CR - OB/GYN Flashcards
(56 cards)
What is the most common nonobstetric surgical emergency of pregnancy and how might it present in the 3rd trimester?
Appendicitis
The incidence of appendicitis in pregnancy is lower than in the general non-pregnant population of the same age. Though the incidence is not higher in pregnancy, complications occur more frequently because of delay in diagnosis.
In the 3rd trimester the appendix is displaced superiorly to the mid or upper right side of the abdomen
What is the most likely diagnosis of a 6 year old female presenting with malodorous, possibly bloody vaginal discharge?
Vaginal foreign body
- children may insert anything
- most common foreign body in prepubertal female is toilet paper
- in adults, think about tampons, pessaries, diaphragms, condoms
- treatment includes removing the object and treating for vaginitis
- in children, suspect possible sexual abuse
- may need to perform vaginoscopy under anesthesia for children
Describe the role of oral acyclovir in herpes simplex infections
Treating an acute infection with acyclovir decreases the duration of viral shedding of that specific outbreak, accelerates healing, and shortens the duration of symptoms but does not affect the frequency or severity of recurrence unless placed on prophylactic dosing.
HSV is a risk factor for cervical and vaginal cancer but has not been shown to be a cause. In pregnant women it is critical to treat genital HSV because neonatal infection can be contracted via passage through an infected birth canal and is associated with significant mortality (29%) and morbidity (primarily neurologic)
What is the most common etiology of dysuria in prepubertal females
Vulvovaginitis
the most common causes of acute vulvovaginitis include:
- infections - gardnerella vaginalis (most common), candida, trichomonas
- irritant or contact
- vaginal foreign body
What is the treatment for bacterial vaginosis (BV) and in what population is it essential to treat?
Metronidazole 500 mg PO BID for 7 days
- BV is the most common cause of vulvovaginitis and is caused by a predominance of anaerobes in the vaginal microflora, BV often presents with complaints of malodorous fishy smelling discharge
- BV should always be treated in pregnant women due to an increased incidence of premature rupture of membranes, preterm labor or delivery, and postpartum endometritis
- alternative treatment regimens include clindamycin 300 mg PO BID or intravaginal clindamycin cream or metronidazole gel for 7 days. The CDC recommends either oral or intravaginal therapy for pregnant women.
What is the most commonly reported STI in the US that is also a leading cause of infertility
Chalmydia trachomatis
In addition to infertility, additional complications include chronic abdominal pain, Fitz-Hugh-Curtis syndrome and tubo-ovarian abscess.
7.3% of people with chlamydia are co-infected with gonorrhea
A 25 year old female presents with the sudden onset of lower abdominal pain and amenorrhea
What is your differential diagnosis?
Ruptured ectopic pregnancy
Hemorrhagic corpus luteum cyst
In the setting of amenorrhea, early ectopic pregnancy, ruptured ectopic pregnancy, and hemorrhage corpus luteal cyst are of primary concern.
However, always consider a broad differential in a female patient with acute pelvic pain, including PID, tubo-ovarian abscess, pyelonephritis, and appendicitis
How do you diagnose preeclampsia?
Preeclampsia: new onset of hypertension > 140/90 and proteinuria or new onset hypertension and end-organ dysfunction after 20 weeks gestation
End organ dysfunction:
- thrombocytopenic (less than 100,000)
- serum Cr > 1.1 or double normal concentration
- LFTs greater than 2x upper limit of normal
- pulmonary edema
- new onset headache unresponsive to medication or visual symptoms
What is the number one cause of fetal death, after maternal death, following blunt trauma to the mother?
Abruptio placentae
Defined as premature separation of a normally implanted placenta from the uterine wall causing visible or hidden bleeding, placental abruption is the cause of 30% of 3rd trimester bleeding
In addition to trauma, risk factors include HTN (most common), smoking, ETOH, cocaine, multiparity, advanced maternal age, prior abruption
A prolapsed umbilical cord is a true obstetrical emergency. What should the emergency physician due while awaiting arrival of the obstetrician?
The examiners hand should be used to elevate the presenting fetal part until a cesarean section can occur
In the 3rd trimester of pregnancy this antibiotic should not be used in the therapy of urinary tract infections?
Sulfonamides
Sulfonamides can cause kernicterus because of a rise in serum bilirubin
Prescribing sulfonamides or nitrofurantoin in the first trimester is still considered appropriate when no other suitable alternative antibiotics are available, but should be considered second line
What is the most common organism causing septic arthritis in patients less than 50 years old, particularly teenagers and young adults
Neisseria gonorrhoeae
- most commonly a monoarticular infection involving knee, wrist, or elbow
- joint effusion, warmth, and decreased range of motion are usually present
- arthrocentesis will usually reveal > 50,000 WBC in synovial fluid
Which antibiotics should be avoided throughout pregnancy?
Tetracyclines, streptomycin, and kanamycin
What are the most common causes of vaginal bleeding for premenarchal girls, women in their reproductive years, and those after menopause?
Premenarche: trauma / foreign body, infeciton, anovulation
Reproductive years: normal menstrual cycle, pregnancy (intrauterine and ectopic)
Post menopause: atrophic vaginitis is most common, malignancy should be considered
What defines preeclampsia with severe features
Blood pressure > 160/110
Organ dysfunction
- new onset cerebral or visual dysfunction
- liver function test 2x greater than normal
- thrombocytopenia < 100K
- pulmonary edema
- serum creatinine > 1.1 or double normal concentration
How is candida vulvovaginitis treated?
Oral fluconazole 150 mg x 1 dose
May repeat dose in 72 hours if symptoms persist
Most common side effects are GI symptom, rash, and headache
What is a special population to be considered when using metronidazole
Nursing - instruct women to stop breastfeeding during and for 3 days after concluding metronidazole therapy
What is the treatment for a bartholin gland cyst or abscess?
Incision and drainage, followed by insert of word catheter or pediatric foley
Must be left in place for 4-6 weeks
consider antibiotics in special cases (recurrent abscess, MRSA, systemic infection
What is the most common cause of mortality in women with pelvic inflammatory disease
Ruptured tubo-ovarian abscess
Mortality is 5-10%
True or false: in patients with an IUD who are diagnosed with PID, the IUD should be removed
False
In cases of PID, the likely source of infection is an STI and not the device. The presence of a modern IUD does not put patients at higher risk of PID, and curent guide-lines do not support removal of the IUD
Does breastfeeding need to be stopped in cases of mastitis?
No, breastfeeding may continue
Key aspects of treatment are antibiotics and milk drainage
40% of cases are caused by staph aureus
What is the most common coagulation disorder associated with heavy uterine bleeding
Von-willebrand disease
What are the causes of dysfunctional uterine bleeding?
PALM COEIN
Structural:
- polyp
- adenomyosis
- leiomyoma
- malignancy
Non-structural:
- coagulopathy
- ovarian dysfunction
- endometrial
- iatrogenic
- not otherwise classified
What is the most common location of ectopic pregnancy implantation?
Ampulla of the fallopian tube
