Adam Shared "OB/GYN" - 185 Picmonics
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OB/GYN
Granulosa Cell Tumor
- Granulosa Cells
- Non-germ cell tumor
- Endometrial Carcinoma
- Call-Exner bodies
- Estrogen producing
- Precocious Puberty
43 secs
Pelvic Inflammatory Disease (PID)
- Mechanism
- Neisseria gonorrhoeae
- Chlamydia Trachomatis
- Symptoms
- Cervical Motion Tenderness
- Chandelier Sign
- Salpingitis
- Tubo-ovarian abscess
- Hydrosalpinx
- Complications
- Ectopic Pregnancy
- Infertility
- Adhesions
- Fitz-Hugh-Curtis Syndrome
2 mins
Acute Abdominal/Pelvic Pain in Women 12160
- Mittelschmerz
- Recurrent mild & unilateral mid-cycle (around day 14) pain prior to ovulation
- Pain lasts hours to days
- No peritoneal signs
- Ultrasound: Not indicated
- Rupture of the follicle releases the egg; concomitant release of some blood during process irritates peritoneum
- Reassure patients
- Ruptured ovarian cyst
- Sudden-onset, severe, unilateral lower abdominal pain immediately following strenuous or sexual activity
- Nausea & vomiting
- Unilateral, tender adnexal mass on examination
- Can cause hemoperitoneum often while on anticoagulants
- Diffuse severe abdominal pain, pleuritic chest pain, and shoulder pain (due to phrenic nerve irritation)
- Gynecologic emergency typically occurring in premenopausal patients
- Diffuse abdominal rigidity with rebound and guarding is present
- Symptoms arise due to ischemia and eventually necrosis
- Decreased hematocrit due to intra-abdominal blood loss
- Twisting around its supporting structures (infundibulopelvic ligament or utero-ovarian ligament) which contains ovarian blood supply
- Ultrasound + Doppler: Pelvic free fluid and possible adnexal mass if the cyst is incompletely drained
- Enlarged ovary with decreased or absent blood flow
- Dermoid cysts in particular have a higher likelihood of torsion than other types of ovarian masses
- Treatment: prompt surgical laproscopy with detorsion, cystectomy, possibly removal of the adnexa (if necrosis despite restoration)
- Untreated torsion may lead to chronic pelvic pain, infertility, hemorrhage, or peritonitis and sepsis
Normal Physiological Changes During Pregnancy 2804
- Multiple skin tags
- Nocturnal leg pain is also common due to muscle cramping from lactic and pyruvic acid accumulation
- Renal/Urinary
- Increased Glomerular filtration rate & renal size
- Increased cardiac output & renal blood due to progesterone with increased renal excretion
- Decreased blood urea nitrogen & serum creatinine
- Urinary frequency, nocturia
- Increased urine output & sodium excretion
- Mild hyponatremia
- Hormones reset threshold to to increase ADH release from pituitary
- Increased basement membrane permeability --> increased renal protein excretion
- Heme
- Dilutional anemia
- Increased Plasma volume & red blood cell mass
- Prothrombotic state
- Hormone mediated decrease in total protein S antigen & activity; increase in fibrinogen & coagulation factors
- Pregnant patients often have mildly decreased (> 70,000/mm3) platelet counts, a condition known as gestational thrombocytopenia
- Cardiovascular
- Increased Heart Rate
- Decreased systemic vascular resistance
- Systolic ejection murmur
- Decreased blood pressure
- Edema
- Pulmonary
- Chronic respiratory alkalosis with metabolic compensation, increased PaO2 & decreased PaCO2 (metab comp with decrease HCO3)
- Progesterone directly stimulates central respiratory centers (medulal) to increase tidal volume & minute ventilation
- Decreased functional residual volume
- Dyspnea
- Hgb goes down because its a concentration but theres both more plasma and RBCs (just even more plasma)
- Tidal volume (VT) increases
- Functional residual capacity decreases
- Clotting factors increase (VII, VIII, X, von Willebrand) and anticlotting factors decrease (Protein C, Protein S, and Antithrombin III)
- ↑ Fibrinogen (so “normal” fibrinogen at delivery is likely DIC); ↑ D-Dimer (so dont use D-dimer for thrombosis testing)
- Creatinine should decrease through pregnancy. “Normal” values at the upper end of normal should be considered pathologic
Osteogenesis Imperfecta
- Pathophysiology
- Autosomal Dominant
- Decreased Type I Collagen Production
- Symptoms
- Phenotypically Diverse
- Brittle Bone Disease
- Fractures from Minimal Trauma
- Confused with Child Abuse
- Hearing Loss
- Dental Imperfections
- Blue Sclera
1 min
Achondroplasia
- Mechanism
- Autosomal Dominant
- Advanced Paternal Age
- Most Common Cause of Dwarfism
- Mutation of FGFR3 (Fibroblast Growth Factor Receptor 3)
- Defective Endochondral Ossification
- Symptoms
- Delayed Motor Milestones
- Shortened Limbs with Normal Axial Skeleton Size
- May Develop Hydrocephalus
