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OB/GYN
| Objective | Answer |
|---|---|
| Identify the health promotion and disease prevention areas that should be discussed with female patients | Exercise/ Diet, ETOH/ Tobacco use; Birth control, including condoms to prevent STD's; Safety: safety belts, sunscreen, domestic violence; Exams: reg. dental, vision and BSE's |
| Appropriate clinical preventive services recommended for women by ages 18-39? | BP, Cholesterol, Yearly check up, TSH, Paps, Chlamydia, STD, mental health screen; at ages 20-29 checks eyes/ ear @ least 1 time; at ages 30-39 @ least 2 times |
| At what age should cholesterol testing begin? | Age 20 |
| At what age should TSH testing begin? | 35 and every 5 yrs thereafter |
| At what age should pap smears and pelvic exams begin? | 3 yrs post beginning sexual intercourse or older than 21 |
| When is it acceptable to stop testing for chlamydia? | 25 |
| At ages 40-49, what of the screenings done to pts. 18-39 can be discontinued? | chlamydia testing |
| What exams, in addition to yearly exams/ cholesterol, tsh (every 5), b.p. checks should actually begin at 45? | Glucose testing |
| At what age should mammograms begin? | every 1-2 yrs from 40+ |
| When should chlamydia still be tested for in pts. over 25? | Anytime a new partner (or multiple) enters the pictures |
| Identify the appropriate clinical preventive services recommended for women by ages 50-64? | Start doing colorectal exams yearly and flexible sigmoidscopy w/ FOBT every 5 yrs. if no colonoscopy (if colonscopy, every 10 yrs) |
| 2. Identify the appropriate clinical preventive services recommended for women by age 65 and older? | Discuss reproductive health w/ provider to det. pap/ etc. |
| At what age should self skin exams begin? | Age 20 and every 3 yrs thereafter |
| At what age should skin exams begin yearly? | Age 40 |
| How often should a dental exam be performed? | 1-2 times/ yr |
| At what age do flu vaccines begin yearly? | At age 50 |
| At what age should a pneumococcal vaccine be given? | At 65 or older, just 1 time |
| What is the cut off age for HPV vaccine? | 26 |
| At what age does the herpes zoster vaccine to prevent shingles need to be given? | Starting at 60 |
| List the components of the menstrual history. | Age @ menarche/ menopause, 1st day of LMP, Cycle interval, Cycle duration, Cycle regularity, Amount of flow, Dysmenorrhea, bleeding between periods, post-coital bleeding, pre or peri menstrual sx's |
| If pt. menopausal, what are the sx's? | Hot flashes, night sweats, vaginal dryness, dysmenorrhea, post-menopausal bleeding (6 mos. after cessation of menses), HRT use (and duration) |
| What is a nL. amt of menstrual flow? | 25-80 cc is nl. |
| How do you quantify menstrual flow? | Ask about how many pads/ tampons used/ day |
| How much flow does a pad/ tampon hold? | ~5 cc |
| What is a nl. cycle duration? | 3-7 days |
| What is a nl. cycle interval? | 21-35 days |
| amenorrhea | abscence of menstrual pd. in woman of reproductive age |
| What is primary amenorrhea? | A delay in initial menstrual cycle. |
| What is secondary amenorrhea? | Cessation of menstrual cycles |
| What is oligomenorrhea? | Having infrequent menstrual cycles - greater than 35 day cycle interval |
| What is hypomenorrhea? | Light, but regular uterine bleeding |
| What is polymenorrhea? | Menstrual periods that are too frequent, less than 21 day interval |
| What is menorrhagia? | Abnormally heavy OR prolonged menstrual period at reg. intervals; greater than 80 cc of blood |
| What is menometrorrhagia? | Abnormally heavy or prolonged periods at irregular intervals |
| Listthe components of the obstetric history. | Possibility of current pregnancy, # of pregnancies/ children (wts @ birth); length of labor; mode of delivery; complications |
| What is multigravida? | Pregnant more than 1 time |
| What is elderly primigravida? | 1st pregnancy when pt. is past 35 |
| What does abortions include? | induced and spontaneous |
| What is gravida (a)? | # pregnancies |
| What is para (b)? | term pregnancies beyond 36 wks |
| What is para (c)? | pre-term pregnancies 20-36 wks |
| What is para (d) | # of abortions/ ectopic pregnancies (<20 wks) |
| What is para (e) | # living children |
| What is GP(T-PAL) | Gravida, Para (Term, Pre-term, Abortions, # living children) |
| List and discuss the components of the gynecologic history | Previous gyno surgery/ procedures; last pap; hx of abn. paps (& treatments); GI and GU are part of gyno hx for women |
| What should be asked during the GU portion of the gyno hx? | UTI sx's and incontinence |
| What should be asked during the GI portion of the gyno hx? | About chronic constipation & BRBPR and melena |
| List and discuss the components of the contraceptive history | Desire for contraception, method and satisfaction of contraceptive use; previous methods; future contraceptive plans |
| List and discuss the assessment of the family history for common single gene disorders and multifactorial disorders | Ask about FH of any female CA (breast, uterine, endometrial, ovarian, colorectal, melanoma (two or more)) |
| What questions should be asked regarding sexual hx? | Sex of partner, age @ 1st intercourse, # of tot. partners; # of current partners; length of time w/ current partner; pain during sex; bleeding pre or post coital; hx of sex abuse; hx of STD's; hx of high risk behaviors |
| Who should undergo annual pap smears regardless of age? | Someone w/ cervical CA dx or showed pre-cancerous cells; HPV infxn; exposure to DES before birth; HIV infxn; weakened immune syst. |
| What is considered hx of high risk behaviors? | IVDU, blood transfusion before 1980; relations w/ IVDU or bisexuals |
| Describe the diagnostic approach to a woman with a breast mass | 1st elicit hx, then look |
| What should be asked when taking a breast mass hx? | Changes (size, shape, consistency); How long present; how discovered; assoc. sx's` |
| What are considered associated sx's for breast mass? | pain, skin changes, discharge |
| What are characteristics of palpable benign mass? | Smooth, rounded, or lobulated, well-circumscribed, mobile; firm or rubbery consistency |
