ob/gyn Flashcards

Question

functional ovarian cysts

Answer 1

follicular cysts- when follicsles don't rupture and just grow corpus luteal cycstS: fail to degenerate after ovulation asymptomatic until rpture- unilateral RLQ or LLQ pain pelvic US- smooth, thin walled unilocular luteal- complex, thicker walled with peripheral vascularitiy r/o pregnancny most cysts less than 8 cm spontaneously reoslve- repeat ultrasound after 6 weeks

Answer 2

ocps are protective- decreases ovulatry cycles HIGHEST MORTALITY in all gyn cancers less ovulatry cycles put u at risk- inferitlity, nulliparity BRCA1/BRcA2, turner's, peutz jehgrers rarely symptomatic, constipation, abd fullness/distentions abd or ovarian mass, ascites, METS TO UMBilical lymph nodes (sister mary joseph's nodeS_ biopsy- 90% EPITHELIAL!!!!- serum CA-124 levels used to monitor TREATMENT PROGRESS!

Answer 3

dermoid cystic teratomas- mc enign ovarian neoplasma

Answer 4

amenorrhea, obesity, hirsuitism, insulin resistance LH DRIVEN, in ovaries- androgen production increased!!!, increased insulin!! oligomenorrhea, amenorrhea secondary hirsuitms is from too much androgen type II DM, obesity bilateral ENLARGED, smooth mobile ovaries- acanthosis nigricans increased testosterone in labs, LH AND FSH ration: 3 to 1, LH IS REALLY HIGH!!! string of pearls in pelvic- peripheral cysts OCP is treatment- noramlizes bleed- suppresses androgen, spirnolactone for hirsuitism- but teratogenic leuprolide, finasteride clomiphene for inferitlity metformin for reducing insulin

Answer 5

Management of Abnormal PAPs in Adult Women > 25 years • ASC-US: • If HPV negative – rescreen in 3 years with co-testing • If HPV positive – colposcopy • ASC-H: colposcopy • LSIL (mild dysplasia): colposcopy, if pt > 30 yrs and HPV negative - repeat co- testing in 1 year is acceptable • HSIL (mod/severe dysplasia CIS-carcinoma in situ): colposcopy or immediate LEEP excision (diagnostic excisional biopsy) • AGC: endometrial biopsy/ECC (endocervical curettage) /colposcopy

Answer 6

Management of Abnormal Pap Women 21-24 • ASC-US: repeat cytology in 12 months, HPV testing (positive hpv: repeat cytology in 12 months, negative go back to routine screening) • ASC-H: colposcopy • ***********LSIL: repeat cytology in 12 months, no HPV testing *********** - MORE LENIANT! • HSIL: colposcopy, no excisional biopsy option

Answer 7

LSIL: 1/3 thickeness affected HSIL: CIN 2: moderate dysplasia- 2/3 thickness CIN 3: full thickness- carcinoma en situ

Answer 8

human papilloma virus- 16,18!!!!!, 31,33,45, endomet cancer, ovarian cance, THEN cervical is mc hpv, DES exposure!! SQUAMOUS is MOST COMMON TYPE!! clear cell carcinoma- DES exposures post coital bleed/spotting- MC colpo with biopsy!! GARDASIL!!=-11 to 26 years old gardasil 9 covers for more! less than 15- 2 dose, more than 15-3 doses

Answer 9

can't maintain pregnancy- DES exposure- risk factor, previous cervical trauma CERCLAGE AND BED REST!!!- to prevent premature cervical dilation!!

Answer 10

e.coli, staph,gonorrhea! tender if infectious I AND D with abx

Answer 11

squamous cell MOST of the times- clear cell if DES exposure!! asymtomatic- ab vaginal bleed, vag discharge

Answer 12

squamous pruritis is MOST COMMON SYMPTOM!! red/white/ulcerative, crusted LESIONS!- biopsy

Answer 13

decreased estrogen- dryness, painful sex, infection and recurrent uti! vaginal estrogen, vaginal moisturizers

Answer 14

mostly in laactating women, s. AURESU!! MC infectious: unilateral!, tender, warmth, swelling, nipple discharge- mother can continue to nurse or breast pump!! congestive: bilateral breast abscess: fluctuance with induration, infectious: dicloxacillin, nafcillin, breast abscess: I AND D- discontinue from the affected BREAST!

