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gynecology notes... - USMLE Forum

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* gynecology notes...
e lbam aritza - 11/03/08 16:26

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GYNEC OLOGY 1. Turner: ovarian failure with FSH higher than LH 2. C hancroid...painful ulcer. Gram positive rods 3. Granuloma inguinalypainless. Start as papuleulcerirregular bordersbeefygranular base 4. Lymphogranulama.painless..shallownon specific symptoms.after a month buboes appear .elephantiasis 5. Siphilis.painless.pouched out ulcer with rolled edges and painless adenopaty 6. Infertility testing; first basal temperature and mid luteal level of progesterone 7. First step in dg of RC IU..measure by abdominal circumference 8. Diabetes screen in pregnant more than 24 weeks.1h /50 g glucose tolerance test. In 1h glucose should be less than 140. If more than 140 do 3h GT oral. 9. Mild dysplasia in Pap.follow with colposcopy 10. Mild granulocytosis is Ok after immediate postpartum 11. Raloxifen in Rx of osteoporosis increase the risk of trombo-embolism 12. Fetal death as a clinic diagnosis has to be followed with ultrasonogram in real time 13. Diabetes in less than 24 weeks..check fasting urine sample 14. Hypertensive lady that get pregnantstop AC E and start labetalol 15. Olygohydramnios presentcheck if delivery is possible 16. Oxytocine can causewater retention, hyponatremia and seizures. Pt with seizures in postpartumcheck TA or think in hyponatremia due to oxytocine. The risk is more severe if pt has diabetes or had receive insulin 17. C lomipheno..anti-estrogenic in Rx of infertility when cause is increase estrogens 18. C lomipheno can give intermenstrual bleeding, breast discomfort and hot flashes 19. Kallman..hypogonadism hypogonadotrophic. 46XX with absence of secondary sexual characters and decrease of FSH and GnRh 20. Al l oral antidiabetics are teratogenic.change to insulin 21. Pregnant with HTA use hydralazine, metildopa and labetalol 22. Arrest in the active phase of labor..c section 23. C hemotherapy induce premature menopause. FSH highmore than the LH showing ovarian failure 24. Estrogen therapyincrease requirements of tyroid hormones 25. Bacterian vaginits.20% of cellsclue cells and ph more than 4.5 26. Testicular feminization is the same as androgen insensitivity syndrome 27. Due date.LMP less than 3 months plus seven days. If cycles are of 21 days instead to add 7 days, subtract seven days. And if periods are more than 35 days, add 7 days more (14 ) 28. SLEabortion due to anti-phospholipids antibodies cause placental infraction with decrease fetal growth . (placental thrombolytic disease) 29. If mom does not feel the baby.check heart with Doppler..nextreal time ultrasonography.if death is confirmeddo coagulation profile 30. Avoid tiazides in pregnant to avoid volume depletion 31. Endometriosis. First Rx. OC P if woman want to have family in the future. Second: Danazol if cannot tolerate OC P or if OC P fail. Danazol does a pseudo menopause state and can cause hirsutism, acne, deep voice. Instead of Danazol GNRh agonist can be usedinhibit secretion of FSH/LHtemporary castration. If woman wants to conceive soon go for laser. If more than 40 and does not want family go for hysterectomy or salpingectomy/ooforectomy. If younger ablation of endometrial spots can be done. 32. Pregnant women with HTA can be preeclampsia but if has a massive proteinuria or malar rash or high ANA think in glomerulonephritis chronic OF sLE 33. Manage of Bleeding: If heavy bleeding: take conjugated estrogens for 25 days. If teenager: add 10 mg of progesterone during last 10-15 days to simulate normal cycle and allow 5 to 7 days for withdrawal 34. If heavy bleeding more than 36 y/odo endometrial biopsy. Then cyclic progestin then endometrial ablation if fails. Obese more than 35 yo and diabetics or hypertensive woman are a high risk. 35. Postpartum fever: think first in endometritis ( manipulation, prolonged labor, rupture of membranes)..prescribe clinda and aminoglucosidesif fever keep going up and upthink in pelvic tromboflebitis and prescribe heparin. 36. OC P: the cycles or hypo or anovulatoriosincrease of androgens that become estrogensgenerate endometrial hyperplasia. Rx. With OC P or cyclic progestin. 37. Superficial tromboflebitis if it is away of junction with femoral treat with Nsaids, bed rest. Anticoagulation is not used for superficial thrombosis. 38. Streptococcus b or agalactie is normal flora that can cause meningitis. Should be screened at 36-37 week with culture. If positive use Peniciline G during labor. 39. Urgent contraception pill.up to 72 hours ( etinil estradiol and levonorgestrol) 40. Daughters of women that took DEB are at increase risk of adenocarcinoma of vagina and cervix or malformation if boys like adenocarcinoma of testicles and infertility. 41. Preeclampsia criteria. If mild: HTA between 140/90 to 160/110. Proteinuria more than 300 and less than 5mg. If severe HTA more than 160/110. Oliguria, alter conscious, pulmonary edema, cyanosis, alt. liver function test, increase creatinine and RC IU 42. Scarred and fenestrated vulva and oral lesions and uveitis think in Bechet disease.can have also joint problems and burning sensation. Differentials: It s not syphilis ( has painless chancre), is not herpes ( not uveitis), it is not chron ( more GI symptoms) 43. Donovan bodies in Giemsa or Wright: reddish encapsulated intracellular with bipolar staining bacteria. Treat with tetracycline 10-21 days. The ulcer start as pustule.beefy granular with irregular borders. 44. Syphilis ulcer: painlessrolled edges and punched out base 45. C hancroidvery painfulgray base and foul smelling..painful inguinal nodes and buboes 46. Herpespainful vesicles.burning.itching 47. LGV.painless.shallowpay attentionthis one has systemic symptoms 48. Management of pre-eclampsia: Mild preeclampsia: 1. If pregnancy at term or lung Ok proceed with delivery. 2. If pregnancy early and lung not Ok.bed rest, low salt, close observation, dexametasone (24-34) then delivery. Severe preeclampsia: bed rest, decrease salt and add hypo tensors. 1. If patient go right and fetus maturation is ok .delivery . 2. If pt go right and fetus immature..wait until mature plus dexametasone. 3. If patient go wrong: delivery 49. Maternal or fetal deteriorationdelivery regardless of gestational age 50. All the time prefer vaginaljust do C section if vaginal is contraindicated 51. In Hypertension use drugs if . 1. TA more than 160/110 or C NS start getting altered regardless level or PA 52. Hypertension near term or in labor: hydralazine or labetalol. 53. Hypertension away from term: metyldopa. Second line are b blockers like atenolol or metoprolol. 54. Beta blockers in fetus can cause bradicardia and hypoglycemia 55. Gonorrhea if nullipare: admit plus cefotetan or cefotaxim plus doxicilin 56. Mass in ovaries.precous puberty.cell granulose ( increase estrogen) I appear in post menopause can show as bleeding 57. Disgerminomas tend to strangulate and do not produce hormones

