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LMCC > Obs/Gyn > Flashcards

Obs/Gyn Flashcards

1
Q

Sexual history

A
  • age with first partner
  • # of partners in the past
  • # partners now
  • male/female/both
  • anal/vaginal/oral
  • unprotected sex
  • sexual abuse
  • STDs
  • HIV
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2
Q

Gyne history

A 
Age at menarche
LMP 
Age of menopause 
Menstrual: 
-regularity 
-#days of bleeding
-amount of bleeding- # pads 
-associated symptoms: dysmenhorrhea, bloating, PMS 
-# days between periods 
-spotting btwn periods
  • contraception
  • last PAP
  • abnormal PAP
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3
Q

Obsterical history

A

pregnancies
# children: living, dead
-pregnancy complications- diabetes, pre-eclampsia, eclapsia, liver, wks of gestation, thyroid disease, infections during pregnancy
-delivery complications- placenta pre via, vasa, abrupt, PROM
-post delivery complications- bleeding, rupture
-problems of with baby
-# abortions: at which weeks, spontaneous vs planned

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4
Q

Abortion history

A
  • social history
  • status of relationships with child’s father
  • social suport: family, friends, boyfriend, do they know? what support are they providing
  • employment
  • finances
  • education
  • how does she feel about pregnancy?
  • how is she coping?
  • ready to raise a child?
  • Depression screening: MSIGECAPS
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5
Q

Abortion counseling

A
  • difficult situation
  • encourage engaging social support, visit with both patient and support person
  • health while pregnant: abstinence from alcohol, smoking, drugs, healthy eating, activity
  • abortion: usually decision made before 16 weeks, referral to gynecologist if she wants
  • arrange for follow up
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6
Q

OCP History

A
  • why does pt want OCP?
  • previous forms of contraception? why was it stopped?
  • sexually active?
  • number of partners?
  • current contraception
  • pregnancy?
  • LMP?
  • Pregnancy hx
  • Gyne hx: first period, menstrual history, STD, PID, fibroids, PAP smear
  • Contraindications to OCP: thromoembolic disease, heart problems, cancer, liver disease. migraines
  • Basic info: PMHx, meds, allergies, smoking, alcohol, drugs, hx of breast cancer, FMhx of breast cancer
  • ROS
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7
Q

Absolute Contraindications to OCP

A
  • current pregnancy
  • undiagnosed vaginal bleeding
  • active cardiovascular/thromboembolic disease
  • hx of breast cancer, estrogen dependent tumours
  • impaired liver fxn
  • age>35 and smoking
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8
Q

Relative contraindications

A
  • smoker
  • diabetes
  • migraines
  • fibroids
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9
Q

Mechanism of action of OCP

A
  • prevents ovulation by interfering with hormone signalling: atrophic endometrium, change in cervical mucous
  • estrogen and progesterone or just progesterone pills

21 or 28 day pills

  • Depo injections Q3 months
  • IUD
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10
Q

Benefits of OCP

ABCDE

A
  • less anemia, acne
  • less benign crest disease and cyst
  • less cancer (ovarian), regular cycles, inc cervical mucous to dec STDs
  • dec dysmenorrhea
  • decrease ectopic pregnancy
  • 98-99.5% effective
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11
Q

Disadvantages of OCP

A
  • inc risk DVT (with smoking)
  • may stimulate estrogen receptor positive breast cancer
  • still need barrier methods to prevent STDs
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12
Q

Directions for OCP

A
  • start OCP, 1st sunday of next period
  • put in obvious place, take same time everyday
  • if miss 1 day, take 2 next day. if miss 2 days, take 2 next 2 days, use alternative method until next period.
  • follow up
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13
Q

History for vaginal discharge

A
  • onset, chronology, color, consistency, odor, timing (related to menses)
  • associated symptoms: abdo pain, burning, itching, dyspareunia, disuria, urgency, frequency
  • things that make it better or worse
  • recent use of antibiotics
  • sexual history: #partners, type of contraception, possibility of pregnancy, hx of STD
  • obstetric hx
  • gyne hx: menstrual pattern, PAP smears

