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272 Cards in this Set

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Decreased fetal movement
perform NST
Non-reactive NST
vibroacoustic stimulation
Positive-reactive CST
delivery if fetus is mature; repeat CST in 24 hours Perform BPP
Positive nonreactive CST
Delivery immediately, regardless of gestational age
BPP score of 0 to 2
deliver immediately, regardless of gestational age
Biophysical profile score of 4 or 6
deliver if fetus mature' repeat CST in 24 hours
Perform BPP
BPP of 8 or 10
Repeat BPP weekly or biweekly
+ HIGH MS-AFP
obstetrical sonogram to rule out dating error
+ LOW MS-AFP
obstetrical sonogram to rule out dating error
uterus is SMALL for dates/FHT present
obstetrical sonogram to rule out IUGR, oligohydramnios
uterus is LARGE for dates
obstetrical sonogram to rule out: twins, macrosomia, polyhydramnios
Suspected postdates pregnancy
establish how sure is gestational age
Postdates pregnancy: dates firm and cervix favorable
induce labor with AROM or oxytocin
Post dates pregnancy: dates firm but cervix unfavorable
induce labor with PG or twice weekly NSTs, AFIs
Postdates pregnancy, dates unsure
twice weekly NSTs, AFIs, and await onset of labor
First trimester bleeding
vital signs? Sonogram? Cramping? cervix openeind? passed tissue?
threatened abortion
conservative management
missed abortion
scheduled suction D&C
Incomplete abortion
emergency suction D&C
Inevitable abortion
emergency suction D&C
Completed abortion
serial beta-hCG titers
septic abortion
broad spectrum antibiotics and gentle suction D&C
3rd trimester bleeding
vital signs? sonogram for placental localization
3rd trimester bleeding: vasa previa
immediate cesarean section
3rd trimester bleeding: uterine rupture
immediate cesarean section
3rd trimester bleeding: abruptio placenta with stable mom and fetus and rapid vaginal delivery expected
allow vaginal delivery
3rd trimester bleeding: abruptio placenta with unstable mom and fetus with vaginal delivery unlikely
immediate cesarean section
3rd trimester bleeding: abruptio placenta with stable mom and fetus, remote from term but no more bleeding, pain, or DIC
conservative management
3rd trimester bleedinG": placenta previa with stable mom and fetus remote from tern
conservative in-house management
3rd trimester bleeding: placenta previa with unstable mom or fetus, remote from term
immediate cesarean delivery
3rd trimester bleeding" placenta previa with stable mom and fetus at term
scheduled cesarean delivery
twin pregnancy: cephalic-cephalic presentation
vaginal delivery
twin pregnancy: cephalic-breech presentation
vaginal or cesarean delivery
twin pregnancy: breech-cephalic presentation
cesarean delivery
suspected fetal demise
obstetrical sonogram
confirmed fetal demise
rule out DIC
confirmed fetal demise with evidence of DIC
immediate delivery
confirmed fetal demise duration unknown; Mom wants conservatice management
assess for possible DIC
just confirmed recent fetal demise
assess psychological readiness for delivery
isoimmunization: ∆OD450 in Liley zone I
repeat amniocentesis in 3 weeks; deliver at term if ≥37 weeks
isoimmunization: ∆OD450 in Liley zone II
repeat amniocentesis
in 1 week if HIGH zone 2
in 2 weeks if LOW zone 2
deliver at term if ≥37 weeks
isoimmunization: ∆OD450 in Liley zone
intrauterine transfusion: if <34 weeks
deliver if ≥34 weeks
sonographic findings suggestive of GTN
baseline b-hcg titer
baseline chest x-ray
suction d&c
histologically confirmed beign gtn
weekly b-hcg titers until negative X 3; monthly b-hcg titers until negative X 12 months; effective contraception X 12 months
histologically confirmed malignant GTN with good prognostic risk factors
single agent chemo (methotrexate); weekly b-hcg titers until neg X 3; monthly b-hcg titers until neg X 12 months; effective contraception X 12 months
histologically confirmed malignant GTN with poor prognostic risk factors
multiple agent chemo;
weekly b-hcg titers until neg X 3;
monthly b-hcg titers until neg X 2 years;
quarterly b-hcg titers until neg X 5 years;
effective contraception entire time
mild pre-eclampsia ≥ 36 weeks
promt delivery; IV MgSO4
severe pre-eclampsia, remote from term
prompt deliver; IV MgSO4
Severe pre-eclampsia ≥ 36 weeks
prompt deliver; IV MgSO4
Eclampsia; remote from term
prompt deliver; IV MgSO4
Eclampsia ≥ 36 weeks
prompt deliver; IV MgSO4
chronic hypertension, remote from term
conservative management (methyl dopa is drug of choice)
Chronic hypertenison ≥ 36 weeks
evaluate fetal well being; deliver at term or with fetal lung maturity.
