USMLE OBGYN2
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| cause of GDM, when onset | due to human placental lactogen (hPL) and insulinase; last 1/2 preg
🗑
|
||||
| describe White classif DM A-D | A1= GDM diet; A2=GDM insulin; B: onset <20 duration <10; C: 10-19, duration 10-19; D: <10, >20, vascular cxns
🗑
|
||||
| describe DM White classif F, R, T, H | F=nephropathy, R=prolifer retino, T=renal tx, H=aterioscler heart dz
🗑
|
||||
| 2 MC cxns of IDM, most specific | MC are NTD and cardiac, most specific is caudal regression
🗑
|
||||
| risk factors GDM, 3 MC, 4 others | MC: FMH, obesity, >30yo; maternal cxns during prev (still birth, traumatic delivery w shoulder dystocia, congenital anomaly, macrosomia) or poly, macrosomia or fetal anomaly in current
🗑
|
||||
| what are goals for glu while in preg | fasting <90, 1hr <140, 2hr <120
🗑
|
||||
| what are doses of insulin for DM in preg by trimester | 0.5U/kg for 1st tri, 0.6 for 2nd, 0.7 for 3rd
🗑
|
||||
| how are insulin doses distributed | 2/3 in am and 1/3 in eve, in am give 2/3 NPH and 1/3 regular, in eve 1/2 and 1/2
🗑
|
||||
| cut offs 3hr OGTT | fasting ≥95/≥180/≥155≥140
🗑
|
||||
| management baby GDM/DM | Monthly US&BPP for fetal grwth and well being; 32 wks do NST and AFI (amniotic fluid index) 2x/wk if using insulin, macrosomia, or h/o still birth. at 26wks if vasculopathy, HTN, or poor glu control
🗑
|
||||
| management DM (not GDM) before/beginning of preg | 4mg folate 3mo before conception, check for end organ dz (24hr protein and Cr clr, fundoscopy, neuropathy, Kaplan says get HbA1c ea tri)
🗑
|
||||
| fetal screening for IDM | 15-20wks triple marker for NTD, 16-18wk US for NTD, 18-20wks US for other structural anomalies, 22-24 fetal echo if glu hadn't been well controlled
🗑
|
||||
| during/after delivery and timing delivery IDM | during keep glu 80-100, after watch for PPH from overdistension and rapid drop in insulin needs, deliver no later than 40wks [tend to be late mature, so don't want deliver too early]
🗑
|
||||
| 4 types of pelvis | Gynecoid-round oval 50%; Android-male 30%, inlet is triangular, restricted all lvls, arrest of descent common; Anthropoid (ape like) 20%, inlet is large A-P,head will engage A-P (occiput posterior); Platypelloid- squashed gynecoid, head engages transvers
🗑
|
||||
| what's presentation? 5 exs | which part of baby is presenting over os, ie cephalic, also footling breech=legs/thigh extended; complete breech=legs/thigs flexed; freank breech=thighs flexed legs extended; compound
🗑
|
||||
| what's attitude? 4 types | if chin of baby is flexed (vertex MC) or extended (partial=brow, max=face) (partial flex=military)
🗑
|
||||
| what's position? 3 types | portion of baby ag pelvis, MC occiput anterior, also sacrum, mentum/chin/face presentation
🗑
|
||||
| only breech can be delivered vaginally | frank breech
🗑
|
||||
| brady in baby and causes? Tachy? | brady <110, tachy >160; Brady: b blockers, anesthetics, congenital heart block in baby (maternal SLE); b agonists (terbutaline, rinodrine), F, thyroxociosis, premie, fetal arrhythmia, baby moving a lot
🗑
|
||||
| cut offs for variability | absnet, min 5 or less, moderate (nml) 6-25), marked >25
🗑
|
||||
| cut offs accel, prolonged accel, baseline change | Abrupt incrs in FHR (<30sec) _15bpm and _15sec. [if <32 wks _10bpm and _10sec], unrelated to cxns; prolonged accel if 2-10min, baseline change if 10min
