OB/GYN Flashcards

Question

Cervical insufficiency Tx, CI

Answer 1

Cervical weakness associated with painless 2nd-trimester pregnancy loss Tx: - In patients with history-based dx: prophylactic cerclage placed prior to cervical shortening or dilation. - In patient with US or PE based dx: Emergency cerclage. However, prolapsing amniotic membranes is a predictor for imminent delivery and indicates poor prognosis. CI: exercise

Answer 2

High: - Open neural tube defect ( anencephaly, open spina bifida) - Ventral wall defects (omphalocele, gastroschisis) - Multiple gestation Low: - Aneuploidies (trisomy 18 & 21) If abnormal - 1st: repeat serum AFP - 2nd: US - 3rd: Amniocentesis to obtain amniotic fluid AFP, acetylcholinesterase.

Answer 3

Causes: Chlamydia, Neisseria , foreign object, latex, douching Sx: Asx, Mucopurulent discharge, postcoital/intermenstrual bleeding, friable cervix Dx: NAAT, Wet mount Tx: Empiric tx with Ceftriaxone and Doxycycline. If pregnancy, CTX & Azithromycin

Answer 4

- Requires hospitalization with IV hydration and IV antibiotic therapy (CTX, Cefapime). - Once afebrile for 48 hours, patient placed on oral antibiotics for 10–14 days. - Patient then continues on daily suppressive therapy until 6 weeks postpartum.

Answer 5

Screen at 36-38 weeks Indication for intrapartum ppx: - GBS bacteriuria or UTI in current pregnancy - GBS + culture - Unknown GBS PLUS <37 weeks, fever or ROM >18hrs - Prior infant with early onset GBS infection Management: - If deterred early in pregnancy --> treat immediately with amoxicillin & cephalexin. - Repeat test 1 week after finishing abx. - Regardless of results, treat with intrapartum Abx ppx (penicillin)

Answer 6

RF -Prolonged or induced labor - Chorioamnionitis - Multiple gestations - Polyhydramnios - Grand multiparity - Operative delivery Causes: - Uterine atony (most common) - Retained placenta - Genital tract laceration - Uterine rupture - Coagulopathy Tx: - Bimanual uterine massage, oxytocin - IVF, oxygen. - Uterotonic (methylergonovine, carboprost, misoprostol) - Intrauterine balloon tamponade - Uterine artery embolization - Hysterectomy

Answer 7

Lactation Mastitis: Path: Bacteria from skin enter the milk ducts, and proliferate in stagnant milk —> infection - Most likely to develop in the first 3 months. - RF: Difficult breast-feeding —> prolonged engorement, inadequate milk, drainage, clogged milk ducts. - Bug: most commonly Staph aureus - Sx: Fever, breast pain, focal inflammation.Can also have myalgia, chills, malaise. - Tx: Dicloaxacillin and cephalexin Comp: Abscess Sx: Fever, focal inflammation, flutuant tender mass Dx: US Tx: US guided fine needle aspiration

Answer 8

Dx: 1. Renal and Pelvic US 2. transvaginal US 3. Treat empirically OR MRI OR low-dose CT

Answer 9

1st stage: beginning of contractions and end at 10cm dilated. ----- Latent phase: beginning of contractions to 6cm (slow cervical changes) ----- Active phase: 6cm to 10cm (rapid cervical changes ~ 1cm/2hrs) Tx: Oxytocin and amniotomy

Answer 10

After 40 weeks gestation, the placenta function deteriorates, and is no longer able to supply adequate oxygen and nutrition to the fetus, leading to fetal malnutrition and wasting. Sx: - Small for gestational age - Wrinkled peeling skin - Long thin body - Decreased subcutaneous fat - Long fingernails - Lanugo hair - Increase scalp hair - Meconium stained placenta Complications - Oligohydramnios - Umbilical cord compression - Fetal heart rate abnormalities - Meconium aspiration - Respiratory distress - Hypoglycemia - Seizures

Answer 11

Upward displacement of appendix Atypical presentation: no peritoneal signs and no McBurney point tenderness Dx: graded compression abd US. If inconclusive --> abd MRI If untreated, patients can develop pylephlebitis: inflammation and thrombus of the portal veins.

