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ObGyn Stuff


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Signs of chorioamnionitis
1) Maternal fever
2) Uterine tenderness
3) Fetal tachycardia
4) Elevated WBC
What is definition of late pregnancy bleeding?
Bleeding after 20 weeks
What is the most common cause of late-trimester bleeding?
Placental abruption
Risk factors for placental abruption
1) Previous abruption
2) Maternal trauma
3) Hypertension
4) Maternal cocaine abuse
5) Premature membrane rupture
Signs of mild abruption
Moderate vaginal bleeding with no fetal monitor abnormality. Localized uterine pain and tenderness.
Signs of moderate abruption
Pain and bleeding can be gradual or abrupt in onset.
FHT may show tachycardia, decreased variability or mild late decels
Signs of severe abruption
Abrupt pain that is continuous and knifelike. Greater than 50% separation.
FHT shows severe late decels, bradycardia or death.
DIC may occur
Why does DIC occur with abruption?
Release of tissue thromboplastin from placenta into maternal circulation.
What is couvelaire uterus?
Blood extravasating between myometrial fibers. Bruises appear on serosal surface.
What are complications of severe abruption?
Acute tubular necrosis from severe hypotension.
DIC from release of tissue thromboplastin.
What is characteristic of bleeding with abruption?
Painful bleeding
What is characteristic of bleeding with previa?
Painless bleeding
Which single dose oral regimens for gonorrhea should be avoided in pregnancy?
Ciprofloxacin and ofloxacin.
Single dose treatment for gonorrhea
Intramuscular ceftriaxone
Treatments for chlamydia
Single dose azithromycin
1 week regimen of doxycyline or erythromycin
Who should be routinely screened for gonorrhea and chlamydia?
All sexually active women who are young or have other risk factors.
What is the most common cause of septic arthritis in sexually active young adults?
Neisseria gonorrhea
What is the hormone imbalance in polycystic ovarian syndrome?

