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STEP 2 CK PREP SB > OBGYN > Flashcards

OBGYN Flashcards

1
Q

Pregnancy Dating

A
  • Conceptional Dating: 266 days or 38 weeks
  • Menstrual dating: 280 days or 40 weeks
  • Calculated due date (NAEGELE’S RULE): last menstrual period - 3 months + 7 days
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2
Q

Ectopic Pregnancy TRIAD

A
  • Secondary amenorrhea
  • Unilateral abdominal or pelvic pain
  • Vaginal Bleeding
  • DX is presumed when B-hCG is > 1500 iu/L
  • TX: Methotrexate
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3
Q

Abruptio Placentae Triad

A
  • Late trimester painful bleeding
  • Normal placental implantation
  • Disseminated intravascular coagulopathy (DIC)

-Placenta Accreta (most common 80% of cases)

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4
Q

Placenta Previa Triad

A
  • Late trimester bleeding
  • Lower segmental placental implantation
  • No pain
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5
Q

Late Pregnancy Bleeding

A

Occurs after 20 weeks of gestation.

  • Cervical: erosion, polyps, rarely carcinome
  • Vaginal: varicosities and lacerations
  • Placental: abtuptio placentae, placenta previa and vasa previa.
  • Initial eval of patient, labs, sonogram por placental location (NEVER perform a digital or speculum examination until US rules out placenta previa)
  • Initial tx: IV with isotonic fluids w/o dextrose, urinary catheter. If there is fetal jeopardy the goal is delivery
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6
Q

Vasa Previa Triad

A
  • Amniotomy-AROM
  • Painless vaginal bleeding
  • Fetal bradycardia
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7
Q

Uterine Rupture Triad

A
  • Late trimester painful bleeding
  • Previous uterine incision
  • High perinatal mortality
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8
Q

Cytomegalovirus Triad

A
  • Most common congenital viral syndrome
  • Most common cause of deafness in children
  • Neonatal thrombocytopenia and petachiae
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9
Q

Fetal Circulation In Uterus Shunts

A
  • Ductus venousus carries blood from umbilical vein to the inferior vena cava
  • Formaen ovale carries blood from right to left atrium
  • Ductus arteriosus shunts blood from pulmonary artery to descending aorta.
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10
Q

Period of GREAT TERATOGENIC RISK

A

-Postconception weeks 3-8.

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11
Q

Types of Teratogens

A
  • Infectious
  • Ionizing radiation
  • Chemotherapy
  • Environmental
  • Recreational Drugs
  • Medication
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12
Q

Safe Immunizations PREGNANCY

A
  • Influenza
  • Tetanus, diphtheria, pertussis (Tdap)
  • Hepatitis A & B
  • Pneumococcus (only high risk)
  • Meningococcus
  • Typhoid
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13
Q

Unsafe Immunizations PREGNANCY

A
  • MMR (Measles, Mumps, Rubella
  • Polio
  • Yellow fever
  • Varicella
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14
Q

First Trimester

A

Conception to 13 weeks.

  • Normal symptoms: nausea, vomiting, fatigue, breast tenderness, frequent urination
  • Spotting and bleeding occur in 20% of pregnancies
  • Average weight gain 5-8 lbs
  • Complications include spontaneous abortion
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15
Q

Second Trimester

A

From 13 to 26 weeks
-Normal symptoms: improved feeling of general well being
-Round ligament pain is common
-Braxton-Hicks contractions: painless, low intensity, low duration and can be palpable since 14 week.
-Maternal awareness of fetal movement detected between 16-20 weeks.
-Average weight gain 1 lb per week after 20 weeks
Complications: incompetent cervix, premature membrane rupture, and premature labor

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16
Q

Third Trimester

A

From 26-40 weeks
- Normal symptoms: decreased libido, lower back and leg pain, urinary frequency, and Braxton-Hicks contractions
-Lightening describes descent of fetal head into pelvis
-Bloody show describes vaginal passage of bloody endocervical mucus, result of cervical dilation before labor
-Average weight gain 1 lb after 20 weeks
Complications include: premature membrane rupture, premature labor, preeclampsia, gestational diabetes, UTI, anemia.

