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OBGYN > Gynecological Infections, Vaginal disorders, Pregnancy Complications and OBGYN Cancers > Flashcards

Gynecological Infections, Vaginal disorders, Pregnancy Complications and OBGYN Cancers Flashcards

1
Q

Endometritis

A

Bacterial infection of the endometrium (Uterus), can be d/t vaginal flora, aerobic and anaerobic but usually some combination of the three
MC gram pos aerobe: Group B strep
MC gram neg aerobe: E. Coli
R/F:
C-Section
Low socioeconomic status
Excessive digital vaginal exams
Group B strep colonization
S/Sx:
Fever/chills
Soft and tender uterus
Abd pain
Bleeding and foul smelling discharge
Can progress to sepsis, shock, death
2nd-3rd day postpartum
Early fever (w/i hours of postpartum) + hypertension= Group B strep
Tx: Clindamycin + Aminoglycoside: First line
Single agent therapy with 2nd or 3rd generation cephalosporin is acceptable

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2
Q

Bacterial Vaginosis

A

MC Gardnerella Vaginalis
NOT an STI
MCC of vaginal discharge/malodorous
S/Sx:
50% asymptomatic
Thin-off white fishy smell discharge
Dx:
Vaginal pH above 4.5, Pos “Whiff test”
“Clue cells” on wet mount
Tx:
Metronidazole or clindamycin
Clinda= high risk of C. diff

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3
Q

Trichomoniasis

A

Sexually transmitted protozoa Trichomonas Vaginalis that causes vaginitis in females
Among the MC STIs
S/Sx:
Voluminous
Frothy yellow-green vaginal discharge
Urinary Sx
Discharge worsens after menses
Dx:
Mobile Protozoa and WBCs on wet mount
Tx:
Metronidazole
Repeat testing in 3 months

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4
Q

Bartholin Cyst and Abscess

A

Bartholin glands are located within the labia majora bilaterally at 4 o’clock and 8 o’clock positions

Cyst: Obstructed opening, fluid backup, NON-tender mass
R/F: Trauma
Abscess: Cyst converting to abscess, infection, VERY painful/tender
R/F: +/- STI’s

Dx: Culture fluid from I&D
Tx:
Cyst: Reassurance
Abscess: Drainage with word catheter under local anesthetic
Severe/recurrent: Bactrim +/- metronidazole

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5
Q

Chlamydia

A

Sexually Transmitted bacterial infection of C. Trachomatis
Leading cause of infertility and most commonly reported STD in US frequently coexists with Gonorrhea
MC 26> y/o and r/f for ectopic
s/sx:
70% female present as asymptomatic
Purulent, watery discharge (but less than gonorrhea)
Can cause pneumonia/conjunctivitis if active infection at birth
Dysuria, abnormal bleeding, dyspareunia
Dx: NAAT
Tx:
Doxycycline
Single dose Azithromycin IF PREGNANT (less effective)
No sex until 7 days following completion of antibiotics
Re-test in 3 months

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6
Q

Lymphogranuloma venereum

A

Chronic form that spreads to lymph nodes of genital/rectal areas. Inguinal buboes

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7
Q

Gonorrhea

A

Sexually transmitted bacterial infection of N. Gonorrhoeae
Second MC reported STD in U/S
S/Sx:
Thick green/yellow discharges
Lower abd/pelvic pain
Can cause rectal, conjunctival infections
Dysuria, abnormal bleeding, dyspareunia
Lesions on palms
septic arthritis (KNEE)
Dx: NAAT
Tx:
IM Ceftriaxone and chlamydia coverage
Retest in 3 months

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8
Q

Syphilis

A

Sexually transmitted bacterial infection of Treponema Pallidum
Can cross placenta and infect fetus
S/sx: Three stages
Primary: Chancre (painless ulcer with indurated borders) lasts 3-6 weeks
Secondary: 3-6 weeks after the end of primary stage. Lymphadenopathy, sore throat, malaise, fever, headaches
Rash: palms,soles, and trunks “The great imitator”
Tertiary: 3-20 years after initial infection. Can affect any organ.
Meningitis, coronary stenosis, aortic regurg, neuropathy, painful disfiguring facial lesions, death
Dx:
Nontreponemal: RPR,VDRL
Treponemal: Immunofluorescence and hemagglutination
Tx: Penicillin G or course of Doxy if pen allergic

