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OBGYN > Clerkship > Flashcards

Clerkship Flashcards

1
Q

Primary Amenorrhea

A
  1. Gonadal Dysgenesis
  2. Mullerian Agenesis
  3. Androgen insensitivity
  4. Turner
  5. Imperforate Hymen
  6. 17 alpha hydroxylase
  7. HPA defects
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2
Q

Gonadal Dysgenesis

A
  • No secondary sexual characteristics
  • Increased LH, FSH, low E2
  • Phenotypic female
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3
Q

Mullerian Agenesis

A
  • Yes secondary sex characteristics
  • Pelvic exam will be abnormal
  • No pelvic hair
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4
Q

Androgen Insensitivity

A
  • Externally phenotypically female
  • Will have breasts
  • Will have XY, no internal structures
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5
Q

IMperorforate Hymen

A

-Cyclical pain with menstruation

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6
Q

17 alpha hydroxylase

A
  • No breasts or secondary sex characteristics
  • Elevated mineralocorticoids. Hypokalemia, hypernatremia, alkalosis
  • Decreaed cortisol
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7
Q

HPA defects

A
  • Decresased FSH, LH, E2
  • No secondary sex characteristics
  • Caused by tumors, malformation, Fe, bilirubin deposits
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8
Q

Secondary Amenorrhea

A
  1. Pregnancy
  2. Menopause
  3. Premature Ovarian Failure
  4. Hyper/hypo thyroid
  5. PCOS
  6. Outflow obstruction
  7. Ashermans
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9
Q

PRegnancy

A

Always get pregnancy test no matter what

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10
Q

Menopause

A

-Often accompanied by other signs
-FSH, LH will be increased and E2 will be decreased
Negative pregnancy test
-Dyspareunia common

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11
Q

Premture ovarian failure

A

Less than 40 and menopause signs.

Dyspareunia common presenting because of decrease E2 and decrease vaginal secretition

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12
Q

Thyroid

A
  • Look for other signs and order TSH

- DM can also cause amenorrhea

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13
Q

PCOS

A
  • Hyperandrogenism
  • Elevated LH
  • Oligomenorrhea, irregular
  • Tx with OCP to prevent endometrial CA and regulate sycles
  • Tx with clomiphene for ovulation
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14
Q

Ashermanns

A

Look for previous D and C or ablation

-Can treat surgically and with E2

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15
Q

Outflow obstrctuion

A

Commonly caused by cervical stenosis.

-Following LEEP or cold knife for cervical CA

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16
Q

Hyperandrogenism

A

Virrulization, hair growing, oily skin, decreased ovulation

  • PCOS
  • Theca Tumor
  • Other Tumor, ACTh etc
  • Cushings disease
  • Adrenal Tumor (DHEA)
  • 21 hydroxylase, 11 hydroxylase
  • Leydig sertolli tumors
  • Hyperthecosis
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17
Q

PCOS

A
  • Obesity leads to increased E2 leads to supression of FSH leads to incrase LH leads to hypertestosterone
  • Treat with OCP to prevent dendometirla complications
  • Treat with clomipohine for ovulation
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18
Q

Theca Leutin Cyst

A
  • Seen commonly in pregnancy

- Will have baby with ambiguous genetalia and mother with virilization, often subsides after pregnancy

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19
Q

Hilar tumor

A
  • Tumor of strtomal cells of the ovary
  • Leads to icnrase Testosterone production beyond what can be converted by granulosa
  • High T and High E
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20
Q

Hyperthecosis

A

-Extreme form of PCOS, hyperplasia of ovarian stroma resistant to treatment

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21
Q

-Idiopathic virilizatoin

A

-Virilization in the absence of any disease or biochemical test

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22
Q

Cushings

A

-Elevated cortisol and signs of cushings

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23
Q

21 hydroxylase deficincy

A
  • hypotension and virilization

- decreased mineralocorticoids

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24
Q

11 hydroxylase deficency

A

-HTN and increased mineralocorticoids

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25
Q

Postpartum Alopecia

A
  • Elevated levels of E2 in pregnancy cause growht of hairs at the same rate
  • Leads to loss at same time and alopecia
  • treatment is conservative and hair will return
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26
Q

Prolactinemia

A
  • Caused by microadenoma, macroadenoma, drugs, decreased renal clearance, empty sella leding to pit hypertrophy, hypothyroid (Decrease - feedback on TRH)
  • Workup is PRL and TSH (Can cause decrase TSH)
  • 5HT and TRH are stimulating, DA inhibits
  • Tx bromocriptine, surgery if failed medical therapy or macroadenoma.
  • Causes loss of ovulation because of negative feebnack on gNRH. Can lead to osteoprosis from decreased estrogen
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27
Q

