Medical Quiz on Ovarian Conditions

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Questions and Answers

What is a primary symptom associated with ovarian torsion?

Acute severe adnexal pain (correct)

Intermittent headaches

Lower back pain

Vaginal discharge

Which diagnostic tool is most useful for assessing ovarian cysts?

Transvaginal ultrasound (correct)

CT scan

Physical exam

MRI

What is a common complication associated with ovarian cysts larger than 8cm?

Ovarian torsion (correct)

Decreased fertility

Increased menstrual flow

Chronic pelvic pain

What are the potential symptoms of ovarian torsion in patients?

Nausea and vomiting Signup and view all the answers

Which factor increases the risk of ovarian torsion in patients?

Pregnancy Signup and view all the answers

What is a characteristic feature of a complete hydatidiform mole?

Absence of embryo and amniotic fluid Signup and view all the answers

Which symptom is most commonly associated with gestational trophoblastic disease?

Elevated Beta-hCG levels Signup and view all the answers

What is the most common cause of spontaneous abortion according to WHO?

Chromosomal abnormalities Signup and view all the answers

Which of the following tests is essential for diagnosing a threatened abortion?

Beta Quant (serum) Signup and view all the answers

What is the most common presenting complaint in cases of spontaneous abortion?

Vaginal bleeding with or without abdominal pain Signup and view all the answers

What is the primary reason a gynecology referral is essential for managing conditions like endometriosis?

To expedite diagnosis of possible complex conditions Signup and view all the answers

Which symptom is NOT typically associated with leiomyomas?

Nausea and vomiting Signup and view all the answers

What does the classic triad for ectopic pregnancy include?

Vaginal bleeding, abdominal pain, and amenorrhea Signup and view all the answers

Which treatment is NOT typically recommended for managing hyperemesis gravidarum?

Ibuprofen Signup and view all the answers

What is a significant risk factor for ectopic pregnancy?

Previous pelvic inflammatory disease (PID) Signup and view all the answers

What should be included in the work-up for a patient presenting with nausea and vomiting during pregnancy?

CBC and BMP Signup and view all the answers

Which of the following statements is true regarding endometriosis?

Correlation of symptoms with menstrual cycles can be helpful Signup and view all the answers

In cases of ectopic pregnancy, what is the percentage likelihood that abdominal pain will be present?

90% Signup and view all the answers

What characteristic differentiates a threatened abortion from an inevitable abortion?

Normal examination findings Signup and view all the answers

What is a feature of a missed abortion?

Fetal death without tissue passage Signup and view all the answers

What is a common indicator of septic abortion?

Fever and vaginal discharge Signup and view all the answers

Which treatment is recommended for Rh-negative women experiencing complications from abortion?

Administration of anti-Rho (D) immunoglobulin Signup and view all the answers

What defines incomplete abortion?

Presence of grayish-white products of conception (POC) Signup and view all the answers

What is the main indication for administering broad spectrum antibiotics in the context of dilation and curettage?

Septic conditions Signup and view all the answers

Which blood pressure reading qualifies as hypertension in pregnant women under the diagnostic criteria for preeclampsia?

140/90 mmHg Signup and view all the answers

What is a common clinical manifestation of HELLP syndrome?

Schistocytes on peripheral blood smear Signup and view all the answers

What is the definitive treatment for preeclampsia?

Delivery of fetus Signup and view all the answers

What is a possible non-diagnostic indicator that can replace proteinuria in the diagnosis of preeclampsia?

Elevated liver enzymes Signup and view all the answers

What symptom is NOT typically associated with preeclampsia?

Hypoglycemia Signup and view all the answers

When should HELLP syndrome be evaluated in pregnant women?

If there is abdominal pain after 20 weeks gestation Signup and view all the answers

What is a common treatment used to prevent seizures in eclampsia?

IV Magnesium Signup and view all the answers

What is a key clinical feature of placental abruption?

Abdominal pain Signup and view all the answers

Which condition is characterized by painless vaginal bleeding during the second half of pregnancy?

Placenta previa Signup and view all the answers

During the work-up for placental abruption and previa, which imaging study is prioritized?

Transabdominal ultrasound Signup and view all the answers

What is a common clinical presentation of postpartum endometritis?

Foul-smelling lochia Signup and view all the answers

Which antibiotic is contraindicated in breastfeeding women for treating postpartum endometritis?

Doxycycline Signup and view all the answers

Which of the following lab tests is NOT typically included in the work-up for suspected placental abruption?

X-ray Signup and view all the answers

What is a possible treatment for stable patients diagnosed with postpartum endometritis?

Amoxicillin + Metronidazole Signup and view all the answers

What characterizes mastitis in the context of breast infections?

