Obs/Gyne Flashcards
Signs of PCOS
Hirsutism, obesity, insulin resistance, acne, balding, an ovulation, abnormal uterine bleeding
All as a result of androgen excess (too much LH)
Score on the Rotterdam scale
Pregnant? What vaccines do you need?
Give Adecel (booster) aka TDAP
Flu shot
Hep B
No MMRV
Causes of uterine prolapse?
Childbirth, Trauma to the perineum, obesity, chronic straining, hysterectomy, connective tissue disorders, aging, congential malformation
How much folic acid for pregnant ladies?
.4-1 mg od, 5 mg if previous NTD
Risks of obesity and pregnancy?
Macrosomia, post-term, maternal HTN, increased risk of c-section, decreased success of VBAC, link to congenital heart defects
Mirena dosing?
Total of 52mg of levoprogesterone - for a daily dose of about 20mcg/day which will decrease by half over 5 years
Kyleena (3 year) has 19.2mg
What is actinomycetes?
GI bacteria can be found on IUD if there was a chance of contamination. Culture removed IUD if removed for sx - pelvic pain/ discharge
Tx is high dose Pen V from 2-6 months, never treat asymptomatic people, and if severe sx may need IV or longer PO course
Most likely causes of Erectile Dysfunction? (Sorry I don’t know why this is in obs/gyne)
Psychosomatic, vascular pathology (diabetes, HTN), medication side effect (SSRIs, SNRIs, benzodiazepines, antipsychotics, anti-epileptics (gabapentin), hormonal chemotherapy, possibly OCP)
Low testosterone is not usually the cause unless very seriously low - and then would see other symptoms.
Causes of dysparunia?
STIs/PID GSM/ vaginal atrophy CA Breastfeeding/ hormonal changes Post-partum allodynia Prolapse Endometriosis
When is someone considered menopausal?
1 year no period.
Treatment options of vulvodynia?
Topical estrogen, (or PO - consider contraindications), pelvic floor physio, topical gabapentin/ TCAs, vulvar hygiene, counselling - treat like a chronic neuropathic pain syndrome.
Common exam finding in GSM (vaginal atrophy from menopause)
Pale vaginal mucosa, dryness, bleeding, stenosis of vagina, atrophy.
Effective contractions?
1 every 10 mins, 5 times consecutively, active labour 1x2-3 lasts for 20-30s
Bishops score?
Cervical measurement:
Station (3- to +3), effacement (as a % - 0% = long, 100% = paper thin), dilation (0 - 10cm), position (relative to the fetal head and maternal pelvis), consistency (firm vs soft) - over >8 is go time for labour or induction, less than 6 not favourable - consider cervical ripening.
Fetal variables
Size, lie(longitudinal, oblique, transverse - must do a c-section), presentation (what is showing first- sutures - compare ocuput compared to mom), attitude, position (where the anterior suture is - most are LOA or ROA and OA everything that are correct position), station (plus - on its way or minus based on ischial spines)
CPD
Cephalic pelvic disproportion - not progressing, need to have c-section.
Hyperemesis gravidarum?
Can be related to increased parity (increased Beta HCG)
ROM - how long do you have to deliver?
24 hours or C-section.
Oxytocin
From posterior pituitary, stimulates contractions
Stages of labour
Latent - start of cervical dilation
Expulsion - delivery at the end the second stage
Placental
Homeostasis
Definitive treatment for hypertension in pregnancy
Delivery of the placenta
When should the patient go to hospital
ROM
Bloody show
Contractions 5 mins apart lasting 60 seconds for the past hour
Can also ask about mucus plug
Fetal movements amount?
Should have at least 6 movements/ 2hrs - and emergency if decreased movements or sudden cessation.
Interpretation of FHR?
Baseline (110-160), variability (want moderate), accelerations (should be there esp with contractions), decelerations (early decels are ok - all others are not)
Interventions for abnormal FHR
Change maternal position (left lateral decubitus position), discontinue oxytocin infusion, maternal vital signs, take a look - do a vaginal exam (how far is the baby - are they coming along well - where is the cord), consider expedited delivery, aminoinfusion (theoretically), can try fluids
Causes of antepartum hemorrhage
Placenta previa - placenta blocks the cervical os, painless bleeding, no vaginal exam. Dx via U/S, can improve, may need c-section. MUST NOT GO INTO LABOUR.
Placenta abrupta - premature separation of implanted placenta, painful bleeding, small bleed common, complete is stillbirth,
Pregnancy and asymptomatic bacteria?
Treat! Amoxicillin.
Polyhydraminos why?
We don’t know, or the babies have renal problems
Rupture of membranes - have to deliver baby soon
24-48 hours to avoid infection
Cervical cerclage
For incompetent cervix - sew them up and you need to make sure it is cut BEFORE they start labouring. Multips, genetics, surgical?
PPROM
Premature rupture of membranes and not in labour, NO BIMANUAL, expectant management. Test the nitrite stick.
