OBGYN stuff Flashcards
Abd pain, n/v, in young patient with known adnexal mass WITHOUT doppler flow - think?
Tx?
ovarian torsion
Laparoscopy with cystectomy
Syphilis is pregnancy - do you still treat?
YES
Hypothyroidism - what happens to demand for levo during pregancy?
So do what?
Demand increases
So increase the dose when pregnant
Gestational hypertension vs chronic hypertension?
Chronic needs two separate measurements BEFORE 20 weeks gestation
Chronic hypertension in pregnancy - increases risks of what (5 major FAPPS)?
Fetal growth restriction Abruptio placentae Preterm labor Preeclampsia (superimposed) Stillbirth
Urinary retention after birth (esp. with epidural) - due to?
do what?
To check what?
Bladder atony
Urethral cath
To check post void residual less than 150 (normal) otherwise likely to be overflow incontinence
Persistent fever postpartum or postop, unresponsive to ABX - think?
Veins affected?
Treat?
Septic thromboembolism
Deep pelvic or ovarian veins
Anti-coag and broad-spectrum ABX
Pharyngitis, fever, lower abd pain in sexually active woman?
Gonococcal pharyngitis with assoc PID
Effect of OCPs on ovarian and endometrial cancer risk?
And on HTN?
Reduce it
Can worsen HTN
How to stop HIV transmission from mom to baby?
Triple anti-retroviral tx for mom in pregnancy and zidovudine for neonate
Pregnancy labs: up, down, or normal?
Hgb, Cr and BUN, PLT, LFTs, GFR, protein in urine?
Hgb down, Cr and BUN down, PLT normal/down, LFTs normal, GFR up, protein urine up (1+)
Vaginal yeast infx tx?
topical nystatin or oral azole
When is a diagnostic lap indicated in suspected endometriosis?
After failure of NSAIDs and hormonal contraceptives
In placenta previa where is the placenta?
So what is contraindicated?
Over the internal cervical os
No labor or vaginal delivery (get CS 36-37 weeks)
High grade intraepithelial lesion (HSIL) on PAP, next step? And for pregnant patients?
LEEP
If pregnant, colposcopy then LEEP if invasive cancer
Raditing suprapubic pain after traumatic delivery, worse when walking - think?
treat?
Pubic symphysis diastasis
supportive care
Heat exhaustion vs heat stroke?
No CNS probs in heat exhasution
Heat exhaustion caused by inadequate water and sodium replacement so drop in cardiac output
Heat stroke due to thermoregulation failure
Pharm tx for PCOS (to induce ovulation)?
But not until you’ve tried what lifestyle mod?
Clomiphene
Weight loss
Amenorrhea in athletes due to?
hypothalmus (eg GnRH defic), so decreased LH secretion and decreased estrogen (so decr bone density too)
Oxytocin can cause what complications (3)?
Tachysystole (all induction agents can), hyponatremia, hypptension
Contraindications to breastfeeding (mom 6) and kid (1)?
Mom: untreated TB, varicella infx, herpetic breast lesions, current chemo, illicit drug use, HIV
Kid: galactosemia
Abnormal first trimester screen - next step?
10-13 weeks chorionic villi sampling
15-20 weeks amniocentesis
Ectopic pregnancy mgmt - stable vs unstable?
Stable: methotrexate
Unstable: surgery
Most accurate test for determining fetal gestational age?
First trimester US
UNIateral bloody nipple discharge - suggests?
Benign or malignant?
Intraductal papilloma
benign
Vaginosis tx?
Metro or clinda
Week cutoff for delivery rather than tocolytics in preterm labor?
34 weeks
Postpartum endometritis presenting with fever ?24 hours postpartun, puluent lochia and uterine tenderness - bugs? and drugs?
polymicrobial
clinda and gentamicin
Acute onset unilateral pelvic pain after sex or exercise - think?
Diagnose with
Ruptured ovarian cyst
US showing free fluid in pelvis
Etiologies of incontience:
Stress?
Urge?
Overflow?
Urethral hypermobility
Detrusor overactivity
Impaired detrusor contractility or bladder outlet obstruction
Mechanism of hypotension after epidural anesthesia?
Vasodilation and venous pooling in LE (from sympathetic blockade)
Infertility in PCOS is due to?
failed follicular maturation
Greatest risk factor for clear cell adenocarcinoma of vagina and cervix
Daughters of women given DES in pregnancy
Lichen sclerosus dx test?
Rx?
Vulvar punch bx
Topical steroids
Nuchal cord decels?
variable
Loss of fetal station during labor - (with abd pain, bleeding, fetal HR abnormalities) - think?
uterine rupture
Do you treat partner in trichomonas?
YES
Palpable breast mass next steps:
adolescents?
<30?
>30?
observe through 1-2 menstrual cycles
ultrasound (+/- mammogram)
mammogram (+/- US)
Amenorrhea after chemo - think?
ovarian failure
When fetus is anything but occiput anterior it’s called?
Fetal malposition
Painful, heavy menstrual bleeding progressing to chronic pelvic pain - think?