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57. Disgerminomas tend to strangulate and do not produce hormones 58. Sertoli Leydig..produce androgens, cause virilization and amenorrhea 59. Teratomasare benign and do not produce hormones 60. PID: Hospitalization requirement: More than 39 fever if nullipari, adolescent if previous treatment fall, low socio economic status 61. pID: drugs cefoxetin/doxi ..cefotetan/doxiclinda/genta 62. Overflow incontinence has residual volume.Due to detrusor hypotonic or acontractility like in diabetes, MS, spinal cord injury. 63. Pt taking NSAID make worse the incontinence. Treat with bethanecol and intermittent catheterization 64. Glucosa in pregnangt: first urine dipstick.if positivedo fasting urine sampleif positive 1h glucose if positive do 3 h glucose 65. PC OD: LH/FSH ratio more than 2/1.Has increase of DHEA and AC TH normal. If give AC TH to these pt can have an exaggerated 66. Abruptio: If its mild and stable and fetus pretermino.tocolitics and fetal maduration 67. Abruptio: if progress and augement labor.do fast vaginal delivery if possible 68. Abruptio..if labor is an early stage and mom or fetus are unstablec section 69. Tricomoniasis: metronidazol .. oral. 2 gr or 250 three times a day for 7 days. If pregnant do clotrimazol 100 mg. 70. Bacteriuria asymptomatica in pregnant with more than 100 000 colonies give nitrofurantoin 7 to 10 days. 71. AFP increased: real causes: neural tube, gastroschisis, omphalocele. False causes: multiple pregnancy, fetal dismise, wrong gestational age. 72. AFP increased: do ultrasoundrule out false positive..then amniocentesis and measure AFP in amniotic fluid and AchE that increase in neural tube defect. 73. AFP decreased, bhC G increase and UE3 drecreaseDown 74. AFP decreased, bhC G decrease and UE3 decrease..Trysomy 18 75. AFP, bhC G and UE3 are called triple test ( 16-18 weeks) 76. Amnioscentesis 16-20 week 77. C VS 10 -12 week. 78. C lomipheno block the estrogen receptors in hypotalmo. Produce more FSH and LH.ovulation 79. Danazolproduce hot flashes, brest enlargement, bloating, uterine bleeding. Has inhibitory effect on gonadotrophins good to treat endometriosis, fibroids, fibroystic breast disease. 80. Magnesium sulfate: if intoxication treat with calcium gluconate 81. Status epileptic in pregnant treat with diazepam 82. AFI: less than 5means oligohydrmnios. Delivery 83. Pr. Pubertydo test of GnRh stimulation with 100 mg of GnRhthat has to increase LH, if does is a true isosexual, that means the puberty is due to activation of pituitary- hypophisis and ovary axis. 84. Infertility: most common cause in women is peritoneal factor like endometriosis, adherences, laparoscopy has to be done and treat with danazol or medroxiprogesterone. 85. Infertility: ovulatory factor: defect in axis, diagnose with basal temperature and progesterone in mid lutheal phase. 86. Infertility: Tubouterine factor: diagnose with histerosalpingograhy and laparoscopy 87. Infertility: cervical factor, diagnose with mucus examination and postcoital test 88. Amenorrhea: Meyer Rokitansky: Mullerian agenesia: vaginal pouch, no uterus. Pt looks with normal Tanner with no menstruation and is 46 xx. 89. Amenorrhea: Testicular feminization: or androgen resistance syndrome. Is a 46 xy with a feminine phenotype. Due to the presence of peripheral estrogen pt has breast but lack of axilary and pubic hair. Intraabdominal testicles can be confused with ovaries 90. Amenorrhea: Savage Sd. Or ovary resistance to FSH/LH. There is amenorrhea and lack of sexual characters 91. Abortion: Missed abortion: do dilation and curettage. If more than 16 weeks proceed to labor with oxitocine 92. Abortion: Inevitable or incompletedo suction curettage because the oc is open 93. Abortion: C omplete require follow with bhC G for risk of choriocarcinoma 94. All Rh negative woman should habe anti D and globuline 95. Syphilis: if pregnant is allergic do desensitization 96. Mc. C une Albright..cafe au lait spotspolyostosis fibrous displacia and pr. Puberty independent of level of gonadotropic hormones 97. Pt comes to office with delay on pubertythink about Kallman ( hypogonadism hypogonadotrophic and anosmia). C ongenital abscense of GnRh with normal kariotype and eunocoid stature 98. IUGR: plus oligoamnios.think delivery 99. IUGR: if not oligoamnios..do stress test and BPP twice a week 100. IUGR: if lungs are mature.delivery 101. Eclampsia: First cause of death is hemorrhagic stroke 102. Infertility> start to ruling out spermatic causesthen do basal body Temp. or mid luteal progesterone level..