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OBGYN > OBGYN Shelf > Flashcards

OBGYN Shelf Flashcards

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1
Q

Clinical features of vaginal cancer (3)

A

Vaginal bleeding
Malodorous vaginal discharge
Irregular vaginal lesion

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1
Q

Risk factors for vaginal cancer (4)

A

Age > 60
HPV infection
Tobacco use
In utero DES exposure

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2
Q

Indication for endometrial bx

A

Postmenopausal bleeding and endometrial stripe >4mm on US

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3
Q

Theca lutein cyst presentation (3)

A

Multilocular
Bilateral
10-15 cm ovaries

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4
Q

Theca lutein cyst pathogenesis (3)

A

Ovarian hyperstimulation due to:
Gestational trophoblastic dz
Multifetal gestation
Infertility tx

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5
Q

Complete hydatidiform mole

A

A gestational trophoblastic dz resulting from the abnormal fertilization of an empty ovum by either 2 sperm or single sperm that duplicates its genome upon fertilization
The resultant gestation is composed of abnormal, proliferative trophoblastic tissue that secretes markedly elevated b-hCG.
b-hCG causes hyperstimulation of the ovaries and hypertrophy and luteinization of the theca cells. The thecal cells secrete androgens, leading to acute hyperandrogenism

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6
Q

Absolute contraindications for combined hormonal contraceptives (9)

A

Migraines with aura
Severe HTN
Ischemic heart disease, stroke
Age >35 and smoking >15 cigarettes/day
<3 weeks postpartum
Hx of VTE
Thrombophilia (factor V Leiden, antiphospholipid syndrome)
Active breast cancer
Active or severe liver dz

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7
Q

Vesicovaginal fistula

A

Aberrant connection between the bladder and vagina allowing urine to constantly drain into the vaginal, creating continuous, painless urinary leakage.
Dx visualization of pooling of clear fluid in vaginal on pelvic exam vs bladder dye testing

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8
Q

Causes and timing of vesicovaginal fistulas

A

Immediately following intraoperative bladder injury (c-section, hysterectomy)

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8
Q

Stress urinary incontinence (SUI)

A

Intermittent, involuntary loss of urine with increased intraabdominal pressure (coughing, laughing, sneezing).
D/t either decreased urethral sphincter muscle tone or urethral hypermobility from weakened pelvic floor muscles

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8
Q

Overflow incontinence

A

Continuous, painless loss of urine due to chronic urinary retention.
D/t diminished contractility of bladder detrusor (neurogenic bladder from DM), external compression of urethral outlet (fibroids, prolapse) that impede bladder emptying

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8
Q

Peripartum cardiomyopathy (PPCM)

A

Dilated cardiomyopathy that develops during the last month of pregnancy or within 5 months following delivery. Present with progressive dyspnea on exertion, lower extremity edema, and an S3 suggestive of decompensated heart failure. PPCM often causes secondary mitral regurgitation, which causes a holosystolic murmur best heard at the apex.

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8
Q

Overactive bladder (OAB)

A

Excessive involuntary detrusor muscle spasms creating a sudden urge to urinate, typically followed by an immediate loss of urine

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9
Q

3 type of urinary incontinence

A

Stress urinary incontinence
Overflow incontinence
Urge incontinence/ overactive bladder

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9
Q

3 risk factors for peripartum cardiomyopathy

A

Maternal age >30
Multiple gestation
Eclampsia or preeclampsia

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10
Q

Peripartum cardiomyopathy management

A

Urgent delivery if hemodynamically unstable vs standard management of HFrEF (beta blockers, diuretics)

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11
Q

Ectopic pregnancy dx

A

positive hCG
Transvaginal US showing adnexal mass and empty uterus

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12
Q

Ectopic pregnancy clinical features

A

Abdominal pain, amenorrhea, vaginal bleeding
Hypovolemic shock in ruptured ectopic pregnancy
Cervical motion, adnexal and/or abd tenderness
+/- palpable adnexal mass

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13
Q

Ectopic pregnancy management

A

MTX if stable vs surgery if unstable

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14
Q

Preterm prelabor rupture of membranes (PPROM)

A

ROM <37 w gestation prior to the onset of labor (closed cervix and irregular cxns)

