UWORLD OBGYN Flashcards
Sxs:
Thin, off white vaginal discharge
fishy odor
no inflammation
Bacterial vaginosis (Gardnerella vaginalis)
Tx: metro or clinda
Vaginitis sxs Micro:
pH >4.5
clue cells
positive whiff test (amine odor with KOH)
Bacterial Vaginosis
(garnerella vaginalis)
Tx: metro or clinda
Vaginitis sxs:
Thin yellow-green frothy discharge
Vaginal inflamatin
Trichomoniasis
(trichomonas Vaginalis)
TX: Metro and treat sexual partner
Vaginits sxs :
Thick, cottage cheese discharge
vaginal inflammation
Candida vaginitis
Tx: fluconazole
Vaginitis sxs micro:
pH >4.5
Motile trichomonadas
Trichomoniasis
(trichomonas Vaginalis)
TX: Oral Metro and treat sexual partner
vaginits sx micro:
normal pH (3.8-4.5)
Pseudohyphae
Candida Vaginitis
Tx: Fluconazole
vaginal metronidazole for trichomoniasis
vaginal metro fails to eradicate T.vaginals from all reservoirs of infection (eg concomitant urethral and periurethral gland infections.
Not recommended tx
classical Lobular Carcinoma in situ (LCIS)
Incidental finding on breast biopsy for other reason. Arises in the terminal ducts and lobules of the breast.
No pleomorphic changes, non invasive lesion, observed with survailance
non classical LCIS
Arises in terminal ducts and lobules.
Has nuclear pleomorphism, distorted cellular adherence, and areas of necrosis.
Increases risk of invasive lobular or ductal carcinoma. Require excisional biopsy.
Step up treatment of n&v in pregnancy
- Dietary changes (small frequent meals)
- Vit b6 &H1 antihistamine
- Oral dopamine &seretonin antagonist
- IV fluids & IV antiemetics
- Corticosteroids
- TPN or tube feeding (refactory)
Tx of PMDD
SSRi are first line treatment.
Fluoxetine is nor studied and relieves both affective and somatic sxs.
However, if it doesnt work trial different SSRI. If not switch to combined OCP (progestin not effective)
pathophys of preeclampsia
abnormal cytotrophoblast invasion –>
underdeveloped maternal spiral arteries with high resistance –>
chronic placental ischemia –>
^ release of antiangiogenic factors–>
Decreased proangiogenic factors (VEGF and placental growth factor)
Effect of decreased proangiogenic factors
inhibited angiogenesis and widespread maternal endothelial cell dysfunction
dysregulated vascular tone
abnormally increased vascular permeability
Decreased end organ perfusion
Endothilin and thromboxane A2 in preeclampsia
Endothelin adn TXA2 are potent vasoconstrictors.
Typically increased due to increased production in dysfunctional endothelial cells
risks for cervical cancer
infection with high- risk HPV (eg. 16, 18)
Hx of STI
Early onset sexual activity
multiple or high-risk partners
immunosuppresion
OCP use
low socioeconomic status
tobacco use
Presenting features of invasive cervical cancer
Most common:
irregular vagginal bleeding
friable exophytic cervical mass
other:
postcoital bleeding
watery mucoid vaginal discharge
ulcerative cervical lessions
Best next step in managment for suspected cervical cancer?
Cervical biopsy
Turner Syndrome and Pregnancy
Greatest risk is aortic dissection. Very high risk in pregnancy because of hormone-induced aortic wall weakening and the hyperdynamic state of pregnancy can precipitate dissection.
Factor the increase risk of aortic dissection in Turners
Pregnancy
coarctation of the aorta
bicuspid aortic valve
hypertension
Additional screening for mom with turner syndrome in pregnancy
Periodic repeat imaging of the aorta
SLE and pregnancy
test for antiphospholipid syndrome (APS)
APS causes recurrent miscarriages, placental insufficiency, preeclampsia, fetal thrombosis and preterm delivery
Comorbidities in Turner Syndrome
CV: congenital heart defect, aortic dilation/dissection, metabolic syndrome
Renal: horseshoe
MSK: osteo
ENT: strabismus, myopia, otits media, hearing loss
rhem: celiacs, hypothyroid
Vulvular cancer presenation
Vulular pruritus
abnormal bleeding
dyspareunia
Single raised plaque or ulcer covering labia majora. (raised pigmented fungating)
Cause of valvular cancer
persistent HPV
chronic inflammation (typically due to lichen sclerosis)
Risk factors vulcular cancer
tobacco use
vulvar lichen sclerosis
immunodeficiency
prior cervical cancer
vulvar/cervical intraepithelial neoplasia
management of Lichen Sclerosus
An autoimmune inflammatory dermatologic condition.
routine examination and topical corticosteroids. biopsy with atypical lesions or refractory
Tx vulvar cancer
surgical excision and possible chemoradiation
Physiologic nipple discharge features
bilateral
multiductal
nonbloody
only with expression or manipulation
physiologic nipple discharge etiolofy
endocrine abnormalities
medications
stress
exs breast/nipple stimulation
pathologic nipple discharge features
unilateral
bloody
spontaneous
management of physiologic nipple discharge
lab workup for galactorrhea (pregnancy test, prolactin, TSH)
mammogram
all normal: reassurance and observation.
Persistence or bothersome: duct excision
