Gynec Flashcards
Vaginal bleeding + pelvic pain + amenorrehea
Ectopic pregnancies
Painless vaginal bleeding before delivery + rupture of membrane + fetal bradycardia
Vasa previa
One or more unexplained second trimester pregnancy loss
Cervical insufficiency
46 XY + impaires testosterone to DHT which promotes development of male external genitalia
Increased testosterone
5-alpha reductase deficiency
Cessation of ovarian function + infertility + irregular menses + menopausal symptoms (elevated FSH + decreased Estrogen)
Primary ovarian insufficiency
High grade on Pap test then negative on colposcopy what is next step
Endocervical curettage
Pooling of clear nitrazine positive fluid on speculum
Asymptomatic bacteruria : PROM
Early pregnancy bleeding
- cytogenetic
- Mendelian etiology
- antiphospholipid syndrome
Painful vaginal bleeding at third trimester and normal placenta implantation
Abruption
Painful vaginal bleeding and loss electronic fetal heartbeat and loss of station of fetal head
Uterine rupture
- > 20 week and < 37
- uterine contraction at least 3 in 30 min
- cervical changes: effacement and dilation > 2 cm
Post Partum hemorrhage
1- Fundus mit palpable: uterine inversion beefy appearance
2- Fundus bogy and soft: uterine stony
3- placent incomplete: retained placenta
4- undiagnosed tears: lacerations
5- generalised oozing: DIC
6- diagnosis of exclusion: unexplained hemorrhage
Post partum fever
> 38 in 2 occasions last > 6 hours excluding the first 24 hours
A- lung crackles: atelectasis (pp day 0)
B- flank pain dysuria : UTI 1-2 pp
C- tender uterus: endometritis 2-3pp
D - wound purulence : wound infection 4-5 pp
E- pelvic mass : pelvic abscess
F- dx of exclusion: septic pelvic thrombophlebitis
Obstetric anesthesia
1- intra venous agents: neonatal depression ( nalaxon)
2- paracervical block : block frankenhauser ( transitory fetal Brady)
3- pudendal block : stage 2 of Labor
4- epidural block: stage 1 and 2
Complication from epidural block
1- hypotension: aggressive intra venous fluid and left uterine displacement
2- post puncture headache: slight herniating of brain and brain stem like meningitis
Obstetric complications during Labor
1- prolapsed umbilical cord :
A- occult ( wall and fetal head ) b- partial ( head and dilated cervical os )
C- complete ( protrude into the vagina ) knee chest position and CS
2- shoulder dystocia : mcroberts flattens the sacral promontory and supra pubic pressure
3 - obstetric lacerations : rectovaginal fistula within the 2 first weeks ( incontinece of flatus or fecal malodorous discharge
4- episiotomy
Abnormal Labor
1 - prolonged latent phase: dilation < 6
Duration > 20 primipara and > 14 in multi ( therapeutic rest)
2- prolonged or arrested active phase
Cervical dilation > 6
A- protraction: dilation slower than expected oxytocin
B - arrest: no cervical changes for > 4 with contraction or > 6 h with inadequate contraction
3- prolonged second stage
Insufficient fetal decent after pushing > 3 hours nulliparous or 2 h in multi add an hour for epidural analgesia
Management
engaged: oxytocin
If not : CS
Benign vulvar lesions
1- bartholin cyst : conservative unless pressure symptoms ( drainage and word catheter)
2- bartholin abscess: word catheter under Local anesthesia
ATB is not required
Premalignant vulvar dermatosia
1- squamous hyperplasia: firm and cartilaginous on palpation
2- lichen sclerosus : early hypo pigmented area on palpation parchment like and late stage thickness
Epithelial thinning
Clobetasol cream
3- squamous dysplasia partial thickness
4- CIS full thickness
Malignant vulvar lesions
1- squamous: HPV most commonly stage 1
2- melanoma: any dark or black lesions should be biopsied
3- paget disease :
Dx punch biopsy
Radical vulvectomy
Modified radical for unilateral lesion
Lymphadenoctomy
Lichen planus
Desquamation and erosion
- brightly erythematous with border serpentine appearing
Punch biopsy to rule out cancer
Coticosteroide
Disorder of the cervix
1- cervical polyps: finger like growth smooth
Vaginal bleeding after intercoourse
Trt: Twisting or surgical string
2- nabothian cyst : mucous filled cyst on the surface
Small smooth rounded lump
No trt
3- cervical neoplasm
Cervical neoplasm
Asymptomatic
From premalginat to kc (8-10)
Most lesions will spontaneously regress
Most common etiology HPV
Subtype (6,11)
Early age intercourse
Pap test
Most common site the transformation zone ( T-zone)
Invasive cervical cancer penetrate through the basement membrane
- postcoital vaginal bleeding and irregular vaginal bleeding
Disorders or the uterus
A - failure to form :
1- hypo or agenesis: primary amenorrhea in fully developed second sexual characteristics
2- unicornuate : one of the mullerian ducts failure to form single horn banana shape
Failure to fuse
1- didelphys : complete failure oh the 2 mullerian duckt to fuse together ( separate uterus) preterm delivery is common
2- bicornuate : failure of fusion between the the ducts at the top ( incomplete fusion)
