ob-gyn Flashcards
most common uterine cancer
adenocarinoma
risk factor for uterine neoplasm?
estrogen
uterine cancer has similar risk to what other type of CA
breast
Endometriosis define
uterine tissue outside of the uterus
Dysfunctional Uterine Bleeding treatment
OCPs or hormonal therapy (Progesterone) to regulate/shorten cycle
○ NSAIDs for dysmenorrhea & reduce bleeding
decreases despite small relative platelet dysfunction)
○ Surgical ligation or embolization of uterine arteries, D&E, hysterectomy
most common site for endometriosis
most common site of implantation is peritoneal
how to dx endometriosis
laproscopy
tx for endometriosis
hormone replaced / OCP
symptoms of endometriosis
cyclic cramping and heavy bleeding during peroids
Leiomyomata
benign uterine fibroid
leiomyosarcoma
cancerous uterine fibroid
how are leiomyomata (uterine fibroids) dx
US
tx of uterine fibroids
depends on what location:hormonal control (symptomatic relief), ablation/ligation/embolization of uterine
arteries, hysterectomy
Why are Patty & Selma, Bart Simpson’s aunts at risk for endometrial cancer?
given their obesity, diabetes, hypertension, and alcohol consumption. Both had periods at 9 years old, never had children, suffered from infertility and PCOS. both had breast cancer and took Tamoxifen
what increases the risk of ovarian torsion
cysts >5cm are at increased risk of torsion, may check flow with doppler, fertile patient dealt with Emergent. pain meds should be offered
benign bleeders (another name for?)
leiomyomata
normal cycling cyst
follicular 2.5cm
chocolate cyst
Corpus Luteum: associated with pregnancy
Thecal cyst
often bilateral, result from excess hCG secretion in molar and multi gestation pregnancy
risk of ovarian cancer
ovulation
ovarian cancer is associated with what syndromes
BRCA mutations & Lynch
Syndrome/HNPCC
what is C125 used for
ovarian cancer
is bleeding common in ovarian cancer?
no
dx ovarian ca
US or CT
tx of ovarian ca
chemo or surgery
cancer is secreting tumor markers (alphaFP,
betahCG, LDH, alkaline phosphate. you should think:
germ cell or tetratoma
Gardnerella is…..
bacterial vaginosis —tx is flagyl
tx of Trichomonas
metronizole
Asherman Syndrome
uterine scaring
Premenstrual Dysphoric Disorder (Premenstrual Syndrome)
must interact with daily function. try SSRI, hormonal replacement
what hormones do ovaries continue to produce after menopause
After menopause, the ovaries continue to produce testosterone and androstenedione
○ But estrone is the main postmenopausal
circulating estrogen
how do you dx menopause
FSH > 30 mIU/mL diagnostic
do not use hormonal replacement with what pts
Cannot use HRT with unexplained vaginal bleeding, history of DVT/PE, or history of GYN
tumors that may be estrogensensitive
breast are tender during what phase of menstral cycle
lutealphase
antibiotic for mastitis
dicloxacillin, nafcillin, or cephalosporin
risk for developing breast cancer
Nulliparity or delayed childbearing, Early menarche or late menopause, Longterm
estrogen exposure i.e. being on OCPs for years
○ Radiation exposure
○ First degree relative with breast cancer
more common breast cancer ductal or lobar
ductal
what is Paget’s Disease of the Breast
● Scaly, eczematous, erythematous nipple lesion
● Ductal carcinoma of the nipple
ddx for gactorrhea
Pituitary adenoma (hyperprolactinemia)
○ Thyroid disorders
○ Medication side effect: H2 blocker (cimetidine); antipsychotic
(risperdone)
Gynecomastia
Caused by an imbalance of testosterone and estrogen effect (too strong an effect)
● Can also be caused by medication: spironolactone
OCP benefits
Less dysmenorrhea and menorrhagia (less irondeficiency
anemia)
○ Less PID
○ Some protection against ectopic pregnancy
○ Less acne and hirsutism; benign breast disease
○ Reduced risk of ovarian and endometrial CA
work up for infertility
Semen analysis: first step ● Endocrine workup: TSH, FSH, prolactin levels ● Anatomical workup (hysterosalpingogram, ultrasound)
tx for infertility
Clomiphene citrate (Clomid): given to anovulatory women
○ Stimulates ovaries to produce eggs
● Artificial insemination
● Assisted reproductive therapy: IVF, GIFT, surrogate
● Therapies are expensive but about 75% effective
Cervical motion tenderness (chandelier’s sign)
PID
PID work up
GC and Chlamydia: DNA probe testing
● Pelvic ultrasound: to ruleout
TOA
prenatal care schedule
Visit once a month until 28 weeks, once every 23
weeks until 36 weeks, then once a
week until term
Quickening will start at what week (fetal movement):
about 18 weeks
during the first trimester: Low PAPPA (pregnancy associated
plasma protein A) and high hCG increased risk of what genetic disorders
trisomy 18,
trisomy 21
2nd trimester: if low estriol, low AFP, high inhibin→ increased risk of
genetic disorders
Nuchal translucency screening (nuchal fold scan)
what is this, when is done and what does it screen for?
