Broad-spectrum IV antibiotics: Gentamicin + clindamycin (or ampicillin-sulbactam). Switch to oral when afebrile for 24-48 hours. obstetrics and gynaecology questions and answers pdf
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. Vesicovaginal fistula
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. Treatment: surgical repair (usually delayed 3-6 months)
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?
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.