EM - OBGYN Flashcards
primary amenorrhea
the failure to begin menstruating at puberty
secondary amenorrhea
absence of menses for >3 cycles or 6 months in a previously menstruating patient
sheehans syndrome
postpartum pituitary necrosis
workup of secondary amenorhea
-pregnancy test
-TSH and prolactin
-estrogen and progesterone challenge test
treatment of amenorrhea
-if desiring pregnancy: letrozole or clomid
-if not desiring pregnancy: estrogen/ progesterone
evaluation of dysfunctional uterine bleeding
-pelvic US
-endometrial biopsy
-hysteroscopy
treatment of premenopausal dysfunctional uterine bleeding
-observation
-hormone therapy
-definitive: hysterectomy
MC site of ectopic pregnancy
ampulla
diagnosis of ectopic pregnancy
US
treatment of ectopic pregnancy
-methotrexate
risk factors for endometriosis
-early menarche
-nulliparity
-family history
-heavy menstrual bleeding
s/s of endometriosis
-dysmenorrhea
-pelvic pain
-dyspareunia
-infertility
-tender nodules in posterior vaginal fornix
diagnosis of endometriosis
surgery with biopsy
-powder burn
-chocolate cysts
treatment of endometriosis
-NSAIDs
-OCPs
-surgical removal
MCC of mastitis
-staph aureus
s/s of mastitis
-painful erythematous lobule in outer quadrant of breast
-systemic signs of infection
treatment of mastitis
-avoid milk stasis
-warm compress
-dicloxacillin or keflex
etiology of breast abscess
mastitis
s/s of breast abscess
-redness, tender, fluctuant
treatment of breast abscess
I&D
etiology of functional ovarian cysts
cyclic ovarian changes
s/s of ovarian cysts
menstrual irregularities
-pelvic pressure or pain
-constipation or urinary frq
diagnosis of functional ovarian cysts
pelvic US
MC type of functional cyst
follicular
etiology of follicular cyst
failure in ovulation
s/s of follicular cyst
-usually asymptomatic
treatment of follicular cyst
-observation
-OCPs
etiology of corpus luteum cyst
accumulation of fluid inside a corpus luteum
s/s of corpus luteum cyst
-local pain, tenderness
-amenorrhea
treatment of corpus luteum cyst
-OCPs
etiology of theca lutein cyst
elevated levels of HCG
s/s of theca lutein cyst
-pelvic heaviness or aching
treatment of theca lutein cyst
symptomatic
etiology of endometrioma
endometric foci on ovarian surface
s/s of endometrioma
-pelvic pain
-dyspareunia
-dysmenorrhea
-infertility
treatment of endometrioma
as for endometriosis
s/s of PID
-lower abdominal pain
-discharge
-n/v
-fever
-cervical motion tenderness
etiology of PID
polymicrobial
treatment of PID
-rocephin + doxy + flagyl
etiology of placental abruption
premature separation of a normally implanted placenta
s/s of placental abruption
-painful vaginal bleeding
-abdominal pain
-uterine tenderness
-fetal distress
treatment of placental abruption
immediate delivery
etiology of placenta previa
-placenta over or very near to the internal cervical os
s/s of placenta previa
painless bright red bleeding
diagnosis of placenta previa
transvaginal ultrasound
treatment of placenta previa
-serial US
-delivery by CS
s/s of PROM
-pooling of amniotic fluid
diagnosis of PROM
-nitrazine swab
-ferning
-pooling of amniotic fluid within the vagina
management of PROM
-patient hospitalized for remainder of pregnancy
-corticosteroids
-tocolysis
-antibiotics
complete abortion
complete expulsion of all products of conception before 20 weeks
treatment of complete abortion
-send POC to pathology
incomplete abortion
-partial expulsion of some but not all POC before 20 weeks
-nonviable IUP on US
treatment of incomplete abortion
-D&C
-prostaglandins
-cytotec
inevitable abortion
no expulsion of products but vaginal bleeding and dilation of the cervix such that a viable pregnancy is unlikely
-IUP on US
treatment of inevitable abortion
-prostaglandins
-expectant management
missed abortion
-death of the embryo or fetus before 20 weeks with complete retention of all POC
-nonviable IUP on US
treatment of missed abortion
-D&C
-prostaglandins
-expectant management
threatened abortion
vaginal bleeding before 20 weeks without dilation of the cervix or expulsion of any POC
Treatment of threatened abortion
-monitor
