OBGYN Flashcards
Fetal survey
20 weeks
Quad screen
16 weeks
1 hour glucose tolerance test
28 weeks
Mom shots (TDAP)
after 28 weeks
Normal fetal heart rate
110-160
Anemia
28 weeks
GBS
urine 10 weeks
swab 36 weeks
Regular visit schedule
Monthly until 28 weeks
Every two weeks until 36 weeks
Weekly until delivery
Layers of the abdominal wall
Skin, campers fascia, scarpas fascia (where needle goes t o close), fascia, muscle (rectus for C section), peritoneum
Causes of abnormal uterine bleeding
Polyp Adenomyosis Leimyoma Malignancy (>40 years) Coagulopathy (vWD) Ovulatory dysfunction (every 21-35 days, change in ten days). If you don't ovulate, you don't get progesterone (need decrease in progesterone to trigger menses). Can be due to menarche, menopause Endocrine (TSH, prolactin) - can be from PCOS, Athlete's triad Iatrogenic/IUD Not otherwise specified
More likely to be a structural cause after 35 years of age
How to tell placenta is ready for delivery
Cord lengthening, gush of blood, desire to push
Workup for abnormal uterine bleeding
Ultrasound, biopsy
Vulvovaginitis
Candida: Risks: DM, steroids, antibiotics.
Thick, white discharge, no odor
Wet prep: hyphae
Tx: antifungals (fluconazole)
Bacterial Vaginitis
Thin, gray/white discharge with fishy odor
Clue cells on saline
Tx: metronidazole
Trichomonas (ping-ponging)
Yellow-green frothy discharge, strawberry cervix
Flagellated motile
Metronidazole BOTH PARTNERS
Cervicitis
Inflammation of the cervix
Gonorrhea, chlaymdia or those that cause vulvovaginitis
Cervical motion tenderness, discharge, no other sxs of PID
Dx: GC/chlamydia and wet prep
Tx: Ceftriaxone x1 IM and doxy (not when pregnant) or azithro
Pelvic inflammatory disease
Ascending infection
Gonorrhea, chlamydia, or vaginal flora
Pelvic/abdominal pain, no other cause for sxs, any one fo the following: CMT, adnexal or uterine tenderness
Look for fever, WBC on wet prep, discharge
Dx: clinical
Tx: Inpatient if severe, with n/v, or pregnant
cefoxitin and doxy
OR clinda and gent
Outpatient: ceftriaxone + doxy + metro
Treatment of menopause
SSRI for hot flashes
Estrogen creams for vaginal atrophy
Screen for LDL - place on statin if needed
Screen for osteoporosis - tx with bisphosphonates. Prophylaxis with Vit D and calcium + exercise
Stress incontinence
Big or multiple births - stretch the cardinal ligament
Increase in pressure - leaking. No urge or nocturnal sxs.
Dx: PE - cystocele
Tx: kegel, pessary, surgery
Hypertonic, motor urge (Overactive bladder)
Random spasms of detrusor muscle
Has urge, nocturnal, leak with every spasms
Dx: cystometry will show spasms
Tx: antispasmotics (Oxybutynin)
Hypotonic, overflow, neurogenic
Absent detrusor contractions (no sensation or signal from brain is disrupted)
-MS, trauma, antispasmotic medication
no urge, but there is nocturnal sxs
Dx: distended bladder, cystometry
Tx: bethanecol to induce spasms or intermittent versus indwelling catheter
Irritative bladder
Inflammation from stones, cancer, or UTI Frequency, urgency, and dysuria No nocturnal sxs. UA will show diagnosis Tx: UTI - antibiotics stones - capture cancer - surgery
PCOS
Anovulation. testosterone modestly elevated - hirsutism DHEAS normal Bilateral ovaries imaging LH:FSH ratio greater than 3:1 or ultrasound that shows follicles
Tx: exercise, weight loss, metformin, OCP. If she wants to get pregnant, use clomiphene. Spironolactone to treat symptoms of testosterone
Sertoli-lydig tumor
Cancer so testosterone very elevated - causes virilization
DHEAS normal
Imaging: unilateral ovary, ultrasound
Tx: resection
Adrenal tumor
Cancer so DHEAS very elevated - causes virilization. Testerosterone normal
Imaging: unilateral adrenal, CT/MRI
Adrenal vein sampling to check which adrenal gland is hyper-functioning
resection
Congenital adrenal hyperplasia
Elevations in DHEAS that are moderate = hirsuitism. testosterone normal.
Imaging would be bilateral adrenal by CT/MRI
17OH progesterone in urine (absent enzymes)
Tx: cortisol or fludrocortisone
