GU 2 Flashcards
(512 cards)
1
Q
What organs make up the female reproductive system??
A
- Ovaries
- Uterine (fallopian) tubes or oviducts
- Uterus
- Vagina
- Vulva or Pendulum
- Mammary glands
2
Q
What hormones do the ovaries produce?
A
- Progesterone
- Estrogen
- Inhibin
- Relaxin
3
Q
Size and shape of the ovaries?
A
Unshelled almonds
4
Q
What type of tissues cover the surface of the ovaries?
A
Simple Germinal Epithelium
5
Q
What are paired organs that produce secondary oocytes?
A
Ovaries
6
Q
What are cells that develop into mature ova, or eggs following fertalization?
A
Oocytes
7
Q
What is the region under the germinal epithelium made of dense connective tissue that contains ovarian follicles?
A
Ovarian Cortex
8
Q
What consists of oocytes and a variable number of surrounding cells that nourish the developing oocyte and begin to secrete estrogens as the follicle gets bigger?
A
Ovarian Follicle (Folliculus little bag)
9
Q
What is the large, mature, fluid filled follicle that is preparing to rupture and expel a secondary oocyte?
A
Graafian Follicle
10
Q
What does the remnants of the ovulated follicle develop into?
A
Corpus Luteum (Yellow body)
11
Q
What hormones does the Corpus luteum produce?
A
- progesterone
- estrogen
- relaxin
- inhibin
12
Q
The Corpus Luteum degenerates and turns into fibrous tissue called?
A
Corpus Albicans (White body)
13
Q
What region of the ovaries consists of loose connective tissue and contains blood vessels, lymphatic vessels, and nerves?
A
Ovarian Medulla
14
Q
What extends laterally from the uterus and transports the secondary oocytes from the ovaries to the uterus?
A
Uterines (fallopian tubes) 2
15
Q
What is the open funnel shaped tube at each end of the fallopian tubes and lies close to the ovaries, but is open to the pelvic cavity?
A
Infundibulum
16
Q
What are the finger like projections at the end of the uterine tubes?
A
Fimbriae
17
Q
What extends medially from the upper and outer comers of the uterus?
A
Uterine tubes
18
Q
The oocyte is moved along the uterine tubes by what two methods?
A
- peristaltic contractions of smooth muscle layer
- cillia in the tubes mucous lining
19
Q
What is the usual site for fertilization of a secondary oocyte by a sperm cell?
A
Uterine tube
20
Q
Fertilization may occur any time up to about how many hours after ovulation?
A
24 hours
21
Q
The fertilized ovum(zygote) descends into the uterus within how many days?
A
7
-unfertilized oocytes disintegrate
22
Q
What is the site of implantation of the fertilized ovum, development of the fetus during pregnancy, and labor?
A
Uterus
23
Q
What is the source of menstrual flow during reproductive cycles when implantation does not occur?
A
Uterus
24
Q
What is situated between the urinary bladder and the rectum and is shaped like an inverted pear?
A
Uterus
25
What part of the uterus is the dome shaped portion superior to the uterine tubes called?
Fundus
26
What is the tapering central portion of the uterus called?
The body
27
What part of the uterus is the narrow opening into the vagina?
Cervix
28
What is the interior body of the uterus called?
Uterine cavity
29
What is the middle muscle layer of the uterus that is consistent with smooth muscle and form the bulk of the uterine wall?
Myometrium
30
During child birth, coordinated contraction of what muscles help expel the fetus?
Uterine
31
What is the inner most part of the uterine wall made of mucous membrane, nourishes a growing fetus or is shed each month during menstruation if fertilization does not occur?
Endometrium
32
What glands are contained by the endometrium? Secretion nourish sperm and the zygote
Endometrial glands
33
What is the tubular canal that extends from the exterior of the body to the uterine cervix?
Vagina
34
The vagina is situated between the urinary bladder and the rectum. A recess called the _________ surrounds the cervix?
Fornix
35
When properly inserted a contraceptive diaphragm rest on the _________ covering the cervix?
Fornix
36
The mucosa of the vagina contains large stores of what? The decomposition of which produces what?
- Glycogen
- Organic acids
37
What is the thin fold of mucous membrane, partially covering the vaginal orifice?
Hymen
38
Wat is the diamond-shaped area between the thighs and buttocks of both males and females that contains the external genitals and anus?
Perineum
39
What terms refer to the external genitals of the female?
- Vulva
- Pudendum
40
What is the elevation of adipose tissue covered by coarse pubic hair, which cushions the pubic symphysis?
Mons Pubis
41
What are the two folds of longitudinal skin that extend down and back from the mons pubis?
Labia majora
42
In females the labia majora is developed from the same emryonic tissue as what?
Male scrotum
43
The labia majora is composed of adipose tissue and what kinds of glands?
- Sebacias (oil) glands
- Sudoriferous (sweat) glands
44
Medial to the labia majora are two folds of skin called the?
Labia minora
45
What part of the vagina does not contain pubic hair or fat and have few sudoriferous glands but contain numerous sebaceous glands?
Labia minora
46
What is the small, cylindrical mass of erectile tissue and nerves, located at the anterior junction of the labia minora?
Clitoris
47
What is the layer of skin also known as the foreskin that forms the point where the labia minora unite and cover the clitoris?
Prepuse
48
What is the exposed portion of the clitoris capable of enlargement upon sexual stimulation?
Glans
49
What is the region between the labia minora called?
Vestibule
50
What is contained in the vestibule?
- hymen (if present)
- vaginal orifice
- external urethral orifice
- the opening of the ducts of the paraurethral glands
51
What is another name for paraurethral glands?
Skenes gland
52
The male prostate develops from the same embryonic tissue as the female what?
Paraurethral glands (Skenes)
53
What is on either side of the vaginal orifice that produce a small quantity of mucus during sexual arousal and intercourse that adds to the cervical mucus and provide lubrication?
Greater vestibular glands
54
What is another name for the greater vestibular glands?
Bartholin glands
55
What is the male equivalent of the Bartholin gland?
Bulbourethral gland
56
The mammary gland are located in the breasts and made of what kinds of glands that produce milk?
Modified sudoriferous glands
57
What lies over the pectoralis major and serratus anterior muscles and are attached to them by a layer of connective tissue?
The breasts
58
What is the pigmented projection of the breast with a series of closely spaced openings of ducts where milk emerges?
The nipple
59
What is the pigmented area of skin surrounding the nipples called?
Areola
60
What gives the areola/nipples a rough appearance?
modified sebaceous (oil) gland
61
Each mammary gland consists of how many lobes arranged radially?
15-20
62
What is the adipose tissue and strands of connective tissue that separates the lobes of the mammary glands and support the breasts?
Suspensory Ligaments of the breast
63
The suspensory ligaments of the breast are also called?
