- Benign neoplastic proliferation of smooth muscle arising from myometrium - are estrogen responsive

- Metformin - OCPs (if don't want kids) - Ovulation induction (if wants kids) - Clomiphene - Spironolactone (for hirsutism) - Weight loss

OBGYN 7 Flashcards by Giselle McIntyre

Where do ovarian arteries branch from?

Directly off the aorta

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Where do ovarian veins branch from

R side branches directly off the IVC (think that R is closer to IVC than left)

L side branches off renal vein

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Where do uterine arteries branch from

Off the internal iliac arteries

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What are the size cut-offs for ovarian cysts that can be ignored vs. removed

If it is <3 cm = most likely simple cyst, can ignore

If it is <10 cm = most likely simple cyst, but should reimage

If it is >10 cm = less likely to resolve on it’s own / possibly a tumor - remove

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What is an endometrioma

♣ Chocolate cyst
Caused by endometriosis
♣ Dx: diagnostic laparoscopy with laser ablation

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Tx of endometriosis

♣ NSAIDS and/or OCPs

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What is the discriminatory zone

• “Discriminatory zone” when BHCG >1500-2000, should see some findings of IUP (i.e. gestational sac) on US

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Describe pH of different causes of vulvovaginitis

BV = pH > 4.5
Trich = pH > 4.5
Candida = pH < 4.5

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What are the causes of cervicitis

♣ Gonorrhea/Chlamydia

♣ Or organisms that cause vulvovaginitis (BV, Trich, Candida)

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Describe subtypes of PID

♣ Endometritis
♣ Salpingitis
♣ Tuboovarian abscess
♣ Peritonitis

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What are the causative organisms of PID

Gonorrhea (33%)
Chlamydia (33%)
Vaginal flora (33%)

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Diagnosis of PID

♣	Pelvic or abd pain
♣	No other cause for symptoms
♣	1 of the following positive:
•	Cervical motion tenderness
•	Adnexal tenderness
•	Uterine tenderness

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Tx of PID

• Ceftriaxone IM x1 + Doxy + Metronidazole
o Ceftriaxone cover gonorrhea
o Doxy covers chlamydia
o Metro covers anaerobes

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What is criteria to be able to use methotrexate as tx for an ectopic pregnancy

bhCG < 5000
Gestational sac < 3.5 cm
No fetal heart tones

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What are the causes of abnormal uterine bleeding

PALM COIEN

PALM = structural
P = poly
A = adenomyosis
L = leiomyoma
M = malignancy

COEIN = nonstructural
C = coagulopathy
O = ovulatory dysfunction
E = endometrial
I = iatrogenic
N = not yet classified

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What is a leimyoma

Benign neoplastic proliferation of smooth muscle arising from myometrium
are estrogen responsive

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Tx of fibroids

♣ First line:
• OCP/IUD +/- NSAIDs for pain

♣ Surgery:
• Leuprolide to shrink prior to surgery
• Myomectomy if want to maintain fertility
• TAH if she doesn’t want kids

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How do you diagnose PCOS

(1) + (2) or (3)

(1) Oligo- or anovulation
(2) Hyperandrogenism
♣ Elevated DHEAS
♣ Elevated Testosterone
♣ LH:FHS > 3:1
(3) Polycystic ovaries on US

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Treatment of PCOS

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Metformin
OCPs (if don’t want kids)
Ovulation induction (if wants kids) - Clomiphene
Spironolactone (for hirsutism)
Weight loss

Describe order of events of puberty in women

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(Think: Tits, pits, mits, and lips) 
♣	Breasts (8)
♣	Axillary (9)
♣	Growth (10) 
♣	Menarche (11)

Define: False pregnancy – appearance of clinical or subclinical signs and symptoms associated with pregnancy when a person is not actually pregnant

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Pseudocyesis

Tx of pseudocyesis

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Psychiatric eval and tx

Tx of Bartholin duct cyst

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Observation - most resolve spontaneously

If it is symptomatic you can treat it as you would a Bartholin duct abscess - with I&D

At what gestational age do you screen for GBS in a pregnant woman

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35-37 weeks

At what gestatioal age should RHOGAM be given in a Rh negative patient

28 weeks and after delivery if infant is Rh(D) positive

What antidepressant is contraindicated in pregnancy

Paroxetine - increased risk of cardiac malformations and persistent pulmonary HTN

Describe intrahepatic cholestasis of pregnancy (ICP)

* Intrahepatic cholestasis of unknown etiology in pregnancy whereby the patient usually complains of pruritus with or without jaundice and no skin rash * Bile salts are incompletely cleared by the liver, accumulate in the body, and are deposited in the dermis, causing pruritus

Tx of ICP

• Ursodeoxycholic acid (UDCA) – decreases total serum bile acid levels and helps to relieve the itching

Describe Pruritic urticarial papules and plaques of pregnancy (PUPP)

♣ A common skin condition of unknown etiology unique to pregnancy characterized by intense pruritic and erythematous papules on the abdomen that spread extremities and often the buttocks

Tx of PUPP

♣ Therapy includes topical corticosteroids and antihistamines

What proteinuria values are diagnostic for Pre-E

>300 mg on a 24 hour urine, P:C >0.3

What proteinuria value is diagnostic for Pre-E with severe features

> 500 mg*

Tx of 39 week woman with new Pre-E without severe features

Delivery Do not need mag

Tx of eclampsia

- Magnesium IM or IV | - Delivery after maternal stabilization

What is the therapeutic level of magnesium

4-7 mEq/L

At what level of magnesium does loss of DTR occur

7-10 meq/L

What can occur at mag levels of 11-15

Respiratory depression

What can occur at mag levels >15

Cardiac arrest

What is the risk of isoimmunization in an Rh- woman who gave birth to a Rh+ baby without Rhogam

2% antepartum 7% after full term delivery 7% with subsequent pregnancy So less than 20% total

Best non-invasive test to detect fetal anemia in an Rh- mom

US - middle cerebral artery peak systolic velocity

What will be seen on US on fetal hydrops

- Collection of fluid in two or more body cavities (e.g. ascites, pericardial fluid, pleural fluid, scalp edema) - Placentomegaly (placental edema) - Polyhydramnios

Describe theory for etiology of hydrops fetalis

Severe anemia may cause heart failure, or induction of the hematopoietic centers in the liver to replace normal liver tissue, leading to low serum protein

What intervention has shown to decrease preterm delivery of twins

Adequate weight gain in the first 20-24 weeks of pregnancy

What type of twins can experience twin twin transfusion syndromr

Monochorionic/diamniotic

What is the most concerning complication for multiple gestation

Preterm delivery

What gestational age time frame is most at risk for developing intellectual disability in response to radiation exposure

8-15 weeks

Most common cause of preterm labor

Idiopathic

OBGYN 7 Flashcards

(47 cards)