Review Flashcards
(164 cards)
1
Q
Bartholin cysts are located where?
A
4 and 8 o’clock
2
Q
What does Estrogen do?
A
Thickens the endometrium
3
Q
What does Progesterone do?
A
Maintains pregnancy and prevents endometrial sloughing and miscarriage
4
Q
What does Prostaglandin do?
A
Contract the uterine causing endometrial ischemia and uterine cramping
5
Q
During the follicular phase there is a a spike in what hormone?
A
Estrogen
6
Q
Ovulation occurs on what day of cycle?
A
Day 14
7
Q
During the luteal phase there is a spike in what hormone?
A
Progesterone
8
Q
What is the phases of the uterine cycle?
A
- Menstrual phase
- Proliferative phase
- Secretory phase
9
Q
What structures are apart of the adnexa?
A
Fallopian tubes and ovaries
10
Q
KOH (potassium hydroxide) is a dx test used for what?
A
Vulvovaginal Candidiasis
11
Q
What are the risks of breast cancer?
A
- > 50 yo
- 1st degree relatives
- postive BRCA1 and BRCA2
12
Q
Is BRCA 1 or 2 associated with early onset of breast cancer and ovarian cancer?
A
BRCA 1
13
Q
Medullary carcinoma (breast cancer) is MC in who?
A
Younger women and women with BRCA1
14
Q
Where is breast cancer MC’ly located?
A
Upper outer quadrant
15
Q
What age do you start screening (pap/hpv) for cervical cancer?
A
- Age: 21-39 pap q3 yrs
- Age: 30-65 Pap + HPV, q 5 yrs or pap q3 yrs
- Age: >65: not needed
16
Q
When do you give a pt the HPV vaccine?
A
- 1st at age 11-12 yo
- catch up: 13-26 yo
17
Q
When do you do mammograms?
A
- Every yr starting at age 40 or high-risk pts
- Every 1-3 yrs for women age 20-39 yo
- Every other yr for women age 50-74
18
Q
When do you do a colonoscopy, FIT/FOBT and sigmoidoscopy?
A
- Colonoscopy: starting at age 50, then every 10 yrs
- FIT or FOBT: annual
- Sigmoidoscopy: every 5 yrs
19
Q
What is the MC menopause complaint?
A
Sleep disturbances
20
Q
What is the MC GYN cancer?
A
Breast cancer- Infiltrating ductal carcinoma
21
Q
What GYN cancer has the highest mortality?
A
Ovarian cancer
22
Q
What are S/Sxs of candidiasis?
A
- Thick, curdy, white d/c
- <4.5
- KOH odor: Negative
- Wet mount: WBC, Spores, hypae
23
Q
What are txs for candidiasis?
A
Topical or vaginal suppository OTC: - Miconazole - Clotrimazole Rx: - Fluconazole - Boric acid-fatal if swallowed
24
Q
Ovulation occurs when?
A
30-36 hrs of LH surge
25
What are S/Sxs of trichomoniasis?
- Frothy, green/yellow d/c
- >5
- KOH odor: Positive
- Wet mount: WBC, Motile, Trichomonas, flagella
- Exam: petechia/strawberry patches
26
What is the tx for trichomoniasis?
- Metronidazole
| - Tinidazole
27
What is the S/Sxs of bacterial vaginosis?
- Thin, white, gray d/c
- >4.5
- KOH odor: positive "whiff cells"
- Wet mount: few WBC, clue cells
28
What is the tx for bacterial vaginosis?
- Metronidazole
| - Clindamycin
29
What is the tx for PID caused by Gonorrhea?
Ceftriaxone or Cefixime
30
What is the tx for PID caused by Chlamydia?
Azithromycin or Doxy
31
What is PID also known as?
Salpingitis
32
What is the MC location for an ectopic pregnancy?
Fallopian tubes
33
What are some risk factors for ectopic pregnancy?
- Non white
- >35 yo
- untreated PID
- hx of STI
34
What is the classic triad for ectopic pregnancy?
- Amenorrhea
- Pain
- Vaginal bleeding
35
What are classic findings for malignant breast cancer?