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17
Q

Turner syndrome 45X

A
  • US shows: nuchal skin fold thickening & cystic hygroma
  • Triad: primary amenorrhea, web neck, streak gonads
  • Characteristics on those who survive: short stature, absence of secondary sexual development, streak gonads, primary amenorrhea/infertility, broad chest, urinary tract anomalies, neck webbing, bicuspid aortic valve and aortic coarctation.
  • NORMAL INTELLIGENCE
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18
Q

Klinefelter Syndrome 47, XXY

A
  • Triad: testicular atrophy, gynecomastia, azoospermia
  • Characteristics: tall stature, testicular atrophy, azoospermia, gynecomastia and truncal obesity
  • Common: learning disorders, low IQ, autoimmune diseases
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19
Q

Down Syndrome (trisomy 21)

A
  • Triad: short stature, intellectual disability, endocardial cushion cardiac defects
  • Characteristics: short stature, intellectual disability, endocardial cushion cardiac defects, short neck, muscular hypotonia, brachycephaly, flat nasal bridge, oblique orbital fissures, protruding tongue, small ears and nystagmus.
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20
Q

Postpartum Bleeding

A
  • Uterine Atony: tx uterine massage, oxytocin, carboprost
  • Lacerations: tx surgical repair
  • Retained Placenta: tx manual removal or uterine curettage
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21
Q

HELLP Syndrome

A
  • Hemolysis (H), Elevated liver enzymes (EL), low platelets (LP)
  • Tx: prompt delivery and use of maternal corticosteroids
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22
Q

Preeclampsia TRIAD

A
  • Pregnancy >20 weeks
  • Sustained HTN (>140/90 mm Hg)
  • Proteinuria (>300 mg/24 h)
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23
Q

Preeclampsia with Severe Features

A

-Pregnancy >20 weeks
-Sustained HTN (140/90 mm Hg)
-Headache or epigastric pain or visual changes
-DIC or elevated liver enzymes or pulmonary edema
Tx:prompt delivery with evidence of maternal or fetal jeopardy. Prevent seizures and BP control.
Tx: IV MgSO4 (prevents convulsiones), Lower BP (IV Hydralazine or Labetalol), Attempt vaginal delivery with IV oxytocin if both are stable

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24
Q

Chorioamnionitis TRIAD

A
  • Ruptured membranes
  • Maternal fever
  • No UTI or URI
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25
Q

Examples of Multifactorial Inheritance

A
  • Neural tube defects (all women should take 0.4 mg of folic acid if high risk of NTD 4mg of folic acid)
  • Congenital heart disease
  • Cleft lip and palate
  • Pyloric stenosis (more in males)
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26
Q

Gestational Hypertension

A
  • Pregnancy >20 weeks
  • Sustained HTN
  • NO proteinuria
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27
Q

Cytomegalovirus

A

-Most common congenital viral syndrome
-Most common cause of deafness in children
-Neonatal thrombocytopenia and petechiae
Tx: Ganciclovir

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28
Q

Autosomal Dominant Inheritance examples

A
  • Polydactyly
  • Huntington chorea
  • Achondroplasia
  • Marfan syndrome
  • Myotonic dystrophy
  • Polycystic kidneys
  • Neurofibromatosis
  • Osteogenesis imperfecta
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29
Q

Chromosomal Aberrations

A
  • The most common aneuploidy is trisomy, presence of an extra chromosome
  • The most common trisomy in first-trimester losses is trisomy 16
  • The most common trisomy at term is trisomy 21
30
Q

Autosomal Recessive Inheritance Examples

A
  • Deafness
  • Congenital adrenal hyperplasia
  • Thalassemia
  • Albinism
  • Sickle-cell anemia
  • Tay-Sachs disease
  • Cystic fibrosis
  • Phenylketonuria
  • Wilson disease
31
Q

X-Linked Recessive Inheritance

A
  • No male-male transmission, expressed only in males, female carriers
  • Hemophilia A
  • Color blindness
  • Complete androgen insensitivity
  • Diabetes insipidus
  • Hydrocephalus
  • Duchenne muscular dystrophy
32
Q

