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Family Medicine EOR > OB/GYN > Flashcards

OB/GYN Flashcards

1
Q

Dysmenorrhea

A
  • Primary Dysmenorrhea: (No Pelvic Pathology)
    • E: ^Prostaglandins –> painful uterine muscle wall activity.
  • Secondary Dysmenorrhea: ( Pelvic Pathology)
    • E: Pelvic Pathology
      • Endometriosis
      • Uterine Fibroids (Leiomyoma)
      • adenomyosis

Treatment:

  1. Heat & Vit E
  2. NSAID’s (1st line)
    1. MOA: inhibits prostaglandin-mediated uterine activity.
  3. Want Contraceptives:
    1. 1st line for contraception and dysmenorrhea pain relief.
    2. combined estrogen-progestin oral pills, transdermal patch, or vaginal ring
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2
Q

Dysfunctional Uterine Bleeding

  • Menorrhagia
  • Metrorrhagia
  • Oligomenorrhea
  • Polymenorrhagia
A
  • Polymenorrhea
    • Frequent cycles <21 days
  • Menorrhagia
    • Heavy or Prolonged Bleeding (Normal intervals)
  • Meterorhagia
    • Bleeding between expected menstrual cycles
  • Oligomenorrhea
    • infrequent menstruation ( >35 days between but not >6months)
  • Etiology:
    • Chronic Anovulation (90%)
      • Hypothalamus Pituitary Axis issues
      • Extreme ages (starting or ending menopause)

Dysfunctional Uterine bleeding is a result of either no ovulation or ovulation with abnormal bleeding.

  • Anovulation = no progesterone because the ovum is what secretes that progesterone –> No progesterone to oppose the estrogen –> ^ risk of Endometrial cancer.
    • The unopposed estrogen caused excessive endometrial growth –> outgrows its own blood supply –> dies and sluffs off at unpredictable times.
  • Ovulation:
    • Ovulation with increased progesterone levels dilation of endometrial vessels + Prostaglandins which results in Menorrhagia.
  • Dx: Diagnosis of Exclusion
  • Tx:
    • Acute:
      • High-dose IV estrogens titrated to stop bleeding.
    • Anovulatory:
      • OCP: 1st line
        • reduces endometrial cancer risk by regulating unopposed estrogen.
      • Progesterone only for CI to Estrogen:
        • Medroxyprogesterone Acetate
    • Ovulatory:
      • OCP: Regulates Cycle
    • Surgery:
      • Hysterectomy: Definitive treatment
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3
Q

Vaginitis

Dia

A

Atrophic Vaginitis

  • Pathophysiology
    • Caused by a decrease in estrogen
  • Patient
    • Postmenopausal woman
  • Presentation
    • Dyspareunia, dryness, bleeding, itching
  • Physical Exam
    • • Show a pale, dry, shiny vaginal epithelium
  • Management
    • • Lubricants, moisturizers, topical estrogen (second line)
  • SE of Vaginal Estrogens:
    • ​PE, DVE, CVA
    • endometrial cancer
    • Less risk than PO estrogen
    • breast Pain
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4
Q

Pelvic Inflammatory Disease

  1. complications of PID?
    1. What is the name of the syndrome associated with PID?
    2. ??
  2. Treatment:
    1. Outpatient
    2. Inpatient
A

Complications:

  1. Fitz-Hugh Curtis Syndrome:
    1. Perihepatitis with no LFT ^
    2. RUQ pain
  2. Infertility
  3. Ectopic
  4. Chronic Pelvic pain
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5
Q

Fibroadenoma

  • What is the difference between fibroadenoma and fibrocystic breast disorder?
A

Fibroadenoma does not wax/Wayne with menstruation.

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6
Q

Fibrocystic Breast Disease

A

Fluctuating Estrogen

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7
Q

Breast Cancer

  • Etiology
  • Risk Factors
  • Types
  • Presentation:
  • Physical Exam
  • Diagnosis:
  • Treatment:
  • Prevention in High-risk Patients:
A

