OB-Gyn Flashcards
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…
breast CA
Patient p/w:
- unilateral localized breast pain w/ associated tenderness, erythema, warmth
- Cracked nipples/fissure +/- purulent d/c
- systemic sxs
Acute mastitis
Acute mastitis is most common in what population?
lactating women
MC pathogen responsible for acute mastitis and breast abscess?
staph aureus
1st line tx for acute mastitis…
supportive care/NSAIDs, breast pump
Anti-staph abx available for acute mastitis
dicloxacillin, nafcillin, cefazolin
Tx for breast abscess…
I & D or needle aspiration
+
nafcillin/dicloxacillin/cefazonlin + metronidazole
MC breast d/o in women 30-50 yo (reproductive age)?
fibrocystic breast
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?
fibrocystic breast
On physical examination of a reproductive aged female, you notice multiple nodular, mobile, smooth round lumps bilaterally
Found in upper-outer /tail of spense
fibrocystic breast
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
Fibroadenoma
First diagnostic test performed for breast mass that has suspicious features?
mammogram
Imaging of choice for fibrocystic/fibroadenoma?
ultrasound
what offers definitive dx of fibroadenoma?
FNA/Bx showing “swirl” collagen
Patient presents with:
mass felt in left breast
immobile, painless, firm, irregular lump
+/- bloody nipple d/c
breast CA
4 risk factors for breast cancer?
- BRCA1 and 2
- increasing age (> 60 yo)
- Increased number of menstrual cycles (early menarche, late menopause, late pregnancy)
- increased estrogen exposure
MC type of breast CA?
infiltrating intraductal carcinoma
60 yo women presents with chronic eczematous itchy, scaly rash on nipples and areola with a breast lump at the tail of spence…
paget disease
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?
inflammatory breast CA
Poor prognosis
What is a sign of locally advanced breast CA?
axillary LAD
Which type of breast CA is responsible for 10% of cases and is often bilateral?
infiltrating lobular carcinoma
Red flags for malignancy on mammogram… (2)
spiculated, microcalcification
Which imaging modality should be used as first line image for women < 40 yo with breast mass?
ultrasound
What is a disadvantage of FNA for breast CA testing?
doesn’t allow receptor testing
What type of Bx is the most accurate diagnostic test for breast CA?
open Bx
Tx of choice for early stage breast CA?
lumpectomy with sentinal node biopsy + radiation
What Tx can be used in PRE-menopausal women with estrogen receptor positive tumors?
tamoxifen
What tx is useful for POST-menopausal estrogen receptor positive tumors?
aromatase inhibitors (letrozole, anastrozole, exemestane)
What tx is useful for anti-HER2 breast CA?
trastuzumab.
USPSTF guidelines for breast CA screening?
mammo q 2 years from 50-74
start at 40 yo if increased risk factors
45 yo female presents with:
post coital bleeding
friable, bleeding cervical lesion on physical exam
cervical CA
MC type of cervical CA…
squamous cell carcinoma
MC area of spreading for cervical CA?
paracervical lymph nodes
Dx of cervical CA?
colposcopy + Bx
45 yo female presents with:
- pressure in pelvis when straining
- incomplete bladder emptying after urination
- urinary incontinence
cystocele
4 diagnostics for cystocele…
- POP-Q
- US
- MRI
- VCUG
Tx of cystocele
flexible ring/pessary
bladder mesh surgery
What is the primary cause of an AUB in a woman without identifiable anatomic lesion?
endocrine/hypothalamic-pituitary-ovarian axis problems
Pelvic exam for a true AUB will be…
normal
Gold standard Dx for AUB…
uterine dilation and curettage
Workup for AUB…
Labs + imaging
urine preg
CBC, iron studies, coags, progesterone, prolactin, FSH, LFTs
US
Tx for AUB…
OCPs and NSAIDs
Dx of dysmenorrhea
urine preg + pelvic US
Primary dysmenorrhea has does or doesn’t have an organic cause?
doesn’t
Primary dysmenorrhea is often found in what age group?
teens-early 20s
Primary or secondary dysmenorrhea?