Redness and engorgement of breast tissue Signup and view all the answers

Study Notes

Emergency Medicine - Reproductive Disorders

Objectives: Synthesize etiology, epidemiology, symptoms, signs, lab findings, work-up, and treatment for reproductive disorders. List of disorders includes vaginal bleeding in non-pregnant and pregnant females, pelvic pain, ectopic pregnancy, abortion, nausea and vomiting of pregnancy, postpartum endometritis, mastitis, vulvovaginitis, pelvic inflammatory disease, and ovarian torsion.
Objectives: Recognize when pelvic ultrasound is needed for pelvic pain and abnormal vaginal bleeding, identify presenting signs and symptoms of ovarian torsion and ectopic pregnancy, differentiate causes of abnormal uterine bleeding in non-pregnant patients, teach prevention of vaginitis, cervicitis, and pelvic inflammatory disease, differentiate classifications of spontaneous abortion.
Objectives: Write a prescription for PID treatment and causes of vaginitis.

Vaginal Bleeding in the Nonpregnant Patient

Definitions:
- Abnormal uterine bleeding (AUB): Bleeding abnormal in regularity, volume, frequency, or duration, present for at least 6 months
- Heavy menstrual bleeding (HMB): Excessive menstrual bleeding impacting a woman's physical, emotional, social, and quality of life.
- Amenorrhea: Absence of menstruation for more than 6 months.
- Prolonged menstrual bleeding: Menstrual periods lasting >8 days
- Intermenstrual bleeding: Bleeding between normal menstrual cycles
- Irregular menstrual bleeding: Erratic cycle variations (>20 days) over a year
- Postmenopausal bleeding: Bleeding > 12 months after menopause
Categories:
- Prepubertal: Trauma, abuse, vaginitis, tumors, foreign bodies (FB)
- Reproductive Age/Perimenopausal: Anovulation, exogenous hormones, coagulopathy, uterine leiomyomas, polyps, infection, thyroid dysfunction
- Postmenopausal: Exogenous estrogen, atrophic vaginitis, endometrial lesions
PALM-COEIN:
- Structural causes (PALM): Polyp, adenomyosis, leiomyoma, malignancy/hyperplasia
- Non-structural causes (COEIN): Coagulopathy, ovarian dysfunction, endometrial, Iatrogenic, not otherwise classified
Clinical Features: Amount, duration, reproductive and sexual history, STIs, trauma, medications, retained foreign bodies (FB), bleeding disorders, endocrine disorders, thyroid issues (e.g., TSH)
Physical Exam: Abdominal exam, complete pelvic exam, speculum exam, bimanual exam, skin assessment (pallor), eye assessment (palpebral conjunctiva pallor), evaluation for significant blood loss (dizziness, weakness, abnormal vital signs, orthostasis, syncope).
Work-Up: Pregnancy test, urinalysis (UA), complete blood count (CBC), prothrombin time/INR, partial thromboplastin time (PTT), thyroid-stimulating hormone (TSH), pelvic ultrasound (transvaginal), endometrial evaluation, look for lesions, free fluid in cul-de-sac, can defer to outpatient if stable and nonpregnant.
Vaginal Bleeding During 2nd Half of Pregnancy:
- Placental Abruption: premature separation of placenta from uterine wall. Possible causes include (trauma, spontaneous or any trauma), clinical features include painful vaginal bleeding, abdominal pain, fetal distress, uterine tenderness, hypertonic contractions and DIC.
- Placenta Previa: Implantation of the placenta over the cervix. Clinical features include painless vaginal bleeding, usually admitted near end of pregnancy for monitoring, treatment is often a C-Section
Work-up: Transabdominal ultrasound, prior to digital or speculum exam, ABCs, and emergent OB consult are important. Possible emergent cesarean delivery, CBC ,CMP, PT/INR, PTT, type and cross for blood typing, and ensure Rhesus negative women receive 300 micrograms of anti-Rho (D) immunoglobulin

Nausea and Vomiting

Etiology: 90% of pregnancies experience nausea and vomiting (N&V). Severe N&V is known as hyperemesis gravidarum, with symptoms of weight loss, hypovolemia, hypokalemia, and ketonemia.
Clinical Findings and Work-up: Absence of abdominal pain suggests another diagnosis. Labs should include CBC, BMP, electrolytes, BUN/Cr, UA, and ketones.
Treatment: IV fluids, dextrose, anti-emetics (e.g., metoclopramide, ondansetron), potential outpatient treatment (e.g., doxylamine with pyridoxine [B6]).