Answer 15

exaggeraetd response to HORMONEs- fluid filled!! Most COMMON breast d/o multiple, mobile, lumps in breast- tender, BILATERAL no axillary involvement or nipple discharge breast cysts- INCREASE OR DECREASE WITH MENSTRUAL hromonal changes FNA- straw colored fuluid no blood

Answer 16

2nd MC benign breast disorder smooth wellcircumscribed, non tender- freely mobile, rubbery lump- DOES NOT WAX OR WANE WITH MENSTURATION!! no axillary invovlement or nipple discharge! observation

Answer 17

BRCA and BRCA2, age more than 65 years old, too many menstrual cycles!- nulliparity, prolonged uonpposed estrogen, never breastfed, increased estrogen infiltrative ductal carcinoma- MC painless, hard, fixed, non mobile lump- mc in UPPER OUTER QUADRANT, skin changes- skin retraction!!!, discoloration, ulceration, nipple INVERSION!! pagets disease of nippe: chronic eczematous itchy, scaling rash on the nipples and areola! inflmattory: red, swollen, warm, itchy brest peud'orange, lymphatic obstruction caause peu'd oranges, peud orange is poor prognonsis mamogram shows microcalcification and spiculated masses!!- ultrasound- for less than 40 y, biopsy lumpectomy, mastectomy, rmoeval of axillary lymph nodes, radiation therapy/chemo, OR ANTI-ESTROGEN!--- TAMOXIFEN!- useful for those dependent on the estrogen!!- blocks receptors of estrogen in breast tissue mammogram: every 2 years- 50 to 74 years old- start at 40 if increased risk factors every 2 years check breast: immediately after mesnturation ro on days 5-7 of mesnutral cycle.

Answer 18

hepatic fibrosis, uq pain due to perihepatitis- liver capsule involvement- complicatino from PID!

Answer 19

S. AUREUS cause- tampon use, diaphragm or sponge high fever, ertyheatmous macular rash, hypotension! TX: CLINDA and VANCO!

Answer 20

bv: mc: gardnella vaginaliis, anareobes , fish, grey-white watery, fishy odor with koh prep, clue celols, metro X 7 days, clinda no douching, trich: frothy, yellow green discharge, strawberry cervix, metro 2 g x 1 dose cervical petechiae, candida: thick crud like- coattage cheese, hyphae, yeast on koh, flucoazole or intravaginal antifungals, keep vagina dry

Answer 21

painLESS genital ulcer, anjd PAINFUL inguinal LAD , nucleic acid, azithro and doxy

Answer 22

hamephilus ducreyi- gram neg BACILLUS genital ulcer is painful and painful inguinal LAD- AZITHRO

Answer 23

5 days after conception- beta hcg increases in SERUM urine- 14 days after conception hega's sign: softening after 6-8 weeks gestation chadwick's : bluish discoloration 8-12 weeks! 10-12 weeks- fetal heart sound heard!!! pelvic ultrasound sees fetus in 5-6 weeks! 16-20 weeks: fetal movement

Answer 24

12 weeks- above pubic symphysis 16 weeks: midway between pubis and umbilicus 20 weeks: at the umbilicus 38 weeks: 2-3 cm below the xiphoid process

Answer 25

nagel's: 1st day of last menstural period plus 7 days and minus 3 montsh first visit: CBC, ua, glucose, protein, blood type and rh, random glucose, hep b, hiv, syphillis, rubella, sickle cell and cystic fibrois,s pap smear

