OBGYN Flashcards
LH
Theca cells
chol-> androstenedione
FSH
Granulosa cells
aromatase
testosterone-> estrogen
Tanner staging: buds, course/curly hair, areola mound
stage 2: buds
stage 3: curly hair
stage 4: areola mound
estrogens: reproductive, preg, menopause
reproductive yrs: estradiol
preg: estriol
menopause: estrone
DUB: Tx
bleeding: estrogens, OCP
OCP, Medroxyprogesterone, Lupron
Dysmenorrhea: causes, Tx
primary: incr prostaglandins
secondary: pelvic pathology
Tx: NSAIDs
PMDD Tx
gold std: SSRI
amenorrhea: definitions
primary: no menarche by 13y/o NO secondary sex characteristics, 15y/o with characteristics
secondary: no menses for 3mo- previously normal, 9mo- oligo
- hyp: abnorm GnRH (anorexia, stress), N FSH/LH
- pit: decr FSH/LH, incr prolactin (pituitary adenoma)
- ovary: incr FSH/LH, decr E
progesterone challenge test
- withdrawal bleed: ovary (PCOS)
- no bleed: uterus (Asherman’s), hyp
adenomyosis
endometrial tissue in myometrium
TENDER, symmetric, enlarged BOGGY uterus
leiomyoma: population, presentation
uterine fibroids, fibromyoma
Population: AA, >35y/o
Sx: irregular, asymmetric, NONTENDER
BLEEDING
Tx leiomyoma
observe
endometritis MCC
infxn endometrium during preg
MCC: GABHS, S. aureus
C-section, post-abortion
Dx endometritis
fever, abdom pain, uterine tenderness
**C-section, post-abortion
endometriosis: MC location, Tx
location: ovaries
Tx: Progesterone
MCC infertility
endometriosis
endometrial hyperplasia: screening test, definitive test
screening: TVUS
definitive: Bx
MC GYN CA
endometrial CA
RF endometrial CA
Tamoxifen, E, nulliparity, anovulation
when to do endometrial Bx
TVUS: stripe >4mm —- Bx
most sensitive test for menopause
FSH
prevention of osteoporosis in menopause
bisphosphonates, SERM (tamoxifen, raloxifene)
stress incontinence: Tx
sneeze, cough, laugh
Tx surg
urge incontinence: Tx
overactive detrusor, elderly
Tx meds
1st line: anticholinergics
nonselective: oxybutynin, Detrol (NOT elderly)
selective: Vesicare
bladder training
overflow incontinence: PVR, Tx
post void residual >200mL
if bladder atony: catheter 1st line
MC GYN CA mortality
ovarian CA
RF ovarian CA
FH, infertility, nulliparity, >50y/o, BRCA
OCP protective
CA125
ovarian CA - monitor Tx
Sister Mary Joseph’s node
ovarian CA
mets to umbilical LN
MC benign ovarian neoplasm
dermoid cyst teratomas
incr LH:FSH ratio 3:1
PCOS
PCOS Tx, complication
combo OCP
spironolactone
metformin
complications: endometrial CA
Pap screening
Q2yrs, age 21 or 3yrs of sex
Q3yrs, >=30y/o (if 3neg)
DC 65-70y/o
yearly if incr RF (HIV, DES)
ASC-US
HPV test
neg (repeat Pap/HPV in 6-12mo)
pos (colposcopy)
ASC-H
colposcopy
LSIL
30y/o HPV test
HSIL
colposcopy
RF cervical CA
smoking, HPV, DES, early sex
Clear Cell carcinoma
DES
cervical CA, vulvar CA: MC type
squamous
HPV vaccine
6, 11, 16, 18
vulvar CA Dx
pruritis, red/white ulcerative crusted lesions
Tx BV, Trich
metronidazole
BV x 7days
Trich x 1dose
strawberry cervix
trich
Tx Chlamydia, GC
Chlamydia: Azithro OR Doxy
GC: Ceftriaxone
Haemophilus ducreyi
chancroid
painful genital ulcer, painful inguinal LAD
Chancroid
Tx chancroid
Azithro OR Ceftriaxone
