OBGYN 10 Flashcards
What is an enterocele
Defect of the pelvic muscular support of the uterus and cervix (if still in situ) or the vaginal cuff (if hysterectomy). The small bowel and/or omentum descend into the vagina
What is a pessary
Synthetic device used to act as a “hammock” to suspend the pelvic organs
What can happen to a baby born to a mom with Graves
Neonatal thyrotoxicosis - due to transplacental passage of anti-TSH receptor antibodies during the third trimester
Baby born with sx of hyperthyroidism (warm skin, tachycardia, irritability, low birth weight)
Tx of neonatal thyrotoxicosi
- Temporary Methimazole PLUS beta-blockers
- Self-resolves within 3 months
Tx of postpartum endometritis
♣ Clindamycin and Gentamicin
Treatment of hydatidiform moles
• D&C
• Monitoring of b-hCG
o Want to monitor until b-hCG is undetectable and then for another 6 months
o Newly elevated b-hCG is diagnostic for gestational trophoblastic neoplasia
o Contraception is necessary during surveillance period so you can accurately follow b-hCG levels
What is an ovarian tumor containing thyroid tissue called?
Struma ovarii
What are the subtypes of ovarian germ cell tumors
Teratoma, dysgerminoma, endodermal sinus tumor, choriocarcinoma
Most common complication of mature teratomas
Ovarian torsion
What are the subtypes of ovarian epithelial tumors
Serous, mucinous, endometriod, Brenner
What are the subtypes of ovarian sex cord-stromal tumors
Granulosa-theca
Sertolig-Leydig
Fibroma
Describe presentation of Granulosa-theca cell tumor
- Precocious puberty
- Menorrhagia/metrorrhagia
- Postmenopausal bleeding
Describe the ovarian sizes that are concerning for tumor and management of different sizes
< 5 cm = most likely functional cyst; observe
5-10 cm = get US; septations, solid components, or growth on surface of inner lining are all indication for operation; if those all absent, can observe and re-US in 1 month
> 10 cm = operate
At what age is there a sharp decline in a woman’s follicle number
> age 35
How does ABO incompatibility present in a newborn
MILD hemolytic disease - most babies are asymptomatic or mildly anemia at birth
May need phototherapy for hyperbilirubinemia
What are the 2 levels that are decreased in both Trisomy 21 and 18
Alpha-fetoprotein and estriol
THINK: boy (alpha) and girl (estriol)
What are causes of elevated AFP
NTD, abd wall defects, multiple gestation
Describe potential side effect of epidural + treatment
Epidural can lead to hypotension in mom –> placental insufficiency (recurrent late decelerations)
Tx = IV fluids, then vasopressor (e.g. Ephedrine - causes vasoconstriction of the peripheral vasculature but spares the uterine arteries)
What is considered term pregancy
37-42 weeks
identify each type of Diabetes classification (A1, A2, B, C, D, R, F, H, T)
- A1 = gestational; no meds
- A2 = gestational; meds
- B = onset >20 y/o; duration <10 years
- C = onset 10-19 y/o; duration 10-19
- D onset <10 y/o; duration >20 years
- R = proliferative retinopathy
- F = nephropathy (>500 mg/day)
- H = atherosclerotic heart disease
- T = prior renal transplant
Management of placenta previa
Expectant management as long as no excessive bleeding
C-section at 34 weeks
Management of placenta accreta
Hysterectomy
Next step in managment of ASCUS on pap smear
HPV typing
What might you expect to see in an arterial blood gas of a pregnancy woman
Compensated respiratory alkalosis (low CO2 with compensatory low HCO3)
Low CO2 is due to the increased minute ventilation during pregnancy
Tx of amniotic fluid embolism
Mostly supportive with immediate delivery if there is rapid maternal or fetal decompensation
Management of pre-eclampsia without severe features
- Monitor closely for severe disease
- Growth ultrasounds/NSTs
- Delivery at 37 weeks
- BPP once a week for fetal well being
