Obs/Gyn Flashcards
List 8 pre-disposing risk factors for ectopic pregnancy
- prior ectopic pregnancy
- tubal abnormalities (infection, congenital anomalies, tumor)
- Hx of PID (GC/Chlamydia)
- IVF/ infertility
- IUD
- Tubal surgery (sterilization, reconstruction)
- smoking
- age (<18 at first sexual encounter, older >35)
Most common organism in neonatal breast infection; what antibiotics to use
Staph aureus (including MRSA) in > 75% of cases
IV vancomycin/clindamycin +/- ceftriaxone
DDx of gynecomastia in adolescent male
post pubertal physiologic gynecomastia (occurs in 50% of teen males); exogenous hormone stimulation, meds (steroids, cannabis, tricyclic antidepressants), testicular/adrenal tumor, hyperthyroidism, renal disease
Lab work-up for oligomenorrhea in a teen girl
beta HCG, serum FSH (> 40 think POF, if normal or low HPA axis suppression), LH, TSH, testosterone (> 200 think tumor), prolactin
List the diagnostic criteria for PCOS
Need 2/3: - oligo or anovulation - clinical or biochemical signs of hyperandrogenism - polycystic ovaries and exclusion of other etiologies
List 4 drugs that can cause galactorrhea
- Antipsychotics: chlorpromazine, haloperidol, risperdone
- Drugs for GI: metoclopramide
- AntiHTN: verapamil, methyldopa
- Other: codeine, morphine
Medications (and doses) for treatment of primary dysmenorrhea
- NSAIDS at the start of cramping/ bleeding are most effective for primary, if ineffective, try OCP
- Naproxen 500 mg PO BID, or ibuprofen 600-800 mg PO q6h
Definition of menorrhagia
bleeding that occurs at regular intervals but lasts longer than 7 days or in excess of 80 ml
List 8 conditions in the differential diagnosis of vaginal bleeding in a PRE-pubertal girl
- Central precocious puberty: CNS tumors or malformations, idiopathic
- Peripheral precocious puberty: adrenal, ovarian, testicular tumors, McCune Albright syndrome, CAH, exposure to exogenous sex steroids
- Trauma (ensure no concern for sexual abuse or NAI)
- Foreign Body
- Infectious vulvovaginitis: Shigella, GAS, N gonorrhea, C. albicans
- Tumors (Sarcoma botryoides)
- Vascular malformation: hemangioma
- Urethral prolapse
- bleeding disorder (ex. von Willebrand disease, thrombocytopenia)
6 contra-indications to using estrogen-containing OCP
migraine with aura, liver dysfunction, hx of breast/ ovarian cancer, hx of DVT/PE, stroke, inherited prothrombotic d/o, + APLA, uncontrolled HTN
Steps in the management of moderate-severe menorrhagia
moderate (Hg 100-120) or severe bleeding (Hg <100)
- stop bleeding; consider OCP (as a taper if active ongoing bleeding, starting with 1 tablet 4X/day until bleeding stops);
- iron supplement, anti-emetic while on high-dose estrogen
- severe bleeding can get IV estrogen q4h up to 6 doses (until bleeding stops)
- Admission for severe ongoing blood loss, orthostatic hypotension or other symptoms of anemia, hemoglobin less 80; consider blood transfusion if severe and TXA
At what quantitative levels of beta-HCG is an intra-uterine pregnancy visible on US
Intra-uterine pregnancy visible on:
- transvaginal US with beta > 1000-2000 (5 weeks after LMP)
- transabdominal US with beta > 6000 (6-7 weeks after LMP)
Who is a candidate for medical management of an ectopic pregnancy
hemodynamically stable, no evidence of bleeding, hemoglobin > 80, gestational sac < 4 cm, not immunocompromised, no bleeding diathesis, liver or renal disease, close follow up
DDx of bleeding in late pregnancy (list 3)
placenta previa, abruptio placenta, vasa previa, uterine rupture
DDx of bleeding in early pregnancy
Ectopic, spontaneous abortion (threatened, incomplete, complete, septic, missed), trauma, STI’s
DDx of vulvovaginitis in pre-pubertal child
- non-specific vaginitis
- Infections: Resp/enteric flora (group A strep, staph aureus, etc. Candida uncommon pre-pubertal)
- STI’s (chlamydia/ gonorrhea, trich)
- Vaginal foreign body (can use gentle irrigation to remove it)
- Local trauma / irritants
- Congenital anomalies: ectopic ureter, urethral prolapse
- Atopic or contact dermatitis
Treatment of non-specific vulvovaginitis
avoid bubble baths or harsh soaps, bathe daily 10-15 min warm water, supervise children under 5 and assist with toilet hygiene, wipe front to back, allow air circulation sleepwear, wear cotton underpants, avoid use fabric softeners, launder clothing, hypoallergenic detergents, barrier ointment
Medications and doses to treat chlamydia and gonorrhea
- chlamydia: azithromycin PO 1g single dose
- gonorrhea: ceftriaxone 250 mg IM + azithro PO 1 g x 1 (or doxy 100 mg for 7 days)
Medications to treat PID (inpatient and outpatient)
- outpatient PID: Ceftriaxone 250 mg IM x 1 + Docycline 100 mg PO BID x 14 days +/- flagyl PO
- inpatient PID: cefoxitin + doxycycline (+flagyl is TOA present)
Diagnostic criteria of PID
Must have:
o Pelvic/ lower abdominal pain +
o 1 of: uterine or adnexal or cervical motion tenderness
- Other criteria that increase likelihood of diagnosis: fever, abnormal discharge, high inflammatory markers
- Most specific criteria: US showing thickened fluid-filled tubes/ free fluid in the pelvis
List 4 complications of PID
- Tubo-ovarian abscess / rupture –> shock, peritonitis
- Perihepatitis (Fitz-Hugh-Curtis)
- chronic pelvic pain, infertility, ectopic pregnancy
List 6 criteria for hospital admission in PID
- Age < 15
- Immunodeficiency
- Pregnancy
- Failed PO antibiotics
- Poor compliance/ can’t tolerate PO antibiotics
- Severe illness, N/V, high fever
- Tubo-ovarian abscess
3 conditions in the DDx of genital ulcers (and describe their characteristics)
HSV (painful, shallow, vesicular) , syphilis (non-tender), chancroid (deep, purulent, lymphadenopathy)
Management of urethral prolapse
Warm, moist compress, sitz baths, 2 weeks of topical estrogen
Lab workup for excessive vaginal bleeding in a teenager
beta-HCG, CBC+diff, INR/PTT, von Willebrand assay (von Willebran factor antigen, risocetin cofactor assay, VIII), consider type and cross, urine for C+G NAAT
Management of labial adhesions
Topical estrogen cream (Premarin) 1-2 x/day for 2-4 weeks, never separate manually, good hygiene, Vaseline to prevent recurrence
List the perineal findings concerning for sexual abuse
lacerations of posterior aspect of hymen (4-8 o’clock), posterior fourchette, ecchymosis of the hymen, perianal lacerations
List the emergency considerations post-sexual assault
- Call CAS
- physical exam if < 72 hours from assault
- sexual assault evidence kit
- STI testing and post-exposure prophylaxis (GC, Chlamydia, trichomonas, HIV, Hep B)
- Pregnancy testing and emergency contraception
