gine+obste Flashcards
embarazo+lesion cervical de alto grado (CIN 2 o CIN 3)
manejo?
colposcopia+biopsia cada 12-24 semanas
colposcopia hasta ≥ 4 después de parto
placenta previa. manejos?
sulfato de magnesio 24-32 semana (neuroproteccion)
cesarea 36-37 semanas
strongest risk factor for pelvic organ prolapse ?
multiparidad
POP is caused by weakness of the pelvic floor muscles (levator ani) and ligamentous supportive structure of the uterus and vagina
What are the most common causes of hyperandrogenism in pregnancy?
luteoma (solida/uni o bilateral)
theca lutein cysts: (quistica/bilateral)
large cells with abundant clear cytoplasm in vagina
dx y factor de riesgo?
dx: adenocarcinoma vaginal de celulas claras
Factor de riesgo: dietilestilbestrol exposure in utero (was used to prevent miscarriage in pregnant women). Aumenta riesgo de cancer vaginal en hijas de quienes lo usaron y cancer se seno en las mujeres que lo usaron
chancroide. sintomas, agente y tx?
sintomas:
multiples ulceras purulentas, dolorosas, base necrotica +linfadenopatia
tx:
Azitromicina oral una dosis
ceftrixona IM una dosis
agente: hemophilus ducrei
posmenopausal endrometrio >5mm SIN atipia, sin invasion presenta sangrado. Dx, tx, follow up?
hiperplasia de endometrio SIN atipia
tx: progestina (levonorgestrel IUD or oral progestins) (opposes strogen>decreases bleeding)
follow up: US 3-6 m to rule out hiperplasia/endometrial carcinoma
CON atipia: quitar utero y los dos ovarios
cual es el examen mas sensitivo y especifico para aneuploidias fetales y a partir de cuando se puede hacer?
Prueba de detección prenatal de ADN libre de células
desde la 10ma semana de gestación
sheehan sd.
factor de riesgo y dx?
isquémia de la pituitaria anterior
factor de riesgo: hemorragia posparto
dx: silla turca vacía
During pregnancy, hypertrophy of prolactin-producing regions increases the size of the pituitary gland, making it very sensitive to ischemia, e.g., secondary to prolonged or severe postpartum bleeding
During pregnancy, the size of the pituitary gland doubles, but blood supply does not increase significantly
rash macular en palmas, plantas,muslos internos + inflamacion de mucosas (conjuntivitis no purulenta, hiperemia de gargante)
dx?
sindrome de shock toxico producido x exotoxinas de staph aureus
causas: tampon, nasal packing, infeccion herida ppstqx o de quemadura
What antibiotic regimen is used for empiric treatment of toxic shock syndrome? What antibiotic regimen is used for empiric treatment of toxic shock syndrome?
Vancomycin + clindamycin + cefepime
amenorrea primaria+no utero+todo lo demas normal
dx?
agenesis mulleriana
se asocia a anormalidad renal/urologica
amenorrea primaria+no utero+virilizacion
dx?
5-alpha reductasa deficiencia
amenorrea primaria+no utero+senos normales+ NO vello publico
dx?
insensible a androgenos
Ultrasonography would reveal undescended testicles.
glucose challenge test cuando se hace?
semana 24-28
Intrauterine growth restriction fetuses should be monitored 1-2 times weekly with:
non-stress tests (NST),
biophysical profile,
amniotic fluid index (AFI),
umbilical artery doppler
Prolonged rupture of membrane and chorioamnionitis is managed with __
gentamicina iv+ ampicilina iv
Prolonged rupture of membrane and postpartum endometritis is managed with ____
gentamicina + clindamicina
a quien se vacuna por HPV y cuantas dosis?
9-14 y.o, 2 dosis, cada 6 meses
15-26 y.o, 3 dosis, 0-2-6 meses
method of choice to confirm fetal aneuploidy in patients at ≥ 15 weeks’ gestation?
amniocentesis
en que momento se puede hacer Chorionic villus sampling?
semana 10-13
can be performed to obtain fetal DNA for establishing the diagnosis of Down syndrom
fever, uterine tenderness, and foul smelling lochia?
dx, tx?
Postpartum endometritis
genta+clinda iv
acido folico dosis y tiempo? para q se usa?
uso: prevent neural tube defect
400–800 μg of folate for all women planning pregnancy for at least 4 weeks prior to conception, and supplementation should be continued through the first trimester.
Neural tube defects arise due to failure of the neuropores to fuse by the 4th week of pregnancy
Foam cells and multinucleated giant cells on breast biopsy. Dx, tx? que se ve en la mamografia?
mamografia: quiste sebaceo calcificado
dx: necrosis grasa de la mama
hx previa de trauma o pancreatitis aguda
tx: no ocupa manejo
como se presenta una mama con rubella y en que momento del embarazo es peligroso?
rash maculopapular de aparición cefalócaudal+linfadenopatia postauricular en MAMA
peligroso para bb si mama se contagia antes de semana 16 de gestacion, después no
screening for group b strep?cuando?como? tx?
36 - 38 semanas
cultivo+gram stain de vaginal and rectal swabs
si positivo: intrapartum antibiotic prophylaxis with IV penicillin G or ampicillin.
non-anaphylactic penicillin allergy? Cefazolin
group b strep causes neonatal sepsis (Streptococcus agalactiae)
Intracytoplasmic inclusions on Giemsa stain of vaginal discharge
dx?
Chlamydia trachomatis
anticoncepción de EMERGENCIA en pt con contraidicacion para disposivito intrauterino?
Acetato de ulipristal via oral
levonorgestrel oral
ovario poliquistico tx para paciente que quiere quedar embarazada?