- Hard
- Painless
- Irregular edge
- Fixation to skin or chest wall
- Dimpling of skin
- Unilateral bloody nipple d/c
- Nipple retraction
36
What are classic findings for benign breast cancer?
- Smooth, rubbery
- Painful
- Well-defined
- Easily moves under skin
- Green/yellow nipple discharge
37
What are the top 3 MC breast cancer?
1. Invasive ductal carcinoma
2. Invasive lobular carcinoma
3. Medullary carcinoma
38
What mammogram finding is most concerning?
Speculated
39
What is mastitis?
Infection of breast tissue
40
What is the cause of mastitis?
Staph aureus
41
What is the tx for mastitis?
- Antibiotics
- Cont. breast feeding, safe in full term healthy babies
- Cessation of breast feeding then pump
- w/o emptying the breast the resolution will be delayed and painful with increased engorgement
42
What should you think if you treat a pt with mastitis but sxs persists?
Mastitis w/ abscess
43
What does bloody nipple d/c indicate?
Intraductal papilloma
44
What does green/brown nipple d/c indicate?
- Mammary duct ectasia
| - Fibrocystic breasts
45
What does milky nipple d/c indicate?
Galactorrhea
| - Drug related, thyroid, prolactinoma
46
What does purulent nipple d/c indicate?
Acute mastitis
47
What is Adenomyosis?
Endometrial glands and stroma extend into the uterine musculature
48
What are S/Sxs of Adenomyosis?
- Heavy prolonged bleeding
- Dysmenorrhea
- Cramps through menses, worsen when you get older
- Large blood clots
- Dyspareunia
49
What are leiomyomas?
Benign tumors derived from smooth muscle cells surrounded by pseudocapsule or compressed muscle fibers
- MC in AA women and 5th decade of life
50
What is the MC leiomyoma?
Fibroids
51
What are S/Sxs of leiomyomas?
- MC: abnormal uterine bleeding, usually heavier
- Iron def anemia
- "something pressing down"
- Urinary or defecation problems
- Secondary dysmenorrhea
52
What are PE findings of leiomyomas?
Feels "hard" or solid quality; "lumpy-bumpy"
53
What is endometriosis?
Endometrial gland and stroma grow outside the uterine cavity
54
What is the S/Sxs of endometriosis?
- Progressive dysmenorrhea
- Progressive dyspareunia
- Dyschzia
"3 Ds"
55
What is a cause of endometriosis?
Retrograde menstruation
56
What is retrograde menstruation?
- Fragments of endometrium pass through fallopian tubes to pelvic cavity
- Once in pelvic cavity tissue implants on peritoneal surface, growing into endometriotic lesions
57
What is a classic finding of endometriosis during direct visualization?
Chocolate cysts
58
PCOS is due to what?
Hyperandrogenism
59
What are S/Sx of PCOS?
- Hirsutism
- Anovulation or oligo-ovulation
- Obesity
- Metabolic syndrome: insulin resistant
- Increased acne
- Infertility
- Irregular menses
60
What is seen on the US in a pt with endometriosis?
"necklace" or "string of pearls"
61
What are S/Sxs of ovarian torsion (ischemic condition)?
- Sudden onset severe unilateral lower abdominal pain
| - Pain may occur after exertion
62
What is the hallmark finding during PE for a pt with ovarian torsion?
Tenderness
63
What is the Dx test and Tx for ovarian torsion?
Dx: Doppler US
Tx: Surgical emergency
64
What is the definition of infertility?
Failure of a couple to conceive after 12 mos of frequent, unprotected intercourse
65
What vaginal changes occur during menopause and what is the tx?
- Vaginal changes: atrophy
| - Tx: topical estrogen
66
What is the difference between primary and secondary amenorrhea?
- Primary: has never had a period
| - Secondary: have period and then doesn't have one
67
What is the criteria for secondary amenorrhea?
- Absence of menses for >3 cycle intervals
| - Absence of menses for 6 consecutive mos
68
What is the MCC of amenorrhea?
Pregnancy
69
What lab test are drawn for amenorrhea?
- FSH
- LH
- Prolactin
- TSH
70
What is S/Sxs of primary dysmenorrhea?