| What are characteristics of malignant masses? | Irreg. shape; ill-defined margins; non-mobile; firm to rock hard consistency; +/- skin changes |
| What is the 1st thing to think about when determining management of a palpable mass? | Consider age |
| If pt. under 30, what is the 1st step to take post PE? | If cystic, aspirate |
| If pt. under 30 and aspirate is bloody or the mass persists, what do you do? | FNA/ Core bx, or excise (but if aspirate not bloody will resolve post aspiration) |
| If truly a palpable cyst in pt. under 30, what do you do post-aspiration? | FU `4-6 weeks |
| If PE reveals that a pt. under 30 does not have a cyst, what should be done? | Ultrasound |
| If a pt. under 30 has a solid mass revealed by US, what should be done? | FNA/ Core bx, or excision |
| If FNA/Bx/exsicion reveals a benign mass, how often should Pt have FU? | every 3 months for the first year, then q 6 mon X 1yr, then q 1 yr |
| If mass is determined to be malignant, what isdone next? | Mammogram - Excision/Definitive therapy |
| For all Pts. > 29, what is the first step for diagnostic procedures with a paplable bresat mass? | Mammogram/US |
| In pt. over 30 if mamogram reveals cyst, what now? | aspirate and if bloody or persistent, do a FNA, Core bx |
| In pt. over 30 if a solid mass is revealed on mammogram, what should be done? | FNA/ Core bx |
| If FNA/ Core bx reveals benign mass, what should be done? | excise and fu in 3 mos. |
| If pt. over 30 on bx reveals malignant mass, what should be done? | Excision/ definitive TX |
| What should be asked of a pt. coming in w/ breast pain? | Location (focal vs. diffuse); duration; relationship to menses/ hormone use; hx of trauma; caffeine; aggravators/ relievers |
| Is breast pain a common CP of breast CA? | Nope |
| If breast pain is a cp of breast CA, who is the typical pt.? | older pt. |
| What type of breast Ca can MRI's miss? | In situ |
| What are the Tx options for breast CA? | breast conserving surgery, mastectomy; analyze the sentinel lymph node |
| What is the role of radiation in breast CA management? | Do post lumpectomy or partial mastectomy or post mastectomy; TX of chest wall recurrence after mastectomy; bone metastasis |
| What is the adjuvant systemic TX of breast CA? | Targeted combo TX's: chemo, hormonal TX |
| Who should receive hormonal TX in treatment of breast CA? | If ER or PR positive tumors; admin. Tamoxifen if premenopausal or aromatase inhibitors post menopausal |
| Example of aromatase inhibitors? | Letrozole |
| How can effects of radiation be limited? | By administering to lumpectomy site ONLY; treatment will only take 4-5 days |
| Et and risk factors of vulvar neoplasia | HPV is et. and 90% are squamous cell carcinomas |
| S/Sx of vulvar Ca? | Sx: Chronic Pruritis MC; usu. dyspareunia or dysuria; Signs: mass; ulcerated or wht discharge; bleeding; pain is rare |
| the risk factors for development of cervical neoplasia | SR HEEN, discovered cervical cancer...: Smoking, Risky behavior of sex partners, HPV infxn, Early coitarche, Econ status is low, Number of sex partners |
| What are primary RF for cervical CA? | HPV (oncogenic infection); persistence of HPV infxn past two yrs; lack of reg. screening |
| What are 2ndary rf for cervical CA? | SOO? need ID: Smoking, Other STD's, OCP use (b/c not likely using condoms; Immunosuppressed, Diet (malnutrition) |
| Current recommendations of the American College of Obstetricians and Gynecologists concerning screening for cervical dysplasia | 21 or 3 yrs from onset of intercourse whichever comes first; At or after age 30, women who have had three normal test results in a row may get screened q. 2-3yrs. May test more pt has RF: HIV; 70 y.o.+ w/3+ nl. paps can stop; total hysterectomy: no need |
| What is the most commonly utilized diagnostic evaluation of cervical neoplasia? | Bethesda 2001 |
| What are the classifications? | Negative for intraepithelial lesion or malignancy; ASC-US; ASC-H; LGSIL (low grade squamous interepithelial lesions); HGSIL (high grade); squamous cell carcinoma |
| If a pt. has ASC-H, can HGSIL be excluded? | Nope |
| What is the management if nl. pap? | Follow guidelines |
| What is the management if pap comes back ASC-US | HCR: Hybrid capture II, Consider colposcopy or Repeat cytology @ 4-6 mos. |
| What is the management if the pap comes back ASC-HG? | Colposcopy w/ directed Bx's |
| What is the management if pap comes back LGSIL? | HCR: Hybrid capture II, Consider colposcopy or Repeat cytology in three mos. |
| What if pap comes back HGSIL? | Colposcopy w/ directed Bx |
| What is the management if a pap comes back w/ invasive CA? | Refer to gynocologic oncologist |
| What's the CP of cervical carcinoma? | FOU(l) C-PAPP: Foul vaginal discharge, Often silent til advanced, Unilateral leg swelling or pain, (l); Cervical lesion is gross; Post-coital bleeding, Abn. bleeding, Pelvic pain, Pelvic mass |
| What is the TX for cervical carcinoma? | Conizatin or simple hysterectomy or radical hysterectomy; chemo/rad TX |
| The dx of cervical carcinoma is made via what? | Cone or hysterectomy specimen |
| What is the mainstay of Tx'ing advanced cervical carcinoma? | Chemoradiation (concurrent cisplatin) |
| How often should pts. treated for cervical CA be followed up? | Every 3-4 mos. in first 2 yrs; q. 6 mos. for next 3 yrs; annually thereafter |
| What is the management of endometrial CA? | Surgery is most effective TX. |
| What's the CP of endometrial CA? | Postmenopausal bleeding is CA until proven otherwise |
| Discuss the significance of unopposed HRT in post-menopausal women w/development of endometrial hyperplasia/carcinoma | Unopposed estrogen is dangerous to the endometrium |
| What are the RF of endometrial carcinoma | LAH ENDO: Late menopause, Atypical hyperplasia, Htn; Estrogen unopposed, Nulliparity, Dm, Obesity |
| What is considered stage I Endometrial CA? | confined to uterus |
| What is considered Stage II endometrial CA in FIGO surgery staging? | Cervical involvement |
| What is considered Stage III endometrial CA? What % of women w/ endometrial CA are in this stage and what is the survival rate? | involvement of Uterine Serosa, adnexa, + cytology, vaginal metastasis, pelvic or aortic node metastasis; 8% of women w/ endo CA are in Stage III and have 30% survival rate |
