OB Exam #1 Flashcards by Breanna Lawler

Absence of menses
- normal in prepubertal, pregnant, postpartum, and postmenopausal females
- primary vs. secondary
- treatment is dependent on type (correct underlying factors)
- Causes: weight loss/gain, excessively exercising, stress, depression, PCOS, etc.
- Dx: draw labs to identify cause; pregnancy test

amenorrhea

How well did you know this?

Not at all

Perfectly

Painful menstruation
- common in adolescence & caused by increased prostaglandin production causing increased uterine contractions
- can also be secondary to other pelvic or uterine issues (most commonly endometriosis)
- goal is to provide adequate pain control to maintain ADLs
- Tx: pain relief, contraceptive (hormones), OTC remedies
- Dx: CBC (anemia), UA, pregnancy test, pap smear (STDs), pelvic/vaginal US, laparotomy

dysmenorrhea

How well did you know this?

Not at all

Perfectly

painless endometrial bleeding that is prolonged, excessive, & irregular
- most common at the beginning and end of reproductive years & is related to hormone disturbance
- Common causes: polyp, endometrial tissue growing in uterine wall, fibroids, cancer, coagulation issues
- Tx: treat & normalize bleeding; correct anemia; prevent or diagnose cancer; restore quality of life; contraceptives; NSAIDs; D&C; ablation; biopsy; hysterectomy (last resort)

abnormal uterine bleeding (AUB)

How well did you know this?

Not at all

Perfectly

recurrent symptoms that occur during the last half of menstruation
- wide variety of S&S: dysphoria, breast pain, bloating, weight gain, tension headache, retain fluid, social withdrawal, interruptions w/ sleep or want to sleep more
- difficult to define & hard to diagnose
- exact cause = unknown
- Tx: lifestyle changes & meds (NSAIDs, contraceptives, antidepressants, diuretics); vitamins

premenstrual syndrome (PMS)

How well did you know this?

Not at all

Perfectly

functional endometrial tissue implants in areas other than the uterine cavity such as the ovaries, fallopian tubes, outer surface of uterus, bowels, anal verge, pelvic wall
- this tissue responds the same way as endometrial lining during the menstrual cycle
- S&S begin as early as adolescence & stop after menopause
- cause = unknown
- Tx: surgical removal or ovarian suppressive agents; NSAIDs; hormonal suppression

endometriosis

How well did you know this?

Not at all

Perfectly

inability to conceive a child after 1 year of regular sexual intercourse unprotected by contraception – secondary is the inability to conceive after previous pregnancies
- impacts emotional, social, and economic well-being of couples
- Female causes: ovarian dysfunction or tubal/pelvic pathology; anovulation, tubal damage, endometriosis, ovarian failure
- Male causes: low or absent numbers of motile sperm in the ejaculate; erectile dysfunction
- Tx: lifestyle changes; medication to promote ovulation; intrauterine insemination; IVF

infertility

How well did you know this?

Not at all

Perfectly

refraining from sexual activity
- Failure rate: none
- Pros: costs nothing
- Cons: difficult to maintain
- STI protection, unless, body fluids are exchanged in other ways

abstinence

How well did you know this?

Not at all

Perfectly

refrain from sex during fertile period
- Failure rate: 25%
- Pros: no side effects, acceptable to most religions
- Cons: high failure rate w/ incorrect use
- STI protection: none
- Methods: cervical mucus ovulation; basal body temperature; symptothermal; standard days

fertility awareness-based methods

How well did you know this?

Not at all

Perfectly

male withdraws before ejaculation occurs
- Failure rate: 27%
- STI protection: none
- oldest & most widely used means of preventing pregnancy in the world
- one of the least effective ways of preventing pregnancy

withdrawal (coitus interruptus)

How well did you know this?

Not at all

Perfectly

continuous breastfeeding can usually postpone ovulation & prevent pregnancy
- only works for about 6 months [must be exclusively breastfeeding– this is when kids are introduced to solid foods]
- important to educate women that pumping or manual milk expression can reduce effectiveness
- common method for postpartum women

lactational amenorrhea method

How well did you know this?

Not at all

Perfectly

thin sheath placed over penis or into the vagina to block sperm
- Failure rate: 15%
- Pros: widely available, low cost, physiologically safe
- Cons: breakage risk, decreased sensation & spontaneity
- STI protection: provides protection
- made of latex (allergy alert) or polyurethane

condom [barrier method]

How well did you know this?

