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Prep Study > OBGYN > Flashcards

OBGYN Flashcards

1
Q

Primary Amenorrhea

A

No Menses by age 13 with no secondary sexual characteristics
or
No menses by 15 with normal growth and secondary sex characteristics

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2
Q

Secondary Amenorrhea

A

Previous menstrual cycle but now absent for 3 cycles or 6 months

Pregnancy, Weight changes, Hypothyroid, Prolactinoma, drug use, exercise, etc

Endometrial atrophy (Asherman’s syndrome)
Pituitary Dysfunction (Sheehan’s Syndrome)
Premature ovarian failure (FSH >40)

Dx: HCG, FSH, PRL, Thyroid panel, Estrogen ,progesterone

TX: OCP if don’t want to be pregnant
Cyclic progesterone 10mg for 10 days if want to get pregnant

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3
Q

Physiologic Amenorrhea

A

Seen prepubescently, During pregnancy and post menopause

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4
Q

Most common cause of secondary amenorrhea

A

Pregnancy

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5
Q

Genetic reasons for Primary Amenorrhea

A

Turners Syndrome
Hypothalamic Pituitary insufficiency
Androgen insensitivity
Anorexia
Mullerian agenesis
Imperforate Hymen

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6
Q

Dysmenorrhea

A

Uterine pain at time of Menses (primary or secondary)
Painful Menstruation that affects Daily Activities

Primary - Due to increased prostaglandins
Secondary - Due to pelvic uterus pathology

Recurrent Crampy Midline Lower Abdominal pain 1-2 days before menses starts
Lasts 12-72 hours

Normal exam

Tx: Supportive care, heat etc,
NSAIDS and hormone therapy
Laparoscopy

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7
Q

Dysfunctional uterine Bleeding (Abnormal Uterine Bleeding)

A

Unexplained bleeding in nonpregnant women

Normal Exam
No specific test - HCG, H&H, etc.
Endometrial biopsy to rule out cancer in >35 with obesity, hypertension or DM
Biopsy for all postmenopausal women

Causes = PALM COEIN

Acute hemorrhage = IV high dose estrogen or high dose OCP

Chronic management = Estrogen progestin OCP First line
Progesterone if Estrogen is contraindicated
Levonorgestrel IUD
NSAIDS if hormones are unwanted
Surgery (hysterectomy is definitive), Can do endometrial ablation

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8
Q

PALM COEIN

A

Polyp
Adenomyosis
Leiomyoma
Malignancy or hyperplasia

Coagulopathy
Ovulatory Dysfunction
Endometrial
Iatrogenic
Not Classified

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9
Q

Menopause

A

Cessation of Menses over 12 months
FSH >30 (not necessary for diagnosis)
Over 40 with no pathologic cause

If under 40 (Premature ovarian failure)

Average 51 years

Hot flashes, Night Sweats, dyspareunia, vaginal dryness Classic symptoms

Tx:
If uterus = HRT (Estrogen+ Progesterone)
If No uterus = Estrogen

HRT can cause increased risk of MI, DVT, CVD, Breast Cx, increased TGL

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10
Q

Unopposed estrogen Risk

A

Endometrial cancer

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11
Q

Normal Cycle Physiology Phases

A

2 phases

Follicular Phase (proliferative)
Day 0 to day 14

Luteal Phase (Secretory)
day 15 to day 28

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12
Q

Normal Physiology Phases
Follicular Phase

A

First part of menstrual cycle, day 0 - day 15

First, GNRH (from hypothalamus) stimulates FSH and LH release (anterior pituitary)

A follicle grows, secreting estrogen

Estrogen initially gives negative feedback

Once estrogen levels are high enough from follicle secretion, it begins to give positive feedback on FSH and LH which then surge

Estrogen secretion is increased even more from the follicle,
It induces an LH spike which causes ovulation

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13
Q

Normal Physiology Phases
Luteal Phase

A

Typically the luteal phase is days 15-28 of the cycle

After ovulation, the follicle becomes the corpus luteum which secrets progesterone and provides negative feedback to FSH and LH

If pregnancy does not occur, the corpus albicans is formed which no longer secretes estrogen or progesterone.

This decrease in hormones leads to endometrial sloughing or menses

To begin a new follicular phase of the menstrual cycle, GNRH is secreted and cycle restarts

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14
Q

Normal Physiology of Menstrual cycle

A

Average 28 day cycle

Can be from 20-35 days

2 phases (Follicular and Luteal)

Cycle begins on first day of bleeding (Menstruation) (day one of cycle)

Ovulation or release of the oocyte from ovary begins 14 days before first menstruation (day 14 of average cycle)

Fertilization chance is highest between day 11 and 15 of average cycle

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15
Q

Premenstrual Dysphoric Disorder

A

Repeated episodes of significant depression and similar symptoms in the week before menstruation
(Occur during Luteal Phase and resolve with menstruation)

Tx SSRI (Fluoxetine, Sertraline)
Can be use symptomatically or regularly

Others: Benzos, TCAs, Clomipramine, Birth Control, Diuretics, Low dose estrogen, GNRH
Ovariectomy for severe refractory cases

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16
Q

Premenstrual Syndrome

A

Caused by an imbalance of estrogen and progesterone along with excess prostaglandin production