- Typically does not require magnesium sulfate (seizure prophylaxis)
Management of pre-eclampsia with severe features
• Maintain sufficient oxygen saturation
• If >34 weeks, deliver
• Administer MgSO4 for seizure prophylaxis
• If severe HTN (>160/110), therapy should be initiated to prevent stroke
o Labetalol, Hydralazine, or Nifedipine
• If <34 weeks, evaluate if expectant management is appropriate
o If deciding to deliver, give antenatal corticosteroid (for lung maturity) and GBS prophylaxis
Management of preterm labor
♣ Antenatal corticosteroids to enhance fetal lung maturity
♣ Tocolysis: attempts to stop preterm contractions
♣ Magnesium sulfate for neuroprophylaxis (protection against cerebral palsy)
♣ GBS prophylaxis
Management of gestational HTN
- Rule out preeclampsia
- Growth ultrasounds/NSTs
- BPP once a week for fetal well being
- Delivery at 37 weeks
What test can confirm the diagnosis of menopause
Elevated FSH
Diagnose: uniformly enlarged uterus
Adenomyosis
1st step in management of short cervix
Transvaginal progesterone
Describe how obesity can lead to amenorrhea
Due to anovulation - ovaries are still producing estrogen, but progesterone is not being produced therefore progesterone withdrawal menses does not occur
FSH and LH are normal
Management of chorioamnionitis
Broad spectrum abx + induction of labor
Most common organisms of endometritis
Staph and strep
Why does it take a while for mothers to produce milk after delivery
Needs time for estrogen and progesterone levels to decrease in order to remove the inhibitory effect on prolactin
How do you diagnose chorioamnionitis
♣ Maternal fever PLUS >/=1 of the following: • Fetal tachycardia (>160) • Maternal leukocytosis • Purulent amniotic fluid • Maternal tachycardia (>100) • Uterine fundal tenderness
Tx of endometrial hyperplasia
Progesterone or hysterectomy
Describe presentation of germ cell tumor
♣ Are non-malignant
♣ Usually present in teenage girls as an adnexal mass and weight gain
♣ Dx: transvaginal US
♣ Tx: unilateral salpingoophorectomy
What are the 4 types of germ cell tumor
- Choriocarcinoma
- Teratoma
- Dysgerminoma (tumor of oocytes)
- Endodermal sinus tumor (yolk sac tumor)
What are diagnostic values of GDM after 3 hr GTT
Fasting > 90
1 hour > 180
2 hour > 155
3 houe > 140
Compare tx of 3 vulvar cancers
- SCC = vulvectomy and lymph node dissection
- Melanoma = vulvectomy and lymph node dissection
- Pagets = wide local excision (less aggressive)
Describe effects of Raloxifene and Tamoxifen on breast and endometrium
Both used for prevention of breast cancer (estrogen antagonist)
Raloxifene antagonist in endometrium and Tamoxifen agonist (increased risk of endometrial hyperplasia)
Tx of fibroids
♣ First line:
• OCP/IUD +/- NSAIDs for pain
♣ Surgery:
• Leuprolide to shrink prior to surgery
• Myomectomy if want to maintain fertility
• TAH if she doesn’t want kids
How do you diagnose PCOS
(1) + (2) or (3)
(1) Oligo- or anovulation
(2) Hyperandrogenism
♣ Elevated DHEAS
♣ Elevated Testosterone
♣ LH:FHS > 3:1
(3) Polycystic ovaries on US
Tx of postpartum endometritis
Clindamycin + Gentamicin
Order of events of puberty
THINK: Tits, pits, mits, lips
♣ Thelarche (Breasts) (8)
♣ Pubarche (Axillary and pubic hair) (9)
♣ Growth (10)
♣ Menarche (11)
Tx of breast fibrocystic change
o Decreasing caffeine, adding NSAIDs, tight-fitting bra, OCP, oral progestin
Management of single, mobile, firm, rubbery breast mass
Most likely benign fibroadenoma
FNA to confirm
Management of single, mobile, firm, rubbery breast mass
Most likely benign fibroadenoma
FNA to confirm
Managment of Intraductal papilloma
Mammography + US
Biopsy to rule out malignancy +/- excision
Managment of Intraductal papilloma
Mammography + US
Biopsy to rule out malignancy +/- excision
How often should women have breast exams
Age 20-39 = q3 years
>40 = annually
