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OBGYN Flashcards

1
Q

What is Theca lutein cyst

A

proliferation of theca cells in ovarian follicles in view of over stimulation like high B-HCG.

Bilateral, multilocular ovarian cysts

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2
Q

dermoid cyst or mature cystic teratoma

A

Hyperechoic with calcifications on US.

Pelvic pain woresens on excercise and intercourse.

Increases risk of torsion,
Should be laparoscopically removed.

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3
Q

DD of adenomysosis and leiomyoma

A

Adenomyosis: is endometrial tissue in the myometrium ( uniformly enlarged uterus)

Liomyoma or fibroids: SM tumor, irregularly enlarged uterus.

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4
Q

What is Hyaditiform mole ?

A

type of gestational trophoblastic disease

can be complete or partial

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5
Q

What is partail hyaditiform mole

A

fertilization of an egg with 2 sperms

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6
Q

What causes hydrop fetalis ?

A

Parvo virus b 19

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7
Q

CF of Hydrops fetalis ?

A

skin thickening
fetal ascites
Polyhydramnios

Drops for P.

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8
Q

What is a complete Hyaditiform mole ?

A

An empty egg fertilized with a sperm

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9
Q

Diagnosis of Ectopic Pregnancy ?

A

TVUS
Pregancy test

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10
Q

Asherman Syndrome

A

Is formation of adhesions post endometral procedures.

Ligh bleeding or amenorrhea, not responsive to progesterone challange
Normal FSH and LH

Structural cause of ammenorrhea

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11
Q

What is endomyometritis ?

A

Infection caysed by polymicrobes in view of prolonged labor, miscarriage or abortion

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12
Q

what is septic pelvc thrombophlebitis ?

A

A complication of endomyometritis. spread of infection and thrombosis of veins despite proper Rx.

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13
Q

Contraception

A
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14
Q

Levoneorgestrel IUD

A

Does not inhibit ovulation
Increases cervical mucous thickness
decreases sperm ft.
decreases risk of implantation

Does not increase the risk of Thromboembolic events

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15
Q

Absolute Contraindication to hormonal Contraception ?

A
  1. uncontrolled HTN
  2. Ischemic Heart disease/ stroke
  3. Actibe breast Ca
  4. Migraine with Aura
  5. thrombophilia ( Factr V, APS)
  6. Prolonged Immoblization
  7. VTE
  8. Hepatitis
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16
Q

Levonorgestrel IUD is beneficial in

A

Patients who suffer from heavy bleedings, because it causes endometrial atrophy, and thus prevents anemia.

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17
Q

What is the most effective emergency contraception

A

Copper IUD

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18
Q

SE of Tamoxifen

A
  1. Endometrial Ca
  2. VTE
  3. Hot flushes ( due to anti-estrogenic activity in the CNS).
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19
Q

What is the Indication of Hormone replaement therapy ?

A

Vasomator symptoms of patients with menopause in the last 10 years, < 60 y.o.

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20
Q

Patients with Contraindication to HRT can be treated with ?

A

SSRI.

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21
Q

Abnormal Uterine bleeding

A
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22
Q

What is the effect of Obesity on bleeding

A

obesity increases insulin resistance, and decreases androgen biding globulin.
Also increased androstendione, and its conversion to estradiol in the fat cells.

Leads to high frequency, short interval GnRH levels and imbalance in LH and FSH –> anovulation and abnormal bleeding

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23
Q

Cause of Atypical Endometrial Hyperplasia ?

A

Unopposed estrogen exposure ( especially in cases of obesity where peripherally produced androstenedione is converted to estrogen, also leading to anovulation and absence of progesterone effect).

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24
Q

CF of Endometriosis ?