1-2 weeks before menses (Luteal Phase)
Resolve with menses

Bloating, breast tenderness, HA, edema,
irritability,Depression, Anger, Anxiety, Social withdrawal, Confusion (disruption in function)

Tx: Exercise and stress reduction are beneficial
decrease caffeine, NSAIDS
SSRI are first Line
Combined OCP
GNRH agonist
Surgery (bilateral oophorectomy/salpingo oophorectomy is last resort

does not hinder life

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17
Q

Cervicitis

A

Infection of the cervix, usually from STD.
Inflammation of Cervix from Allergy, spermicide or chemical exposure

Gonorrhea
Chlamydia
Herpes Simplex
Human Papillomavirus (HPV)
Trichomoniasis

Tx:
Infection: Proper ABX
Inflammation: remove offending agent

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18
Q

Gonorrhea

A

N

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19
Q

Lactational Masitis

A

First line is NSAIDS (Ibuprofen)
Continue breast feeding
Cool Compress

If not improvement ABX (dicloxacillin or cephalexin)

Consider MRSA coverage (Bactrim, Clinda, Vanco)

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20
Q

PCOS US

A

String of pearls

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21
Q

Polycystic Ovary Syndrome (PCOS)

A

Amenorrhea, obesity or overweight, hirsutism

PE will show bilateral ovarian enlargement, acanthosis nigricans

Labs will show high LH to FSH, androgen excess

Most commonly caused by insulin resistance

Treatment is combination oral contraceptive pills, lifestyle
changes, metformin

Most common cause of infertility

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22
Q

Endometriosis

A

Patient presents with pre- or mid-cycle dysmenorrhea, dyspareunia, dyschezia (painful bowel movement)

PE may show uterosacral nodularity or a fixed or retroverted uterus or adnexal mass

Definitive diagnosis is made by laparoscopy

Most common site is ovaries

Tx: NSAIDs, COCs, depot medroxyprogesterone acetate, GnRH agonists, surgery

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23
Q

Preeclampsia Severe features

A

Systolic over 160
Diastolic over 110
Platelet under 100,000
Serum Creatinine over 1.1
LFTS twice normal
RUQ or Epigastric pain
Refractory Headache
Neuro symptoms (vision, hearing etc.)

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24
Q

Screening Glucose tolerance test

A

Diagnostic criteria for the 100-gram three-hour GTT to diagnose gestational diabetes:

100-gram oral glucose load is given in the morning to a patient who has fasted overnight for at least 8 hours.

Glucose concentration greater than or equal
to these values at two or more time points is generally considered a positive test

100 gram load

Fasting 95
1 hour 180
2 hour 155
3 hour 140

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25
Q

Follow up Glucose Tolerance test

A

Obtain a random glucose on all pregnant women during the first prenatal visit to check for preexisting diabetes, then conduct a repeat screening at 24-28 weeks

**Screening consists of administering a nonfasting 50-g glucose challenge test, followed by a serum glucose level 1 hour later. If the 1-hour serum glucose = > 130,

  • Fasting: 95
  • One hour > 180
  • Two hour > 155
  • Three hour > 140
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26
Q

Gestational Diabetes Mellitus

A

Screening between 24 and 28 weeks with 50 g glucose load (abnormal: glucose > 130–140 mg/dL after 1 hr)

  • Diagnostic criteria
  • A 100 g glucose challenge with > 95 mg/dL fasting, > 180 mg/dL at 1 hour, > 155 mg/dL at 2 hours, or > 140 mg/dL at 3 hours
  • > 130–140 mg/dL after 1 hour challenge can be positive depending on facility and local prevalence
  • Rx: lifestyle changes, fetal growth monitoring, insulin
  • Fetal risks: macrosomia, respiratory distress syndrome, neonatal hypoglycemia
  • ↑ maternal risk of type 2 DM
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27
Q

Cervical Cancer Risk Factors

A

HPV
HIV
Immunosuppression
Smoking
Young age intercourse <18
Multiple sex partners
High risk partners (HPV)
Multiparity
Long term OCP use
history of chlamydia
Family history of cervical cancer

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28
Q

Uterine Fibroids (Leiomyoma)

A

Common during reproductive-ages

Menorrhagia and dysmenorrhea

PE will show a enlarged, asymmetric, and nontender uterus

Diagnosis is made by pelvic ultrasound

Majority do not require surgical or medical treatment

Severe cases: myomectomy (fertility can be preserved) or hysterectomy

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29
Q

Cystocele

A

refers to a prolapse of the posterior bladder into the anterior vagina

Risk factors for cystocele include pregnancy, vaginal delivery, advanced age, obesity, multiparity, menopause, and diabetes mellitus.

Funnel-shaped bladder.

Additional testing that may be needed includes the cotton swab test, voiding cystourethrogram, and cystometrogram.

Treatment of a cystocele consists of conservative management (weight reduction, pelvic floor and Kegel exercises, pessaries) and surgical interventions (anterior vaginal colporrhaphy, tension-free vaginal tape procedure).

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30
Q

Uterine Prolapse

A

Stage 1 is characterized by a pelvic organ that is > 1 cm above the hymen.

Stage 2 is characterized by a pelvic organ extending from 1 cm above to 1 cm below the hymen.

Stage 3 is characterized by a pelvic organ located > 1 cm past the hymen without complete uterine prolapse.

Stage 4 is characterized by complete uterine prolapse.

