Terms in this set (64)
Massive obstetric hemorrhage and hypovolemic shock causing lactation failure, amenorrhea, loss of hair, anorexia, lethargy and hyponatremia.
Autoimmune mediated hypothyroidism after birth.
Headaches, visual disturbances, and hypopituitarism post-partum.
Gestational Diabetes Mellitus (diet modification, Insulin if 1 hr postprandial >140)
Obsesity. Risk gestational hypertension, preeclampsia, fetal macrosomia/ polycythemia/ shoulder dystocia/ organomegaly/ small left colon syndrome, cesarean delivery. Screen 24-28 weeks.
Granulosa cell tumor of ovary
Precocious puberty in child or bleeding/ endometrial hyperplasia in post-menopausal woman. High estrogen. Pelvic ultrasound ovarian mass, thickened endometrium. Get biopsy.
Granuloma inguinale (Donovanosis)
Painless genital ulcers red, beefy base and no associated adenopathy. No response to antibiotics.
Ulcer with deep, purulent base and painful lymphadenopathy.
Multiple vesicles following a prodrome of burning and pruritus within days becoming painful ulcers.
Condyloma acuminatum; HPV (trichloroacetic acid or podophyllin)
Clusters of pink teardrop lesions on the genitalia. Complication cutaneous squamous cell carcinoma.
Condyloma lata; Primary syphillis (Penicillin)
Painless flat, velvety papule ulcerates forming chancre with punched-out base and raise, indurated margins. Spontaneously heals in 1 to 3 months. Trichloroacetic acid turns papule white. Darkfield best. VDRL, RPR screen has false negatives. FTA-ABS confirmation.
Vulvar lichen planus
Middle-aged women with hyperkeratotic, erosive or papulosquamous. Pruritis, soreness, and vaginal discharge common.
Placenta accreta (Cesarean hysterectomy)
Hemorrhage at time of attempted placental delivery. Risk factors prior cesarean, D&C, maternal age >35 years. US absent placental-myometrial interface with intraplacental villous lakes.
Antepartum bleeding with vaginal bleeeding, abdominal pain, tense and distended uterus and fetal heart rate abnormalities. Risk factor cocaine use.
Contraction and cervical dilation cause painless antepartum hemorrhage after 20 weeks gestation. Speculum but no digital cervical exam.
Abdominal pain, loss of fetal station, and abnormal fetal heart tracing. Risk factor history of cesarean delivery.
Bleeding and soft uterus after placental delivery.
Severe abdominal pain, postpartum hemorrhage and smooth mass protruding from cervix/ vagina.
Painless antepartum bleeding and fetal heart rate abnormalities just after rupture of membranes.
Endometriosis (NSAIDs, OCP, laparoscopy)
Chronic pelvic pain, dysmenorrhea, deep dyspareunia, dyschezia. Immobile uterus, cervical motion tenderness, adnexal mass, recto-vaginal septum, posterior cul-de-sac, uterosacral nodules. Complication infertility.
Leiomyomata uteri fibroids (US, laparoscopy)
Stress urinary incontinence and pelvic pressure with irregular uterine contour. Benign smooth muscle tumors arising from the myometrium. Risk factors reproductive age, African American. Complications dysmenorrhea, recurrent pregnancy loss.
Dysmenorrhea, menorrhagia and soft, boggy, uniformly enlarge uterus. Endometrial tissue grows into myometrium.
Endometrial polyps (hysteroscopy)
Intermenstrual spotting without uterine enlargement.
Adnexal mass, nonspecific GI symptoms, early satiety, constipation/ diarrhea, anorexia, bloating, and increased abdominal girth.
Abnormal uterine bleeding, pelvic pressure, uterine mass in post-menopausal women.
Mammary paget disease
Persistent, painful, eczematous, ulcerating rash localized to the nipple spreads to the areola. Vesicles, scales, bloody discharge, nipple retraction. No improvement with steroids. 80% have underlying adenocarcinoma.
Palpable, mobile, rubbery, firm breast mass without nipple changes.
Painless, palpable breast mass without cutaneous manifestations in a postmenopausal woman.
Intraductal unilateral bloody nipple discharge.
HELLP (hemolysis, elevated liver enzymes, and low platelet) syndrome (delivery >34 weeks, Mg, Antihypertensives)
Preeclampsia, nausea, vomiting, epigastric and RUQ pain. Hypertension. Thrombocytopenia, microangiopathic hemolytic anemia, proteinuria and increased liver enzymes. Hepatic and systemic inflammation, activation of coagulation cascade and platelet consumption.
New onset hypertension (BP >140/ >90) at >20 weeks on 2 occassions >4 hours apart with proteinuria (24 hour urine total protein > 300 or Urine protein/Cr >0.3) or signs of end organ damage. Risk abruptio placentae. Complications thrombocytopenia, high Cr, transaminases, pulmonary edema, new onset visual or cerebral symptoms.
Eclampsia (Magnesium sulfate, labetalol or hydralazine, deliver)
Hypertension, proteinuria and headaches, visual disturbance, right upper quadrant pain and 3-4 minutes of self-limited tonic clonic seizure. Complications posterior shoulder dystocia - adduct, internal rotate (Xray "light bulb sign", >6 mm joint space "rim sign", 2 parallel cortical bone lines "trough line sign")
Transient unilateral weakness following tonic-clonic seizure.
Intrahepatic cholestasis of pregnancy
Generalized pruritus, hyperbilirubinemia and transaminitis.