Uterus on exam?
adenomyosis
Boggy, tender, uniformly englarged
Major role of bHCG?
preservation of corpus luteum in early pregnancy
Dry vagina, and mucosal membranes, and dental caries - think?
lack of lubrication due to Sjogrens
Raloxifene when given for osteoporosis …
Indication:
Contraindication:
High risk for breast cancer
Hx of thromboembolism (etc.)
Maternal complications of abruption?
Hypovolemic shock and DIC
Trisomy 21 AFP and bHCG levels?
Neural tube marker?
Trsiomy 18?
low AFP and high bHCG and inhibin A
high AFP
normal inhibin A and low everything else
Decels linked to:
Early?
Late?
Variable?
fetal head compression/normal (same time as contraction)
uteroplacental insuff
cord compression/oligohydramnios/cord prolapse
Persistent variable contractions - next step?
Re position mom ( to alleviate cord compression)
Best test for risk of preterm delivery after cervical surgery?
Trans vaginal US
Best contraception for pts with breast cancer?
Copper IUD
3 modifiable breast cancer risk reducers?
reduce alcohol, increase exercise, breastfeed
Hypertension casues symmetric or asymmetric growth restriction?
Asymmetric
Inevitable abortion, hemodynamically unstable - next step?
suction curettage (surgery)
When can you perform external cephalic version (i.e. after how many weeks)?
37
Pelvic mass and ascites with highly suspected ovarian cancer - Next step?
Ex lap
1 lifestyle mod to lower BP?
DASH diet
Maternal fever and fetal tachycardia - suspect?
Chorioamnionitis
Preeclampsia urine protein/Cr ratio?
> 0.3
Magnesium is renally or hepatically excreted?
Renally
PPROM before 34 weeks - next step?
When to deliver (3)?
steroids and antibiotics
after 34 weeks, intrauterine infection, deteriorating fetal/maternal status
Major risk factor for chorioaminonitis?
Tx?
prolonged rupture of membranes
amoxicillin & genta plus oxytocin to speed up labor
Itchy rash on nipple, post-menopausal woman - think?
paget dz of breast (underlying adenocarcinoma)
Postmenopausal adnexal mass - next step? Then?
CA-125
if normal then periodic US
if elevated or suspicious features on USthen MRI/CT
How close to cervical os does placenta need to be to be contraindication to vaginal delivery?
<2cm
When does quad screen take place?
Second trimester
Primary ovarian insuff vs hypogonadotropic hypogonadism?
FSH is high in ovarian insuff and low in in HH
AUB - indications for endometrial biopsy?
All with AUB >45
If less than 45 with AUB then get biopsy if chronic anovulation due to obesity
Postaprum woman with enlarged uterus, irregular vaginal bleeding, pulm sx, CXR infiltrates - think?
Best test?
Choriocarcinoma
bHCG
Which gyn cancer is smoking a risk factor for?
Cervical
Do graves TSH antibodies cross placenta?
yes
Gestational DM - 1st and 2nd line tx?
1st: diet mod and exercise
2nd: insulin, metformin, glyburide
Initial steps for shoulder dystocia?
suprapubic pressure and McRoberts (hip flexion toward abd)
Decreased fetal movement, first and possible second tests?
NST, then biophysical profile if nonreactive
When to give RhoGam (anti D immune globulin)?
in negatvie moms, 28-32 weeks and again if baby is positive
OR after miscarriage or abortion, whenever blood might mix
Preterm labor pharm?
Steroids (betamethasone)
If <34 weeks add Tocolytics (indomethacin, nifedipine)
If <32 weeks add Mg
And if GBS positive add PCN
Lung complication to look out for in pre-eclampsia?
pulmonary edema
DA-agonsits to stop lactation?
NO! avoid stimulation wear a supportive bra and OTC analgeiscs and ice packs for engorgement pain
Risks for being underweight in pregnancy?
fetal growth restriction and preterm delivery
> 35 yo with atypical gladular cells on PAP - what next?
endometrial biopsy
Most effective emergency contraception?
Copper IUD
Looks like breast cancer but bx shows foamy macrophages and fat globules, hx of surgery or trauma?
Fat necrosis
Gonorrhea and chlamydia tx?
Azithromycin + ceftriaxone
UNLESS it is confirmed to be only chlamydia, then ONLY azithro
Eclampsia/preeclampsia/HELPP - pathology?
abnormality in placents triggers SYSTEMIC inflammation and activation of coag system and complement, with PLT consumption
Fibroids: type of incontinence assoc?
Imaging modality?
Stress
US
Clear, thin cervical mucus (accompanied by LH surge haha) - due to?
Ovulation
Tamoxifen - estrogen acitivity in breast vs uterus?
Antagonist in breast, agonist in uterus/endometrium
Vaginal cancer, age >60, risk factors same as cervical, foul bloody discharge - type of cancer?
squamous cell carcinoma
Young woman, sexually active, no barrier contraception: PID with liver involvement (painful)?
Fitz-Hugh-Curtis dz
