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IPAP > PPP ROSH- Repro/GU > Flashcards

PPP ROSH- Repro/GU Flashcards

1
Q

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

A

Dz processes w/ calcifications

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

HTN, Arterial Dzs

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2
Q

MC non-cutaneous male Ca

How often are PTs f/u after Tx

When are screening initiations considered

A

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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3
Q

How does epididymitis present on PE

What causes this to occur in sexually active men

If pos STD panel, how are PTs Tx

A

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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4
Q

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

How are Pts Tx how practice receptive anal intercourse

MC ectopic pregnancy location

A

-floxacin or TMP/SMX

Ceftriax/TMP-SMX

Ampullary

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5
Q

MC RF for developing ectopic pregnancy

How are Stage 1-2 uterine prolapses Tx

What is the definitive method of Dx ovarian torsion

A

Previous ectopic pregnancy

Pessary

Surgical w/ direct visualization

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6
Q

MC type of vulvar cancer w/ ? MC association

How does this MC present on PE

What are the RFs for this Ca

A

SCC d/t HPV

Pruritic labia lesion

HPV Smoking Vulvar lichen sclerosis

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7
Q

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

A

Catheter-

Warm, boggy, tender prostate

Septicemia induced from DRE

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8
Q

How are Pts w/ bacterial prostatitis Tx

Two characteristics of Inevitable Abortion

What is the MC puerperal infection

A

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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9
Q

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 ?

A

Inevitable, Incomplete, Septic

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

12, 20

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10
Q

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

A

Testicular Ca

Painless nodule/swelling

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

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11
Q

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

MOA of PD-5 inhibitors

MOA of nitrofurantoin

A

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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12
Q

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

A

EColi

Kleihauer Betke test

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

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13
Q

How do placenta previas present

How are these Pts best assessed upon arrival

How doe placental abruptions present

A

Painless bright red blood in 3rd trimester

Transvaginal US

Painful, third trimester bleeding

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14
Q

Tumor marker for tracking ovarian Ca

How does this type of Ca present depending on age

What are protective factors against this Ca

A

Ca-125

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

Hormonal contraception
Tubal ligation
Hysterectomy

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15
Q

MC pelvic tumor

How are these Dx and Tx

? medication is MC associated w/ developing endometrial polyps

A

Leiomyoma- smooth muscle/uterine mass

TV-US, GnRH agonist (-relix)

Tamoxifen- SERM for Tx breast Ca

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16
Q

BV presentation on PE

How is this Tx

This Dx is the MCC of ?

A

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

Metronidazole or Clinda

Vaginitis

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17
Q

BV is caused by imbalance of ? microbe

What criteria must be met for Dx

How is intrauterine pregnancy Dx

A

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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18
Q

What is the earliest sign of an embryo seen on US

Atrophic vaginitis is AKA ?

MCC of mastitis and how is pain Tx

A

Fetal pole- thickened margin of yolk sac

GU syndrome of menopause

Clogged ducts d/t Saph A/albus;
Ibuprofen

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19
Q

If ABX are used for mastitis, ? ones are selected

Infants should be solely breast fed for how long

MC breast mass in young adults

A

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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20
Q

Define Gestational Trophoblastic Dz

What are the two types

How does this appear on TV-US

A

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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21
Q

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

A

Vit A

Consumptive coagulopathy- thrombyocytopenia, hypofibrinogenemia

Hypofibrinogenemia

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22
Q

MC type of Gyn Ca

Mnemonic for BPH Sxs

How is AUB initially Tx

A

Uterine

Hesitant 
Intermittence/Incontinence
Frequency/Fullness
Urgency
Nocturia

OCPs w/ NSAIDs

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23
Q

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

A

Desmopressin

Smooth, firm and enlarged

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

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24
Q

MOA of cervical ripening

How are prostate Cas categorized into severity

Define Cystocele

A

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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25
Q

