PPP ROSH- Repro/GU Flashcards by brandon lovin

What types of images are best done by CT w/out contrast

What are the four T’s of post-partum hemorrhage

What conditions make the use of methyergonovine a c/i for Tx post-partum hemorrhage

Dz processes w/ calcifications

aTony- MC
Trauma to birth canal
Tissue retention
Thrombin/coagulopathy d/o

HTN, Arterial Dzs

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MC non-cutaneous male Ca

How often are PTs f/u after Tx

When are screening initiations considered

Prostate: smooth, enlarged prostate w/ focal hard nodule on DRE

PSA q6mon x5yrs then annually

50y/o; 40-45 in AfAm or +FamHx

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How does epididymitis present on PE

What causes this to occur in sexually active men

If pos STD panel, how are PTs Tx

Gradual onset w/ inc color/size on Doppler relieved w/ elevation (Prehns sign)

C>G (>35- EColi)

Ceftriax and Doxy (Azith if intolerant to Doxy)

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How is epididymitis Tx in non-sexually active/>35y/o Pts

How are Pts Tx how practice receptive anal intercourse

MC ectopic pregnancy location

-floxacin or TMP/SMX

Ceftriax/TMP-SMX

Ampullary

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MC RF for developing ectopic pregnancy

How are Stage 1-2 uterine prolapses Tx

What is the definitive method of Dx ovarian torsion

Previous ectopic pregnancy

Pessary

Surgical w/ direct visualization

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MC type of vulvar cancer w/ ? MC association

How does this MC present on PE

What are the RFs for this Ca

SCC d/t HPV

Pruritic labia lesion

HPV Smoking Vulvar lichen sclerosis

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What is c/i during the Tx of acute bacterial prostatitis

How is this ID’d on PE

Why is care taken during PE work up

Catheter-

Warm, boggy, tender prostate

Septicemia induced from DRE

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How are Pts w/ bacterial prostatitis Tx

Two characteristics of Inevitable Abortion

What is the MC puerperal infection

4-6wks w/ fluroquinolone and culture of cure

Open os, Gestational sac at uterus opening

Post-partum endometritis d/t c-section induced infection of decidua

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Only three pregnancy issues w/ open os

What are the RFs for post-partum endometritis

Uterus grows out of the pelvis at ? week of pregnancy and reaches umbilicus at wk ?

Inevitable, Incomplete, Septic

C-section, PROM >24hrs, Labor >12hrs, Multiple pelvic exams

12, 20

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MC malignancy in males age 15-35y/o

How does this MC present on PE

What serum markers are used for tracking this Ca depending on the type

Testicular Ca

Painless nodule/swelling

Seminoma: b-hCG, LDH
Non-seminoma: b-hCG , AF-protein, LDH

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What male PE finding suggests a testicular Ca from germ cell tumor

MOA of PD-5 inhibitors

MOA of nitrofurantoin

Gynecomastia

Inhibits break down of c-GMP to inc Ca allowing for smooth muscle relaxation and inc blood into penis

Cidal and inhibits cell wall synthesis to Tx uncomplicated lower UTIs

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MCC of UTIs

Name of test to identify if maternal and fetal blood mixing has occurred

How does the week of pregnancy/trauma change the dose of Rhogam

EColi

Kleihauer Betke test

<12wks: 50ug, >12wks: 300ug, both must be done <72hrs

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How do placenta previas present

How are these Pts best assessed upon arrival

How doe placental abruptions present

Painless bright red blood in 3rd trimester

Transvaginal US

Painful, third trimester bleeding

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Tumor marker for tracking ovarian Ca

How does this type of Ca present depending on age

What are protective factors against this Ca

Ca-125

Epithelial: >50y/o
Stromal: any age
Germ: 15-19y/o

Hormonal contraception
Tubal ligation
Hysterectomy

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MC pelvic tumor

How are these Dx and Tx

? medication is MC associated w/ developing endometrial polyps

Leiomyoma- smooth muscle/uterine mass

TV-US, GnRH agonist (-relix)

Tamoxifen- SERM for Tx breast Ca

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BV presentation on PE

How is this Tx

This Dx is the MCC of ?

Gray/white d/c w/ odor, clue cells on KOH prep (epithelial cells surrounded by bacteria)

Metronidazole or Clinda

Vaginitis

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BV is caused by imbalance of ? microbe

What criteria must be met for Dx

How is intrauterine pregnancy Dx

Lactobacillus- Gardnerella vaginalis and Mycoplasma hominis

3 of 4:
White/Gray d/c Clue cells pH >4.5
Fishy odor w/ whiff test

Gestational sac w/ yolk sac in uterus at 5.5wks gestation

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What is the earliest sign of an embryo seen on US

Atrophic vaginitis is AKA ?