Lifestyle modifications that decrease the risk of uterine prolapse include weight loss if overweight, fiber-rich diet, avoidance of heavy lifting or straining, smoking cessation, and Kegel exercises to strengthen the pelvic floor muscles.

Treatment for uterine prolapse includes lifestyle changes, pessary placement, and hysterectomy.

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31
Q

Uterine Prolapse Risk Factors

A

Risk factors:
multiparity, age, decreasing estrogen levels, trauma

Tx:
Kegel exercises, pessary, surgery

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32
Q

Gestational Diabetes complications for Fetus

A

Macrosomia
RDS
Neonate Jaundice
Neonate Hypoglycemia
polycythemia
hypocalcemia
hypomagnesium
polyhydramnios
shoulder dystocia

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33
Q

Gestational Diabetes complications for Mother

A

Preeclampsia
Birth Trauma
Risk for DM2

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34
Q

Ovarian Torsion

A
  • Patient will be a woman, 15–30 years old or postmenopausal
  • Sudden onset of unilateral (right > left) abdominal and pelvic pain
  • Labs will show leukocytosis
  • Imaging will show enlarged ovary or ovarian mass
  • Definitive diagnosis and management: laparoscopy
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35
Q

Rectocele

A

History of childbirth, trauma, previous surgeries

PE will show a vaginal bulge at posterior vaginal wall or anterior rectum wall

Most commonly caused by weak pelvic muscles

Management includes managing constipation (high-fiber diet),
pessary device, and surgery when conservative measures fail

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36
Q

Endometrial cancer risk

A

Elderly
Nulliparity
Diabetes
Obesity
Menstrual irregularity
Estrogen monotherapy
Hypertension

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37
Q

Most common cause of fetal abortion before 20 weeks

A

Chromosomal Abnormalities

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38
Q

Tubo-Ovarian Abscess

A
  • History of pelvic inflammatory disease (PID)
  • Lower abdominal pain, fever, vaginal discharge
  • PE will show unilateral adnexal tenderness
  • Diagnosis is made by ultrasound
  • Most commonly caused by a complication of pelvic inflammatory disease
  • Treatment is intravenous antibiotics, surgical drainage, or both
    Most common in women 15-25
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39
Q

Vulvovaginal Candidiasis

A
  • Risk factors: diabetes, HIV, recent antibiotic use, steroid use, pregnancy, immunosuppression
  • Sx: vulvar pruritus, dysuria, dyspareunia
  • PE: white, cottage cheese-like discharge
  • Labs: normal pH < 4.5, wet prep: budding yeast, pseudohyphae, hyphae
  • Most commonly caused by Candida albicans
  • Tx: topical azoles, oral fluconazole
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40
Q

Endometrial Cancer

A
  • Peak incidence is in postmenopausal patients between age 60–70 years
  • Most common type is adenocarcinoma
  • Risk factors: nulliparity, obesity, unopposed estrogen (postmenopausal estrogen therapy without progestin), tamoxifen
  • Sx: abnormal vaginal bleeding
  • Dx: endometrial biopsy
  • Tx: total hysterectomy AND bilateral salpingo-oophorectomy
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41
Q

Hyperemesis Gravidarum

A
  • Peak incidence: weeks 8–12
  • Weight loss
  • Hypokalemia
  • Ketonemia
  • Rx: IVF with 5% dextrose, antiemetics
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42
Q

Genitourinary Syndrome of Menopause (Atrophic Vaginitis)

A
  • Risk factors: natural or surgical menopause, antiestrogenic drugs
  • Sx: dyspareunia, vulvar and vaginal dryness, bleeding, itching
  • PE: pale, dry, shiny epithelium
  • Caused by a decrease in estrogen
  • Tx: lubricants, moisturizers, topical estrogen
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43
Q

Osteoporosis

A

Decline in bone mass that results in increased bone fragility and fracture risk

Risk factors: female sex, advancing age, chronic steroid use, alcohol or tobacco use, family history of fragility fracture

Diagnosis is made by DXA scan: T-score ≤ −2.5 or presence of a fragility fracture

Osteopenia: T-score -1.0 to -2.5

Tx:
Lifestyle: calcium, vitamin D, weight bearing exercise, smoking cessation

First line pharmacotherapy: bisphosphonates
Second line: SERMs, recombinant PTH, denosumab

Most common fracture: vertebral body compression fractures

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44
Q

Seizure prophylaxis in Pregnancy

A

Mag Sulfate

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45
Q

Lymphogranuloma Venereum

A
  • Primarily seen in men who have sex with men
  • History of recent travel to tropical and subtropical areas of the world
  • Small, shallow painless genital ulcer
  • PE will show tender inguinal or femoral lymphadenopathy
  • Most commonly caused by Chlamydia trachomatis
  • Treatment is doxycycline 100mg BID x 21 days
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46
Q

Rh Isoimmunization

Add more…..

A
  • Rh-negative mothers exposed to Rh-positive blood → anti-Rh antibodies
  • Subsequent pregnancies: jaundice, anemia, fetal hydrops, fetal death
  • Anti-D globulin at 28 weeks (and within 72 hrs of delivery if infant is Rh+)
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47
Q

When do prolactin levels return to normal in a mother who is not nursing?

A

2 to 3 weeks following delivery.