- Painful uterine muscle activity
- Lower abdominal pain
- SP pain
- Intermittent pain
- N/V/D
- Fatigue
- HA
71
What is the PE finding and tx for primary dysmenorrhea?
- PE: normal
| - Tx: NSAIDs, heat, exercise, psychotherapy
72
What are the S/Sxs for secondary dysmenorrhea?
- caused by an identifiable cause
- Pain persists after menses
- Pain starts before menses
- Gets worse before it gets better
73
What are the Dx and Tx for secondary dysmenorrhea?
- Dx study for suspected underlying disease
| - Tx: treat underlying disease
74
What is menorrhagia?
- Regular flow, excessive flow or long duration
| - "gushing" or "open faucet" bleeding
75
What is metrorrhagia?
- Irregular cycles
| - Intermenstrual bleeding
76
What is menometrorrhagia?
- Irregular cycles
- Excessive flow
- Duration varies
77
What is polymenorrhea?
Menses occurring too frequently <21 days
78
What is oligomenorrhea?
- Menses >35 days apart
| - Bleeding usually decreased in amount.
79
What is PMS?
Cyclic occurrence of sxs that are sufficient severity to interfere with some aspect of life and appear to be consistent and predictable in relationship to the menses
80
What are S/Sxs of PMS?
1 affective sx:
- Depression, angry outburst, irritability, confusion, social w/d
1 somatic sx
- Mastodynia, bloating, HA
81
What is the tx for PMS?
- < caffeine, EtOH, tobacco, chocolate, sodium
- Stress management, CBT, exercise
- Meds: fluoxetine, sertraline, SSRIs, hormonal interventions
82
When does spontaneous abortion occur?
<20 wks gestation
83
What is the MCC of first trimester spontaneous abortion?
chromosomal anomalies
84
What is the management for 1st trimester abortion?
D and C and emotional support!
85
What is the MCC of 2nd trimester abortion?
pathological (can be treated)
86
What is the management for 2nd trimester abortion?
D and E and emotional support!
87
If pt has a hx of recurrent pregnancy lost what procedure can be done?
cervical cerclage procedure
88
What is complete abortion?
- Spontaneously passes all the produce of conception
| - Closed cervical os
89
What is incomplete abortion?
- Internal cervical os opens and allows passage of blood and some tissues
- Some retained placental tissue remains in cervical canal
- Suction curettage may be needed to remove remaining POC
90
What is threatened abortion?
- Bleeding in 1st trimester w/o loss of fluid or tissue
| - Closed cervical os
91
What is inevitable abortion?
- Vaginal bleeding and/or gross rupture of membranes in the presence of cervical dilation
- Uterine contractions
- No expulsion of POC
- Open cervical os
92
What is the effects of valproic acid on pregnancy?
NT defect- spina bifida
93
What are the effects of warfarin on pregnancy?
- Nasal and midface hypoplasia
- Stippled femoral and vertebral epiphysis (focal bone calcification)
- Later exposure: hydrocephalus
94
What are the effects of EtOH on pregnancy?
Fetal alcohol syndrome:
- Growth restriction
- DNX dysfunction (microcephaly, mental retardation)
- Behavior disorders
- Facial abnormalities (low set ears, midfacial hypoplasia, shortened palpable fissures, thin upper lip)
95
What are the effects of Tobacco on pregnancy?
- Low birth weight
- Intrauterine growth restriction
- Fetal mortality
96
What are the effects of tetracycline (doxy) on pregnancy?
Discoloration of deciduous teeth
97
What are the effects of phenytoin on pregnancy?
- Abnormal facies, cleft lip/palate
- Microcephaly
- Growth defects
98
What are the effects of retinoids (accutane) on pregnancy?
- Fetal loss
| - Congenital malformation
99
What are the effects of Lithium on pregnancy?
Cardiac defects- Ebstein anomaly (tricuspid valve defect and large right atria)
100
Pt who is of eastern Europe decent is at high risk for a variety of genetic disorder, what test do you run?
Ashkenazi Jew panel
101
What is molor pregnancy also known as?
hydatidiform mole
102
What is molar pregnancy?
