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Concept of how to treat TOA

TOA = tubovarian abscess

Want to start w/ aggressive broad spectrum IV abx (cefotetan or cefoxitin + doxy)
-but may be hard for abx to penetrate TOA (b/c no blood supply and capsulated)

=> may need to surgically drain the abscess if abx don't work


Differentiate the two classification systems used for cervical cancer

1. Cytology- this is what you see on pap smears

2. Histology- seen when you take biopsy of colposcopy


Why does uterine atony cause bleeding post-partum?

Uterine atony = lack of uterine tone
Uterine tone is needed for contractions to clamp down on the spiral arteries- so much vasculature, need to clamp down to stop the bleeding


Briefly describe the IVF process

1. ovarian stimulation
2. oocyte retrieval, done transvaginally
3. fertilization of egg w/ sperm in petri dish (hence the in vitro)
4. insertion of fertilized egg into uterus


Age at which you stop needing pap smears?

After 65 you can stop (and never restart!) if never had CIN II or worse



(a) When does it peak?
(b) Peak level
(c) Level at term

beta-hCG (pregnancy hormone)
rule of 10s

(a) Peaks at abotu 100,000
(b) At 10 weeks of gestation
(c) About 10,000 at time of term fetus


Causes of spontaneous abortion

1st T most common i is spontaneous abortion
2nd T: maternal infection/anatomic abnormality, teratogen exposure, uterine malformation, trauma
-thyroid disease
-diabetes 2/2 poor vascularization
-antiphospholipid syndrome


Relationship btwn BMI and risk of osteoporosis

Low BMI have higher risk of osteoporosis- less body weight = less pressure being put on bones


Medical management of first trimester spontaneous abortion

Prostaglandings such as Misoprostol (cytotec) to
-contract uterus and open the cervix to expel POCs


Describe the details of administering a medical abortion

1-3 tablets of RU-486 (Mifepristone = progesterone antagonist to stop growth of pregnancy) given

Then 6-72 hrs later insert 4 tablets of misopristol (prostaglandin analogue to induce uteirne cramping and POC crampign) transvaginally

-pregnancy passes w/in 4-6 hrs of misopristol

Then F/u apt for US or beta-hCG to confirm completion


Possible consequences of untreated PID

-infertility 2/2 tubal scarring
-chronic pain/adhesions


Most common location for ectopic pregnancy

95+% are in the fallopian tubes
-majority of which are located in the ampulla


Discriminatory zone of b-hCG and its relevance

Discriminatory zone 1500-2000
-level above which imaging scan should be able to se gestational sac w/in the uterus

So if b-hCG is >2000 and you don't see gestational sac = high suspicion for ectopic, but if b-hCG is 1,000 and no gestation sac it's still pregnancy of unknown location


Indication for continuous GnRH therapy

Continuous GnRH can be given to suppress ovulation in girls w/ precocious puberty


Leading cause of maternal death in the first trimester

Ectopic pregnancy


Buzzword: violin strings

Fitzhugh-Curtis = perihepatitis = adhesions from liver edge to anterior abdominal wall
-inflammation of liver capsule to adjacent periotneal surfaces


Buzzword: cervical motion tenderness

Buzzword for PID


Diagnostic criteria for PID

Need 1 major and 1 minor criteria (at least)

Major criteria: 1 of 2
1. Cervical motion tenderness
2. Adnexal/uterine tenderness

-elevated CRP/ESR


Fitz-Hugh-Curtis syndrome

= Perihepatitis = inflammation of the liver capsule and adjacent periotoneal surfaces

-increased risk in PID
-adhesions from liver edge to anterior abdominal wall


'Chocolate cyst'

Chocolate cyst = ovarian endometrioma


Purpose of HPV testing in pt w/ diagnosis of HSIL

In LSIL and HSIL pt is assumed to be HPV+
-especially if age 21-29: most likely that the patient is + if she's sexually active, and high probability of clearing it on her own