Arab Board Ob/Gyn Final Written cheat sheet

Estimated delivery date by Naegele's rule is last menstrual period plus 280 days; first-trimester ultrasound is more accurate when it differs by more than 7 days.

Active-phase labor begins at 6 cm dilation with regular contractions; arrest is no cervical change for 4 hours with adequate contractions or 6 hours with inadequate contractions.

Second-stage duration limits: nullipara 3 hours without epidural and 4 hours with epidural; multipara 2 hours without and 3 hours with epidural.

Category III fetal heart tracing includes absent baseline variability with recurrent late or variable decelerations or bradycardia; it requires immediate evaluation and expedited delivery.

Active management of third stage: intramuscular oxytocin 10 IU within 1 minute, controlled cord traction, and uterine massage reduce postpartum hemorrhage.

Postpartum hemorrhage is blood loss of 1000 mL or more or loss with hypovolemic signs within 24 hours; uterine atony is the most common cause.

First-line shoulder dystocia maneuvers are McRoberts and suprapubic pressure; fundal pressure is contraindicated.

Group B streptococcus prophylaxis uses penicillin G 5 million units IV then 2.5-3 million units every 4 hours; clindamycin is an alternative when susceptibility is confirmed.

Bishop score of 8 or more indicates a favorable cervix for induction; components are dilation, effacement, station, consistency, and position.

Pre-eclampsia with severe features includes blood pressure 160/110 mmHg or higher, platelets below 100,000, transaminases twice normal, creatinine above 1.1 mg/dL, pulmonary edema, or cerebral/visual symptoms.

Delivery is recommended at 34 weeks or later for pre-eclampsia with severe features; before 34 weeks, expectant management is considered in a tertiary center.

Magnesium sulfate regimen for eclampsia prophylaxis: 4-6 g IV loading dose over 15-20 minutes, then 1-2 g/hour; monitor reflexes, respiratory rate, and urine output.

Calcium gluconate 10% 10 mL IV is the antidote for magnesium toxicity.

Low-dose aspirin 81 mg daily started at 12-16 weeks reduces pre-eclampsia risk in high-risk women.

Antiphospholipid syndrome is treated with low-dose aspirin plus prophylactic low-molecular-weight heparin during pregnancy.

Gestational diabetes screening: 50 g glucose challenge at 24-28 weeks; a 1-hour value of 140 mg/dL or higher prompts a 100 g 3-hour test using Carpenter-Coustan thresholds 95, 180, 155, and 140 mg/dL.

Betamethasone 12 mg IM twice 24 hours apart or dexamethasone 6 mg IM four times 12 hours apart accelerates fetal lung maturity between 24 and 34 weeks.

Fetal growth restriction with absent or reversed umbilical artery end-diastolic flow warrants delivery generally at 32-34 weeks after corticosteroids.

Cervical cancer screening starts at age 21 with cytology every 3 years; ages 30-65 may use co-testing every 5 years or cytology every 3 years.

FIGO 2018 cervical cancer stage IB1 is 2 cm or less, IB2 is 2-4 cm, and IB3 is 4 cm or greater.

Endometrial carcinoma is the most common gynecologic cancer; type I is endometrioid and estrogen-driven, type II is serous and p53-associated.

Lynch syndrome should be suspected in endometrial cancer before age 50 or with colorectal cancer family history; test with immunohistochemistry and microsatellite instability.

Ovarian cancer debulking aims for no residual disease; residual tumor greater than 1 cm is suboptimal.

Germ cell tumor markers: yolk sac tumor secretes alpha-fetoprotein, dysgerminoma secretes lactate dehydrogenase, and choriocarcinoma secretes beta-hCG.

Low-risk gestational trophoblastic neoplasia (FIGO score 6 or less) is treated with single-agent methotrexate or actinomycin-D.

BRCA1 carriers have a 40-50% lifetime ovarian cancer risk; risk-reducing salpingo-oophorectomy is advised at 35-40 years, and at 40-45 years for BRCA2.

