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EM 3 > ob/gyn emergencies > Flashcards

ob/gyn emergencies Flashcards

1
Q
  • US: less blood to ovary w/ ovarian cyst
  • unilateral abdominal pain
A

ovarian cyst
call OBGYN ASAP– SURGICAL EMERGENCY

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2
Q

3 risk factors for ovarian torsion

A
  • cysts
  • PCOS
  • masses
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3
Q

very painful condition diagnosed via transvaginal US; not a surgical emergency

A

ovarian cyst– benign
- tx: pain control and f/u w/ OBGYN d/t risk of torsion
- can give OC to prevent future cysts

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4
Q

triad: fever, RLQ pain, anorexia
CT is used for definitive diagnosis
rebound tenderness w/ mcburney’s point
(+) herosin sign
tx: broad spectrum abx– zosyn, ceftriaxone, etc

A

appendicitis

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5
Q
  • infection; obstruction of cystic duct
  • RUQ pain
  • US/HIDA scan
  • (+) Murphys
A

acute cholecystitis
tx: cholecystectomy, abx

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6
Q
  • obstruction common bile duct; RUQ pain w/ jaundice
A

choledocholithiasis
- US/ERCP

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7
Q

reynolds pentad: RUQ, jaundice, fever, AMS, hypotension

A

acute ascending cholangitis
US/ERCP; Abx

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8
Q

cervical motion tenderness
high WBC, ESR/CRP, fever

A

PID

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9
Q

tx for gonorrhea

A

ceftriaxone 500mg IM

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10
Q

tx for chlamydia

A

doxycyline 100 mg BID

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11
Q

complication of PID that can rupture or result in sepsis
dx with US
tx with abx and gyn consult

A

tuboovarian abscess

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12
Q

condition & tx

malodorous discharge, postcoital bleeding, dysparenunia, dysuria
cervical petechiae (strawberry cervix)
dx w/ wet mount

A

trichomoniasis vaginalis
tx: metronidazole

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13
Q

condition & tx

  • candida albicans overgrowth- wet prep shows hyphae/spores
  • irritation, erythema, discomfort
  • thick white discharge
  • normal pH
A

vulvovaginal candidiasis
tx: fluconazole, cotton undies, no bubble baths

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14
Q

condition & tx

  • odor thats worse after intercourse, itching/irritation, thin watery gray discharge w/ fishy smell
  • clue cells
A

bacterial vaginosis
tx: metronidazole

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15
Q

which two conditions will have pH above 5

A

BV
trich

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16
Q

condition & tx

  • infected gland causing pain and tenderness
  • unilateral swelling on PE; fluctuant if abscess
A

bartholian cyst
tx: I & D w/ abx if its an abscess; if no sx then no intervention

17
Q

3 things to include in work up? 3 treatments

  • unexplained bleeding in non pregnant woman w/ normal P.E
A
  • work up: STD check, HCG, endometrial biopsy if postmenopausal
  • tx: support –> OCP/IUD –> endometrial ablation/hysterectomy
18
Q

what does PALM-COEIN mean in abnormal uterine bleeding

A

Polyp
Adenomyosis
Leiomyoma
Malignancy

Coagulopathy
Ovulatory
Endometrial
Iatrogenic
Not yet classified

19
Q

what is this? what are you concerned for?

  • rupture of membranes before labor + before 37 wks
A

Preterm prelabor rupture of membranes (PPROM)
- if under 34 wks, concerned about underdeveloped lungs– give steroids to delay labor and increase surfactant
- Tocolytics to delay delivery
- abx

20
Q

rupture of membranes after 37 wks but before labor

A

PROM– admit for fetal monitoring; will go into labor or will induce it

21
Q

3 ways to diagnose premature rupture of membranes

A

sterile speculum exam (NO DIGITAL VAGINAL EXAM)
nitrazine paper test (positive if ph over 6.5)
fern test w/ amniotic fluid

22
Q

what are the 4 types of miscarriages? which one is viable?

