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OBGYN > OBGYN Shelf > Flashcards

OBGYN Shelf Flashcards

1
Q

Clinical features of vaginal cancer (3)

A

Vaginal bleeding
Malodorous vaginal discharge
Irregular vaginal lesion

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1
Q

Risk factors for vaginal cancer (4)

A

Age > 60
HPV infection
Tobacco use
In utero DES exposure

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2
Q

Indication for endometrial bx

A

Postmenopausal bleeding and endometrial stripe >4mm on US

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3
Q

Theca lutein cyst presentation (3)

A

Multilocular
Bilateral
10-15 cm ovaries

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4
Q

Theca lutein cyst pathogenesis (3)

A

Ovarian hyperstimulation due to:
Gestational trophoblastic dz
Multifetal gestation
Infertility tx

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5
Q

Complete hydatidiform mole

A

A gestational trophoblastic dz resulting from the abnormal fertilization of an empty ovum by either 2 sperm or single sperm that duplicates its genome upon fertilization
The resultant gestation is composed of abnormal, proliferative trophoblastic tissue that secretes markedly elevated b-hCG.
b-hCG causes hyperstimulation of the ovaries and hypertrophy and luteinization of the theca cells. The thecal cells secrete androgens, leading to acute hyperandrogenism

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6
Q

Absolute contraindications for combined hormonal contraceptives (9)

A

Migraines with aura
Severe HTN
Ischemic heart disease, stroke
Age >35 and smoking >15 cigarettes/day
<3 weeks postpartum
Hx of VTE
Thrombophilia (factor V Leiden, antiphospholipid syndrome)
Active breast cancer
Active or severe liver dz

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7
Q

Vesicovaginal fistula

A

Aberrant connection between the bladder and vagina allowing urine to constantly drain into the vaginal, creating continuous, painless urinary leakage.
Dx visualization of pooling of clear fluid in vaginal on pelvic exam vs bladder dye testing

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8
Q

Causes and timing of vesicovaginal fistulas

A

Immediately following intraoperative bladder injury (c-section, hysterectomy)

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8
Q

Stress urinary incontinence (SUI)

A

Intermittent, involuntary loss of urine with increased intraabdominal pressure (coughing, laughing, sneezing).
D/t either decreased urethral sphincter muscle tone or urethral hypermobility from weakened pelvic floor muscles

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8
Q

Overflow incontinence

A

Continuous, painless loss of urine due to chronic urinary retention.
D/t diminished contractility of bladder detrusor (neurogenic bladder from DM), external compression of urethral outlet (fibroids, prolapse) that impede bladder emptying

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8
Q

Peripartum cardiomyopathy (PPCM)

A

Dilated cardiomyopathy that develops during the last month of pregnancy or within 5 months following delivery. Present with progressive dyspnea on exertion, lower extremity edema, and an S3 suggestive of decompensated heart failure. PPCM often causes secondary mitral regurgitation, which causes a holosystolic murmur best heard at the apex.

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8
Q

Overactive bladder (OAB)

A

Excessive involuntary detrusor muscle spasms creating a sudden urge to urinate, typically followed by an immediate loss of urine

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9
Q

3 type of urinary incontinence

A

Stress urinary incontinence
Overflow incontinence
Urge incontinence/ overactive bladder

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9
Q

3 risk factors for peripartum cardiomyopathy

A

Maternal age >30
Multiple gestation
Eclampsia or preeclampsia

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10
Q

Peripartum cardiomyopathy management

A

Urgent delivery if hemodynamically unstable vs standard management of HFrEF (beta blockers, diuretics)

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11
Q

Ectopic pregnancy dx

A

positive hCG
Transvaginal US showing adnexal mass and empty uterus

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12
Q

Ectopic pregnancy clinical features

A

Abdominal pain, amenorrhea, vaginal bleeding
Hypovolemic shock in ruptured ectopic pregnancy
Cervical motion, adnexal and/or abd tenderness
+/- palpable adnexal mass

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13
Q

Ectopic pregnancy management

A

MTX if stable vs surgery if unstable

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14
Q

Preterm prelabor rupture of membranes (PPROM)

A

ROM <37 w gestation prior to the onset of labor (closed cervix and irregular cxns)

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15
Q

PPROM management

A

<34 w w/o complications require inpatient expectant management with prophylactic latency abx (ampicillin and azithromycin), corticosteroids (betamethasone) to decrease risk of NRDS, and fetal surveillance (nonstress test, fetal growth US)