🗑
|
||||
| what makes cat I tracing | FHR 110-160, moderate variability, no late or variable decels, may have early decels
🗑
|
||||
| cat III tracing | absent variability AND ANY of : recurrent late or variable decels, bradycardia
🗑
|
||||
| what are lab findings for acute cholestasis of preg | incrsd bile acids, +/- ALT/AST and pruritis
🗑
|
||||
| tx for acute cholestasis of preg | ursodeoxycholic acid (helps bile flow) w cholestyramine (prevents bile reabsorption) and anti His
🗑
|
||||
| tx of Graves during preg | use methimazole or PTU to make mom euthyroid--maternal IgG cross placenta
🗑
|
||||
| what syndrome can appear like acute cholestasis of preg | PUPP=pruritic uriticarial papules and plaques of preg--but these appear perimbulical and don't affect preg
🗑
|
||||
| management of the preg if cholestasis is present | if severe deliver 36wks if fetal lung matures, if not severe deliver by 38
🗑
|
||||
| tx PUPP | steroids and anti His
🗑
|
||||
| how resuscitate baby if bad FHT | decrs ctx by d/c oxytocin, give terbutaline 0.25subQ, 500ml bolus NS, high O2, change position (sit up or L lateral to incrs CO, lateral also to help w cord compression); check for prolapsed cord and can do scalp stim
🗑
|
||||
| pathophys cervical effacement | oxytocin and prostaglandins breaking disulfide links of collagen fibers leading to increased water content
🗑
|
||||
| pathophys of incrsing ctx | formation of gap jxns bw uterine myometrial cells, correlated w incrsd oxytocin and prostaglandins and multiplcation of receptors
🗑
|
||||
| what are the 5 cardinal mvmts of labor | EDFIEERE=engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
🗑
|
||||
| 4 stages of labor | 1 latent=(Effacement), ends w accel of cervical dilation ~3-4; 1 active=cardinal mvmts of labor begin, ends w complete dilation; Stage 2=descent (ends w delivery of baby); Stage 3=expulsion, delivery of placenta; 4=recovery
🗑
|
||||
| times for ea stage of labor | 1 latent=14 for multipara, 20 for primi; 1 active=1.2cm/hr for primi, 1.5 for multi; 2=2 hr primi, 1 hr for multi +1hr if epidural; 3=30min
🗑
|
||||
| tx of prolonged latent phase, MC cause | anesthesia; tx=sedation, avoid oxytocin or c/s
🗑
|
||||
| tx of prolonged active | oxytocin if ctx inadequate
🗑
|
||||
| w/o IUPC how can tell if ctx are inadequate | if last less than 45 sec and <3 in 10min
🗑
|
||||
| how define prolonged 2nd stage | (from complete dilation to delivery of baby=descent), >2hrs of active pushing if primi or 1 hr multip (+1 epidural)
🗑
|
||||
| management prolonged 2nd stage if ctx adequate | emergency c/s if head not engaged, otherwise vacuum extraction or forceps
🗑
|
||||
| management prolonged3rd stage | oxytocin if ctx inadequate or manual delivery of placenta
🗑
|
||||
| management of prolapsed cord | put pt in knee-chest, elevate presenting part, avoid palpating cord, immediate c/s
🗑
|
||||
| manage shoulder dystocia | suprapubic pressure, maternal thigh flexion (McRobert’s maneuver), internal rotation of fetal shoulder into oblique plane (Wood’s corkscrew), manual delivery of P arm, and Zavanelli maneuver (cephalic replacement
🗑
|
||||
| perineal lacs | 1=only perineal mucosa, 2=perineal mscl, 3=some of anal sphincter (external and/or internal), 4=rectal mucosa **careful prevent rectovaginal fistula
🗑
|
||||