Answer 12

B: Breathe: do not push E: elevate legs and flex hips (thighs against abdomen) C: Call for help A: Apply suprapubic pressure L: enLarge vaginal opening with episiotomy M: Maneuvers - Delivery posterior arm - Rotate posterior shoulder: apply pressure to the anterior aspect of the posterior shoulder - Adduct posterior fetal shoulder: apply pressure to the posterior aspect of the posterior shoulder - Mother on hands & knees: "all fours" - Replace fetal head into pelvis for C-section

Answer 13

Ultrasound appearance is indistinguishable from leiomyomas Should be suspected in postmenopausal patients RF: tamoxifen use and pelvic radiation Tx: hysterectomy Aggressive tumor with a high risk of recurrence and poor prognosis

Answer 14

Prenatal care: - baseline 24hrs urine collection/testing for total protein ---worsening chronic HTN doesn't have sig change in proteinuria ---superimposed preeclampsia have progressive proteinuria - Baseline chemistry panel - Serial urine culture - Pneumococcal vaccination - Folic acid - Aspirin - Series fetal growth US exams Obstetric complications: - Spontaneous abortion - Preeclampsia, eclampsia - Abruptio placentae - Antepartum bleeding Fetal complications: - Fetal growth restriction - Oligohydramnios - Preterm birth Acute sickle hepatic crisis - Episodes can be more severe during pregnancy with increasing gestational age. - Repetitive RBC sickling cause destruction of erythrocytes and intra-extravascular hemolysis. - Repetitive episodes are associated with increased fetal and maternal morbidity.

Answer 15

Complication of ovulation induction therapy for infertility Path: - high hCG enhances ovarian - acute fluid shift to extravascular space (third spacing) Sx: - N/V/abd pain - Ascites - Respiratory distress - Hemoconcentration - Hypercoagulabiltiy - Electrolyte imbalance - Multiorgan failure (renal failure) - DIC -Rapid weight gain Dx: - Fluid balance monitoring - Serial CBG, electrolytes - Serum hCG - Pelvic US: bilateral enlarge ovaries with multiple follicles - Chest xray: pleural effusion - Echo: pericardial effusion Tx: - Corrected electrolyte imbalance - Paracentesis and/or thoracentesis - Thromboembolism prophylaxis

Answer 16

- Presentation: fetal body part close to birth canal - Position: -----Occipital anterior is best -----chin anterior is possible -----chin poster (next to sacrum) is not - Station

Answer 17

Sx: infertility, hot flashes, night sweats, vaginal atrophy Labs: Elevated FSH but low estrogen before 40 Pelvic US: thin endometrial and small ovaries Additional testing to find underlying cause: adrenal antibodies, TSH and karyotype analysis Tx: estrogen replacement

Answer 18

Most common type is Epithelial ovarian carcinoma RF: Family hx, genetic mutation (BRCA1/BRCA2), age >50, endometriosis, infertility, early menarche/late menopause Protective factors: OCP, multiparty, breastfeeding Sx: - Asx: incidental adnexal mass - Pelvic/abd pain, bloating, early satiety - Dyspnea, obstipation/constipation, abd distension Labs: - High CA-125 - US: solid complex mass, thick separations, ascites - If US is suspicion --> CT Tx: - Surgical exploration, chemotherapy

Answer 19

RF : HPV (strains 16,18), history of STI, early onset of sexual activity, multiple or high-risk sexual partners, immunosuppression, oral contraception use, low socioeconomic status, tobacco use Sx: - Mostly asymptomatic - Irregular vaginal bleeding and a friable exophytic cervical mass - Postcoital bleeding; watery, mucoid vaginal discharge; and ulcerative cervical lesions Dx: - Suspicious cervical lesions require a cervical punch biopsy

