OB uworld Flashcards
How does obesity lead to increased estrogen
Adipose tissue converts androgens into estrogens
Is breast cancer associated with ovarian or endometrial cancer or both
Breast and ovarian cancer associated (BRCA), not endometrial
Which female hormone increases risk and which decreases risk of endometrial cancer
Estrogen increases risk - proliferation
Progesterone decreases risk - differentiation
How does breast feeding cause contraception
Prolactin inhibitd GnRH release, so prevents FSH LH ovulation and menstruation
What cancer drug causes endometrial huperproliferation and increased risk of endometrial cancer
Tamoxifen
Asherman syndrome
Etiology
Symptoms
Intrauterine adhesions eg from prior endometrial curettage
Amenorrhea and cyclic pelvic pain from obstruction of endometrial outflow
When postpartum do b-hCG levels become undetectable
2-4 weeks postpartum
Oral or intravaginal fluconazole for vaginal candidiasis?
Either works, oral usually preferred first line by patients, just easier
Define adenomyosis
Endometrium growing in the myometrium
Symptoms pf bicornuate uterus
Usually asymptomatic, discovered incidentally during unrelated surgery
May cause pregnancy complications – IUGR or preterm delivery
Treat PMS/PMDD in pt w migraines with aura
SSRI
OCPs contraindicated in migraines with aura
What phase of the menstrual cycle should symptoms arise in symptom diary to be consistent with PMS/PMDD
Luteal phase (1-2 weeks prior to menstruation, the phase when LH amd Progesterone are higher after ovulation)
Menopause is characterized by elevation in what hormone
FSH
TF
BMI of 20 rules out functional hypothalamic amenorrhea as a cause of amenorrhea in a competitive athlete
False
RELATIVE caloric deficiency causes decreased GnRH and decreased FSH LH E P and sc such as breast atrophy, infertility, vaginal atrophy, osteoporosis – all the manifestations of estrogen deficiency
Mechanism of functional hypothalamic amenorrhea in a competitive athlete
RELATIVE caloric deficiency causes decreased GnRH and decreased FSH LH E P and sx such as breast atrophy, infertility, vaginal atrophy, osteoporosis – all the manifestations of estrogen deficiency
Symptoms of androgenic steroid use in a female athlete
Virilization (male baldness, deep voice, big clit)
Hypertension
Aggressive behavior / Mood Disorders
Pathophys of HELLP Syndrome
Abnormal placentation causing systemic inflammation and activation of the complement and coagulation cascades
MAHA microangiopathoc hemolytic anemia hurts the liverin particular
Prolonged PT and PTT Hypoglycemia Encephalopathy In 3rd trimester or early postpartum Think...
Acute fatty liver of pregnancy – acute hepatic failure in 3rd trimester or early postpartum
Treat HELLP syndrome
Antihypertensive med and/or mag for seizure prophylaxis
Then deliver baby when mom stabilized
When to consider transfusion for HELLP Syndrome
Preop before cesarean if plt v40,000/mm^3
Prophylactically if plt v 20,000/mm^3
Otherwise delivery of baby spontaneously resolves HELLP
so standard tx is Antihypertensive med and/or Mag for seizure prophylaxis, then Deliver baby when mom stabilized
Bartholin duct cyst
Typical age
Pathophys
Common v30yo
Duct obstruction by dried mucoid glandular secretions, trauma, or idiopathic
Condyloma accuminata
Derm description
Pathogen
Exophytoc or sessile vulvar growths that may be solitary or multiple
HPV 6 and 11
Gartner duct cysts
Number, Location
Pathophys
Single or multiple submucosal along upper anterior vagina
Incomplete regression of Wolffian duct during development
Most common symptom of vulvar swuamous cell carcinoma
Pruritus, long-standing vulvar pruritus
Treat bartholin cyst
Observation if asymptomatic.. may regress spontaneously
I and D if symptomatic or abscess, can place Word catheter to prevent recurrence
How do renal function and renal bmp labs change during pregnancy
inc RBF and GFR and protein excretion
so dec BUN and Cr
TF
Cr 1.2 mg/dl is normal in pregnancy
F
Normal in non-pregnant
Renal insufficiency in pregnant (GFR should ^^)
Mechanism of hypercoagulability in pregnancy
Dec protein S
Protein C resistance
Inc fibrinogen
TF
Urine dipstick +1 for protein is normal in pregnancy
T
HPV testing is recommended when _____ is identified on pap
HPV testing is recommended when ASCUS is identified on pap
Cerical cancer screening guidelines
v21 pap only if immunocompromised
21-30 pap q3
30-65 pap + hpv testing q5, or pap q3
65+ stop screening if prior screens negative for 10 years and most recent within 5 years