Endometriosis

A
  • Nulip, cyclical pain, pain with sex and defecation. Retroflexed nodular uterosacral ligament
  • Diagnose with clinical findings or laproscopy with biopsy for diffinitive diagnosis
  • Tx 1st symptomatic, then OCP
  • If doesn’t work then can use leuprolide (Osteoporsosis), Danazol (virilization)
  • Post childbearing with hyst and BSO
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28
Q

Adenomyosis

A
  • Noncylical pain, often multparous, later in life. Enlarged uterus
  • Dx with U/S or MRI, sometimes difficult to distinguish from myoma
  • Treatment is hysterectomy, not hormonally responsive
  • Ablation is ineffective because it is the myoma layer tha is bad not the endometrium
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29
Q

Hemorrhagic Cysts

A
  • Diagnosed via ultrasound, generally simple cysts
  • Treatment is waiting. WIll often resolve in 3 monthts or so
  • Surgery after first diagnosis is premature
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30
Q

Ovarian Torsion

A
  • Rapid onset lower abdominal pain
  • Can be confused with appendicitis
  • Get u/s for diagnosis
  • Treatment is emergent laparotomy
31
Q

Pelvic Mass

A
  • Most important workup is PE, Bhcg, and U/S
  • Differential: Physiologic, Endometrioma, Leiomyoma, Malignancy, PID, Theca Leutin, Ectopic
  • Also consider endometrial CA for enlarged uterua
32
Q

Phsyiolgic Cysts

A
  • Most common in reporoductive age females
  • Often seen within recent time of LMP
  • Can be painful or painless
  • Most can be watched when they are less than 5cm
  • Indications for surgery are severe pain and torsion, or increaseing size over 5 cm because of risk of torsion
  • OCP can help to reduce symptoms of small cysts that will not be operated on
  • Usually go away within 3 months, if they don’t, consider surgery
33
Q

Leutin

A
  • Corpus Leutin occurs after rupture and ovarian follice leaves
  • MAy secrete progesterone indefinitiely and mess with menstrual cycle causing irregular or heavy bleeding
  • Rupture can cause blood and pain leading to acute abdpmen
34
Q

Theca Leutin

A
  • Seen in the setting of very high Bhcg
  • such as GTT
  • usually bilateral
35
Q

Tubo-ovarian-abcess (TOA)

A
  • Can occur because of ascending infection, spread within pelvis from bowel perf, iatrogenic
  • Diagnose with u/s and signs of fever, leuk etc
  • Treatment is abx first line and often effective. Cover +,-, anaerobes
  • If abx don’t work consider surgery
36
Q

Endometrioma

A
  • Chocolate cyst
  • Seen in patients with endometriosis
  • Surgical removal is the only definitive treatment
37
Q

Benign Teratoma (Dermoid)

A
  • Most common malignancy in child bearing women
  • Will have tissue from all three germ layers, can be simple or complex cysts
  • Treatment is a cystecomy if patient desires future fertility or oophrectomy if does not
38
Q

Malignant

A
  • Epithelila, sex cord, germ
  • Often assymptomatic or nonspecific GI/GU symptoms
  • Diagnose with U/S and Bx
  • CA-125 can be helpful
  • Treatment is surgical removal and post op chemo for extensive disease
39
Q

Leiomyomoa

A
  • Smooth muscle tumor that is hormonally responsive
  • most common presenting symptom is menorrhagia, enlarged uterua, or pain. Anemia possible
  • Diagnose with enlarged uterus, u/s. R/O endometrioal CA
  • Treatment is generally conservative to start with pain managment and anemia managment
  • Can use leuprolide for shrinking often before surgery
  • Can cause infertiliy. Use myomectomy for desired fertility
  • Do not use ablation or embolization for desired fertility
  • Conservative treatment is often the best approach, do not intervene generally until greater than 14cm or patient desires
  • Infertility is commonly observed in submucosal tumors
  • During pregnancy increase risk of malpresentation and placental abruption.
40
Q

Cervical Cancer Presentation

A
  • Postcoital bleeding, hematuria
  • High risk sexual behaviors and HPV 6, 11 infection
  • Can cause extension in to ureters, uterus and cause spotting and bleeding or obstruction
  • When extensive can cause blockage of lymphatics and cause nerve damage (Sciatica)
  • Risk factors are sexual, HPV, smoking, Immunocompromised
41
Q

Pap Smear

A
  • Begins at age 21
  • Once every 3 years if normal and once every 5 years if done as co-test with HPV
  • If ASCUS do HPV testing, if positive do colposcopy. Can also wait one year, but not preferred
  • For everything that is higher grade do colposcopy
  • Conization is the next step above colposcopy
  • Must get the squamocolunar junction or TZ
  • Can use acetic acid to highlight malignant areas (Increasenuclear to cytoplasm ration)
  • Once diagnosed, CT is indicated for staging
42
Q

