OBGYN II 🚺 Flashcards
GENITAL ULCERS DDX
How to DDx AIS and 5æred def
Both very similar. Main difference is that in AIS, the breast buds develop (no T. Action to oppose it). 5 alpha red def the action of T still works and prevents breast buds developing. 5alpha red def will virility at puberty, but AIS patient do not.
What features of a dysmenorrhea can suggest secondary underlying cause
Unilateral, starts above 25 yo, AUB concomitant, no systemic signs
Mx of CINIII, given that margins are negative for dysplasia
Conization/LEEP and then pap/HPV contest every 1-2 years.
If margins are positive, will have to remove again, or even hysterectomy
Risk factors for lactational mastitis
Weaning off milk, fight bra, clogged pore, poor latch, using pump
Breast engorgement vs mastitis symptoms
Similar, but engorgement is usually bilateral and diffuse, whereas mastitis is localised.
How to manage high grade CIN of the cervix in pregnancy
Do colposcopy, and biopsy. But avoid surgery until after birth, unless signs of invasive cervical CA
Out of inflammatory breast Ca and mastitis… which is painful
Mastitis
How does an ENDOMETRIOMA appear on US
which appears on ultrasound as a homogenous ovarian cyst with a ground-glass appearance.
How does TOA present, and how is it seen on US
tuboovarian abscess presents with fever, diffuse lower abdominal pain, and a complex,
multicystic adnexal mass with thickened walls on ultrasound.
How many HPV doses needed in > or < 15 years old. Why the difference?
Individuals age ≥15 require 3 doses of the human papillomavirus (HPV) vaccine to achieve
immunity. In contrast, individuals age <15, such as this patient, require only 2 doses administered 6
months apart to achieve equivalent immunity. This difference is likely attributable to a less mature immune system, which promotes increased antibody production and subsequent immunity with fewer doses.
Annual chlamydia screening for women?
Annual Chlamydia trachomatis screening is indicated for all sexually active women age <25
due to the increased incidence of infection in this patient population.
Different colours that physiological galactorrhea can present
Physiologic galactorrhea is usually bilateral and guaiac negative, as in
this patient; the appearance is typically milky or clear but can also be yellow, brown, gray, or green.
Endometrial biopsy when patient bleeds and endometrium stripe is how thick?
Endometrial biopsy is indicated to evaluate for endometrial cancer in women with
postmenopausal bleeding and an endometrial lining >4 mm on ultrasound.
How to Mx premenopausal women with adnexal mass, which is being appearing on US
If the ultrasound shows a benign cyst, a repeat ultrasound in 6 weeks is performed to
evaluate for cyst resolution. Do relevant conservative Mx
If a patient has a history of cervical intraepithelial neoplasia 2 or higher on histology, screening continues for another ? years after detection (past age 65 if indicated).
20
When is the pain in fibrocytsic changes
Patients with fibrocystic breast changes typically have cyclic, premenstrual breast tenderness
Is costochonritis usually bilateral or unilateral pain
Unilateral
Can endometriosis cause cervical motion tenderness and cervical displacement
Yes
Genito pelvic pain syndrome vs vulvodynia
Genito-pelvic pain/penetration disorder (also called vaginismus) is pain caused by vaginal
penetration only, possibly due to involuntary contraction of pelvic floor muscles.
Vulvodynia can cause painful intercourse; however, patients have pain of the surrounding
external genitalia (eg, vulva) only. Therefore, they do not have dysmenorrhea, cervical motion tenderness, or cervical displacement.
Risk factors and protective factors for ovarian CA
Risk factors
• Family history
• Genetic mutations (BRCA1, BRCA2)
• Age ≥50
• Hormone replacement therapy
• Endometriosis
• Infertility
• Early menarche/late menopause
• Oral contraceptives
Protective factors
• Multiparity
• Breastfeeding
How can size of ovarian mass predict malignancy
Adnexal mass size alone is not predictive of malignancy because benign masses (eg,
mucinous cystadenomas) can also be significantly enlarged. However, rapid interval growth on repeat
imaging may suggest malignancy.
Dx the gynae abd pain
Recurrent mild & unilateral mid-cycle pain priorto ovulation
• Pain lasts hours to days
Mittelschmerz
Dx the gynae abd pain
Amenorrhea, abdominal/pelvic pain & vaginalbleeding
No intrauterine pregnancy on US
• Positive B-hCG
Ectopic pregnancy
Dx the gynae abd pain
Sudden-onset, severe, unilateral lower abdominal pain; nausea & vomiting
Enlarged ovary with decreased or absent BF on US
Unilateral, tender adnexal mass on examination
Ovarian torsion
Dx the gynae abd pain
Sudden-onset, severe, unilateral lower abdominal pain immediately following strenuous activity or excersize
Pelvic free fluid on US
Ruptured ovarian
cyst
Dx the gynae abd pain
Fever/chills, vaginal discharge, lower abdominal
‡ Tuboovarian abscess
pain & cervical motion tenderness
PID
Two hormones high in granulosa cell tumour
• 1 Estradiol
• 1 Inhibin
When should intimate partner violence screening be done
that screening be performed in all women of childbearing age and appropriate patients be given referral for support services. Do open and specific questions
When does breast cancer screening begin
Breast cancer screening with mammography should begin at age 40-50 for women of average
risk. Earlier screening should be considered for certain high-risk patients (eg, BRCA1 mutation, history of radiation therapy in the chest) but is not routinely advised.
Primary amenorrhea classification
Primary amenorrhea is the lack of menses without secondary sex characteristics at
age ≥13 or with secondary sex characteristics at age ≥15.
Why might patients have back pain in placenta abruption
If the placenta is posterior
Why does uteroplacental insufficiency and maternal malnutrition cause asymmetrical FGR
Because the blood redirects to the vital organs like the brain
Two main causes of symmetrical FetaL growth restriction
Congenital infection and trisomy. There are more however
Absolute CI to do excersize in preg
Amniotic fluid leak
• Cervical insufficiency
• Multiple gestation
• Placenta abruption or previa
• Premature labor
• Preeclampsia/gestational hypertension
• Severe heart or lung disease
Which sports and excisize cannot be done in pregnancy
- Contact sports (eg, basketball, ice hockey, soccer)
• High fall risk (eg, downhill skiing, gymnastics, horseback riding)
• Scuba diving
• Hot yoga
PID likely in pregnancy
No. Because cervical mucus plug protective
CTG decels. Early, late and variable
What is this CTG pattern?
Sinusoidal
