OBGYN Flashcards
Rx for pelvic organ prolapse (uterus, bladder, rectum) if poor surgical candidate?
Pessary.
50s female with sparse pubic hair, fissures in vestibule, and multiple areas of petechiae in vagina. Labial volume is decreased. Dx?
Genitourinary syndrome of menopause (atrophic vaginitis). Vaginal epithelium has decreased elasticity and loss of keratinization.
Confirmation test for atrophic vaginitis?
Elevated vaginal pH≥5 confirms the hypoestrogenic state.
40s female presents with severe NV and an enlarged uterus with bilaterally enlarged ovaries. US reveals uterus is filled with multiple small cysts but no embryo. Ovaries are 10cm with multilocular cystic appearance. Pregnancy test positive. Dx?
Complete hydatidiform mole leading to theca lutein cysts. The enlarged ovaries are stimulated to produce cystic changes due to hyperstimulation by elevated ßhCG from the mole. They should resolve with suction D&C of the mole.
40s female presents with fever, right lower quadrant abd. pain, and a complex multiloculated adnexal mass with thick walls and internal debris on US. She is sexually active with 1 partner and uses condoms. Dx?
Tubo-ovarian abscess. This is a complication of PID due to chlamydia and gonorrhea. A multiloculated mass in the adnexa with debris is classic.
Pregnant female with clear discharge from her vagina on standing and negative nitrazine test. Dx?
Stress urinary incontinence.
Sx in uterine prolapse.
Pressure in pelvis
Urinary retention/incontinence/obstrxn
7yo girl with precocious puberty is found to have a pelvic mass. US shows right ovarian mass. Dx?
Granulosa cell tumor.
20s female presents with shrinking breasts and scant, irregular menstruation for a year. She has not had a period now for 1 year. She has facial hair and a deep voice. US shows an ovarian tumor. PE reveals enlarged clitoris. Dx?
Sertoli-Leydig cell tumor. These tumors produce androgens and lead to masculinization and period irregularity that leads to amenorrhea.
Granulosa cell tumors secrete?
Estrogen.
Sertoli-Leydig cell tumors secrete?
Testosterone.
13yo presents with abd. pain and amenorrhea. She has never had a period. Consider what dx?
Imperforate hymen.
Sarcoma botryoides Sx?
Vaginal bleeding in infancy with polypoid or grape-like mass protruding from vagina.
Copper IUD for emergency contraception MOA and timeframe?
Inflammatory response in uterus. Up to 120 hours from sex.
Ulipristal pill for emergency contraception MOA and timeframe?
Antiprogestin delays ovulation; 0-120 hours from sex
Levonorgestrel pill (plan B) for emergency contraception MOA and timeframe?
Progestin delays ovulation. 0-72 hrs from sex.
SS of acute cervicitis?
Postcoital bleeding Thick, mucopurulent discharge Dysuria Dyspareunia Pruritis Friable cervix
MCC of acute cervicitis?
Chlamydia
Gonorrhoeae
Gold std for acute cervicitis testing?
NAAT (nucleic acid amplification test) which has high sensitivity and specificity for chlamydia and gonorrhea. Light microscopy reveals no organisms.
Adolescents frequently have anovulatory cycles with irregular, heavy menstrual bleeding Why?
Immature hypothalamic-pituitary axis. Unopposed estrogen stimulation due to lack of progesterone prodxn from absence of the corpus luteum development leads to proliferation of the endometrium and instability.
How to manage menometrorhaggia in a healthy adolescent?
Progesterone or OCs with progesterone.
After a sxn D&C for a molar pregnancy, what is prescribed until ß-hCG is undetectable?
Contraception (ß-hCG must be undetectable for 6 months).
When is an operative vaginal delivery indicated?
Protracted 2nd stage of labor
Second-stage fetal HR tracing abnormalities
Poor maternal pushing
Valsalva contraindicated
Operative vaginal delivery can lead to what in mother?
Deep lacerations in GU, rectum, urinary tract. Thus, inspection of genitals required for suturing of lesions.
Reason for infertility in endometriosis?
Pelvic adhesions interfere with oocyte release and block sperm entry.
Cervical stenosis can occur after?
Loop electrosurgical excision or cold knife conization
What Sx are shared in PID and endometriosis?
