Obstetrics and Gynecology Flashcards
how is secondary amenorrhea described
Absence of menses for 3 months in a woman with previously normal menstruation or 6 months in a woman with a history of irregular cycles
what is the treatment of secondary amenorrhea
treat the underlying cause
use OCPs
cyclic progesterone 10mg for 10 days
a 27-year-old female who comes to the emergency department with a 2-day history of lower abdominal pain, fever, chills, and malaise. The patient also complains of nausea and multiple episodes of vomiting in the past 24 hours. On physical examination, there is bilateral adnexal tenderness, mucopurulent cervical discharge, and cervical motion tenderness.
What is the diagnosis
pelvic inflammatory disease
what are the causative agent for pelvic inflammatory disease
Gonorrhea and chlamydia
what is chandelier sign
cervical motion tenderness
what are complications of Pelvic inflammatory disease
infertility
ectopic pregnancy
tubo-ovarian abscess
what is the outpatient treatment of pelvic inflammatory disease
Ceftriaxone IM 500mg one + PO Doxycycline 100mg BID for 14 days +/- flagyl 500mg BID for 14 days
how is dysfunctional uterine bleeding defined
excessive uterine bleeding with no demonstrable organic cause
what is Menorrhagia
prolonged/heavy bleeding; regular intervals
what is metorrhagia
variable amounts of bleeding at irregular, frequent intervals
what is menometrorrhagia
more blood loss during menses and frequent and irregular bleeding between menses
what is polymenorrhea
menses that occur more frequently (menses <21 days apart)
what is oligomenorrhea
menses that occur less frequently (>35days)
what is the gold standard diagnostic test for dysfunctional uterine bleeding
uterine dilation and curettage
a 22-year-old female complaining of severe left lower quadrant abdominal pain associated with some spotting. She is sexually active, does not use contraception, and has a history of PID. She denies being pregnant. Her last period was 9 weeks ago. On physical exam, the patient is hypotensive and tachycardic. A vaginal ultrasound is performed, demonstrating free fluid and a mass in the right adnexa.
what is the diagnosis
ectopic pregnancy
what is the most common cause of ectopic pregnancy
occlusion of tube secondary to adhesions
what are risk factors associated with ectopic pregnancy
hx of previous ectopic
previous salpingitis (Caused by PID)
previous abdominal or tubal surgery
use of IUD
assisted reproduction
smoking
how is ectopic pregnancy diagnosed
betaHCG >1,500 but no fetus in utero
US - ring of fire sign
what is the ring of fire sign
aka ring of vascularity signifies a hypervascular lesion with peripheral vascularity on color or pulsed doppler exam of adenexa due to low impedance high diastolic flow
what is the treatment for ectopic pregnancy
methotrexate
surgical laparoscopy salpingostomy
a 29-year-old at 36 weeks gestation who arrives at the emergency department with a sudden onset of back pain with uterine contractions that are very close together, one after another. She describes PAINFUL, bright red vaginal bleeding. There is pelvic tenderness on examination which reveals a closed cervix and no evidence of rupture of the membranes.
What is the diagnosis
placenta abruption
what is the most common cause of third trimester bleeding
placenta abruption
what are risk factors for placenta abruption
trauma
smoking
HTN
preeclampsia
cocaine abuse
what is the treatment of placenta abruption
delivery of the fetus and placenta is the definitive treatment
blood type and cross
coag studies
corticosteroids as indicated to enhance fetal lung maturity
a 24-year-old nulligravid woman comes to your office with an 18-month history of painful intercourse, difficulty defecating, and dysmenorrhea. These symptoms are cyclical and come and go with her menses. Her menses are regular and heavy, requiring 10 to 15 thick pads on the days of heaviest flow. She denies ever being diagnosed with a sexually transmitted infection (STI). She and her husband have been engaging in regular intercourse without contraception for 1 year in an attempt to conceive. On pelvic examination, you find a normal-sized, immobile, retroverted uterus with nodularity and tenderness on palpation of the uterosacral ligaments.
What is the diagnosis
endometriosis
how is endometriosis diagnosed
pelvic laparoscopy and biopsy = gold standard
what are treatment options for endometriosis
surgical: resection
medical:NSAIDS, progestins, OCPs, danazol
a 32-year-old woman, G2P1, at 35 weeks gestation with a complaint of painless vaginal bleeding that began two hours ago and has delivered a substantial amount of blood with clots. She has had no evident pain or cramping. Upon physical examination, the fetal heart rate is noted to be normal. Her last pregnancy was delivered by emergency cesarean at 37 weeks due to a breech presentation during labor.
what is the diagnosis
placenta previa
what is the presentation of placenta previa
painless vaginal bleeding - usually occurs after 28 weeks
what are risk factors for placenta previa
prior c-sections
multiple gestations
multiple induced abortions
advanced maternal age
how is placenta previa diagnosed
US (transvaginal)
vaginal exam is contraindicated
what is the treatment of placenta previa
strict pelvic rest (no intercourse)
no vigorous exercise
blood transfusion may be necessary so get a type and screen
what is the APGAR score
appearance
pulse
grimace
activity
respiration
what APGAR score is considered normal
> 7
what is the presentation of PROM (premature rupture of membranes)
sudden “gush” of clear or pale yellow fluid from vagina occuring after 37 weeks of gestation
what is chadwicks sign
bluish discoloration of vagina and cervix
how is PROM diagnosed
speculum
Nitrazine test - blue
microscopic examination - ferning
what is Linea nigra
vertical line up the abdomen - caused by stimulation of melanocyte
what is Hegar’s sign
softening between fundus and cervix
a breastfeeding woman 3 weeks postpartum complaining of a painful area of the breast that is reddened and warm. The patient feels very fatigued, with a fever of 101.5 ° F and chills. She reports a burning pain present constantly or at times only while breastfeeding. On exam, the patient appears ill. Breast examination shows an erythematous right breast with a palpable mass, induration, erythema, and tenderness to palpation.
What is the diagnosis
infectious mastitis
what is the treatment of infectious mastitis
dicloxacillin, cephalexin or erythromycin for staff
a 32-year-old lactating female with breast pain, swelling, fever, chills, and a fluctuant mass of her left breast. The area directly above the lesion is warm, erythematous, and tender to touch.
what is the diagnosis
breast abscess
what is the treatment of breast abscess
I&D and anti-staph antibiotics
- Nafcillin/oxacillin IV or cefazolin + metronidazole
- pump and dump
what are three types of ovarian cysts
- follicular cyst (mc)
- corpus luteum
- Theca lutein cysts
what are three main complications of ovarian cysts
hemorrhagic
rupture
torsion
what is the imaging of choice for ovarian cysts
abdominal and pelvic ultraound for suspected ovarian tosion
MRI
Serum CA-125
what is the presentation of bacterial vaginitis
milky vaginal discharge
pH >4.5
amine “whiff” test
clue cells
what is the treatment of BV
Metronidazole (PO or intravaginally) or clindamycin
what is the treatment of candida vaginitis
fluconazole (150 mg PO x1)
vaginal cream: miconazole, terconazole, clotrimazole