Breast Cancer

  • Risk Factors
    • BRAC1
    • BRAC2
    • Increase exposure to ESTROGEN
  • Types
    • Ductal Carcinoma
      • METS lymphatic
      • 75%
    • Lobar Carcinoma
  • Presentation:
    • Breast Mass:
      • Painless
      • Hard
      • Immobile
      • Upper Outer Quadrant
    • Unilateral Nipple Discharge
      • Purulent/green/+- Bloody
  • Physical Exam
    • Skin Changes:
    • Pagets Disease of the Nipple:
      • chronic eczematous itchy, scaling rash on the nipple/areola
    • Inflammation of the Breast
      • red, swollen, warm, itchy
      • Peau D’ Orange –> orange peel appearance
        • due to Lymphatic Obstruction
        • Poor prognosis
  • Diagnosis:
    • Monogram:
      • Microcalcification
      • Spiculated
    • Ultrasound:
      • BEST INITIAL TEST TO EVLATUTE BREAST MASS
    • Biopsy:
  • Treatment:
      • Lumpectomy (w/ radiation) —> Mastectomy —> Regional removal of lymphnodes.
        • Pharmacology:
          • Based on if the tumor is Estrogen Receptor +, Progesterone Receptor +, or HER2 +
          • Anti Estorgen: (blocks estrogen receptor at breast tissue.
            • Tamoxifen
          • ER + : Aromaatase Inhibitors: (< Estrogen Production)
            • Letrozole
            • Anastrozole
          • HER2 +: Monoclonal AB tx:
            • Trastuzumab
              • CARDIOTOXICITY
  • Prevention:
    • Tamoxifen/Raloxifen
    • PostMenopausal or
    • >35 with High Risk
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8
Q

Cystocele

A
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9
Q

Rectocele

  • Risk Factors
  • Management
A

Risk Factors:

  • The Older you get the more kids you have the fatter you get.
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10
Q

Menopause

  • Tx:
    • Vasomotor insufficiency/ Hot flashes
    • Vaginal Atrophy
    • Osteoporosis
    • Hormone Replacement Therapy
A
  • E:
    • Cessation of Menses >1 year due to Loss of Ovarian Function.
  • P:
    • Hot Flashes
    • Dyspareunia
      • Vaginal Atrophy
    • Osteoporosis
  • Dx:
    • ^ FSH, ^ LH, v Estrogen ( ovarian follicles depletion)
    • FSH assay most sensitive Initial Test
  • Tx:
    • Vasomotor insufficiency/ Hot flashes
      • Estrogen/Progesterone
      • Clonidine
      • SSRI
      • Gabapentin
    • Vaginal Atrophy
      • Estrogen topical
    • Osteoporosis
      • Calcium + VD
      • weight-bearing exercise
      • BISPHOSPHONATES
        • Alendronate (Fosamax™, Fosamax™ Plus D)
        • Risedronate (Actonel™, Actonel™ with Calcium, and Atelvia™)
        • Ibandronate (Boniva™)
        • Zoledronic acid (Reclast™)
      • SERM
        • Raloxifene
          • CVA
          • Pregnancy
        • Tamoxifen
          • ^ risk of Uterine Cancer past 5 years.
    • Hormone Replacement Therapy
      • Estrogen Only (Most Effective) (No Uterus)
        • ^ Endometrial Cancer
        • ^Thromboembolism
      • Estrogen + Progesterone: (Yes Uterus)
        • Protective against Endometrial Cancer
          *
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11
Q

Contraception

A
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12
Q

Spontaneous Abortion

A
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13
Q

Cervicitis

  1. Gonorrhea
  2. Chlamydia
  3. Herpes Simplex
  4. HPV
A
  • Chlamydia:
    • E: Chlamydia Trachomatis- MC std in US
    • P: Cervical Motion Tenderness
    • Dx: Nucleic Acid Amplification
      • Gonorrhea as well
    • Tx:
      • Azithromycin/Doxy
      • Ceftriaxone
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14
Q

Syphilis

A

Treatment:

  1. Primary, Secondary, Neuro
    1. See Rosh Review
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15
Q

Lymphogranuloma Venereum

A

E: Chlamydia infection

P: Genital/Rectal Lesion with softening, suppuration, and Lymphadenopathy

Dx:

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16
Q

Chancroid

A
  • E: Haemophilus ducreyi
  • P: Painful Ulcer: Papule–> Pustule –> Ulcer
    • Lymphadenopathy
  • Tx:
    • Azithromycin
    • Ceftriaxone
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17
Q

Premenstrual Syndrome

A
  • E: Luteal Phase mood changes
  • P:
    • Physical
      • Breast Swelling, Bloating
    • Emotional
      • Depression, Hostility
    • Behavioral
      • Food Craving, Poor Concentration
  • Dx:
    • Sx start in Luteal Phase (1-2 weeks before menses)
    • Relieved 2-3 days after menses
    • 7 symptom-free days during the follicular phase
  • Tx:
    • SSRI
    • OCP: induce Anovulation
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18
Q