( lutheal defect)means low progesterone is produced by corpus lutheum pt can have history of abortion in this case..then do endometrial biopsy.show lag in endometrial maturation of 2 days or more. 103. Liquen : sclerous in vulva treat with high potency corticosteroids..but do always biopsy in old lady with an itchy spot.do not assume that is liquen without doing the biopsy 104. Tocolitis: in diabetes or heart disease not use beta 2. Ritrodina ( b2 agonist) the only tocolitic in preterm. Magnesium sulfato is the drug of choice y tocolysis 105. HypertiroidisM. B blockers can cause placental isquemia dn IUGR. PTU can be use but not metimazol. Durign second trimester surgery can be anoption if medical treatment fail. 106. Amenorrhea. Until when we can wait to start to investigate? until 14 if no sexual characters or until 16 if sexual character. are present. 107. Suspecting Sheehan.ask Gh and prolactine 108. OC P: Protection: ovarian and endometrial cancer, C UB, dysmenorrea, ectopic pregnancy and PID. 109. OC P: can cause: depression, increase wight, increase cholesterol, cholecystitis. 110. Most common cause of non reactive NST: sleepy babyso do vibroacutstic stimulation in low risk pregnancy to reassure, if not reactive do BPP 111. NST is good if in 20 mins reach at least 2 accelerations (more than 15 beats per minute) 112. BPP; measure toe, moves (3 in 10 min), breth (30 in 10 min), AFI ( 5 to 20)normal index is 8 to 10 for BPP 113. C lamidia in pregnantone single dosis of azytromicine 114. Toxoplasma in mom: IgM toxoplasma. Fetal infectiondo cord blood or placentl culture ( IgM), also amniotic fluid culture, serologic, ultrasound. Treat with spiramine if mom decide to keep the baby ( first trimester), not pirimetamine ( contraindicated in first trimester) Durign 3th. Trimester use sulfadiazine and pirimetmine. Sulfadiazine can cause medular toxicity and need supplemental folinic acid. 115. MC C of hypertiroidism in pregnancy is Grave. Mom can present with atrail fibrillation 116. If signs of hypertiroidism in early pregnancy think also in coriocarcinoma because bhC G has the alpha chain similar to TSH, so can stimulate receptors 117. Other cause of atrial fibrillation in women pregnan is mitral stenosis.become evidente with the increase of volume during pregnancy. High frecuency in asian countries. 118. MC C of PID: 1. C lamidia. 2. Gonorrhea. 3. Micoplasm 119. PID: if abscess is present: think in E coli, Bacteroides, and Gardnerella. Treat with cefotetan and doxi l.or clinda and genta..or cefoxitin and doxiif is an outpatient use ceftraxone and doxycilin. 120. Rhogam: less than 1:6 means mom not sensitize.so Rhogam is indicated . At 28 weeks or within 72 hours after any procedure ( delivery/abortion) If antibodies is equal to 1:6 or greater than 1:4..Rhogam is useless. So next pregnancy use amniotic fluid spectrophotometry to check levels of Bb in amniotic fluid. 121. Edwards> low AFP. ;pw UE3, low bhC G 122. Gonorrhea in pregnanttreat the same as in pregnant.ceftriaxone and eritromicine 123. ASC US .means inflammatory when compare with Bethseda classification. 124. PAP is III: go for conization under colposcopy.endocervical curettage and biopsy are equivocal or unsatisfactory. 125. Turner is a menopause before menarche. No estrogen.cause no inhibinso increase FSH and LH. Ovaries have just stroma and not follicles at all. 45 xo. Diagnost is made by kariotyping. Risk of gonadoblastoma. 126. Hypotyroid patient taking HRT. Estrogen replacement require increase dosis of thyroxin, due to increase of crom..p 450 in livear that clear T4. 127. Lithium.Ebstein anomaly 128. PC OS. Inccrease sensitivity of adrenal gland to AC TH. So if give AC TH, increase androgens lik e DHEA..

