Ob-Gyn 3 Flashcards
What is another name for atrophic vaginitis?
The genitourinary syndrome of menopause
___ maintains the moisture, blood flow, and collagen content (eg, elasticity, turgor) of the vulvovaginal tissues (eg, vagina, vulva, urethra). Thus, patients with low ___ levels eventually develop dryness and decreased blood flow and elasticity in these tissues.
Estrogen
What are the symptoms of atrophic vaginitis?
- Vulvovaginal dryness, irritation, pruritis
- Dyspareunia
- Vaginal bleeding
- Urinary incontinence, recurrent UTI
- Pelvic pressure
What causes the symptoms of atrophic vaginitis?
Thinning of the vulvar skin -> irritation
Narrowing of the vaginal introitus -> dyspareunia
Loss of natural lubrication -> dryness
Physical exam findings of atrophic vaginitis?
Narrowed introitus
Pale, easliy-denuded, retracted, atrophic vulvovaginal epithelium (eg, clitoral shrinkage), decreased elasticity, decreased rugae
Petechiae, fissures
Loss of labial volume
First-line treatment of atrophic vaginitis?
OTC lubricants or moisturizers
Treatment of persistent or severe atrophic vaginitis?
Vaginal estrogen
___ is a chronic, inflammatory skin dystrophy that results in glazed, brightly erythematous, vulvar lesions with a purple hue that may be overlaid by white reticular lines known as ___.
Lichen planus; Wickham striae
Patients with ___ have thin, wrinkled vulvar skin that can form into thickened white plaques that eventually obliterate the labia majora and minora, scarring the normal external landmarks. It does not affect the vagina.
Lichen sclerosus
___ creates asymptomatic or pruritic vulvar lesions, particular in smokers. It appears as raised, multifocal vulvar lesions (eg, white, erythematous, hyperpigmented).
Vulvar intraepithelial neoplasia
___ causes dyspareunia due to a sharp, burning pain on the vulvar vestibule often triggered by touch (eg, positive ___ test).
Vulvodynia; Q-tip
Patients may have vestibular erythema but no associated vaginal tissue narrowing or clitoral tissue shrinkage.
___ is an insidious progressive disease, and physiologic and hemodynamic changes during pregnancy can precipitate symptoms in previously asymptomatic patients. The development of new ___ can further increase transmitral gradient and left atrial pressure, with dramatic worsening of pulmonary congestion and pulmonary edema.
Rheumatic mitral stenosis; atrial fibrillation
___ causes rapid-onset systolic heart failure (fatigue, dyspnea, cough, pedal edema) at >36 weeks gestation or the early puerperium.
Peripartum cardiomyopathy
Why is pregnancy contraindicated during breast cancer treatment?
Use of teratogenic agents such as chemotherapy and radiation
Why are hormone-containing methods of contraception avoided in patients with breast cancer?
Estrogen and progesterone may have a proliferative effect on breast tissue
True or false - BRCA2 carriers tend to have estrogen receptor-positive breast cancer.
True
List absolute contraindications to combined hormonal contraceptives.
- Migraine with aura
- 15+ cigarettes/day + 35+ years of age
- HTN 160/100+ mmHg
- Heart disease
- DM with end-organ damage
- History of thromboembolic disease
- Antiphospholipid-Antibody syndrome
- History of stroke
- Breast cancer
- Cirrhosis and liver cancer
- Major surgery with prolonged immobilization
- Use <3 weeks postpartum
True or false - combined OCs decrease the risk for ovarian cancer.
True (in the general population as well as in BRCA mutation carriers)
Typical condom use is only ___% effective in preventing pregnancy.
80
List 3 risk factors for ectopic pregnancies.
- Previous ectopic pregnancy
- Previous pelvic/tubal surgery
- PID
List 2 risk factors for a cornual ectopic pregnancy?
- Uterine anomalies (eg, bicornuate, “heart-shaped” uterus)
2. IVF
What is the first-line imaging for confirming the location of a gestational sac?
