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Family Medicine EOR > Obstetrics and Gynecology > Flashcards

Obstetrics and Gynecology Flashcards

1
Q

What are the characteristics of breast cancer?

A

Most common malignancy in women

  • risk factors (increased exposure to estrogen)
  • menarche before age 12
  • old age of first full-term pregnancy, no pregnancies
  • menopause after age 52
  • breast mass - immobile, irregular
  • nipple retraction, bloody nipple discharge
  • tumors may be estrogen receptor (ER) positive 75%, progesterone receptor (PR) positive 65% as well as HER2 positive 25%
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2
Q

What is the most common type of breast cancer?

A

infiltrating intraductal carcinoma (IIC) 80%

  • infiltrating lobular (10%) frequently bilateral
  • Paget’s disease of the nipple (1%) chronic eczematous itchy, scaling rash on the nipples and areola
  • inflammatory breast cancer (2%) red swollen, warm and itchy breast often with nipple retraction and beau d’orange (NO LUMP)
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3
Q

What are the USPSTF guidelines for breast cancer screening?

A
  • baseline mammogram every 2 year from age 50-74
  • every 2 years beginning at age 40 if increased risk factors - 10 years prior to the age the 1st degree relative was diagnosed
  • clinical breast exam every 3 years in women age 20-39 years then annually after age 40
  • breast self-exam monthly beginning at age 20 - immediately after menstruation on days 5-7 os the menstrual cycle
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4
Q

What is the tx of breast cancer?

A
  • segmental mastectomy (lumpectomy) followed by breast irradiation in all patients and adjunctive chemotherapy in women with positive stage I and stage II with tumors less than 4 cm in diameter
  • anti-estogren Tamoxifen is useful in tumors that are ER-positive - binds and blocks the estrogen receptor in the breast tissue
  • aromatase inhibitors are useful in postmenopausal ER-positive patients with breast cancer - reduces the production of estrogen
  • monoclonal AB treatment is useful in patients with HER2 positivity (human epidermal growth factor receptor)
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5
Q

What are the characteristics of a breast mass?

A

differenital includes: fibroadenoma, Paget disease, fibrocystic breast, breast abscess, malignant (invasive or noninvasive)

  • the clinical presentation of a palpable breast mass is variable
  • the characteristics of the mass to be evaluated include density (such as soft, hard, firm), skin changes, nipple areolar changes, and/or fixation to the chest wall
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6
Q

What is the first diagnostic test performed for a breast mass?

A

for all women with a suspicious breast mass, a mammogram is the first diagnostic test performed
-frequently, an ultrasound is also performed concurrently as a component of the evaluation

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7
Q

What are the characteristics of an ultrasonography for a breast mass?

A

for young women with a clinically benign mass, such as a fibroadenoma, and no family history of premenopausal breast cancer, an ultrasound is a useful initial diagnostic imaging study

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8
Q

What are the characteristics of a mammography for a breast mass?

A

a diagnostic mammogram is the first imaging study performed for a women with a new, palpable breast mass and should be performed even if a recent mammogram was negative

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9
Q

What are the characteristics of a MRI for a breast mass?

A

breast magnetic resonance imaging (MRI) is not indicated for the workup of an undiagnosed mass
-MRI is best reserved for diagnostic dilemmas and used with discretion, as there is a significant false positive rate, which dramatically increases the rate of benign biopsies

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10
Q

How is a definitive diagnosis of a breast mass?

A

by a breast biopsy, which includes a fine needle aspiration, core biopsy, or an open biopsy

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11
Q

What are the characteristics of Paget’s disease of the nipple?

A

1%

-chronic eczematous itchy, scaling rash on the nipples and areola

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12
Q

What are the characteristics of fibroadenoma?

A

a young women in her 20’s with a small, rubbery, firm, usually painless, well-circumscribed, completely round, and freely mobile breast mass

  • the classic description with respect to consistency is “rubbery”, does not usually was and wane with menstruation
  • no changes with the menstrual cycle
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13
Q

What is the tx of a fibroadenoma?

A

treatment of choice is a biopsy

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14
Q

What are fibrocystic changes?