Vulvar squamous cell carcinoma spreads to inguinal femoral nodes; sentinel node biopsy is used for tumors 4 cm or smaller.

PCOS diagnosis by Rotterdam criteria requires two of three: oligo-ovulation or anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries (12 or more follicles of 2-9 mm or ovarian volume 10 mL or more).

Letrozole is first-line ovulation induction in PCOS and achieves higher live-birth rates than clomiphene citrate.

Premature ovarian insufficiency is loss of ovarian function before age 40 with FSH above 40 IU/L on two occasions 4-6 weeks apart; treat with hormone therapy until age 51.

Recurrent pregnancy loss is three or more losses before 20 weeks; evaluation includes antiphospholipid antibodies, parental karyotype, and uterine cavity imaging.

WHO 2021 semen reference limits: volume 1.4 mL or more, concentration 16 million/mL or more, total motility 42% or more, normal morphology 4% or more.

Ovarian hyperstimulation syndrome is classified mild, moderate, severe, and critical; severe OHSS includes ascites, oliguria, hemoconcentration, and thrombosis risk.

Cabergoline 0.5 mg daily for 8 days reduces OHSS risk when given after hCG trigger.

Elective single embryo transfer is recommended for women under 35 with good prognosis to reduce multiple gestation.

Endometriosis is staged surgically by ASRM I-IV; GnRH agonists and dienogest are medical options.

POP-Q stage II prolapse has the leading edge between 1 cm above and 1 cm beyond the hymen; stage III extends more than 1 cm beyond the hymen.

Supervised pelvic floor muscle training for at least 3 months is first-line for stress urinary incontinence.

Midurethral synthetic sling is standard surgical treatment for stress incontinence; bulking agents are options for poor surgical candidates.

Overactive bladder second-line therapy includes antimuscarinics or beta-3 agonists such as mirabegron after behavioral therapy.

Low-dose vaginal estrogen treats genitourinary syndrome of menopause and reduces recurrent urinary tract infections.

Pessaries are effective nonsurgical options for prolapse; follow-up is needed for erosion and discharge.

Anterior colporrhaphy corrects cystocele using native tissue; mesh use is restricted because of erosion and pain risks.

Urodynamic testing is indicated before surgery for complicated incontinence, suspected detrusor overactivity, or prior failed surgery.

Posthysterectomy vaginal vault prolapse can be treated with sacrocolpopexy or sacrospinous ligament fixation.

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

Leiomyomas are classified by FIGO types 0-8; types 0-2 are submucosal and most associated with heavy bleeding and infertility.

During bipolar hysteroscopy with saline distension, stop at a fluid deficit of 2000 mL to avoid hyponatremia and fluid overload.

Medical treatment of ectopic pregnancy with methotrexate requires hemodynamic stability, no rupture, hCG below 5000, no fetal cardiac activity, and reliable follow-up.

Laparoscopic detorsion with ovarian preservation is standard for ovarian torsion; oophorectomy is reserved for necrotic or suspicious ovaries.

Endometrial ablation is contraindicated when future fertility is desired or endometrial cancer is suspected.

Diagnostic laparoscopy for pelvic pain uses carbon dioxide pneumoperitoneum at 12-15 mmHg and Trendelenburg positioning.

Myomectomy is preferred over hysterectomy for fibroids when fertility preservation is desired; recurrence risk remains.

Cervical stenosis can cause hematometra and is treated by dilation or hysteroscopic resection.

Combined oral contraceptives have a perfect-use failure rate of 0.3% and typical-use failure rate of about 9% per year.

Migraine with aura is an absolute contraindication to combined hormonal contraception because of ischemic stroke risk.

Copper IUD inserted within 5 days of unprotected intercourse is the most effective emergency contraception and provides ongoing contraception.

Levonorgestrel 1.5 mg is effective within 72 hours; ulipristal acetate 30 mg is effective within 120 hours; both are less effective with higher body weight.