Cooper's ligaments
64
What are the small units within the lobes of the breasts?
Lobules
65
How many lobules per lobe?
20-40
66
What consists of milk-producing acini cells that empty into lactiferous ducts during lactation?
20-40
67
What are the milk secreting glands within the lobules called?
Alveoli
68
With the onset of puberty under the influence of what two hormones do the female breasts begin to develop?
- estrogen
- progesterone
69
What are the function of the mammary glands?
synthesis, secretion, and ejection of milk (lactation)
70
Milk production is largely stimulated by what hormone?
Prolactin
- with contributions of estrogen and progesterone
71
Where is prolactin produced?
anterior pituitary
72
The ejection of milk is stimulated by what hormone?
Oxytocin
73
Where is oxytocin released from?
posterior pituitary
74
What is the formation and development of gametes in females?
Oogenesis
75
Hormones from where control the major events of oogenesis?
- hypothalamus
- anterior pituitary
- ovaries
76
What kind of hormones released by the ovaries control the uterine(menstrual) cycle?
Steroid
77
The general term female reproductive cycle encompasses what?
- ovarian and uterine cycles
- hormonal changes that regulate them
- related cyclical changes in the breasts and cervix
78
What is released by the hypothalamus and controls the ovarian and uterus cycle?
Gonadotropin-releasing hormone GnRH
79
GnRH stimulates the release of what two hormones from the anterior pituitary?
- Luteinizing hormone (LH)
- Follicle stimulating Hormone (FSH)
80
What increase follicular growth and the secretion of estrogen by the growing follicles?
FSH
81
What stimulates further development of ovarian follicles and their full secretion of estrogen?
LH
82
At mid cycle, what triggers ovulation and then promotes formation of the yellow body?
LH
83
When stimulated by LH what does the corpus luteum produce and secrete?
- estrogen
- inhibin
- progesterone
- relaxin
84
What is secreted by ovarian follicle and has several important functions throughout the body?
estrogen
85
What promotes the development and maintenance of the female reproductive structure, feminine secondary sex characteristics, and the mammary glands?
estrogen
86
What stimulates protein synthesis, acting together with insulin-like-growth factors, insulin, and thyroid hormones?
estrogen
87
What lowers blood cholesterol and is probably the reason that women under 50 have a much lower risk of CAD then men of comparable age?
estrogen
88
Progesterone, secreted by the corpus luteum acts together with what to prepare and maintain the endometrium for implantation of a fertilized ovum and prepare the mammary glands for milk secretions?
estrogen
89
What is produced by the corpus luteum to relax the uterus by inhibiting contractions of the myometrium?
relaxin
90
During pregnancy what continuous to produce relaxin to relax the uterine smooth muscles?
placenta
91
At the end of pregnancy what increase the flexibility of the pubic symphysis and helps dilate the uterine cervix?
relaxin
92
What is produce by the growing follicle and the corpus luteum after ovulation to lesser the extent of LH and stop the secretion of FSH?
inhibin
93
The duration of the female reproductive cycle varies between how many days?
24-36 average 28
94
What are the 4 phases of the female reproductive cycle?
- menstrual
- pre-ovulatory
- ovulation
- post-ovulation
95
The menstrual phase also called the mensuration or meses lasts roughly how many days?
First five days of cycle
96
During what phase do several ovarian follicles grow and enlarge?
menstrual phase
97
Menstrual flow from the uterus consists of about how many mLs of blood and tissue cells from the endometrium?
50-150
98
A declining level of what two ovarian hormones causes the uterine arteries to constrict resulting in oxygen deprived tissue of the endometrium to slough off?
- progesterone
- estrogen
99
What is the time between menstruation and ovulatory phase?
pre-ovulatory phase
100
What phase accounts for most of the variation in cycle length?
pre-ovulatory phase
101
In a 28-day cycle how long does the pre-ovulatory phase last?
6-13
102
By about what days does a single follicle outgrow the other to become the dominants follicle?
day 6
103
What does the dominant follicle secrete to decrease FSH causing the death of lesser follicles?
- estrogen
- inhibin
104
What does the one dominant follicle become?
mature graafian follicle
105
What forms a blister like bulge on the surface of the ovary?
mature graafian follicle
106
What is the term for the menstrual and pre-menstrual phase?
follicular phase
107
What is liberated into the blood by growing ovarian follicles stimulating the repair of the endometrium?
estrogen
108
What is happening as the endometrium is thickening?
- the short, straight endometrial glands develop
- arterioles coil and lengthen
109
What phase encompasses the rupture of the mature graafian follicle and the release of the secondary oocyte into the pelvic cavity?
ovulatory
110
Ovulation usually occurs on what day in a 28 day cycle?
day 14
111
The high levels of estrogen during the last part of the pre-ovulatory phase exert a positive feedback system of what two hormones?
- LH -anterior pituitary
- GnRH - hypothalamus
112
The surge in LH brings about what?
rupture of the mature graafian follicle and expulsion of secondary oocyte
113
What can detect the LH surge associated with ovulation to predict ovulation a day in advance?
over-the-counter home test
114
What phase of the female reproductive cycle is between ovulation and the onset of the next menstruation?
postovulatory phase
115
The postovulatory phase is the most constant in duration lasting how many days? what days in a 28-day cycle?
- 14 days
- days 15-28 in a 28-day cycle?
116
After ovulation what stimulates the remaining follicle cells to enlarge and form the corpus luteum?
LH
117
Ovulation phase is also known as?
Luteal phase
118
If the oocyte is not fertilized how long does the corpus luteum last?
2 weeks
119
When the secondary oocyte is fertilized what is produced by the embryo to rescue the corpus luteum and expand its life span?
HCG
120
About how many days does it take the embryo to produce HCG?
8 days
121
Progesterone and estrogen secrete by the corpus luteum promote the growth of what?
endometrial glands
122
What is secreted by the endometrial glands?
glycogen
123
The preparatory changes of vascularization and thickening of the endometrium peak at about how many weeks after ovulation? at the time a fertilized ovum might arrive?
1 week after ovulation
124
What is the term for absence of menstrual cycle?
amenorrhea
125
More than how many days is considered prolonged menses?
more than 7 days
126
What is the term for external female genital organs?
vulva
127
What is another name for the mons pubis?
mons veneris
128
What is included in the vulva?
- mons pubis
- labia majora
- labia minora
- clitoris
- vestibular glands
- vaginal vestibule
- vaginal orifice
- urethral opening
129
Under the majora are the hairless labia minora divide into?
two lamellae
130
The labia minora fuse together to form the?
fourchette
131
What is the small bud of erectile tissue that is the primary center of sexual excitement?
clitoris
132
What forms the functional sphincters for the vagina, rectum, and urethra?
muscles
133
What is in the labia minora and what does it contains?
