Obstetrics and Gynecology Flashcards
Most common agent in acute mastitis and treatment
Staph aureus, dicloxacillin or nafcillin or a cephalosporin or erythromycin if pcn allergic
Initial test of choice for suspected fibrocystic breast changes/fibroadenoma of the breast
Ultrasound
Paget disease of the breast definition
Ductal carcinoma presenting as an eczematous nipple lesion, may have bloody discharge, may present as chronic eczematous itchy scaly rash on the nipples and areola
Inflammatory breast cancer definition
Red swollen warm and itchy breast that presents like peau d’orange due to lymphatic obstruction and rarely has a lump but has a poor prognosis
Initial modality to eavluate breast masses in women <40 years vs >40 years
Ultrasound vs mammography
Hormone breast cancer therapy in premenopausal vs postmonopausal patients
Pre menopausal is tamoxifen, post menopausal is letrozole or anastrozole
Breast cancer screening guidelines
Mammogram every 2 years beginning at age 50-74 in average risk patients, in more moderate risk for those with first degree relative can start 10 years prior to age first degree relative was diagnosed if earlier than 50
2 HPV types responsible for majority of cervical and anal cancers
16 and 18
Gardasil vaccination schedule
Given in women age 11-26, men age 11-21, if <15 years 2 doses of HPV vaccine at least 6 months apart, if 15 years or older or immunocompromised 3 doses over minimum of 6 months at 0, 2, and 6 months with minimum dosing interval between first 2 being 4 weeks and between second and third 12 weeks
Management of cervical insufficiency (2)
- Cerclage (suturing of cervical os) and bed rest
- Weekly injection of 17 alpha hydroxyprogesterone
Clomiphene drug function
Induces ovulation for infertility treatment
Definition of infertility
Failure to conceive after 1 year of regular unprotected sexual intercourse
Cervical cancer screening guidelines (NOTE THESE ARE THE 2020 GUIDELINES)
Testing begins at age 25 (change from 21 years previously) - 65, HPV test every 5 years or HPV/Pap co test every 5 years or Pap smear every 3 years
Most common gynecologic cancer
Endometrial cancer
Most common clinical manifestation of cervical cancer
Post coital bleeding or spotting
Spontaneous abortion diagnosis
Ultrasound or cervical exam, cbc, blood type and Rh screen, serial beta hCG titers (remember should see doubling), progestorone levels
Types of abortion
Threatened - cervical os is closed and potentially viable pregnancy still requiring close follow up and observation at home as well as serial b hCG
Inevitable - cervical os is dilated but products of conception retained, treated with surgical evacuation via dilation and curetage or misoprostal or expectant management
Incomplete - cervical os is dilated, some products of conception expelled, options include expectant management with transvaginal US to determine when complete, or surgical evacuation such as dilation and curettage or misoprostal
Complete - cervical os is closed, all products of conception are expelled, treated with RhoGAM if indicated and follow up beta hCG
Missed - cervical os is closed, products of conception are retained, treated with surgical evacuation such as dilation and curettage or misoprostal
Septic - Cervical os closed, some products of conception retained, cervical motion tenderness and foul brown discharge, fever, chills, treated with dilation and curettage to remove products of conception plus broad spectrum antibiotics
Elective induced abortion medical therapy vs surgical therapy
Mifepristone (dilates and softens cervix and causes placental separation) followed by misoprostal (causes uterine contractions, its also used to prevent stomach ulcers caused by nsaids!)
