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OBGYN Flashcards

1
Q

Recurrent mild and unilateral mid cycle pain prior to ovulation
Pain lasts hours to days

A

Mittelschmerz

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2
Q

Amenorrhea, abdominal/pelvic pain and vaginal bleeding
Positive Beta-hCG
US shows no intrauterine pregnancy

A

Ectopic pregnancy

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3
Q

Sudden onset severe unilateral lower abdominal pain
Nausea and vomiting
Unilateral tender adnexal mass on examination
US shows enlarged ovary with decreased or absent blood flow

A

Ovarian torsion

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4
Q

Sudden onset severe unilateral lower abdominal pain immediately following strenuous or sexual activity
US shows pelvic free fluid

A

Ruptured ovarian cyst

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5
Q

Fever/chills, vaginal discharge, lower abdominal pain and cervical motion tenderness
US shows +/- Tubo-ovarian abscess

A

Pelvic Inflammatory disease

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6
Q

PCOS clinical features

A

Androgen excess (acne, male pattern baldness, hirtuism)
Menstrual irregularities/ infertility
Obesity
Polycystic ovaries on US

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7
Q

PCOS lab findings

A

Elevated Testosterone
Elevated estrogen
LH/FSH imbalance (often >2:1 ratio of LH:FSH)

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8
Q

Comorbidities associated with PCOS

A

Metabolic syndrome (DM, HTN)
OSA
NASH
Endometrial hyperplasia/cancer

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9
Q

Tx. for PCOS

A

1st line Weight loss
OCPs for menstrual regulation
Clomiphene citrate for ovulation induction

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10
Q

Clomiphene citrate

A

Primarily block estrogen receptors at the hypothalamus, inhibiting the negative feedback mechanism and restoring pulsatile release of GnRH

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11
Q

Clinical features of endometriosis

A 
Dyspareunia (pain w/ sexual activity) 
Dysmenorrhea (pain with cycle)
Chronic Pelvic pain
Infertility due to adhesions
Dyschezia( excessive straining with stools)
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12
Q

Physical exam of endometriosis

A

Immobile uterus
Cervical motion tenderness
Adnexal mass
Recto-vaginal septum, posterior cul-de-sac, uterosacral ligament nodules

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13
Q

Treatment of Endometriosis

A

OCP’s, NSAIDs
Surgical resection (can improve conception)
laparoscopy is reserved for treatment failure, adnexal mass, or infertility

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14
Q

Epithelial ovarian carcinoma

A

Is due to abnormal proliferation of ovarian or tubal epithelium or peritoneum
Usually post-menopausal women

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15
Q

Clinical presentation of epithelial ovarian carcinoma

A

Acute: SOB, obstipation/constipation with vomiting, abdominal distension
Subacute: Pelvic/abdominal pain bloating and or early satiety
Asx adnexal mass

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16
Q

Lab findings of Epithelial ovarian carcinoma

A

Increase CA-125

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17
Q

US findings of epithelial ovarian carcinoma

A

Solid mass
thick septations
Ascites

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18
Q

Management of epithelial ovarian carcinoma

A

exploratory laparotomy

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19
Q

What serum tumor marker is used for monitoring treatment response and recurrence

A

CA-125

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20
Q

Modifiable Breast Cancer risk factors

A

Hormone replacement therapy
Nulliparity
Increased age at first live birth
Alcohol consumption

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21
Q

Non-modifiable Breast Cancer risk factors

A 
Genetic mutation
Breast cancer in 1st degree relatives
White race
Increasing age
Early menarche 
Later menopause
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22
Q

Risk of developing breast cancer is directly correlated with lifetime exposure to what?