Vestibule
- urethra
- vagina
- skene gland
- bartholin gland
134
What drains the urethral glands?
skene glands
135
What gland secretes lubrications during sexual excitement?
bartholin gland
136
What is located posteriorly on each side of the vaginal orifice, open onto the sides of the vestibules in the groove between the labia and the hymen?
bartholin glands
137
What is a musculomembranous tube that is transversely rugated during the reproductive phase of life and inclines posteriorly?
vagina
138
The anterior wall of the vagina is separated from the bladder and urethra by the?
vesicovaginal septum
139
The posterior wall is separated from the rectum by the?
rectovaginal septum
140
The pelvic organs may be palpated through pockets around the cervix called?
fornices
141
The nonpregnant uterus is usually positioned anteroposterioly and weighs?
60-90 grams
142
The uterus is divided anatomically in to what?
corpus and cervix
143
The uterine corpus consists of?
- fundus
- body
- isthmus
144
What extends from the isthmus into the vagina?
cervix
145
The uterus opens into the vagina via?
external cervical os
146
What is the adnexa of the uterus composed of?
- fallopian tubes
- ovaries
147
What are the pair of oval organs resting in a slight depression on the lateral pelvic wall at the anterorsuperior iliac spine?
ovaries
148
The external genitalia are supported by what ligaments?
- cardinal
- uterosacral
- round
- broad
149
What is the average age of monarch in the united states?
11 and 14 years old
150
Ovarian function diminishes around what age?
40
151
Menopause occurs between what age?
40 and 55 years old
152
Ovulation ceases about how many years before menopause?
1-2 years
153
Menopause is conventionally defined as?
1 year with no menses
154
What is the position for a pelvic exam?
lithotomy
155
What pelvic examination is used for disabled women?
The disabled women is the best judge of position
156
What are some alternative position for pelvic exams?
- diamond
- obstetric stirrups
- m- shaped
- v- shaped
157
The clitoris is generally how long?
2 cm or less
158
What is indicated with bulging of the anterior wall and urinary incontinence?
cystocele
159
What is indicated by bulging of the posterior wall?
rectocele
160
What is marked by protrusion of the cervix or uterus upon straining?
Uterine prolapse
161
A cervix with a blueish color and increased vascularity is a sign of what?
pregnancy
162
A cervix that is positioned anteriorly indicates what?
retroverted uterus
163
A cervix that is positioned pointing posteriorly indicates what?
anterverted uterus
164
A cervix that is positioned pointing posteriorly indicates what?
anteverted uterus
165
Cervix deviation left or right may indicated what?
- pelvic mass
- uterine adhesion
- pregnancy
166
Rectovaginal exams allow the provider to reach how much higher into the pelvis allowing better evaluation of the pelvic organs and structures?
2.5cm(1in)
167
External labia swelling, pain, warmth, and redness may mean?
Bartholin gland abscess
168
ENlarged clitoris in children suggests what?
adrenal hyperplasia
169
Swelling of the vulvar tissues with bruising or foul smelling odor suggests what?
sexual abuse
170
Young women who are not sexually active should have there first pelvic exam by what age?
21 y/o
171
By age of menarche vaginal opening should be at least how many cm wide?
1 cm
172
Urethral inflammation or dilation suggests what?
UTI
173
What is Regar sign?
softening of the isthmus
174
What is chadwicks sign?
bluish cervix
175
What is Goodell sign?
cervical softening
176
The uterus deviates at how many weeks of gestation? What is the sign?
- 8 to 10 weeks
- Piskacek sign
177
What age does PMS usually occur?
late 20s
178
How long do PMS sx last?
5-7 days
179
What is characterized by edema, HA, weight gain, behavioral disturbances, nervousness, dysphoria, lack of coordination?
PMS
180
Infertility is the inability to conceive over how long of unprotected regular intercourse?
1 year
181
What is the presence of growth of endometrial tissue outside of the uterus causing pelvic pain, dysmenorrhea, and heavy prolonged menstral flow?
endometriosis
182
What is warty lesions on the labia, within the vestibule or in the perianal region as a result of HPV infection.
Condyloma Acuminatum (Genital warts)
183
What are sexually transmitted and are flesh-colored, whitish pink to reddish brown, discrete, soft growths and may form cauliflower-like masses?
Veneral warts
184
What are benign skin infection caused by poxvirus, may be transmitted by sexual contact. Lesions are white or flesh colored, dome shaped papules that are round or oval. surface characteristics is central umbilication from a thick creamy core can be expressed?
Molluscum Contagiosum
185
What is the incubation period for Molluscum Contagiosum?
2-7 weeks
186
What is the incubation period for Molluscum Contagiosum?
2-7 weeks
187
What lesion are secondary syphilis appear about 6-12 weeks after infection. Flat, round, or oval papule covered by gray exudates?
Condyloma Latum
188
What is a firm, painless ulcer. develop internally?
Syphilitic chancre (Primary syphilis)
189
What STI produces small red vesicles. lesions may itch and are painful and usually confined to small localized patch on the vulva, perineum, vagina or cervix?
Herpes lesion
190
What is caused by gonococcal infection. Acute inflammation produces a hot, red, tender, fluctuant swelling that may drain pus. Chronic inflammation results in a nontender cyst on the labium?
Inflammation of the Bartholin gland
191
What is a hernial protrusion of the urinary bladder through the anterior wall of the vagina. bulging can be seen as the woman bears down?
Cystocele
192
What is the hernial protrusion of part of the rectum through the posterior wall of the vagina?
Rectocele
193
What is suspected with findings of vaginal discharge, lesions, masses. Appears as ulcerated or raised red lesions on the volva?
Carcinoma
194
What is the bright red polypoid growth that produces from the urethral meatus?
Urethral carbuncle
195
What presents with water discharge, usually not foul smelling, dysuria, profuse frothy, greenish discharge?
Trichomoniasis
196
What presents with purulent discharge from the cervix, skene and bartholin inflammation?
Gonorrhea
197
What presents with homogenous thin, white or gray discharge, positive KOH with clue cells?
Bacterial vaginosis
198
What presents with enlarged fluid filled retention cyst that vary in size?
Infected Nabothian cysts
199
What presents with bright red, soft and fragile arise from the endocervical canal?
Cervical polyps
200
What appears as shiny red tissue around the os that may bleed easily?
columnar epithelium
201
What is the result of weakening of the supporting structures of the pelvic floor, often occurring with a cystocele or rectocele?
Uterine prolapse
202
What degree of uterine prolapse appears with the cervix at the introitus?
2nd degree
203
What degree of uterine prolapse appear when the cervix and vagina drop outside of the introitus?
3rd degree
204
What are common, benign, uterine tumors that appear firm, irregular nodules in the contour of the uterus?
myomas
205
What is a growth that can occur unilaterally or bilaterally with smooth cyst?
ovarian cyst
206
What is a cause of marked pelvic tenderness, with tenderness and rigidity of the lower abdomen. A tender unilateral adnexa mass may indicate the site of pregnancy?
