OBGYN Flashcards
Mx of amntoic fluid emboli syndrome
Ventilate, Pressor, Transfuse
What should be done after a patient has been raped
Emergency contraception, prphlx for (chlam, gon, hiv, hepB, tichomonas), urine preg test, sexual assault evidence kit
What is pubertal gynaecomastia
In boys, mid puberty when E:A is high. So a limb may be felt (both or one side). Usually tender. Exclude red flags like redness, warmth, discharge etc. if there are red flags, can do imaging. Often have tanner 3 stage
Ovarian mass and false positive preg test could be??
Choriocarcinoma
PCOS and Sertoli Leydig cell tumour sign difference
PCOS more gradual.
When to hospitalise and do inpatient treatment for PID
If severe (fever, vomiting etc.), preg, outpatient Tx failed, TOA, Fitz Hugh Curtis, non compliance
When to add metronidazole to PID Tx
Add if TOA concomitant
Review CI for IUDs
Preg, gynae CA, distorted endometrial cavity, PID or other active gynae infx, trophoblastic disease, unexplained vag bleed. Wilson’s (Cu only), Breast CA (P only), Liver disease (P only)
Contraceptive for APLS patient
Cu IUD, need hormone negative. Not even prog
Vaginismus
Pain and spasm on penetration of vagina. Desentize and counsel and kegels.
If patient needs emergency contraception, what does a pregnancy test infer to us
If positive, we can’t use emergency contraception, instead give misoprotol. If the preg test is negative, we can give EC
Lichen sclerosis vs VULVAL CA
Lichen is whiter and Papular. Whereas CA is a plaque and usually friable, red etc.
Once you have seen that a galactorreeha is physiological, and you have normal prolactin, and patient on no alarm meds….what to do?
No Mx needed
Assymp fibroids…. mx?
No Mx
First and second line for stress incontinence
Kegel excersizes. If that fails, try the mid urethral sling (reduces hyper mobile urethra)
Can we do speculum in adolescence
No, the vaginal introitus is so narrow that causes discomfort
Vaginal foreign body management in paediatric
Examination, attempt removal, usually including irrigation with warm fluid. If that doesn’t work can do vaginoscopy under Anastasia
Ovarian mass described as homogenous cystic, and ground glass appearance
Endometrioma
How might a TOA be described on ultrasound
Multiloculated, cystic mass
How to manage a teratoma of the ovary
Either do ooporectomy or cystectomy, to reduce the risk of torsion
Main proceeding cause of vesicovaginal fistula
Usually months after a pelvic surgery, like a hysterectomy
Talk to me about genitourinary syndrome
Low oestrogen, means low collagen and elastin and blood flow to the bladder trigone and vulva/vagina. This causes urge incontinence and dyspareunia. Low glycogen also means an elevated pH and increased UTI risk. Damaged epithelium in that area also causes dysuria
Is it normal for a adolescent to have in regular menses. Explain why. What is the treatment and how does this help
Yes it is normal, because the corpus luteum isn’t so well formed in adolescence. Therefore there is not sufficient progesterone, so we have unopposed oestrogen. This causes a unopposed proliferation of the endometrium (no secretory Endometrium). This causes a breakthrough bleeding. The treatment would be oral progesterone, to supplement the lack thereof
Treatment for cyclical mastalgia
Supportive bra and NSAID
Suspicion of fibroids, what is the best investigation. Consider if subserosal and submucosal
Ultrasound. For submucosal you can do sonohysterography (essentially filling the uterus with saline before doing ultrasound)
How to distinguish an acute cervicitis from a Trichomonas vaginalis
Chlamydia and gonorrhoea is more common, the cervix is friable and bleeds, and the discharge is usually purulent in yellow. Trichomonas has a green frothy discharge and more punctate haemorrhage of the cervix. Of course Trichomonas is less common. But generally the two overlap
How does an ovulation increase endometrial hyperplasia and cancer
Progesterone naturally Dan regulates oestrogen receptors and its protective against hyperplasia. Therefore in anovulation, you don’t make the corpus lutuem, therefore you don’t make prog, therefore you have unopposed oestrogen
Take me through a common cycle of Mx for adenomyosis
Usually a clinical diagnosis and ultrasound/MRI. Then can give NSAID or COCP et cetera. If continues do hysterectomy and biopsy the specimen = this is the definitive diagnosis and treatment
Most common sight of choriocarcinoma metastasis
Vagina.
