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OBGYN > Case Files - Approach To The Patient > Flashcards

Case Files - Approach To The Patient Flashcards

1
Q

Pregnant women younger than 17 or older than 35 are at increased risk for

A

Preterm labor
Preeclampsia
Miscarriage

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2
Q

Gravidity

A

Number of pregnancies including the current one.

Includes miscarriages, ectopic pregnancies and stillbirths

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3
Q

Parity

A

Number of pregnancies that have ended at gestational age >20 weeks

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4
Q

Abortuses

A

Number of pregnancies that have ended at gestational age

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5
Q

Clinical Pearl -

G
T
P
A
L
A 
Gravidity
Term Deliveries
Preterm Deliveries
Abortuses
Living Children
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6
Q

LMP

A

The FIRST DAY of the last menstrual period. Important in determining gestational age.

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7
Q

Expected Due Date

A

LMP - 3 months + 7 days

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8
Q

Chief Complaint: Postmenopausal bleeding

What are you most worried about?

A

Endometrial cancer

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9
Q

What are the risk factors for endometrial cancer?

A 
Hypertension
Diabetes
Anovulation
Early age of menarche
Late age of menopause
Obesity
Infertility
Nulliparity
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10
Q

What should the first line of every obstetric presentation include?

A 
Age
Gravidity
Parity
LMP
EGA
Chief Complaint
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11
Q

Age of menarche - Normal range

A

9 years old - 16 years old

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12
Q

Interval from first day of one menses to the first day of the next - Normal range

A

21 to 35 days

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13
Q

Quality of menses - Normal range

A

Lasts less than 7 days

Less than 80mL in total volume

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14
Q

Menorrhagia

A

Excessive menstrual flow

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15
Q

Menometrorrhagia

A

Irregular AND heavy menses

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16
Q

STIs we ask about in the history

A 
Herpes simplex
Syphillis
Gonorrhea
Chlamydia
HIV
PID
HPV
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17
Q

Past Medical History - Don’t miss these!

A 
Hypertension
Hepatitis
Diabetes
Cancer
Heart disease
Thyroid disease

Include duration, severity and therapies!

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18
Q

Surgical history - Detail to remember

A

Note if surgical procedures were via laparoscopy or laparotomy

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19
Q

Review of systems - What makes us worry about preeclampsia?

A

Headache
Visual disturbances
Epigastric pain
Facial or hand swelling

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20
Q

Review of systems - Elderly patient considerations

A

Symptoms suggestive of cardiac disease:

Chest pain
Dyspnea
Fatigue
Weakness
Palpitations
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21
Q

Clinical Pearl - What do we look out for in every pregnancy > 20 weeks gestational age?

A

Preeclampsia

22
Q

What are we looking for in the breast examination?

A 
Symmetry
Skin or nipple retraction with hands on hips
Masses (palpation)
Nipple discharge
Axillary and supraclavicular nodes
23
Q

Systolic flow murmurs in a pregnant woman

A

Normal. Increased cardiac output.

24
Q

Diastolic murmurs in a pregnant woman

A

Unusual

25
Q

Grey Turner sign

A

Discoloration at the flank areas.

May indicate intra-abdominal or retroperitoneal hemorrhage.

26
Q

Ulcers on the external genitalia may indicate

A

Herpes simplex
Vulvar carcinoma
Syphillis

27
Q

Vulvar mass at 5:00 or 7:00 position may suggest

A

Bartholin gland cyst or abscess

28
Q

If you see pigmented lesions on the external genitalia

A

Get a biopsy.

Malignant melanoma is not uncommon in the vulvar region.

29
Q

Rectal Exam - Nodularity and tenderness in the uterosacral ligament may suggest

A

Endometriosis

30
Q

Rhogam - When and to whom?

A

Administer at 28 weeks gestational age if the mother is Rh (-) in order to prevent isoimmunization.

Administer again at delivery if the baby is, indeed, Rh (+)

31
Q

Mom tests positive for HBsAg. What do you do?!

A

At birth, give the newborn Hep B Immune Globulin (HBIG) and Hep B vaccine to prevent neonatal hepatitis.

32
Q

If mom is not already immune to rubella, why don’t we vaccinate her until immediately postpartum?

A

It is a live-attenuated vaccine, so can’t be given during pregnancy

33
Q

Mom tests positive for syphillis while pregnant but she’s allergic to penicillin. What do you do?

A

Desensitize her, then give penicillin.

34
Q

What are we looking for with a urine culture or urinalysis?

A

Asymptomatic bacteriuria.

6 - 8% of pregnancies are complicated by this

35
Q

Why do many physicians prefer liquid-based media for ectocervical and endocervical sampling in a pap smear?

A

Provides better cellular sampling

Allows for HPV subtyping

36
Q

What do we screen the serum for between 16 and 20 weeks gestational age?

A

Down’s Syndrome
Neural Tube Defects

Also screening for trisomies with serum Pregnancy-Associated Plasma Protein-A (PAPP-A) and βhCG as well as nuchal translucency (NT) has gained popularity at this point.

37
Q

PAPP-A

A

Pregnancy-Associated Plasma Protein-A

Found in the serum, used for first-trimester screening for trisomies

38
Q

βhCG

A

Beta Human Chorionic Gonadotropin

Used in first trimester screening for trisomies, among many other things we will get to.

39
Q

NT

A

Nuchal Translucency

Used in first trimester screening for trisomies

40
Q

What do we screen for at 26 - 28 weeks gestational age?

A

Gestational diabetes.

Give a 50g oral glucose load
Assess the serum glucose after 1 hour

41
Q

If adopting the “culture strategy” for Group B Strep, when are introital cultures obtained?

A

35 - 37 weeks gestational age

42
Q

What does quantitative hCG and progesterone level tell us?

A

Viability of the pregnancy

Possibility for ectopic pregnancy

43
Q

Menorrhagia due to uterine fibroids - Lab tests to run

A 
CBC
Endometrial biopsy (to assess for endometrial cancer)
Pap smear (to assess for cervical dysphasia or cancer)
44
Q

55+ year old woman with an adnexal mass - Labs to run

A

CA-125
CEA tumor markers

Looking for epithelial ovarian tumors

45
Q

Sonography - Thickened endometrial stripe in a postmenopausal woman

A

May indicate malignancy

46
Q

Sonography - What is the point of a saline infusion into the uterine cavity?

A

Enhances the ultrasound examination of intrauterine growths, such as polyps

47
Q

Clinical Pearl - Sonohysterography

A

Ultrasound examination of the uterus after injecting saline into endometrial cavity

This is done via transcervical catheter

It can help identify endometrial polyps or submucous myomata

48
Q

Why does the gynecological ultrasound exam usually involve the kidneys as well?

A

Hydronephrosis may suggest a pelvic process (ureteral obstruction)

49
Q

IVP

A

Intravenous Pyelogram

IV dye is used to assess:

Concentrating ability of the kidneys
Patency of the ureters
Integrity of the bladder

Can also detect:

Hydronephrosis
Ureteral stone
Ureteral obstruction

50
Q

HSG

A

Hysterosalpingogram

Radiopaque dye is introduced through transcervical cannula, and radiographs are taken.

Useful in detecting:

Intrauterine abnormalities (submucous fibroids or intrauterine adhesions)
Patency of fallopian tubes (tubal obstruction or hydrosalpinx)
51
Q

Clinical Pearl - What is the single most important tool in obtaining a diagnosis?

A

The history

OBGYN (3 decks)

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