OBGYN Flashcards
(225 cards)
1
Q
VDRL +, miscarriages, thrombocytopenia, prolonged PTT
A
Anti-phospholipid anti-body syndrome –> LMW heparin
2
Q
Vaginal bleeding 8wks after delivery
A
Gestational trophoblastic disease - Choriocarcinoma –> lungs
3
Q
Dx Choriocarcinoma or GTD
A
HCG
4
Q
Verrucous, papilliform lesions near anus, puritus
A
Condylomata acuminata –> Podophyllin, 5-FU, surgery. IF-a
5
Q
Flat, velvety lesions near anus
A
Condyloma lata (2 syphilus) –> PCN
6
Q
High fever, IVDU, prostatute, migratory arthralgias, pustules w/ central necrosis on arms, current menses, (-) culture
A
Disseminated gonococcal infection
7
Q
Intense pruritis, extensive patches of erythema, vesicles and tense bullae on limbs > trunk
A
Herpes gestationis (IgG to BM) –> IUGR & stillbirth = steroids
8
Q
Risk factor for endometrial CA
A
Anovulation, nulliparous, >35, tamoxifen, unopposed estrogen, OBESITY
9
Q
Cis to uterine ablation
A
Polyp, leiomyoma, bicornate utrus
10
Q
Complication of Tubo-ovarian abscess?
A
Rupture –> shock = surgery
11
Q
Baseline fetal HR
A
110-160bpm
12
Q
Early decelerations
A
mirror image of uterine contractions = fetal HEAD compressions
13
Q
Late decelerations
A
Follow uterine contractions = HYPOXIA & >50% = Acidemia
14
Q
Variable decelerations
A
Abrupt, jagged clips below baseline = most common = caused by CORD COMPRESSIONS
15
Q
1 cause post-partum hemorhhage
A
Uterine atony
16
Q
Post-partum bleeding with FIRM uterus
A
Gential tract lesion
17
Q
Mechanism of acute dyspnea 2 days after tx for pyelopnephritis
A
Endotoxin mediated capillary leakage
18
Q
Complication of PID or salpingitis
A
Ectopic pregnancy, sterility
19
Q
Anthroipoid pelvis
A
Predisposes to occiput posterior - >AP diameter than Transverse
20
Q
12h RLQ colicky pain w N/V, guarding, hx of ovarian cyst, 14 wks pregnant
A
Ovarian torsion —> laparotomy ovarian cystectomy d/t pregnancy
21
Q
1 complication of benign ovarian cyst
A
Ovarian torsion
22
Q
N/V, fever, anorexia, R abd/flank pain
A
Appendicitis —> surgery and IV antibiotics
23
Q
Generalized pruritis, >palms, soles, worse at night, no rash or papules, inc bili, bile, LFTs
A
Intrahepatic cholestasis of pregnancy = INC circulating bile acids —> preme, fetal distress and death
24
Q
Intense pruritis, erythematous papules surrounded by narrow pale halo on abd and butt
A
PUPPP = sx tx only
25
Tx cholestasis
Anti-histamines, cornstarch bath ---> cholestyramine, UDA
26
RUQ pain, malaise, N/V, ARF, hypoglycemia, jaundice, coagulopathy
Acute fatty liver of pregnancy (LCHAD deficiency) = DELIVERY
27
Acute dyspnea, tachy, low O2, clear lungs
PE ---> CTA, but D-dimer not helpful = heparin 5-7d for 3months to 6 wks post-partum
28
#1 maternal mortality
PE (cause = stasis)
29
Grave's, tachy, fever, diarrhea, tender thyroid, confused, leukocytosis
Thyroid storm = propanolol, steroids and PTU
During pregnancy --> PTU, surgery in 2nd trimester
30
Hypothyroid b4 pregnancy, changes with pregnancy?
High estrogen --> inc thyroid-binding globulin, total T4/INC serum total thyroxine levels ----Free T3,4, TSH unchanged
Inc dose of Levo in pregnancy and menopause if receiving estrogen
31
Most common cause of post-partum hyperthyroidism
Lymphocytic (anti-microsomal abs) thyroiditis NOT Grave's disease (overall and DURING pregnancy)
32
Smoker, underweight mother, small uterine size for gestation, 900g dx and next step?