Ruptured tubal pregnancy
- surgical emergency
207
What is often caused by gonococcal and chlamydial infection that may be acute or chronic?
Pelvic inflammatory disease
208
What can produce very tender bilateral adnexal areas and fixed adnexal areas?
Acute PID
209
What is the inflammation or infection of the fallopian tube and associated with PID?
Salpingitis
210
What is a vaginal secretion that collects behind an imperforated hymen and manifested by small midline lower abdominal mass or small cysts between the labia?
Hydrocolops
- infants and children
211
What is vaginal discharge accompanied by warm, erythematous, and swollen vulvar tissue in infants and children?
Vulvovaginitis
212
What is common during pregnancy and may involve both the vulva and rectal area. Pressure from the pregnant uterus contributes to information?
Vulvar varicosities
213
What is caused by lack of estrogen. vaginal mucosa is dry and pale. vaginal discharge may be white, gray, green, or blood-tinged?
Atrophic vaginitis
214
What is a loop of cord that may advance with the presenting parts. usually occurs with rupture of the membrane?
Prolapse of the umbilical cord
215
The cervix may protrude how far into the vagina?
1-3 cm
216
Projection of the cervix greater than how many cm indicated pelvic or uterine mass?
3 cm
217
For a gonococcal culture specimen hold the cotton swab on the cervical os for how long?
10-30seconds
218
How do you spread the specimen from a gonococcal culture specimen?
Z pattern over the culture medium
219
What kind of swab is used for DNA probe for chlamydia and gonorrhea?
Dacron swab
220
How long do you rotate the dacron swab in the endocervical canal?
30 seconds
- swab is then place in reagent tube
221
How do you document location of masses in the breast?
- clock position
- distance from nipple
222
In women breasts extend from the what ribs to what ribs?
2-3 to 6-7 ribs
- sternal margin to midaxillary line
223
Female breast are composed of what type of tissue?
glandular and fibrous tissue
224
What muscles from the floor of the breasts?
- serratus anterior
- latissimus dorsi
- subscalpularis
- external oblique
- rectus abdominis
225
What is the vascular supply to the breasts?
lateral thoracic cavity
226
The breast are divided into how many segments?
5
- 4 quadrants
- tail of spence
227
Where does the greatest amount of granular tissue lie in the breasts?
Upper outer quadrant
228
What kinds of stimuli contract smooth muscles of the breasts and produces erection of the nipple and causes the lactiferous ducts to empty?
- tactile
- sensory
- autonomic
229
What are the 5 Ds related to nipple exams?
- discharge
- depression
- discoloration
- dermatologic
- deviation
230
What are benign cyst formation caused by ductal enlargement is associated with a long follicular or luteal phase of the menstrual cycle. the lesions are filled with fluid and usually bilateral and multiple?
Fibrocystic changes
231
What are benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process. account for the majority of breast tumor in young women?
Fibroadenoma
232
Malignant breast tumors have a peak incidence between what ages?
40 - 75
- normally occurring in women over 50
233
What do you suspect with mass or thickening in the breast, marked asymmetry, prominent unilateral veins, discoloration, peau d orange, ulcerations, dimpling, puckering, retraction of skin, fixed inversion or deviation in position of the nipples?
Breast cancer
234
What is a response to local injury of the breasts, firm, irregular mass, often appearing as an area of discoloration?
fat necrosis
235
What are benign 2-3 cm tumors of the subareolar ducts that occur singly or in multiples. A common cause of serous or bloddy nipple discharge?
- Intraductal papilloma
- papillomatosis
236
What is a surface manifestation of underlying ductal carcinoma. red scaling, crust patch forms on the nipple, areola, and surrounding skin. Lesions appear eczematous and usually unilateral.
Paget disease
237
What is a smooth, firm mobile, tender disk of breast tissue located behind the areola in males . Caused by hormones imbalance?
Gynecomastia
238
What is an inflammation of the sebaceous glands in the areola?
Retention cyst
239
What is lactation not associated with childbearing?
Galactorrhea
240
Galactorrhea are most commonly caused by what?
pituitary tumor
241
What other factors can cause galactorrhea?
- cushing sydrome
- hypoglycemia
- drugs such as phenothiazines, trycylics, antidepressants and estrogen
242
What is the inflammation and infection of the breast tissue characterized by sudden onset of swelling, tenderness, erythema, and heat. Usually the result of a staph infection and most common in lactating women?
Mastitis
243
What is the most commonly occurs in menopausal women. the subareolar duct become blocked with desquamating secretory epithelium, necrotic debris, nd chronic inflammatory?
Mammary duct ectasia
244
What should you suspect with recently developed unilateral nipple inversion?
malignancy
245
Where do supernumerary nipples present?
embryonic mammary ridge
246
What is the most common cause of secondary amenorrhea in premenopausal women?
pregnancy
247
What is the most common cause of maternal death during the first trimester?
undiagnosed or undetected ectopic pregnancy
248
What is the most popular method of birth control for couples who want no more children?
sterilization
249
What is the most effective method of emergency contraceptive?
copper-bearing IUD
250
What is the most common reason for discontinuing Nexplanon?
irregular bleeding
251
What is the most common cause of dyspareunia in premenopausal women?
vulvodynia
252
What is most common in young, nulliparous, sexually active women with multiple partners and is a leading cause of infertility and ectopic pregnancy?
pelvic inflammatory disease
253
What is the second most common cancer of the female reproductive tract?
adenocarcinoma of the endometrium
254
What is the most common benign neoplasm of the female genital tract?
- leiomyoma
- fibroid
- myoma
255
Once regular menses is established what is the most comon cause of ovulatory dysfunction?
AUB-O
256
What is the most common anovulation?
ovulatory dysfunction
257
What nipple discharge is most likely benign fibrocystic changes like duct ectasia?
Serous
258
What kind of nipple discharge is most likely non neoplastic (endocrine in etiology) ?
Bilateral
259
What kind of discharge is more likely neoplastic or carcinoma?
bloody
260
Nipple discharge with an associated mass is more likely what?
neoplastic
261
Unilateral nipple discharge is most likely?
neoplastic or non-neoplastic
262
What is the most reliable indicator of prognosis for female breast carcinoma?
stage
263
What is the most reliable means of detecting breast cancer before a mass can be palpable?
Mammography
264
Most slow growing cancers can be identified by mammography at least how many years before the mass is palpable?
2 years
265
What is the most significant risk factor for female breast carcinoma?
Age
- Risk rapidly rises until early 60s and peaks in 70s then declines
266
What is the most common cancer in women and effects every 1-8 in American women?
female breast carcinoma
267
What is a common benign neoplasm most frequently occurs in young women and usually discovered incidentally?