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16
Q

Stress urinary incontinence management

A

Conservatives: pelvic floor muscle exercises to strengthen and stabilize pelvic musculature
Pts who fail conservative tx or desire surgical management can undergo midurethral sling procedure which prevents urethral hypermobility and allows urethral compression

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17
Q

Ddx for postpartum hemorrhage

A

Uterine atony
Retained products of conception
Genital tract trauma
Inherited coagulopathy

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18
Q

Abnormally elevated maternal serum AFP (MSAFP) work up

A

MSAFP >2.5 MoM is suggestive of fetal NTD but can also be due to benign causes such as multiple gestations and incorrect gestational age dating (most common cause)
Abnormal MSAFP level require US to evaluate for NTDs, multiple gestations, and determine accurate gestational age

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19
Q

Rubella infection during pregnancy

A

Can cause spontaneous, abortion, intrauterine fetal demise, or congenital rubella syndrome (deafness, cardiac defects, hepatosplenomegaly, cataracts, microcephaly)
All women are tested for rubella immunity at 1st prenatal visit by anti rubella IgG. Vaccination is contraindicated during pregnancy but all nonimmune pts should be vaccinated during the immediate postpartum period

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20
Q

Anemia in pregnancy

A

Hemoglobin <11 g/dL and MCV <80 fL

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21
Q

Rho(D) immunoglobulin administration

A

Rho(D) immunoglobulin administration given to Rh(D)-negative patients at 28 w and after delivery if the infant is Rh(D) positive. 1st trimester immunization is only indicated in the setting of uterine bleeding

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22
Q

Spinal epidural abscess presentation

A

Classic triad: fever, focal/severe back pain, and neurologic findings (motor/sensory changes, bowel/bladder dysfunction, paralysis)
Elevated ESR

23
Q

Spinal epidural abscess management

A

Broad spectrum abx (ceftriaxone and vancomycin)
Urgent aspiration/surgical decompression

24
Q

Classic exam findings of endometriosis

A

Posterior fornix tenderness,
Decreased uterine mobility
Uterosacral ligament thickening
Cervical motion tenderness
Adnexal mass
Rectovaginal septum, posterior cul-de-sac, and uterosacral ligament nodules

25
Q

Endometriosis management

A

Initial tx: NSAIDs and combined OCP
Pts who fail medical management, diagnostic laparoscopy recommended because it allows for definitive dx and is therapeutic via removal of endometriotic lesions

26
Q

Common symptoms of endometriosis

A

Chronic pelvic pain
Dysmenorrhea
Deep dyspareunia
Dyschezia
Infertility
Cyclic dysuria, hematuria

27
Q

Clinical features of breast fibroadenoma

A

Solitary, firm, well circumscribed mobile mass
Cyclic premenstrual tenderness

28
Q

Clinical features of a breast cyst

A

Solitary, well circumscribed mobile mass
+/- tenderness

29
Q

Clinical features of fibrocystic changes

A

Multiple, diffuse nodulocystic masses
Cyclic premenstrual tenderness

30
Q

Management of solitary palpable breast mass

A

Pts < 30: US +/- mamo
Pts >40: mamo +/- US
Pts 30-40: can do either

31
Q

Preeclampsia definition

A

New-onset HTN (>140/90) at >20 w AND proteinuria OR signs/symptoms of other end-organ damage

32
Q

Preeclampsia severe features

A

BP >160/110
Platelets <100,000
Creatinine >1.1 mg/dL or 2X normal
Elevated transaminases >2x ULN
Pulmonary edema
Vision or cerebral symptoms (HA)

33
Q

Preeclampsia management

A

<37 w w/o sever features: expectant
>37 w or >34 w w/ severe features: delivery
Severe range BPs: IV labetalol, IV hydralazine, PO nifedipine
Magnesium sulfate seizure prophylaxis

34
Q

HELLP syndrome

A

Hemolysis Elevated Liver enzymes and Low Platelets
Life-threatening disorder related to preeclampsia with severe features. Likely related to abnormal placental development early in pregnancy with the placental release of antiangiogenic factors which cause widespread maternal endothelial dysfunction and dysregulation of vascular tone

34
Q

Clinical findings of HELLP syndrome

A

N/V
RUQ pain
HA
Visual changes
HTN

35
Q

HELLP syndrome lab abnormalities (4)

A

Microangiopathic hemolytic anemia
Elevated liver enzymes
Thrombocytopenia
+/- proteinuria

36
Q

HELLP syndrome treatment (3)

A

Delivery
Magnesium sulfate for seizure prophylaxis
Antihypertensives (hydralazine)

37
Q

HELLP syndrome complications (5)