| 4 types forceps and how used | Simpson-for traction only; Kjelland-rotation and traction; Piper-for the aftercoming head of a vaginal breech delivery; Barton-to deliver head in occiput transverse w a platypelloid pelvis
🗑
|
||||
| at what station forceps used | outlet forceps=fetal head on pelvic floor; low forceps= +2 station but not on pelvic floor
🗑
|
||||
| MC indication forceps, 3 others | prolonged 2nd stage, also nonreassuring FHT, avoid maternal pushing (cardiac dz), breech (shorten delivery of head)
🗑
|
||||
| 3 reasons c/s, MC | MC=cephalopelvic disproportion (doesn't follow nml dilation curve, prolonged/arrest labor); fetal malpresent (MC breech), nonreassuring FHT
🗑
|
||||
| risks assoc c/s relative to vaginal | Blood loss 2x vaginal (~1L), risk of infxn, DVT incrsd, visceral injury can occur
🗑
|
||||
| required to be able to use low transverse incision | longitudinal lie, formed lower uterine seg
🗑
|
||||
| rate of successful vag s/p c/s | 80% in carefully selected
🗑
|
||||
| when cerclage placed/removed, 2 types | placed 14wks, Shirodkar=suture is beneath cervical mucosa and left in place w delivery by c/s; McDonald=simple purse string, removed at 36wks to allow vaginal delivery
🗑
|
||||
| pain from uterine ctx and cervical dilation from what nerves? Perineal distention? | T10-12, S2-4
🗑
|
||||
| describe paracervical block, pudendal block; what stages used | Bilateral transvaginal local anesthetic blocking Frankenhauser ganglion lateral to cervix. active phase (watch transient fetal brady); Bilateral transvaginal injxn to block pudendal n as passes by ischial spines, stage 2;
🗑
|
||||
| describe epidural and spinal block | Local anesthesia into epidural space blocking lumbosacral n roots during Stage 1&2; Injxn into subarachnoid to block lumbosacral. Saddle block for stage 2 and c/s.
🗑
|
||||
| SE epidural and tx | hypotension from sympathetic blockade and spinal HA. Tx hypotension w fluids and ephedrine (sympathomimetic). Spinal HA w hydration, caffeine, or blood patch
🗑
|
||||
| describe lochia and progression | Vaginal flow: bright red is not nml, lochia (shedding of decidual layers) seen, red (lochia rubra) in first few days, pink/yellow <2wks (lochia serosa), then white >2wks (lochia alba
🗑
|
||||
| tx perineal or episotomy pain | ice packs, after 24hr that use heap lamp or sitz baths
🗑
|
||||
| define hypotonic bladder after delivery, tx | postvoid residual vol (>250ml) from hypotonic bladder (might need a cholinergic agent, ie bethanechol
🗑
|
||||
| if mom was not rubella immune, what do after birth | give live attenuated vaccine; breastfeeding is ok but prevent preg for 1mo
🗑
|
||||
| how long BF provide contraception | 3mo
🗑
|
||||
| when refit vaginal diaphragm? IUD | after 6wks
🗑
|
||||
| when use progestin only v combo OCPs, when start | Progestin-only: USE IN LACTATING (milk yield is not affected); combo: don’t use if lactating. For nonlactating wait 3wks until not hypercoagable
🗑
|
||||
| definition PPH | 500ml vagina, 1000ml c/s <24hr
🗑
|
||||
| MC cause PPH, risks for that | uterine atony (50%), at risk rapid or protracted labor (MC), chorio, b adrenergic, halothane, Mg, overdistension
🗑
|
||||
| tx uterine atony and contraindications | uterine massage, oxytocin, methylergonovine, PGF2/Hemabate/carboprost; **can’t use methergine in HTN or PreE (vasoconstrictor) and *can’t use PGF2 (hemabate/carboprost) in asthmatics (broncho-constrict)
🗑
|
||||
| MC cause retained placenta, look for | accessory lobe, missing placental cotyledons in the presence of contracted uterus
