OBGYN study guide incorrect Flashcards
causes of peripheral precocious puberty
adrenal tumors
other hormone secreting tumors
exogenous hormones
congential adrenal hyperplasia
mean age menarche in US
13
definition precocious puberty
< 8 yo F
< 9 yo M
incomplete or complete si/sx pubertal change
lab fings distinguish central precocious puberty from peripheral precocious puberty
central: increased LH
peripheral: decreased LH
tx central precocious puberty
GnRH continuous
if approp age, nothing
if mass, surg
phase menstrual cycle fixed at 14 is
luteal phase
FSH stimulates release of H from follicle
estradiol
as periods are decreasing in perimenopause, what hormonal changes are occurring
increased FSH
decreasted/fluctuating estrogen
what determines wheter a woman taking estrogen need to take progesterone as well?
if has uterus, needs progesterone
inducers of P450 mnemonic
Guiness, Corona, PBRs induce chronic alcoholism
griseofulvin carbamazepine phenytoin barbital rifampin st. johns wort chronic EtOH
MOA OCPs
inhibit follicle development
prevent endometrial proliferation/change endometrial quality
decrease mucous secretions/thicken cervical mucous
OCPs decrease incidence of which types of cancer
endometrial
ovarian
colon
four different options for emergency contraception
levonorgestrel (plan B)
levonorgestrel and high dose ethinyl estradiol (OCPs)
mifepristone/ulipristal (anti-progestins)
copper IUD
tx of choice for primary dysmenorrhea
NSAIDs
OCPs
timing of the pain of primary dysmenorrhea during menstrual cycle
starts with menses x several days
meds effective in tx of PMS and PMDD
NSAIDs SSRIs (esp PMDD) GnRH continuous agonists exercise relaxation
timing sx PMS and PMDD
2-3 days before period
definitively diagnose endometriosis
laparoscopy
definition dysmenorrhea and causes
pain with menses
primary: PG driven, starts with menses, follicular phase
secondary: endometriosis, PID, fibroids, cysts, etc. starts during luteal phase
MC cause irregular heavy uterine bleeding in non-pregnant, premenopausal woman
ovulatory dysfunction/anovulation
MC cause of regular heavy menstrual bleeding in non-pregnant, premenopausal woman
fibroids
when endometrial biopsy necessary for abnL uterine bleeding
> 45 yo
<45 yo with persistent bleeding and RF endometrial cancer
multiple RF
MC cause of secondary amenorrhea
pregnancy
androgen insensitivity syndrome from Mullerian agensis
BOTH: breasts, no uterus
AIS: no secondary sexual characteristics, high testosterone, 46 XY
Mullerian agenesis: has secondary sexual characteristics, low (normal for female) testosterone, 46 XX
progesterone withdrawal test tells you….
if there is a problem with estrogen (primary ovarian insufficiency, anatomic abnL) or a problem with ovulation
diagnostic criteria for PCOS
> =2 of:
irregular menses
increased androgens
polycystic ovaries on US
45 F G4P4 no complains, PEx shows mild descent of bladder into agine, dx and tx
cystocele
observe bc asx
pelvic floor muscle exercises
classic presentation of TSS
tampons hypotension fever sunburn rash involving palms and soles multiorgan dysfxn
STI: “groove” sign
lympohgranuloma venereum
STI: donovan bodies
granuloma inguinale
STI: ulcer with beefy-red base
granuloma inguinale
STI: GNR in “school of fish” pattern
charcroid
primary syphilis sx
painless ulcer
secondary syphilis sx
generalized fever, myalgias, palm and sole rash, condyloma lata
tertiary syphilis sx
aortitis, aortic regurg, gummas
neurosyphilis sx
dementia
tabes dorsalis
Argyll-Robertson pupils
general paresis
Tx syphilis per stage
PENICILLIN G
primary: x one
secondary: x one
latent: x one
tertiary: weekly x three
neuro: IV x 10-14 days
DES exposure cancer assoc
clear cell adenocarcinoma of vagina
current recs cervical cancer screening
start age 21 q3 years 21-29 yo > 30 q5 with HPV > 30 q 3 without HPV stop > 65 if nL or hysterectomy
next step: pt with pap HSIL
LEEP if > 25 y
next step ASC-H
colposcopy
classic present ovarian cancer
abd pain
early satiety
new ascities
previously healthy
RF ovarian cancer
uninterupted ovulation early menarche late menopause nulliparity FHx: HNPCC, BRCA 1/2 infertility
drugs causing gynecomastia
STACKED spironolactone thc alcohol cimetidine ketoconazole estrogen digoxin
tx for ductal carcinoma in situ of breast
lumpectomy +/- radiation
no rx
once you have ruled out invasive cancer, what is most approp tx of LCIS
observe
tamoxifen
+/- b/l ppx mastectomy
tamoxifen works bc all LCIS are ER and PR positive!