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128. PC OS. Inccrease sensitivity of adrenal gland to AC TH. So if give AC TH, increase androgens lik e DHEA.. 129. BPP: 6 and no oligohydramnios.do contraction testif bad.deliveryif suspicious repeat next day. 130. BPP: 4 withouth oligohydramnios.if lungs normal.deliveryif lung inmaturesteroid and repeat BPP in 24 hours. 131. BPP: less than 4delivery independently of maturity 132. Magnesium sulfate.no more than 4 to 6 grams.LGV: do serologic test to confirm chlamidia. First is the ulcer and later is the lymph node. Treat with tetraciclin or erytromicin for 3 weeks. Second choice doxicilin and sulfas 133. C ocain abusers mom: fetus with intracranial hemorrhage or newborns with necrotizing enterocolitis. 134. Pt middle age with endometrial hyperplasia without atypia.treat withciclic progestins and biopsy again in 3 -6 months 135. HPV infections. Vulvar papilomatosis: condiloma acuminate. Koilocitos in microscopy. Treat with 25% ac. C loracetic or podofiline. Do not use podofiline in pregnancy. 136. HPV in pregnancy. Use dinitroclorobenzeno and c section.l 137. Hydantoin syndrome: hypoplasia distal phalange. C an develop neuroblastoma.Hirsutism. 138. Vulvar hyperkeratosis. C ause of pruritus . treat with fluorinated corticosteroids ointment. Diferentiate from squamous cell carcinoma, and from lichen 139. Gardnerella in pregnant treat with clindamicina intravaginal cream or metronidazol in cream. If not pregnant metronidazol oral route. 140. GINEC OLOGIC HY FROM VIDEOS 141. C ancer takes from 8 to 10 years to develop from precancer 142. MC gynecologic cancer is endometrial carcinoma 143. MC cancer in woman is breast cancer 144. The highest mortality for gynecological cancer in woman is ovarian cancer. 145. Highest mortality in woman (all groups) is lung cancer 146. Incidence of cancer in women overall is breast, lung and colon 147. Mortality overall is lung, breast and colon 148. Ovarian cancer spread or exfoliate by seeding and gives ascitis and usually is diagnose in stage III 149. All women with ascitis has to have a differential with ovarian cancer 150. Etiology of cancer: 151. C ervical cancer link to HPV. 16. 18. 31. 35. Genital warts. 6 to 11. 152. Endometrial cancer in postmenopause if she is obese and in premenopause who has PC OS. 153. SERM:Selective estrogen modulator like Tamoxifen 154. Raloxifen give benefit of estrogen without the risk of breast cancer. 155. SERM does not decreases the hot flashes and can increase DVT and PE 156. HRT use less estrogen than OC P. OC P has 10 times estrogen than HRT 157. OC P: two conditions increase the risk for TEP. More than 35 years old and smoker 158. OC P: The dominant hormone in birth control pill is progesterone. The advantage is contraception effectiveness and regulation of menses. 159. Ovarian C ancaer is linked to ovalution. The most common cancer from ovary is epithelial because of the trauma of ovulation. That is why pregnancy and OC P are a protection facts. 160. DUB: 10-15% of DUB in postmenopausal are due to endometrial cancer, so always , always do endometrial sampling. 161. MC C of genital bleeding in postmenopausal is vaginal atrophy 162. Vaginal C ancer: Associated with prurite, mucoid discharge with blood. 163. Postemnopausal woman with clear discharge think in Falopian C ancer. 164. Ovarian cancer: masculinizing. Sertoli-Leydig. Hormone producing. Estroma cell 165. Ovarian C ancer: early feminization: Teca. Is a estroma cell cancer. 166. Ovarian tumors: cistadenoma can be: mucinous, serous, and endometroid. 167. MC cistadenoma is serous. 168. C A 125 is a marker for epithelial cancer in postmenopausal 169. Epitelial cancer present at stage III require debunking surgery plus platinum derivatives 170. Ovarian cancer: Germ cell cancers: 1. Dysgerminoma.2. Teratoma 3. C horiocarcinoma 4. Endodermal sinus tumor 171. Dysgerminoma: LDH. Is the most common. 172. C oriocarcinoma: HC G 173. Endodermal sinus: AFP 174. Dysgerminoma is the equivalent to seminoma in male and respond to radiation. Is the most common of ger cell. Usually present at stage I because they grow fast. Treat: keep uterus, ovaries out and gave chemotherapy 175. Vulvar cancer: first is squamous second is melanoma (more than 0.76 able to metastazise) 176. Vulvar melanoma is a black lesion, depth of invasion is most important prognostic factor. 177. C larke classification is base on histology appearance. 178. Brestlow invasion is base on mm of invasion 179. Vulvar lesion: If red can be Paget. Lesion is red with icing ,most of the time is just intraepithelial different than the pagest of the breast that is invasive 180. Paget treatment; wide excision only if it is invasive vulvectomy ( less than 20%) 181. Paget in vulva is associated with carcinoma in breas, Gi or Gu carcinomas. 182. Paget in vulva confirmed then do GI series and mammography 183. Mortality: Pt with cervical cancer in advance state die from renal failure, and patients with ovarian cancer die from bowel obstruction 184. Screening; the only screen test for genital cancer is the pap test for cervical cancer. 185. Screening: women have 3 types of screening: PAP, mammogram and colon cancer . The detection of this cancer allows treatment and decrease incidence. 186. C ancer: C olon cancer screening in woman: 50 years old do annual guaiac test. 3 5 years a colonoscopy. 187. MC type of cancer in cervis: squamous 188. MC type of cancer in vulva: squamous 189. MC type of cancer in vagina: squamous. All related with HPV. 190. MC type of cancer in ovary: epithelial 191. MC type of cancer in endometrium: adenocarcinoma 192. Displasia can be mild, Moderate or severe. 193. Mild dysplasia affect the upper layers of epithelium, moderate dsplasia can affect the middle third of epithelium, severe dysplasia is when also the lower third of epitleium is affected. When this happen is call carcinoma in situ. 194. C ervical intraepithelial neoplasia (C IN) is called I when is mild, is called II when is moderate and is calle III when severe. 195. Always next step after abnormal PAP test is colposcopy, use acidic acid to see cervix better. 196. C olposcopy with acid: if u see tiles..mosaicism ( pre cancer), If you see dots.called punctuation is precancer too, if you see white patches.white epithelium is precancer too. 197. Pre cancer can appear as: mosaicismpunctuacion or white epithelium 198. In USA crio excision is the preferred method to destroy dysplastic epithelium. Other methods are hot, cold, laser or wide surgical excision. 199. After treat a dysplasic epithelium do PAP every 3 moths for the next 3 years. If it come back again : threat the same way again. 200. C one biopsy indications: 1. When the endocervical curettage is positive for dysplastic cells. 2. When insatisfactory or inadecuade colposcopy that do not let see the entire lesion. 3. With discrepancy between the cytology and histology results. 4. When diagnosis of micro-invasive cervical cancer was made in the past. 201. PAP showing severe dysplasia in a 16 week pregnant. What to do next? C olposcopy. In pregnant do not do endocervical curetaje. If the ectocervical biopsy come back severe dysplasia the treatment Is nothing and treat after the baby born with laser or crio. However during pregnancy has to be followed every 3 months during pregnancy. 202. If invasive cancer is find in ultrasound in early pregnancyfinish the pregnancy and hysterectomy, if advance pregnancy wait until baby is born. In this case baby has to born by c section. 203. ASC USatypical squmos of undetermined significancedoes not have koilocitosis present. Next step repeat pap in 3 to 6 months. 204. If PAP come back saying ASC US or HPVdo HPV typing to see HPV 6 or 11. If come back HPV 6 or 11, see the patient in 1 year. If come 16, 18, 31,32, colposcopy or biopsy. 205. In a pap report is worse to see HPV positive than see ASC US . 206. If an endometrial sampling of a woman comes cystic think in adenomatosis if it is atypical then is

