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STEP 2 CK > OB > Flashcards

Flashcards in OB Deck (283):
1

No vaginal bleeding, closed cervical os, no fetal cardiac activity, empty sac

Missed

2

Vaginal bleeding, closed cervical os, fetal cardiac activity

Threatened

3

Vaginal bleeding, dilated cervical os, products of conception may be seen or felt at or above cervical os

Inevitable

4

Vaginal bleeding, dilated cervical os, some products of conception expelled & some remain

Incomplete

5

Vaginal bleeding or none, closed cervical os, products of conception completely expelled

Complete

6

Heavy menses, constipation, urinary frequency, pelvic pain/heaviness, enlarged uterus

Fibroids

7

Dysmenorrhea, pelvic pain, heavy menses, bulky, globular & tender uterus

Adenomyosis

8

Obesity, no kids, chronic anovulation, irregular bleeding, intermenstrual bleeding, or postmenopausal bleeding, nontender uterus

Endometrial cancer/ hyperplasia

9

No cervical change for > or = 4 hours with adequate contractions

Labor arrest get a C-section

10

No cervical change for > or = 6 hours with inadequate contractions

Labor arrest get a C-section

11

Cervical change slower than expected?

Oxytocin

12

MC cause of labor protraction

contraction inadequacy

13

MC ovarian cancer in postmenopausal women? Tx?

Epithelial ovarian carcinoma. Vague sx. Pleural effusion and rectovaginal nodularity = mets. Tx: Ex Lap

14

Nagle Rule

Subtract 3 months from last period and add 7 days = date of birth.

15

Preterm

25-37 weeks

16

Early term

37 wks - 38 wk and 6 days

17

Full Term

39 weeks - 40 wks and 6 days

18

Late Term

41wks - 41wks and 6 days

19

Post Term

after 42 weeks

20

Previabile

before 24 weeks

21

First sign of pregnancy on physical exam. Where cervix softens.

Goodell's Sign happens at 4 weeks

22

Ladin Sign

Midline uterus softens at 6 weeks

23

Chadwick Sign

Blue discoloration of vagina and cervix 6-8wks

24

the "mask of pregnancy" hyperpigmentation of the face. Can worsen with sun exposure

Cholasma 16 weeks

25

When does a pregnant women develop telangiectasias

First Trimester - develop in palms

26

Fist trimester

14 wks GA 12 weeks DA

27

2nd trimester

24 weeks DA and 26 weeks GA

28

When can a gestational sack be seen on US? What's the Beta HCG

5 weeks or Beta-HCG of 1000-1500 or higher. (go with 1500 if have to pick)

29

Beta HCG has increased to 20,000-30,000 what trimester is it

3rd

30

Beta HCG is dropping, what trimester is it

2nd

31

Changes in Cardiology when pregnant?

Increased CO (increased HR) and decreased BP (slightly)

32

GI changes when pregnant?

Morning sickness (from incerased E and P, and HCG from placenta), GERD, and Constipation (Decreased colon motility)

33

Renal changes when pregnant

Increased risk of pyelo due to increase in kidney and ureter size. Bigger uterus can compress ureters. Increases GFR

34

Hematology when prego

Anemic (from increased plasma), Hypercoaguable

35

First Trimester... What happens?

See pt every 4-6 weeks. Get a US between 11 and 14wks. Hear heart at end of trimester. Get bloodwork, pap, and gonorrhea/chlamydia. Screening if desired.

36

Most precise time to get fetus age?

US first trimester

37

2nd Trimester... what happens?

Screen for genetic and congenital problems at 15-20weeks (triple or quad screen). Auscultate fetal heart rate. 16-20wks quickening (feel fetal movement 1st time), multiparous may feel sooner. 18-20wks routine US for malformation.

38

Quad Screen

Use MSAFP, Beta-HCG, Estriol, and Inhibin A(neural tube or abdominal wall defect) Looking for Downs.

39

Third Trimester... what happens?

