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Woman's Health Flashcards

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1
Q

What is a Bishop score? What is it used for?

A

Scoring of the cervix during/before labor. This helps us determine whether or not the patient is in labor, what phase of labor they’re in and how the labor is progressing. Predictor of whether or not IOL is necessary

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2
Q

Bishop score >8?

A

Vag delivery likely, the cervix will probably do just fine.

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3
Q

Bishop <6?

A

Probably need some kind of induction method

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4
Q

5 Components of a Bishop Score

A

“Call PEDS Fast”

Cervical Position (it kind of retracts for labor
Effacement (thinning)
Dilation 
Softness (consistency)
Fetal Station
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5
Q

Stage I of labor

A

Onset of labor until complete dilation of cervix. Consists of active phase and latent phase

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6
Q

How long does stage 1 take if nullip? Mulltip?

A

Null: 10-12 hrs
Mull: 6-8 hrs

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7
Q

What defines the latent phase of labor?

A

Onset of labor until the cervix is dilated 3-4 cm. Not considered active until 3-4 cm.

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8
Q

When does active phase start? When does it end? How long does this take (null vs mull)

A

Starts at 3-4cm, ends at 9cm.

Null: 1cm/hr
Mull 1.2cm/hr

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9
Q

What are the 3 P’s

A

Power of contractions
Passenger- size and position of the kid
Pelvis/Passage- size/shape of pelvis

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10
Q

What defines stage 2 labor? Length of time null vs mull

A

9cm until the delivery of the infant

Null- >2 hours is considered prolonged. >3 if epidural
Mull- >1 hr is prolonged. >2 if epidural

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11
Q

Repetitive early & variable decels in stage 2 labor?

A

Totally normal! Have to do with contractions. Being repetitive is good

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12
Q

Late decels, bradycardia or loss of variability?

A

NOT OKAY! This is when we consider an urgent cesarean

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13
Q

What defines stage III delivery

A

Delivery of the infant until the delivery of the placenta. Takes 5-30 min

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14
Q

3 signs of placental separation

A

Cord lengthening
Sudden blood gush
Uterine fundal rebound as placenta detaches

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15
Q

First degree tear

A

Vaginal mucosa

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16
Q

Second degree tear

A

Perineal tear. Taint

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17
Q

3rd degree tear

A

Anal sphincter involvement

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18
Q

4th degree tear

A

Tears into the rectum

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19
Q

RF for molar pregnancy

A

Extremes in age. Hx of GTD. Nullip. OCP use

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20
Q

Pathognomonic for molar pregnancy

A

PEC, hyperemesis and hyperthyroidism happening <20 weeks. It’s like pregnancy gone rogue. ALSO HEAVY VAGINAL BLEEDING

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21
Q

PE on molar preg

A

PEC, hyperthyroid, NO FETAL HEART TONES, uterus is MASSIVE for GA, grape like goop coming out of the cervix, theca lutein cysts

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22
Q

Molar pregnancy on US

A

Molar tissue looks like “diffuse mixed echogenc pattern”. Not a fetus, it’s a weird clump of tissue made from chorionic villi and intrauterine blood clots.

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23
Q

Management of a molar pregnancy

A

Immediate removal to prevent persistant/malignant GTD.

Also tx the symptoms
PEC? Anti HTN
HCG induced hyperthyroid? BB to prevent thyroid storm
Done with childbearing? Cut that uterus out

