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407 Cards in this Set
- Front
- Back
|
Question
|
Answer
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When does standard HCG test for pregnancy become positive?
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2 weeks after conception
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What is Heagar's sign
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sofetening and compressivility of the lower uterine segment indicating pregnancy
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What is Chadwick's sign
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dark discoloration of the vulva and vaginal walls
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What is the significance of linea nigra in preganancy?
|
normal benign finding
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What is melasma?
|
hyperpigmentation of sun exposed areas; often in pregnancy
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When does quickening occur?
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"primigravida: 18-20 weeks
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When during pregnancy do you need a pap smear?
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at first visit unless done in last 6 months
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When during pregnancy do you need a urinalysis?
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at every visit
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Urinalysis in pregnancy is used to screen for...
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"- pre-eclamppsia
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When during pregnancy do you need a CBC?
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at first visit
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When during pregnancy do you need a blood type/screen?
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at first visit
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When during pregnancy do you need a syphilis test?
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at first visit, repeat later if high risk
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When during pregnancy do you need a rubella titer?
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first visit if vaccination history not known
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When during pregnancy do you need diabetes screening?
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- betwen 24-28 weeks; at first visit if high risk factors
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High risk factors for gestational diabetes
|
"- obese
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When during pregnancy do you need a triple screen?
|
15-20 weeks for older/high risk women
|
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Significance of low AFP on triple screen
|
"- Down syndrome
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Significance of high AFP on triple screen
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"- neural tube defects
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What do you do if triple screen is abnormal.
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"- order an US to check dates and look for anomalies
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When during pregnancy do you need a Group b strep culture?
|
35-37 weeks
|
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How do you treat group B strep in pregnant mom?
|
treat with amoxicillin during labor
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When can fetal heart tones be heard?
|
"- doppler: 10-12 weeks
|
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What is significant for size/date discrepency
|
uterine size difference of 2-3 cm to dates; get US
|
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What do HCG levels do in the first trimester of pregnancy?
|
double every 2 days
|
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Ongoing increase in HCG or increase after delivery indicates
|
"- hydatiform mole
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HCG level at 5 weeks
|
>2000
|
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Transvaginal US can detect intrauterine pregnancy at
|
5 weeks
|
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Average weight gain of pregnancy
|
28 pounds
|
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With extra weight gain in pregnancy think
|
diabetes
|
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With poor weight gain during pregnancy think
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"- hyperemesis gravidum
|
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ESR in pregnancy
|
very elevated
|
|
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Thyroid tests in pregnancy
|
"- free T4 same
|
|
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Hematocrit in pregancy
|
#NAME?
|
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BUN and Cr in pregnancy
|
decrease (GFR increases)
|
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Alkaline phosphatase in pregnancy
|
very increased
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Mild proteinuiria in pregnancy
|
normal
|
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Mild glucosuria in pregnancy
|
normal
|
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Electrolyte in pregnancy
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unchanged
|
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Liver function tests in pregnancy
|
unchanged
|
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BP changes in pregnancy
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decreases slightly
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HR changes in pregnancy
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increased 10-20 beats per minute
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Stroke volume and cardiac output in pregnancy
|
increase, often by 50%
|
|
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Minute ventillation in pregnancy
|
increases (increased tidal volume, rate about the same)
|
|
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Residual lung volume in pregnancy
|
decreased
|
|
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Respiratory alkalosis in pregnancy is
|
normal
|
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Definition of IUGR
|
below 10th percentile for age
|
|
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3 classes of causes of IUGR
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"- maternal
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|
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US parameters to look for IUGR
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"- biparietal diameter
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Components of biophysical profile (BPP)
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"- heart rate tracing
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If you are concerned about a fetus, but non-emergent, what is the series of investigations?
|
- BPP, if abnormal then contractile stress test. If decels, usually go to c-section
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What is the contraction stress test
|
"- looks for uretroplacental dysfunction.