chronic hypertension with superimposed pre-eclampsia remote from term
prompt deliver; IV MgSO4
Chronic HTN with superimposed pre-eclampsia ≥36 weeks
prompt deliver; IV MgSO4
HEELP syndrome, remote from term
prompt deliver; IV MgSO4
HEELP syndrome ≥36 weeks
promt delivery, IV MgSO4
Transient hypertension in pregnancy
conservative management
1hr 50 g glucola screen ≥140 mg/dl
3 hr 100 g OGTT
positive 3 hr 100 g OGTT
education: ADA diet
Education: importance of glucose controle
Home glucose monitoring
gestational diabetes: glucose values in target range, remote from tern, no risk factors
conservative management
gestational diabetes: glucose values NOT in target range, remote from term, no other risk factors.
start insulin treatment; begin NST/AFIs at 32 weeks
gestational diabetes; glucose values in target range at term
consider delivery; start NSTs and AFIs
Iron deficiency anemia in pregnancy
FeSO4, 3 tablets per day
folate deficiency in pregnancy
folic acid, 1 mg per day
culture proven asymptomatic bacteruria
single agen oral antibiotic
culture proven acute cystitis
single agent oral antibiotic
acute pyelnoephritis in pregnancy
hospital admission; IV antibiotics; IV hydration
patient in labor with history of acute toxoplasmosis in pregnancy
vaginal delivery
patient in labor with history of acute rubella in pregnancy
vaginal delivery
patient in labor with primary herpes in pregnancy and membranes ruptured 3 hours
vaginal delivery regardless if genital lesions present or not
patient in labor with secondary herpes during pregnancy and membranes intact
vaginal delivery if no genital lesions; cesarean delivery if genital lesions
patient in labor with secondary herpes during pregnancy and membranes ruptured 3 hours
vaginal delivery if no genital lesions;
c/s if genital lesions
patient in labor with secondary herpes during pregnancy and membranes ruptured 18 hours
vaginal delivery regardless if genital lesions present or not
patient in labor with history of treated syphilis in pregnancy
vaginal delivery
patient in labor with + hep BsAg in pregnancy
vaginal delivery with active and passive immunizaton of baby
patient in labor with + HIV in pregnancy
vaginal delivery with AZT in labor
patient in labor with + GBBS culture in pregnancy
vaginal delivery with prophylactic IV penicillin
prolonged latent phase of labor
therapeutic rest or sedation
prolonged active phase of labor
access uterine contraction quality; IV oxytocin if inadequate
arrest of dilation in active phase of labor
assess uterine contraction quality; IV oxytocin if inadequate; c/s if no response
arrest of descent in 2nd stage of labor
assess uterine contraction quality; IV oxytocin if inadequate; vacuum extractor, forceps, or C/S
prolonged 3rd stage of labor
IV oxytocin; attempt manual placental removal; r/o abrnomal trophoblastic invasion
repetitive accelerations on EFM in labor
conservative management
repetitive early decelerations on EFM in labor
conservative management
repetitive mild variable decelerations on EFM in labor
conservative management
repetitive moderate variable decelerations on EFM in labor
conservative management
repetitive severe variable decelerations on EFM in labor
genericinterventions; rapid delivery if no response
repetitive mild late decelerations on EFM in labor
generic interventions; rapid delivery if no response
repetitive severe late decelerations on EFM in labor
generic interventions; rapid delivery if no response
fetal blood sampling obtained in labor with pH 7.15
immediate delivery
fetal blood sampling obtained in labor with pH 7.25
conservative management
suspected PROM 21 weeks gestation without regular contractions
speculum exam for pooling, nitrazine, ferning
