ObGyn1 Flashcards
(70 cards)
1
Q
Acute salpingitis, aka PID (tx)
A
ceftriaxone (IM) and doxycycline (PO)
2
Q
Signs and sxs of acute salpingitis
A
- Tenderness: abdominal, adnexal, CMT
- Fever
- Vaginal d/c
- Pelvic mass on PE or US
3
Q
Important sequela of PID
A
TOA: tubo-ovarian abscess
4
Q
Best method (“gold standard”) for confirmation of PID
A
Laparoscopy
5
Q
TOA (tx)
A
Anaerobic organisms:
-Clindamycin or metronidazole
6
Q
Complication of TOA
A
Rupture (surgical emergency)
7
Q
Complications of PID
A
- Chronic pelvic pain
- Infertility
- Ectopic pregnancy
8
Q
Which contraceptive increases the risk of PID and which one decreases it?
A
- Increased risk w/ IUD
- Decreased risk w/ OCP
9
Q
Salpingitis/aka PID (etiology)
A
-Polymicrobial: GC, Chlam, g(-) anaerobes
10
Q
Differentiate 2 benign breast masses
A
- Fibrocystic change: cyclical/hormonal
- Fibroadenoma: non-cyclical/non-hormonal
11
Q
4 characteristics of fibroadenomas
A
- Firm
- Rubbery
- Mobile
- Solid
12
Q
4 characteristics of fibrocystic changes
A
- Multiple
- Irregular
- Painful
- Can have serous/green d/c
13
Q
Next step in discovery of any 3D breast mass
A
Biopsy (FNA, core-needle, excisional)
14
Q
Fibroadenoma (histo)
A
Benign smooth muscle tumor
15
Q
Bloody (serosanguineous) nipple d/c without breast mass (dx)
A
Intraductal papilloma
16
Q
Signs suggestive of breast malignancy
A
- Skin dimpling
- Nipple retraction
- Fixed mass
- Bloody d/c
17
Q
What determines the amount of tissue needed for biopsy?
A
Number of risk factors (higher the risk = more tissue)
18
Q
UTI sxs w/ negative cultures (ddx x3)
A
- Urethritis (chlam)
- Candidal vulvovaginitis (pH <4.5)
- Urethral syndrome
19
Q
UTI sxs without fever or CVA tenderness (dx)
A
-Cystitis (E.coli)
20
Q
Urethral syndrome (definition)
A
- Urgency and dysuria
- Urethral inflammation of unknown etiology
21
Q
Gross hematuria (ddx)
A
- Nephrolithiasis
- Hemorrhagic cystitis
22
Q
Bacteriuria (definitions)
A
- Clean catch (100,000 CFU/cc)
- Cath (10,000 CFU/cc)
- Sxs present (1,000 CFU/cc)
23
Q
Cystitis (tx x4)
A
- TMP/SMX (“Bactrim”)
- Nitrofurantoin
- Norfloxacin/ciprofloxacin (fluoroquinolones)
- Cephalosporins
24
Q
Urethritis (bugs)
A
- GC (ceftriaxone+doxy)
- Chlam (doxy)
- Trichomonas (metronidazole)
25
Pyelonephritis (tx)
- Mild/nonpregnant: TMP/SMX or fluoroquinolone
| - Severe/pregnant/immunocompromised: ampicillin+gentamicin (IV), or cephalosporin (IV)
26
Complication of tx pyelonephritis
- ARDS d/t endotoxin damage (causes leaky capillaries)
| - Endotoxin damage of myocardium, liver (LFTs), kidneys (Cr), and lungs
27
No improvement in pyelonephritis after 48-72hrs of tx (ddx x2)
- UTI obstruction
| - Perinephric abscess
28
ARDS (CXR finding)
Diffuse bilateral or interstitial infiltrates
29
MC cause of septic shock in pregnancy
Pyelonephritis
30
Breast cancer risk factors (x2)
- Age (most important)
| - Family history of breast cancer
31
Breast biopsy (conservative vs. aggressive)
- Young: conservative (FNA)
| - Old: aggressive (excisional)
32
MC cause of unilateral serosanguineous nipple d/c
Intraductal papilloma
33
Secondary amenorrhea (definition)
Absence of menses for at least 6mo in a woman who previously had spontaneous/NL menses
34
Secondary amenorrhea (ddx x5)
- 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
Diagnostic/confirmatory tests in suspicion of Asherman's syndrome/Intrauterine Adhesions (IUA)
- Hysterosalpingogram (diagnosis)
| - Hysteroscopy (confirmation)
36
Asherman's syndrome/IUA (tx)
Hysteroscopic resections
37
Suspicious mammography (findings x2)
- Cluster of calcifications around a mass, or
| - Mass w/ ill-defined borders
38
Size threshold for feeling a breast mass on PE
1cm
39
Breast biopsy methods in younger vs. older women
- Younger: FNA
| - Older: stereotactic core or needle-localization excisional biopsies (NOT FNA)
40
Primary amenorrhea (definition)
No menses by age 16
41
2MC causes of primary amenorrhea in the context of NL breast development
-Mullerian agenesis (uterus, cervix, fallopian tubes): 46,XX
-Androgen insensitivity (phenotypically female): 46,XY
{of course, r/o pregnancy}
42
Hormonally, what do breast development and presence of axillary/pubic hair connote?
