Gynob- Ross Flashcards
What can cause bHCg to give a false neg?
Vit C, dilute urine and early pregnancy
If a patient has a strong suspicion of pregnancy and bHCG qualatative says no, what should you do?
Quantatative bHCG to get the number value
B-hCG normally ______- every two days and levels that do not increase by ____-% in two days imply an abnormal IUP or ectopic
double, 50%
Someone in shock has these three things?
Hypotension, tachycardia, poor peripheral perfusion (cold, clammy extremities and diaphoretic)
What are 4 RFs for ectopic pregnancy?
- Hx PID
- IUD
- Infertility
- Previous ectopic
- Older age
- Cigarette smoker
- Previous pelvic surgery
If you have a tubal ligation and pregnant with bleed… what should you consider?
ectopic
What is the leading cause of death in the first trimester of pregnancy?
ectopic pregnancy
What are the steps for vaginal bleeding/pain?
- Pregnancy test
- Rule in IUP with U/S
- Quantitative b-HCg
Seeing these two things on U/S should be reassuring?
-Fetal pole and double ring sign
What is the discriminatory zone for b-hCG?
1500-2000 below which you may not see IUP on U/S
What should we see at this b-hCG levels?
>1500
- should see gestational sac: 4.5 wks
- need a trans-vaginal U/S
What should we see at this b-hCG levels?
>5000
-Should see a fetal pole: 6.5 wks
What should we see at this b-hCG levels?
>15,000
-should see a heart beat
What does a b-hCG of <1500 mean?
- normal early pregnancy
- ectopic
- miscarriage
What should we see at this b-hCG levels?
2000
yolk sac
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?
official transvaginal u/s
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?
You should re-check in 48 hours since it should double in 2 days
b-Hcg of >1500 and U/S with no IUP is by default _______. What is the next step?
ectopic
Surgery
The __________ dept is where patients go to die
radiology
What pill can be used for an ectopic to terminate?
Methotrexate (helps dissolve the cells so you don’t have to do surgery)
What are the criteria for a threatened abortion?
- Vaginal bleeding
- Closed os
- quant >1500
- U/s shows IUP
Pregnancy w/ bleeding. If the os is open then what?
inevitable miscarriage
Pregnancy w/ bleeding. If the os is closed then what?
discharge and restrict sexual and physical activity
-Have pt f/u needs bHCG
If bleeding has caused the Hct to drop or there is hypotension what should you do?
obtain gyno consult
What if there is a fetal heat beat and quant 60,000?
consult gyn (probs will offer d&c or misoprostol)
What is an important thing to order in a patient with bleeding?
Rh type & screen
What is the mc cause of 3rd trimester bleeding?
Abruptio placenta: rock hard uterus with painful vag bleeding; separation of placental from uterus
You will usually see elevated BP, proteinuria and edema in what condition?
pre-eclampsia
Diastolic >105
Proteinuria +2
Seizure
htn, elevated LFT, low platelets are a sign of what?
HELLP
*need emergency GYN consult
How to treat pre-eclampsia?
Labetalol or Nifidipine
What meds should be avoided in pregnancy?
Thiazides
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.
Hyperemesis
Lower abd pain ddx for non-pregnant and lower abd pain?
- Ectopic
- Miscarriage
- PID
- Tubo-ovarian abscess
- Ovarian torsion
- Ovarian cyst (rupture)
What is mittleschmerz?
one-sided, lower abdominal pain associated with ovulation
Sudden onset of pelvic unilateral pain
Ruptured ovarian cyst
These are findings of what?
- Fever
- Vag discharge
- Elevated ESR or CRP
- Lab evidence for infection
PID
What is the tx for PID?
Ceftriaxone 250 mg IM plus doxy 100 mg PO BID for 14 days
*Metro added if evidence of vaginitis
A patient who has unilateral pain with a fullness palpated on exam, sometimes sicker could be what?
tubo-ovarian abscess
Treatment for tubo-ovarian abscess?
Ceftriaxone 1 g IV with azithromycin and flagyl