Dilation and curettage and evacuation
Common etiologies of placental insufficiency
Placenta previa, abruption, post term pregnancy, intrauterine growth restriction
Diagnosis of placental insufficiency
Late decelerations on fetal heart monitoring due to mechanical compression of maternal vessels during uterine contractions
Management of placental insufficiency
Place mother on side, administer oxygen, and correct hypotension
Diagnosis of uncomplicated pregnancy (2)
Serum quantitative B hCG 5 days after conception, urine B hCG 14 days after conception
Goodell’s sign
cervical softening sign of pregnancy
Abortion is the term at < or =___ weeks
20
Fundal height at 12 weeks vs 20 weeks vs 38 weeks
Pubic symphysis, Umbilicus, Below xiphoid process
Neagele’s rule
((LMP+7 days)-3 months) + 1 year
PAPP-A first trimester screening
Low with down syndrome
Nuchal translucency ultrasound first trimester screening
Increased thickness is abnormal and may indicate chromosomal abnormalities such as trisomy 13 or 21, if abnormal chorionic villous sampling or amniocentesis is offered
1st trimester is from week
1-12
alpha feto protein a-FP second trimester screening
Usually part of triple screening including unconjugated estriol and b-hCG, low in down syndrome, high with neural tube defects like spina bifida
2nd trimester is from week
12-27
Gestational diabetes second trimester screening
at weeks 24-28 perform 50 gram 1 hr glucose challenge test, if positive do a 100 gram 3 hour oral glucose tolerance test (diagnostic gold standard)
Most common type of neural tube defect
Spina bifida with myelomeningocele
When is RhoGAM given in pregnancy?
28 weeks gestation and within 72 hrs of delivery of an RH(D) positive baby
Leading cause of neonatal infection and sepsis in newborns
Group B strep
GBS third trimester screening
Rectovaginal screening culture at 36-37 weeks gestation with exception of those with current bacteriuria and those who previous gave birth with GBS disease, those need intrapartum antibiotic prophylaxis (IV pen G first line)
Toxic shock syndrome causative agent
Staph aureus
Toxic shock syndrome treatment
IV fluids and antibiotics like clindamycin and vancomycin plus hospital admission and removal of offending agent
At risk pregnancy for RH alloimmunization
Rh negative mother with Rh positive father or unknown father status because it is dominantly inherited
Diagnosis of placenta previa (2)
Transabdominal ultrasound initially (screening) with confirmation via transvaginal ultrasound
Vasa previa definition
Vessels present over cervical os that has high fetal mortality due to exsanguination, presents with rupture of membranes followed by painless vaginal bleeding and fetal distress in the form of bradycardia, managed with immediate cesarean section
Hypertension vs transitional hypertension vs preeclampsia vs eclampsia
Hypertension is before 20 weeks gestation, transitional hypertension is after 20 weeks but no proteinuria, edema, or end organ dysfunction, preeclampsia is after 20 weeks and with proteinuria or end organ dysfunction, and eclampsia is preeclmapsia plus seizures or coma
Medication for pre-existing hypertension during pregnancy or transitional hypertension
Labetalol, nifedipine, methyldopa first line agents, hydralazine second line
Management of mild pre-eclampsia
if >37 weeks delivery, if <37 weeks expectant management such as antenatal corticosteroids for fetal lung maturity, planned delivery, weekly blood pressure monitoring, bed rest
Management of severe pre-eclampsia
If viable 33 weeks or greater prompt delivery after hospitalization plus mag sulfate and blood pressure control with labetalol, nifedipine or methyldopa
Management of gestational diabetes
- Lifestyle mods initial treatment of choice
- Insulin first line medical treatment of choice
- Glyburide or metformin 2ndary choices
Erb’s palsy
Brachial plexus injury most often occurs due to shoulder dystocia in delivery of newborn resulting in arm weakness, most often times self resolves
Breech presentation diagnosis
Leopold maneuvers
Umbilical cord prolapse presentation
Sudden onset of severe prolonged fetal bradycardia or variable decelerations after a previously normal tracing, requires emergent c-section
Morning sickness vs hyperemesis gravidarum
Morning sickness is nausea and vomiting in the first trimester that should resolve, hyperemesis gravidarum is severe excessive form of morning sickness that persists into second trimester and can cause more severe symptoms like hypokalemia, metabolic alkalosis, weight loss
Morning sickness/hyperemesis gravidarum treatment
- Lifestyle mods
- Vit B6 with or without doxylamine
Lightening definition
Fetal head descent into pelvis causing change in abdomen shape and sensation that baby has become lighter
Bloody show definition
Passage of blood tinged cervical mucus late in pregnancy, occurs when the cervix begins thinning
Stages of labor
I - true regular contractions to full dilation of cervix
II - Active expulsion of fetus to delivery
III - postpartum until delivery of placenta
Diagnosis of PROM
Sterile speculum exam and nitrazine paper test (turns blue if pH is >6.5 indicating aminotic fluid) or fern test
What % of patients go into spontaneous labor within 24 hrs after PROM
90%
What to give if patient doesn’t go into labor spontaneously after PROM
Prostaglandin cervical gel or oxytocin
When should delivery be delayed?