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Define oligohydramnios
|
<300-500 ml
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4 major causes of oligohydramnios
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"- IUGR
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|
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4 complications of oligohydraminios
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"- pulmonary hypoplasia
|
|
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Define polyhydramnios
|
>1700-2000ml
|
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5 major causes of polyhydramnios
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"- maternal diabetes
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Maternal complications of polyhydramnios
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"- uterine atony
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At term normal fetal heart rate is
|
110 to 160 bpm
|
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Discuss early decelerations
|
"- low point of fetal HR and high point of uterine contraction coincide
|
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Discuss varible decelerations
|
"- most common
|
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Treatment of variable decelerations
|
"- mom in lateral decub
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Discuss late decelerations
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"- fetal HR nadir occurs after contraction
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Treatment in late decelerations
|
"- lateral decub, O2, stop oxytocin
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Examples of tocolytic agents
|
"- ritodrine
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Discuss the loss of fetal variability if heart rate in labor
|
"- check fetal scalp pH
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In labor, what are the scalp pH parameters that indicate need for delivery?
|
- fetal scalp pH < 7.2 or abnormal O2
|
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How can you distinguish true labor
|
"- regular contraction (every 3 minutes)
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Describe "false labor"
|
"aka Braxton-Hicks contraction
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Desribe the stages of labor
|
"1st- true labor to full dilation
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1st stage of labor lasts how long?
|
"- nuligravida: < 20 hours
|
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In the active phase of 1st stage of labor, how fast does the cervix dilate?
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"- nuligravida: >1cm/hr
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Time from full cervical dilation to start delivery of baby
|
"- nuligravida: 30min - 3 hrs
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Time to delivery baby
|
0-30 minutes
|
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Time to delivery placenta and maternal stabilization
|
up to 48 hours
|
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What is protraction disorder
|
Labor takes long than expected
|
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What is labor arrest disorder?
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No change in cervical dilation occurs over 2 hours and no change in fetal descent after 1 hour
|
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Treatment of arrest disorder
|
"- check fetal lie
|
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Name 3 ways to augment labor
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"- oxytocin
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|
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Most common cause of "failure to progress" in labor
|
cephalopelic disporoprtion (labor augmentation contraindicated)
|
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Half life of oxytocin
|
less than 10 minutes
|
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Side effects of oxytocin
|
"- uterine hyperstimulation
|
|
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Side effects of PGE2 used for ripening cervix
|
uterine hyperstimulation
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|
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Decision of vaginal delivery with HSV based on...
|
if active lesions during labor, opt for c-section
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Orientation of "classic" c- section incision
|
vertical
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Signs of placental separation
|
"- fresh blood from vagina
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What is the first step during delivery with shoulder dystocia
|
#NAME?
|
|
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List the order of labor positions
|
"- descent
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Postpartum discharge
|
- red the first few days, usually white by day 10
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Foul smelling lochia is concerning for
|
endometritis
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What is the underlying likely cause when new mom develops PE
|
PE from amniotic fluid
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Definition of post-partum hemorrhage
|
">500 cc with vaginal
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|
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Most common cause of post-partum hemorrhage
|
uterine atony
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Complication of severe post-partum hemorrhage
|
Sheeham sydrome
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Risk factors for retained placenta after delivery
|
"- previous uterine surgery
|
|
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Risk factors for uterine atony
|
"- overdistended
|
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Treatment of uterine atony
|
"1. uterine massage with low dose oxytocin
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Treatment of retained products of conception
|
"- remove placenta manually to stop bleeding
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Most common cause of uterine inversion
|
iatrogenic; pulling too hard on the cord
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Treatment of uterine inversion
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"- manually replace uterus may need anesthesia)
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Definition of post-partum fever
|
fever for 2 days
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5 most common causes of post-partum fever
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"- breast engorgement
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Risk factors for endometritis
|
"- C-section
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Treatment of endometritis
|
"- obtain cultures of endometrium, vagina, blood and urine
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If endometritis doesn't resolve, what's likely going on?
|
"- pelvic abscess
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|
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Treatment of post-partum pelvic thrombphlebitis
|
heparin
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3 major things to think of with postpartum shock and no evident bleeding
|
"- amniotic fluid embolus
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If a woman doesn't want to breastfeed, what would you prescribe
|
"- tight bra
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Mastidis after delivery usually occurs
|
within 2 months
|
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Usual organism of mastidis
|
staph aureus
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Treatment of mastidis
|
"* keep breast feeding
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|
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Contraindications to breast feeding
|
"- maternal HIV
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Define abortion
|
termination of pregnancy before 20 weeks or fetus less than 500 grams
|
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Define threatened abortion
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uterine bleeding without cervical dilation and no expulsion of tissue
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Treatment of threatened abortion
|
pelvic rest
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What percentage of pregnancies with threatened abortion go on to be normal?