A

multiple bilateral breast masses that increase in size and pain before menses

  • bilateral breast involvement
  • wax and wane with period
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15
Q

How is the dx of fibrocystic changes made?

A

diagnosis is by breast cyst aspiration supplemented by ultrasound and/or mammogram

  • straw-colored fluid with no blood
  • treat with NSAIDs, OCPs
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16
Q

What is a breast abscess?

A

a pocket of contained infection within the breast

  • a progression from mastitis - symptoms are the same with addition of localized mass and systemic signs f infection
  • staphylococcus aureus is the most common cause
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17
Q

What is the tx of a breast abscess?

A

I&D and anti-staph antibiotics

  • regimen: nafcillin/ocacillin IV or cefazolin PLUS metronidazole
  • alternative is vancomycin
  • stop breast-feeding on the affected side - pump and dump
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18
Q

What is cervical cancer?

A

the third most common type of cancer, squamous-mot common (90%)

  • patient is often asymptomatic or will often present with postcoital bleeding, friable, bleeding cereal lesion
  • HPV is 99% the reason for cervical cancer, types that cause cancer 16, 18, 31, and 22, especially types 16, 18, associated with cigarette smoking
  • transformation zone most commonly affected
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19
Q

What is the tx of cervical cancer?

A

resect and/or chemotherapy and radiation

  • stage 1: conservative, simple, or radical hysterectomy
  • stage 2 +: chemo +/- radiation
  • 5-y survival - stage 1: 85-90% Stage 2: 65% Stage 3 29% Stage 4: 21%
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20
Q

What are the characteristics of barrier methods?

A

failure rates are as high as 40%, offer STI protection, safe for patients with contraindications to hormones

  • male condoms: 20% failure rate, offers STI protection
  • female condoms: 21% failure rate, offers STI protection
  • diaphragm: 15% failure rate, must remain in place 6-24 hours after intercourse, requires pelvic exam and fitting
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21
Q

What are the characteristics of spermicides nontoxynol-9?

A

destroys sperm - often used with other forms of BCP such as condoms

  • 27% failure rate
  • slighting increased risk for HIV
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22
Q

What are the characteristics of OCP’s?

A

prevents ovulation by inhibiting mid-cycle LH surge, thickens cervical mucus, thins the endometrium

  • 9% failure rate, 0.3% failure rate when used correctly
  • improves dysmenorrhea and controls the menstrual cycle
  • protects against ovarian cysts, ovarian and endometrial caner and improves acne
  • there is no convincing evidence that OCP’s increase the risk of breast, cervical, or liver cancer, potential complications include thromboembolic events, hypertension, hepatic adenoma
  • breakthrough bleeding, nausea, and breast tenderness usually resolve within the first three cycles
  • combined estrogen and progesteron - not used in women > 35 years of age that are smokers, patients with a history of blood clots, breast cancer or migraines with aura
  • 35 and younger who smoke OK
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23
Q

What are the characteristics a the transdermal patch?

A

this method is very effective, the contraceptive efficacy of the transdermal patch is comparable to that of combined OCP’s

  • the failure rate is 0.3 percent with perfect use and 9% with typical use
  • some evidence suggests that efficacy is slightly decreased in women who weigh more than 198 pounds; however, the patch is still a very effective method for these women
  • the overall risk of VTE is all, approximately 100 cases per 100,00 per year
  • for women 25 to 35 years old, the incidence is only 30 cases per 100,000 per year
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24
Q

What are the patient instructions for a transdermal patch?

A
  • the patch should be applied to clean, dry skin on the abdomen, buttock, upper outer arm, or upper torso (excluding breasts)
  • it should not be placed in areas that receive a lot of friction, such as under bra straps
  • the patch must be changed weekly
  • when the patch is removed, it should be folded closed to reduce the release of hormones and should be disposed of in the garbage
  • to avoid the release of hormones into the soil and water supply, a used patch should not be flushed down the toilet
  • non-hormonal back-up contraception is needed for the first 7 days if the patch is started any day other than day 1 of the mensural cycle
  • if the patch falls off, a new patch should be applied immediately
  • if the patch was off for more than 24 hours, 7 days of backup contraception is required
  • this method does not protect against STIs
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25
Q

What are the characteristics of NuvaRing?