Too much LH
What are the origins of ovarian cancers?
Epithelial, germ cell and stromal
What is the most common type of ovarian cancer?
Serous cystadenocarcinoma
What do women over 35 with abnormal bleeding need to rule out?
Endometrial carcinoma
What prevents gonadal malignancy in Turner's syndrome?
Prophylactic removal of gonads.
What congenital anomalies are associated with Turner's syndrome?
1) Coarctation of the aorta
2) Cystic hygroma
3) Renal anomalies
What is the most common cause of primary amenorrhea?
Turner's syndrome (45, X0)
What happens if a Turner patient is given progesterone?
Nothing, no bleeding because there was no estrogen to begin with.
What conditions has bacterial vaginosis been linked with?
Postpartum endometritis, pelvic infections, preterm labor.
What are three classical presentations of endometriosis?
Pain, abnormal bleeding and infertility
At what ages do most women present with endometreosis?
Between 20 and 35
What is medical therapy for endometriosis?
NSAIDS for pain; OCPs, danazol and GnRH agonists to induce "medical menopause" for relief of symptoms
What is normal pH of the vagina in a premenopausal woman?
Acidic (<4.5)
What is characteristic of the discharge produced by bacterial vaginosis?
Profuse, thin, foul smelling, "dirty-grey"
What is the treatment for BV?
Metronidazole for 7 days
What is the alternative treatment for BV?
What time period during pregnancy should Metronidazole be avoided?
First trimester
Classic findings for endometriosis on physical exam
Fixed, retroverted uterus
Nodularity of uterosacral ligaments
Fixed ovaries
T or F: High parity is a risk factor for cervical cancer
What can vaginal discharge of cervical cancer look like?
Malodorous, purulent or clear
HPV serotypes that cause cancer
16, 18, 33, 36 and others
Type of herpes that mostly causes genital warts
HSV Type II (90% of cases)
What is the treatment for herpes genitalis?
Acyclovir, valacyclovir or famcicyclovir for 7-10 days
In which eating disorder are severe electrolyte abnormalities and cardiac arrythmias seen?
What should be the antibiotic coverage for treatment of PID?
Chlamydia, gonorrhea, gram negative rods and anaerobes
What is the treatment for PID?
Cefotetan or cefoxitin and doxycyline
How long do you watch a tubo-ovarian abscess on antibiotics before resorting to surgery?
72 hours
In what type of patient is and IUD a bad idea?
Women under 35, promiscuous women, those desiring future fertility
T or F: Patients with adenomyosis tend to present at a later age than patients with endometriosis
True (35-45 years)
Smooth symmetrically enlarged, boggy uterus that may be tender to palpation probably describes....
What is condyloma accuminata assiciated with?
Genital warts or HPV
Which conditions can cause genital warts to grow rapidly and larger?
Pregnancy, diabetes, immunosuppresion and taking OCPs.
What has to be included in the investigation of vaginal bleeding in postmenopausal woman?
Pap smear, endocervical curettage, endometrial biopsy
What is benign cystic teratoma known as?
Mature teratoma or dermoid cyst
What are the most common ovarian neoplasms?
Benign cystic teratoma
What is struma ovarii?
Fuctioning thyroid tissue in a benign teratoma causing hyperthyroidism
What are the screening tests for syphilis?
Nonspecific, false positives, become negative after treatment
What are confirmatory tests for syphilis?
More specific, stay positive for life
What is Jarish-Herxheimer?
It is a reaction that occurs in patients with syphilis on the first day of treatment.
Fever, sweating, malaise.
Not an allergic reaction!
What might a false positive syphilis screening test mean?
Lupus or some collagen vascular disorder (anti-phospholipid syndrome)
How early can pregnancy be detected by transvaginal ultrasound?
5 weeks
T or F: Mild glucosruia and proteinuria is normal in pregnancy
What LFT value is normally elevated in pregnancy?
Alkaline phosphatase
When in pregnancy is the "triple screen" done?
16-20 weeks
When in pregnancy is diabetes screening done?
24-28 weeks
What are normal pregnancy levels of beta-HCG?
What is another name for molar pregnancy?
Gestational trophoblastic neoplasia (GTN)
What is the next step in a molar pregnancy if beta-HCG levels continue to rise after a D&C?
Chemotherapy with methotrexate or actinomycin D
Describe complete molar pregnancy
46, XX; no fetal tissue present
Describe incomplete molar pregnancy
47, XXY; some fetal tissue present
Date of delivery based on LMP
subtract 3 months and add 7 days
What is the definition of spontaneous abortion?
Expulsion of fetus at <20 weeks or <500 grams
In which trimester does Pregnancy Induced Hypertension classically occur?
Third trimester
Second trimester + signs of pre-eclampsia = ?
Possible molar pregnancy
What are classic complaints of PIH?
Dec. urine output, headache, visual changes, altered mental status, RUQ pain, face, hand or leg swelling
What defines pre-eclampsia?
Hypertension + PROTEINURIA + edema
What distinguishes pre-eclampsia from eclampsia?
What is in the HELLP syndrome?
Hemolysis, elevated liver enzymes, low platelets +/- RUQ pain
What can occur with magnesium sulfate toxicity?
Dec. deep tendon reflexes
Respiratory depression
Which PIH is okay to treat with BP control and observation?
Those with mild disease:
BP < 160/110, 1-2+ proteinuria and no symptoms besides edema
What is symmetric IUGR a result of?
Fetal anomalies and infections
What is asymmetric IUGR a result of?
Maternal or placental factors
More common
What are the three most common presenting complaints for an ectopic pregnancy?
Amenorrhea, abdominal pain and vaginal bleeding.
24 year old, RLQ pain, spotting, LMP 5 weeks ago: first test?
Name three initial lab values to check in a pre-menopausal woman presenting with amenorrhea.
beta-HCG, TSH, prolactin
Which metabolic disorders are women with PCOS at risk for?
Diabetes mellitus type 2 and dyslipidemia

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