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Flashcards in OBGYN Deck (225)
1

VDRL +, miscarriages, thrombocytopenia, prolonged PTT

Anti-phospholipid anti-body syndrome --> LMW heparin

2

Vaginal bleeding 8wks after delivery

Gestational trophoblastic disease - Choriocarcinoma --> lungs

3

Dx Choriocarcinoma or GTD

HCG

4

Verrucous, papilliform lesions near anus, puritus

Condylomata acuminata --> Podophyllin, 5-FU, surgery. IF-a

5

Flat, velvety lesions near anus

Condyloma lata (2 syphilus) --> PCN

6

High fever, IVDU, prostatute, migratory arthralgias, pustules w/ central necrosis on arms, current menses, (-) culture

Disseminated gonococcal infection

7

Intense pruritis, extensive patches of erythema, vesicles and tense bullae on limbs > trunk

Herpes gestationis (IgG to BM) --> IUGR & stillbirth = steroids

8

Risk factor for endometrial CA

Anovulation, nulliparous, >35, tamoxifen, unopposed estrogen, OBESITY

9

Cis to uterine ablation

Polyp, leiomyoma, bicornate utrus

10

Complication of Tubo-ovarian abscess?

Rupture --> shock = surgery

11

Baseline fetal HR

110-160bpm

12

Early decelerations

mirror image of uterine contractions = fetal HEAD compressions

13

Late decelerations

Follow uterine contractions = HYPOXIA & >50% = Acidemia

14

Variable decelerations

Abrupt, jagged clips below baseline = most common = caused by CORD COMPRESSIONS

15

#1 cause post-partum hemorhhage

Uterine atony

16

Post-partum bleeding with FIRM uterus

Gential tract lesion

17

Mechanism of acute dyspnea 2 days after tx for pyelopnephritis

Endotoxin mediated capillary leakage

18

Complication of PID or salpingitis

Ectopic pregnancy, sterility

19

Anthroipoid pelvis

Predisposes to occiput posterior - >AP diameter than Transverse

20

12h RLQ colicky pain w N/V, guarding, hx of ovarian cyst, 14 wks pregnant

Ovarian torsion ---> laparotomy ovarian cystectomy d/t pregnancy

21

#1 complication of benign ovarian cyst

Ovarian torsion

22

N/V, fever, anorexia, R abd/flank pain

Appendicitis ---> surgery and IV antibiotics

23

Generalized pruritis, >palms, soles, worse at night, no rash or papules, inc bili, bile, LFTs

Intrahepatic cholestasis of pregnancy = INC circulating bile acids ---> preme, fetal distress and death

24

Intense pruritis, erythematous papules surrounded by narrow pale halo on abd and butt

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