Visits every 2-3 weeks. After 36 weeks you visit every week. Get a CBC at week 27 (replace Fe orally as needed). Get a glucose load (at 24-28wk) if high confirm with oral glucose tolerance test. Cervical cultures for Chlamydia/ Gonorrhea and GBS at 36 weeks.

40

3rd Trimester contractions. Sporadic and no cervical dilation

Braxton Hicks contractions

41

If Braxton Hicks Contractions become regular, what do you do?

Check cervix to rule out preterm labor before 37 weeks. If preterm labor, cervix will be open.

42

How do you treat GBS

Prophylactic abx during labor

43

When do you treat Chlamydia and Gonorrhea when prego

Treat it when you see it. Get it out of there!

44

A test done at 10-13 weeks in advanced maternal age or known genetic disease in parent.

Chorionic Villus Sampling

45

Chorionic Villus Sampling

10-13wks, obtains Karyotype, catheter into intrauterine cavity to aspirate chorionic villi from placenta (transabdominally or transvaginally)

46

Done after 11-14 weeks for advanced maternal age or known genetic disease in parent

Amniocentesis (gives fetal karyotype. Needle transabdominally into amniotic sac

47

When do you get a fetal blood sample?

Patients w/ Rh isoimmunization and when a fetal CBC is needed. Needle transabdominally into uterus to get blood from umbilical cord

48

Where does ectopic pregnancy usually implant?

Ampulla of the fallopian tube

49

Ectopic pregnancy risk factors?

PID, Intrauterine Devices, Previous ectopic pregnancies

50

Strongest risk factor for Ectopic Pregnancy?

Previous Ectopic Pregnancies

51

test for ectopic pregnancy?

Beta-HCG, US (location), Laparoscopy (removal)

52

If suspect Ectopic, what meds?

1 dose of methotrexate (follow for 4-7 days). Watch for a 15% decrease. If no decrease give another dose. If no decrease... surgerize. Follow until Beta-HCG is zero.

53

If giving methotrexate... what labs should you follow

Transaminases to detet changes indicating hepatotoxicity

54

When to avoid methotrexate for ectopic treatment?

Immunodeficient, noncompliant, Liver problems, If ectopic is 3.5cm or larger. If you can auscultate a fetal heartbeat.

55

Surgery treatment for ectopic pregnancy?

Salpingostomy (cut whole in fallopian tube to preserve it). Do a salpingectomy if needed and just remove it all. If mom is Rh negative, give her Rhogam so that other pregnancies won't be affected.

56

Pregnancy that ends before 20 weeks or a fetus <500g

Abortion

57

When do most spontaneous abortions occur?

before 12 weeks (60-80% due to chromosomal problems)

58

Maternal factors that increase risk of abortion?

Anatomic abnormalities, STDs, Antiphospholipid Syndrome, Endocrine (DM or Hyperthyroid), Malnutrition, Trauma, Rh isoimmunization

59

Prego with crampy abdominal pain and vaginal bleeding. What do you need to be thinking about?

Abortion

60

How do you distinguish the different types of abortions?

GET A US!!! MUST GET IT!!! need to get a CBC for blood loss and Blood type for Rh, but US makes the diagnosis.

61

Complete Abortion treatment

F/U in office

62

Incomplete Abortion treatment

Dilation and curettage (D&C/medical)

63

Inevitable Abortion treatment

D&C/ medical

64

Threatened Abortion

Bed rest, pelvic rest

65

Missed Abortion

D&C/ medical

66

Septic Abortion

D&C and IV antibiotics, such as levofloxacin and metronidazole

67

Mom has big uterus, rapid weight gain, and incresed beta-HCG and MSAFP (higher than expected for gestational age)

CONGRATULATIONS! You have twins! Drinks for everyone!!! Except you, cause you're pregnant.

68

Monozygotic

1 egg and 1 sperm that split. Identical Twins

69

Dizygotic

2 eggs and 2 sperm. Fraternal Twins

70

Complications/ Risks for twins (or more) in utero

Spontaneous abortion of one fetus, premature labor and delivery, placenta previa, anemia

71

Number 1 risk factor for preterm labor

Other preterm labor

72

Contractions, dilation of cervix, (between 20-37wks)

Preterm Labor

73

Evaluation of fetus in preterm labor?

weight, GA, and presenting part (Cephalic vs. breech)

74

When do you not stop preterm labor?

