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PGY1 > Section 8 - OB/GYN > Flashcards

Section 8 - OB/GYN Flashcards

1
Q

First step when a vaginal bleeder comes to the ED

A

pregnancy status/test

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2
Q

causes of vaginal bleeding in prepubertal female

A

sexual assault needs to be excluded, vulvovaginitis most common

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3
Q

causes of prepubertal vulvovaginitis

A

candidiasis, strep, e coli, shigella, viruses, pinworms

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4
Q

Cause of bleeding and vaginal discharge

A

foreign bodies

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5
Q

most common cause of vaginal bleeding in women of reproductive age

A

anovulation

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6
Q

most common cause of vaginal bleeding in postmenopausal women

A

exogenous estrogens, atrophic vaginitis, endometrial lesions (ca), tumors

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7
Q

treatment of patients with severe vaginal bleeding

A

conjugated estrogen 25 mg IV q2-6 hours, medroxyprogesterone when bleeding subsides

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8
Q

stable patients, treatment of DUB with a clear diagnosis

A

oral contraceptive, medroxyprogesterone, tranexamic acid

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9
Q

mittelschmerz

A

self-limited, unilateral, dull aching pain that occurs mid cycle from leakage of prostaglandin containing follicular fluid

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10
Q

image modality for pelvic cyst ruptured

A

pelvic/transvaginal ultrasound

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11
Q

image modality of choice for ovarian torsion

A

ultrasound with Doppler flow imaging

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12
Q

symptoms of endometriosus

A

recurrent pelvic pain with menstrual cycle, dysmenorrhea, dyspareunia

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13
Q

risk factors of ectopic pregnancies

A

PID hx, surgical procedures on tubes, previous ectopic pregnancy, IUD, assisted fertility.

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14
Q

classic triad of ectopic pregnancy

A

abdominal pain, vaginal bleeding, amenorrhea

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15
Q

definitive diagnosis for ectopic pregnancy

A

US or direct through surgery

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16
Q

labs for treatment of ectopic pregnancy

A

type and cross, call ob/gyn, give fluids

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17
Q

threatened abortion

A

vaginal bleeding in first 20 weeks, closed cervical os, benign exam, no passage of tissue

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18
Q

inevitable abortion

A

vaginal bleeding in first 20 weeks, dilated cervical os, benign exam, no passage of tissue

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19
Q

incomplete abortion

A

partial passage of conceptus

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20
Q

complete abortion

A

passage of all fetal tissue before 20 weeks gestation

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21
Q

missed abortion

A

fetal death at less than 20 weeks without passage of fetal tissue for 4 weeks after fetal death

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22
Q

septic abortion

A

infection during abortion with pelvic pain, fever, CMT, uterine tenderness, foul-smelling

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23
Q

differential diagnosis with ectopic pregnancy

A

implantation bleeding, gestational trophoblastic disease

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24
Q

gestational trophoblastic disease

A

hydatidiform mole, partial mole, trophoblastic tumor, choriocarcinoma

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25
Q

nausea and vomiting of pregnancy normally seen…

A

first 12 weeks of pregnancy

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26
Q

treatment of n/v with pregnant patients

A
  1. 5% dextrose in nl saline or LR
  2. metoclopramide, promethazine, odansetron
  3. doxylamine with pyridoxine at home
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27
Q

UTI in pregnancy treatment

A
  1. nitrofurantoin 100 mg PO twice daily
  2. amox 500 PO 3 times daily
  3. cephalexin 500 mg PO 4 times daily
28
Q

time period when fetus is most at risk

A

2nd-8th week post conception

29
Q

abruption placentae

A

premature separation of placenta from uterine wall

sx: vaginal bleeding, abd pain, uterine tenderness, hypertonic contractions, increased uterine tone, fetal distress, DIC

30
Q

placenta previa

A

implantation of placenta over cervical os

sx: bright red vaginal bleeding, painless

31
Q

diagnosis of abruption placentae vs placenta previa

A

transabdominal ultrasound before SSE or bimanual exam

32
Q

clinical presentation of PROM

A

rush of fluid or continuous leakage of fluid from the vagina, pH greater than 7.0 and ferning pattern

33
Q

what should you avoid if patient has PROM

A

no digital pelvic examination! - increase rate of infection, can do sterile speculum

34
Q

what tests should be run for preterm labor (

A

GC, bacterial vaginosis, GBS, ultrasound

35
Q

what meds should be used for preterm labor?