- Symptoms of Spinal Stenosis
- Normal Life Span and Fertility
2 mins
Paget's Disease of Bone
- Pathophysiology
- Men > Age 40
- Increased Osteoblast and Osteoclast activity
- Mosaic Pattern
- Signs and Symptoms
- Increased Skull Diameter
- Hearing Loss
- Fractures
- Bone Ache and Joint Pain
- High Output Heart Failure
- Diagnosis
- Bone Scan
- Normal Parathyroid hormone (PTH) and Calcium
- Elevated ALP
- Treatment
- Bisphosphonate
- Calcitonin
2 mins
Hyperemesis Gravidarum
- Signs and Symptoms
- Excessive Vomiting
- Significant Weight Loss
- Dehydration
- Hypotension
- Electrolyte Imbalance
- Interventions
- Antiemetics
- Frequent Small Meals
- IV Therapy
2 mins
Genito-Pelvic Pain/Penetration Disorder (Vaginismus) 3861
- Risk factors
- Sexual trauma
- Lack of sexual knowledge
- History of abuse
- Clinical features
- Pain with vaginal penetration
- May occur with tampon insertion or gynecologic exam
- Distress/anxiety over symptoms
- No other medical cause
- Treatment
- Desensitization therapy
- Kegel exercises
- Vulvodynia
- Formerly termed vestibulodynia
- Painful entry dyspareunia
- Physical examination shows pain to superficial touch of the vaginal vestibule
Magnesium Sulfate
- Mechanism
- Muscle Relaxant
- Indications
- Preterm Labor Contractions
- Preeclampsia
- Side Effects
- Warm Feeling
- Hypotension
- Decreased Deep Tendon Reflexes (DTRS)
- Decreased Respiratory Rate
- Decreased Urine Output
- Paralytic Ileus
- Antidote
- Calcium Gluconate
2 mins
Oxytocin (Pitocin)
- Mechanism of Action
- Increase Uterine Contractions
- Indications
- Labor Induction
- Control Postpartum Hemorrhage
- Side Effects
- Uterine Rupture
- Water Intoxication
- Contraindications
- Fetal Lung Immaturity
- Cervix Not Ripened
- Active Genital Herpes Infection
- Considerations
- Use Lowest Dose
- IV Pump
3 mins
hCG 580
- Source: Syncytiotrophoblast of placenta
- Other functions include promotion of male sexual differentiation and stimulation of the maternal thyroid gland
- Production begins at day eight after fertilization, levels double every 48 hours until they peak at six to eight weeks gestation
- Placental hormone secretion generally increases over the course of pregnancy, but hCG peaks at 8–10 weeks
- Function
- Maintains corpus luteum (and thus progesterone) for first 8–10 weeks of pregnancy by acting like LH (otherwise no luteal cell stimulation causes abortion)
- After 8–10 weeks, placenta synthesizes its own estriol and progesterone and corpus luteum degenerates
- Used to detect pregnancy because it appears early in urine (2 weeks) or via blood (1 week)
- Has identical α subunit as LH, FSH, TSH (states of increased hCG can cause hyperthyroidism)
- β subunit is unique (pregnancy tests detect β subunit)
- hCG is increased in multiple gestations, hydatidiform moles, choriocarcinomas, and Down syndrome
- hCG is decreased in ectopic/failing pregnancy, Edward syndrome, and Patau syndrome
- Stimulates the production of thyroid hormones by binding to thyrotropin (TSH) recepto rs on thyroid follicular cells
Estrogen 577
- Source: Ovary (17β-estradiol), placenta (estriol), adipose tissue (estrone via aromatization)
- Potency: estradiol > estrone > estriol
- Induction of prolactin production during pregnancy
- FUNCTION
- Development of genitalia and breast, female fat distribution
- Growth of follicle, endometrial proliferation, increased myometrial excitability
- Upregulation of estrogen, LH, and progesterone receptors; feedback inhibition of FSH and LH, then LH surge; stimulation of prolactin secretion
- Increased transport proteins, SHBG, thyroxine-binding globulin; increased HDL; decreased LDL
- Pregnancy
- 50-fold increase in estradiol and estrone
- 1000-fold increase in estriol (indicator of fetal wellbeing)
- Estrogen receptors expressed in cytoplasm; translocate to nucleus when bound by estrogen
- Increased GnRH receptor on anterior pituitary
- Production
- LH stimulates desmolase in theca cells to form androgen from cholesterol
- FSH stimulates aromatase in granulosa cells to make androgens into estrogen
Acute Mastitis, Periductal Mastitis and Mammary Duct Extasia (
- Acute mastitis
- Staph Aureus infection
- Associated with breast feeding (fissures develop in nipple and bacteria enter)
- Erythematous breast, purulent nipple discharge, may have abscess
- Continue breastfeeding, dicloxacillin
- Periductal mastitis
- Usually seen in smokers
- Smoking causes relative Vit A decifiency, Vit A deficiency causes squamous metaplasia of periductal cells
- Cells produce keratin and block the duct resulting inflammation
- Subareolar mass with nipple retraction - due to inflammation and fibrosis
- Mammary duct ectasia (dialation)
