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Gynecology > Nagy's favorites > Flashcards

Nagy's favorites Flashcards

1
Q

Definition of preeclampsia/eclampsia

A

After the 20th gestational week

  • Preeclampsia: BP > 140/90 mmHg
  • Proteinuria > 300mg/24 hours

Eclampsia: Tonic-clonic seizures

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2
Q

Gestational diabetes

A

Part of screening program = check all pregnant at 24-28 gw

Fasting glucose < 5.6mmol/l => Healthy
Fasting glucose 5.6-7.0mmol/l => Do OGTT
Fasting glucose > 7.0mmol/l on two separate measurements => DM

OGTT «5,6,7,8»:
Normal at 0 min: under 5,6 mmol/l
At 120 mins:
- If < 7.8mmol/l => Impaired Fasting Glucose (IFG)
- If 7.8-11 mmol/l => Impaired Glucose Tolerance (IGT)
- If > 11 mmol/l => DM

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3
Q

Indications for C-section

A

6 groups:
1. Vital maternal
(HF, pulm.edema, severe hemorrhage, DIC)
2. Vital fetal
(asphyxia, cord prolapse, neglected transverse lie, ascending infection, fetal pneumonia)
3. Vital maternofetal
(ecclampsia, uterine rupture, placenta previa/abruption)

  1. Prophylactic maternal
    (maternal illness, previous operation uterus, decr.pelvic capacity, late primiparity (over 30 yrs))
  2. Prophylactic fetal
    (threatened asphyxia, placental dysfunction, or hypoxia, fetal illness, pregnancy after infertility treatment)
  3. Prophylactic maternofetal
    (damning gestational history, dystocia, prolonged labor, FDP, malpresentation/position, twins)
    __________________________________________________
    M/F:
    - Cephalopelvic disproportion
    - Failed induction of labor

Maternal: Eclampsia

  • Cervical cancer
  • Fibroids, tumor
  • Herpes

Fetal:

  • Non-reassuring fetal HR (bradycardia)
  • Cord prolapse
  • Malpresentation
  • Multiple gestations
  • Fetal abnormalities => Hydrocephalus

Placental:

  • Previa
  • Abruptio
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4
Q

US in pregnancy

A

0 (6-7w) = transvaginal diagnostics

  • Confirm (gestational sac, HR)
  • Location: Intra-/extrauterine
  • Twins

I (11-13+6w) = gestational age & pathology

  • Nuchal translucency (Down’s)
  • Neural tube defects
  • Biometrics: ductus venosus flow

II (18w) = genetic screening

  • Congenital malformations
  • Chromosomal abberations

III (28-32w) = fetal size screening

  • IUGR
  • Late congenital malformations

IV (38w) = information for delivery

  • Fetal presentation
  • Fetal weight
  • High-risk?
  • gw are from Nagy in lecture
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5
Q

Placenta abruptio / placenta previa

A

Hello, CTG, use hands to palpate the uterus

Abruptio: Painful, hard uterus => C-section

Previa: Painless, CTG normal

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6
Q

Post-partum haemorrhage

A
  • Tissue: Retained placenta
  • Trauma: Vaginal lacerations
  • Thrombin: Coagulopathy (DIC)
  • Tone: Uterine atony (exclude other causes)
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7
Q

Stages of birth

A
  1. Onset of labor: Longest stage
    a. Latent (3cm) - nulli: 8-20 hrs, multi: 5-12 hrs
    b. Active (3-10cm) - nulli: 5-7 hrs, multi: 2-4 hrs
  2. Birth: 30-90mins (nulli: ~2hrs, multi ~1hr)
    a. Propulsive phase (full dilation, descend to pelvic floor)
    b. Expulsion phase (delivery)
  3. Placenta: 5-30mins
    a. Separation
    b. Expulsion
  4. Postplacental stage: 2 hours
    a. Incr. risk of bleeding
    b. Repair lacerations
    c. D-Ig
    _____________________________________________________
    Dr. Nagy times:
    1: Cervix (nulli: 9-11 hrs, multi: half)
    2: Fetus (nulli: 50-60 hrs, multi: half)
  5. Placenta (nulli: 5-15 (max 30 min)
  6. Observation: 2 hrs
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8
Q

Techniques of C-section

A

Abdominal wall:

  • Transverse (Pfannenstiel)
  • Vertical (Midline)

Uterus:

  • Lower segment incision (Transverse)
  • Classical (Vertical)
  • (Low vertical)
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9
Q

Pearl index

A

No. of pregnancies in 100 females/year with chosen contraceptive.

  • OCP: 0.1-2.5
  • Sterilization: 0.3-6
  • Post-coital pill: 0.5-2.5
  • IUD: 0.5-5
  • Condom: 3-28
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10
Q

Routine exams

A
  • Colposcopy
  • Cytology
  • Bimanual exam
  • Breast exam
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11
Q

Long-term OCP use

A

Good: All decreased

  • Ovarian/endometrial cancer
  • Bone loss
  • Dysmenorrhea
  • Acne
  • Risk of trisomies in high maternal age
  • Regulates cycle

Bad: all increased

  • DVT/stroke
  • BP
  • Weight
  • Depression
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12
Q

Endometriosis (+ Dx, Tx)

A

Endometrial-like tissue outside the uterine cavity.

