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obgyn > ObGyn1 > Flashcards

ObGyn1 Flashcards

1
Q

Acute salpingitis, aka PID (tx)

A

ceftriaxone (IM) and doxycycline (PO)

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2
Q

Signs and sxs of acute salpingitis

A
  • Tenderness: abdominal, adnexal, CMT
  • Fever
  • Vaginal d/c
  • Pelvic mass on PE or US
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3
Q

Important sequela of PID

A

TOA: tubo-ovarian abscess

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4
Q

Best method (“gold standard”) for confirmation of PID

A

Laparoscopy

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5
Q

TOA (tx)

A

Anaerobic organisms:

-Clindamycin or metronidazole

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6
Q

Complication of TOA

A

Rupture (surgical emergency)

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7
Q

Complications of PID

A
  • Chronic pelvic pain
  • Infertility
  • Ectopic pregnancy
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8
Q

Which contraceptive increases the risk of PID and which one decreases it?

A
  • Increased risk w/ IUD

- Decreased risk w/ OCP

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9
Q

Salpingitis/aka PID (etiology)

A

-Polymicrobial: GC, Chlam, g(-) anaerobes

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10
Q

Differentiate 2 benign breast masses

A
  • Fibrocystic change: cyclical/hormonal

- Fibroadenoma: non-cyclical/non-hormonal

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11
Q

4 characteristics of fibroadenomas

A
  • Firm
  • Rubbery
  • Mobile
  • Solid
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12
Q

4 characteristics of fibrocystic changes

A
  • Multiple
  • Irregular
  • Painful
  • Can have serous/green d/c
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13
Q

Next step in discovery of any 3D breast mass

A

Biopsy (FNA, core-needle, excisional)

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14
Q

Fibroadenoma (histo)

A

Benign smooth muscle tumor

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15
Q

Bloody (serosanguineous) nipple d/c without breast mass (dx)

A

Intraductal papilloma

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16
Q

Signs suggestive of breast malignancy

A
  • Skin dimpling
  • Nipple retraction
  • Fixed mass
  • Bloody d/c
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17
Q

What determines the amount of tissue needed for biopsy?

A

Number of risk factors (higher the risk = more tissue)

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18
Q

UTI sxs w/ negative cultures (ddx x3)

A
  • Urethritis (chlam)
  • Candidal vulvovaginitis (pH <4.5)
  • Urethral syndrome
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19
Q

UTI sxs without fever or CVA tenderness (dx)

A

-Cystitis (E.coli)

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20
Q

Urethral syndrome (definition)

A
  • Urgency and dysuria

- Urethral inflammation of unknown etiology

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21
Q

Gross hematuria (ddx)

A
  • Nephrolithiasis

- Hemorrhagic cystitis

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22
Q

Bacteriuria (definitions)

A
  • Clean catch (100,000 CFU/cc)
  • Cath (10,000 CFU/cc)
  • Sxs present (1,000 CFU/cc)
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23
Q

Cystitis (tx x4)

A
  • TMP/SMX (“Bactrim”)
  • Nitrofurantoin
  • Norfloxacin/ciprofloxacin (fluoroquinolones)
  • Cephalosporins
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24
Q

Urethritis (bugs)

A
  • GC (ceftriaxone+doxy)
  • Chlam (doxy)
  • Trichomonas (metronidazole)
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25
Q

Pyelonephritis (tx)

A
  • Mild/nonpregnant: TMP/SMX or fluoroquinolone

- Severe/pregnant/immunocompromised: ampicillin+gentamicin (IV), or cephalosporin (IV)

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26
Q

Complication of tx pyelonephritis

A
  • ARDS d/t endotoxin damage (causes leaky capillaries)

- Endotoxin damage of myocardium, liver (LFTs), kidneys (Cr), and lungs

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27
Q

No improvement in pyelonephritis after 48-72hrs of tx (ddx x2)

A
  • UTI obstruction

- Perinephric abscess

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28
Q

ARDS (CXR finding)

A

Diffuse bilateral or interstitial infiltrates

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29
Q

MC cause of septic shock in pregnancy

A

Pyelonephritis

30
Q

Breast cancer risk factors (x2)

A
  • Age (most important)

- Family history of breast cancer

31
Q

Breast biopsy (conservative vs. aggressive)

A
  • Young: conservative (FNA)

- Old: aggressive (excisional)

32
Q

MC cause of unilateral serosanguineous nipple d/c

A

Intraductal papilloma

33
Q

Secondary amenorrhea (definition)

A

Absence of menses for at least 6mo in a woman who previously had spontaneous/NL menses

34
Q

Secondary amenorrhea (ddx x5)

A
  • Pregnancy
  • HTH (hypothyroidism, hyperprolactinemia) [hypothyroidism, galactorrhea]
  • Pituitary (Sheehan’s syndrome) [PPH]
  • Ovarian (Premature ovarian failure) [hot flashes]
  • Uterine (Asherman’s syndrome) [post D&C]
35
Q

Diagnostic/confirmatory tests in suspicion of Asherman’s syndrome/Intrauterine Adhesions (IUA)

A
  • Hysterosalpingogram (diagnosis)