Fibroadenoma
268
Fibroadenoma usually occurs within how many years after puberty?
20 years
269
What is the most frequent lesion of the breast?
fibrocystic changes
270
What is the most common age for fibrocystic changes?
30-50
271
What is the diagnostic testing for fibrocystic changes?
core needle biopsy
272
Normal menstrual bleeding last an average of how many days?
5 days
- range 2-7 days
273
What is blood loss over 80ml?
Menorrhagia
274
What is bleeding between periods?
Metrorrhagia
275
What is the mean blood loss per cycle?
40ml
276
What is bleeding that occurs more often than every 21 days?
Polymenorrhea
277
What is bleeding that occurs less frequently than every 35 days?
Oliomenorrhea
278
Abnormal uterine bleeding (AUB) used to be called what?
Dysfunctional uterine bleeding (DUB)
279
In adolescence AUB is usually the result of what?
Anovulation (not yet ovulating)
280
What is caused by immature hypothalamic-pituitary ovarian axis?
Most likely anovulation
281
AUB in women 19-39 is often the result of?
- pregnancy
- structural lesion
- anovulatory cycles
- hormonal contraceptive
- endometrial hyperplasia
282
The presence of blood clots or the degree of inconvenience caused by the bleeding serve as a useful indicator for what diagnosis?
AUB
283
A history of using warfarin, heparin, and exogenous hormones is indicative of what diagnoses?
AUB
284
What imaging is indicated for AUB?
- transvaginal ultrasound
- sonohysterography or hysteroacopy
285
How do you treat AUB-O?
- hormonal LT with progestin to oppose estrogen
- NSAIDS can reduce blood loss
286
Post menopausal bleeding is what? Until proven otherwise
Cancer
287
What is considered post menopausal bleeding?
Bleeding that occurs 6 months or more following cessation of menstrual cycle
288
What is an important tool in evaluating the etiology of bleeding in post menopausal women?
Transvaginal ultrasound
289
What is the recurrent variable cluster of troublesome physical and emotional symptoms that develop during the 5 days before the onset of menses and subside within 4 days after menstruation occurs?
Premenstrual syndrome (PMS)
290
What happens when emotional or mood symptoms predominate along with physical symptoms and there is a clear functional impairment with work or personal relationships.
Premenstrual dysphoric disorder (PMDD)
- may be thought of as complicated PMS
291
PMDD intermittently affects about what percentage of premenopausal women?
40%
292
What is the primary age for PMDD?
25-40
5-8% symptoms are severe
293
Patient suspected of PMDD should keep a diary of symptoms for how longs?
2-3 moths
294
In regards to PMDD of symptoms occurs throughout the month rather than in the two weeks before menses what is suspected?
- depression
- mental health issues
- may be in addition to PMDD/PMS
295
What vitamin is give as treatment for PMS/PMDD?
Vitamin D
296
What can be used to lessen symptoms of PMS/PMDD?
Medications that prevent ovulation
Combined oral contraceptives
- depo provera
- nexplanon
297
How can we treat mood symptoms in PMS/PMDD?
SSRI
- Paroxetine (Paxil)
298
What is inflammation and infection of the vagina and are common gynecological complaints?
Vaginitis
299
What can cause vaginitis?
- pathogens
- allergic reaction to contraceptive
- vaginal atrophy
- friction during coitus
300
Pregnancy, diabetes, and use of broad spectrum antibiotics or corticosteroids predispose patients to?
Vulvavaginal Candidiasis (yeast infection)
301
Pruitus, vulvavaginal erythema and white curd-like discharge that is NOT malodorous is indicative of what?
Candida Infection
302
What is a sexual transmitted protozoal flagellate infection?
Trichomonas Vaginalis Vaginitis
303
What infects the vagina, skene ducts, lower urinary tract in women and lower gu tract in men?
Trichomonas
304
Pruritus and malodorous frothy, yellow-green discharge occur, along with diffuse vaginal erythema and strawberry cervix?
Trichomonas
305
What is red macular lesions on the cervix that presents in severe cases of Trichomonas?
Strawberry cervix
306
What is a polymicrobial disease that is not sexually transmitted and may be chronic in nature? Overgrowth of gardenella and other anaerobes
Bacterial Vaginitis
307
What presents with malodorous discharge without obvious vulvitis or vaginitis
BV
308
Clue cells are indicative of?
BV
309
Vaginal pH greater than 4.5 in T is associated with?
BV
310
What is the treatment for Vulvovaginal Candidas?
Fluconazole (diflucan) antifungal
311
What is the treatment for Trichomonas?
Metronidazole (Flagyl) antibiotic
Treat both partners
312
What is the treatment for BV?
Metronidazole (Flagyl) antibiotic
313
What is the treatment for chlamydia?
Doxycycline
314
What is the treatment for gonorrhea?
Ceftriaxone (rocephin) cephalosporin
315
What is a periodic painful swelling on either side of the intoitus, dyspareunia, fluctuating swelling 1-4cm in diameter lateral to either labium minus? Tenderness is evidence of infection
Bartholins gland abscess
316
What can cause bartholins gland abscess?
- gonorrhea
- chlamydia
- polymicrobial
317
What is the treatment for bartholins gland’s abscess?
I and D
318
What is the treatment for bartholins gland abscess with the presents of cellulitis?
Antibiotics
319
What is the treatment for frequent recurring bartholins gland abscess?
Marsupilization
320
Women under what age do not require therapy for bartholins gland abscess unless large or cause problems with coitus?
40
321
Women over what age with a bartholins need a biopsy or removal to rule out vulva carcinoma?
40
322
What start in puberty because of hormonal influences and changes in the vaginal pH and tissue of the cervix and under goes cellular changes?
Cervical Dysplasia
323
What can lead to cervical cellular abnormalities and develop over a period of time?
Cervical dysplasia or cancer
324
What is the presence of abnormal cells?
Atypia
325
Cervical dysplasia is also called?
Cervical Intraepithelial neoplasia (CIN)
326
What is another word for dysplasia?
Neoplasia
327
What is the portion of the uterus that opens into the vagina, the neck of the uterus?
Cervix
328
Cervical cancer is vary rare in women under what age?
21
329
In immunocompetent women cervical cancer screening should begin at what age regardless of onset of intercourse?
21
330
US preventative service task force recommends screening for cervical cancer in women of what age? Every how many years?
- 21 to 65
- every 3 years
- 30 to 65
- every 5 years
331
Why does the USPSTF recommend against screening women for cervical cancer in conjunction with HPV in women younger that 30 y/o?
HPV can go away in younger women
332
What are the 3 diagnostic testing for cervical dysplasia?
- Papanicolaou smear
- Colposcopy
- Biopsy
333
What system is used to describe cervical finding of a pap?
Bethesda system
334
What is the Bethesda system composed of?
