Repro/Obgyn Flashcards
Chandelier sign
pain on manipulation of the cervix and uterus during a pelvic examination in a patient with pelvic inflammatory disease.
PID complication
Salpingitis, endometritis, hydrosalpinx, tubo-ovarian abscess, Fitz-Hugh–Curtis syndrome
Fitz-Hugh–Curtis syndrome
infection of the liver capsule and “violin string” adhesions of peritoneum to liver
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.
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)
Thick vaginal discharge, vaginal pruritus, dysuria, vaginal pH 4–5, dx/rx?
Vaginal candidiasis, budding hyphae or spores on 10% KOH; rx topical azole
Painful penile, vulvar, or cervical vesicles and ulcers; can cause systemic symptoms such as fever, headache, myalgia
Genital herpes (HSV2); rx Valacyclovir
Polyarthalgia, Tenosynovitis,, Vesiculopustular skin lesions, sexually active?
Disseminated Gonococcal infection
Urethritis, cervicitis, PID, prostatitis, epididymitis, arthritis, creamy purulent discharge
Neisseria gonorrhoeae; rx Ceftriaxone
Urethritis, cervicitis, conjunctivitis, reactive arthritis, PID
Chlamydia trachomatis (D-K)
Painful genital ulcer, inguinal adenopathy
Haemophilus ducreyi
Infection of lymphatics; painless genital ulcers, painful lymphadenopathy (i.e., buboes)
C. trachomatis (L1–L3)
Smooth pink teardrop-like lesions on vulva; dx/rx?
Condyloma acuminata (genital warts) HPV 6/11; rx trichloroacetic acid or podophyllin
Early decelerations, which begin and end at approximately the same time as the maternal contraction.
Vagal stimulation due to Fetal head compression
Severe late decelerations, and usually with absent variability
Myocardial depression is associated with severe acidosis and perinatal morbidity and mortality.
Mild late decelerations
CNS reflex response to fetal hypoxia, from uteroplacental insufficiency, a sign of placental abruption or hypotension.
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)
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
1st trimester screen w/ low maternal serum α-fetoprotein, low estriol, low β-HCG, low or normal inhibin A
Trisomy 18, Edward’s syndrome
1st trimester screen w/ low β-hCG, low PAPP-A, and nuchal translucency.
Patau syndrome Trisomy 13
1st trimester screen w/ nuchal translcency, hypoplastic nasal bone, low serum PAPP-A, increased free β-hCG
Down syndrome (trisomy 21), 1:700
2nd trimester screen w/ low α-fetoprotein and estriol, high β-hCG and inhibin A.
Down syndrome (trisomy 21), 1:700
1st trimester elevated maternal AFP?
Neural tube defect (anencephaly, spina bifida), GI defect (gastroschesis, omphalocele), multiple gestation
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
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
<p>Amonorrhea w/ elevated FSH>40 and LH>25in <40yo?</p>
<p>Primary ovarian insufficiency (premature ovarian failure)</p>
<p>Amonorrhea w/ normal FSH (5-30) and LH (5-20)in <40yo?</p>
<p>Anovulation, normal estrogen but lack of progestrone leads to lack of withdrawl bleeds (a/w obesity)</p>
Amonorrhea in athlete w/ low BMI?
Estrogen deficiency, low GnRH and LH
<p>Amonorrhea <40, hot flashes, vaginal dryness, breast atrophy, recent chemo, normal TSH and prolactin; dx? LH/FSH levels?</p>
<p>Premature ovarian failure w/ decreased Estrogen, elevated FSH and LH, w/ FSH:LH>1</p>
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