(Prolactin is responsible for milk production after delivery)

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48
Q

Safe vaccines in pregnancy

A

Hep A
Hep B
Incativated Flu
Inactivated Polio
TDAP
Meningococcal
Rabies
Pneumococcal
COVID

Dont give (unsafe)
MMR, Live varicella, Oral Polio, BCG live

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49
Q

Unsafe vaccines for pregnancy

A

MMR
Live Varicella
Oral polio
BCG Live

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50
Q

How is menopause Diagnosed

A

Clinically is best

FSH is most sensitive test FSH>30

Increased LH
Decreased Estrogen

Cessation of Menses >1 year

Hot flashes, Mood changes, Etc.

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51
Q

Osteoporosis screening starts at what age

A

65

USPSTF

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52
Q

Hyperemesis Gravidarum

A
  • Peak incidence: weeks 8–12
  • Weight loss
  • Hypokalemia
  • Ketonemia
  • Rx: IVF with 5% dextrose, antiemetics
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53
Q

ABX for UTI in Pregnancy

A

Nitrofurantoin (do not use in first trimester)
Fosfomycin
cephalexin
amoxicillin
bactrim

Pregnant Pyelonephritis =
IV ampicillin and Gentamicin or 3rd gen Ceph

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54
Q

Fibrocystic Breast Changes

A
  • Risk factors: women 30−50 years old
  • Sx: intermittent breast pain and tenderness that peak before each menstruation
  • Ultrasound may show dense, prominent, fibroglandular tissue with cysts but no discernible mass
  • Most commonly caused by fluctuating hormone levels during menstrual cycles
  • Treatment is well-fitting supportive bras, applying heat to the breasts, or over-the-counter pain relievers
  • Most common lesion of the breast
  • Fibrocystic changes are generally benign and do not increase risk for breast cancer
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55
Q

Term for low amniotic fluid

A

Oligohydramnios

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56
Q

Preeclampsia

A
  • Pregnancy > 20 weeks gestation or postpartum
  • Visual disturbances, severe headaches, or asymptomatic
  • Evaluation will show new-onset hypertension (≥ 140/90 mm Hg) with either proteinuria (≥ 300 mg/24 hr or urine protein: creatinine ratio ≥ 0.3) OR significant end-organ dysfunction
  • Treatment: delivery at 37 weeks (without severe features) and 34 weeks (with severe features) AND prevention of seizures with magnesium sulfate and prevention of permanent maternal organ damage
  • New-onset hypertension < 20 weeks gestation: suspect molar pregnancy
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57
Q

Which medication can be offered to women with risk factors for preeclampsia

can help prevent preeclampsia?

A

Aspirin

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58
Q

HPV types responsible for cancer

A

16
18
31
33

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59
Q

HPV types responsible for warts

A

6
11
42

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60
Q

Pelvic Inflammatory Disease (PID)

A
  • History of multiple sexual partners or unprotected intercourse
  • Lower abdominal pain, cervical motion tenderness, painful sexual intercourse
  • PE will show mucopurulent cervical discharge
  • Most commonly caused by Chlamydia trachomatis
  • Outpatient treatment is ceftriaxone + doxycycline + metronidazole
  • Fitz-Hugh-Curtis syndrome: perihepatitis + PID
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61
Q

Fibroadenoma

A
  • Patient will be a woman of childbearing age
  • PE: painless, firm, solitary, mobile, slowly growing breast mass
  • Treatment: conservative management or surgical excision
  • Most common breast tumor in adolescents
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62
Q

Reactive Fetal Heart rate

A

Two accelerations of 15 bpm above baseline for 15 seconds each in a 20-minute period

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63
Q

Shoulder Dystocia

A

Large fetal size
Turtle sign: fetal head pulled tight against perineum
Management
Empty bladder
McRoberts maneuver: flexing hips and legs
Suprapubic pressure
Delivery of posterior arm
Clavicle fracture
Last resort: Zavanelli maneuver (reinsert fetal head followed by C-section)

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64
Q

Danzanol or tamoxifen for
Fibrocystic breast changes pain

A

Tamoxifen

Tamoxifen has less side effects

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65
Q

Common Tocolytic Drugs

A

Mag sulfate, Indomethacin, Terbutaline, Nifedipine

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66
Q

What are tocolytics used for?

A

tocolytics are meant to suppress labor for a limited time to allow for the fetus to mature

Mag sulfate, Indomethacin, Terbutaline, Nifedipine

Nifedipine is the first-line agent for tocolytic therapy in women between 32–34 weeks gestation.

Nifedipine is the second line in women between 24–32 weeks gestation.

Magnesium sulfate is first line for women with suspected preterm labor between 24–32 weeks gestation because it provides neuroprotection against cerebral palsy and other types of severe motor dysfunction.

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67
Q

What is Oxytocin (pitocin) for?

A

Labor induction

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68
Q

Vulvar Cancer

A

History of human papillomavirus (types 16, 18, 33)

Vulvar lesion and pruritus

PE will show unifocal vulvar ulcer, plaque, or mass, predominantly on the labia majora

Most common type is squamous cell carcinoma (SCC)

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69
Q

Mag sulfate for preterm labor

A

First line suspected preterm labor between
24–32 weeks gestation

because it provides neuroprotection against cerebral palsy and other types of severe motor dysfunction.

