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EOR: Family Medicine > OB-Gyn > Flashcards

OB-Gyn Flashcards

1
Q

a 66-year-old female with mass she felt in her left breast on recent breast self-examination.

No nipple discharge, hx of breast or other cancers.

Physical examination confirms painless, firm, irregular and immobile lump in the superolateral quadrant of the left breast

there are no evident overlying skin changes and there is no notable axillary lymphadenopathy on palpation.

This presentation is concerning for…

A

breast CA

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2
Q

Patient p/w:

  • unilateral localized breast pain w/ associated tenderness, erythema, warmth
  • Cracked nipples/fissure +/- purulent d/c
  • systemic sxs
A

Acute mastitis

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3
Q

Acute mastitis is most common in what population?

A

lactating women

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4
Q

MC pathogen responsible for acute mastitis and breast abscess?

A

staph aureus

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5
Q

1st line tx for acute mastitis…

A

supportive care/NSAIDs, breast pump

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6
Q

Anti-staph abx available for acute mastitis

A

dicloxacillin, nafcillin, cefazolin

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7
Q

Tx for breast abscess…

A

I & D or needle aspiration

+

nafcillin/dicloxacillin/cefazonlin + metronidazole

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8
Q

MC breast d/o in women 30-50 yo (reproductive age)?

A

fibrocystic breast

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9
Q

30-50 yo patient presents with breast mass on both breasts that changes in size with menstruation.

Reports worsening just before period begins.

initial DDx?

A

fibrocystic breast

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10
Q

On physical examination of a reproductive aged female, you notice multiple nodular, mobile, smooth round lumps bilaterally

Found in upper-outer /tail of spense

A

fibrocystic breast

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11
Q

Patient complains of a firm, nontender, solitary well circumscribed lump in the breast

it is freely mobile and feels rubbery to the touch.

doesn’t change with menstrual cycle

A

Fibroadenoma

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12
Q

First diagnostic test performed for breast mass that has suspicious features?

A

mammogram

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13
Q

Imaging of choice for fibrocystic/fibroadenoma?

A

ultrasound

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14
Q

what offers definitive dx of fibroadenoma?

A

FNA/Bx showing “swirl” collagen

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15
Q

Patient presents with:

mass felt in left breast

immobile, painless, firm, irregular lump

+/- bloody nipple d/c

A

breast CA

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16
Q

4 risk factors for breast cancer?

A
  1. BRCA1 and 2
  2. increasing age (> 60 yo)
  3. Increased number of menstrual cycles (early menarche, late menopause, late pregnancy)
  4. increased estrogen exposure
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17
Q

MC type of breast CA?

A

infiltrating intraductal carcinoma

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18
Q

60 yo women presents with chronic eczematous itchy, scaly rash on nipples and areola with a breast lump at the tail of spence…

A

paget disease

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19
Q

60 yo women presents with red, swollen, warm and itchy breast

nipple retraction and peau d’orange.

What is suspected and what is the prognosis?

A

inflammatory breast CA

Poor prognosis

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20
Q

What is a sign of locally advanced breast CA?

A

axillary LAD

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21
Q

Which type of breast CA is responsible for 10% of cases and is often bilateral?

A

infiltrating lobular carcinoma

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22
Q

Red flags for malignancy on mammogram… (2)

A

spiculated, microcalcification

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23
Q

Which imaging modality should be used as first line image for women < 40 yo with breast mass?

A

ultrasound

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24
Q

What is a disadvantage of FNA for breast CA testing?

A

doesn’t allow receptor testing

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25
Q

What type of Bx is the most accurate diagnostic test for breast CA?

A

open Bx

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26
Q

Tx of choice for early stage breast CA?

A

lumpectomy with sentinal node biopsy + radiation

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27
Q

What Tx can be used in PRE-menopausal women with estrogen receptor positive tumors?

A

tamoxifen

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28
Q

What tx is useful for POST-menopausal estrogen receptor positive tumors?

A

aromatase inhibitors (letrozole, anastrozole, exemestane)

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29
Q

What tx is useful for anti-HER2 breast CA?

A

trastuzumab.

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30
Q

USPSTF guidelines for breast CA screening?

A

mammo q 2 years from 50-74

start at 40 yo if increased risk factors

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31
Q

45 yo female presents with:

post coital bleeding

friable, bleeding cervical lesion on physical exam

A

cervical CA

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32
Q

MC type of cervical CA…

A

squamous cell carcinoma

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33
Q

MC area of spreading for cervical CA?

A

paracervical lymph nodes

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34
Q

Dx of cervical CA?

A

colposcopy + Bx

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35
Q

45 yo female presents with:

  • pressure in pelvis when straining
  • incomplete bladder emptying after urination
  • urinary incontinence
A

cystocele

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36
Q

4 diagnostics for cystocele…

A
  1. POP-Q
  2. US
  3. MRI
  4. VCUG
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37
Q

Tx of cystocele

A

flexible ring/pessary

bladder mesh surgery

38
Q

What is the primary cause of an AUB in a woman without identifiable anatomic lesion?

A

endocrine/hypothalamic-pituitary-ovarian axis problems

39
Q

Pelvic exam for a true AUB will be…

A

normal

40
Q

Gold standard Dx for AUB…

A

uterine dilation and curettage

41
Q

Workup for AUB…

A

Labs + imaging
urine preg

CBC, iron studies, coags, progesterone, prolactin, FSH, LFTs

US

42
Q

Tx for AUB…

A

OCPs and NSAIDs

43
Q

Dx of dysmenorrhea

A

urine preg + pelvic US

44
Q

Primary dysmenorrhea has does or doesn’t have an organic cause?