MCC of mastitis and how is pain Tx

Fetal pole- thickened margin of yolk sac

GU syndrome of menopause

Clogged ducts d/t Saph A/albus;
Ibuprofen

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If ABX are used for mastitis, ? ones are selected

Infants should be solely breast fed for how long

MC breast mass in young adults

Dicloxacillin, Cephalexin- anti-staph
Clinda/TMP- MRSA
Vanc- inpatient

First 6mon

Fibroadenoma- painless, firm, mobile mass (breast mouse- slips under hand during exam)

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Define Gestational Trophoblastic Dz

What are the two types

How does this appear on TV-US

Hydatidiform mole- potential to mets w/ association w/ choriocarcinoma

Complete: 46XX or 46XY
Partial: Triploid, Tetraploid: 69XXX, 69XXY

Inc b-hCG w/ anechoic spaces (snow storm)
Bag of grapes appearance

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Dietary insufficiency of ? increases female risk for complete mole

MC maternal complication of placental abruption

What lab abnormality would be seen and consistent w/ abruption dx

Vit A

Consumptive coagulopathy- thrombyocytopenia, hypofibrinogenemia

Hypofibrinogenemia

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MC type of Gyn Ca

Mnemonic for BPH Sxs

How is AUB initially Tx

Uterine

Hesitant 
Intermittence/Incontinence
Frequency/Fullness
Urgency
Nocturia

OCPs w/ NSAIDs

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How is AUB Tx in Pts w/ coagulation d/os

How does BPH present on DRE

MC med used to induce labor in women w/ favorable cervix

Desmopressin

Smooth, firm and enlarged

Oxytocin- inc receptor sensitivity and increased by fetal pressure on cervix

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MOA of cervical ripening

How are prostate Cas categorized into severity

Define Cystocele

Breaking of disulfide bonds

Gleason pattern:
2-6: well differentiated, low
7: intermediate, mod
8-10: poor differentiated, high

Bladder pushes posteriorly into vaginal wall (forms anterior wall hernia)

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? marker is best for monitoring for recurrent gestation trophoblastic dz What four presentations make this Dx a possibility How is endometrial carcinoma excluded in post-menopausal women

Quant b-hCG Vaginal bleeding w/ pressure/pain Uterine size bigger than EGA Hyperemesis gravidarum Pre-E <20wks gestation Endometrial thickness <4mm in TV-US

MC type of endometrial carcinoma What is a positive nitrazine test What other test can help Dx ROM

Adenocarcinoma Paper turns blue Ferning test

Why would TMP-SMX be avoided in Tx PPROM 3 Ds of Endometriosis MC location of the ectopic endometrial tissue

Necrotizing enterocolitis Dysmenorhea Dyspareunia Dyschezia d/t retrograde menstruation Ovaries

Ovarian torsion PE findings MC gyn condition in pre-pubertal children Preg A/B/C verbiage

Pain w/ testicular elevation Absent cremaster reflex Horizontally lying testicle Vulvovaginitis A: adequate trial fail to show risks B: animal trials fail to show danger to fetus C: animal trials have shown adverse effects

How is cervical dysplasia ID'd on PE When are cervical Ca screenings started ? puts Pts at increased risk for Pre-E

Acetic acid application reveals white, sharply demarcated lesions on cervix PAP smears at 21y/o and q3yrs Autoimmune Dz

What is the only medication proven to reduce developing Pre-E How is gestational DM Dx

Low dose ASA ``` 1hr 50g challenge at 24-28wks. 130-140 after 1hr, 3hr test must be done <1wk. 100g challenge w/ 2 findings makes a Dx: >95mg fasting >180 after 1hr >155 after 2hrs >140 after 3hrs ```

RFs for Leiomyoma development MCC of menorrhagia How are UTIs in pregnancy Tx

Hyper-estrogen/tension Age Nulliparity Fibroids Amoxicillin

Criteria for HELPP Syndrome Dx What would be seen if HELPP also had DIC

Hemolysis: Significant Hgb drop, Abnormal smear, Lower haptoglobin, Elevate bili ≥1.2mg Elevated liver enzymes ≥2x normal Low Platelets <100K Bleeding Inc PT/PTT Dec fibrinogen

Major criteria for PID How is this Tx What lab is ordered when working up premenstrual syndrome

Lower abdominal pain w/ uterine/adnexal/cervical motion tenderness Ceftriax 500mg IM x 1, w/ Doxy 100mg BID and Metronidazole 500mg BID x 14days TSH

How does genital HSV present How are these Tx MCC of AUB in post-menopausal woman