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206. If an endometrial sampling of a woman comes cystic think in adenomatosis if it is atypical then is adenocarcinoma. 207. Mole. 1/12000. Snow storm. Treat with suction and curettage, then see once a week HC G 208. Moleafter evacuation bhC G takes 10-12 weeks to goes down in 80% cases. If keep going up do chemotherapy. Pt with mole pregnancy has to go to strict contraception for 1 year. (oral) 209. If bhC G keeps going high next step is doing ct scan of brain, thorax, abdomen and pelvis. 210. C horiocarcinoma has a bad prognosis if it is in liver or brain, if hC G is more than 40 000 after curettage or more than 4 months with hcG increase after a normal baby. 211. C horiocarcinoma is 50% after mola, 25% after ectopic pregnancy or miscarriage, 25% after normal baby. 212. Mole..treatment: if not metastatic, metrotrexate or actinomicin. If multiple metastasis or poor prognosis use a multiple agent like MTx plus actinomicin D and citosin ( MAC ) 213. Postcoital bleeding..colposcopy and punch biopsy. If mass is present do metastatic work upif result invasive.do chemotherapy plus cistoscopy, sigmoidoscopy and iv pielogram, cx chest and pelvic examination 214. Gynecological cancers are surgical stageall need pathology just the cervix cancer can be clinically staged. 215. Emergency contraception, within 72 hours and 12 hours later 216. DES. To threatened abortion, In 1971 know is theratogenic. Daughter of those woman has vaginal adenosis ( the most common result ) where the vaginal columnar epithelium behave like cervix epithelium. Also can have clear cell vaginal adenocarcinoma. Dg. Around 19 yo. With better prognosis than squamous cell. Other severe malformations were reported. 217. Endometrial cancer risk factor: obese, nullipare, late menopause, HTA, diabetes, breast C ancer, colon cancer, ovarian cancer, increase estrogen levels, tamoxifen. 218. Squamous cell: main risk fact is HPV 219. Precocious puberty can be 1. Ture isosexual and 2. Pseudoisosexual. 220. Precocious puberty true isosexual when exis hiphotalamic, hypphofisis and ovary is working in high levels. 221. Precocious puberty pseudoisosexual due to malfunction of ovary, adrenal, exogen estrogen, hypothyroidism, mc. C une Albright. 222. Dg. Df. Between isosexual and pseudoisosexual is GnRH stimulation test: 100 mc Iv bolus. If LH increase is true isosexual 223. Tocolitic. The only tocolitic drug accepted in USA is Ritodrine ( b2 agonist) however, magnesium sulfate is better and compete with calcium to get into the cell 224. Mastitis in breast feeding. Suspend breast feeding and give doxiciline ( UW..other sources says not suspend). 225. Postpartum contraception: progestin pills 226. Syphilis diagnosis: dark fieldsee the spirochete 227. C ontraceptives predispose to cervical ectopy and facilitate colonization with C hlamydia 228. Precocious puberty and mass in ovary> is granulose cell tumor, with increase estrogens 229. Granulose cell tumor also appears in postmenopausal woman, with bleeding, myohyperplasia and good vaginal lubrication. 230. Next step after fetal dismiss is search for cause: TORC H, anticardiolipinas, chromosome cause, 231. AFP increase need to rule out: fetal dismiss, twins, and wrong last menstrual period date. Next step ultrasound .. AFP is low in Downthen amniocentesis to confirm. 232. Incontinence: real stress: is a real anatomic problem. miss urine during valsalva maneuvers.do surgery 233. Incontinence : urge: Detrusor instability.treat with anticholinergic..oxibutine 234. Incontinence: differentiate between urge and real stress with cytometric studies 235. Incontinence: overflowlike diabetes, m sclerosisbethanecol and alpha blockers also self catheterization 236. C onstant wetness after a surgery pelvic or abdominal surgery.fistula 237. Ultrasound accuracy is +/- 5 days at 12 weeks and +/- 7 days at 12-18 weeks. 238. Ultrasound> Optimal age for detecting fetal anomaly is between 18-10 weeks. C an be so late for measurements taken. 239. Karyotype: C VS 9 12 weeks. 240. Amniocentesis; for kariotyping, alpha fetus protein and biochemical studies need to be done between 15-20 weeks 241. Amniocentesis for Rh immunization do it around week 24 242. Amniocentesis for maturation do around week 34 243. PUBS: require blood from umbilical vein> useful for karyotyping, measure of IgM, blood type. Do after 20 week 244. Fetoscopy. Do around week 18-20. 245. Trysomy: most common at abortion is trysomy 16, most common at birth is 21. 246. Turner can have normal intelligence but urinary malformation and coartaction are some frequent 247. Teratogenic risk: big during week 4 8 248. Teratogenic radiation: 20 rads 249. HC G: appears at day 10. Peak at 9-10 week. Plateau at 20-22 250. Hormones: Estradiol: the most important during reproductive years in non pregnant women. Estriol: the most important in pregnancy. Estrone: come from androstenendione ( fat transformation ) in menopause years 251. Murmurs: A systolic murmur due to increase in C O could be normal, a new diastolic murmur during pregnancy is never normal. 252. Weight: during 1 trimester. 5 to 8 pounds. Up to 13 weeks. 253. Weight: during 2 trimester: ( 13 to 26 week). One pound per wek 254. Weight: during 3 trimester: 1 pound per week 255. HRT: no cv beanefits, Reduce risk of colon cancer, reduce the risk of osteoporosis, increase risk of breast cancer some formulations, increase risk of stroke in long term use. 256. Endometritis: after partum; anaerobes: peptostreptococus, streptococcus, bacterioidis flagilis. Or aerobs like e coli, and enterococus. That is why treatment is started with clinda plus ampi until culture results are coming 257. Endometritis postpartum. 70% are caused by anaerobes, if the is abscess think in E. coli. 258. Stages of partum: First stage from onset of labor to full dilationcan be latent: that is slow dilation until 2 oer 3 cm is dilated and require 20 h in nullipare and less than 14 hours to multipare...can be active: where the dilation is faster like 1 cm per hour 259. Stages of partum: Second stage: expulsion can be from 30 minutes to 3 hours in primipara and 5 to 30 mins in multipara 260. Stages of partum: Third stage: until placental expulsion 261. Stages of partum: Fourth stage: up to 6 hours after placental expulsion: high risk of postpartum bleeding. 262. Latente phase can be prolonged by excess of anesthesia, hiper or hipocontraction ( ineffective) 263. Hypertonic contraction: morphine sulfate 264. Hypotonic contraction: oxitocineif then is too much.therapeutic rest 265. HIV: increase risk of transmission if: recently infected, with advance disease or preterm delivery. 266. HIV risk: decrease from 25 to 8% with ZDV trough pregnancy, labor, delivery and newborn during the first 6 weeks of babys life. 267. Risk for endometrial cancer: diabetes and hypertension 268. Risk for cervical cancer; young age first sexual intercourse, young first baby, several sexual partners, smoke , low economic level. 269. Risk for breast cancer: late births and pauciparity 270. OC P: decrease risk of ovarian and endometrial cancer. 271. MC C of intravascular coagulation in pregnancy is abruption 272. Fetal dismiss; first do dopler.then Eco..then Tp and TTP, fibrin and platelets. During the first weeks there is labor with no induction required, between 13 to 28 weeks require induction. 273. Induction for fetal dismiss: prostaglandin suppositories are 97% effective. After 28 weeks no Pg but oxitocine due to Pg can cause uterine rupture. 274. More than 43 weeks, delivery is mandate. 275. AFI: more than 5 and less than 25 276. Deceleration: variable: not related with contractiondue to cord compretionchange mom position and see 277. Deceleration: early: fetal head compression 278. Deceleration: late: utero placaental insufficiency 279. Extreme fetal tachycardia, associated with infection 280. Solid mass in ovaries during pregnancyluteoma of ovariesvirilization of mom and fetus can occur due to the androgens secreted by stromal cells. Are bilateral, multinodular, solid masses, more in African American and multiparous. 281. Low progesterone in a woman is a defect in lutheal phase, can cause short cycles and abortion.

