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Clin Med IV: Emergency Medicine > EM OBGYN > Flashcards

EM OBGYN Flashcards

1
Q

what defines abnormal uterine bleeding?

A

anything different per the patient

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2
Q

What is PALM COEIN

A

PALM: structural
- Polyps, adenoyosis, leiomyoma (fibroids), Malignancy
COEIN: non-structural
- Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified

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3
Q

what is the treatment of abnormal uterine bleeding

A

will depend on severity
estrogen OCP 3 pills x 2 days or until bleeding stopped and then 2 x 3d - do not stop for next menstrual cycle
if IUD goes through uterus

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4
Q

What is the treatment of massive hemorrhage

A

may require massive transfusion
consider hormone supplementation
consider TXA
consider uterine tamponade
consult surgery
obtain US

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5
Q

what is the most common cause of PID

A

GC and chlamydia

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6
Q

what is PID

A

ascending vaginal/uterine infection

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7
Q

what is the presentation of PID

A

bilat lower abdominal pain, discharge, fever, chills, malaise, cervical motion tenderness, adnexal tenderness

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8
Q

what is the treatment of PID

A

abx for STI
admit if PG, Toxic or complicated (abscess, ectroic, fitz-hugh-curtis)

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9
Q

what is an inflammatory mass of the fallopian tube and ovary

A

tubo-ovarian abscess

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10
Q

what is the treatment of tubo-ovarian abscess

A

if < 7cm abx (cefotetan 2g IV BID + doxy 100mg PO BID)
if larger needs surgery

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11
Q

what is a bartholin cyst

A

bartholin duct that is blocked - leading to fluid accumlation

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12
Q

what is the treatment of bartholin cyst

A

drainage with word cath - stays in for 6-8 weeks

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13
Q

what is rotation of the ovary on the ligamentous supports

A

ovarian torsion
- impedes blood flow and causes necrosis

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14
Q

what is the presentation of ovarian torsion

A

severe painw ith peritonitis
N/V
fever
vaginal bleeding

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15
Q

what is the treatment of ovarian torsion

A

pain management and Zofran PRN
needs to go to the OR immediately

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16
Q

what is an inflammatory reaction of the vulva and vagina

A

vulvovaginitis

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17
Q

what is most common cause of vulvovaginitis

A

candidiasis
bacterial vaginosis
trichomoniasis

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18
Q

what is the presentation of breast abscess

A

breast pain
swelling
erythema
fever
malaise

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19
Q

what is the most common causative agent for breast abscess

A

infection arises in milk
m/c S. aureus and E.coli

20
Q

what is the treatment of mastitis

A

breast feed
NSAIDs
Warm compress
abx if > 12-24 hours (cephalexin, augmentin or clinda)

21
Q

what is the treatment of breast abscess

A

US to confirm
needs drainage
lido with epi
may try aspiration depending on size
larger: I&D, consult with surgery

22
Q

what is the leading cause of death in women in first trimester of pregnancy

A

ectopic pregnancy

23
Q
A
24
Q

what is the presentation of ectopic pregnancy

A

POOP typically 6-8 weeks after LMP
Pain typically along one of the lower quadrants
vaginal bleeding
may be in shock
syncope

25
Q

how are ectopic pregnancies diagnosed

A

Qualitative hCG
Quantitative hCG
transvaginal US
type and screen
direct visualization

26
Q

what is given with a Rh- mom

A

give rhogam

27
Q

what is the treatment of spontaneous abortion

A

if stable - misoprostol +/- Mifepristone
if heavy bleeding, later term, infectious - surgical options such as vacuum or curettage (D&C)

28
Q

what is septic abortion

A

infectious agent is able to enter endometrium and/or myometrium
risk increased with unsafe abortion techniques
m/c associated iwth vaginal bacteria

29
Q

what is the difference between pre-eclampsia and eclampsia

A

eclampsia is pre-eclampsia with seizures

30
Q

what is the definition of pre-eclampsia/eclampsia

A

new onset HTN after 20 weeks gestation with proteinuria or end-organ dysfunction
BP > 140/90 with proteinuria

31
Q

how long post partum can pre-eclampsia/eclampsia present

A

up to 6 weeks post partum

32
Q

what can be seen on exam for pre-clampsia/eclampsia

A

fetal heart tones
abdominal pain
fudnal height
LE edema
petechail rash
neurologic deficit
hyperreflexia

33
Q

what is the typical presentation of pre-clampsia/eclampsia

A

HA and HTN

34
Q

how is pre-eclampsia/eclampsia treated

A

BP control: hydralazine 5mg IV, Labetalol 10mg IV or nifedipine 10mg PO
IV mag 4-6 g loading over 10-20 min then 1-2 g/hr

35
Q

What is HELLP syndrome

A

Hemolysis, elevated liver enzymes, low platelet count
variant of preeclampsia with more severe manifestations

36
Q

what is the presentation of HELLP syndrome

A

RUQ pain, N/V,
HA, visual changes, jaundice, malasie

37
Q

what is the treatment of HELLP syndrome

A

Magnesium, BP control, delivery
have blood ready

38
Q

what is placental abruption

A

premature separation of placenta from the endo uterine lining
m/c 24-28 weeks gestation

39
Q

what is the presentation of placenta abruption

A

acute back pain or abdominal pain, contractions
vaginal bleeding is common
exam may show uterus to be rigid and tender

40
Q

what is the treatment of placenta abruption

A

get ready to deliver, call OB, call anesthesia
if unstable will need c-section

41
Q

what is placenta previa

A

placenta develops over cervix

42
Q

what is PROM

A

premature rupture of memebranes
< 37 weeks gestation

43
Q

what is shoulder dystocia

A

anterior shoulder is stuck on moms pubic symphysis
baby’s head will “turtle” and will go back betweencontractions

44
Q

what is McRobers

A

hyperflex moms hips/knees and apply pressur on the pubis.

45
Q

how is postpartum hemorrhage treated

A

consider lacerations although uterine atony is m/c
find/fix lacerations
atony: oxytocin IM, Misoprisol IM, uterine massage
consider retained products
consider DIC if hx of preeclampsia
begin resuscitation with blood

Clin Med IV: Emergency Medicine (18 decks)

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