Letrozole
in polycystic ovarian syndrome (PCOS), excess androgen (from theca cells) is converted to estrone in adipose tissue, which inhibits FSH secretion from anterior pituitary
por que en anorexicas y atletas no les viene la regla?
Decreased frequency of GnRH release from the hypothalamus, due to decreased caloric intake
que es insuficiencia cervical y tx?
dilatacion de cervix sin contracciones ni otras patologías
> 25 mm antes de las 24 semanas
a partir de semana 14 se puede hacer cerclaje
multiple vaginal infections+urinary incontinence+ a scar on the anterior vaginal wall
dx? forma de dx?
vesicovaginal fistula
dx: positive double dye test, se inyecta azul en la vejiga y sale por la vagina
tx: surgical repair
- paises pobres: sucede por parto dificil
- paises ricos: sucede por daño a vejiga en histerectomía
paget disease of the breast
dx, a q se asocia?
punch biopsi + mamografia
usualmente asociado a carcinoma ductal in situ
postpartum endometritis tx?
clindamycin + gentamicin
hemolisis+elevated liver enzymes+low plateles+hipoglicemia
dx?
Hígado graso agudo del embarazo
patoneumonico de rompimiento uterino?
loss of fetal station
como esta FSH y LH en ovario poliquistico y el ratio?
FSH disminuido
LH elevado leads to excees androgen production from theca cells
LH:FSH ≥ 3:1
polycystic ovarian syndrome (PCOS), excess androgen (from theca cells) is converted to estrone in adipose tissue, which inhibits FSH secretion from anterior pituitary
caul es la abnormalidad cardiaca en sindrome de X fragil?
mitral valve prolapse leading to mitral regurgitation
recuerda también: pie plano y testiculos grandes. Cara larga delgada y orejas grandes
patent ductus arteriosus
que medicamento lo cierra y q medicamento lo mantiene abierto?
lo cierra: NSAIDS como indometacina
lo mantiene abierto: prostaglandina E1
cuando se hace screening por Diabetes en mujer embarazada?
24-28 s
cuando se hace screening por group b strep en embarazada?
36-38 s
abdominal pain+right adnexal tenderness+periodo tarde
dx?
embarazo ectopico
mujer q no ha podido salir embarazad + stress and excessive exercise
cual es el problema y su efecto?
diagnostico?
tx?
dx: functional hypothalamic amenorrhea
dysfunction in the pulsatile secretion of GnRH leads to low FSH and low LH
tx: Pulsatile GnRH injections
erythematous, pruritic, ulcerated skin of the breast
dx? metodo dx?
paget disease of the breast
dx: punch biopsy + mamografía bilateral
associated with an underlying adenocarcinoma (e.g. DCIS) and therefore must be biopsied
tumor marker for ovarian cancer?
CA-125
prognostic marker and for the assessment of treatment response.
indicaciones para uso de matrotexate en embarazo ectopic?
hCG <5.000
Masa <3,5 cm
Uncomplicated ectopic pregnancies
Hemodynamically stable patients
Unruptured mass
What is the appropriate management for a pregnant patient with HBV?
Spontaneous vaginal delivery
If viral load > 200,000 U/mL, start tenofovir
cervix de fresa
dx, descripcion de organismo y tx?
tricomonas
flagellated protozoa
tx: metronidazole al pt y la pareja
¿Qué tipo de quiste ovárico está asociado con una mola hidatidiforme?
Quistes tecaluteínicos.
Theca-lutein cysts arise due to ovarian hyperstimulation secondary to markedly elevated β-hCG levels
Theca-lutein cysts are often associated with gestational trophoblastic disease and multifetal gestation
que es la insuficiencia cervical y cual es su tx?
cervix que mide <25 mm antes de las 24s
tx:
cerclaje 14-24s
For individuals with a short cervix (< 25 mm) on transvaginal ultrasound at less than 24 weeks’ gestation and no history of preterm birth, intravaginal progesterone supplementation is generally recommended in addition to regular prenatal monitoring to reduce the risk of preterm birth.
Vaginal discharge + uterine and adnexal tenderness
dx? tx?
pelvic inflammatory disease
Tx: ceftrixona im +doxiciclina+metronidazole (oral)
N. gonorrheae (ceftriaxone) and C. trachomatis (doxycycline) and also provides coverage against anaerobes (metronidazole).
What is the treatment of meconium ileus?
Gastrografin enema to help break down obstruction
microcolon —> meconium ileus
triada de Meigs syndrome?
Ovarian fibroma ( typically shows spindle-celulas fusiformes which correspond to fibroblasts)
ascitis
pleural effusion
pt >45 y.o = pap smear resultado: endometrial cell with no atypia
proximo paso?
endometrial sampling
en mujeres >45 y.i endometrial cells cpild mean endometrial hyperplasia or cancer, en <45 es un resultado benigno, al menos q haya red flags para hiperplasia (spotting, high risk etc)
pelvic inflammatory disease
tx, sx?
tx
ceftriaxona im (gonorrea)
doxicilina vo (clamidi)
metronidazol (anaerobicos)
sx?
Lower abdominal pain,
dyspareunia,
purulent vaginal discharge,
uterine and cervical motion tenderness
IECAs when taken during pregnancy can cause:
poor cranial ossification
renal hypoplasia
oligohydramnios
tx de pt con sindrome antifosfolipidpo que esta embarazada ?
Enoxaparin (aka low molecular weight heparin) + aspirin
bb nace con mucho pelo+hipoplasia de deos+microcefalia
que tomo la mama durante embarazo?
fenitoina, carbamazepine