Vaccines

A

Males and females from 9-26 years

-6,11, 31,33,45

43
Q

Adenocarcinoma

A

Seen with DES commonly, Not reliable pap smear

-If pap says ASGUS glandular cells then should look at uterus with ECC too

44
Q

Mets

A

Commonly mets to uterus and vagina

  • Mets to bladder or ureter can cause obstruction and common cause of death is uremia
  • Adeno mets commonly go to lung, so CXR is indicated for surveilance
45
Q

Treatment

A
  • Local resenction for confined lesions (LEEP)
  • Radical hysterectomy for lesions 1-2
  • Radiation is also mainstay
  • Systemic chemo if there are systemic mets
46
Q

Endometrial Hyperplasia

A
  • Simple is glands and stroma
  • Complex is mainly glands
  • Complex with atypia is glands with atypical features
  • These can all be treated with progestins, but there is an indication for hysterecotmy in patient with atypia
47
Q

Postmenopausal bleedings

A

-All postmenopauseal bleeding and bleeding in those greater than 35 yrs is diagnosed with EMB regardless

48
Q

Workup for endometrial CA

A
  • Bx. If insufficient smaple then can do diagnostic d and c
  • U/S may be indicated as part of the initial workup but is not necessary
  • If diagnosed then a chest x ray is necessary
  • pelvic CT and MRI may be indicated if staging is necessary
49
Q

Grading and Staging

A
  • Grading is the most important prognostic factor
  • Solid component indicates atypia. G1 has very little solid, G2 has half and half, G3 has mostly solid
  • Staging I and II are in the uterus and local structurs. 3 is into local mets/nodes
  • 4 is distant mets/nodes. Lungs are the most common place
50
Q

Tx Endometrial CA

A

-TAH, for cure of 1 and 2 disease
3 needs lymph node dissection and overy removal
-4 needs chemo, radiation and surgery

51
Q

Leiomyosarcoma

A
  • Rare form of uterin cancer
  • Seen classically in a rapidly enlarging fibroid
  • Seen more commonly in african americans
52
Q

Glucosuria, hydronephrosis

A

Common finding in pregnancy, does not indicae diabetes

53
Q

Placenta Acreta

A

Placenta will be attached to the submucosal tissue and will be difficult to pull out and will come out in pieces, cause for PPH

54
Q

Placenta Succinate

A

Ectopic placental tissue, often missed and cause for atony and PPH

55
Q

Placenta Previa

A

Vaginal bleeding

Risk factors include smoking and prior C section

56
Q

Fetal attitdue

A

Whether the fetus is flexed or extended

57
Q

Saltatory FHR

A

Signs of intermitent hypoxia, commonly seen during labor

58
Q

Contractions

A

Regular contractions spaced less than 5 minutes for 1 hour is labor
Any time they are irregular it is likely something else (Braxton hicks)

59
Q

Umbilical Prolapse

A

Reason for emergent C-section

60
Q

MgSO4 effects on baby

A

Can cause respiratory depression

61
Q

Diabetes in pregnancy

A

DM1 often have small baby because there is low amounts of insulin
DM2/GDM often have large
Both at risk for hypoglycemia

62
Q

GDM effects on baby

A

-Polycythemia, hyperbili, hypocalcemia, hypoglycemia, respiratory depression

63
Q

Narcotic adicted mother

A

Never give baby naloxone because it may cause withdrawl.
Provide supportive care for respiration
???

64
Q

HIV

A

Control mother viral load
Adminiester AZT immediately to baby
Can test 24 hours later

65
Q

If there is a discrepancy between the biopsy results and coloposcopy and the pap smear then you should do a conization or leep

A

If there is a positive biopsy you should do a Leep

66
Q

PMS treatment

A

Use NSAIDs to manage symptoms and OCP to decrease disease secerity, will decrease the ammount of progesterone/decrease endometrial thickness

67
Q

Functional amenorrhea of all kinds check FSH and LH Levels

A

a

68
Q

Estrogen after menopause

A

From aromatization in fat

69
Q

If there is bleeding and anemia with an unstable patient then get surgery for abortion

A

Otherwise can use methotrexate

70
Q

Bleeding

A

get EMB, if negative then pelvic US

71
Q

Co test

A

5 year screening after age of 30

72
Q

OCP

A

endometrial atrophy leads to improved symptoms

73
Q

Molar Pregnancies

A

Always present with vaignal bleeding, also will have size greater than dates and increased hcg

74
Q

Emergency contraception

A

copper is the most efective. LEvenogosterol pill is plan B and is most common, works by delaying ovulatoin, 85% effective. Ulipistap is a littler better, but plan B is more common oral medication.

OBGYN (1 decks)

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