- Hysteroscopy (confirmation)

36
Q

Asherman’s syndrome/IUA (tx)

A

Hysteroscopic resections

37
Q

Suspicious mammography (findings x2)

A
  • Cluster of calcifications around a mass, or

- Mass w/ ill-defined borders

38
Q

Size threshold for feeling a breast mass on PE

A

1cm

39
Q

Breast biopsy methods in younger vs. older women

A
  • Younger: FNA

- Older: stereotactic core or needle-localization excisional biopsies (NOT FNA)

40
Q

Primary amenorrhea (definition)

A

No menses by age 16

41
Q

2MC causes of primary amenorrhea in the context of NL breast development

A

-Mullerian agenesis (uterus, cervix, fallopian tubes): 46,XX
-Androgen insensitivity (phenotypically female): 46,XY
{of course, r/o pregnancy}

42
Q

Hormonally, what do breast development and presence of axillary/pubic hair connote?

A
  • Breast: estrogen presence

- Axillary/pubic hair: androgen presence

43
Q

Differentiate mullerian agenesis and androgen insensitivity

A
  • Axillary/pubic hair (present in mullerian agenesis [NL serum testosterone] absent in androgen insensitivity [high serum testosterone])
  • Karyotype (46,XX vs 46XY)
44
Q

Complications in mullerian agenesis and androgen insensitivity

A
  • Mullerian agenesis: renal anomalies

- Androgen insensitivity: need gonadectomy

45
Q

Genital characteristics in mullerian agenesis and androgen insensitivity

A
  • NL breast development (tanner IV/V by 16yo)

- No cervix and blind vaginal pouch

46
Q

MC cause of delayed puberty and absent breast development after 14yo

A

Gonadal dysgenesis (eg, Turner’s syndrome)

47
Q

Delayed puberty in a female (definition)

A

Absence of secondary sexual characteristics by age 14

48
Q

First step in dx of gonadal dysgenesis (eg, Turner’s)

A

FSH levels, differentiate between:

  • CNS [low FSH, low estrogen]]: hypogonadotropic hypogonadism
  • ovarian [elevated FSH, low estrogen]: hypergonadotropic hypogonadism
49
Q

Female pubertal development

A

1) Thelarche (10.8yo)
2) Pubarche/adrenarche (11yo)
3) Growth spurt (1yr after thelarche)
4) Menarch (2.2yrs after thelarche)

50
Q

Delayed puberty (mgmt)

A

OCPs

  • estrogen
  • progestin
51
Q

MC cause of mastitis and tx

A
  • S.aureus

- Dicloxacillin

52
Q

Galactocele (definition)

A

Noninfected collection of milk d/t blocked mammary duct

53
Q

Fluctuant mass in a red, tender, indurated breast (dx and tx)

A
  • Breast abscess

- I&D and ABX

54
Q

Breast abscess in the context of mastitis (signs x2)

A
  • Fever after 48hrs of ABX therapy

- Fluctuant mass

55
Q

Confirmatory test in suspected breast abscess

A

US

56
Q

Galactocele (mgmt)

A
  • Spontaneous resolution

- Aspiration

57
Q

Sources of androgen in woman (x3) and their markers

A
  • Adrenals (DHEA-S)
  • Ovaries (serum testosterone)
  • Peripheral conversion
58
Q

Hirsutism (differentiation by history)

A
  • Fast onset: adrenal/ovarian tumor

- Slow onset: PCOS

59
Q

Hirsutism (ddx and labs x5)

A
  • Tumors: adrenal [DHEA-S] and Sertoli-Leydig [serum testosterone]
  • Dysfunction: CAH [high 17-OH-progesterone] and PCOS [elevated LH:FSH ratio]
  • Cushing’s syndrome [dexamethasone suppression test]
60
Q

Sertoli-Leydig tumor (tx)

A

Surgical removal

61
Q

Appearance of d/c of 3 vaginal infections

A
  • BV: homogeneous, white d/c
  • Trichomonal vaginitis: frothy, yellow-green
  • Candidal vulvovaginitis: curdy, lumpy
62
Q

pH of 3 vaginal infections

A
  • BV: >4.5
  • TV: >4.5
  • CVV: <4.5
63
Q

Whiff test (fishy odor on KOH) of 3 vaginal infections

A
  • BV: ++++
  • TV: ++
  • CVV: none
64
Q

Microscopy in 3 vaginal infections

A
  • BV: clue cells
  • TV: trichomonads
  • CVV: pseudohyphae
65
Q

Treatment in 3 vaginal infections

A
  • BV: metronidazole
  • TV: metronidazole
  • CVV: oral fluconazole or imidazole cream
66
Q

Punctations on cervix (“strawberry cervix”)

A

Trichomonal vaginitis

67
Q

Desquamative Inflammatory Vaginitis (histo)

A

Parabasal cells

68
Q

Desquamative Inflammatory Vaginitis (tx)

A

Clindamycin

69
Q

Ten or more PMNs on microscopy (dx)

A

Cervicitis

70
Q

Yellow exudative d/c from the endocervix (dx)

A

Cervicitis

obgyn (5 decks)

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