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ICM > OBGYN > Flashcards

OBGYN Flashcards

1
Q

Pre-pubertal causes of vaginal bleeding?

A
  • Vulvar lesions
    • excoriations
  • Foreign body
  • Trauma
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2
Q

Causes od adolescent vaginal bleeding?

A
  • Normal menses
    • anovulation
  • Pregnancy
  • Exogenous hormones
  • Infections
  • Hematologic abnormalities
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3
Q

Causes of anovulation?

A
  • PCOD
  • Eating disorder
  • Excessive physical exercise
  • Thyroid disease
    • both hypo/er
  • Obesity
  • Hyperprolactinemia
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4
Q

What must be ruled out in a patient with abnormal bleeding in reproductive age women?

A

Pregnancy

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5
Q

What exogenous hormones can cause abnormal vaginal bleeding?

A
  • Oral contraception
  • DMPA (Depo shot)
  • Levonorgestrel implant
  • Mirena IUD
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6
Q

What age group has the highest rate of chlamydial infections and PID?

A

Adolescents

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7
Q

What are causes of vaginal bleeding in women of reproductive age?

A
  • Abnormal uterine bleeding
    • “PALM-COEIN”
    • polyps, adenomyosis, leiomyomas, malignancy, coagulopathy, endometrial, iatrogenic, NOS
  • Pregnancy related bleeding
  • Endocrine causes
  • Infections
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8
Q

Two most common causes of postmenopausal vaginal bleeding?

A
  • Exogenous estrogens
  • Atrophic vaginitis
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9
Q

Types of management of Abnormal uterine bleeding?

A
  • Nonsurgical
    • NSAIDS
    • Hormonal management
      • OCP, progesterone, IUD
  • Surgical
    • for patients with failed medical therapy
    • Hysteroscopy for resection of polyps, myoma, endometrial ablation
    • Hysterectomy
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10
Q

Normal vaginal secretions? flora? pH?

A
  • Secretions
    • floccular in consistancy, white, usually in posterior fornix
  • Flora
    • aerobic; lactobacilli most abundant
  • pH <4.5
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11
Q

Most common vaginitis in the US?

Cause?

A
  • Bacterial vaginosis
  • Polymicrobial
    • gardnerella
    • anaerobic bacteria
  • Lactobacillus usually absent
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12
Q

Clinical features of BV?

A
  • Fishy vaginal odor
  • Vagnal secretions are grey and thinly coated walls’ bubbles
  • pH>4.5
  • Wet prep - Clue cells: “moth eaten cells”
  • Positive “whiff test”
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13
Q

What is bacterial vaginosis associated with in pregnancy?

A

Associated with preterm delivery/premature rupture of membranes

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14
Q

Cause and symptoms of vulvovaginal candidiasis?

A
  • Candida albicans
  • Sx
    • white curd-like discharge
    • pruritis
    • erythema
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15
Q

Predisposing factors to vulvovaginal candidiasis?

A
  • Prgnancy
  • DM
  • Abx
  • AIDS
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16
Q

Diagnosis of vulvovaginal candidiasis?

A

Vaginal pH <4.5

Wet prep (KOH) - visualization of spores and hyphae

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17
Q

Trichomonas vaginalis: transmission? sx? diagnosis?

A
  • Sexually transmited
  • Profuse purulent green malodorous vaginal discharge
  • “strawberry cervix”
  • pH > 4.5
  • Wet mount - mobile flagellated organisms
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18
Q

Hormonal contraception methods?

A
  • OCP/ring/patch
    • 92% efficacy with typical use; 99% with perfect use
    • Lightened and shortened menses
    • AE: bleeding, nausea, bloating, moodiness
  • Progesterone-based IUD/Implant
    • most effective to prevent pregnancy aside from tubal sterilization
    • Light to absent period; protective against endometrial CA
    • AE: bleedint, bloating, HA, depression
  • Depo shot
    • less effective than IUD
    • Light to absent period; protective against endo CA
    • SE: same as IUD + wt gain, decreased bone density
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19
Q

HSV:

Where is the latent virus?

Incubation period?

Signs/Symptoms?

Diagnosis?

A
  • Lumbosacral root ganglion
  • Incubation: 2-7 days
  • S/S: vulvar parasthesias, painful - ulcerative lesions, urinary retention, dysuria, and inguinal lymphadenopathy
  • Dx: PCR most accurate/sensitive
    • also viral culture, Tzank smear, and Ab titers
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20
Q

Gonorrhea:

Coinfection with what is common?

Symptoms?