|
50%
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Define inevitable abortion
|
uterine bleeding with cervical dilation, crampy pain and no tissue
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Treatment of inevitable abortion
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follow, D&C of uterine cavity
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Define incomplete abortion
|
passage of some products of conception through cervix
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Treatmetn of incomplete abortion
|
observation, often need D&C
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Define complete abortion
|
expulsion of all products of conception from the uterus
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Treatment of complete abortion
|
Serial HCGs to be sure returns to zero. D&C if pain or opeen cervical os
|
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Define missed abortion
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fetal death without expulsion of fetus
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Treatment of missed abortion
|
most women go on to have spontaneous miscarriage but D&C often performed
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Define induced abortion
|
intentional temination prior to 20 weeks (elective or therapeutic)
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Define recurrent abortion
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two or three successive unplanned abortions
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4 infectious causes of recurrent abortion
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"- syphilis
|
|
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3 environmental causes of recurrent abortion
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"- alcohol
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2 metabolic causes of recurrent abortion
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"- hypothyroidism
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3 autoimmune causes of recurrent abortion
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"- lupus
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3 anatomic causes of recurrent abortion
|
"- cervical incompience
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|
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Classic cause of painless recurrent abortions in the second trimester
|
cervical incompetence
|
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Treatment of cervical incompetence
|
cerclage at 14-16 weeks
|
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Typical time when ectopic pregnancy presents
|
4-10 weeks.
|
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Definitive diagnosis and treatment of ectopic pregnancy in unstable patient
|
laparoscopy
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Major risk factors for ectopic pregancy
|
"** history of PID
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In 3rd trimester bleeding always do a ______ before a ______
|
always do an US before a pelvic exam
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Ddx of 3rd trimester bleeding
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"- placenta previa
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In all patients with 3rd trimester bleeding, what do you do?
|
"- IV
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|
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Risk factors for placenta previa
|
"- multiparity
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Why do you do an US before a pelvic exam in 3rd trimester bleeding
|
because of placenta previa.
|
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Accuracy of US in dx placenta previa
|
95-100%
|
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Characteristics of bleeding in placenta previa
|
"**painless
|
|
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Treatment of placenta previa
|
"- if premature, can try rest and tocolysis if stable
|
|
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Risk factors for abruptio placentae
|
"- HTN
|
|
|
3rd trimester bleeding where blood may not be visible
|
abruptio placentae
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Woman in 3rd trimester with uterine pain/tenderness and hyperactive contraction pattern and fetal distress is concerning for
|
abruptio placentae
|
|
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Use of US in diagnosing abruptio placentae
|
may be falsely normal
|
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Complication of abruptio placentae
|
maternal DIC if fetal products enter blood stream
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Treatment of abruptio placentae
|
rapid delivery (vaginal preferred)
|
|
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Risk factors for uterine rupture
|
"- previous uterine surgery
|
|
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Sudden onset of abdominal pain in 3rd trimester with sudden materal hypotension most concerning for
|
uterine rupture
|
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Changes in maternal abdomen that occur with uterine rupture
|
"- fetal parts palpable in abdomen
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Treatment of uterine rupture
|
"- laparotomy for delivery
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2 major causes of 3rd trimester fetal bleeding
|
"- vasa previa
|
|
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Major risk factor for 3rd trimester fetal bleeding
|
multiple gestation (higher # of fetuses = higher risk)
|
|
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3rd trimester bleeding with painless bleeding, stable mom and fetal distress
|
from fetal bleeding
|
|
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How do you differentiate maternal from fetal blood (such as in 3rd trimester bleeding?)
|
The Apt test
|
|
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Treatment of fetal bleeding in 3rd trimester
|
c-section
|
|
|
Cervical/vaginal lesions commonly causing 3rd trimester bleeding
|
"- herpes
|
|
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How can you decide on the dose of rhogam needed in a pregnant mom with 3rd trimester bleeding?
|
Use the Kleihauer-Betke test to quantify fetal blood in maternal circulation and use this to calculate dose
|
|
|
Define preterm labor
|
labor between 20-37 weeks
|
|
|
1st line treatment of preterm labor
|
"- lateral decub position
|
|
|
Can a patient in preterm labor on tocolytics be discharged home?