HaHa trick question. I guess long is more clinically significant, but he’s not the most common
Patient has mullarian agenesis, what other test you have to do
Renal ultrasound
What are the signs of vagina foreign body
Abdomen pain, vaginal discharge
What is the general Tx idea for ovarian cyst rupture
If stable then observe. If unstable, do surgery
Urethral diverticulum signs
Anterior vaginal mass, usually from recurrently periurtetheal gland infx. Tender and pain on intercours. May even show as purulent discharge. Unlike cycteocele (no pain, in older women with many kids, and no discharge)
Dx and Tx of asherman
Hysterisocpy (Dx and lyse them)
When does physiological thelarche begin?
Usually around 8-10. Signifies beginning of puberty. Tender, small firm nodule behind nipple. Menarche around 2.5 years after.
When to start the primary amenorrhea algorithm? Age wise
13 or more, if no secondary sexual characteristic. If has the characterises, 15 or more
Difference in size of abdomen in adenomyosis vs fibroids
Fibroids can grow way more and cause contains pelvic pressure. Mimics gest age around 20 weeks. Whereas adenomyosis is usually less than 12 weeks and rarely causes constant pelvic pressure
Managment for patient who plans to conceive in PCOS
Weight loss always first line. If unsuccessful, letrozole is used (our aromatase inhibitor). This would decrease the conversion of Androgen to estrogen (which in PCOS decreases LH and FSH)
If see being in endometrial cells on pap…. What to do? Consider pre and post menopause, risk factors etc
If pre menopause, then it’s ok unless they have AUB or major endometrial cancer risk factors. If post menopause, it’s not normal, so biopsy
Man has breast mass. How to mx
Exactly the same as women
CI to use oxytocin in labour
If HR deceleration (makes sense), or previous c sec
Recall our whole preterm Mx algorithm. Which time frame is MgSO4 given and what for?
Less than 32 weeks. It reduces risk of cerebral palsy
In preterm Mx. Why does Indo change to nifedipine after 32 weeks.
Risk of DA closure
AFI normal range
4-24
Main RF for previa
High mum age, previous c sec or myomectomy, twins (more placenta)
Many painless preterm deliveries….
Lille Cervicle insuff. So do cerclage
Use of FetaL fibronectin testing
High when labour occurs, helps distinguish between false and true labour
When do we consider cervical insufficiency
• Painless cervical dilation in the current pregnancy (ie, examination-based) OR
• A second-trimester cervical length of ≤2.5 cm plus a prior preterm delivery (ie, ultrasound-based) OR
• two or more prior consecutive, painless, second-trimester losses (ie, history-based), which typically present with mild symptoms (eg, vaginal discharge, light spotting) followed by precipitous delivery
How can maternal DM cause hypocalcemia in infants
Sugary blood causes diuresis of Mg, and thus low Mg. This causes low PTH and low Ca
Infant of DM mum, with jitteryness,,,, glucose normal. What to check next?
Calcium. Maybe low Ca
Not passing Meconium after how many hours is concerning
48 hours. Obviously if the patient has other dodgy signs prior, would Invx
Name as many complications of maternal DM on foetus
Prematurity
• Congenital anomalies (eg, caudal regression
syndrome)
• Macrosomia & associated complications
risks
(eg, brachial plexus injury, clavicle fracture)
• Respiratory distress syndrome
• Hypertrophic cardiomyopathy
Lab findings of infant of mum with DM
Hypoglycemia
• Polycythemia, low iron
• Hypocalcemia & hypomagnesemia
• Hyperbilirubinemia
Aside from renal abnormalities, what else can cause Potter sequence
PROM before 26 weeks
If post partum US reveals thin endometrial stripe…. What does this mean
Uterus is empty
Dx this:
Post partum hemorrhage. And severe abdominal pain, a smooth mass protruding from the cervix or vagina, and no palpable uterine fundus.
Uterine inversion
Risk factors for uterine atony post partum
worn out uterus
Uterine fatigue from prolonged, induced, or precipitous labor
• Intraamniotic infection
• Uterine overdistension (multiple gestation, macrosomia, polyhydramnios)
• Retained placenta
• Grand multiparity (>4 prior deliveries)
Talk to me about uterine atony
The most common cause of postpartum hemorrhage within 24 hours of delivery is uterine atony, which results from inadequate uterine contractility and inability to compress the placental bed blood vessels. Patients typically have a soft, boggy, enlarged uterus with blood clots in the lower uterine segment and profuse vaginal bleeding. Risk factors include fetal macrosomia, prolonged induction of labor, and operative vaginal delivery. Amongst others.