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15
Q

PPROM management

A

<34 w w/o complications require inpatient expectant management with prophylactic latency abx (ampicillin and azithromycin), corticosteroids (betamethasone) to decrease risk of NRDS, and fetal surveillance (nonstress test, fetal growth US)

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16
Q

Stress urinary incontinence management

A

Conservatives: pelvic floor muscle exercises to strengthen and stabilize pelvic musculature
Pts who fail conservative tx or desire surgical management can undergo midurethral sling procedure which prevents urethral hypermobility and allows urethral compression

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17
Q

Ddx for postpartum hemorrhage

A

Uterine atony
Retained products of conception
Genital tract trauma
Inherited coagulopathy

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18
Q

Abnormally elevated maternal serum AFP (MSAFP) work up

A

MSAFP >2.5 MoM is suggestive of fetal NTD but can also be due to benign causes such as multiple gestations and incorrect gestational age dating (most common cause)
Abnormal MSAFP level require US to evaluate for NTDs, multiple gestations, and determine accurate gestational age

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19
Rubella infection during pregnancy
Can cause spontaneous, abortion, intrauterine fetal demise, or congenital rubella syndrome (deafness, cardiac defects, hepatosplenomegaly, cataracts, microcephaly) All women are tested for rubella immunity at 1st prenatal visit by anti rubella IgG. Vaccination is contraindicated during pregnancy but all nonimmune pts should be vaccinated during the immediate postpartum period
20
Anemia in pregnancy
Hemoglobin <11 g/dL and MCV <80 fL
21
Rho(D) immunoglobulin administration
Rho(D) immunoglobulin administration given to Rh(D)-negative patients at 28 w and after delivery if the infant is Rh(D) positive. 1st trimester immunization is only indicated in the setting of uterine bleeding
22
Spinal epidural abscess presentation
Classic triad: fever, focal/severe back pain, and neurologic findings (motor/sensory changes, bowel/bladder dysfunction, paralysis) Elevated ESR
23
Spinal epidural abscess management
Broad spectrum abx (ceftriaxone and vancomycin) Urgent aspiration/surgical decompression
24
Classic exam findings of endometriosis
Posterior fornix tenderness, Decreased uterine mobility Uterosacral ligament thickening Cervical motion tenderness Adnexal mass Rectovaginal septum, posterior cul-de-sac, and uterosacral ligament nodules
25
Endometriosis management
Initial tx: NSAIDs and combined OCP Pts who fail medical management, diagnostic laparoscopy recommended because it allows for definitive dx and is therapeutic via removal of endometriotic lesions
26
Common symptoms of endometriosis
Chronic pelvic pain Dysmenorrhea Deep dyspareunia Dyschezia Infertility Cyclic dysuria, hematuria
27
Clinical features of breast fibroadenoma
Solitary, firm, well circumscribed mobile mass Cyclic premenstrual tenderness
28
Clinical features of a breast cyst
Solitary, well circumscribed mobile mass +/- tenderness
29
Clinical features of fibrocystic changes
Multiple, diffuse nodulocystic masses Cyclic premenstrual tenderness
30
Management of solitary palpable breast mass
Pts < 30: US +/- mamo Pts >40: mamo +/- US Pts 30-40: can do either
31
Preeclampsia definition
New-onset HTN (>140/90) at >20 w AND proteinuria OR signs/symptoms of other end-organ damage
32
Preeclampsia severe features
BP >160/110 Platelets <100,000 Creatinine >1.1 mg/dL or 2X normal Elevated transaminases >2x ULN Pulmonary edema Vision or cerebral symptoms (HA)
33
Preeclampsia management
<37 w w/o sever features: expectant >37 w or >34 w w/ severe features: delivery Severe range BPs: IV labetalol, IV hydralazine, PO nifedipine Magnesium sulfate seizure prophylaxis
34
HELLP syndrome
Hemolysis Elevated Liver enzymes and Low Platelets Life-threatening disorder related to preeclampsia with severe features. Likely related to abnormal placental development early in pregnancy with the placental release of antiangiogenic factors which cause widespread maternal endothelial dysfunction and dysregulation of vascular tone
34
Clinical findings of HELLP syndrome
N/V RUQ pain HA Visual changes HTN
35