- atypical squamous cells of unknown significance (ASC-US)
- squamous intraepithelial lesions (SIL)
- low grade (LSIL)
- high grade (HSIL)
335
Women with ASC-US and a positive HPV need what?
Colposcopy
336
What is a diagnostic procedure used to provide illuminated, magnified view of the cervix, vagina, vulva, or anus
Colposcopy
337
What is necessary for diagnosis and planning treatment of cervical dysplasia?
Colposcopically directed punch biopsy and enforcer vocal curettage
338
What treatment for cervical dysplasia is effective for noninvasive small lesions visible on the cervix?
Cryosurgery
339
What treatment for cervical dysplasia minimizes tissue destruction and is colopscopically directed?
CO2 Laser
340
What treatment for cervical dysplasia uses a wire loop for excision
LEEP
- loop electrosurgical excision
341
What treatment for cervical dysplasia is reserved for cases of severe dysplasia or cancer?
Conization of the cervix
342
What has describe, round, firm often multiple uterine tumors composed of smooth muscle and connective tissue that may cause miscarriages and pregnancy complications because they interfere with implantation?
Leiomyoma (fibroid tumor)
343
Leiomyoma affects what layer of the uterus?
Myometrium
344
What is defines by the endometrium growing into the myometrium?
Adenomyosis
345
What imaging is indicated for pelvic mass?
- transvaginal ultrasound
- MRI with contrast
- hysterogrphy or hysterscope
346
What is used to assess location within muscle and blood flow of pelvic tumors?
MRI with contrast
347
What is used to confirm presence and monitor growth of pelvic mass?
Tranvaginal ultrasound
348
What is the treatment for an acute torsion on a pedi cluster myoma?
Emergency surgery
349
What can help decrease bleeding associated with fibroids?
LNG IUD
350
What can be used to reduce volume, size and menstrual blood loss associated with pelvic masses?
Hormonal therapy
351
What is the definitive and curative treatment for pelvic mass?
Surgical therapy
352
Abnormal uterine bleeding is the presenting sign in 90% of what cases?
Carcinoma of the endometrium
353
All post menopausal bleeding requires evaluation for what?
Carcinoma of the endometrium
354
After a negative pregnancy test what is need to confirm carcinoma of the endometrium?
Endometrial tissue
355
Adenocarcinoma of the endometrium most often affects women of what age?
50-70
356
What is the imaging used for carcinoma of the endometrium?
- vaginal ultrasound
- hysterectomy
357
What is the treatment for carcinoma of the endometrium?
- surgery
- post op radiation
- chemotherapy
358
What is the strongest predictor of prognosis in carcinoma of the endometrium?
Depth of cancer invasion into myometrium
<66% = 98%
>66% = 78%
359
What is the ectopic growth of the endometrium outside the uterus, particularly in the dependent parts of the pelvis and in the ovaries?
Principal manifestations are chronic pain and infertility
Endometriosis
360
What can present with tender nodules in the cul-de-sac or rectovaginal septum, cervical motion tenderness and adnexal mass or tenderness?
Endometriosis
361
What is the definitive diagnosis of endometriosis?
Histology of lesions removed at surgery (Laparoscopy)
362
What presents with lesions typically located in the pelvis but can include bowel or diaphragm?
Endometriosis
363
What imaging is used for endometriosis?
Transvaginal ultrasound
364
What is the treatment for endometriosis?
- NSAIDS
- hormone therapy
- inhibit ovulation for 4-9 months
365
What are the commonly used regimes for endometriosis?
- low dose combined oral contraceptive
- contraceptive patch
- vaginal ring
- progestins
- progestin intrauterine device
366
What surgical intervention is effective in reducing pain and promoting fertility for endometriosis?
Larporoscopic ablation of endometrial implants
367
What is definitive therapy for those with intractable pelvic pain, adnexal masses, or multiple previous ineffective surgical procedures in regards to endometriosis?
Hysterectomy with bilateral saplingo oophorectomy
368
What is associated with post coidal bleeding, urinary urgency, and low back pain?
PID
369
What is the imaging of choice for PID?
- vaginal ultrasound
- laparoscopy
370
What can be used to diagnose PID?
Laparoscopy
371
What is the treatment for PID?
- cefoxtin (mefoxtin)
- ceftriaxone
- metronidazole
372
What is the treatment for severe PID
- cefoxitin (medicine) and doxycycline
373
What is a complication of PID?
Tubo-ovarian abscess
374
What is the leading cause of death from reproductive tract?
Malignant ovarian tumors
375
What are the lab findings for ovarian mass?
- tumor marker
- cancer antigen 125
- HCG
- lactate dehydrogenase
- alpha fetoprotein
376
What imaging should be ordered for pelvic mass?
Transvaginal ultrasound
Color doppler may further enhance specificity
377
What is the treatment for malignant ovarian mass?
- hysterectomy
- bilateral salpingoophorectomy
- omentectomy
- selective lymphadenopathy
- chemotherapy
378
What is treatment for benign ovarian neoplasm?
Removal or unilateral oopherectomy
379
What is a common endocrine disorder effecting 5-10% of reproductive age women?
Polycystic ovarian syndrome (PCOS)
380
What is characterized by chronic anovulation with abnormal menses, polycystic ovaries, and hyperandrogenism?
PCOS
381
What is associated with hirsutism, obesity, increased risk for diabetes and cardiovascular disease, increased risk of endometrial cancer to unopposed estrogen secretion?
PCOS
382
What presents with menstrual disorder, infertility, skin disorders, and insulin resistance?
PCOS
383
What labs should be ordered for PCOS?
- FSH
- LH
- prolactin
- TSH
- A1 C
- lipid panel
384
What imaging is used for PCOS?
Tranvaginal ultrasounds
385
What is the treatment for PCOS?
- weight loss and exercise
- metformin therapy
- combine contraceptives, LNG IUD
- treatment of hirsutism
386
What is a type of sexual pain disorder with recurrent or persistent genital pain associated with sexual intercourse that is not associated with lack of lubrication or vaginismus?
Dyspareunia
387
What is a sexual pain disorder with recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina?
vaginismus
388
What sexual pain disorder results fear, pain, sexual violence, or a negative attitude towards sex?
vaginismus
389
What is the initial treatment for Vaginismus?
sexual counseling and education
- Botox injections on refractory cases
390
What is the treatment for vulvodynia?
- topical agent and topical anesthetics
- tricyclic antidepressants
- SSRIs
- gabapentin
- physical therapy
391
What is the normal minimum amount of sexual act per week in regard to infertility?
2 per week
392
What percentage of couples experience infertility?
25%
393
The decline in fertility in women begins at what age?
early 30s
- accelerates late 30s
394
Male partners contribute to what percentage of infertility cases?
40%
395
In the absence of identifiable causes what percentage of couples will achieve pregnancy within how many years?
