Obgyne Flashcards
Cervicitis is found, send swab for 4 ?
1- Chalmydia (NAAT)
2- Gonorrhea (NAAT)
3- Bacterial Vaginosis
4- Trchiomoniasis
Ceftriaxone 500mg or 1000mg IM once ( < or > 150 kg )
+ Doxycycline 100mg BID for 1 week
Or if pregnant give azithromycin 1g ( to cover chlamydia )
Pap smear after cervical removal indication?
History of cervical CIN grade 2 or greater
HRT candidates ( name 6 )
1- Age <60
2- Within 10 years of Menopause
3- Moderate to severe hot flashes
4- Not responding to behavioral intervention
5- Healthy without contraindications
6- Primary ovarian failure or early menopause
HRT and risk of endometrial cancer
- unopposed estrogen increase the risk
HRT and risk of breast cancer
- risk increased with COC
- estrogen alone is okay ( possible reduction in breast cancer was observed )
- micronized progesterone instead of medroxyprogestrone
HRT and risk of ovarian cancer
- inconsistent risk. Possible increase if >10 years of usage
HRT and colon cancer
Lower the incidence of colon cancer and related morality
HRT and fracture
Lower the risk of fracture
Risky 2 conditions in HRTv
1- VTE
2- Stroke
CAD and HRT
1- with COC
2- unopposed estrogen was okay
Generally no risk observed if started <60 years old
Define Anemia of pregnancy depends on trimester (1st and 3rd - 2nd )
1st and 3rd: Hg <11
2nd: Hg <10.5
Physiological changes in pregnancy?
- Insulin resistance [ mild fasting hypoglycemia, postprandial hyperglycemia, GLUCOSURIA ]
- increased GFR [ decrease BUN and creatinine ]
- increase Tidal Volume “amount of air breathed in or out” [ decreased PCo2 creating mild respiratory alkalosis ]
HSV in pregnancy, C/S indications
Active genital ulcer at the time of labor onset or membrane rupture
HSV in pregnancy, primary or recurrent risk of transmission
- primary: 30-50%
- Recurrent or primarily acquired during the first half of pregnancy: <1%
Antiviral for HSV in pregnancy indications
- Usually prescribed at 36w to decrease presence of active lesions at the onset of labor
Tubal sterilization ( risk factors for regret, most effective procedure, ovarian ca and menses? )
1- Postpartum and young age tubal sterilization risk factors for increased regret
2- Postpartum partial salpingectomy has the lowest pregnancy rate (most effective)
3- it decrease risk of ovarian cancer and don’t affect menstruation
UTI treated with Bactrium (TRI/SULFA), how it will interact with OCPS?
- No interaction
- The only Antibiotic affect OCPs is Rifampin (non hormonal contraceptive is recommended while using Rifampin)
Complicated VAGINAL CANDIDA INFECTION FIVE CRITERIA
1- Immunocompromised ( Uncontrolled DM, HIV,..)
2- Pregnant
3- severe debiliating symptoms
4- candida species other than albicans
5- >4 Episodes per year (recurrent infection)
Complicated Candida treatment
- Less likely to respond to short course oral or topical therapy
- EITHER oral fluconazole 150mg 2-3 sequential doses 3 days apart
OR
Topical prolonged therapy (1-2weeks)
Candida glabarta treatment
Vaginal boric acid suppositories (70% success rate)
Postpartum and RA Incidence?
- x5 fold increased risk of new onset RA ( DUE TO HEIGHTENED INFLAMMATORY ACTIVITY )
- risk is higher after the first pregnancy
- RA Typically improved or stabilized at pregnancy period
GDM screening
- 24-28 weeks ( first prenatal visit if risk factors present )
- Two steps approach: 50g NON FASTING OGTT for screening.
- If after one hour plasma glucose is 130 or more proceed with 100g fasting oral glucose challenge test for confirming
*( fasting 95,1h 180, 2h 155, 3h 140) 2/4 considered diagnostic - One step approach: 75g fasting, 1hr, 2hr. If ANY of the following met
Fasting 92, 1h 180, 2h 153
Postpartum: 1-3m screening 75g OGTT, to be measured 2hr after, 200 is diagnostic (the most sensitive test overall for DM screening)
Pneumococcal routine vaccination
Age: 65 or 19-64 immunocompromised
One dose of: PCV20
Two doses one year apart: PCV15 and PPSV23
If previsouly received PPSV23 or 13 > PCV 15-20
“Minimum 2 months if immunocomrpomised, Cochlear implant, or CSF leak “
Asthma prognosis in pregnancy?
1/3; worse
1/3: improved
1/3: unchanged
Average age of menupause?
51.4
Early menopause verses. Primary ovarian insufficiency or premature ovarian failure
- 40-45 years old: Early menopause
- <40 years old: POI
When vasomotor symptoms and urogenital atrophy occurs?
