Obstetrics / Gynecology Flashcards
1
Q
Most common breast disorder
A
Fibrocystic breast disorder
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
3
Q
Diagnosis of fibrocystic breast disorder
A
- Ultrasound
2. FNA - straw colored fluid
4
Q
Management of fibrocystic breast disorder
A
Most will resolve spontaneously
+/- FNA removal of fluid if symptomatic
5
Q
2nd most common breast disorder
A
Fibroadenoma of the breast
6
Q
Composed of glandular and fibrous tissue (collagen arranged in “swirls”)
A
Fibroadenoma of the breast
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
8
Q
Management of fibroadenomas
A
Observation
Most small tumors resorb with time
Excision if painful
9
Q
Most common forms of breast cancer
A
Ductal (milk ducts) or lobular (lobules that produce milk)
10
Q
Most common non-skin malignancy in women
A
Breast Cancer
11
Q
2nd most common cause of cancer death in women
A
Breast cancer
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
13
Q
Most common type of breast cancer
A
- Infiltrative ductal carcinoma
2. Upper outer quadrant
14
Q
Breast mass - usually painless, hard, fixed
Pain is rare
+/- axillary lymphadenopathy
Unilateral nipple discharge
A
Breast cancer
15
Q
Most common locations of breast CA METS
A
Lung
Liver
Bone
Brain
16
Q
Chronic eczematous itchy, scaling rash on the nipples and areolas
A
Paget’s Disease of the Nipple
Indicative of breast CA
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
18
Q
Peau d’ orange
A
Skin changes due to lymphatic obstruction associated with poor prognosis
19
Q
Diagnosis of breast CA
A
- Mammogram
- Ultrasound - recommended initial modality
- FNA biopsy, core biopsy, excisional biopsy
20
Q
Chemotherapy for breast CA
A
Used in stages II-IV and inoperable dz
Especially ER neg CA
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
22
Q
Painful menstruation that affects normal activities
A
Dysmenorrhea
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
24
Q
Secondary dysmenorrhea is due to ___________, such as:
A
Pelvic pathology Endometriosis Adenomyosis Leiomyomas Adhesions PID
25
Most common secondary cause of dysmenorrhea in younger patients. Most common secondary cause of dysmenorrhea in older pts
Endometriosis - younger
| Adenomyosis - older
26
Diffuse pelvic pain right before or with onset of menses. May be associated with HA, N/V. Cramps usually last 1-3 days
Dysmenorrhea
27
Management of dysmenorrhea
NSAIDs first line
Local heat and vitamin E
Ovulation suppression - OCPs, etc.
Laparoscopy if medication fails to r/o secondary causes
28
Abnormal frequency/intensity of menses due to non organic causes - diagnosis of exclusion
Dysfunctional uterine bleeding (DUB)
29
Absence of menstrual period
Amenorrhea
30
Light flow or spotting
Cryptomenorrhea
31
Heavy or prolonged bleeding at normal menstrual intervals
Menorrhagia
32
Irregular bleeding between expected menstrual cycles
Metorrhagia
33
Irregular, excessive bleeding between expected menstrual cycles
Menometrorrhagia
34
Infrequent menstruation with a prolonged cycle length > 35 days but < 6 months
Oligomenorrhea
35
Frequent cycle interval (< 21 days)
Polymenorrhagia
36
Two etiologies of dysfunctional uterine bleeding (DUB)
1. Chronic anovulation
| 2. Ovulatory
37
Cause of chronic anovulation
Unopposed estrogen
| Seen especially with extremes of age
38
Workup of dysfunctional uterine bleeding includes:
1. Pelvic exam
2. Hormone levels
3. Transvaginal US
39
Management of acute severe bleeding with DUB
High dose IV estrogens or high dose OCPs
40
Management of anovulatory DUB
OCPs first line
| Progesterone if estrogen CI
41
Definitive treatment for DUB
Hysterectomy - done if not responsive to medical treatment
| Endometrial ablation - can be done if hysterectomy not wanted
42
Two etiologies of vaginitis
1. Infectious (bacterial, trichomoniasis, candida, cytolytic)
2. Atrophic (postmenopausal, allergic rxn)
43
Copious discharge, watery grey-white "fish rotten" smell from vagina
Bacterial vaginosis
44
Malodorous discharge, frothy yellow-green vaginal discharge, strawberry cervix
Trichomoniasis vaginosis
45
Thick curd-like/cottage cheese vaginal discharge
Candidiasis vaginosis
46
Non odorous vaginal discharge that is white to opaque
Cytolytic vaginosis
47
Diagnosis of bacterial vaginosis
```
Whiff test (fishy odor)
Microscopic: epithelial cells covered with bacteria
```
48
Diagnosis of trichomoniasis vaginosis
Mobile protozoa on wet mount, WBCs
49
Diagnosis of candidiasis vaginosis
Hyphae, yeast and spores on KOH prep
50
Diagnosis of cytolytic vaginosis