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70
Q

Nifedipine for pre term labor

A

First-line agent for tocolytic therapy in women between
32–34 weeks gestation.

Second line in women between
24–32 weeks gestation.

71
Q

First line steroid for preterm labor

A

Betamethasone

72
Q

Intra-amniotic Infection (Chorioamnionitis)

A
  • Infection, inflammation, or both of the amniotic fluid, placenta, fetus, fetal membranes, or decidua
  • Risk factors: nulliparity, prolonged rupture of membranes, meconium-stained amniotic fluid, internal fetal or uterine contraction monitoring
  • Genital tract infection: STIs, group B Streptococcus, bacterial vaginosis
  • Rx: ampicillin + gentamicin
73
Q

Placental Abruption

A

Patient will be in third trimester

History of hypertension, trauma, or cocaine use

Painful vaginal bleeding

Labs will show hypofibrinogenemia

Tx: fetal monitoring, hemodynamic stabilization, delivery

74
Q

Uterine Prolapse

A

Risk factors: multiparity, age, decreasing estrogen levels, trauma

Rx: Kegel exercises, pessary, surgery

Stage 1 - Uterus ia in upper half of vagina
Stage 2 - Uterus is at introitus
Stage 3 - Uterus protrudes from vagina
Stage 4 - Al of uterus is protruding from vagina

75
Q

Stages of labor

A

Stage 1 =
Time from onset of labor to complete cervical dilation

Stage 2 =
Time from complete cervical dilation to fetal expulsion

Stage 3 =
Time from Fetal Expulsion to Placenta expulsion

76
Q

Bacterial Vaginosis

A
  • Patient presents with malodorous vaginal discharge
  • PE will show thin, gray or white discharge
  • Labs will show pH > 4.5, clue cells
  • Diagnosis is made by potassium hydroxide smear → fishy odor, whiff test, Amsel criteria
  • Most commonly detected bacteria is Gardnerella vaginalis (usually due to decrease in Lactobacillus sp)
  • Treatment is metronidazole
77
Q

Lochia Rubra

A

Postpartum Discharge
red brown
Few days after delivery

78
Q

Teratogenic Vitamin

A

Vitamin A

79
Q

Cystocele first line

A

Pessary

80
Q

Most important risk factor for breast cancer

A

Age is the most significant risk factor for breast cancer.

81
Q

Mastitis

A
  • Patient will be a breastfeeding mother
  • Breast erythema, tenderness, fever
  • Most commonly caused by Staph. aureus
  • Management includes cool compresses and analgesics between feedings
  • Antibiotics: dicloxacillin, cephalexin, TMP-SMX (MRSA), clindamycin (PCN allergy)
  • Continue breast feeding to avoid progression to abscess
82
Q

What tumor markers would you expect to be elevated in a patient with cervical cancer?

A

Beta-hCG, squamous cell carcinoma, and serum sialyl-Tn (STN).

83
Q

Ovarian Cancer Tumor Marker

A

CA 125

84
Q

Ovarian Cancer
*

A

Patient commonly presents with vague gastrointestinal symptoms, early satiety, bloating, abdominal or pelvic pain
* Adnexal mass
* Most common histologic type is epithelial carcinoma
* Tumor marker: CA 125
* Rule out germ cell tumors in patients < 30 years old with tumor markers such as hCG and AFP
* The most common cause of gynecologic death
* Routine screening not recommended (lack of benefit)

85
Q

Requirements for preterm labor

A

Cervical Dilation over 3cm
or
Cervical length less than 20mm on transvag US
or
Cervical Length 20-30mm on trans vag US with +fibronectin

86
Q

What med can cause premature closure of the ductus arteriosus.

A

Indomethacin

87
Q

Abnormal Uterine Bleeding

A

Sx: heavy menstrual bleeding or intermenstrual bleeding
Etiology
Structural causes: polyp, adenomyosis, leiomyoma, malignancy or hyperplasia (PALM)
Nonstructual causes: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified (COEIN)
Laboratory assessment: pregnancy test, CBC
Endometrial tissue sampling for all women age ≥ 45 years
First-line imaging study: transvaginal ultrasound
Hormonal treatment is combination OCPs, IV estrogen, progestins, levonorgestrel IUD

88
Q

What type of cancer does administration of estrogen-only therapy in a perimenopausal woman with an intact uterus increase the risk of?

A

Endometrial Cancer

89
Q

When can the yolk sac be visualized

A

5 weeks

last til 11-12 weeks

90
Q

Most common Bacterial STD

A

Chlamydia

91
Q

Which syndrome is characterized by inflammation of the liver capsule and normal liver enzymes in a patient with a pelvic inflammatory disease?

A

Fitz-Hugh-Curtis syndrome.

