Repro/Obgyn Flashcards by Mani Yavi

Chandelier sign

pain on manipulation of the cervix and uterus during a pelvic examination in a patient with pelvic inflammatory disease.

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PID complication

Salpingitis, endometritis, hydrosalpinx, tubo-ovarian abscess, Fitz-Hugh–Curtis syndrome

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Fitz-Hugh–Curtis syndrome

infection of the liver capsule and “violin string” adhesions of peritoneum to liver

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Thin white vaginal discharge, vaginal pH > 4.5, fishy odor on 10% potassium hydroxide “whiff” test, and clue cells on saline mount microscopy

Bacterial vaginosis via Gardnerella vaginalis; rx metronidazole or clindamycin.

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Foul-smelling, greenish discharge; itching and burning; “strawberry cervix”; pH>4.5 ;dx/rx?

Trichomonas vaginalis, mobile protozoan with multiple flagella on microscopy; rx Metronidazole for patient and partner (prophylaxis)

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Thick vaginal discharge, vaginal pruritus, dysuria, vaginal pH 4–5, dx/rx?

Vaginal candidiasis, budding hyphae or spores on 10% KOH; rx topical azole

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Painful penile, vulvar, or cervical vesicles and ulcers; can cause systemic symptoms such as fever, headache, myalgia

Genital herpes (HSV2); rx Valacyclovir

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Polyarthalgia, Tenosynovitis,, Vesiculopustular skin lesions, sexually active?

Disseminated Gonococcal infection

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Urethritis, cervicitis, PID, prostatitis, epididymitis, arthritis, creamy purulent discharge

Neisseria gonorrhoeae; rx Ceftriaxone

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Urethritis, cervicitis, conjunctivitis, reactive arthritis, PID

Chlamydia trachomatis (D-K)

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Painful genital ulcer, inguinal adenopathy

Haemophilus ducreyi

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Infection of lymphatics; painless genital ulcers, painful lymphadenopathy (i.e., buboes)

C. trachomatis (L1–L3)

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Smooth pink teardrop-like lesions on vulva; dx/rx?

Condyloma acuminata (genital warts) HPV 6/11; rx trichloroacetic acid or podophyllin

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Early decelerations, which begin and end at approximately the same time as the maternal contraction.

Vagal stimulation due to Fetal head compression

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Severe late decelerations, and usually with absent variability

Myocardial depression is associated with severe acidosis and perinatal morbidity and mortality.

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Mild late decelerations

CNS reflex response to fetal hypoxia, from uteroplacental insufficiency, a sign of placental abruption or hypotension.

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Fetal alcohol sx features?

growth retardation (weight or height ≤ 10th percentile), facial dysmorphia (smooth philtrum, thin vermilion border, short palpebral fissures, hypoplastic midface, and microcephaly), CNS (structural or functional abnormalities, MR)

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effects of beta-HCG on thyroid?

beta-HCG is a weak TSH-R stimulator, leading to increased T3/T4, increased TBG (even higher total T4), decreased TSH, subclinical hyperthyroidism

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1st trimester screen w/ low maternal serum α-fetoprotein, low estriol, low β-HCG, low or normal inhibin A

Trisomy 18, Edward’s syndrome

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1st trimester screen w/ low β-hCG, low PAPP-A, and nuchal translucency.

Patau syndrome Trisomy 13

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1st trimester screen w/ nuchal translcency, hypoplastic nasal bone, low serum PAPP-A, increased free β-hCG

Down syndrome (trisomy 21), 1:700

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2nd trimester screen w/ low α-fetoprotein and estriol, high β-hCG and inhibin A.

Down syndrome (trisomy 21), 1:700

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1st trimester elevated maternal AFP?

Neural tube defect (anencephaly, spina bifida), GI defect (gastroschesis, omphalocele), multiple gestation

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Child born w flat facial profile, prominent epicanthal folds, upslanting palpebral fissure, clinodactyly, simian crease, and congenital heart disease. 15–18 weeks of gestation triple marker screen shows?