Premenstrual Dysphoric Disorder

A

Severe PMS with functional impairment

“it is impairing their everyday life”

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19
Q

Amenorrhea

  • Definition:
  • Work UP
  • Primary Amenorrhea
  • Secondary Amenorrhea
    • E:
      • Pregnancy
      • Hypothalamus Dysfunction
      • Pituitary Dysfunction
      • Ovarian Disorders
      • Uterine Disorders
        • Asherman’s Syndrome
A

Amenorrhea

  • Definition:
    • Absence of Menses
  • Work up:
    • Pregnancy Test
    • serum Prolactin
    • FSH, LH, TSH
  • Primary Amenorrhea (Never had Menarche)
    • 15yo - Sex Character
    • 13yo- NO sex Character
    • Uterus/Breast Present:
      • Outflow Obstruction (Blocking blood flow)
        • transverse vaginal septum
        • imperforate hymen
    • Uterus(OK)/NO Breasts:
      • ^FSH, ^LH –> Ovarian Cause
        • Turners Syndrome (Gonadal Dysgenesis)
      • vFSH, vLH –> Hypothalamus-Pituitary Failure
  • Secondary Amenorrhea
    • E:
      • Pregnancy
        • MC cause of secondary Amenorrhea.
      • Hypothalamus Dysfunction
        • E:
          • Suppression of Hypothalamus
            • Disorder of Hypothalamus
            • Excessive Exercise
            • Stress
            • Nutritional Deficits
        • Dx:
          • normal/vFSR,vLH
        • Tx:
          • Clomiphene (SERM)
      • Pituitary Dysfunction
        • E: Prolactin-Secreting Pituitary Adenoma
        • Dx:
          • v FSH, LH, ^ PROLACTIN
          • ​Prolactin inhibits GnRH
        • Tx:
          • Tumor Removal
      • Ovarian Disorders
        • E: Premature Ovarian Failure
        • P:
          • Symptoms of Menopause (Estrogen Deficiency)
          • ^FSH & LH, v Estradiol
        • Dx:
          • Progesterone Challenge Test→ Causing Pseudo Mensis
          • Tests:
            • Adequate Estrogen
            • Competent Endometrium
            • Patent Outflow tract

By giving progestin you can see if the ovaries are producing any estrogen (ovarian cause), if the endometrium of the uterus has been scarred (uterine cause) or if there is an anatomic anomaly.

  • Uterine Disorders
    • Asherman’s syndrome= Acquired endometrial Scarring (postpartum hemorrhage, D&C).

Workup:

  • Amenorrhea ==> Breast/No Breast and Uterus/No uterus==> FSH, LH, estrodiol levels ==> Hypo/Pit (
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20
Q

Normal Physiology

  • When does Menstruation happen?
  • What phase does Ovulation happen in?
  • What causes GnRH to be secreted from Hypothalamus?
  • Follicular Phase
    • What does GnRH cause to be secreted?
    • What prevents the release of more LH and FSH?
  • Ovulation:
    • What is the time frame when Ovulation happens?
    • What happens to happen during ovulation
  • Luteal Phase
    • What predominates
    • Where does progesterone come from?
      *
A
  • Follicular Phase:
    • 1-12 days
    • Estrogen Predominates
    • PULSATILE (the body stops the pulsatile secretion of GnRH when they don’t have enough stores in extreme athletes or poor nutrition)GnRH –> Pitutirary (FSH) & LH–> Overies –> Follicle Maturation (FSH) & Follicle Estrogen Secretion (LH)
    • Estrogen BUILDS the endometrium
    • NEGATIVE FEEDBACK of Estrogen on Hypothalamus.
  • Ovulation:
    • ^ Estrogen from mature follicle –> Negative to Postive feedback—> ^ Estrogen, FSH, LH
    • ^LH causes ovulation.
  • Luteal Phase:
    • ​Progesterone predominates.
    • Implantation occurs during this phase if there is fertilization.
  • When does Menstruation happen?
    • 1st day of the Follicular phase.
    • < in estrogen/progesterone stops the negative feedback.
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21
Q