Preeclampsia/eclampsia, Maternal cardiac disease, cervical dilation >4cm, Maternal hemorrhage (abruptio placenta, DIC), fetal death, or chroioamnionitis

75

When do you stop preterm delivery?

If 24-33 Estimated GA and 600-2500g

76

How do you stop preterm delivery?

Betamethasone and Tocolytics

77

When do you not stop preterm labor?

34-37wk estimated GA and/or >2500g

78

What does betamethasone do for preterm labor/ fetus?

matures fetus's lungs (effect starts at 24 hours, peaks at 48 hours and lasts for 7 days)

79

What do tocolytics do for preterm labor/ fetus?

Administer after steroids. Slow progression of surgical dilation by decreasing uterine contractions.

80

Common tocolytics?

Mg, CCBs, Terbutaline

81

What's most common tocolytic, what are it's side effects?

MG sulfate. SE: flushing, Head aches, diplopia, and fatigue. Toxicity can cause respiratory depression and cardiac arrest. Check via deep tendon reflexes.

82

Terbutaline

causes myometrial relaxation. SE: increased HR leading to palpitations and hypotension

83

CCB

SE: Head ache, flushing, and dizziness

84

Indomethacin can be used as a tocolytic. When do you use it?

NEVER!!! DONT YOU DARE F'ING PUT IT AS AN ANSWER!!!!! IT'S ONLY USED TO CLOSE A PDA.

85

Gush of fluid from vagina in pregnant woman, what happened?

Premature Rupture of Membranes

86

How do you diagnose Preterm Rupture of Membranes

Speculums: fluid in posterior fornix, fluid turns nitrazine paper blue, fluid has a ferning pattern when allowed to air dry (WTF?)

87

When is premature rupture of membranes a problem?

When it becomes prolonged. 24 hours before delivery.

88

Premature rupture of membranes leads to?

Premature labor, cord relapse, placental abruption, chroioamnionitis

89

Premature rupture of membranes treatment

Chorioamnitis = delivery now. If fetus is term then deliver. Preterm fetus (betamethasone, tocolytics, ampicillin and 1 dose azithromycin.

90

Abnormal implantation of placenta over the internal cervical os

Placenta Previa (cause of 20% of prenatal hemorrhages)

91

Increased risk of placenta previa

Previous c section, previous uterine surgery, multiple gestations, previous placenta previa

92

when is digital vaginal exam or transabdominal US contraindicated?

Third trimester vaginal bleeding. May cause increased separation between placenta and uterus = sever hemorrhage. (Placenta Previa)

93

Painless vaginal bleeding in pregnant woman, >28 weeks

Placenta Previa (can detect on US)

94

Diagnose placenta previa

transabdominal US

95

Types of placenta previa

Complete, Partial, Marginal, Vasa Previa, Low-Lying Placenta

96

Placenta Previa - Complete

Complete covering of internal cercial os

97

Placenta Previa - Partial

Partial covering of the cercial os

98

Placenta Previa - Marginal

Placenta is adjacent to the internal os (often touching he edge of os)

99

Placenta Previa - Vasa Previa

Fetal vessel is present of the cervical os

100

Placenta Previa - Low Lying Placenta

Placenta that is implanted in the lower segments of the uterus, but not covering the internal cervical os (more than 0cm, but less than 2cm away)

101

Placenta Previa Tx

Treat if lots of bleeding or decreased hematocrit. Treatment is strict pelvic rest (with no sexy time!!!)

102

When do you deliver with Placenta Previa?

Unstaoppable labor (cervix dilated more than 4cm), Severe hemorrhage, Fetal distress. Give betamethasone, If have to deliver, you're headed to Rome get that C-Section!!!

