Women's Health Flashcards
(192 cards)
1
Q
First prenatal visit workup
A
- BP
- Type and screen
- CBC
- UA
- Random glucose
- BHsAg
- HIV
- Syphilis
- Rubella titer
- SCD screen
- Cystic fibrosis screen
- Pap smear
2
Q
First trimester screening tests
A
- Chromosomal screening (Biochemical and nuchal translucency ultrasound)
- Ultrasound
- Chorionic villus sampling may be performed up to 15 weeks
3
Q
Second semester screening tests
A
- Triple screening
-alpha-fetoprotein
-Beta hCG
-Unconjugated estraiol - Gestational DM (24-28)
- Amniocentesis
4
Q
Third semester screening tests
A
- Gestational DM (24-28)
- Repeat Rh titers
- Non stress testing
- Group B strep testing
5
Q
Symmetrically enlarged, “boggy” uterus think….
A
Adenomyosis
6
Q
What does “chandelier sign” indicate?
A
PID (cervical motion tenderness) (Can also be septic abortion or ectopic)
7
Q
What do you treat PID with?
A
Ceftriaxone 250 IM + Doxy x 14 days (100mg) (2nd gen cephalosporin if inpatient)
8
Q
What should “violin-string adhesions” make you think of?
A
Fitz Hugh-Curtis Syndrome
9
Q
What is the most common case of PID and Fitz Hugh-Curtis Syndrome?
A
Chlamydia (Gonorrhea next most common)
10
Q
Bacterial Vaginosis diagnostic criteria?
A
- Copious, thin, grayish-white discharge
- Vaginal pH > 4.5
- Whiff test with KOH
- Clue cells
11
Q
“Copious grey white discharge”…
A
BV
12
Q
pH of BV?
A
> 4.5
13
Q
Clue cells….
A
BV
14
Q
How do you treat BV?
A
Metronidazole (or Clindamycin)
15
Q
What is trichomonas?
A
A flagellated protozoan
16
Q
“Copious frothy yellow-green vaginal discharge”…
A
Trich
17
Q
Cervical petechiae (strawberry cervix)…
A
Trich
18
Q
What is trichomonas on microscopy?
A
Mobile protozoan trophozoites
19
Q
Trich vaginal pH
A
> 4.5
20
Q
Trich treatment
A
Metronidazole
21
Q
Pink/red well-circumscribed, punctated lesion on colposcopy
A
Carcinoma in situ
22
Q
Disarray of blood vessels and atypical vessels on colposcopy
A
Invasive carcinoma
23
Q
Translucent or yellow lesions on the cervix
A
Nabothian cysts
24
Q
Define first-stage labor arrest
A
6 cm or greater dilation with membrane rupture and no cervical change for :
- 4+ hours with adequate contractions or
- 6+ hours with oxytocin admin and inadequate contractions
25
Define second stage labor arrest
No progress for...
- 4+ hours, nullpari, with epidural
- 3+ hours, nullpari, without epidural
- 3+ hours, multipari, with epidural
- 2+ hours, multipari, without epidural
26
Define failed induction of labor
Failure to generate regular contractions after at least 24 hours of oxytocin and artificial membrane rupture if possible
27
What are the 4 causes of postpartum hemorrhage?
(The 4 T's)
1. Tone (uterine atony)
2. Trauma to birth canal
3. Tissue retention (fetal or placental)
4. Thrombin disorder or coagulopathy
28
What is first line for uterine atony
Uterine massage/compression and then oxytocin
29
What are second lines for uterine atony
Carboprost and methylergonovine
30
When is carboprost contraindicated
Asthma
31
When is methylergonovine contraindicated?
HTN and CAD
32
What are the risk factors for endometrial cancer?
"ENDOMET"
Elderly
Nulliparity
DM
Obesity
Menstrual irregularity
Estrogen monotherapy
T HTN
33
Smooth palpable mass of ovary on exam...
Ovarian fibroma
34
What cancer might be associated with recurrent UTIs?
Transitional cell carcinoma (bladder)
35
What cancer is associated with GI bleeding?
Rectal adinocarcinoma
36
What is the most common type of endometrial cancer?
Adenocarcinoma
37
What are the components of HELLP syndrome?
Hemolysis
Elevated
Liver enzymes
Low
Platelet count
38
What is the cut off for hemolysis in HELLP syndrome?
> 2 of the following:
-Abnormal smear
-Elevated serum bili >= 1.2
-Low serum haptoglobin
-Significant drop in Hgb (without blood loss)
39
What is the cut off for liver enzymes in HELLP syndrome?
AST or ALT >/= 2x the upper limit
40
What is the cut off for low platelets in HELLP syndrome?
< 100,000
41
What marker is often associated with ovarian malignancy?