92
Q

Chlamydia Cervicitis

A

Diagnosis is made by nucleic acid amplification testing (NAAT)

Most commonly caused by Chlamydia trachomatis

Treatment is doxycycline (100 mg BID x 7 days), azithromycin should be used in pregnancy

Reinfection testing after treatment:

Nonpregnant: three months after treatment or at the first visit in the 12 months after treatment

Pregnant: four weeks after treatment

Most commonly reported sexually transmitted disease in the United States

Empirically treat for concomitant gonorrhea

The USPSTF recommends routine screening for chlamydia and gonorrhea in sexually active women < 25 years of age and in women age ≥ 25 years who are at increased risk

93
Q

BV First Line

A

Flagyl

94
Q

Bacterial Vaginosis

A
  • Patient presents with malodorous vaginal discharge
  • PE will show thin, gray or white discharge
  • Labs will show pH > 4.5, clue cells
  • Diagnosis is made by potassium hydroxide smear → fishy odor, whiff test, Amsel criteria
  • Most commonly detected bacteria is Gardnerella vaginalis (usually due to decrease in Lactobacillus sp)
  • Treatment is metronidazole
95
Q

Outpatient Tx
PID

A

Ceftriaxone 500 im
plus
Doxy 100 bid x 14
plus
Flagyl 500 bid x 14

96
Q

Inpatient Tx
PID

A

Cefotetan 2g IV q12
plus
Doxy PO 100mg Q 12

97
Q

Pelvic Inflammatory Disease (PID)

A
  • History of multiple sexual partners or unprotected intercourse
  • Lower abdominal pain, cervical motion tenderness, painful sexual intercourse
  • PE will show mucopurulent cervical discharge
  • Most commonly caused by Chlamydia trachomatis
  • Outpatient treatment is ceftriaxone + doxycycline + metronidazole
  • Fitz-Hugh-Curtis syndrome: perihepatitis + PID
  • Major complications of PID include tubo-ovarian abscess, chronic pelvic pain, infertility, and ectopic pregnancy.
98
Q

Postpartum Hemorrhage

A
  • Blood loss of ≥ 1,000 mL or bleeding associated with signs and symptoms of hypovolemia within 24 hours of birth regardless of route of delivery
  • Most commonly caused by uterine atony
  • PE will show an enlarged boggy uterus
  • Management
  • Empty bladder
  • Bimanual exam and uterine massage
  • Oxytocin and additional uterotonics (e.g., prostaglandins)
  • Tamponade (balloon or surgery)
99
Q

Causes of postpartum Hemorrhage

A

4 t”s

Tone = Uterine Atony (Most Common)
Trauma
Tissue = Retained placenta parts
Thrombin = Coagulopathy or thrombin disorder

99
Q

Causes of postpartum Hemorrhage

A

4 t”s

Tone = Uterine Atony (Most Common)
Trauma
Tissue = Retained placenta parts
Thrombin = Coagulopathy or thrombin disorder

100
Q

When is ophthalmia neonatorum most likely to appear in a newborn?

A

2-5 days after birth

Tx with prophylactic erythromycin ointment

101
Q

Urge incontinence

A

Scheduled toileting, weight loss, and Kegel exercises are recommended for management of urge incontinence. First-line pharmacologic treatments include antimuscarinics (e.g., oxybutynin) and beta-adrenergics (e.g., mirabegron).

Topical vaginal estrogen may be used in postmenopausal women with urge or stress incontinence

102
Q

Stress incontinence

A

Stress incontinence is caused by pelvic floor weakness, resulting in involuntary leakage of urine with increased intra-abdominal pressure (e.g., coughing, sneezing, laughing, exercise). Urethral hypermobility and intrinsic sphincter deficiency can result in stress incontinence. A bladder stress test is useful for confirming stress incontinence.

Topical vaginal estrogen may be used in postmenopausal women with urge or stress incontinence

103
Q

Episiotomy complications

A

There are numerous complications of episiotomy as compared to spontaneous vaginal laceration.

These include extension of the incision deeper into the perineum that result in more third- and fourth-degree lacerations, a higher risk of infection, a higher risk of wound dehiscence, more postpartum pain, and more dyspareunia.

Additionally, episiotomy increases the risk of repeat vaginal laceration in a subsequent vaginal delivery.

104
Q

Preferred type of episiotomy

A

A mediolateral incision is preferred over a posterior midline incision to reduce the risk of anal sphincter laceration.

It is typically performed in the second stage of labor when the fetus is crowning

105
Q

Test of cure in pregnant chlamydia patient treated for infection.

A

Single dose azithromycin 1gram PO initial treatment
(add 500 IM Cef if pos for gonorrhea)

then test of cure in 3-4 weeks after

Also retesting is recommended 3 months after test of cure

106
Q

Which sexually transmitted infection is associated with the congenital abnormality known as Hutchinson teeth?

A

Syphilis

107
Q

What is the Quad Screen fro pregnancy

A

Alpha-fetoprotein
human chorionic gonadotropin
estriol
inhibin

108
Q

Daily calcium supplement for pregnant women

A

1000mg

109
Q

Cervical Cerclage

A
  • Procedure to stitch the cervix to prevent premature delivery or miscarriage
  • Used for those with cervical insufficiency, short cervix, previous preterm labor

Shirodkar procedure
McDonald procedure
Transabdominal procedure: open or laparoscopic approach

110
Q

Abnormal uterine bleeding first line

A

Progesterone IUD

111
Q

Most common cause of Primary Amenorrhea

A

Gonadal Dysgenesis

Other causes of primary amenorrhea include
Müllerian agenesis, physiologic delay of puberty, polycystic ovary syndrome, isolated gonadotropin-releasing hormone deficiency, transverse vaginal septum, weight loss or anorexia nervosa, and hypopituitarism.

Rare causes of primary amenorrhea include imperforate hymen, androgen insensitivity syndrome, prolactinoma, congenital adrenal hyperplasia, and hypothyroidism.

