PPP ROSH- Repro/GU Flashcards
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
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
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)
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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)
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
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
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
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
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)
? 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