Not at all

Perfectly

shallow latex cup that is placed in the vagina
- Failure rate: 16%
- Pros: no hormones, medically safe, cervical cancer prevention
- Cons: requires accurate fitting by healthcare professional, increased UTIs
- STI protection: none

diaphragm [barrier method]

How well did you know this?

Not at all

Perfectly

pill that suppresses ovulation by combined action of estrogen & progestin
- most common and used by millions of women
- needs to be taken at same time everyday to be most effective
- can be used for Tx of acne, PMS, endometriosis, reduce risk of endometrial cancer & protects from PID
- Failure rate: 8%
- Pros: easy to use, high rate of effectiveness
- Cons: must take pill at exact same time everyday, possible undesirable effects, prescription needed
- STI protection: none
- ACHES: abdominal pain (liver or gallbladder issues); chest pain/SOB (PE); headache (HTN, impending stroke); eye problems (HTN); severe leg pain (DVT)

oral contraceptives [hormonal method]

How well did you know this?

Not at all

Perfectly

injectable progestin that inhibits ovulation
- Failure rate: 3%
- Pros: long duration (3-MOS), highly effective, estrogen-free, can be used by smokers & lactating women
- Cons: menstrual irregularities, return visits every 12 weeks, return to fertility up to 12 months
- STI protection: none

Depo-Provera [hormonal method]

How well did you know this?

Not at all

Perfectly

transdermal patch that releases estrogen and progestin into circulation
- Failure rate: 8%
- Pros: easy system to remember, very effective – once they stop using, fertility is restored pretty quickly
- Cons: skin irritation possible, may fall off and not be noticed providing no protection
- STI protection: none

Ortho Evra [hormonal method]

How well did you know this?

Not at all

Perfectly

vaginal contraceptive ring about 2” in diameter that is inserted into the vagina; releases estrogen and progestin
- Failure rate: 8%
- Pros: easy system to remember, very effective
- Cons: may cause vaginal discharge; can be expelled w/o noticing and not offer protection
- STI protection: none

NuvaRing [hormonal method]

How well did you know this?

Not at all

Perfectly

a time-release implant (one rod) of levonorgestrel for 3 yrs
- Failure rate: 0.05%
- Pros: long duration of action; low dose of hormones; reversible; estrogen-free
- Cons: irregular bleeding; weight gain; breast tenderness; headaches; difficulty in removal
- STI protection: none

Nexplanon [hormonal method]

How well did you know this?

Not at all

Perfectly

a T-shaped device inserted into the uterus that releases copper or progesterone or levonorgestrel
- Failure rate: 1%
- Pros: immediately & highly effective; allows for sexual spontaneity; can be used during lactation; return to fertility not impaired; requires no motivation by user after insertion
- Cons: insertion requires skilled professional; menstrual irregularities; prolonged amenorrhea; can be unknowingly expelled; may increase the risk of pelvic infection
- STI protection: none

intrauterine devices (IUD) [hormonal method]

How well did you know this?

Not at all

Perfectly

combo of levonorgestrel-only pills; combined estrogen & progestin pills
- used within 72-120 hours of unprotected sex, more effective the quicker they take it
- reduce risk of pregnancy by almost 90%
- Pros: provides a last chance to prevent a pregnancy
- Cons: risk of ectopic pregnancy if EC fails
- STI protection: none

emergency contraceptives (Plan-B) [hormonal methods]

How well did you know this?

Not at all

Perfectly

occur in older women around 30-50
caused by overgrowth of fibrous tissue, in response to the monthly progesterone & estrogen levels
rare in postmenopausal women
S&S: palpable, movable lump; nipple discharge; breast tenderness
Tx: supportive bra; decrease caffeine; ibuprofen; biopsy/aspiration

fibrocystic changes

How well did you know this?

Not at all

Perfectly

occurs in women age 15-30
caused by hormone replacements (birth control), pregnancy, lactation
benign, solid breast tumors
S&S: round, movable lump; may have tenderness
Tx: monitor; lump aspiration/biopsy; surgical removal

fibroadenomas

How well did you know this?

Not at all

Perfectly

caused by bacteria and result in inflammation/infection in breast tissues
S&S: localized swelling, redness, warmth, tenderness of breast, flu-like symptoms
Tx: warm compress; pain meds; antibiotics; expressing breastmilk

mastitis

How well did you know this?

