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OB/GYN > Final > Flashcards

Final Flashcards

1
Q

estrogens in normal menstruation

A
  • levels start to increase 1 week before ovulation

- rise 24 hours prior to ovulation initiates LH surge that produces ovulation

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2
Q

progesterone in normal menstruation

A
  • secretory effects on endometrium
  • stimulates development of lobules in breast
  • withdrawal results in menses
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3
Q

reproductive cycle hormones

A 
-hypothalamus releases GnRH 
(acts on pituitary)
-pituitary releases FSH and LH
(acts on ovaries)
-ovaries release estrogen and progesterone
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4
Q

contraception interruption

A
  • ovulation/implantation
  • fertilization
  • sperm function
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5
Q

ovulation suppression

A

High doses of progesterone cause negative feedback to pituitary to prevent LH surge and ovulation

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6
Q

why estrogen in BC

A
  • proper estrogen/progesterone ratio needed to maintain endometrial lining
  • excess estrogen = hyperplasia
  • excess progestin = atrophy
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7
Q

estrogen containing contraception advantages

A
  • control period timing
  • cancer prevention
  • reduce amount of bleeding
  • decrease BP
  • reduce androgens (reduce acne & PCOS)
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8
Q

estrogen containing contraception disadvantage

A
  • nausea
  • headache
  • increase blood clot
  • DVT
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9
Q

progestin only contraception advantages

A
  • no estrogen S/S (headache, clot, BP)

- don’t have to worry about missing pill

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10
Q

progestin only contraception disadvantage

A
  • irregular bleeding (prolonged, not heavy)
  • bad mood
  • weight gain
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11
Q

copper IUD absolute contraindications

A
  • anatomical abnormality
  • cervical cancer awaiting treatment
  • current PID
  • immediate postseptic abortion
  • postpartum sepsis
  • endometrial cancer
  • suspected intrauterine disease
  • pregnancy
  • current cervicitis, chlamydia, or gonorrhea
  • pelvic TB
  • unexplained vaginal bleeding
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12
Q

progestin IUD absolute contraindications

A
  • distorted uterine cavity
  • current breast cancer
  • cervical cancer awaiting treatment
  • current PID
  • postseptic abortion
  • postpartum sepsis
  • endometrial cancer
  • suspected intrauterine disease
  • pregnancy
  • current cervicitis, chlamydia, or gonorhea
  • pelvic TB
  • unexplained vaginal bleeding
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13
Q

implant absolute contraindication

A

-current breast cancer

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14
Q

depot absolute contraindications

A

-current breast disease

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15
Q

progestin only pill absolute contraindication

A

-current breast disease

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16
Q

combined OC absolute contraindication

A
  • current breast disease
  • breast feeding <21 days postpartum
  • severe cirrhosis
  • recurrent DVT/PE risk
  • acute DVT/PE
  • surgery with prolonged immobilization
  • HTN 160/100
  • vascular disease
  • current ischemic disease
  • known thrombogenic disease
  • peripartum cardiomyopathy <6 months
  • moderate/impaired cardiac function
  • <21 days postpartum
  • nephropathy, retinopathy, neuropathy
  • vascular disease or DM >20 yrs
  • headaches with aura
  • age >35 & >15 cigarettes
  • complicated solid organ transplant
  • lupus with positive antiphospholipid antibody
  • complicated valvular heart disease
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17
Q

emergency contraception

A
  • only works if ovulation has not happened
  • does not cause abortions
  • sperm live 5-7 days in tract
  • fertile days are 5 days prior to ovulation
  • large doses of progesterone can inhibit LH surge and ovulation
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18
Q

anatomical sources of abnormal bleeding

A
  • polyp
  • adenomyosis
  • leiomyoma/fibroid
  • malignancy
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19
Q

functional sources of abnormal bleeding

A
  • coagulopathy
  • ovulation dysfunction
  • endometrium/hyperplasia
  • iatrogenic, inflammatory
  • not yet classified
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20
Q

polyp

A
  • direct visualization is best
  • ultrasound with saline
  • high cancer suspicion or decreased pain tolerance gets OR biopsy
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21
Q

adenomyosis

A
  • tissues that line the uterus encroach the muscles of the uterus
  • difficult to diagnose w/o hysterectomy
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22
Q

malignancy

A
  • cervical (visualize with speculum)