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9
Q

Herpes Simplex

A

Viral infection spread by mucosal surface or non intact skin exposure to HSV virus
Can be transmitted without active outbreak but less likely
S/Sx:
2-24 prodrome of burning/tingling +/- systemic
Groups of vesicles on erythmatous base that erode.
Exquisitely painful/tender. +/- dysuria
First outbreak usually the worst
Dx: clinically obvious but Tzanck test
Tx:
First outbreak-”Clovir”x 7-10 days
Subsequent outbreak- “clover” x5 days

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10
Q

Chancroid

A

Bacterial infection of H.ducreyi
More common in African/Caribbean
Cofactor for HIV infections
S/Sx:
Painful erythematous papule
Ulcerates but pustular rather than vesicular
Buboes: Painful lymphadenopathy 1-2 weeks after primary infection
Lymph Nodes necrose if untreated
Ulcerations rarely recurrent
Dx: CLINICAL
R/O HSV
Tx:
I&D buboes to prevent fistulas
Single dose Azithromycin PO
OR IM ceftriaxone

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11
Q

Genital Warts (Condylomata Acuminata)

A

HPV can infect genital tract to cause genital warts and cervical cancer
VERY common with different genotypes
S/Sx:
Flesh colored papules or cauliflower-like projections on external genitalia and perianal region
Incubation: 1-8 months
Usually PAINLESS
Dx: clinical
Tx: ACOG: Recommend routine HPV vaccination for both m/f ages 11-12 y.o
Tx with topical podofilox or topical imiquimod or cryotherapy/trichloroacetic acid

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12
Q

Vaginal Candidiasis

A

Overgrowth of Candida albicans in the vagina/vulva
MC related to the use of systemic abx. Due to normal bacterial flora being less able to “crowd out” candida
R/F:
Diabetes
Pregnancy
Corticosteroid use
S/Sx:
Thick “Cottage cheese-like” discharge, swelling, burning and intense itching of the vulva/vagina
Dx: KOH prep
Tx:
Topical “Azole”

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13
Q

PID

A

Ascending bacterial infection from the cervix/vagina to the upper reproductive tract
Usually gonorrhea and/or Chlamydia is involved but up to 80% of cases are found to be polymicrobial, including vaginal flora
S/Sx:
Lower abd/pelvic pain and tenderness
Fever/chills, N/v
Extreme pain with cervical palpation on pelvic exam
Cervical motion tenderness “Chandelier Sign”
Uterine tenderness
Adnexal tenderness
Fitz Hugh-Curtis Syndrome:
RUQ pain/tenderness
+/- Radiation to right shoulder caused by liver capsule aggravation
Dx:
Low threshold to make clinical dx per CDC
Gold Standard: Laparoscopy
Transvaginal U/S
Endometrial biopsy
Tx:
Outpatient: Ceftriaxone IM single dose + Doxy x 14 days +/- Metronidazole x 14 days
Anaerobic coverage
Inpatient: 2nd gen cephalosporin (Cefoxitin or Cefotetan)+ Doxycycline
Alt: Clinda + Genta if PREGNANT

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14
Q

Abortion

A

Pregnancy that ends before 20 w gestation
MC Cause is chromosomal abnormalities
ALL spontaneous abortions should get rhogam if Rh (-)

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15
Q

Threatened Abortion

A

Bleeding but os closed, products of conception (POC) intact
Tx: Red rest, close FU, serial HCG (doubling)

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16
Q

Inevitable Abortion

A

POC intact but os open and uterine content visible
Tx: Dilation and curettage (D&C) to remove products or misoprostol to hasten POC evacuation

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17
Q

Incomplete Abortion

A

Some, but not all POC expelled. OS open
Tx: Wait for body to finish expelling, misoprostol, D&C