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24
Q

Which type of mole is more likely to lead to persistent GTD

A

Complete

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25
Why do we recommend patients to not have another pregnancy for 6-12 months after a mole pregnancy
We do serial HCG levels for months afterwards to watch the levels drop and make sure there's no persistent disease going on. If the patient is pregnant so soon afterwards there's A) a chance the mole could happen again and B) HCG levels will be high from that so we won't know if there's also something scary going on
26
What freaky kind of malignant GTD can happen from a complete mole
Choriocarcionma
27
Gestational HTN definition
HTN w/o proteinuria that happens after 20 wks. Previously normal BP too. Lil bitch HTN, >140/90
28
PEC definition
HTN + Proteinuria after 20 weeks.
29
Proteinuria definition for PEC
>0.3g in a 24hr urine. Remember there should be no proteins
30
Severe PEC definition
>160/110, and protein >5g in a 24 hr or >3g in a spot, symptomatic HTN. This is pre HELLP and it's very bad
31
Superimposed PEC
Newonset proteinuria or worsening BP in a woman with prexisting CHTN. Or if they get HTN symptoms, like HA/scotoma/epigastric pain
32
Eclampsia definition
PEC + Seizures
33
Management for PEC
Delivery! IOL is GS for term moms, unstable moms or any pregnancy that shows lung development
34
Management for PEC with a stable preterm
Bedrest & betamethasone until we can induce
35
IOL with PEC, let's talk mag
Give Mg (4g loading, 3g/hr maintenance) during labor, & 12-24 hrs PP
36
Signs of severe PEC
``` BP >160/110 >5g 24hr or >3g in a spot Oliguria Scotoma Pulm edema/cyanosis Epigastric/RUQ pain LFT fuckups Thrombocytopenia Fetal growth restriction ``` This is HELLP waiting to happen
37
Momma with signs of renal/liver failure/pulmedema/HELLP/DIC?
C SECTION TIME
38
Eclampsia managment
Seizure management, BP control, seizure ppx. They get Mg from the time of diagnosis until 12-24hr pp. This is when it's okay to load the fetus with Mg
39
Can we section a seizing mom because baby is having decels?
No fucking way. Decels are to be expected. Fix the seizures, fix the decels
40
What does HELLP stand for
Hemolytic anemia Elevated Liver enzymes Low Platelets
41
Signs of hemolytic anemia
Elevated LDH Elevated Bili Schistocytes on smear
42
Signs of elevated liver enzymes
Elevated AST/ALT
43
Signs of low platelets
thrombocytopenia
44
What week is the fundus at the umbilicus
24 weeks
45
Nageles rule
Subtract 3 months from the LMP and add 7 days
46
Don't know the LMP but you want to calculate the EDD?
Via US, measure the crown-rump length. If done in the first trimester, this will give you a fairly accurate estimate. Within 3-5 days.
47
Four steps to leopold maneuvers
First- fundus Second- sides Third- presenting part fourth- pubic symphesis
48
Role of leopold maneuvers
Way to gage the position of the fetus if you don't have US
49
Suppressive Tx for HSV
1g of PO valcyclovir QD forever
50
Syphilis PE
``` Chance LA Torso, palm, sole rash AMS on neuro exam Genitalia, perianal, oral cavity lesion (2nd degree syph_ ```
51
When is serology highest for syp
2nd degree
52
Chancre are wicked painful right
nah dude
53
Screening for syph
Non trep VDRL/RPR test. Titers. this can be your false positive. Need another test to be diagnositic
54
Diagnostic for syph
Trep FTABS antibody test. This is diagnostic for syphilis
55
Have a lesion? What test is solidly mediocre for syph
Darkfield microscopy for spirochetes
56
When to consider getting a LP for syphilis
If they have positive titers and neuro sx like meningitis-like, hearing loss, CN dysf, AMS
57
LP CSF Syph interpertation
Pleocytosis (>5WBC) Inc protein (>45) + VDRL/FTABS
58
Syphilis tx lowkey vs high key
Lowkey is 2.3 million IM units one dose | Highkey is 7.2 million IM units given in three doses each a week apart
59
What is CIN
It is a premalignant condition of the uterine cerxix. It's the histological result of a pap smear
60
Cytology & Histology matchup LSIL correlates to? HSIL?
LSIL - CIN 1 HSIL- CIN2,3
61
ASCH Management
<25? Pap & colpo every 6 months for 1 yr | >25? Automatic colpo. If it's lowkey just do cotesting in 12/24 months. Highkey (CIN2,3) LEEP
62
CIN1/LSIL management
FU necessary CIN1 for 2 years straight? Can either keep following up or LEEP CIN2/3? LEEP
63
CIN 2/3 HSIL management
Tx necessary. LEEP right away. Do cotesting afterwards
64
Timing of PMS/PMDD
Repetitively in the second half of the menstrual cycle, resolves after menses.
65
Difference between PMS and PMDD
PDMD is characterised by anger, irritability, and internal tension. Like a total asshole
66
Tx for PMDD
1) SSRI! 2) OCP 3) Maybe low dose alprazolam? 4) GnRH 5) Surg
67
Main causes of primary amenorrhea