|
yes, on oral tocolytics
|
|
|
List the more common contraindications to tocolysis in preterm labor
|
"- herat disease
|
|
|
Describe the use of fetal fibronectin
|
"- useful in preterm labor between 22-34 weeks
|
|
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What action for the fetus must be taken in a stable patient with possible pre-term labor and positive fetal fibronectin?
|
measures for lung maturity
|
|
|
Amniocentesis results that indicate immature lungs
|
"- lecithin : sphingomyelin (L:S) ration less than 2:1
|
|
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At what age in premature labor do you give steroids to hasten lung maturity
|
between 26 and 34 weeks
|
|
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Define premature rupture of membrance
|
#NAME?
|
|
|
3 critera for premature rupture of membranes
|
"- pooling of amniotic fluid
|
|
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What test should be done in confirmed premature rupture of membranes
|
US
|
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|
How long do you give a mom at full term with PROM before inducing labor?
|
6-8 hours
|
|
|
Mom with PROM, fever and tender uterus likely has
|
chorioamnionitis
|
|
|
Classic cause of chorioamnionitis
|
premature rupture of membranes
|
|
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Complications of chorioamnionitis in mom and fetus
|
"- neonatal sepsis
|
|
|
Empiric treatment of chorioamnionitis
|
ampicillin
|
|
|
Define preterm PROM
|
premature rupture of membranes before 36-37 weeks
|
|
|
What do you need to test for with preterm PROM
|
culture fluid for group B step and treat mom with ampicillin if positive culture
|
|
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2 major clues that twins are dizygotic
|
"- different sexes
|
|
|
If placenta is monochorionic then twins are
|
monozygotic
|
|
|
What can you do to further investigate if twins are mono or dizygotic?
|
HLA typing
|
|
|
4 major maternal complications of multiple gestations
|
"- anemia
|
|
|
9 major fetal complications of multiple gestations
|
"- polyhydramnios
|
|
|
When can you try to delivery twins vaginally?
|
When they are BOTH vertex; any other combo, do c-section
|
|
|
Define post-term pregnancy
|
after 42 weeks
|
|
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If dates for pregnancy are known and reach 42 weeks, what do you do?
|
induce labor
|
|
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If dates for pregnancy are unknown and reach 42 weeks, what do you do?
|
twice weekly BPP
|
|
|
Post post-maturity for fetus increase risk of morbidity and mortality?
|
yes
|
|
|
Prolonged gestation is classically associated with what congenital anomaly?
|
anencephaly
|
|
|
Fetus with "frog-like" appearance on US likely has
|
anancephaly
|
|
|
Risk factors for hyperemesis gravidarum
|
"- younger
|
|
|
Hyperemesis gravidarum presents in which trimester?
|
1st
|
|
|
With all high risk pregnancies, consider weekly _____ during the third trimester
|
biophysical profiles
|
|
|
Can chorionic villi sampling detect neural tube defects?
|
no
|
|
|
When can chorionic villi sampling be done?
|
at 9-12 weeks (earlier than amniocentesis)
|
|
|
chorionic villi sampling is generally reserved for
|
testing of genetic diseases
|
|
|
What is the miscarriage rate of chorionic villi sampling compared to amniocentesis
|
higher with chorio
|
|
|
How do you know if a woman has pre-eclampsia if she already had HTN?
|
Increased greater than 30/15
|
|
|
What does HELLP syndrome stand for?
|
"H- hemolysis
|
|
|
S/s for pre-eclampsia
|
"- HTN
|
|
|
Pain in what location often does with HELLP syndrome?
|
RUQ or epigastric pain
|
|
|
When does pre-eclampsia usually occur?
|
3rd trimester
|
|
|
Main risk factors for pre-eclampsia
|
"- chronic renal disease
|
|
|
Treatment of pre-eclampsia
|
"- stabilization
|
|
|
Treatment for pre-eclampsia if fetus is not full term
|
"- hydralazine or labetalol
|
|
|
Indications in pre-eclampsia to delivery baby regardless of gestational age
|
"- oliguria
|
|
|
Is severe ankle edema normal in pregnancy?
|
No, look for pre-ecclampsia
|
|
|
HTN + proteinuria in pregnancy = ______ until proven otherwise
|
pre-eclampsia
|
|
|
Complications of pre-eclampsia and eclampsia
|
"- uretoplacental insufficiency
|
|
|
Does pre-eclampsia during pregnancy mean higher risk for HTN later in life?
