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Family Medicine Rotation > Obstetrics/Gynecology > Flashcards

Obstetrics/Gynecology Flashcards

1
Q 
Breast Mass
Path:
Pt:
Dx:
Tx:
A

Path:
Fibrocystic breast disease MC benign lesion in breast-> fluctuating estrogen levels during menstrual cycles

Pt:
Rope-like or cobblestoning texture in bilateral breasts w/ cyclical pain associated w/ mensuration
30-50 y/o

Dx:
U/S: dense, prominent fibroglandular tissue w/ cysts but no discernible mass

Tx:
Therapeutic aspiration 
Avoidance of trauma to breasts
Wearing a supportive bra 
Oil of evening primrose 
Diet modifications:
-Caffeine restriction
-Low-fat diet
-Decrease alcohol consumption
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2
Q

Breast cancer
Path:
Dx:
Tx:

A

Path: MC: invasive ductal carcinoma

Dx:
Mammography + core biopsy (stereotactic biopsy)
Soft tissue mass or density and clustered microcalcifications
Spiculated soft tissue mass
MC location: upper outer quadrant
Biomarker: cancer antigen 27.29

Tx:
Estrogen receptor (ER) and progesterone receptor (PR)- cell proliferation controlled by estrogen (inhibited by tamoxifen)
-Endocrine therapy: Tamoxifen, letrozole
-Chemotherapy for high-risk characteristics:
High-grade tumors, Large size (>2cm), Pathologically involved lymph nodes

ER-negative and PR-negative
Unlikely to respond to endocrine therapy
Cytotoxic chemotherapy

HER2 (human epidermal growth factor 2) +
Trastuzumab, targets HER2 receptors

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3
Q

PAP Smear: Negative

A

Neg HPV-> q3y

> 25 y/o +HPV-> repeat annually

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4
Q

PAP Smear: ASC-US

A 
atypical squamous cells of undermined significance 
<30: repeat in 1 yr
>30:
HPV +: colposcopy
HPV -: repeat in 3 yrs
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5
Q

PAP Smear: LSIL

A

Low grade squamous intraepithelial lesion

Colposcopy

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6
Q

PAP Smear: ASC-H

A

Atypical squamous cells cannot exclude HSIL- high grade squamous intraepithelial
Colposcopy

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7
Q

PAP Smear: HSIL

A

High grade squamous intraepithelial lesions

Colposcopy or loop excision

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8
Q

PAP Smear: AGC

A

Atypical glandular cells of undetermined significance
Colposcopy
>35: endometrial bx

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9
Q

OCPs
MOA
Contraindications:

A

MOA:
Progestin: Suppression of LH-> inhibits ovulation, Thickening of cervical mucus, Altered fallopian tube peristalsis
Estrogen: Suppressed FSH-> prevents development of dominant follicle, Potentiates progestin effects, Primarily cycle control

Contraindications:
Epilepsy 
Breastfeeding 
High risk for VTE
Morbid obesity 
severe vascular HA (migraine) 
DM
Severe HTN
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10
Q

Progestin
Indications
MOA

A

Indication: breast feeding, cannot take estrogen
MOA: thickening of cervical mucus

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11
Q 
Cystocele 
Path:
Pt:
Dx:
Tx:
A

Path: Posterior bladder herniating into the anterior vagina

Pt: Incontinence

Dx: Speculum exam-> anterior bulge in vagina

Tx:
Pelvic floor muscle training
Vaginal pessary
Colporrhaphy: surgical repair of defect in vaginal wall

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12
Q

Dysfunctional uterine bleeding
Path:
Dx:
Tx:

A

Path:
Chronic anovulation (90%):
disruption of hypothalamus-pituitary axis (teens, perimenopausal)
Unopposed estrogen: inc endometrial overgrowth
Ovulatory (10%)

Dx: DOE
hormone levels, TV U/S,
endometrial bx: endometrial stripe >4mm on U/S, women >35yrs

Tx:
Acute severe bleeding:. High-dose IV estrogen or high dose OCPs. Reduce dose as bleeding improves, D&C may be used if IV estrogen fails

Anovulatory (90%)
OCPs 1st line, Progesterone (medroxyprogesterone): if estrogen is contraindicated, GnRH agonists (leuprolide): causes temporary amenorrhea (if given in continuous fashion)

Ovulatory (10%)
OCPs: regulate cycles, thins endometrial lining
Progesterone: orally or IUD (mirena reduced bleeding in 79-94%)
GnRH agonists: Leuprolide w/ add-back progesterone (to reduce the S/E of leuprolide)

Surgery: hysterectomy, endometrial ablation

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13
Q

Dysmenorrhea
Path:
Tx:

A

Painful menstruation that affects normal activities
Path:
Primary: not due to pelvic pathology
Inc prostaglandins -> painful uterine muscle wall activity.
Secondary: due to pelvic pathology
endometriosis, adenomyosis, leiomyomas, adhesions, PID

Tx:
NSAIDs
Ovulation suppression
Laparoscopy

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14
Q

Intrauterine pregnancy

Dx:

A

Yolk sac within a gestational sac
intrauterine fetal pole
Intrauterine fetal heart activity
TVUS >38 days after LMP or beta-hCG >1500
Abdominal US >45 days after LMP or beta-hCG >4000