Cancer antigen 125
42
T/F anti-D Rh should be given for abortions
True
43
What 2 meds are used for elective abortions?
1. Mifepristone
2. Misoprostol
44
Elective abortion is safe up to __ weeks
10
45
Mifepristone MOA
Progesterone receptor antagonist (leads to dilation and softening of the cervix)
46
Misoprostol MOA
Prostaglandin analog (causes uterine contractions)
47
Methotrexate MOA
Folic antagonist
48
What should you think with late decelerations?
Placental insufficiency
49
What is the classic triad of endometriosis?
1. Cyclic premenstrual pelvic pain
2. Dysmenorrhea
3. Dyspareunia
50
What is diagnostic for preeclampsia?
>140/90 and
-proteinuria
After 20 weeks gestation
51
What is diagnostic for severe pre eclampsia
>160/110
and
proteinuria
OR
-thrombocytopenia < 100,000
-kidney insuf.
-Impaired liver
-Pulmonary edema
-Cerebral symptoms
52
What is the DOC for seizure prophylaxis in preeclampsia?
Magnesium
53
What should you think with early decelerations?
Fetal head compression
54
What can cause fetal heart accelerations?
Fetal movement or uterie contractions
55
What causes variable decelerations?
Umbilical cord compression
56
What is a normal fetal heart rate?
110-160
57
What does a complex multiloculated adnexal mass on imaging likely indicate?
Tubo-ovarian abscess
58
Below what age should you do u/s instead of mammography for a breast mass?
<30
59
What is the most common type of breast cancer?
Infiltrating ductal carcinoma
60
What is the most common organism in mastitis?
Staph aureus
61
What are first line abx for mastitis?
Dicloxacillin or cephalexin
62
What marker elevates in ovarian cancer?
CA-125
63
What marker elevates in endometrial and muscle sarcomas?
Desmin
64
What marker elevates in adrenocortiol carcinoma and stromal ovarian cancer?
Inhibin
65
What marker elevates in melanomas and sarcomas?
S100 protein
66
What is the primary etiology of hot flashes?
Decreased estradiol
67
What is most useful for decreasing pruritis in intrahepatic cholestasis of pregnancy?
Ursodiol
68
What is the most effective form of emergency contraception?
Copper IUD within 5-7 days
69
What is the MOA of levonogrestrel?
Inhibits of delays ovulation
70
When does Plan B need to be used?
Within 72 hours of intercourse
71
What is Ulipristal?
Emergency contraception
72
What is combined OCP protective against?
1. Osteoporosis
2. Ovarian cancer
3. Endometrial cancer
73
What is used to enhance fertility in PCOS pts?
Clomiphene citrte
74
What is the MOA of leuprolide?
Inhibition of estrogen and testosterone if given continuously
75
What is the effect of using leuprolide in a pulsatile way?
Increased fertility
76
What is the MOA of Danazol?
Hypoesterogenic and hyperadrogenic via LH and FSH supression
77
When should endometrial biopsy be performed in abnormal uterine bleeding? (4)
1. >35 and obese
2. >35 with HTN
3. >35 with DM
4. Postmenopausal bleeding
78
Primary dysmenorrhea is due to ____
increased prostaglandins
79
Secondary dysmenorrhea is due to ____
pelvic or uterus pathology
80
What is the main distinction between PMS and PMDD?
Functional impairment
81
Define primary amenorrhea
Failure of menarche onset by 15 years with secondary characteristics or 13 years without secondary characteristics
82
All primary amenorrhea should be worked up with _____
hCH and FSH testing
83
Define secondary amenorrhea
Absence of menses for >3 months in a patient with normal menstruation
84
What is delay of period due to exercise etc?
Functional hypothalamic amenorrhea
85
What is the female athlete triad?
1. Hypothalamic amenorrhea
2. Eating disorder
3. Osteoporosis
86
What is Asherman's Syndrome?
Acquired endometrial scarring secondary to postpartum hemorrhage, after D&C or endometrial infection
87
What does absence of normal uterine stripe on ultrasound indicate ?
Asherman's syndrome
88
What is a leiomyoma?
A benign uterine smooth muscle tumor
89
What type of leiomyoma is most likely to cause bleeding?
Submucosal
90
What does a firm, nontender, asymmetric mobile mass or masses in the abdomen or pelvis on bimanual exam indicate?
Leiomyoma
91
What bacteria causes TSS?
Staph aureus
92
What is the classic skin presentation of TSS?
Erythroderma- diffuse erythematous macular rash
93
What are the standard treatments of TSS?
Agressive fluid replacement and IV abx
94
What abx are usually used for TSS?
Clindamycin and Vancomycin
95
At what Rh(D) titer level do you need to perform amniocentesis?
