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EOR - Emergency Medicine > Obstetrics and Gynecology > Flashcards

Obstetrics and Gynecology Flashcards

1
Q

2 types of amenorrhea

A

primary
secondary

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2
Q

primary amenorrhea is no menses by _ yo with an absence of secondary sex characteristics
OR
by _ yo w. normal growth of secondary sex characteristis

A

13
15

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3
Q

causes of primary menses

A

pregnancy
imperforate hymen
turner syndrome (dysgenesis)
HPO axis abnl
anorexia
bulimia
wt loss
exercise

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4
Q

secondary amenorrhea is absence of menses for _ mo in women w. previously normal menstruation,
OR
_ mo in a woman w. a hx of irregular cyles

A

3
6

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5
Q

mc cause of amenorrhea

A

pregnancy

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6
Q

ascending infxn that ascends from the cervix or vagina to the endometrium and/or fallopian tubes

A

PID

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7
Q

2 mc pathogens associated w. PID

A

GC
CT

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8
Q

what is chandelier’s sign

A

cervical motion tenderness -> PID

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9
Q

3 complications of PID

A

infertility
ectopic
tubo-ovarian abscess

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10
Q

dx for PID

A

abdominal tenderness, cervical motion tenderness, and adnexal tenderness

PLUS 1 or more:
temp > 38
WBC > 10,000
pelvic abscess

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11
Q

tx for PID: inpt vs outpt

A

outpt: ceftriaxone + doxy +/- metro

inpt: doxy + cefoxitin OR cefotetan x 48 hr, followed by doxy

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12
Q

indications for inpt tx w. PID

A

severely ill/vomiting
dx uncertain
ectopic/appendicitis can’t be ruled out
pregnancy
pelvic abscess suspected
HIV
failed outpt tx

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13
Q

excessive uterine bleeding w. no organic cause

A

dysfunctional uterine bleeding

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14
Q

types of dysmenorrhea

A

menorrhagia
metorrhagia
menometrorrhagia
polymenorrhea
oligomenorrhea

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15
Q

prolonged/heavy uterine bleeding
regular intervals

A

menorrhagia

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16
Q

variable amt of bleeding
irregular, frequent intervals

A

metrorrhagia

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17
Q

more blood loss during menses
frequent irregular bleeding btw menses

A

menometrorrhagia

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18
Q

menses that occur more frequently (< 21 days)

A

polymenorrhea

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19
Q

menses that occur less frequently (> 35 days)

A

oligomenorrhea

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20
Q

what types of dysfunctional uterine bleeding to uterine lesions cause (2)

A

menorrhagia
metrorrhagia

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21
Q

uterine lesions include (6)

A

endometrial ca/sarcoma
endometrial hyperplasia
submucosal fibroid
endometrial polyps
endometritis
adenomyosis

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22
Q

blood disorders associated w. dysfunctional uterine bleeding (4)

A

vWD (von willebrand)
prothrombin deficiency
leukemia
severe sepsis

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23
Q

which types of dysfunctional uterine bleeding is hypothyroidism associated w. (2)

A

menorrhagia
metrorrhagia

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24
Q

which 2 types of dysfunctional uterine bleeding is hyperthyroidism associated w. (2)

A

oligomenorrhea
amenorrhea

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25
Q

continuous unopposed production of estradiol 17 beta causes

A

anovulatory dysfunctional uterine bleeding:

continuous proliferation of endometrium w.o corpus luteum -> sloughs off in irregular pattern

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26
Q

LH surge is associated w. what type of dysfunctional uterine bleeding

A

mid cycle spotting

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27
Q

gs dx for dysfunctional uterine bleeding

A

dilation and curettage

diagnostic and therapeutic

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28
Q

_ can be used acutely if pt presents w. hemorrhage due to DUB

A

IV estrogen

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29
Q

_ reduce menstrual blood loss

A

NSAIDs

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30
Q

dysmenorrhea prior to menses, not relieved by NSAIDs or OCPs
dyspareunia

A

endometriosis

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31
Q

2 types of dysmenorrhea

A

primary
secondary

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32
Q

primary menorrhea begins w.in _ to _ mos of menarche

A

6-12

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33
Q

dysmenorrhea is due to excess _ production (2)

A

PG
leukotriene

-> increased uterine contraction

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34
Q

describe pain w. dysmenorrhea

A

begins w. start of menses
lasts 2-3 days
worst on day 1

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35
Q

3 sx associated w. dysmenorrhea

A

ha
nausea
diarrhea

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36
Q

painful menstruation caused by clinical identifiable cause

A

secondary amenorrhea

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37
Q

causes of secondary amenorrhea (lots!)