Dx: Gold standard => Laparoscopic visualization

Tx:

  • Surgery
  • Drugs (Pseudopregnancy, Pseudomenopause => GnRH analogue)
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13
Q

Urinary incontinence

A

1) Irritative: Urinalysis => Cystitis/tumor/foreign body
2) Stress: Loss of bladder support => Cough
3) Urge: Hypertonic => overactive detrusor (Tx: Anticholinergics)
4) Overflow/neurogenic: Hypotonic w/ dribbles (Tx: Cholinergics)
5) Bypass/Fistula

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14
Q

Main vaginal infections

A
  • Bacterial vaginosis
  • Trichomonas
  • Mycosis (Candida)
    Mycosis has normal pH, the others have increased
    Tx: metronidazole if pH increased, antifungal if not
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15
Q

Spontaneous abortion (Hx, Dx)

A

Hx: Pain + bleeding
Dx: Cervix, US, hCG

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16
Q

Contraindications to tocolysis

A

Obstetric:

  • Severe abruption
  • Ruptured membranes
  • Chorioamnionitis

Fetal:

  • Lethal anomaly
  • Fetus is already dead
  • Fetal jeopardy

Maternal:

  • Eclampsia
  • Advanced dilation
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17
Q

Leopold maneuvers

A
  1. Fundal grip = fundal height, which pole in fundus (head, butt)
  2. Umbilical grip = One hand on each side of belly (lie, position)
  3. Pelvic grip (1st pelvic grip) = Grasp lower portion of abdomen just above the pubic symphysis with thumb and fingers of the right hand (presenting part and its relation to pelvic inlet (engagement))
  4. Pawlick grip (2nd pelvic grip) = Face woman’s feet, attempt to locate fetus’ brow. Fingers of both hands moved gently down the sides of the uterus => Pubis. The side where there is resistance to the descent of the fingers is greatest where the brow is located (presenting part, descent, engagement)
  5. Zangemeister maneuver = cephalopelvic disproportion
18
Q

Stopping uterine bleeding

A

Young: Progesterone => Preserve fertility

Old: D&C

19
Q

Mayer-Rokitansky-Küster-Hauser Syndrome

A

Müllerian agenesis.
- Congenital malformation
- Failure of Müllerian duct to develop
o Missing uterus, cervix, vagina
o Variable degree of upper vaginal hypoplasia (shortened)
- Causes 15% of primary amenorrhea
- Ovaries intact, ovulation usually occurs
- Enter puberty with secondary sexual characteristics

20
Q

Papanicolau classification

A 
P0: Improper sample
P1: Negative result
P2: No dysplasia, some benign aberration
P3: Pathologic cells, but impossible to tell due to inflammation or dysplasia
P4: Atypical cells => Suspect malignancy
P5: True malignancy
21
Q

Bethesda

A

Reporting cervical or vaginal cytological Pap smear results.

Important steps:

  1. Quality of the slide
  2. Whether the result is positive or negative
  3. Details of the slide (LSIL/HSIL)
  4. Physician recommendation of how to proceed
22
Q

Puerperium

A

Period beginning immediately after the birth of a child extending for ~ 6w

23
Q

When prenatal care starts

A

Before conception

24
Q

Mortality rates

A

Neonatal Mortality Rate: No. of neonatal deaths during the 1st month/1,000 live births.

  • Early NMR: 1st week
  • Late NMR: 2nd-4th weeks

Perinatal Mortality Rate: No. of perinatal deaths (stillbirths + neonatal deaths, from 22nd gestational week to 7th week postpartum)/1,000 total births.

25
Q

To exclude ectopic pregnancy

A

Measure b-hCG:

  • 1,000 U/L => Gestational sac
  • 7,000 U/L => Yolk sac
  • 10,000 U/L => Embryo

Brown spotting and abdominal pain indicates ectopic pregnancy => Check fallopian tubes.

b-hCG doubles every 2nd day. If high but not double => Ectopic pregnancy.

26
Q

Vitamin supplements

A

Preconception: Folic acid up to 6 weeks before (400 microgr/day)

2nd trimester: Low dose Iron and Iodine (250 microgr/day)

27
Q

History taking

A
  • Previous operations
  • Allergy to medications
  • Obstetric anamnesis
  • Illness, drugs
  • First day of last menstrual period
    o Naegele’s rule: Can only be applied if menses are regular and cycle is 28 days.
28
Q

Signs of pregnancy

A

Presumptive: in man and woman
- Nausea, vomit

Probable: in women

  • Physical changes
  • Positive pregancy test

Definite sign (only in pregnant)

  • Fetal HB
  • Detecting fetus (US)
29
Q

Physical signs of pregnancy

A

Chadwick sign: bluish discoloration over cervix and vagina (ca. 6th gw)

Piskacek sign: Soft prominence over the site of implantation

Goodell’s sign: Softening of the cervix (4-6 gw)

Hegar’s sign: Softening of the cervical isthmus (6-8 gw)

Chloasma

Linea nigra

30
Q

Location of Bartholin’s Cyst

A

Lower 1/3 of labia major

31
Q

Marsupialization of Bartholin’s Cyst

A

Cyst opened at the edges + sutured, forming an open pocket

32
Q

Asherman’s syndrome

A

Adhesions/fibrosis of the uterine cavity, usually from D&C. Reversible infertility.

