OBGYN 🤰🏻 Flashcards
Best contraceptive for women with APLS
IU Cu device
What are the signs of partial and complete ovarian torsion
Severe Pain on one side. Not too much tenderness. N/V. BP stable. Partial = comes and goes. Complete = constant
Mx of ovarian torsion
Laparoscopy
Recall post menopausal bleeding algorithm
Tx for endometrial hyperplasia
Hysterectomy or Prog IUD (do if wants baby, and has no dysplasia). Will need a biopsy every 3 mo to monitor
Which women get endometrial biopsy for AUB
If postmenopausal, above 45, more than 6mo Hx, tamoxifen, obese, trialled COCP that didn’t work
Premenopausal women with AUB, do what?
COCP. If doesn’t work, then do biopsy
most common cause of bloody nipple discharge with no existing mass/LN
intraductal papilloma
main way to distinguish papilloma and duct ectasia
ectasia usually has erythema and pain…. papilloma does not
can hypothyroidism cause galactorrhea
yes, low TH can cause high TRH, which increases prolactin
Cervical cancer screening overview
Management of breast pain overview
Breast pain patient:
Cyclical, bilateral and diffuse.
Mass is present.
Mx?
Imaging
Breast pain patient:
Cyclical, bilateral and diffuse.
Mass is absent.
Mx?
Observe
Breast pain patient:
Non Cyclical, unilateral and focal.
Mass is present.
Mx?
Biopsy and refer to surgeon
Breast pain patient:
Non Cyclical, unilateral and focal.
Mass is absent.
Mx?
Imaging (if abnormal then biopsy)
When is BRCA testing indicated
More than two first degree relatives with breast cancer. One must have been below 50
what signs can be seen after uterine artery embolisation?
pelvic pain and later can see watery/bloody discharge. The FBC should be normal
first line therapy for lactational mastitis
dicloxacillin
Mx of androgen insensitivity syndrome?
gender ID counselling and gonadectomy
what to enquire, regarding a child with condyloma
sexual abuse
Mx of condyloma acuminatum
can just observe. but Tx any non resolving/symptomatic ones. can do topical podophyllin/imiquimod, cryotherapy, cauterization etc
Adenomyosis usually seen in which patient population?
Above 40yo
What is pelvic thrombophlebitis
Septic pelvic thrombophlebitis is a rare diagnosis associated with endometritis and is characterized by relapsing- remitting fevers.
What is genitourinary syndrome
Vaginal estrogen therapy is used in patients with genitourinary syndrome of menopause (eg, vaginal dryness,
atrophy) due to estrogen deficiency. In postmenopausal patients, localized estrogen can relieve urinary symptoms (eg,
stress and/or urge incontinence) related to atrophy.
Pruritic urticarial papules and plaques of pregnancy (PUPPP) symptoms and Tx
Symptoms
occurs in late third trimester or postpartum
extremely pruritic, erythematous urticarial papules and plaques within striae on abdomen
periumbilical sparing of rash
can spread to extremities, chest, and back
spares palms, soles, and face
lasts 4-6 weeks, typically resolving within 2 weeks postpartum
ToPical CS, or oral if refractory
Kleihauer-Betke test ?
identification of fetal blood cells to screen for the degree of fetomaternal hemorrhage.
measures the amount of fetal hemoglobin transferred from a fetus to a mother’s bloodstream
can inform Rh Ig therapy in Rh-negative patients to prevent Rh disease in future pregnancies
Relationship between rosette and kleihauer betke test
Rosette test
to detect fetal-maternal hemorrhage
Kleihauer-Betke test
if Rosette test is positive, can conduct this test
measures fetal red blood cells in utero in maternal circulation to determine dose of RhoGAM
What is pseudocyesis
a rare somatic symptom disorder where a non-pregnant and non-psychotic woman thinks she is pregnant, patients also exhibit signs and symptoms of pregnancy
Child with Very insist, and premature Thelarche
Follicular cyst, producing oestrogen
Pre-menopausal woman with ovarian cyst. Has delayed menses. What could this cyst be
It could be a corpus luteal cyst, which produces progesterone.
Pelvic ultrasound findings compared follicular cyst versus luteal cyst
Follicular cyst is thin walled, luteal cyst is thick walled and has high vascularity
What type of ovarian cysts form due to GnRH stimulation (PCOS, clomiphene, ovulation induction, multi gestation)
Theca luteal cyst
Presentation of theca luteal cyst
Usually a symptomatic, but can cause hyperandrogenism
Brief overview of Pat testing regime
21 to 30, du Pape every three years. Then 30 to 65 to Pap every three years or cotest every five years. After 65 stop if all previously were negative.
