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EOR Family Medicine > Obstetrics / Gynecology > Flashcards

Obstetrics / Gynecology Flashcards

1
Q

Most common breast disorder

A

Fibrocystic breast disorder

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2
Q

Multiple, mobile, well demarcated lumps in breast tissue.
Often tender and bilateral.
May increase/decrease in size with menstrual hormonal changes

A

Fibrocystic breast disorder

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3
Q

Diagnosis of fibrocystic breast disorder

A
  1. Ultrasound

2. FNA - straw colored fluid

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4
Q

Management of fibrocystic breast disorder

A

Most will resolve spontaneously

+/- FNA removal of fluid if symptomatic

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5
Q

2nd most common breast disorder

A

Fibroadenoma of the breast

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6
Q

Composed of glandular and fibrous tissue (collagen arranged in “swirls”)

A

Fibroadenoma of the breast

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7
Q

Smooth, well-circumscribed, nontender, freely mobile, rubbery lump in breast.
Gradually grows over time
Does not wax and wane with menstruation

A

Fibroadenomas

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8
Q

Management of fibroadenomas

A

Observation
Most small tumors resorb with time
Excision if painful

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9
Q

Most common forms of breast cancer

A

Ductal (milk ducts) or lobular (lobules that produce milk)

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10
Q

Most common non-skin malignancy in women

A

Breast Cancer

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11
Q

2nd most common cause of cancer death in women

A

Breast cancer

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12
Q

Risk factors for breast cancer

A 
BRCA1 and BRCA2
1st degree relative w/ breast CA
Age > 65 y/o
Hormonal (increased number of menstrual cycles)
Increased estrogen

75% have no risk factors

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13
Q

Most common type of breast cancer

A
  1. Infiltrative ductal carcinoma

2. Upper outer quadrant

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14
Q

Breast mass - usually painless, hard, fixed
Pain is rare
+/- axillary lymphadenopathy
Unilateral nipple discharge

A

Breast cancer

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15
Q

Most common locations of breast CA METS

A

Lung
Liver
Bone
Brain

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16
Q

Chronic eczematous itchy, scaling rash on the nipples and areolas

A

Paget’s Disease of the Nipple

Indicative of breast CA

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17
Q

Red, swollen, warm, itchy breast

A

Inflammatory breast cancer

Often will also see nipple retraction, peau d’orange, usually not associated with lump

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18
Q

Peau d’ orange

A

Skin changes due to lymphatic obstruction associated with poor prognosis

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19
Q

Diagnosis of breast CA

A
  1. Mammogram
  2. Ultrasound - recommended initial modality
  3. FNA biopsy, core biopsy, excisional biopsy
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20
Q

Chemotherapy for breast CA

A

Used in stages II-IV and inoperable dz

Especially ER neg CA

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21
Q

Breast CA prevention in high risk patients

A

SERM: Tamoxifen or Raloxifene
Can be used in postmenopausal women or women > 35 y/o with high risk
Treatment usually lasts 5 years

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22
Q

Painful menstruation that affects normal activities

A

Dysmenorrhea

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23
Q

Primary dysmenorrhea is not due to ___________ but is due to increased ___________

A

Not due to pelvic pathology
Due to increased prostaglandins
Painful uterine muscle wall activity

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24
Q

Secondary dysmenorrhea is due to ___________, such as:

A 
Pelvic pathology
Endometriosis
Adenomyosis
Leiomyomas
Adhesions
PID
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25
Q

Most common secondary cause of dysmenorrhea in younger patients. Most common secondary cause of dysmenorrhea in older pts

A

Endometriosis - younger

Adenomyosis - older

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26
Q

Diffuse pelvic pain right before or with onset of menses. May be associated with HA, N/V. Cramps usually last 1-3 days

A

Dysmenorrhea

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27
Q

Management of dysmenorrhea

A

NSAIDs first line
Local heat and vitamin E
Ovulation suppression - OCPs, etc.
Laparoscopy if medication fails to r/o secondary causes

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28
Q

Abnormal frequency/intensity of menses due to non organic causes - diagnosis of exclusion

A

Dysfunctional uterine bleeding (DUB)

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29
Q

Absence of menstrual period

A

Amenorrhea

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30
Q

Light flow or spotting

A

Cryptomenorrhea

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31
Q

Heavy or prolonged bleeding at normal menstrual intervals

A

Menorrhagia

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32
Q

Irregular bleeding between expected menstrual cycles

A

Metorrhagia

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33
Q

Irregular, excessive bleeding between expected menstrual cycles

A

Menometrorrhagia

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34
Q

Infrequent menstruation with a prolonged cycle length > 35 days but < 6 months

A

Oligomenorrhea

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35
Q

Frequent cycle interval (< 21 days)