🗑
|
||||
| MC cause genital lacs | uncontrolled vaginal delivery, also macrosomia, forceps, vacuum
🗑
|
||||
| MC causes of postpartum F | MC endometritis, then UTI
🗑
|
||||
| etiology of fever after c/s depending on POD | POD 0=wind (atelectasis), 1-2=water UTI, 2-3=womb endometriosis, 4-5=wound, 5-6 walk incl septic pelvic thrombophlebitis
🗑
|
||||
| MC time for mastitis and how treat | 7-21d PP, tx w dicloxacillin
🗑
|
||||
| tx endometritis | gent and clinda [I've also seen amp and gent listed]
🗑
|
||||
| how difft HELLP and acute fatty liver of preg | if have renal damage w elevated Cr and coag then its acute fatty liver of preg
🗑
|
||||
| s/s septic pelvic thrmobophlebitis, what day occurs, tx | POD 5-6; persistent wide F swings despite Abx “picket fence F”, normal pelvic and physical exam. Feels fine; tx IV hep 7-10d
🗑
|
||||
| risks endometritis, phys exam | emergency c-section, PROM, prolonged labor, mltpl vaginal exam. See moderate F w uterine tenderness
🗑
|
||||
| when does portpartum blues occur, how freq, sympt, tx | 20%; <2wks; tearfulness, mood swings, feeling of inadequacy in caring for self and infant. But pt is still taking care of self and infant. No tx
🗑
|
||||
| when does portpartum depression occur, freq, sympt, tx | 10% <6wks): absence of tearfulness but feelings of despair, hopelessness, anxiety, neglect of child and self. Need psychotherapy and Rx
🗑
|
||||
| when does postpartum psychosis occur, sympt, risks for | first few wks,Loss of reality and hallucinations. Need hospitalization, psych meds and psychotherapy, often h/o mental illnes ie bipolar, recurrence 50-80%
🗑
|
||||
| what are good px factors for gestationl tropho tumor | low bCHG (<40000) and mets to lung or pelvis (not brain or liver), <4mo since preg and wasn't full term preg
🗑
|
||||
| describe hydatiform mole and risk malig | 1) Complete (MC): 2 sperms fertilize an egg w/o a nucleus=46XX all from dad. Grape like vesicles w/o a fetus. 20% progress to malignancy; 2) Incomplete mole: 2 sperms fertilize nml egg->69XXY. No vesicles, fetus present, only 5% progress to malignancy
🗑
|
||||
| which hydatiform mole is more concerning for cancer | complete (46XX all from dad)
🗑
|
||||
| clinical findings suggestive of hydatiform mole | bleeding <16wks (MC), pre eclampsia <20wks, severe hyperemesis, new onset hyperthyroid, very high bHCG, fundus larger than dates, bilateral theca lutein cysts
🗑
|
||||
| if uterus larger than dates and bHCG very high, think… | hydatiform mole
🗑
|
||||
| US showing snowstorm pattern, unrecognizable detail of gestational sac…think | hydatiform mole
🗑
|
||||
| what w/u and tx (exc chemo details) needed for hydatiform mole/gestational tropho dz | bHCG for f/u, CXR to check for mets, D&C, need to make sure on contraception and chemo
🗑
|
||||
| f/u benign hydatiform mole | follow bHCG q1wk until negx3wk, then f/u q1mo for 1yr. If bHCG plateaus/persists need do CT and w/u for met
🗑
|
||||
| chemo tx in gestational tropho dz? | nonmet or good px: MTX or actinomycin D until bHCG negativex3wks, then follow qmo for 1 yr; poor px: mltpl agents (MTX, actinomycin D, cytoxan) until bHCG negativex3wks, then follow qmo for 2 yr and q3mo for another 3yrs
🗑
|
||||
| sites of ectopic preg | MC is oviduct (95%, MC distal ampulla), then uterine cornu, then abd
🗑
|
||||