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281. Low progesterone in a woman is a defect in lutheal phase, can cause short cycles and abortion. 282. C VS is preferred than serum screen in women over 35 years old where fails to detect trisomy or the results are not concluyent. Is the best choice if antecedents of genetic disorders. 283. C uldoscentesis, if suspect of ectopic pregnancy that is bleeding, but always after to measure a HC G and do transvaginal ultrasound. 284. Do not do abdominal ultrasound, because US do not see if HC G is less than 1500 or 2000 285. FSH more than LH is patognomonic of ovarian failure. FSH has to be blocked by inhibin 286. C hemotherapy can cause failure of follicular cells, with decrease of estrogens and inhibin.causing increase of FSH and LJ. 287. Differentials in a women with puerperal fever: pelvic tromboflebitis, pelvic abscess, septic shot, endometritis ( 2 or 3 days post partum) 288. Endometritis is more common after C section or instrumentation 289. DOC in endometritis is clinda and aminoglucoside or ampiciline 290. Fever during the first 24 hours post partum.athelectasias. 291. Type of delivery in vasa previa: c section 292. Pt with history of distention of abdomen and heaviness that suddenly develops peritonitisthink in pseudomyxoma peritonei due to rupture of mucinous cystadenoma. Ovarian neoplasma with slow growing pattern. 293. An ovarian mass that appears during first week of gestation, unilateral and disappear at the second trimester is a classic corpus luteum cyst of pregnancy, that resolved whtn placenta took over function of progesterone production 294. Girl that is showing changes of breast development and vaginal bleeding with an ovarian mass unilateral in sonogramis classical of granulose cell tumor that is causing isosexual precious puberty due to increase of estrogens. 295. Postmenopausal woman with temporal balding clitoromegaly, and facial hair with unilateral pelvic mass: is a Sertoly Leydig cell tumor that is hormonally functional producing androgens. 296. Asymptomatic unilateral mass solid, cystic and calcification components in a young women can be assumed until proven otherwise as benign cystic teratoma. 297. A young infertile nulligravida with history of dysmenorrheal and pain with intercourse and bowel movements, endometriosis. 298. Douching is a risk factor for tubo-ovarian abscess 299. Intrauterine devices are risk factors for PID and tubo-ovarian abscess 300. Gonadoblastoma are tumors that occurs in patient that have intersex disorders. The mc presentation ins amenorrhea following puberty. Pt in risk are male pseudohermaphroditism, mixed gonadal digenesis, and turners.