<34 weeks, delay with tocolytics and betamethasone to enhance fetal lung maturity
Placenta previa typically requires what kind of delivery?
C section
APGAR scoring
Appearance 0 - blue all over 1 - acrocyanosis 2 - no cyanosis
Pulse 0 - not detected 1 - <100bpm 2 - >100 bpm
Grimace 0 - no response 1 - feeble 2 - pulls away
Activity 0 - none 1 - some flexion 2 - flexes arms and legs, resists extension
Respiration 0 - absent 1 - weak 2 - strong crying
7 or greater is normal, done at 1 and 5 minutes and repeated at 10 if abnormal
Cervical motion tenderness might indicate 1 of these 2 conditions
Ectopic pregnancy, PID
Pelvic ultrasound description of molar pregnancy
Central heterogenous mass with muliple discrete anechoic spaces, snowstorm or cluster of grapes appearance
Most effective postcoital emergency contraception method
Copper IUD if inserted within 5-7 days after unprotected intercourse
When should OCP’s be stopped in smokers?
> 35 years due to thrombotic potential
Most common cause of abnormal uterine bleeding
Anovulatory
What should be done with all abnormal uterine bleeding patients >35 years
Endometrial biopsy to rule out endometrial carcinoma
Work up for primary amenorrhea
- bHCG and FSH
- TSH and prolactin
- Karyotyping for turner syndrome (xo)
Most common clinical presentation of leiomyoma and diagnosis
Most are asymptomatic but bleeding is most common symptom
Transvaginal ultrasound most widely used initial imaging test
Most sensitive initial test for menopause
FSH assay
Management of hot flashes in menopause
Hormone replacement therapy first line (risks and benefits must be weighed)
2nd line SSRI’s like paroxetine or gabapentin
Endometritis definition
Infection of pregnancy endometrium, c section is biggest risk factor, typically occurs 2-3 days after delivery and may have vaginal bleeding or discharge (foul smelling lochia), managed with clindamycin+gentamycin first line
Endometriosis clinical manifestations
- Cyclic premenstrual pain, dysmenorrhea, dyspareunia
- Dyschezia or abnormal bleeding
- Infertility
Physical exam description of endometriosis
May have fixed tender adenexal mass, a fixed retroverted uterus, or nodular thickening of uterosacral ligament
Endometriosis diagnosis
- Clinical
- Ultrasound to rule out other causes
- Laparoscopy with biopsy definitive diagnosis, may see endometrioma (chocolate cyst)
Endometrial hyperplasia or cancer diagnosis
Transvaginal ultrasound initial diagnostic test, endometrial biopsy definitive diagnosis
Normal LH:FSH ratio vs LH:FSH ratio in PCOS
normally 1:2, >3:1 in pcos
PID outpatient management
Ceftriaxone 250 mg IM one dose plus doxycycline 100 mg bid x 14 days, metronidazole 500 mg bid x14 can be added
Fitz Hugh Curtis syndrome definition
Perihepatitis in the setting of pelvic inflammatory disease, sees RUQ pain that may radiate to the right shoulder, often LFT’s unchanged
BV vaginal pH
Basic >4.5
Trichomoniasis vaginal pH
Basic >4.5
BV treatment
Metronidazole x 7 days
Trichomoniasis treatment
Metronidazole 2 g oral dose or 500 mg bid x7 days, partners must be treated because it is an STI
Vulvovaginal candidiasis treatment
Fluconazole 1 dose