A

tocolytics with glucocorticoids, dex 6 mg IM

36
Q

diagnosis of HTN in pregnancy?

A

systolic blood pressure > 140 or diastolic > 90 with two measrements prior to 20 weeks gestation

37
Q

diagnosis of preclampsia?

A

HTN > 140/90 and proteinuria in patients 20 weeks gestion to 4-6 weeks after delivery

38
Q

severe preeclampsia symptoms?

A

end organ involvement: HA, visual disturbances, metnal status changes, edema, oliguria, dyspnea, abdominal pain

39
Q

symptoms of eclampsia?

A

HTN > 140/90 and proteinuria and seizures in patients 20 weeks gestation to 4-6 weeks after delivery

40
Q

HELLP syndrome symptoms?

A

epigastric and RUQ abdominal pain

41
Q

lab findings for severe preclampsia?

A

anemia, thrombocytopenia, elevated creatinine, elevated liver enzymes, elevated LDH

42
Q

HELLP lab findings?

A

schistocytes on peripheral smear, platelet count lower than 150000, elevated AST/ALT

43
Q

tx of severe preeclampsia or eclampsia?

A

mg sulftate 4-6 g over 20 min followed by maintenance infusion
- monitor reflexes

44
Q

severe HTN tx?

A

labetalol 20 mg IV bolus with repeat boluses of 40-80 mg to max 300 mg or hydralazine 5.0 mg followed by 5 and 10 mg every 10 min

45
Q

Diff diagnosis of postpartum hemorrhage?

A

uterine atony, uterine rupture, lac of lower genital tract, retained placental tissue, uterine inversion, coagulopathy

46
Q

tx of uterine atony?

A

oxytocin 20 units NS at 200 mL/h, uterine massage

47
Q

sx of postpartum endometritis? Time frame?

A

fever, lower abdominal pain, foul-smelling lochia

  • several days after delivery
48
Q

phys exam findings of endometritis?

A

CMT and discharge

49
Q

labs for endometritis?

A

CBC, UA, cervical cx

50
Q

tx for postpartum endometritis?

A

abx, clinda plus gent or cefoxitin

51
Q

sx of mastitis?

A

swelling, redness, tender engorgement of breast

52
Q

tx of mastitis?

A

diclox or cephalexin or clinda if PCN allergy

  • continue nursing, pump if purulent discharge
53
Q

sx of amniotic fluid embolism?

A

CV collapse with hypoxemia, seizures, DIC

54
Q

braxton hicks contraction diagnosis?

A

false labor with irregular in intensity and duration contractions

55
Q

what do you do if you have a palpable pulsating cord on bimanual examination?

A

keep hand on presenting fetal part and elevate, get in touch with ob right away –> CSECTION INDICATED

56
Q

types of breech presentation with tx?

A

frank/complete - can deliver vaginally

incomplete/footling - cannot deliver vaginally, need csection

57
Q

normal vaginal flora pH

A

3.8-4.5

58
Q

sx of bacterial vaginosis

A

malodorous fishy smelling vaginal discharge

- vaginal irritation, excoriation, fissures

59
Q

dx of BV

A

vaginal discharge, pH greater than 4.5, positive amine test, clue cells

60
Q

tx of BV

A

metronidazole 500 mg PO 2 times daily for 7 days, clinda 300 mg PO 2 times daily for 7 days

61
Q

pt susceptible to candida vaginitis?

A

DM, systemic abx, pregnancy, BCP

62
Q

sx of candida vaginitis?

A

pruritus, vaginal discharge, external dysuria, dyspareunia, thick cottage cheese discharge

63
Q

tx of candida vaginitis?

A

azoles vaginal tablets

64
Q

trichomoniasis sx

A

frothy, malodorous vaginal discharge, vaginal erythema, vulvur irritation

65
Q

trichomoniasis tx

A

metronidazole 2 g single dose or tinidazole 2 g single dose

PGY1 (33 decks)

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