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* Re:gynecology notes...
posha - 11/03/08 16:36

#1543231

wow! good job. thx

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* Re:gynecology notes...
se m se m 2007 - 11/03/08 16:44

#1543238

thank you so much god bless you

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* Re:gynecology notes...
aajtak - 11/06/08 15:02

#1547657

1) Timeline: prenatal testing @ 6-8wks, Triple Screen @ 15-18, Ultrasound, 18-20wk GBS culture @ 35-37wk RhoGAM @ 28wk (if +, treat at 28 wks and 72 hrs postportum Diabetes checkup @ 26-28wks (high risk pt @ prenatal visit), C horionic Villous Sampling @ 9-12wks 2) What tests makeup a normal prenatal visit? C BC , UA, Rubella, RPR, HBV, Rh typing, sickle cell prep and if pt is a teenager then do gonorrhea and chlamyida 3) What are the weeks of utmost teratogenicity in the fetus? 3-8 weeks 4) Where is progesterone made? 0-6 wks at chorionic villus, 6-9 weeks between chorionic villus and placenta and then >9 weeks placenta alone 5) What do you do NEXT if hC G or AFP levels comes back too high or too low? always recheck the dates with an ultrasound (vaginal is best) 6) What are some causes of HIGH hC G? Low hC G? For high hC G (remember H C G: Hydatidiform mole, C horiocarcinoma and Gestations multiple (twins and stuff), but also due to Downs syndrome and embryonal cancer). Low hC G includes incorrect dates, ectopic and missed abortions) 7) What are some causes of High AFP? Low AFP? High AFP includes gatrocele, omphalocele, NTD, incorrect dates. Low AFP includes Downs synd., Edwards syndrome, incorrect dates. 8) Mom says she doesnt feel the baby move anymore, what is the next step? U/S 9) Ultrasound does not pick up fetal heart tones, what is the next step? Real-time U/S 10) In fetal demise, at what weeks do you do D&C ? 16wks 11) Mom does not feel the baby move and after an ultrasound is done, fetal heart tones are heard, what is the next step? NST 12) NST comes back nonreactive, what is the next step? do FAS, after that repeat NST. If its reactive, thast good (means the baby was sleeping). if its still nonreactive do BPP. 13) BPP comes back 8-10, what is the next step? Repeat in 4 days. What about 4-6? Do stress test. What about 0-2? Emergency delivery

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gynecology notes... - USMLE Forum