A

a flexible plastic vaginal ring

  • 7% failure rate
  • applied every week for 3 weeks than 1 week off
  • withdrawal bleeding
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26
Q

What is the progestin-only mini pill?

A

failure rates similar to combined OCP’s - 9% failure rate, 0.3% failure rate when used correctly

  • safe in lactation - can be used in a breastfeeding woman
  • no estrogenic side effects (headache, nausea, HTN)
  • decreased ovarian and endometrial cancer risk
  • may cause menstrual irregularities
  • slightly less effective than combined OCP’s
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27
Q

What are the characteristics of an IUD?

A

most effective form of birth control, reversible

  • Copper IUD (paragard) - 0.8% failure rate, women who cannot have hormones that want children later in life (replaced every 10 years)
  • progestin only - IUD (Mirena) - 0.2% failure rate, replaced every 3-5 years
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28
Q

What are the characteristics of emergency contraception?

A

continue to recommend a levonorgestrel emergency contraceptive (Plan B one-step, etc) within 3 days of unprotected sex or prescribe Ella (ulipristal) within 5 days

  • Up to 25% failure rate
  • levonorgestrel works up to 5 days after sex…but labeling doesn’t recommend it and the efficacy decreases the longer the patient waits
  • consider a copper IUD within 5 days if the woman also wants a long-lasting contraception, its the most effective emergency contraceptive
  • you may also see drug interaction alerts pop up with CYP3A4 inducers (carbamazepine, topiramate, St. John’s worst, etc.), these may possibly decrease the efficacy of levonorgestrel or Ella, but do not shy away from these emergency contraceptives in women on an interacting med, or if it’s practical, got with a copper IUD instead
  • for women on an oral contraceptive, tell them to resume or start a pack as soon as possible after levonorgestrel, but advise waiting 5 days after Ella…OC’s and Ella may decrease the effectiveness of one another
  • also, recommend backup for 7 days after levonorgestrel and for 14 days or until the next period after Ella, whichever comes first
  • watch for women using emergency contraception as their primary birth control form
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29
Q

What are the characteristics of depo-provers?

A

long-acting progesterone injection

  • 5% failure rate
  • lasts 3 months
  • may cause menstrual irregularities
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30
Q

What are the characteristics of nexplanon?

A

long-acting progesterone implanted in the upper arm

  • 0.05% failure rate
  • lasts 3 years
  • may cause menstrual irregularities
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31
Q

What are the characteristic of sterilization?

A
  • tubal ligation - 0.5% failure rate, permanent
  • essure - chemical or coils to scar Fallopian tubes - 0.5% failure rate, can be done in the office
  • vasectomy - 0.15% failure rate - vas deferens from each testicle is clamped, cute or otherwise sealed, this prevents sperm from mixing with the semen that is ejaculated from the penis
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32
Q

What is a cystocele?

A

bladder prolapse is a bulge of the bladder into the vagina

  • anterior vaginal prolapse of the posterior bladder wall into the vagina, emerging from the introitus
  • a cystocele can result from childbirth, constipation, violent coughing, heavy lifting, or other pelvic muscle starins
  • concurrent urinary incontinence
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33
Q

What are the symptoms of a cystocele?

A

feeling pressure in the pelvis and vagina, discomfort when straining and feeling that the bladder hasn’t fully emptied after urinating

  • feels like “sitting on a ball” or “something is falling out”
  • worse with Valsalva and better with redundancy
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34
Q

How is a cystocele dx?

A

POP-Q (pelvic organ prolapse quantification): quantifies the extent and location of defects, ultrasound or MRI
-additional testing: Q-tip test, voiding cystourethrogram (VCUG), cystometrogram

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35
Q

What is the tx of cystocele?

A

treatment includes a flexible ring pessary to support the bladder or surgical repair with mesh augmentation

  • prophylaxis with Kegel exercises: strengthen levator ani and perianal muscles
  • estrogen therapy after menopause maintains tone and vitality of the tissue
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36
Q

What is dysfunctional uterine bleeding?