A

Estrogen

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23
Q

Thin whitish discharge, fishy odor
Clue cells (epithelial cells coated with bacteria)
pH >4.5
Positive whiff test with KOH

A

Bacterial vaginosis

Gardnerella vaginalis

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24
Q

Treatment for BV

A

Metronidazole or clindaymcin

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25
Q

Thin yellow-green, malodorous, frothy discharge
Vaginal inflammation
pH >4.5
Motile protozoa
Some cases can have punctate hemorrhages on cervix (strawberry cervix)

A

Trichomoniasis

protozoan parasite

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26
Q

Treatment for Trichomoniasis

A

Metronidazole, treat sexual partner

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27
Q 
Thick white cottage cheese
normal pH (3.8-4.5)
Pseudohyphae
A

Candida vaginitis

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28
Q

Treatment for Candida vaginitis

A

Fluconazole

29
Q

Pathophysiology of bacterial vaginosis involves decreased colonization of the vagina with ?
leading to increased pH and overgrowth of anaerobic bacteria

A

lactobacilli

30
Q

what causes of vaginitis are associated with elevated pH (>4.5)

A

Trichomoniasis

Bacterial vaginosis

31
Q

OCPs are associated with a decreased risk for what?

A

Ovarian and endometrial cancers

32
Q

Benefits of estrogen-progestin contraceptives (OCPs)

A

Pregnancy prevention
Endometrial & ovarian cancer risk reduction
Menstrual regulation
Hyperandrogenism tx.

33
Q

Risks of estrogen-progestin contraceptives (OCPs)

A 
Venous thromboemoblism
HTN
Hepatic adenoma
Stroke MI
Cervical cancer
34
Q

3 major causes of abnormal menstrual bleeding

A

Fibroids
Adenomyosis
Endometrial cancer/hyperplasia

35
Q

Clinical features of Fibroids (leiomyomata uteri)

A

Heavy menses
Constipation, urinary frequency, pelvic pain/ heaviness
Asymmetrically enlarged uterus

36
Q

Clinical Features of Adenomyosis

A

Dysmenorrhea, pelvic pain
heavy menses
bulky globular symmetrically/uniformaly enlarged and tender uterus

37
Q

Clinical features of Endometrial cancer/hyperplasia

A

history of obesity, nulliparity or chronic anovulation (PCOS)
irregular inermenstrual or postmenopausal bleeding
non-tender uterus

38
Q

Adenomyosis

A

= the presence of endometrial tissue in the uterine myometrium
typically presents in >40 yo female with new onset dysmenorrhea

39
Q

What is the recommended treatment for a breastfeeding woman with a suspected breast abscess?

A

needle aspiration, antibiotics, and continued feeding

common antibiotics for mastitis include dicloxacillin and cephalexin; incision and drainage is typically reserved for abscesses that are not responsive to needle aspiration and antibiotics

40
Q

Acute mastitis is due to what type of bacterial infection

A

Staph aureus

41
Q

treatment for acute mastitis

A

Analgesia
Frequent breastfeeding or pumping
Antibiotics

42
Q

Young woman that presents with a soft, mobile, well-circumscribed mass at the base of the labia majora?

A

Bartholin duct cysts

43
Q

Treatment for asymptomatic Bartholin duct cysts

A

1st line Observation

spontaneous drainage and resolution may occur; symptomatic cysts require incision & drainage, followed by placement of a Word catheter

44
Q

A 6-month postpartum woman that presents with irregular vaginal bleeding, an enlarged uterus, and dyspnea with multiple infiltrates on CXR?

A

Choriocarcinoma

classically occurs after a complete hydatidiform mole, but can occur after normal pregnancy or spontaneous abortion

45
Q

Risk factors for Choriocarcinoma

A

Advanced maternal age

Prior complete hydatidiform mole

46
Q

Clinical presentation for Choriocarcinoma

A 
Amenorrhea or abnormal uterine bleeding
Pelvic pain/pressure
Symptoms from metastases (lung vagina brain)
--> SOB, hemoptysis, chest pain
Uterine mass
Elevated Beta-hCG level
47
Q

Treatment for Choriocarcinoma

A

Chemotherapy

48
Q

What serum marker is characteristically elevated in choriocarcinoma?