Single uterus’s and single cervix but it branches into two horns at the top
Failure to dissolve the septum
Failure of degeneration of the median septum
Enlarged uterus
1- pregnancy
2- leiomyoma
3- adenomyosis
4- leiomyosarcoma
Leiomyoma
Smooth muscle growth
Most common benign tumour
A- intra mural : within the wall cannot be felt in the examination unless it they are large
B- submucosal : inter menustral bleeding most common symptom can result in anemia
Most do not affect pregnancy unless large
C- subserosal : firm nontender and asymmetric
Pressure on the bladder recrum or uterus
Bulk related symptoms ( pelvic pressure, pain …
Natural history fibroids
1- slow growth most asymptomatic only if massive
2- rapid growth estrogen receptors enlarging during pregnancy
3- degeneration outgrow their blood supply, resulting in ischemic degeneration of a fibroid
4- shrinking: when estrogen falls , will decrease in size
After menopause
Adenomyosis :
Ectopic gland within the myometrium
Enlarged symmetric tender in absence of pregnancy causing dysmenorrhea
Trt : levonorgestrel and IUS if not surgery
Endometrial neoplasia
Post menopausal bleeding
Endometrial carcinoma is the most common gynaecological malignancy
Differential : kc or vaginal or endometrial atrophy and post menopausal therapy
Most common cause of post menopausal bleeding is vaginal or endometrial atrophy
Disorder of the ovaries
1- functional cysts
2- luteoma of pregnancy
3- theca lutein cysts : stimulation by fsh and b HCG ( twins and molar pregnancy
4- premenopausal pelvic mass
5-painful adexnal mass
6- prepubertal pelvic mass
7-post menopausal pelvic mass
8-
Functional cysts
Most common cause of simple cystic mass in the reproductive age
Laparoscopy if cyst >7cm
Should not form if under contraception
Luteoma of pregnancy :
Non neoplasm Tumor during pregnancy, produce androgen
Regression spontaneous
Premenopausal pelvic mass
Most common complex adexnal mass in young women ( dermoid or teratoma)
From all 3 germ cells most commonly ectodermal skin appendages
Dx: b hcg - and complex mass on ultrasound ( calcification and hyperechoic nodules
Cyctectomy if not oophorectomy
Painful adexnal mass
Most common dermoid cyst
Sudden onset pelvic pain with a known ovarian mass
Dx : ultrasound absent blood flow
Ruptured ovarian cyst
Reproductive age after strenuous activity or sexual intercourse
Sudden onset of unilateral lower abdominal pain
Prepubertal pelvic mass
Ovarian enlargement is suspicious for neoplasm
Germ cells Tumor
- LDH
- b-HCG
- alpha fetoprotein
- simple mass laparoscopy
Complex laparotomy
Then : - benign: cystectomy
- germ cells tumour: unilateral salpingo oophorectomy and staging
Post menopausal mass
Ovarian carcinoma second most common gynaecological cancer
BRCA1 positive
Malignant features ( thick septation, solid components, ascitis)
A- epithelial most commonly serous
B- germ cells : dysgerminoma
C- stromal Tumors includes :
1- granulosa theca secretes estrogen
Rule out the endometrial cancer
In children: precocious puberty
2- sertoli lydig testosterone: virilization and sign of estrogen deficiency
Gestational trophoblastic neoplasia abnormal proliferation of placenta tissue
A- complete mole most commonly GTN
Empty egg with single sperm
Grape like vesicles ( a vascular villi)
B- incomplete mole
Normal egg with two sperms
Fetus and umbilical cord is seen but ultimately fetal demise
Secondary dysmenorrhea
Presence of pelvic pathology
1- endometriosis: most ectopic glands in ovaries ( chocolate cysts) second site cul de sac ( uterosacral ligament nodularity and tenderness which leads to fibrosis and adhesive ( dyspareunia ) and dyschezia
Menstrual abnormalities
1- premenarchal vaginal bleeding
Most commonly foreign body then sarcoma botryoides
Abnormal vaginal bleeding
1- pregnancy
2- anatomical changes: if pregnancy test - ( unpredictable bleeding without cramping
3- inherited coagulopathy : von willbrand disease most commonly
4- dysfunctional uterine bleeding: unpredictable in amount and duration ( an ovulation and cervical mucus clear thin and watery
Basal body temperature chart will not show mid cycle ( absence of the thermogenic effect of progesterone
Abnormal vaginal bleeding
1- pregnancy
2- anatomical changes: if pregnancy test - ( unpredictable bleeding without cramping
3- inherited coagulopathy : von willbrand disease most commonly
4- dysfunctional uterine bleeding: unpredictable in amount and duration ( an ovulation and cervical mucus clear thin and watery
Basal body temperature chart will not show mid cycle ( absence of the thermogenic effect of progesterone
Primary amenorrhea
14 without sexual characters 16 wit it
Breast + uterus + : imperfotr hymen
Breast + uterus- : mullarian agenesis and complete androgen insensitivity
Testosterone and karyotype
Breast- uterus + : turner and hypothalamic
Secondary amenorrhea
1- rule out pregnancy
-2- an ovulation ( progesterone challenge test )
3- estrogen progesterone test : low estrogen ( ovarian or HP axis
4- hysterosaling: outflow obstruction
