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Step 2 Review > OB-Gyn > Flashcards

OB-Gyn Flashcards

1
Q

Options if pap smear reveals ASCUS?

A
  1. Repeat pap in 4-6mo and 1yr (no HPV testing)
  2. HPV testing
  3. Colposcopy
  • -> If HPV+ then get colposcopy
  • ->If HPV- then repeat pap in 1yr
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2
Q

What is colposcopy?

A

If pap smear was weird (ASCUS/HSIL+):

  1. apply acetic acid to highlight areas of nuclear density
  2. biopsy highlighted areas
  3. follow with endocervical curettage
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3
Q

Special consideration for ASCUS in post-menopausal woman

A

treat with vaginal estrogen, then repeat pap

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4
Q

Benign breast nodules

A

Fibrocystic changes - small mobile and tender w/ cycle
Fibroadenomas - small mobile and non-tender
*Don’t get a mammogram in women <30yo

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5
Q

What to do with a palpable breast mass

A
  1. diagnostic mammogram
    • if neg, then image by U/S
    • if pos, radiologist to grade: benign vs needs bx
  2. if not determined benign, then get sample:
    • aspirate if cystic appearing
    • biopsy if solid appearing
  3. definitely biopsy if: still palpable after aspiration, or aspirate is bloody

*15% of brca can be mammographically silent

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6
Q

Bi-RADS scale

A 
0 = need more info
1 = negative
2 = benign
3 = probably benign (0-2% chance of malig)
4 = suspicious for malignancy (a-10/b-50/c-95)
5 = 95%+ it's malignant
6 = bx-proven malignant
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7
Q

4 symptoms that point to acute bacterial cystitis

A
  1. frequency
  2. dysuria (acute onset)
  3. hematuria
  4. back pain
    In contrast - absence of dysuria and back pain r/o UTI
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8
Q

How often do men get cystitis and/or pyelonephritis?

A

uncommonly - if they have urinary sx and are ill (and have a normal urinary tract) then think prostatitis

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9
Q

What is the work-up for post-menopausal vaginal bleeding?

A
  1. pelvic exam
  2. r/o STIs and anatomic abnormalities
  3. endometrial biopsy
    * don’t perform bx if pregnant, has PID or a bleeding diathesis
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10
Q

Explain hormones of menstrual cycle.

A

Follicular Phase:
1. GnRH –> FSH (lots) and LH (small)
2. FSH –> follicle to produce estrogen
3. Low dose estrogen –I LH
Surge:
1. FSH builds and causes build of Estrogen
2. High dose estrogen –> LH
3. LH surge –> ovulation
Luteal Phase:
1. Corpus luteum –> progesterone, inhibin, and some estrogen
2. Inhibin –I FSH (stall before next follicle)
3. Progesterone –I GnRH (stall before next FSH/LH)
*Then when corpus luteum dies, progesterone withdrawal causes endometrial shedding

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11
Q

What to do for heavy AUB?

A
  1. High dose estrogen - to switch back to proliferative phase
  2. OCPs with estrogen and progesterone
    - -> Surgery if needed
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12
Q

Mnemonic for causes of AUB

A 
PALM (structural) COIEN (functional)
P-polyps
A-adenomyosis
L-leiomyoma
M-malignancy
C-coagulopathy
O-ovarian dysfunction
E-endometrium
I-iatrogenic (IUD)
N-not otherwise classified
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13
Q

Anti-depressant that’s ok for pregnancy

A

Fluoxetine

DON’T give paroxetine, lithium, BZDs

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14
Q

Big side effects of vacuum assisted delivery

A
  1. cephalohematoma
  2. retinal hemorrhage
  3. increased risk of shoulder dystocia
    BUT it has less maternal soft tissue trauma than forceps
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15
Q

Work up and treatment of hyperemesis gravidarum

A
  1. it’s N/V past first trimester, along with weight loss and ketonuria
  2. r/o molar pregnancy with BhCG and U/S
  3. evaluate lytes, LFTs, and amylase/lipase
  4. treat with: B6, doxylamine, promethazine;
    +if dehydrated: IVF, nutrition, dymenhydrinate
    +if severe: reglan, zofran, prochlorperazine, promethazine
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16
Q