- 60%
- 3 years
396
Couples with unexplained infertility who do not achieve pregnancy within 3 years may be offered what?
- ovulation induction
- assisted reproductive technology such as IVF
- women over the age of 35 are offered a more aggressive approach
397
What percentage of the 213 million pregnancies in 2012 were unitended?
40%
- 50% aborted
- 13 percentage miscarriage
- 38% unplanned births
398
What is the mechanism of action for combined oral contraceptives?
Suppression of ovulation by inhibiting GnRH, LH, FSH, and the mid cycle LH surge
399
The suppression of FSH prevents what?
folliculogenesis
400
What oral contraceptive effect the endometrium rendering less suitable for implantation, thickening of the cervical mucus to prevent penetration by sperm and impairment of normal tubal motility and peristalsis which alters ovum transport?
progestin
401
What is the perfect use failure rate for oral contraceptive?
0.3%
402
What is the typical use failure rate for oral contraceptive?
8%
403
Oral contraceptive is ideally started on what days of the menstrual cycle?
- day 1
- first Sunday after the onset of the cycle
- any day of the cycle
404
If oral contraceptive is started on any other day than the first day of the cycle what should be used?
a backup method for the first month
405
If an active pill is missed at any time, and no intercourse occurred in the past 5 days what should be done?
2 pills should be taken immediately and a backup method should be used for 7 days
406
If intercourse occurred within the previous 5 days of a missed pill what should be done?
- emergency contraceptive used immediately
- pills restarted the following day
- back up method used for 5 days
407
What is the mechanism of action for the progestin minipill?
effects the endometrium rendering less suitable for implantation, thickening of the cervical mucus to prevent penetration by sperm and impairment of normal tubal motility and peristalsis which alters ovum transport.
408
What oral contraceptive is safe for patients over 35?
minipill
409
What oral contraceptive has a low dose of progestin and absence of estrogen making it safe during lactation and might increase flow of milks?
minipill
410
What form of contraception is associated with bone mineral loss, initial irregular bleeding that subsequently develop into amenorrhea, and ovulation delay?
injectable long acting progestins
411
Injectable progestin- DMPA is given intramuscularly or subcutaneous how often?
every 3 months (11-13 weeks)
412
What is a single rod progestin implant inserted into the proximal aspect of the nondominant arm?
Nexplonon
- Etonogestrel
- no delay in return to fertility
413
What is othro evra?
transdermal contraceptive patch
414
The transdermal patch is the combination of what 2 hormones?
estrogen and progestin
415
Where is the transdermal patch applied?
- lower abdomen
- upper torso
- buttocks
416
What is the timeline for the transdermal contraceptive?
3 weeks consecutively on then 1 week off
417
Discontinuation for side effects is more frequent in what form of contraceptive?
transndermal
418
What is a soft and flexible and is placed in the upper part of the vagina for 3 weeks removed and replaced after 1 week?
NuvaRing
- Contraceptive vaginal ring
- can also be removed and replaced after 4 weeks for continuous cycling
419
What form of contraception will have increased incidences of vaginal discharge?
NuvaRing
420
What form of contraception is highly effective with failure rates similar to those achieved with surgical sterilization?
Intrauterine devices
421
What are the two types of intrauterine contraceptives?
- Levonorgestrel (LNG) releasing
- Copper Bearing (Parafard)
422
When can an IUD be placed?
- during or after menses
- at mid cycle to prevent implantation
- or later in the cycle if the patient has not become pregnant
423
When can a copper IUD be placed as post coital contraceptive?
5 days following a single episode of unprotected sex
424
Women using an IUD who become pregnant should?
have the IUD removed if string is visible
425
IUD is contraindicated in what women?
pregnant
426
What risk is increased during the first month of IUD placement?
Pelvic infection
427
What is transcervical strings that cannot be visualized on pelvic exams concerning of?
unnoticed expulsion or migration through the uterus into the abdomen
- pelvic ultrasound
- gynecology referral
428
What is the failure rate among couples that use condoms properly?
18%
- only 2% become pregnant after 1 year
429
Latex and polyurethane condoms offer protection against STD. What kind of condoms dont?
animal membrane
430
What is the failure rate for female condoms?
5-21%
431
What is the only control method of birth control that offers significant protection from both pregnancy and STDs?
Female condom
432
What is contraception based on awareness of fertility periods?
-couple restrict intercourse to the post ovulatory phase and use barrier methods at other times
- Symptom thermal natural family planning
- calendar method
- basal body temperature method
433
What form of contraceptive planning is based on patients monitoring their cyclic physical and temperature changes?
Syntomtothermal natural family planning
434
What is brief abdominal midcycle discomfort?
mittelschmerz
435
What form of family planning observes clear elastic cervical mucous?
Syntomtothermal natural family planning
436
What method of contraception uses the length of the menstrual cycle after being observed for at least 8 months the calculation are made to determine fertile periods?
Calendar method
437
What form of contraception indicates when it is safe time for intercourse after ovulation has passed?
basal body temperature method
438
A slight drop in temperature often occurs how many hours before ovulation?
12-24 hours
- a rise of about 0.4 Celsius occurs 1-2 days after ovulation
439
The risk for pregnancy increase starting how many days prior to ovulation?
5 days
- rapidly decreases to zero by the day after ovulation
440
I unprotected intercourse occurs in midcycle what methods are effective in preventing implantation?
- Levonorgestrel
- Combination oral contraception
- Ulipristal (Ella)
- IUD
441
The methods of emergency contraception should be started as soon as possible and with how many hours after unprotected coitus?
120 hours (5 days)
442
What form of emergency contraceptive is available over the counter for women 17 or older, has a 1% failure rate when taken within 72 hours after coitus, and an efficacy up to 120 hours after intercourse?
Levonorgestrel (plan b)
443
What form of emergency contraceptive contains ethinyl estradiol, Levonorgestrel, given twice in 12 hours, used within 72 hours has a failure rate of 3% and usually anti nausea medication are necessary?
combination oral contraceptive
444
What form of emergency contraception is more effective than Levonorgestrel especially when used between 72 and 120 hours, partially among overweight women?
Ulipristal
445
What form of emergency contraception can be used after one episode of unprotected midcycle coitus?
IUD
- copper most effective
446
What is the premature expulsion of products of contraception from the uterus usually occurring before the 20th week? can be elective or spontaneous
abortion
447
What navy references cover abortions?
- BUMEDINST 6300.16 series
- OPNAVINST 6000.1 series
448
The DoD prohibits the use of DoD facilities and funds to perform abortions unless under what conditions?
- pregnancy threating to service member
- pregnancy was a result of rape
449
What is the sterilizing procedure where the vas deferens is severed and sealed through a scrotal incision under local anesthesia?