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18
Q

Complete Abortion

A

All POC expelled
Tx: Close follow up

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19
Q

Missed Abortion

A

POC intact and Os closed but fetus not viable
Tx: D&C, Misoprostol

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20
Q

Septic Abortion

A

Incomplete abortion with infected uterus. Foul discharge, fever/chills, cervical motion tenderness.
Tx: Dilation and evacuation, IV broad spectrum anbx

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21
Q

Placenta Abruption

A

Separation of the placenta from the uterine wall after 20 w gestation
R/F:
Blunt trauma
Smoking
Chronic HTN
Preeclampsia
Drug use/ETOH
Multiparity
>35
S/sx:
Abrupt onset PAINFUL
Third trimester vaginal bleed
Fetal distress
DO NOT PERFORM PELVIC EXAM
Tender, rigid uterus
Dx:
Transabdominal US may show retroplacental clot but not reliable enough to R/O based on its absence
Tx:
Immediate delivery if fetal distress (c-section)
<34 and stable OBSERVATION until 37 w with corticosteroids given to mom

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22
Q

Gestational Trophoblastic disease

A

Benign and malignant proliferations of placental or trophoblasts
Incomplete and complete
Tx: Surgery (Definitive) or Methotrexate

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23
Q

Complete Mole

A

Empty egg fuses with normal sperm that then multiplies to create 46 chromosomes
No maternal chromosomes so no fetal
Abnormal HIGH levels of HCG
have a higher risk of developing Choriocarcinomas
Aggressive
Metastasize to lungs
CXR: Cannonball metastases
Vaginal bleeding +/- passage of the mole “Grape-like clusters”
Abnormal high HCG
preeclampsia, hyperemesis, hyperthyroidism, cysts
Dx:
Uterus that’s too big for gestational age
No fetal parts on US Snow storm” sign
P57 protein gene staining negative

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24
Q

Incomplete Mole

A

Two sperms and one egg
Fetal parts form but not viable
Elevated HCG
Vaginal Bleeding
Will NOT have sx of preeclampsia, hyperemesis, hyperthyroidism, cysts
Dx:
Uterus not larger than expected for gestational age
Fetal parts visible on U/S
P57 protein gene staining positive

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25
Q

Hypertension Disorders of Pregnancy

A

> 140mmHg Systolic/>90mmHg diastolic AFTER 20 weeks of pregnancy WITHOUT proteinuria or organ damage
Typically incidental finding
VERY important to R/O Preeclampsia
WEEKLY Urine protein, platelets, and liver enzymes
BP checks 1-2x/w
½ with gestational HTN -> preeclampsia
TX: Avoid antihypertensives
SAFE: Methyldopa, Labetalol, Nifedipine, Hydralazine
AVOID: ACEIs, ARBs, Atenolol

26
Q

Preeclampsia

A

Eclampsia and HELLP syndrome are a progression from untreated or insufficiently treated…
Tx: Antihypertensive + Magnesium
Definitive: Delivery of fetus and placenta
SOB/cough
Epigastric/RUQ pain
Headaches visual disturbances

27
Q

Eclampsia

A

Preeclampsia symptoms + SEIZURES
CAN occur postpartum
Tx: Antihypertensive + Magnesium
Definitive: Delivery of fetus and placenta
SOB/cough
Epigastric/RUQ pain
Headaches visual disturbances

28
Q

HELLP

A

Uteroplacental arteries fibrose, resulting in placental hypoperfusion which elicits the release of placental inflammatory proteins, which damage vascular endothelial cells resulting in H.E.L.L.P
D/t increased vascular permeability:
Pulmonary, cerebral, generalized edema
DIC
Placental Abruption
SOB/cough
Epigastric/RUQ pain
Headaches visual disturbances

29
Q

Placenta Previa

A

Placental implantation in the more inferior portion of the uterus, directly over or close to the internal cervical os
R/F:
Previous C-section or placenta previa
Multipara
Previous uterine sx
s/sx:
PAINLESS third trimester vaginal bleed
NO uterine tenderness
NO DIGITAL OR SPECULUM EXAM

Initial:Transabdominal Ultrasound
Then Transvaginal U/S
Tx: If mother and fetus stable- Pelvic rest
If 24-36 weeks then pelvic but also bed rest
If fetal distress or maternal hemorrhage -> Deliver baby