- Neoplasm resulting from abnormal placental development w/ trophoblastic tissue proliferation derived from gestational tissues.
"Tumor pregnancy"
103
What are the S/Sxs of molar pregnancy?
- Painless vaginal bleeding
- Uterine size/date discrepancies
- Hyperemesis gravidarum
104
What can occur d/t molar pregnancy?
Choriocarcinoma
| -Mets to lungs is MC
105
What is seen on a US in a pt with molar pregnancy?
snowballs/snowstorm, cluster of grapes
106
What are S/Sxs of hyperemesis gravidarvum ?
- Severe, excessive morning sickness
- Weight loss
- Significant fluid/electrolyte imbalance
- Extends beyond 16 wks
107
What is the tx for hyperemesis gravidarum?
- Hospitalization required: IV fluids and electrolyte correlation
- Antiemetics: pyridoxine (B6) + doxylamine
108
What is the biggest difference between hyperemesis and morning sickness?
Hyperemesis requires hospitalization and fluid resuscitation.
109
How and when do you screen for maternal DM?
- Screen with 50 grams 1 hr glucose tolerance test at 24-28 wks
- Abnormal results (>130-140): fasting 100mg 3 hr glucose tolerance test
110
Group B streph is the MCC of what?
Sepsis in neonates
111
How and when do you screen for group B strep?
- Swab both the lower vaginal and rectum (in that order)
| - Universal screening at 35 and 37 wks
112
What is the tx for group B strep?
Penicillin is drug of choice
113
What is Hegars sign?
Softening of the uterine isthmus
114
What is chadwicks sign?
Blueish discoloration of cervix and vulva
115
What is the tx for heartburn?
Smaller, more frequent meals and bland food recommended
116
What are derm changes that occur during pregnancy?
- Spider angiomata: telangiectasia located on the upper torso, face and arms
- Striae gravidarum: stretch marks, appear pink/purple; eventually turn pale, no tx.
- Melasma: Hyperpigmentation patches on cheeks
- Linea nigra: Vertical hyperpigmented line down abdomen
117
What is Naegels rule?
LMP + 7 days - 3 months
118
What does folate supplement do and what is the recommended dose?
- Prevents NT defect
- 0.4 mg daily
- 4mg if prior NT defect
119
What is the MC event in which isoimmunization can occur?
Delivery of baby and placenta
120
What occurs with first pregnancy of Rh incompatibility?
Rh + dad, Rh- mom = fetus Rh+
| - no hemolysis
121
What occurs with 2nd pregnancy of Rh incompatibility?
Anti Rh antibodies developed from first pregnancy which results in hemolysis in newborn
122
What is the tx for Rh incompatibility?
RoGam
123
If newborns heartbeat is less that 100 bpm what should you do?
Postive pressure ventilation (PPV)
124
If newborns heartbeat is less that 60 bpm despite PPV, what should you do?
Chest compressions
125
If newborns heartbeat is less that 60 bpm despite PPV and chest compressions, what should you do?
Give Epi
126
When is APGAR testing done?
Right after birth; 1 min and again at 5 min
127
What is the scoring for appearance?
```
0 = no blood flow
1 = Poor blood perfusion to extremities
2 = full blood flow
```
128
What is the scoring for pulse?
```
0 = no pulse
1 = <100 bpm
2 = >100 bpm
```
129
What is the scoring for grimace?
```
0 = no facial expression/crying
1 = minor facial expressions
2 = full facial expressions/crying
```
130
What is the scoring for activity?
```
0 = no movement/floppy
1 = minor movements
2 = full body movements
```
131
What is the scoring for respirations?
```
0 = no respiration
1 = week/slow
2 = strong cry
```
132
What is the complication of the vacuum used during delivery?
Cephalohematoma
133
What is the MC postpartum hemorrhage?
Uterine atony (loose and floppy)
134
What are the S/Sxs of the congenital infection: cytomegalovirus?
- Blueberry muffin rash
- Hepatosplenomegaly
- Chorioretinitis
- Periventricular calcifications
- Sensorineural hearing loss
- IU growth restrictions
135
What are S/Sx of post partum depression?