103

Placenta Acreta

abnormally adheres to the superficial uterine wall

104

placenta attaches to the myometrium

Placenta Increta

105

Placenta invades into the uterine serosa, bladder wall, or rectum wall

Placenta percreta

106

Why is placenta acreta bad?

When it's time for he placenta to detach, it can't. Results in hemorrhage and shock. Patient will likely need a hysterectomy.

107

Placental Abruption

premature separation of the placenta form the uterus

108

Why is placental abruption bad?

tears the placental blood vessels and results in hemorrhaging into separated space.

109

What can placental abruption result in?

life-threatening bleeding, premature delivery, uterine tetany, DIC, and hypovolemic shock

110

Risk factors for placental abruption

Maternal HTN, prior placental abruption, cocaine, exgternal trauma, smoking

111

Placental abruption presentation?

Third trimester vaginal bleeding, severe abdominal pain, contractions, fetal distress

112

Tx for placental abruption

Immediate laparotomy w/ delivery of fetus. They don't do a c-section because the baby might not be in the uterus.

113

Patient had placental abruption and their uterus was repaired after delivery. How does this affect subsequent pregnancies

All new pregnancies will be delivered at 36 weeks by c-section

114

Mom is Rh - and baby Rh +... what happens

Not a problem in first pregnancy. Mom antibodies attach baby. Causing hemolysis of fetus's RBCs or hemolytic disease of the new born.

115

Fetal anemia and extramedulary production of RBCs. Can result in Kernicterus.

Hemolytic disease of the Newborn (hemolysis increses released heme and bili)

116

When do you test mom's Rh?

Initial prenatal visit

117

Mom initially tests Rh-, what's next?

get an Rh antibody titer done. if it's negative, then mom is unsensitized.

118

What is the antibody screen of mom for?

see if mom is Rh- or +

119

What is the antibody titer of mom for?

see how many antibodies to Rh+ blood mom has

120

If mom is unsensitzed how do you keep her that way?

Give RhoGam anytime fetal antibodies might cross the placenta: (amniocentesis, abortion, vaginal bleeding, placental abruption, delivery)

121

Prenatal antibody screening done at 28 and 35 weeks... Mom is still unsenstized, what next?

Give RhoGam to mom

122

Mom is unsensitized and baby is Rh+ at delivery. What next?

Give RhoGam to mom

123

Mom is sensitized if titer is > 1.4. What happens if it rises to above 1.16?

She gets RhoGam if it's 1.4 or more. If its above 1.16 she gets amniocentesis to check fetal bilirubin level.

124

Chronic HTN?

BP above 140/90 before the patient became pregnant or before 20 weeks gestation.

125

What do you use to treat Chronic HTN?

Methyldopa, Labetalol, or Nifedipine

126

BP > 140/90 that starts after 20 weeks gestation. (no proteinuria and no edema)

Gestational HTN, treat with methyldopa, labetalol, or nifedeipine

127

Risk Factors for preeclampsia

Chronic HTN, Renal disease

128

Severe Preeclampsia

3+ protein on dipstick, mental status changes, changes in vision, impaired liver function. (you have end organ damage sort of)

129

What med prevents eclampsia

Mg Sulfate

130

Patient with history of preeclampsia has a tonic clonic seizure

It's eclampsia

131

Eclampsia tx?

stabilize mom, then deliver baby. Control seizure with mg sulfate and bp with hydralazine

132

HELLP

Hemolysis, Elevated LIver enzymes, Low Platelets

133

How do you treat HELLP?

Same as eclampsia: stabilize mom then deliver baby

134

Complications of pregestational DM (Type 1 or 2)

4x more likely preeclampsia, 2x more likely spontaneous abortion, increased rate of infection, increased postpartum hemorrhage

135

Fetal complications of Moms pregestational DM (Type 1 or 2)

Increase in congenital anomalies (heart and neural tube defects), Macrosomnia

136

Macrosomnia complications

Shoulder dystocia (shoulder gets stuck under the symphysis pubis during delivery)

137

How do you evaluate mom with pregestation DM

EKG, 24 hour urine (creatine clearance and protein), HbA1C, Opthalmological exam

138

How do you evaluate fetus when mom has pregestation DM

32-36wk (weekly nonstress test w/ US; >36wk twice weekly testing (one NST and one Biophysical Profile); 37wk Lesithin/sphingomyelin ration; 38-39wk just induce labor

139

Gestational DM Complications

Preterm birth, Fetal Macrosomnia (etc.), Neonatal hypoglycemia. 2-4x more likely to develop type 2 dm after delivery

140

Gestaional DM evaluated?