Pap smear management
ASC – undetermined significance in a patient with positive HPV
Colposcopy
Pap smear management
Patient between 20 and 30 with ASC - Undetermined significance
Redo PAP test in one year
Pap smear management
Patient with ASC – undetermined significance, who is above 30 and HPV negative
Repeat co test in three years
Pap smear management
Patient with low grade squamous intraepithelial lesion (LSIL), who is between 21 and 24
Repeat Pap in one year
Pap smear management
Patient with LSIL, who is between 25 and 29 years old
Do you colposcopy
Pap smear management
Patient with LSIL and is above 30. Consider if the patient has HPV or does not have HPV
Colposcopy if HPV. Can do colposcopy or Pap test first if HPV unknown
Pap smear management
Patient with a typical squamous cells, can’t exclude HSIL. Regardless of age or HPV status
colposcopy
Pap smear management
If patient has high Grade squamous intraepithelial lesion (HSIL). Consider if patient between 21 and24, 25 and onwards, and if HPV positive or negative
Colposcopy in all, but if above 25 do excision (LEEP, CKC, laser)
Breast atypical hyperplasia mx
Yearly mammogram and Tamoxifen (aromatase inhibitor is postmenopausal)  This is the only breast pathology you struggle with management wise
Which antibiotic is given in every toxic shock syndrome regime, and why
Clindamycin, because it has an anti-toxic affect
Post partum blues should be over within?
~ 2 weeks of birth . Usually begins in days after birth
Post partum depression timeframe usually
Within a month and can last for up to a year. Meets criteria for MDD
Prior HSV infx. Do what at 36 weeks
Give acyclovir until birth. If patient has lesions near time of delivery, then do c sec
Recall fetal hydatoin syndrome PHEN mnemonic
3 differentials for late post partum hemorrhage
Retained POC - boggy or firm uterus (do DandC)
Post partum endometritis - uterus will be tender and patient has fever (broad spectrum Abx)
Placental site subinvolution - stony of uterus (give uterotonic)
Study this
Vasa preview only produces small amount of bleeding, why?
It’s from fetal blood, so it’s minimal. Enough to harm foetus though!
Gestational TCP PLT levels roughly. If goes below X, we should search for other causes. What are the other causes
100-150. If symptomatic or goes below 100, consider alternative Dx: TTP, ITP, DIC.HELLP
Is there an association between hyperemesis gravidarum and thiamine def
Yes!
Acute fatty liver of preg. Occurs in which trimester
3
Lochia Rubra
Birth to 3-4 days postpartum
Dark or bright red (blood); odor similar to that of menstrual
blood; occasional small clots; quantity decreasing each day
Lochia Serosa
• 4th postpartum day to 10th or • 14th postpartum day
Serosanguineous (pink); brownish (old blood); quantity
gradually decreasing in amount
Lochia Alba
11th postpartum day to 6 weeks postpartum
White/yellow; creamy; light quantity
When would we be sus of a lochia rubra case.
If symptomatic from blood loss, if large blood loss (changing pad every hour), passing large clots
What is granulomatous infantsepticum
Congenital listeria. Terrible gastroenteritis, meningitis. Many abscess etc.
Fetal US findings of congenital CMV
Periventricular calcifications
• Ventriculomegaly
Microcephaly
• Intrahepatic calcifications
• Fetal growth restriction
• Hydrops fetalis
First phase of labour. When is the active stage? (Cervicle width wise)
When cervix is dilated above 6cm
In active phas of 1st stage of labour, how much Cervicle lpdilation should we get every 2 hr. If it’s not this, what does it mean?