Ovarian Cancer

  • Risk Factors
  • Protective Factors
  • Presentation
  • Physical Exam
  • Diagnosis
    • What type of tissue?
  • Management
A
  • Risk Factors
    • Family History
    • ^ # of ovulatory cycles
    • Infertility, Nullparity
    • >50yo/late menopause
  • Protective Factors
    • OCP’s Protective by < number of ovulatory cycles
  • Presentation
    • Asymptomatic until late in the disease
    • Lower ABD pain/fullness /Irregular Menstruation……etc.
  • Physical Exam
    • Palpable Mass +/- acites
  • Diagnosis
    • Biopsy- Epithelial
  • Management
    • ????????
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22
Q

Cervical Carcinoma

  • Etiology
    • Tissue types
  • Risk Factors
  • Presentation
  • Diagnosis
  • Treatment:

Staging:

A

Cervical Carcinoma

  • Etiology:
    • HPV 16,18, 31,32 (MC)
    • 3rd MC Gynecologic Cancer
    • Squamous 90%
    • Adenocarcinoma 10%
  • Risk Factors
    • RF of PID/HPV
  • Presentation
    • Post Coital Bleeding/Spotting
  • Diagnosis
    • Colposcopy with Biopsy
  • Treatment:
    • Dependant on staging which determines the location of the tumor.

Staging:

  • 0: Carcinoma In Situ: Excision/Ablation
  • 1a: Microinvation: Surgery
  • IIb-4a: metastasis to cervix, vagina, bladder, rectum.
    • II: beyond the cervix but local
    • II: lower 1/3 vagina
    • IVa: Local METS: bladder rectum
    • RADIATION + CHEMO
  • 4b:
    • Distant METS: Palliative radiation/chemo
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23
Q

Pap Smear Schedule

When do you start getting a pap smear

A
  • 21yo –> 3 years
  • >30 w/ negative –> 5 years
  • >25yo + HPV –> Cytology & HPV test 12 month
    • or Genotyoe for HPV 16,18
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24
Q

HPV Vaccination

  • Age and number of does
  • CI
A
  • Gardasil Vaccine
  • <15yo 2 doses q 6months
  • >15 3doses over a minimum of 6 months.
  • CI:
    • Immunosuppressed, pregnant, lactating
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25
Q

Mammography Screening

  • Mammography:
  • Clinical Exam
  • Self Exam
    • When
A
  • Mamography:
    • 45-55: Annual Mamogram
    • >55 q 2y
  • Clinical Breast Exam:
    • q 3y
  • Self Exam:
    • >20yo Monthly
    • Immediately after Menstruation or:
    • 5-7 days of the menstrual cycle.
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26
Q

Endometrial Cancer

  • Etiology:
  • Risk Factors:
  • Protectives
  • presentation:
  • Diagnosis
  • Tx:
  • What is the Quick Picture
A

Endometrial Cancer

  • Etiology:
    • MC GYN Cancer in US
    • Estrogen Dependent Cancer
    • MC Postmenopausal Cancer
    • Adenocarcinoma MC
  • Risk Factors:
    • ^ Estrogen Exposure
    • Tamoxifen:
      • decreases estrogen in the breast but increases in the uterus and bones.
  • Protectives:
    • OCP’s protective for Endometrial Cancer and Ovarian Cancer
  • Presentation:
    • Postmenopausal Bleeding
  • Diagnosis
    • Endometrial Biopsy
    • Ultrasound
      • Endometrial Stripe>4mM
  • Tx:
    • Stage I: Hysterectomy
  • QUICK PICTURE:
    • Postmenopausal
    • Vaginal Bleeding
    • Dx: Endometrial Biopsy
    • Adenocarcinoma MC
    • Tx: Complete Hysterecotmy
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27
Q

Estimated Date of Delivery?

How do you calculate?

A

(1st day of Menstration + 7 days) - 3 MONTHS

28
Q

1ST TRIMESTER SCREENING/TEST

Maternal Blood Screening?

Ultrasound?

Chorionic Villus Sampling?