suspected PROM 31 weeks gestation without regular contractions
speculum exam for pooling, nitrazine, ferning
suspected PROM 37 weeks gestation without regular contractions
speculum exam for pooling, nitrazine, ferning
confirmed PROM 21 weeks gestation without regular contractions
observation at hom/induce labor; servical cultures, prophylactic penicillin, steroids for fetal lung maturity
confirmed PROM 27 weeks gestation without regular contractions
observation in-hospital; cervical cultures, prophylactic penicillin
confirmed PROM 37 weeks gestation without regular contractions
deliver expeditiously or wait 24 hours if cervix unfavorable
Confirmed PROM 21 with regular contractions
conservative management without tocolytic therapy
confirmed PROM 31 weeks gestation WITH regular contractions
conservative management without tocolytic therapy
confirmed PROM 37 wks gestation with regular contractions
conservative management without tocolytic therapy
confirmed PROM 21 weeks gestation with no contractions or chorioamnionitis
home management
confirmed PROM 31 weeks gestation with no contractions or chorioamnionitis
observation at home/induce labor; cervical cultures, prophylactic penicillin, steroids for fetal lung maturity
confirmed PROM 37 weeks gestation with fever and uterine tenderness
deliver expeditiously or wait 24 hours if cervix unfavorable
confirmed PROM 21 weeks gestation WITH fever and uterine tenderness
deliver promptly; obtain cervical cultures; begin broad-spectrum antibiotics
Confirmed PROM 31 weeks gestation with fever and uterine tenderness
deliver promtpy; obtain cervical cultures; begin broad spectrum antibiotics
confirmed PROM 37 weeks gestation with fevere and uterine tenderness
deliver promptly; obtain cervical cultures; begin broad spectrum antibiotics
regular uterine contractions, 28 weeks festation, fetal demise
induce labor expeditiously
regular uterine contractions, 28 weeks gestation, severe IUGR
conservative management
regular uterine contractions, 28 weeks gestation, severe fetus with renal agenesis
conservative management
regular uterine contractions, 28 weeks gestation, severe pre-eclampsia
deliver expeditiously; start MgSO4; maintain BP 90-100 mm Hg
regular uterine contractions, 28 weeks gestation, 8 cm dilated
conservative management
regular uterine contractions, 28 weeks gestation, 3 cm dilated
tocolysis if no contraindications; obtain cervical cultures, prophylactic penicillin
regular uterine contractions, 28 weeks gestation, cervix closed
conservative management
regular uterine contractions, 36 weeks gestation, 3 cm dilated, previous classical c/s
emergency repeat c/s
Regular uterine contractions, 36 weeks gestation, 3 cm dilated, previous transverse segment c/s
emergency repeat c/s or attempt VBAC
Regular uterine contractions, 36 weeks gestation, 3 cm dilated, previous low vertical c/s
emergency repeat c/s or attempt VBAC
regular uterine contractions, 36 weeks gestation, 3 cm dilated, frank breech presetation
emergency c/s or attempt VBAC
regular uterine contractions, 36 weeks gestation, 3 cm dilated, complete breech presentation
emergency c/s
regular uterine contractions, 36 weeks gestation, 3 cm dilated, footling breech presentation
emergency c/s
no uterine contractions, 27 weeks gestation, cervix closed, complete breech
conservative management
no uterine contractions, 37 weeks gestation, 2 cm dilation, complete breech
attempt external version; discuss c/s
no uterine contractions, 37 weeks gestation, 2 cm dilation, frank breech
attempt extrenal version; discuss c/s; consider vaginal delivery
postpartum bleeding due to uterine atony
uterine massage, oxytocin, ergotamine, 15 methyl F2alpha
postpartum bleeding due to genital lacerations
repari lacerations.