1:16
96
When do you do amniocentesis for Rh antibodies?
16-20 weeks
97
When do you give RhoGAM?
1. 28 weeks gestation
2. Within 72 hours of deliver if baby is Rh+
3. After any potential blood mixing
98
What is adenomyosis?
Islands of endometrial tissue within the myometrium
99
What does adenomyosis often present with?
Menorrhagia and dysmenorrhea
100
What is a symmetrically enlarged, globular, boggy uterus usually?
Adenomyosis
101
Define menorrhagia
102
What is first line for endometritis after C section?
Clindamycin and Gentamycin (can also add ampicillin to cover additional GBS)
103
What is used for endometritis prophylaxis?
First gen cephalosporin during C-section
104
What is first line for endometritis after vaginal delivery or choriooamnionitis?
Ampicillin and Gentamicin
105
What is a likely cause of painless bleeding in the third trimester?
Placenta previa
106
What is the most common rf for placental abruption?
Maternal HTN
107
What is a likely cause of painful third trimester vaginal bleeding/abdominal pain?
Placental abruption
108
How does the uterus often present in placental abruption?
Tender and rigid
109
What is the triad of vasa previa?
1. Rupture of membranes
2. Painless vaginal bleeding
3. Fetal distress
110
Define preexisting/chronic HTN in pregnancy
HTN of > 140/90 before 20 weeks gestation or prior to pregnancy
111
What meds are first line for chronic/transitional HTN in pregnancy?
-Labetalol
-Nifedipine
-Methyldopa
112
Can you use ACEI/ARBs in pregnancy?
No
113
Define transitional HTN in pregnancy?
New onset HTN >140/90 after 20 weeks with no proteinuria, edema or end-organ dysfunction
114
What is the cut off for the 1 hour glucose test?
140
115
What is the amount for the 1 hour glucose test?
50 g
116
What is the amount for the 3 hour "gold standard" glucose test?
100 g
117
What are the cut offs for the 3 hour tests?
-Fasting >95
-1 hour >180
-2 hours >155
-3 hours >140
118
First line for gestational DM
Insulin
119
Second line for gestational DM
Metformin or glyburide
120
What is the most common instance of shoulder dystocia?
Macrosomic infants of diabetics
121
What is a Tzank smear for?
HSV
122
How does HSV appear on Tzank smear?
Giant multinucleated cells
123
What 2 maneuvers can be done to deliver a baby with shoulder dystocia?
McRoberts and Woods corckscrew
124
What should you think with a sudden onset of severe, prolonged fetal bradycardia or variable decelerations after previously normal tracing?
Umbilical cord prolapse
125
What likely needs to be done in umbilical cord prolapse?
Emergency C-section
126
What antibiotic is used for prophylaxis in a C-section?
IV Cefazolin
127
Hyperemisis gravidarum is commonly associated with ____
Weight loss and electrolyte imbalance
128
What labs may be seen in hyperemesis gravidarum
Hypokalemia
Hypocholeremic metabolic acidosis
Ketones
129
What is first line treatment for hyperemesis gravidarum
Pyridoxine (B6) with or without Doxylamine
130
What labor complication should you consider for "sudden onset of extreme abdominal pain with decreased or absent uterine contractions"?
Uterine rupture
131
What are Braxton-Hicks?
Spontaneous contractions not associated with cervical dilation
132
What is lightening?
Fetal head descending into pelvis, feels "lighter"
133
What are the Cardinal Movements of labor (7)?
1. Engagement
2. Descent
3. Flexion
4. Internal rotation
5. Extension
6. External rotation
7. Expulsion
134
Define engagement
Fetal presenting part enters the pelvic inlet
135
Define descent
Passage of head into pelvis (lightening)
136
Define flexion
Flexion of head to allow the smallest diameter to present the pelvis
137
Define internal rotation
Fetal vertex moves from transverse position to sagittal suture parallel to anteroposterior diameter of pelvis
138
Define extension
Vertex extends as it passes beneath pubic symphysis
139
Define external rotation
Fetus externally rotates after head is delivered so shoulder can be delivered
140
What is considered premature rupture of membranes?
Before 37 weeks
141
What can prolonged ROM lead to?
Chorioamnionitis or endometritis
142
How can you confirm presence of amniotic fluid?
Nitrazine paper test or Fern Test
143
What pH does Nitrazine paper turn blue at?
>6.5
144
What do you use to induce labor if needed after ROM?
Prostaglandin cervical gel or oxytocin
145
What should be given for fetal lung development if PROM occurs at <34 weeks?
Corticosteroids
146
Define preterm labor
Cervical dilation 3 cm or greater + 80% effacement or presence of fetal fibronectin between 20 and 34 weeks
147
What value suggests fetal lung immaturity?
