Arab Board OB/GYN Final Clinical & Oral cheat sheet

Aneuploidy screening: combined first-trimester test (nuchal translucency + free beta-hCG + PAPP-A) at 11+0 to 13+6 weeks; cell-free DNA from 10 weeks has highest detection for trisomy 21.

Folic acid 400 mcg daily from at least 1 month preconception reduces neural tube defects; 4-5 mg daily if prior affected pregnancy, diabetes, obesity, or antiepileptic use.

Physiologic changes: plasma volume rises ~40-50%, cardiac output ~30-50%, systemic vascular resistance falls; BP nadirs in mid-pregnancy and normal BP does not exclude preeclampsia.

Gestational diabetes screening at 24-28 weeks; treat when fasting >=5.1, 1-h >=10.0, or 2-h >=8.5 mmol/L on 75-g OGTT.

Preeclampsia with severe features: BP >=160/110, platelets <100, transaminases >2x upper limit, creatinine >97 micromol/L, pulmonary edema, or new cerebral/visual symptoms.

RhD-negative unsensitized women: anti-D prophylaxis at ~28 weeks and within 72 hours of delivery of an RhD-positive infant; Kleihauer-Betke or flow cytometry quantifies fetomaternal hemorrhage.

Fetal growth restriction: estimated fetal weight <10th centile plus abnormal umbilical artery Doppler (raised pulsatility index, absent or reversed end-diastolic flow) signals placental insufficiency.

Magnesium sulfate for fetal neuroprotection in anticipated preterm birth before 32 weeks; also first-line for eclampsia prevention and treatment.

Normal latent first stage: cervical dilatation to ~5 cm with regular contractions; active first stage: from 5 cm to full dilatation, typically ~0.5-1 cm/hour progress threshold.

Second stage: nulliparous up to 3 hours and parous up to 2 hours with epidural are accepted before diagnosing delay.

Fetal heart monitoring: category III tracing (absent variability with recurrent decelerations, sinusoidal, or bradycardia) requires immediate intrauterine resuscitation and delivery planning.

Tachysystole: >5 contractions per 10 minutes averaged over 30 minutes; reduce or stop oxytocin and consider tocolysis.

Shoulder dystocia maneuvers: McRoberts, suprapubic pressure, internal rotation, delivery of posterior arm, then all-fours or Zavanelli as last resort; never fundal pressure.

Umbilical cord prolapse: elevate presenting part, knee-chest or Trendelenburg position, fill bladder, immediate delivery; tocolysis may buy time if delivery is delayed.

Active third-stage management (uterotonic, controlled cord traction, uterine massage) reduces postpartum hemorrhage compared with expectant management.

Instrumental delivery prerequisites: fully dilated cervix, engaged head at or below station 0, ruptured membranes, known position, empty bladder, adequate anesthesia, and consent.

Postpartum hemorrhage: blood loss >=500 mL after vaginal or >=1000 mL after cesarean birth, or any loss causing hemodynamic instability; uterine atony is the commonest cause.

Atony sequence: uterine massage, oxytocin, ergometrine (avoid in hypertension), carboprost (avoid in asthma), misoprostol, tranexamic acid 1 g IV within 3 hours, then balloon tamponade, compression sutures, vessel ligation, hysterectomy.

Puerperal sepsis: fever >=38 C with uterine tenderness; obtain cultures and start broad-spectrum antibiotics within 1 hour; retain products and endometritis are common sources.

Venous thromboembolism risk persists up to 6 weeks postpartum; low molecular weight heparin prophylaxis is indicated after prior VTE, thrombophilia, or cesarean with additional risk factors.

Eclampsia: magnesium sulfate 4-6 g IV loading then 1-2 g/hour; recurrent seizures get a further 2 g bolus; monitor reflexes, respiratory rate, and urine output.

Maternal collapse causes: hemorrhage, sepsis, pulmonary embolism, amniotic fluid embolism, anaphylaxis, eclampsia, cardiac disease; resuscitate mother first with left lateral tilt.

Secondary postpartum hemorrhage (24 hours to 12 weeks) most often reflects retained placental tissue or endometritis; assess with ultrasound and treat with antibiotics plus evacuation if retained.

Postpartum psychosis presents within 2 weeks in most cases with confusion, mania, and delusions; it is a psychiatric emergency requiring admission and specialist care.

Abnormal uterine bleeding is classified by PALM-COEIN: polyp, adenomyosis, leiomyoma, malignancy/hyperplasia versus coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified.

Postmenopausal bleeding warrants endometrial sampling; transvaginal ultrasound endometrial thickness <=4 mm has high negative predictive value in low-risk women.

Polycystic ovary syndrome uses Rotterdam criteria: two of oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology.

Endometrioma on ultrasound: unilocular cyst with homogeneous low-level echoes; surgical management is reserved for pain, infertility, or diagnostic uncertainty.

Ovarian torsion presents with sudden unilateral pain and nausea; Doppler flow may be normal, so clinical suspicion justifies laparoscopy.

Fibroids: submucosal distort the cavity and cause bleeding and infertility; intramural and subserosal cause bulk symptoms; treatment options include hysteroscopic resection, embolization, myomectomy, and hysterectomy.

Ectopic pregnancy: discriminatory human chorionic gonadotropin zone ~1500-3500 IU/L; a pregnancy of unknown location requires serial hCG and safety-net advice.

Bartholin cyst abscess: incision and drainage with Word catheter or marsupialization; biopsy if a woman is over 40 years to exclude malignancy.

Cervical cancer screening: primary HPV testing or co-testing from age 25-30; abnormal results triaged by cytology or colposcopy; vaccination prevents HPV 16 and 18 disease.