A
  • Coinfection with chlamydia
  • Sx
    • purulent cervical discharge
    • friable cervix
    • however 70% of cases it is asymptomatic
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21
Q

Complications of gonorrhea?

What occurs in disseminated infection?

A
  • Complications
    • Bartholin’s gland absess
    • Gonococcal salpingitis
    • Infertility, ectopic pregnancy
    • Tubal damage can occur within 72 hours
  • Disseminated
    • more common in women
    • pyrexia, vasculitic rash, and unilateral large joint arthropathy
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22
Q

Chlamydia vs gonorrhea?

Complications of chlamydia?

A
  • Chlamydia is 3x more common and less symptomatic
  • Complications
    • male - epididymitis
    • Reactive arthritis
    • Females - salpingitis (infertility/abscess)
    • Fitz-Hugh-Curtis syndrome
      • peritonitis
      • liver capsule inflammation
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23
Q

What is Reiters syndrome?

A
  • Arthritis
  • Conjunctivits
  • Uveitis
  • Urethritis
24
Q

Primary syphilis:

Incubation?

Symptoms?

A
  • 3 weeks
  • Chancre –> red papule –> ulceration with serous exudate
    • this is single, painless, and not well demarcated
25
Q

Secondary syphilis:

When does this develop?

Symptoms?

A
  • Develops 7-10 weeks after
  • Symptoms
    • Malaise
    • mild fever
    • Headache
    • Skin rash
    • Arthralgia
    • Bone pain
    • Lesions on palms and soles of feet
26
Q

Tertiary syphilis:

What are the symptoms?

A
  • Neurosyphilis - dectectable in CSF only
    • Argyll Robertson pupil - small, constant in size, accomodation present but doesnt react to light
    • Tabes dorsalis - sharp back pains
  • Gummatous
    • mass, granulomas on skin/bone
  • Cardiovascular
    • Aortic dilation with regurgitation
    • Destruction of elastic tissue
    • Aortic aneurysm formation
27
Q

Diagnosis and treatment of syphilis?

A
  • Diagnosis:
    • Nonspecific test: RPR or VDRL cardiolipin ab tests
    • Specific: FTA-ABS flourescent treponemal ab absorption test
  • Treatment
    • penecillin: one dose for early and multiple for late and tertiary
28
Q

HPV diagnosis? Treatment?

A
  • Mainly clinical
  • Biopsy if diagnosis unclear
  • Abnormal pap smear

Treatment - cure not really possible: trichloroacetic acid (TCA) surgery, or laser common

(this is assuming youve read a bajillion things on HPV so i left out the SX and such)

29
Q

Molluscum contagiosum:

Type of virus?

With widespread infection it may incidate what is present?

Diagnosis and treatment?

A
  • DNA virus (poxvirus)
  • Check for HIV with widespread infection
  • Diagnosis - clinical
  • Treatment: scraping out lesion, cryotherapy, electrocautery
30
Q

Cause of lymphogranuloma venerum? Defining symptom?

A
  • Chlamydia trachomatis
  • Painful
31
Q

Hemophilus ducreii causes what type of lesion?

A

Painful chancroid

32
Q

What causes granuloma inguinale? Presentation?

A

Klebsiella granulomatis

Enlarging painless ulcer

33
Q

Definition of PID?

Predisposing factors?

A
  • Definition: infection of tubes, ovaries, and adjacent tissues
  • Predisposing factors
    • multiple partners
    • previous episode
    • Chlamydia/gonorrhea infection
34
Q

Etiology of PID?

Signs/symptoms?

A
  • 60% polymicrobial; 30% gonococcal; 30% chlamydia
  • Signs/Symptoms
    • abdominal, adnexal, and cervical motion tenderness
    • Temp >38deg
    • Leukocytosis >10,000
    • Purulent cervical discharge
    • Pelvic mass/abscess
35
Q

Complications of PID?

A
  • TOA
  • Ectopic pregnancy
  • Infertility
  • Chronic pelvic pain
36
Q

Causes of acute pelvic pain?

A
  • ovarian torsion
    • sudden onset
    • associated with abrupt position change
    • extremely painful, tender, unilateral adnexa
    • N/V
    • no doppler flow
  • Ruptured ovarian cyst - corpus luteum
37
Q

Endometriosis:

Symptoms?

Causes?

A
  • Symptoms
    • pelvic pain
    • dysmenorrhea
    • dyspareunia
    • infertility
    • nodularity of uterosacral ligaments
  • Causes
    • retrograde menstruation
    • lymphatic or vascular spread
    • metaplasia
38
Q

Endometriosis diagnosis? Treatment?

