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Gynec Flashcards

(46 cards)

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1
Q

Vaginal bleeding + pelvic pain + amenorrehea

A

Ectopic pregnancies

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2
Q

Painless vaginal bleeding before delivery + rupture of membrane + fetal bradycardia

A

Vasa previa

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3
Q

One or more unexplained second trimester pregnancy loss

A

Cervical insufficiency

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4
Q

46 XY + impaires testosterone to DHT which promotes development of male external genitalia
Increased testosterone

A

5-alpha reductase deficiency

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5
Q

Cessation of ovarian function + infertility + irregular menses + menopausal symptoms (elevated FSH + decreased Estrogen)

A

Primary ovarian insufficiency

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6
Q

High grade on Pap test then negative on colposcopy what is next step

A

Endocervical curettage

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7
Q

Pooling of clear nitrazine positive fluid on speculum

A

Asymptomatic bacteruria : PROM

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8
Q

Early pregnancy bleeding

A
  • cytogenetic
  • Mendelian etiology
  • antiphospholipid syndrome
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9
Q

Painful vaginal bleeding at third trimester and normal placenta implantation

A

Abruption

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10
Q

Painful vaginal bleeding and loss electronic fetal heartbeat and loss of station of fetal head

A

Uterine rupture

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11
Q
  • > 20 week and < 37
  • uterine contraction at least 3 in 30 min
  • cervical changes: effacement and dilation > 2 cm
A
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12
Q

Post Partum hemorrhage

A

1- Fundus mit palpable: uterine inversion beefy appearance
2- Fundus bogy and soft: uterine stony
3- placent incomplete: retained placenta
4- undiagnosed tears: lacerations
5- generalised oozing: DIC
6- diagnosis of exclusion: unexplained hemorrhage

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13
Q

Post partum fever
> 38 in 2 occasions last > 6 hours excluding the first 24 hours

A

A- lung crackles: atelectasis (pp day 0)
B- flank pain dysuria : UTI 1-2 pp
C- tender uterus: endometritis 2-3pp
D - wound purulence : wound infection 4-5 pp
E- pelvic mass : pelvic abscess
F- dx of exclusion: septic pelvic thrombophlebitis

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14
Q

Obstetric anesthesia

A

1- intra venous agents: neonatal depression ( nalaxon)
2- paracervical block : block frankenhauser ( transitory fetal Brady)
3- pudendal block : stage 2 of Labor
4- epidural block: stage 1 and 2

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15
Q

Complication from epidural block

A

1- hypotension: aggressive intra venous fluid and left uterine displacement
2- post puncture headache: slight herniating of brain and brain stem like meningitis

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16
Q

Obstetric complications during Labor

A

1- prolapsed umbilical cord :
A- occult ( wall and fetal head ) b- partial ( head and dilated cervical os )
C- complete ( protrude into the vagina ) knee chest position and CS
2- shoulder dystocia : mcroberts flattens the sacral promontory and supra pubic pressure
3 - obstetric lacerations : rectovaginal fistula within the 2 first weeks ( incontinece of flatus or fecal malodorous discharge

4- episiotomy

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17
Q

Abnormal Labor

A

1 - prolonged latent phase: dilation < 6
Duration > 20 primipara and > 14 in multi ( therapeutic rest)
2- prolonged or arrested active phase
Cervical dilation > 6
A- protraction: dilation slower than expected oxytocin
B - arrest: no cervical changes for > 4 with contraction or > 6 h with inadequate contraction
3- prolonged second stage
Insufficient fetal decent after pushing > 3 hours nulliparous or 2 h in multi add an hour for epidural analgesia
Management
engaged: oxytocin
If not : CS

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18
Q

Benign vulvar lesions

A

1- bartholin cyst : conservative unless pressure symptoms ( drainage and word catheter)
2- bartholin abscess: word catheter under Local anesthesia
ATB is not required

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19
Q

Premalignant vulvar dermatosia

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A

1- squamous hyperplasia: firm and cartilaginous on palpation
2- lichen sclerosus : early hypo pigmented area on palpation parchment like and late stage thickness
Epithelial thinning
Clobetasol cream
3- squamous dysplasia partial thickness
4- CIS full thickness

20
Q

Malignant vulvar lesions

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A

1- squamous: HPV most commonly stage 1
2- melanoma: any dark or black lesions should be biopsied
3- paget disease :
Dx punch biopsy
Radical vulvectomy
Modified radical for unilateral lesion
Lymphadenoctomy

21
Q

Lichen planus

Study These Flashcards
A

Desquamation and erosion
- brightly erythematous with border serpentine appearing
Punch biopsy to rule out cancer
Coticosteroide

22
Q

Disorder of the cervix

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A

1- cervical polyps: finger like growth smooth
Vaginal bleeding after intercoourse
Trt: Twisting or surgical string
2- nabothian cyst : mucous filled cyst on the surface
Small smooth rounded lump
No trt
3- cervical neoplasm

23
Q

Cervical neoplasm
Asymptomatic
From premalginat to kc (8-10)
Most lesions will spontaneously regress

Study These Flashcards
A

Most common etiology HPV
Subtype (6,11)
Early age intercourse
Pap test
Most common site the transformation zone ( T-zone)