Bacterial Vaginosis

A

TRIAD: pH >4.5, Fishy Odor, Clue Cells

  • Most common vaginal discharge complain
  • Sx: vaginal discharge typically thin, grayish-white, vaginal pH elevated, KOH + fishy odor, and clue cells.
  • TX: metronidazole (same during pregnancy) or clindamycin
33
Q

Trichomonas Vaginalis

A
  • TRIAD: pH > 4.5, itching and burning, Strawberry cervix
  • STD
  • Sx: green vaginal discharge, itching, burning, and pain with intercourse
  • Tx: Metronidazole for patient and partner VO
34
Q

Candida Vaginitis

A
  • TRIAD: pH <4.5, itching and burning, pseudohyphae
  • NO STD
  • Sx: itching, burning, pain with intercourse
  • Tx: fluconazole VO, or azol vaginal cream
35
Q

Physiologic Discharge

A
  • Thin, watery cervical mucus discharge
  • Sx: increased watery discharge
  • Tx: steroid contraception, progestins
36
Q

Benign Vulvar Diseases

A
  • Molluscum contagiousum: bening, viral infection. umbilicated tumors, transmitted through direct contact. Tx: observation, curettage, cryotherapy.
  • Condylomata acuminata: benign cauliflower-like lesions due to HPV 6 & 11. Tx: clinical lesions only
  • Bartholin cyst: obstruction. Tx: conservative unless pressure symptoms due to size.
  • Bartholin abscess: infection. Tx: drainage
37
Q

Cervical Lesions

A
  • Cervical Polyps: Sx: vaginal bleeding, smooth red or purple fingerlike projections from the cervix. Tx: removal and ATB.
  • Nabothian Cysts: mucus filled cysts on the surface of the uterine cervix, benign, small, smooth, rounded lumps on the surface of the cervix. Tx: not required (they do not reduce by themselves), but cryotherapy can get rid of them.
  • Cervicitis: Sx: only vaginal discharge. mucopurulent cervical discharge and a friable cervix, Dx: confirmed by cotton swab with blood from the endocervical canal. Tx: Azitromicine VO one dose or Doxycycline BID for 7 days.
38
Q

Cervical Neoplasia

A
  • Premalignant lesions of the cervix are usually asymptomatic
  • Progression from premalignant to cancer takes 8-10 years
  • Most lesions disappear spontaneously
  • Cause: HPV 16,18 (31,33,35)
  • HPV: 6 and 11 are associated with benign condiloma acuminata
  • Risks: early age of sexual activity, multiple sexual partners, smoking, and immunosuppression
  • Abnormal Pap smear –> HPV DNA testing/colposcopy/biopsy
  • Tx: depending on biopsy results (consult every 6 mo for 2 years), LEEP/cryotherapy/cauterization/cone/surgery
39
Q

Pap Smear

A
  • Start at 21 years all women
  • If abnormal Pap, repeat in 12 mo if negative repeat in 12 mo, if its abnormal do colposcopy and biopsies.

-Stop pap in people with total hysterectomy, women above 65 yrs without previous risks.

40
Q

Invasive Cervical Cancer

A
  • Cervical neoplasia that has passed through the basement membrane
  • Sx: post coital vaginal bleeding, irregular menstrual bleeding and if advanced edema and pelvic pain
  • Dx: cervical biopsy, metastatic workout, imaging (invasive cervical cancer is the only one that can be staged clinically no imaging methods are effective)
  • Tx: surgery & chemotherapy or radiotherapy or both
41
Q

Cervical Neoplasia in Pregnancy

A
  • Pregnant women with abnormal Pap smear should follow with a colposcopy and biopsy.
  • Endocervical curettage is NOT performed in pregnant women.
  • Tx: CIN: repeat Pap smear 6-8 weeks, Microinvasive: cone biopsy and reevaluation, Invasive Carcinoma: before 24 weeks total hysterectomy, after 24 weeks conservative treatment and cesarean surgery for 32-33 weeks.
42
Q