A
  1. threatened: viable; closed os
  2. inevitable: open os but still in; do cervical evacuation
  3. incomplete: open os; half in/out; do cervical evacuation
  4. complete: nothing inside; os may be closed
23
Q

who gets RhoGAM & when

A
  • RH neg females and antibody neg females if there is any mixing of blood (abortion, ectopic too)
  • w/in 72 hours of delivery
24
Q

condition & 4 things to do to manage it

  • abdominal pain, vaginal bleeding, h.o positive pregnant test
  • beta HCG does NOT double q 2-3 days
  • left shoulder pain if it ruptures; could be in shock
A

ectopic pregnancy
1. confirm pregnancy w/ quantitative betaHCG (repeat in 2-3 daysif below 1500); call OB if a lot of bleeding or shock
2. TVUS shows no gestational sac w/ beta HCG over 2000
3. MTX +/- RhoGAM if hemodynamically stable & beta HCG under 5K (another dose if it doesnt drop to 0)
4. if unstable or rupured do lap salp w/ RhoGAM

25
Q

what is this? tx?

  • painless vaginal bleeding, uterine size/date mismatch & high beta HCG (over 100K)
  • US: snowstorm/cluster of grapes w/o fetal parts/heart tones
A

Molar pregnancy: abnormal placenta w/ trophoblastic tissue
- tx: surgery before choriocarcinoma develops; weekly beta HCG till back to undetectable

26
Q

what are the two types of molar pregnancies

A

complete (diploid): empty egg fertilized by sperm; most common; becomes choriocarcinoma
partial (triploid): egg fertilized by 2 sperm of 1 that duplicates its chromosome

27
Q

what is this? how is mild vs severe managed?

  • HTN after 20 wks + proteinuria in previously healthy person
  • can have end organ disfunctional or renal involvement
A

preeclampsia
Mild full term: delivery; mild under 37 wks: steroids & close f/u
severe: delivery, labetolol, nifedipine, methldopa, hydralazine, Magnesium

28
Q

what is HELLP

A

a form of preeclampsia
Hemolytic Anemia
Elevated Liver enzymes
Low platelets

29
Q

what is this? tx?

  • preeclampsia + seizures
A

eclampsia
tx: delivery + IV magnesium or lorazepam
IV labetolol, hydralazine, nicardipine

30
Q

what is it? diagnosis? treatment

  • painless vaginal bleeding in 3rd trimester
  • placenta covering cervical os
  • risk factors: previous occurance, C section, multiple gestation
A

placenta
dx: US
tx: pelvic rest and delivery

31
Q

conditon? diagnosis? tx?

  • painful vaginal bleeding/firm uterus in 3rd trimester
  • placenta separating from uterine wall
  • RF: HTN, tobacco/alc, cocaine, older maternal age, trauma, multiple gestations
A

placental abruption
dx: clinical/US
tx: delivery and supportive care

32
Q

what is it? 4 ways to tx

  • vomiting in pregnant person causing hypokalemia, hypophosphatemia, hypomagnesium & wt loss
A

hyperemesis gravidarum
tx: pyridoxine + doxylamine, Metoclopromide/promethaxine, zofran, IV fluids/electrolytes

33
Q

what is this? 4 causes?

blood loss over 500mL (vaginal delivery) or over 1000mL (c-section)

A

postpartum hemorrhage
- uterine atony
- retained placenta tissue
- trauma
- coagulation abnormalities

34
Q

conditon? 3 tx?

  • soft flaccid boggy uterus
  • RF: c-section, over distended uterus, prolonged labor
A

uterine atony
- uterine massage
- oxytocin to increase contractions
- arterial embolization or hysterectomy

35
Q

what is this? 3 ways to tx?

s. aureus infection of the breast

A

mastitis
tx: compress, pain meds, dicloxacillin or nafcillin
moms should keep feeding

36
Q

what is this? tx?

  • polymicrobial infection of endometrium
  • fever, tachy, pain, foul smelling lochia
A

endometritis
tx: clindamycin + gentamicin or augmentin
can give 1st gen ceph in c-section for prophylaxis

EM 3 (4 decks)

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