HELLP syndrome lab abnormalities (4)
Microangiopathic hemolytic anemia Elevated liver enzymes Thrombocytopenia +/- proteinuria
36
HELLP syndrome treatment (3)
Delivery Magnesium sulfate for seizure prophylaxis Antihypertensives (hydralazine)
37
HELLP syndrome complications (5)
Abruptio placentae Subcapsular hematoma Acute renal failure Pulmonary edema DIC
38
Clinical features of uterine leiomyomas (fibroids) (3)
Heavy, prolonged periods Pressure symptoms (pelvic pain, constipation, urinary frequency) Obstetric complications (impaired fertility, pregnancy loss, preterm labor) Enlarged, irregular uterus
39
Uterine leiomyoma work-up
US
40
Uterine leiomyoma treatment
Observation if asymptomatic vs hormonal contraception or hysteroscopic myomectomy
41
Cervical conization
A cone-shaped bx performed to remove the entirety of the transformation zone while allowing adequate depth to access the endocervical canal dysplasia. It is both diagnostic (evaluation for concurrent invasive cancer) and therapeutic (Removal of dysplasia
42
Adenocarcinoma in situ of the cervix
A premalignant lesion of cervical adenocarcinoma that has a 30-70% chance of progression to invasive cancer, along with a 15% chance of cobcurrent invasive cervical cancer. Tx requires excision (cervical conization) of the lesion
43
Evaluation of atypical glandular cells on Pap in pts ≥35
Colposcopy Endocervical curettage* Endometrial bx* *Nonpregnant
44
Evaluation of atypical glandular cells on Pap in pts ≤35 with risk factors
Colposcopy Endocervical curettage* Endometrial bx* *Nonpregnant
45
Evaluation of atypical glandular cells on Pap in pts ≤35 without risk factors
Colposcopy Endocervical curettage* *Nonpregnant
46
GBS antenatal screening
Rectovaginal cx at 36-38 w gestation. Good for 5 weeks
47
Indications for intrapartum GBS prophylaxis
GBS bacteriuria or UTI in current pregnancy GBS positive rectovaginal cx in current pregnancy Unknown GBS status PLUS any of the following : <37 w, intrapartum fever, ROM >18 hrs Prior infant with early-onset neonatal GBS infection
48
Intrapartum GBS prophylaxis
IV penicillin If pt has a pcn allergy then cefazolin if mild vs clindamycin or erythromycin depending on sensitivity if severe pcn allergy
49
Active phase of labor
6-10 cm dilation Has an expected, predictable rate of cervical dilation of ≥ 1 cm every 2 hours
50
Active phase arrest
No cervical change in 4 hours despite adequate cxns (≥200 Montevideo units averaged over 10 minutes) OR No cervical change in ≥6 hours with inadequate cxns Management is c-section
51
Prostaglandin use in labor
Used for cervical ripening (softening the cervix) in early labor induction
52
Oxytocin
A uterotonic used to augment labor by increased the frequency and force of cxns if cxns are inadequate (<200 Montevideo units and can be used in protracted labor (cervical dilation rate <1 cm/2 hours but not arrested)
53
Protracted labor
Cervical dilation rate <1 cm/2 hours but not arrested
54
Initial evaluation of anovulatory infertility
TSH and PRL levels
55
Epithelial ovarian carcinoma presentation
Asymptomatic: incidental adnexal mass Subacute: pelvic/ abdominal pain, bloating, early satiety Acute: dyspnea, obstipation/constipation, abdominal distention
56
Epithelial ovarian carcinoma risk factors
Family hx BRCA1, BRCA2 Age ≥50 Endometriosis Infertility Early menarchy/late menopause
57
Lab and US findings of epithelial ovarian carcinoma
Elevated CA-125 On US: solid, complex mass; thick septations; ascites
58
CA-125
a protein released by cells from the peritoneum, uterus, and fallopian tubes; which are in close proximity to the rapidly growing ovary (malignancy) In postmenopausal women with malignant appearing mass, CA-125 aids in dz monitoring and response to tx In postmenopausal women with benign-appearing mass, CA-125 stratifies the risk for cnacer
59
Cervical insufficiency
A structural weakness of the cervix causing spontaneous, painless cervical dilation and potential second-trimester pregnancy loss Patient present with mild symptoms (increased vaginal discharge, light vaginal bleeding, pelvic pressure) on exam, bulging amniotic membranes may be seen
60
Rescue cerclage
A suture used to reinforce and add tensile strength to the cervix to prevent further dilation in the setting of cervical insufficiency
61

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