| What is considered Stage IV endometrial CA? What % of women w/ endometrial CA are in this stage and what is the survival rate? | bladder, bowel, inguinal node, and distal metastasis; 4% are in Stage IV of endo Ca and there's a 10% survival rate |
| Describe the Et/epidemiology of ovarian neoplasia. | Increased ovulation it's an autosomal dominant inheritance; Epidemiology: white women more commonly affected over blacks; women >40 @ increased risk, peaks @ 65-75 |
| What is the most lethal gynocologic malignancy? | Ovarian CA |
| What are RF for ovarian CA? | inheritance,increased age, FH, Low fertility; personal CA hx |
| What is the CP of ovarian CA? | 95% report Sx's: vague : ab bloating; increased girth; fatigue; GI disturbance; urinary Sx's; ab or pelvic pain; menstrual irregularities; Sx's unrelenting day after day |
| How is ovarian Ca dx'd | Rectovaginal pelvic; CT/MRI; Ca 125; laproscopy; surgical exploration |
| How is ovarian Ca treated? | TAH/BSO & staging |
| At what stage is most ovarian CA found? | Stage III |
| What is considered Stage IV ovarian CA? | blood borne metastasis |
| What is the overall survival rate for ovarian CA? | 50% |
| Labor | presence of contractions with cervical changes; must have both |
| True vs. false labor | False labor: no regular pattern not progressing to being closer together of weak contractions usu. felt in the front only that may stop or slow down when you walk, lie down, change position or increase your fluid intake; True labor is the opposite |
| What are Braxton-Hicks contractions? | The tightening up of the uterus in the 3rd trimester that feels like the baby is balling up |
| What is lightening? | The sensation the pregnant woman feels when the baby drops; occurs when the lowermost presenting portion of the fetus drops into the maternal pelvis |
| Define lie | The baby's body position compared to mother's spine |
| Define presentation | Refers to fetal part that will come out first: Cephalic, Breeched or Shoulder |
| Define position | Right Occiput Anterior; Left Occiput Anterior |
| What are the four Leopold maneuvers? | 1: feel upper abdomen for head vs. butt; 2: feel for the back (1 hand at a time); 3: superpubic confirmation of 1; 4: locating the brow - should face the same side as the limbs |
| How are the Leopold maneuvers used to describe lie, presentation and position? | 4 palpations of fetus through ab wall help to det. fetal lie, presentation, position |
| What are the various positions in vertex presentation? | LOA, ROA; LOP; ROP |
| What is cervical effacement? | Thinning of the cervix |
| What is cervical dilatation? | Dilating of cervix; must be at 4 cm to be admitted |
| What is station? | In comparison to the ischial spines; presenting part is above ischial spines, the station is (-) # from 0 to -3; presenting part lies below the ischial spines, the station is reported as a positive number from 0 to 3 cm; Engaged is 0 station |
| What is engagement? | The positioning of the biparietal diameter at the pelvic inlet |
| Discuss mechanism of labor to include the cardinal movements of labor | Effacement, Dilatation, strong contractions and Cardinal Movements |
| What is the 1st cardinal movement? | Engagement (dropping of biparietal diameter into pelvic inlet) |
| What is the 2nd cardinal movement? | Flexion |
| What is the 3rd cardinal movement? | Descent - head comes to cervix (can see head @ cervix) |
| What is the 4th cardinal movement? | Internal rotation so that sagittal line is midline |
| What is the 5th cardinal movement? | Extension, baby's and face are out |
| What is the 6th cardinal movement? | External rotation (in direction of body - will face one of his/her mother's inner thighs |
| Describe Stage I of labor and its clinical management | Divided up into latent and active |
| What is Stage I latent labor? | <4 cm |
| How long does Stage I last in a G1 pt.? | 20 hrs |
| What is Stage I active? | <4 cm; regular contraction pattern; cervical change should happen |
| How long does Stage 1 labor last for a GN+1? | ~ 14 hrs. |
| What is the rate of dilatation for Stage 1 G1? | 1.2 cm/ hr. |
| What is the dilatation for Stage 1 GN+1? | 1.5 cm/ hr. |
| What is considered Stage 2 labor? | Fully dilated and baby has been delivered |
| What is length of Stage 2, G1 w/ epi | 3hrs |
| What is the length of Stage 2. G1 w/o epi? | 2 hrs |
| What is the length of Stage 2, GN+1 w/ epi | 2 hrs |
| What is the length of Stage 2, GN+1 w/o epi? | 1 hr |
| What is the clinical management of Stage 1 latent labor? | Send home w/ tylenol and ambien |
| What is the management of Stage 1 active labor? | take vital signs q 30 min.; NPO except H2O, hard candy, Hct, Type&Screen, Plt, UA (gluc/prot); IV line; Catheterize; fetal HR monitoring; pelvic exams to i.d. dil, ef, station, pos; rupturing of the membranes &/ or pitocin if labor stalls |
| What is the management of Stage II labor? | Use vaccum or forceps if pt. is +2 and exhausted from pushing or fetal HR not reassuring |
| What is Stage III of labor? | Delivery of the placenta: uterus rises in the abdomen becoming globular, indicating that placenta has separated and is in lower uterine segment; a gush of blood &/or lenghtening of umbilical cord also occurs |
| What is the timing of the delivery of the placenta? | up to 30 min. w/ massage and 40 units of pitocin; apply suprapubic pressure while doing traction on umbilical cord |
| What steps should be taken if placenta not delivered in 30 min.? | Reach in and peel off of uterus; administer demerol IV and abx |
| What is stage IV of labor? | When Post-partum hemorrhage can occur |
| What is considered post-partum hemorrhage w/ vaginal delivery? | >500 cc |
| What is considered post partum hemorrhage status post c-section? | 1000 cc |
| What are the most common etiologies of postpartum hemorrhage? | Atony is the MC cause; |
| What causes Atony? | ATONY: Hx, MG, Mg, MUM!: Anesthesia (general), Too long a labor, Oxytocin during labor, amNiotic fluid: poly, chorio, embolus, hYpotension; Hx of postpartum hemorrhage; Multiple Gestations, Mg sulfate; Multiparity, Uterine Leiomyomas, Macrosomia |
| What is considered a 1st degree laceration? | small tear |