|
No, not generally
|
|
|
Pre-eclampsia prior to the third trimester is likely
|
molar pregnancy
|
|
|
Best way to prevent eclampsia?
|
routine prenatal care
|
|
|
Initial treatment of choice for eclamptic seizures?
|
#NAME?
|
|
|
Toxic effects of magnesium sulfate
|
"- hyporeflexia (1st sign)
|
|
|
3 maternal complications of gestational diabetes
|
"- polyhydramnios
|
|
|
2 difference is fetus for gestational DM vs. pre-existing DM
|
"- gestational: macrosomia
|
|
|
6 fetal complications of gestational DM
|
"- respiratory distress syndrome
|
|
|
What is caudal regression syndrome?
|
lower half of body incompletely formed (risk with gestational DM)
|
|
|
Use of oral hypoglycemics in pregnancy
|
contraindicated (use insulin)
|
|
|
Infants born to DM mothers are classically at risk for what right after birth?
|
postdelivery hypoglycemia
|
|
|
Why do babies of DM mother's get hypoglycemic after delivery?
|
fetal islet cell hypertrophy
|
|
|
Only maternal antibody category to cross the placenta
|
IgG
|
|
|
Meaning of elevated neonatal IgM concentration?
|
never normal
|
|
|
Meaning of elevated neonatal IgG concentration
|
often represents maternal antibodies
|
|
|
When does Rh incompatilbity occur
|
"mom Rh negative
|
|
|
At what time do you give Rh immune globulin
|
"- 28 weeks
|
|
|
What type of prevention is Rh immune globulin?
|
primary
|
|
|
IS Rh immune globulin effective if maternal Rh antibodies are strongly postiive?
|
no
|
|
|
What is hydrop fetalis
|
edema, ascites, pleural/pericardial effusions
|
|
|
Undetected Rh incompatability can lead to
|
"- hemolytic disease of newborn
|
|
|
Who do you test the severity of fetal hemolysis
|
Amniotic fluid spectrophotometry
|
|
|
Treatment of hemolytic disease of the fetus
|
"- delivery if mature
|
|
|
Mother with type O blood and baby with any other type, baby at risk for
|
hemolytic disease of the newborn
|
|
|
Snow storm pattern on US =
|
hydatiform mole
|
|
|
"grape like vesicles" with 1st or 2nd trimester bleeding
|
hydatiform mole
|
|
|
uterine size/dates discrepancy brings concerns for
|
hydatiform mole
|
|
|
Karyotype of complete moles
|
46XX or 46 XY (all from father)
|
|
|
Do complete moles contain fetal tissue?
|
no
|
|
|
Karyotype of incomplete moles
|
69 XXY
|
|
|
Do incomplete moles contain fetal tissue?
|
yes
|
|
|
Treatment of moles
|
D&C, follow HCG levels to zero
|
|
|
What happens if patient treated for hydatiform mole and HCG doesn't return to zero
|
invasive mole or choriocarcinoma and patient needs chemo
|
|
|
Chemo options for invasive mole or choriocarcinoma
|
"- methotrexate
|
|
|
Source of choriocarcinoma
|
"- denove
|
|
|
Can choriocarcinoma develop from incomplete mole?
|
no
|
|
|
Prevention of aborption in when with antiphsophlipid antibodies and previous pregnancy problems
|
Low dose ASA and heparin
|
|
|
How do you treat TB in a pregnant patient
|
same treatment
|
|
|
Drug to avoid if need to treat pregnant patient for TB
|
streptomycin
|
|
|
Streptomycin given during preganancy risks causing ____ and ____ in the fetus
|
"- deafness
|
|
|
Is thalidomide safe in preganancy?
|
phocomelia
|
|
|
Is tetracycline safe in preganancy?
|
yellow/brown teeth
|
|
|
Is aminoglycoside safe in preganancy?
|
deafness
|
|
|
Is valproic acid safe in preganancy?
|
"- spina bifida
|
|
|
Is progestersone safe in preganancy?
|
masculinization of females
|
|
|
Is cigarettes safe in preganancy?
|
"- IUGR
|
|
|
Is birth control pills safe in preganancy?
|
"VACTRERL syndrome:
|
|
|
Is llithium safe in preganancy?
|
Ebstein anomalies (atrialization of right ventricle)
|
|
|
Is aminopterin safe in preganancy?
|
"- IUGR
|
|
|
Is radiation safe in preganancy?
