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OB/GYN > Gynecology APGO uWise > Flashcards

Gynecology APGO uWise Flashcards

1
Q

Dysmenorrhea + Dyspareunia

What else?

A

Endometriosis

- nodularity on uterosacral ligament

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2
Q

Endometrial glands embedded in wall of uterus

A

Adenomyosis

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3
Q

Oligomenorrhea in an overweight patient?

A

Polycystic ovarian syndrome

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4
Q 
Inability to conceive for 1 year +
Dysmenorrhea + dyspareunia
Palpable, tender adnexal mass
Complex ovarian cyst
Simple cyst
A

Endometriosis = endometrial glands outside the uterine cavity

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5
Q

Complex ovarian cyst

A

Endometrioma

- chocolate cyst

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6
Q

Conservative management for endometriosis?

A

OCP’s

NSAIDs

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7
Q

Treatment for severe endometriosis w/ failed conservative medical management (OCP’s)?

A

Surgery to manage symptoms
- conservative: ablation, excision
- definitive (total hysterectomy/BSO)
So in young pt who desires pregnancy, laser ablation if no adnexal masses and ovaries are not enlarged.

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8
Q

Why OCP’s for conservative treatment of endometriosis?

A

Get - feedback to pituitary-hypothalamic axis

  • this stops stimulation of ovary
  • this suppresses sex hormone production (E)
  • Estrogen normally stimulates endometrial tissue and we want this suppressed
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9
Q

Danazol

  • indications?
  • SE’s?
A
  • synthetic androgen
    • used to treat endometriosis
      SE: androgenic side effects Dan the Man
  • wt gain + hair + ache + lipid levels
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10
Q

GnRH

- indications?

A

Can only be used short-term

  • control pelvic pain in endometriosis pt only if unresponsive to other hormone treatments
  • have more side effects that OCP’s when treating endometriosis
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11
Q

Test/procedure to confirm endometriosis?

A

Diagnostic laparoscopy

Biopsies

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12
Q

Complex ovarian cyst

- how differentiate?

A
  1. ) Symptoms of endometriosis? (dysmenorrhea + dyspareunia)
  2. ) Mid-cycle: think hemorrhagic cyst
  3. ) Obese + oligomenorrhea: think PCOS
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13
Q

Complex ovarian cyst

  • 48yo smoker
  • next best step?
A

Repeat U/S in 2 months
- if mid cycle will resolve on it’s own
OCP’s are contraindicated in 35+ smoker

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14
Q

Ovarian mass w/ sudden onset severe pain + nausea

A

Ovarian torsion

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15
Q

Severe RLQ pain + nausea + tachycardia + ovarian mass + free fluid in pelvis + hematocrit 29%…next step?

A

Surgical exploration

  • likely ovarian torsion
  • already did U/S
  • ovarian torsion requires immediate surgical attention
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16
Q

Endometriosis + unable to conceive for 18 months + otherwise negative workup…next step to help fertility?

A

1.) Clomiphene citrate: stimulate ovulation
2.) Intrauterine insemination is also option
If these fail…in vitro fertilization or adoption

17
Q

Urinary frequency, urgency, nocturia
Mild cystocele + rectocele
Post-void volume = 400cc

A

Overflow incontinence: failure to empty bladder adequately
1.) Underactive detrusor (DM, MS, neuro)
2.) Obstruction (postop, severe prolapse)
Normal post-void residual = 50-60cc

18
Q

What is mixed urinary incontinence?

A

Stress incontinence

Urge incontinence

19
Q

Risk factors for pelvic organ prolapse?

A

Increased age, obesity, CT disorders (Ehlers-Danlos) + chronic constipation + vaginal delivery
Also: family hx of prolapse!

20
Q 
Urinary leakage w/ cough, sneeze, lift
Vaginal deliveries infants > 9lbs
Previous hysterectomy + BSO
Post-void volume = normal
Q-tip test = straining angle 60 degrees
Pt failed kegel exercises
A

Stress incontinence - increased and pressure in absence of detrusor contraction
Most due to urethral hypermobility
Straining Q-tip > 30 degrees from horizon
Very occasionally due to sphincter deficiency of urethra

21
Q

Surgery for stress incontinence?

