Obs/gyne Flashcards by Conor Barrie

What percentage of women with heavy menstrual bleeding will have an underlying bleeding disorder? What is the most common disorder?

Up to 20%. Von willebrand is most common.

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Ddx of abnormal uterine bleeding in non-pregnant patient

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What is anovulatory bleeding?

When, for whatever reason ovulation does not occur, this leads to no corpus luteum to produce progesterone which leads to high amounts of oestrogen and increased bleeding

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Txa dose in heavy uterine bleeding?

1 g PO TID for five days

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Presentation of symptomatic ovarian cyst

Sudden onset unilateral pain. Often starts during physical activity or intercourse.

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What size of ovarian cyst is generally observed and how quickly does it resolve?

Less than 10 cm and unilocular usually resolved within two menstrual cycles

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What is risk of ovarian cyst greater than 10 cm

Increased risk of malignancy and torsion

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Vaginal Bleeding or ovarian mass in post menopausal women is what until prove otherwise?

Endometrial, cancer, ovarian cancer

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Risk factors for ovarian torsion

Pregnancy, ovarian cyst, greater than 10 cm, ovarian tumor, PCOS, chemical induction of ovulation and prior tubal ligation

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How does ovarian torsion present?

Usually sudden onset, severe unilateral, lower, abdominal pain, right more common than left, pain may be gradual and atypical presentations are common. Nausea and vomiting happened 70% of the time.

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Is there any test or historical or exam feature that excludes ovarian torsion?

No. Even ultrasound is not 100% sensitive.

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Differential diagnosis of ectopic pregnancy

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Can qualitative beta hCG testing 100% rule out ectopic?

Pretty close but not 100% if high clinical suspicion need quantitative serum test

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Risk factors for ectopic pregnancy

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Two most common signs/symptoms of ectopic pregnancy

Vaginal bleeding and pain. Presence of one of these should make you think about the diagnosis lack of one of them does not exclude the diagnosis.

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What is a normal beta hCG doubling time in normal pregnancy? What does a longer doubling time suggest

Should double approximately every two days longer doubling time is indicative of pathological pregnancy i.e. Ectopic declining levels indicate miscarriage.

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Does any beta hCG trend or value rule in or out topic pregnancy

Fuck no

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What is a heterotopic pregnancy?

Simultaneous intro, uterine, and ectopic pregnancy

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Rate of heterotopic pregnancy in general population and in IVF patient

One in 30,000 for general public, one in 100 for IVF

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What is the concept of the discriminatory zone in ectopic pregnancy?

It is a beta hCG level that is used when there is no definitive intrauterine pregnancy on ultrasound. If hCG is above the cut off, it’s suggests ectopic as something should be seen in the uterus. If it is below the cut off, it may just be too early still.

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What is the discriminatory zone beta hCG cut off for trans? Abdominal ultrasound

6000 (1500 for transvaginal)

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Who gets rhogam in ectopic pregnancy? What dose?

RH negative women with ectopic pregnancy get rhogam

Dose is controversial. 50 µg IM or 300 µg IM are both acceptable under 12 weeks GA

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Who gets Rhogam in any pregnancy?

Any pregnant woman who is RH negative with vaginal bleeding should get it in the ED before discharge

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terminology for different spontaneous abortions

What is hyperemesis gravidum

Severe nausea and vomiting that is intractable with weight loss, volume depletion, and hypokalaemia or ketonaemia/ketonuria

Admission criteria for hyperemesis gravidum

Uncertain dx, persistent electrolyte abn or ketone elevation after volume repletion, intractable vomiting

Size cut off for blighted ovum?

> 25 mm in length makes it almost certain to be a blighted ovum. Should still be confirmed with formal elective ultrasound.

Bladed ovum versus pseudo gestational sack

Bleed over them is an intruder in pregnancy that has failed. Therefore, you see an empty gestational sac. A pseudo gestational sac isn’t it gestational sac in the uterus when there is an ectopic pregnancy elsewhere

At what gestational age should you see certain structures on trans? Abdominal obstetrics ultrasound

Gestational sack six weeks. Yolks seven weeks. Fetal eight weeks.

