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Final Flashcards

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1
Q

estrogens in normal menstruation

A
  • levels start to increase 1 week before ovulation

- rise 24 hours prior to ovulation initiates LH surge that produces ovulation

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2
Q

progesterone in normal menstruation

A
  • secretory effects on endometrium
  • stimulates development of lobules in breast
  • withdrawal results in menses
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3
Q

reproductive cycle hormones

A 
-hypothalamus releases GnRH 
(acts on pituitary)
-pituitary releases FSH and LH
(acts on ovaries)
-ovaries release estrogen and progesterone
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4
Q

contraception interruption

A
  • ovulation/implantation
  • fertilization
  • sperm function
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5
Q

ovulation suppression

A

High doses of progesterone cause negative feedback to pituitary to prevent LH surge and ovulation

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6
Q

why estrogen in BC

A
  • proper estrogen/progesterone ratio needed to maintain endometrial lining
  • excess estrogen = hyperplasia
  • excess progestin = atrophy
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7
Q

estrogen containing contraception advantages

A
  • control period timing
  • cancer prevention
  • reduce amount of bleeding
  • decrease BP
  • reduce androgens (reduce acne & PCOS)
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8
Q

estrogen containing contraception disadvantage

A
  • nausea
  • headache
  • increase blood clot
  • DVT
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9
Q

progestin only contraception advantages

A
  • no estrogen S/S (headache, clot, BP)

- don’t have to worry about missing pill

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10
Q

progestin only contraception disadvantage

A
  • irregular bleeding (prolonged, not heavy)
  • bad mood
  • weight gain
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11
Q

copper IUD absolute contraindications

A
  • anatomical abnormality
  • cervical cancer awaiting treatment
  • current PID
  • immediate postseptic abortion
  • postpartum sepsis
  • endometrial cancer
  • suspected intrauterine disease
  • pregnancy
  • current cervicitis, chlamydia, or gonorrhea
  • pelvic TB
  • unexplained vaginal bleeding
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12
Q

progestin IUD absolute contraindications

A
  • distorted uterine cavity
  • current breast cancer
  • cervical cancer awaiting treatment
  • current PID
  • postseptic abortion
  • postpartum sepsis
  • endometrial cancer
  • suspected intrauterine disease
  • pregnancy
  • current cervicitis, chlamydia, or gonorhea
  • pelvic TB
  • unexplained vaginal bleeding
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13
Q

implant absolute contraindication

A

-current breast cancer

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14
Q

depot absolute contraindications

A

-current breast disease

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15
Q

progestin only pill absolute contraindication

A

-current breast disease

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16
Q

combined OC absolute contraindication

A
  • current breast disease
  • breast feeding <21 days postpartum
  • severe cirrhosis
  • recurrent DVT/PE risk
  • acute DVT/PE
  • surgery with prolonged immobilization
  • HTN 160/100
  • vascular disease
  • current ischemic disease
  • known thrombogenic disease
  • peripartum cardiomyopathy <6 months
  • moderate/impaired cardiac function
  • <21 days postpartum
  • nephropathy, retinopathy, neuropathy
  • vascular disease or DM >20 yrs
  • headaches with aura
  • age >35 & >15 cigarettes
  • complicated solid organ transplant
  • lupus with positive antiphospholipid antibody
  • complicated valvular heart disease
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17
Q

emergency contraception

A
  • only works if ovulation has not happened
  • does not cause abortions
  • sperm live 5-7 days in tract
  • fertile days are 5 days prior to ovulation
  • large doses of progesterone can inhibit LH surge and ovulation
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18
Q

anatomical sources of abnormal bleeding

A
  • polyp
  • adenomyosis
  • leiomyoma/fibroid
  • malignancy
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19
Q

functional sources of abnormal bleeding

A
  • coagulopathy
  • ovulation dysfunction
  • endometrium/hyperplasia
  • iatrogenic, inflammatory
  • not yet classified
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20
Q

polyp

A
  • direct visualization is best
  • ultrasound with saline
  • high cancer suspicion or decreased pain tolerance gets OR biopsy
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21
Q

adenomyosis

A
  • tissues that line the uterus encroach the muscles of the uterus
  • difficult to diagnose w/o hysterectomy
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22
Q

malignancy

A
  • cervical (visualize with speculum)