Screen between 24 and 28 weeks. Glucose load test first, if above 140 then do glucose tolerance test. If any of the 3 measurements in glucose tolerance test are elevated then you have gestational diabetes.

141

Gestational DM treatment

Diet and exercise. then insulin (never tell a pregnant woman to lose weight)

142

Fetus <10% for gestational age?

Fetal Growth Restriction

143

Symmetric Intrauterine Fetal Growth Restriction

Brain in proportion to rest of body. Happens before 20 weeks gestation

144

Brain weight is not decreased, Abdomen is smaller than head. Occurs after 20 weeks

Asymmetric Intrauterine Fetal Growth Restriction

145

Number 1 preventable cause of Intrauterine Fetal Growth Restriction in US

Smoking

146

Intrauterine Fetal Growth Restriction Dx:

US to confirm weight and gestational age

147

Intrauterine Fetal Growth Restriction Complications

Premature labor, stillbirth, fetal hypoxia, low IQ, seizures, mental retardation

148

Intrauterine Fetal Growth Restriction Treatment

Quit smoking, and get immunized to prevent infections, but no live immunizations when pregnant

149

Fetus with an estimated birth weight >4500g

Macrosomia

150

Macrosomia Risk Factors?

Maternal DM or Obesity, advanced maternal age, Postterm pregnancy

151

Macrosomia Dx:

Fundal height > 3cm gestation age. Then get a US. US confirms gestational age

152

How does a US confirm gestational age?

Mesaure femul length, abdominal circumference, and head diameter

153

Macrosomia complications

Shoulder dystocia, Birth injuries (clavical fracture), low apgar, hypoglycemia

154

Macrosomia tx:

Induction of labor if lungs are mature before fetus is >4500g

155

If fetus is > 4500g what do you?

All Roads Lead to Rome, get a Cesarean Section

156

Non Stress Test

Measures fetal movements and assesses the HR.

157

Reactive Non Stress Test

Detection of 2 fetal movements, and acceleration of HR greater than 15bpm lasting 15-20s over a 20 min period

158

If non stress test is reactive...

Fetus doing well

159

if non stress test is nonreassuring...

Fetus could be sleeping. Use Vibroacoustic stimulation to wake up the baby.

160

Biophysical Profile consists of?

NST, Fetal chest expansions (normal is 1/ 30 min), Fetal movement (normal is 3/30 min), Fetal muscle tone, & Amniotic fluid index (volume based on US). Each category is worth 2 points.

161

Score Ranges of a Biophysical Profile?

8-10 = normal; 4-8 = inconclusive; 4 = below normal (consider delivery)

162

Normal fetal HR

110-160BPM

163

What's a normal acceleration of fetal HR?

increase in HR of 15 or more bpm for longer than 15-20s. Twice in 20 minures is normal

164

What is an early deceleration and what causes it?

Decrease in HR that occurs with contractions. Head Compression

165

What is a variable deceleration and what causes it?

Decrease in HR and return to baseline with no relationship to contractions. Umbilical Cord Compression

166

What is a late Deceleration? is it serious? what causes it?

Decrease in HR after contraction started. No return to baseline until contractions ends. Most serious. Fetal Hypoxia

167

Fetal descent into the pelvic brim?

Lightening

168

Benign contractions that don't result in cervical dilation?

Braxton Hicks

169

Blood tinged mucus from vagina, released with cervical effacement?

