OB/GYN Flashcards
Tx for ovarian torsion
diagnostic laparascopy
What causes a tender, globular uterus and heavy menstrual bleeding with dull midline pelvic pain?
Adenomyosis
What presents with nausea/vomiting, acute onset unilateral pelvic pain (LLQ), adnexal tenderness?
Ovarian torsion
Bilateral nipple discharge workup vs. unilateral nipple discharge workup
Bilateral: pregnancy vs. galactorrhea eval
Unilateral: over 30= US + mammography, under 30= US plus/minus mammography
When should a pregnant woman with hyperemesis gravidarum be admitted to the hospital?
If she has ketonuria (ketones in urine due to prolonged hypoglycemia 2/2 inadequate oral intake) –> admit for IV antiemetics, rehydration, electrolyte repletion
**as a result, make sure to get UA for ketones on patient with HG b/c it will guide management
Carboprost (hemabate) is contraidicated in
Asthma
Methergine is contraindicated in
HTN
What do you give before methergine/hemabate for hemorrhage?
Uterine massage, oxytocin/misoprostol, tranexamic acid
Complications of PPROM?
preterm labor, placental abruption (decreased amniotic fluid–> uterine decompression–> placental vessels shear and separate), umbilical cord prolapse, intraamniotic infection
Workup of Atypical glandular cells on pap
Could be do to cervical or endometrial cancer so–>
colposcopy, endocervical curettage, endometrial biopsy
Normal progression for:
Latent phase of labor (0-6 cm)
Active phase labor (over 6-10 cm)
Latent phase- no defined rate of expected cervical change
Active phase- normal progression of greater than or equal to 1 cm every 2 hours
Active phase labor arrest is defined as:
no cervical change for 4 hours or more with adequate contractions and 6 hours or more with inadequate contractions (less than 200 mvu)–> C-section
When to administer anti-D immune globulin?
28-32 weeks and again within 72 hours of delivery if baby is RhD positive
60 year old patient with post-menopausal bleeding, breast tenderness, 11 cm ovarian mass, thickened endometrial stripe indicative of endometrial hyperplasia, and endometrial biopsy with hyperplasia without atypic- what is the diagnosis?
Granulosa cell tumor
- secretes estradiol/inhibin–> chronic, unopposed estrogen exposure–> endometrial hyperplasia/postmenopausal bleeding
**breast tenderness, endometrial hyperplasia from estrogen exposure
**call-exner bodies (rosette pattern)
Predisposing factors to hepatic adenoma
Young woman on oral contraception
- complications: malignant transformation in 10% and rupture/hemorrhagic shock
- resect if over 5 cm or symptomatic
Work-up/tx of lichen sclerosis
Vulvar punch biopsy to confirm dx and r/o vulvar cancer
-tx w/ superpotent corticosteroid cream (clobetasol)
24-28 week prenatal stuff
Hgb/Hct, Antibody screen if Rh-D negative, 1-hr 50-g GCT
36-38 weeks
Group B strep rectovaginal culture
Presentation of amniotic fluid embolism
Shock, hypoxemic respiratory failure, DIC, coma/seizures
Tx= respiratory/hemodynamic support, +/- transfusion
intubation with ventilation for hypoxemia, vasopressors for BP, and massive transfusions to correct DIC
pH ddx of vaginitis
- BV
- Trichomonas
- Candidiasis
- BV/Trichomonas= >4.5
Candidiasis= 3.8-4.5 (normal pH)
Presentation of Hydatidiform mole
Can present with 1st trimester bleeding, early preeclampsia, uterine size greater than expected
- hyperemesis gravidarum
- Ultrasound of pelvis will show bilateral multilocular ovarian cysts (theca-lutein cysts) and abnormal echogenicity in uterus (mole) - treat with dilation and curettage/suction
Complications of maternal gestational diabetes on infant
- neonatal hypoglycemia
- neonatal respiratory distress
- macrosomia
- polycythemia
- hypocalcemia (jitteriness), hypomagnesemia
1st line tx for infertility in PCOS
weight loss (then letrozole if ineffective)
Breast cancer screening
50-74 every 2 years
Urinary incontinence type and tx
Stress - leaking with vasalva, coughing, sneezing, laugh
Urgency (bladder overactivity)- sudden overwhelming or frequent need to void
Mixed - stress + urgency
Overflow - constant dribbling and incomplete emptying
Stress - lifestyle mod, pelvic floor exercise, pessary, surgery
Urgency - bladder training, antimuscarinic drugs, beta adrenergic agonists – oxybutynin
Overflow - cholinergic agonists (carbachol, bethenechol), terazosin (alpha adrenergic antagonist) for outflow obstruction 2/2 BPH
Imaging modalities to confirm suspected placenta previa
Transabdominal US followed by transvaginal US (still safe)
Tocolytic used at <32 weeks
Indomethacin
Tocolytic used at 32-34 weeks
Nifedipine (side effects nausea, flushing, HA, tachycardia)
Tocolytic for uterine tachysystole during term delivery
Terbutaline (b-agonist)
Benefits/risks of OCPs
Benefits: reduced risk ovarian/endometrial cancer,
Risk: increased risk cervical/breast cancer, hepatic adenoma, stroke, venous thromboembolism
Normal physiologic changes of pregnancy
- Systolic murmur
- Ankle edema
- Avg. 25 lb weight gain
- Increased uterine weight (estrogen mediated hypertrophy)
- Increase renal flow, increase GFR early then plateaus
- enlarged cardiac silhouette
- Increased HR, increased cardiac output
- GERD, constipation due to progesterone relaxation
- Physiologic anemia of pregnancy (plasma increases more than RBC)
- hyperventilation, dyspnea, increased tidal volume
- *respiratory alkalosis: decreased PaCO2 with slightly increased O2 (i.e. 29 and 109)
- Thrombocytopenia of pregnancy (100,000-150,000= benign finding)
Thrombocytopenia in pregnancy
Thrombocytopenia of pregnancy (isolated)
HELLP
Immune-mediated
TTP
DIC
– Mild- 100,000-150,000
- less than 100,000
- less than 100,000
- less than 30,000
- less than 100,000 with decreased fibrinogen and increased PT and aPTT
Mullerian agenesis results in:
46XX female with blind pouch (normal external genitalia/anterior 2/3 vagina)
- check with renal ultrasound for renal abnormalities upon diagnosis
Vaginal cancer risk factors
- vaginal bleeding, malodorous discharge, vaginal lesion
- could have constipation as bulk sxs
Tobacco, HPV, age over 60
- in utero DES exposure only for clear cell adenocarcinoma NOT squamous cell carcinoma
Risk factors for ovarian cancer
Anything that results in a higher number of ovulatory cycles
- early menarche, late menopause, nulliparity, decreased fertility, late childbearing, family hx, genetic mutation
Protective factors for ovarian cancer
OCPs for over 5 years, lactation, bilateral salpingo-oophorecomy, multiple childbearing
