Gynecology Flashcards
1) Conception, Implantation, Placentation
- Where does fertilization occur?
- What is 16 cell stage called?
- What happens during placentation?
-Fallopian tube
-Morula
- Trophoblasts create placental disc and chorionic membranes
2) Gyn evaluation
- Goal of colpopscopy?
- Pap smear?
- Why more white with acetic acid?
- Distinguish normal from abnormal appearing tissue
- Look for changes in the cells that show cancerous or precancerous lesions
- Higher nuclear density (biopsy)
2) Bimanual examination:
- Size, nature of uterus, adnexal masses
- Mobility and tenderness
2) Obstetric evaluation
- First visit?
- and then?
- Naegele´s rule?
- Bw week 6 and 8
- Until w28: every 4th
- Until w35: every 2nd
- Until birth: weekly
- To calculate due date:
First day of last mens - 3 months + 7 days (add 1 year)
2) Obstetric evaluation
- Gravidity (G)?
- Parity?
- Low levels HCG?
- High levels HCG?
- Which 3 tests is important to perform?
- Total number of pregnancies
- TPAL
T: term delivered
P: premature delivered
A: abortions #
L: Living children - Ectopic pregnancy, abortion, inaccurate dates
- Multiple gestation, molar pregnancy, trisomy 21, inaccurate dates
- Urinalysis, urine culture and dental examination
3) Endocrinology
- List hormones
- hCG
- Estrogen
- Progesterone
- hPL
- Prolactin
- Oxytocin
- Relaxin
- Cortisol
- Thyroid - TSH, T4
6) Changes in pregnancy
- Which three physiological changes are seen in the circulatory system?
- Increased metabolic demands
- Expansion of vascular channels
- Increase in steroid hormones
6) Changes in pregnancy
- Which three factors are involved when there are changes seen in the respiratory system?
- The mechanical effect of the enlarging uterus
- The increased total body O2 consumption
- The respiratory stimulant effects of progesterone
8) HTN
- Diagnosis og HTN
- How do we classify it?
- 140/90 mmHg
- Preexisting or gestational
8) HTN
- What is transient HTN?
- What is essential HTN?
- Transient: >140/90 occurring before 20 weeks of gestation, non-sustained with no symptoms
- Essential: >140/90 occurring before 20 weeks of gestation, and persisting 7 weeks postpartum
8) HTN
- Essential HTN can lead to?
- Treatment of essential HTN?
- Gestational HTN, abruptio placenta, IUGR, intrauterine fetal demise
- alpha-methyldopa, beta-blockers or Ca-channel blockers
8) HTN
- What is gestational HTN?
- What is preeclampsia?
- Gestational: >140/90 developing after 20 weeks of gestation and return to normal after 12 weeks postpartum
(tx. same as essential)
- Preeclampsia: developing after 20 weeks.
Mild: >140/90 mmHg + proteinuria (300mg/day)
Severe: >140/90 mmHg + proteinuria >5g/day
8) HTN
What is eclampsia?
Unexplained general seizures in a woman with preeclampsia
8) HTN
Risk factors for preeclampsia?
- Nulliparity
- Multifetal pregnancy
- Family history
- First conception with a new partner
- <18 or >35
- DM
- Obesity
8) HTN
- Triad of preeclampsia?
- Other symptoms?
1) New onset HTN
2) Proteinuria
3) Edema (non-dependent)
- Headache
- Petechiae and other signs of coagulopathy
- Nausea, vomiting
Vasospasm: - Visual disturbance
- RUQ pain (due to liver)
- Oliguria w/ proteinuria
8) HTN
- Tx other than delivery?
- g. age >37 weeks: Magnesium sulfate and deliver
- g. age <37 weeks: risk/benefit. If premature but can be delivered give CS, magnesium and b-blocker/ca-ch. bl.
8) HTN
- What is HELLP syndrome?
- Stand for?
- Most common presenting sign?
