Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EM200 > OB/GYN Emergencies > Flashcards

OB/GYN Emergencies Flashcards

1
Q

% of patients with surgical or life-threatening illness:

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Complications of missed diagnosis of acute abdominal or pelvic pain esp in women:

A

A missed diagnosis can compromise future fertility, lead to chronic pain or even death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Most common US findings in ovarian torsion:

A

A. Intraovarian hemorrhage
B. Ovarian enlargement
C. Lack of blood flow through color Doppler imaging
D. Pelvic Free-fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Age for ovarian torsion

A

Most common in reproductive years, avg age mid-20s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pregnancy and ovarian torsion:

A

Pregnancy predisposes to adnexal torsion (20% of torsion cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Issue with doppler flow with ovarian torsion dx:

A

~ 50% of surgically confirmed torsion cases will have had normal Doppler flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pathophysiology of Ovarian Torsion:

A

A twisting of the ovary on its vascular pedicle

Most cases due to an underlying ovarian pathology (60% of cases will ultimately reveal a mass–most common = teratoma)

Normal ovaries can undergo torsion, but much lower frequency

Some studies show torsion occurs more often on right side since sigmoid colon in LLQ helps prevent left ovary from twisting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clinical Presentation of ovarian torsion:

A

Symptoms often varied and non-specific

“Classic” pain = described as sharp, intermittent, localized

Often associated with vomiting and fever

Physical exam may show tenderness and rebound in RLQ/LLQ associated with/without an adnexal mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Good and bad dx tests for ovarian torsion:

perks of the different imaging techniques for ovarian torsion:

A

Lab studies help rule out differentials but not specific

Imaging by Ultrasound is diagnostic and favored over other modalities

US: fast, inexpensive, diagnostic

MRI: better resolution but costly, lengthy study, difficult to obtain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

US findings for ov. torsion

A

Ovarian enlargement is the most commonly associated sonographic finding secondary to obstructed venous drainage

Suspicion of ovarian torsion should be high in the setting of clinical symptoms and ovarian enlargement, regardless of the presence or absence of an ovarian Doppler signal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What can lead to false interpretation of maintained flow in ov. torsion US?

A

Presence of dual ovarian blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment for ov. torsion:

A

Definitive surgical management = Salpingo-oophorectomy

Conservative surgical management =

  • Gentle untwisting of the pedicle
  • Possibly cystectomy
  • Oophoropexy

It’s all surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

A 21 yo female presents to the ED for a “recheck” of her B-HCG level. She was seen by your colleague 2 days ago for lower abdominal pain and vaginal spotting and found to be pregnant. Her B-HCG level at the time was 1350 mIU/mL but her US was not diagnostic. Her pain and bleeding have resolved, and her B-HCG today is 2400 mIU/mL. What is the best next step in management?

A

Obtain another US to evaluate uterus and adnexa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ß-HCG level needed to be considered as “intra-uterine preg”?

A

1500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Risk factors for ect preg:

A

prior ectopic pregnancies (strongest predictor)

hx of PID (most common, ~50% cases)

hx of surgery or instrumentation altering normal tubal or cervical function such as tubal ligation, IUD placement, D&C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Most common site for ectopic preg:

A

Isthmus of fallopian tube

17
Q

Clinical presentation of ect preg:

A

Often asymptomatic, especially with early detection from improved US techniques

Signs and Symptoms are often unreliable and varied

18
Q

Sign that means an ectopic likely ruptured and why?

A

Dizziness and syncope

  • Causes hemorrhage
19
Q

DDx for ectopic:

A

Any 1st trimester bleeding

Common non-GYN / abd complaints

20
Q

Which type of abortion looks like an ectopic pregnancy:

A

Complete abortion

21
Q

Next steps in female patient in child-bearing age presenting with lower abdominal pain +/- vaginal bleeding (dx steps for ect)?

A

Serum ß-hcg + Pelvic sonogram

Type and screen

22
Q

Suspected ß-HCG levels for IUP visualized transvaginally? Transabdominally?

A

Transvaginal visualization of IUP: B-HCG > 1500 mIU/mL

Transabdominal visualization of IUP: B-HCG > 4000 mIU/mL

23
Q

Management of ectopic preg?

When is each option indicated?