IUGR = US - symmetric (head affected) or asymmetric, assess amniotic fluid, evaluate fetal well being (breathing, movement, tone)
33
IUGR complications & tx
Pre-term, fetal stress, death (esp reverse end-diastolic flow)
<34wks and ok = steroids
32-36wks - severe HTN, REDF, poor BPP, no growth
37wks = deliver
34
#1 cause of asymmetric IUGR (<10 percentile)
Maternal vascular disorder - HTN, smoking, illicit drug use
| Abd < head size & >20wks
35
Symmetric IGUR causes
Aneuploidy, early infection
| <20wks
36
Morbidities in IUGR
INC meconium aspiration, necrotizing enterocolitis, hypoglycemia, thrombocytopenia
37
Neonatal tachy, restlessness, diarrhea, poor weight gain, goiter
Thyrotoxicosis - Mom tx for Graves w/ remaining TSI
38
Prolonged PT, PTT, 3rd tri or early PP, inc LFTs
Acute fatty liver of pregnancy (LCHAD deficiency) = DELIVERY (34+ wks)
39
1st step in young person (<30), pregnant or pain w/o evidence of mass
US
40
1st step in older person (>30) w/ breast mass
Mammo + US --> guided core Bx
41
Indication for breast Bx
Aspiration --> blood, reoccurance of mass, or mass doesn't disappear, both cystic and solid parts
42
Risk factors for breast CA
1st degree relative esp pre-menopausal or B/L, BRCA, menarche 55, obese, etOH
43
Benign characteristics of breast masses
Soft, smooth, mobile, tender, <30
44
Malignant characteristics of breast masses
Firm/hard, fixed/immoble, painless, >50
45
Firm, hard, fixed mass, coarse calcifications, core bx shows fat globules and foamy histiocytes
Fat necrosis
46
Young woman, firm, rubbery mass, mobile
Fibroadenoma --> FNA or US
47
Very young adolescent, very rapid growth breast mass
Giant juvenile fibroadenoma
48
Late 20s, many yrs growth, very large, fixed, distorting breast mass
Cystosarcoma Phyllodes --> core bx and removal can become malignant
49
30-40s b/l, masses inc last 2 weeks of cycle
Fibrocystic - not persistent = Mammo, persistent = aspiration; recurrs --> bx
50
20-40s, bloody nipple discharge
Intraductal papilloma --> mammo
51
Standard form of breast CA, needs pre-op chemo and has worse prognosis if inflammatory
Infiltrating ductal CA
52
Breast CA type w/ inc risk for B/L CA?
Invasive Lobular CA
53
Rock hard, most invasive breast CA?
Invasive ductal CA
54
Tx ductal carcinoma in situ
Total mastectomy (recurrs w/ local excision), NO mets
55
When to suspect breast CA
Ill-defined mass, "orange peel," nipple retraction, eczematous areola, palpable nodes
56
Irregular inc density and MICROcalcifications on mammo
Breast CA
57
Tx breast CA in pregnancy
Lumpectomy, mastectomy but NO radiation and NO chemo in 1st timester
58
HER2 breast CA tx
Trastuzumab ---> cardiotoxic = get ECHO b4 starting
59
Pre-menopausal CA tx
Tamoxifen
60
Post-menopausal CA tx
Anastrozole
61
Persistent HA or back pain w/ local tenderness w/ hx breast CA
MRI of spine PEDICLES
62
Indication for surgical excision
atypical ductal hyperplasia
63
Tx for reducing breast pain
Primrose, red caffeine, topical NSAIDs, red stress, Danazol, Tamoxifen, Toremiphene, Bromocriptine
64
Physiologic nipple discharge
W/ stimulation, clear, yellow, green
65
Pathologic nipple discharge
Spontaneous, persistent, bloody, from single duct, w/ mass, >40 --> mammogram --> excision of terminal duct
66
Meds causing galactorrhea
SSRIs, TCAs, atenolol, verapamil, anti-psychotics, H2 blockers, opiates, estrogen
67
Work-up for galactorrhea w/ (-) pregnancy test
TSH, free T4, prolactin
68
Pathologic marker w/ impact on future Tx
Oncgoene/HER2 expression by FISH or IHC --> anthracyclines for overexpression
69
Negative prognostic indicator by flow cytometry in breast CA
DNA content - aneuploidy, higher % in s-phase = higher proliferation
70
Active phase of labor
4cm dilated --> full dilation
71
What predicts normalcy in labor?