A

endometriosis
adenomyosis
polyps
fibroids
PID
IUD
tumors
adhesions
cervical stenosis/lesions
psych

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38
Q

describe pain w. secondary menorrhea

A

pain begins mid cycle
increases in severity til the end

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39
Q

mc age for secondary dysmenorrhea

A

20-40

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40
Q

top 2 locations for ectopic pregnancy

A
  1. fallopian tubes
  2. ampulla of tube
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41
Q

3 hallmark findings of ectopic

A

abd pain
bleeding
adnexal mass

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42
Q

mc cause of ectopic

A

occlusion of tube 2/2 adhesions

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43
Q

6 rf for ectopic

A

previous ectopic
previous salpingitis
previous abd/tubal surgery
IUD
assisted reproduction
smoking

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44
Q

5 sx of ruptured ectopic

A

severe abd pain or shoulder pain
peritonitis
tachycardia
syncope
orthostatic hypotn

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45
Q

dx for ectopic

A

b hcg > 1,500 w. no fetus in utero on US

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46
Q

when bHCG > _ there should be evidence of developing intrauterine gestation on US

A

1,500

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47
Q

hallmark US finding of ectopic

A

ring of fire (ring of vascularity)

hypervascular lesion w. peripheral vascularity

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48
Q

what is this showing

A

ring of fire -> ectopic

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49
Q

indications for MTX for ectopic

A

b HCG < 5,000
ectopic mass < 3.5 cm
no FHR
hemodynamically stable
no blood d.o
no pulm. dz
no peptic ulcer
normal renal fxn
normal hepatic fxn
compliant pt

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50
Q

contraindications for MTX for ectopic (3)

A

bf’ing
active pulm dz
immunodeficiency

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51
Q

moa for MTX

A

folic acid antagonist -> inhibits DNA replication

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52
Q

indications for emergent laparoscopy salpingostomy for ectopic

A

rupture
MTX contraindicated

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53
Q

premature separation of all/sections of otherwise normally implanted placenta from uterine wall after 20 weeks gestation

A

placental abruption

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54
Q

mc cause of third trimester bleeding

A

placental abruption

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55
Q

5 rf for placental abruption

A

trauma
smoking
HTN
preeclampsia
cocaine

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56
Q

painful 3rd trimester bleeding is always _ until proven otherwise

A

placental abruption

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57
Q

dx for placental abruption

A

clinical…always

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58
Q

US findings of placental abruption

A

retroplacental blood collection

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59
Q

PE finding of placental abruption

A

blood stained amniotic fluid in vagina

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60
Q

_ indicate fetal hypoxia/bradycardia

A

decelerations

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61
Q

tx for placental abruption (5)

A

delivery
type and match
coag studies
large bore IV
steroids

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62
Q

management of small placental abruptions

A

expectant management

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63
Q

endometriosis is mc found in the (2)

A

ovary
peritoneum

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64
Q

t/f: the severity of endometriosis sx does not equate to severity of dz

A

t!

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65
Q

endometriosis is most likely caused by

A

retrograde menstruation: endometrium floats back out of fallopian tubes into ovary

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66
Q

rf for endometriosis

A

early menarche
short cycles
heavy/prolonged cycles
mullerian anomalies
fam hx
autoimmune dz

67
Q

3 factors that decrease risk for endometriosis

A

multiparity
longer lactation
regular exercise

68
Q

3 d’s of endometriosis

A

dyspareunia
dyschezia
dysmenorrhea

69
Q

PE finding of endometriosis

A

**uterus is fixed and retroflexed **
tender nodularity of cul de sac/uterine ligaments

70
Q

gs dx for endometriosis

A

pelvic laparoscopy and bx

71
Q

laparascopy findings of endometriosis

A

chocolate cysts

72
Q

tx for endometriosis (5)

A

endometrial resection
NSAIDs
progestins/OCPs
danazol
GnRH agonist

73
Q

max duration of tx w. danazol

A

6 mos

risk for bone loss after

74
Q

increasing intake of _ can decrease risk of endometriosis

75
Q

placental lies very low in the uterus -> covers all or part of the cervix

A

placenta previa

76
Q

painless third trimester bleeding is always _ until proven otherwise

A

placenta previa

77
Q

5 types of placenta previa

A

complete
partial
marginal
low-lying
vasa previa

78
Q

6 fetal complications associated w. placenta previa

A

preterm delivery
PPROM
intrauterine growth restrition
malpresentation
vasa previa
congenital abnl

79
Q

4 rf for placenta previa

A

prior c section
multiple gestations
multiple induced abortions
advanced maternal age

