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OBGYN Flashcards

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1
Q

Recurrent mild and unilateral mid cycle pain prior to ovulation
Pain lasts hours to days

A

Mittelschmerz

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2
Q

Amenorrhea, abdominal/pelvic pain and vaginal bleeding
Positive Beta-hCG
US shows no intrauterine pregnancy

A

Ectopic pregnancy

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3
Q

Sudden onset severe unilateral lower abdominal pain
Nausea and vomiting
Unilateral tender adnexal mass on examination
US shows enlarged ovary with decreased or absent blood flow

A

Ovarian torsion

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4
Q

Sudden onset severe unilateral lower abdominal pain immediately following strenuous or sexual activity
US shows pelvic free fluid

A

Ruptured ovarian cyst

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5
Q

Fever/chills, vaginal discharge, lower abdominal pain and cervical motion tenderness
US shows +/- Tubo-ovarian abscess

A

Pelvic Inflammatory disease

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6
Q

PCOS clinical features

A

Androgen excess (acne, male pattern baldness, hirtuism)
Menstrual irregularities/ infertility
Obesity
Polycystic ovaries on US

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7
Q

PCOS lab findings

A

Elevated Testosterone
Elevated estrogen
LH/FSH imbalance (often >2:1 ratio of LH:FSH)

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8
Q

Comorbidities associated with PCOS

A

Metabolic syndrome (DM, HTN)
OSA
NASH
Endometrial hyperplasia/cancer

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9
Q

Tx. for PCOS

A

1st line Weight loss
OCPs for menstrual regulation
Clomiphene citrate for ovulation induction

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10
Q

Clomiphene citrate

A

Primarily block estrogen receptors at the hypothalamus, inhibiting the negative feedback mechanism and restoring pulsatile release of GnRH

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11
Q

Clinical features of endometriosis

A 
Dyspareunia (pain w/ sexual activity) 
Dysmenorrhea (pain with cycle)
Chronic Pelvic pain
Infertility due to adhesions
Dyschezia( excessive straining with stools)
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12
Q

Physical exam of endometriosis

A

Immobile uterus
Cervical motion tenderness
Adnexal mass
Recto-vaginal septum, posterior cul-de-sac, uterosacral ligament nodules

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13
Q

Treatment of Endometriosis

A

OCP’s, NSAIDs
Surgical resection (can improve conception)
laparoscopy is reserved for treatment failure, adnexal mass, or infertility

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14
Q

Epithelial ovarian carcinoma

A

Is due to abnormal proliferation of ovarian or tubal epithelium or peritoneum
Usually post-menopausal women

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15
Q

Clinical presentation of epithelial ovarian carcinoma

A

Acute: SOB, obstipation/constipation with vomiting, abdominal distension
Subacute: Pelvic/abdominal pain bloating and or early satiety
Asx adnexal mass

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16
Q

Lab findings of Epithelial ovarian carcinoma

A

Increase CA-125

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17
Q

US findings of epithelial ovarian carcinoma

A

Solid mass
thick septations
Ascites

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18
Q

Management of epithelial ovarian carcinoma

A

exploratory laparotomy

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19
Q

What serum tumor marker is used for monitoring treatment response and recurrence

A

CA-125

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20
Q

Modifiable Breast Cancer risk factors

A

Hormone replacement therapy
Nulliparity
Increased age at first live birth
Alcohol consumption

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21
Q

Non-modifiable Breast Cancer risk factors

A 
Genetic mutation
Breast cancer in 1st degree relatives
White race
Increasing age
Early menarche 
Later menopause
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22
Q

Risk of developing breast cancer is directly correlated with lifetime exposure to what?

A

Estrogen

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23
Q

Thin whitish discharge, fishy odor
Clue cells (epithelial cells coated with bacteria)
pH >4.5
Positive whiff test with KOH