Prevention of Cervical Dysplasia by Vaccination

A
  • Gardasil- 9: all females between 9-45 with target age 11-12
  • 3 doses: first, second after 2 months, third after 6 months.
43
Q

Leiomyoma Uteri

A
  • Benign tumor formed from smooth muscle growth of the myometrium
  • Types: Intramural is the most common location, Submucosal most common symptom is anemia and the Subserosal.
  • Dx: pelvic examination, sonography, hysteroscopy, histology.
  • Tx: Presurgical shrinkage, myomectomy, embolization, hysterectomy
44
Q

Adenomyosis

A
  • Presence of ectopic endometrial glands and storm located in the myometrium of the uterine wall.
  • Common presentation is diffuse
  • Dx: made clinically by identifying an enlarged, symmetric, tender uterus in the absence of pregnancy.
  • Sx: majority are asymptomatic, secondary dysmenorrhea and menorrhagia
  • Tx: levonogetrel, DIU or hysterectomy
45
Q

Endometrial Neoplasia

A
  • Endometrial carcinoma is the most common
  • There is no screening test
  • Risk factors: obesity, hypertension and DM
  • Dx: endometrial biopsy or transvaginal US or hysterocopy
  • Staging
  • Stage 1 Tx: hormone replacement therapy
  • Adenocarcinoma Tx: surgery, radiation and or chemotherapy
46
Q

Functional Ovarian Cyst

A
  • Pelvic mass in reproductive years
  • B-hCG (-)
  • Sonogram + for fluid filled ovarian simple cyst
  • Tx: Observation, Oral contraception, Laparoscopy
47
Q

Polycystic Ovarian Syndrome

A
  • Ovaries are bilaterally enlarged with multiple peripheral cysts (20-100 in each ovary)
  • Cause: high circulating androgens and high circulating insulin levels.
  • Tx: conservative
48
Q

Ovarian Hyperthecosis

A
  • Occurs in postmenopausal women
  • Similar to PCOS, hirsutism is more severe
  • Tx: oral contraceptive pills
49
Q

Theca Lutein Cysts

A
  • Benign neoplasms
  • High levels of FSH and B-hCG
  • Natural course of these tumors is post partum spontaneous regression and conservative management
50
Q

Benign Cyst Teratoma

A
  • Pelvic mass: reproductive years
  • B-hCG (-)
  • Sonogram: complex mass, calcification
50
Q

Benign Cyst Teratoma

A
  • Pelvic mass: reproductive years
  • B-hCG (-)
  • Sonogram: complex mass, calcification
51
Q

Premenopausal Pelvic Mass

A

Dysgerminoma

  • Solid pelvic mass in reproductive years
  • B-hCG (-)
  • Elevated LDH level
  • Tx: cystectomy
  • Oophorectomy
52
Q

Ovarian Torsion

A
  • Abrupt unilateral pelvic pain
  • B-hCG (-)
  • Sonogram: > 7cm adnexal mass
  • Tx: untwist the ovary with laparoscopy or laparotomy.
53
Q

Choriocarcinoma

A
  • Postmenopausal woman
  • Pelvic mass
  • hCG level elevated
54
Q

Sertoli-Leydig Tumor

A
  • Postmenopausal pelvic mass
  • Masculinization
  • Elevated testosterone level
55
Q

Endometrial Carcinoma Metastasic to Ovaries

A
  • Postmenopausal woman with bilateral pelvic masses
  • Postmenopausal bleeding
  • Enlarged uterus
  • Tx: surgical exploration, abd and pelvic CT scan, unilateral salpingo-oophorectomy, chemotherapy
56
Q

Ovarian Carcinoma with Peritoneal Metastasis

A
  • Postmenopausal bilateral pelvic masses
  • Weight gain, anorexia
  • Abdominal shifting dullness
  • Tx: surgical staging and and pelvic CT, debunking surgery, chemotherapy
57
Q

Molar Pregnancy

A
  • Pregnancy <20 weeks
  • HTN and proteinuria
  • No fetal heart tones
  • Tx: baseline quantitative B-hCG, chest x-ray to rule out lung metastasis and suction D&C to evacuate the uterine contents, oral contraception.
58
Q