Down’s sx 3markers: decreased alpha-fetoprotein and estradiol, increase beta-hcg

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Child born w rocker-bottom feet, low-set ears, micrognathia, prominent occiput, clenched hands, and congenital heart disease.. 15–18 weeks of gestation triple marker screen shows?

Trisomy 18, Edward’s syndrome; decreased alpha-fetoprotein, estradiol, and beta-hcg

Irregular menses, infertility, LH:FSH ratio > 3, increased dehydroepiandrosterone; dx?

PCOS; b/c of elevated androgens and may also present with acne, hirsutism, and weight gain

Pt w/ hirsutism, menstrual abnormalities, obesity, acanthosis nigricans, and precocious puberty; increased risk for?

PCOS a/w breast and endometrial cancer secondary to unopposed estrogen; increased risk of infertility, metabolic syndrome, DMT2

Primary amenorrhea without secondary sexual characteristics, anosmia; dx?

Kallmann’s sx GnRH synthesis disorder w/ olfactory bulb agenesis

Indication for treatment of maternal HTN?

Hydralazine or labetalol for pt w/ SBP>150, DBP>100

Post partum bleed greater than 8wks, multiple lesions in lungs; dx test?

Check beta-HCG for metastatic Choriocarcinoma, a malignant form of gestational trophoblastic disease

Amonorrhea w/ elevated FSH>40 and LH>25 in <40yo?

Primary ovarian insufficiency (premature ovarian failure)

Amonorrhea w/ normal FSH (5-30) and LH (5-20) in <40yo?

Anovulation, normal estrogen but lack of progestrone leads to lack of withdrawl bleeds (a/w obesity)

Amonorrhea in athlete w/ low BMI?

Estrogen deficiency, low GnRH and LH

Amonorrhea <40, hot flashes, vaginal dryness, breast atrophy, recent chemo, normal TSH and prolactin; dx? LH/FSH levels?

Premature ovarian failure w/ decreased Estrogen, elevated FSH and LH, w/ FSH:LH>1

Painless antepartum vaginal bleed with rupture of membranes, normal maternal vitals, rapid fetal tachy followed by bradycardia; dx/rx?

Vasa previa w/ fetal blood vessel (transverse internal os) rupture; rx immediate C-section

Painless vaginal bleed, normal maternal vitals, fetal HR not acutely changed; dx?

Placenta previa; risk factors - multiparity, previous c-sec, maternal age, smoking

Painful antepartum vaginal bleed with painful abdomen, tender hypertonic uterus; dx?

Placenta abrupcion

Painful sudden antepartum vaginal bleeding and diffuse abd pain w/ maternal tachycardia, tachypnea, agitation, previous c-sec, usually during labor; dx?

Uterine rupture

Postpartum fever, uterine tenderness, foul smelling lochia, prolonged ROM/labor, dx/rx?

Endometritis, polymicrobial infection; rx Clindamycin plus Gentamycin (aminoglycoside)

Incontinence w/ sneezing, coughing (increased intra-abdominal pressure) and urethral straining angle>30 degrees (urethral hypermobility) dx/rx?

Stress incontinence (ineffective sphincter closure, weak pelvic floor muscles); rx Kegels, urethropexy, alpha-adrenergics

Incontinence w/ feeling the urge to urinate, frequency, nocturia, small volume void; dx/rx?

Urge incontinence, overactive bladder (hyperactive detrusser muscle); rx Oxybutynin (antimuscarinic)

Incontinence w/ abd fullness, increased frequency and low volume void; dx/rx?

Overflow incontinence from obstruction (BPH) or bladder atony (diabetic autonomic neuropathy); rx r/o obstruction 1st, Betahnecol cholinergic agonists (detrusser tone), alpha-antagoinst (decrease bladder neck tone)

45 yoF w/ eczematous rash on nipple resistant to topical treatment; large cells with halo-like clearing invading epidermis; dx?

Paget's dz of breast w/ underlying adenocarcinoma

G3P0 6th wk pregnancy w/ previous miscarriages, positive VDRL, negative FTA-ABS, thrombocytopenia, increased PTT; dx/rx?

Antiphospholipid syndrome; rx Heparin LMWH while pregnant, warfarin after for long term

Tocolysis meds to stop contractions? SE?