A

Abruptio placentae
Subcapsular hematoma
Acute renal failure
Pulmonary edema
DIC

38
Q

Clinical features of uterine leiomyomas (fibroids) (3)

A

Heavy, prolonged periods
Pressure symptoms (pelvic pain, constipation, urinary frequency)
Obstetric complications (impaired fertility, pregnancy loss, preterm labor)
Enlarged, irregular uterus

39
Q

Uterine leiomyoma work-up

A

US

40
Q

Uterine leiomyoma treatment

A

Observation if asymptomatic vs hormonal contraception or hysteroscopic myomectomy

41
Q

Cervical conization

A

A cone-shaped bx performed to remove the entirety of the transformation zone while allowing adequate depth to access the endocervical canal dysplasia. It is both diagnostic (evaluation for concurrent invasive cancer) and therapeutic (Removal of dysplasia

42
Q

Adenocarcinoma in situ of the cervix

A

A premalignant lesion of cervical adenocarcinoma that has a 30-70% chance of progression to invasive cancer, along with a 15% chance of cobcurrent invasive cervical cancer.
Tx requires excision (cervical conization) of the lesion

43
Q

Evaluation of atypical glandular cells on Pap in pts ≥35

A

Colposcopy
Endocervical curettage*
Endometrial bx*
*Nonpregnant

44
Q

Evaluation of atypical glandular cells on Pap in pts ≤35 with risk factors

A

Colposcopy
Endocervical curettage*
Endometrial bx*
*Nonpregnant

45
Q

Evaluation of atypical glandular cells on Pap in pts ≤35 without risk factors

A

Colposcopy
Endocervical curettage*
*Nonpregnant

46
Q

GBS antenatal screening

A

Rectovaginal cx at 36-38 w gestation. Good for 5 weeks

47
Q

Indications for intrapartum GBS prophylaxis

A

GBS bacteriuria or UTI in current pregnancy
GBS positive rectovaginal cx in current pregnancy
Unknown GBS status PLUS any of the following : <37 w, intrapartum fever, ROM >18 hrs
Prior infant with early-onset neonatal GBS infection

48
Q

Intrapartum GBS prophylaxis

A

IV penicillin
If pt has a pcn allergy then cefazolin if mild vs clindamycin or erythromycin depending on sensitivity if severe pcn allergy

49
Q

Active phase of labor

A

6-10 cm dilation
Has an expected, predictable rate of cervical dilation of ≥ 1 cm every 2 hours

50
Q

Active phase arrest

A

No cervical change in 4 hours despite adequate cxns (≥200 Montevideo units averaged over 10 minutes)
OR
No cervical change in ≥6 hours with inadequate cxns

Management is c-section

51
Q

Prostaglandin use in labor

A

Used for cervical ripening (softening the cervix) in early labor induction

52
Q

Oxytocin

A

A uterotonic used to augment labor by increased the frequency and force of cxns if cxns are inadequate (<200 Montevideo units and can be used in protracted labor (cervical dilation rate <1 cm/2 hours but not arrested)

53
Q

Protracted labor

A

Cervical dilation rate <1 cm/2 hours but not arrested

54
Q

Initial evaluation of anovulatory infertility

A

TSH and PRL levels

55
Q

Epithelial ovarian carcinoma presentation

A

Asymptomatic: incidental adnexal mass
Subacute: pelvic/ abdominal pain, bloating, early satiety
Acute: dyspnea, obstipation/constipation, abdominal distention

56
Q

Epithelial ovarian carcinoma risk factors

A

Family hx
BRCA1, BRCA2
Age ≥50
Endometriosis
Infertility
Early menarchy/late menopause

57
Q

Lab and US findings of epithelial ovarian carcinoma

A

Elevated CA-125
On US: solid, complex mass; thick septations; ascites

58
Q

CA-125

A

a protein released by cells from the peritoneum, uterus, and fallopian tubes; which are in close proximity to the rapidly growing ovary (malignancy)

In postmenopausal women with malignant appearing mass, CA-125 aids in dz monitoring and response to tx
In postmenopausal women with benign-appearing mass, CA-125 stratifies the risk for cnacer

59
Q

Cervical insufficiency

A

A structural weakness of the cervix causing spontaneous, painless cervical dilation and potential second-trimester pregnancy loss

Patient present with mild symptoms (increased vaginal discharge, light vaginal bleeding, pelvic pressure) on exam, bulging amniotic membranes may be seen

60
Q

Rescue cerclage

A

A suture used to reinforce and add tensile strength to the cervix to prevent further dilation in the setting of cervical insufficiency

61
Q
A

OBGYN (1 decks)

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