A

dysperunia
dyschezia
dysmenorrhea
Chronic pelvic pain

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25
Congenital Diseases
26
Characteristics of Androgen insensitivity syndrome
Breast development (high estrogen levels) and tall stature Absent axillary and pubic hair (inactive testosterone) blind vaginal pouch with absent ovaries and uterus cryptorchid testes ammenorrhea
27
CF of 5 alpha reductase
1- no breast development (inhibited by testosterone) 2- Undescendant testes (labia majora masses) 3- absence of male external genitalia (presence of female external genitalia) 4- Virilization at puberty in view of high testosterone levels
28
Pathophysiology og 5 alpha reductase def.
1- Absence of conversion of testosterone to dihydrotestosterone. (testosterone resp. for internal male organs) DHT: is responsible for external male organs.
29
Mullerian agenesis
lack of mesonephron and paramesonephric ducts responsible for fprmation of: 1- Fallopian tube, uterus, cervix and upper 1/3 of vagina 2- and kidney and ureters Normal ovarian function, normal FSH levels and normal external genitalia.
30
What are the risk factors of placental insufficiency
1- DM 2- HTN 3- Maternal age 4- Use of tobacco
31
What is a normal biophysical profile
AMI >5, or single pocket >2. Fetal tone >1 flexion, extension fetal movement >3 Fetal breathing >1 over 30 sec.
32
Low biophysical profile indicates
Uretroplacental Insufficiency
33
Understanding decelarations
1. Early: happens with contractions..could be normal fetal tracing or head compression 2. Delayed: happens after the contractions, related to Uteroplacental insufficiency 3. Variable: unrelated to the contractions and happen randomly, related to Cord compression, oligohydramnios or cord prolapse
34
Pregnancy changes
35
effect of pregnancy on thyroid hormones
1. Beta- HCG increases thyroid hormone production directly 2. Estradiol induces Thyroid binding globulin which increases binding of Thyroid hormones to TBG, so thyroid production is increased to maintain free t4 levels In normal individual: low TSH High Total T4 and T3, normal free T4 levels.
36
Non-alcoholic fatty liver in pregnancy
RF: obesity, DM, Metabolic syndrome Insulin resisatnce, prevents fat uptake by liver, fat deposition in the liver leads to non-alcoholic fatty liver US: Hyperechoic liver
37
Why does Intrahepatic cholestasis of pregnancy cause Fetal demise ?
increased bile acids, cross the placenta to the fetus and becomes toxic.
38
What is the management of Intrahepatic cholestasis of pregnancy ?
1. Antihistamin for pruritis 2. Ursodeoxycholic acid for high Bile acids 3. Non-stress test of pregnancy 4. Delivery by 37 weeks
39
What are severe features of Pre-eclampsia ?
1. sbp >160, dbp >110 (x2, more than 4 hours apart) 2. rise in Cr 3. Rise in transaminases 4. thrombocytopenia 5. pulmonary edema 6. Visual or cerebral symptoms.
40
CF of pre-eclampsia
HTN > 20 weeks of gestation End-organ damage (proteinuria, or Prtn/Cr >0.3)
41
Managment of Pre-eclampsia:
1. HTN (hydralazine, labetolol IV) and oral nifedipine 2. IV magnesium sulfate to prevent seizures
42
DD of postpartum hemorrhahe
1. Intrabdominal bleed 2. Uterine atony
43
What is oxytocin used for ?
1- induction of labor 2- post-partum hemorrhage
44
SE of prolonged oxytocin exposure ?
hyponatremia. As it has a similar effect to ADH, causing free water reabsorption.
45
CF of Intraamniotic fluid infection
1. Fetal tachy 2. Maternal leukocytosis 3. purelent amniotic fluid
46
Hyaline membrane disease of infancy or neonatal resp. symptom is due to ?
Increased Insulin exposure of fetus, leading to macrosomia and poor pulmonary maturation ( inhibits surfactant).
47
Infertility in women >35
failure to concieve after 6 months of unprotected intercourse
48
Pathophys of Infertility
decreased oocyte number and quality, decreases inhibin and estrogen. high FSH Diagnosis with 3rd day FSH levels (follicular phase).
49
When are Anti-D Ig given ?
at 28 weeks and within 72 hours of first delivery