Beta-agonists (terbutaline, ritodrine) increase HR/CO, bronchodilate, pulm congestion/edema; CCB (nifdedipine) reflex tach; Cyclooxygenase inhibitors (indomethacine) used 24-32wks close PDA

New onset hirsutism and acne in pregnant african american woman, b/l solid ovarian masses on US; dx/rx?

Luteoma, solid benign yellow mass, with hyperandrogenism affecting mother and risk of fetus verilization

New onset hirsutism and acne in pregnant woman, elevated beta-HCG, cystic ovarian masses on US; dx/rx?

Theca luteal cysts, a/w molar pregnancy or multiple gestation; regresses after birth, suction curretage if molar; low risk fetus verilization

New onset hirsutism and acne in pregnant woman, abdominal pain, GI bleeds, b/l ovarian masses on US; dx/rx?

Krukenberg tumor; GI malignancy metastatic to ovaries, high risk requires biopsy

PID rx? (T>38, leukoytosis, ESR, purulent cervical discharge, adnexal/cervical motion/lower abd tenderness)

Outpt: IM ceftriaxone + PO doxycycline (or IM cefoxitin + PO doxy+probenecid); Inpt: IV Cefotetan + Doxycycline

Menorrhage w/ pain, dyspareunia, infertility?

Endometriosis

Menorrhage w/ dysmenorrhea, bulky globular tender uterus?

Adenomyosis (endometrial invasion of myometrium)

Menorrhage w/ heavy menses and clots, large firm irregular uterus, urinary frequency, constipation, pelvic pain?

Uterine fibroids (leiomyoma)

Menorrhage w/ irregular, intermenstral or postmenopausal bleeds, small nontender uterus, hx of obesity/anovulation/nulliparity?

Endometrial hyperplasia or cancer

Menorrhage w/ fever, foul discharge, recent instrumentation hx?

Endometritis

Newborn w/ microcephaly, midfacial hypoplasia, cleft lip/palate, digit hypoplasia, hirsutism, developmental delay; dx? (utero exposure)

Fetal hydantoin sx from exposure to antiepileptic Carbamazepine or Phenytoin

Newborn w/ diffuse echymotic scalp swelling

Capput seccundum

Newborn w/ scalp swelling limited to one skeletal bone

Cephalohematoma

Pre-eclampsia definition?

New onset severe HTN (>140/90) after 20wks gestation w/ proteinuria (300mg/24h or 3+)

60yoF p/w vulvar itching, thin, white, dry appearance, white macules and patches; dx/rx?

Lichen Sclerosis (inflamattory atrophy); punch biopsy (r/o SCC); rx topical corticosteroids

Abortion rx?

Mifepristone and misoprostol

Morning after pill?

Levonogestrel or Ulipristal; Copper implant has best efficacy in stopping post fertilization pregnancy

Rapid onset virilization in 40yo non-obese woman, workup/dx?

Serum testosterone and DHEAS; elevated DHEAS usually>700 (normal T) - adrenal neoplasm vs elevated T (normal DHEAS) - Ovarian

Estrogen producing ovarian tumor p/w precocious puberty in adolescent or postmenopausal bleeds

Granulosa cell tumor; also Thecoma (benign ovarian neoplasm) produces Estrogen

Most common ovarian tumor, psammomma bodies, often b/l?

Serous cystadenocarcinoma

Androgen producing ovarian tumor causing defeminization and masculinization?

Sertoli-Leydig cell tumor

Triad of ovarian fibromas, ascites, hydrothorax; p/w pulling at the groin; dx?

Meigs syndrome

32 wks gravida p/w intense pruritis especially palms& soles at night, elevated ALT/AST, alkphos, total bile acids; dx?

Intrahepatic cholestasis of pregnancy; dx Ursodeoxycholic acid, supportive

32 wks gragida p/w progressive malaise, RUQ abd pain, N&V, hypoglycemia, ascites, encephalopathy, elevated bilirubin, mildly elevated ALT/AST, possibly sever coagulopathy, fatty infiltrates in liver; dx?

Acute fatty liver of pregnancy, w/ liver failure complications, AKI, DIC