Exam 2 Part 2 Flashcards
(88 cards)
1
Q
What are the phases of menstruation?
A
Follicular (pre-ovulation), Ovulation, Luteal (post-ovulation), Menstruation
2
Q
What is the typical length of a menstrual cycle?
A
28 days; varies between patients and month to month
3
Q
What hormone is released from the anterior pituitary in response to low estrogen?
A
Follicle-stimulating hormone (FSH)
4
Q
What triggers ovulation?
A
Luteinizing hormone (LH) spike
5
Q
What is the role of progesterone in the menstrual cycle?
A
Maintains endometrium lining in preparation for implantation
6
Q
Define primary amenorrhea.
A
No menses by age 15 OR within 5 years of thelarche
7
Q
What are some causes of primary amenorrhea?
A
- Turner syndrome (XO)
- Imperforate hymen
- Mullerian agenesis
- Outflow tract obstruction
- Functional delay
8
Q
Define secondary amenorrhea.
A
No menses for 3 cycles in previously menstruating women OR 6 cycles in women with irregular cycles
9
Q
What is the most common cause of amenorrhea?
A
Polycystic ovarian syndrome (PCOS) or pregnancy
10
Q
List the initial work-up for amenorrhea.
A
- Physical exam * Pregnancy test * LH * FSH * TSH * Prolactin * CMP * CBC * Pelvic US
11
Q
What does PALM stand for in abnormal uterine bleeding (AUB)?
A
- Polyp * Adenomyosis * Leiomyoma (Fibroids) * Malignancy/Hyperplasia
12
Q
What is adenomyosis?
A
Endometrial tissue extends into the uterine myometrium
13
Q
What is the test of choice for adenomyosis?
A
Pelvic ultrasound and/or MRI
14
Q
What are the clinical findings associated with uterine leiomyomas?
A
- AUB * Dyspareunia * Pelvic heaviness * Abdominal mass
15
Q
What is the test of choice for identifying uterine leiomyomas?
A
Ultrasound
16
Q
What are the symptoms of endometriosis?
A
- Dysmenorrhea * Dyspareunia * Dyschezia
17
Q
What is the diagnosis method for endometriosis?
A
Laparoscopy
18
Q
What is the clinical presentation of polycystic ovarian syndrome (PCOS)?
A
- Irregular menses * Acne * Hirsutism * Infertility
19
Q
What are the diagnostic criteria for PCOS?
A
Must have 2 out of 3: * Evidence of hyperandrogenism * Evidence of ovarian dysfunction * Exclusion of other disorders
20
Q
What is HAIR-AN syndrome?
A
Subset of PCOS characterized by HyperAndrogenism, Insulin Resistance, and Acanthosis Nigricans
21
Q
What are the treatment options for PCOS when pregnancy is desired?
A
- Weight loss if obese * Induce ovulation: metformin, clomiphene, letrozole
22
Q
What are the findings obtained from pap smears?
A
- Atypical cells of unknown significance (ACUS) * Low grade squamous intraepithelial lesion (LGSIL) * High grade squamous intraepithelial lesion (HGSIL)
23
Q
What are the two stains used in colposcopies to identify abnormal cells?
A
- Acetic Acid (vinegar) * Lugol’s iodine stain
24
Q
What are the treatment options for cervical dysplasia?
A
- Loop Electrical Excision Procedure (LEEP) * Conization
25
List the strains of HPV covered by the Gardasil vaccination.
* 16 * 18 * 31 * 33 * 45 * 52 * 58 (cancer) * 6 * 11 (warts)
26
What is Genitourinary Syndrome of Menopause?
Thinning/drying of mucosal tissues due to lack of estrogen
27
What are the symptoms of Bartholin gland cysts/abscesses?
Can become abscess; management depends on size
28
What are relative contraindications for contraceptives?
* High blood pressure * Migraine with aura * Smoking, age >35
29
What are the ovarian phases of the menstrual cycle?
Follicular and luteal phases
30
What is the role of GnRH in the menstrual cycle?
