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A ORAL BOARDS 2016 > OB GYN > Flashcards

Flashcards in OB GYN Deck (19):
1

Differential diagnosis for female with possible appendicitis

In women, it is important to include

Mittleschmirz,
salpingitis,
tuboovarian abscess,
ovarian torsion,
ruptured ovarian cyst

and shared diff:
Infectious causes, such as
mesenteric adenitis,
urinary tract infection,
pyelonephritis, should also be considered.

2

most common gynecologic causes for lower-abdominal pain

complications of pregnancy (ectopic pregnancy or spontaneous abortion),
hemorrhagic or ruptured ovarian cysts,
pelvic inflammatory disease (PID),
ovarian torsion,
dysmenorrhea,
degenerating uterine leiomyomas,
endometriosis,
pelvic adhesive disease.

Nongynecologic causes that should be considered include appendicitis, diverticulitis, acute cystitis, and urinary calculi

3

work up right lower abdominal pain in 35-year-old female

Menstral history

Sexual history

Pregnancy history

Quantitative Beta hCG

CA 125 (ovarian CA)
AFP (ovarian CA)
LDH (ovarian CA)
Inhibin level (ovarian CA)

LFT
Urinalysis
CVC
BMP

In addition to pelvic ultrasound (Doppler to eval ovarian flow)

CT scan

4

When no intrauterine gestational sac is noted with an hCG level over 1,500 to 2,000 mIU/ mL,

then an ectopic pregnancy should be strongly considered.

5

If the hCG level rests below this discriminatory zone,

then serial hCG levels can be helpful to differentiate between a normal and abnormal early gestation

levels usually rise at least 66% over 48 hours.

6

While an adnexal mass can be found with an ectopic pregnancy, it can be differentiated by:

usually smaller than those associated with torsion

often is paraovarian in location.

7

treatment of ectopic

Historically, surgical removal was the standard approach to treatment.

With accurate hCG assays and improving ultrasound technology, earlier diagnosis has made medical management with methotrexate more prevalent.

8

Management of ruptured ovarian cyst

Usually conservative with ultrasound have no knowledge often resolving within six weeks

If in the genetic instability may require urgent surgical intervention

9

Cherney incision

When a pfannestiel incision is converted by detaching the rectus muscle from the tendon insertions on the pubic symphasis

10

Time cut off for irreversible ovarian necrosis with torsion

24 hours

11

Management with a over that remains dark or dusky after detorsion

Leave it in place do surveillance of viability

12

Assessment of questionable perfusion to ovary after detorsion

fluorescein injecton

ovarian bivalves

13

ovarian cystectomy

Used to concert over in reproduction aged

Benign pathology or indeterminate

Elliptical incision over the top of the anti-mesenteric portion of the ovary mass

Separate it from the surrounding strumma with mets

Do not rupture or still trimmer

Hemostasis with suture ligation and cautery

Sorrows left open or reapproximated with fine suture

14

Salpingo-oophorectomy

Develop pararectal space

infundibulopelvic ligament at the pelvic sidewalk - incision parallel to the round ligament toward the white line of Toldt

External iliac artery in vain identified

Blunt dissection meal two these vessels to open up the pararectal space

Identify ureter over the iliac vessels by lifting the infundibulopelvic ligament

Window is made between the ureter and ovarian vessels

Ligate divide her ovarian vessels

Fallopian tube and utero ovarian ligament transected at the uterus

15

Management of incidental simple ovarian cyst in reproductive aged

Female less than 5 cm

This is usually functional and will resolve on its own leave it there

16

Management of incidental solid tumor greater than or equal to 10 cm

or associated with excrescence

Likely to be malignant removal should be considered

17

Management of incidental ovarian mass in postmenopausal patient

Considered for removal

18

Enter operative incidental ovarian mass management

Consult intraoperative gynecologist

If not available, closing and referral is an option excepting approach may result in a second operationHowever, this allows for better planning, gives the patient time to deal with potential impacts on fertility, hormonal status, malignant diagnosis, and risks

19

Minimum management of ovarian mass suspected cancer

oophrectomy
Paracentesis - for cytology
omentectomy
lymphadectomy:
pelvic
and
periaortic

chemo:
Taxane
carbaplatinum
(sim to the TC of breast carbaplatinum is sim to cysplatin)

No xrt!?

yes for cervical and uterin