Basic info: PMHx, Meds (OCP, antibiotics), allergies, PFHx

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14
Q

Differential diagnosis for vaginal discharge

A
  • physiological: midcycle, increased estrogen states
  • infectious: candidiasis, bacterial vaginosis, trichomonas, chlomydia, gonorrhea, bartholinitis, PID
  • neoplastic: vaginal intraepithelial neoplasia, vaginal SCC, cervical carcinoma
  • other: allergic/irritative vaginitis, foreign body, atrophic vaginitis
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15
Q

Investigations for Vaginal discharge

  • cadidiasis
  • bacterial vaginosis
  • tricomonas
A
  • speculum exam
  • swab and culture
  • saline slide microscopy
  • KOH whiff test
  • cadidiasis- white, lumpy
  • bacterial vaginosis: grey, thin, clue cells, fishy door
  • trichomonas: frothy yellow/gray/green discharge, motile tricomonads seen under microscope
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16
Q

Management of vaginal discharge

A
  • cadidiasis: canesten (clotrimazole) or miconazole creamx7 days
  • bacterial vaginosis and trichomonas: metronidazole 500 mg PO BID x 7 days
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17
Q

History for 24 yo with LLQ abdo pain with IUD, has signs of peritoneal irritation

A
  • onset, PQRST of pain, relation to periods/intercourse
  • sexual history: partners, men/women/both, protection used, contraception used before
  • Gyne history: first period, menstrual history, LMP, STD, PID, fibroids, PAP smear
  • pregnancy history
  • fever
  • N/V/D, blood in stools, urinary freq/urgency/dysuria, trauma
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18
Q

Ddx for LLQ abdo pain with IUD

A
  • uterine perf with IUD
  • PID
  • tubo-ovarian abscess
  • ovarian cyst w/torsion
  • ectopic pregnancy
  • GI: gastro, IBD, intestinal obstruction, appy
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19
Q

Physical for LLQ abdo pain with IUD

A
  • vitals

- abdominal exam: inspection- symmetry, distension, bruising, auscultation, percussion, palpation

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20
Q

Investigations for abdo pain with IUD

A
  • CBC, lytes, glucose, creat, INR/PTT, BHCG, UA, urine culture
  • PAP smear, cervical swab for gono, chlamydia
  • Abdo ultrasound
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21
Q

Definition of pre-eclampsia, eclampsia

HELLP

A

Pre-eclampsia= pregnancy-induced or worsened HTN

  • SBP inc 30 mmgHg
  • DBP inc 15 mmHg
  • with renal impairment: proteinuria
  • /+ non-dependent edema (face, hands) at >20 wks

Eclampsia- pre-eclampsia with CNS involvement (LOC, seizures, hyperreflexia)

Due to imbalance of thromboxanes, prostaglandins

HELLP: complication of pre-eclampsia, hemolysis, elvated liver enzymes, low platelet

22
Q

Criteria for severe pregnancy induced hypertension (PIH/pre-eclampsia)

A 
2 of the following 
BP> 160/110 
Resp: pulm edema
CVS: CHF
Kidney: proteinuria/oliguria, inc creat
Abdo: N/V/ RUQ pain, inc LFT 
Heme: thrombocytopenia, hemolysis 
Neuro: visual disturbance, hyperreflexia, clonus, headache
IUGR
23
Q

Physical exam for pre-eclampsia

A
  • vitals
  • Resp: for pulm edema
  • CVS for CHF
  • Abdo: RUQ tenderness
  • Neuro: reflexes, clonus
  • peripheral edema
24
Q

Investigations for pre-eclampsia

A

CBC, lytes, creat, LDH
liver enzymes, INR/PTT
UA with microscopy

Fetal HR, non-stess test, BPP, doppler flows

25
Q

Management of pre-eclampsia

A

Daily BP
Daily fetal movement counts at home

Weekly CBC, lytes, creat, liver enzymes, fetal monitoring

Seek medical attention if abdo pain, visual disturbance, persistent headache, drowsy, seizure

