OB-Gyn Flashcards
Flank pain that radiates to groin
Renal colic (kidney stones)
Dx: US of kidneys & pelvis in pregnant pt
Ferning (Fern Test)
+amniotic fluid → Rupture of membranes (detects onset of labor)
- Occurs due to the presence of sodium chloride in cervical mucus under estrogen effect when the mucus dries on a glass slide. When high levels of estrogen are present, just before ovulation, the cervical mucus forms fern-like patterns due to crystallization of sodium chloride on mucus fibers. Also known as “arborization”.
- Disappearance of ferning suggests ovulation (when progesterone is dominant hormone)
- Persistence of ferning throughout menstrual cycle suggests anovulation
Anterior vaginal wall tenderness
Bladder pain syndrome
(+urinary Sx)
Postcoital bleeding/spotting
Cervical carcinoma
Chronic pelvic pain + uniformly enlarged boggy uterus + HMB (heavy menstrual bleeding)
Adenomyosis
(trapped endometrial glands in myometrium)
Tenderness in posterior cul-de-sac
(Pouch of Douglas; between uterus & colon)
Endometriosis
Atypical glandular cells on Pap
Endometrial biopsy indication
- +colposcopy
- +endocervical curettage
- to r/o cervical or endometrial adenocarcinoma
PCOS ovulation induction if wt loss fails
Letrozole > Clomiphene citrate
- Letrozole = nonsteroidal aromatase inhibitor
- Better fertility outcomes & fewer heterotrophic pregnancies compared to clomiphene
PCOS first line Tx
Wt loss
PCOS menstrual regulation Tx
OCPs
Failure of follicle maturation
PCOS
MOA: High adipose tissue → High peripheral androgen conversion → Persistently elevated estrone → Inhibitory feedback to hypothalamus → FSH suppression (+lack of LH surge) →Failure of follicle maturation → Infertility
Word catheter placement
for Bartholin gland cysts
- following I&D to allow for continued drainage & reepithelialization of a tract for future drainage
Contraindicated in migraine w/ aura
OCPs
(Estrogen-containing medications)
FSH in menopause
Elevated
Dx of PMS
Symptom diary of luteal phase symptoms
(2 weeks before menses until menses)
PMS Tx
SSRIs
Eczematous/ulcerating, itchy rash localized to nipple
Paget disease of the breast → Underlying adenocarcinoma
(thought to be caused by migation of neoplastic cells through the mammary ducts to the nipple surface)
UL bloody nipple discharge w/o lesions (clear breast)
Breast papilloma
- When a single tumor grows in a large milk duct, it’s called a solitary intraductal papilloma
Breast binding/tight bras are NOT RECOMMENDED for lactation suppression due to
Risk of mastitis, plugged ducts, increased pain, & inadvertent nipple stimulation
Failed induced progesterone withdrawal bleed
Asherman syndrome
(intrauterine adhesions)
- Secondary amenorrhea from previous uterine instrumentation or infection
Mittelschmerz
UL abd pain w/ ovulation in young women
(Day 10-14)
Clear, elastic, thin (uncooked egg white in appearance) cervical mucus secretion at cervical os
Corresponds to LH surge, indicating ovulation
(occurs just prior to ovulation & used to time intercourse in couples trying to conceive)
Erythematous breast + dimpling or pitting
Inflammatory Breast Carcinoma
- Order mammography, US, & tissue biopsy
Chemotherapy + amenorrhea
Ovarian failure
- Decreased Estrogen (due to loss of estrogen production from follicular granulosa cells)
- Elevated FSH & LH
- Normal PRL & TSH
- Hypergonadotropic hypogonadism (primary ovarian insufficiency)
- Tx: Hormone replacement therapy (HRT)
Theca cells & granulosa cells produce:
- Theca: Androstenedione (estradiol precursor)
- Granulosa: Estradiol (conversion from aromatase)