Change in cervix per time
72
Nulliparous cervix dilation rate
1.2 cm/hr
73
Latent phase of labor
Cervical effacement (thins), <4cm
PGE2 breaks DISULFIDE bonds in collagen
74
Protraction of active phase
Dilation in active phase <1.2cm/hr NP or 1.5cm/hr MP
75
Arrest of active phase
No dilation for 2hrs
No descent for 1hr
Cephalopelvic disproportion --> C/S
76
Stage 1 of labor
Labor --> complete dilation
77
Stage 2 of labor
Complete dilation --> delivery of infant
78
Stage 3 of labor
Infant ---> delivery of placenta
79
Adequate uterine contractions
q2-3 min, firm to palpations lasting 40-60 seconds; >200 Montevideo units
80
How to calculate Montevideo units
Sum of amplitudes above baseline of uterine contractions w/in 10minute window
81
Contractions 3-4 minutes, dilation 1-2cm over 3hrs next step?
Observation - still in latent phase
82
O' Station
Head @ Ischial spines, NOT pelvic inlet
83
39 weeks, dark vaginal blood mixed w/ mucous cause?
Bloody show/mucous plug (vs. antepartum bleeding)
84
of weeks to deliver w/o inc risk of neonatal complications
39weeks
85
Pre-eclampsia, epigastric tenderness, high LFTs --> hypotension
Hepatic rupture (glissen capsule)
86
Complications of preeclampsia
ICH, coagulopathies, renal failure, hepatic hematoma/ruptures, uteroplacental insufficiency, IGUR
87
Risks for preeclampsia
Nulliparous, age extremes, AA, hx of preeclampsia or HTN, obesity, anti-phosphilopid ab
88
Severe vs. mild preeclampsia
Severe = >5g protein, 160/110, RUQ/epigastric pain, vision changes = delivery regardless of age
89
29 wks, contractions 3-5min, 2cm dilated, 80% efface, nulliparous, +fFN
Pre-term labor (>20 - < 37wks)
90
Manage preterm labor
Tocoylsis for cause (<34), GBS, fetal fibronectin, mag sulfate for neuroprotection
91
Risks of pre-term labor
PREVIOUS, PROM, multiple gest, cocaine, A.A, trauma, surgery in preg, hydramnios, pyelonephritis, gonococcal infections
92
Hx of pre-term, medication to dec risk of pre-term
Progesterone weekly from 16-36wks
93
37 weeks, breech position next step
External cephalic version
| - can self-correct b4 37wks
94
Convert second twin from transverse/oblique to breech
Internal podalic version
95
Carpal tunnel management
Splint ---> steroid injection ---> surgery only w/ muscular atrophy
96
Risks for placenta accreta (decidua basalis)
Previous uterine incisions (c-section), anterior > post. or low lying/previa, prior myomectomy, >35, Downs
97
1st step in placenta accreta
Hysterectomy d/t hemorrhage and death
98
Accreta - Increta - Percreta layers
decidua basalia - myometrium - serosa and bladder
99
Dense blue tissue adherent to uterus and bladder, hematuria
Placenta precreta
100
Accreta refuses hysterectomy next step and complication
Ligate cord, + IV MTX --> hemorrhage, infection
101
Week when placenta is major progesterone source
10 weeks
102
Mom has HBsAg, next step for baby?
HBIG and Hep B vaccine at birth
103
How to tx syphilus in mom
PCN; w/ allergy, desensitize and give PCN
104
When to give Rubella?
