OBGYN ROSH Flashcards
PICTURES
Ectopic Pregnancy
- Patient with a history of prior ectopic, PID , tubal surgery, IUD
- Complaining of vaginal bleeding, abdominal pain,amenorrhea
- PE will show adnexal tenderness or unexplained hypotension
- Labs will show positive pregnancy test and lower than expected serum beta-hCG levels
- NORMAL: 100,000 AT 10 WEEKS & 10,000 AT TERM
- ECTOPIC: <6500
- Diagnosis is made by ultrasound (will show adnexal mass)
- Most commonly located in a fallopian tube
- Treatment is methotrexate or surgery
Placenta Previa
- Patient will be a pregnant woman in her third trimester
- Complaining of painless vaginal bleeding
- Diagnosis is made by ultrasound (transvaginal > transabdominal)
- Comments: Do not do a digital vaginal exam
- Treatment:
- Persistence of placenta previa at the third trimester is an indication for cesarean section as the route of delivery.
- <36 weeks give corticosteroids
Mastitis
- Patient will be a breastfeeding mother
- Complaining of breast erythema, tenderness, fever
- Most commonly caused by Staph. aureus
- Management includes cool compresses and analgesics in between feedings
- If no MRSA suspected: dicloxacillin, keflex
- if MRSA suspected: bactrim (but baby has to be at least 1mo old), clindamycin
- Comments: continue breast feeding to avoid progression to abscess
Premenstrual Syndrome
- Patient will be a woman, 1 - 2 weeks prior to cycle
- Complaining of sleep disturbances, decreased focus, emotional lability, breast tenderness, or HA, that resolves after menstruation begins
- Treatment is dec caffeine intake, exercise, stress reduction, NSAIDs, SSRIs, OCPs
- Comments: Symptoms do not hinder personal/professional life (unlike premenstrual dysphoric disorder)
premenstrual dysphoric disorder
Association DSM-5, mood swings, anger, irritability, sense of hopelessness or tension, and anxiety or feeling on edge associated with severe premenstrual syndrome symptoms is defined as premenstrual dysphoric disorder.
Vulvar Cancer
- Patient will be mostly postmenopausal woman
- With a history of human papillomavirus (types 16, 18, and 33)
- Complaining of a vulvar lesion and pruritus
- PE will show unifocal vulvar ulcer, plaque, or mass, predominantly on the labia majora
- Most common type is squamous cell carcinoma (SCC)
- Diagnosis is confirmed with biopsy
ECTOPIC PREGNANCY US
- patient comes in with abdominal pain and suspicion od pregnancy then think ECTOPIC!
- The transvaginal ultrasound shows an early gestational sac without a yolk sac or fetal pole within the uterus.
- It is expected that above the discriminatory hCG zone of 1500-2500 mIU, a definitive IUP should be identified. Patients with a beta hCG below the discriminatory zone without a definitive IUP can be managed conservatively with a repeat hCG level in 48 hours
Bartholin Abscess
- ↑ Pain with sitting/walking
- Pea-sized mucous secreting gland located on each side of the labia minora in the 4 and 8 o’clock positions.
- Rx: I&D on mucosal surface, word catheter
Fundal Height
- Week 12: Pubic symphysis
- Week 20: Umbilicus
- Week 36: Xiphoid Process
- After week 37: Regression
- After delivery: Umbilicus
Etonogestrel Implant
- Under the skin of arm
- Lasts for three years
- May affect length of periods
- Fertility returns shortly after removal
- Does not protect against HIV/STIs
Long-acting reversible contraception (LARC) such as the etonogestrol implant and intrauterine device (IUD) are first-line recommendations for adolescents requesting to initiate birth control.
Uterine Fibroids (Leiomyoma)
- Patient will be an African-American woman, 20 - 40-years-old
- Complaining of menorrhagia and dysmenorrhea
- PE will show a palpable, asymmetric, and non-tender uterus
- Diagnosis is made by pelvic ultrasound
- Majority do not require surgical or medical treatment
- Severe cases: Myomectomy (fertility can be preserved) or hysterectomy
Treatment with a gonadotropin-releasing hormone (GnRH) agonist is the most effective oral therapy with the majority of women achieving amenorrhea and a reduction in uterine size by up to 60%. However, most patients experience significant side effects like hot flashes, irritability, vaginal dryness and myalgias. In addition, significant bone loss is observed after six months of therapy. Therefore, use is typically limited in duration. Surgical intervention with hysterectomy is offered to those with uncontrolled symptoms who no longer desire to have children.
Abnormal Uterine Bleeding (formerly Dysfunctional Uterine Bleeding)
- MCC of abnormal vaginal bleeding in reproductive women
- Menarche, perimenopause
- Anovulatory:
- Estrogen, progesterone endometrial hyperplasia/bleeding
- Unpredictable bleeding
- Ovulatory:
- Predictable bleeding
- Dx of exclusion
- Rx: combination OCPs
- Unstable bleeding: IV estrogen
what are the structural and nonstructural causes?
HELLP Syndrome (Hemolysis, Elevated Liver function tests, and Low Platelets)
- Patient will be a pregnant
- Labs will show microangiopathic hemolytic anemia (low hemoglobin and schistocytes on blood smear), thrombocytopenia, and elevated liver function tests
- Management is blood pressure management (labetalol, hydralazine, and nifedipine), magnesium sulfate for prevention of eclamptic seizures and delivery of the fetus (definitive tx)
Endometrial hyperplasia
- most common cause of abnormal uterine bleeding in older, obese women.
- result of unopposed estrogen over a period of time
- experiences abnormal uterine bleeding should undergo an endometrial biopsy
- transvaginal US only helpful in postmenopausal women
- Hyperplasia with atypia has a higher likelihood of transitioning to carcinoma.
Endometrial Cancer
- Patient will be a postmenopausal woman
- Complaining of abnormal vaginal bleeding
- Diagnosis is made by transvaginal ultrasound or endometrial biopsy
- Most common type is adenocarcinoma
- Treatment is total abdominal hysterectomy and bilateral salpingo-oophorectomy(TAH-BSO)
Chorioamnionitis
- Intra-amniotic infection
- Risk factors: preterm labor, premature rupture of membranes, prolonged rupture of membranes
- GBSinfection at 18 hrs
- Rx:ampicillin+gentamicin