postpartum bleeding due to retained placental tissues
manual uterine exploration; uterine curettage
postpartum bleeding due to DIC
remove all placental fragments; ICU of mom, selective blood product replacement
postpartum bleeding due to uterine inversion
elevate vaginal fornices; massage uterus; give oxytocic agents
postpartum fever due to endometritis
broad spectrum antibiotics to treat polymicrobial flora
postpartum fever due to UTI
urine culture and sensitivity; start single agent Antibiotic (unless pt is septic, then multiple agents)
postpartum fever due to atelectasis
pulmonary exercises; encourage ambulation
postpartum fever due to wound infection
obtain cultures; broad spectrum antibiotics; drain wound and pack
pap smear: inflammation without atypia
treat inflammation; no need to repeat Pap smear
Pap smear: inflammation with atypia
treat inflammation; repeat Pap smear
Pap smear: low grade SIL
colposcopy with directed biopsy
Pap smear: low grade SIL
colposcopy with directed biopsy
pap smear: high grade SIL
colposcopy with directed biopsy
Pap smear: invasive carcinoma
colposcopy with directed biopsy
unsatisfactory colposcopy (T zone extends into endocervical canal); ap smear report: low grade SIL
endocervical curettage
unsatisfactory colposcopy (T zone extends into endocervical canal); pap smear report: low grade SIL
cone biopsy
unsatisfactory colposcopy (T zone extends into endocervical canal) pap smear report: high grade SIL
cone biopsy
satisfactory colposcopy; pap smear: low grade SIL; cervical biopsy: mild dysplasia (patient is pregnant)
observation (look for spontaneous involution)
satisfactory colposcopy; pap smear: low grade SIL; cervical biopsy: mild dysplasia
epithelial destruction: cryotherapy, LEEP
Satisfactory colposcopy; Pap smear: low grade SIL; cervical biopsy: severe dysplasia
epithelial destruction: cryotherapy, leep, CO2, laser, cone biopsy
Satisfactory colposcopy; Pap smear: high grade SIL: cervical biopsy: microinvasive carcinoma
cone biopsy
Satisfactory colposcopy; Pap smear: high grade SIL; cervical biopsy: mild dysplasia
cone biopsy
Satisfactory colposcopy; pap smear: high grade SIL; cervical biopsy: adenocarcinoma
cone biopsy
35 y/o woman with cervical biopsy: CIS
TOTAL HYSTERECTOMY (abdominal or vaginal) OR cone biopsy
55 y/o woman with cervical biopsy: CIS
total hysterectomy (abdominal or vaginal)
35 y/o woman with cervical biopsy : invasive carcinoma, stage IA1
total hysterectomy (abdominal or vaginal)
55 y/o woman with cervical biopsy: invasive carcinoma, stage IA1
total hysterectomy (abdominal or vaginal)
35 y/o woman with cervical biopsy: invasive carcinoma, stage IA2
extrafascial TAH
55 y/o woman with cervical biopsy: invasive carcinoma, stage IA2
extrafascial TAH
35 y/o woman with cervical biopsy: invasive carcinoma, stage IB or II
radical hysterectomy and bilateral lymphadenectomy or radiation therapy
55 year old woman with cervical biopsy: invasive cancer, stage IB or II
radiation therapy
35 y/o woman with cervical biopsy: infasive cancer, stage III or IV
radiation therapy
55 y/o woman with cervical biopsy: invasive cancer, stage III or IV
radiation therapy
23 y/o with vaginal complaints: minimal discharge with "fishy" ordor
vaginal pH; wet prep (look for clue cells)
23 y/o woman with significant discharge with itching and pain
vaginal pH; wet/KOH prep (look for pseudohyphae and trichomonads)
23 y/o w/ diagnosis of bacterial vaginosis
metrondiazole/clindamycin orally or vaginally
23 y/o woman with diagnosis of candida gainitis
vaginal "azole" creams or single dose fluconazole
23 y/o woman with diagnosis of trichomonas vaginitis
metronidazole cream/tablets, orally treating partner as well
undiagnosed vulvar lesion
vulvar biopsy
vuvar biopsy: hyperplastic lesion
fluorinated corticosteroids
vulvar biopsu: lichen sclerosis
testosterone cream
vulvar biopsy: vulvar carcinoma, stage 0
skinning vulvectomy OR laser ablation if younger patient
vulvar biopsy: vulvar dysplasia
surgical excision
vulvar biopsy: pagets disease
simple vulvectomy with lymphadenectomy (if invasive disease)
vulvar biopsy: invasive carcinoma
radical vulvectomy and bilateral lymphadenectomy
43 y/o woman with mild cystocele/rectocele
kegel's exercises
57 y/o woman with mild cystocele/rectocele
kegel's exercises
43 y/o woman with significant cystocele
anterior colporrhaphy
57 y/o woman with significant cystocele