Post-partum b/c it's a live vaccine
105
When and how to screen for neural tube defects
B/W 16-20wks - preg assoc protein-A (PAPP-A), bhCG, nuchal translucency
106
Screen for GBS
35-37wks
107
Threatened abortion lab test
bHCG and/or progesterone levels
108
Menorrhagia d/t uterine fibroids work-up
CBC, endometrial bx and papsmear
109
Women >55 y/o w/ adnexal mass work-up
CA-125 & CEA markers
110
Amenorrhea w/ some spotting, lower abd/pelvic pain, sharp/tearing, syncope
Ectopic pregnancy ---> bHCG TVUS
- IVFs if unstable
- CBC, LFTs, b-hcg + *MTX*
- surgery w/ <2cm w/ desire for fertility
111
#1 cause 1-2nd trimester maternal mortality & hemoperitoneum
Ectopic pregnancy
| - risks = previous, IUD, PID, ovulation induction, ART, tubal
112
Irregular menses, obese, inc body hair
PCOS
113
Benefits of sonohysterography
Saline injected into uterus + US to better ID polyps or submucosal myomata
114
When to use CT?
Pelvic or abd mass to delineate LNs
115
When to use MRI?
Mullerian defects - vaginal agenesis, double uterus, location or pregnancy
116
Benefits of hysterosalpingogram
Submucosal fibroids, uterine adhesions, patency of fallopian tubes
117
Fetal HR w/ sinus wave cycles 3-5/min
Severe anemia or asphyxia
118
PPROM (gush, +nitrazine, ferning), fever, fetal tachy, tender uterus
Intra-amniotic infection (chorioamnionitis - + gram stain) --> amp or gent & deliver after 34wks
119
Risks for PPROM
Poor, STDs, smoking, cervical cone, cerclage, abruption, hydramnios, multiple gestations
120
Chorioamnionitis W/O PROM organism
Listeria (otherwise GBS and EC)
121
Clear fluid, + PG, 33wks next step?
PG = fetal lung maturity = delivery
122
Fetal heart tracing abnormality in PPROM
Variable decelerations
123
Fever, myalgias, child w/ red cheeks, height > gestation, can't palpate baby?
Hydramnios + Parvovirus in pregnancy --> severe anemia ---> hydrops fetalis
124
Fetal hydrops, inc middle cerebrl doppler flow cause?
Rh isoimmunization
125
Parvovirus IgM and IgG (-) next step?
Repeat in 1-2wks to ensure incubation period has elapsed
126
(+) Chlamydia DNA assay, no sx next step?
Erythromycin or amox for 7d or 1dose Azithro ---> WB or PCR confirmation
127
Fetal sequela of Chlamydia infection
Conjunctivitis (NOT cured w/ erythromycin), PNA
128
Most common neonatal conjunctivitis cause and tx?
Chlamydial = 14d oral erythromycin
129
Complications of gonococcal cervicitis
abortion, pre-term, PPROM, sepsis, chorioamnionitis and post-partum infection
130
Pustular skin lesions, arthralgias, septic arthritis in 3rd trimester
Disseminated gonococcal infection
131
Tx and goal of HIV in pregnancy
<1000 RNA copies/ml, HAART therapy, IV ZDV during vaginal labor, no breast feeding, ZDV to neonate
132
Organism is #1 cause of preventable blindness, propensity for columnar and transitional epithelium
Chlamydia --> LATE post-partum endometritis
133
Pyelonephritis w/ EC (#1) sensitive to amp --> acute dyspnea
ARDS (Endotoxin release --> leaky capillaries) = supportive measures
134
Most common cause of sepsis in pregnant women
Pyelonephritis = hospitalization, IV antibiotics (cephalosporins or amp + gent)
135
No improvement in pyelonephritis/sepsis in 2-3d next step?
Look for urinary obstruction or perinephric abscess = CT scan
136
Prevention of pyelonephritis
Urine culture @1st pre-natal and 1st trimester and tx early UTI/bacturia
137
Post-c-section, hypotension, fever, lethagy, tender incision w/ crepitus, anemia, inc Cr
Necrotizing fasciitis ---> isotonic IVFs, antibiotics, debridement
138
Rapidly progressing infection of episiotomy or c-section, most common cause?
Group A strep
139
C-section, fever, somewhat tender fundus, no other abnormalities
Endomyometritis (#1 fever followiing c-section)
140
Cause and tx of endomyometritis
Ascending vaginal infection = Anaerobic (Bacteroides), some GNR (Polymycrobial) ---> Gent & Clinda
141
Post c-section fever after antibiotics persists after 48hrs? 72hrs cause?