A

Polymenorrhagia

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36
Q

Two etiologies of dysfunctional uterine bleeding (DUB)

A
  1. Chronic anovulation

2. Ovulatory

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37
Q

Cause of chronic anovulation

A

Unopposed estrogen

Seen especially with extremes of age

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38
Q

Workup of dysfunctional uterine bleeding includes:

A
  1. Pelvic exam
  2. Hormone levels
  3. Transvaginal US
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39
Q

Management of acute severe bleeding with DUB

A

High dose IV estrogens or high dose OCPs

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40
Q

Management of anovulatory DUB

A

OCPs first line

Progesterone if estrogen CI

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41
Q

Definitive treatment for DUB

A

Hysterectomy - done if not responsive to medical treatment

Endometrial ablation - can be done if hysterectomy not wanted

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42
Q

Two etiologies of vaginitis

A
  1. Infectious (bacterial, trichomoniasis, candida, cytolytic)
  2. Atrophic (postmenopausal, allergic rxn)
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43
Q

Copious discharge, watery grey-white “fish rotten” smell from vagina

A

Bacterial vaginosis

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44
Q

Malodorous discharge, frothy yellow-green vaginal discharge, strawberry cervix

A

Trichomoniasis vaginosis

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45
Q

Thick curd-like/cottage cheese vaginal discharge

A

Candidiasis vaginosis

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46
Q

Non odorous vaginal discharge that is white to opaque

A

Cytolytic vaginosis

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47
Q

Diagnosis of bacterial vaginosis

A 
Whiff test (fishy odor)
Microscopic: epithelial cells covered with bacteria
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48
Q

Diagnosis of trichomoniasis vaginosis

A

Mobile protozoa on wet mount, WBCs

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49
Q

Diagnosis of candidiasis vaginosis

A

Hyphae, yeast and spores on KOH prep

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50
Q

Diagnosis of cytolytic vaginosis

A

Copious lactobacilli, large number of epithelial cells

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51
Q

Management of:

  1. Bacterial vaginosis
  2. Trichomoniasis
  3. Candidiasis vaginosis
  4. Cytolytic vaginosis
A
  1. Metronidazole or Clindamycin
  2. Metronidazole or Tinidazole
  3. Fluconazole, intravaginal antifungals
  4. Discontinue tampon usage, sodium bicarbonate (sitz baths)
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52
Q

Ascending infection of the upper reproductive tract (may lead to sepsis, ectopic pregnancy or infertility)

A

Pelvic inflammatory disease

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53
Q

Most common causes of PID

A

N gonorrhea

Chlamydia

54
Q

People at increased risk of PID

A 
Multiple sex partners
Unprotected sex
Prior PID
Age 15-29
Nulliparous
IUD placement
55
Q

Pelvic/lower abdominal pain, dysuria, dyspareunia, vaginal discharge, nausea, vomiting

A

Pelvic inflammatory disease

56
Q

Lower abdominal tenderness, fever. Purulent cervical discharge. +/- bleeding

A

Pelvic inflammatory disease

57
Q

Cervical motion tenderness to palpation and rotation so severe they seem to rise off the bed

A

Chandelier sign

Pelvic inflammatory disease

58
Q

Diagnosis of PID

A
  1. Primarily clinical
  2. Obtain BhCG to r/o pregnancy
  3. Gram stain, WBC > 10,000
  4. Pelvic ultrasound if abscess suspected
  5. Laparoscopy if uncertain, severe disease or if no improvement with antibiotics
59
Q

Management of outpatient PID

A

Doxycycline + IM Ceftriaxone

60
Q

Management of inpatient PID

A

IV doxycycline + Cefoxitin or Cefotetan

61
Q

Complications of PID

A 
Fitz-Hugh Curtis Syndrome
Infertility
Tubo-ovarian abscess
Ectopic pregnancy
Chronic pelvic pain
62
Q

Hepatic fibrosis/scarring and peritoneal involvement. RUQ pain due to perihepatitis. May radiate to right shoulder. Often have normal LFTs. Violin string adhesions on anterior liver surface

A

Fitz-Hugh Curtis Syndrome

Complication of PID

63
Q

Uterine herniation into the vagina

A

Uterine prolapse

64
Q

Risk factors for pelvic organ prolapse

A 
Weakness of pelvic support structures
MC after childbirth
Multiple vaginal births
Obesity
Repeated heavy lifting
65
Q

Posterior bladder herniating into anterior vagina

A

Cystocele

66
Q

Pouch of Douglas (small bowel) into the upper vagina

A

Enterocele

67
Q

Distal sigmoid colon (rectum) herniates into the posterior distal vagina

A

Rectocele

68
Q

Pelvic or vaginal fullness, heaviness, “falling out” sensation. Lower back pain, vaginal bleeding, purulent discharge. Urinary frequency, urgency, stress continence