Admission if any of the symptoms for MgSO4, and induction of delivery, c/s

If high blood pressure (>160/110), admit for hydrazine or labetalol, or nifedipine

26
Q

History for third trimester vaginal bleeding

A
  • ID, age
  • GPA- # born at term, #living
  • weeks of gestation
  • bleeding: onset, duration, quantity, color and consistency of blood
  • contractions
  • fetal movt
  • last sexual intercourse
  • abdominal trauma

-this pregnancy: serology, ultrasounds, prev bleeding, HTN, diabetes,

27
Q

Physical exam for third trimester vaginal bleeding

A
  • no speculum or vaginal exam until US to r/o placenta pre via
  • vitals
  • fetal monitoring
28
Q

Differential diagnosis for third trimester vaginal bleeding

A
  • placenta previa: placenta covers internal os, most common cause of painless bleeding
  • blood show- shedding of cervical mucous plug
  • vasa previa: fetal blood from root of vessel of umbilical cord overlying cervical os
  • abruptio placenta- separation of placenta from uterine wall (+++ abdo pain)
  • uterine rupture, vaginal infection, cervicitis
  • blood from bladder, bowel?
29
Q

Investigations for third trimester vaginal bleeding

A
  • CBC, INR/PTT, fibrinogen
  • type and cross match, Rh status
  • Ultrasound, BPP
  • Apt test for fetal hemoglobin
30
Q

History for spontaneous abortion at 6 weeks

A
  • bleeding: onset, duration, clots?
  • fever, abdo pain, trauma, weakness/faintness
  • this pregnancy: serology, hypertension, diabetes, problems?
  • medical visits to this point? investigations done at this point?
  • Past obs hx
  • Past gyne hx
  • PMHx, meds, allergies, smoking, alcohol, drugs
31
Q

Types of abortions

  • threatened
  • inevitable abortion
  • incomplete abortion
  • complete abortion
  • missed abortion
A
  • threatened abortion: any bleeding/cramping in first 20 wks. 50% will continue to have abortions. (closed cervix)
  • inevitable abortion: pain, bleeding, cervix open, but hasn’t passed products of conception
  • incomplete abortion: part of products of conception passed, cervix open
  • complete abortion: uterus empty, bleeding+products passed, cervix open
  • missed abortion: as symptomatic, mild bleeding but failure for pregnancy to progress- absence of uterine growth and decreased symptoms of pregnancy
32
Q

Physical exam for incomplete abortion

A

findings consistent with incomplete abortion

  • ruptured membranes
  • products of conception passed
  • cervix dilated (os open)
33
Q

History of secondary amenorrhea, polycystic ovary syndrome

A

Gyne history: age at menarche, previous menses, duration, heavy bleeding, headache, visual disturbances
Sexual history- contraception, pregnancy?

Signs of virilization: body hair, acne, muscle bulk, galactorrhea

Hypothyroid/hyperthyroid symptoms?
Exercise?
gain/lost weight?
stress?

34
Q

Investigations for PCOS

A
  • pregnancy test
  • TSH, prolactin, testosterone, DHEAS
  • FSH, LH (high= ovarian failure, low= hypothalamic dysfunction)
  • progesterone challenge (for withdrawal bleed)- if there is withdrawal bleed, indicates anovulation, if no withdrawal bleed- suggests end organ failure or outlet obstruction
  • abdo ultrasound

in PCOS: high LH, androgens, ovarian cysts on US

35
Q

Ddx for PCOS (amenorrhea)

A 
pregnancy
excessive exercise 
stress
weight loss 
thyroid dysfunction 
prolactinoma 
hypopituitarism
36
Q

Differential for symmetric IURG

A

TORCH infections
Chromosomal abnormalities
Familial

37
Q

Differential for asymmetric IUGR

A

-placental insufficiency: maternal nutrition, smoking, alcohol, drugs, illness during pregnancy, hypertension

38
Q

Causes of neonatal jaundice

unconjugated

A
  • physiological
  • hemolytic: ABO incompatability, sepsis, hereditary spherocytosis, G6PD
  • nonhemolytic: breast milk jaundice, breastfeeding jaundice, breakdown of cephalohematoma, sepsis, hypothyroid, filberts, crippler-najjar
39
Q