A

Bacterial vaginosis

Gardnerella vaginalis

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24
Q

Treatment for BV

A

Metronidazole or clindaymcin

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25
Thin yellow-green, malodorous, frothy discharge Vaginal inflammation pH >4.5 Motile protozoa Some cases can have punctate hemorrhages on cervix (strawberry cervix)
Trichomoniasis | protozoan parasite
26
Treatment for Trichomoniasis
Metronidazole, treat sexual partner
27
``` Thick white cottage cheese normal pH (3.8-4.5) Pseudohyphae ```
Candida vaginitis
28
Treatment for Candida vaginitis
Fluconazole
29
Pathophysiology of bacterial vaginosis involves decreased colonization of the vagina with ? leading to increased pH and overgrowth of anaerobic bacteria
lactobacilli
30
what causes of vaginitis are associated with elevated pH (>4.5)
Trichomoniasis | Bacterial vaginosis
31
OCPs are associated with a decreased risk for what?
Ovarian and endometrial cancers
32
Benefits of estrogen-progestin contraceptives (OCPs)
Pregnancy prevention Endometrial & ovarian cancer risk reduction Menstrual regulation Hyperandrogenism tx.
33
Risks of estrogen-progestin contraceptives (OCPs)
``` Venous thromboemoblism HTN Hepatic adenoma Stroke MI Cervical cancer ```
34
3 major causes of abnormal menstrual bleeding
Fibroids Adenomyosis Endometrial cancer/hyperplasia
35
Clinical features of Fibroids (leiomyomata uteri)
Heavy menses Constipation, urinary frequency, pelvic pain/ heaviness Asymmetrically enlarged uterus
36
Clinical Features of Adenomyosis
Dysmenorrhea, pelvic pain heavy menses bulky globular symmetrically/uniformaly enlarged and tender uterus
37
Clinical features of Endometrial cancer/hyperplasia
history of obesity, nulliparity or chronic anovulation (PCOS) irregular inermenstrual or postmenopausal bleeding non-tender uterus
38
Adenomyosis
= the presence of endometrial tissue in the uterine myometrium typically presents in >40 yo female with new onset dysmenorrhea
39
What is the recommended treatment for a breastfeeding woman with a suspected breast abscess?
needle aspiration, antibiotics, and continued feeding common antibiotics for mastitis include dicloxacillin and cephalexin; incision and drainage is typically reserved for abscesses that are not responsive to needle aspiration and antibiotics
40
Acute mastitis is due to what type of bacterial infection
Staph aureus
41
treatment for acute mastitis
Analgesia Frequent breastfeeding or pumping Antibiotics
42
Young woman that presents with a soft, mobile, well-circumscribed mass at the base of the labia majora?
Bartholin duct cysts
43
Treatment for asymptomatic Bartholin duct cysts
1st line Observation spontaneous drainage and resolution may occur; symptomatic cysts require incision & drainage, followed by placement of a Word catheter
44
A 6-month postpartum woman that presents with irregular vaginal bleeding, an enlarged uterus, and dyspnea with multiple infiltrates on CXR?
Choriocarcinoma classically occurs after a complete hydatidiform mole, but can occur after normal pregnancy or spontaneous abortion
45
Risk factors for Choriocarcinoma
Advanced maternal age | Prior complete hydatidiform mole
46
Clinical presentation for Choriocarcinoma
``` Amenorrhea or abnormal uterine bleeding Pelvic pain/pressure Symptoms from metastases (lung vagina brain) --> SOB, hemoptysis, chest pain Uterine mass Elevated Beta-hCG level ```
47
Treatment for Choriocarcinoma
Chemotherapy
48
What serum marker is characteristically elevated in choriocarcinoma?
Beta-hCG
49
Diagnosis in a young, sexually active woman that presents with fever, sore throat, and lower abdominal pain, Physical exam reveals erythematous tonsils without exudates and non-tender cervical lymphadenopathy?
Gonococcal pharyngitis with pelvic inflammatory disease versus Epstein-Barr virus, which typically causes tender cervical lymphadenopathy and exudative pharyngitis
50
Three "D's" of endometriosis
dysmenorrhea, deep dyspareunia, and dyschezia
51
Congenital aromatase deficiency is characterized by what?
in newborn females is characterized by normal internal genitalia and ambiguous external genitalia due to high levels of gestational androgens low levels of estrogen
52
What is the likely diagnosis in an adolescent girl with delayed puberty, clitoromegaly, and osteoporosis? Laboratory exam reveals undetectable estrogen and elevated testosterone levels. also with polycystic ovaries
Congenital aromatase deficiency
53
What is the likely diagnosis in a women age < 30 with a well-circumscribed, firm, mobile breast mass?
Fibroadenoma (benign)
54
Fibroadenoma vs. breast cyst
fibroadenoma is firm and most common before age 30, versus a breast cyst, which is soft and most common after age 30
55
Benign breast diseases?
Breast cyst fibrocystic changes Fibroadenoma Fat necrosis
56
Clinical features of breast cyst
Soft Solitary, well-circumscribed, mobile mass | +/-tenderness
57
Clinical features of fibrocystic changes of the breast
Multiple diffuse nodulocystic masses | Cyclic premenstrual tenderness
58
Clinical features of fibroadenoma
Firm Solitary, well-circumscribed, mobile mass | Cyclic premenstrual tenderness
59
Clinical features of fat necrosis
Post trauma/surgery Firm irregular mass +/- ecchymosis, skin/ nipple retraction
60
What is the initial test/imaging study for a women age < 30 with a palpable breast mass?
Ultrasound helps differentiate a cystic lesion versus a solid lesion; mammogram is not as useful due to increased breast tissue density in younger women
61
The diagnosis of a palpable breast mass can only be confirmed with a biopsy e.g. fine needle aspiration or core needle biopsy
Simple cyst--> (FNA) Complex cyst/mass (solid mass) --> Image-guided biopsy Suspicious for malignancy core biopsy
62
What is the gold standard diagnostic test for acute cervicitis (Red inflamed friable cervix, with purulent discharge)
Nucleic acid amplification testing (NAAT) has a high sensitivity/specificity for Chlamydia trachomatis and Neisseria gonorrhoeae, which are the most common causes of acute cervicitis
63
BRCA mutations result in significantly increased risk of what?
Breast and ovarian cancer
64
BRCA-positive individuals are recommended to have what to decrease incidence of ovarian cancer
a prophylactic bilateral salpingo-oophorectomy
65
Treatment for HELLP syndrome
Delivery-->delivery should occur at > 34 weeks gestation or with deteriorating maternal/fetal status; antihypertensive medications and/or magnesium may be needed for stabilization Magnesium for seizures and antihypertensives
66
HELLP lab findings
Microangiopathic hemolytic anemia Elevated liver enzymes Low platelet count
67
Granulosa cell tumor of the ovary | Clinical features
Child: Precocious puberty Postmenopasula woman: breast tenderness, bleeding/endmetrial hyperplasia Large adnexal mass
68
Granulosa cell tumor of the ovary | Lab findings
Elevated estrogen | US shows ovarian mass with thickened endometrium (stripe)
69
Gold standard test for postmenopausla women with vaginal bleeding and thickened endometrial stripe
endometrial biopsy

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