| What is a 3rd degree laceration? | A tear upto and including some rectal fibers of the rectal sphincter, but not through it |
| What is considered a 4th degree laceration? | Tear through and including the rectal sphincter |
| What is the clinical presentation of uterine atony? | boggy uterus; not hard as it should be |
| the management of uterine atony in terms of manipulative, medical and surgical managements | 1:massage; 2: 40 units of pitocin; 3: Prostin: 200 micrograms (3 q. 20 min.);4) Admin. Methogen (ergot alkaloid) - .25; 5: look for lacerations, if still hard: surgery; Massage->Inc or initiate oxytocin->Methergine .2 mg via IM->misoprostil (pr)->surgery |
| What is surgically done for PPH? | Tie off uterine arteries; B Lynch; Hysterectomy? |
| What is the contraindication for prostin? | Asthma |
| What is the contraindication of methogen? | HTN |
| RF for predisposing to lacerations of the lower genital tract? | CPD (cephalopelvic disproportion); 2: Macrosomic baby; 3: malpresentation |
| management of lower genital tract lacerations | Suture |
| What is predisposing to retention of the placenta? | Scaring due to previous fibroid removal or previous c-section while attempting a vaginal delivery |
| the precautionary measures used to prevent or minimize postpartum | Massage the uterus and 40 units of pitocin |
| What are the maternal physiologic changes associated with pregnancy? | Changes in cervical mucus (ferning present) and cessation of menses |
| What is the effect of pregnancy on common diagnostic studies? | LFT's increase |
| What are the positive manifestations of pregnancy? | Fetal heart tones; Palpation of fetus; evidence of fetal outline on US |
| What are the probable manifestations of pregnancy? | +hCG, Chadwick's sign, Hegar's sign, Evidence of gestational sac, Ballottment, Braxton Hicks, Palpation of fetal outline |
| What are the presumptive manifestations of pregnancy? | Amenorrhea; N/V; breast tenderness; Fatigue, Uterine enlargement, Melasma, Colostrum |
| What are the the types of pregnancy tests available for the diagnosis of pregnancy? | Serum and urine |
| What are the components of an initial antenatal evaluation visit? | History taking: menstrual hx, past pregnancies, PMH; Genetic screening; Infection hx; Initial PE, Meds; Labs; Education |
| What is the importance of HCG? | Prevents the involution of the corpus luteum |
| What is appropriate schedule of subsequent visits for good prenatal care? | 0–32 weeks' gestation: once every 4 weeks; 32–36 weeks' gestation: once every 2 weeks; and 36 weeks' gestation to delivery: once each week |
| What are the indications for the routine screening tests done during the initial antenatal evaluation visit? | HCT, Hgb, WBC w/diff, blood typing, Rh, abs to blood group antigens; RPR; rubella, hepatitis B, and HIV |
| How is an EDC calculated? | Nägele's rule: subtract 3 months from the month of the LNMP, and add 7 to the first day of the LNMP |
| What are additional methods used to determine gestational age? | Crown to rump measurement (better indicator of gestational age) |
| What are the nutritional needs of a pregnant woman? | an increase of 100-300 cal. |
| What is the expected weight gain of a pregnant woman in each trimester of pregnancy, considering a BMI of< 19.8? | 28-40 lbs |
| What is the expected weight gain of a pregnant woman in each trimester of pregnancy, considering a BMI of 19.8-26? | 25-35 |
| What is the expected weight gain of a pregnant woman in each trimester of pregnancy, considering a BMI of 26-29 | 15-25 |
| What is the expected weight gain of a pregnant woman in each trimester of pregnancy, considering a BMI of>29? | </= 15 |
| What is the expected weight gain of a pregnant woman in each trimester of pregnancy, considering a multiple birth pregnancy | 35-45 |
| What is the Fe requirement of a pregnant woman? | 27 mg |
| What is the folate requirement for pregnant woman? | 400 microunits |
| What are contraindicated vitamin supplements in pregnancy? | Selenium and Vitamin A (as in acutane) |
| What guidelines should be given to pregnant women concerning exercise? | No need to limit; Don't start a new rigorous exercise program; do moderate intensity work out for 30 min. ea. day; avoid potential abdominal trauma exercise |
| What guidelines should be given to pregnant women concerning employment? | Avoid overly physically demanding work |
| What guidelines should be given to pregnant women concerning travel? | Can fly up to 36 weeks; must get up and stretch to avoid DVT; wear seat belts; don't disable air bags |
| What guidelines should be given to pregnant women concerning bathing? | Do not bathe in water >100 degrees (can lead to miscarriage) |
| What guidelines should be given to pregnant women concerning constipation? | Common, can lead to hemorrhoids; advise pt. to avoid constipation by stool softners, hydration, and exercise |
| When should sex be avoided in pregnancy? | In face of preterm labor or placenta previa |
| What guidelines should be given to pregnant women concerning vaccines? | No live-attenuated vaccines such as MMR, varicella |
| What guidelines should be given to pregnant women concerning caffeine? | <300 mg/ day |
| What guidelines should be given to pregnant women concerning N/V? | Commonly continues until wks 14-16 |
| What guidelines should be given to pregnant women concerning low back pain? | Explain that common and can refer for ortho consult if severe |
| What guidelines should be given to pregnant women concerning varicosities? | Due to standing, pregnancy, and advancing age; treat w/ compression hoses |
| What guidelines should be given to pregnant women concerning hemorrhoids? | Common: Tx w/ topical anesthetics, warm soaks, and stool softeners |
| What guidelines should be given to pregnant women concerning heartburn? | Explain displacement and recommend small meals, as well as PPI or antacids |
| What is ptylaism? | Excessive salivation |
| What is the MC craving w/ pica? | Starch |
| What's the #1 cancer found in women? | Breast |
| What is the #1 cause of CA deaths in women? | Lung |
| What are the top three causes of CA deaths in women? | Lung, Breast, and Colorectal |
| What is the MC cell that ovarian CA develops in? | Epithelial cells |