Answer 26

``` 1-12 weeks free beta hcg papp-a nuchal traslucency!! - thickness is bad uterine size and gestation- IF ABNormal; CVS or amniocentesis- 10-13 weeks ``` ultrasound CVS: 10-13 weeks- offered to those with chromosal abnromality before , maternal age more than 35, 1st or 2nd trimesterer maternal screen abnormalities, abnormal utlrasound, prior preg loss INCREASES RISK OF SPONTAENOUS abortion!!

Answer 27

13-27 weeks 15-20 weeks- tripple screen for fetoprotien, beta hcg and estradiol low estradiol and low alpha feta BUT HIGH beta hcg!- down syndrome- 21 high alpah feta- open neural tube defects LOW EVERYTHING- trisomy 18! inhibin A: high levels is abnormal chromosome amnicoentesis: - for those at risk- 15-18 weeks GESTATIONAL DIAbETES: 24-28 weeks

Answer 28

28 to birth rhogam- 29 weeks and within 72 horus after childbirth group b strep checked- 32-37 weeks h and h biophysical: breath, tone, fluid, NST, movement!: CHECKED ON FETUS!

Answer 29

mroe than 2 accelerations in 20 mins, 15 bpm increae in heart rate from baseline- lasting more than 15 seconds is acceleration non reactive: no fetal heart rate acceleration or elss than 15 bpm in less than 15 seconds (sleeping abyb, or immature or compromised vetus)- fibratory stimulation used

Answer 30

CONTRACTION STRESS TEST: response to STRESS @ uterus contraction negative: no late deceelrations in the prescence of 3 c oontractions in 10 mins repetive LATE DECELERATIONS = in the presence of 3 contractions in 10 mins- DELIVERY of baby should be done!! variable deceleration: cord compression- which is not HORRIBLE but late decelerations are bad!

Answer 31

can't concieve fater a year! hysterosalpingography clomiphene- induces ovluation

Answer 32

mc in fallpian tube- risk factor: due to adhesions from surgery, pid cmt, adnexal mass serial b hcg should double in 24 to 48 hours trans vag- no sac with more than 2000 strongly suggests ectopic !! METROtrexate!!i s treatment!!- for stable, early gestation ones but not for ruptured rhogham if mother is rh neg ruptured: laparsocopic salpingotomy

Answer 33

Spontaneous Abortion • Pregnancy terminating before the 20th completed week • Bleeding, cramping, abdominal pain • 20% of pregnancies terminate in abortion • Majority (62%) occur prior to 8 weeks • 60% result from major chromosomal abnormalities • Diagnosis-ultrasound, serial beta-HCG (should double every 48 hours) Definitions of Abortion • Threatened Ab – Bleeding with or without cramping with a closed cervix • Inevitable Ab – Above with dilatation of cervix • Complete Ab – All products have been expelled • Missed Ab – Embryo or fetus dies but the products of conception are retained • Incomplete Abortion – Some portion of the products of conception remain in the uterus • Anembryonic pregnancy – blighted ovum • Habitual Ab – three or more abortions in succession; think SLE, thyroid

Answer 34

• Blood pressure greater or equal to 140/90 • Occurs at or after 20 weeks of gestation • No proteinuria • Treatment • Usually refrain from using anti-hypertensives • Treatment indicated for systolic > 160 mmHg or diastolic > 105-110 mmHg • NO ACE inhibitors/ARBs • Preferred drugs ▪ Labetalol, Hydralazine, Methyldopa, Nifedipine

Answer 35

htn and proteinuria and EDEMA mild: 140/90 more than that, with prtoein like 300 mg/24 hours severe: 160/110 with more than 5 g of protein, thrombocytopenia, dic, hellp syndroem!!! headache, visual! mild: delivery at 36 weeks steroids to mature lungs if less than 34 weeks severe: prompt delivery only cue plus hsop and mag sulfate- hydralazine and labetalol

Answer 36

seizures or coma- tonic-clonic seizures hyperrreflexia mag sulfate, delivery of fetus once stable,

Answer 37

methyldopa, labetalol

Answer 38

painful, vaginal bleed, dark red, abd pain, tender, rigid uterus, fetal distress!! PROMPT DELIVERY!!! mya lead to DIC

Answer 39

no abd pain, soft non tender uterus, no fetal distress | give tocolytics- mag sulfate, steroids given 24-34 weeks for lung maturity! and deliver when stable!

Answer 40

/DM only present during pregnancy risk: infant was heavy before, multiple gestations, obesity screen: 50- g oral glucose challenge test at 24-28 gestation= if more than 140 mg/dl after 1 hour- do 3 hour 3 hour 10 g- gold standard: fasting more than 95, 1 hour more than 180, 2 hour more than 155, 3 hour more than 140 give insulin glyburide labor indution at 38 weeks!!if uncontrolled 40 weeks if controlled