A

Surgical = Salpingectomy

  • No longer Gold Standard for all ectopics
  • Indicated if patient is unstable or ruptured
  • Laparoscopic preferred over laparotomy

Medical = Methotrexate
- inhibits folic acid synthesis –> inhibits DNA synthesis
- Indications:
• Unruptured adnexal mass < 3.5 cm
• Hemodynamically stable
• Desire for future fertility
• Stable or rising ßhCG < 15,000 mIU/mL

24
Q

Absolute and relative contraindications to medical tx of ectopic pregancies:

A 
Absolute Contraindications
• Breastfeeding
• Immunodeficiency
• Abnormal creatinine (>1.3 mg/dL), or liver  enzymes (AST = twice the normal value)
• Alcoholism or liver disease
• Preexisting blood dyscrasias
• Peptic ulcer disease
• Active pulmonary disease
• Known sensitivity to methotrexate

Relative Contraindications
• Gestational sac >3.5 cm
• Fetal cardiac activity

25
Q

It is change of shift in your community hospital, and you notice a 22 y/o 36-week pregnant patient appears quite somnolent. She was signed out as “already treated and nothing to do, awaiting transfer for OB evaluation”. She is minimally responsive, has a decreased respiratory rate and marked decreased deep tendon reflexes.

What is the most likely dx?

What are the next best steps in management?

A

Pre-Eclampsia

Secure airway + administer IV Mg-SO4

26
Q

Range of times pre-eclampsia can occur:

A

20w gestation to 2 weeks post-partum

27
Q

Clinical criteria for dx of pre-eclampsia:

A

Blood pressure above 140/90 or an increase in SBP>20 or DBP>10 above baseline, AFTER 20 weeks of gestation, on 2 separate measurements, 6hrs apart

28
Q

Clinical presentation of severe pre-eclampsia:

A

SBP of 160 mm Hg or higher or DBP of 110 mm Hg or higher on 2 occasions at least 6 hours apart

Proteinuria of more than 5 g in a 24-hour collection with or without LE edema

SOB from pulmonary edema

Oliguria (< 400 mL in 24 h)

Persistent headaches

Epigastric pain and/or impaired liver function

Thrombocytopenia

Oligohydramnios, decreased fetal growth, or placental abruption

29
Q

Management of patients with pre-eclampsia

A

Definitive Treatment: Delivery!

Magnesium sulfate used for seizure prophylaxis in severe cases

Anti-hypertensive medications: Hydralazine or labetalol

IV fluid maintenance - pts are intravascularly volume depleted

30
Q

Signs and Sx of Magnesium toxicity:

How to avoid?

Antidote?

A

Signs/Sx: decrease or loss of deep tendon reflexes, respiratory depression, bradycardia

“Titrate to reflexes”

Calcium gluconate is antidote

31
Q

Possible sequelae of pre-eclampsia:

A

Eclampsia: pre-eclampsia + seizure

HELLP syndrome: a severe variant of pre-eclampsia

  • Hemolysis (LDH>600, often seen as schistocytes on smear)
  • Elevates Liver enzymes (AST>70)
  • Low Platelets (<100,000)
  • Epigastric or RUQ abdominal pain
32
Q

A 17 year old girl presents complaining of dysuria x3 days, she denies fever, abdominal pain, vomiting, and diarrhea. Abdominal exam is normal. Pelvic exam reveals a homogeneous white discharge and coats the vaginal walls. The wet mount features clue cells.

What is the most likely dx?

What is the best treatment?

A

Candidal vaginosis

Fluconazole 50mg PO once

33
Q

Etiology / Patho of PID:

A

Acquired: Chlamydia trachomatis (most common), Neisseria gonorrhoeae

Overgrowth of other natural flora:

  • Vaginal flora: Gardnerella vaginalis
  • Anaerobes: Bacteroides spp, peptococcus

Ascending infection from cervical infection

Bypass natural barriers to infection

  • Cervical mucous may be affected by hormones during ovulation / menstruation
  • Monthly endometrial sloughing allows for opening of the cervix
34
Q

Typical cause of bacterial vaginosis:

A

Gardnerella vaginalis overgrowth

35
Q

CDC dx guidelines for PID:

A

Low abdominal pain without other cause + 1 or more minimum criteria:

  • Uterine tenderness
  • Adnexal tenderness (95.5% sensitivity)
  • Cervical motion tenderness
36
Q

Very rapid and typically diagnostic test for PID:

A

Wet-mounts

37
Q

Management of PID:

A

Outpatient:

  • Ceftriaxone 250mg IM once PLUS
  • Doxycycline 100mg BID x14days
  • With/Without Metronidazole 500mg BID x14days

Inpatient Admission criteria:

  • Inability to tolerate PO
  • Severe illness, fever, nausea and vomiting - - Pregnancy
  • Failed outpatient therapy
  • Tubo-ovarian abscess
38
Q

DDx for PID:

A

Trichomoniasis

Bacterial Vaginosis

Candidal Vulvovaginitis

HSV, HPV

**and don’t forget to educate patient on HIV testing!

EM200 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions