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Clin Med Final Material 5 > Gynob- Ross > Flashcards

Gynob- Ross Flashcards

1
Q

What can cause bHCg to give a false neg?

A

Vit C, dilute urine and early pregnancy

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2
Q

If a patient has a strong suspicion of pregnancy and bHCG qualatative says no, what should you do?

A

Quantatative bHCG to get the number value

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3
Q

B-hCG normally ______- every two days and levels that do not increase by ____-% in two days imply an abnormal IUP or ectopic

A

double, 50%

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4
Q

Someone in shock has these three things?

A

Hypotension, tachycardia, poor peripheral perfusion (cold, clammy extremities and diaphoretic)

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5
Q

What are 4 RFs for ectopic pregnancy?

A
  1. Hx PID
  2. IUD
  3. Infertility
  4. Previous ectopic
  5. Older age
  6. Cigarette smoker
  7. Previous pelvic surgery
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6
Q

If you have a tubal ligation and pregnant with bleed… what should you consider?

A

ectopic

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7
Q

What is the leading cause of death in the first trimester of pregnancy?

A

ectopic pregnancy

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8
Q

What are the steps for vaginal bleeding/pain?

A
  1. Pregnancy test
  2. Rule in IUP with U/S
  3. Quantitative b-HCg
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9
Q

Seeing these two things on U/S should be reassuring?

A

-Fetal pole and double ring sign

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10
Q

What is the discriminatory zone for b-hCG?

A

1500-2000 below which you may not see IUP on U/S

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11
Q

What should we see at this b-hCG levels?

>1500

A
  • should see gestational sac: 4.5 wks

- need a trans-vaginal U/S

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12
Q

What should we see at this b-hCG levels?

>5000

A

-Should see a fetal pole: 6.5 wks

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13
Q

What should we see at this b-hCG levels?

>15,000

A

-should see a heart beat

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14
Q

What does a b-hCG of <1500 mean?

A
  • normal early pregnancy
  • ectopic
  • miscarriage
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15
Q

What should we see at this b-hCG levels?

2000

A

yolk sac

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16
Q

If you do a bediside US and you see an IUP you can be confident not ectopic, however, if you don’t see an IUP what is the next step you should take?

A

official transvaginal u/s

17
Q

If a patient presents with + urine or quanlatative b-hCG, lower abd pain and vaginal bleeding and b-hCG is <1500 what should you do next?

A

You should re-check in 48 hours since it should double in 2 days

18
Q

b-Hcg of >1500 and U/S with no IUP is by default _______. What is the next step?

A

ectopic

Surgery

19
Q

The __________ dept is where patients go to die

A

radiology

20
Q

What pill can be used for an ectopic to terminate?

A

Methotrexate (helps dissolve the cells so you don’t have to do surgery)

21
Q

What are the criteria for a threatened abortion?

A
  • Vaginal bleeding
  • Closed os
  • quant >1500
  • U/s shows IUP
22
Q

Pregnancy w/ bleeding. If the os is open then what?

A

inevitable miscarriage

23
Q

Pregnancy w/ bleeding. If the os is closed then what?

A

discharge and restrict sexual and physical activity

-Have pt f/u needs bHCG

24
Q

If bleeding has caused the Hct to drop or there is hypotension what should you do?

A

obtain gyno consult

25
Q

What if there is a fetal heat beat and quant 60,000?

A

consult gyn (probs will offer d&c or misoprostol)

26
Q

What is an important thing to order in a patient with bleeding?

A

Rh type & screen

27
Q

What is the mc cause of 3rd trimester bleeding?

A

Abruptio placenta: rock hard uterus with painful vag bleeding; separation of placental from uterus

28
Q

You will usually see elevated BP, proteinuria and edema in what condition?

A

pre-eclampsia

Diastolic >105
Proteinuria +2
Seizure

29
Q

htn, elevated LFT, low platelets are a sign of what?

A

HELLP

*need emergency GYN consult

30
Q

How to treat pre-eclampsia?

A

Labetalol or Nifidipine

31
Q

What meds should be avoided in pregnancy?

A

Thiazides

32
Q

This is extreme, persistent nausea and vomiting during pregnancy. It can lead to dehydration, weight loss, and electrolyte imbalances. Elevated specific gravity of urine, ketones and hemoconcentration.

A

Hyperemesis

33
Q

Lower abd pain ddx for non-pregnant and lower abd pain?

A
  • Ectopic
  • Miscarriage
  • PID
  • Tubo-ovarian abscess
  • Ovarian torsion
  • Ovarian cyst (rupture)
34
Q

What is mittleschmerz?

A

one-sided, lower abdominal pain associated with ovulation

35
Q

Sudden onset of pelvic unilateral pain

A

Ruptured ovarian cyst

36
Q

These are findings of what?

  • Fever
  • Vag discharge
  • Elevated ESR or CRP
  • Lab evidence for infection
A

PID

37
Q

What is the tx for PID?

A

Ceftriaxone 250 mg IM plus doxy 100 mg PO BID for 14 days

*Metro added if evidence of vaginitis

38
Q

A patient who has unilateral pain with a fullness palpated on exam, sometimes sicker could be what?

A

tubo-ovarian abscess

39
Q

Treatment for tubo-ovarian abscess?

A

Ceftriaxone 1 g IV with azithromycin and flagyl

Clin Med Final Material 5 (18 decks)

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