Transvaginal U/S
___ is required in a patient with hemoperitoneum and unstable vital signs.
Emergency surgical exploration
___ is used to remove uterine contents for spontaneous or incomplete abortion.
D&C
___ is used to treat a stable ectopic pregnancy. Ruptured ectopic pregnancy is a contraindication to its use.
MTX
___ is used to treat an incomplete or missed abortion. It causes cervical dilation and myometrial contraction to expel intrauterine contents.
Misoprostol
What is fetal growth restriction?
U/S estimated fetal weight <10th % for gestational age
List 4 risk factors for fetal growth restriction.
- Maternal HTN
- Pregestational DM
- Genetic abnormalities
- Congenital infection
List 5 physical exam features of an infant with fetal growth restriction.
- Large anterior fontanel
- Thin umbilical cord
- Loose, peeling skin
- Minimal subcutaneous fat
- Meconium-stained amniotic fluid
Although the underlying cause of FGR can be of fetal, maternal, or placental origin, the results are usually ___ and ___.
Utero-placental insufficiency; poor fetal growth
How should fetal growth restriction be evaluated?
- Placenta histopathology
2. Consider karyotype, urine toxicology, serology
Cranial ultrasonography evaluates for ___.
Intraventricular hemorrhage
Indications for cranial ultrasonography?
Gestational age of <30 weeks at delivery, respiratory distress (eg, tachypnea, grunting), and hypotension
List 4 risk factors for pubic symphysis diastasis.
- Fetal macrosomia
- Multiparity
- Precipitous labor
- Operative vaginal delivery
After a traumatic delivery, patients can develop a symptomatic pubic symphysis diastasis. How does it present?
- Difficulty ambulating
- Suprapubic pain radiating to the back, hips, thighs, or legs
- Pubic symphysis tenderness
- Intact neurologic examination
How is pubic symphysis diastasis managed? Most patients recover within the first ___ weeks PP.
Conservative with supportive care - NSAIDs, physical therapy, pelvic support; 4
Define primary dysmenorrhea.
Recurrent lower abdominal pain associated with menstruation
What is first-line treatment of primary dysmenorrhea in sexually active patients?
Combined estrogen-progestin OCPs
How do OCPs decrease pain symptoms in primary dysmenorrhea?
Thinning the endometrial lining, reducing prostaglandin release, and decreasing uterine contractions
List 9 side effects of OCPs.
- Breakthrough bleeding
- Breast tenderness, nausea, bloating
- Amenorrhea
- Hypertension
- Venous thromboembolic disease
- Decreased risk of ovarian and endometrial cancer
- Increased risk of cervical cancer
- Liver disorders (eg, hepatic adenoma)
- Increased triglycerides (due to estrogen component)
What is the most common side effect of OCPs? It is usually associated with ___ estrogen doses.
Breakthrough bleeding; lower
What is the first-line treatment in primary dysmenorrhea in non-sexually active patients?
NSAIDs
Which contraceptive may increase body fat, decrease lean muscle mass, and cause weight gain?
Medroxyprogesterone
Why is medroxyprogesterone not recommended for adolescents or young women?
Significant loss of bone mineral density
DDx - acute abdominal/pelvic pain in women?
- Mittelschmerz
- Ectopic pregnancy
- Ovarian torsion
- Ruptured ovarian cyst
- PID
How does Mittelschmerz present?
Recurrent mild and unilateral mid-cycle pain prior to ovulation; pain lasts hours to days
How does ectopic pregnancy present?
Amenorrhea, abdominal/pelvic pain, vaginal bleeding; positive beta-hcg
How does ovarian torsion present?
Sudden-onset, severe, unilateral lower abdominal pain; N/V; unilateral, tender adnexal mass on examination
How does ruptured ovarian cyst present?
Sudden-onset, severe, unilateral lower abdominal pain immediately following strenuous or sexual activity