L:S ratio < 2
148
What should you do for preterm labor <34 weeks
Delay with tocolytics and Betamethasone for lung immaturity
149
What can be given in preterm labor to provide neuroprotection?
Magnesium sulfate
150
What are absolute contraindications to induction of labor? (C section indicated)
1. Transmural myomectomy
2. Placenta previa
3. Prolapsed cord
4. Active genital herpes
5. Transverse fetal lie
6. Uterine scar from classical C-section incision
7. Cephalopelvic disproportion
151
What does APGAR stand for?
Appearance
Pulse
Grimace
Activity
Respiration
152
What is a normal APGAR score?
>/= 7
153
What is a fairly low APGAR score?
4-6
154
What is a critically low APGAR score?
155
When is the uterus back to normal size after pregnancy?
6 weeks
156
What is Lochia serosa?
Pink/brown vaginal bleeding after pregnancy for up to 3-4 weeks
157
Define postpartum hemorrhage
>500 ml after vaginal or >1000 ml if after C section
158
What is the classic description of uterine atony?
Soft, flaccid, boggy uterus
159
What is the strongest risk factor for ectopic?
Previous ectopic
160
What is the classic triad of ectopic pregnancy?
1. Unilateral pelvic or lower pelvic pain
2. Vaginal bleeding
3. Amenorrhea
161
What is Kehr sign?
L shoulder pain (ectopic, with severe abdominal pain)
162
How often should hCG double?
Every 48-72 hours
163
When is methotrexate indicated in ectopic pregnancy?
-Hemodynamically stable
-Early gestation: <4 cm, beta-hCG < 5,000, no fetal tones)
164
What is indicated for unstable/ruptured ectopics?
Laparoscopic salpingostomy
165
Define complete molar pregnancy
Diploid, egg is absent of DNA, no fetal tissue
166
Define incomplete molar pregnancy
1 egg fertilized by 2 sperm, may have nonviable fetal tissue
167
APGAR A
Appearance
0= blue-grey, pale all over
1=acrocyanosis: body pink, extremities blue
2=all pink
168
APGAR P
Pulse
0= none
1= <100
2= >100
169
APGAR G
Grimace (reflex)
0=No response to stimulation
1=Grimaces feebly
2=Pull away, sneezes or coughs
170
APGAR A
Activity (muscle tone)
0=None
1=Some flexion
2=Flexes arms and legs, resists extension
171
APGAR R
Respiration
0=Absent
1=Weak, irregular
2= Strong, crying, 30-60 per min
172
What areas does Pruritic Urticarial Papules/Plaquees of pregnancy usually spare?
Face, palms and soles
173
What four clinical signs should indicate molar pregnancy?
1. Painless vaginal bleeding
2. Preeclampsia before 20 weeks
3. Hyperemisis gravidarum
4. Abnormally high hCG
174
What does complete molar pregnancy look like on u/s?
"Snowstorm" or "Cluster of grapes"
175
What is the guideline for average risk mammography?
Every 2 years from 50-74
176
Define incompetent cervix
Cervical length 25 mm or less before 24 weeks
177
What can induce ovulation in infertility?
Clomiphene
178
What is the most common type of cervical cancer?
Squamous cell carcinoma
179
What. is the classic triad of endometriosis?
1. Cyclic premenstrual pelvic pain
2. Dysmenorrhea
3. Dyspareunia
180
Endometrial hyperplasia is a precursor to _____ and the main risk factor is _____
Endometrial carcinoma, prolonged unopposed estrogen
181
What u/s finding indicates endometrial hyperplasia?
Thickened endometrial stripe > 4 mm
182
Tx for endometrial hyperplasia without atypia
Progestin
183
Tx for endometrial hyperplasia with atypia
Total hysterectomy
184
What is the most common type of endometrial cancer?
Adenocarcinoma
185
Name the locations of a cystocele, rectocele and enterocele
1. Cystocele: anterior
2. Rectocele: posterior
3. Enterocele: upper vagina
186
Ovarian cysts < ___ usually resolve spontaneously
8 mm
187
What is the most common benign ovarian neoplasm?
Dermoid
188
What is diagnostic of PCOS?
(2/3) Rotterdam criteria
1. Lab or clinical signs of androgens
2. Amenorrhea or oligomenorrhea
3. Cystic ovaries on ultrasound
189
What should "bilateral enlarged, smooth, mobile ovaries" make you think of
PCOS
190
What labs are characteristic of PCOS?
-Increased testosterone
-LH:FSH >/= 3:1
191
What ultrasound finding is consistent with PCOS?
String of pearls
192
What strains of HPV cause cancer?
16 and 18