30
Q

Premature rupture of membranes (PROM)

A

Amniotic membrane rupture in the absence of uterine contractions after 37 W
Dx: Nitrazine paper test and fern test
U/S
Fetal non-stress test to eval fetal HR
Test for STI/UTI & GBS
Tx: After 37 w- induce labor
Oxytocin or C-section
Cervix not dilated
Misoprostol
GBS positive
Ampicillin (Prophylactically)
R/f:
UTI/STI
Abd. trauma
Polyhydramnios
S/Sx: “Gush” of clear/pale yellow fluid or persistent leak
If longer than 24 hours there’s an increased chance of intrauterine infection

31
Q

Preterm Premature rupture of membrane (PPROM)

A

Amniotic membrane rupture in the absence of uterine contractions before 37 W
dx: Perform sterile speculum exam
Nitrazine paper test and fern test
U/S
Fetal non-stress test to eval fetal HR
Test for STI/UTI & GBS
tx: ALL should receive prophylaxis
>34 w
Deliver and ampicillin
24-34 w
Corticosterois, tocolytics, Mg+ sulfate
Delivery within 1 week
<24 w: Abortion
R/f:
UTI/STI
Abd. trauma
Polyhydramnios
S/Sx: “Gush” of clear/pale yellow fluid or persistent leak
If longer than 24 hours there’s an increased chance of intrauterine infection

32
Q

Ectopic Pregnancy

A

Occurs when the zygote implants in any location other than uterus
MC in fallopian tube
R/F: Hx of PID, tubal surgery, IUD, IVF (uterine and ectopic can occur at the same time), advanced age, smoking, endometriosis, in utero exposure to DES
S/Sx:
Classic Triad:
Sudden onset sharp abdominal/pelvic pain
Spotting
Amenorrhea
DON’T RELY on for CLINICAL
Rupture can lead to hypotension/tacycardia, peritoneal abd exam, adnexal mass/tenderness
If vagal nerve gets stimulated, can have paradoxical relative bradycardia
Dx:
Initial: Urine pregnancy test
Quantitative HCG:
Normal Serum HCG levels double every 48 hours
Longer doubling times can indicate a pathological pregnancy
U/S: Confirmatory
If HCG values less than 1000mlU/ml “Empty uterus”
Discriminatory zone: refers the quant HcG level at which evidence of intrauterine pregnancy should be visible on U/S
Standard: 1k-2k
ACOG 3.5k
Tx: Send to ER. ER consult OB
Laparoscopic salpingostomy (preserves tube)
Laparoscopic salpingectomy (removes tube) If pt. Is unstable
Methotrexate if pt. Is stable

33
Q

Rh Incompatibility

A

A protein that is either bound to or absent from surface of red blood cells
Dx: Rh typing and antibody screen of mom at first prenatal visit
Tx: RhoGram can be given to Rh(-) mothers who are exposed to Rh(+) fetal blood during delivery or antepartum bleeding to prevent antibody formation
Medication should be given within 72 hours of bleeding or delivery or prophylactically at 28 weeks gestation

34
Q

Gestational Diabetes

A

R/F:
Being in 2nd or 3rd trimester
>25 y.o
BMI>25
PCOS
HTN
Multiple gestation
Macroscomic event
Unexplained fetal loss
Maternal complications:
DM prolonged after pregnancy
Preeclampsia
Polyhydramnios
Fetal Complications:
Macrosomia
Preterm labor
Shoulder dystocia
Hypoglycemia
Hyperbilirubinemia
Stillbirth
Obesity later in life
Dx:
INITIAL: 50-gram 1 hr glucose challenge test. Positive=glucose >130-140mg/dl
GOLD STANDARD: 100-gram 3-hr oral glucose test. Positive= 2 of the 4
Fasting>95, 1hr>180, 2hr>155, 3hr>140
Tx: Exercise/diabetic diet.
Insulin first line
Glyburide or metformin