Stimulates FSH and LH release from anterior pituitary
31
What is Naegele’s rule for calculating estimated date of confinement?
EDC = LMP - 3 months + 7 days
32
Where is human chorionic gonadotropin (hCG) secreted?
By syncytiotrophoblast starting at 8-10 days post-fertilization
33
What is Naegele’s rule for estimating the date of confinement?
EDC = LMP - 3 months + 7 days
34
What is the significance of human chorionic gonadotropin (hCG) in early pregnancy?
Maintains corpus luteum to continue progesterone secretion, doubles every 48-72 hours until 9-10 weeks
35
Where is human chorionic gonadotropin secreted?
Secreted by syncytiotrophoblast starting at 8-10 days post-fertilization
36
List the physiological changes in pregnancy related to the respiratory system.
* Increased tidal volume
* Same respiratory rate with increased minute ventilation
* Respiratory alkalosis
* Decreased arterial pCO2 and serum bicarbonate
37
What are the cardiovascular changes during pregnancy?
* Decreased systemic vascular resistance (SVR)
* Increased cardiac output (CO)
* Decreased mean arterial pressure (MAP) initially
38
What routine labs are ordered during the first visit in pregnancy?
* CBC
* Rubella
* RPR
* Pap smear
* GC/chlamydia
* Hep B
* Blood type & Rh screen
39
Differentiate between screening and diagnostic tests in pregnancy.
* Screening: Identifies high-risk patients but does not confirm disease
* Diagnostic: Confirms diagnosis
40
What are the diagnostic criteria for gestational diabetes mellitus?
* 1 hour OGTT (normal <140 mg/dL)
* Fasting > 95 mg/dL
* 1-hr >180 mg/dL
* 2-hr >155 mg/dL
* 3-hr >140 mg/dL
41
Define teratogenicity.
Malformations on a developing fetus by external exposure/environmental agents
42
Name the TORCH pathogens.
* Toxoplasmosis
* Other (syphilis, varicella)
* Rubella
* CMV
* Herpes
43
What are the symptoms of mild pre-eclampsia?
* BP >140/90 after 20 weeks gestation
* Proteinuria >300 mg/24h or dipstick 1+
* Sudden weight gain
* Upper extremity/facial edema
44
What is the initial management for mild pre-eclampsia?
* Deliver at 37 weeks
* Stabilize BP
* Magnesium sulfate for seizure prophylaxis
45
What are the USPSTF guidelines for breast cancer screening?
Biennial screening mammography for women ages 40-74 y/o
46
List the risk factors for breast cancer.
* Age >50 y/o
* Family history of breast cancer
* Personal history of breast cancer
* Hormonal factors
* Exogenous estrogen
* Hx of radiation exposure
47
What distinguishes benign breast tumors: fibroadenoma, intraductal papilloma, and phyllodes tumor?
* Fibroadenoma: Most common in women <30 y/o, rubbery mass, low risk of malignancy
* Intraductal Papilloma: Can cause bloody discharge, may need excision
* Phyllodes Tumor: Rapid growth, treated as malignant
48
What is the test of choice for breast mass evaluation in patients <30 years old?
Ultrasound ± Mammogram
49
Describe fibrocystic changes.
Benign, associated with cyclical pain, no discrete mass
50
What is the difference between invasive and non-invasive breast carcinomas?
Invasive: Invades basement membrane; Non-invasive: Does not invade
51
What are breast conservation therapies?
Lumpectomy + Radiation therapy
52
What are the indications for adjuvant radiotherapy for breast cancer?
* After breast conservation therapy
* Positive margins after mastectomy
* Positive nodes
* Initial tumor > 5 cm
53
What are the two most emergent conditions in a woman of childbearing age with abdominal/pelvic pain?
* Hemorrhagic shock (ectopic pregnancy)
* Septic shock (PID)
54
What can untreated pelvic inflammatory disease (PID) lead to?
* Tubo-ovarian abscess
* Increased incidence of ectopic
* Decrease in fertility
55
What are the important areas of focus in the history of a woman with abdominal/pelvic pain?