80
Q

dx for placenta previa

A

transvaginal US

81
Q

what PE test is contraindicated in placenta previa

A

pelvic exam

82
Q

management of placenta previa (4)

A

strict pelvic rest
+/- transfusion
c section
rhogam

83
Q

preferred delivery for placenta previa

84
Q

3 types of fetal monitoring

A

non stress
contraction stress test
APGAR

85
Q

good stress test findings

A

good = reactive:
> 2 accelerations x 20 min
increased FHR 15 bpm lasting > 15 sec

86
Q

bad stress test findings

A

nonreactive = bad:
no FHR accelerations OR < 15 bpm lasting < 15 sec

87
Q

what do order if you see nonreactive stress test

A

order contraction test

88
Q

good stress test findings

A

negative = good:
-no late decelerations in presence of 2 contractions in 10 min

repeat as needed

89
Q

bad stress test findings

A

positive = bad:
-repetitive late decelerations in the presence of 2 contractions x 10 min

prompt delivery

90
Q

what does apgar stand for

A

appearance
pulse
grimace
activity
respiration

91
Q

when is apgar ordered

A

1 and 5 min after birth

92
Q

clinical definition of PROM

A

rupture of membranes at >/= 37 weeks gestation prior to start of uterine contractions

93
Q

clinical definition of PPROM

A

PROM < 37 weeks gestation

94
Q

2 major comlications of PPROM

A

infxn
cord prolapse

95
Q

sx of PROM

A

sudden gush of clear/pale/yellow fluid from vagina after 37 weeks gestation

96
Q

dx for PROM

A
  1. speculum: fuid pooling in posterior fornix
  2. nitrazine test: blue = pH > 7.1 -> positive
  3. microscopy: ferning
97
Q

what is this showing

A

ferning: crystallization of estrogen and amniotic fluid

98
Q

management of PROM based on gestational age

A

> 34 weeks: induce labor
32-34 weeks: collect fluid, check lung maturity, induce
< 32 weeks: stop contractions, 2 doses steroid injxn, deliver, abx

99
Q

fetus/infant nomenclature: abortion, premature, full term, postmature

A

abortion: < 20 weeks OR < 500 g
premature: 20-36 weeks OR 1,000-2,500 g
full term: 37-42 weeks OR > 2,500 g
postmature: < 42 weeks

100
Q

what does GTPAL stand for

A

gravidity (# pregnancies)
term (>/= 37 weeks)
preterm (20-36 weeks)
abortion (loss prior to 20 weeks)
living

101
Q

how do twins count in GTPAL

A

one pregnancy
two live children

102
Q

when are fetal movements (quickening) felt: nulliparas vs multiparas

A

nulliparas: 18-20 weeks
multiparas: 14-16 weeks

103
Q

5 signs of pregnancy

A

chadwick sign
increased body temp
melasma/chloasma
linea nigra
hegar’s sign

104
Q

what is chadwick’s sign

A

bluish discoloration of vagina/cervix

105
Q

what is hegar’s sign

A

softening btw fundux and cervix

106
Q

normal uterine growth

A

12 weeks: pubic symphysis
20 weeks: umbilicus
> 20 weeks: 1 cm/week

107
Q

normal FHR
when is it visible on US

A

120-160 bpm
6 weeks

108
Q

2 important lab changes of pregnancy

A

cholesterol increase
BUN/Cr decrease

109
Q

what labs are done at the firs prenatal visit

A

CBC
blood type
Rh factor
random BG
VDRL/RPR
hep B
rubella
UA
pap
GBS
+/- SSA, CF, Tay-Sachs

110
Q

what is done at every prenatal visit

A

maternal weight
bp
fundal height
fetal size/presenting part
urine dipstick for protein/glucose/ketones

111
Q

recommended wt gain during pregnancy

A

normal BMI: 20-35 lb
underweight: 40-45 lb
overweight: 10-15 lb

112
Q

pregnancy nutrition to know

A

300 kcal/day
folic acid: 0.4 mg/day
iron: 30 mg/day

113
Q

pregnancy nutrition to know

A

300 kcal/day
folic acid: 0.4 mg/day
iron: 30 mg/day

114
Q

8 random things to avoid during pregnancy that we need to know

A

apple cider vinegar
deli meat
king mackerel
shark
swordfish
tuna
tilefish
farm salmon