A
  • Maternal Blood Screening
    • Down Syndrome:
      • Free B-hCG
      • PAPP-A
      • Nuchal Translucency
    • Uterine Size / Gestation
      • Do you want an abortion if abnormal?
  • Ultrasound
    • Heartbeat 5-6 weeks
  • Chorionic Villus Sampling
    • Increased risk for Spontaneous abortion.
    • Do you want an abortion.
29
Q

2nd Trimester Screening/Tests

  • What is a positive diagnosis for Down Syndrome?
  • Postive test for Spina Bifida?
  • When is Gestational diabetes tested?
A
  • 15-20 weeks
    • Triple Screen
      • Downs:
        • a-FP: LOW
        • Estradiol: LOW
        • B-hCG: HIGH
      • Spina Bifida:
        • a-FP: HIGH
  • Ultrasound
    • Fetal Growth
  • Amniocentesis
  • 24-28weeks
    • Gestational Diabetes
30
Q

3rd Trimester Screening/Tests:

  • When is RhoGam administered?
  • Non-Stress Testing Readings?
  • Contraction Stress Testing Reading?
A
  • 28 WEEKS
    • RhoGam
      • 72 hours after birth
  • 32-37 weeks:
    • Group B Strep
  • Non-Stress Testing Readings
    • SEE PPP - 292
  • Contraction Stress Testing Reading
    • SEE PPP 292
31
Q

Stages of Labor:

Stage 1:

Stage 2:

Stage 3:

A
  • Stage 1:
    • ONset to Full 10cm dilation of cervixs
      • Latent Phase:
        • SLOW cervical Dilation and effacement.
      • Active Phase:
        • 3-4cm –> 10cm
        • FAST dilation
  • Stage 2:
    • 10cm —> Delivery of Baby.
      • Passive Phase:
        • 10cm –> maternal expulsive efforts
        • Maternal expulsive efforts —> delivery
      • Active Phase:
  • Stage 3:
    • Fetus —> Placenta Delivery
      • Signs of Placental Separation:
        • Gush of blood
        • Lengthening of the umbilical cord
        • Anterior-cephalad movement
          • uterus becomes globular and firmer.
            *
32
Q

Cardinal Movements of Labor: (mechanism of labor)

A
  • Engagement
  • Flexion:
  • Descent:
  • Internal Rotation:
  • Extension:
  • External Rotation:

https://www.youtube.com/watch?v=ruIa1bC4tsw

33
Q

Physiologic Changes of Pregnancy

A
34
Q

Multiple Gestations

A
35
Q

APGAR

A
36
Q

ECTOPIC PREGNANCY

  • Definition:
  • Risk Factors:
    • High vs. Intermediate
  • Presentation:
    • Classic Triad:
    • Signs of Ruptured Ectopic
  • Physical Exam
  • Diagnosis
  • Management:
    • Stable/Unruptured
    • Unstable/Ruptured
A
  • Definition:
    • Implantation outside the Uterus
  • Risk Factors:
    • High:
      • ABD Surgery (Adhesions)
      • PID
      • IUD
    • Intermediate:
      • STD
  • Presentation:
    • Classic Triad:
      • Unilateral Lower ABD Pain
      • Vaginal Bleeding
      • Amenorrhea
    • Signs of Ruptured Ectopic
      • Severe Pain
      • Signs of Shock
  • Physical Exam
    • Cervical Motion Tenderness
    • Adnexal Mass
  • Diagnosis
    • Serial Quant B-hCG
      • Should: Double q 24-48hrs.
      • Ectopic: Fails to Double in 24-48hrs
    • Transvaginal Ultrasound:
      • Absense of Sac w/ B-hCG > 2000
  • Management:
    • Stable/Unruptured
      • Methotrexate:
        • MOA: detroys trophoblastic tissue
        • Criteria:
          • Stable
          • Early Gestation <4cm
          • B-hCG < 5000
          • No Fetal Tones
        • CI:
          • ​Ruptured Ectopic
          • history of TB
        • Administer RoGham if mom is Rh-Negative.
    • Unstable/Ruptured
      • Laparoscopic Salpingostomy
        • 1st Choice
37
Q

Placental Previa vs Abruptio Placenta

What is the diagnosis?

Treatment:

What is DIC?

Risk Factors of AP?

A
  • Placental Previa:
    • Painless Bright Blood
    • Soft Uterus
    • No fetal distress
      • Treatment:
        • Hospitalization/Bed Rest
        • Delivery:
          • Vaginal +/-: partial/marginal obstruction of the cervical os.
          • C-Section: in complete when mature.
        • Stabilize Fetus:
          • Tocolytics: MAGNESIUM SULFATE
          • Amniocentesis to determine lung stability.
  • Abruptio Placenta:
    • Risk Factors:
      • Maternal HTN
      • Drugs/Alcohol
    • Painful Dark blood
    • Firm/Tender Uterus
      • Fetal distress
        • Treatment:
          • C-Section
        • Complications:
          • Disseminated Intravascular Coagulation
38
Q