- endometrial

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23
Q

coagulopathy

A
  • von willebrand disease
  • thrombocytopenia
  • inherited factor disorder
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24
Q

ovulatory dysfunction

A
  • usually PCOS related to insulin resistance
  • higher risk for endometrial cancer
  • flipped LH/FSH
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25
Q

endometrial/hyperplasia

A

-no available tests to diagnose

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26
Q

idiopathic/inflammatory

A
  • high doses of progesterone
  • dopamine blockers increase prolactin which can cause breakthrough bleeding
  • gonorrhea or chlamydia infections
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27
Q

excessive bleeding Tx

A
  • lysteda/TXA
  • mirena
  • GnRH antagonist/agonist
  • cauterize lining
  • hysterectomy
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28
Q

amenorrhea work up

A
  • uterus and outflow
  • ovary
  • pituitary
  • hypothalamus
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29
Q

uterus and outflow amenorrhea

A
  • imperforate hyman
  • mullerian agenesis (no uterus/cervix)
  • androgen insensitivity (no uterus)
  • asherman’s syndrome (scarred uterus, give OCP 1 month to check endometrium)
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30
Q

ovaries and amenorrhea

A
  • no progesterone = anovulation
  • no estrogen = ovarian failure

administer progesterone

  • bleeding occurs = anovulation
  • no bleeding occurs = hypogonadism
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31
Q

pituitary and amenorrhea

A
  • primary ovarian failure

- pituitary dysfunction

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32
Q

hypothalamus to pituitary and amenorrhea

A
  • hard to assess because GnRH is pulsatile
  • clinical diagnosis
  • low body fat, stress, thyroid disease
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33
Q

medical contraindications for all BC

A
  • pregnancy
  • genital tract malignancy
  • undiagnosed abnormal uterine bleeding
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34
Q

medical contraindications for oral BC

A
  • clot
  • HTN
  • complicated migraine
  • liver disease
  • ischemic heart disease
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35
Q

medical contraindication for IUD

A
  • current PID/cervicitis
  • misshapen uterine cavity
  • copper allergy (paragard)
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36
Q

bacterial vaginosis examination findings

A
  • thin, off white discharge with fishy odor

- no inflammation

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37
Q

bacterial vaginosis treatment

A

metronidazole

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38
Q

trichomoniasis examination findings

A
  • thin, yellow-green, malodorous, frothy discharge

- vaginal inflammation

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39
Q

trichomoniasis treatment

A
  • metronidazole

- treat sexual partner

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40
Q

candida vaginitis examination findings

A
  • thick cottage cheese discharge

- vaginal inflammation

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41
Q

candida vaginitis treatment

A

fluconazole

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42
Q

herpes

A
  • painful

- infects dorsal root ganglia

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43
Q

syphilis

A
  • not painful

- single lesion that is large and hard

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44
Q

PID diagnostic criteria

A
  • cervical motion tenderness or uterine tenderness or adnexal tenderness
  • from untreated gonorrhea or chlamydia
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45
Q

PID treatment for uncomplicated

A

-outpatient unless can’t comply with keeping ABX down

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46
Q

PID treatment for tuboovarian abscess

A
  • always treat inpatient
  • sepsis work up
  • drainage
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47
Q

genital warts

A
  • caused by HPV
  • worsens when cell mediated immunity suppressed
  • aldara only non destructive treatment that takes weeks to months
  • can do cryo or laser therapy
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48
Q

fibroids (leiomyomata uteri)

A
  • rarely malignant
  • benign tumors in smooth muscle that are hormone dependent
  • 50% have aneuploidy
  • clonal expansion
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49
Q

fibroids management

A
  • 80% require no treatment
  • bleeding/pain treated symptomatically
  • GnRH agonists/antagonists used for temporary (6 month) relief
  • myomectomy (conservative)
  • uterine fibroid embolization (conservative)
  • hysterectomy
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50
Q

pelvic organ prolapse cause

A
  • failure of ligaments

- cardinal ligaments support cervix and prevent vaginal prolapse

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51
Q

pelvic organ prolapse risk factors

A
  • genetic
  • menopause
  • parity
  • aging
  • previous hysterectomy
  • obesity
  • smoking
52
Q

anterior compartment pelvic organ prolapse symptoms

A

bladder prolapse

  • urinary symptoms
  • pelvic pain
  • intercourse difficulty
53
Q

apical compartment pelvic organ prolapse symptoms

A

vagina/uterus prolapse

  • urinary symptoms
  • pelvic pain
  • intercourse difficulty
54
Q

posterior compartment pelvic organ prolapse symptoms

A

rectum prolapse

  • constipation
  • pelvic pain
  • intercourse difficulty
55
Q

pelvic organ prolapse management

A
  • kegel
  • don’t smoke
  • stool softener
  • lose weight
  • pessary
  • surgery to reinforce vaginal wall
56
Q