A

excessive uterine bleeding and prolonged menses that is NOT caused by pregnancy or miscarriage, diagnosis of exclusion, look for an underlying endocrine disorder

  • AUB in the absence of an anatomic lesion, caused by a problem with the hypothalamic-pituitary-ovarian axis
  • polymenorrhea, menorrhagia and/or metrorrhagia
  • unremarkable physical exam
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37
Q

How is dysfunctional uterine bleeding dx?

A

diagnosis of exclusion, uterine dilation, and curettage is the gold standard diagnosis

  • urinary beta-hCG levels r/o pregnancy
  • labs: CBC, iron studies, PT, PTT, TSH, progesterone, prolactin, FSH, LFTs
  • progestin trial - if the bleeding stops, anovulatory cycles confirmed
  • ovulation journal, pap smear
  • pelvic U/S, endometrial biopsy, HSG, hysteroscopy
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38
Q

What is the tx of dysfunctional uterine bleeding?

A

oral contraceptives and NSAIDs

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39
Q

What is dysmenorrhea?

A

refers to uterine pain around the time of menses, which can either by primary or secondary

  • reserved for women who pain prevents normal activity and requires medication, whether an over-the-counter or a prescription drug
  • pain occurs with menses or precedes menses by 1 to 3 days
  • pain tends to peak 24 h after the onset of menses and subside after 2 to 3 days
  • DX: pregnancy testing and pelvic ultrasonography
40
Q

What are the characteristics of primary dysmenorrhea?

A

no organic cause

  • painful uterine muscle activity due to an excess of prostaglandins (F2a)
  • teen-early 20’s, declines with age, no associated pelvic pathology
  • risk factors include menarche before age 12, nulliparity, smoking, family history, obesity
  • pain with menstruation, lower abdominal, intermittent, “labor-like” on days 1-3
  • nausea, vomiting, diarrhea (smooth muscle contraction), headache
  • normal pelvic exam
  • Treatment: NSAIDs and oral contraceptive pills
41
Q

What is secondary dysmenorrhea?

A

pathologic cause

  • painful menstruation caused by clinically identifiable cause
  • etiology: endometriosis, adenomyosis, polyps, fibroids, PID, IUD, tumors, adhesions, cervical stenosis/lesions, psych
  • pain with menstruation beings mid-cycle and increases in severity until end
  • common women age (20-40s)
  • treat underlying cause
42
Q

What is fetus/infant nomenclature?

A
  • abortion (either elective or spontaneous) < 20 weeks gestation or weight < 500 grams
  • premature infant: 20-36 weeks gestation or 1000-2500 grams
  • full term infant: after 37-42 weeks gestation or >2500 grams
  • postmature infant: > 42 weeks gestation
43
Q

What are the abbreviation of obstetrical history?

A

G_PTPAL

  • T: Total number of full-term pregnancies (37-42 weeks)
  • P: total number of preterm pregnancies (20-36 weeks)
  • A: total number of abortions (elective or spontaneous occurring before 20 weeks)
  • L: total number of living children
  • **twins count as one pregnancy, two live children
44
Q

When is fetal movement (quickening) felt at?

A

nulliparas: 18-20 weeks
multiparae: 14-16 weeks

45
Q

What are the signs of pregnancy?

A
  • chadwick’s sign: bluish discoloration of vagina and cervix
  • increased basal body temperature
  • skin changes:
  • melasma/chloasma (dark patches on the face across the bridge of the nose or forehead)
  • linea nigra: vertical line up the abdomen
  • caused by stimulation of melanocytes
46
Q

What is Hegar’s sign?

A

softening between the fundus and cervix

47
Q

What are the stages of uterine growth?

A
  • 12 weeks at the symphysis pubis
  • 20 weeks at the umbilicus
  • after 20 weeks 1 cm for every week gestation
48
Q

What is the heart rate of the baby while in the womb?

A

120-160

-will be visible on the US at 6 weeks gestation

49
Q

What are important lab changes during pregnancy?

A
  • cholesterol will INCREASE and this is normal if elevated just repeat at the 6-week postpartum visit
  • BUN and Creatinine will be DECREASED
50
Q

What are the first visit prenatal labs?

