O&G incorrects Flashcards
First step in management of woman of reproductive age with abdominal pain? BP = 110/80
Hemodynamically stable thus = BHCG !!
If deemed pregnant then TVUSS
If not then other imaging to rule out other causes. Also need to know if pregnant to use other imaging modalities
Unstable = straight to resus, laparoscopy if ectopic suspected f
Why is decreased uterine mobility and uterosacral ligament thickening seen in endometriosis?
Inflammation of excess tissue and fibrosis and adhesions
Adhesions are extrauterine!
Intrauterine = pelvic inflammatory disease
Raloxifene is used in post menopausal osteoporosis especially in patients at risk of? However this drug increase the risk of?
Breast cancer
VTE risk due to estrogen agonist activity. Avoid in history of
38 year old. Amenorrhea 3 months. Bitemporal hair thickening, coarse hair on upper lip. Abdominal bloating and cramping. Large pelvic mass extending through left lower quadrant. No tenderness or ascites. Urine pregnancy test negative. Diagnosis?
Serotoli leydig cell tumour (deepening of voice, male pattern baldness, increased muscle bulk and clitoromegaly may be present and help distinguish from PCOS)
Not PCOS as you would have bilateral ovarian symptoms and symptoms happen over a longer period
Not struma ovarii as you have hyperthyroidism not virilisation
Choriocarcinoma = positive pregnancy test
Pregnant woman, shortness of breath doing household chores or walking 2/6 systolic murmur. 2+ pitting Edema. Bloods show respiratory alkalosis? Next step in management?
Provide reassurance only
Chronic hyperventilation occurs in pregnancy due to elevated progesterone and gives the sensation of dyspnea
Murmur = physiological, edema is normal due to urterine compression of vena cava
Patient did not have pulmonary embolism as PaO2 was high !! And you would expect a low one/hypoxia Pe
Patient did not have heart failure as auscultation of the lungs was clear with no crackles
Urethral diverticulum symptoms?
Dysuria
Post voidal dribbling
Dyspareunia
Anterior vaginal wall mass
Purulent/bloody urethral discharge
Stress inncontinence in contrast = +ve valsalva
Vesicovaginal fistula = continuous urine flow, no vaginal mass
managment of pregnant patient with no increase in dilation from 8cm in 4 hours?
- Proceed to ceasarean delivery!! -> patient is in active phase arrest (active phase is 6cm - 10cm)
- oxytocin is used to enhance contractions if less than 200 montevideo units, it is used in protracted labour eg rate of <1cm every 2 hours, but NOT arrested
prostaglandin is just used for cervical ripening in early labour induction
- operative vaginal delivery only an option at 10cm dilation eg expedite delivery in cat 3 tracings, maternal exhaustion etc
insert notes on google drive for incorrects
patients are at risk of lead exposure need lead levels monitored if they live in house built before?
1978!!
past question put date 1983 of a house as trick option
at first prenatal visit, how is syphilis screened for?
rapid plasma reagin test
30 weeks pregnant, twin pregnancy
RUQ pain, severe nausea and vomiting
- elevated liver enzymes - scleral icterus
- Thrombocytopenia!!! (due to dic)
- profound hypoglycemia!!! - helps distinguish
- leukocytosis!!! - helps distinguish
- anemia (hemolytic anemia due to dic)
- raised creatinine (AKI)
next step in management?
immediate delivery!!
patient has acute fatty liver of pregnancy
pregnant patient with new onset htn >20 weeks with no signs of end organ damage, minimal proteinuria +1
next step in management?
24 hour urine protein collection!!!
clinical signs of end organ damage = headache, visual changes, RUQ
lab signs of end organ damage = raised creatinine or transaminases, elevated platelet count
protein of at least +2 is diagnostic!!
10 weeks pregnant, thrombocytopenia, no other symptoms. blood smear shows clumping of platelets
most likely diagnosis?
pseudothrombocytopenia
intrauterine demise management?
IOL for vaginal delivery, ideally within a week
when a pregnant mother tests positive for carrying an autosomal recessive gene for a condition eg tay sachs, next step in management?
test father
if positive, then CVS or amnio
tuboovarian abscess symptoms
cystic masses with distortion of adnexal structures , fever, abnormal discharge, cervical motion tenderness
management of adnexal mass on ultrasound for mass with benign features vs malignant features
malignant -> (solid components, thick septations, increased vascularity) = immediate laparoscopy
benign = reassurance and observation if premenopausal, ca-125 if post menopausal
irregular menses with spotting
sexually active with a partner
lower abdominal pain 5 days ago -> now RUQ pain
fevers, chills, vomiting
diagnosis?
Pelvic inflammatory disease!
sti can present with irregular menstrual bleeding -> subtle sign
ascending infection to uterus -> fever and lower abdominal pain
further ascension -> perihepatitis/fitz hugh curtis syndrome = nausea, vomiting RUQ
other than pregnancy, what other obstetric condition may present with preeclampsia with severe features?
management?
hydatidiform mole
suction currettage
name some beniign physiological conditions that develop in pregnancy
increased upper lip hair, PUPP (itchy abdomen in straie), spider angioma, melasma
what is pathological nipple discharge?
how is it investigated?
how is physiological nipple discharge investigated?
unilateral, bloody discharge, spontaneous OR associated with breast abnormalities (palpable mass, skin changes)
<30 = ultrasound
>30 = mammogram
>/= 40 =. ultrasound and mammogram
if normal ultrasound/mammogram -> MRI of breast!!!
physiological = measure serum prolactin and TSH!, do a pregnancy test
describe breast cyst management pathway
breast ultrasound is 1st line imaging if <30 years
helps determine if complex cyst (thick walled, septated, solid and cystic components) or simple cyst (thin walled, anechoic/fluid filled, no echogenic debris or solid components)
- complex = biopsy
- simple:
- asymptomatic simple cyst = observe
- Tender simple cyst = FNA for pain relief. if non bloody aspirate and the cyst resolves no additional management. if it doesnt resolve = biopsy and additional imaging!!!. If Bloody aspirate = biopsy and additional imaging.
management of non cyclic unilateral focal breast bain?
mass -> biopsy
no mass -> imaging
cyclical lower abdominal pain and pain with defecation 13 year old, no menarche yet, firm mass protruding between labia majora which swells with valsalva maneuevre
most likely diagnosis/
imperforate hymen
- collecting blood -> pain on defecation, back pain, pelvic pressure due to pressure on surrounding organs