* Character/Quality
* Onset/Rate of onset
* Location/Radiation
* Severity
* Duration/Pattern
* Previous similar episodes
56
What are the risk factors for ectopic pregnancy?
* Previous ectopic pregnancy
* Tubal pathology
* Previous tubal surgery
* Age (young women and older women)
* Presence of IUD
57
What is the physical exam focus in a childbearing aged female patient with severe lower abdominal/pelvic pain?
* Vital signs
* General appearance
* Abdominal exam
* Pelvic exam
58
What vital signs should be monitored in a childbearing aged female patient with severe lower abdominal/pelvic pain?
Vital signs including orthostatics
59
What general appearance signs might indicate shock in a patient with severe abdominal pain?
Pallor, diaphoresis, poor capillary refill
60
How do patients with cramping or stabbing pain typically behave?
They move about
61
What behavior do patients with peritoneal signs exhibit?
They lay still
62
What are the components of an abdominal exam for a patient with pelvic pain?
* Peritoneal signs
* Localized tenderness
* Bowel sounds
63
What should be assessed during a pelvic exam of a patient with severe abdominal pain?
* External genitalia
* Internal genitalia
* Cervical motion tenderness (CMT)
* Discharge
64
What is the most reliable and sensitive method of pregnancy testing today?
Beta-HCG testing
65
What is a limitation of urine pregnancy tests compared to serum tests?
Less sensitive / specific
66
What is the role of urinalysis in the work-up of lower abdominal/pelvic pain?
Helps differentiate UTI & calculi from PID / ectopic
67
What is the preferred method for obtaining a urine sample for urinalysis?
Clean catch specimen
68
What imaging technique is used to exclude ectopic pregnancy?
Ultrasound
69
What is the earliest sign of pregnancy detectable by ultrasound?
Fetal pole / gestational sac at 4-5 weeks
70
What is the significance of the transvaginal transducer in pregnancy ultrasound?
Best resolution for early detection
71
What are the classic presenting symptoms of ectopic pregnancy?
* Delayed menses
* Severe abdominal pain
* Vaginal bleeding
72
What laboratory findings may indicate an ectopic pregnancy?
* Possible anemia
* Positive hCG
73
What is the management for a ruptured ectopic pregnancy?
* IV fluids / PRBC transfusion
* Pain control
* Emergent ob/gyn consult for surgery
74
What are the associated symptoms of Pelvic Inflammatory Disease (PID)?
* Fever
* Chills
* Malaise
* Lower abdominal tenderness
75
What laboratory findings are indicative of PID?
* Leukocytosis
* Purulent discharge
* Positive genital cultures
76
What is the management for PID?
Broad-spectrum antibiotics
77
What are the characteristics of pain associated with endometriosis?
* Constant
* 2-7 days before menses
* Radiates to back, thigh, rectum
78
What laboratory findings may be needed to diagnose endometriosis?
Laparoscopy may be needed
79
What is the typical pain history for a ruptured corpus luteum cyst?
* Sudden onset
* Initially severe, intermittent
* Localized to one adnexa
80
What are the associated symptoms of a ruptured corpus luteum cyst?
* Afebrile
* Abdomen tender, distended, rigid
81
What are the management strategies for a ruptured corpus luteum cyst?
* Pain relief
* Further treatment if cyst torsion occurs
82
What is the pain history associated with degeneration of uterine fibroids?
* Sudden, severe pain
* Poorly localized in pelvis
83
What lab findings may indicate degeneration of uterine fibroids?
* CBC may show anemia if heavy vaginal bleeding
84
What is the management for degeneration of uterine fibroids?
Admission may be required for pain relief
85
What is the pain history associated with Mittelschmerz?
* Sudden onset
* Sharp
* Continuous
86
What is the management for Mittelschmerz?
Pain relief at home
87
What is the most common alternative diagnosis to ectopic pregnancy?
Threatened abortion
88
What lab findings are associated with threatened abortion?
* Positive hCG
* Ultrasound to determine if pregnancy is intrauterine