- endometrial

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23
Q

coagulopathy

A
  • von willebrand disease
  • thrombocytopenia
  • inherited factor disorder
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24
Q

ovulatory dysfunction

A
  • usually PCOS related to insulin resistance
  • higher risk for endometrial cancer
  • flipped LH/FSH
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25
endometrial/hyperplasia
-no available tests to diagnose
26
idiopathic/inflammatory
- high doses of progesterone - dopamine blockers increase prolactin which can cause breakthrough bleeding - gonorrhea or chlamydia infections
27
excessive bleeding Tx
- lysteda/TXA - mirena - GnRH antagonist/agonist - cauterize lining - hysterectomy
28
amenorrhea work up
- uterus and outflow - ovary - pituitary - hypothalamus
29
uterus and outflow amenorrhea
- imperforate hyman - mullerian agenesis (no uterus/cervix) - androgen insensitivity (no uterus) - asherman's syndrome (scarred uterus, give OCP 1 month to check endometrium)
30
ovaries and amenorrhea
- no progesterone = anovulation - no estrogen = ovarian failure administer progesterone - bleeding occurs = anovulation - no bleeding occurs = hypogonadism
31
pituitary and amenorrhea
- primary ovarian failure | - pituitary dysfunction
32
hypothalamus to pituitary and amenorrhea
- hard to assess because GnRH is pulsatile - clinical diagnosis - low body fat, stress, thyroid disease
33
medical contraindications for all BC
- pregnancy - genital tract malignancy - undiagnosed abnormal uterine bleeding
34
medical contraindications for oral BC
- clot - HTN - complicated migraine - liver disease - ischemic heart disease
35
medical contraindication for IUD
- current PID/cervicitis - misshapen uterine cavity - copper allergy (paragard)
36
bacterial vaginosis examination findings
- thin, off white discharge with fishy odor | - no inflammation
37
bacterial vaginosis treatment
metronidazole
38
trichomoniasis examination findings
- thin, yellow-green, malodorous, frothy discharge | - vaginal inflammation
39
trichomoniasis treatment
- metronidazole | - treat sexual partner
40
candida vaginitis examination findings
- thick cottage cheese discharge | - vaginal inflammation
41
candida vaginitis treatment
fluconazole
42
herpes
- painful | - infects dorsal root ganglia
43
syphilis
- not painful | - single lesion that is large and hard
44
PID diagnostic criteria
- cervical motion tenderness or uterine tenderness or adnexal tenderness - from untreated gonorrhea or chlamydia
45
PID treatment for uncomplicated
-outpatient unless can't comply with keeping ABX down
46
PID treatment for tuboovarian abscess
- always treat inpatient - sepsis work up - drainage
47
genital warts
- caused by HPV - worsens when cell mediated immunity suppressed - aldara only non destructive treatment that takes weeks to months - can do cryo or laser therapy
48
fibroids (leiomyomata uteri)
- rarely malignant - benign tumors in smooth muscle that are hormone dependent - 50% have aneuploidy - clonal expansion
49
fibroids management
- 80% require no treatment - bleeding/pain treated symptomatically - GnRH agonists/antagonists used for temporary (6 month) relief - myomectomy (conservative) - uterine fibroid embolization (conservative) - hysterectomy
50
pelvic organ prolapse cause
- failure of ligaments | - cardinal ligaments support cervix and prevent vaginal prolapse
51
pelvic organ prolapse risk factors
- genetic - menopause - parity - aging - previous hysterectomy - obesity - smoking
52
anterior compartment pelvic organ prolapse symptoms
bladder prolapse - urinary symptoms - pelvic pain - intercourse difficulty
53
apical compartment pelvic organ prolapse symptoms
vagina/uterus prolapse - urinary symptoms - pelvic pain - intercourse difficulty
54
posterior compartment pelvic organ prolapse symptoms
rectum prolapse - constipation - pelvic pain - intercourse difficulty
55
pelvic organ prolapse management
