OBGYN Flashcards
Recurrent mild and unilateral mid cycle pain prior to ovulation
Pain lasts hours to days
Mittelschmerz
Amenorrhea, abdominal/pelvic pain and vaginal bleeding
Positive Beta-hCG
US shows no intrauterine pregnancy
Ectopic pregnancy
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
Ovarian torsion
Sudden onset severe unilateral lower abdominal pain immediately following strenuous or sexual activity
US shows pelvic free fluid
Ruptured ovarian cyst
Fever/chills, vaginal discharge, lower abdominal pain and cervical motion tenderness
US shows +/- Tubo-ovarian abscess
Pelvic Inflammatory disease
PCOS clinical features
Androgen excess (acne, male pattern baldness, hirtuism)
Menstrual irregularities/ infertility
Obesity
Polycystic ovaries on US
PCOS lab findings
Elevated Testosterone
Elevated estrogen
LH/FSH imbalance (often >2:1 ratio of LH:FSH)
Comorbidities associated with PCOS
Metabolic syndrome (DM, HTN)
OSA
NASH
Endometrial hyperplasia/cancer
Tx. for PCOS
1st line Weight loss
OCPs for menstrual regulation
Clomiphene citrate for ovulation induction
Clomiphene citrate
Primarily block estrogen receptors at the hypothalamus, inhibiting the negative feedback mechanism and restoring pulsatile release of GnRH
Clinical features of endometriosis
Dyspareunia (pain w/ sexual activity) Dysmenorrhea (pain with cycle) Chronic Pelvic pain Infertility due to adhesions Dyschezia( excessive straining with stools)
Physical exam of endometriosis
Immobile uterus
Cervical motion tenderness
Adnexal mass
Recto-vaginal septum, posterior cul-de-sac, uterosacral ligament nodules
Treatment of Endometriosis
OCP’s, NSAIDs
Surgical resection (can improve conception)
laparoscopy is reserved for treatment failure, adnexal mass, or infertility
Epithelial ovarian carcinoma
Is due to abnormal proliferation of ovarian or tubal epithelium or peritoneum
Usually post-menopausal women
Clinical presentation of epithelial ovarian carcinoma
Acute: SOB, obstipation/constipation with vomiting, abdominal distension
Subacute: Pelvic/abdominal pain bloating and or early satiety
Asx adnexal mass
Lab findings of Epithelial ovarian carcinoma
Increase CA-125
US findings of epithelial ovarian carcinoma
Solid mass
thick septations
Ascites
Management of epithelial ovarian carcinoma
exploratory laparotomy
What serum tumor marker is used for monitoring treatment response and recurrence
CA-125
Modifiable Breast Cancer risk factors
Hormone replacement therapy
Nulliparity
Increased age at first live birth
Alcohol consumption
Non-modifiable Breast Cancer risk factors
Genetic mutation Breast cancer in 1st degree relatives White race Increasing age Early menarche Later menopause
Risk of developing breast cancer is directly correlated with lifetime exposure to what?
Estrogen
Thin whitish discharge, fishy odor
Clue cells (epithelial cells coated with bacteria)
pH >4.5
Positive whiff test with KOH
Bacterial vaginosis
Gardnerella vaginalis
Treatment for BV
Metronidazole or clindaymcin
Thin yellow-green, malodorous, frothy discharge
Vaginal inflammation
pH >4.5
Motile protozoa
Some cases can have punctate hemorrhages on cervix (strawberry cervix)
Trichomoniasis
protozoan parasite
Treatment for Trichomoniasis
Metronidazole, treat sexual partner
Thick white cottage cheese normal pH (3.8-4.5) Pseudohyphae
Candida vaginitis
Treatment for Candida vaginitis
Fluconazole
Pathophysiology of bacterial vaginosis involves decreased colonization of the vagina with ?
leading to increased pH and overgrowth of anaerobic bacteria
lactobacilli
what causes of vaginitis are associated with elevated pH (>4.5)
Trichomoniasis
Bacterial vaginosis
OCPs are associated with a decreased risk for what?
Ovarian and endometrial cancers
Benefits of estrogen-progestin contraceptives (OCPs)
Pregnancy prevention
Endometrial & ovarian cancer risk reduction
Menstrual regulation
Hyperandrogenism tx.