Etonogestrel implant is effective for 3 years; levonorgestrel IUD for 3-8 years depending on product; copper IUD for 10-12 years.

Depot medroxyprogesterone acetate may reduce bone mineral density and delays return to fertility by up to 6-12 months.

Medical abortion through 10 weeks uses mifepristone 200 mg followed by misoprostol 800 mcg buccally or vaginally 24-48 hours later.

Postpartum LARC can be inserted immediately after delivery, including intracesarean; progestin-only methods are compatible with breastfeeding.

Tubal sterilization is permanent; regret is higher in young women and those with postpartum or coercion circumstances.

Nuchal translucency is measured at 11-14 weeks; 3.5 mm or more increases risk of aneuploidy, cardiac defects, and genetic syndromes.

First-trimester combined screening uses maternal age, nuchal translucency, free beta-hCG, and PAPP-A; detection for trisomy 21 is about 85-90%.

Cell-free DNA screening detects trisomy 21 with over 99% sensitivity but is not diagnostic; positive results require amniocentesis or CVS.

The anatomy scan is performed at 18-22 weeks; it assesses fetal anatomy, growth, placenta, and amniotic fluid.

Genetic amniocentesis is performed at 15-20 weeks; chorionic villus sampling is performed at 10-13 weeks.

Biophysical profile includes fetal breathing, movement, tone, amniotic fluid volume, and nonstress test; score 8 or 10 is normal.

Fetal anemia is assessed by middle cerebral artery peak systolic velocity; a value above 1.5 multiples of the median suggests anemia.

Trisomy 21, 18, and 13 are autosomal trisomies; Turner syndrome is 45,X and often presents with cystic hygroma.

Cystic fibrosis carrier screening is offered to all couples planning pregnancy; Ashkenazi Jewish panels include Tay-Sachs and Canavan disease.

Maternal cardiac arrest at 20 weeks or more requires left uterine displacement, standard ACLS, and perimortem cesarean within 4-5 minutes if resuscitation is unsuccessful.

Sepsis in pregnancy requires broad-spectrum IV antibiotics within 1 hour, fluid resuscitation, source control, and early critical care involvement.

Local anesthetic systemic toxicity is treated with 20% lipid emulsion 1.5 mL/kg bolus followed by infusion; avoid vasopressin and calcium channel blockers.

Magnesium toxicity presents with loss of deep tendon reflexes, respiratory depression, and cardiac arrest; give calcium gluconate 10% 10 mL IV.

Aspiration prophylaxis before cesarean includes sodium citrate and H2 blockers; rapid sequence induction uses a smaller endotracheal tube (6.0-7.0 mm).

Neuraxial anesthesia is preferred for cesarean when not contraindicated; general anesthesia is reserved for emergency or neuraxial failure.

Massive postpartum hemorrhage transfusion uses a balanced ratio of red cells, plasma, and platelets, commonly 1:1:1, with tranexamic acid 1 g IV within 3 hours.

Amniotic fluid embolism is managed supportively with oxygenation, circulation support, and correction of coagulopathy.

Eclampsia seizures are treated with magnesium sulfate; ergometrine is contraindicated because it raises blood pressure.

Number needed to treat equals 1 divided by the absolute risk reduction.

Sensitivity is true positives divided by true positives plus false negatives; specificity is true negatives divided by true negatives plus false positives.

Positive predictive value depends on disease prevalence; a high-sensitivity test is best for ruling out disease when negative.

The Belmont Report principles are respect for persons, beneficence, and justice.

Informed consent requires capacity, voluntariness, disclosure of diagnosis, treatment, risks, benefits, alternatives, and consequences of refusal.

Level I evidence includes systematic reviews of randomized trials; Level II includes individual randomized trials; Level III includes cohort studies.

A p-value below 0.05 indicates statistical significance but does not measure effect size or clinical importance.

Institutional review board approval is required before human-subjects research; exempt and expedited categories exist.

Conflict of interest must be disclosed and managed; it does not automatically invalidate research but requires transparency.