A
  • CBC
  • blood type, RH factor, antibodies to blood group antigens
  • random glucose
  • VDRL (RPR)
  • hepatitis B
  • rubella
  • urine
  • Pap smear (if less than 1 year since last)
  • Group B streptococcus
  • As indicated:
  • sickle cell trait
  • cystic fibrosis
  • Tay-Sachs
51
Q

What is done at every prenatal visit?

A
  • maternal weight
  • blood pressure
  • fundal height
  • fetal size and presenting part
  • urine dipstick for protein, glucose, ketones
52
Q

What is the screening blood tests for Trisomy 21?

A

1’st trimester
-pregnancy-associated plasma protein A (PAPP-A) low
-free beta human chorionic gonadotropin (free b-HCG) high
2’nd trimester
-unconjugated estriol - low
-maternal alpha-fetoprotein - low
-inhibin A - high

53
Q

What are the optional screening tests during pregnancy?

A
  • nuchal translucency screening test
  • done in the first trimester at 10-13 weeks
  • measurement of excess fluids in the folds of the back of the fetus’ neck - abnormal fluid is indicative of Down’s Syndrome (Trisomy 21), 13, 18 and Turner’s syndrome
54
Q

What is the optional diagnostic tests?

A

10-13 weeks: chorionic villus sampling (CVS)

-15-20 weeks: amniocentesis

55
Q

What is the recommended weight gain during pregnancy?

A
  • 20-35 lbs: average weight women
  • 40-45 lbs: underweight women
  • 10-15 lbs: overweight women
56
Q

What is the nutrient during pregnancy?

A
  • pregnant intake = increase in calories should be 300 kcal/day
  • prenatal vitamins:
  • folic acid (0.4 mg/day)
  • iron (30 mg/day)
57
Q

What are things to avoid during pregnancy?

A
  • smoking, ETOH, drugs - teratogens
  • unpasteurized foods (apple cider, soft cheese) - listeria
  • raw meet, seafood - listeria
  • deli meat - listeria
  • king mackerel, shark, swordfish, tuna, tilefish - mercury
  • farm salmon - PCBs
58
Q

What are the stages of labor?

A
  • first stage: onset of labor to fully dilated (10 cm)
  • second stage: fully dilated to the birth to the infant
  • third stage: delivery of infant to delivery of the placenta
59
Q

What is the Antepartum fetal monitoring?

A 
Nonstress Test (NST) 
-2 accelerations in 20 minutes, up to 15 beats from baseline for 15 seconds 
-a positive test is a good thing 
Contraction stress test (CST) 
-also called oxytocin challenge test 
-pitocin is given to cause contractions 
-late decelerations with each contraction constitute a positive test
-a positive test is a bad thing 
Vibroacoustic stimulation (VAS) 
-auditory source placed on the maternal abdomen 
-short bursts of sound delivered to fetus to "wake up" fetus 
-used when NST is nonreactive 
A biophysical profile (five components) 
-most often done after a non-reactive NST and heart rate stays non-reactive after VAS
-Each component is worth 2 points 
-NST reactivity 
-Fetal breathing 
-gross body movement 
-fetal tone
-amniotic fluid index
60
Q

What is the monitoring done during labor?

A
  • heart rate and the pattern is an indicator of infant well-being
  • normal heart rate in newborn 120-160 beats per minute
  • consistent decelerations after a contraction can indicate fetal distress
  • external fetal monitor - on the maternal abdomen
  • internal fetal monitor - electrode attached to the infants head
61
Q

What are FHR accelerations?

A
  • increase of baseline 15 bmp for 15 seconds
  • response to fetal movement
  • reassuring
62
Q

What is FHR early decelerations?

A
  • mirror images of contractions
  • fetal head compression
  • benign
63
Q

What is FHR variable decelerations?

A
  • rapid FHR drop with a return to baseline with variable shape
  • cord compression
  • benign if mild or moderate
  • worrisome if severe
64
Q

What is FHR late decelerations?

A
  • FHR drop at the end of the contraction
  • uteroplacental insufficiency
  • always worrisome
65
Q

What is menopause?

A

is a retrospective diagnosis on 12 or more months of amenorrhea occurring at a mean age of 51 years

66
Q

What are the characteristics of menopause?