|
"- IUGR
|
|
|
Is phenytoine (diphenyhydantoin) safe in preganancy?
|
"- craniofacial defects
|
|
|
Is trimethadione safe in preganancy?
|
"- craniofacial defects
|
|
|
Is warfarin safe in preganancy?
|
"- craniofacial defects
|
|
|
Is carbamazepine safe in preganancy?
|
"- fingernail hypoplasia
|
|
|
Is isotretinoin safe in preganancy?
|
"- CNS defects
|
|
|
Is iodine safe in preganancy?
|
"- goiter
|
|
|
Is cocaine safe in preganancy?
|
"- cerebral infarcts
|
|
|
Is diazepam safe in preganancy?
|
#NAME?
|
|
|
Is diethylstilbestrol safe in preganancy?
|
"- clear cell vaginal cancer
|
|
|
Is acetaminophen safe in preganancy?
|
Yes
|
|
|
Is penicillin safe in preganancy?
|
Yes
|
|
|
Is cepahlosporins safe in preganancy?
|
Yes
|
|
|
Is erythromycin safe in preganancy?
|
Yes
|
|
|
Is nitrofurantoin safe in preganancy?
|
Yes
|
|
|
Is H2-blocker safe in preganancy?
|
Yes
|
|
|
Is antacid safe in preganancy?
|
Yes
|
|
|
Is heparin safe in preganancy?
|
Yes
|
|
|
Is hydralazine safe in preganancy?
|
Yes
|
|
|
Is methyldopa safe in preganancy?
|
Yes
|
|
|
Is labetalol safe in preganancy?
|
Yes
|
|
|
Is insulin safe in pregnancy?
|
yes
|
|
|
Is docusate safe in pregnancy?
|
yes
|
|
|
3 important features of PID
|
"- abdominal pain
|
|
|
4 supporting features of PID
|
"- elevated ESR
|
|
|
3 biggest organisms in PID
|
"- Neiseria gonorrhoeae
|
|
|
Organism causing PID in patient with IUD
|
actinomyces israeli
|
|
|
Most common preventable cause of infertility
|
PID
|
|
|
Likely cause of infertility in woman under 30 with regular menstrual cycles
|
PID
|
|
|
Treatment of PID
|
"* more than 1 abx
|
|
|
Unusual feature of tubo-ovarian abscess
|
may resolve with antibiotics alone
|
|
|
Vaginal discharge like cottage chees
|
candida
|
|
|
Vaginal discharge with pseudohypahe on KOH
|
candida
|
|
|
Vaginal discharge with history of diabetes
|
candida
|
|
|
Vaginal discharge with history of antibiotic treatment
|
candida
|
|
|
Vaginal discharge with during pregancy
|
candida
|
|
|
Treatment of candidal vaginitis
|
oral or topical antifungal
|
|
|
Vaginal discharge with organisms seen swimming under microscope
|
trichomonas
|
|
|
Vaginal discharge that is pale green, frothy, watery
|
trichomonas
|
|
|
Vaginal discharge with strawberry cervix
|
trichomonas
|
|
|
Treatment of trichomonas
|
metronidazole
|
|
|
Vaginal discharge with fishy smell on KOH prep
|
Gardnerella
|
|
|
Vaginal discharge with clue cells
|
Gardnerella
|
|
|
Vaginal discharge that is malodorous
|
Gardnerella
|
|
|
Treatment of Gardnerella
|
Metronidazole
|
|
|
Venereal warts are caused by
|
human papillomavirus
|
|
|
Koilocytosis on pap smear =
|
human papillomavirus venereal warts
|
|
|
Multiple shallow painful vaginal ulcers =
|
herpes
|
|
|
Treatment of vaginal herpes
|
acyclovir, valacyclovir
|
|
|
Most common sexually transmitted disease
|
Chlamydia
|
|
|
STD that often causes dysuria
|
Chlamydia
|
|
|
Treatment of chlamydia
|
"- doxycycline
|
|
|
One time oral treamtment option for chlamydia
|
- 1 gram of azithromycin
|
|
|
Treatment of chlamydia in pregnant patient
|
erythromycin or amoxicillin
|
|
|
STD for mucopurulent cervicitis
|
Neisseria gonorhoeae
|
|
|
Gram negative STD
|
Neisseria gonorhoeae
|
|
|
Treatment of Neisseria gonorhoeae
|
"- ceftriaxone
|
|
|
STD with intracellular inclusions
|
molluscum
|
|
|
Treatment of pediculosis
|
"(crabs)
|
|
|
If a patient has gonorrhea, what should you also treat for?