A

doesn’t

45
Q

Primary dysmenorrhea is often found in what age group?

A

teens-early 20s

46
Q

Primary or secondary dysmenorrhea?

increases in severity until end

common in women aged 20-40

A

secondary dysmenorrhea

47
Q

Menopause occurs with ____ months of amenorrhea at an average age of ____

A

12 months

51 yo

48
Q

FSH level in menopause…

A

FSH > 30

49
Q

6 contraindications for HRT for menopause

A

increased triglycerides

endometrial CA

Hx of breast CA

Heart disease, Stroke, DVT, PE Hx

50
Q

what population should not use estrogen solo therapy to treat menopause sxs?

A

intact uterus

51
Q

Full term infant…

A

37-42 weeks gestation

52
Q

TPAL =

A

T = full term

P = preterm

A= abortions before 20 wks

L = living children

53
Q

Chadwick’s sign…

A

bluish discoloration of vagina/cervix in pregnancy

54
Q

2 skin changes in pregnant women…

A

melasma/chloasma

linea nigra

55
Q

hegar’s sign…

A

softening between uterine fundus and cervix

56
Q

at 12 weeks the uterus is at ______

at 20 weeks the uterus is at ____

A

12 weeks = symphysis pubis

20 weeks = umbilicus

57
Q

HR of fetus…

A

120-160

58
Q

Which labs will increase and decrease in pregnancy?

A

cholesterol increase

BUN/Cr decrease

59
Q

9 labs to be completed at first prenatal visit…

A

CBC

blood type, RH factor, antibodies to blood group antigens

Random glucose

VDRL (RPR)

Hepatitis B

Rubella

Urine

Pap smear (if less than 1 year since last)

Group B streptococcus

60
Q

5 components present at every prenatal visit

A

Maternal weight

Blood pressure

fundal height

fetal size and presenting part

urine dipstick for protein, glucose, ketones

61
Q

Screening at 10-13 weeks…

A

PAPP-A, nuchal translucency (downs, turners, trisomy 13, 18)

62
Q

Screening at 15-18 weeks?

A

AFP/quadruple screen

63
Q

Screening at 18-22 weeks…

A

official anatomical sonogram

64
Q

Screening at 24-28 weeks…

A

Glucose Challenge Test

65
Q

Screening at 28 weeks…

A

Rhogam if woman is RH negative

66
Q

Screening at 32 weeks… (4)

A

CBC, VDRL, G/C, GBS

67
Q

Recommended weight gain for an average weight woman during pregnancy…

A

20-35 lbs

68
Q

A positive nonstress test during labor is…

A

2 accelerations in 20 minutes up 15 beats for 15 seconds

69
Q

is a positive NST good or bad during labor?

A

good

70
Q

Oxytocin challenge test (or Contraction Stress Test) is positive if…

A

late decelerations with each contraction

71
Q

Is a positive oxytocin challenge test good or bad?

A

bad

72
Q

What FHR change?

rapid FHR drop with return to baseline

A

variable deceleration (benign to severe, indicates cord compression)

73
Q

What FHR change?

FHR drop at the end of contraction

A

Late deceleration

always worrisome, indicates uteroplacental insufficiency

74
Q

Consistent _____ after a contraction can indicate fetal distress

A

decelerations

75
Q

Outpatient Tx of PID…

A

250 mg ceftriaxone IM x 1 dose

+

Doxy 100mg BID x 14 days

+/-

Metronidazole 500 mg BID x 14 days

76
Q

50-year-old female with pelvic pressure reports and a sensation of a mass present in the vagina. She reports chronic constipation and a sensation that the rectum is not completely emptied following a bowel movement. Occasionally, she experiences episodes of fecal incontinence.

A

Rectocele

77
Q

What type of abortion?

bloody vaginal discharge before 20 weeks of gestation with or without uterine contractions

closed cervix

A

threatened abortion

78
Q

What type of abortion?

dilated cervical os with the passage of some but not all products of conception before 20 weeks of gestation

A

incomplete abortion

79
Q

What type of abortion?

dilated cervical os without passage of tissue before 20 weeks of gestation

A

Inevitable abortion

80
Q

What type of abortion?

death of the fetus before 20 weeks of gestation, with products of conception remaining intrauterine

A

Missed abortion

81
Q

What type of abortion?

expulsion of all or part of the products of conception before 20 weeks of gestation

A

Spontaneous abortion

82
Q

Tx of candidal vaginitis?

A

fluconazole 150mg PO x 1, repeat in 7 days

83
Q

Tx of BV (3)

A

metronidazole 500 mg PO BID x 7 days

or

metronidazole 750 mg QD x 7

or

clindamycin intravaginal gel x 7 days

84
Q

3 diagnostics of bacterial vaginosis…

A

pH > 4.5 (bacterial = basic)

(+) whiff test

Clue cells

85
Q

Patient presents with:

malodorous green/yellow frothy vaginal d/c

strawberry cervix

A

Trichomoniasis

86
Q

Tx for trichomoniasis…

A

metronidazole 2g PO x 1

87
Q

Pt. p/w

painful intercourse

recurrent UTIs despite treatment

thin appearing vaginal mucosa

A

atrophic vaginitis

88
Q

Tx for atrophic vaginitis

A

conjugated estrogen cream

89
Q

trichomoniasis vaginal pH…

A

5-6

90
Q

vulvovaginal candidiasis vaginal pH

A

4-4.5 (normal)

91
Q

bacterial vaginosis vaginal pH…

A

> 4.5

EOR: Family Medicine (14 decks)

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