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PAM Semester 4 > quick notes Clin med repro > Flashcards

quick notes Clin med repro Flashcards

1
Q

Leiomyoma

A

Uterine fibroids (benign)

Very common

Firm, well circumscribed mass

Pain, bleeding

Miscarriages, infertility

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2
Q

Pap smear

A

Screens for cervical cancer

Q3 after 21

Q5 after 65

Over 65, clean, 10y, no need

Q1 if abnormal

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3
Q

Cervical cancer

A

HPV 16,18 (most get HPV and clear it)
2nd most common, 1st most lethal

PAP for screening

Late stage, visible lesion (most are asymptomatic)

Surg, radiation, chemo

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4
Q

Ovarian cancer

A

BRCA 1/2 increased risk

Mostly asymptomatic

Ovarian mass

CA125 80% for mass

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5
Q

Ovarian mass

A

Cysts under 5cm benign

Larger need surg

Hyster/oophor/lymphadnectomy then chemo

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6
Q

Endometrial cancer

A

Most common GYN cancer

Post menopause

Obese, HRT, Tamoxifen

Adenocarcinoma 80%

Abnormal vaginal discharge, leukorrhea

Hyster/bilateral salpingo oophorectomy
Radiation

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7
Q

Irregular uterine bleeding

Mneumonic

A

POLICEMAN

Polyps
Ovulatory dysfunction**
Leiomyoma**
Iatrogenic
Coaguopathy
Endometrial**
Malignancy
Adenomyosis
Not classified
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8
Q

Menstruation

Regularity

A

> 38 days Infrequent

24-38 normal

<24 Frequent

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9
Q

Menstruation

Volume

A

<5ml light

5-80ml Normal

> 80 Heavy

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10
Q

Menstruation

Duration

A

<4.5 days short

4.5-8 Normal

> 8 Long

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11
Q

Amennorrhea

A

No bleeding for 90 days

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12
Q

Primary amenorrhea

A

No menarche by 15

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13
Q

Secondary amenorrhea

A

6 months no bleeding after regular cycles

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14
Q

Precocious Menstruation

A

Begins before 9

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15
Q

Menopause

A

No bleeding 12 months without cause

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16
Q

Post menopause bleeding

A

Always worked up

Polyp, hyperplasia, atrophic vaginitis, atrophy

HRT a common cause

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17
Q

Atrophic vaginitis

A

From decrease in estrogen

loss of thickness, elasticity

PH increases over 5 (lack of lactobacilli)
More prone to infection

irritation, itching, infection, urinary issues

White/yellow discharge

Estrogen cream, ring, tablets, suppositories

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18
Q

Contraception

Tier 1

A

Long term, reversible

IUD
Implant

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19
Q

Contraception

Tier 2

A

Moderately effective

Injection
Pill
Patch
Ring

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20
Q

Contraception

Tier 3

A

Least effective

Condoms
Diaphragms, cap, sponge
Withdrawal
Timing
Spermicides
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21
Q

Emergency contraception

A

Up to 120 hours after (6 days)