115
Q

5 rf for spontaneous abortion

A

smoking
infxn
maternal systemic dz
immunologic parameters
drug use

116
Q

early pregnancy w. bleeding/pain is _ until proven otherwise

117
Q

gs evaluation of bleeding during pregnancy

A

transvaginal US

118
Q

normal bHCG progression during pregnancy

A

doubles q 48 hr

119
Q

management of spontaneous abortion

A

D&C
monitor bHCG
US
+/- Rh

120
Q

management of septic/infected abortion

A

complete evacuation of uterine contents
abx

121
Q

cervical os is open in what 2 types of abortions

A

inevitable
incomplete

122
Q

cervical os is closed in what 2 types of abortions

A

threatened
complete

123
Q

mastitis is caused by

A

skin/oral flora of bf’ing baby enter erosion/cracked nipple

124
Q

mc cause of mastitis

A

clogged milk ducts

125
Q

difference btw congestive and infectious mastitis

A

infectious: unilateral
congestive: bilateral

126
Q

pathogen associated w. mastitis

127
Q

abx for mastitis (3)

A

dicloxacillin
cephalexin
erythromycin

128
Q

t/f: pt should continue bf’ing on affected side w. a breast abscess

A

f!

pump and dump affected side
bf unaffected side

129
Q

pathogen associated w. breast absces

130
Q

abx for breast abscess

A

nafcillin/oxacillin
OR
cefazolin PLUS metro

131
Q

3 sx of ovarian cyst

A

bloating
lower abd pain
lbp

132
Q

classification of ovarian cysts

A

-functional: variant of normal menstruatal cycle
-non functional: non associated w. menstrual cycle

133
Q

mc type of ovarian cyst

A

follicular

134
Q

3 types of functional cyst

A

follicular
corpus luteum
theca lutein

135
Q

3 characteristics of functional ovarian cysts

A

2-10 cm
clear serous liquid
smooth internal lining

136
Q

dominant follicle fails to rupture

A

follicular ovarian cyst

137
Q

dominant follicle ruptures but closes again and doesn’t dissolve

A

corpus luteum cyst

138
Q

-overstimulation of hcg produced by placenta
-only seen in pregnancy

A

theca lutein cysts

139
Q

5 types of non functional/neoplastic cysts

A

PCOS
endometriomas
dermoid (teratomas)
ovarian serous
mucinous cystadenoma

140
Q

amenorrhea
hirsutism

141
Q

chocolate cyst

A

endometrioma

142
Q

3 characteristics of non functional/neoplastic cysts

A

> 10 cm
irregular borders
internal septations

143
Q

3 main complications of ovarian cysts

A

hemorrhagic
rupture
torsion

144
Q

hemorrhage is mc w. what 2 types of cyst

A

follicular
corpus luteal

145
Q

ovarian cyst rupture mc occurs after

146
Q

torsion mc occurs w. cysts > _

147
Q

sx of ruptured ovarian cyst

A

pain
hypotn
abd/shoulder pain
tachycardia

148
Q

3 sx of torsed ovarian cyst

A

waxing/waning pain
n/v
low grade fever

149
Q

dx for ovarian torsion

A
  1. US

2. direct visualization during surgery -> gs

150
Q

tx for ovarian cysts based on size

A

< 5 cm: obs
> 5 cm: laprascopic removal
uncomplicated rupture: NSAIDs, expectant management
+/- surgery

151
Q

4 types of vaginitis

A

BV
candidiasis
trichomonas
atrophic vaginitis

152
Q

-low hydrogen peroxide -> lack of lactobacilli
-pH > 4.5
-gradnerella

153
Q

2 PE findings of BV

A

milky d.c
fishy odor

154
Q

microscopy findings of BV

A

clue cells
stipled epithelial cells

155
Q

AMSEL criteria

A

thin, white homogenous d.c
presence of clue cells
pH > 4.5
fishy odor

must have 3/4

156
Q

tx for BV

157
Q

2 PE findings of vaginal candidiasis

A

thick white d.c
beefy red vaginal mucosa

158
Q

tx for vaginal candidiasis

A

fluconazole

159
Q

rf for recurrent vulvovaginal candidiasis

160
Q

which type of vaginitis can affect fertility

A

trichomonas

161
Q

2 PE finding of trichomonas

A

grothy white/grey d.c
strawberry cervix

162
Q

tx for trichomonas

A

metro
test of cure
full STI screen
treat partner

163
Q

PE findings of atrophic vaginitis

A

fragile tissue
fissures
petechiae
labia minoa resorption
loss of rugae/elasticity
prominent meatus
urethral eversion/prolapse

164
Q

tx for atrophic vaginitis

A
  1. non hormonal OTC lubricants
  2. topical estrogen vs estrogen ring

EOR - Emergency Medicine (13 decks)

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