| risk factors for ectopic preg | salpingitis (MC), previous ectopic preg, tubal ligation/sx, IUD, DES (pretty much any reason for abd scarring)
🗑
|
||||
| clinical findings suggestive of ectopic preg | amenorrhea, vaginal bleeding, abd pain incl cervical motion tenderness or adnexal tenderness
🗑
|
||||
| cut offs for bHCG and US=ectopic preg | if bHCG>1500 and no gestational sac visualized
🗑
|
||||
| tx for ectopic preg | if unruptured and bHCG<6000, no fetal heart motion, <3.5cm, no h/o folate suppl give IM MTX, otherwise need surgical
🗑
|
||||
| lab test/value most predictive of chorioamniotis | IL6
🗑
|
||||
| components of bishops score | dilation, effacement, station, cervical consistency, position of the cervix (ie anterior higher than posterior)
🗑
|
||||
| high Bishops score | >5-8 (varies)
🗑
|
||||
| components favorabl cervix | dilated, effaced, soft, anterior to mid
🗑
|
||||
| what do if bHCG isn't rising properly | do a D&C, if see chorionic villi then it was a miscarriage, if don't see chorionic villi then likely ectopic and consider MTX
🗑
|
||||
| describe early onset GBS, late. Mortality? | Early onset-(MC) few hrs-days: fulminant PNA and sepsis. 50% mortality; Late onset- <1wk. meningitis, usu hospital acquired, 25% mortality
🗑
|
||||
| when give intrapartum GBS prophyl? Which Rx? | if + GBS urine or prev baby w GBS sepsis, if 28wk vag GBS cx +, if no 28wk test give if preterm, ROM>18h, maternal F; IV PCN (erythro if allergy)
🗑
|
||||
| how toxo acquired, likelihood transmitting to baby | cat feces, raw goat milk, uncooked meat; only acquired if 1ry infxn (lifelong immunity), 1st tri low risk transmission but bad dz; 2nd tri high risk but mild dz
🗑
|
||||
| key features toxo baby | symm IUGR, microcephaly, scattered intracranial Ca++, chorio, sz, HSP, thrombocytopenia
🗑
|
||||
| which TORCHes can cause chorioretinitis? Cataracts? | chorio=toxo, varicella, CMV; cataracts=varicella, rubella
🗑
|
||||
| tx of toxo in preg | pyrimethamine and sulfadiazine
🗑
|
||||
| risk of transplacental transmission varicells, highest risk when | 25-40%, greatest if rash 5d before partum to 2 d post partum
🗑
|
||||
| key features congenital varicella | zigzag scarring skin, hypoplasia limbs, chorioretinitis or cataracts
🗑
|
||||
| risk of transmission rubella | >90% in 1st Tri, only 5% 3rd tri (opposite of Toxo)
🗑
|
||||
| key features of congenital rubella, MC feature | congenital deaf (MC), CHD (VSD), cataracts, MR, HSP, thrombocytopenia, blueberry muffin rash
🗑
|
||||
| risk of transmission CMV | 50% in 1ry regardless of tri, <1% w reactivation
🗑
|
||||
| congenital CMV causes, of babies + what % show dz | 10% show dz: petechial rash, periventricular Ca++, meningoencephalitis, HSP, thrombocytopenia, jaundice(MC congenital infxn)
🗑
|
||||
| newborn w hearing loss and jaundice--TORCH? | CMV (intracranial Ca++ periventricular), rubella (hepatomegaly, cataracts) [[syph also has hearing loss]]
🗑
|
||||
| newborn w purpural type rash | CMV and rubella
🗑
|
||||
| which congenital TORCH can cause non immune hydrops | CMV, toxo, syph
🗑
|
||||
| which TORCHEs have low plts and HSP | CMV, toxo, rubella, syph
🗑
|
||||
| which TORCHes assoc w jaundice | rubella, CMV, Syph
🗑
|
||||
| risk of infxn HSV | 50% w 1ry infxn, <5% reactivation; mortality 50%
🗑
|
||||
| risk transmission HIV, greatest help c/s | 30% w/o AZT, 10% wAZT, <5% if c/s. C/s most helps those w low CD4 and high viral load.