whitening with 4% acetic acid application
HPV
cauliflower lesions, flesh colored
HPV
genital warts HPV
6, 11
CA HPV
16, 18, 31, 33
complication of PID
Fitz-Hugh Curtis
bartholin cyst- nontender Tx
none
UC >100,000 CFU
definitive Dx cystitis/pyelonephritis
UTI organism in sexually active
Staph saprophyticus
Tx UTI in preg
amoxicillin, macrobid
NOT cipro
OCP for acne
combo
absolute CI to OCP
smoker >35y/o, biliary/liver dz, HLD, thromboemb, unDx vag bleed, preg, breast CA, hepatic CA
OCP in lactating
progestin only
Lupron
GnRH
pulsatile: agonist
cont: antagonist
Tamoxifen ADR
risk endometrial CA
ectopic Dx
TVUS: no gest sac, HCG >2000
McRoberts maneuver
shoulder dystocia Tx
US: cluster of grapes
molar pregnancy
gestational trophoblastic dz
molar preg
molar preg: sx
painless vaginal bleeding
HCG markedly incr >100,000
hyperemesis gravidarum
Tx hyperemesis gravidum
doxylamine/pyridoxine (B6)
fetus normal in: non stress test, contraction stress test
non stress test: >=2 accelerations in 20min
stress test: no late decelerations
gestational DM screening
24-28wks gestation
3hr oral GTT (gold std)
Tx gest DM
insulin
early delivery 38wks
RhoGAM given at
28wks
PROM test
nitrazine pH test…
L:S fetal lung immaturity
premature labor
=3cm, >=80% effacement
Tx premature labor
tocolytics: Mg sulfate, terbutaline, ritodrine
antenatal corticosteroids (fetal lungs)
threatened, spontaneous abortion
threatened: possible fetal viability (only one)
spont: before 20wks
MCC 1st trimester bleeding
threatened abortion
threatened, inevitable, incomplete, complete, missed, septic abortion (POC, cervix)
threatened: NO, closed- bloody DC; Tx rest, serial HCG
inevitable: NO, dilating
incomplete: some, dilated
complete: all, closed
missed: NO, closed- NO preg sx
septic: some, closed- foul brown DC, F/C
3rd trimester bleeding, rigid uterus, fetal bradycardia
abruptio placenta
Tx placenta previa
tocolytics (Mg sulfate)
delivery when fetus stable (L:S>2, >36wks)
Tx abruptio placenta
immediate delivery
painless vaginal bleeding, fetal bradycardia
vasa previa
vessels crossing os (pelvic US)
Tx immediate C-section
severe pre-eclapmpsia Dx, Tx
BP>160/110
proteinuria >5g/24hrs
HELLP
Tx: delivery, BP>180/110: hydralazine
Tx eclampsia
Mg sulfate
triple screen
15-20wks
AFP, HCG, estradiol
GTT in preg
24-28wks
low AFP, high hCG, low estradiol
trisomy 21
high AFP
open neural tube defects
low AFP, hCG, estradiol
trisomy 18
GBS screen
32-37wks
Tx post partum hemorrhage
oxytocin IV, misoprostol
Tx mastitis
warm compress, breastfeed
abx (Keflex, Augmentin- Amox/clav, dicloxacillin)
breast cyst, incr/decr with menses, tender
fibrocystic breast d/o
30-50y/o
breast cyst, NO change with menses
fibroadenoma
teens-20s
BRCA
breast, ovarian CA
MC breast CA
infiltrative ductal carcinoma
in men too
scaling, itchy nipples- assoc with what and what?
Paget’s
assoc with: DCIS, infiltrative ductal CA
suspicious mammogram findings
microcalcifications, spiculated mass
peau d’orange
inflammatory breast CA
ER pos meds
SERM: tamoxifen, raloxifene
aromatase inhib: letrozole
HER2 pos meds
herceptin, tykerb, perjeta
CBE screening
Q3yrs 20-39y/o
Q1yr >40y/o