|
chlamydia
|
|
|
Typical treatment for fonorrhea
|
ceftraizone and doxycycline (assume also chlaymdia infection)
|
|
|
STDs where the partner does NOT need to be treated
|
candida, Gardnerella
|
|
|
Test to do in primary amenorrhea
|
- if basic overview normal, administer progesterone; if no bleeding, likely no estrogen or anatomic abnormality
|
|
|
If patient with primary amenorrhea bleeds with progesterone test, this means
|
"- estrogen is present
|
|
|
If patient with primary amenorrhea has normal breasts but no pubic/axillary hair, likely
|
androgen insensitvity syndrome
|
|
|
Features of androgen insensitivity syndrome
|
"- phenotypically female
|
|
|
Secondary amenorrhea with + progesterine challenge and HIGH leutinizing hormone
|
polycystic ovarian syndrome
|
|
|
In polycystic ovarian sydrome, LH is
|
high
|
|
|
Ddx for secondary amenorrhea with + progesterine challenge and LOW leutinizing hormone
|
"- pituitary adenoma
|
|
|
Causes of low gonadotropin hormone
|
"- drugs
|
|
|
Test to check is patient has secondary amenorrhea that you think is from pituitary adenoma
|
prolactin
|
|
|
Patient with secondary amenorrhea with normal prolactin, normal TSH and low gonadotropin likely has
|
anorexia nervosa
|
|
|
A patient with secondary amenorrhea with + progesterone bleeding test can likey become pregnant by using which drug?
|
clomiphene
|
|
|
Secondary amenorrhea with no bleeding on progesterine challenge has (generally)
|
insuffecient estrogen
|
|
|
Secondary amenorrhea with no bleeding on progesterine challenge with elevated FSH has
|
premature ovarian failure/menopause
|
|
|
FSH is _____ in premature ovarian failure
|
elevated
|
|
|
Secondary amenorrhea with no bleeding on progesterine challenge with low/normal FSH may have
|
neoplasm of hypothalamus (get MRI of brain)
|
|
|
First test to order in amenorrhea
|
pregnancy test
|
|
|
Nulliparous 35 yr woman with dyspareunia and dyschezia
|
endometriosis
|
|
|
Most common site for endometriosis
|
#NAME?
|
|
|
Tender adnexa WITHOUT evidence of PID =
|
endometriosis
|
|
|
Endometriosis may be associated with this uterine position
|
retroverted
|
|
|
Gold standard for diagnosis of endometriosis
|
laparoscopy with visualization
|
|
|
Mulberry spots
|
endometriosis
|
|
|
flat brown colored powder burns
|
endometriosis
|
|
|
chocolate cysts
|
endometriosis
|
|
|
Most likely cause of infertility in menstruating woman over 30
|
endometreosis
|
|
|
Treatment of endometriosis
|
"1st: birth control pills
|
|
|
Effect of surgery for endometriosis on fertility
|
often improves it
|
|
|
Define adenomyosis
|
ectopic endometrial glands within uterine musculature
|
|
|
Typical characteristics of adenomyosis
|
"- over 40
|
|
|
Woman over 40 with large boggy uterus and dymenorrhea
|
adeomyosis
|
|
|
Treatment of adenomyosis
|
"- D&C to r/u endometrial cancer
|
|
|
Define dysfunctional uterine bleeding
|
abnormal uterine bleeding not associated with tumor inflammation or pregnancy
|
|
|
70% of dysfunctional uterine bleeding is associated with
|
anovulatory cycles
|
|
|
When is dysfunction uterine bleeding common and physiologic?
|
Right are menarche and before menopause
|
|
|
If dysfunctional uterine bleeding that doesn't appear simple, think
|
polycystic ovarian syndrome
|
|
|
What needs to be done in woman over 35 with dysfunctional uterine bleeding?
|
D&C to r/o endometrial cancer
|
|
|
Why should you get a CBC in patient with polycystic ovarian syndrome?