Vasectomy
- follow up semen analysis at 3 months to confirm sterility
450
Female sterilization is most often achieved by what process?
tubal ligation
tubes can be clipped, clamped, cauterized, tied, or cut
451
What form of contraception/sterilization prevents an ovulated ovum from reaching the uterus and prevents the sperm from reaching the unfertalized ovum?
tube ligation
- female sterilization
452
What are the references for sexual assault?
- SECNAVINST 1752.4 SERIES
- BUMEDINST 6310.11 SERIES
- COMNAVSURFLANT/COMNAVSURFPACINST 6000.1
- COMUSFLTFORCOM/COMPACFLTINST 6310.2 SERIES
453
What is the treatment for sexual assault?
MEDEVAC
454
The rape trauma syndrome comprises of what two principles?
- immediate or acute
- late or chronic
455
What are the repeat labs for sexual assault?
- HCG
- HIV, 2-4 months
- RPR, 16 weeks
- GC
- Chlamydia
456
What are the times spans for HIV and RPR in regards to sexual assault?
- HIVE, 2-4 months
- RPR, 16 weeks
457
What is the navy instruction for pregnancy?
OPNAVINST 6000.1
458
What is the perception of first movement noted about the 18th week of pregnancy?
Quickening
459
When is the uterine fundus palpable above the pubic symphysis?
12-15 weeks
- reaches unbilicus 20-22 weeks
460
Fetal heart tones can be heard by doppler at what weeks of gestation?
8-10 weeks
461
What is used to confirm intrauterine pregnancy?
transvaginal ultrasound
462
Pregnant service members may serve aboard ships until what week of pregnancy?
20th week
463
What percentage of all clinically recognized pregnancies terminate spontanously?
20%
464
Pregnancy loss
- bleeding or cramping occurs, but pregnancy continuous
- the cervix is not dilated
threatened abortion
465
Pregnancy loss
- products of conception are completely expelled
- pain ceases, but spotting may persist
- cervical os is closed, some blood in the vaginal vault
Complete abortion
466
Pregnancy loss
- cervix is dilated
- some portion of the products of conception remain in uterus
- only mild cramping
- bleeding is persistent and often excessive
incomplete abortion
467
Pregnancy loss
- brownish vaginal discharge but no active bleeding
- cervix is slightly firm and slightly patulous
- abortifacient and curettage
missed abortion
468
What is the treatment for pregnancy loss?
- medevac
- if product of conception are visible remove and place in specimen bottle
- acetaminophen
- narcotics
469
Any female with vaginal bleeding, positive HCG and abdominal pain is considered?
ectopic pregnancy until proven otherwise
470
Ectopic pregnancy occurs in what percentage of first trimester pregnancies?
2%
471
Qualitative HCG levels with be greatly lower in what kinds of pregnancies?
ectopic pregnancies
472
What is the surgical procedure of choice to confirm and remove ectopic pregnancies?
laparoscopy
473
When patients is stable with an early ectopic pregnancy what medication can be used?
Methotrexate IM
474
Anyone with suspected ectopic pregnancy should have emergent referral to where?
obstetrics
475
What is usually the causative factor of mastitis?
staphylococcus
476
What is indicated in nonlactating women when nonresponsive to antibiotics?
biopsy
477
What occurs sporadically in nursing mothers, usually with symptoms onset after discharge from the hospital?
postpartum mastitis
478
Postpartum mastitis freguently begins within how many months after delivery?
3 months
479
What presents with engored breast and sore or fissured nipples? celulitis is typically unilateral. fevr and chills
mastitis
480
What labs are indicated for mastitis?
CBC for leukocytosis
481
What imaging is indicated for mastitis?
breast ultrasound
482
What is the treatment for mastitis? MSSA
- cephalexin (Keflex)
- clindamycin
483
What is the treatment for mastitis? MRSA
Trimethoprim/sulfamethoxazole (Bactrim)
-regular emptying of the breast
- nursing of the breast on the affected side is safe
484
What is the preferred NSAID for pain and inflammation for lactation??
Motrin
485
What is defined as the failure for menarche to appear?
primary amenorrhea
486
What is the absence of menses for 3 consecutive months in women who have passed menarche??
secondary amenorrhea
487
What is the terminal episode of naturally occurring amenorrhea
- retrospective diagnosis
- usually after 6 months of amenorrhea
Menopause
488
What causes functional amenorhea?
hypothalamic-pituitary causes
- low levels of GnRH affecting FSH and LH levels
489
What etiologies can cause amenorhea?
- pregnancy
- hypothalamic-pituitary causes
- hyperandrogenism
- uterine causes
- premature ovarian failure
- menopause
490
What is considered early menopause?
before 45
491
What is considered premature menopause?
before 40
492
What is elevated testosterone levels?
hyperandrogenism
493
What is the normal age range for menopause?
48-55
494
What labs are indicated for amenorrhea?
- HCG
- FSH
- LH
- TSH
- Prolactin
- testosterone if hirsutism or virilization is present
495
What imaging in indicated with amenorhea?
transvaginal ultrasound
- confirm pregnancy
- identify PCOS
MRI if pituitary tumor is suspected
496
What is the treatment amenorhea?
- no estrogen therapy
- estrogen replacement therapy
497
What women have
- 50% increased chance of CAD
- 23% increased risk of stroke
- 12% increased risk of overall mortality
with what predisposing factor?
premature menopause
498
What is a surgical emergency that is almost always associated with ovarian enlargements, requires prompt diagnosis and is an ischemic condition?
ovarian torsion
499
Nearly what percentage of torsion happen on the right side? and why?
70%
- increased length of the utero-ovarian ligament on the right side
500
Ovarian torsion may involve just the ovary or?
the ovary and the oviduct ( adnexal torsion )
501
What are the classic symptoms of ovarian torsion?
- sudden onset severe unilateral abdominal pain
- develops after episode of exertion or athletics
- nausea and vomiting
502
What presents with unilateral lower abdominal pain with guarding, unilateral adnexal tenderness upon bimanual exam, possible palpable adnexal mass?
ovarian torsion
503
What is the imaging of choice for ovarian torsion?
transvaginal ultrasound with doppler
504
What are lab finding on CBC with ovarian torsion?
- amenia
- leukocytosis with necrosis
505
What is the treatment for ovarian torsion?
prompt gynecological surgical procedure
506
How many times do you swab the female with a swab soaked in antiseptic? in regard to cauterization?
4-5
507
How many times do you swab the male with a swab soaked in antiseptic? in regard to cauterization?
3-4
508
Where do you advance the catheter in a male?
hilt
509
For females advance the catheter until urine returns then?
advance 4-5cm(1-2in) further to make sure balloon is well within bladder
510
in males the urethra leaves the bladder at the?
trigone
511
What lies in the superior fornix of the vulva, above the vaginal opening and below the clitoris and appears as small dimple or slit in the midline?
urethral meatus
512
What size syringe is used for catheterization?
10 mL