sign of softening of cervix in early pregnancy
Goodell sign
sign of early pregnancy: dark bluish-red discoloration of vaginal mucosa
Chadwick sign
how does CO, plasma volume, BP, and Cr change during pregnancy
CO increases
plasma volume increases
BP decreases
Cr decreases
when screen for syphilis in prenatal
1st and 3rd if high risk
when do quadruple screen in prenatal visits
15-20 w
when do screening for GDM
24-28 w
when screen for GBS
35-37 w
conditions suggestbed by increased alpha fetoprotein
NTD
multigestation
abd wall defect
incorrect dating
wt gain for overweight woman during pregnancy
15-25 #
wt gain for nL wt woman during pregnancy
25-35 #
wt gain for underweight during pregnancy
28-40 #
wt gain for obese during pregnancy
11-20 #
definintive test for Down syndrome at 11 w
chorionic villous sampling
10-13 w
tx N/V during pregnancy
1st line:
vitamin B6
doxylamine (Unasom)
2nd line:
zofran, meclizine, metocloperamide, diphenhydramine
pregestational diabetes puts infants at risk of
macrosomia fetal hypoglycemia congenital cardiac/caudal regression malform SAB stillbirth
diagnostic criteria for preeclampsia
new onset > 20 w GA >140/90 AND proteinuria OR end organ damage (dec PLT, inc LFTs, pul edema, CNS, HA, vision change, renal failure)
33 F, 39w GA, active labor, second stage of labor she complains of dyspnea, suddenly becomes unresponseive, pulse cannot be detected, not to have bleeding from mouth and nose dx
amniotic fluid embolism
looks just like PE with the addition of DIC
tx amniotic fluid embolism
ACLS protocol
susceptible pregnant woman is exposed to someone with chickenpox next step
VZV immune globulin
pregnant woman develops chickenpox rash around time of delivery next step
acyclovir to mom
VZV immune globulin to infant
pregnant woman develops chickenpox rash early in pregnancy next step
acyclovir
management options for intrauterine fetal demise
expectant manage (risk inf and DIC)
D&E
Rx: misoprostol, oxytocin
components of biophysical profile
NST fetal tone fetal movement fetal breathing amniotic fluid volume
8-10 is reassuring
definition of IUGR
< 10% expected fetal weight
definition macrosomia
<4500 g
recipient twin in twin-twin transfusion syndrome is at risk for what complications
polyhydramnios
polycytoemia
heart failure
volume overload
tocolytic agents
MgSo4
CCB nifedipine
indomethacin
terbutaline
classic present uterine rupture
constant pain (loss of contractions) fetal bradycardia change uterine shape hypotension tahcycardia hx uterine surgery induction of labor
go to surgery for C/S and hysterectomy
meds in management of uterine atony
oxytocin
methylergonovine
misoprostol
carboprost
abx tx postpartum endometritis
gentamicin and clindamycin
