SMLE Obstetrics and Gynecology Syllabus

Obstetrics and Gynecology syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Obstetrics and Gynecology in SMLE, not a summary of it.

1. 1

   Obstetrics

   3 topics

   • Antenatal Care
   • Labor and Delivery
   • Postpartum Care
2. 2

   Gynecology

   3 topics

   • Menstrual Disorders
   • Pelvic Inflammatory Disease
   • Gynecologic Cancers

Obstetrics and Gynecology flashcards for SMLE

24 of 51 cards from the Obstetrics and Gynecology deck — real questions with worked answers.

1. What is Naegele's rule for estimating the expected date of delivery (EDD) from the last menstrual period (LMP)?

   Add 7 days to the first day of the LMP, subtract 3 months, and add 1 year. Formula: $EDD = LMP + 7\text{ days} - 3\text{ months} + 1\text{ year}$. It assumes a regular 28-day cycle.

2. During antenatal care, at what gestational age is the first-trimester combined screening (nuchal translucency + PAPP-A + free $\beta$-hCG) performed?

   Between $11$ and $13^{+6}$ weeks of gestation.

3. What are the recommended daily folic acid doses for low-risk versus high-risk women to prevent neural tube defects?

   Low-risk: $400\ \mu g$/day starting preconception through the first trimester. High-risk (previous NTD, diabetes, on antiepileptics): $4$–$5\ mg$/day.

4. What defines gestational hypertension versus preeclampsia?

   Gestational hypertension: new-onset BP $\geq 140/90$ mmHg after 20 weeks without proteinuria or end-organ damage. Preeclampsia: hypertension after 20 weeks PLUS proteinuria ($\geq 300$ mg/24h) or end-organ dysfunction.

5. What screening test and diagnostic threshold are used for gestational diabetes with the 1-step 75 g OGTT?

   A 75 g oral glucose tolerance test at 24–28 weeks; diagnostic if any value is met: fasting $\geq 92$ mg/dL, 1-hour $\geq 180$ mg/dL, or 2-hour $\geq 153$ mg/dL.

6. When is anti-D immunoglobulin routinely given to an Rh-negative unsensitized pregnant woman?

   At $28$ weeks gestation, and again within $72$ hours after delivery if the neonate is Rh-positive. Also after any sensitizing event (bleeding, trauma, amniocentesis).

7. How is the fundal height (in cm) expected to correlate with gestational age between 20 and 36 weeks?

   The symphysis-fundal height in centimeters approximately equals the gestational age in weeks $\pm 2$ cm (e.g., $28$ weeks $\approx 28\pm2$ cm).

8. What are the components and scoring range of the Biophysical Profile (BPP)?

   Five components: fetal breathing, gross body movement, fetal tone, amniotic fluid volume, and non-stress test. Each scores $0$ or $2$, total range $0$–$10$; $\geq 8$ is reassuring.

9. List the recommended vaccinations during pregnancy.

   Inactivated influenza vaccine (any trimester) and Tdap (each pregnancy, ideally $27$–$36$ weeks). Live vaccines (MMR, varicella) are contraindicated.

10. What is the definition of a positive (reactive) non-stress test (NST)?

    At least $2$ accelerations of the fetal heart rate of $\geq 15$ bpm above baseline lasting $\geq 15$ seconds within a $20$-minute window (in fetuses $\geq 32$ weeks).

11. What are the three stages of labor and what defines each?

    First stage: onset of regular contractions to full cervical dilation ($10$ cm). Second stage: full dilation to delivery of the fetus. Third stage: delivery of the fetus to delivery of the placenta.

12. Differentiate the latent and active phases of the first stage of labor.

    Latent phase: cervix $0$ to ~$6$ cm with slow dilation. Active phase: from ~$6$ cm to $10$ cm with rapid dilation (roughly $\geq 1$ cm/hr in nulliparas).

13. What are the seven cardinal movements of labor in order?

    Engagement, Descent, Flexion, Internal rotation, Extension, External rotation (restitution), and Expulsion.

14. What are the three signs of placental separation in the third stage of labor?

    A gush of blood, lengthening of the umbilical cord, and the uterus becoming globular and firm (rising in the abdomen).

15. Define the Bishop score and what it predicts.

    A scoring system ($0$–$13$) assessing cervical dilation, effacement, consistency, position, and fetal station to predict likelihood of successful labor induction. A score $\geq 8$ predicts a favorable cervix.

16. According to the fetal heart rate categories, what characterizes a Category III (abnormal) tracing?

    Absent baseline variability with recurrent late decelerations, recurrent variable decelerations, bradycardia, OR a sinusoidal pattern. It requires prompt intervention.

17. What is the mechanism and clinical significance of early, variable, and late decelerations?

    Early: head compression (vagal), benign, mirror contractions. Variable: umbilical cord compression, abrupt. Late: uteroplacental insufficiency, onset after contraction peak — concerning for fetal hypoxia.

18. What are the '4 Ps' that determine the progress and outcome of labor?

    Power (uterine contractions), Passenger (fetus size/position), Passage (maternal pelvis), and Psyche (maternal psychological state).

19. What defines prolonged (postterm) pregnancy and its main risks?

    Pregnancy reaching $\geq 42^{+0}$ weeks. Risks include macrosomia, oligohydramnios, meconium aspiration, stillbirth, and dysmaturity syndrome.

20. What is the definition of preterm labor?

    Regular uterine contractions with cervical change occurring between $20^{+0}$ and $36^{+6}$ weeks of gestation.

21. What are the two most common causes of primary postpartum hemorrhage, and what is the '4 Ts' mnemonic?

    Uterine atony is the most common cause. The 4 Ts: Tone (atony), Trauma (lacerations), Tissue (retained products), and Thrombin (coagulopathy).

22. Define primary versus secondary postpartum hemorrhage by timing and blood loss.

    Primary: $>500$ mL (vaginal) or $>1000$ mL (cesarean) within $24$ hours of delivery. Secondary: excessive bleeding from $24$ hours up to $12$ weeks postpartum.

23. What is the first-line uterotonic drug for postpartum hemorrhage due to uterine atony?

    Oxytocin (IV or IM). Second-line agents include ergometrine, carboprost (contraindicated in asthma), and misoprostol.

24. What is the normal duration and progression of lochia after delivery?

    Lochia rubra (red, days $1$–$3$), lochia serosa (pink-brown, days $4$–$10$), then lochia alba (yellow-white, up to $6$ weeks).

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