Lecture 16: OB-GYN Emergencies

Question 1

The MCC of abnormal vaginal bleeding in a PRE-menarcheal girl is…

Answer 1

Trauma/abuse :(

Question 2

The MCC of abnormal vaginal bleeding once you hit reproductive age is…

Answer 2

Coagulopathies

It was first on her slide so im guessing MC

Question 3

The MCC of abnormal vaginal bleeding in a POST-menopausal woman is…

Answer 3

Exogenous hormones

That OCP MHT

Question 4

An unstable abnormal vaginal bleed can be treated with IV (), but a stable abnormal vaginal bleed can be treated with oral ()

Answer 4

• IV Estrogen
• Oral short-term MHT or TXA

Question 5

The 5 RFs for an ectopic pregnancy are:

• Prior () pregnancy
• Prior () surgery
• () infections
• () disease
• (-osis)

Answer 5

• Prior ectopic
• Prior abd/pelvic/fallopian tube surgery
• STIs
• PID
• Endometriosis

Also smoking + older with fertility issues

Question 6

The classic triad of ectopic pregnancy is:

• () pain
• () bleeding
• ()rrhea

Answer 6

• Abdominal pain
• Vaginal bleeding
• Amenorrhea

Question 7

Which hCG lab test is preferred and WHY

Answer 7

Quantitative is preferred, aka it gives you an actual number like 30.

Question 8

The first US you would get of a suspect ectopic pregnancy is…

Answer 8

TransABDOMINAL (bladder full)

TVUS is empty bladder

Question 9

A typical home pregnancy test is the equivalent of hCG being ()

Answer 9

20

Question 10

T/F: An unstable vaginal bleed in early pregnancy (< 20 weeks) with an Rh+ mother and Rh- fetus requires Rhogam and emergent OB consult.

Answer 10

False. It is for Rh- mothers with an Rh+ fetus

Question 11

() describes the implantation of the placenta over the cervical os

Answer 11

Placenta previa

Question 12

A pool of fluid in the posterior fornix is diagnostic of …

Answer 12

PROM

Question 13

() describes vaginal bleeding in the first 20 weeks of pregnancy with a closed cervical os, benign exam, and no passage of tissue.

Answer 13

Threatened abortion

Question 14

() describes partial passage of conceptus, usually between 6-14 weeks.

Answer 14

Incomplete abortion

Question 15

() describes fetal death at less than 20 weeks without passage of any fetal tissue for 4+ weeks after fetal death

Answer 15

Missed abortion

Question 16

The only two abortion types that require a D&C are…

Answer 16

• Incomplete: partial passage of products of conception
• Missed: fetus died 4 weeks ago

Question 17

The empiric ABX for septic abortion are () or (), along with ()

Answer 17

• Unasyn or clinda
• Gentamicin

Question 18

The timeframe for chronic HTN is beginning before () gestation or lasting () weeks after delivery

Answer 18

Started before 20 weeks or lasting 12+ weeks after delivery

AKA it already existed or it existed way beyond pregnancy

Question 19

The time frame for gestational HTN is after () weeks gestation or in the immediate () period.

Answer 19

After 20 weeks gestation or with immediate postpartum period.

Question 20

Elevated BP in pregnancy is SBP greater than () OR DBP > 90 on () occasions more than () hours apart.

Answer 20

• > 140
• > 90
• 2 occasions more than 4 hours apart

Question 21

You should treat gestational HTN via ()

Answer 21

Lifestyle modifications

Question 22

The presence of () turns gestational HTN into pre-eclampsia.

Answer 22

Proteinuria >= 300mg in 24 hrs

Alternative criteria linked

Question 23

Besides proteinuria, HELLP syndrome is basically the equivalent to pre-eclampsia. It stands for…

Answer 23

• Hemolysis
• Elevated LFTs
• Low Platelets

HELLP!!!!!!

Question 24

Severe pre-eclampsia is pre-eclampsia + ()

Answer 24

End-organ involvement

Question 25

Pre-eclampsia becomes eclampsia once () occurs.

Answer 25

Seizures

Question 26

In HELLP syndrome, () may not be present, which is always present in pre-eclampsia

Answer 26

HELLP does not always have elevated BP!!! | But it is a clinical variant of pre-eclampsia

Question 27

Besides focused US for pre-eclampsia evaluation, you can also order a...

Answer 27

CT Abdomen

Question 28

The DOC for both severe pre-eclampsia and eclampsia is...

Answer 28

IV MgSO4 4-6g

Question 29

Severe HTN in pregnancy (with a goal to reduce by (%)), is either using () or ()

Answer 29

* 10% reduction in BP is goal * IV Labetalol * IV Hydralazine

Question 30

Overall, the definitive way to solve severe pre-eclampsia/eclampsia is...

Answer 30

Delivering the fetus!

Question 31

Pelvic pain is usually due to gynecologic pathology, but you must always get a ()

Answer 31

ALWAYS GET A PREGNANCY TEST N REPRODUCTIVE AGED WOMEN

Question 32

Primary dysmenorrhea is essentially () pain that comes () period

Answer 32

Crampy abdominal pain before or after prior | NOT DURING

Question 33

Mittelschmerz is pelvic pain that occurs () period

Answer 33

DURING period (ovulation) | Mittel like Middle

Question 34

Ovarian cyst rupture causes (side) pain

Answer 34

Unilateral

Question 35

You should be concerned about an ovarian cyst if it is greater than () cm, multi(), or (consistency)

Answer 35

* Greater than 8cm * Multiloculated * Solid | Normally just fluid filled

Question 36

() describes sudden onset of unilateral, severe adnexal pain with N/V and fever. They have a hx of chemical ovulation.

Answer 36

Ovarian torsion

Question 37

() describes chronic inflammation within the pelvis resulting from ()tissue implanting outside the uterus

Answer 37

* Endometriosis * Endometrium-like tissue

Question 38

T/F: Leiomyomas are benign smooth muscle tumors in the uterus and/or GI tract.

Answer 38

Trueeee | Uterine fibroids, the big single ones

Question 39

PID encompasses 4 diseases: * ()itis * ()itis * () abscess * Pelvic ()itis

Answer 39

* Endometritis * Salpingitis * Tubo-ovarian abscess * Pelvic Peritonitis

Question 40

PID has 3 groups of diagnostic criteria: * Group 1 (minimum criteria): () tenderness and () motion tenderness * Group 2 (increased specificity): (systemic), Secretions elevated ESR/CRP, positive () * Group 3 (procedures based): lappy, Pelvic US/MRI, () biopsy

Answer 40

* Group 1: Uterine/adnexal tenderness and cervical motion tenderness * Group 2: Fever, positive pelvic cultures * Group 3: Endometrial biopsy

Question 41

T/F: PID is a risk factor for ectopic pregnancy and infertility

Answer 41

TRUEEE

Question 42

Pelvic pain is initially evaluated via a (imaging)

Answer 42

TVUS

Question 43

T/F: A tubo-ovarian abscess causing pelvic pain is an indication to admit.

Answer 43

Trueee

Question 44

2 ways to treat PID via IVs: * () or (), with () * (), plus ()

Answer 44

* Cefotetan or cefoxitin, plus doxy * Clinda plus gentamicin * alternate: unasyn + doxy | Tin tan goes the dock, clint is a gentleman to women

Question 45

# If FQ resistance is high Oral/OP tx of PID: * () IM once, or () IM once with probenecid ORRRR * another 3rd gen cephalo with () +/- Metronidazole | I wrote more important slide?

Answer 45

* Rocephin or Cefoxitin + probenecid * 3rd gen + doxy +/- metro