OBGYN Flashcards
pain management in PACU following ambulatory surgery
short acting IV opioids
PO opioids
APAP/opioid combo
d.c: NSAIDs
pain management for minimally invasive intraabdominal procedures
regional anesthesia:
nerve blocks
PCA vs nurse administered opioid boluses
pain control for major open abd/thoracic surgery and for pt who is dependent on opioids
neuraxial analgesia:
continuous epidural analgesia vs single epidural/spinal opioid
epidural vs intrathecal morphine
PCA vs nurse administered bolus
maintain pt’s usual level of opioid therapy
special considerations for opioid dependent pt’s
continue methadone/buprenorphine through perioperative period
if IV methadone: decrease to 1/2 dose
mc adenopathies seen w. gynecological infxns (4)
axillary
internal mammary
parasternal
supraclavicular
scaling rash/dermatitis of the nipple caused by an invasion of skin cells from a ductal carcinoma
paget’s dz of the breast
8 skin changes during pregnancy
melasma
spider angiomas/varicosities
striae gravidarum (stretch marks)
pruritis
hirsutism
nail growth
androgenic alopecia
chadwick/goodell sign
tx for pregnancy induced pruritis
chlorpheniramine (first gen antihistamine)
bluish/purplish coloration of the vagina during pregnancy
chadwick sign
bluish/purplish coloration of the cervix during pregnancy
goodell sign
mc benign breast tumor
fibroadenoma
do fibroadenomas wax/wane w. menstruation
no!
but pt may experience increased discomfort
describe a fibroadenoma
painless, firm, solitary, rubbery, well defined mobile mass
mc location for fibroadenomas
upper, outer quadrants
etiology for fibroadenomas
probs hormonal due to:
persist during reproductive years
increase during pregnancy or w. estrogen
regress after menopause
dx for fibroadenoma (4)
clinical
US
mammogram
FNA
3-6 mo f/u
US finding of fibroadenoma
well defined solid mass
t/f: mammograms are not indicated for adolescents to dx fibroadenoma due to large amt of glandular tissue
t!
definitive dx for fibroadenoma
core bx vs excision
tx for fibroadenoma
< 5 cm w.o red flags: obs q 2 mos
if persistent: US
if growth or > 5 cm: excisional bx/surgical removal
benign, slow growing breast tumor w. epithelial and stromal components
fibroadenoma
common benign breast condition consisting of fibrous and cystic changes in breast
fibrocystic breast dz
FNA findings of fibrocystic changes
straw colored/green fluid
tx for fibrocystic dz
no caffeine
NSAIDs
vit E
primrose oil
last resort: danazol, OCP
mcc of bloody nipple d.c in a young woman
intraductal papilloma
3 mc causes of nipple d.c in a non lactating woman: mc -> lc
duct ectasia
intraductal papilloma
carcinoma