Bloody Show

170

Stage 1 of Labor

Onset to full dilation of cervix. Primipara = 6-18 hours. Multiparious: 2-10 hours

171

Latent Phase of Labor

Onset to 4cm dilation. Primipara = 6-7 hours. Multiparious: 4-5 hours

172

Active Phase of Labor

4cm dilation to full dilation. Primipara = 1cm/hour. Multipara: 1.2cm/hour

173

Stage 2 of Labor

Full dilation of cervix to delivery. Primipara: 30 minutes-3 hours. Multipara: 5-30minutes. This is where fetal descent happens.

174

Stage 3 of Labor

Delivery of neonate to delivery of placenta. 30 minutes

175

While waiting for the placental separation in stage 3, what should you do?

inspect and repair any lacerations of the vagina

176

Medications used to induce labor?

Prostaglandin E2 (cerivical ripening). Oxytocin (increases uterine contractions). Amniotomy (puncture the amniotic sac via an amnio hook)

177

Arrest of Cervical Dilation

no cervical dilation for more than 2 hours

178

Prolonged latent stage

latent phase lasts longer than 20 hours for primipara or 14 hours multipara.

179

Prolonged latent stage tx

Hydration and rest. Most will convert to spontaneous labor in 6-12 hours.

180

Protracted Cervical Dilation

Slow dilation during active phase of labor. <1.2cm for primipara and <1.5cm for multipara

181

3 Ps of Protracted Cervical Dilation

Power (contraction strength and frequency), Passenger (size and position of fetus), and Passage (fetus is larger than pelvis (cephalopelvic disproportion)

182

Protracted Cervical Dilation - Cephalopelvic Disproportion Tx?

C-Section, all roads lead to Rome

183

Protracted Cervical Dilation - Weak contractions Tx?

Oxytocin

184

Types of Arrest Disorders

Cervical Dilation (no dilation for 2 hours) and Fetal Descent (no fetal descent for 1 hour)

185

Etiology of Arrest Disorders?

Fetal presentation, , Cephalopelvic Disproportion, Excessive sedation/anesthesia

186

Malpresentation (arrest disorder) what do you feel on vaginal exam?

a soft mass instead of the normal hard surface of the skull. Confirm with US

187

Fetus's hips are flexed and extended knees bilaterally?

Frank Breech

188

Complete breech

Fetus hips and knees are flexed bilaterally

189

Fetus's feet are first: one leg (single footling) or both legs (double footling)

Footling Breech

190

When do you perform an external cephalic version for breech?

After 36 weeks. Fetus will likely maneuver itself before 36 weeks.

191

Shoulder Dystocia

Anterior shoulder is stuck behind the pubic symphysis.

192

Risk Factors of Shoulder Dystocia

maternal DM and obesity, postterm pregnancy, hx of prior shoulder dystocia

193

Treatment of Shoulder Dystocia

In this order!!! 1. McRoberts Maneuver. 2. Rubin Maneuver. 3. Woods maneuver. 4. Deliberate fetal clavicle fracture. 5. Zavanelli maneuver

194

McRoberts Maneuver?

Mom Knees to chest to increase suprapubic pressure

195

Bleeding more than 500ml after delivery

Postpartum hemorrhage

196

Early postpartum hemorrhage timeline?

w/in 24 hours after delivery

197

Late postpartum hemorrhage timeline?

w/in 24hrs-6 weeks after delivery

198

Most common cause of postpartum hemorrhage?

Uterine Atony

199

Inability to breastfeed after postpartum hemorrhage?

Sheehan Syndrome

200

Tx of postpartum bleeding?

Check for rupture. If the exam is normal then do a bimanual compression and massage. If that doesn't work give oxytocin.

201

When do Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) begin?

When women are in their 20-30s

202

PMDD is a more severe version of?

PMS. It will disrupt daily activities

203

PMS and PMDD sx

Head Ache, Breast Tenderness, Pelvic Pain and bloating, Irritability and Lack of energy.

204

PMS and PMDD Dx

Sx for 2 consecutive cycles, sx free period of 1 week in first part of the cycle (follicular phase). Sx must be present in the 2nd half of the cycle (luteal phase) and dysfunction in life

205

PMS and PMDD Tx:

Decrease caffeine consumption and smoking. Give SSRI's if sx are severe

206

Menopause Age

48-52

207

How does menopause start?

