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Flashcards in OBGYN Deck (57):
1

Pre-pubertal causes of vaginal bleeding?

  • Vulvar lesions
    • excoriations
  • Foreign body
  • Trauma

2

Causes od adolescent vaginal bleeding?

  • Normal menses
    • anovulation
  • Pregnancy
  • Exogenous hormones
  • Infections
  • Hematologic abnormalities

3

Causes of anovulation?

  • PCOD
  • Eating disorder
  • Excessive physical exercise
  • Thyroid disease
    • both hypo/er
  • Obesity
  • Hyperprolactinemia

4

What must be ruled out in a patient with abnormal bleeding in reproductive age women?

Pregnancy

5

What exogenous hormones can cause abnormal vaginal bleeding?

  • Oral contraception
  • DMPA (Depo shot)
  • Levonorgestrel implant
  • Mirena IUD

6

What age group has the highest rate of chlamydial infections and PID?

Adolescents

7

What are causes of vaginal bleeding in women of reproductive age?

  • Abnormal uterine bleeding
    • "PALM-COEIN"
    • polyps, adenomyosis, leiomyomas, malignancy, coagulopathy, endometrial, iatrogenic, NOS
  • Pregnancy related bleeding
  • Endocrine causes
  • Infections

8

Two most common causes of postmenopausal vaginal bleeding?

  • Exogenous estrogens
  • Atrophic vaginitis

9

Types of management of Abnormal uterine bleeding?

  • Nonsurgical
    • NSAIDS
    • Hormonal management
      • OCP, progesterone, IUD
  • Surgical
    • for patients with failed medical therapy
    • Hysteroscopy for resection of polyps, myoma, endometrial ablation
    • Hysterectomy

10

Normal vaginal secretions? flora? pH?

  • Secretions
    • floccular in consistancy, white, usually in posterior fornix
  • Flora
    • aerobic; lactobacilli most abundant
  • pH <4.5

11

Most common vaginitis in the US?

Cause?

  • Bacterial vaginosis
  • Polymicrobial
    • gardnerella
    • anaerobic bacteria
  • Lactobacillus usually absent

12

Clinical features of BV?

  • Fishy vaginal odor
  • Vagnal secretions are grey and thinly coated walls' bubbles
  • pH>4.5
  • Wet prep - Clue cells: "moth eaten cells"
  • Positive "whiff test"

13

What is bacterial vaginosis associated with in pregnancy?

Associated with preterm delivery/premature rupture of membranes

14

Cause and symptoms of vulvovaginal candidiasis?

  • Candida albicans
  • Sx
    • white curd-like discharge
    • pruritis
    • erythema

15

Predisposing factors to vulvovaginal candidiasis?

  • Prgnancy
  • DM
  • Abx
  • AIDS

16

Diagnosis of vulvovaginal candidiasis?

Vaginal pH <4.5

Wet prep (KOH) - visualization of spores and hyphae

17

Trichomonas vaginalis: transmission? sx? diagnosis?

  • Sexually transmited
  • Profuse purulent green malodorous vaginal discharge
  • "strawberry cervix"
  • pH > 4.5
  • Wet mount - mobile flagellated organisms

18

Hormonal contraception methods?

  • OCP/ring/patch
    • 92% efficacy with typical use; 99% with perfect use
    • Lightened and shortened menses
    • AE: bleeding, nausea, bloating, moodiness
  • Progesterone-based IUD/Implant
    • most effective to prevent pregnancy aside from tubal sterilization
    • Light to absent period; protective against endometrial CA
    • AE: bleedint, bloating, HA, depression
  • Depo shot
    • less effective than IUD
    • Light to absent period; protective against endo CA
    • SE: same as IUD + wt gain, decreased bone density

19

HSV:

Where is the latent virus?

Incubation period?

Signs/Symptoms?

Diagnosis?

  • Lumbosacral root ganglion
  • Incubation: 2-7 days
  • S/S: vulvar parasthesias, painful - ulcerative lesions, urinary retention, dysuria, and inguinal lymphadenopathy
  • Dx: PCR most accurate/sensitive
    • also viral culture, Tzank smear, and Ab titers

20

Gonorrhea:

Coinfection with what is common?

Symptoms?

  • Coinfection with chlamydia
  • Sx
    • purulent cervical discharge
    • friable cervix
    • however 70% of cases it is asymptomatic

21

Complications of gonorrhea? 