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15
Q

Menopause
Dx:
Tx:

A

Dx: Inc FSH/LH dec estrogen

Tx:
hot flashes: estrogen, progesterone, clonidine, SSRIs
Vaginal atrophy: estrogen
Osteoporosis prevention: calcium + vit D, weight bearing exercise, bisphosphonates, calcitonin
RTC:
Estrogen only:
pros: most effective tx sx, no inc risk of breast cancer
cons: inc risk endometrial cancer, VTE, liver disease
E + P:
pros: sx relief, dec heart and stroke risk, dec osteoporosis, dec dementia, protective against endometrial cancer
cons: VTE, slight increase risk of breast cancer

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16
Q 
Pelvic inflammatory disease
Path:
Pt:
Dx:
Tx:
A

Path:
MC Chlamydia trachomatis
Hx of unprotected sex w/ multiple partners

Pt:
Cervical motion tenderness -> “chandelier sign”
Dyspareunia

Dx: 
Abdominal tenderness + cervical motion tenderness + adnexal tenderness plus at least one of the following:
\+gram stain
Temperature >38
WBC >10k
Pus culdocentesis or laparoscopy

Tx:
Out pt:
Ceftriaxone 250mg IM x1 dose + doxycycline 100mg BID x14d +/- metronidazole
In pt:
IV doxycycline + 2nd gen cephalosporin (cefoxitin, cefotetan) OR
Clindamycin + gentamicin

17
Q 
Rectocele
Path:
Pt:
Dx:
Tx:
A

Path:
Distal sigmoid colon (rectum) herniated into the posterior distal vagina

Pt:
Constipation
Hx of childbirth, trauma, previous surgeries

Dx: Speculum exam-> posterior bulge in posterior vaginal wall

Tx:
Colporrhaphy: surgical repair of defect in vaginal wall
Manage constipation-> high fiber diet
Pessary device

18
Q 
Threatened abortion 
Path:
Pt:
Dx:
Tx:
A

Path:
Pregnancy may be viable or abortion may follow
MC cause of 1st trimester bleeding

Pt:
Bloody vaginal discharge 
Spotting -> profuse
\+/- contractions 
Uterus size compatible w/ dates

Dx:
Products of conception: No POC expelled from uterus
Cervical OS: Closed

Tx:
Supportive: rest @ home, return to ER if sx persist or passage of POC
Serial B-HCG to see if doubling
RhoGAM if indicated

19
Q 
Vaginitis 
Path:
Pt:
Dx:
Tx:
A

Path: Trichomonas vaginalis
Pt:Malodorous frothy, green/yellow vaginal discharge
Strawberry cervix

Dx: 
Wet mount 
Labs: 
pH>5
Flagellated motile, pear shaped

Tx: PO metronidazole 2g x1 dose or tinidazole

Bacterial Vaginitis
Path: Gardnerella vaginalis
Pt:Malodorous vaginal secretions

Dx: 
3/4 Amsel criteria
thin, gray/white discharge 
pH>4.5
clue cells 
KOH to smear -> fishy odor, “whiff test”

Tx: Metronidazole (ok while pregnant)

20
Q 
Inevitable abortion 
Path:
Pt:
Dx:
Tx:
A

Path: Pregnancy not salvageable

Pt:
Moderate bleeding >7d
Mod-severe uterus cramping
Uterus size compatible w/ dates

Dx: 
Products of conception: No POC expelled 
Cervical OS:
Progressive cervix dilation: >3cm, effaced
\+/- rupture of membranes

Tx:
2nd trimester: Dilation and Evacuation (D&E)
1st trimester: suction curettage
RhoGAM if indicated

21
Q 
Incomplete abortion 
Path:
Pt:
Dx:
Tx:
A

Path: Pregnancy not salvageable

Pt:
Heavy bleeding
Mod-severe cramping
Retained tissue
Boggy uterus

Dx:
Products of conception: some POC expelled, some still retained
Cervical OS: Dilated

Tx:
May be allowed to finished 
D&amp;E after 1st trimester 
D&amp;C in 1st trimester 
Pitocin
RhoGAM if indicated
22
Q 
Complete abortion 
Path:
Pt:
Dx:
Tx:
A

Path: Complete passage of all products

Pt:
Pain, cramps and bleeding usually subsides
Pre-pregnancy size of uterus

Dx:
Products of conception: All POC expelled from uterus
Cervical OS: usually closed

Tx:
RhoGAM if indicated

23
Q 
Missed abortion 
Path:
Pt:
Dx:
Tx:
A

Path: Fetal demise but still retained in uterus

Pt:
Loss of pregnancy sx
Brown discharge

Dx:
Products of conception: no POC expelled
Cervical OS: closed

Tx:
D&E 2nd trimester
D&C 1st trimester
Misoprostol

24
Q 
Septic abortion 
Path:
Pt:
Dx:
Tx:
A

Path: The retained POC becomes infected -> infection of uterus and organs

Pt:
Foul brownish discharge, fever, chills
Uterine tenderness
Spotting -> heavy bleed

Dx:
Products of conception: Some POC retained
Cervical OS: Closed, CMT

Tx:
D&E to remove POC + broad spectrum abx
+/- hysterectomy if refractory

Family Medicine Rotation (14 decks)

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