Ovarian mass
- workup x2?
Pelvic U/S
CA-125 level - elevated in malig
Don’t do needle aspiration as may drag CA cells everywhere
No malignant features:
- small, simple cyst
How does obesity get you to cancer in female?
Peripheral conversion of androgens to estrogens
Aromatization of andro’s to estrone
Then endometrial hyperplasia or CA
3 things lead to shoulder dystocia:
- Post-term pregnancy > 42 weeks
- DM and macrosomia
- Excess maternal weight gain
When see increased 17-hydroxyprogesterone levels?
Think CAH: congenital adrenal hyperplasia
- 90% due to 21-hydroxylase deficiency
- low cortisol, get high ACTH
- ACTH gets adrenal hyperplasia
- since can’t make cortisol, shunt to androgens
How treat just:
- chlamydia
- gonorrhea
Chlamydia: azithromycin or doxycycline
Gonorrhea: ceftriaxone
Screen for both with NAAT (nucleic acid amplification test) which is 96/99 sen/spec
Sjogren syndrome
- think what?
- test for what?
Inflammation of exocrine glands - low lacrimal production - dry mouth (dental caries) - dry vaginal mucosa (dysparunia) \+ Raynaud Test for anti-Ro (SSA) or Anti-La (SSB)
How confirm fetal demise?
- No fetal movement felt
- Doppler ultrasound no heartbeat
- Diagnosis w/ transabdominal U/S which shows no fetal heartbeat
Adenomyosis buzzwords
- dysmenorrhea w/ heavy menstrual bleed
- soak pad every 1-2 hours
…..chronic pelvic pain
Boggy (soft/flaccid) uterus
Tender uterus
UNIFORMLY enlarged uterus
All pregnant women should receive screening for:
HIV
Hep B
Chlamydia trachomatis
Syphilis: treat penicillin G (1dose/week for 3 weeks)
- rapid plasma reagin = nontreponemal
- Fluorescent trep Ab absorption = treponemal.
Antiphospholipid syndrome
sometimes seen w/ SLE
Recurrent pregnancy loss
Transient Ischemic Attack
. . . think thrombophilia & hyper coagulability
Membrane antibodies
Have to give heparin
3 modifiable risk factors for osteoporosis after menopause?
- Smoking
- Alcohol
- Calcium/Vitamin D
Hyperechoic nodules on ovarian cyst Adnexal fullness - expect what else? - age? - diagnosis?
Expect calcifications
Often younger women
Dermoid ovarian cyst = mature cystic teratoma
HTN, PROM or PPROM and why?
HTN = PROM, abruption, stillbirth, IUGR
Infection or hx PPROM = PPROM
Itchy palms/soles during preg?
Intrahepatic cholestasis of pregnancy
- pruritis, palms/soles, worse at night
- increased alk phase
- increased liver enzymes
Tx: ursodeoxycholic acid to increase bile flow and reduce itching
Fetal station reverses from 0 to -3
Uterine rupture