Irregular menstrual bleeding. Oocytes produce less estrogen and progesterone, both have LH and FSH start to rise. Women are asymptomatic for 12 months. Some women experience symptoms for years.

208

Menopause Sx

menstrual irregularity, sweats and hot flashes (vasospasms), Mood changes, dyspareunia (pain in sex)

209

Physical Exam findings of Menopause

Atropic vaginitis, decreased breast size, vaginal and cervical atrophy

210

Menopause Dx

Increased FSH is diagnostic of menopause

211

Tx of menopause

HRT for short term symptom relief and prevention of osteoporosis

212

HRT is associated with ________________ and can lead to ________________.

Endometrial hyperplasia and endometrial carcinoma

213

Contraindications to HRT in menopause

Estrogen dependent carcinoma (breast or endometrial cancer). History PE or DVT.

214

Postcoital bleeding is....

Cervical Cancer until proven otherwise

215

Menorrhagia, what is it?

Heavy and prolonged menstrual bleeding

216

Hypomenorrhea, what is it?

Light menstrual flow. May only have spotting

217

Metrorrhagia, what is it?

Intermenstrual bleeding

218

Menometrorrhagia, what is it?

Irregual bleeding (time intervals, duration, amount of bleeding).

219

Oligomenorrhea

Menstrual cycles >35 days long

220

Postcoital bleeding

Bleeding after sexy times (cervical cancer till proven otherwise)

221

Menorrhaia causes

Endometrial hyperplasia, uterine fibroids, dysfunctional uterine bleeding, IUD

222

Hypomenorrhea causes

Obstruction (hymen, cervical stenosis), OCP

223

Metrorrhagia causes

Endometrial polyps, endometrail/cervical cancer, exogenous E administration

224

Menometrorrhagia causes

Endometrial polyps, endometrial/cervical cancer, Exogenous E administration, Malignant Tumors

225

Oligomenorrhea causes

Pregnancy, Menopause, Significant weight loss (anorexia), Tumor secreting E

226

Postcoital bleeding

Cervical Cancer, Cervical Polyps. Atrophic Vaginitis

227

Dysfunctional Uterine Bleeding (DUB)

Unexplained or abnormal bleeding. Happens with anovulation. Ovaries make E but no corpus luteum is formed, so no progesterone. Endometrium will out grow blood supply and result in bleeding.

228

Dx DUB ?

Endometrial biopsy for women over 35 to exclude carcinoma

229

Any patient older than 35 with DUB should get what?

Endometrial biopsy to rule out carcinoma

230

DUB Tx?

OCPs. D&C can be done to stop bleeding.

231

DUB Severe Tx?

when patients are anemic, can't be controlled by OCPs, or compromised lifestyle. Tx endometrial ablation or hysterectomy

232

OCPs reduce risk of:

Ovarian carcinoma, endometrial carcinoma, and ectopic pregnancy.

233

OCP risk?

Thromboembolism and Hepatocellular Adenoma

234

IUD SE?

PID when placed. Must do genital cultures before they are placed.

235

When does labial fusion occur?

Presence of excess androgens. MC cause is 21-B-hydroxylase deficiency.

236

Labial fusion treatment?

Reconstructive surgery

237

Who does Lichen Sclerosis affect?

affects any age. Postmenopause is increased risk of cancer

238

Lichen Sclerosis and treatment?

White, thin skin extending from labia to perianal area. Tx is topical steroids.

239

Who does Squamous Cell Carcinoma affect?

Any age, patients who have had chronic vulvar pruritus

240

Squamous Cell Carcinoma and treatment?

Patients with chronic irritation develop hyperkeratosis (raised white lesion). Ts: sitz baths or lubricants (relieve the pruritis)

241

Who does Lichen Planus affect?

30s-60s

242

Lichen Planus and treatment?

Viole, flat papules. Tx: Topical Steroids

243

where are Bartholin Glands?

