OBGYN Flashcards
(113 cards)
1
Q
breast abscess etiology
A
S. aureus
2
Q
fibroadenoma vs fibrocystic changes
A
fibroadenoma doesn’t change w/ menstrual cycle
3
Q
fibroadenoma tx
A
observation
US Q3-6mo
surgery if mass changes or enlarges
4
Q
straw colored fluid on FNA bx
A
fibrocystic changes
5
Q
1st line fibrocystic changes
A
OCP
Mild mastalgia: NSAIDS
Severe mastalgia: Tamoxifen or Danazol
6
Q
galactorrhea tx
A
Tx underlying
Dopamine (bro/cab): decrease prolactin
levothyroxine: if hypothyroidism
7
Q
MC med that cause gynecomastia
A
spironolactone
8
Q
tx gynecomastia
A
testosterone replacement
tamoxifen
mastectomy
tx underlying
9
Q
risk factor breast cancer
A
BRCA1 BRCA2
FHx, >70yo, never breastfed, OCP use
estrogen exposure (obese, nulliparity, early menarche, late menopause, late 1st pregnancy)
10
Q
protective against breast cancer
A
breastfeeding
parity
11
Q
MC location breast cancer
A
upper outer quadrant
12
Q
breast cancer mammogram
A
microcalcifications
spiculated
13
Q
guidelines breast cancer prevention
A
Mammo 50-74 q 2yrs (40-49 if high risk)
14
Q
tx high risk of breast cancer
A
tamoxifen or raloxifene
15
Q
cervical cancer screen
A
21-65 yo
21-29 Q3yrs
>30 Pap + HPV or Pap Q3yrs
16
Q
MC cervical cancer
A
squamous
17
Q
DES exposure
A
clear cell cervical cancer
clear cell vaginal cancer
18
Q
Gardasil
A
HPV vaccine
start 11-12
<15 (2 doses, 6mo apart)
>15 (day 0, 2mo, 6mo)
19
Q
cervical dysplasia management
A
Repeat pap Q6mo, colopscopy, return to routine screening
ASCUS: <30 repeat Q1yr, >30 + HPV colpo, >30 no HPV repeat Q3yrs
LGSIL: mild dysplasia, colpo if HPV, cytology in 1yr
HGSIL: mod/severe, colpo or loop, cytology in 6mo
20
Q
missed abortion
A
abnormal US w/ no bleeding
no cervical dilation
21
Q
threatened abortion
A
normal US w/ minimal bleeding
no cervical dilation
no POC
22
Q
inevitable abortion
A
abnormal US w/ bleeding
dilated cervix, no POC
23
Q
incomplete abortion
A
abnormal US w/ bleeding
dilated cervix, loss of some POC but not all
24
Q
completed abortion
A
closed cervix
empty contracted uterus
25
abortion tx
curettage in 1st trimester or D&E in 2nd trimester
misoprostol
rhogam
26
MC RF placental abruption
HTN
| cocaine user
27
placental abruption tx
stable and <34w: management w/ fetal monitoring
>36w: induction, oxytocin, vaginal delivery preferred
unstable: C section
28
variable deceleration and bradycardia in fetus
cord prolapse
29
tx cord prolapse
digital disengatement
knee to chest
C section
30
MC location of ectopic pregnancy
ampulla
31
ectopic pregnancy triad
unilateral pelvic pain
vaginal bleeding
amenorrhea
32
ectopic pregnancy tx
stable: monitor w/ HcG or MTX if identified later (<4cm), rhogam
unstable (hypotensive, tachycardia): laparoscopy
33
tx endometritis
C section: IV clindamycin w/ gentamicin
Vaginal delivery: ampicillin and gentamicin
prophylaxis 1st gen ceps during c section
34
gestational diabetes screen
24-28w increased fasting plasma glucose >125
initial: 1h OGTT (>140)
3h OGTT (>180 1h, >155 2h, >140 3h)= confirm
35
gestational diabetes tx
insulin TOC
metformin/glyburide (refuse insulin)
induce at 38w if uncontrolled, 40w if controlled
36
molar pregnancy dx
bhcg >100k
| transvaginal US: snowstorm, cluster of grapes, honeycomb
37
molar pregnancy tx
D&C
rhogam
chemo if choriosarcoma (MTX)
do not give misoprostol, risk of incomplete uterine evacuation
38
1st line hypertensive meds in pregnancy
BB (labetalol)
CCB (nifedipine)
hydralazine
methyldopa
39
IV magnesium sulfate toxicity
hyporeflexia
| tx w/ calcium gluconate
40
pregnancy induced HTN diagnosis
BP >140/90 after 20wks
41
tx preeclampsia
definitive: delivery
prophylaxis: ASA
prevention of eclampsia: IV mg sulfate + diazepam
42
tx eclampsia
IV mg sulfate + diazepam
| definitive: delivery
43
HELLP syndrome
preeclampsia + hemolysis + increased LFT + low plt
44
tx HELLP
BP management
Mg sulfate
deliver if term
45
tx cervical insufficiency
No hx: vaginal progesterone (no hx)
hx: PO progesterone a + cerclage
no sex
46
CI in placenta previa
pelvic exam
47
preterm placenta previa tx
bed rest
tocolytics (mg sulfate)
CS
48
tx postpartum hemorrhage
uterine massage
oxytocin
misoprostol
49
PROM tests
+ fern test
+ nitrazine test (blue = ph > 6.5)
pooling of fluid in vaginal fornix
50
PROM tx
betamethasone/CS if <34w
| delivery if >34w
51
preterm labor tx
tocolytics
CS
MG sulfate
52
Rh incompatibility sx
hydros fetalis
hemolytic anemia, jaundice, hepatosplenomegaly
kernicterus
53
rhogam when
28w
| w/in 72h of delivery or potential mixing of blood