Causes of conjugated

A
  • bile duct obstruction

- drug induced

40
Q

Counseling for pregnancy in older women

A
  • ID, planned pregnancy
  • status of relationship
  • social supports
  • social situation- finances, work, ready to have baby
  • morning sickness, vaginal bleeding
  • mood

-Current pregnancy: LMP, ultrasound dating
Expected delivery date: LMP+7 dates- 3 months

  • Menstrual history:
  • PObsHx:
  • PMHx, PSHx, meds, allergies
  • hypertension, diabetes
  • smoking, alcohol, drugs, diet, exercise
  • FMhx: inherited disorders, heart disease, circulatory problems, renal disease
41
Q

Physical history for new pregnancy

A
  • vitals
  • CVS
  • Abdo
  • Breast exam
  • measure uterus size
  • doppler fetal heart
  • vaginal exam- swab for GC, chlamydia
42
Q

Investigations for new pregnancy

A
  • CBC, lytes, INR/PTT, urea, Cr
  • Folate
  • UA
  • blood group and type
  • VDRL and HbSAg
  • Rubella
  • HIV
43
Q

Investigations for new pregnancy for screening of chromosomal abnormalities

A

-Triple screen: AFP, BHCG, uE3 at 16 weeks
trisomy 18, trisomy 21
-Amniocentesis at 16 weeks
-chorionic villus sampling at 10-12 weeks
-fetal ultrasound

44
Q

General counselling for pregnant patient

A
  • daily vitamin, milk, healthy diet
  • weight gain of 2-3 lbs/mo, total weight gain of 25-30 lbs
  • normal activities
  • no alcohol, smoking
  • for morning sickness: small meals
  • common: hemmorhoids, backache, heartburn, vaginal discharge
  • F/U Q4 wks until 32 weeks then q2 weeks
  • call if any concerns- abdo pain, bleeding, infection
45
Q

Post menopausal bleeding

Hx

A
  • onset, chronology, amount, vaginal discharge, pain
  • abdo pain
  • weight loss, fever, night sweats, lymph nodes?
  • sexually active? protection?
  • post coital bleeding
  • rectal bleeding
  • easy bleeding/bruising?
  • gyne history: age of first period, # days, regular, dysmenorrhea, when did periods stop
  • STDs, last PAP smear
  • hx of fibroids, polyps, PID, PCOS
  • PObsHx, GPA, complications
  • PMHx, PSHx, FHx, meds, allergies
46
Q

Ddx for post menopausal bleeding

A
  • malignancy: endometrial cancer
  • endometriosis
  • fibroids, polyps
  • thyroid
  • bleeding disorder
47
Q

History for gonnococcal infection

A
  • joint pain (migratory joint pain)
  • fever, abdo pain, vaginal discharge, pain with urination, dyspareunia
  • hx for other cause of joint pain: arthritis, osteoarthritis, reiter’s syndrome, ankylosing spondylitis
Gyne hx 
Previous STDs, PID 
Sexual history, # partners, protection used 
PObxHx
PMhx, FHx
48
Q

Investigations for STDs, Gonnorrhea

A

CBC, lytes, urea, Cr, ESR
Blood cultures
cervical swab for gonnorrhea and clamydia
Joint aspiration for microscopy and culture

49
Q

PAP smear results of CINIII/HSIL

Take history

A
  • vaginal discharge?
  • post-coital bleeding?
  • pelvic or back pain?
  • sexual history, age of 1st intercourse
  • # partners
  • previous STDs
  • previous HPV infection
50
Q

PAP smear schedule

A

Start q1 year after sexually active
Start at age 21
If normal x3 or if after age 30 then can do q2 years
Stop at age 70, if neg x3 or no abnormalities in past 10 years

51
Q

PAP smear results
CIN-I/LSIL
CIN II-III/ HSIL

A

CIN-I: repeat in 3 months, many lesions will regress on their own. if +x3 then colposcopy

CIN-II, III: colposcopy

  • laser
  • LEEP

LMCC (8 decks)

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