35
Q

Shoulder Dystocia

A

Abnormal labor resulting from fetal shoulder impaction after the head has been delivered
R/F:
Prior shoulder dystocia
Increased fetal birth weight
Prolonged gestation
Preexisting DM
Complications:
Brachial plexus injury (Erb’s palsy)
Clavicular fracture (MC)
Diaphragmatic Paralysis (C3 and C4 injury)
Horner syndrome
Facial nerve injuries

36
Q

Breech Presentation

A

<28 weeks fetus is small enough to flip and flip back easily but once they grow flipping back to cephalic position becomes difficult
3-5% of full term deliveries
Types:
Frank, complete, incomplete
Associated risks:
Developmental dysplasia of the hip, torticollis, umbilical cord compression, fractures, skull/brain injury, spinal cord injury
S/Sx: Soft mass instead of hard surface palpable
Dx: CLINICAL but u/s can confirm
Tx: External cephalic version before labor. Cesarean if unsuccessful and trial of labor if successful

37
Q

Umbilical Cord Prolapse

A

The cord descends through the cervical os prior to the fetus. If sustained, the resulting undue cord compression can lead to compromised fetal circulation, hypoxia, brain damage, and death
Worsen fetal hypoperfusion when cord is exposed to air
R/F:
Low birth weight
Wrong fetal positioning
Long cord
Pelvic deformities
Polyhydramnios
Low lying placenta
s/x:
Sudden onset
Palpable cord
SEVERE bouts of prolonged fetal bradycardia
Tx:
Place mom on trendelenburg position
EMERGENT c-section

38
Q

Thromboembolic Disease (DVT/PE)

A

Risk remains high in the postpartum period especially if C-section was performed
R/F:
DM, Heart disease, Lupus, smoking, obesity >35y.o, IVF, multiparity, comorbid hypercoagulable states
S/Sx:
Tachycardia/pnea, unilateral extreme swelling of leg, Dyspnea (also common symptoms of pregnancy)
Dx:
DVT: doppler U/s
PE:
If doppler is + give anticoagulation
If doppler is -
CT/CTA despite pregnancy and radiation
Tx: LOW MOLECULAR-WEIGHT HEPARIN
NO WARFARIN or DOACS

39
Q

Uterine Rupture

A

Complete transection of all uterine wall layers and peritoneum.
R/F: Attempting vaginal delivery with previous delivery via C-section (No VBAC)
LIFE THREATENING TO MOTHER AND FETUS
50-75% fetal mortality rate
s/sx:
Sudden onset of severe abdominal pain and or cessation of uterine contractions
Vaginal hemorrhage
Fetal bradycardia

Tx:
Immediate laparotomy and delivery
+/- subsequent hysterectomy
ALL subsequent deliveries should be c-section and receive rhogam.

40
Q

Postpartum Hemorrhage

A

Bleeding of >500ml if vaginal delivery or >1000ml if C-Section or any loss requiring blood transfusion or a 10% decrease in hematocrit
MCC of maternal mortality worldwide
Etiologies:
Uterine atony: unable to contract to stop bleeding
Retained placental fragments
lacerations/incisions
Uterine rupture/invasion
Hereditary coagulopathy
s/sx: hypovolemic shock
Soft, flaccid boggy uterus if uterine atony, dilated cervix
Dx:
CLINICAL
Order CBC:
H&H
Fibrinogen
Type/cross
U/S
Tx: Uterine massage/compression, IV oxytocin
Non-aggressive fluids (avoid washing out clot)
Mechanical removal of retained POC

41
Q

Hyperemesis Gravidarum

A

Persistent, severe vomiting, that generally begins soon after first absent period until 5 months of gestation
MUST HAVE:
Intractable vomiting
Weight loss
Volume depletion
Orthostatic dizziness
weakness/fatigue
Syncope
Elevated urine/serum ketones or hypokalemia
Hyperchloremic alkalosis
Tx: Hosp admission, IV fluids, antiemetics, methylprednisolone if intractable
MAY BE DISCHARGED AFTER reversal of ketonuria
Class C antiemetics:
Promethazine, prochlorperazine, chlorpromazine
Class B antiemetics:
Metoclopramide, Ondansetron, Diphenhydramine