54
klinefelter syndrom karyotype
47XXY
55
heart defect assoc w/ klinefelter
MVP
56
klinefelter tx
testosterone for life
57
Turner syndrome karyotype
45X
58
heart defect assoc w/ turner syndrome
coarctation of aorta
59
tx turners syndrome
estrogen and progesterone substitution
60
tx infertility
clomid (ovulation inducer)
male: therapeutic insemination, intrauterine insemination
corrective surgery if occlusion
61
menopause labs
high FSH and LH
| low estrogen/estradiol
62
secondary amenorrhea due to hypothalamus tx
normal or low FSH/LH
| clomiphene
63
secondary amenorrhea due to pituitary tx
low FSH/LH, high prolactin
| transphenoidal surgery
64
secondary amenorrhea due to ovarian etiology labs
high FSH
high LH
low estradiol
65
secondary amenorrhea criteria
menses absent for at least 3 cycles or 6 consecutive months
66
athletic triad
amenorrhea
fatigue (eating disorder)
osteoporosis
67
tx dysmenorrhea
NSAIDS
heat, exercise, OCP
laparoscopy if everything fails
68
tx DUB
leuprolide
anovulatory: OCP first line
acute severe bleed: high dose IV estrogen, high dose OCP
ablation: pt that dont want hysterectomy
hysterectomy definitive
69
PMS phase
must occur on 2nd half of menstrual cycle (luteal phase)
| sx improve w/ menses
70
PMS tx
diet and exercise 1st line
| SSRI
71
tx PMDD
1st line SSRI
72
tx ovarian cyst
asx= observation (<8cm), repeat US Q6wks
laparoscopy: >6cm
rupture: pain management, observation. laparoscopy to control hemorrhaging if unstable
73
triad PCOS
hirsutism, amenorrhea, obesity
74
PCOS US and lab
string of pearls
high testosterone, high DHEA
high LH/FSH >3:1
75
tx PCOS
weight loss
| OCP mainstay
76
GYN cancer w/ highest mortality
ovarian cancer
77
chlamydia tx
azithromycin (pregnancy) or doxycycline (tx partner)
| test for gono but no need to tx
78
lymphogranuloma venereum caused by
chlamydia trachomatis
79
tx gonorrhea
```
ceftriaxone
tx chlamydia (azithromycin or doxycycline)
```
80
fitz hugh curtis syndrome
complication of PID
peri-hepatitis
violin string adhesions
glisson's capsule surrounds liver
81
chandelier sign
PID
82
tx PID
outpt: ceftriaxone + doxy +/- metro
inpt: cefoxitin/cefotetan + doxy
83
congenital syphilis hallmark
hutchington teeth
84
syphilis sx
primary: chancre painless
secondary: rash palmes and soles, F, LAD, arthritis, hepatitis
tertiary: gummatous lesions, argyll robinson pupil, neurosyphilis
85
tx chancroid
azithromycin, rocephin
86
pregnancy systematic changes
hyperventilation (resp alk)
increased CO, dec peripheral resistance
high plasma vol, high RBC vol, hypercoagulable
inc GFR
87
AFP low, BHCG high, estradiol low
Down syndrome (trisomy 21)
88
when triple screen pregnancy
AFP, Bhcg, estradiol
| 15-20w
89
high AFP in triple screen
spina bifida or multiple gestation
90
low AFP, Bhcg, and estradiol
trisomy 18: stillborn or die w/in 1yr
91
misoprostol indication
induce labor, cervical ripening
92
terbutaline indication L&D
lung development
93
normal fetal HR
120-160 bpm
94
early decelerations on NST
compression of baby's head
baby HR dec at same time as contractions
normal
95
late decelerations on NST
HR declines after contraction ends
uteroplacental insufficiency or fetal growth restriction
needs intervention
96
variable decelerations on NST
baby HR responding at different times
cord compression
needs intervention
97
abdominal size in pregnancy
12w: pubic symphysis
20w: umbilicus
36w: xiphoid process
98
group B strep screen during pregnancy
35-37w
99
endometriosis triad
cyclical premenstrual pelvic pain
dysmenorrhea
dysparenuria or dyschezia
100
endometriosis dx
laparoscopy w/ bx definitive: powder burn appearance
101
chocolate cyst
endometrioma
102
endometriosis tx
observation if asx
1st: laparoscopic ablation to preserve fertility
2nd: hysterectomy w/ oophorectomy
OCP/ NSAIDS 1st line
103
tx leiomyoma
asx observation w/ f/u q 6-12m
leupralide most effective
myomectomy if fertility desired
hysterectomy definitive
104
vaginal prolapse tx
kegals, pessary
| surgery
105
MC endometrial cancer
adenocarcinoma
106
endometrial cancer dx
PAP w/ endometrial bx
| endometrial stripe >4mm
107
tx endometrial cancer
total hysterectomy +/- rad
108
tx endometrial hyperplasia
1st line: progestin therapy, repeat bx in 3-6mo
| atypical: hysterectomy
109
BV etiology
gardnerella vaginalis
110
atrophic vaginosis tx
vaginal or PO estrogen
111
MC vaginal cancer
squamous cell carcinoma
112
MC valvular cancer
SCC
113
APGAR score
appearance, pulse, grimace, activity, respiration
7+ normal
4-6: fairly low
<4 critically low