When is D&C utilised in PPH
If the cause is retained products of conception. Would never do it for atony or trauma
Carboprost in asthmatics?
CI
Ergometrine in HTN patients
CI
Avoid what types of contraceptives in first month after preg
Oestrogen containing
Cu or Prog IUD. Which decreases thrombosis risk
Prog
How do we monitor fetal movment after 28 weeks
Ask mum to self monitor. Kick count. 10 and over in 2 hours. If less, can do Non stress test
Causes of FHR bradycardia (<110/min)
Maternal hypothermia
• Medication side effect (eg, beta blockers)
• Fetal hypothyroidism
• Fetal heart block (eg, anti-Ro/SSA, anti-
La/SSB)
Causes of FHR tachycardia (>160/min)
Maternal fever (eg, intraamniotic infection)
• Medication side effect (eg, beta agonists)
• Fetal hyperthyroidism
• Fetal tachyarrhythmia
Normal fetal HR near delivery
110-160
Mention the 4 types of variability in FHR
4 causes of hyperandrogenism in pregnancy
Placental aromatase def. Luteoma. Theca luteal cyst. Seroli leydig.
Hyperandrogenism in preg Dx
• No ovarian mass
• High maternal & fetal virilization risk
• Resolution of maternal symptoms after delivery
Placental aromatase def
Pregnancy hyperandrogenism Dx
Solid, unilateral/bilateral ovarian masses
• Moderate maternal virilization risk; high fetal virilization risk
• Spontaneous regression of masses after delivery
Luteoma
Hyperandrogenism in preg Dx
Cystic, bilateral ovarian masses
• Moderate maternal virilization risk; low fetal virilization risk
• Spontaneous regression of masses after delivery
Theca luteal cyst
Hyperandrogenism in pregnancy
Solid unilateral ovarian mass
• High maternal & fetal virilization risk
• Surgery required (2nd trimester or postpartum)
Sertoli leydig tumour
What liver issues occurs in HELLP syndrome
Tense liver capsule and sub capsular liver hematoma. Even necrosis later on
Difference in presentation between AFLP and HELLP… in terms of the liver stuff
AFLP is way worse/fulminant. Jaundice, hypoglycaemia, enceph.
Main respiratory complication of preelclamsia
Pulmonary edema
What is the first few stuff we do with a normal routine newborn.
Steps
• Dry and stimulate
• Clear airway (ie, suction oropharynx) as needed
• Provide warmth (eg, skin-to-skin with mum is important)
Then do Vx, Vit K etc. roughly an hour later
Baby must be at Term gestation AND
• Breathing or crying AND
• Appropriate tone
(Decent APGAR)
If before 37 weeks and foetus in malprespentation…. How to Mx
Expectantly, most with go to cephalic. Only Mx after 36/37 weeks
Is previous c sec a CI for vag delivery
If low transverse c sec, it’s ok. But traditional vertical incision, yes
Risk factors for post partum endometritis
Cesarean birth
• Intraamniotic infection
• Group B Streptococcus colonization
• Prolonged rupture of membranes
• Operative vaginal delivery
Abx for post partum endometritis
Gentamicin and clindamycin
Fetal complications of delayed late birth
Macrosomia
• Dysmaturity syndrome
• Oligohydramnios
• Demise
Maternal complications of delayed late birth
Severe obstetric laceration
• Cesarean delivery
• Postpartum hemorrhage
What is the pathophys of why plasters insuff causes oligohydramnios
Low BF, blood will shunt to fetal brain. Less urine BF, means less urine output. Meaning oligo
When to give prophlx GBS penicillin
GBS bacteriuria or GBS urinary tract infection in current
pregnancy (regardless of treatment)
• GBS-positive rectovaginal culture in current pregnancy
• Unknown GBS status PLUS any of the following:
• <37 weeks gestation
• Intrapartum fever
• Rupture of membranes for ≥18 hours
Prior infant with early-onset neonatal GBS infection
Issues with giving NSAIDs in the first and third trimester
Renal issues, and premature DA closure respectively
Patient in pregnancy, has high grade squamous cells on Pat. What do we do
Do colposcopy, and do the biopsy. However cannot do colonisation. So if invasive on colposcopy, wait until after pregnancy to do the surgery
How many years after menopause do most sources say you do not give HRT
- Or after six years of age
Is it normal for newborn girls have swollen and potentially bloody labia, with large memory glands
Yes, just observing routine care
Oestrogen increases which component of the RAAS system
ATII
Remember the rules for vaginal foreign body in children
Attempt to remove by irrigating with warm water and giving local anaesthetic first. Second line is to do vaginoscopy under general anaesthesia. Cannot do speculum here
Cyclical mastalgia. Give COCP o NSAID
NSAID
Siri what’s the reasoning behind a late 30s early 40s-year-old woman struggling to get pregnant. Given the examination was normal and she still having menses
Decrease ovarian reserve
Is a Caesarean a risk factor for adenomyosis
Yes
Friable cervix inflamed, with yellowish discharge. Is this more trichomoniasis oh Chlamydia/gonorrhoea
The latter
Clear mucus at the cervical os. 