What occurs in disseminated infection?

  • Complications
    • Bartholin's gland absess
    • Gonococcal salpingitis
    • Infertility, ectopic pregnancy
    • Tubal damage can occur within 72 hours
  • Disseminated
    • more common in women
    • pyrexia, vasculitic rash, and unilateral large joint arthropathy

22

Chlamydia vs gonorrhea?

Complications of chlamydia?

  • Chlamydia is 3x more common and less symptomatic
  • Complications
    • male - epididymitis
    • Reactive arthritis
    • Females - salpingitis (infertility/abscess)
    • Fitz-Hugh-Curtis syndrome
      • peritonitis 
      • liver capsule inflammation

23

What is Reiters syndrome?

  • Arthritis
  • Conjunctivits
  • Uveitis
  • Urethritis

24

Primary syphilis:

Incubation?

Symptoms?

  • 3 weeks
  • Chancre --> red papule --> ulceration with serous exudate
    • this is single, painless, and not well demarcated

25

Secondary syphilis:

When does this develop?

Symptoms?

  • Develops 7-10 weeks after
  • Symptoms
    • Malaise
    • mild fever
    • Headache
    • Skin rash
    • Arthralgia
    • Bone pain
    • Lesions on palms and soles of feet

26

Tertiary syphilis:

What are the symptoms?

  • Neurosyphilis - dectectable in CSF only
    • Argyll Robertson pupil - small, constant in size, accomodation present but doesnt react to light
    • Tabes dorsalis - sharp back pains
  • Gummatous
    • mass, granulomas on skin/bone
  • Cardiovascular
    • Aortic dilation with regurgitation
    • Destruction of elastic tissue
    • Aortic aneurysm formation

27

Diagnosis and treatment of syphilis?

  • Diagnosis:
    • Nonspecific test: RPR or VDRL cardiolipin ab tests
    • Specific: FTA-ABS flourescent treponemal ab absorption test
  • Treatment
    • penecillin: one dose for early and multiple for late and tertiary

28

HPV diagnosis? Treatment?

  • Mainly clinical
  • Biopsy if diagnosis unclear
  • Abnormal pap smear

 

Treatment - cure not really possible: trichloroacetic acid (TCA) surgery, or laser common

(this is assuming youve read a bajillion things on HPV so i left out the SX and such)

29

Molluscum contagiosum:

Type of virus?

With widespread infection it may incidate what is present?

Diagnosis and treatment?

  • DNA virus (poxvirus)
  • Check for HIV with widespread infection
  • Diagnosis - clinical
  • Treatment: scraping out lesion, cryotherapy, electrocautery

30

Cause of lymphogranuloma venerum? Defining symptom?

  • Chlamydia trachomatis
  • Painful

31

Hemophilus ducreii causes what type of lesion?

Painful chancroid

32

What causes granuloma inguinale? Presentation?

Klebsiella granulomatis

Enlarging painless ulcer

33

Definition of PID?

Predisposing factors?

  • Definition: infection of tubes, ovaries, and adjacent tissues
  • Predisposing factors
    • multiple partners
    • previous episode
    • Chlamydia/gonorrhea infection

34

Etiology of PID?

Signs/symptoms?

  • 60% polymicrobial; 30% gonococcal; 30% chlamydia
  • Signs/Symptoms
    • abdominal, adnexal, and cervical motion tenderness
    • Temp >38deg
    • Leukocytosis >10,000
    • Purulent cervical discharge
    • Pelvic mass/abscess

35

Complications of PID?

  • TOA
  • Ectopic pregnancy
  • Infertility
  • Chronic pelvic pain

36

Causes of acute pelvic pain?

  • ovarian torsion
    • sudden onset
    • associated with abrupt position change
    • extremely painful, tender, unilateral adnexa
    • N/V
    • no doppler flow
  • Ruptured ovarian cyst - corpus luteum

37

Endometriosis: 

Symptoms?

Causes?

  • Symptoms
    • pelvic pain
    • dysmenorrhea
    • dyspareunia
    • infertility
    • nodularity of uterosacral ligaments
  • Causes
    • retrograde menstruation
    • lymphatic or vascular spread
    • metaplasia

38

Endometriosis diagnosis? Treatment?