Ectopic Pregnancy

Definition: Pregnancy outside the uterus, leading cause of maternal death during first trimester.
Risk Factors: Pelvic inflammatory disease (PID), prior ectopic pregnancies, surgical procedures, intrauterine devices (IUDs), assisted reproductive techniques.
Location: Most common locations are in the fallopian tubes; other possible locations include ovaries, cervix, or abdominal cavity.
Classic Triad: Abdominal pain (90%), vaginal bleeding (50-80%), amenorrhea (70%). Often occurs between 5-7 weeks of gestation.
Presentation Differences: Ruptured (vs. non-ruptured), location of ectopic pregnancy, hemoperitoneum, diaphragmatic irritation, upper abdominal or shoulder pain.
Clinical Features: Vital signs might be normal though potentially fluctuating, pelvic exam finding variables, possible cervical motion tenderness, tenderness of adnexa, possible uterine enlargement.
Laboratory Work-Up: CBC, quantitative beta-hCG, ultrasound, type and cross if needed, for individuals with Rh-negative blood, 50 mcg of anti-Rh(D) immunoglobulin should administered.
Diagnosis: Determining if intrauterine pregnancy is present. High Beta-hCG (> 6000 TA or 1500 TV) and an empty uterus strongly suggest an ectopic pregnancy; low B-hCG (< 1500 TV) suggests a pregnancy that is too early to make an accurate diagnosis.
Care and Disposition: Combination of pelvic mass, free fluid in the cul-de-sac, and empty uterus is highly suggestive of an ectopic pregnancy– emergent OB/GYN consult. Must STRICT and clear return precautions and follow-up advice, stable or unstable status.
Gestational Trophoblastic Disease: Neoplasm arising from trophoblastic cells of placenta; possible complete or partial hydatidiform mole (premalignant), choriocarcinoma, placental site trophoblastic tumor, or epithelioid trophoblastic tumor
Symptoms: Vaginal bleeding, urine pregnancy test, hyperemesis, persistent symptoms into second trimester, pre-eclampsia, and hypertension. Ultrasound is important to evaluate; high β-hCG (> 100,000) is indicative. Confirmed diagnosis by uterine evacuation and histological analysis.

Threatened Abortion & Abortion

Spontaneous abortion: According to WHO, 20-40% of pregnancies end in spontaneous abortion, with 75% occurring before 8 weeks of gestation; most commonly due to chromosomal abnormalities.
Classification Threatened, Inevitable, Incomplete, Complete, Missed, Septic abortion- categorized by fetal survival and passage of tissue/placental tissue.
Symptoms: Bleeding with or without abdominal pain often characterize the presentation; bleeding is most common complaint.
First-trimester vaginal bleeding work up: History (pads per hour, LMP, OB history), pelvic exam (cervix open/closed, amount and site of bleeding, passage of tissue), CBC, beta-quantitive-blood/serum, Rh Factor, Ultrasound.
Care and Disposition: Rh-negative patients should receive anti-Rho(D) immunoglobulin.

Emergencies After 20 Weeks Gestation

Preeclampsia: Characterized by hypertension (>140/90 mmHg on 2 occasions >4 hours apart) and proteinuria (>300 mg in 24 hours); or thrombocytopenia (<100,000), elevated liver enzymes, and renal insufficiency, or 1.1 Cr, doubling or rising levels). Symptoms reflect end-organ damage (e.g., headache, visual disturbances, altered levels of consciousness (ALOC), edema, oliguria, and/or abdominal pain). Note: This can occur from 20 weeks gestation up until 6 weeks postpartum.
HELLP Syndrome: A serious complication of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets (symptoms include Hemolysis, schistocytes on peripheral blood smear, elevated Liver Function Test (LFTs), and low Platelets).
Eclampsia: Pregnancy complication marked by new-onset seizures or coma in addition to preeclampsia symptoms– requiring emergent OB consult, lab testing, and possible delivery of fetus.

Postpartum Emergencies

Postpartum Endometritis: Polymicrobial infection of the uterine lining typically several days after delivery, presenting with fever, lower abdominal pain, foul-smelling lochia, and uterine/cervical motion tenderness. Diagnostically, complete blood count (CBC), urinalysis (UA), and cervical cultures are helpful.
Mastitis: Infection of breast tissue, potentially presenting with swelling, redness, and tender engorgement; fever and chills possible.

Vaginitis

Types and Characteristics: Different types of vaginitis (e.g., bacterial vaginosis, vaginal candidiasis, and trichomoniasis) are characterized by specific symptoms in (discharge (fishy, cottage cheese, frothy/malodorous), pH, and microscopic findings (saline wet prep, potassium hydroxide [KOH] wet prep).
Treatment: Vary based on type and typically involves specific antimicrobial medications (e.g., metronidazole, fluconazole, clindamycin) based on wet prep results and suspected etiology.

Case Presentations

Case Presentation: A 35-year-old woman G3P2 at 35 weeks gestation presents to the ER with painless vaginal bleeding. She has had two prior C-Sections.

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Description

Test your knowledge on ovarian conditions, including ovarian torsion and cysts. This quiz covers symptoms, diagnostic tools, complications, and associated diseases. Perfect for medical students and healthcare professionals looking to refresh their understanding.