- kegel - don't smoke - stool softener - lose weight - pessary - surgery to reinforce vaginal wall
56
stress incontinence
due to increased abdominal pressure under stress | -weak abdominal floor muscles
57
urge incontinence
- due to involuntary contraction of bladder muscles | - treat with Rx
58
overflow incontinence
due to blockage of urethra
59
neurogenic incontinence
due to impaired nervous system function
60
adenocarcinoma of the endometrium
- most common gyn malignancy - not the most deadly - good outcomes due to early detection - early symptom of abnormal bleeding
61
estrogen dependent endometrial cancer
- obesity - anovulation/PCOS - exogenous estrogen - tamoxifen - good prognosis
62
less estrogen dependent endometrial cancer
- poor prognosis - mismatch repair gene failure - serous and clear cell subtype
63
endometrial hyperplasia and endometrial cancer
- complex hyperplasia with atypia has 30% chance to progress to endometrial cancer - should be treated as well differentiated adenocarcinoma
64
endometrial hyperplasia treatment
- progestin to combat unopposed estrogen | - hysterectomy
65
endometrial cancer staging
- always done surgically with hysterectomy | - majority of cases stage I
66
endometrial cancer treatment stage 1
surgery
67
endometrial cancer treatment stage 2
surgery and chemo/radiation
68
endometrial cancer treatment stage 3 and 4
surgery and palliative
69
uterine sarcoma presentation
- not common - postmenopausal uterine growth - pain - pressure - vaginal bleeding
70
uterine sarcoma diagnosis
- endometrial biopsy, but many false negative | - most incidentally diagnosed at hysterectomy
71
uterine sarcoma prognosis
- poor - high stage at diagnosis - poor response to chemo
72
uterine sarcoma treatment
- hysterectomy - lymph node removal not helpful because it spreads hematologically - radiation/chemo for inoperable
73
cervical cancer
- 3rd most common gyn cancer in US - #1 cancer killer in underdeveloped due to lack of widespread effective screening - caused by HPV
74
subtypes of ovarian cancer
- epithelial: most common - germ cell: typically teenagers - stromal: 20s-30s - metastatic
75
ovarian cancer symptoms
- typically at stage 3 or 4 - ABD pain, bloating, distention - constipation - back pain
76
ovarian cancer risk factors
- age 50 or older #1 risk - familial (BRCA gene) - anything that increases number of ovulations in a lifetime
77
ovarian cancer prevention
- ovulation suppression | - no good means to screen
78
ovarian cancer treatment
- surgery typically regardless of stage - no consensus on optimal chemotherapy - radiation not primary but may be used to treat symptomatic metastatic disease
79
adnexal mass
- any mass >5cm = referral to gyn - a simple cystic mass <5cm should be reimaged in 6-12 weeks - any pelvic mass found on CT should be followed up with pelvic U/S
80
fallopian tube cancer
- thought to be rare but some ovarian cancer may actually be tubal - presents with water vaginal discharge - same treatment as epithelial ovarian cancer
81
vulvar cancer types
- HPV associated: young, smoking, VIN associated | - lichen sclerosis associated: more common, older
82
vulva intraepithelial neoplasia characteristics
- elevated - irregular borders - warty - itchy - multicentric
83
vulva intraepithelial neoplasia diagnosis and treatment
- direct visualization - colposcopy - biopsy - treatment is ablative
84
paget disease of vulva
- erythematous plaque with white scaling - itching, burning pain - wide local excision - recurrence is common
85
fecundability
-likelihood of conception per cycle
86
fecundity
likelihood of live birth per cycle
87
fertility
likelihood of live birth over some period of time
88
subfertility
no pregnancy after 6 cycles
89
infertility
no pregnancy after 1 year
90
causes of infertility
- male factors - female factors - combination of factors in both partners - all 1/3 responsibility
91
male infertility
easiest and cheapest to test for with semen analysis
92