A

Retropubic urethropexy: tension free vaginal tape or sling procedure best 5-year rates.

22
Q

Intrinsic sphincter deficiency; best first treatment?

A

Urethral bulking procedure

  • constant leaking of urine
  • previous cystocele repairs
23
Q

Treat stress incontinence?

A

Urethral bulking procedure/injection
- reduces diameter of urethra, creating resistance to leakage
Sling procedure: voiding difficulties are significant
Pseudoephedrine: improve urethral tone
Kegel: strengthen pelvic floor m. and decrease urethral hyper mobility

24
Q

Uninhibited detrusor contractions upon bladder filling. Treatment?

A

Oxybutynin:

  • ACh transmits parasympathetic signal for bladder emptying via muscarinic receptors
  • Anticholinergics = mainstay of medical management
25
Q

Treat pelvic protrusion:
Symptoms of vaginal pressure + heaviness
(large pelvic prolapse)

A
  1. ) Pessary: ring to support = initial treatment
  2. ) Pubocervical fascia plicated in midline and laterally to acrus tendineus fascia (white line) to fix:
          • white line = fix cystocele
26
Q

Urgency, nocturia + large urine loss for several seconds.
Post-residual volume - 50cc
Urine loss standing or sitting, not activity related

A

Urge incontinence:

  • overactive detrusor muscle
  • get uninhibited contractions
  • increase in bladder pressure over urethral pressure = leakage
27
Q

Associated defects related to urge incontinence?

A

Structura/ mechanical defects of:

  • cystocele
  • urethrocele
28
Q

Asymptomatic pelvic prolapse

A

NO intervention necessary

Observation

29
Q 
90yo w/ apex/ant/post vaginal prolapse
Cardiac + DM
Hydronephrosis due to prolapse
Can't urinate w/o reduction of prolapse
Best next step?
A

Colpocleisis
- removal of ant/post vaginal wall
- small vaginal canal will exist
For women who are no longer sexually active

30
Q

Two ways to treat Gon/Chla IV?

A
  1. ) Cefotetan/xitin + Doxycycline

2. ) Clindamycin + Gentamicin

31
Q

Outpatient treatment of Gon/Chla?

A

Ceftriaxone (3rd gen) + Doxycycline +/- Metronidazole

32
Q

What does metronidazole cover?

A

Anaerobic + protozoal infections

  • treat C. diff assoc diarrhea
  • great against H. pylori & Gardnerella v.
33
Q

Acute cystitis in healthy, non-pregnancy women cause?

A

E. coli in 85% of cases

Also: Staph saprophyticus, Klebsiella, Enterococcus, Proteus.

34
Q

Young F cramping + low pelvic pain

Urinating much more frequently

A

UTI: do urine analysis

35
Q

What does Clindamycin cover?

A

Treats anaerobes + streptococcal + staphylococcal infections.
Causes C. diff.

36
Q

Doxycycline covers?

A

Chronic bronchitis

Weird bacteria: H. flu, Moraxella, Legionella, Mycoplasma, Chlamydia

37
Q

How reduce risk of ovarian cancer in young female?

A

OCP’s

  • five years continuous use reduces risk by 1/2
  • but total risk is 1% per female if no family hx
38
Q

How screen pt for ovarian cancer?

A

BRCA1 & 2 mutations typically seen in hereditary ovarian cancers. So if mom has breast cancer, test mom for BRCA1/2. BRCA covers breast & ovarian cancers.

39
Q

Unilocular simple cyst without evidence of blood, soft tissue elements or excrescences
+/- symptoms
Fluctuates w/ cycle

A

Functional ovarian cyst

  • Serous cyst adenoma’s are typically much larger than functional ovarian cysts
  • Mucinous cystadenoma are multilocular and quite large

OB/GYN (9 decks)

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