A
  • average age 51.5 years (44-55 years old)
  • on average women will spend 30+ years in the postmenopausal state
  • perimenopause - the transition between reproductive capability and menopause hallmark is irregular menstrual function, lasts 3-5 years
  • menstrual irregularity (more frequent), vasomotor symptoms (hot flashes, and night sweats), sleep disturbances, irritability, mood disturbances
  • vaginal dryness = dyspareunia, vaginal atrophy, loss of urogenital integrity, loss of skin elasticity
67
Q

How is menopause dx?

A

one year of no periods (amenorrhea) after age 40 with no pathologic cause

  • cessation of menses for at least 12 months
  • FSH and estradiol (FSH >30) with decrease estradiol (although not necessary for diagnosis)
  • onset < 40 years old = premature ovarian failure
68
Q

What is the tx of menopause?

A
  • Estrogens are used to treat hot flashes
  • if uterus: HRT (estrogen + progesterone), if no uterus (ERT)
  • women with an intact uterus should not use estrogen alone because of the increased risk of endometrial cancer
  • progestins: hot flashes, increased risk of breast cancer
  • HRT - severe menopausal symptoms (hot flashes, night sweats, vaginal dryness)
  • “smallest dose for shortest possible time and annual reviews of the decision to take hormones”
  • HRT should not be used to prevent cardiovascular disease due to slightly increased risk of breast cancer, MI, CVD, DVT
  • hormone therapy effect on lipid profile: HDL and TG levels increase, LDL levels decrease
69
Q

What are the contraindications for HRT?

A
  • increase triglycerides
  • undiagnosed vaginal bleeding
  • endometrial cancer
  • history of breast CA or estrogen-sensitive cancers
  • CVD history
  • DVT or PE history
70
Q

What are the non-hormonal therapies for menopause?

A

cool temperatures, avoid hot, spicy foods or beverages, avoid ETOH, exercise, soy

  • alternative drugs for vasomotor symptoms
  • SSRIs (paroxetine)
  • SNRIs
  • clonidine
  • gabapentin
71
Q

What is pelvic inflammatory disease?

A

infection that ascends from the cervix or vagina to involve the endometrium and/or Fallopian tubes

  • causative agents include gonorrhea and chlamydia
  • chandelier sign (cervical motion tenderness)
72
Q

What are the symptoms of pelvic inflammatory disease?

A

pelvic pain and fever, there may be vaginal discharge (cervicitis)

73
Q

What are the complications of pelvic inflammatory disease?

A
  • infertility
  • ectopic pregnancy
  • tubo-ovarian abscess (adnexal mass)
74
Q

What are the clinical findings of pelvic inflammatory disease?

A

direct abdominal tenderness, cervical motion tenderness, and adnexal tenderness plus 1 or more of the following

  • temperature >38
  • WBC count > 10,000/mm3
  • pelvic abscess found my manual examination or ultrasonography
75
Q

What is the outpatient tx of pelvic inflammatory disease?

A

ceftriaxone IM 250 mg once + PO doxycycline 100 mg BID x 14 d +/- PO Flagyl 500 mg BID x 14 d

76
Q

What is the inpatient tx of pelvic inflammatory disease?

A
  • severely ill or nausea and vomiting precludes outpatient management
  • consider hospitalization if the diagnosis is uncertain, ectopic and appendicitis cannot be ruled out, pregnancy, pelvic abscess suspected, HIV positive, unable to follow or tolerate outpatient regimen, or failed to respond to outpatient therapy
  • doxycycline + IV cefotetan or cefoxitin x 48 h until the condition improves, then PO doxycycline 100 mg BID x 14 d
  • clindamycin + gentamicin daily, if normal renal function x 48 h until the condition improves, then PO doxycycline 100 mg BID x 14 d
77
Q

What is a rectocele?

A

herniation of rectum into the posterior wall of the vagina

  • childbirth and other processes that put pressure on the tissue wall can lead to a rectocele
  • results in pelvic pressure + bowel symptoms
78
Q

What are the symptoms of a rectocele?

A

a soft bulge of tissue in the vagina that may or may not protrude through the vaginal opening

  • defecatory dysfunction (constipation, straining, incomplete emptying)
  • perceived or discovered bulge into the vagina, low back pain
79
Q

How is a rectocele dx?