Not at all

Perfectly

Types: ductal, tubular, colloid, medullary
2nd leading cause of cancer in women, much rarer in men
Non-modifiable risk factors: female, age, genetics, history, race, timing of menarche/menopause
Modifiable risk factors: hormone therapy; childbirth; non-breastfeeding; alcohol consumption; smoking; obesity
Early S&S: none – why self breast exam & mammograms are important
S&S: changes in color of breast, shape/contour of breast, lump in breast in one, changes in nipple-discharge, retraction, inverted, tenderness
Dx: mammograms, needle aspiration, biopsy
Tx: mastectomy, chemo, radiation, hormonal therapy

invasive breast cancers

How well did you know this?

Not at all

Perfectly

bladder drops into the vagina

cystocele

How well did you know this?

Not at all

Perfectly

rectum sags/bulges into the vagina

rectocele

small intestine bulges into the vagina

enterocele

uterus drops into the vagina

uterine prolapse

***any organ that is herniated or protruding into or outside the vaginal canal affecting urination, defecation, sexual activity, and quality of life*** - non-life threatening - Risk factors: obesity; atrophy/weakening of pelvic floor; pregnancy/childbirth; hysterectomy; family Hx; increased abdominal pressure - Tx: Kegels; hormone replacement therapy; diet & lifestyle modifications; pessaries devices; surgical interventions

pelvic organ prolapse

- small growth, usually benign - results from infection, chronic inflammation, high levels of estrogen, or local congestion of cervical vasculature - malignancy is higher in perimenopausal or postmenopausal women, common in middle age women and those who have bared children - S&S: asymptomatic; abnormal vaginal bleeding after intercourse - Appearance: endocervical = cherry red; closer to cervix = grayish white - Dx: pap smear, US, hysteroscopy - Tx: removal & biopsy

polyps

- benign tumor made up of composed smooth muscle & fibrous C.T., found in uterus - slow-growing, vary in size - highly evident during child-bearing years - S&S: chronic pelvic pain; low back pain/sciatic; constipation/bloating; dysmenorrhea; dyspareunia; menorrhagia - Predisposing factors: age, genetics/ethnicity, HTN, obesity, PCOS, diabetes - Tx: hormone replacement, myomectomy, laser surgery, hysterectomy

uterine fibroid

- occurs more often than thought of as Bartholin glands are in the labia minora and produce lubrication during sexual arousal can be occluded and lead to infected abscess - S&S: swollen, redness, painful, fluid-filled abscess on labia - Dx: physical exam - Tx: sitz bath, analgesics, antibiotics, I&D, word catheter placement

Bartholin cyst

***most common endocrine syndrome in women*** - cyst-like follicle within the ovary, interfering w/ ovarian function - eggs never mature & no ovulation occurs - multifaceted disorder -- hyperandrogenemia; hyperinsulinemia; other issues (sleep apnea, obesity, elevated BP, etc.) - most common cause for infertility - Dx: hyperandrogenism, ovarian dysfunction - Tx: contraceptive; antihyperglycemic drugs; ovulation agents; lifestyle changes

polycystic ovary syndrome (PCOS)

***malignancy in uterine cervix and most common cause is HPV*** - 3rd most frequently diagnosed cancer in women & most treatable cancers when detected early - Risk factors: age of menarche; age of first intercourse; # of sexual partners; contraceptive use; unprotected sex; family Hx; smoking - S&S: asymptomatic - Dx: pap smear, colposcopy - Tx: cryotherapy; cone biopsy; LEEP; hysterectomy; chemotherapy; radiation - Preventive care: Gardasil vaccine

cervical cancer

***abnormal growth of cells within uterine lining & high incidence of metastasis -- the 4th most common cancer in women*** - Risk factors: nulligravida; Hx; Hx of uterine fibroids; infertility; obesity; timing of menarche/menopause; diabetes; HTN; PCOS - S&S: dyspareunia; back/pelvic pain; weight loss; change in GU/GI patterns; vaginal bleeding - Dx: pelvic exams; transvaginal US; endometrial biopsy - Tx: total hysterectomy; radiation; chemo

uterine/endometrial cancer

***abnormal growth of ovarian cells occurring in women older than 63 & is the 5th most common cancer and deaths of women due to being undiagnosed & metastasizing*** - develops slowly & advances before the women experiences symptoms - Risk factors: age, genetics, Hx, infertility, nulligravida, timing of menarche/menopause, hormonal therapy, obesity - S&S: pelvic/abdominal pain; urinary issues; increased abdominal size - Dx: labs & US - Tx: total hysterectomy, radiation, chemo

