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Emergency EOR > Gynecology > Flashcards

Gynecology Flashcards

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1
Q

Painful menstruation that affects normal activities

A

Dysmenorrhea

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2
Q

Primary dysmenorrhea is not due to ________ but is due to increased ___________

A

Not due to pelvic pathology
Due to increased prostaglandins
Painful uterine muscle wall activity

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3
Q

Secondary dysmenorrhea is due to __________, such as

A 
Pelvic pathology
Endometriosis
Adenomyosis
Leiomyomas
Adhesions
PID
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4
Q

Most common secondary cause of dysmenorrhea in younger patients. Most common secondary cause of dysmenorrhea in older pts

A

Endometriosis - younger

Adenomyosis - older

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5
Q

Diffuse pelvic pain right before or with onset of menses. May be associated with HA, n/v. Cramps usually last 1-3 days

A

Dysmenorrhea

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6
Q

Management of dysmenorrhea

A

NSAIDs first line
Local heat and vitamin E
Ovulation suppression - OCPs, etc.
Laparoscopy if medication fails to ro secondary causes

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7
Q

Absence of menstrual periodd

A

Amenorrhea

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8
Q

Light flow or spotting

A

Cryptomenorrhea

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9
Q

Heavy or prolonged bleeding at normal menstrual intervals

A

Menorrhagia

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10
Q

Irregular bleeding between expected menstrual cycles

A

Metorrhagia

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11
Q

Irregular, excessive bleeding between expected menstrual cycles

A

Menometrorrhagia

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12
Q

Infrequent menstruation with a prolonged cycle length > 35 days but < 6 mo

A

Oligomenorrhea

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13
Q

Frequency cycle interval (< 21 days)

A

Polymenorrhagia

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14
Q

Two etiologies of dysfunctional uterine bleeding (DUB)

A
  1. Chronic anovulation

2. Ovulatory

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15
Q

Cause of chronic anovulation

A

Unopposed estrogen

Seen especially with extremes of age

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16
Q

Workup of dysfunctional uterine bleeding includes:

A
  1. pelvic exam
  2. Hormone levels
  3. Transvaginal US
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17
Q

Management of acute severe bleeding with DUB

A

High dose IV estrogens or high dose OCPs

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18
Q

Management of anovulatory DUB

A

OCPs first line

Progesterone if estrogen CI

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19
Q

Definitive treatment for DUB

A

Hysterectomy - done if not responsive to medical treatment

Endometrial ablation - can be done if hysterectomy not wanted

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20
Q

Workup for amenorrhea

A

Pregnancy test
Serum prolactin
FSH, LH, TSH

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21
Q

Primary amenorrhea

A

Failure of menarche onset by age 15 y/o in the presence of secondary sex characteristics or 13 y/o in the absence of secondary sex characteristics

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22
Q

Secondary amenorrhea

A

Absence of menses for > 3 months in a pt with previously normal menstruction

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23
Q

Etiologies of secondary amenorreha

A
  1. Pregnancy (MC)
  2. Hypothalamus dysfunction
  3. Pituitary dysfunction
  4. Ovarian dysfunction
  5. Uterine disorder
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24
Q

Presence of endometrial tissue (stroma and gland) outside the endometrial (uterine) cavity. The ectopic endometrial tissue responds to cyclical hormonal changes

A

Endometriosis

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25
Q

Most common site for endometriosis

A

Ovaries

Also: posterior cul de sac, broad and uterosacral ligaments, rectosigmoid colon, bladder

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26
Q

Risk factors for endometriosis

A

Nulliparity
Family history
Early menarche

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27
Q

Signs/Symptoms of endometriosis

A
  1. Cyclic premenstrual pelvic pain
  2. Dysmenorrhea (painful menstruation)
  3. Dyspareunia (painful intercourse)
  4. Infertility
    +/- low back pain
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28
Q

Diagnosis of endometriosis

A

Physical exam: normal, +/- fixed tender adnexal masses

Laparoscopy with biopsy - definitive treatment

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29
Q

Endometriosis involving the ovaries large enough to be considered a tumor, usually filled with old blood appearing chocolate-colored