- Breast: estrogen presence
| - Axillary/pubic hair: androgen presence
43
Differentiate mullerian agenesis and androgen insensitivity
- Axillary/pubic hair (present in mullerian agenesis [NL serum testosterone] absent in androgen insensitivity [high serum testosterone])
- Karyotype (46,XX vs 46XY)
44
Complications in mullerian agenesis and androgen insensitivity
- Mullerian agenesis: renal anomalies
| - Androgen insensitivity: need gonadectomy
45
Genital characteristics in mullerian agenesis and androgen insensitivity
- NL breast development (tanner IV/V by 16yo)
| - No cervix and blind vaginal pouch
46
MC cause of delayed puberty and absent breast development after 14yo
Gonadal dysgenesis (eg, Turner's syndrome)
47
Delayed puberty in a female (definition)
Absence of secondary sexual characteristics by age 14
48
First step in dx of gonadal dysgenesis (eg, Turner's)
FSH levels, differentiate between:
- CNS [low FSH, low estrogen]]: hypogonadotropic hypogonadism
- ovarian [elevated FSH, low estrogen]: hypergonadotropic hypogonadism
49
Female pubertal development
1) Thelarche (10.8yo)
2) Pubarche/adrenarche (11yo)
3) Growth spurt (1yr after thelarche)
4) Menarch (2.2yrs after thelarche)
50
Delayed puberty (mgmt)
OCPs
- estrogen
- progestin
51
MC cause of mastitis and tx
- S.aureus
| - Dicloxacillin
52
Galactocele (definition)
Noninfected collection of milk d/t blocked mammary duct
53
Fluctuant mass in a red, tender, indurated breast (dx and tx)
- Breast abscess
| - I&D and ABX
54
Breast abscess in the context of mastitis (signs x2)
- Fever after 48hrs of ABX therapy
| - Fluctuant mass
55
Confirmatory test in suspected breast abscess
US
56
Galactocele (mgmt)
- Spontaneous resolution
| - Aspiration
57
Sources of androgen in woman (x3) and their markers
- Adrenals (DHEA-S)
- Ovaries (serum testosterone)
- Peripheral conversion
58
Hirsutism (differentiation by history)
- Fast onset: adrenal/ovarian tumor
| - Slow onset: PCOS
59
Hirsutism (ddx and labs x5)
- 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
Sertoli-Leydig tumor (tx)
Surgical removal
61
Appearance of d/c of 3 vaginal infections
- BV: homogeneous, white d/c
- Trichomonal vaginitis: frothy, yellow-green
- Candidal vulvovaginitis: curdy, lumpy
62
pH of 3 vaginal infections
- BV: >4.5
- TV: >4.5
- CVV: <4.5
63
Whiff test (fishy odor on KOH) of 3 vaginal infections
- BV: ++++
- TV: ++
- CVV: none
64
Microscopy in 3 vaginal infections
- BV: clue cells
- TV: trichomonads
- CVV: pseudohyphae
65
Treatment in 3 vaginal infections
- BV: metronidazole
- TV: metronidazole
- CVV: oral fluconazole or imidazole cream
66
Punctations on cervix ("strawberry cervix")
Trichomonal vaginitis
67
Desquamative Inflammatory Vaginitis (histo)
Parabasal cells
68
Desquamative Inflammatory Vaginitis (tx)
Clindamycin
69
Ten or more PMNs on microscopy (dx)
Cervicitis
70
Yellow exudative d/c from the endocervix (dx)
Cervicitis