Gestational Diabetes

  • Risk Factors:
  • Diagnosis:
  • Management:
  • Maternal Complications:
A

Gestational Diabetes

  • Risk Factors:
    • Prior GD
    • Culture
      • Black, Asian, Islander, American Indian
    • Obesity
  • Diagnosis:
    • 50g Glucose test: >140 in 1 hour –> (perform)–> 3hour 100g GTT (GOLD STANDARD) >140 after 3 hours
    • NORMAL: <95 Fasting.
  • Management:
    • Diet/Exercise
    • Insulin: Treatment of Choice
      • DOES NOT CROSS PLACENTA
      • Indications:
        • FBG >105
        • Post-Prandial>120
    • Glyburide
    • Metformin
    • 38 WEEKS and Uncontrolled = INDUCTION
  • Maternal Complications:
    • 50% Chance of DM
    • 50% Chance of Recurrence GD
    • 6weeks postpartum screening for DM
      • Yearly afterward
39
Q

Preeclampsia vs Eclampsia

  • Similarities
    • Criteria for BP
  • Differences:
  • What do you have to watch out for in Severe Preeclampsia/Eclampsia?
  • What is the difference between treating Pre/Eclamptic BP than chronic preexisting HTN?
  • What do you avoid when treating HTN in pregnancy?
A
  • Similarities
    • > 20weeks
    • Criteria for BP
      • Mild: >140/90
        • +Protienuria
      • Severe: >160/110
          • Proteinuria
  • Differences:
    • Eclampsia:
      • HYPERREFLEXIA
  • Severe Complications:
    • Thrombocytopenia +/- DIC
    • HELLP Syndrome:
      • Hemolytic anemia
      • Elevated LIver enzymes,
      • Low platelets
  • PRECLAMPSIA:
    • Treatment:
      • Mild:
        • >37 Weeks: Delivery
        • <34 weeks: Bedrest + Steroids in Delivery
      • Severe:
        • DELIVERY–> MAG Sulfate–> Hydralazine/Labetalol.
  • ECLAMPSIA:
    • Seizures:
      • Mag Sulfate
      • Lorazepam -2nd line
    • DELIVERY
    • BP: Hydralazine/Labatolol
  • What is the difference between treating Pre/Eclamptic BP than chronic preexisting HTN?
    • Chronic= Methyldopa 1st line
  • What do you avoid in treating HTN in pregnancy?
    • ACE-I
    • Diuretics
40
Q

Endometriosis

A

Treatment:

  • Mild:
    • OCP + NSAIDs
    • Leuorolide (GnRH analog) Suppresses FSH/LH
  • Surgical:
    • Ablation = Preserves Fertiligy
    • Total Hysterectomy
41
Q

Ovarian Cyst

A
42
Q

Leiomyoma

A

Treatment:

  • Observation:
  • Pharm:
    • Leuprolide (gnrh analog- < fsh/lh)
  • Surgery:
    • Hysterecomy- Not fertile
    • Myomectomy: Preserves fertility
43
Q

Sexual Assault

A
44
Q

Domestic Violence

A
45
Q

Urinary Incontinence

A
46
Q

Infertility

A
47
Q

Pelvic Organ Prolapse:

  • Uterine Prolapse
  • Cystocele:
  • Enterocele
  • Rectocele
  • Uterine Prolapse Stages:
  • Treatment:
A
  • Cystocele: Anterior Vagina
  • Enterocele: Upper Vagina
  • Rectocele: Posterior Vagina
  • Stages: (4 total)
    • II: Cervix at introitus
  • Treatment:
    • Kegal
    • Hysterectomy
      *
48
Q

Ovarian torsion

A
49
Q

Breast Abscess vs Mastitis

A
  • Etiology:
    • Infection: Staph Aureus- Early BF
    • Congestion: Bilateral
  • Presentation:
    • Infection: Unilateral breast pain/nipple discharge
    • Congestion: Bilateral
    • Abscess: Induration with fluctuance
  • Management:
    • Infection:
      • Anti-Staphlococcal:
        • Dicloxacillin, Nafcillin
      • KEEP BREASTFEEDING
    • Congestion:
      • No BF: Stop stimulating and support for breast
      • Yes BF : Empty Breast after feeding
    • Abscess:
      • I&D
      • STOP BREASTFEEDING
50
Q