  • Diagnosis
    • laparoscopy with biopsy
    • "powder burn" lesions: black, dark brown, bluish lesions
    • Clear or red lesions
  • Treatment
    • observation, medical, surgical

39

What is the cause of primary dysmenorrhea?

What is it?

Treatment?

  • This is caused by increased endometrial PG production
  • Pain beginning prior to or just after the onset of menstrual period
  • Treatment: NSAID or OCPs (relief in 90% of pts)

40

What is adenomyosis?

symptoms?

Treatment?

  • Definition: ingrowth of endometrium into uterin musculature
  • Symptoms
    • dysmenorrhea
    • very heavy or prolonged period
  • Treatment
    • NSAIDs
    • OCP
    • Hysterectomy

41

What is the most common benign uterine tumor?

Who is it more common in?

Leiomyoma (diagnosed by physical or imaging)

African american women

42

Signs and symptoms of a leiomyoma?

  • Abnormal bleeding, pain, pressure
  • Fewer than half are symptomatic with:
    • urinary frequency
    • infertility
    • prolapse of pedunculated fibroid through cervix
    • pelvic pressure or pain
    • dyspareunia

43

Treatment options for leiomyoma?

  • Observation
  • Surgical
    • myomectomy or hysterectomy
  • Angiography embolization
    • obstruction of BF to fibroid
  • Depo 

44

What is stress incontinence? What is it caused by and how is it treated?

  • Leaking of urine with activity
  • Caused by an increase in intrabdominal pressure that exceeds urethral sphincter closure pressure
  • Tx: pelvic floor PT, pessary (??), or surgery

45

What is urge incontinence?

What is it triggered by?

Treatments?

  • Leaking of urine accompanied with urgency (spontaneous contraction) with frequent, involuntary loss of urine
    • nocturia is common
  • Triggered by daily routines
  • Treatment: 
    • antimuscarinics
    • Alpha agonists
    • Pelvic floor PT

46

What is interstitial cystitis also known as? Signs/symptoms?

  • Painful bladder syndrome
    • Pelvic pain
    • Pain with intercourse
    • Pain on bladder filling
    • Urinary frequency and urgency
    • Nocturia

47

Intersititial cystitis cycle?

Bladder insult --> epithelial layer dysfunction --> potassium leak into interstitium --> activation of C-fibers and release of substance P --> mast cell activation and histamine release --> more inflammation --> bladder insult

48

Menopause definition? What occurs?

  • Definition: cessation of ovarian follicular function with absence of menstrual bleeding for greater than or equal to one year
    • vaginal atrophy
    • pelvic relaxation
    • skin changes
    • vasomotor instability
    • sleep disturbances
    • osteoporosis
    • CV changes

49

Osteoporosis: what are osteoblasts responsive to?

Osteoblasts responsive to estrogen and in estrogen deficienct state: osteoclasts dominate

50

What are advantages and disadvantages of HRT?

  • Advantages
    • Increased HDL, decreased LDL
    • Improved memory and bone health
    • Decreased vaginal dryness and menopausal sx
    • Decreased risk for colon cancer
  • Disadvantages
    • increased risk for CV disease
    • Increased risk for stroke/PE/DVT
    • Increased breast cancer risk

51

Contraindications of HRT?

  • Breast or endometrial cancer
  • Active liver disease
  • Acute vascular thrombosis
  • Pregnancy
  • Unexplained vaginal bleeding

52

Benign and malignant examples of breat disease?

  • Benign
    • fibroadenoma
    • papilloma
    • fibrocystic breast disease
    • fat necrosis
    • mastitis
  • Malignant
    • ductal carcinoma
    • lobular carcinoma
    • inflammatory breast cancer

53

What is a fibroadenoma? Who is it usually found in?

  • Painless, solitary mass
  • Can be bilateral
  • Typically in younger women

54

Fibrocystic breast disease: signs/symptoms? 

  • Diffuse and described as "lumpy"
  • Can be tender - cyclical breast pain associated with menses
  • Can increase in size before menses and crease afterwards

55

What is mastitis? What is it associated with? Treatment?

  • Erythematous, edematous area of the breast
    • fever is common
  • Associated with pregnancy
  • Treatment: dicloxicillin

56

Signs and symptoms of inflammatory breast cancer?

When is it commonly misdiagnosed?

  • Diffuse erythema and edema
  • "Peau d'oirange" with dimpling
  • Can be misdiagnosed as mastitis during pregnancy

57