Lateral sides of the vulva at 4 and 8 o'clock

244

Bartholin Gland cysts/ abscess treatment?

I&D with cultures for gonorrhea and chlamydia

245

Recurrent Bartholin Gland cyst/abscess tx?

Marsupialization (I&D where space is kept open with sutures)

246

Vaginitis Risk Factors?

Antibioitcs, DM, Overgrowth of normal flora. Any factor that will increase the pH of the vagina

247

Vaginitis sx?

itching, pain, abdominal odor, and discharge

248

Saline wet mount shows clue cells

Bacterial Vaginosis = Gardnerella

249

KOH shows psuedohyphae

Candida

250

White cheesy vaginal discharge

Candida

251

Candida tx

Pick an "azole" or nystatin

252

Gardnerella Tx

Metronidazole or Clindamycin

253

Profuse, green, frothy vaginal discharge

Trichomonas

254

Saline wet mount shows motile flagellates

Trichomonas

255

Trichomonas treatment

patient and partner with metronidazole

256

Vulvar soreness and pruritis appearing as a red lesion with a superficial white coating

Pagets

257

Who does Pagets affect

postmenopausal caucasion women

258

Treatment of Pagets

vulvectomy

259

Most common type of vulvar cancer

Squamous Cell Carcinoma

260

Pruritis, bloody vaginal discharge, and postmenopausal bleeding

Squamous Cell Carcinoma

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How do you diagnose pagets or squamous cell carcinoma? When is staging done?

Biopsy. staging done in surgery

262

Tx of unilateral squamous cell lesions w/out lymph node invovlement

modified radical vulvectomy. If lymph nodes are involved they must be excised (lymphadenectomy)

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Adenomyosis

invasion of endometrial glands into myometrium

264

What age does adenomyosis affect?

Women age 35-65

265

Endometriosis and uterine fibroids are risk factors for what?

Adenomyosis

266

How do you diagnose adenomyosis definitively?

Hysterectomy

267

Large, globular, and boggy uterus

Likely adenomyosis

268

What is endometriosis

implantation of endeometrial tissue outside of the endometrium

269

What sites are most common for endometriosis

ovary and pelvic peritoneum

270

Who does endometriosis affect?

Women of reproductive age

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Endometriosis presentation

Cyclical pelvic pain that starts 1-2 weeks before menstruation and peaks 1 to 2 days before menstruation. Pain ends with menstruation. Abdnormal bleeding, and nodular uterus and adnexal mass are common!!!

272

Endometriosis dx

Visualization via laparoscopy. Will look dark and rusty. Potentially described as chocolate cyst on ovary

273

Endometriosis tx

NSAIDs, OCPs for mild. Moderate to severe = Danazole or Leuprolide (Decrease FSH)

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Androgen derivative that is associated with acne, oily skin, weight gain, and hirsutism

Danazol

275

GnRH agonist and when given continuously suppresses E. Ass/ w/ hot flashes and decreased bone density.

Leuprolide

276

When to surgerize for Endometriosis?

Severe or infertile. Goal is to restore pelvic anatomy and remove endometrial implants. May receive total hysterectomy and bilateral salpingo-oophorectomy

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PCOS Sx

Amenorrhea, or irregular menses, hirsutism and obesity. Acne, DM type 2

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Dx PCOS?

Bilaterally enlarged ovaries with multiple cysts on US. Increased T and obese. Increased LSH and decreased FSH. LSH/ FSH ration of 3:1

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Tx of PCOS

Weight loss. OCPs (controls androgens and prevents endometrial hyperplasia) Use OCPs if they don't want kids

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PCOS and want to conceive?

Clomiphene and metformin

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Vaccines Contraindicated in Pregnancy

HPV, MMR, Live Attenuated Influenza, Varicella

282

Recommended Vaccines during Pregnancy

TDAP, Inactivated Influenza, Rho(D) Immunoglobulin

283

Vaccines indicated if high risk Pregnancy

Hep B, and Hep A, Pneumococcus, H. Influenza, Meningococcus, Varicella Zoster Immunoglobulin