TF
Oophorectomy for an ovarian teratoma
F
Just cystectomy usually – young girls, benign mass, high risk of contralateral recurrence, don’t start taking ovaries out, just get the mass
BRCA1/2 increases risk for
All GYN cancers – breast ovarian uterine
Paclitaxel chemo for what kind of ovarian cancer
Dysgerminoma
Very sensitive to chemo, like seminoma in testicular cancer
Rokitansky nodule
Mural nodule in a benign ovarian teratoma / dermoid cyst
Mural nodule in a benign ovarian teratoma / dermoid cyst
Rokitansky nodule
Manage BRCA1/2+ pt with no signs of cancer yet (ca125 neg, mammo neg, tvus neg)
Prophylactic bilateral mastectomy at any age, if not willing then Tamoxifen chemoprevention, if not willing then semiannual screening with MRI and Mammo
TAH+BSO at 35yo, semiannual TVUS and CA-125 till then
Which ovarian cancers are hormone-secreting and what are their demographics
Granulosa-Theca cell tumor – child precocious puberty
Serous cystadenocarcinoma – old lady
TF
Ovarian germ cell tumors secrete hormones
F
Stromal Granulosa-Theca cell tumors do
And
Epithelial Serous CystAdenoCarcinomas do
What is the tumor marker for ovarian dysgerminoma
LDH
TF
CA-125 is the tumor marker for ovarian dysgerminoma
F
LDH is the tumor marker for dysgerminoma
Add tumor to tumor marker:
LDH CA-125 CA19-9 bHCG AFP
LDH - ovarian dysgerminoma
CA-125 - epithelial ovarian cancers, colon cancer
CA19-9 - pancreatic cancer
bHCG - choriocarcinoma, molar pregnancy
AFP - yolk sac tumors, hepatocellular carcinoma
The Only tumor marker that Can be used diagnostically
AFP
eg characteristic lesion on ultrasound or triple phase CT and elevated AFP is HCC without need for biopsy
Treat condyloma acuminata
Imiquimod and cryotherapy
What cancer was caused by in utero DES exposure?
Vaginal Adenocarcinoma
TF
DES exposure in utero is a risk factor for Endometrial cancer
F
DES in utero raises risk of Vaginal Adenocarcinoma
What does vulvar squamous cell carcinoma look like
Is it caused by HPV
What other cancer can it be confused with
Pruritic, darkly pigmented
Not caused by HPV (that’s vaginal amd cervical SCC)
Can be confused with vulvar Melanoma
The more times a woman ____, the more likely she is to get ovarian adenocarcinoma
The more times a woman Ovulates, the more likely she is to get ovarian adenocarcinoma
TF
Basal cell carcinoma of the vagina is common
F
Think more face and sun exposed areas for BCC
Vaginal cancers are pretty confined to SCC Melanoma and Pagets
3 forms of vulvar cancer
SCC Melanoma and Pagets
Itchy black lesion on vulva
Next step
What cancers are you looking for
Biopsy
diff SCC from Melanoma
teardrop shaped growths at vestibule of vulva turn white with acetic acid application
Dx
Pathogen
Tx
Condyloma accuminata from HPV
Imiquimod, podophylin, or trichloroacetic acid if they are small
Excision or fulgerationif they are large
What vulvar lesion do you treat with wide incision and resection
Invasive Melanoma
Itchy porcelain white atrophic thin skinned vulvar macules or patches Dx Pathophys Next step What must be ruled out How can it progress over time
Lichen sclerosis
Chronic inflammation
Punch biopsy to rule out SCC
With excoriations can erode minora clit and introitus, thicken, constrict, cause dyspareunia and dysmenorrhea
4 things that make MTX a good option for extopic treatment
v3cm
bHCG quant v8,000
Not taking Folate
No Fetal Heart Tone
Management options and indications for retained fetal parts in seting of spontaneous abortion
Expectant management if inevitable or incomplete abortion (admit, IVMF, determine RhD status, monitor for signs of sepsis or hemorrhage, wait for parts to pass)
D and C for missed abortion v24 weeks
Induced delivery for missed abortion ^24 weeks
What os a “shock index”
HR greater than SBP
Acute abdomen with peritoneal signs, intraperitoneal fluid on FAST, hemodynamic instability
Transfuse before ex lap?
No
Not going to admit to floor, prder blood, wait for type/cross, thaw blood product, wait for CBC after transfusion
You are going to take to OR for ex lap and get iv access and start fluids and get the transfusion process going as you operate
TF
Ripening but closed os with dead fetus counts as an inevitable abortion
T
Abx for tuboovarian abscess
IV cefoxitin and PO or IV Doxycycline
IV cefotetan and PO or IV Doxycycline
IV gent and clinda
IV azythro?
+- metronidazole
Which is more important in inpatient infection management, source control or antibiotics?