anterior colporrhaphy and hormone replacement therapy
57 y/o woman with 2º uterine prolapse (not a surgical candidate)
vaginal pessary and hormone replacement therapy
43 y/o woman with involuntary urine loss
urinalysis and culture
43 y/o woman with involuntary urine loss & cannot suppress the urge to void
anticholinergics, NSAIDs
43 y/o woman with involuntary yrine loss & + Q tip test
elevate urethrovesical angle
43 y/o woman with involuntary yrine loss & residual volume of 450 cc
intermiittent self catheterization; cholinergic agents, d/c systemic medications
43 y/o womane wtih involuntary urine loss with history of radical hysterectomy (indigo carmine leaks onto vaginal tampons_
surgical repair of fistula
6 y/o girl with isolated pubic hair growth
conservative observation
6 y/o girl with diopathic isosexual constitutional percocity
GnRH agonist suppression
6 y/o girl with isosexual complete precocity and unilateral pelvic mass
remove granulosa cell tumor/fibrothecoma
6 y/o firl with heterosexual precocity and inulateral pelvic mass
remove Sertoli-Leydig tumor/hilar cell tumor
13 y/o girl with 1º amenorrhea and absent 2º sex characteristics
conservative management
15 y/o girl with 1º amenorrhea and absent 2º sex characteristics
FSH and karyotype
15 y/o girl with 1º amenorrhea WITH 2º sex characteristics
conservative management
16 y/o with 1º amenorrhea no uterus but breast present
serum testosterone and karyoptye
21 y/o no pregnant woman with 2º amenorrhea, progesterone challenge test +
TSH; prolactin, periodic progestin cycline
21 y/o nonpregnanty woman with 2º amenorrhea; progesterone challenge test negative
estrogen-progesterone challenge test
21 y/o non pregnant woman with 2º amenorrhea and + estrogen -progesterone challenge test
FSH (CNS imaging if FSH low)
21 y/o non pregnant woman with 2º amenorrhea and - estrogen -progesterone challenge test
hysterosalpingogram
17 y/o woman with primary dysmenorrhea and normal pelvic exam
NSAIDS; combination OCPs
22 y/o woman with secondary dysmenorrhea (infertility, dyspareunia, dyschezia)
diagnostic laparoscopy (look for endometriosis)
22 y/o woman with diagnosed endometriosis (requests medical management)
steroid contraception; GnRH agonists; pregnancy
16 y/o woman with abnormal menstrual bleeding
qualitative b-hcg test to r/o pregnancy
33 y/o woman with abnormal menstrual bleeding
qualitative b-hcg test to r/o pregnancy
15 y/o adolescent with dysfunctional uterine bleeding
periodic cycling with progestagens; no endometrial biopsy
30 y/o woman (normal weight and BP0 with dysfunctional uterine bleeding
periodic cycling with progestagens; no endometrial biopsy
30 y/o woman (obese, hypertensive) with dysfunctional uterine bleeding
endometrial biopsy with progestagen cyclinc if histology is normal
35 y/o woman (obese, htn) with dysfunctional uterine bleeding
endometrial biopsy with progestagen cycling if histology is normal
55 y/o woman (obese, htn) with abnormal uterine bleeding
endometrial biopsy to r/o endometrial cancer
30 y/o woman (normal weignt and BP) with dysfunctional uterine bleeding not normalized with progestagens
hysteroscopy and D&C to look for endometrial pathology; consider hysterosonography
30 y/o woman with abnormal uterine bleeding with regular, predictable menses
hysteroscopy and D&C to look for endometrial pathology, consider hystersonography
29 y/o woman with varied symptos exacerbated prior to menses
keep a menstrual diary
29 y/o woman with confirmed PMS
treatment directed at specific symptom cluster; consider SSRIs
30 y/o woman with hirsutism requests laboratory evaluation
serum testosterone, DHEAS, 17-OH progesterone, cortisol, LH/FSH ratio
30 y/o woman with hirsutism due to androgen producing ovarian tumor
surgical removal of tumor
30 y/o wih hirsutism due to androgen producing adrenal timor
surgical removal of tumor
30 y/o wih hirsutism due to congenital adrenal hyperplasia
glucocorticoid replacement
30 y/o wih hirsutism due to excessive hair follicle conversion of testosterone to DHT
spironolactone
30 y/o woman with hirsutism due to PCO syndrome
oral contraceptive pills
53 y/o postmenopausal woman after hysterectomy requests hormone replacement therapy
continuous estrogen replacement
53 y/o postmenopausal woman with intact uterus requests hormone replacement therapy
continue estrogen and progesterone replacement