STD’s

A
  • Bacterial: chancroid, lymphogranuloma venereum, granuloma inguinale, chlamydia, gonorrhea and syphilis.
  • Viral: condyloma acuminatum, herpes simples, hepatitis B, HIV
  • Protozoan: trichomoniasis
59
Q

STD’s with Ulcers

A
  • Herpes Simples Virus
  • Syphilis
  • Chancroid: haemophilus ducreyi, painful ulcer with ragged edge. Tx: Azithormycin VO, IM dose of ceftriaxone, oral erythromycin for 7 days.
  • Lymphogranuloma Venerum: chlamydia trachomatis, painless ulcer, spontaneously heals. Tx: Doxycycline or erythromycin VO for 3 weeks.
  • Granuloma inguinale: donovanosis, calymmatobacterium granulomatis, painless, red, ulcer with lymphadenopathy and lymphatic obstruction. Dx: Donovan bodies. Tx: doxycycline or azithromycin VO for 3 weeks.
60
Q

STD’s WO Ulcers

A
  • Condyloma Acuminatum: most common STD, HPV 6 and 11. Sx: Pain, odor, bleeding, pedunculate, soft papule that progresses into a cauliflower like mass. Dx: biopsy. Tx: topical or local (cryotherapy, imiquimod)
  • Trichomonas Vaginitis
  • Chlamydia: chlamydia trachomatis, most common bacterial STD, pelvic adhesions, chronic pain and infertility, transmission to a newborn baby make take place at delivery, causing conjunctivitis and otitis media. Dx: NAAT. Tx: azithromycin or doxycycline for 7 days VO.
  • Gonorrhea: neisseria gonorrhoeae, pelvis adhesions, chronic pain, infertility, vulvovaginal discharge, itching, burning, dysuria or rectal discomfort. Mucupurelnt discharge cervical motion tenderness, petechial skin lesions. Dx: NAAT. Tx: Single dose of IM ceftriaxone plus a single oral dose of azithromycin.
  • Hepatitis B Virus
  • HIV
61
Q

Pelvic Inflammatory Disease

A
  • Upper genital tract conditions
  • Most commonly caused by chlamydia and gonorrhae
  • Infection starts at the cervix and moves up to the ovaries and oviducts
62
Q

Cervicitis

A
  • Asymptomatic except for mucopurulent cervical discharge. No pelvic tenderness, afebrile, friable cervix.
  • Tx: single dose VO of cefixime and azithromycin.
63
Q

Acute Salpingo-Oophoritis

A
  • Bilateral abdominal and pelvic pain
  • Mucopurulent cervical discharge
  • Cervical motion tenderness
  • Tx: empiric broad spectrum coverage, ceftriaxone IM + doxycycline VO BID for 14 days with or without metronidazole VO for 14 days.
64
Q

Primary Dysmenorrhea

A
  • Recurrent crampy lower abdominal pain, along nausea.

- Tx: NSAIDs and oral contraceptives.

65
Q

Secondary Dysmenorrhea

A
  • Painful menstruation in the presence of pelvic pathology.

- Most common in women in decades 4 & 5

66
Q

Endometriosis

A
  • Chronic pelvic pain
  • Painful intercourse
  • Painful bowel movements
  • Most common site: ovary
  • Dx: laparoscopy
  • Tx: conservative (laparoscopic approach) , aggressive (if fertility is not desired, hysterectomy and bilateral sapling-oophorectomy. Estrogen replacement necessary.
67
Q

Sterilization

A

-Most common: tubal ligation or vasectomy

68
Q

Abnormal Uterine Bleeding

A 
(PALM COEIN)
P: polyps
A: adenomyosis
L: leiomyoma
M: malignancy
C: coagulopathy
O: ovulatory disorders
E: endometrial
I: iatrogenic
N: not yet classified
69
Q

Polycystic Ovarian Syndrome

A
  • HA: HyperAndrogenism
  • IR: Insulin Resistance
  • AN: Acanthosis Nigricans

STEP 2 CK PREP SB (5 decks)

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