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272 Cards in this Set
- Front
- Back
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
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52 y/o wman G1P1 with stage II ovarian serous cystadenocarcinoma
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TAH, BSO, CHEMO
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25 y/o woman with a diffusely enlarged uterus
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qualitative b-hcg test to r/o pregnancy
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25 y/o woman with a uterine submucous leiomyoma causing intermenstrual bleeding
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hysteroscopic resection
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25 y/o woman with an asymmptomatic 7 cm uterine subserosal leiomyoma
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conservative management w/ observation
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25 y/o infertile woman with multiple 5-7 cm uterine intramural leiomyomata
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preoperative involution by GnRH agonist suppresion followed by myomectomy
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36 y/o woman G3P3 with multiple 5-7 cm uterine intramural leiomyomata not desiring fertility
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TAH
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22 y/o woman G3P2A1, afebrile, with mucopurulent vervical discharge, cervical motion tenderness, and bilateral adnexal tenderness
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outpatient antibiotic therapy with IM cephalosporin plus oral doxycycline/tetracycline
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22 y/o woman G0P0, afebrile, with mucopurulent cervical discharge, cervical motion tenderness and bilateral adnexal tenderness
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inpatient antibiotic therapy with IV cephalosporin plus doxycyclin or clindamycin plus gentamycin
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22 y/o woman G3P2ab1, T 102ºF with mucopurulent cervical discharge, cervical motion tenderness, and bilateral adnexal tenderness
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inpatient antibiotic therapy with IV cephalosporing plus doxycycline or clindamycin plus gentamycin
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22 y/o woman G3P2AB1, T 102º, with mucopurulent cervical discharge, cervical motion tenderness and bialteral fluctuant adnexal masses
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INPATIENT ANTIBIOTIC THERAPY WITH PERCUTANEOUS DRAINAGE/EMERGENCY LAPAROTOMY IF INADEQUATE RESPONSE TO MEDICAL TREATMENT
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22 y/o woman G3P2A1, afebrile, with no cervical discharge, but with cervical motion tenderness and bilateral adnexal masses
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Qualitative b-hcg to r/o pregnancy, then conservative management. TAH, BSO if unsatisfactory response (remember ERT).
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19 y/o woman with unilateral adnexal tenderness, and quantitative b-hcg of 800.
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transvaginal sonogram to look for intrauterine gestational sac.
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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
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observationand repeat b-hcg and tv sono in 2-3 days
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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
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pelvic laparoscopy or methotrexate therapy
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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
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emergency exploratoy laparotomy
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19 y/o woman, G1 P0 A1 with laparoscopically confirmed unruptured ampullary ectopic tubal pregnancy
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laparoscopic linear salpingostomy
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35 y/o woman, G4P3A1, with laparoscopically confirmed unruptured ampullary ectopic tubal pregnancy. post tubal ligation.
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laparoscopic salpingectomy
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19 y/o woman G1P0A1 with laparoscopically confirmed ruptured isthmic ectopic tubal pregnancy
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laparoscopic segmental tubal resection
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f/u studies after laparoscopic linear salpingostomy for ectopic pregnancy
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Rd(D) immune globulin if Rh negative; serial b-hcg titers weekly until titers negative
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f/u studies after laparscopic segmental tubal resection for ectopic pregnancy
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Rh (d) immune globulin if Rh negative; serial b-hcg titers unnecessary
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f/u studies after methotrexate therapy for ectopic pregnancy
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Rh (D) immune globulin if Rh (-); serial b-hcg titers weely until titers negative
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54 y/o postmenopausal with hypoactive sexual desire not on HRT
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HRT
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54 Y/O postmenopausal with hypoactive sexs desire on HRT
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referral to sex therapist
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21 y/o woman with 1º anorgasmia
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self-stimulation
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26 y/o with vaginismus
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gradual accommodation of vaginal dilators
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32 y/o w/ dyspareunia
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thorough hx and pelvic exam
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21 y/o after a sexual assault
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immediate attention to medical needs, then address psychological needs, followed by collection of evidence
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pregnancy prevention for a sexual assault victim
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high progestin combination oral contraceptives in divided doses 12 hours apart
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31 y/o G2P2 on postpartum day#2 with congestive mastitis desiring to breast feed
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empty breast manually after infant feeding
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31 y/o G2P2 on postpartum day #2 with congestive mastitis not desiring to breast feed
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bind breasts with breast binder. ICE PACKS AND ANALGESICS. AVOID BREAST STIMULATION.
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31 y/o breastfeeding woman G2P2 no 2 weeks postpartum with infectious mastitis.
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oral antibiotics for S. aureus. local heat, breast support, analgesics. continue lactating.
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35 y/o woman with a dominant cystic breast mass
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mammography, sonography, followed by cyst aspiration.
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35 y/o woman with a single solid breast mass
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mammography, sonography, followed by open breast biopsy
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40 y/o woman with biopsy confirmed stage I infiltrating ductal breast carcinoma
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partial mastectomy plus axillary dissection followed by radiation therapy
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31 y/o infertile woman G0P0 with dicumented anovulation
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clomiphene citrate or hMG stimulation
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31 y/o infertile woman G0P0 with documented anovulation treated with ovulation induction now has developed ovarian hyperstimulation
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d/c ovulation induction. conservative management.
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31 y/o infertile woman G0P0 with suspected tubal disease
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hysterosalpingography and pelvic laparoscopy
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