Answer 20

Melasma: - Acquire hyperpigmentation on sun-exposed areas of face - RF: darker skin, family hx, thyroid dysfunction, medications (antiepileptics, oral contraception) - Most common in women, esp during pregnancy, when elevated estrogen, progesterone, and melanocytes-stimulating hormone levels caused melanocyte stimulation - mostly resolved within 1 year of giving birth but some areas stay. Tx: - Try to minimize sun exposure, using sunscreen - skin-lightning agents and topical retinoid cream

Answer 21

new onset HTN, proteinuria and/or end organ damage at >20 weeks Thought to be caused by abnormal increase in platelet aggregation and vasoconstriction --> placenta infarction and ischemia. In high risk patients, daily low-dose aspirin therapy initiated between 12 - 16 weeks

Answer 22

Breast mass: Age <30: US -------Simple cyst --> Needle aspiration -------Complex cyst/mass --> Biopsy Age 30-39: Mammogram or US Age >40: Mammogram + US -------Suspicous? Biopsy ----If aspiration is non bloody (clear, green, straw-colored) and the cyst resolves: no additional testing ----if blood and/or mass persist: biopsy Gynecomastia: Physiologic: imbalance in hormones - Androgens are converted to estrogen --> unilateral/bilateral, asymmetric or tender for boys at Tanner stage 3-4. Pathologic: Occuring before or after mid-puberty (Tanner stage 1 or 5), rapid progression or size >4cm, around nipple or persistence for >3 years. Can order CMP (to r/o hepatic or renal disease) and hormonal studies (TSH, testosterone, estrogen, prolactin, LG, beta-hcg). Nipple discharge Pathologic: unilateral, bloody, spontaneous --> imaging Physiologic: bilateral, multi-ductal expressed only with manipulation --> galactorrhea work up

Answer 23

Screen: - Age 50-74 every 2 years - age 40-49 based on shared decision making and RF's - Gene testing for high risk patients. High risk is two 1st-degree family members or 3+ 2nd-degree family members RF: 1. Tumor suppressor gene mutation: BRCA1 and BRCA2 are tumor suppressor genes that repair dsDNA breaks. Mutations are inherited in AD manner 2. Klinefelter syndrome: extra X increases estrogen/androgen ratio. Sporadic error so family history does not increase risk. Breast-conserving therapy: lumpectomy, lymphadenectomy, radiation CI: multifocal disease (>2 tumors in separate quadrants), inflammatory breast cancer, prior therapeutic chest wall radiation therapy Other treatment: chemo, mastectomy w/axillary LN dissection, and radiation ______________________________________________ Lobular carcioma in situ: - Classically has no pleomorphic changes, consistent with non-invasive lesions. Usually observed with surveillance. - Nonclassical LCIS does have suggestions of possible malignancy, and increased risk of developing invasive carcinoma. - Tx: If core needle biopsy is concerning --> Excisional biopsy ______________________________________________ Intraductal papilloma - Benign papillary tumor arising from breast duct lining - Dx: unilateral, bloody discharge (can be non-bloody), no associated breast mass (nonpalpable d/t to size and location), no lymphadenopathy. Tx: Mammography but if negative: US or MRI Biopsy +/- excision ______________________________________________ Mammary duct ectasia: - Causes fibrosis and inflammation of subareolar ducts --> multicolored discharge (blue or green-brown) and breast mass.

Answer 24

Full thickness disruption of the uterine wall RF: - Prior uterine surgery - Induction of labor/prolonged labor - Congenital uterine anomalies - Fetal macrosomia - Interpregnancy interval <18mo Sx: - PAINFUL Vaginal bleeding - Intraabdominal bleeding (hypotension, tachyardia) - Fetal heart rate: late deceleration - Loss of fetal station - Palpable fetal parts on abdominal exam - Loss of intrauterine pressure Tx: Laparotomy for delivery and uterine repair