Gestational diabetes

A
  • dx by 1hr OGTT >140, then 3hr OGTT >140
  • start with ADA diet, exercise, add insulin for tight glucose control, monitor baby regularly
  • > 50% will go on to develop DM later
17
Q

Pregestational diabetes in pregnancy

A

pre-gestational = mother already had DM; may be found by hyperglycemia or glucosuria in 1st trimester

  • insulin requirements may increase up to 3 fold
  • monitor mom for DM complications
  • strict glucose control
  • close eye on fetus during later term and delivery; C/S if EFW>4500g
18
Q

Pre-E, E, and HELLP

A 
Pre-E = HTN, proteinuria, edema
E = seizures
HELLP = Hemolytic anemia, elevated LFTs, Low Plt; this is a variant of Pre-E with poor prognosis; physio is vasospasm leading to hemorrhage and organ necrosis

Control BP with labetalol and/or hydralazine, prevent sz with Mg drip, treat sz with diazepam

19
Q

Complete vs. Incomplete Mole

A

Complete: sperm + empty egg = 46,XX; no fetal tissue

Incomplete: 2 sperm + normal egg = 69,XXY; contains fetal tissue

20
Q

Gestational trophoblastic disease

A 
Benign = complete/incomplete moles
Malignant = molar pregnancy that progresses to GTD, meaning invasive mole or choriocarcinoma
21
Q

What to do for preterm labor

A
  1. sterile spec to r/o PROM
  2. U/S to evaluate baby
  3. tocolytics (Mg, CCB, PGIs), steroids (beta or dex), and PCN/Amp for GBS ppx
22
Q

Risks of external version

A

cord compression or placental abruption; be prepared for C-section

23
Q

Triad of postpartum endometritis; treatment; and complication

A
  1. fever >38 w/in 36hrs
  2. uterine tenderness
  3. malodorous lochia
    Tx: Clinda+Gent until AFx48hrs
    Watch out for septic pelvic thrombophlebitis (picket fence fevers; get CT pelvis; broad-spec abx and heparin x7-10d)
24
Q

How to diagnose Sheehan syndrome?

A

provocative hormonal testing and MRI brain to r/o pituitary tumor

25
Q

Hypergonadotropic hypogonadism

A

no secondary sex characteristics because gonads are not responding to the HIGH amounts of gonadotropic hormones (FSH/LH); check karyotype and/or work up for no ovaries

26
Q

Hypogonadotropic hypogonadism

A

no secondary sex characteristics because no gonadotropic hormones (FSH/LH); check all the other hormones that could be throwing these off, as well as chronic disease (CBC/LFT/ESR) and MRI for compressive pituitary tumor
*If that’s all negative then it’s constitutional growth delay and just wait

27
Q

Work-up for Primary amenorrhea

A

Think about HPO Axis and Anatomy:
+axis, +anatomy = anorexia, pregnancy, imperforate hymen
+axis, - anatomy = Mullerian agenesis, AIS
-axis, +anatomy = Kallman, Craniopharyngioma, Turner’s

28
Q

How to differentiate Kallmans, Craniopharyngioma, and Turner’s syndrome in w-u for 1˚ amenorrhea

A
  • only Turner’s will have super high FSH/LH, because it’s a normal axis trying to talk to absent ovaries
  • Kallman and CP will have low FSH/LH because something is wrong with the central axis
  • MRI brain will show mass in CP, show nothing in Kallman’s
29
Q

Work-up for secondary amenorrhea

A
  1. Pregnancy - check UPT
  2. Hypothyroidism - check TSH, FT4
  3. High prolactin - check Prl level
  4. Low DA - check meds list for antipsychotics
  5. Another problem with the HPO axis - work backwards from the EM: progesterone challenge, E+P, FSH/LH, U/S ovaries, MRI brain; hypothalamus problem would be dx of exclusion
30
Q

When evaluating virilization:
testosterone - think?
DHEA-S - think?

A

testosterone - think ovaries; PCOS or Sertoli-Leydig cell tumor

DHEA-S - think adrenals; CAH or adrenal tumor

31
Q

Buzz words for uterine rupture

A
  • palpable irregular abdominal protuberance
  • loss of fetal station, “no fetal presenting part” or retraction of fetal part (pathognomonic)
  • late decels and loss of intrauterine pressure
  • mother will also have HOTN, vaginal bleeding, and sudden onset pain

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