- Vasomotor: may occur in the phase prior to the onset of LMP
- Atrophy: typically in the late postmenopausal period
DMPA (depot medroxyprogesterone acetate)
1- Injectable only progestin
2- given every 3 months
3- long acting and reversible
4- preferred in SCA AND ANTI-EPILEPTIC AND SMOKER AND CONTRAINDICATIONS TO ESTROGEN LIKE BREASTFEEDING
5- 1-2% decline in BMD every year.
All society advise advantages outweigh theoretical concerns about BMD loss.
BMD recover once DMPA STOPPED
6- Proven 5% of body weight GAIN
7- Amenorrhea, infrequent bleeding, spotting, prolonged bleeding
8- Check prolactin if GALACTORRHEA OCCURED
9- Recommendation to prescribe 1300 mg calcium + 600 IU vitamin D3 daily
10- No longer recommendation to DEXA, or limiting injections for 2 years only
UTI in pregnancy complications
- premature birth and low birth weight, increased perinatal mortality, increase incideince of HTN and chorioamniotitis
FDA Pregnancy categories?
A
Appropitate human studies showed safety
B
Human study showed safety and Animal showed issues
Animal study showed safety and Human study in insuffienct
C
Insufficient human study ( and animal study showed issues or was insufficient )
D
Human study showed risk, with or without animal studies, but the drug may be imp
X
NO SITUATION TO JUSTIFY IT USE. CI
UTI in pregnancy (1st, 2nd, and 3rd line)
1st line:
TNF
Tri-sulfa ( c )- Three days
Nitrofurantion ( b )- Five days
Fosfomycin ( b )- single day
2nd line (C):
Ciprofloxacin
Levofloxacin
3rd line (B):
Augmentin
Cefpodoxime
Cephalexin
Cefdinir
Notes:
- For Nitro and trisulfa: try to search for alternative in first trimester and near term
- For Nitro and Fosomycin: Not in pyelonephritis
Absolute Contraindications to COC
1- Current breast cancer
2- Acute DVT, or history of DVT with high risk of recurrence
3- Postpartum <3 weeks
4- Major surgery with prolonged immoblization
5- Age 35 years PLUS smoking 15 Ciggrate per day
6- History of Stroke or MI
7- Migrane with aura
8- Solid organ transplant
9- SLE with positive or unknown antiphospholipid antibodies
10- DM >20 years duration or with microvascular/macrovascular complications
11- HTN >160/100 or with Vascular disease
12- Peripartum cardiomyopathy
13- Complicated VHD
14- Liver: acute or flare of viral hepatitis, severe cirrhosis adenoma, malignant liver tumor
15- Acute porphyria
CHC first line in older adults
Ethinyl estradiol 20mcg/ 1mg norethisterone ( Loestrin 20 ), lowest dose pill with safest progestron
What is the dominant clinical feature of Vulvovaginal candidiasis?
- Vulvular pruritis
Wet prep by adding 10% KOH, what will show in case of Candidiasis?
- Hyphea
Candidiasis in pregnancy treatment
- First line: Topical azole
intravaginal suppository: Miconazole 100, 200, 1200mg for 7,3,1 day
Cream:
Miconazole 2%, 4% for 7,3 days
Clotrimazole 1%, 2% for 7-14,3 days
- 2nd line: Oral fluconazole (not recommended in the first trimester > increased incidence of miscarriages)
Intrahepatic cholestasis of pregancny management
- Ursodeoxycholic acid + consider early delivery
DVT In pregnancy treatment?
- LMWH is the Drug of choice for Pregnant with DVT or PE
- Should be stopped 24h before the use of epidural anesthesia during delivery
Preeeclampsia
- New onset hypertension (140/90) or worsening hypertension “superimposed preeclampsia” + Either Proteinuria (24hr protein urine excretion 0.3g) or Sign or symptoms of end organ damage.
-
According to ACOG, what is the threshold and goal in initiate Anti-HTN medication
1- Systolic 160 ( goal is 120-160)
2- Diastolic 105 (goal is 80-105)
Labetalol, Nifedipine, methyldopa, hydralazine
Acute hypertension during pregnancy treatment?
First line is labetalol.
If CI as asthma; use hydralazine
Nicradapine or nifedipine is acceptable alternative
ANC dates
1- Pelvic dating Ultrasound: 7-12w
2- AFP + Nuchal translucency: 10-13w
3- Blood chromosomal screening: 15-18w
4- Urine dipstick for proteins: 20w
5- Anatomy scan: 18-22w
6- GDM: 24-28w
7- GBS swab: 36-37w
8- Tdap: 27-36w
9- Anti-D: at 28w or at 28 AND 34w- within 72hrs of delivery
10- visits
10-28: monthly
28-36: 2-3 weeks
After: weekly or more
