EM OBGYN Flashcards
what defines abnormal uterine bleeding?
anything different per the patient
What is PALM COEIN
PALM: structural
- Polyps, adenoyosis, leiomyoma (fibroids), Malignancy
COEIN: non-structural
- Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified
what is the treatment of abnormal uterine bleeding
will depend on severity
estrogen OCP 3 pills x 2 days or until bleeding stopped and then 2 x 3d - do not stop for next menstrual cycle
if IUD goes through uterus
What is the treatment of massive hemorrhage
may require massive transfusion
consider hormone supplementation
consider TXA
consider uterine tamponade
consult surgery
obtain US
what is the most common cause of PID
GC and chlamydia
what is PID
ascending vaginal/uterine infection
what is the presentation of PID
bilat lower abdominal pain, discharge, fever, chills, malaise, cervical motion tenderness, adnexal tenderness
what is the treatment of PID
abx for STI
admit if PG, Toxic or complicated (abscess, ectroic, fitz-hugh-curtis)
what is an inflammatory mass of the fallopian tube and ovary
tubo-ovarian abscess
what is the treatment of tubo-ovarian abscess
if < 7cm abx (cefotetan 2g IV BID + doxy 100mg PO BID)
if larger needs surgery
what is a bartholin cyst
bartholin duct that is blocked - leading to fluid accumlation
what is the treatment of bartholin cyst
drainage with word cath - stays in for 6-8 weeks
what is rotation of the ovary on the ligamentous supports
ovarian torsion
- impedes blood flow and causes necrosis
what is the presentation of ovarian torsion
severe painw ith peritonitis
N/V
fever
vaginal bleeding
what is the treatment of ovarian torsion
pain management and Zofran PRN
needs to go to the OR immediately
what is an inflammatory reaction of the vulva and vagina
vulvovaginitis
what is most common cause of vulvovaginitis
candidiasis
bacterial vaginosis
trichomoniasis
what is the presentation of breast abscess
breast pain
swelling
erythema
fever
malaise
what is the most common causative agent for breast abscess
infection arises in milk
m/c S. aureus and E.coli
what is the treatment of mastitis
breast feed
NSAIDs
Warm compress
abx if > 12-24 hours (cephalexin, augmentin or clinda)
what is the treatment of breast abscess
US to confirm
needs drainage
lido with epi
may try aspiration depending on size
larger: I&D, consult with surgery
what is the leading cause of death in women in first trimester of pregnancy
ectopic pregnancy
what is the presentation of ectopic pregnancy
POOP typically 6-8 weeks after LMP
Pain typically along one of the lower quadrants
vaginal bleeding
may be in shock
syncope
how are ectopic pregnancies diagnosed
Qualitative hCG
Quantitative hCG
transvaginal US
type and screen
direct visualization
what is given with a Rh- mom
give rhogam
what is the treatment of spontaneous abortion
if stable - misoprostol +/- Mifepristone
if heavy bleeding, later term, infectious - surgical options such as vacuum or curettage (D&C)
what is septic abortion
infectious agent is able to enter endometrium and/or myometrium
risk increased with unsafe abortion techniques
m/c associated iwth vaginal bacteria
what is the difference between pre-eclampsia and eclampsia
eclampsia is pre-eclampsia with seizures
what is the definition of pre-eclampsia/eclampsia
new onset HTN after 20 weeks gestation with proteinuria or end-organ dysfunction
BP > 140/90 with proteinuria
how long post partum can pre-eclampsia/eclampsia present
up to 6 weeks post partum
what can be seen on exam for pre-clampsia/eclampsia
fetal heart tones
abdominal pain
fudnal height
LE edema
petechail rash
neurologic deficit
hyperreflexia
what is the typical presentation of pre-clampsia/eclampsia
HA and HTN
how is pre-eclampsia/eclampsia treated
BP control: hydralazine 5mg IV, Labetalol 10mg IV or nifedipine 10mg PO
IV mag 4-6 g loading over 10-20 min then 1-2 g/hr
What is HELLP syndrome
Hemolysis, elevated liver enzymes, low platelet count
variant of preeclampsia with more severe manifestations
what is the presentation of HELLP syndrome
RUQ pain, N/V,
HA, visual changes, jaundice, malasie
what is the treatment of HELLP syndrome
Magnesium, BP control, delivery
have blood ready
what is placental abruption
premature separation of placenta from the endo uterine lining
m/c 24-28 weeks gestation
what is the presentation of placenta abruption
acute back pain or abdominal pain, contractions
vaginal bleeding is common
exam may show uterus to be rigid and tender
what is the treatment of placenta abruption
get ready to deliver, call OB, call anesthesia
if unstable will need c-section
what is placenta previa
placenta develops over cervix
what is PROM
premature rupture of memebranes
< 37 weeks gestation
what is shoulder dystocia
anterior shoulder is stuck on moms pubic symphysis
baby’s head will “turtle” and will go back betweencontractions
what is McRobers
hyperflex moms hips/knees and apply pressur on the pubis.
how is postpartum hemorrhage treated
consider lacerations although uterine atony is m/c
find/fix lacerations
atony: oxytocin IM, Misoprisol IM, uterine massage
consider retained products
consider DIC if hx of preeclampsia
begin resuscitation with blood