33
Q

Types of anaesthetics used

A
  • Vaginal delivery: Epidural
  • C-section: Spinal
  • Emergency C-section: Intratracheal narcosis
34
Q

Endometrial cancer staging

A 
0: CIS (Carcinoma in situ)
I: Limited to the uterus
- Ia: < 50% myometrial invasion
- Ib: > 50% myometrial invasion
II: Cervical involvement
III: Local spread
- IIIa: Uterine serosa / adnexa (fallopian tubes, ovarian, ligaments)
- IIIb: Vagina/parametrium
- IIIc1: Pelvic nodes
- IIIc2: Paraaortic nodes
IV: Metastasis
- IVa: Bladder/rectal mucosa
- IVb: Distant metastasis, ascites, peritoneum
35
Q

Vulvar cancer

A 
0: VIN
I: Limited to vulva/perineum < 2cm
- Ia: < 1mm stromal invasion
- Ib: > 1mm stromal invasion
II: Extension to adjacent perineum
III: Any size + extension to perineal structures with positive inguinofemoral LN 
- IIIa1: 1 LN > 5mm
- IIIa2: 1-2 LN < 5mm
- IIIb1: > 2 LN > 5mm
- IIIb2: > 3 LN < 5mm
IV: Metastasis
- IVa: Bladder, urethra, rectum, bone
- IVb: Distant metastasis (Pelvic LN)
36
Q

Vaginal cancer

A 
0: VAIN
I: Limited to vagina
II: Paravaginal invasion w/ no extension beyond 
     pelvic side walls
III: Invasion of pelvic side wall
IV: Metastasis beyond pelvis
- IVa: Bladder, rectum
- IVb: Distant metastasis
37
Q

Cervical cancer (must know)

A

0: CIN
I: Limited to cervix
Ia: Invasion dx by microscopy
- Ia1: Stromal invasion < 3mm depth, < 7mm extension (microinvasive)
- Ia2: Stromal invasion 3-5mm depth, > 7mm extension
Ib: Clinically visible lesion
- Ib1: < 4cm
- Ib2: > 4cm
II: Beyond cervix, no pelvic side walls, no lower 1/3 of vagina
IIa: Involved upper 2/3 of vagina, no parametrial involvement
- IIa1: < 4cm
- IIa2: > 4cm
IIb: Parametrial invasion
III:
- IIIa: Lower 1/3 of vagina, no pelvic wall extension
- IIIb: Pelvic side wall extension, obstructive uropathy
IV: Metastasis
- IVa: Bladder, rectum
- IVb: Distant organs

38
Q

Breast cancer (TNM)

A

Tis: DCIS (Ductal Carcinoma in situ), LCIS (Lobular Carcinoma in situ)

T1: less than 2cm (a-d)
T2: 2-5cm
T3: > 5cm
T4: Tumor extends to skin or chest wall
- T4a: Chest wall
- T4b: Skin
- T4c: Chest wall + Skin
- T4d: Inflammatory cc

N: Lymph nodes (Nx: cannot be assessed)
- N0: no Cancer cells

  • N1: (Ipsilateral) movable axillary LN
  • N2: (Ipsilateral) fixed axillary LN or internal mammary LN (w/o axillary)
  • N3: (Ipsilateral) infra-/supraclavicular LN or internal mammary LNs (w/axillary)

M: Metastasis

  • M0: No metastasis
  • M1: Metastasis
39
Q

Ovarian cancer

A

I: Ovary/fallopian tube

  • Ia: 1 ovary (capsule intact, no tumor on surface, negative washings)
  • Ib: Both ovaries (same as above)
  • Ic: a/b +
  • Ic1: Surgical spill
  • Ic2: Capsule rupture before surgery, tumor on ovary/fallopian tube surface
  • Ic3: Malignant cells in ascites/peritoneal washings

II: Pelvic extension/primary peritoneal cancer

  • IIa: Uterus/fallopian tubes
  • IIb: Other pelvic intraperitoneal tissues

III: Cytologically/histologically confirmed spread to peritoneum and retroperitoneal LN

  • IIIa: Retroperitoneal LN, microscopic metastasis beyond pelvis
  • IIIa1(i): Retroperitoneal LN < 10mm
  • IIIa1(ii): Retroperitoneal LN > 10mm
  • IIIa2: Microscopic extrapelvic peritoneal metastasis
  • IIIb: Macroscopic peritoneal metastasis < 2cm
  • IIIc: Macroscopic peritoneal metastasis > 2cm

IV: Metastasis

  • IVa: Pleural effusion with positive cytology
  • IVb: Distant metastasis
40
Q

LSIL/HSIL

A

LSIL

  • Condyloma
  • CIN I

HSIL

  • CIN II
  • CIN III => In situ => invasive cc

Gynecology (4 decks)

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