- Estradiol is later converted to estrogen, which is released from follicle during follicular phase;
- Estrogen peaks at end of follicular phase causing LH surge
- Progesterone is released from corpus luteum
- Progesterone is elevated during luteal phase (following ovulation)
- Hypothalamus (GnRH) → Anterior Pituitary (LH/FSH) → Ovary (theca/granulosa cells) → androstenedione, estrogen, progesterone (LH)
- Males:
- LH → Leydig → T → inhibits hypothalamus & AP
- FSH → Sertoli → Inhibin → inhibits AP
PID can lead to this presentation w/ RUQ pain
Perihepatitis
(Fitz-Hugh-Curtis Syndrome)
Sharp or stabbing pain w/ intercourse
Ovarian cyst (ruptured)
Natural form of contraception for first 6 months postpartum
Elevated prolactin for lactation (production, not ejection)
- PRL inhibits GnRH → decreased LH/FSH → Anovulation
Heterosalpingogram
Visualization of uterus/fallopian tubes to investigate infertility
Endometriosis after failing NSAIDs & OCPs
Diagnostic laparoscopy
Most common reason for female infertility
Endometriosis (~25%)
Pts w/ endometriosis are at an increased risk for
Infertility
(most common reason for female infertility; ~25%)
Adnexal mass w/o doppler flow
Ovarian torsion
(Adnexal torsion)
- Dx: Ultrasound
- Tx: Laparoscopy (cystectomy & detorsion)
Cervical lesion
“the answer is always colposcopy”
Proliferation of SM cells within the myometrium, irregular uterine enlargement, & chronic anemia/AUB (abnormal uterine bleeding)
Leiomyomata uteri
(fibroids)
Uniformly enlarged uterus
Adenomyosis
(proliferation of endometrial glands inside the uterine myometrium)
Irregularly enlarged uterus
Fibroids
Simple, small, thin-walled cyst
Follicular ovarian cyst
Adnexal mass w/ hyperechoic nodules, calcifications
Cystic teratoma
(non-seminomatous dermoid ovarian cyst)
- Elevated B-hCG, Elevated AFP
Stress incontinence is associated with
Urethral hypermobility
Tx:
- Kegels
- Urethral sling surgery
- Pseudoephedrine (alpha-adrenergic)
- SUO POB
Urge incontinence Tx
- Oxybutynin (antimuscarinic) and/or
- Tamsulosin (alpha-blocker)
Overflow incontinence Tx
Bethanechol (cholinergic)
“Bethany call me to stimulate your bowels and bladder”
HTN + Proteinuria in pregnant pt
Preeclampsia
- +seizures = Eclampsia
- Tx:
- Delivery
- Magnesium for Sz PPX
- Antihypertensive management
Hemolysis, elevated LFTs, thrombocytopenia in pregnant pt
HELLP Syndrome
(severe pre-eclampsia)
- Tx:
- Delivery
- Magnesium for Sz PPX
- Antihypertensive management
UL bloody nipple discharge w/o mass
Intraductal Papilloma
Ovarian mass + thick septations + ascites
Epithelial ovarian cancer
(from abnormal proliferation of tubal epithelium or ovarian epithelium)
CA-125 is used to detect epithelial ovarian cancer, particularly in:
Postmenopausal women
Also elevated in:
- Leiomyomata
- Endometriosis
Diminished ovarian reserve in women begins at
>35yo
Uterine synechiae
Asherman syndrome
(synechiae = adhesions)
Urethral hypermobility
Stress Incontinence
- Kegels
- Urethral sling surgery (long-term)
- Pseudoephedrine (alpha-adrenergic)
High-risk HPV
16 & 18
(cervical cancer)
Non-high risk strains of HPV
6 & 11
(Condylomata acuminata–genital warts)
- Tx: Trichloroacetic acid or surgical removal
Tamoxifen (SERM) is contraindicated if
h/o VTE
Tamoxifen (SERM) can cause
Endometrial carcinoma
Antiestrogens/Estrogen antagonists (SERMs) are indicated in
(Tamoxifen, raloxifene, clomiphene citrate)
ER+ breast cancer
- ADE: Vaginal dryness, decreased libido
- Tamoxifen can lead to endometrial cancer
- Clomiphene is Tx for PCOS infertility