stress incontinence

A

due to increased abdominal pressure under stress

-weak abdominal floor muscles

57
Q

urge incontinence

A
  • due to involuntary contraction of bladder muscles

- treat with Rx

58
Q

overflow incontinence

A

due to blockage of urethra

59
Q

neurogenic incontinence

A

due to impaired nervous system function

60
Q

adenocarcinoma of the endometrium

A
  • most common gyn malignancy
  • not the most deadly
  • good outcomes due to early detection
  • early symptom of abnormal bleeding
61
Q

estrogen dependent endometrial cancer

A
  • obesity
  • anovulation/PCOS
  • exogenous estrogen
  • tamoxifen
  • good prognosis
62
Q

less estrogen dependent endometrial cancer

A
  • poor prognosis
  • mismatch repair gene failure
  • serous and clear cell subtype
63
Q

endometrial hyperplasia and endometrial cancer

A
  • complex hyperplasia with atypia has 30% chance to progress to endometrial cancer
  • should be treated as well differentiated adenocarcinoma
64
Q

endometrial hyperplasia treatment

A
  • progestin to combat unopposed estrogen

- hysterectomy

65
Q

endometrial cancer staging

A
  • always done surgically with hysterectomy

- majority of cases stage I

66
Q

endometrial cancer treatment stage 1

A

surgery

67
Q

endometrial cancer treatment stage 2

A

surgery and chemo/radiation

68
Q

endometrial cancer treatment stage 3 and 4

A

surgery and palliative

69
Q

uterine sarcoma presentation

A
  • not common
  • postmenopausal uterine growth
  • pain
  • pressure
  • vaginal bleeding
70
Q

uterine sarcoma diagnosis

A
  • endometrial biopsy, but many false negative

- most incidentally diagnosed at hysterectomy

71
Q

uterine sarcoma prognosis

A
  • poor
  • high stage at diagnosis
  • poor response to chemo
72
Q

uterine sarcoma treatment

A
  • hysterectomy
  • lymph node removal not helpful because it spreads hematologically
  • radiation/chemo for inoperable
73
Q

cervical cancer

A
  • 3rd most common gyn cancer in US
  • # 1 cancer killer in underdeveloped due to lack of widespread effective screening
  • caused by HPV
74
Q

subtypes of ovarian cancer

A
  • epithelial: most common
  • germ cell: typically teenagers
  • stromal: 20s-30s
  • metastatic
75
Q

ovarian cancer symptoms

A
  • typically at stage 3 or 4
  • ABD pain, bloating, distention
  • constipation
  • back pain
76
Q

ovarian cancer risk factors

A
  • age 50 or older #1 risk
  • familial (BRCA gene)
  • anything that increases number of ovulations in a lifetime
77
Q

ovarian cancer prevention

A
  • ovulation suppression

- no good means to screen

78
Q

ovarian cancer treatment

A
  • surgery typically regardless of stage
  • no consensus on optimal chemotherapy
  • radiation not primary but may be used to treat symptomatic metastatic disease
79
Q

adnexal mass

A
  • any mass >5cm = referral to gyn
  • a simple cystic mass <5cm should be reimaged in 6-12 weeks
  • any pelvic mass found on CT should be followed up with pelvic U/S
80
Q

fallopian tube cancer

A
  • thought to be rare but some ovarian cancer may actually be tubal
  • presents with water vaginal discharge
  • same treatment as epithelial ovarian cancer
81
Q

vulvar cancer types

A
  • HPV associated: young, smoking, VIN associated

- lichen sclerosis associated: more common, older

82
Q

vulva intraepithelial neoplasia characteristics

A
  • elevated
  • irregular borders
  • warty
  • itchy
  • multicentric
83
Q

vulva intraepithelial neoplasia diagnosis and treatment

A
  • direct visualization
  • colposcopy
  • biopsy
  • treatment is ablative
84
Q

paget disease of vulva

A
  • erythematous plaque with white scaling
  • itching, burning pain
  • wide local excision
  • recurrence is common
85
Q

fecundability

A

-likelihood of conception per cycle

86
Q

fecundity

A

likelihood of live birth per cycle

87
Q

fertility

A

likelihood of live birth over some period of time

88
Q

subfertility

A

no pregnancy after 6 cycles

89
Q

infertility

A

no pregnancy after 1 year

90
Q

causes of infertility

A
  • male factors
  • female factors
  • combination of factors in both partners
  • all 1/3 responsibility
91
Q

male infertility

A

easiest and cheapest to test for with semen analysis

92
Q

couples factor and infertility

A
  • coital frequency and timing
  • smoking
  • alcohol
  • illicit drugs
  • antisperm antibodies
93
Q

female infertility causes

A
  • ovulation disorders
  • tubal obstruction
  • endometriosis
  • uterine disorders
  • idiopathic
94
Q

endometriosis

A

histologically normal endometrial glands and stroma with hemosiderin laden macrophages outside the endometrial cavity