59 y/o postmenopausal woman with undiagnosed vaginal bleeding
hysteroscopy and fractional D&C after ruling out GI tract and lower reproductive tract causes
38 y/o premenopausal woman with complex hyperplasia without atypia desiring fertility preservation
cyclic progestin and rebiopsy in 3-6 months
38 y/o premenopausal woman with complex hyperplasia without atypia not desiring fertility preservation
cyclic progestin and rebiopsy in 3-6 months
38 y/o premenopausal woman with complex hyperplasia with atypia desiring fertility preservation
cyclic progestin and rebiopsy in 3-6 months
38 y/o premenopausal woman with complex hyperplasia with atypia not desiring fertility preservation
TVH or TAH
52 y/o postmenopausal woman with complex hyperplasia without atypia
TVH or TAH
52 y/o postmenopausal woman with complex hyperplasia with atypia
TVH or TAH
52 y/o woman with STAGE 1, GRADE 1, endometrial cancer
TAH and BSO with peritoneal washing cytology
50 y/o woman with stage 1, grade 3 endometrial cancer
TAH, BSO, peritoneal cytology and lymph node sampling
50 y/o woman with stage II endometrial carcinoma
TAH, BSO after preoperative whole pelvis radiation
50 y/o woman with stage III or stage IV endometrial cancer
TAH, BSO, progetin therapy, chemotherapy, and radiation therapy
25 y/o with a pelvic mass
qualitative b-hcg to r/o pregnancy
25 y/o nonpregnant woman with a unilateral 5 cm cystic pelvic mas using diaphragm for contraception
observation or place on combination oral contraceptives to suppress a functional cyst
25 y/o nonpregnant woman with a unilateral 5 cm cystic pelvic mass on combination oral contraceptive pills
scheduled pelvic laparoscopy
25 y/o pregnant woman with bilateral 7 cm ovarian masses, partiall y solid and partially cystic
observation of theca-lutein cysts or luteomas of pregnancy
25 y/o nonpregnant woman with a unilateral 5 cm solid pelvic mass
scheduled pelvic laparoscopy
25 y/o nonpregnant woman with a unilateral 9 cm cystic pelvic mass complaining of sudden onset of RLQ pain
EMERGENCY EXPLORATORY LAPAROTOMY
55 y/o postmenopausal woman with a unilateral 5 cm cstic pelvic mass
stagin exploratory laparotomy
55 y/o postmenopausal woman with a unilateral 5 cm solid pelvic mass
staging exploratory laparotomy
26 y/o woman G1P1 with stage Ia ovarian serous cystadenocarcinoma desiring retention of fertility
unilateral salpingo-oophorectomy
38 y/o woman G4P3A1 with stage Ia ovarian serous cystadenocarcinoma not desiring retention of fertility
TAH, BSO
38 y/o woman G1P1 with stage II ovarian serous cystadenocarcinoma
TAH, BSO, chemo
52 y/o wman G1P1 with stage II ovarian serous cystadenocarcinoma
TAH, BSO, CHEMO
25 y/o woman with a diffusely enlarged uterus
qualitative b-hcg test to r/o pregnancy
25 y/o woman with a uterine submucous leiomyoma causing intermenstrual bleeding
hysteroscopic resection
25 y/o woman with an asymmptomatic 7 cm uterine subserosal leiomyoma
conservative management w/ observation
25 y/o infertile woman with multiple 5-7 cm uterine intramural leiomyomata
preoperative involution by GnRH agonist suppresion followed by myomectomy
36 y/o woman G3P3 with multiple 5-7 cm uterine intramural leiomyomata not desiring fertility
TAH
22 y/o woman G3P2A1, afebrile, with mucopurulent vervical discharge, cervical motion tenderness, and bilateral adnexal tenderness
outpatient antibiotic therapy with IM cephalosporin plus oral doxycycline/tetracycline
22 y/o woman G0P0, afebrile, with mucopurulent cervical discharge, cervical motion tenderness and bilateral adnexal tenderness
inpatient antibiotic therapy with IV cephalosporin plus doxycyclin or clindamycin plus gentamycin
22 y/o woman G3P2ab1, T 102ºF with mucopurulent cervical discharge, cervical motion tenderness, and bilateral adnexal tenderness
inpatient antibiotic therapy with IV cephalosporing plus doxycycline or clindamycin plus gentamycin
22 y/o woman G3P2AB1, T 102º, with mucopurulent cervical discharge, cervical motion tenderness and bialteral fluctuant adnexal masses
INPATIENT ANTIBIOTIC THERAPY WITH PERCUTANEOUS DRAINAGE/EMERGENCY LAPAROTOMY IF INADEQUATE RESPONSE TO MEDICAL TREATMENT
22 y/o woman G3P2A1, afebrile, with no cervical discharge, but with cervical motion tenderness and bilateral adnexal masses
Qualitative b-hcg to r/o pregnancy, then conservative management. TAH, BSO if unsatisfactory response (remember ERT).