| What are the screening recommendations for ovarian CA for a pt. w/ 1 or none family members? | Annual retrovaginal pelvic exam |
| What are the screening recommendations for a pt. w/ 2+ members FH? | 1). Annual retrovaginal pelvic, 2). Transvaginal ultrasound, 3). CA 125, 4). Genetic counseling |
| What is the surgical TX for early disease in ovarian CA? | 1) TAH/ BSO + staging (pelvic and PALN), 2). Reprod. conservation in younger women may be appropriate, 3). Approx. 30% will have histo evidence of metastatic dz |
| What is the surgical TX for advanced ovarian CA? | Cytoreduce: include possible removal of spleen, appendix, diaphragmatic and peritoneal implants, bowel resection, omenectomy, entire removal of uterus, ovarian and pelvic tumors |
| What is the most malignant gyno CA? | Ovarian CA |
| What is the median survival for Stage III/ IV Ovarian CA w/ chemo? | 38 mos. |
| What are the chemo agents administered in Ovarian CA? | Taxane and platinum |
| What percentage of patients w/ Ovarian CA relapse? | 75% |
| What are the two endometrial CA types? | Type I and Type II |
| What is considered Type I endometrial CA? | It is estrogen related, therefore, Younger, Heavier, Exogenous Estrogen, Perimenopausal, Low Grade |
| What is considered Type II endometrial CA? | Unrelated to Estrogen Stim, Older, Thinner women; Aggressive, Potential Genetic basis such as: Lynch Syndrome & Familial Trend |
| Who needs an endometrial Bx? | Anyone w/ postmenopausal bleeding, post menopausal women w/ atypical glandular cells on pap, perimenopausal intermenstrual bleeding, abn bleeding w/ Hx of anovulation, thickened endometrial stripe via sonography |
| What are the components of pre-op evaluation for endometrial CA? | Measure Ca 125, Transvaginal ultrasound, mammogram, CXR |
| What is the surgical approach for endometrial CA for grades I and II? | All verified via frozen section: TAH/ BSO washings only, <50% myometrial invasion, endometrioid, and < 2 cm tumor diameter |
| Whatdoes Stage III endometrial CA? | >50% myometrial invasion, >2 cm tumor diameter, clear or serous cells |
| What is the surgical approach for Stage III endometrial CA? | TAH/ BSO washings, lymphadenoctomy, omental or peritoneal Bx |
| What is adjuvant therapy in endometrial CA? | Various chemo agents |
| What are the poor prognostic factors in endometrial CA? | GOSH, I HAVE CA - Grade, Other, Stage, Histological subtype, Increasing age (>65), h, Aneuploidy, Vascular invasion, Endometrial Cytokinetics, Altered onco/ tumor suppressor gene expression |
| What is the follow up protocol for endometrial CA survivors? | Pelvic exam, pap, CA 125 high risk and CXR high risk |
| What % of endometrial CA recurs in the 1st 3 years? | 80% |
| Will most endo Ca recurrences be symptomatic? | Yes |
| What is the cure rate for vaginal endo Ca recurrence? | 50% |
| If endo CA recurs in a distant location, is the cure rate high? | No, rare to cure |
| What % of recurrent endo CA recurs in distant locations? | 65% |
| What % of recurrent endo CA recurs in pelvis and distant areas? | 15% |
| What % of recurrent endo CA recurs in pelvis only? | 15% |
| What % of recurrent endo CA recurs in vagina? | 5% |
| What is the Et. of Cervical Ca? | This an STD; Persistent HPV infection after the age of 30 is necessary (MC: HPV 16) |
| Can HPV be latent for many yrs before inducing cervical neoplasia? | yes |
| What are the histologic dx's of cervical CA? | CIN 1, CIN 2, CIN 3/ CIS, and Invasive CA |
| What are the specimen classifications under the Bethesda 2001 system? | Satisfactor or unsatifactory |
| What are the general categories in the Bethesday 2001 system? | Negative, epithelial cell abn., other |
| Is hybrid capture II testing useful in women <30? | Not useful as primary screen for women <30 as incidence of transient HPV is high |
| Who should hybrid II capture test be used on? | High risk HPV types only |
| Why are pap smears important? | There is a dramatic decrease in death from cervix cancer for screened women compared to women who do not participate in regular screening. |
| True or false, single pap false negative rate is <50%? | False |
| True or false: The latency period from dysplasia to cancer of the cervix is variable. | True |
| What % of women w/ cervical CA have never had a pap? | 50% |
| What % of cases and deaths due to cervical Ca occur in women >65? | 25% of cases, 41% of deaths |
| What is the typical profile of a woman not getting paps? | Poor, uninsured, elderly, ethnic minorities, in developing countries w/ poor attitudes and concerns w/ logistical problems |
| What is the protocol if CIN 1 upon colpscopy bx? | Observation |
| What is the protocol if CIN 2 upon colposcopy bx? | LEEP, cryo, or cone bx |
| What is the protocol if invasive cancer found upon colposcopy? | Refer to gyno onc. |
| What is the mainstay in treating advanced cervical CA? | Chemoradiation is the mainstay of treatment; Concurrent Cisplatin-based chemotherapy significantly improves the chances of survival |
| What is the purpose of chemo in treating advanced cervical ca? | Chemotherapy acts as a radiation sensitizer and may also control distant disease |
| (blank) | No lymph-vascular invasion |
| How long is radiation administered in treating advanced cervical CA? | 4-5 weeks of external radiation |
| What is the action of radiation in treating advanced cervical ca? | It treats the primary tumor and adjacent tissues and lymph nodes |
| How is early cervical Ca dx'd? | Conization or simple hysterectomy (removal of the uterus) - microinvasive cancer |
| What is tx in early cervical Ca? | Radical hysterectomy - Ovarian preservation; Chemoradiation therapy |
| What's the 5 yr. survival rate for Stage 1B Cervical Ca w/ a radical hysterectomy? | 85-95% |
| What's the 5 yr. survival rate for Stage II b Cervical Ca w/ just radiation and Chemo? | 85-90% |
| What's the 5 yr. survival rate for Stage IIb w/ just radiation and chemo therapy? | 70-80% |
| What's the 5 yr. survival rate for Stage IIIb w/ just chemo and radiation? | 55-65% |
| What rate of vaginal Ca are metastatic? | 80 to 90% of malignancies found in the vagina are metastatic |
| Is vaginal Ca rare? | Yes: 3% of cancers of the female reproductive system |