Biophysical profile single deepest pocket <2cm or amniotic fluid index <5. Indicates fetal hypoxia due to placental dysfunction. Risk factors maternal age, tobacco use, hypertension and diabetes.
Second trimester quadruple (15-20 weeks) screen low maternal serum AFP, B-hCG, and estriol. Normal Inhibin A
Second trimester quadruple screen (15-20 weeks) low maternal serum AFP and estriol. High B-hCG and Inhibin A.
Neural tube defect
Second trimester quadruple screen (15-20 weeks) high maternal serum AFP. Normal B-hCG, Estriol, Inhibin A.
PCOS (OCP, Metformin, Clomiphene)
Anovulation, signs of androgen excess and ovarian cysts. Insulin resistance.
Postpartum urinary retension (pain control, ambulate, catheter)
Inability to void, sensation of bladder fullness, and dribbling of urine or small-volume voids. Straight cath post void >150 mL. Risk factors Nulliparity, prolonged labor, perineal injury, regional analgesia, cesarean delivery, instrument vaginal delivery.
Complete androgen insensitivity syndrome
Absence of menses by age 15. Breasts. Ultrasound no uterus or upper vagina, cryptorchid testes. Minimal to absent axillary/ pubic hair. 46XY. X-linked.
Absence of menses by age 15. Breasts. Ultrasound absent or rudimentary uterus and upper vagina with normal ovaries. Normal axillary/ pubic hair. 46 XX.
Transverse vaginal septum
Absence of menses by age 15. Breasts. Ultrasound normal uterus, abnormal vagina, normal ovaries. Normal axillar/ pubic hair. 46XX.
Absence of menses by age 15, short stature, no breast development. Ultrasound normal uterus and vagina with streak ovaries. Normal axillary/ pubic hair. 45XO
Ambiguous genitalia and male internal urogenital tract (due to AMH)
Recurrent mild and unilateral midcycle pain prior to ovulation. Pain lasts a few hours to couple of days. No ultrasound findings.
Ectopic pregnancy (stable: methotrexate; unstable: surgery)
Amenorrhea, abdominal/ pelvic pain and vaginal bleeding. Positive BhCG. No intrauterine pregnancy. Risk factors: previous ectopic, pelvic surgery, or PID.
Sudden onset severe unilateral lower abdominal pain, nausea and vomiting. Unilateral, tender adnexal mass on examination. Enlarged ovary with decreased blood flow.
Ruptured ovarian cyst
Sudden-onset severe unilateral lower abdominal pain immediately following strenuous or sexual activity. Free fluid near ovarian cyst.
Pelvic inflammatory disease
Fever, chills, vaginal discharge, lower abdominal pain and cervical motion tenderness. +/- Tuboovarian abscess
Klumpke palsy (PT)
Shoulder dystocia causing traction on C8 and T1 leading to left hand paralysis, miosis and ptosis.
Shoulder dystocia causing traction to C5 and C6 leading to upper arm abducted/ internal rotaiton, elbow extended, forearm pronated, wrist and fingers flexed. Absent/ reduced moro on affected arm. Inact grasp reflex.
Infant delivered with altered mental status, respiratory and feeding difficulties, poor tone, and seizure.
Infant delivered with hyperreflexia and hypertonia in arm.
New onset hirsuitsm and acnes in pregnacy. Yellow-brown masses (areas of hemorrhage) of large lutein cells. Ultrasound solid ovarian masses (50% bilateral). Regress spontaneously after delivery. high risk
Theca luteum cyst
New onset hirsuitism and acne in pregnancy. Bilateral multiseptated ovarian cysts on ultraound. Associated with molar pregnancy and multiple gestations. Regress spontaneously after delivery. low risk
New onset hirsutism in pregnancy with unintentional weight loss, abdominal pain. Bilateral solid ovarian masses on ultrasound. Metastases from primary GI tract cancer. high risk.
Genito-pelvic pain/ penetration disorder
Ongoing difficulty with vaginal penetration, pain, or tenseness of pelvic floor muscles during attempted vaginal penetration for at least 6 months causing significant distress.
Variable presentation from no symptoms to light vaginal bleeding. Pregnancy symptoms may decrease. Closed cervix. Ultrasound non-viable fetus.
Inevitable Abortion (stable prostaglandins; unstablee: D&C)
Vaginal bleeding, uterine cramps, possible intrauterine fetus with heartbeat. Open cervix. Fetus with possible heartbeat.
Incomplete abortion (stable expectant, prostaglandins; unstable: D&C)
Vaginal bleeding with passage of flarge clots or tissue. Uterine cramps. Products of conception often visualized in dilated cervical os and by ultrasound.
Threatened abortion (reassurance and OP followup)
Variable vaginal bleeding. Closed cervix. Viable pregnancy that may proceed.
Septic abortion (cultures, broad antibiotics, and surgical evacuation)
Fever, malaise, signs of sepsis, foul smelling vaginal discharge, cervical motion and uterine tenderness. Rarely occurs after spontaneous abortion. Usually induced abortions, can be life threatening. Ultrasound retained products of conception.
Amniotic fluid embolism
Cardiogenic shock, hypoxemic respiratory failure, disseminated intravascular coagulopathy, coma or seizures. Risk factors advanced maternal age, gravida >5, cesarean or instrumental delivery, pracenta previa/ abruptio or preeclampsia.
Genitourinary syndrome of menopause; atrophic vaginitis (Vaginal moisturizer, topical vaginal estrogen)
Vulvar or vaginal dryness, itching, dyspareunia, narrow introitus, pallor, low elasticity, low rugae. Urinary frequency, urgency, incontinence, infection.
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