US at 12 weeks
○ Screen for trisomies, Turner’s
○ If abnormal→ offer CVS or amniocentesis
Fetal heart rate: normal (reactive) =
2 accelerations in 20 minutes of up to 15
bpm from baseline and no decelerations
stations of labor
Spine: 0 station, Above spine: 1,
2cm, etc; below spine: +1, +2cm
stage 1 first baby: labor can last up to ____hours and still be considered within a normal time frame
20 hours
stage 2 is defined by
complete dilation of cervix
third stage
delivery to delivery of placenta
benefits & cons of Internal (fetal scalp electrode;
need to have at least 2cm cervical dilation): most accurate
● Look for accelerations and decelerations
Late decels are
bad→ uteroplacental insufficiency with lack of blood flow to infant
If concerned about FHR then…
● change mom to lay on left side, given oxygen, stop pitocin
Cardinal movements of birth
engagement→ descent→ flexion→ internal rotation→
extension→ external rotation→ expulsion
Examine placenta and cord: there should be
3 vessels→ 2 arteries, 1 vein
APGAR score at 1 and 5 minutes stands for?
(Appearance, Pulse, Grimace, Activity, Respiration)
○ Categories: color, heart rate, respiration, reflex, motor tone
risks of c-section
higher risks of thromboembolism, bleeding, infection, longer length of stay
transfusion if blood loss is ____mL or hematocrit drops by ___%
Blood loss requiring transfusion or a 10% drop in hematocrit
○ Or >500ml blood loss from vaginal birth or 1000ml after csection
management of hemorrhage
Uterine massage
○ Manual compression
○ Oxytocin, ergonovine or prostaglandins to enhance contraction
uterus returns to normal size how many weeks about birth?
6 weeks
Most common etiology of ectopic pregnancy
adhesions (scars from previous surgery, infection, etc) ● Risk factors ○ Previous ectopic ○ PID ○ Tubal/abdominal surgery ○ IUD ○ Assisted reproductive therapy
symptoms of ruptured ectopic pregnancy
Hypotension, Shoulder pain (referred pain), Peritonitis
Bradycardia or tachycardia
hCG normally doubles every 48 hours → if less than doubling, suspicious, order what imaging?
transvaginal US
tx of ectopic pregnancy
methotrexate (if early, small, patient is stable, and good followup
available)
■ Folic acid antagonist → kills embryo
Gestational Trophoblastic DIsease
A group of diseases arising from the placenta
○ Hydatidaform mole
○ Trophoblastic tumors
○ Choriocarcinoma
○ Hydatidaform mole
partial and complete molar pregnancy
○ Chorionic villi that grow into a tumor
○
US of molar pregnancy
Complete: “grape like vesicles” or “snowstorm” on US with empty egg
can complete and incomplete molar pregnancy go on to be cancerous
Yes
20% of complete
5% of partial
high hCG level, uterine size bigger than date, nausea, and Hyperemesis gravidarum and abnormal uterine bleeding
molar pregnancy
tx of molar pregnancy
chemo or surgery
when to screen for gestational DM?
Screen at 24-28
weeks
how to test for Gestational DM
Nonfasting: 50g glucose tolerance test, then check glucose at 1 hr—- If >130mg/dL→ then do a 3hr
test
3hr GTT: 100g glucose load in Am after fasting. Then check glucose levels at 1,2 and 3 hours→ if 2 or more abnormal values, diagnosis is made.
Threatened abortion :
vaginal bleeding, os closed
Inevitable abortion :
vaginal bleeding, os open
Incomplete abortion :
vaginal bleeding, os open
important post abortion management
Give RhoGam if mom is Rh ()
○ If incomplete/missed abortion: may need D&C
Painless 3rd trimester vaginal bleeding
Placental Previa
Placental Previa
Risk factors ○ Advanced maternal age ○ Smoking ○ High parity ○ Scarring
dx of Placental Previa
US
Sympathomimetic use, smoking, heavy alcohol use ○ Trauma ○ HTN ○ Advanced maternal age ○ High parity are risk factors for
Abruptio Placentae
aburptio placentea DX?
Diagnosis: US not diagnostic enough
○ Need to monitor fetus and fetal stress testing
○ Lack of blood flow would reflect in fetal heart rate with decelerations
Pelvic examination reveals a dilated cervical os with visible tissue in the endocervical canal. Which of the following types of abortion is best represented in this case?
incomplete abortion
Routine PAP smear reveals high grade squamous intraepithelial lesions (HGSIL). What is the next step in this patient’s management?
Colposcopy
Pelvic ultrasound is ordered and reveals uterine fibroids. She is concerned because she would still like to have children in the future. Which of the following is the recommended therapy for this disease?