Likely ovulation. Mucus plug is darker and yellow
Talk to me a bit about the urethral diverticulum
Commonly from recurrent periurethral gland infection. Often present with a tendon mass in the anterior vaginal wall, plus or minus some puritan discharge. MRI is usually needed to confirm
Cystocoel versus urethral glands diverticulum
Urethral gland diverticulum causes pain and discharge. Cystocoel does not
How would you describe physiological leukorrhea
White and mucoid, odourless, no erythema, stops when minces, occurs midcycle
Complications of cervical conization
Cervical stenosis, preterm birth, PPROM, second trimester loss
If no secondary sexual characteristics, when does the workup start for primary amenorrhea 
13….
If patient has partial mastectomy. Lateral borders in pathology are still positive for a type/cancer. What do you do
Re-excised lateral margins. Only do radiation if the margins are negative
Recall risk factors for endometrial cancer
No kids, early menarche late menopause. Tamoxifen. Obesity. PCOS. Essentially people who have more cycles, more unopposed oestrogen.
APLS choice of contraception
Cu
The sign clitorimegaly is virilization or hyperandrogenism? Is this scene in PCOS
Virilisation. Not seen in PCOS. Can be seen in five alpha reductase deficiency
Main sign to tell between androgen insensitivity syndrome and five alpha reductase deficiency
Boobs. AIS have boobs. Because testosterone is what inhibits breast development. Five alpha reductase deficiency still has testosterone working. Also five alpha reductase deficiency will have the whole vitilization at puberty
What are some signs that tell us a dysmenorrhoea probably isn’t primary
Unilateral, or abnormal radiation. Above 25 when starts. Bleeding accompanying that is abnormal. And none of the of the systemic sign in primary dysmenorrhoea
Contrast if patient has colonisation for CIN3. If clear margins or not clear margins
If clear margins do your pap/contest everyone to 2 years. If positive margins need another surgery or even hysterectomy
Which is the morning after pill. So somebody had sex last night and once emergency contraception
Progesterone
If see a raised ulcerated cervix/lesion what do you do
Do a biopsy, don’t bother doing Pap
When are boys supposed to get that potentially painful breast lump physiologically
Mid puberty
Using spermicides increase the risk of what infection
UTI
Which PID patients need inpatient treatment
Pregnant, patient failed, non-compliance risk, TOA, Fitz Hugh Curtis, severe (vomiting and high-temperature). I would say most cases
Which antibiotic do we add is a TOA has formed in PID
Metronidazole
Why is an unexplained bleed a contraindication for an iud
They can mask symptoms potentially of cancer and thus delay treatment
How many fold decrease in non-trep titres do we need when checking treatment efficacy of syphilis Tx
4 fold decrease
If you see a Volvo plaque. Is this more indicative of lichen sclerosis or vulval carcinoma o
Carcinoma. LS is more white papule
If after surgery the patient is Okay at first then becomes delirious is this good or bad
Bad, because it’s unlikely post-operative delirium (which would be immediately after surgery)
For patients that have primary dysmenorrhoea, is it normal that the mince is when they first began were okay
Yes, at first progesterones only slightly elevated so the pain is usually a lot less. So it’s normal for primary dysmenorrhoea to happen a few years after menarche
All the risk factors for lactational mastitis usually revolve around what
Decrease drainage of milk, causing stagnation an infection risk
Management of breast engorgement
NSaid and warm compress
BUN and Cr… in preg
Should go down
GInissues in preg
Gallstones, constip, GERD
We know to take 400 micrograms of folate in keep. But when do we give 4000
If previous NTD or on valproate/carbamazepine