50
When does production of hcg start ? and when does it peak ?
8 days after fertilization. Peaks at 6-8 weeks
51
Complications of N. gonorrhea Infection ?
Gonorrhea pharyngitis
52
MC and patho of toxic shock syndrome ?
staph aureus due to prolonged use of tampons or nasal packings release of toxic shock syndrome toxin, acts like super Ag. causes hypotension
53
CF of TSS ?
1. Hypotension 2. rash maculopapular that invilves palms and soles and causes desquamation 1-3 weeks after 3. fever 4. vomiting and diarrhea
54
Breast Mass
55
Assesing of a breast mass/ lump
Age <30 Us +/- Mammogram --> simple cyst: Needle aspiration and re review in 2 months --> Solid component: guided core bx Age >30: Mammohram +/- US --> suspicion of Malignancy: core Bx.
56
Presentation of Intraductal papilloma
Bloody nipple discharge No mass felt, no breast changes Mamogram and US of breast. Present of papilloma inside of the duct (obstructing the duct). | Similar to nephrolithiasis idea
57
DD of paget disease with Intraductal papilloma
Paget disease of the breast: includes eczematous changes on the breast, involving th areola and blody discharge. It is a form of Intraductal carcinoma.
58
Surgery Complication:
59
Complications of Hysterectomy and bilateral Salphingo-oophorectomy
Hydronephrosis due to ureter obstruction. Presents with Normal creatinine, only one kidney is affected.
60
Endometrial Cancer
61
Suspicion of Endometrial Ca
1. Postmenopausal bleed 2. start with US: enodmetrial thickness ( <4mm) is normal, so no need for Bx > 4mm, Furthter investigation.
62
RF of vulvar Ca.
1- Valvular/ cervical Intraep. neoplasia 2- Tobacco use 3- Lichen sclerosis 4- Immunodeficiency 5- prior cervical Ca
63
RF of Vaginal Ca.
1- Age >60 2- Tobacco use 3- DES exposure 4- HPV
64
Granulosa Cell Tumor
Secretes estrigen and inhibin Has a juvenile and adult subtype. Juvenile shows precocious puberty Adult shows bilateral breast tenderness, abnormal uterine or post-meno bleeding.
65
Histopathology of Granulosa cell tumor
Cell-exner bodies ( in a rosette form).
66
Vulvar lichen sclerosis
whitish plaques surrounding the vulva and perianal skin thickening. Diagnosed with Vulvar punch Biopsy. Rx: steroid ointment
67
Mechanism of action of Tamoxifen
Estrogen antagonist in breast Estrogen agonist in Endometrium. Thus SE: increases endometrial hyperplasia and risk of Ca. in postmenopausal women and endometrial polyp in pre.
68
Management of CIN lesions in young patients
Conization
69
complications of conization ?
Cervical STenosis
70
RF of Cervical Cancer
HPV infection Multiple sexual partners Early onset of sexual activity OCP
71
72
Infections
73
Organisms causing cervicitis ?
Chlamydia trachomatis N. gonorrhea
74
Rx of chlamydia, N. gonorrhea
1. Azithromycin 2. Ceftriaxone
75
Gardinella Infection ?
Bacterial Vaginosis Grey white discharge Malodorous discharge Increased PH > 4.5 Fishy odor on KOH presence of clue cells on wet mount test | Gardenella for gray
76
Trichomonas Vaginalis
Green Discharge with foul smell Motile organisms seen on Wet mount
77
what causes intertigo ?
candida albicans (normal flora of Urogenital tract). Causes symmetric erythema of the folds (inguinal, axillary,..). Rx with clotrimazole, ketoconazole
78
Pathophys of Incontinence
1. urge: detrusor hyperactivity or decreased estrogen 2. Overflow: detrusor hypoactivity, obstruction 3. stress: sphinchter decreased tone, or urethral hypomobility
79
Urgency incontinence in patients with genitourinary symptoms of menopause
decreased estrogen, affects bladder and urethra (estrogen sensitive organs) results in atrophy and increases urgency followed by immediate loss of urine which causes nocturia. Dcereased glycogen content, causes thin vulvovaginal ep, which causes dysuria when in contact with urine.
80
when does Beta HCG produced and when does it peak
81
what is the main ft. of BHCG
maintain corpus luteum to keep progesterone elevated

OBGYN (1 decks)

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