What size fetal pole should have a visible heartbeat on transabdominal ultrasound

If 10 mm or longer, you should see a heartbeat

Should you use a D dimer to rule out DVT in pregnancy?

No. This is in contrast to PE.

Is the Wells DVT score validated in pregnancy?

Nope

DVT work up in pregnancy

from thrombosis canada guideline

PE work up in pregnancy

YEARS criteria algo, from thrombosis canada guideline

Why is a CT pulmonary embolism study probably more favourable than a VQ scan even in pregnancy

VQ scan has more radiation to feed us but less to breast tissue. CTPE has less to feed us but more to breast tissue CTPE is also going to be more widely available and more sensitive and specific.

First line antibiotics for asymptomatic bacturia in pregnancy

Keflex, amoxicillin, cefixime Macrbid and septra can be used, but both have limits on when in the pregnancy they can be used

Postpartum haemorrhage (PPH) algorithm?

Gestational, hypertension versus chronic hypertension

Anything over 140/90 before 20 weeks gestation is chronic, anything after 20 weeks is gestational

Definition of preeclampsia

Gestational hypertension, plus proteinuria or other end organ disfunction (liver, neurological)

Why can HELLP syndrome? Be tricky to diagnose.

It doesn’t always have hypertension and it’s classic right upper quadrant pain can be misdiagnosed as other things

A woman greater than 20 weeks gestation or up to seven days postpartum with abdominal pain should be evaluated for what?

HELLP syndrome

What are the components of treatment for severe preeclampsia, HELLP syndrome or eclampsia?

Management of hypertension can include IV labetalol, magnesium infusion (4 g over 20 minutes). Emergent OB consult for possible early delivery.

Symptoms of postpartum endometritis

Fever, pelvic pain, foul, smelling discharge, uterine tenderness

Time period of eclampsia

Greater than 20 weeks gestation less than four weeks postpartum

Presentation of eclampsia. Initial management of eclampsia.

Magnesium infusion, 4 g IV over 20 minutes then 2 g an hour. Any seizure in woman greater than 20 weeks gestation or less than four weeks postpartum is eclampsia until proven otherwise. Even in the absence of hypertension or protein area. If hypertension present need to treat this as well.

Risk factors for PID

When is a digital or speculum exam contraindicated in pregnant vaginal bleeding?

Vaginal bleeding beyond 20 weeks gestation when placental location is unknown or known to be placenta previa

Three causes of serious vaginal bleeding beyond 20 weeks gestation

Placenta abruption, placenta, previa, vasa previa

Who suffers blood loss in placenta abruption?

The mother. Obviously baby can die from this too.

Presentation of placental abruption.

Usually painful abdomen with vaginal bleeding beyond 20 weeks gestation. Usually some kind of trauma history, can be minor, but can also be spontaneous.

Management of placental, abruption, or suspected abruption

Large bore IV, grouping screen, administer rhogam if RH negative mother. Resuscitation as needed. Pelvic ultrasound either before or after GYN consult

Differential diagnosis of fever in a postpartum woman?

Pelvic infection until proven otherwise, namely, endometritis. Respiratory infection, Pieloon, arthritis, mastitis, appendicitis, and flus also in differential.

What is fits-Hugh-Curtis syndrome

Perihepatits from PID. Presented with PID plus RUQ pain and slightly elevated liver enzymes. Responds to usual PID treatment

Diagnostic criteria for PID. Mostly for reference but just have an idea.

Imaging for suspected PID

Ultrasound however CT scan can also show signs that are suggestive. CT is most useful if you also need to rule out things like appendicitis or renal colic, etc..

Two physical exam findings in PID. Absence of both of these pretty much rules out the diagnosis.

Uterine or adnexal tenderness. Cervical motion tenderness

One complication of mastitis that requires procedural intervention

Breast abscess. Present about 3% of the time in mastitis.

Where do Bartholin cysts/abscesses develop?

At 4 o’clock or 8 o’clock in the posterior introitus