A

Endometrioma (chocolate cyst)

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30
Q

Management of endometriosis

A
  1. Medical - ovulation suppression
    OCPs + NSAIDs as needed
    Leuprolide
    Danazol (testosterone)
  2. Surgical - laparoscopy with ablation or hysterectomy if no desire to conceive
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31
Q

Occur when follicles fail to rupture and continue to grow

A

Follicular ovarian cysts

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32
Q

Occurs when corpus luteum fails to degenerate after ovulation

A

Corpus luteal ovarian cysts

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33
Q

Excess hCG causes hyperplasia of the theca interna cells

A

Theca Lutein ovarian cyst

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34
Q

Signs/symptoms of ovarian cysts

A

Most are asymptomatic until they rupture, undergo torsion or become hemorrhagic
Menstrual changes, dyspareunia

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35
Q

Diagnosis of ovarian cysts

A

Pelvic US

Order hCG to r/o pregnancy

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36
Q

Smooth, thin-walled unilocular ovarian cyst on ultrasound

A

Follicular

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37
Q

Complex, thicker-walled with peripheral vascularity ovarian cyst on ultrasound

A

Luteal

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38
Q

Management of ovarian cysts

A

Most < 8 cm are functional and spontaneously resolve
NSAIDs, repeat US after 6 weeks
OCPs
Surgical intervention if > 8 cm or cysts found postmenopause

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39
Q

Two etiologies of vaginitis

A
  1. Infectious (bacterial, trichomoniasis, candida, cytolytic)
  2. Atrophic (postmenopausal, allergic rxn)
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40
Q

Copious discharge, watery grey-white “fish rotten” smell from vagina

A

Bacterial vaginosis

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41
Q

Malodorous discharge, frothy yellow green vaginal discharge, strawberry cervix

A

Trichomoniasis vaginosis

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42
Q

Thick curd-like/cottage cheese vaginal discharge

A

Candidiasis vaginosis

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43
Q

Non odorous vaginal discharge that is white to opaque

A

Cytolytic vaginosis

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44
Q

Diagnosis of bacterial vaginosis

A 
Whiff test (fishy odor)
Microscopic: epithelial cells covered with bacteria
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45
Q

Diagnosis of trichomoniasis vaginosis

A

Mobile protozoa on wet mount, WBCs

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46
Q

Diagnosis of candidiasis vaginosis

A

Hyphae, yeast and spores on KOH prep

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47
Q

Diagnosis of cytolytic vaginosis

A

Copious lactobacilli, large number of epithelial cells

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48
Q

Management of:

  1. Bacterial vaginosis
  2. Trichomoniasis
  3. Candidiasis vaginosis
  4. Cytolytic vaginosis
A
  1. Metronidazole or Clindamycin
  2. Metronidazole or Tinidazole
  3. Fluconazole, intravaginal antifungals
  4. Discontinue tampon usage, sodium bicarbonate (sitz baths)
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49
Q

Ascending infection of the upper reproductive tract (may lead to sepsis, ectopic pregnancy or infertility)

A

Pelvic inflammatory disease

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50
Q

Most common causes of PID

A

N gonorrhea

Chlamydia

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51
Q

People at increased risk of PID

A 
Multiple sex partners
Unprotected sex
Prior PID
Age 15-29
Nulliparous
IUD placement
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52
Q

Pelvic/lower abdominal pain, dysuria, dyspareunia, vaginal discharge, nausea, vomiting

A

PID

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53
Q

Lower abdominal tenderness, fever. Purulent cervical discharge, +/- bleeding

A

PID

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54
Q

Cervical motion tenderness to palpation and rotation so severe they seem to rise off the bed

A

Chandelier sign

PID

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55
Q

Diagnosis of PID

A
  1. Primarily clinical
  2. Obtain hCG to r/o pregnancy
  3. Gram stain, WBC > 10,000
  4. Pelvic ultrasound if abscess suspected
  5. Laparoscopy if uncertain, severe disease or if no improvement with antibiotics
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56
Q