couples factor and infertility
- coital frequency and timing - smoking - alcohol - illicit drugs - antisperm antibodies
93
female infertility causes
- ovulation disorders - tubal obstruction - endometriosis - uterine disorders - idiopathic
94
endometriosis
histologically normal endometrial glands and stroma with hemosiderin laden macrophages outside the endometrial cavity
95
endometriosis symptoms
- painful periods - painful sex - infertility
96
endometriosis treatment
- symptom related: NSAIDs - hormonal: progestins, GnRH suppression - surgery
97
adenomyosis
- enlarged globular, tender uterus without focal mass - treat symptoms - primarily histological diagnosis
98
pelvic pain differential
GI, GU, reproductive organs, ABD wall pain, bony pelvis
99
bleeding in 1st trimester
- 50/50 on normal vs abnormal | - all need a workup
100
pain in 1st trimester
- nearly everyone has pain - most pain without bleeding is not pathological - pain and bleeding is possibly pathological
101
threatened abortion
- vaginal bleeding with or without pain | - has normal, live pregnancy
102
incomplete abortion
- partially passed products of conception - open cervix - increasing pain
103
complete abortion
- passage of all products of conception | - subsiding pain
104
missed abortion
no passage of tissues and asymptomatic
105
septic abortion
secondary infection of incomplete abortion
106
why do ectopic pregnancies cause vaginal bleeding
does not produce enough progesterone or hCG to maintain endometrium so irregular bleeding occurs
107
why do ectopic pregnancies cause pain
fallopian tube stretch and blood in tube causes irregular pain
108
complete molar pregnancy
-egg with no nucleus that 1 sperm that duplicates or 2 sperm
109
partial molar pregnancy
normal egg fertilized by 2 sperm
110
discriminatory zone
gestational sac expected at hCG >2000
111
yolk sac
presence of is conclusive of intrauterine pregnancy
112
fetal pole
- should grow at least 2 mm per day | - heartbeat should be detectable within 1 week of pole development
113
ectopic pregnancy
- number 1 finding is empty uterus - free fluid concerning for ruptured ectopic - can treat with methotrexate or surgery
114
variations from baseline
- general rule all variations from baseline are reflexes designed to maintain homeostasis, particularly oxygen delivery - can't manage vascular beds, can only manage HR
115
variability
- increases in HR due to increase in O2 demand via sympathetic nervous system - implies intact CNS
116
absent variability
- sleep (no more than 45 minutes) - meds (opioids, mag) - CNS injury (diagnosis of exclusion)
117
accelerations
- reflex increase in HR due in increased O2 demand and implies intact CNS - less than 32 weeks, increase HR 10 BPM for 10 seconds - 32 weeks and greater, increase HR 15 BPM for 15 seconds
118
Early decelerations
- start with initiation of contraction, bottom out at contraction peak, and end with contraction - thought to be vagal response - not associated with hypoxemia/acidemia
119
variable decelerations
- hypoxemic event - >15 BPM drop reaching peak in <30 seconds - lasting at least 15 seconds but no more than 2 minutes - possibly due to cord occlusion - can result in secondary hypoxemia
120
late decelerations
- hypoxemic event - symmetric, gradual decrease in HR - onset at peak of contraction, nadir at contraction termination, termination after contraction ends - during contraction lactic acidosis occurs
121
pre-eclampsia
blood pressure >140/90 with at least 300 mg protein without end organ damage
122
pre-eclampsia with severe features
BP>160/110 or with end organ damage
123
acute HTN emergency
- BP >160/110 for >15 minutes - labetalol and hydralazine - goal is BP <160/110
124
eclamptic seizure phases
1. facial automatisms 2. tonic/clonic seizures 3. post-ictal don't abolish the seizure with benzos, give mag
125
isoimmunization
-Rh negative mother and Rh positive fetus

OB/GYN (2 decks)

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