Endometrial cancer: most common gynecologic malignancy; risk factors include obesity, nulliparity, unopposed estrogen, tamoxifen, and Lynch syndrome; postmenopausal bleeding is the cardinal symptom.

Ovarian cancer: CA-125 lacks specificity; risk of malignancy index combines CA-125, menopausal status, and ultrasound score; optimal cytoreduction improves survival in advanced disease.

Epithelial ovarian cancer subtypes: high-grade serous (most common, BRCA-associated), endometrioid, clear cell, and mucinous; germ cell tumors affect younger women and are chemosensitive.

Vulvar cancer: squamous cell carcinoma accounts for most cases; lymphatic spread is to inguinofemoral nodes; sentinel node biopsy is used for unifocal tumors <4 cm.

Gestational trophoblastic disease: complete mole has higher malignant potential than partial; serial beta-hCG monitoring detects persistent disease; methotrexate is first-line for low-risk disease.

Cervical cancer staging is clinical (FIGO) rather than surgical; stage IB1 (<=2 cm) may be treated with fertility-sparing trachelectomy.

BRCA1/2 carriers: risk-reducing salpingo-oophorectomy is recommended around age 35-40 for BRCA1 and 40-45 for BRCA2 after childbearing.

Infertility definition: failure to conceive after 12 months of regular unprotected intercourse; investigate earlier if age >=35, irregular cycles, or known pathology.

Ovulation assessment: mid-luteal progesterone >16 nmol/L (or ~3 ng/mL) confirms ovulation; day 2-4 FSH, LH, and estradiol assess ovarian reserve.

WHO ovulation disorder groups: group I hypogonadotropic, group II normogonadotropic (PCOS), group III hypergonadotropic; clomiphene and letrozole induce ovulation, metformin is adjunct in PCOS.

Polycystic ovary syndrome first-line ovulation induction is letrozole; clomiphene is an alternative; gonadotropins carry higher multiple pregnancy risk.

Male factor: semen analysis after 2-7 days abstinence; normal thresholds include volume >=1.4 mL, concentration >=16 million/mL, total motility >=42%, and normal morphology >=4%.

Assisted reproduction: in vitro fertilization is indicated for tubal disease, severe male factor, and failed ovulation induction; intracytoplasmic sperm injection addresses severe male factor.

Premature ovarian insufficiency: loss of ovarian function before age 40; hormone replacement therapy is required until at least the normal age of menopause for bone and cardiovascular protection.

Hypothalamic amenorrhea from low energy availability or excessive exercise is managed with lifestyle correction, calcium and vitamin D, and hormone replacement if bone loss is present.

Stress urinary incontinence is involuntary leakage on effort or sneezing; urge incontinence is leakage with a sudden compelling desire to void.

Pelvic organ prolapse quantification uses POP-Q stages 0-IV; stage II is descent to 1 cm above or below the hymen, stage III beyond the hymen, and stage IV complete eversion.

First-line treatment for stress incontinence: pelvic floor muscle training for at least 3 months; midurethral sling or colposuspension for surgical cases.

Overactive bladder management: bladder training, fluid and caffeine modification, then antimuscarinics or beta-3 agonists; intradetrusor botulinum toxin or neuromodulation for refractory cases.

Urodynamic testing is indicated before surgery for stress incontinence, in mixed incontinence, and when diagnosis is uncertain; it is not required for all cases.

Anterior compartment prolapse relates to cystocele; posterior compartment to rectocele; apical to uterine or vault prolapse; combined defects are common.

Pessaries are a valid first-line option for prolapse and incontinence, especially in older or frail women; regular follow-up prevents erosion and infection.

Obstetric anal sphincter injury: third degree involves the anal sphincter, fourth degree involves the anal epithelium; repair by an experienced clinician and follow-up reduce incontinence.

Combined oral contraceptives are contraindicated in migraine with aura, prior VTE, known thrombophilia, uncontrolled hypertension, and smokers over 35 years.

Progestogen-only methods include implants, injectables, and levonorgestrel intrauterine systems; they are suitable when estrogen is contraindicated.

Copper intrauterine device is effective emergency contraception up to 5 days after unprotected intercourse; ulipristal and levonorgestrel are alternatives within 120 hours.

Intrauterine device insertion is avoided in active pelvic infection, unexplained vaginal bleeding, and pregnancy; it is effective for 5-10 years depending on device.

Combined hormonal contraception reduces ovarian and endometrial cancer risk; it increases venous thromboembolism risk and is not protective against sexually transmitted infections.

Female sterilization is intended to be permanent; regret is higher in young women and those without children; male vasectomy is lower risk than tubal surgery.

Lactational amenorrhea method is effective only if amenorrhea is present, the infant is fully breastfed, and the woman is under 6 months postpartum.

Barrier methods: male condoms reduce sexually transmitted infection transmission; typical-use failure is higher than perfect-use failure for all user-dependent methods.

Informed consent requires capacity, adequate disclosure of material risks, understanding, and voluntariness; documentation should reflect the discussion.

Confidentiality may be breached only when required by law, when there is serious risk of harm to the patient or others, or with valid consent.

Capacity assessment: patient understands information, retains it, weighs it, and communicates a choice; capacity is decision-specific rather than global.

When a patient lacks capacity, treatment decisions follow advance directives or the best-interests standard with involvement of family and an ethics committee.

Obstetric emergencies: emergency treatment may proceed without consent when delay would threaten life or serious harm; document the circumstances.

Medical error disclosure: patients should be told promptly about harmful errors, with apology, explanation, and a plan; this supports patient safety and trust.

Clinical handover should use a structured format (e.g., situation, background, assessment, recommendation) to reduce communication-related adverse events.

Patient safety reporting: incident reports are non-punitive learning tools; near misses should be reported because they identify system vulnerabilities.