Myomectomy
complaints of spasmodic, cramping abdominal pain during her periods, which radiates to her upper thighs and her lower back. She states that she has had these symptoms for a long time but now the pain is getting so bad that she can’t bear it anymore. Which of the following medications would be the best choice for treatment of this patient?
A.
Mefenamic acid (Ponstel) is the only NSAID that is currently approved for use in spasmodic dysmenorrhea
lab work reveals no proteinuria; however she does have a trace of glucosuria. Which of the following best explains this finding?
The glomerular filtration rate increases during pregnancy and may lead to a finding of trace glucose in the urine.
In fetal heart monitoring, cord compression is most likely to cause which of the following?
Variable decelerations
Which of the following subtypes of ovarian cancer is the most common?
Epithelial cell
This is the cause of over 90% of ovarian malignancies.
Which of the following best represents the luteal phase of the menstrual cycle?
Decrease in estradiol and increase in progesterone
This most accurately describes the luteal phase of the menstrual cycle. These hormone changes occur during days 15 to the 1st day of menses with decrease in LH and FSH; if fertilization does not occur progesterone will drop rapidly.
Turner syndrome is suspected. Which of the following best describes this patient’s menstrual disorder?
primary
A premenopausal patient presents to the clinic with the chief complaint of abnormal vaginal bleeding, irregular cycles and vaginal dryness. Which of the following is the most common cause of abnormal vaginal bleeding in this patient population?
Anovulation: This is the number one cause of dysfunction uterine bleeding.
Which of the following is considered first line therapy in the treatment of anovulation?
Clomiphene is indicated as first line therapy in the treatment of anovulation. This drug is an estrogen antagonist that will relieve the negative feedback on FSH allowing for follicular development. Sometimes OCP’s can also be used to treat anovulation.
edward syndrome is another name for
trisomy 18
A 41 year old pregnant woman comes to your OB/GYN clinic asking about screening for neural tube defects. Besides educating her on the need for folic acid supplementation you inform her that the best screening method is which of the following?
Maternal serum alpha fetoprotein levels
This is the primary method of screening for neural tube defects and is performed at around 16-18 weeks.
Endometriosis most commonly affects what other organ?
Ovaries are affected in greater than 60% of cases of endometriosis.
Which of the following is the earliest sign seen in preeclampsia?
Hypertension
Neurofibromatosis is inherited according to which of the following patterns?
Neurofibromatosis and achondroplasia are inherited in an autosomal dominant fashion.
1st line therapy for the treatment of pre-menstrual syndrome.
Fluoxetine
SSRI’s
Which of the immunoglobulins would you expect to be equal in both the mother and the fetus? Hint it is the smallest
IgG
Which of the following types of HPV is the most severe and has the worse prognosis?
11 & 16 (lost molly and parents divorce)
Lithotomy
position for pelvic exam
warfarin may not be used in __________
pregnancy
initial test of choice to dx PCOS
Total testosterone levels
A 26 year old woman presents for routine PAP smear. She is sexually active and has been for over 6 years, she also has a history of smoking and some recreational drug use. Her PAP smear results in atypical squamous cells of undetermined significance (ASC-US). What is the next step in the evaluation of this patient?
A.
Human Papilloma Virus Testing
The preferred strategy for Atypical Squamous Cells of Undetermined Significance (ASC-US) is reflex HPV testing. HPV-negative patients should be re-tested in 3 years. HPV-positive patients should undergo colposcopy.
A 27 year old female presents to the OB/GYN clinic complaining of dyspareunia and intermenstrual bleeding. She also states that she is noticing pain in her left abdominal region on the lower side. Ultrasound is ordered and reveals a simple 4cm left sided ovarian cyst. Pregnancy test is negative. Which of the following is the most appropriate therapy at this time?
Repeat US in one month
This is the correct answer and is the best initial approach to a patient with a simple ovarian cyst less than 5cm in diameter. Most cysts of this nature will resolve on their own, and 1 month follow-up is sufficient unless symptoms worsen.
In a patient with Polycystic Ovarian Syndrome, which of the following would most likely be found on laboratory studies?
2:1 LH:FSH ratio
This abnormality is seen in nearly 95% of patients with PCOS.
In a couple who is trying to conceive, the husband has already tested normal on semen analysis. What is the initial work up for the female?
This along with basal body temperature charting is usually the initial step in the work up of female infertility.
What is the treatment of choice for vaginal candidiasis in a pregnant patient?
Miconazole nitrate vaginal cream
Which of the following subtypes of ovarian cancer is the most common?
Epithelial cell
This is the cause of over 90% of ovarian malignancies.
A premenopausal patient presents to the clinic with the chief complaint of abnormal vaginal bleeding, irregular cycles and vaginal dryness. Which of the following is the most common cause of abnormal vaginal bleeding in this patient population?
anovulation