42
Q

Cervical Insufficiency (Incompetent Cervix)

A

Painless cervical dilation in the second trimester and can lead to an expulsion of an immature fetus (spontaneous abortion)
R/F:
Prior cervical trauma
Maternal DES exposure in utero
Marfan/Ehlers-Danlos syndromes
Dx: CLINICAL- dilation of internal os and visible membranes
Tx: Cervical cerclage (sex cervix shut)
Emergently but preferred prophylactically
Removed at 37 weeks

43
Q

Multiple Gestation

A

Dizygotic: Fraternal
R/F: African-American, Advanced maternal stage, IVF
Monozygotic: identical
R/F: IVF and FHX
Dx: Higher than normal HCG and alpha-fetoprotein, U/S
Complications:
Preterm
Preeclampsia
Fetal growth restrictions
Breech
Cord prolapse

44
Q

Cesarean Delivery

A

Manual removal of the fetus via surgical transection of the uterine wall.
Used in situations were vaginal delivery will put mom or fetus at risk
Need prophylactic IV cefazolin +/- other anbx d/t risk of endometritis
Should also give compression stockings and those who are high risk for thromboembolism should get pharmacologic prophylaxis

45
Q

Ovarian Torsion

A

Ovary rotates on its ligamentous structures, resulting in ischemia-infarction
R/F:
MC REPRODUCTIVE AGE
Cysts/PCOS
Tubal ligation
Hx PID/pelvic surgery
Strenuous exercise
S/Sx: Sudden onset, severe sharp, unilateral adnexal pain with n/v
Focal tenderness with adnexal mass
Dx: Doppler U/S is Definitive
“Whirlpool sign”/ ”Strings of pearls sign”
Tx: Initial: Laparoscopy with manual detorsion to attempt to save the ovary
Salpingo-oophorectomy: removal of ovary and fallopian tube
IF NECROSIS or high suspicion of malignancy

46
Q

Ovarian Cysts

A

S/sx:
Most are incidental findings on imaging
Ruptures can cause adnexal pain, dyspareunia, polyuria
Often ruptures during intercourse
Sudden onset-concern for torsion/rupture
Size impacts symptoms
Dx: U/S or advanced imaging
IF pt is MENOPAUSAL or POSTmenopausal, serum CA-125 helps r/o Ovarian CA
Tx:
NO tx if smaller than 5cm
Ruptures but hemodynamically stable, ONLY pain management
If larger than 5cm and symptomatic consider surgical removal

47
Q

Functional Cysts

A

Result of normal, cyclic development of ovaries being disrupted
R/F:
Reproductive age
Fertility tx
Tamoxifen, hypothyroidism, hyperandrogenism

48
Q

Follicular cyst

A

Functional cyst
follicle fails to rupture and keeps growing

49
Q

What kind of cysts to PCOS have?

A

Functional

50
Q

Corpus Luteal cysts

A

Functional Cyst
Follicle ruptures but then closes up after ovulation and continues to grow
Aka hemorrhagic cyst- small arteries can rupture

51
Q

Theca lutein cysts

A

Functional Cyst
overstimulation of follicular theca cells by HCG
Only occur in pregnancy and usually BILATERAL

52
Q

Neoplastic Cysts

A

Result of abnormal production of cells on/in the ovary. Can be either benign or malignant.

53
Q

Endometriomas

A

Neoplastic Cysts
Endometriosis specifically in an ovary. Bleeds according to menstrual cycle “Chocolate cysts”

54
Q

Serous/Mucinous Cystadenomas

A

Neoplastic Cysts
Develop from cells on the outer surface of the ovary. Serous are more commonly BILATERAL

55
Q

Mature cystic teratoma (Dermoid cyst)

A

Neoplastic Cysts
contains fat, muscle, hair, teeth. MC BENIGN ovarian neoplasm
CHANCE OF MALIGNANT TRANSFORMATION

