OBGYN Flashcards
Mx of amntoic fluid emboli syndrome
Ventilate, Pressor, Transfuse
What should be done after a patient has been raped
Emergency contraception, prphlx for (chlam, gon, hiv, hepB, tichomonas), urine preg test, sexual assault evidence kit
What is pubertal gynaecomastia
In boys, mid puberty when E:A is high. So a limb may be felt (both or one side). Usually tender. Exclude red flags like redness, warmth, discharge etc. if there are red flags, can do imaging. Often have tanner 3 stage
Ovarian mass and false positive preg test could be??
Choriocarcinoma
PCOS and Sertoli Leydig cell tumour sign difference
PCOS more gradual.
When to hospitalise and do inpatient treatment for PID
If severe (fever, vomiting etc.), preg, outpatient Tx failed, TOA, Fitz Hugh Curtis, non compliance
When to add metronidazole to PID Tx
Add if TOA concomitant
Review CI for IUDs
Preg, gynae CA, distorted endometrial cavity, PID or other active gynae infx, trophoblastic disease, unexplained vag bleed. Wilson’s (Cu only), Breast CA (P only), Liver disease (P only)
Contraceptive for APLS patient
Cu IUD, need hormone negative. Not even prog
Vaginismus
Pain and spasm on penetration of vagina. Desentize and counsel and kegels.
If patient needs emergency contraception, what does a pregnancy test infer to us
If positive, we can’t use emergency contraception, instead give misoprotol. If the preg test is negative, we can give EC
Lichen sclerosis vs VULVAL CA
Lichen is whiter and Papular. Whereas CA is a plaque and usually friable, red etc.
Once you have seen that a galactorreeha is physiological, and you have normal prolactin, and patient on no alarm meds….what to do?
No Mx needed
Assymp fibroids…. mx?
No Mx
First and second line for stress incontinence
Kegel excersizes. If that fails, try the mid urethral sling (reduces hyper mobile urethra)
Can we do speculum in adolescence
No, the vaginal introitus is so narrow that causes discomfort
Vaginal foreign body management in paediatric
Examination, attempt removal, usually including irrigation with warm fluid. If that doesn’t work can do vaginoscopy under Anastasia
Ovarian mass described as homogenous cystic, and ground glass appearance
Endometrioma
How might a TOA be described on ultrasound
Multiloculated, cystic mass
How to manage a teratoma of the ovary
Either do ooporectomy or cystectomy, to reduce the risk of torsion
Main proceeding cause of vesicovaginal fistula
Usually months after a pelvic surgery, like a hysterectomy
Talk to me about genitourinary syndrome
Low oestrogen, means low collagen and elastin and blood flow to the bladder trigone and vulva/vagina. This causes urge incontinence and dyspareunia. Low glycogen also means an elevated pH and increased UTI risk. Damaged epithelium in that area also causes dysuria
Is it normal for a adolescent to have in regular menses. Explain why. What is the treatment and how does this help
Yes it is normal, because the corpus luteum isn’t so well formed in adolescence. Therefore there is not sufficient progesterone, so we have unopposed oestrogen. This causes a unopposed proliferation of the endometrium (no secretory Endometrium). This causes a breakthrough bleeding. The treatment would be oral progesterone, to supplement the lack thereof
Treatment for cyclical mastalgia
Supportive bra and NSAID
Suspicion of fibroids, what is the best investigation. Consider if subserosal and submucosal
Ultrasound. For submucosal you can do sonohysterography (essentially filling the uterus with saline before doing ultrasound)
How to distinguish an acute cervicitis from a Trichomonas vaginalis
Chlamydia and gonorrhoea is more common, the cervix is friable and bleeds, and the discharge is usually purulent in yellow. Trichomonas has a green frothy discharge and more punctate haemorrhage of the cervix. Of course Trichomonas is less common. But generally the two overlap
How does an ovulation increase endometrial hyperplasia and cancer
Progesterone naturally Dan regulates oestrogen receptors and its protective against hyperplasia. Therefore in anovulation, you don’t make the corpus lutuem, therefore you don’t make prog, therefore you have unopposed oestrogen
Take me through a common cycle of Mx for adenomyosis
Usually a clinical diagnosis and ultrasound/MRI. Then can give NSAID or COCP et cetera. If continues do hysterectomy and biopsy the specimen = this is the definitive diagnosis and treatment
Most common sight of choriocarcinoma metastasis
Vagina.
HaHa trick question. I guess long is more clinically significant, but he’s not the most common
Patient has mullarian agenesis, what other test you have to do
Renal ultrasound
What are the signs of vagina foreign body
Abdomen pain, vaginal discharge
What is the general Tx idea for ovarian cyst rupture
If stable then observe. If unstable, do surgery
Urethral diverticulum signs
Anterior vaginal mass, usually from recurrently periurtetheal gland infx. Tender and pain on intercours. May even show as purulent discharge. Unlike cycteocele (no pain, in older women with many kids, and no discharge)
Dx and Tx of asherman
Hysterisocpy (Dx and lyse them)
When does physiological thelarche begin?
Usually around 8-10. Signifies beginning of puberty. Tender, small firm nodule behind nipple. Menarche around 2.5 years after.
When to start the primary amenorrhea algorithm? Age wise
13 or more, if no secondary sexual characteristic. If has the characterises, 15 or more
Difference in size of abdomen in adenomyosis vs fibroids
Fibroids can grow way more and cause contains pelvic pressure. Mimics gest age around 20 weeks. Whereas adenomyosis is usually less than 12 weeks and rarely causes constant pelvic pressure
Managment for patient who plans to conceive in PCOS
Weight loss always first line. If unsuccessful, letrozole is used (our aromatase inhibitor). This would decrease the conversion of Androgen to estrogen (which in PCOS decreases LH and FSH)
If see being in endometrial cells on pap…. What to do? Consider pre and post menopause, risk factors etc
If pre menopause, then it’s ok unless they have AUB or major endometrial cancer risk factors. If post menopause, it’s not normal, so biopsy
Man has breast mass. How to mx
Exactly the same as women
CI to use oxytocin in labour
If HR deceleration (makes sense), or previous c sec
Recall our whole preterm Mx algorithm. Which time frame is MgSO4 given and what for?
Less than 32 weeks. It reduces risk of cerebral palsy
In preterm Mx. Why does Indo change to nifedipine after 32 weeks.
Risk of DA closure
AFI normal range
4-24
Main RF for previa
High mum age, previous c sec or myomectomy, twins (more placenta)
Many painless preterm deliveries….
Lille Cervicle insuff. So do cerclage
Use of FetaL fibronectin testing
High when labour occurs, helps distinguish between false and true labour
When do we consider cervical insufficiency
• Painless cervical dilation in the current pregnancy (ie, examination-based) OR
• A second-trimester cervical length of ≤2.5 cm plus a prior preterm delivery (ie, ultrasound-based) OR
• two or more prior consecutive, painless, second-trimester losses (ie, history-based), which typically present with mild symptoms (eg, vaginal discharge, light spotting) followed by precipitous delivery
How can maternal DM cause hypocalcemia in infants
Sugary blood causes diuresis of Mg, and thus low Mg. This causes low PTH and low Ca
Infant of DM mum, with jitteryness,,,, glucose normal. What to check next?
Calcium. Maybe low Ca
Mention the 4 types of variability in FHR