🗑
|
||||
| when start mom on AZT | 14wks, continue through delivery
🗑
|
||||
| describe early congenital syph, late | **watch for large edematous placenta; early=skin, anemia, thrombocytopenia, HSP. Later: Hutchinson teeth, mulberry molars, saber shins, saddle nose, 8th n deafness
🗑
|
||||
| risk of HepB transmission. Risk infected child will get chronic. % Chronic HepB from vertical transmission | 10% if HepBsAg, 80% if also HepBeAg…once infected 80% wil get chronic. Overall 40% chronic HepB is vertical transmission
🗑
|
||||
| neonate of HepB mom gets what. Susceptible mom's should get what | HepB Ig and HepB vaccine. Preg mom's at risk should get HepBIg, active immuniz safe bc it's a killed virus
🗑
|
||||
| types of abnml placenta attachment | previa=att is near or covering os, accreta=attach to myometrium, increta=goes through myometrium, percreta=to uterine serosa
🗑
|
||||
| tx for stress incontinence | kegel exercises, estrogen in post menopause, urethroplexy (move urethra up back into pelvic cavity)
🗑
|
||||
| tx for urge incontinence | antichol (oxybutinin, propantheline), B adrenergic (flavoxate), NSAIDs (also TCA antichol and CCB)
🗑
|
||||
| contrast sympt for difft types of incontinence | stress: small amts urine lost w cough or sneeze, not at night, cystometry is nml; urge: detrusor ctx invol larger amts of urine, incl at night, cystometry hypertonic bladder; hypotonic: constantly lose small amts of urine day and night
🗑
|
||||
| tx of hypotonic | cholinergic (bethanecol), a adrenergic blocker (phenoxybenzamine)
🗑
|
||||
| name degrees of uterine prolapse | 1st degree if in vagina, 2nd degree if at introitus, 3rd degree if both vagina and cervix out of introitus, 4th if whole uterus is out
🗑
|
||||
| name types of vaginal prolapse | cystocele (bladder, so anterior), rectocele (rectum, posterior), enterocele (small bowel upper posterior)
🗑
|
||||
| tx trichomonas vaginitis, if preg | metronidazole (same as bac vaginosis but need to treat sex partner), if 3rd tri need vaginal betadine
🗑
|
||||
| 3 common sympt of endometriosis | dysmenorrhea, dyspareunia, constipation
🗑
|
||||
| 4 tx of endometriosis | progestin, OCPs, danazol, GnRH (for short time) (also surgery)
🗑
|
||||
| describe adenomyosis, sympt, treatment | endometrial glands and stroma in myometrial wall (ie type of endometriosis) w cyclic bleeding (dysmenorrhea or menorrhagia), tx=hysterectomy
🗑
|
||||
| physical exam for fibromas v adenomyosis | fibromas=enlarged, firm, nontender and asymmet uterus; adenomyosis=tender, symmetric enlarged uterus
🗑
|
||||
| risks for endometrial hyperplasia and cancer | unopposed estrogen (nulliparity, late menopause, chronic anovulation, PCOS), DM, HTN, obesity
🗑
|
||||
| types of endometrial hyperplasia | simple, cystic & complex w/o atypia rarely progress to cancer; complex w atypia 1/3 progress to cancer
🗑
|
||||
| tx endometrial hyperplasia | if w/o atypia cyclic progestins may reverse it, would need f/u bx 3-6mos; if done w childbearing do hysterectomy
🗑
|
||||
| 2 key abnml bleeding | endometriosis the bleeding isn't bw cycles, just dysmenorrhea (MC location ovaries); if bleeding bw cycles its anovulatory or endometrial hyperplasia/cancer
🗑
|
||||
| how dx anovulatory bleeding | if don't have reg cycles then give progestin and see if wdrawal bleeding…if get wdrawal bleeding its anovulatory and tx w cyclic progestin
🗑
|
||||
| if ovulatory and still bleeding bw cycles | usu structural ie polyps
🗑
|
||||
| MC causes of dysmenorrhea | endometriosis (incl adenomyosis), fibroids
🗑
|
||||
| menorrhagia in ovulatory usu due to | fibroids
🗑
|
||||
| staging for endometrial cancer | I limited to uterus (a if <1/2, b if >1/2 myometrium), II cervix, III a=ovary or tube, vagina, pelvic nodes, cytology +; IV=bladder, bowel, distant (MC lungs)