? 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

A

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

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26
Q

MC type of endometrial carcinoma

What is a positive nitrazine test

What other test can help Dx ROM

A

Adenocarcinoma

Paper turns blue

Ferning test

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27
Q

Why would TMP-SMX be avoided in Tx PPROM

3 Ds of Endometriosis

MC location of the ectopic endometrial tissue

A

Necrotizing enterocolitis

Dysmenorhea Dyspareunia Dyschezia d/t retrograde menstruation

Ovaries

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28
Q

Ovarian torsion PE findings

MC gyn condition in pre-pubertal children

Preg A/B/C verbiage

A

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

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29
Q

How is cervical dysplasia ID’d on PE

When are cervical Ca screenings started

? puts Pts at increased risk for Pre-E

A

Acetic acid application reveals white, sharply demarcated lesions on cervix

PAP smears at 21y/o and q3yrs

Autoimmune Dz

30
Q

What is the only medication proven to reduce developing Pre-E

How is gestational DM Dx

A

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
31
Q

RFs for Leiomyoma development

MCC of menorrhagia

How are UTIs in pregnancy Tx

A

Hyper-estrogen/tension
Age
Nulliparity

Fibroids

Amoxicillin

32
Q

Criteria for HELPP Syndrome Dx

What would be seen if HELPP also had DIC

A

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

33
Q

Major criteria for PID

How is this Tx

What lab is ordered when working up premenstrual syndrome

A

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

34
Q

How does genital HSV present

How are these Tx

MCC of AUB in post-menopausal woman

A

Painful, shallow lesions 2-7d after contraction

Acyclovir

Endometrial/vaginal atrophy

35
Q

Criteria to Dx post-partum hemorrhage

MC type of invasive breast Ca

MC cystic structure of the ovary

A

≥1000mL blood loss

Infiltrating ductal

Follicular cyst

36
Q

How does fibrocystic breast dz present

What is initial therapy

What dz causes eczematous lesion of the nipple

A

Sxs worse leading up to cycle

Bra support, Dec caffeine

Paget’s

37
Q

Define Chadwick’s sign

Define Goodell’s sing

Define Hegar sign

A

Bluish discoloration d/t inc vasculature

Cervical softening

Uterus enlargement/softening

38
Q

How are inevitable miscarriages Tx

What complication would Pt w/ Ehlers Danlos present w/

How are these Pts managed

A

DnC, Misoprostol, Expectantly

2nd trimester loss w/out contractions

Cerclage placement 12-14wks

39
Q

What causes AUB

What is a RF for occiput posterior

First and Second line Tx for dysmenorrhea

A

Failed formation of corpus luteum leading to no progesterone and unopposed estrogen stimulation

Nulliparous

NSAID (dec prostaglandins) then Hormones

40
Q

How does Trichomoniasis present

How is this Tx

ED Tx med w/ longest duration

A

Frothy green/yellow d/c w/ strawberry cervix

Metronidazole/Tinidazole w/ alcohol avoidance

Tadalafil- 24-72hrs

41
Q

Define criteria for PMS Dx

What is the best initial Tx for these Pts

? serum marker is elevated during testicular Ca

A

Daily function altered by menstrual Sxs

SSRI- Fluoxetine

A-F-protein (also in hepatocellular Ca)

42
Q

MC location for renal calculus to become stuck

? sizes are most to least likely to pass

Bladder Ca is ? type

A

Ureterovescular junction

<5mm: most
>8: least

Transitional cell carcinoma

43
Q

What two expousres increase chances of bladder Ca

Define Oligomenorrhea

Define Polymenorrhea

A

Smoking, Industrial dyes: Anilline

Cycle >35days

Cycle <21d

44
Q

Define Menorrhagia

Define Metrorrhagia

Define Menometrorrhagia

A

Regular cycles w/ excessive flow/duration

Irregular cycles

Irregular cycles w/ excessive flow/duration

45
Q

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

A

Gabapentin

TMP-SMX or Cipro/O-floxacin x 4-6wks

A-blockers: -osin (used first)
PD5 inhibitors: -steride

46
Q

Monotherapy for Chlamydia

Monotherapy for Gonorrhea

Turners Dx will have ? type of amenorrhea

A

Doxy

Ceftriax

Primary

47
Q

Define Hydrocele

What are the two types

When is surgical Tx indicated

A

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

48
Q

? is the MC germ cell tumor

Define Chorioamnionitis

What PE findings suggest this Dx

A

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

49
Q

Preterm labor is prior to ?