24
Q

Invasive cervical cancer penetrate through the basement membrane

Study These Flashcards
A
  • postcoital vaginal bleeding and irregular vaginal bleeding
25
Disorders or the uterus
A - failure to form : 1- hypo or agenesis: primary amenorrhea in fully developed second sexual characteristics 2- unicornuate : one of the mullerian ducts failure to form single horn banana shape
26
Failure to fuse
1- didelphys : complete failure oh the 2 mullerian duckt to fuse together ( separate uterus) preterm delivery is common 2- bicornuate : failure of fusion between the the ducts at the top ( incomplete fusion) Single uterus’s and single cervix but it branches into two horns at the top
27
Failure to dissolve the septum
Failure of degeneration of the median septum
28
Enlarged uterus
1- pregnancy 2- leiomyoma 3- adenomyosis 4- leiomyosarcoma
29
Leiomyoma Smooth muscle growth Most common benign tumour
A- intra mural : within the wall cannot be felt in the examination unless it they are large B- submucosal : inter menustral bleeding most common symptom can result in anemia Most do not affect pregnancy unless large C- subserosal : firm nontender and asymmetric Pressure on the bladder recrum or uterus Bulk related symptoms ( pelvic pressure, pain …
30
Natural history fibroids
1- slow growth most asymptomatic only if massive 2- rapid growth estrogen receptors enlarging during pregnancy 3- degeneration outgrow their blood supply, resulting in ischemic degeneration of a fibroid 4- shrinking: when estrogen falls , will decrease in size After menopause
31
Adenomyosis : Ectopic gland within the myometrium
Enlarged symmetric tender in absence of pregnancy causing dysmenorrhea Trt : levonorgestrel and IUS if not surgery
32
Endometrial neoplasia Post menopausal bleeding Endometrial carcinoma is the most common gynaecological malignancy
Differential : kc or vaginal or endometrial atrophy and post menopausal therapy Most common cause of post menopausal bleeding is vaginal or endometrial atrophy
33
Disorder of the ovaries
1- functional cysts 2- luteoma of pregnancy 3- theca lutein cysts : stimulation by fsh and b HCG ( twins and molar pregnancy 4- premenopausal pelvic mass 5-painful adexnal mass 6- prepubertal pelvic mass 7-post menopausal pelvic mass 8-
34
Functional cysts Most common cause of simple cystic mass in the reproductive age
Laparoscopy if cyst >7cm Should not form if under contraception Luteoma of pregnancy : Non neoplasm Tumor during pregnancy, produce androgen Regression spontaneous
35
Premenopausal pelvic mass Most common complex adexnal mass in young women ( dermoid or teratoma)
From all 3 germ cells most commonly ectodermal skin appendages Dx: b hcg - and complex mass on ultrasound ( calcification and hyperechoic nodules Cyctectomy if not oophorectomy
36
Painful adexnal mass Most common dermoid cyst
Sudden onset pelvic pain with a known ovarian mass Dx : ultrasound absent blood flow
37
Ruptured ovarian cyst Reproductive age after strenuous activity or sexual intercourse
Sudden onset of unilateral lower abdominal pain
38
Prepubertal pelvic mass Ovarian enlargement is suspicious for neoplasm Germ cells Tumor - LDH - b-HCG - alpha fetoprotein
- simple mass laparoscopy Complex laparotomy Then : - benign: cystectomy - germ cells tumour: unilateral salpingo oophorectomy and staging
39
Post menopausal mass Ovarian carcinoma second most common gynaecological cancer BRCA1 positive
Malignant features ( thick septation, solid components, ascitis) A- epithelial most commonly serous B- germ cells : dysgerminoma C- stromal Tumors includes : 1- granulosa theca secretes estrogen Rule out the endometrial cancer In children: precocious puberty 2- sertoli lydig testosterone: virilization and sign of estrogen deficiency
40
Gestational trophoblastic neoplasia abnormal proliferation of placenta tissue
A- complete mole most commonly GTN Empty egg with single sperm Grape like vesicles ( a vascular villi) B- incomplete mole Normal egg with two sperms Fetus and umbilical cord is seen but ultimately fetal demise
41
Secondary dysmenorrhea Presence of pelvic pathology
1- endometriosis: most ectopic glands in ovaries ( chocolate cysts) second site cul de sac ( uterosacral ligament nodularity and tenderness which leads to fibrosis and adhesive ( dyspareunia ) and dyschezia
42
Menstrual abnormalities
1- premenarchal vaginal bleeding Most commonly foreign body then sarcoma botryoides
43
Abnormal vaginal bleeding
1- pregnancy 2- anatomical changes: if pregnancy test - ( unpredictable bleeding without cramping 3- inherited coagulopathy : von willbrand disease most commonly 4- dysfunctional uterine bleeding: unpredictable in amount and duration ( an ovulation and cervical mucus clear thin and watery Basal body temperature chart will not show mid cycle ( absence of the thermogenic effect of progesterone
44
Abnormal vaginal bleeding
1- pregnancy 2- anatomical changes: if pregnancy test - ( unpredictable bleeding without cramping 3- inherited coagulopathy : von willbrand disease most commonly 4- dysfunctional uterine bleeding: unpredictable in amount and duration ( an ovulation and cervical mucus clear thin and watery Basal body temperature chart will not show mid cycle ( absence of the thermogenic effect of progesterone
45
Primary amenorrhea 14 without sexual characters 16 wit it
Breast + uterus + : imperfotr hymen Breast + uterus- : mullarian agenesis and complete androgen insensitivity Testosterone and karyotype Breast- uterus + : turner and hypothalamic
46
Secondary amenorrhea
1- rule out pregnancy -2- an ovulation ( progesterone challenge test ) 3- estrogen progesterone test : low estrogen ( ovarian or HP axis 4- hysterosaling: outflow obstruction

Medecine (8 decks)

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