More than 1cm,
. If fails to do this, consider stuck head (macrosomia, cephalopelvic dissociation)
How does epidural effect labour time
Prologues 2nd stage
Choriocarcinoma Mx
Dilation and suction curretage. With a lil MTX. Take HCG for weeks then months after. Contraception for 6mo
Complications and signs of Choriocarcinoma / hydatid mole
Abnormal vaginal bleeding ‡ hydropic tissue
Uterine enlargement > gestational age
Abnormally elevated B-hCG levels
Theca lutein ovarian cysts
• Hyperemesis gravidarum
Preeclampsia with severe features
Hyperthyroidism
Does cervicits have Cervicle motion tenderness
No
Shoulder dystocia complications for baby. And quick point on each one’s presentation
Clavicle or humeral fracture. Crepitus, deformity, negative Moro, DTR ok
Erbs. Waiter tip (c5-c6 palsy)
Klumpke. Claw hand (c8-T1 palsy) can be with horners (USMLE Q)
Asphyxia
Two types of FGR and the differentials in each
Symmetrical: head and body involved equally. Due to Chr issue or infection
Unsymmetrical: head spared. Due to vascular issues (placental insufficiency), where BF is shunted to vital areas like the head. Also seen in malnutrition
How many Montevideo’s is a good contraction in active labour
More than 200 over 10 mins
How to Tx active labour phase arrest
C sec
What is active phase arrest in labour
No cervical change in >4hr if good Montevideo, or >6hr if poor Montevideo. In the active phase of labour. We usually expect more than 1cm in 2 hour
Main risk for active phase arrest and protracted active phase of labour
Cephalopelvic disproportion (seen in late term, gest diabetes etc.)
Dx?
Active phase arrest
Dx
Protracted active phase of labour
Can the FetaL presentation change late on?
Yes! Must keep checking as it can change. Also, can do digital cervical exam to palpate presenting part in labour. If cannot palpate, do trans abdominal US. RECALL USMLE Q
Tip to age foetus based on uterus fundal height
They are the same. Roughly 32cm is 32 weeks
If foetus was dated using early first trimester US, is the chance of incorrect dating likely?
No
RFs for shoulder dystocia
Maternal obesity, large weight gain in preg, macros increased foetus, DM, post term preg
After birth, suspected endometritis. But with Abx, the pain is still relapsing remitting.
Septic pelvic thrombophlebitis
Only fetal based CI to breast feed?
Galactosemia
Can women with hep B or C breastfeed
Yes. Child needs to have had the Hep B ig and vx at birth though. And don’t breastfeed if there are visual cracks on nipples
Spontaneous abortion. Mx if stable, vs unstable or septic. In simple terms (mx sheets overcomplicates it)
Can do observant, misoprostol. If unstable or septic do suction curretage.
Why is oxytocin not useful for abortion or to expel spontaneous abortion; in first and second trimester
There are few oxytocin receptors in these periods.
Recommendations to prevent listeria in pregnant women
Avoid raw meat, cheese stuff, deli, raw veg, wash hands if handle soil
Patient has cervical insufficiency. Mx? When do we not do this specific Mx..
Do rescue cerclage. If there is bulging amniotic sac, don’t do cerclage (risk of rupture)
How to calculate Montevideo units in a labour
Take difference between baseline uterine tone and peak contraction pressure (mmHg). Add these contraction pressures within 10 mins. 200-250 is good in active phase
Tx for congenital todo
Sulfadiazine, pyrimethamine, folinic acid
Disseminated abcesses and sepsis….. which congenial or perinatal infx?
Listeria
Signs of congenital varicella syndrome
Malformed digits, skins lesions (in dermatomal areas)
Less than how many CM, do we do cerclage
Less than 2.5 cm length of cervix
Causes and risk factors for second phase arrest
Maternal obesity, large weight gain in pregnancy, DM = cause cephalopelvic disproportion
Also malpresentation, inadequate Montevideo, tired mum
Fetal decent stations
During delivery, we prefer which occipital position
Occipital anterior. Not occipital transverse
Hydroneohrosis of pregancy
In first trim, the ureter relaxes. Then the uterus compresses the ureters. May cause a little discomfort, but generally it’s ok. No need to Mx. Bilateral hydronephrosis with normal urinalysis (rules stones out)
Causes of hydrops fetalis
• Rh(D) alloimmunization
• Parvovirus B19 infection
o Fetal aneuploidy
• Cardiovascular abnormalities
• Thalassemia (eg, hemoglobin Barts)
Symptoms of Sheehan and cause for each symptoms
• Lactation failure (1 prolactin)
• Amenorrhea, hot flashes, vaginal atrophy (I FSH, LH)
• Fatigue, bradycardia (1 TSH)
• Anorexia, weight loss, hypotension (¡ ACTH)
Decreased lean body mass (¡ growth hormone)
What’s going on here:
Fetus with edematous scalp, polyhydramnios, ascites, thick nuchal fold, thickened placenta, increased FHR
Hydrops
Stage 1 of labour is what?
Cervical dilation. We have passive and active phase (active when dilated beyond 6cm)
In the first stage of labour, when do we put in a Pressure catheter and measure Montevideo’s
When the active phase slows <1 cm dilation in 2 hours
What is considered an alkali vag pH
Above 4.5
