Ob-Gyn 1 Flashcards
List medical circumstances in which minors can provide their own consent.
- Emergency care (all states)
- STIs (all states)
- Mental health and substance abuse treatment
- Pregnancy care
- Contraception
List legal circumstances in which minors can provide their own consent.
- Financial independence
- Parent
- Married
- Active military service
- High school graduate
True or false - in situations in which minors may be treated without parental consent, the patient also has the right to confidential treatment.
True
Atypical glandular cells (AGC) on Pap testing may be due to either ___ or ___.
Cervical or endometrial adenocarcinoma
When is an endometrial biopsy indicated?
35+ y/o: atypical glandular cells on Pap test
45+ y/o: abnormal uterine bleeding, postmenopausal bleeding
<45 y/o: abnormal uterine bleeding PLUS unopposed estrogen (obesity, anovulation), failed medical management, Lynch syndrome (hereditary nonpolyposis colorectal cancer
How is AGC on Pap testing investigated?
Colposcopy, endocervical curettage, and endometrial biopsy (evaluates ectocervix, endocervix, and endometrium)
List 2 risk factors for chlamydia and gonorrhea in women.
- <25 y/o
2. High-risk sexual behavior
List 4 manifestations of chlamydia and gonorrhea in women.
- Asymptomatic (most common)
- Cervicitis
- Urethritis
- Perihepatitis (Fitz-Hugh-Curtis syndrome)
How is chlamydia and gonorrhea diagnosed in women?
NAAT
How are chlamydia and gonorrhea treated empirically?
Azithromycin + ceftriaxone
How is confirmed chlamydia treated? Confirmed gonorrhea?
Chlamydia - azithromycin
Gonorrhea - azithromycin + ceftriaxone
List 3 complications of chlamydia and gonorrhea in women.
- PID
- Ectopic pregnancy
- Infertility
Classic presentation of acute cervicitis?
Mucopurulent discharge, friable cervix
___ is a broad-spectrum regimen that provides polymicrobial coverage for PID.
Cefoxitin + doxycycline
___ is used in the treatment of bacterial vaginosis and trichomoniasis.
Metronidazole
List 4 risk factors for vaginal cancer.
- Age >60
- HPV infection
- Tobacco use
- In utero DES exposure (clear cell adenocarcinoma only)
List the clinical features of vaginal cancer.
Vaginal bleeding, malodorous vaginal discharge, irregular vaginal lesion
How is vaginal cancer diagnosed?
Vaginal biopsy, which determines the depth of invasion of atypical cells
How is vaginal cancer treated?
Surgery + chemoradiation
Describe the classic presentation of lesions inv aginal cancer.
Irregular plaque or ulcer located in the upper third of the posterior vagina
When is endometrial biopsy indicated to evaluate for endometrial cancer?
Postmenopausal bleeding + an endometrial lining >4mm on U/S
List the 4 major types of antepartum fetal surveillance.
- Nonstress test
- Biophysical profile
- Contraction stress test
- Doppler sonography of the umbilical artery
What does antepartum fetal surveillance evaluate for?
Fetal hypoxia
When is antepartum fetal surveillance performed?
Pregnancies with a high risk for fetal demise due to maternal (eg, HTN, DM) or fetal (eg, post-term pregnancy, growth restriction) conditions.
What is the most common antepartum fetal surveillance modality?
Biophysical profile (BPP)
What is involved in a nonstress test?
External fetal heart rate monitoring for 20-40 minutes
What is a normal non-stress test result?
Reactive: 2+ accelerations that are 15+ bpm above baseline and 15+ seconds long within a 20-minute period (can test for 40-minutes to account for a 20-minute fetal sleep cycle)
What is an abnormal non-stress test result?
Non-reactive: <2 accelerations
Recurrent variable or late decelerations
What is involved in a biophysical profile?
Non-stress test + ultrasound assessment of amniotic fluid volume, fetal breathing movement, fetal movement, fetal tone
How is a biophysical profile scored?
2 points/category (5 total), 0 points if abnormal; normal result = 8 or 10 points, equivocal = 6 points, abnormal = 0, 2, or 4 points or oligohydramnios
What is involved in a contraction stress test?
External fetal HR monitoring during spontaneous or induced uterine contractions
What is a normal result in a contraction stress test?
No late or recurrent variable decelerations
What is an abnormal result in a contraction stress test?
Late decelerations with >50% of contractions
When is Doppler sonography of the umbilical artery used for antepartum fetal surveillance?
Fetal intrauterine growth restriction only
What is a normal result of Doppler sonography of the umbilical artery?
High-velocity diastolic flow in the umbilical artery
What is an abnormal result of Doppler sonography of the umbilical artery?
Decreased, absent, or reversed end-diastolic flow
If a BPP is equivocal (6/10), what should be done?
Repeat in 24 hours
___ is administered for seizure prophylaxis in patients with preeclampsia with severe features.
Magnesium sulfate
What is vibroacoustic stimulation used for during NST?
Stimulate a fetus to determine if lack of fetal HR accelerations is from fetal sleep
List 4 causes of hyperandrogenism in pregnancy.
- Placental aromatase deficiency
- Luteoma
- Theca lutein cyst
- Sertoli-Leydig tumor
Compare the types of ovarian masses seen in the 4 causes of hyperandrogenism in pregnancy.
- Placental aromatase deficiency - no ovarian mass
- Luteoma - solid, unilateral/bilateral ovarian masses
- Theca lutein cyst - cystic, bilateral ovarian masses
- Sertoli-Leydig tumor - solid unilateral ovarian mass
Compare the maternal and fetal virilization risk of the 4 causes of hyperandrogenism in pregnancy.
- Placental aromatase deficiency - high maternal and fetal virilization risk
- Luteoma - moderate maternal virilization risk; high fetal virilization risk
- Theca lutein cyst - moderate maternal virilization risk; low fetal virilization risk
- Sertoli-Leydig tumor - high maternal and fetal verilization risk
Compare the outcome/management of the 4 causes of hyperandrogenism in pregnancy.
- Placental aromatase deficiency - resolution of maternal symptoms after delivery
- Luteoma - spontaneous regression of masses after delivery
- Theca lutein cyst - spontaneous regression of masses after delivery
- Sertoli-Leydig tumor - surgery required (2nd trimester or postpartum)
How are patients with virilization during pregnancy and bilateral ovarian masses managed?
Observe and manage expectantly; symptoms and masses spontaneously regress after delivery due to falling beta-hcg levels
How do luteomas of pregnancy cause virilization?
Elevated beta-hcg levels stimulate the luteoma to release androgens, which may cause maternal virilization
How do theca lutein cysts cause virilization in pregnancy?
Markedly elevated beta-hcg levels (eg, hydatidiform mole, multiple gestation) cause ovarian hyperstimulation
Compare the risk of virilization of the female fetus in luteomas vs. theca lutein cysts.
Luteomas - high risk
Theca lutein cysts - low risk
___ causes hyperandrogenism, anovulation, and infertility in non-pregnant women.
PCOS
___ is defined as fetal death at 20+ weeks.
Intrauterine fetal demise (aka stillbirth)
How is intrauterine fetal demise diagnosed?
Absence of fetal cardiac activity on U/S
How is intrauterine fetal demise managed?
20-23 weeks - dilation and evacuation OR vaginal delivery
24+ weeks - vaginal delivery
Even after an optimal evaluation of the cause of stillbirth, up to ___ of cases have no identifiable etiology.
Half
Most common cause of genital herpes?
HSV-2