- A variant of severe preeclampsia w/ high mortality
(HTN may be absent) - Hemolysis, elevated Liver enzymes, Low Platelets
- Epigatric/RUQ pain
8) HTN
Symptoms of HELLP
- Blurry vision
- Chest pain
- Headache, fatigue
- Nausea
- Quiet weight gain and swelling
8) HTN
What is the Mississippi classification?
LDH > 600 U/L +
ASAT and/or ALAT > 40 U/L +
Class I: platelets < 50.000
Class II: 50.000-100.000
Class III: 100.000-150.000
9) Pregnancy sy
Which 3 categories do we divide into?
1) Presumptive
2) Probable
3) Definite
9)
What are presumtive signs associated with primarily?
What presumptive signs do we have?
- Primarily those associated with skin and mucous membrane changes
- Discoloration and cyanosis of the vulva, vagina and cervix
- Pigmentation of the skin and abodmen
- Nausea, vomiting
What is chadwick´s sign?
Bluish discoloration of the cervix and the vagina due to pelvic engorgement (6th week)
What are probable signs of pregnancy?
- Uterine enlargement
- Breast engorgement
- Piscacek sign
- Goodell´s sign
- Hegar´s sign
- Positive home urine pregnancy test
What is Piscacek sign?
Soft prominence over the site of implantation
What is Goodell´s sign?
Softening of the cervix (4-6 weeks)
What is Hegar´s sign?
Softening of the cervical isthmus (6-8 weeks)
What are definite signs of pregnancy?
Detection of fetal heart beat
Detection of movement
Late signs and symptoms in pregnancy?
Difficulty sleeping
IVC sy.
Galactorrhea
Edema
Fetal movement
Constipation
Weight gain
Tachypnea
When can you usually feel fetal movement?
After 18-20 weeks
What is normal weight gain?
9-14 kg
How do you determine gestational age with US?
Measure crown-rump length between 6-11th week
Triple marker screen test:
Down syndrome
afp: low
Estriol: low
hCG: high
Triple marker screen test:
Edwards sy.
afp: low
Estriol: low
hCG: low
Triple marker screen test:
NT defect
afp: high
Estriol: N/A
hCG: N/A
What does Nuchal tranlucency test measure?
Thickness of nuchal fold
Gestational diabetes screening?
GBS screening?
24-28 weeks
35-37 weeks
Which classification is used for GDM?
White classification
When is the GDM screening?
24-28 weeks
What is step 1 in GDM testing?
What is abnormal?
- 50 g, 1hr oral glucose challenge test OGCT
- > 7.2-7.8 mmol/L
if higher than 11.1 mmol/L, OGTT not necessary
What is step 2 in GDM testing?
Measure fasting first, then:
3h, 100g oral glucose tolerance test (OGTT)
When is the patient diagnosed w GDM?
> = 2 abnormal values:
Fasting >= 5.3 mmol/L
1h >= 10 mmol/L
2h >= 8.6 mmol/L
3h >= 7.8 mmol/L
Poorly controlled preexisting diabetes during organogenesis may lead to?
Poorly controlled diabetes later in pregnancy may lead to?
- congenital malformations, spontaneous abortion
- fetal macrosomia, preeclampsia, spontaneous abortion, shoulder dystocia, arrested labor
After kidney transplant which condittions must be present?
1) Kidney has been in place for two years
2) Normal renal function
3) No episodes of rejection
4) Normal BP
What risks are related to UTI or asymptomatic bacteriuria?
Increases risk of preterm labor
Premature rupture of membranes
Tx for asymptomatic baceriuria?
Oral nitrofurantoin
Tx UTI pregnancy?
Cephalexin
Nitrofurantoin
TMP/SMX (avoid: 1st trim/3rd trim)
What is hyperemesis gravidarum?
persisten nausea and vomiting in pregnancy associated w/ ketosis and loss of >5% pre-pregnancy body weight
