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elmaya > Obs/Gyn > Flashcards

Obs/Gyn Flashcards

1
Q

List 8 pre-disposing risk factors for ectopic pregnancy

A
  1. prior ectopic pregnancy
  2. tubal abnormalities (infection, congenital anomalies, tumor)
  3. Hx of PID (GC/Chlamydia)
  4. IVF/ infertility
  5. IUD
  6. Tubal surgery (sterilization, reconstruction)
  7. smoking
  8. age (<18 at first sexual encounter, older >35)
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2
Q

Most common organism in neonatal breast infection; what antibiotics to use

A

Staph aureus (including MRSA) in > 75% of cases

IV vancomycin/clindamycin +/- ceftriaxone

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3
Q

DDx of gynecomastia in adolescent male

A

post pubertal physiologic gynecomastia (occurs in 50% of teen males); exogenous hormone stimulation, meds (steroids, cannabis, tricyclic antidepressants), testicular/adrenal tumor, hyperthyroidism, renal disease

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4
Q

Lab work-up for oligomenorrhea in a teen girl

A

beta HCG, serum FSH (> 40 think POF, if normal or low HPA axis suppression), LH, TSH, testosterone (> 200 think tumor), prolactin

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5
Q

List the diagnostic criteria for PCOS

A 
Need 2/3:
- oligo or anovulation
- clinical or biochemical signs of hyperandrogenism
- polycystic ovaries
and exclusion of other etiologies
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6
Q

List 4 drugs that can cause galactorrhea

A
  • Antipsychotics: chlorpromazine, haloperidol, risperdone
  • Drugs for GI: metoclopramide
  • AntiHTN: verapamil, methyldopa
  • Other: codeine, morphine
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7
Q

Medications (and doses) for treatment of primary dysmenorrhea

A
  • 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
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8
Q

Definition of menorrhagia

A

bleeding that occurs at regular intervals but lasts longer than 7 days or in excess of 80 ml

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9
Q

List 8 conditions in the differential diagnosis of vaginal bleeding in a PRE-pubertal girl

A
  • 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)
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10
Q

6 contra-indications to using estrogen-containing OCP

A

migraine with aura, liver dysfunction, hx of breast/ ovarian cancer, hx of DVT/PE, stroke, inherited prothrombotic d/o, + APLA, uncontrolled HTN

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11
Q

Steps in the management of moderate-severe menorrhagia

A

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
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12
Q

At what quantitative levels of beta-HCG is an intra-uterine pregnancy visible on US

A

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)
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13
Q

Who is a candidate for medical management of an ectopic pregnancy

A

hemodynamically stable, no evidence of bleeding, hemoglobin > 80, gestational sac < 4 cm, not immunocompromised, no bleeding diathesis, liver or renal disease, close follow up

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14
Q

DDx of bleeding in late pregnancy (list 3)

A

placenta previa, abruptio placenta, vasa previa, uterine rupture

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15
Q

DDx of bleeding in early pregnancy

A

Ectopic, spontaneous abortion (threatened, incomplete, complete, septic, missed), trauma, STI’s

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16
Q

DDx of vulvovaginitis in pre-pubertal child

A
  • 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
17
Q

Treatment of non-specific vulvovaginitis

A

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

18
Q

Medications and doses to treat chlamydia and gonorrhea

A
  • chlamydia: azithromycin PO 1g single dose

- gonorrhea: ceftriaxone 250 mg IM + azithro PO 1 g x 1 (or doxy 100 mg for 7 days)

19
Q

Medications to treat PID (inpatient and outpatient)

A
  • 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)
20
Q

Diagnostic criteria of PID

A

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

21
Q

List 4 complications of PID

A
  • Tubo-ovarian abscess / rupture –> shock, peritonitis
  • Perihepatitis (Fitz-Hugh-Curtis)
  • chronic pelvic pain, infertility, ectopic pregnancy
22
Q

List 6 criteria for hospital admission in PID

A
  • Age < 15
  • Immunodeficiency
  • Pregnancy
  • Failed PO antibiotics
  • Poor compliance/ can’t tolerate PO antibiotics
  • Severe illness, N/V, high fever
  • Tubo-ovarian abscess
23
Q

3 conditions in the DDx of genital ulcers (and describe their characteristics)

A

HSV (painful, shallow, vesicular) , syphilis (non-tender), chancroid (deep, purulent, lymphadenopathy)

24
Q

Management of urethral prolapse

A

Warm, moist compress, sitz baths, 2 weeks of topical estrogen

25
Q

Lab workup for excessive vaginal bleeding in a teenager

A

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

26
Q

Management of labial adhesions

A

Topical estrogen cream (Premarin) 1-2 x/day for 2-4 weeks, never separate manually, good hygiene, Vaseline to prevent recurrence

27
Q

List the perineal findings concerning for sexual abuse

A

lacerations of posterior aspect of hymen (4-8 o’clock), posterior fourchette, ecchymosis of the hymen, perianal lacerations

28
Q

List the emergency considerations post-sexual assault

A
  • 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

elmaya (5 decks)

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