Fixed, tender uterus on bimanual.
Best test for Chlamydia?
PCR
Fibrocystic changes presentation?
- Multiple, diffuse nodulocystic masses
- Cyclic premenstrual tenderness
- May increase in size with OCs (estrogen)
Fibroadenoma presentation?
- Solitary
- Well-circumscribed
- Mobile mass
- Cyclic premenstrual tenderness
- May increase in size with OCs (estrogen)
Breast cyst presentation?
-Solitary
-Well-circumscribed
-Mobile mass
+/- tenderness
Fat necrosis presentation?
- Post trauma/surgery
- Firm/irregular mass
- +/- Echymosis
- +/- Skin/nipple retraction
Confirmational testing for breast mass?
Biopsy required to confirm anything. US used to ID cysts vs solid mass only and does not confirm.
Newborn presents as thin with loose skin, a thin umbilical cord, and a wide anterior fontanel. LIkely Dx?
Fetal growth restriction. (weight<10th percentile for gestational age).
Definition of fetal growth restriction?
<10th percentile for gestational age. Typically are thin with loose skin, a think umbilical cord, and have a wide anterior fontanel.
Preterm premature rupture of membranes (PPROM) definition?
Rupture of membranes (pooling of fluid in vagina, nitrazine-positive, ferning) prior to 37 wks gestation in the absence of uterine contrxns.
Preterm premature rupture of membranes (PPROM) is expectant until when?
34 wks gestation. 34 wks or more require delivery with PPROM as the risks of rupture (chorioamnionitis) outweight the benefits of leaving a premature baby unborn.
PPROM management before 34 wks?
At 33 wks gestation, patients are given steroids for fetal lung maturity and a course of broad spectrum antibiotics.
Fetal heart rate expected in chorioamnionitis?
≥160/min (sustained)
Signs of overt chorioamnionitis (fever, fetal HR≥160, leukocytosis, purulent amniotic fluid) should lead to?
Delivery. Delivery indicated regardless of gestational age in uterine infxn.
RFs for vulvovaginal candidiasis?
High estrogen (eg pregnancy)
Immunosuppression
Diabetes
Vaginal pH in yeast infxn?
Normal pH (3.8-4.5)
Vulvovaginal atrophy from menopause and lichen sclerosis share what qualities?
Burning, itching, dyspareunia in both, but menopausal atrophy does NOT affect perianal skin as lichen sclerosis does.
Lichen sclerosus vaginal Sx?
Burning, itching with excoriations
Dyspareunia
Thin, white, “cigarette paper” skin or wrinkled vaginal skin
Lichen planus vaginal Sx?
Erosive (Glassy, bright red erosions)
Ulcerations of vulvovaginal area
Lichen simplex chronicus vaginal Sx?
Hyperplastic response to repetitive (chronic) scratching/irritation.
Thick, leathery textured skin.
Genital herpes outbreaks occur most frequently during what period after infxn?
During the first year after infxn, the median outbreak recurrence is 5x, but the frequency decreases over time as cell mediated immunity improves.
HBsAg positivity in the mother of a newborn requires what Rx for baby?
Hep B Ig as well as HBV recombinant vaccine.
What is the risk of chronic hepatitis in newborns born with vertical Tx of Hep B?
90%. Must receive IVIg against Hep B and HBV recombinant vax.
HBeAg positivity in mother indicates what and affects what outcome in newborn children?
HBeAg indicates current viral replication and infectivity. It increases the child’s risk of infxn to 95% from 20% if mother did not have active infxn (HBeAG positivity).
Thin, off-white discharge with fishy odor and no vaginal inflammation. Dx?
BV
pH>4.5 with positive whiff test (amine odor with KOH). Dx?
BV
Rx for BV?
Metronidazole or clindamycin.
Thin, yellow-green, stinky, frothy discharge with vaginal inflammation. Dx?
Trichomoniasis.
Trichomoniasis pH?
> 4.5, like BV.
Trichomoniasis Rx?
Metronidazole - treat partner
Thick, “cottage cheese” discharge with vaginal inflammation. Dx?
Candida.
Vaginal candidiasis Rx?
Fluconazole
BV organism and path?
Death of normal lactobacilli leads to increased pH and overgrowth of Gardnerella vaginalis