Painful, shallow lesions 2-7d after contraction Acyclovir Endometrial/vaginal atrophy

Criteria to Dx post-partum hemorrhage MC type of invasive breast Ca MC cystic structure of the ovary

≥1000mL blood loss Infiltrating ductal Follicular cyst

How does fibrocystic breast dz present What is initial therapy What dz causes eczematous lesion of the nipple

Sxs worse leading up to cycle Bra support, Dec caffeine Paget's

# Define Chadwick's sign Define Goodell's sing Define Hegar sign

Bluish discoloration d/t inc vasculature Cervical softening Uterus enlargement/softening

How are inevitable miscarriages Tx What complication would Pt w/ Ehlers Danlos present w/ How are these Pts managed

DnC, Misoprostol, Expectantly 2nd trimester loss w/out contractions Cerclage placement 12-14wks

What causes AUB What is a RF for occiput posterior First and Second line Tx for dysmenorrhea

Failed formation of corpus luteum leading to no progesterone and unopposed estrogen stimulation Nulliparous NSAID (dec prostaglandins) then Hormones

How does Trichomoniasis present How is this Tx ED Tx med w/ longest duration

Frothy green/yellow d/c w/ strawberry cervix Metronidazole/Tinidazole w/ alcohol avoidance Tadalafil- 24-72hrs

# Define criteria for PMS Dx What is the best initial Tx for these Pts ? serum marker is elevated during testicular Ca

Daily function altered by menstrual Sxs SSRI- Fluoxetine A-F-protein (also in hepatocellular Ca)

MC location for renal calculus to become stuck ? sizes are most to least likely to pass Bladder Ca is ? type

Ureterovescular junction <5mm: most >8: least Transitional cell carcinoma

What two expousres increase chances of bladder Ca Define Oligomenorrhea Define Polymenorrhea

Smoking, Industrial dyes: Anilline Cycle >35days Cycle <21d

# Define Menorrhagia Define Metrorrhagia Define Menometrorrhagia

Regular cycles w/ excessive flow/duration Irregular cycles Irregular cycles w/ excessive flow/duration

What non-hormone Tx method can be used for hot flashes How is non-sexual acute prostatitis Tx Combo therapy of ? classes can be used for BPH Tx

Gabapentin TMP-SMX or Cipro/O-floxacin x 4-6wks A-blockers: -osin (used first) PD5 inhibitors: -steride

Monotherapy for Chlamydia Monotherapy for Gonorrhea Turners Dx will have ? type of amenorrhea

Doxy Ceftriax Primary

# Define Hydrocele What are the two types When is surgical Tx indicated

Peritoneal fluid between parietal/visceral layers of tunica vaginalis Communicate: younger Pt, +size changes Non-Communicate: older Pt, no size changes Unresolved at 2y/o

? is the MC germ cell tumor Define Chorioamnionitis What PE findings suggest this Dx

Dermoid cyst (benign cystic mature teratoma) Intrauterine infection/inflammation d/t microbe invasion from cervix > hematogenous spread (Listeria) Fever Leukocytosis >15K Fetal tachy >160 Purulent/malodrous amniotic fluid

Preterm labor is prior to ? How is tender breast engorgement Tx in non-breastfeeding postpartum Pt How is postpartum endometritis Tx

<37wks Support bra, Cold compress, Avoid breast stimulation Clinda + Gentamicin, Amp-Sulbactam

MC form of testicular torsion Anti-hypertensive meds for severe Pre-E When is gestational diabetes screened

Intravaginal torsion- bell clapper Nifedipine Hydralazine Labetalol 24-28wks gestation

? tocolytics (uterine relaxants) can be used to post-pone labor How is prostatitis Dx ? complication arises from PID

It's Not My Time: Indomethacin Nifedipine Mg sulfate Terbutaline Urinary bacteria w/ WBCs Tubo-ovarian abscess: pain, fever, d/c, CMT and adnexal tenderness w/ mass Dx: TVUS w/ thick, well defined mass Tx: admit, IV ABX and surgical drainage

Post-menopausal bleeding Pt is best evaluated for Ca by ? What is used for seizure prophylaxis of Pre-E What is the antidote if too much is given

TVUS or Endometrial biopsy via pipelle suction curette Mg sulfate Ca gluconate

# Define Leopold Maneuver What week are these maneuvers usually performed Prostate screening criteria along w/ shared decision making

Determines lie and presentation of fetus: Superior, Sides, Inlet, Attitude/Extension 37wks Serum PSA and DRE

How often are STI screenings done for women Presentation of hydronephrosis Why does this have pain

Annual for G/C for women <25y/o Intermittent, colicky back pain radiating to groin Swelling of Gerotas fascia d/t obstructive uropathy