>48 = enterococcal --> amp; >72hrs = CT scan for abscess, hematoma, thrombophlebitis (antibiotics + heparin)
142
Young, nulliparous, fever, abd pain near menses, dysparenunia, hyperemic cervix, uterine and adnexal tenderness
PID/Salpingitis --> infertility, ectopic; get US to R/O tubo-ovarian abscess
143
Cause of PID/salpingitis
G/C, GNR, anaerobes (MULTIPLE) = test, antibiotics, US for abscess
144
Salpingitis not improve after 48hrs
Laproscopy "GS for Dx," & for abscess (anaerobes) --> clind or metronidzaole
145
Risks for PID
Nulliparity, IUDs (OCPs, and depot DEC risk)
146
Copious, white or yellow discharge, nonmalodorous, no other sx
Physiologic leukorrhea
147
Thin-whitish/gray discharge from vagina, no CMT, pH 5, epithelial cells w/ adherent bacteria, no PMNs
BV = metronidazole
148
Use of transcranial doppler
>20wks
| Fetal anemia w/ inc flow = has replaced PUBS
149
Pseudocyesis
```
Signs of pregnancy BUT
- normal endometrial stripe
- (-) hCG
- strong desire for child
= CONVERSION disorder
```
150
1st sign of pregnancy
Goodell sign = softening of cervix @ 4wks
Ladin - midline uterus softening - 6wks
Chadwick - blue discoloration of vagina - 6-8wks
151
Physiologic changes of pregnancy
Inc CO --> murmur
Lower BP
Dec SVR
Inc TV & minute ventilation --> resp alkalosis
GERD, constipation
*INC GFR*
*Estrogen --> INC TBG --> INC total T4, T3*
Anemia, inc WBC
Hypercoagulable - no change in PT, PTT, INR but dec platelets and inc fibrinogen
152
How to do DM testing
50g --> >140 at 1 hr do 100g glucose tolerance test
100g --> 180, 155, 140
153
Risk with chorionic villus sampling
In high risk pts, advances maternal age or known genetic disorder
b4 9-10 wks ---> limb defects
154
Type of abortion
1. "liver passed"
2. some products + dilation
3. some products intact + bleeding + dilation
4. products intact + bleeding + NO dilation
5. 2nd trimester dilation w/o cramps
1. Complete
2. Incomplete --> D&C
3. Inevitable --> D&C
4. Threatened --> bed rest, no sex, reassurance
5. Incompetent cervix (hx LEEP) --> cerclage
155
Work-up for threatened abortion
bhcg should rise 66% inn 48hrs, progesterone >25
Otherwise get TVUS to assess pregnancy and viability
156
Twins same gender + 2 placentas
Monozygotic
Dichorionic
Diamniotic
0-72 hr split, tubal
157
Twins same gender + 1 placenta + 1 sac/no septums
```
Monzygotic
Monochorionic
Monoamniotic
8-12d split
conjoining, cord entanglement
```
158
Deliver vs. delay pre-term labor
Deliver
- Pre-eclampsia, fetal demise, pROM, abruption/DIC, 34-37wks, >2500g
Delay
- 24-33 wks, 600-2500g --> Mag sulfate, terbutaline, or CCBs + steroids (48hrs)
159
3rd timester painless bright red bleeding, NO contractions, NON tender uterus
Placenta previa --> abd US
- never do digital exam or TVUS
- strict pelvic rest, no sex
160
Work-up for vasa previa
TVUS
- steroids if 28-32 wks
- NST 2-3x daily
- C/S w/ PROM, variable decel, bleeding + tachy