56
Q

PCOS

A

Dysfunction of the hypothalamic-pituitary-ovarian axis (regulate menstrual cycle) rather than presence of absence of cysts.
Anterior pituitary makes too much luteinizing hormone, resulting in a negative feedback mechanism preventing LH surge which:
Prevents ovulation
Results in too much androstenedione= hirsutism
S/Sx:
Hirsutism
Infertility d/t amenorrhea/oligomenorrhea
Insulin resistance
Obesity/diabetes
Dx: Rotterdam Criteria
2 of 3 required criteria:
Oligo/anovulation
Clinical/biochemical signs of hyperandrogenism
Polycystic ovaries by U/S
Tx:
Spironolactone treats hirsutism
TERATOGENIC
BC to regulate menstrual cycle
Clomid to help induce ovulation
Metformin to increase insulin sensitivity

57
Q

Tubo-ovarian abscess (TOA)

A

Bacterial infection of the fallopian tube and ovary
Often PID or STI related but can also be endogenous flora
Infection can also be spread from appendix, bowel, or bladder
R/F:
PID
Multiple sex partners
15-25
IUD
Recent abd/pelvic sx
IVF
IBD
Diverticulitis
s/sx:
Vaginal discharge
Abd/pelvic pain
Fever
Irregular vaginal bleeding
Urinary sx if not yet ruptured
IF ruptured, localized peritoneal reaction progressing to sepsis, septic shock and death

Dx:
Best: Pelvic U/S
CT but include CBC, ESR/CRP, Upreg, UA and cervical cultures
Tx: REQUIRES HOSPITAL ADMISSION
Anbx if unruptured, hemodynamically stable, and less than 9 cm
Cover gonorrhea/chlamydia and anaerobes (Ceft+doxy+metronidazole)
If ruptured, surgery

58
Q

Leiomyoma (Fibroids)

A

BENIGN, smooth muscle and connective tissue tumors of the uterus
MC benign neoplasm in female genital tract
Estrogen/progesterone promote growth
Grow fast in pregnancy
R/F:
African descent
Mutation of MED12 gene
Early menarche
Prenatal DES exposure
S/x:
Heavy, long menstrual bleeding
Anemia, weakness, dizziness/pallor
Abd/pelvic pain
Infertility/miscarriage, postpartum hemorrhage
Lumpy, bumpy “cobblestone” uterus on palpation

Dx:
Transvaginal U/S can detect their presence and MRI determines type
Tx: BC to suppress period and GnRH agonists to shrink fibroids
Myomectomy/selective ablation: surgical removal/ablation of the fibroid only
Hysterectomy (INVASIVE)

59
Q

Endometriosis

A

Benign endometrial tissue growth outside the uterus:
Ovaries MC, fallopian tubes, uterosacral ligaments
Less common: Bowel, bladder, thorax
s/sx:
Dysmenorrhea
Pelvic pain
Dyspareunia
Menorrhagia
Infertility, chronic pain
Higher risk of ovarian torsion
Dx:
First: abd/pelvic U/S
MRI if u/s inconclusive
Laparoscopy
Tx:
Bc, GnRH antagonists, NSAIDS
Surgery: Laparoscopic removal, hysterectomy

60
Q

Uterine Prolapse

A

Herniation of the uterus into the vagina d/t weakness of the pelvic floor structures
MC after childbirth, Heavy Lifting, obesity
S/Sx:
Heavy/full vaginal sensation with “falling out” feeling
Low back, abd pain
Assoc. Stress incontinence (fecal) and cystocele/rectocele
Sx’s worsen with prolonged standing
Tx:
Mild: Kegels, behavioral modifications, weight control
Moderate/Severe: Pessaries to elevate/support uterus
Surgery: ligament fixation (uterus sparing), hysterectomy

61
Q

Vulvar Cancer

A

Squamous cell carcinoma MC
HPV 16,18
R/F: Post-menopausal
S/Sx:
Vulvar itching
Bleeding, pain
Red or white ulcerative or raised crusted lesion
Tx: surgical excision, radiation, chemo

62
Q

Vaginal Cancer

A

Rare, Usually elderly 60-65 y.o
Usually mets from a more common source
Tx:
Stage I: Surgical excision or radiation
Stage II-IV: Chemo +/- radiation

OBGYN (4 decks)

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