🗑
|
||||
| tx for difft stages of endometrial cancer (after know surgical staging) | Radiation need post-op (they already got TAH-BSO) if poor px: met to LN, >50% into myometrium, + surgical margins, poorly difftd; chemo is for metastatic dz
🗑
|
||||
| describe surgical staging treatment for encomet cancer | TAH-BSO, pelvic and para-aortic LN, peritoneal washings
🗑
|
||||
| MC uterine tumor | fibroid (leiomyomas)
🗑
|
||||
| fibroids more common in | AA, usu in 40s
🗑
|
||||
| types fibroids, MC | intramural (MC), subserous, submucosa
🗑
|
||||
| tx fibroids | GnRH (used preop bc rapidly grow back), myomectomy, embolization, hysterectomy
🗑
|
||||
| name 2 main types of fxnl benign ovarian masses | follicular/corpus luteum cysts; theca lutein cysts
🗑
|
||||
| compare follicular/corpus luteum cyst and theca lutein cyst | follicular/corpus lutein cysts=unilateral and resolve ~2cycles, theca lutein cyst=bilateral due to high bHCG or overstimulation, ie see in preg [note an early IUP will always present w corpus luteum cyst]
🗑
|
||||
| what's a choc ovarian cyst | endometrioma (non fxnl ovarian cyst)
🗑
|
||||
| types of nonfxnl ovarian masses | endometriomas and PCOS
🗑
|
||||
| benign ovarian neoplasms | serous and mucinous cystadenomas, cystic teratoma
🗑
|
||||
| how differentiate serous and mucinous ovarian cystadenomas | serous=unilocular, mucinous=multilocular, if rupture can lead to pseudomyxoma peritonei
🗑
|
||||
| MC benign ovarian neoplasm <30yo | cystic teratoma, any combo of germ layers, often on long pedicle
🗑
|
||||
| risks for ovarian cancer | BRCA gene, fam hx, grtr
🗑
|
||||
| staging ovarian cancer | I=ovaries; II tubes/uterus, + cytology; III=beyond pelvis w peritoneal implants; IV=distant mets, bladder, rectum
🗑
|
||||
| surgical staging tx for malignant ovarian cancer | cytoreductive debulking surgery: TAH-BSO, omentectomy, bowel resxn as nec
🗑
|
||||
| after surgical stagin/cytoreduction what else do ovarian cancer get? f/u? | post op chemo (carboplatin&Taxol). F/u q3mo for 2 yrs, then q6mo for 2 yrs and follow CA1
🗑
|
||||
| management of simple cystic ovarian mass | likely fxnl. f/u 6-8 wks, should have resolved. Be aware of torsion. OCP can help prevent further fxnl cysts from forming; laparoscopy if: >7cm or if had been on OCP for at least 2mos
🗑
|
||||
| management of complex ovarian mass | needs surgery (laparoscopy or laparotomy), try to preserve ovary (ovarial cystectomy) ** but be careful 10-15% dermoid cysts are bilateral
🗑
|
||||
| prepubertal adnexal mass is likely, features/markers? | germ cell tumor, LDH=dysgerminoma, bHCG=chorio, AFP=endodermal sinus
🗑
|
||||
| management adnexal mass perpuberty | simple mass=laparoscopy, complex needs laparotomy; if germ cell need unilateral salpingo-oophorectomy and surgical staging (peritoneal and diaphragmatic dx, peritoneal cytology, pelvic and para-aortic LN, omentectomy
🗑
|
||||
| tx germ cell cancer, f/u, px | salpingo oopherectomy, post op chemo (vinblastin, bleomycin, cisplatin), f/u q3mo w marker measurements and pelvic exam, px 95%
🗑
|
||||
| dx of PID | clinical, needs following: mucopurulent cervical discharge, cervical motion tenderness, bilateral adnexal tenderness, WBC and ESR incrsd
🗑
|
||||
| when tx PID in patient | T>39C, nulligravida, adolescent, IUD, pelvic abscess, preg, outpt tx failure
🗑
|
||||
| tx PID | in patient: IV cefox or ceftriax + doxy or amp + gent; outpt: cephalo and doxy
🗑
|
||||
| tx tubulovarian abscess | in pt clinda and gent, if F doesn't resolve 72hrs may need explor lap or drainage
🗑
|
||||
| how dx chronic PID | by lap showing adhesions
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
ehstephns
Popular Midwifery sets