OBGYN Flashcards

1
Q

How does hormonal contraception work?

A

Disrupts the negative feedback loops of the anterior pituitary gland which stops FSH from being produced which therefore stops ovulation

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2
Q

Dysfunctional uterine bleeding in a post-menopausal woman

A

Almost always related to cancer of varying degrees of aggressiveness

Could also be caused by UTI

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3
Q

Clinical management of dysfunctional uterine bleeding

A

Order hCG to determine if pregnant

Order basic labs: CBC, BMP

Pelvic exam to determine if bleed is coming from the os or from lesion in the vagina

Pelvic ultrasound to examine the endometrium (thickness, presence of masses, presence of products of conception)

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4
Q

Ovarian Torsion: Causes, presentation, Diagnosis, treatment

A

Gynecological emergency
Caused by ovarian enlargement due to a cyst or tumor

Presents with severe abdominal pain, vomiting, pre-syncope
Could intermittent pain as it untorses

Diagnosed with ultrasound

Treatment is urgent surgery hopefully within 4 hours of time of onset

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5
Q

What does a strawberry cervix indicate

A

Trichomoniasis

  • Usually accompanied with a frothy greenish discharge and a musty smell
  • Treated with metronidazole 2g PO x1
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6
Q

Pelvic Inflammatory Disease: Causes, presentation, diagnosis, treatment

A

Caused generally by gonorrhea or chlamydia that pass the cervix and enter the endocervical canal and travel to the uterus or fallopian tubes

Usually sxs begin with vaginitis/cervicitis and then progress to lower abd pain and fever

  • –Pain is much worse with movement and often causes difficulty walking
  • –Usually significant cervical motion tenderness

Treatment:
Mild: Ceftriaxone 250mg IM and Doxycycline 100mg PO BID x14 days
Severe: Usual care for sepsis
Cefoxitin 2gm IV every 6 hours and Doxycycline 100mg IV every 12 hours (“Foxy Doxy”)

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7
Q

Most common female reproductive cancers

A

Dermoid Cysts: Teratomas
Cystadenomas: Benign tumors
Mullerian cysts: Almost always malignant and usually appear post-menopausal - CA 125 will be elevated

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8
Q

Risk factors for ectopic pregnancy

A
Prior ectopic
Tubal pathology or surgery
Tubal Ligation
STD (usually PID from chlamydia, causing stenosis of the fallopian tubes)
IUD
Smoking
Advanced maternal age
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9
Q

Know the different types of abortion

A

Spontaneous abortion:

  • Loss of pregnancy before 20 weeks
  • Fetal death after the age of viability (24 weeks) is labeled “still birth”
  • Most common sxs is bleeding

Inevitable abortion:

  • Patient has vaginal bleeding and crampy abd pain with notable cervix dilation.
  • Products of conception can be seen through cervical os.

Incomplete abortion:

  • Vaginal bleeding and pain present
  • Cervix is dilated and products of conception are noted in the cervix.

Missed abortion:
-Spontaneous abortion in a pt with or without sxs and a closed cervical os - can cause infection and DIC

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10
Q

When is Rhogam given?

A

In all women with vaginal bleeding with Rh negative blood type
Prevents hemolytic anemia in the next baby

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11
Q

Pregnancy-related hypertensive disorders: Clinical presentation

A

Preeclampsia:

  • Most common
  • Causes hypertension, proteinuria and end-organ dysfunction (usually liver or kidney)

HELLP (hemolysis, transaminitis, thrombocytopenia):

  • Thought to be related to preeclampsia but up to 15% of patients with HELLP do not have an elevated BP
  • Can have elevated uric acid

Eclampsia:

  • Medical emergency
  • HTN with the development of seizures
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12
Q

Treatment of Preeclampsia/HELLP

A
  • Reduction in the BP is the priority
  • Usually done with labetalol, nifedipine or hydralazine
  • —Remember ACE-I and ARBs are contraindicated in pregnancy

Magnesium Sulfate given IV to treat recalcitrant HTN and prevent seizure

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13
Q

Treatment of Eclampsia

A

Delivery of the fetus is the priority

Treatment with Magnesium Sulfate is the treatment of choice
—check Mg level every few hours and keep below 10

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14
Q

Management of postpartum hemorrhage

A
Usually caused by the 4 T's
Tone: Atonic uterus
Trauma: From birth
Tissue: Retained products of conception
Thrombin deficiency: Usually diagnosed at this time but was not known prior

Treatment:
Best treatment is prevention
—Administration of oxytocin postpartum
-Start massive infusion protocol
-Pack vagina or cervical os to help stop bleeding that could be in vagina or cervix
-Suture any wounds
-Obtain ultrasound to assess for RPOC
-Give uterotonics if indicated
-Urgent OBGYN consult
—-Can consider a Bakri Balloon into the uterus to tamponade bleeding
—Can also consider hysterectomy if all else fails

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15
Q

Resuscitation of the pregnant patient in cardiac arrest - physical resuscitation

A
  • Intubation becomes more of a priority to provide enough O2 for mom and baby
  • Faster respiratory rate is provided
  • Smaller ET tube sometimes needed d/t edema
  • NG/OG tube should be placed to decompress the stomach to make room for the uterus
  • Manual uterine displacement to the patient’s left is needed to assure adequate perfusion and venous return
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16
Q

Resuscitation of the pregnant patient in cardiac arrest - medications

A

In ventricular arrhythmias, amiodarone is contraindicated
—Defibrillation and cardioversion are safe
Perimortem c-section is indicated at 4 minutes following maternal cardiac arrest if fetus is >24 weeks

17
Q

Fibroadenoma of the breast

A

Most common breast mass
Occurs within 20 years of puberty
Benign - no intervention needed unless cosmetic

18
Q

Causes of nipple discharge

A

In a non-lactating woman, nipple discharge can be a sign of hormonal dysregulation, infection, ductal vascular ectasia, intraductal papilloma or carcinoma

19
Q

Mastitis: Causes, presentation, treatment

A

Common in lactating women - clogged milk duct that results in a painful, erythematous, warm, swollen breast

Sometimes the milk becomes infected and an abscess forms

Treatment is based on severity:

  • Frequent feedings, pumping or massage can help express the duct
  • Hot compresses can be used
  • Antibiotics can be considered but need to be safe for lactation

Mastitis in the non-lactating woman is highly suspicious for carcinoma