A

Beta-hCG

49
Q

Diagnosis in a young, sexually active woman that presents with fever, sore throat, and lower abdominal pain, Physical exam reveals erythematous tonsils without exudates and non-tender cervical lymphadenopathy?

A

Gonococcal pharyngitis with pelvic inflammatory disease

versus Epstein-Barr virus, which typically causes tender cervical lymphadenopathy and exudative pharyngitis

50
Q

Three “D’s” of endometriosis

A

dysmenorrhea, deep dyspareunia, and dyschezia

51
Q

Congenital aromatase deficiency is characterized by what?

A

in newborn females is characterized by normal internal genitalia and ambiguous external genitalia
due to high levels of gestational androgens
low levels of estrogen

52
Q

What is the likely diagnosis in an adolescent girl with delayed puberty, clitoromegaly, and osteoporosis? Laboratory exam reveals undetectable estrogen and elevated testosterone levels. also with polycystic ovaries

A

Congenital aromatase deficiency

53
Q

What is the likely diagnosis in a women age < 30 with a well-circumscribed, firm, mobile breast mass?

A

Fibroadenoma (benign)

54
Q

Fibroadenoma vs. breast cyst

A

fibroadenoma is firm and most common before age 30, versus a breast cyst, which is soft and most common after age 30

55
Q

Benign breast diseases?

A

Breast cyst
fibrocystic changes
Fibroadenoma
Fat necrosis

56
Q

Clinical features of breast cyst

A

Soft Solitary, well-circumscribed, mobile mass

+/-tenderness

57
Q

Clinical features of fibrocystic changes of the breast

A

Multiple diffuse nodulocystic masses

Cyclic premenstrual tenderness

58
Q

Clinical features of fibroadenoma

A

Firm Solitary, well-circumscribed, mobile mass

Cyclic premenstrual tenderness

59
Q

Clinical features of fat necrosis

A

Post trauma/surgery
Firm irregular mass
+/- ecchymosis, skin/ nipple retraction

60
Q

What is the initial test/imaging study for a women age < 30 with a palpable breast mass?

A

Ultrasound
helps differentiate a cystic lesion versus a solid lesion; mammogram is not as useful due to increased breast tissue density in younger women

61
Q

The diagnosis of a palpable breast mass can only be confirmed with a biopsy
e.g. fine needle aspiration or core needle biopsy

A

Simple cyst–> (FNA)
Complex cyst/mass (solid mass) –> Image-guided biopsy
Suspicious for malignancy core biopsy

62
Q

What is the gold standard diagnostic test for acute cervicitis (Red inflamed friable cervix, with purulent discharge)

A

Nucleic acid amplification testing (NAAT)
has a high sensitivity/specificity for Chlamydia trachomatis and Neisseria gonorrhoeae, which are the most common causes of acute cervicitis

63
Q

BRCA mutations result in significantly increased risk of what?

A

Breast and ovarian cancer

64
Q

BRCA-positive individuals are recommended to have what to decrease incidence of ovarian cancer

A

a prophylactic bilateral salpingo-oophorectomy

65
Q

Treatment for HELLP syndrome

A

Delivery–>delivery should occur at > 34 weeks gestation or with deteriorating maternal/fetal status; antihypertensive medications and/or magnesium may be needed for stabilization
Magnesium for seizures and antihypertensives

66
Q

HELLP lab findings

A

Microangiopathic hemolytic anemia
Elevated liver enzymes
Low platelet count

67
Q

Granulosa cell tumor of the ovary

Clinical features

A

Child: Precocious puberty
Postmenopasula woman: breast tenderness, bleeding/endmetrial hyperplasia
Large adnexal mass

68
Q

Granulosa cell tumor of the ovary

Lab findings

A

Elevated estrogen

US shows ovarian mass with thickened endometrium (stripe)

69
Q

Gold standard test for postmenopausla women with vaginal bleeding and thickened endometrial stripe

A

endometrial biopsy

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