Copious lactobacilli, large number of epithelial cells
51
Management of:
1. Bacterial vaginosis
2. Trichomoniasis
3. Candidiasis vaginosis
4. Cytolytic vaginosis
1. Metronidazole or Clindamycin
2. Metronidazole or Tinidazole
3. Fluconazole, intravaginal antifungals
4. Discontinue tampon usage, sodium bicarbonate (sitz baths)
52
Ascending infection of the upper reproductive tract (may lead to sepsis, ectopic pregnancy or infertility)
Pelvic inflammatory disease
53
Most common causes of PID
N gonorrhea
| Chlamydia
54
People at increased risk of PID
```
Multiple sex partners
Unprotected sex
Prior PID
Age 15-29
Nulliparous
IUD placement
```
55
Pelvic/lower abdominal pain, dysuria, dyspareunia, vaginal discharge, nausea, vomiting
Pelvic inflammatory disease
56
Lower abdominal tenderness, fever. Purulent cervical discharge. +/- bleeding
Pelvic inflammatory disease
57
Cervical motion tenderness to palpation and rotation so severe they seem to rise off the bed
Chandelier sign
| Pelvic inflammatory disease
58
Diagnosis of PID
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
Management of outpatient PID
Doxycycline + IM Ceftriaxone
60
Management of inpatient PID
IV doxycycline + Cefoxitin or Cefotetan
61
Complications of PID
```
Fitz-Hugh Curtis Syndrome
Infertility
Tubo-ovarian abscess
Ectopic pregnancy
Chronic pelvic pain
```
62
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
Fitz-Hugh Curtis Syndrome
| Complication of PID
63
Uterine herniation into the vagina
Uterine prolapse
64
Risk factors for pelvic organ prolapse
```
Weakness of pelvic support structures
MC after childbirth
Multiple vaginal births
Obesity
Repeated heavy lifting
```
65
Posterior bladder herniating into anterior vagina
Cystocele
66
Pouch of Douglas (small bowel) into the upper vagina
Enterocele
67
Distal sigmoid colon (rectum) herniates into the posterior distal vagina
Rectocele
68
Pelvic or vaginal fullness, heaviness, "falling out" sensation. Lower back pain, vaginal bleeding, purulent discharge. Urinary frequency, urgency, stress continence
Pelvic organ prolapse
69
Bulging vaginal mass especially with increased intra abdominal pressure
Pelvic organ prolapse
70
Management of pelvic organ prolapse
1. Kegel exercises, weight control
2. Pessaries, estrogen treatment (improves atrophy)
3. Hysterectomy, ligament fixation
71
Cessation of menses > 1 year due to loss of ovarian function. Average age in the US is 50-52 y/o
Menopause
72
Menopause before age 40 y/o; may occur sooner in pts with DM, smokers, vegetarians, malnourished pts
Menopause
73
Signs/symptoms of menopause
1. Estrogen deficiency changes
| 2. Atrophic vaginitis
74
Estrogen deficiency changes
```
Menstrual cycle alterations
Vasomotor instability (hot flashes)
Mood changes
Skin/nail/hair changes
```
75
Thin, yellow discharge, vaginal pH > 5.5, pruritus
Atrophic vaginitis (menopause)
76
Diagnosis of menopause
1. FSH Assay
| 2. Increased FSH, LH, decreased estrogen
77
________ is the predominant estrogen after menopause
Estrone
78
Complications of menopause
Osteoporosis (fractures)
Cardiovascular risk
Hyperlipidemia
79
Management of vasomotor instability with menopause
Estrogen, progesterone
Clonidine
SSRIs
Gabapentin
80
Management of vaginal atrophy with menopause
Estrogen (transdermal, intravaginal)
81
Management of osteoporosis prevention with menopause
```
Calcium + Vitamin D
Weight bearing exercises
Bisphosphonates
Calcitonin
SERMs (Raloxifene, Tamoxifen)
```
82
Indications for estrogen treatment for menopausal pts
Cannot have uterus
| Cannot have prior CVAs, DVTs, PEs or liver disease
83
Indications for estrogen + progesterone for menopausal pts
Often used if pt has intact uterus
84
Pregnancy is diagnosed with:
hCG levels and/or urine pregnancy test
85
During pregnancy, hCG should _______ every ______ days and will plateau at _________ gestation
double
2-3 days
10 week gestation
86
Intrauterine pregnancy is seen after HcG quantity reaches about _________ (or at about _______ gestation)
2,000
| 5 weeks gestation
87
Gravida
Total number of pregnancies (including abortions)
88
Parity
Total number of births (over 20 weeks gestation)
89
Naegele Rule
First day of LMP - 3 months + days + 1 year = conception date
90
If patient has irregular menstrual periods, Naegele's Rule should not be used, instead a ________ should be obtained for correct dating
US
91
Increase in plasma levels during pregnancy may lead to:
```
Hypotension
Increased cardiac output
Increased urinary frequency
Anemia
Increased GFR (decreased creatinine)
Edema
```
92