A
  • Diagnosis
    • laparoscopy with biopsy
    • “powder burn” lesions: black, dark brown, bluish lesions
    • Clear or red lesions
  • Treatment
    • observation, medical, surgical
39
Q

What is the cause of primary dysmenorrhea?

What is it?

Treatment?

A
  • This is caused by increased endometrial PG production
  • Pain beginning prior to or just after the onset of menstrual period
  • Treatment: NSAID or OCPs (relief in 90% of pts)
40
Q

What is adenomyosis?

symptoms?

Treatment?

A
  • Definition: ingrowth of endometrium into uterin musculature
  • Symptoms
    • dysmenorrhea
    • very heavy or prolonged period
  • Treatment
    • NSAIDs
    • OCP
    • Hysterectomy
41
Q

What is the most common benign uterine tumor?

Who is it more common in?

A

Leiomyoma (diagnosed by physical or imaging)

African american women

42
Q

Signs and symptoms of a leiomyoma?

A
  • Abnormal bleeding, pain, pressure
  • Fewer than half are symptomatic with:
    • urinary frequency
    • infertility
    • prolapse of pedunculated fibroid through cervix
    • pelvic pressure or pain
    • dyspareunia
43
Q

Treatment options for leiomyoma?

A
  • Observation
  • Surgical
    • myomectomy or hysterectomy
  • Angiography embolization
    • obstruction of BF to fibroid
  • Depo
44
Q

What is stress incontinence? What is it caused by and how is it treated?

A
  • Leaking of urine with activity
  • Caused by an increase in intrabdominal pressure that exceeds urethral sphincter closure pressure
  • Tx: pelvic floor PT, pessary (??), or surgery
45
Q

What is urge incontinence?

What is it triggered by?

Treatments?

A
  • Leaking of urine accompanied with urgency (spontaneous contraction) with frequent, involuntary loss of urine
    • nocturia is common
  • Triggered by daily routines
  • Treatment:
    • antimuscarinics
    • Alpha agonists
    • Pelvic floor PT
46
Q

What is interstitial cystitis also known as? Signs/symptoms?

A
  • Painful bladder syndrome
    • Pelvic pain
    • Pain with intercourse
    • Pain on bladder filling
    • Urinary frequency and urgency
    • Nocturia
47
Q

Intersititial cystitis cycle?

A

Bladder insult –> epithelial layer dysfunction –> potassium leak into interstitium –> activation of C-fibers and release of substance P –> mast cell activation and histamine release –> more inflammation –> bladder insult

48
Q

Menopause definition? What occurs?

A
  • Definition: cessation of ovarian follicular function with absence of menstrual bleeding for greater than or equal to one year
    • vaginal atrophy
    • pelvic relaxation
    • skin changes
    • vasomotor instability
    • sleep disturbances
    • osteoporosis
    • CV changes
49
Q

Osteoporosis: what are osteoblasts responsive to?

A

Osteoblasts responsive to estrogen and in estrogen deficienct state: osteoclasts dominate

50
Q

What are advantages and disadvantages of HRT?

A
  • Advantages
    • Increased HDL, decreased LDL
    • Improved memory and bone health
    • Decreased vaginal dryness and menopausal sx
    • Decreased risk for colon cancer
  • Disadvantages
    • increased risk for CV disease
    • Increased risk for stroke/PE/DVT
    • Increased breast cancer risk
51
Q

Contraindications of HRT?

A
  • Breast or endometrial cancer
  • Active liver disease
  • Acute vascular thrombosis
  • Pregnancy
  • Unexplained vaginal bleeding
52
Q

Benign and malignant examples of breat disease?

A
  • Benign
    • fibroadenoma
    • papilloma
    • fibrocystic breast disease
    • fat necrosis
    • mastitis
  • Malignant
    • ductal carcinoma
    • lobular carcinoma
    • inflammatory breast cancer
53
Q

What is a fibroadenoma? Who is it usually found in?

A
  • Painless, solitary mass
  • Can be bilateral
  • Typically in younger women
54
Q

Fibrocystic breast disease: signs/symptoms?

A
  • Diffuse and described as “lumpy”
  • Can be tender - cyclical breast pain associated with menses
  • Can increase in size before menses and crease afterwards
55
Q

What is mastitis? What is it associated with? Treatment?

A
  • Erythematous, edematous area of the breast
    • fever is common
  • Associated with pregnancy
  • Treatment: dicloxicillin
56
Q

Signs and symptoms of inflammatory breast cancer?

When is it commonly misdiagnosed?

A
  • Diffuse erythema and edema
  • “Peau d’oirange” with dimpling
  • Can be misdiagnosed as mastitis during pregnancy
57
Q
A

ICM (9 decks)

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