ob gyn Flashcards
breast hyperplasia is caused by decrease in _____ and/or increase in _____
dec progesterone
inc estrogen
women >25 y/o with breast hyperplasia need what workup?
baseline mammography to rule out carcinoma
woman has cyst in breast. you aspirate. fluid is bloody and/or there is still residual mass. what is next step?
must open biopsy
woman < 30 years old with sharply circumscribed mobile nodule in breast. what is it most likely?
fibroadenoma. benign but have malignant potential
50 yr old woman just starting to feel symptoms of menopause. complaining of bloody or serous nipple discharge. what is most likely dx and tx?
intraductal papilloma (benign)
dx: mammogram shows single dilated duct
tx is excisional biopsy of lesion and involved duct
breast carcinoma extension to skin causes ______, to nipple causes _____, to skin lymphatics causes ______
skin - retraction and dimpling
nipple - nipple retraction
lymphatics - lymphedema + skin thickening = peau d’orange
common acute complications of radiation to pelvic area (gyn onc) and their presenting symptoms (4)
acute cystitis - hematuria, urgency and frequency incontinence
proctosigmomiditis (IBD) - tenesmus, diarrhea, blood and mucus in stool
enteritis - nausea, v/d, colicky abdominal pain
bone marrow suppression
chronic complications of radiation (occur 6+months after radiation) (3)
- endarteritis
- fibrosis
- permanent reduction in epithelial and parenchymal cell populations
- bowel stuff - strictures and fistulas and IBD
what is MOA of tamoxifen
ER antagonist in breast
agonist in bone
partial agonist in endometrium
giving estrogen contraindications
hypercoaguability (clotting disorders, immobile?)
chronic htn
breast cancer or hx of
migraines with aura or neurologic deficits
liver tumors
colonoscopy start at ___, Q___
mammograms start at ___, Q___
pap smears start at ___, Q___
(Qs are if everything is normal)
colonoscopy start at 50, Q10yrs
mammograms start at 40 or 50, Q1yrs
pap smears start at 21, Q3yrs
what gyn cancer presents as post coital bleeding in reproductive age
cervical cancer
what gyn cancer presents as black vulvar lesions
vaginal melanoma (squamous cell carcinoma)
what gyn cancer presents as red vulvar lesions
vaginal carcinoma - Paget’s
what gyn cancer presents as ascities/pelvic mass/asymptomatic
ovarian cancer
what gyn cancer presents as post menopausal bleeding
endometrial cancer (adenocarcinoma)
what gyn cancer presents as increased B-hCG (nausea/vomiting, other) despite delivery or abortion
molar pregnancy/choriocarcinoma
what is most common cause of elevated AFP
even tho its a screening test for genetic defects,
UNDERESTIMATION OF GESTATIONAL AGE is most common reason!
other causes include fetal demise, multiple gestation, ventral wall defect (omphalacele/gastrochesis), and liver tumor or dz
what is associated w/ late decelerations on fetal heart tracing? early decels? variable decels?
early - head compression. (normal, from the contractions)
late - placental insufficiency
variable - umbilical cord compression (oligiohydramnois increases the risk of this but itself does not cause variable decels)
Hgb and Hct cutoffs for maternal anemia 3rd trimester screening?
Hgb <10
Hct <30
btw next step is get iron studies. ferritin will be low, MCV low, RDW elevated
tx: iron
initial steps to stabilize for if woman is bleeding out of her uterus and is hemodynamically stable (either PPH or just other gyn bleeding)
2 large bore IVs
intravenous fluid bolus
type and cross, transfuse as needed
To turn off uterine bleeding, IV estrogen is administered
triple abx tx for chorioamnitis/endometritis
gent + amp + clinda
management of intrahepatic cholestasis of pregnancy (3)
ursodeoxycholic acid (decrease bile acid levels) frequent NST to moniter baby deliver by 37 weeks
med for pregnant woman with symptomatic MVP (palpitations, chest pain)
B blockers