19 y/o woman with unilateral adnexal tenderness, and quantitative b-hcg of 800.
transvaginal sonogram to look for intrauterine gestational sac.
29 y/o woman with unilateral adnexal tenderness and quantitative b-hcg of 800 and no intrauterine gestation sac or pelvic masses on tv sonogram
observationand repeat b-hcg and tv sono in 2-3 days
19 yo woman with unilateral adnexal tenderness, and quantitative b-hcg of 2500 and no intrauterine gestation sac but possible left adnexal mass on tv sonogram
pelvic laparoscopy or methotrexate therapy
19 y/o woman with 7 weeks of amenorrhea, now presenting with vaginal bleeding, sudden onset of abdominal pain, BP 70/40 and pulse 150/min
emergency exploratoy laparotomy
19 y/o woman, G1 P0 A1 with laparoscopically confirmed unruptured ampullary ectopic tubal pregnancy
laparoscopic linear salpingostomy
35 y/o woman, G4P3A1, with laparoscopically confirmed unruptured ampullary ectopic tubal pregnancy. post tubal ligation.
laparoscopic salpingectomy
19 y/o woman G1P0A1 with laparoscopically confirmed ruptured isthmic ectopic tubal pregnancy
laparoscopic segmental tubal resection
f/u studies after laparoscopic linear salpingostomy for ectopic pregnancy
Rd(D) immune globulin if Rh negative; serial b-hcg titers weekly until titers negative
f/u studies after laparscopic segmental tubal resection for ectopic pregnancy
Rh (d) immune globulin if Rh negative; serial b-hcg titers unnecessary
f/u studies after methotrexate therapy for ectopic pregnancy
Rh (D) immune globulin if Rh (-); serial b-hcg titers weely until titers negative
54 y/o postmenopausal with hypoactive sexual desire not on HRT
HRT
54 Y/O postmenopausal with hypoactive sexs desire on HRT
referral to sex therapist
21 y/o woman with 1º anorgasmia
self-stimulation
26 y/o with vaginismus
gradual accommodation of vaginal dilators
32 y/o w/ dyspareunia
thorough hx and pelvic exam
21 y/o after a sexual assault
immediate attention to medical needs, then address psychological needs, followed by collection of evidence
pregnancy prevention for a sexual assault victim
high progestin combination oral contraceptives in divided doses 12 hours apart
31 y/o G2P2 on postpartum day#2 with congestive mastitis desiring to breast feed
empty breast manually after infant feeding
31 y/o G2P2 on postpartum day #2 with congestive mastitis not desiring to breast feed
bind breasts with breast binder. ICE PACKS AND ANALGESICS. AVOID BREAST STIMULATION.
31 y/o breastfeeding woman G2P2 no 2 weeks postpartum with infectious mastitis.
oral antibiotics for S. aureus. local heat, breast support, analgesics. continue lactating.
35 y/o woman with a dominant cystic breast mass
mammography, sonography, followed by cyst aspiration.
35 y/o woman with a single solid breast mass
mammography, sonography, followed by open breast biopsy
40 y/o woman with biopsy confirmed stage I infiltrating ductal breast carcinoma
partial mastectomy plus axillary dissection followed by radiation therapy
31 y/o infertile woman G0P0 with dicumented anovulation
clomiphene citrate or hMG stimulation
31 y/o infertile woman G0P0 with documented anovulation treated with ovulation induction now has developed ovarian hyperstimulation
d/c ovulation induction. conservative management.
31 y/o infertile woman G0P0 with suspected tubal disease
hysterosalpingography and pelvic laparoscopy