- Chronic inflammation that causes dilation (ectasia) of subareolar duct
- Periareolar mass with green-brown nipple discharge
- Plasma cells on biopsy
- Rare; classically arises in muliparous postmenopausal women
risk factors for preterm birth
- hx of preterm birth
- short interpregnancy interval
- Bright Red Vaginal Bleeding
- periodontal disease
- cervical surgery
- short cervical length
- low maternal BMI, smoking, alcohol
- progesterone therapy can decr risk
Epithelial Ovarian Carcinoma 12052
- Epithelial ovarian carcinoma refers to a malignancy involving the ovary, fallopian tube, and peritoneum
- Clinical Presentation
- Acute: Shortness of breath, obstipation/constipation with vomiting, abdominal distension, ascites, decreased bowel sounds
- Subacute: Pelvic/abdominal pain, bloating, early satiety
- Firm, non-mobile pelvic mass with nodularity in a postmenopausal patient is concerning for EOC
- Asymptomatic adnexal mass
- Occurs primarily in postmenopausal women and women with BRCA mutations
- Laboratory findings
- Increase CA-125
- CA-125 testing has particularly low specificity in premenopausal women, not used during initial evaluation
- Useful mainly in postmenopausal women and is not recommended for the initial evaluation of an adnexal mass in premenopausal patients
- Ultrasound findings
- Solid mass
- Thick septations
- Ascites
- Management
- Pelvic ultrasonography is the first-line test for evaluation of a palpable adnexal mass
- Exploratory laparotomy
- The ovaries, uterus, omentum, and any cancerous lesion will be removed and pelvic and paraaortic lymph nodes will be dissected
- Chemotherapy with platinum-based agents is initiated after surgery
- O: Paclitaxel
- The ideal time for surgery is in the early second trimester
- Chemotherapy can be admin istered in the second and third trimesters , although recommendations vary depending on the tumor type
- Don't biopsy, risk of seeding
- Risk factors
- Family history
- Genet ic mutations (BRCA 1, BRCA2)
- Age ≥50
- Hormone replacement therapy
- Endomet riosis
- Inferti lity
- Early menarche /late menopause
- Protective factors
- Oral contraceptive pills
- Multipar ity
- Breastfeeding
Contraindications to External Cephalic Version 3118
- Offered at 37 weeks
- External cephalic version (ECV) involves maneuvers to convert a breech into a vertex presentation for delivery
- ECVs has potential to cause fetal distress, perform only when arrangements have been made for a back-up emergency cesarean delivery
- Internal podalic for twin delivery to convert the second twin from a transverse/oblique to a breech for subsequent delivery
- Contraindication
- Indications for cesarean delivery regardless of fetal lie (eg, failure to progress during labor, non-reassuring fetal status)
- Placental abnormalities (eg, placenta previa or abruption)
- Oligohydramnios
- Ruptured membranes
- Hyperextended fetal head
- Fetal or uterine anomaly
- Multiple gestation
- Abnormal fetal heart tracings
- Classical C section as its not advised to proceed with vaginal birth afterwards
- Active labor is a relative contraindication for external cephalic version
Abruptio Placentae
- Mechanism
- Premature Separation of Placenta
- Assessment
- Tearing Pain
- Bleeding (Often Concealed)
- Rigid Uterus
- Contractions
- Interventions
- Corticosteroids as Needed
- Emergent Delivery
- Considerations
- Increased Risks for Neonate
- Rh (Rhesus) Incompatibilities
- Increased Risk for Shock
- Monitor Fetal Heart Rate
3 mins
Syphilis - Diagnostic Serology 4792
- Negative screening but strong clinical evidence of primary syphilis (chancre) --> empiric intramuscular benzathine penicillin G
- Repeat nontrep serology in 2-4 weeks (establish baseline titers); 4-fold titer decrease at 6-12 months --> adequate treatment
- First prenatal visit testing, if one is positive then confirm with the other (high false positive rate)
- Penicillin allergy should have a penicillin skin test to evaluate for the presence of an lgE-mediated response
- If positive, desensitize patient to penicillin before treatment with intramuscular penicillin G benzathine
- 1 dose weekly for 3 weeks
- Nontreponemal (RPR, VDRL)
- Antibody to cardiolipin-cholesterol-lecithin antigen
- Quantitative (titers)
- Possible negative result in early infection
- Nontreponemal tests may have higher false-negative rates (20%-30%) in patients with primary syphilis
- Decrease in titers confirms treatment
- Treponemal (FT A-ABS, TP-EIA)
- Antibody to treponemal antigens
- Qualitative (reactive/nonreactive)
- Greater sensitivity in early infection
- Positive even after treatment
Management of PPROM 3274
- Symbols
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