Answer 41

mdd 2 weeks to 12 weeks postpartum blues: just 2-3 days postpartum- resolves in 10 days, no thoughts of harming baby depression : 3-14 months!!!!!- thoughts of harming baby!

Answer 42

Gestational Trophoblastic Disease: Molar (Hydatidiform) Pregnancy • Presentation • Bleeding • Hyperemesis • Large for dates uterus • hCG markedly high for LMP • Pre-eclampsia in 1st or 2nd trimester pathognomonic for molar pregnancy • Snowstorm or cluster of grapes appearance in uterus on US Molar Pregnancy • Complications: • Metastasize to lung • Choriocarcinoma • Uterus needs to be evacuated, tissue sent to pathology • Effective birth control • No pregnancy for 1 year. . .follow serial HCG weekly to zero, then repeat monthly for one year

Answer 43

Labor and Delivery • First stage – onset of labor to complete dilation of cervix • Latent – 6 hours • Active – 3-7 hours • Second stage – complete dilation of cervix to delivery of fetus – 2 hours • Third stage – delivery of placenta – 5-30 min

Answer 44

Shoulder Dystocia • Occurs when fetal anterior shoulder impacts against maternal symphysis following delivery of head • “Turtle sign” • Risks: Fetal macrosomia (>4500 g at most risk) • Maternal diabetes • Complications: Maternal – post-partum hemorrhage, 4th degree lacerations, fetal- brachial plexus palsies, fracture of clavicle, fetal death • Management: Maneuvers to increase the functional size of pelvis, decrease the shoulder width of fetus and change the orientation of the fetus (McRoberts-flex, flex, suprapubic pressure)

Answer 45

Post-Partum Hemorrhage • Loss of >500 mL of blood after vaginal delivery • Common: 4% of vaginal deliveries • Risk Factors: prolonged 3rd stage of labor, multiple deliveries, episiotomy, hx of post- partum hemorrhage, fetal macrosomia • Causes: ▪ Tone: uterine atony - MOST COMMON CAUSE!!!!! - soft boggy uterus! ▪ Trauma: lacerations ▪ Tissue: retained placenta ▪ Thrombin: coagulopathies • Management: Active management of 3rd stage of labor, Oxytocin (Pitocin), Early cord clamping and cutting with controlled traction on cord, Hysterectomy

Answer 46

returns 6-8 weeks after postpartum uterus: at umbilicus afterdelivery, then shrinks after 2 days- descents into pelvis in 2 weeks lochia serosa: vag bleed after delivery 4-10 days- brownish/pinkish- done by 4 weeks

Answer 47

* Rupture of membranes during pregnancy before 37 weeks gestation and before the onset of labor * 3% of pregnancies; responsible for 1/3 of preterm deliveries * Complications: umbilical cord prolapse, respiratory distress syndrome, neonatal sepsis, placental abruption, fetal death * Evaluation: * Speculum exam (no digital cervical exam) pooling of fluid, nitrazine paper, ferning * Observation of fluid leakage from cervical os with valsalva * Treatment: Antibiotics, Corticosteroids, Short-term tocolysis, Delivery

Answer 48

before 36 weeks gestation antenatal steroids!!!- MOST IMPORTANT- to mature the lungs of baby tocolytics: indometacin, nifedipine, mag sulfate, beta agonists- TERUtaline!!- given for 48 hours to delay delivery so that steroids can take full effecT!!! abx: group B strep- ampicillin and amoxicillin and azithro

Answer 49

prostagland gle for early induction later induction: after some cervix dilationiv oxytocin amniotomy!

Answer 50

due to head compression | variable: due to cord compression

Answer 51

for someone with fibrocystic breast disease and endometriosis Danazol is both a weak progestin and androgen which helps to inhibit ovarian function. It is indicated in both the treatment of endometriosis as well as mastalgias secondary to fibrocystic disease and represents the best drug of choice for this patient.

Answer 52

Gestational trophoblastic neoplasia may range from a simple molar pregnancy to metastatic choriocarcinoma. These conditions are generally associated with first trimester bleeding and hyperemesis gravidarum. Physical exam usually shows an abnormally large uterus, abdominal tenderness, and pelvic exam may reveal abnormalities. Choriocarcinoma may become metastatic, with a high affinity for lung metastasis; therefore, CXR is an essential imaging study to order in these patients.

Answer 53

can cause torsion!