ovarian cancer

fertilization through 2nd week - includes the zygotic & blastocyst stage

Pre Embryonic/Germinal Stage

End of 2nd week through 8th week - not an embryo until week 2

Embryonic Stage

End of 8th week until birth - full-term birth --> 37-40 weeks

Fetal Stage

outer layer that forms the CNS, senses, skin, and glands

ectoderm

middle layer that forms skeletal system, urinary, circulatory, and reproductive organs (heart is first organ to form)

mesoderm

inner layer that forms respiratory, digestive, and endocrine system (liver, pancreas)

endoderm

individual unit of heredity of all traits - organized into long segments of DNA - occupy a specific location on a chromosome - determine a particular characteristic in an organism

gene

any change in gene structure - can alter the amount of protein produced

mutation

specific genetic makeup of an individual - internally coded inheritable info - individual genetic blueprint - what the gene itself looks like

genotype

observed, outward characteristics of an individual - what you see on the outside (outward characteristics) - what the gene does

phenotype

only 1 copy of gene to express the disorder -- only 1 parent has to have the disorder - i.e., achondroplasia, dwarfism, PKD, Huntington's

autosomal dominant inheritance disorders

need 2 copies to express the disease -- only need 1 copy to carry disease but both parents have to have the disease or be carriers - i.e., sickle cell disease, cystic fibrosis

autosomal recessive inheritance disorders

genetic disorder that affects X chromosome, since males only have 1-X, they have less chance of having compared to female who has 2-X chromosomes

X-linked inherited disorders

both X's need to be altered for the female, male needs 1-X to be altered - i.e., color blindness, hemophilia

X-linked recessive inheritance

RARE, male must have abnormal X and female must have abnormal X -- both sons and daughter of mom affected w/ chromosome has 50/50 chance of getting since she is carrier, males are affected more severely since they only have 1-X - i.e., fragile X syndrome (developmental & cognitive delay)

X-linked dominant inheritance

***signs that the mother can perceive*** - most obvious sign: absence of menstruation - LEAST reliable indicator as any one of the signs can be caused by conditions other than pregnancy - fatigue (12 weeks); breast tenderness (3-4 weeks); N/V (4-14 weeks); amenorrhea (4 weeks); urinary frequency (6-12 weeks); hyperpigmentation (16 weeks); fetal movements--[quickening](16-20 weeks); breast enlargement (6 weeks)

presumptive signs

***signs that can be detected on physical exam by a healthcare provider*** - Braxton Hicks contractions (16-28 weeks); positive pregnancy test (4-12 weeks); abdominal enlargement (14 weeks); ballottement (16-28 weeks); Goodell sign --softening of cervix (5 weeks); Chadwick sign --bluish-purplish vaginal mucosa & cervix(6-8 weeks); Hegar sign --softening of lower uterine segment (6-12 weeks); uterine enlargement (7-12 weeks)

probable signs

***signs are a confirmation that a fetus is growing in the uterus*** - US verification of embryo or fetus (4-6 weeks); fetal movement felt by experienced clinician (20 weeks); auscultation of fetal heart tones via doppler (10-12 weeks)

positive signs

each trimester is ______ weeks

13 weeks

identifies gestational diabetes, UTI

urinalysis (UA)

identifies anemia, infection, hypercoagulation

CBC

identifies blood compatibility & transfusion

blood typing/RH factor

assesses immunity

rubella titer & Hep-B surface antigen

STI poses risk on fetus, important to identify

HIV, VDRL, RPR testing (STI screening)

identifies pregnancy complications

identifies structural abnormalities, umbilical cord

doppler flow studies

indicates chromosomal disorder, if high level than nuchal translucency is ordered

alpha-fetoprotein analysis

indicates chromosomal disorder in 1st trimester

nuchal translucency screening

performed in 2nd trimester to assess amniotic fluid, lots of risks

amniocentesis

looking at chorionic villi from placenta and test for chromosomal disorders, lots of risks

chorionic villus sampling (CVS)

HR patterns and response to fetal movement; assess well-being of the fetus, education/steps

nonstress test

fetal movement, fetal tone, fetal breathing, amniotic fluid, nonstress (NST) findings

biophysical profile

- weight, VS, UA, fundal height, heart tones - US to assess for malformations or number of fetuses - AFP @ 12-18 weeks - gestational diabetes screening @ 28 weeks - assess fetal movements - receive Rhogam if she is RH- - Education --> know what to report to Dr

until 28 weeks [1 visit every 4 weeks]