112
Q

Sheehan Syndrome

A

Pituitary necrosis following massive obstetric hemorrhage

Causes GH, TSH, ACTH, FSH, LH deficiency

Failure to lactate
Amenorrhea

113
Q

Anterior pituitary hormones

A

FSH
LH
TSH
PRL
ACH
GH

114
Q

Posterior Pituitary Hormones

A

Oxytocin
ADH

115
Q

Risks of HRT in post menopausal women

A

Increased risk in

Heart disease
Stroke
Thromboembolic disease
Breast cancer

Decreased risk in

Colorectal cancer
Fractures

116
Q

Increased risk for what cancer with HRT in post menopausal women

A

Breast

117
Q

PCOS first line tx

A

Combined OCP

Spironolactone is used as an adjunct in women who do not improve after 6 months of using combined oral contraceptives

118
Q

Combined OCP pills help reduce what risk?

A

They reduce the risk of endometrial hyperplasia and cancer.

119
Q

What is clomiphene used for

A

Ovulation induction

120
Q

Genital Herpes Simplex

A

Sx: painful genital rash, may be asymptomatic
PE: grouped erythematous shallow cluster of vesicles and lymphadenopathy
Labs: multinucleated giant cells on Tzanck smear (poor sensitivity)
Dx: tissue PCR or viral culture
Most commonly caused by herpes simplex virus (HSV) type 2, but HSV-1 infections are increasing in frequency
Tx: acyclovir
Pregnancy: acyclovir for 7 days after primary infection and from 36 weeks to delivery

121
Q

What can untreated PCOS lead to

A

Endometrial cancer

122
Q

Vulvovaginal Candidiasis

A

Risk factors: diabetes, HIV, recent antibiotic use, steroid use, pregnancy, immunosuppression
Sx: vulvar pruritus, dysuria, dyspareunia
PE: white, cottage cheese-like discharge
Labs: normal pH < 4.5, wet prep: budding yeast, pseudohyphae, hyphae
Most commonly caused by Candida albicans
Tx: topical azoles, oral fluconazole

123
Q

Definitive DX of Syphilis

A

Darkfield Microscopy

124
Q

Syphilis

A
  • Primary: painless chancre
  • Secondary: lymphadenopathy, condyloma lata, rash on palms and soles
  • Tertiary: gummas
  • VDRL and RPR positive 1–4 weeks after infection
  • Primary or secondary: IM benzathine penicillin G, 1 dose
  • Tertiary: IM benzathine penicillin G qwk for 3 weeks
125
Q

PMS bloating Edema Treatment

A

Spiroolactone

126
Q

Acute Pyelonephritis

A

Sx: fever, dysuria, and flank pain
PE: CVA tenderness
Labs: UA + leukocyte esterase, nitrites, microscopy +WBCs, Gram stain, urine culture and susceptibility testing
Most commonly caused by Escherichia coli
Treatment depends on infection severity and community/host risk factors for resistant pathogens, options include fluoroquinolones, 3rd/4th gen cephalosporins, TMP-SMX. Critical illness or risk for multidrug resistant organisms: consider coverage for MRSA, VRE

127
Q

Placenta Previa

A

Patient will in third trimester
Painless vaginal bleeding
Diagnosis is made by ultrasound (transvaginal > transabdominal)
Do not do a digital vaginal exam

Common Risk factors - Multiparity, increased age, and tobacco use.

128
Q

Placenta Accreta

A

Placental attachment to the myometrium rather than the decidua, which causes the placenta not to spontaneously separate at delivery.

Invasion of the placenta into the myometrium.

129
Q

Chancroid

A

Risk factors: sexually active
Sx: painful genital ulcers
PE: papule evolves to a pustule which ulcerates, ulcers on an erythematous base covered by a gray or yellow purulent exudate and painful lymphadenopathy (bubo)
Caused by Haemophilus ducreyi
Tx: ceftriaxone 250 mg IM or azithromycin 1 g oral

130
Q

Placental Abruption

A

Patient will be in third trimester
History of hypertension, trauma, or cocaine use
Painful vaginal bleeding
Labs will show hypofibrinogenemia
Tx: fetal monitoring, hemodynamic stabilization, delivery

131
Q

Pharm tx If breast cancer is hormone receptor positive

A

Tamoxifen

Can cause Uterine malignancy and thrombosis

132
Q

Chlamydia Cervicitis

A
  • Diagnosis is made by nucleic acid amplification testing (NAAT)
  • Most commonly caused by Chlamydia trachomatis
  • Treatment is doxycycline (100 mg BID x 7 days), azithromycin should be used in pregnancy
  • Reinfection testing after treatment:
  • Nonpregnant: three months after treatment or at the first visit in the 12 months after treatment
  • Pregnant: four weeks after treatment
  • Most commonly reported sexually transmitted disease in the United States
  • Empirically treat for concomitant gonorrhea
  • The USPSTF recommends routine screening for chlamydia and gonorrhea in sexually active women < 25 years of age and in women age ≥ 25 years who are at increased risk
133
Q

Ovarian Cysts

A

Follicular: most common ovarian mass, non-neoplastic, regress spontaneously
Corpus luteum: most common ovarian mass in pregnancy, non-neoplastic, regress spontaneously
Dermoid: teratoma
Theca lutein: bilateral, ovarian enlargement
Endometrioid: endometriosis within ovary, chocolate cyst
Ultrasound

134
Q

Chadwicks sign

A

is a bluish discoloration of the vulva, vagina, and cervix that occurs as the result of increased blood flow around 8–12 weeks gestation.