MCC of ovulatory infertility This US finding term is also used for ? GI condition

PCOS- Hyperandrogenism Oligo/An-ovulation Polycystic ovaries (string of pearls on US) String of pearls- small bowel obstruction

# Define Balanitis Define Balanoposthitis What DDx needs to be considered and how are they Tx

Inflammation of glans penis Inflammation of glans and foreskin only in uncircumcised Pts Diabetes; Clotrimazole

Unique UTI pathogen of adolescent females How is pyelonephritis Tx How is BV Tx

Staph saprophyticus Cipro Metronidazole 500mg BID x 7d

Urge incontinence Tx Stress incontinence Tx Overflow incontinence Tx Atonic incontinence Tx Mixed incontinence Tx

Anticholinergic- Oxybutynin, Tolterodine Topical estrogen A-blockers Intermittent cath Topical estrogen w/ Anticholinergics

# Define Fitz Hugh Curtis Syndrome What would be seen on ex-lap How are Pts Tx

RUQ pain w/ perihepatitis (normal LFTs) d/t incomplete Chlamydia Tx Violin string adhesions Ceftriax and Doxy

Post-menopause dyspareunia occurs d/t ? What other hormone shifts are seen during menopause ? type of testicular Ca is curable only by orchiectomy

Dec estrogen Inc FSH, Dec estrogen/progesterone Non-seminoma

When would Mg Sulfate be c/i in Tx of pre-e seizures What would be seen during Mg toxicity MC type of prostate Ca

Myathenia gravis Loss of DTRs Adeno

What 3 PE findings suggest appendicitis > PID What 3 PE findings suggest PID > appendicitis How is PID Tx during pregnancy

Migrating pain, Anorexia, Normal pelvic PE Diffuse lower ab pain Hunger, CMT w/ d/c, Sxs x several days Admit, 2nd Gen cepalosporin (pha/fo) and Azith

Candidal vaginitis Trichomoniasis vaginitis Bacterial vaginosis

White d/c, pH <4.5, neg KOH, pseudohyphae on wet mount Green/yellow d/c, pH >5, +KOH w/ motile trichomonads on wet prep Gray/white d/c, pH >4.5, +KOH w/ clue cells

How does H ducreyi present on PE How are Pts Tx How is just chlamydia Tx

Chancroid: multiple, painful papules w/ ulceration and inguinal bubo (adenopathy) Azith Ceftriax Cipro Azith (avoid Doxy in pregnancy), Ceftriax for gonorrhea

H ducreyi morphology How does this appear on PE How is this Tx

Gram-neg coccobacillus Painful ulcers w/ sharply demarcated bases and painful inguinal adenopathy Azithromycin, Ceftriax, Cipro, Erythromycin

Consider empiric Tx for ? w/ Pts Dx w/ H ducreyi chancroids What microbe causes condyloma latum Classic US appearance of ovarian torsion

Syphillis Treponema pallidum- syphilis Enlargement w/ heterogenous stroma and peripherally displaced follicles

Why are ovarian torsions more common on right side All febrile infants w/ first UTI need ? study Shoulder dystocia steps

Sigmoid offers support to L side Renal and bladder US for anatomic abnormals Help, Eval for episiotomy, Legs via McRoberts Pressure, suprapubic, Enter for rotational maneuvers, Remove posterior arm, Roll pts to hands/knees (Gaskin)

Only asthma med Tx that is pregnancy Cat B Define Bartholin Abscess How are these Tx and what age needs biopsy/oncology performed

Budesonide 4 and 8 o'clock labia minora swelling d/t gland obstruction InD w/ Word Catheter, possible marsupilization; 40y/o

? acne meds are avoided during pregnancy ? meds can be used Most specific PE finding for testicular torsion

Topical retinoids, Isotretinoin Azelaic acid, Topical clinda, PO Erythromycin Absent cremaster reflex

Next step for suspected Female Athlete Triad MCC of secondary amenorrhea How is a Dx of stress incontinence made

Begin work up for Primary Amenorrhea (failure at 15 w/ 2* or by 13 w/out 2* characteristics) Pregnancy Bladder stress test

? is the MCC of bladder calculi Gram neg diplococci means ? and is Tx w/ ? monotherapy Presentation of Granuloma Inguinale

Infection of urea splitting bacteria: Proteus Psuedomonas Mycoplasma Klebsiella Staph N gonorrhea, Ceftriaxone Donovanosis- Klebsiella infection in India/Africa/Australia; painless genital nodule that ulcers w/ rolled borders beefy read tissue and easily friable

How is Granuloma Inguinale Tx

Doxy x 3wks Alt: Azith, Cipro