increases in severity until end
common in women aged 20-40
secondary dysmenorrhea
Menopause occurs with ____ months of amenorrhea at an average age of ____
12 months
51 yo
FSH level in menopause…
FSH > 30
6 contraindications for HRT for menopause
increased triglycerides
endometrial CA
Hx of breast CA
Heart disease, Stroke, DVT, PE Hx
what population should not use estrogen solo therapy to treat menopause sxs?
intact uterus
Full term infant…
37-42 weeks gestation
TPAL =
T = full term
P = preterm
A= abortions before 20 wks
L = living children
Chadwick’s sign…
bluish discoloration of vagina/cervix in pregnancy
2 skin changes in pregnant women…
melasma/chloasma
linea nigra
hegar’s sign…
softening between uterine fundus and cervix
at 12 weeks the uterus is at ______
at 20 weeks the uterus is at ____
12 weeks = symphysis pubis
20 weeks = umbilicus
HR of fetus…
120-160
Which labs will increase and decrease in pregnancy?
cholesterol increase
BUN/Cr decrease
9 labs to be completed at first prenatal visit…
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
5 components present at every prenatal visit
Maternal weight
Blood pressure
fundal height
fetal size and presenting part
urine dipstick for protein, glucose, ketones
Screening at 10-13 weeks…
PAPP-A, nuchal translucency (downs, turners, trisomy 13, 18)
Screening at 15-18 weeks?
AFP/quadruple screen
Screening at 18-22 weeks…
official anatomical sonogram
Screening at 24-28 weeks…
Glucose Challenge Test
Screening at 28 weeks…
Rhogam if woman is RH negative
Screening at 32 weeks… (4)
CBC, VDRL, G/C, GBS
Recommended weight gain for an average weight woman during pregnancy…
20-35 lbs
A positive nonstress test during labor is…
2 accelerations in 20 minutes up 15 beats for 15 seconds
is a positive NST good or bad during labor?
good
Oxytocin challenge test (or Contraction Stress Test) is positive if…
late decelerations with each contraction
Is a positive oxytocin challenge test good or bad?
bad
What FHR change?
rapid FHR drop with return to baseline
variable deceleration (benign to severe, indicates cord compression)
What FHR change?
FHR drop at the end of contraction
Late deceleration
always worrisome, indicates uteroplacental insufficiency
Consistent _____ after a contraction can indicate fetal distress
decelerations
Outpatient Tx of PID…
250 mg ceftriaxone IM x 1 dose
+
Doxy 100mg BID x 14 days
+/-
Metronidazole 500 mg BID x 14 days
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.
Rectocele
What type of abortion?
bloody vaginal discharge before 20 weeks of gestation with or without uterine contractions
closed cervix
threatened abortion
What type of abortion?
dilated cervical os with the passage of some but not all products of conception before 20 weeks of gestation
incomplete abortion
What type of abortion?
dilated cervical os without passage of tissue before 20 weeks of gestation
Inevitable abortion
What type of abortion?
death of the fetus before 20 weeks of gestation, with products of conception remaining intrauterine
Missed abortion
What type of abortion?
expulsion of all or part of the products of conception before 20 weeks of gestation
Spontaneous abortion
Tx of candidal vaginitis?
fluconazole 150mg PO x 1, repeat in 7 days
Tx of BV (3)
metronidazole 500 mg PO BID x 7 days
or
metronidazole 750 mg QD x 7
or
clindamycin intravaginal gel x 7 days
3 diagnostics of bacterial vaginosis…
pH > 4.5 (bacterial = basic)
(+) whiff test
Clue cells
Patient presents with:
malodorous green/yellow frothy vaginal d/c
strawberry cervix
Trichomoniasis
Tx for trichomoniasis…
metronidazole 2g PO x 1
Pt. p/w
painful intercourse
recurrent UTIs despite treatment
thin appearing vaginal mucosa
atrophic vaginitis
Tx for atrophic vaginitis
conjugated estrogen cream
trichomoniasis vaginal pH…
5-6
vulvovaginal candidiasis vaginal pH
4-4.5 (normal)
bacterial vaginosis vaginal pH…
> 4.5