A

Pelvic organ prolapse

69
Q

Bulging vaginal mass especially with increased intra abdominal pressure

A

Pelvic organ prolapse

70
Q

Management of pelvic organ prolapse

A
  1. Kegel exercises, weight control
  2. Pessaries, estrogen treatment (improves atrophy)
  3. Hysterectomy, ligament fixation
71
Q

Cessation of menses > 1 year due to loss of ovarian function. Average age in the US is 50-52 y/o

A

Menopause

72
Q

Menopause before age 40 y/o; may occur sooner in pts with DM, smokers, vegetarians, malnourished pts

A

Menopause

73
Q

Signs/symptoms of menopause

A
  1. Estrogen deficiency changes

2. Atrophic vaginitis

74
Q

Estrogen deficiency changes

A 
Menstrual cycle alterations
Vasomotor instability (hot flashes)
Mood changes
Skin/nail/hair changes
75
Q

Thin, yellow discharge, vaginal pH > 5.5, pruritus

A

Atrophic vaginitis (menopause)

76
Q

Diagnosis of menopause

A
  1. FSH Assay

2. Increased FSH, LH, decreased estrogen

77
Q

________ is the predominant estrogen after menopause

A

Estrone

78
Q

Complications of menopause

A

Osteoporosis (fractures)
Cardiovascular risk
Hyperlipidemia

79
Q

Management of vasomotor instability with menopause

A

Estrogen, progesterone
Clonidine
SSRIs
Gabapentin

80
Q

Management of vaginal atrophy with menopause

A

Estrogen (transdermal, intravaginal)

81
Q

Management of osteoporosis prevention with menopause

A 
Calcium + Vitamin D
Weight bearing exercises
Bisphosphonates
Calcitonin
SERMs (Raloxifene, Tamoxifen)
82
Q

Indications for estrogen treatment for menopausal pts

A

Cannot have uterus

Cannot have prior CVAs, DVTs, PEs or liver disease

83
Q

Indications for estrogen + progesterone for menopausal pts

A

Often used if pt has intact uterus

84
Q

Pregnancy is diagnosed with:

A

hCG levels and/or urine pregnancy test

85
Q

During pregnancy, hCG should _______ every ______ days and will plateau at _________ gestation

A

double
2-3 days
10 week gestation

86
Q

Intrauterine pregnancy is seen after HcG quantity reaches about _________ (or at about _______ gestation)

A

2,000

5 weeks gestation

87
Q

Gravida

A

Total number of pregnancies (including abortions)

88
Q

Parity

A

Total number of births (over 20 weeks gestation)

89
Q

Naegele Rule

A

First day of LMP - 3 months + days + 1 year = conception date

90
Q

If patient has irregular menstrual periods, Naegele’s Rule should not be used, instead a ________ should be obtained for correct dating

A

US

91
Q

Increase in plasma levels during pregnancy may lead to:

A 
Hypotension
Increased cardiac output
Increased urinary frequency
Anemia
Increased GFR (decreased creatinine)
Edema
92
Q

Increased progesterone levels during pregnancy may lead to:

A

Relaxes smooth muscles
GERD
Constipation
Hyperventilation

93
Q

Increased levels of estrogen, fibrinogen, and procoagulation factors during pregnancy lead to:

A

Hypercoagulable state

94
Q

Increased blood flow to nasopharynx during pregnancy leads to

A

Rhinorrhea

95
Q

Frequency of scheduled visits for pregnancy

A

Every 4 weeks until 30 weeks gestation
Every 2 weeks until 36 weeks gestation
Every week until delivery

96
Q

Each pregnancy visit should include: (4)

A
  1. Blood pressure check
  2. Urine dipstick
  3. Fundal height
  4. Fetal heart rate (110-160 bpm)
97
Q

Pts who are AMA (> 35) and/or those with abnormal genetic screening are at increased risk for fetal aneuploidy. Testing can be done with: (3)

A
  1. Chorionic villus sampling (done 10-12 wks gestation)
  2. Amniocentesis (15-17 wks)
  3. Cell-free fetal DNA (mother blood - done after 10 wks) +/- ultrasound
98
Q

First trimester is defined as _________ weeks gestation

A

1-12

99
Q

If uterine size on physical exam does not correlate with last menstrual period:

A

Ultrasound should be obtained

100
Q

The fundal height (centimeters) should correlate to the number of weeks between:

A

20-36 weeks gestation

101
Q

Fetal heart rate may be heard at ________ with transvaginal ultrasound

A

6 weeks

102
Q

Fetal heart rate can be heard with hand held doppler at _______ gestation

A

12 weeks

103
Q

All first trimester pregnant patients need : (13)