| Describe the disadvantages to animal skin condoms. | Sensitive, but least effective protection against STD's |
| Describe the advantage and disadvantage to polyurethane condoms | Sensitive but expensive |
| Advantages/ disadvantages to female condom | Have to keep in place for 6-8 hrs, expensive, but provides labial protection against STD's |
| Advantages/ disadvantages of diaphragms | Must be fitted for it; must insert 2 hrs prior; must leave in for 6-8 and doesn't protect against STD's |
| What are possible complications of diaphragm use | Staph infection - toxic shock syndrome, inc. risk for UTI |
| Disadvantages of the cervical cap | More likely to cause irritation or toxic shock syndrome |
| When would you advise a woman against an IUD. | PID - past, recent or current; unmedicated not advised if heavy prolonged pds; if immunosuppressed |
| What are possible complications of the IUD | If methods fails and get pregnant, typically atopic, uterine perforation |
| What does the Mirena IUD release? | Levonogestrel |
| What is the MOA of IUD? | Prevents fertilization by slowing down ovum transport |
| What is the MOA of Depo-provera? | Maintains a sustained high progesterone level, thus preventing LH surge; without LH surge cannot ovulate |
| Who should depo be recommended for? | Somebody wanting complete discretion or unable to tolerate OCP's, if pt. has SCA, seizures or is mentally challenged |
| Who is depo contra-indicated in? | Pts w/ breast CA or liver dz |
| What are side effects of depo | Allopecia, decreased bone density |
| What is the MOA of implantable hormonal agents | Levonorgestrel - suppresses LH surge, endometrial atrophy |
| What are contraindications for the implantable hormonal agents? | Thrombophlebitis/ embolism, Breast CA, Liver Dz |
| What are the emergency contraceptive methods? | Levonorgestrel (Plan B) - take .75 mg w/ in 72 hrs of coitus, & second dose 12 hrs. later; otherwise, can implant a Coppe T IUD |
| What is a fixed dosing OCP? | Same dose every day of the cycle |
| What is a phasic dosing OCP? | Gradual increase in amt of progestin as well as some changes in level of estrogen |
| What is the MOA of estrogen in OCP's? | Inhibits FSH, so w/o it, cannot have a mature follicle |
| What is the MOA of progesterone? | Inhibits GnRH which turn inhibits LH, w/o LH surge, no ovulation |
| What is the difference in progestin only pills vs. combo? | A mature follicle is formed, but not released (due to ovulation prevention); no placebos used |
| What are the indications for progestin only pills? | Lactating women; women >40; women w/ estrogen sensitive tumors |
| What are some benefits of OCP's? | Acne reduction, lighter, regulated periods, decreased irritability, decrease in ovarian and endometrial CA |
| What are contraindications for OCP's? | SHIT, no OCP->HBV: Smokers >35, Hepatic neoplasm, Impaired liver fxn, Thromboembolic or thrombophlebitis; Occlusion of coronaries, Cerebral vascular dz; Hyperlipidemia (congenital), Breast ca dx or suspected; Vaginal bleeding undx'd |
| What are contraindications for DRSP (Yasmin)? | Hepatic, renal, and adrenal insufficiency |
| What medication is contraindicated for use with OCP's? | Anti-convulsant meds |
| How does natural family planning work? | Finding out when you are going to ovulate, avoid sex a few days before and after ovulation |
| Discuss the prevalence and etiology of spontaneous abortion. | Prevalence: 8-20% of all pregnancies; #1 ET. Advanced Maternal age |
| What is the MC complication of early pregnancy? | Spontaneous abortions |
| What are two maternal diseases that can cause SAB? | poorly controlled DM and thyroid dz |
| What is the MC fetal factor in SAB? | Chromosomal abnormalities |
| What is the MC chromosomal abn cause for SAB? | Autosomal trisomy |
| True/ false: Most chromosomal abn. resulting in SAB arise de novo? | True |
| What is a paternal factor in SAB? | Smoking |
| Define threatened abortion. | Occurs before cervical dilation, presents w/ bleeding or cramping and fetus still viable |
| Define inevitable abortion | If cervical dilation occurs and os opens, abortion is inevitable |
| Define incomplete abortion. | partial POC expulsion - b/c already had expulsion, cervix and os are already dilated |
| What is a missed abortion? | Baby dies; typically no cramping - cervical os is CLOSED; found on US |
| What is CP of a missed abortion? | Fever and tenderness |
| Define recurrent abortion. | Once pt. has 1st SAB, chance of 2nd is 20%, chance of 3rd is 30% and 4th 40%; MC et: parental translocation and fetal chromosome abnormalities; MC uterine anomaly: septate uterus; MC thrombophilia et: factor V leiden |
| What percentage of recurrent abortions are unexplained? | 50-75% |
| Define septic abortion. | Can occur at any part of continuum; mother will die if left untreated b/c shock is inevitable; often results in hysterectomy; uterus will feel soft and boggy; cervix soft and dilated |
| 6. Describe the management used in each type of abortion | If hemodynamically unstable, septic or hemorrhaging or in shock: resuscitate and emergent D&C; if stable (no infxn): expectant, medical: Misoprostol, Surgical: D&C |
| 7. Define and discuss the incidence of ectopic pregnancy | pregnancy that implants outside the uterine cavity; Higher in women w/ IUD |
| Where are most ectopic pregnancies found? | in ampulla of fallopian tube |
| What is the leading cause of maternal death during 1st trimester? | Ectopic pregnancy |
| Discuss the causes and risk factors of ectopic pregnancy | AN ECTOPIC: Advancing age, None; Exposure to des inutero; Cigarette smoking; Tubal surgery; Ovulation induction; Prior pid, ectopic; Infertility; Contraceptive (iud) |
| 9. Describe the clinical presentation of an unruptured ectopic pregnancy | Abdominal pain, vaginal bleeding; amenorrhea, pregnancy symptoms |
| 9. Describe the clinical presentation of an ruptured ectopic pregnancy | Lightheadedness, shoulder pain, urge to defecate, sudden acute onset pain, weakness and collapse |
| 11. Describe the diagnostic studies used for ectopic pregnancy. | Serum Hcg, Transvaginal ultrasound; D&C endometrial sampling |
| When can ectopic be dx'd? | When hCG>2000 w/ no hx of signif. bleeding or evidence of IUP or plateau in hCG levels w/ no chroionic villi on D&C |