Increased progesterone levels during pregnancy may lead to:
Relaxes smooth muscles
GERD
Constipation
Hyperventilation
93
Increased levels of estrogen, fibrinogen, and procoagulation factors during pregnancy lead to:
Hypercoagulable state
94
Increased blood flow to nasopharynx during pregnancy leads to
Rhinorrhea
95
Frequency of scheduled visits for pregnancy
Every 4 weeks until 30 weeks gestation
Every 2 weeks until 36 weeks gestation
Every week until delivery
96
Each pregnancy visit should include: (4)
1. Blood pressure check
2. Urine dipstick
3. Fundal height
4. Fetal heart rate (110-160 bpm)
97
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)
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
First trimester is defined as _________ weeks gestation
1-12
99
If uterine size on physical exam does not correlate with last menstrual period:
Ultrasound should be obtained
100
The fundal height (centimeters) should correlate to the number of weeks between:
20-36 weeks gestation
101
Fetal heart rate may be heard at ________ with transvaginal ultrasound
6 weeks
102
Fetal heart rate can be heard with hand held doppler at _______ gestation
12 weeks
103
All first trimester pregnant patients need : (13)
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
Pregnant pts with a HgA1c > _______ are diagnosed with DM
6.5%
105
Nuchal translucency ultrasound should be done from ________ wks gestation to r/o chromosomal abnormalities. This should be combined with first trimester serum testing: (2)
11 - 13.6
PAPP-A (pregnancy associated plasma protein A)
BhCG quantification
106
Second trimester of pregnancy is defined as:
13-27 weeks gestation
107
A quadruple screen should be done between 15-20 weeks gestation to screen for chromosomal abnormalities, including:
1. AFP
2. Unconjugated estriol
3. hCG
4. Inhibin A
108
Most common cause for an abnormal quad screen
Incorrect dating
109
Quickening (sensation of fetal movement) occurs between:
16-20 weeks gestation
110
Diabetes and anemia screening (CBC) should be done between ________ wks gestation. 2 DM screening options:
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
Third trimester is defined as:
28-40 weeks gestation
112
If patient was found to be Rh negative, Rhogam prophylaxis should be administered at
28 weeks gestation (3rd trimester)
113
Vaccination that should be given to all pregnancies during third trimester
TDAP
114
If pt was found to have STD during initial screening, repeat testing is done during:
Third trimester
115
GBS screening should be done at _______ weeks gestation using a vaginal and rectal swab. If positive, prophylactic abx are given intrapartum.
35-37 weeks gestation
116
HPV is associated with ______% of cervical cancer
99.7%
117
Third most common gynecologic cancer
```
Cervical CA
(#1 endometrial #2 ovarian)
```
118
Risk Factors for cervical CA
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
Post coital bleeding/spotting is the most common symptoms. Pelvic pain +/- watery vaginal discharge. Metorrhagia
Cervical CA
120
Diagnosis of cervical CA
Colposcopy with biopsy
| Pap smear with cytology used for screening
121
Individuals less than 15 y/o should receive ____ doses of HPV vaccine at least 6 months apart
2
122
Individuals older than 15 y/o should receive _____ doses of HPV vaccine over a minimum of 6 months
3
123
Termination of pregnancy before 20 weeks
Spontaeous abortion
124
Spontaneous abortion is most common during first ________
7 weeks
125
________ abortion is the only one associated with possible fetal viability
Threatened
126
50% of all cases of spontaneous abortions are associated with:
Fetal chromosomal abnormalities
127
Most common cause of first trimester bleeding
Threatened spontaneous abortion
128
Cervical os is closed, no products of conception are expelled from uterus. Bloody vaginal discharge, spotting progressing to profuse blood
Threatened spontaneous abortion
129
Pregnancy not salvageable, no products of conception expelled from uterus, progressive cervix dilation, +/- rupture of membranes, moderate bleeding > 7 days
Inevitable Spontaneous abortion
130
Pregnancy not salvageable, some products of conception expelled, some still retained. Cervical os is dilated. Heavy bleeding, boggy uterus
Incomplete spontaneous abortion
131
Fetal demise but still remained in uterus. No products of conception expelled, cervical os is closed. Loss of pregnancy symptoms, +/- brown discharge
Missed Spontaneous abortion
132
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
Septic spontaneous abortion