Big head? Little mom?
CPD, remember power, passenger, passage, psyche
Post partum haemorrhage
Tone (uterine atony), tissue (retained placenta), trauma (laceration, uterine rupture), thrombin (coagulopathies)
ABC - crystalloids, cross and type for 4 units of blood pRBC, MASSAGE, oxytocin, ergotamine, hemabate, thrombin, ballon tamponade, hysterectomy as final solution.
Post-partum pyrexia
B-5W - wind (pneumonia), water (UTI), wound, walking, breast (mastitis - not a reason to stop breast feeding), womb (endometritus **)
Risk for endometrial CA?
Unopposed estrogen - age, nulliparity, obesity, PCOS, HRT
Clue cells?
Bacterial vaginosis
Work up for secondary amenorrhea?
What age are they?
Are they pregnant? Urine pregnancy test.
TSH, Prolactin, FSH
Fitz-Hugh-Curtis Sydrome?
pelvic adhesions secondary to PID, often adhesions also found on liver.
Favourite of Dr. Waja’s.
Ways to induce labour?
Cervidil (ribbon - insert and leave it), progesterone cream (more frequent application needed), Foley catheter with balloon, and misoprostol (oral or per vagina)
Cervidil indications/ contraindications?
To start or continue the ripening of the cervix in pregnant women who are at or near the time of labour. Should not be received by women experiencing unexplained vaginal bleeding, already receiving medications to induce labour, birth more than 6 times AND if baby is in distress and need URGENT delivery, not favourable for vaginal delivery) .
Risks primarily of hyperactivation of labour resulting in fetal distress and leading to c-section. Always a minimal risk of DIC
Abnormal uterine bleeding cause?
First rule out organic cause - fibroids, adenomyosis, ectopic, endometriosis, medications, etc.
Then consider dysfunctional uterine bleeding
Why more cramping/ contractions in the summer/ hot weather?
When a person is dehydrated the posterior pituitary produces ADH, this will reduce the output of the kidneys.
The posterior pituitary also produces oxytocin, ADH and oxytocin look very similar, so an excess of ADH can act on the uterus and induce cramping in the same way.
The reverse is also true - oxytocin excess can also lead to ++ water retention.
Free fluid in pelvis, minimal
There is allowed to be - the peritoneum produces around 30-40 mLs a day
Ectopic - how high can the bHCG before can’t use methotrexate?
No more than 5000
Distension and discomfort abdominal post operative - but no true ileum/ SBO
Get them to walk around, chew gum and try to reduce the amount of narcotics they are on.
What can fibroids secrete to try and preserve blood supply?
EPO (like the kidney)
HPV strains of concern?
6, 11 - venereal warts
16, 18 - cancer causing
90% - cancers caused by HPV
HPV + what causes cervical cancer
Chronic HPV + smoking, HIV, immunocompromised, multiple sexual partners
Young people can clear without trouble. See in the 50s and in young people. NEED TIME.
Who gets HPV testing?
> 30, and has ASCUS pap, it is a reflex order (they test the liquid)
Usually about 60-80 dollars
Vag pap?
No cervix, hx of cancer - use the brush and the highest point of the vaginal wall. Do every 5 years.
What makes the transformation zone come out?
Estrogen makes the transition zone come down more, lack of it makes it recede into the os
If you can’t see it, don’t panic, it’s ok, not essential to get transition zone. Unless they have a history of abnormal cells.
Ectropion of the cervix?
Normal, redness around the os, multiple sexual partners, more estrogen warn about spotting, still do the pap.
Can cause post-coital bleeding - if it is persistent refer to gyne
What is a nabothan follicles
The pH of the cervix can lead to more squamous cells, this is just a retention cyst from the mucus of the cervix with the squamous cells growing over the columnar
Endocervical polyps
Comes out of the os, tissue can bleed a lot, benign from up in the uterus is endometrial - refer to gyne for removal
Things that make paps not adequate?
Bleeding, ++mucus, sex in the last 24 hours, ++lubrication, douches
Missed the cervix, no cervix, bad technique
Pap results
NILM - all good
Absent transformation zone - its ok unless other concerns
Squamous - ASCUS (less than 30 - repeat in 6 months - then gyne if abnormal), (>30, can repeat in 6 months or do the testing - if abnormal gyne, if normal go back to 3years), ASC-H (need biopsy - CIN 2,3), LSIL (like ASUS - but still 6months twice, CIN 1), HSIL (need biopsy - CIN 2,3)
Biopsy: CIN (1,2,3) - looking at the epithelium and the depth involved, 60% clear for CIN1, for 2 and 3 5% to 12% risk of CA.
Glandular (goes to GYNE)
Endometrial cells - depends on where they are in cycle - are they post-menopausal? Then gyne.
HPV vaccine?
Have to repeat the whole series if only got Gard-4
After high school - need 3 doses
Less than that only need 2
Of the gard 9
$160 per shot, 2months, 6 to 12 months (or longer)