|
excess blood loss
|
|
|
4 uncommon causes of dysfunctional uterine bleeding
|
"- infections
|
|
|
First line treatment for idiopathic dysfunctional uterine bleeding
|
NSAIDs or OCPs
|
|
|
First line treatment for dysmenorrhea
|
NSAIDs
|
|
|
Treatment of severe bleeding with dysfunctional uterine bleeding
|
progesterone
|
|
|
Overweight woman with infertility and amenorrhea
|
polycystic ovarian syndrome
|
|
|
Most common cause of infertility in woman under 30 with ABnormal menstruation
|
polycystic ovarian syndrome
|
|
|
LH:FSH in polycystic ovarian syndrome
|
greater than 2:1
|
|
|
Cancer risk in polycystic ovarian syndome
|
unopposed estrogen causes increased risk for endometrial hyperplasia and enodmetrial carcinoma
|
|
|
Treatment of polycystic ovarian syndrome
|
"- OPCs
|
|
|
Treatment of premenstrual dysphoric disorder
|
NSAIDs; antidepressants
|
|
|
Average age of menopause
|
50
|
|
|
Increase parabasal cells on vaginal cytology indicates
|
menopause
|
|
|
Fibroids aka
|
leimyoma
|
|
|
Are leiomyomas malignant or benign?
|
benign
|
|
|
Most common indication for hysterectomy
|
leiomyoma
|
|
|
Rate of malignant transformation of leimyoma
|
<1%
|
|
|
When do leiomyomas often grow rapidly?
|
During pregnancy or high estrogen (OCPs)
|
|
|
Anemia with fibroids is an indication for
|
hysterectomy
|
|
|
Test that should be done in woman over 40 with leiomyoma
|
D&C to r/o endometrial cancer
|
|
|
Polyp protruding through cervix is likely
|
leiomyoma
|
|
|
4 non-cancerous causes of breast discharge
|
"- birth control pills
|
|
|
If a patient has bilateral non-bloody breast discharge, what are the chances that it's cancer?
|
very low
|
|
|
Unilateral breast discharge is concerning for
|
cancer
|
|
|
Most common breast disorder
|
fibrocystic disease
|
|
|
Treatment of fibrocystic breast disease if under 35
|
if symptoms are very severe can do progesterone or danazol for a week at the end of each month
|
|
|
Features of fibrocystic breast disease
|
"- under 35
|
|
|
A painless, shaprly circumscribed, rubbery, mobile breast mass is likely
|
fibroadenoma
|
|
|
Most common benign tumor of the female breast
|
fibroadenoma
|
|
|
Age when you become more concerned about breast cancer
|
35
|
|
|
Treatment of fibroadenoma of the breast
|
excision is curative but often not needed
|
|
|
Fibroadenoma of the breast often growns quickly in the setting of
|
OCPs or pregnancy (estrogen)
|
|
|
Is mammogram useful under the age of 35?
|
No. Breast tissue too dense. Proceed directly to biopsy
|
|
|
Approach to fibrocystic breast disease in woman over 35
|
"- aspirate fluid
|
|
|
This potentially malignant tumor often masquerades as a rapidly growing fibroadenoma of the breast
|
phylloides tumor
|
|
|
Treatment of fibroadenoma of the breast if over 35
|
"- baseline mammogram
|
|
|
In a woman over 35 with a breast mass, when in doubt...
|
get a biopsy
|
|
|
A new breast mass in a postmenopausal woman...
|
is breast cancer until proven otherwise
|
|
|
Pelvic heaviness that is worse with standing and improves with lying down may be
|
vaginal prolapse
|
|
|
A bulge into the upper vaginal wall is likely
|
a cystocele
|
|
|
Symptoms of cystocele
|
urianry urgency, frequency and incontinence
|
|
|
A bulge into the lower posterior vaginal wall is likely
|
a rectocele
|
|
|
Symptoms of rectocele
|
difficultly defecating
|
|
|
What is an enterocele
|
bulding of loops of bowel into upper posterior vaginal wall
|
|
|
Treatment of -celes (cystocele, etc)
|
"- pelvic strengthening
|
|
|
Male/female ratio for "problem source" in infertility
|
"- male 1/3
|
|
|
1st step in eval of infertility (after based H&P)
|
semen anlysis
|
|
|
Risk factor for uterine synechiae
|
D&C
|
|
|
What radiographic test do you order to look for uterine structural abnormalities?
|
hysterosalpingogram
|
|
|
Clomiphene can be used to stimulate ovulation in what setting
|
need adequate estrogen
|