161
3rd rimester dark bleeding + pain + contractions
Placental abruption --> abd US
| - C/S w/ hemorrhage, fundal tenderness, fetal distress
162
Risks for abruption
*HTN*
cocaine
trauma
smoking
163
Post-partum bleeding, shaggy mass, placental extraction from funds >30min
Uterine inversion --> halothane, terbutaline or mag sulfate
164
Gush of blood, lengthening of cord, globular, firm uterus
Placental separation
165
Baby tacky --> brady + vaginal bleeding
Apt test = rupture of fetal umbilical vessels
166
Extremem abd pain, HYPERVENTILATION + TACHY, regression of fetus, variable decels seen in MVA pt
Uterine rupture --> laparotomy for delivery
167
Rh work-up
1st prenatal + 24-28wks
- Unsensitized = RHOgam@28wks
- Sensitized >1:16 w/ Rh+ baby --> amniocentesis for bilirubin and anemia --> possible PUBS
168
Management of Eclampsia and HELLP
Mag & deliver
169
Fetal acidosis, late decels, ph<7.35, BG 200
DKA
170
Sequlae of neonatal hyperglycemia
hyperglycemia --> hypoxia --> polycythemia & hyperviscosity, hypoCa
171
Management of GDM
Diet & exercise --> post-patrum 75g test at 6wks
Breast feed
>4500g = c/s
NPH at hs + aspart b4 meals
172
Movements of baby through birth canal
Flex - IR - Extension - ER
173
Contractions in lower abdomen, irregular, equal in intervals and intensity
False labor
- better w/ sedation
- -> reassurance
174
Latent stage >14-20hrs
Prolonged latent stage --> rest & wait for resolution in 6-12hrs
Balloon ---> stim engagement and dilation
Pitocin
175
Stage 2 3hr w/ epidural, >2hrs w/o
Prolonged stage 2 --> oxytocin & re-asses in 2hrs
+1/+2 station = vacuum forceps
0 station = c/s
176
Delivery w/ shoulder dystocia
McRoberts
- flex knees + suprapubic pressure
Delivery of posterior arm --> humerus fx
177
Post-partum bleeding management
#1 uterine atony
Palpate
- Firm/normal uterus = laceration
- Very firm = retained placenta --> D&C, follow hcg
- Boggy = Atony
- Absent = inversion --> tac fornices, pitocin
Massage --> oxytocin --> PGF or misoprostol --> uterine a. ligation or hysterectomy
PGF2a CI in asthmatics
Methergine CI w/ HTN d/t stroke risk
178
Post-partum fever tender uterus, foul lochia, prolonged PROM, C/S
Endometritis --> Gent + clinda
| - normal to have low fever, leukocytosis in 1st 24hrs
179
Hyperemesis
bhcg to r/o mole
US to r/o mole
IVFs
Anti-emetics - doxylamine > promethazine > reglan > zofran
180
Seizures in pregnancy tx
Phenobarbital + FOLATE
181
Dx menopause
Inc FSH
Dec estrogen --> thoracic spine fx, dryness, atrophy
Estrogen replacement --> endometrial hyperplasia
182
Work-up for AUB/DUB
Post-coital = CA
| D&C --> ablation or hysterectomy
183
Contraceptive for breastfeeding
Progestin mini-pill or Depo
184
Risks of OCPs
Inc stroke, MI, cholelithiasis, liver adenomas, breast CA
185
Contraceptive for sickle-cell, epilepsy
Depo --> DEPRESSION, weight gain
186
Vaginal ring left in & patch left on for how long?