| 12. Describe the management of an ectopic pregnancy. | Expectant: if low hCG (>1000), Medical: methotrexate; Surgical: Salpingosotomy |
| When is surgical ectopic pregnancy management indicated? | If hemodynamically unstable, evidence of rupture, relatively high hCG levels (>5K) or relatively large mass |
| Define placenta previa | The presence of placental tissue overlaying or proximate to the internal cervical os |
| CP of placenta previa | Bleeding w/o pain |
| What is the diagnostic study for placenta previa? | CBC, transabdominal/ transvaginal US, coags, type and cross, fetal HR monitoring, sonography |
| management of placenta previa | Activity reduction, avoid coitus, avoid digital exam, can do SSE, C-section delivery |
| What does placenta previa increase the risk of? | PPH |
| 15. Define abruptio placentae. | Premature separation of the normally implanted placenta before delivery |
| 16. Identify conditions that are associated with abruptio placentae | Vascular and maternal-fetal associations |
| What are vascular conditions assoc. w/ abruptio placentae | Pre-eclampsia, chronic HTN, Cocaine use, Thrombophilia, smoking |
| What are the maternal fetal associations w/ abruptio placentae | Prior abruption, Increased age in parity, Multi fetal gestation, Polyhydramnios, Uterine leiomyoma, PPROM |
| What is the CP of abruptio placentae? | Painful uterine bleeding; uterus feels woody (rock hard) |
| What are the diagnostic studies done for abruptio placentae? | Clinical (H&P), US, CBC, Coags, type and screen, BUN/Creat, Tocodynanometry |
| How many cc's of blood should be seen on US to consider abruptio placentae? | 500 cc |
| What is the management of abruptio placentae? | Resuscitation, blood products, vaginal delivery |
| When do you perform C/S in abruptio placentae? | If fetal distress |
| What are the MC etiologies of acute pelvic pain? | Pid, Ectopic, Corpus luteum, Ovarian torsion |
| What is usu. considered acute pelvic pain? | Pain under 1 week |
| Where is the MC location for ectopic pregnancy? | Ampulla of fallopian tube |
| What is the medical Tx for ectopic pregnancy? | Methotrexate |
| What are classic presentation for ectopic pregnancy include? | Vaginal bleeding, Amenorrhea, Pain (abdominal) |
| What CP of PID? | Low ab pain, Bilateral adnexal pain, CMT |
| What is the Tx for PID? | Abx Tx |
| When is surgical intervention necessary for PID? | In those who are very ill w/ surgical abdomen or those who fail to respond to med. TX |
| What is the surgical intervention in PID? | Hysterectom |
| What is the DDx for CMT? | Anything causing Peritoneal inflammation such as appendicitis |
| What is PID? | Infxn of upper genital tract |
| What is an infection of the lower genital tract known as? | Cervicitis |
| What is the consequence of no PID tx? | Damage to tubes/ chronic pelvic pain |
| Who is the typical pt. for adnexal mass? | In extremes of age, uncommon in reproductive aged women |
| Is there bleeding w/ adnexal mass? | Yes |
| Why is there pain w/ an adnexal mass? | b/c of rupture |
| What is the TX for adnexal mass? | If simple cyst, watch for 3-6 mos., if does not resolve, then surgery; |
| What is ovarian torsion? | When the blood supply twists upon itself or ligaments too long |
| What is the CP of ovarian torsion? | Sudden onset low abdominal pain w/ waves of nausea/ vomiting |
| What causes the waves of nausea in ovarian torsion? | b/c the ovary flips and unflips |
| What is the Tx for ovarian torsion? | Rapid surgical eval to preserve ovarian fxn and prevent infectious complications, must unwind to perfuse |
| Is there a way to Dx ovarian torsion? | May see mass on US, may see blood flow on doppler, but no 100% way of dx'ing unless exploratory surgery |
| What are the common et. of chronic pelvic pain? | PPPAALE: Pid, Pcs, Pmp, Adenomyosis, Abuse, Leiomyomata, Endometriosis |
| What is endometriosis? | Presence of Endometrial glands and stroma outside the endometrial cavity & uterine musculature |
| What is the epidemiology of endometriosis? | Rare in young girls and post menopausal women |
| What race has a higher prevalence of endometriosis? | Whites |
| What is the MC age of women Dx'd w/ endometriosis? | 25-35 |
| What is the et. of endometriosis? | Retrograde menstruation, lymphatic dissemination/ vascular spread, Coelomic metaplasia |
| What is the CP of endometriosis? | None, Primary **dysmenorrhea, menorrhagia, **dyspareunia, localized pelvic pain, diffuse pelvic pain, Infertility (2ndary to scarring), Irreg. bleeding |
| What are possible GI/ GU sx's of endometriosis? | Pain or blood w/ urination or BM |
| How is endometriosis Dx'd? | Direct visualization and bx via laproscopy |
| What is the pharmaco management of endometriosis? | Danazol, Progestins (medroxyprogesterone or depo), GnRh agonists (depo lupron) |
| What other med should pt. be on if on Danazol? | OCP to avoid pregnancy |
| What are common SE of GnRh agonist? | Menopausal sx's and osteoporosis |
| What is the only Tx for endometriosis that will increase fertility rates? | Surgical |
| What is adenomyosis? | Endometrial glands & stroma found w/in uterine musculature |
| What is the CP of adenomyosis? | Dysmenorrhea, Asymptomatic, Menorrhagia, and boggy, hypertrophied uterus |
| What is the diagnostic test needed for Adenomyosis? | MRI |
| When is adenomyosis typically dx'd? | as an incidental finding during hysterectomy |
| What is uterine leiomyoma? | Benign smooth muscle tumors |
| What age is most commonly affected by uterine leiomyomas? | Women of reproductive age |
| What are the Sx's of leiomyomas? | Usu asymptomatic but if symptomatic, unusual bleeding,abdominal distention, pain, pressure, infertility |
| What race are leiomyomas MC in? | African Americans |
| What is the MC pelvic tumor? | Leiomyomas |
| Are leiomyomas estrogen responsive? | Yes |
| How are leiomyomas Dx'd? | Gold std: MRI; BME, incidental findings on US |
| How are leiomyomas managed? | Observation, Medical Tx: GnRh agonists, OCP's or Surgery: Myoectomy (for those wanting to preserve fertility), hysterectomy or uterine a. embolization |
| What is a functional ovarian cyst? | Result of failure of ovulation |
