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Case Files - Approach To The Patient Flashcards

(51 cards)

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1
Q

Pregnant women younger than 17 or older than 35 are at increased risk for

A

Preterm labor
Preeclampsia
Miscarriage

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2
Q

Gravidity

A

Number of pregnancies including the current one.

Includes miscarriages, ectopic pregnancies and stillbirths

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3
Q

Parity

A

Number of pregnancies that have ended at gestational age >20 weeks

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4
Q

Abortuses

A

Number of pregnancies that have ended at gestational age

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5
Q

Clinical Pearl -

G
T
P
A
L
A 
Gravidity
Term Deliveries
Preterm Deliveries
Abortuses
Living Children
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6
Q

LMP

A

The FIRST DAY of the last menstrual period. Important in determining gestational age.

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7
Q

Expected Due Date

A

LMP - 3 months + 7 days

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8
Q

Chief Complaint: Postmenopausal bleeding

What are you most worried about?

A

Endometrial cancer

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9
Q

What are the risk factors for endometrial cancer?

A 
Hypertension
Diabetes
Anovulation
Early age of menarche
Late age of menopause
Obesity
Infertility
Nulliparity
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10
Q

What should the first line of every obstetric presentation include?

A 
Age
Gravidity
Parity
LMP
EGA
Chief Complaint
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11
Q

Age of menarche - Normal range

A

9 years old - 16 years old

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12
Q

Interval from first day of one menses to the first day of the next - Normal range

A

21 to 35 days

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13
Q

Quality of menses - Normal range

A

Lasts less than 7 days

Less than 80mL in total volume

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14
Q

Menorrhagia

A

Excessive menstrual flow

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15
Q

Menometrorrhagia

A

Irregular AND heavy menses

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16
Q

STIs we ask about in the history

A 
Herpes simplex
Syphillis
Gonorrhea
Chlamydia
HIV
PID
HPV
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17
Q

Past Medical History - Don’t miss these!

A 
Hypertension
Hepatitis
Diabetes
Cancer
Heart disease
Thyroid disease

Include duration, severity and therapies!

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18
Q

Surgical history - Detail to remember

A

Note if surgical procedures were via laparoscopy or laparotomy

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19
Q

Review of systems - What makes us worry about preeclampsia?

A

Headache
Visual disturbances
Epigastric pain
Facial or hand swelling

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20
Q

Review of systems - Elderly patient considerations

A

Symptoms suggestive of cardiac disease:

Chest pain
Dyspnea
Fatigue
Weakness
Palpitations
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21
Q

Clinical Pearl - What do we look out for in every pregnancy > 20 weeks gestational age?

22
Q

What are we looking for in the breast examination?

Study These Flashcards
A 
Symmetry
Skin or nipple retraction with hands on hips
Masses (palpation)
Nipple discharge
Axillary and supraclavicular nodes
23
Q

Systolic flow murmurs in a pregnant woman

Study These Flashcards
A

Normal. Increased cardiac output.

24
Q

Diastolic murmurs in a pregnant woman

25
Grey Turner sign
Discoloration at the flank areas. May indicate intra-abdominal or retroperitoneal hemorrhage.
26
Ulcers on the external genitalia may indicate
Herpes simplex Vulvar carcinoma Syphillis
27
Vulvar mass at 5:00 or 7:00 position may suggest
Bartholin gland cyst or abscess
28
If you see pigmented lesions on the external genitalia
Get a biopsy. Malignant melanoma is not uncommon in the vulvar region.
29
Rectal Exam - Nodularity and tenderness in the uterosacral ligament may suggest
Endometriosis
30
Rhogam - When and to whom?
Administer at 28 weeks gestational age if the mother is Rh (-) in order to prevent isoimmunization. Administer again at delivery if the baby is, indeed, Rh (+)
31
Mom tests positive for HBsAg. What do you do?!
At birth, give the newborn Hep B Immune Globulin (HBIG) and Hep B vaccine to prevent neonatal hepatitis.
32
If mom is not already immune to rubella, why don't we vaccinate her until immediately postpartum?
It is a live-attenuated vaccine, so can't be given during pregnancy
33
Mom tests positive for syphillis while pregnant but she's allergic to penicillin. What do you do?
Desensitize her, then give penicillin.
34
What are we looking for with a urine culture or urinalysis?
Asymptomatic bacteriuria. 6 - 8% of pregnancies are complicated by this
35
Why do many physicians prefer liquid-based media for ectocervical and endocervical sampling in a pap smear?
Provides better cellular sampling | Allows for HPV subtyping
36
What do we screen the serum for between 16 and 20 weeks gestational age?
Down's Syndrome Neural Tube Defects Also screening for trisomies with serum Pregnancy-Associated Plasma Protein-A (PAPP-A) and βhCG as well as nuchal translucency (NT) has gained popularity at this point.
37
PAPP-A
Pregnancy-Associated Plasma Protein-A Found in the serum, used for first-trimester screening for trisomies
38
βhCG
Beta Human Chorionic Gonadotropin Used in first trimester screening for trisomies, among many other things we will get to.
39
NT
Nuchal Translucency Used in first trimester screening for trisomies
40
What do we screen for at 26 - 28 weeks gestational age?
Gestational diabetes. Give a 50g oral glucose load Assess the serum glucose after 1 hour
41
If adopting the "culture strategy" for Group B Strep, when are introital cultures obtained?
35 - 37 weeks gestational age
42
What does quantitative hCG and progesterone level tell us?
Viability of the pregnancy | Possibility for ectopic pregnancy
43
Menorrhagia due to uterine fibroids - Lab tests to run
``` CBC Endometrial biopsy (to assess for endometrial cancer) Pap smear (to assess for cervical dysphasia or cancer) ```
44
55+ year old woman with an adnexal mass - Labs to run
CA-125 CEA tumor markers Looking for epithelial ovarian tumors
45
Sonography - Thickened endometrial stripe in a postmenopausal woman
May indicate malignancy
46
Sonography - What is the point of a saline infusion into the uterine cavity?
Enhances the ultrasound examination of intrauterine growths, such as polyps
47
Clinical Pearl - Sonohysterography
Ultrasound examination of the uterus after injecting saline into endometrial cavity This is done via transcervical catheter It can help identify endometrial polyps or submucous myomata
48
Why does the gynecological ultrasound exam usually involve the kidneys as well?
Hydronephrosis may suggest a pelvic process (ureteral obstruction)
49
IVP
Intravenous Pyelogram IV dye is used to assess: Concentrating ability of the kidneys Patency of the ureters Integrity of the bladder Can also detect: Hydronephrosis Ureteral stone Ureteral obstruction
50
HSG
Hysterosalpingogram Radiopaque dye is introduced through transcervical cannula, and radiographs are taken. Useful in detecting: ``` Intrauterine abnormalities (submucous fibroids or intrauterine adhesions) Patency of fallopian tubes (tubal obstruction or hydrosalpinx) ```
51
Clinical Pearl - What is the single most important tool in obtaining a diagnosis?
The history

OBGYN (3 decks)

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