E. Med

  1. What is the classic triad of symptoms for ectopic pregnancy?
    Abdominal pain, light vaginal bleeding, amenorrhea
  2. What are the risk factors for ectopic pregnancy?
    PID, Tubal surgeries, IUD, Fertilization
  3. What are the diagnostic tests for ectopic pregnancy?
    • serum quantitative B-hCG
    • transvaginal ultrasound
  4. What are the classifications of spontaneous abortions?
    • Complete-all products expelled
    • Incomplete-some products remain
    • Threatened-Bleeding, cervix closed
    • Inevitable-bleeding, cervix dilated
    • Missed-fetal death <20 weeks
  5. What is the most common first trimester complication?
    • Spontaneous abortion - no tx necessary
    • will require D and E
    • must always check mother's blood type
  6. What is placenta previa?
    • Abnormal location of placenta over or in close proximity to the internal cervical os
    • PAINLESS until labor
    • bleeding is usually maternal in origin
  7. What are risk factors of placenta previa?
    • Previous placenta previa
    • Multiparas
    • 4+ cesarean sections
  8. What is placental abruptio?
    Premature separation of the implanted placenta from the uterine wall
  9. What is placental abruptio associated with?
    • Maternal HTN
    • Hydramnios(excessive amniotic fluid)
    • After multiple deliveries
    • cocaine use
    • trauma
    • smoking
  10. What are signs of placental abruptio?
    • PAINFUL vaginal bleeding
    • enlarged abdomen
    • painful uterus
    • fetal distress, HR<100 bpm
    • Petechiae
  11. What is Pre-eclampsia?
    • Elevated blood pressure 140/90 or higher
    • 20mmHg rise in systolic/10mmHg in diastolic
    • Proteinuria
    • edema
    • headache, visual disturbance, abdominal pain
  12. What is the work-up of pre-eclampsia?
    • UA
    • Coagulation studies
    • CBC
    • Renal and liver function tests
  13. What is Eclampsia?
    Rise in blood pressure just as Pre-eclampsia but with the presense of SEIZURE
  14. How do you treat eclampsia?
    • Hydralazine which preserves uterine blood flow
    • Only cure is delivery of baby
  15. What is PROM?
    • Premature Rupture of Membrane
    • Leaking of amniotic fluid prior to 37 weeks gestation
  16. How do you confirm PROM?
    • Nitrazine paper - detects pH
    • normal vaginal secretions 4.5-5.5
    • amniotic fluid is 7.0-7.4
  17. What are risk factors for pre-term labor?
    PROM, placental abruptio, multiple gestation, infection, incompetant cervix, drug abuse
  18. What are signs and symptoms of pre-term labor?
    • Mentrual like cramps
    • low-dull backache
    • abdominal pressure
    • pelvic pressure
    • increase in change in vaginal discharge
  19. What are risk factors of PID?
    • STD
    • PID
    • high # of sex partners
    • inconsistent or no use of condoms
    • prostitutes
    • sex at an early age
  20. What are signs of PID?
    • Bilateral abdominal pain
    • vaginal discharge
    • low back pain
    • irregular vaginal bleeding
    • fever, N/V
  21. What does PID show on exam?
    • Lower abdominal is usually non-tender
    • Mucupurulent vaginal discharge
    • cervial motion tenderness
    • uterine tenderness
    • adnexal tenderness
  22. What does the PID workup include?
    • Pregnancy test
    • Urinanalysis
    • GC and Chlamydia test
  23. Explain the presentation of a ruptured ovarian cyst
    • dull, aching or severe, sudden, sharp pain
    • lower abdomen, pelvis, vagina, lower back or things
    • Constant or intermittent
    • Fullness, heaviness, pressure, swelling or bloating in the ab
  24. What are signs and symptoms of Ruptured ovarian cyst?
    • Greatly mimic PID
    • bilateral abdominal pain
    • vaginal discharge
    • low back pain
    • irregular vaginal bleeding
  25. What are the token symptom of a tubo-ovarian abscess?
    Symptoms will mimic ovarian cyst but FEVER will be present
  26. What is Ovarian torsion?
    • sx mimic ovarian cyst
    • tenderness with rebound and guarding
    • shown on US or doppler
  27. What is dysfunctional uterine bleeding?
    • Uterine bleeding that occurs outside the normal menstrual cycle
    • 21-45 days cycle
    • 1-7 days of bleeding
    • determining blood loss can be difficult
    • need to get H and H
  28. Describe Bacterial vulvovaginitis
    • "fishy oder"
    • + whiff test
    • "clue cells" on wet prep
    • thin gray-white to yellow discharge
    • -preterm labor, PROM
  29. Describe Trichomonas
    • vaginal erythema, frothy malodorous discharge
    • wet prep diagnosis
  30. Explain Candida
    • thick "cottage cheese" discharge
    • causes severe pruritis, dysuria, dyspareunia
  31. What is Dysmenorrhea?
    • Painful menstuation
    • may be primary or secondary
    • treat symptoms
    • refer to GYN
  32. What is mittelschmerz?
    • Painful ovulation
    • vague aching pain 2 weeks before menses
    • typically unilateral pain, mild to moderate
    • occurs days 14-16
    • no tx other than prego test
  33. What is endometriosis?
    • Prescense of endometrial tissue outside of the uterine cavity
    • severe dysmenorrhea
  34. What are sx of endometriosis?
    • Dysparunia
    • Dysmenorrhea
    • chronic pelvic pain
    • abnormal uterine bleeding
    • infertility
    • pelvic mass
  35. Explain post menopausal bleeding and what it could indicate
    • Uterine Cancer
    • endometrium should be evaluated via endometrial biopsy or US if unable to obtain biopsy
Card Set
E. Med