A
  1. Rhesus type and screen
  2. CBC
  3. Pap smear (only if due)
  4. Rubella titer
  5. Urinalysis
  6. Urine culture
  7. RPR
  8. Hepatitis B Antigen
  9. Chlamydia screening
  10. Gonorrhea screening
  11. HIV
  12. HgA1c
  13. hCG quantification
104
Q

Pregnant pts with a HgA1c > _______ are diagnosed with DM

A

6.5%

105
Q

Nuchal translucency ultrasound should be done from ________ wks gestation to r/o chromosomal abnormalities. This should be combined with first trimester serum testing: (2)

A

11 - 13.6
PAPP-A (pregnancy associated plasma protein A)
BhCG quantification

106
Q

Second trimester of pregnancy is defined as:

A

13-27 weeks gestation

107
Q

A quadruple screen should be done between 15-20 weeks gestation to screen for chromosomal abnormalities, including:

A
  1. AFP
  2. Unconjugated estriol
  3. hCG
  4. Inhibin A
108
Q

Most common cause for an abnormal quad screen

A

Incorrect dating

109
Q

Quickening (sensation of fetal movement) occurs between:

A

16-20 weeks gestation

110
Q

Diabetes and anemia screening (CBC) should be done between ________ wks gestation. 2 DM screening options:

A

24-28 weeks
1. 75 g 2 hour (fasting) oral glucose tolerance test: only one abnormality is needed for diagnosis
2. 50 g 1 hour oral glucose tolerance test - not done fasting
If positive, over 140, patient should have 100 g 3 hour oral glucose tolerance test. Two abnormalities needed in the 3 hour glucose challenge

111
Q

Third trimester is defined as:

A

28-40 weeks gestation

112
Q

If patient was found to be Rh negative, Rhogam prophylaxis should be administered at

A

28 weeks gestation (3rd trimester)

113
Q

Vaccination that should be given to all pregnancies during third trimester

A

TDAP

114
Q

If pt was found to have STD during initial screening, repeat testing is done during:

A

Third trimester

115
Q

GBS screening should be done at _______ weeks gestation using a vaginal and rectal swab. If positive, prophylactic abx are given intrapartum.

A

35-37 weeks gestation

116
Q

HPV is associated with ______% of cervical cancer

A

99.7%

117
Q

Third most common gynecologic cancer

A 
Cervical CA
(#1 endometrial #2 ovarian)
118
Q

Risk Factors for cervical CA

A
  1. HPV
  2. Early onset of sexual activity
  3. Increased # of partners
  4. Smoking
  5. CIN
  6. DEX exposure (diethylstilbestrol was synthetic estrogen used in OCPs)
119
Q

Post coital bleeding/spotting is the most common symptoms. Pelvic pain +/- watery vaginal discharge. Metorrhagia

A

Cervical CA

120
Q

Diagnosis of cervical CA

A

Colposcopy with biopsy

Pap smear with cytology used for screening

121
Q

Individuals less than 15 y/o should receive ____ doses of HPV vaccine at least 6 months apart

A

2

122
Q

Individuals older than 15 y/o should receive _____ doses of HPV vaccine over a minimum of 6 months

A

3

123
Q

Termination of pregnancy before 20 weeks

A

Spontaeous abortion

124
Q

Spontaneous abortion is most common during first ________

A

7 weeks

125
Q

________ abortion is the only one associated with possible fetal viability

A

Threatened

126
Q

50% of all cases of spontaneous abortions are associated with:

A

Fetal chromosomal abnormalities

127
Q

Most common cause of first trimester bleeding

A

Threatened spontaneous abortion

128
Q

Cervical os is closed, no products of conception are expelled from uterus. Bloody vaginal discharge, spotting progressing to profuse blood

A

Threatened spontaneous abortion

129
Q

Pregnancy not salvageable, no products of conception expelled from uterus, progressive cervix dilation, +/- rupture of membranes, moderate bleeding > 7 days

A

Inevitable Spontaneous abortion

130
Q

Pregnancy not salvageable, some products of conception expelled, some still retained. Cervical os is dilated. Heavy bleeding, boggy uterus

A

Incomplete spontaneous abortion

131
Q

Fetal demise but still remained in uterus. No products of conception expelled, cervical os is closed. Loss of pregnancy symptoms, +/- brown discharge

A

Missed Spontaneous abortion

132
Q

Retained products of conception becomes infected, leading to infection of uterus and organs. Cervical os is closed, cervical motion tenderness. Foul brownish discharge, fevers, chills, uterine tenderness

A

Septic spontaneous abortion

EOR Family Medicine (14 decks)

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