- Sxs begin immediately and can last up to 1 yr postpartum
- More pronounced feelings of sadness, anxiety despair
- Interferes w/ daily functioning
- Worsening over wks
136
What are S/Sxs of baby blues?
- Onset 2-4 days postpartum, resolves in 1-2 wks postpartum
| - Mild, intermittent feelings of sadness, anxiety, or anger
137
What are S/Sxs of postpartum psychosis?
- Sxs begin in the 1st-3 mos postpartum
- Severe sxs: attempt to harm self or baby, obsessive thoughts about baby, hallucinations
- More common in women with hx of bipolar or schizophrenia
- Medical emergency and urgent referral!!
138
What the the 3 different breech presentations?
- Frank (MC) - hips and knees flexed, feet at head
- Complete: both hips and knees are flexed (criss cross apple sauce)
- Footling: one or both hips not completely flexed, presenting park may be butt or one or both feet
139
What is cervical effacement?
- % of cervical thinning
| - Occurs in latent phase (1st stage of labor)
140
What is the tx for maternal HTN?
- Methyldopa
| - Labetalol
141
What is placenta accrete?
- Placenta extending into superficial layer of myometrium
| - Complication of placenta previa
142
What is placenta previa?
- Placenta overlaps and implants on the cervix covering the internal os to varying degrees
- occurs in 3rd trimester
143
What are the S/Sxs of placenta previa?
- PAINLESS, bright red virginal bleeding
144
What are the risk factors for placenta previa?
- Prior c-section
- Multiple gestation
- Multiple induced abortions
- Advanced maternal age
145
What is placenta abruption?
Premature separation of the implanted placenta from the uterine wall
146
What are the S/Sxs of placenta abruption?
PAINFUL vaginal bleeding, but bleeding may not always be present
147
What are the risk factors of placenta abruption?
- HTN
- Cocaine use
- Trauma
- Multiparity
148
What is preeclampsia?
Development of HTN after 20 wks gestation age w/ proteinuria
- Proteinuria: >400mg on 24hr specimen
149
What are S/Sxs of preeclampsia?
Edema and rapid weight gain
150
What is the tx for preeclampsia and when do you start tx?
Magnesium sulfate
- Mild: start when induction is initiated
- Severe: institute at time of dx
151
What are S/Sxs of hypermagnesium?
- Loss of DTR
- Flushing, feeling warm
- Somnolence, slurred speech
- MS paralysis
152
What is eclampsia?
Seizures
153
What are the effects of eclampsia on mom and baby?
- Mom: MSK injury, hypoxia, aspiration
| - Baby: seizures may often cause HR abnormalities
154
What is HELLP syndrome?
```
H: hemolysis
E: elevated
L: liver enzymes (AST, ALT, LDH)
L: low
P: platelet count (thrombocytopenia)
```
155
What are the effects of Glucose intolerance/Gestational DM on baby?
- Macrosomia: estimated fetal weight > 4,000 - 4,5000 grams
| - Large gestational age: >90th percentile
156
What are preterm labor sxs?
- LLB
- Braxton-hicks contractions
- Lightening
- Bloody show
157
What is sxs of "lightening" in preterm labor?
Fetal head descending into maternal pelvis causing increased pelvic pressure, lower abdominal pain and thigh pain
158
What occurs during "bloody show" in preterm labor?
Extrusion of mucus from endocervical glands, bleeding from small vessels, associated with cervical thinning (effacement)
[occurs before water breaks]
159
What is the MC warning sign of a still birth?
No fetal movement
160
What is the most common age for vulva cancer?
postmenopausal: 70-80 years old
161
What are the causes of vulva cancer?
- Squamous cell: 90%, may develop thru a precancerous condition
- Melanoma: 2% found on the clitoris or labia minora
- Adenocarcinoma: starts in the Bartholin glands
162
What is the most common age for vaginal cancer to occur?
>55
163
What are the causes of vaginal cancer?
- Squamous cell: 80-90%
| - Usually 2nd to cervical or vulvar cancers
164
What is the clinical feature of vaginal cancer?
most often found in upper 1/3 of vagina
