PANCE_reproductive system M/F 7% Flashcards
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unilateral adnexal tenderness
unilateral mass
chills
maybe fever
….think….
tubo-ovarian abscess
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complication of PID
tubo-ovarian abscess
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treatment for tubo-ovarian abscess
IV abx
surgical drainage
….or both
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if a pt >35 yrs has atypical glandular cells found on cervical cytology, what is the next best step in evaluation?
colposcopy with endometrial biopsy
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RF for placental abruption
previous abruption
HTN
cocaine use
trauma
multiparity
smoking
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what factors distinguish abruption placentae from placenta previa?
significant pain
fetal stress
maternal complications
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placental abruption - pain or no pain? blood or no blood?
PAINFUL
may or may not show blood, b/c bleeding can be external or internal
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“What is the preferred method of delivery in a woman with placental abruption?”
“oxytocin-induced vaginal delivery. Cesarean delivery is reserved for significant maternal and fetal instability”
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what do labs of placental abruption show?
hypofibrinogenemia
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a pt presents with s/s consistent with tubo-ovarian abscess has a PE that reveals cervical motion tenderness and fullness in the L adnexa and a negative pregnancy test. What is most appropriate next step?
PELVIC U/S
Tx: gynecologic consult
admit
IV abx
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“How would a tubo-ovarian abscess appear on ultrasound or CT imaging?
“a complex multiloculated adnexal mass”
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“Where is the uterine fundus palpable at 36 weeks gestation?”
“at the xiphoid process”
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Where is the fundal height at 20 weeks?
the umbilicus
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What does the potassium hydroxide wet prep of a vaginal secretion sample evaluate?
odor
“the KOH whiff wet preparation test mixes a secretion sample w/ saline and 10-20% potassium hydroxide and the presence of a fishy amine odor represents a positive test”
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Clue cells
bacterial vaginosis
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if a pt is showing signs of ectopic pregnancy, is hypotensive, after aggressive resuscitation, what is the most appropriate next step?
emergent OB/GYN consult
….for possible operative management
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What is the best option for emergency contraception in terms of highest efficacy of pregnancies prevented?
copper IUD
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“Which of the following is the most appropriate treatment for stage IV uterine prolapse in a 50-year-old woman with no medical problems and no previous surgical history?
a) abd hysterectomy
b) ant colporrhaphy
c) post colporrhaphy
d) vaginal hysterectomy”
D) VAGINAL HYSTERECTOMY
“vaginal hysterectomy is associated with better outcomes and fewer complications than laparoscopic or abdominal hysterectomy”
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what is the strongest RF for ENDOMETRITIS?
CESAREAN SECTION
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“A 29 yo F has been trying to get pregnant for 7 years. She has never been pregnant before. A previous physical exam and lab work were all within normal limits. An ovulation kit confirms that she is ovulating. Her fiancé has fathered two children and recently had a semen analysis that indicated normal functioning sperm.” [What] is the most appropriate test of choice to evaluate this patient?”
hysterosalpingogram
to assess fallopian tube patency
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neonates who have a pulse under ______ bpm should receive __________
“neonates who have apulse under 100 bpm should receive POSITIVE AIRWAY PRESSURE FOR 30 SECONDS and be reassessed.”
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Babies with APGAR score of 7 or above can be ______.
Babies with APGAR score under 7 require _______
Infants with an Apgar score of seven or above can be warmed, dried, and closely observed. Infants with Apgar scores under seven require further efforts to alleviate their distress, such as positive airway pressure, pulse oximetry, and electrocardiographic monitoring.
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three vaginal infections
candidiasis
trichomoniasis
bacterial vaginosis
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A young woman reports that, for the last 3 days, she has noticed a malodorous greenish discharge. You take a thorough history and perform a pelvic examination. What is the best next step?
microscopic examination of discharge
this will reliably establish the diagnosis and direct proper therapy
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thick, curdy white discharge
think candidiasis
pH <4.5
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frothy green/yellow discharge
trichomoniasis
amine odor with KOH (as does BV)
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thin white grey discharge
bacterial vaginosis
amine odor with KOH (as does trichomoniasis)
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MC bacteria of BV
treatment of BV
Gardnerella vaginalis
metronidazole
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“Which of the following is recommended to use as an anti-hypertensive in a pregnant woman?
a) alpha-methyldopa
b) lisinopril
c) losartan
d) valsartan”
A) ALPHA-METHYLDOPA
(first line)
could also use labetalol, nifedipine, or HCTZ
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What ligament gets twisted with ovarian torsion?
infundibulopelvic ligament
it’s not fixed in place
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which ovary is more commonly affected by ovarian torsion?
THE RIGHT OVARY is more commonly affected b/c the right utero-ovarian ligament is longer than the left.
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what do labs show in ovarian torsion? what does imaging show?
labs - leukocytosis
imaging - enlarged ovary or ovarian mass
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four ways to diagnose PROM
clinical hx
pooling test (collection of amniotic fluid in vaginal fornix)
nitrazine test (pH > 6.5 turns paper blue)
ferning test (ferning of fluid as it dries on slide)
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what do we do for pts with PROM?
admission, OB consult
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pt’s with PCOS have a greater risk of developing what malignancy?
“The incidence of endometrial cancer in patients with PCOS is also much higher due to endometrial hyperplasia from chronic anovulatory cycles”
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lab findings of PCOS
high LH to FSH
androgen excess
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MC cause of infertility
PCOS
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What is PCOS most commony caused by?
insulin resistance