1) GONADAL DYSGENESIS (Turner, XY, primary ovarian insuff, PCOS) 2) Mullerian agenesis (MRKH) 3 )Constitutional delay PCOS Everything else is super rare
68
Main causes of secondary amenorrhea
1) PREGNANCY 2) Hypothal 3) Ovarian dysf Pit
69
Types of hypothalamic dysfunction
Constitutional delay Isolated GnRH def (not common) functional hypothalamic amen (stress, exercise, anorexia)
70
Labs to get for amenorrhea
HCG, FSH, TSH, PRL, Testosterone
71
Women infertility WU PE labs?
PE BMI, sex characteristics, breast/pelvic exam, thyroid exam Labs: TSH, PRL, STI screen, genetic
72
Ovarian evaluation for an infertility woman WU
Confirm ovulation is happening (secretory phase, prog levels) Ovulation reserve testing (FSH and estradiol, antral follicle count)
73
Uterine evaluation for a woman's infertility WU
Lots of scope options Pelvic US Hysterosalpingogram
74
Oligospermia
Most frequent cause of male infertility. it's when there's a low concentration of sperm in ejaculate
75
Azoospermia
Total abcense of sperm. Bilateral obstruction
76
Asthenospermia
Abnormal motlity "asthens, athens, hermes movement"
77
Teratospermia
Abnormal morphology. Teratogenic
78
Two methods of infertility tx
Ovulation induction (clomid) and controlled ovarian stimulation
79
When to do/start a CBE
Age 20-40 q2-3 yrs | >40? yearly
80
Who should do a BSE
High risk patients
81
Mammo guidelines?
ACOR recommends starting @ 40, ending at 75. q1-2 yr
82
Mammo and age
<50? Less sensitive since breast tissue is still pretty dense >50? More sensitive. Most of the breast tissue has been replaced with fat
83
Suspicious lesion found on mammo?
1) US. Find out if it's cystic or solid 2) Biopsy or aspirate Types of biopsies: open excisional, MRI guided, core, stereotactic
84
Cystic mass on US?
Aspirate in office and send to cyto
85
Mammo findings suggestive of cancer
Microcalcifications in a linear distribution, spiculated irregular mass
86
Non palpable mass found on mammo?
Stereotactic bx
87
Palpable mass found on mammo?
Core biopsy
88
WHAT DOES EVERY MASS GET
BIOPSY. YOU CANNOT RULE OUT MALIGNANCY BASED ON PE
89
Most common type of breast cancer
infiltrating ductal carcinoma
90
Signs of poor prognosis in BC
``` Age Menopause Tumor size (>2cm) LN status (sentinel LN is sampled first to avoid axillary LN dissection) ER/PR status HER-2 overexpression ```
91
What's really the only option for triple negative BC
chemo. Yikes
92
Targeted BC tx?
Trastuzumab. It's a monoclonal ab that works against HER2 overexpression. Given with conventional chemo, it has dramatically increased the survival rate in HER-2+ BC
93
Hormonal Tx for BC
Aromatase inhibs and SERM. These work against ER/PR + tumors. It's why they're so curable
94
ER/PR + and pre menopausal?
Tamoxifem/SERM
95
ER/PR + and post menopausal?
Aromatase inhibitors (aromasin, arimidex)
96
Indications for chemo in BC
LN + ER/PR - Good/used regardless of HER status Meant to eliminate micro mets and reduce recurrence
97
What is neoadjuvent chemo and why might we give it
Given before surgery to help reduce tumor size. Gives us a shot at possibly resetion an inoperable tumor. Given before resection. It's a "new" idea to give chemo before surgery
98
Taxane chemo drugs-- especially rad for what type of BC
Paclitaxel, doxetaxel. Esp rad for HER2 overexpression
99
Rotterdam criteria for PCOS
2/3 of the following ``` Ovulatory dysf (oligo/anovulation) Hyperandrogenism Polycystic ovaries on US ```
100
Sx of PCOS
irregular menses acanthos nigrans Hyperandrogen sx mood changes
101
Sx of hyperandrogenism
acne hirtuism male patterned balding high serum T
102
PCOS pt pursuing pregnancy
Clomid Letrozole metformin (weird but helps regulate menses)
103
PCOS pt not pursing pregnancy, sx management
Irregular menses -> Hormonal BP or metformin Insulin res -> metformin HyperA --> Hormonal BC or spironolactone Acne -> Hormonal BC and topical creams
104
First line for obesity in PCOS
diet and exercise
105
Uterine cycle
Proliferation Secretory (post ovulation) Menstruation
106
Ovarian cycle
Follicular phase | Luteal phase
107
What day does menses end
Day 7
108
Theca cells
LH and make androgens
109
Granulosa cells
FSH and convert androgens into E. Also makes E
110
What produces Prog
Corpus luteum
111
When does estradiol peak
Day 14, it drops right after ovulation and then the CL makes prog
112
What hormone surge causes ovulation
LH
113
Low E levels after the corpus luteum becomes the corpus albicans triggers the hypothal to do what
Release GnRH
114
GnRH triggers the ant pit to do what
release FSH and LH
115
FSH and LH triggers what
the granulosa cells and thea cells to dump estrogens and androgens, eventually leading to the LH dump that causes ovulation
116
Repetitive granulosa stimulation triggers what
Inhibition of FSH and GnRH release. Only LH is going now

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