A

POP-Q (pelvic organ prolapse quantification): quantifies the extend and location of defects
-get a colonoscopy to rule out cancer and rectal studies if indicated

80
Q

What is the tx of a rectocele?

A

kegel exercises, pelvic floor retraining, behavioral changes, bowel regimen, pessary, surgical repair or repair with mesh augmentation

81
Q

What is a spontaneous abortion?

A

is an expulsion of all or part of the products of conception before 20 weeks of gestation

82
Q

What are the characteristics of a spontaneous abortion?

A
  • incidence is 15-20% of pregnancies, first 12 wk (80%)
  • Fetal RF: chromosomal abnormalities (MC: trisomy, monosomy X), congenital anomalies
  • Maternal RF: previous spontaneous abortion, smoking, maternal infection, anatomic anomalies (large uterine fibroids), Asherman syndrome, maternal disease, gravidity, fever, prolonged time to achieving pregnancy, BMI <18.5 or > 25, celiac disease
83
Q

What are the symptoms of a spontaneous abortion?

A

vaginal bleeding, or tissue passing the vagina and pain in the belly or lower back

84
Q

What are the labs for a spontaneous abortion?

A

quantitative beta-hCG, CBC, blood type, antibody screen, U/S to assess fetal viability and placentation

85
Q

What is the tx for a spontaneous abortion?

A
  • expectant management (<13 wk): allow complete abortion to occur
  • > 13 weeks: medical abortion
  • mifepristone (ansiprogestion) or misoprostol (prostaglandin). -96% safe and effective
  • D&C (first trimester)
  • dilation and evacuation (2nd)
  • surgery required if ineffective or excessive blood loss
86
Q

What is a threatened abortion?

A

bloody vaginal discharge before 20 weeks of gestation with or without uterine contractions in the presence of a closed cervix

87
Q

What is an incomplete abortion?

A

dilated cervical os with the passage of some but not all products of conception before 20 weeks of gestation

88
Q

What is an inevitable abortion?

A

dilated cervical os without passage of tissue before 20 weeks of gestation

89
Q

What is a missed abortion?

A

death of fetus before 20 weeks of gestation, with products of conception remaining intrauterine

90
Q

What is recurrent, spontaneous abortions?

A

three or more consecutive pregnancy losses

91
Q

What are the characteristics of candidal vaginitis?

A
  • HIV, diabetes, or a patient who has recently completed antibiotics
  • thick, white cottage cheese pruritus, dysuria, burning, dyspareunia, vaginal or vulvar edema and erythema
  • 10% KOH psudohyphae
  • PH< 4.5 (acidic)
  • fluxonazole 150 mg PO x 1 repeat in 7 days
92
Q

What are the characteristics of bacterial vaginosis?

A
  • fishy, grey, scant, thin, sticky
  • burning, dysuria, or pruritus
  • PH > 4.5 (bacterial = basic)
  • +whiff test and clue cells
  • metronidazole 500 mg PO BID x 7 days or 750 mg QD x 7 days or clindamycin intravaginal gel x 7 days
93
Q

What are the characteristics of trichomonas?

A
  • sexual active woman
  • copious malodorous
  • green/yellow “frothy”
  • strawberry cervix
  • motile flagellated protozoa
  • metronidazole 2 g PO x 1 dose
94
Q

What are the characteristics of atrophic vaginitis?

A
  • irritation, dryness, painful intercourse, increased UTIs, urinary incontinence
  • recurrent UTI despite treatment
  • can diagnose on a vaginal exam - thin, pale appearing mucosa - diagnosis of exclusion in postmenopausal women
  • tx with topical estrogen cream
  • conjugated estrogens vaginal cream (0.625 mg/g) 0.5-2 g vaginally daily for 3 weeks, then tapered to lowest effective dose twice weekly; administer cynically (3 weeks on, 1 week off)
  • can give oral HRT if no contraindication
  • non-hormonal vaginal moisturizers
95
Q

What is vaginal pH?

A
  • normal findings: pH of 4-4.5
  • bacterial vaginosis: pH of > 4.5
  • vulvovaginal candidiasis: pH of 4-4.5
  • trichomoniasis: pH of 5-6

Family Medicine EOR (14 decks)

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