135
Q

Goodells Sign

A

Softening of the cervix

136
Q

Hegar sign

A

characterized by a softening of the uterus.

137
Q

Osiander sign

A

Pulsations felt through the lateral vaginal fornices occur around 8 weeks gestation, and are associated with lateral implantation.

138
Q

Piskacek sign

A

Asymmetrical enlargement of the uterus due to lateral implantation.

139
Q

placental abruption common complication

A

DIC

140
Q

What causes early decels

A

Compression of the fetal head causes a vagal reaction, which leads to an early deceleration of the fetal heart rate.

141
Q

Primary Dysmenorrhea
*

A

Pain starts 1 or 2 days before menses
* Pain is only related to menstrual cycle
* ↑ PGF2alpha → ↑ uterine contractions
* Pain management: NSAIDs (first line) or acetaminophen
* Hormonal therapy: estrogen-progestin contraceptives

142
Q

4 t”s of postpartum hemmorhage

A

Tone
Tissue
Trauma
Thrombosis

143
Q

What nutrient is colostrum the highest in

A

Protein

144
Q

Menopause treatment for symptoms. (hot flashes etc)

A

If uterus
Estrogen and Progesterone

If no uterus
Estorgen only

145
Q

APGAR

A
  • Appearance, pulse, grimace, activity, respiration
  • Calculated at 1 and 5 minutes after birth
  • Score of 0, 1, or 2 per section
  • Baby with low score may require intervention
146
Q

Elevated AFP in Pregnancy

A

Neural tube defects

147
Q

What class of medications is associated with neural tube defects?

A

Antiepileptic medications, such as carbamazepine and valproic acid.

148
Q

Abortion types with closed cervix

A

Threatened
complete
missed

149
Q

Abortion types with open cervix

A

Inevitable
Incomplete
Septic

150
Q

Fetal Station heights

A

-5 = highest, pelvis
0 = middle ischial spine
+5 = vaginal opening

151
Q

Genitourinary Syndrome of Menopause (Atrophic Vaginitis)

A

Risk factors: natural or surgical menopause, anti estrogenic drugs
Sx: dyspareunia, vulvar and vaginal dryness, bleeding, itching
PE: pale, dry, shiny epithelium
Caused by a decrease in estrogen
Tx: lubricants, moisturizers, topical estrogen

152
Q

Vaginal Atrophy tx

A

First line = moisturizers
then vaginal estrogen
then systemic estrogen

153
Q

Trich s/s

A

yellow green discharge
fishy odor
flagellated

Vaginal edema, erythema, and punctate macular hemorrhages on the cervix, known as colpitis macularis or strawberry cervix

154
Q

Nausea tx in preg

A

Pyridoxine
(vit b6)

155
Q

Earliest a mole can be setected

A

8 weeks

156
Q

Endometritis Tx

A

Clinda and Genta

(Abdominal pain, foul discharge, uterine tenderness post partum)

3 D’s
Dysmenorrhea, dyspareunia, and dyschezia.

157
Q

Postpartum Endometritis

A
  • Patient will be postpartum, early-onset disease < 48 hours after delivery (C-section more common)
  • Fever, abdominal pain, foul-smelling lochia
  • PE will show uterine tenderness
  • Labs will show leukocytosis
  • Most common postpartum infection
  • Treatment is clindamycin + gentamicin
  • GBS colonized: add ampicillin or use ampicillin-sulbactam
158
Q

Complication of endometritis

A

Septic pelvic thrombophlebitis is a rare complication of postpartum endometritis that occurs when a thrombus occurs in a pelvic vein and becomes infected.

159
Q

Preterm labor meds

A

Mag sulfate
Betamethasone
Ampicillin if grp B strep Unknown

160
Q

At what age can you feel fetal movement

A

19 weeks

161
Q

PID Out patietn ABX

A

Cef
Doxy
Flagyl

162
Q

PID inpatient ABX

A

Cefotetan
Doxy

163
Q

What is tachysystole

A

Side effect of oxytocin (most common)

5 contractions per 10 minutes for over 30 minutes

tx: reduce oxytocin

164
Q

Active labor begins at what cervical dilation?

A

over 6 cm

165
Q

RH incompatibility

A

Mom Negative
Dad Positive (Baby)

Rho Gam at 28 weeks and 72 hours before delivery

Fetal doppler of middle cerebral artery before 28 weeks

166
Q

Colposcopy

A

No lesions - do endocervical biopsy sampling

Lesions, just do colposcopy

167
Q

Fetal fibronectin

A

Used to determine risk of preterm birth

168
Q

Retroverted uterus

A

Endometriosis

169
Q

Most common endometriosis site

A

Ovaries

170
Q

HRT puts you at risk for what cancer

A

Breast cancer

171
Q

Previa vs abruption

A

Previa is painless
Abruption is painful
Vasa previa = Membrane rupture, Painless bleeding, Fetal distress

172
Q

Excessive vomiting can cause what electrolyte imbalance

A

Hypokalemia

173
Q

Cervical insufficiency can be linked to what disorder

A

Ehler danlos

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