95
Q

endometriosis symptoms

A
  • painful periods
  • painful sex
  • infertility
96
Q

endometriosis treatment

A
  • symptom related: NSAIDs
  • hormonal: progestins, GnRH suppression
  • surgery
97
Q

adenomyosis

A
  • enlarged globular, tender uterus without focal mass
  • treat symptoms
  • primarily histological diagnosis
98
Q

pelvic pain differential

A

GI, GU, reproductive organs, ABD wall pain, bony pelvis

99
Q

bleeding in 1st trimester

A
  • 50/50 on normal vs abnormal

- all need a workup

100
Q

pain in 1st trimester

A
  • nearly everyone has pain
  • most pain without bleeding is not pathological
  • pain and bleeding is possibly pathological
101
Q

threatened abortion

A
  • vaginal bleeding with or without pain

- has normal, live pregnancy

102
Q

incomplete abortion

A
  • partially passed products of conception
  • open cervix
  • increasing pain
103
Q

complete abortion

A
  • passage of all products of conception

- subsiding pain

104
Q

missed abortion

A

no passage of tissues and asymptomatic

105
Q

septic abortion

A

secondary infection of incomplete abortion

106
Q

why do ectopic pregnancies cause vaginal bleeding

A

does not produce enough progesterone or hCG to maintain endometrium so irregular bleeding occurs

107
Q

why do ectopic pregnancies cause pain

A

fallopian tube stretch and blood in tube causes irregular pain

108
Q

complete molar pregnancy

A

-egg with no nucleus that 1 sperm that duplicates or 2 sperm

109
Q

partial molar pregnancy

A

normal egg fertilized by 2 sperm

110
Q

discriminatory zone

A

gestational sac expected at hCG >2000

111
Q

yolk sac

A

presence of is conclusive of intrauterine pregnancy

112
Q

fetal pole

A
  • should grow at least 2 mm per day

- heartbeat should be detectable within 1 week of pole development

113
Q

ectopic pregnancy

A
  • number 1 finding is empty uterus
  • free fluid concerning for ruptured ectopic
  • can treat with methotrexate or surgery
114
Q

variations from baseline

A
  • general rule all variations from baseline are reflexes designed to maintain homeostasis, particularly oxygen delivery
  • can’t manage vascular beds, can only manage HR
115
Q

variability

A
  • increases in HR due to increase in O2 demand via sympathetic nervous system
  • implies intact CNS
116
Q

absent variability

A
  • sleep (no more than 45 minutes)
  • meds (opioids, mag)
  • CNS injury (diagnosis of exclusion)
117
Q

accelerations

A
  • reflex increase in HR due in increased O2 demand and implies intact CNS
  • less than 32 weeks, increase HR 10 BPM for 10 seconds
  • 32 weeks and greater, increase HR 15 BPM for 15 seconds
118
Q

Early decelerations

A
  • start with initiation of contraction, bottom out at contraction peak, and end with contraction
  • thought to be vagal response
  • not associated with hypoxemia/acidemia
119
Q

variable decelerations

A
  • hypoxemic event
  • > 15 BPM drop reaching peak in <30 seconds
  • lasting at least 15 seconds but no more than 2 minutes
  • possibly due to cord occlusion
  • can result in secondary hypoxemia
120
Q

late decelerations

A
  • hypoxemic event
  • symmetric, gradual decrease in HR
  • onset at peak of contraction, nadir at contraction termination, termination after contraction ends
  • during contraction lactic acidosis occurs
121
Q

pre-eclampsia

A

blood pressure >140/90 with at least 300 mg protein without end organ damage

122
Q

pre-eclampsia with severe features

A

BP>160/110 or with end organ damage

123
Q

acute HTN emergency

A
  • BP >160/110 for >15 minutes
  • labetalol and hydralazine
  • goal is BP <160/110
124
Q

eclamptic seizure phases

A
  1. facial automatisms
  2. tonic/clonic seizures
  3. post-ictal

don’t abolish the seizure with benzos, give mag

125
Q

isoimmunization

A

-Rh negative mother and Rh positive fetus

OB/GYN (2 decks)

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