Antibiotics
The sooner they are started, the better the outcome
White coat htn is unlikely if diastolic is ^ _____
^105
Fetal hydantoin syndrome
Drugs that cause
Phenytoin, carbamazepine, other anticonvulsants
Early signs of congenital syphillis
Later signs of congenital syphillis
Snuffles (rhinitis)
Hepatomegaly
Skin lesions
Hutchinson teeth Saddle nose Saber shins Deaf Interstitial keratitis
When is D and E vs induced vaginal delivery recommended for intrauterine fetal demise
20-23 wks can do either
24 wks or more, induce vaginal delivery
3 things that ^ maternal serum AFP
1 thing that v
^ abdominal wall defect, neural tube defect, multiple gestation
v aneuploides (18, 21)
TF
Alcohol is a risk cor breast cancer
T
What kinds of cancer diagnoses indicate brca testing
Breast cancer v50yo
Ovarian cancer any age
TF
OCPs decrease breast cancer risk
F
No effect on breast cancer
Decrease ovarian cancer risk (less ovulation)
Adverse effects oxytocin
Water retension, Hyponatremia, Seizures (adh-like effect with prolongued administration)
Hypotension
Tachysystole
Normal Mg level
Therapeutic ramge for preeclampsia
1.5-2 normal
5-8 therapeutic
Gastroschisis is associated with forst trimester use of _____
NSAIDS
4 contributing factors to pathophys of pulmonary edema in preeclampsia/eclampsia
- vasospasm, increased afterload, back up into lungs
- increased vascular permeability
- decreased albumin / intravascular oncotic pressure
- decreased renal function
4 contributing factors to pathophys of pulmonary edema in preeclampsia/eclampsia
- vasospasm, increased afterload, back up into lungs
- increased vascular permeability
- decreased albumin / intravascular oncotic pressure
- decreased renal function
Manage pulmonary edema in preeclampsia/ eclampsia
Supplemental oxygen
Fluid restriction and diuresis very cautiously amd sparingly because intracascular volume depleted from third spacing
First line mgmgt for restoration of ovulatory cycle in pcos
Weight loss
Then OCPs
Premature ovarian failure often concomitant with a ______ disorder
Autoimmune disorder
Delivery is indicated for PPROM at what gestational age
34 weeks
Cause of paget disease of the nipple
We think migration of breast cancer (Adenocarcinoma most common in pagets and breast cancer in general) down ducts to nipple surface
TF
Pts w functional hypothalamic amenorrhea get hot flashes and night sweats
F
No vasomotor symptoms
But decreased estrogen
(Primary ovarian insufficiency may get hot flashes…)
Diagnose and treat antiphospholipid syndrome
Pathophys
Hypercoagulability eg tia dvt stroke
Or
Recurrent miscarriages, fetal growth restriction, preeclampsia
And 1 or more positive -anti-cardiolipin antibody -lupus anticoagulant -anti-beta2 glycoprotein antibody
Treat by anticoagulating - heparin, warfarin
AI antibodies against membrane phospholipids
How does antiphospholipid syndrome cause recurrent miscarriages
Placental thrombosis
TF
Subserosal fibroid is associated with recurrent pregnancy loss
F
Too far from cavity
TF
Uncontrolled hyper or hypothyroidism can cause recurrent pregnancy loss
T… but more often causes menstrual irregularities and infertility
How does hemorrhagoc shock redistribute blood relative to the uterus
Toward brain heart lungs kidneys… so away from uterus
Kleihauer-Betke test is used to
Determine amount antiRhD immunoglobulin to give to Rh negative mother of Rh+ fetus
Pseudocyesis Define Pathophys Presentation Treatment
Define
Pathophys
Presentation
Treatment
Erb-Duchenne vs Klumpke palsy
Aka
Nerves involved
Waiter’s tip vs Claw hand
C5-6 vs C8-T1
Normal contracted fundal hight on postpartum physical
1-2cm above or below umbilicus
What is vulvar paget disease
How is it different from breast paget disease
How do you diagnose it
How do you treat it
Intraepithelial adenocarcenoma that has an erythematous eczematous appearance and intense pruritus
Not different from breast, just not in the breast
Dx with biopsy
Tx with local resection
Forst trimester combined test analyzes risk of ________ by measuring ________
Is it screening or diagnlstic?
Forst trimester combined test analyzes risk of ________ by measuring ________
Is it screening or diagnlstic?
Synovial fluid leukocyte count in prosthetic joint infection
^1 but often less than 50 like in septic native joints
Tome to onset of prosthetic joint infection implicates which bugs accordingly
v3 months postop — suspect birulent organisms like staph aureus amd pseudomonas
Pick new antidepressant for pt failed trial of 2 ssris with weigt gain and sleeping a lot
Buproprion
ndri
promotes weigjt loss and