Management of outpatient PID

A

Doxycycline + IM ceftriaxone

57
Q

Management of inpatient PID

A

IV doxycycline + cefoxitin or cefotetan

58
Q

Complications of pelvic inflammatory disease

A 
Fitz-Hugh Curtis Syndrome
Infertility
Tubo-obarian abscess
Ectopic pregnancy
Chronic pelvic pain
59
Q

Hepatic fibrosis/scarring and peritoneal involvement. RUQ pain due to perihepatitis. May radiate to right shoulder. Often have normal LFTs. Violin string adhesions on anterior liver surface

A

Fitz-Hugh Curtis Syndrome

Complication of PID

60
Q

Inflammation of the breast

A

Mastitis

61
Q

Seen mostly in lactating women secondary to nipple trauma

A

Infectious mastitis

62
Q

Most common bacterial etiologies of infective mastitis

A

Staph aureus
Strep
+/- Candida

63
Q

Signs/Symptoms of infective mastitis

A 
Unilateral breast pain 
Tenderness
Warmth
Swelling
Nipple discharge
64
Q

Signs/Symptoms of congestive mastitis

A

Bilateral breast pain and swelling
Low grade fever
Axillary lymphadenopathy

65
Q

Management of infective mastitis

A

Supportive measures (warm compresses, breast pump)
Anti-staphylococcal abx: Dicloxacillin, nafcilllin, cephalosporin
Fluconazole if fungal
Mothers may continue to nurse/breast pump

66
Q

Management of congestive mastitis

A

If woman does not want to breastfeed: ice packs, tight fitting bras, analgesics, avoid breast stimulation

If women wants to breastfeed, manually empty breast after baby is done, local heat, analgesics

67
Q

Management of breast abscess

A

I&D

Discontinue breastfeeding from affected breast

68
Q

Termination of pregnancy before __________ is classified as spontaneous abortion. Most commonly during first ________ weeks.

A

20 weeks

7 weeks

69
Q

__________ is the only type of spontaneous abortion that is associated with possible fetal viability

A

Threatened

70
Q

Most common cause (50%) of all cases of spontaneous abortion

A

Fetal chromosomal abnormalities

71
Q

Most common cause of first trimester bleeding

A

Threatened spontaneous abortion

72
Q

Signs/symptoms of threatened spontaneous aboriton

A

No products of conception expelled
Cervical os is closed
Bloody vaginal discharge, spotting progressing to profuse blood

73
Q

Signs/symptoms of inevitable spontaneous abortion

A

No products of conception expelled
Progressive cervix dilation > 3 cm
+/- rupture of membranes
Moderate bleeding > 7 days, cramping

74
Q

Signs/symptoms of incomplete spontaneous abortion

A

Some products of conception expelled, some retained
Cervical os dilated
Heavy bleeding, cramping, boggy uterus

75
Q

Signs/symptoms of missed spontaneous abortion

A

No products of conception expelled
Cervical os closed
Loss of pregnancy symptoms, +/- brown discharge

76
Q

Signs/symptoms of septic spontaneous abortion

A

Cervical os closed
Cervical motion tenderness
Foul brownish discharge, fevers, chills, uterine tenderness, spotting progressing to heavy bleeding

77
Q

Abruptio placenta is premature separation of the placenta from the uterine wall after __________ gestation

A

20 weeks

78
Q

Signs/symptoms of abruptio placenta

A

Mild: slight bleeding
Partial: moderate bleeding
Complete: heavy bleeding and increased risk to fetus and mother

Severe abdominal pain, painful contractions, rigid uterus

79
Q

Fetal signs during abruptio placenta

A

Fetal bradycardia - fetal distress due to interference with fetal oxygenation

80
Q

Diagnosis of abruptio placenta

A

Pelvic ultrasound

DO NOT perform pelvic exam

81
Q

Management of abruptio placenta

A

Hospitalization - for hemodynamic stabilization

Immediate delivery - C section preferred

82
Q

Complications of abruptio placenta

A

May lead to DIC (disseminated intravascular coagulation)

83
Q

Risk factors for abruptio placenta

A 
Maternal HTN (MC)
Smoking
EtOH
Cocaine
Increased age, trauma
84
Q

Implantation of fertilized ovum outside of the uterine cavity

A

Ectopic pregnancy

85
Q

Most common location of ectopic pregnancy

A

Fallopian tube (98%)

86
Q

Risk factors for ectopic pregnancy

A 
Previous abdominal or tubal surgery (due to adhesions)
PID
Previous ectopic
History of tubal ligation
Endometriosis
87
Q

Signs/Symptoms of ectopic pregnancy

A

Unilateral pelvic/abdominal pain
Vaginal bleeding
Amenorrhea (pregnancy)
Severe abdominal/shoulder pain (peritonitis)

88
Q

Signs/Symptoms of ruptured ectopic pregnancy

A

Severe abdominal pain, dizziness, nausea, vomiting

Signs of shock: syncope, tachycardia, hypotension

89
Q

Physical exam signs of ectopic pregnancy

A

Cervical motion tenderness
Adnexal mass
Mild uterine enlargement

90
Q

Diagnosis of ectopic pregnancy

A
  1. hCG (serum)
  2. Transvaginal ultrasound
  3. Culdocentesis - nonclotted blood present (not done often)
  4. Laparoscopy
91
Q

hCG trends

A

Should double q 24-48 hours

92
Q

Absence of gestational sac with hCG levels > _________ strongly suggests ectopic or nonviable intrauterine pregnancy

A

> 2000

93
Q

Management of unruptured/stable ectopic pregnancy

A

Methotrexate

Used if hCG < 5000, no fetal tones

94
Q

Contraindications for methotrexate

A 
Ruptured ectopic
History of TB
hCG > 5000
\+ fetal heart tones
Noncompliant
95
Q

Management of ruptured/unstable ectopic pregnancy

A

Laparoscopic salpingostomy
Laparotomy in severe cases
RhoGAM administration if mother Rh negative and unsensitized

96
Q

Most common 2 causes of third trimester bleeding

A

Abruptio placentae

Placenta previa

97
Q 
Abruptio = \_\_\_\_\_\_\_\_\_\_\_\_
Previa = \_\_\_\_\_\_\_\_\_\_\_\_
A 
Abdominal pain (usually severe)
Painless
98
Q

Abdominal placenta placement on or close to the cervical os

A

Placenta previa

99
Q

Partial placenta previa

A

Covering of cervix ahead of fetal presenting part

100
Q

Complete placenta previa

A

total coverage of cervical os

101
Q

Sudden onset of painless bleeding (bright red) at 20-30 weeks. Resolves within 1-2 hours

A

Placenta previa

102
Q

Fetal heart rate with placenta previa

A

Usually normal - no fetal distress

103
Q

Diagnosis of placenta previa

A

Pelvic ultrasound to localize placenta - DO NOT perform pelvic exam

104
Q

Management of placenta previa

A

Hospitalization - for stabilization
Stabilize fetus - magnesium sulfate - inhibits uterine contraction
Amniocentesis - to fetal lung maturity. Steroids given between 24-34 weeks
Delivery when stable

105
Q

Risk factors for placenta previa

A

Multiparity
Increasing age
Smoking

106
Q

Risk factors for premature rupture of membrarnes

A

STDs
Smoking
Prior preterm delivery
Multiple gestations

107
Q

Diagnosis of premature rupture of membranes

A
  1. Sterile speculum exam: visual inspection, pooling of secretions
  2. Nitrazine paper test - if turns blue (pH > 6.5) - PROM likely
  3. Fern test - amniotic fluid - fern pattern - PROM
  4. Ultrasound - avoid digital exam
108
Q

Management of premature rupture of membranes

A

Await spontaneous labor

Monitor for infection (chorioamnionitis or endometritis)

109
Q

During pregnancy, hCG should _______ every __________ days and will plateau at __________ gestation

A

Double
2-3 days
10 week gestation

110
Q

Intrauterine pregnancy is seen after hCG quantity reaches about ________ (or at about _______ weeks gestation)

A

2,000

5 weeks gestation

111
Q

Gravida

A

Total number of pregnancies (including abortions)

112
Q

Parity

A

Total number of births (over 20 weeks gestation)

113
Q

Naegele Rule

A

First day of LMP - 3 months + days + 1 year = conception date

114
Q

If pt has irregular menstrual periods, Naegele’s Rule should not be used, instead a __________ should be obtained for correct dating

A

US

115
Q

Increase in plasma levels during pregnancy may lead to:

A 
Hypotension
Increased cardiac output
Increased urinary frequency
Anemia
Increased GFR (decreased creatinine)
Edema
116
Q

Increased progesterone levels during pregnancy may lead to:

A

Relaxes smooth muscles
GERD
Constipation
Hyperventilation

117
Q

Increased levels of estrogen, fibrinogen, and procoagulation factors during pregnancy lead to:

A

Hypercoagulable state

118
Q

Increased blood flow to nasopharynx during pregnancy leads to

A

Rhinorrhea

119
Q

Frequency of scheduled visits for pregnancy

A

Every 4 weeks until 30 weeks gestation
Every 2 weeks until 36 weeks gestation
Every week until delivery

120
Q

Each pregnancy visit should include (4)

A
  1. BP check
  2. Urine dipstick
  3. Fundal height
  4. Fetal heart rate (110-160 bpm)
121
Q

Pts who are AMA (> 35) and/or those with abnormal genetic screening are at increased risk for fetal aneuploidy
Testing can be done with (3):

A
  1. Chorionic villus sampling
    (10-12 wks)
  2. Amniocentesis (15-17)
  3. Cell-free fetal DNA (mother blood - done after 10 wks)
122
Q

First trimester is defined as __________ wks gestation

A

1-12

123
Q

If uterine size on physical exam does not correlate with last menstrual period

A

US should be obtained

124
Q

The fundal height (cm) should correlate to the number of weeks between:

A

20-36 weeks gestation

125
Q

Fetal heart rate may be heard at _________ with transvaginal ultrasound

A

6 weeks

126
Q

Fetal heart rate can be heard with hand held doppler at ________ gestation

A

12 weeks

127
Q

All first trimester pregnant patients need:

A
  1. Rhesus type and screen
  2. CBC
  3. Pap smear (only if due)
  4. Rubella titer
  5. Urinalysis
  6. Urine culture
  7. RPR
  8. Hepatitis B antigen
  9. Chlamydia screening
  10. Gonorrhea screening
  11. HIV
  12. HgA1c
  13. hCG quant
128
Q

Pregnant pts with a HgA1c > ________ are diagnosed with DM

A

6.5%

129
Q

Nuchal translucency ultrasound should be done from ________ wks gestation to r/o chromosomal abnormalities. This should be combined with first trimester serum testing (2)

A

11-13.6
PAPP-A (pregnancy associated plasma protein A)
hCG quant

130
Q

Second trimester of pregnancy is defined as:

A

13-27 wks gestation

131
Q

A quadruple screen should be done between 15-20 weeks gestation to screen for chromosomal abnormalities, including:

A
  1. AFP
  2. Unconjugated estriol
  3. hCG
  4. Inhibin A
132
Q

Most common cause for an abnormal quad screen

A

Incorrect dating

133
Q

Quickening (sensation of fetal movement) occurs between:

A

16-20 weeks gestation

134
Q

Diabetes and anemia screening (CBC) should be done between __________ wks gestation. 2 DM screening options:

A

24-28 weeks
1. 75 g 2 hour (fasting) oral glucose tolerance test: only one abnormality is needed for diagnosis
2. 50 g 1 hour oral glucose tolerance test - not done fasting
If positive, over 140, pt should have 100 g 3 hour oral glucose tolerance test. Two abnormalities needed in 3 hour glucose challenge

135
Q

Third trimester is defined as

A

28-40 wks gestation

136
Q

If pt was found to be Rh negative, Rhogam prophylaxis should be administered at

A

28 weeks gestation (3rd trimester)

137
Q

Vaccination that should be given to all pregnancies during third trimester

A

Tdap

138
Q

If pt was found to have STD during initial screening, repeat testing is done during

A

Third trimester

139
Q

GBS screening should be done at _________ wks gestation using a vaginal and rectal swab. If positive, prophylactic abx are given intrapartum

A

35-37 weeks gestation

Emergency EOR (12 decks)

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