OB/Gyn Flashcards
Chadwhick’s sign
Bluish/ purple vagina/cervix
Chandelier sign
Cervical motion tenderness, seen with PID
McDonald’s sign
Uterus is flexible at uterocervical junction at 7-8 weeks
Hegar’s sign or Goodell’s
softening of the cervix
Antibiotics to avoid in pregnancy
Floroquinolones
When to administer Rhogam
28 weeks gestation in Rh- mom abortion ectopic pregnancy invasive procedure: AVS, CVS Hydatidiform mole trauma cephalic version (breech) antepartum hemorrhage
Maternal Serum Alpha Fetal Protien in down syndrome
Levels will be LOW
Fundal Height at 20 weeks
umbilicus
Braxton Hicks contractions
Contractions without a change in cervical dilation or effacement
Fetal Heart tones
Variable decelerations : Cord compression
Early decelerations: Head compression
Accelerations: Ok
Late decelerations: Placental insufficiency
*WANT variable acclerations
Fibroadenoma
Seen in young females (25)
rubbery, painless mobile mass that does not change with the menstrural cycle like a fibrocystic mass will
Mastitis
Pain and swelling of breast usually after breast feeding
from STAPH aureus
treat with Dicloxacillin or Keflex, continue breast feeding while on antibiotics
Spontaneous abortion types (must occur before 20 weeks or else its a still birth)
Threatened: Os closed, No products passed TX: bed rest 1-2 days
Inevitable: Os Open, No products passed
Incomplete: Os Open, Some products passed
Complete: Os Closed, Products have passed
Missed: Os Closed, no pregnancy developed
Ectopic pregnancy labs
Beta Hcg will be lower than expected for normal pregnancy (don’t get doubling like with normal pregnancy)
Hcg of 6500 with empty uterine cavity on US is diagnostic, Laparoscopy is definitive
Ectopic pregnancy treatment
Methotrexate in STABLE patient
if hemodynamically unstable surgical management is needed with blood type and cross (only tx if ruptured ectopic pregnancy)
Hydatidiform Mole
benign neoplasm of chorion s/s: vaginal bleeding, enlarged uterus, pelvic pain B-hCg is EXTREMELY high! above 40,000 us shows snowy uterus treat: D&C
Choriocarcinoma
Highly malignant gestasional trophoblastic disease
PAINLESS bleeding in 3rd trimester
Placenta Previa
NO vaginal or speculum exam
Risk factors for placental abruption
Trauma, cocaine, smoking, previous abruption
IS PAINFUL
Placenta Accreata
placenta attaches too deeply in the uterine wall
McRobert’s maneuver
suprapubic pressure on anterior shoulder with legs fully flexed
Primary cause of post partum hemorrhage
uterine atony
tx. with fundal massage 1st then fluid/blood products and oxytocin
Preeclampsia Triad
Hypertension (>140/90), protienuria, edema
Eclampsia Treatment
Deliver baby and give mom betamethasone for fetal lungs
Give Oxytocin to induce contractions
Magnesium Sulfate, if toxicity (decreased reflexes) then reverse with Calcium Gluconate
Biggest risk factors for preterm birth
Multiple gestation
prior preterm birth
treat with tocolytics to stop preterm labor ( CCB’s if 32-34 wks, Indocin if 24-32 wks, Terbutaline, Mag Sulfate)
Group B strep prophylaxis
Screen at 35-37 weeks
administer Penicillin G if positive or with PROM, if PCN allergy five clindamycin or Ancef
Leading indication for a C-section
shoulder dystocia (Failure to profess during labor)
non reassuring fetal status
fetal malpresentation
role of progesterone in ovulation
during luteal phase of cycle if no conception occurs the corpus luteum secretes progesterone and as levels fall, menstrual period is triggered
If implantation occurs, HCG is released from zygote and sustains the corpus luteum for 6-7 weeks until placenta takes over
Midcycle pelvic pain
Middleschmerz
Diagnosis of endometriosis confirmed with…
Laparoscpy, can see chocolate cysts in uterus
Pelvic Inflammatory disease presents with
lower abdominal pain
adnexal tenderness
cervical motion tenderness on bimanual exam (Chandelier sign)
usually from gonorrhea or chlamydia trachomatis
PCOS symptoms
oligomenorrhea or amenorrhea, obesity, hirsutism, androgen excess (testosterone), insulin resistance (acanthosis nigricans)
What hormone spikes at ovulation
LH
Body temp also increases during luteal phase
symptoms of ovarian cancer
abdominal/pelvic pain, bowel changes, gas/bloating
RARELY symptomatic
screen with CA-125
Strawberry cervix consistant with
Trichomonas
Nabothian Cysts
Mucous filled cyst on cervix
benign and usually resolve on their own
HPV types for cervical cancer and genital warts
16 and 18= cancer
6 and 11= warts (condylomata)
Cervical cancer screening
Start pap at age 21 for every 3 years
age 30-65 pap with HPV screening every 5 years
stop at age 65 as long as never above CIN 1
Endometrial cancer # 1 sign
painless bleeding post menopaus
Risks of endometrial cancer
Unopposed estrogen (PCOS, obesity), nulliparity, estrogen use WITHOUT progesterone (Tamoxifen)
Uterine Fibroids
benign tumor of myometrium, usually shrink after menopause
Present with menorrhagia and pelvic pain
PE: enlarged asymmetric uterus
Treat with IUD or myomectomy
Drugs that interact with OCP’s
Ritnavir, Rifampin, phenobarbitol, carbamazepine, phenytoin, St Johns wart
OCPs to use during lactation
Progesterone only
Trichomoniasis
pH: 5-6
frothy green/yellow discharge, post-coital bleeding from strawberry cervix
Tx one time dose PO Flagyl
Bacterial Vaginosis
pH: >4.5
Clue cells on wet mount
fishy odor with white/grey discharge
Treat with FLAGYL (NO ALCOHOL on flagyl)
Candidiasis
pH: 4-4.5 KOH prep with hyphae and budding yeast cottage cheese discharge antibiotic use, pregnant, immunocompromised, DM Tx PO Diflucan and topical Miconazole
***Diagnosis of Herpes
Tzank Smear
What to suspect if palpate ovaries in a postmenopausal women
ovarian cancer
Hormone elevated in menopaus
FSH (low estrogen, low progesterone)
