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Clinical: Emergency Medicine > Obstetrics and Gynecology > Flashcards

Obstetrics and Gynecology Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

how is secondary amenorrhea described

A

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

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2
Q

what is the treatment of secondary amenorrhea

A

treat the underlying cause
use OCPs
cyclic progesterone 10mg for 10 days

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3
Q

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

A

pelvic inflammatory disease

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4
Q

what are the causative agent for pelvic inflammatory disease

A

Gonorrhea and chlamydia

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5
Q

what is chandelier sign

A

cervical motion tenderness

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6
Q

what are complications of Pelvic inflammatory disease

A

infertility
ectopic pregnancy
tubo-ovarian abscess

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7
Q

what is the outpatient treatment of pelvic inflammatory disease

A

Ceftriaxone IM 500mg one + PO Doxycycline 100mg BID for 14 days +/- flagyl 500mg BID for 14 days

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8
Q

how is dysfunctional uterine bleeding defined

A

excessive uterine bleeding with no demonstrable organic cause

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9
Q

what is Menorrhagia

A

prolonged/heavy bleeding; regular intervals

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10
Q

what is metorrhagia

A

variable amounts of bleeding at irregular, frequent intervals

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11
Q

what is menometrorrhagia

A

more blood loss during menses and frequent and irregular bleeding between menses

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12
Q

what is polymenorrhea

A

menses that occur more frequently (menses <21 days apart)

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13
Q

what is oligomenorrhea

A

menses that occur less frequently (>35days)

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14
Q

what is the gold standard diagnostic test for dysfunctional uterine bleeding

A

uterine dilation and curettage

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15
Q

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

A

ectopic pregnancy

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16
Q

what is the most common cause of ectopic pregnancy

A

occlusion of tube secondary to adhesions

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17
Q

what are risk factors associated with ectopic pregnancy

A

hx of previous ectopic
previous salpingitis (Caused by PID)
previous abdominal or tubal surgery
use of IUD
assisted reproduction
smoking

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18
Q

how is ectopic pregnancy diagnosed

A

betaHCG >1,500 but no fetus in utero
US - ring of fire sign

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19
Q

what is the ring of fire sign

A

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

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20
Q

what is the treatment for ectopic pregnancy

A

methotrexate
surgical laparoscopy salpingostomy

21
Q

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

A

placenta abruption

22
Q

what is the most common cause of third trimester bleeding

A

placenta abruption

23
Q

what are risk factors for placenta abruption

A

trauma
smoking
HTN
preeclampsia
cocaine abuse

24
Q

what is the treatment of placenta abruption

A

delivery of the fetus and placenta is the definitive treatment
blood type and cross
coag studies
corticosteroids as indicated to enhance fetal lung maturity

25
Q

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

A

endometriosis

26
Q

how is endometriosis diagnosed

A

pelvic laparoscopy and biopsy = gold standard

27
Q

what are treatment options for endometriosis

A

surgical: resection
medical:NSAIDS, progestins, OCPs, danazol

28
Q

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

A

placenta previa

29
Q

what is the presentation of placenta previa

A

painless vaginal bleeding - usually occurs after 28 weeks

30
Q

what are risk factors for placenta previa

A

prior c-sections
multiple gestations
multiple induced abortions
advanced maternal age

31
Q

how is placenta previa diagnosed

A

US (transvaginal)
vaginal exam is contraindicated

32
Q

what is the treatment of placenta previa

A

strict pelvic rest (no intercourse)
no vigorous exercise
blood transfusion may be necessary so get a type and screen

33
Q

what is the APGAR score

A

appearance
pulse
grimace
activity
respiration

34
Q

what APGAR score is considered normal

A

> 7

35
Q

what is the presentation of PROM (premature rupture of membranes)

A

sudden “gush” of clear or pale yellow fluid from vagina occuring after 37 weeks of gestation

36
Q

what is chadwicks sign

A

bluish discoloration of vagina and cervix

36
Q

how is PROM diagnosed

A

speculum
Nitrazine test - blue
microscopic examination - ferning

37
Q

what is Linea nigra

A

vertical line up the abdomen - caused by stimulation of melanocyte

38
Q

what is Hegar’s sign

A

softening between fundus and cervix

39
Q

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

A

infectious mastitis

40
Q

what is the treatment of infectious mastitis

A

dicloxacillin, cephalexin or erythromycin for staff

41
Q

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

A

breast abscess

42
Q

what is the treatment of breast abscess

A

I&D and anti-staph antibiotics
- Nafcillin/oxacillin IV or cefazolin + metronidazole
- pump and dump

43
Q

what are three types of ovarian cysts

A
  • follicular cyst (mc)
  • corpus luteum
  • Theca lutein cysts
44
Q

what are three main complications of ovarian cysts

A

hemorrhagic
rupture
torsion

45
Q

what is the imaging of choice for ovarian cysts

A

abdominal and pelvic ultraound for suspected ovarian tosion
MRI
Serum CA-125

46
Q

what is the presentation of bacterial vaginitis

A

milky vaginal discharge
pH >4.5
amine “whiff” test
clue cells

47
Q

what is the treatment of BV

A

Metronidazole (PO or intravaginally) or clindamycin

48
Q

what is the treatment of candida vaginitis

A

fluconazole (150 mg PO x1)
vaginal cream: miconazole, terconazole, clotrimazole

Clinical: Emergency Medicine (13 decks)

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