Copper IUD
Pills

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22
Q

Smoking and Contraception

A

No restrictions except for CHC

CHC, don’t smoke

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23
Q

Sexual violence

A

1 in 5 females

1 in 38 males

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24
Q

Rape

A

1 in 3 women / 1 in 4 men 11-17

1 in 8 women / 1 in 4 men <10

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25
3 P's for trafficking protection
Prevention Prosecution Protection
26
Sexual assault exam
White sheet / woods lamp Swab cheeks, vaginal wall Look for injuries Look for sperm under microscope Do colposcopy Pregnancy/STD/HIV Prophylaxis STD/Tetanus/sedatives/Pain/Hep B/Psych
27
STD Prophylaxis Sexual assault
Gonorrhea – Ceftriaxone 500mg + azithromycin 1 g* Chlamydia – Azithromycin 1 g* BV – Metronidazole 500mg BID x 7d Trichomonas - Metronidazole 500mg BID x 7d Hep B – if unvaccinated, give first dose (repeat at 1-2 and 4-6 months) HIV consider retroviral prophylaxis if risk for exposure is high Can use doxy instead of azithro if not pregnant
28
Para Gard
Non hormonal (only IUD) Prevents implantation Everything except para gard stops ovulation
29
Emergency contraception options
Plan B 1 ppill (0.75mg) Plan B 1 step 1 pill (1.5mg) Ella 1 pill ``` COC Ogestrel 2 pills Lo/Ovral 4 pills Trivora 4 pills Aviane 5 pills ``` Paragard (copper IUD)
30
Reportable diseases (STD's)
Aids/HIV Chancroid / syphilis Gonorrhea/chlamydia Hep A/B Granuloma / Lymphogranuloma
31
Ovarian Torsion
80% from cyst over 5cm Usually from benign cyst US Surgery Oophorectomy if recurrent Birth control helps with prevention More common in right
32
Ovarian cancer
Most fatal malignancy High recurrence rate
33
Breast cancer screening
ACOG mammogram after 40 (yearly) Breast exam after 19 (yearly)
34
Bi Rads
Breast cancer nodule likelihood 1 - negative 2 benign 3 probably benign 4 suspicious
35
Ovarian cysts
common Most ovarian masses are cysts rupture doesn't have extensive bleeding Need biopsy/aspiration to tell if malignant No real treatment (ruptured ones will reabsorb) Most are asymptomatic <3cm normal 5-7cm repeat US in 6-12w >7 MRI/surg CA125 unreliable
36
Ovarian teratoma
Benign tumor (60% of benign tumors) slow growing can have other tissues in it (5-10cm)
37
Solid ovarian mass
Benign Surgery
38
Poly Cystic Ovarian Syndrome | PCOS
Common endocrine disorder Associated with DM 2 Hirsutism, obesity, acne Clomiphene if want kids Depo if not OCP for hirsutism + spironolactone
39
Pelvic organ prolapse
Common in women with multiple kids Cystocele - front Urethrocele, Rectocele - back Supportive tx, weight, limit strain, kegels, pessaries Surgery
40
Vaginitis
Common Pruritis, irritation, discharge Malodorous
41
Candidiasis
Caused by ABX, preg, DM, immune Pruritis, thick curd discharge No odor KOH - hyphae, budding PCR -conazole's (1, 3, 7, 14 day tx's) Weekly if recurrent
42
Trichomonas
Protozoa STD Pruritis, malodorous Yellow/green/frothy Motile flagella on scope Flagyl (treat both partners
43
Bacterial Vaginosis
Gardnerella Not STD Malodorous, Fishy Clue cells Flagyl
44
Endometriosis
Endometrial tissue growths Pain, infertility Masses can rupture and bleed heavily Rule out PID, cancer US/MRI Surgery/biopsy definitive Total hysterectomy in no kids desired NSAIDS for pain Contraceptives to limit ovulation
45
Galactorrhea
Milky discharge from breast Elevated PRL Many many causes Check thyroid, check preg Correct underlying condition
46
Mastitis (breast)
pain, tender, red, fever, swell 2nd week post partum from milk stasis/infection Staph A. Hypoechoic US All purpose nipple ointment if not better look for abscess
47
Breast abscess
uncommon PO/IV abx Broad Surg drainage last resort if >48hrs refer to breast surg
48
Cellulitis (breast)
uncommon Red, tender, lymphangitis Refer to breast surg Biopsy to rule out cancer no labs needed Usually Beta hemolytic strep if >48hrs refer to breast surg
49
Acute mastitis in non lactating women
Staph or strep 3rd gen ceph if >48hrs refer to breast surg if >30 need follow up mammogram
50
Hidradenitis suppurativa
Infection of sweat glands (apocrine) Recurrent, chronic, abscesses, scarring Incision and drainage, (lance and pack) Outpatient, very painful Pain meds (opioids) No abx needed
51
Nipple discharge
Bilateral not concerning Unilateral can be linked to cancer Bloody higher risk of cancer Mammogram and fluid analysis
52
Fibrocystic breast disease
common 30-50y due to estrogen imbalance multiple, bilateral mobile masses Tender, comes and goes US/mammogram Biopsy if suspicious Home remedies Medical - danazol and change HRT in menopausal
53
Fibroadenoma (breast)
Common Benign mass Biopsy for Dx Excise
54
Phyllodes tumor (breast)
Fibroadenoma like tumor Grows rapidly Benign or malignant Excise Mets to lungs
55
Breast cancer
Most common cancer in women 2nd cause of death cancer 1 in 8 No pregnancy or other cancers has higher risk TNM scale Found on mammograms (90%) if palpable not painful discharge, pain, erosion, retract, enlarge, itch Asymmetry
56
Paget's (breast)
Eczematoid eruption and ulceration of nipple Associated with adenocarcinoma if palpable (50%), probably invasive cancer uncommon, but frequently misdiagnosed
57
Inflammatory carcinoma (of breast)
Aggressive Diffuse brawny edema with erysiploid border Has palpable mass 35% have METs Not Derm
58
Breast cancer during pregnancy or lactation
Occurs in first post partum year or during preg anytime during lactation pregnancy termination does not improve outcome can get chemo in 2/3 trimesters no radiation
59
Bilateral breast cnacer
Rare | cancer in one breast increases risk in other
60
Mammography
Imaging of choice Only screening found to reduce mortality Use US after mammogram MRI best of all
61
DX of breast cancer
requires biopsy Fine needle safest Core more definitive
62
Breast cancer labs
May see hypercalcemia LFTs due to needing multiple meds CBC,CMP,LFT,PREG,Tumor markers
63
Checking for METS in breast cancer
Not usually necessary CT/MRI/PET
64
Guidelines for screening for breast cancer
ACOR Mammogram yearly over 40 ACOG Mammogram Q1-2 years >40, yearly >50
65
Breast cancer treatment
Radical mastectomy Everything Modified radical mastectomy Everything except muscle and some nodes Lumpectomy Chemo Hormone therapy
66
most common | cause of death for women during pregnancy.
postpartum haemorrhage (PPH)
67
AMTSL | Acute management of third stage of labor
Uterotonic (oxytocin) Delayed cord clamping (1-3 mins) CCT (Controlled Cord traction) Post partum vigilance (assess/reassess/massage) Oxytocin quality and supply (cool, constant) The most important AMTSL component was the administration of a uterotonic
68
Infertility, defined as
failure to achieve pregnancy within 12 months of unprotected intercourse or therapeutic donor insemination in women younger than 35 years or within 6 months in women older than 35 years, affects up to 15% of couples

PAM Semester 4 (7 decks)

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