Fibrocystic Breast Disorder

A
  • Breast Cyts ^/< with menstrual changes.
    *
51
Q

Gestational HTN

A

>20 weeks

Asymptomatic

NO PROTEINURIA

Diet/Exercise

+/- Hydralazine or Labetalol

52
Q

Gestational Trophoblastic Disease

(Molar Pregnancy)

  • Definition:
  • Complete Molar Pregnancy:
  • Partial Molar Pregnancy:
  • Manifestation:
  • Diagnosis:
  • Management:
A
  • Definition:
    • A tumor arising from GESTATIONAL TISSUE (not mom)
    • Abnormal Placental Development
  • Complete Molar Pregnancy:
    • All Parental chromosomes (48xx)
  • Partial Molar Pregnancy:
  • Manifestation:
    • Painless Vaginal Bleeding
    • LARGER uterine size than expected.
    • Hyperemesis Gravidarum: ^ homres
    • CHORIOCARCINOMA: METS to LUNGS
  • Diagnosis:
    • EXTREMELY HIGH B-hCG (>100,000)
    • Ultrasound:
      • SNOWSTORM
      • CLUSTER OF GRAPES
  • Management:
    • Surgical Evacuation
      • Suction Curettage- MAINSTAY
    • METS:
      • Chemo with METHOTREXATE.
53
Q

RH Incompatibility

  • Etiology:
  • Complications:
  • Diagnosis
  • Management
A
  • Etiology:
    • Rh-Negative Mom
    • Rh Positive Baby
  • Complications:
    • If mom exposed to fetal blood –> Antiboties –> attack next fetus —> Hemolysis of fetal RBC
  • Diagnosis
      • Management
    • RhoGam
      • 28 weeks
      • 72 hours after delivery
      • After any potential mixing of blood.
54
Q

Shoulder Dystocia

A
55
Q

Premature Rupture of Membranes

  • Risk Factors
  • Diagnosis
  • Management:
A
  • Risk Factors:
    • Smoking
    • STD’s
  • Diagnosis
    • Sterile Speclulum Exam:
      • Visual Inspection –> Pooling of Secretions
    • Nirazine Paper Test:
      • turns blue= PROM
    • Fern Test:
      • Amniotic Fluid —> Fern pattern
  • Management:
    • Wait for Spontaneous Labor
56
Q

Premature Labor

  • Criteria:
  • Diagnosis
    • How to tell if fetal lungs are immature?
  • Management
A
  • Criteria:
    • Regular uterine Contractions
    • Cervical Changes
    • <37 weeks
  • Diagnosis
    • Nitrazine pH paper test: <6.5 pH BLUE
    • Fern Test:
      • FETAL FIBRONECTIN (20-34 weeks)
    • L:S Ratio <2:1 ===> Fetal Lung Immaturity
  • Management
    • ​Betamethasone ===> Fetal Lung
    • Given between 34-36 weeks
    • TOCOLYTICS:
      • Give for 48hrs to allow Lung Developement
        • Indomethacin: Inhibits prostaglandin uterine contraction.
        • Nifedipine:
        • Magnesium Sulfate: Admit, No Nifedipine w/
        • Beta2 Agonist:
          • SE: Maternal Pulmonary HTN
    • ABx Prophylaxis
      • Group B strep
        *
57
Q

Breech Presentation

A
58
Q

Postpartum Hemorrhage

A

Treatment:

  • Bimanual Uterine massage
  • Uterotonic Agents:
    • Oxytocin
    • Methylergonovine
    • Prostaglandin Analogs:
      • Carboprost
      • Tromethamine
      • Misoprostol
59
Q

Endometritis

A
60
Q

Perineal Laceration/Episiotomy Repair

A

Look Up

61
Q

Normal Physiology Changes of Puerperium

Uterus

Lochia Serosa

Breast/Menstruation

A
  • Uterus:
    • After Delivery: level of the umbilicus
    • 2 weeks: descends into the pelvic cavity
  • Lochia Serosa
    • Post-Partum Bleeing:
      • Pink/Brown: 4-10 days
        • Resolves by 3-4 weeks
  • Breast/Menstruation
    • Breast Milk 3-5 days
    • Menstruation return: 6-8 weeks.
62
Q

Vulvar/Vaginal Cancer

A
63
Q

Incompetent Cervix

A
64
Q

Umbilical Cord Prolapse

A
65
Q

Perineal Lacerations

A

Family Medicine EOR (9 decks)

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