- weight, VS, UA, fundal height, heart tones - US @ 34 weeks to assess fetal size & placenta - GBS swab @ 36 weeks - assess fetal movements & educate them to monitor - Education --> birth plan

28-36 weeks [1 visit every 2-3 weeks]

- weight, VS, UA, fundal height, heart tones - GBS test if not done already - assess fetal position - monitor fetal kick count - discuss infant car safety - Education --> labor process, gestational HTN, preeclampsia

36 weeks and up [1 visit/week until delivery]

- increase in size, weight, length, width, depth, volume, and overall capacity - enhanced uterine contractility (Braxton Hicks) - positive Hegar's sign - pear shape to oval shape

uterus changes

maternal vena cava compression - reduces venous return, decrease CO, and decrease BP - results in feeling weak, dizzy, syncope - Intervention: left lateral side position

supine hypotension syndrome

- softening cervix (Goodell sign) - mucus plug (protection from infection) - increased vascularization (Chadwick's sign)

cervical & vaginal changes

- enlargement - cessation of ovulation

ovary changes

- increase in size & nodularity to prepare for lactation - increase in nipple size (more erect & pigmented) - production of colostrum

breast changes

- heartburn/GERD - Gums: hyperemic, swollen, & friable - ptyalism (excess alvia) - dental problems -- encourage visits - decreased peristalsis & smooth muscle relaxation [constipation] - hemorrhoids

GI changes

- dilation of renal pelvis, elongation, widening, and increase in curve of ureters -- increased urinary stasis -- risk of UTI - increase in GFR; increased urine flow & volume

renal changes

- increase in blood volume, CO, and HR --> can lead to hemodilution - slight decline in BP until mid pregnancy, then returning to pre-pregnancy levels - body has increased risk of blood coagulation (DVT prevention education)

cardiovascular changes

- breathing is more diaphragmatic than abdominal - increase in oxygen consumption - congestion secondary to increased vascularity

respiratory changes

- ligament relaxation from relaxin leads to changes in posture & gait - lordosis, waddle gait

musculoskeletal changes

- hyperpigmentation (facial Melasma) - linea nigra - striae gravidarum [stretch marks] - varicosities - palmar erythema - decline in hair growth; increase in nail growth

integumentary changes

- ***thyroid gland:*** slight enlargement, increased activity, increased BMR - ***pituitary gland:*** enlargement, decreased in TSH & GH, inhibition of FSH & LH, increased in prolactin, gradual increase in oxytocin w/ fetal maturation - ***pancreas:*** baby must make own insulin, gets glucose from mother - ***adrenal glands:*** increase in cortisol & aldosterone secretion - prostaglandin secretion - ***placental secretion:*** hCG, relaxin, progesterone, estrogen

endocrine changes

- defends from antigens - innate immunity - suppression of adaptive immunity - inflammatory responses

immune changes

begins when woman discovers pregnancy (happy, scared, nervous, excited)

ambivalence

mother becomes more focused on herself to support the fetus

introversion

mother accepts changes - typically around the 2nd trimester

acceptance

highs & lows in mood - can be hard on partner

mood swings

ensure mother feels support and loved

changes in body image

Naegele Rule

- use first day of LMP - subtract 3 months - add 7 days - add 1 year

- urinary frequency or incontinence [encourage Kegels] - fatigue [encourage short naps] - N/V [small, frequent meals] - breast tenderness - constipation [increase fiber] - nasal stuffiness - bleeding gums [good hygiene] - epistaxis [humidified air] - cravings - leukorrhea

first-trimester discomforts

- backache [warm heating pad, supportive shoes] - varicosities of the vulva & legs - hemorrhoids [avoid straining, warm sitz bath] - flatulence w/ bloating

second trimester discomforts

- return of first-semester discomforts - SOB & dyspnea [avoid large meals] - heartburn & indigestion [limit spicy foods, eating smaller meals] - dependent edema [avoid sodium & drink fluids] - Braxton Hicks contractions [occurs w/ dehydration, increase water intake; resting on left lateral side]

third-trimester discomforts

- HepB - Flu shot - TDap - Rabies

safe vaccines

- Flu nasal spray - Varicella - Rubella - TB - Typhoid

contraindicated vaccines

OB Exam #1 Flashcards

(94 cards)