3 weeks
Patch Norelgestin + EE --> 2X INC IN DVT
187
CIs to IUDs
STDs, abnormal shape uterus, cancer, fibroids, PID
188
Labial fusion cause
21B-OH deficiency - Excess androgens
189
White, thin labial skin, dysuria, dysparenuina
Lichen sclerosis --> steroids --> punch bx for SCC
190
Sticky, white, adherent discharge w/ PRURITIS, recent abc, pH 4
Candida --> oral fluconazole
191
Grey-white spilled milk, homogenous discharge, pH 6
BV --> metronidazole
192
Yellow-green, profuse discharge, ERYTHEMA
Trichomonas --> metronidazole + partner
193
HEAVY bleeding, midline uterine mass irregularly shaped
Uterine fibroid/leiomyoma
| ---> NSAIDs, progestin --> myomectomy --> uterine rupture --> ***Hysterectomy***
194
PAINFUL heavy bleeding, large, globular, boggy uterus
Adenomyosis --> hysterectomy
195
Cyclical pelvic pain 1-2 wks b4 menses + dysparenunia + dysmenorrhea + DYSCHEZIA w/ nodular uterus and adnexal mass
Endometriosis
dx - laparoscopy w/ chocolate cysts
tx - NSAIDs, OCPs --> danazol and leuprolide
196
LH:FSH >3:1, amenorrhea, obesity
PCOS --> OCPs, weight loss, metformin, clomiphene
197
Post-menopausal adnexal mass work-up
TVUS & CA-125
198
3 wks post-partum fever, breast pain, redness, induration
Mastitis
- I&D, docloxacillin
- Continue feeding
w/o fever or tenderness = galactocele --> aspiration
199
Normal vaginal secretion thick, scant, acidic = which phase
Pre & post-ovulatory = Follicular & mid --> late luteal
200
Resolution w/ TCAA
HPV --> TCAA, podophyllin
201
PainLESS papule --> ulcer, painLESS B/L LAD + flat, velvety lesion w/ raised margin
Syphilis --> IM PCN G
202
Deep purulent base/necrotic, ragged, SCHOOL OF FISH, painful ulcer and LAD
Chancroid --> Azithro or IM ceftriaxone
203
Red, beefy base, painless, NO LAD
Granuloma inguinale
204
Tx HSV during pregnancy
Active = C/S
No Sx = SVD
Acyclovir @ 3wks
205
Blindess 5-14 post delivery
Chlamydia (GC is 2-5d)
206
NST < 15/15 2 in 20 and no rxn to vibroacoustic stim next step
BPP
- 8-10 = good
- 4-8 >36 wks = deliver
- 4-8 CST
CST brady or late decal = deliver now
CST reassuring --> steroid and wait
207
Risk of CA in endometrial hyperplasia
1. Simple
2. Complex
3. Simple atypia
4. Complex atypia
"Penny, nickel, dime, quarter"
1
3
8
29%
208
S/P hsyterectomy, fever, flank pain
Ureteral injury = CARDINAL ligament
- -> CT w/ contrast, abx, stent
- -> dissection --> ischemia ascities
209
Which SERM stimulates endometrium --> CA?
Tamoxifen
210
ASCUS work-up
25 --> HPV + = colpo or repeat 3yrs if -
211
HSIL work-up
Colpo + bx
| Repeat 6-8 wks after delivery if pregnant
212
Cough, sneeze --> urine leak
Stress incontinence --> kegel
213
Urge, frequency, nocturia, delay from cough urine leak
Urge --> oxybuntin or ditropan
| - spastic bladder or instability
214
DM, epidural, NO urge but dribbling throughout day, inc RV
Overflow --> bethanachol, a-blockers, intermittent cath
215
Continuous urine leak but normal function, hx crohns or radiation
Fistula
216
Chronic pelvic pain + urgency, frequency, worse w/ spicy food
Interstitial cystitis
| - *submucosal petechiae & ulcers*
217
Never had menses
+ breasts
- uterus
Normal testosterone + hair
46XX - Mullerian agenesis
| - No vagina or uterus but normal ovaries --> hair
218
Never had menses
+ breasts
- uterus
INC testosterone + scant hair + inguinal buldge + normal female genetalia
46XY - Androgen insensitivity
| - gonadectomy of testes AFTER puberty
219
Never had menses
- breasts
+ uterus
LH, FSH HIGH
Turner
- no secondary characteristics
- give E +P
- --> osteoporosis and coarctation
220
Never had menses
- breasts
+ uterus
LH, FSH low
Craniopharygioma
Kallman syndrome
- No GnRH, anosmia, no pubic hair
221
Amenorrhea
- hcg
Progestin --> bleed
PCOS
222
Amenorrhea
- hcg
Progestin - bleed
+ estrogen --> inc FSH, LH
Menopause
Ovarian failure - FSH/LH <1, Turner, auto-immune
Aromatase deficiency - LOW estrogen, clitoromegaly
Pituitary apoplexy, adenoma or sheehan
223
Virilization - rapid onset
VERY HIGH TESTOSTERONE
U/L adnexal mass
Sertoli-Leydid tumor
224
Virilization
| HIGH DHEAS
Adrenal tumor
| - sample vein
225
Hirsuitism in pregnancy 1st step
US
no mass = check adrenal w/ CT
B/L cystic = THECA-LUTEIN
B/L solid = luteoma
U/L solid --> laparoscopy to r/o CA