How is tender breast engorgement Tx in non-breastfeeding postpartum Pt

How is postpartum endometritis Tx

A

<37wks

Support bra, Cold compress, Avoid breast stimulation

Clinda + Gentamicin, Amp-Sulbactam

50
Q

MC form of testicular torsion

Anti-hypertensive meds for severe Pre-E

When is gestational diabetes screened

A

Intravaginal torsion- bell clapper

Nifedipine Hydralazine Labetalol

24-28wks gestation

51
Q

? tocolytics (uterine relaxants) can be used to post-pone labor

How is prostatitis Dx

? complication arises from PID

A

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

52
Q

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

A

TVUS or Endometrial biopsy via pipelle suction curette

Mg sulfate

Ca gluconate

53
Q

Define Leopold Maneuver

What week are these maneuvers usually performed

Prostate screening criteria along w/ shared decision making

A

Determines lie and presentation of fetus:
Superior, Sides, Inlet, Attitude/Extension

37wks

Serum PSA and DRE

54
Q

How often are STI screenings done for women

Presentation of hydronephrosis

Why does this have pain

A

Annual for G/C for women <25y/o

Intermittent, colicky back pain radiating to groin

Swelling of Gerotas fascia d/t obstructive uropathy

55
Q

MCC of ovulatory infertility

This US finding term is also used for ? GI condition

A

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

String of pearls- small bowel obstruction

56
Q

Define Balanitis

Define Balanoposthitis

What DDx needs to be considered and how are they Tx

A

Inflammation of glans penis

Inflammation of glans and foreskin only in uncircumcised Pts

Diabetes; Clotrimazole

57
Q

Unique UTI pathogen of adolescent females

How is pyelonephritis Tx

How is BV Tx

A

Staph saprophyticus

Cipro

Metronidazole 500mg BID x 7d

58
Q

Urge incontinence Tx

Stress incontinence Tx

Overflow incontinence Tx

Atonic incontinence Tx

Mixed incontinence Tx

A

Anticholinergic- Oxybutynin, Tolterodine

Topical estrogen

A-blockers

Intermittent cath

Topical estrogen w/ Anticholinergics

59
Q

Define Fitz Hugh Curtis Syndrome

What would be seen on ex-lap

How are Pts Tx

A

RUQ pain w/ perihepatitis (normal LFTs) d/t incomplete Chlamydia Tx

Violin string adhesions

Ceftriax and Doxy

60
Q

Post-menopause dyspareunia occurs d/t ?

What other hormone shifts are seen during menopause

? type of testicular Ca is curable only by orchiectomy

A

Dec estrogen

Inc FSH, Dec estrogen/progesterone

Non-seminoma

61
Q

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

A

Myathenia gravis

Loss of DTRs

Adeno

62
Q

What 3 PE findings suggest appendicitis > PID

What 3 PE findings suggest PID > appendicitis

How is PID Tx during pregnancy

A

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

63
Q

Candidal vaginitis

Trichomoniasis vaginitis

Bacterial vaginosis

A

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

64
Q

How does H ducreyi present on PE

How are Pts Tx

How is just chlamydia Tx

A

Chancroid: multiple, painful papules w/ ulceration and inguinal bubo (adenopathy)

Azith Ceftriax Cipro

Azith (avoid Doxy in pregnancy), Ceftriax for gonorrhea

65
Q

H ducreyi morphology

How does this appear on PE

How is this Tx

A

Gram-neg coccobacillus

Painful ulcers w/ sharply demarcated bases and painful inguinal adenopathy

Azithromycin, Ceftriax, Cipro, Erythromycin

66
Q

Consider empiric Tx for ? w/ Pts Dx w/ H ducreyi chancroids

What microbe causes condyloma latum

Classic US appearance of ovarian torsion

A

Syphillis

Treponema pallidum- syphilis

Enlargement w/ heterogenous stroma and peripherally displaced follicles

67
Q

Why are ovarian torsions more common on right side

All febrile infants w/ first UTI need ? study

Shoulder dystocia steps

A

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)

68
Q

Only asthma med Tx that is pregnancy Cat B

Define Bartholin Abscess

How are these Tx and what age needs biopsy/oncology performed

A

Budesonide

4 and 8 o’clock labia minora swelling d/t gland obstruction

InD w/ Word Catheter, possible marsupilization; 40y/o

69
Q

? acne meds are avoided during pregnancy

? meds can be used

Most specific PE finding for testicular torsion

A

Topical retinoids, Isotretinoin

Azelaic acid, Topical clinda, PO Erythromycin

Absent cremaster reflex

70
Q

Next step for suspected Female Athlete Triad

MCC of secondary amenorrhea

How is a Dx of stress incontinence made

A

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

Pregnancy

Bladder stress test

71
Q

? is the MCC of bladder calculi

Gram neg diplococci means ? and is Tx w/ ? monotherapy

Presentation of Granuloma Inguinale

A

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

72
Q

How is Granuloma Inguinale Tx

A

Doxy x 3wks Alt: Azith, Cipro

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