Emergency delivery 14) At what amniotic fluid level do you consider oligohydramnios? 15 15) A stress test comes back c late decelerations, what does that mean? uteroplacental insufficiency. What about early decelerations? Head compression. What about variable decelerations? C ord compression 16) A stress test comes back with any type of deceleration, what is the next step in management? 1st D/C oxytocin, 2nd O2 and fluids, 3rd put pt on L lateral decubitus postion, 4th get scalp pH (normal is 7.25-7.4, if pH 500? Only continue AZT throughout 2nd and 3rd TM and 6 weeks postpartum. 26) What is the 1st test you use to diagnose HIV in a child less than 6 weeks old? PC R (not ELISA) 27) What are the 4 major causes of 1st TM bleeding (for USMLE purposes of course)? Mole, Incomplete abortion, Ectopic, Threatened abortion. What about the 4 major causes of 3rd TM bleeding? Placenta previa, vasa previa, abruptio placenta, uterine rupture. 28) A woman comes with vaginal bleeding in the 1st TM, what is the next step in management? Speculum exam 29) If her cervical os is open and she had vaginal bleeding, what is the diagnosis and tx? Incomplete abortion, do D&C 30) If her cervical os is closed and she had vaginal bleeding, what is the next step in management? Vaginal U/S and bhC G levels 31) If her cervical os is closed and you see a snowstorm pattern on u/s, what is your dx and tx? Mole. what if the u/s showed an intrauterine pregnancy? Threatened abortion. What if it showed no intrauterine pregnancy? Ectopic 32) If you narrowed it down to a mole, and you decide to do a D&C , but her hC G levels stay very high (>100,000) and dont fall, what is your diagnosis? C horiocarcinoma. What is your next step in management? Get C T of chest/abdo/pelvis. What is your treatment? If no metastasis to brain/liver, give MTX. If + METS, give radiation and MAC (MTX, adrenomycin, cytotoxin) and then hysterectomy. 33) If you narrowed it down to an ectopic, and the woman is stable and does not want surgery, what is your treatment? MTX. What if she is unstable and does not want surgery? Surgery. What if she is unstable and just wants to be treated, what is the best treatment then?? Surgery 34) A pt comes in with vaginal bleeding in her 3rd TM, what is your next step in management? Ultrasound. What are you trying to rule OUT? Placenta previa. 35) How will a woman with a placenta previa present? painless vaginal bleeding. If it was preterm and it was mild how will you treat? hydration bed rest. if she was preterm and it was serious how will you treat? c/s. What type of delivery are you expected to do? c/s. 36) How will a woman with abruptio placenta present? painful bleeding. Same questions as above? If mild then observe. If mod-severe, then vaginal delivery if possible, otherwise c/s. 37) How will a woman with Vasa previa present? What type of delivery should you do? painless vaginal bleeding, ROM and fetal bradycardia. C /s 38) How will a woman with uterine rupture present? how can you differentiate it from a ruptured placenta? Sudden painful bleeding with abnormal fetal heart rate. Ruptured placenta wont have abnormal fetal heart rate (normal is 110160) 39) If mom already has (+) Rh antibodies because of failed RhoGAM administration in the past and she now presents to you, what will you do? dont give rhogam, just get titers, if >1:8 then get spectrophotometry to assess degree of hemolysis. 40) If mom has PROM, how can you confirm its correct? Fern + Nitrazine +. What is the next step in management? Get cultures and start ampicillin + gentamycin while waiting for results. Do you wait for results to start treatment? No. What do you do if she has an infection? Deliver. What do you do if there is no fever and child is between 24-35 weeks gestational age? prophylactic Abx, steroids, hydration. What about >24wks? outcome is dismal, induce labor. 41) A woman comes in with labor contractions, how will you be certain she is in preterm labor and that the contractions are not Braxton-Hicks? Look for cervical dilitation. What do you do next if you confirm that it is preterm labor? 1st L lateral decubitus postion c O2 and IVF, 2nd start tocolytics. Would you use tocolytics, if so which one? In this instance, B-adrenergic tocolytics are preferred. 42) Give the 4 known tocolytics, and their adverse effect? MgSO4 (causes hypotension, decrease DTRs and even coma), B-adrenergics (not given to DM and C ardiac Disease), C alcium blockers (not given if hypotensive), Prostaglandins (not given 40 weeks in gestation, what is the next step you do? C heck the dates. What do you do if the cervix is favorable? Induce labor unfavorable? Wait until 42 weeks and then induce. 44) How do you know when its chronic HTN from gestational HTN? C hronic HTN is HTN before 20 weeks gestation. what is the best drugs for HTN in pregnancy? Hydralazine, Lobetolol. What is contraindicated? AC EI 45) How do you manage preeclampsia? hydrate and send home. severe preeclampsia? MgSO4 and deliver. eclampsia? MgSO4 and deliver. Do yo do vaginal or C /Sxn? Vaginal unless mom is unstable then C /S. 46) How do you manage prolonged latent phase? bed-rest. prolonged active phase? oxytocin, then C -sxn. prolonged 2nd stage? If head is engaged, do vaccuum. If head is not engaged, do C /S. If prolonged 3rd stage? manual placental removal, then currettage. prolonged 4th stage? massage, 2nd pitocin, 3rd PGE, 4th Methergin, 5th hysterectomy 47) What is the MC C of prolonged 4th stage? Uterine Atony. What are some other causes? Lacerations, retained placenta (send for ex-lap if you cant get it out), DIC and uterine inversion. 48) How do you manage shoulder distocia? McRoberts maneuver (maternal thigh flexion and push on the suprapubic area) 49) Post-partum fever, what cause are you suspecting at days 0-1? Atelactasis. 2-3? Endometritis. 1 week later? Septic thrombophlebitis 50) How do you treat endometritis? Ampicillin, Gentamycin and Metronidazole. what do you suspect if that treatment does not stop the fevers? Septic Thrombophlebitis. how do you manage that? Heparin 51) How do you manage mastitis? Dicloxacillin and continued breast feeding from same breast 52) Mom does not want to breastfeed, what do you tell her? Ice-packs and tight bra 53) Mom wants OC Ps while breastfeeding, which one do you give her? Progesin only (minipill) 54) How do you manage amniotic fluid embolism? Supportive care (oxygen and intubation if needed, do not use heparin/warfarin as this is not a blood clot). 55) How do you manage acute fatty liver of pregnancy in the emergent setting? IVF, IV glucose and FFPs. Report Abuse
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* Re:gynecology notes...
alve oli - 11/06/08 15:25

#1547705

Thanks Queen Elba!

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* Re:gynecology notes...
yoda1 - 03/31/09 11:53

#1707939

bump it
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* Re:gynecology notes...
e lbam aritza - 10/27/13 23:06

#2992493

I found a collection of my notes Except uspstf all are still ok

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gynecology notes... - USMLE Forum

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* Re:gynecology notes...
m isha_am e rica - 10/28/13 02:05

#2992638

thank you
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