Risks of estrogen-progestin contraceptives (OCPs)
Venous thromboemoblism HTN Hepatic adenoma Stroke MI Cervical cancer
3 major causes of abnormal menstrual bleeding
Fibroids
Adenomyosis
Endometrial cancer/hyperplasia
Clinical features of Fibroids (leiomyomata uteri)
Heavy menses
Constipation, urinary frequency, pelvic pain/ heaviness
Asymmetrically enlarged uterus
Clinical Features of Adenomyosis
Dysmenorrhea, pelvic pain
heavy menses
bulky globular symmetrically/uniformaly enlarged and tender uterus
Clinical features of Endometrial cancer/hyperplasia
history of obesity, nulliparity or chronic anovulation (PCOS)
irregular inermenstrual or postmenopausal bleeding
non-tender uterus
Adenomyosis
= the presence of endometrial tissue in the uterine myometrium
typically presents in >40 yo female with new onset dysmenorrhea
What is the recommended treatment for a breastfeeding woman with a suspected breast abscess?
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
Acute mastitis is due to what type of bacterial infection
Staph aureus
treatment for acute mastitis
Analgesia
Frequent breastfeeding or pumping
Antibiotics
Young woman that presents with a soft, mobile, well-circumscribed mass at the base of the labia majora?
Bartholin duct cysts
Treatment for asymptomatic Bartholin duct cysts
1st line Observation
spontaneous drainage and resolution may occur; symptomatic cysts require incision & drainage, followed by placement of a Word catheter
A 6-month postpartum woman that presents with irregular vaginal bleeding, an enlarged uterus, and dyspnea with multiple infiltrates on CXR?
Choriocarcinoma
classically occurs after a complete hydatidiform mole, but can occur after normal pregnancy or spontaneous abortion
Risk factors for Choriocarcinoma
Advanced maternal age
Prior complete hydatidiform mole
Clinical presentation for Choriocarcinoma
Amenorrhea or abnormal uterine bleeding Pelvic pain/pressure Symptoms from metastases (lung vagina brain) --> SOB, hemoptysis, chest pain Uterine mass Elevated Beta-hCG level
Treatment for Choriocarcinoma
Chemotherapy
What serum marker is characteristically elevated in choriocarcinoma?
Beta-hCG
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?
Gonococcal pharyngitis with pelvic inflammatory disease
versus Epstein-Barr virus, which typically causes tender cervical lymphadenopathy and exudative pharyngitis
Three “D’s” of endometriosis
dysmenorrhea, deep dyspareunia, and dyschezia
Congenital aromatase deficiency is characterized by what?
in newborn females is characterized by normal internal genitalia and ambiguous external genitalia
due to high levels of gestational androgens
low levels of estrogen
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
Congenital aromatase deficiency
What is the likely diagnosis in a women age < 30 with a well-circumscribed, firm, mobile breast mass?
Fibroadenoma (benign)
Fibroadenoma vs. breast cyst
fibroadenoma is firm and most common before age 30, versus a breast cyst, which is soft and most common after age 30
Benign breast diseases?
Breast cyst
fibrocystic changes
Fibroadenoma
Fat necrosis
Clinical features of breast cyst
Soft Solitary, well-circumscribed, mobile mass
+/-tenderness
Clinical features of fibrocystic changes of the breast
Multiple diffuse nodulocystic masses
Cyclic premenstrual tenderness
Clinical features of fibroadenoma
Firm Solitary, well-circumscribed, mobile mass
Cyclic premenstrual tenderness
Clinical features of fat necrosis
Post trauma/surgery
Firm irregular mass
+/- ecchymosis, skin/ nipple retraction
What is the initial test/imaging study for a women age < 30 with a palpable breast mass?
Ultrasound
helps differentiate a cystic lesion versus a solid lesion; mammogram is not as useful due to increased breast tissue density in younger women
The diagnosis of a palpable breast mass can only be confirmed with a biopsy
e.g. fine needle aspiration or core needle biopsy
Simple cyst–> (FNA)
Complex cyst/mass (solid mass) –> Image-guided biopsy
Suspicious for malignancy core biopsy
What is the gold standard diagnostic test for acute cervicitis (Red inflamed friable cervix, with purulent discharge)
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
BRCA mutations result in significantly increased risk of what?
Breast and ovarian cancer
BRCA-positive individuals are recommended to have what to decrease incidence of ovarian cancer
a prophylactic bilateral salpingo-oophorectomy
Treatment for HELLP syndrome
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
HELLP lab findings
Microangiopathic hemolytic anemia
Elevated liver enzymes
Low platelet count
Granulosa cell tumor of the ovary
Clinical features
Child: Precocious puberty
Postmenopasula woman: breast tenderness, bleeding/endmetrial hyperplasia
Large adnexal mass
Granulosa cell tumor of the ovary
Lab findings
Elevated estrogen
US shows ovarian mass with thickened endometrium (stripe)
Gold standard test for postmenopausla women with vaginal bleeding and thickened endometrial stripe
endometrial biopsy