| Are functional ovarian cysts bilateral? | yes |
| What is the CP of functional ovarian cysts? | Asymptomatic |
| What is the Tx for functional ovarian cysts? | Watch, but if >6 cm, surgery, may be unable to save ovary |
| When are pain, torsion, and rupture common in functional ovarian cysts? | If > 6 cm |
| What is CP of Corpus luteum cysts? | Odd period, little late, feel bloated, distended; get US and see cyst |
| How is a Corpus luteum cyst dx'd? | Ultrasound |
| How are corpus luteum cysts managed? | OCP's, repeat US, surgical intervention if bleeding or torsion suspected. |
| Define Gestational HTN | b.p. over 140/90 during pregnancy where patients non-pregnant may have been nl.; no proteinuria is present; normotensive by 12 weeks post partum |
| Define Mild Pre-eclampsia | b.p. >140/90 but also has proteinuria >300 mg for a 24 hr. collection or 1+ protein dipstick |
| Define Severe Pre-eclampsia | B.P. >160/110 and >2 g proteinuria in 24 hr. urine collection or 2+ protein dipstick and end organ damage |
| Define Eclampsia | Seizure assoc. w/ HTN during pregnancy |
| Define Chronic HTN | Overt HTN |
| What is important Historical Info needed in eval of pregnancy related HTN | Pre-pregnancy and current wt., Hx of HA, RUQ pain, visual disturbances, Hx of loss of consciousness or seizures, edema not relieved by rest |
| What are common PE findings in the eval of pre-eclampsia? | Puffy faced edematous woman, evaluate b.p. sitting and supine, tenderness over the liver, hyperreflexia @ achilles or patellar DTR, clonus @ ankle |
| What are the diagnostic studies req'd in evaluation of pregnancy HTN | Creatinine, Urine protein, CBC, AST, Baby |
| What is the Management of for mild Pre-eclampsia? | Bed rest: LLD position, daily weighing, fetal movement counts, and b.p.; hospitalization if pt. does not follow bed rest instructions |
| What is the management for severe pre-eclampsia? | Mag sulfate, anti-HTN meds (initially hydralazine), monitoring, & delivery |
| What is the management of eclamptic seizure? | Mag sulfate and delivery |
| How is chronic HTN managed? | Aldomet and labetolol and check for renal dz |
| What are the risk factor for the HELLP syndrome? | Severe pre-eclampsia (though less hypertensive than avg pre-eclamptic pt.), older pt., multiparous pt. |
| What does HELLP stand for? | Hemolysis, Elevated Liver enzymes, Low Platelets |
| Why does b.p. decrease in 1st 24 wks of gestation? | Vasodilation |
| Why does vasodilation occur in 1st 24 wks of gestation? | b/c of progesterone |
| Discuss the maternal complications of pregnancy associated with maternal diabetes | 50% will develop overt diabetes in next 20 yrs; increases risk of pre-eclampsia and c/s delivery; risk of difficult delivery: i.e. shoulder dystocia |
| Discuss the fetal complications of pregnancy associated with maternal diabetes | Macrosomia most concerning, hypoglycemia, hypocalcemia |
| Discuss the antepartum management of a pregnant patient with overt diabetes mellitus re: preconception counseling | Discuss need for optimal pre-conceptional glucose control: 1). Pre-parandial bet. 70-100, 2) Post-parandial: <140 @ 1 hr and <120 @ 2 hrs., 3) Hgb A1C: w/in or near upper limit of nl. |
| What is assoc. w/ HgbA1C of >10 in pregnancy? | Significant risk of malformation |
| Discuss the antepartum management of a pregnant patient with overt diabetes mellitus to include assessment of end organ status | 24 hr. urine, opthalmology, fetal US |
| Discuss the risks of a pregnant patient with overt diabetes mellitus to include fetal and congenital anomalies. | Miscarriage, esp. if HgbA1C > 12, pre-term delivery, Cardiac, Spina Bifida, Anenecephaly, Renal anomalies, and Caudal regression |
| Is DM in pregnancy assoc. w/ increased risk of chromosomal abnormalities? | No |
| Discuss the antepartum management of a pregnant patient with overt diabetes mellitus to include diet | Diet w/ avg of 30 kcal/ kg/ day based on pre-pregnancy wt.; if BMI > 30 may benefit fr. 30% caloric restriction; insulin |
| What must a clinician be weary of when placing obese DM pt. on caloric restriction? | Ketosis |
| What does ketosis lead to in the fetus? | Impaired psychomotor development |
| Discuss the antepartum management of a pregnant patient with overt diabetes mellitus to include glucose monitoring | good glucose control |
| Discuss the antepartum management of a pregnant patient with overt diabetes mellitus to include insulin therapy | No oral agents; explain dosing |
| Who needs insulin Tx in pregnancy? | If fasting CBG > 105 on ADA diet (A2DM) |
| Discuss universal and targeted screening used to detect gestational diabetes mellitus. | Universal: 1 hr glucose test post oral glucose; Targeted screening (selective: for those w/ Hx of gestational DM, Macrosomic or stillborn baby) |
| How does human placental lactogen affect blood glucose? | Acts as an anti-insulin, therefore increased serum glucose levels |
| Describe the laboratory diagnosis of glucose intolerance/diabetes in pregnancy to include interpretation of results. | At 1 hr. screening, exceeding 140 mg is considered a positive screen; in the 3 hr glucose challenge, having 2+ abn. readings defined as GDM: fasting: 105; after 1 hr, level should be <190, after 2 hrs.: 165; 3 hrs: 145 |
| Compare and contrast antepartum management of gestational diabetes mellitus classified as A1DM versus A2DM | A1DM: considered fasting <105 and post-parandial <120 and diet controlled; A2DM: considered fasting >/= 105 and post-parandial >120 and meds are req'd |
| Discuss fetal assessment in the diabetic pregnancy | Fetal HR tracing, fetal kick counts, est. fetal wt. by ultrasound |
| 8. Discuss the intrapartum management of pregnant patients with diabetes mellitus | Constant glucose monitoring and 5% dextrose solution |
| Discuss the post partum management of patients with overt versus gestational diabetes | If overt DM, red. insulin dosage by 50% of pre-pregnancy dosage; if GDM, monitor glucose levels and minimal insulin injections |
| Discuss the hormones responsible for the follicular phase | Estrogen dominant with FSH involvement |
| Discuss the hormones responsible for ovulation | LH |
| Discuss the hormones responsible for luteal phase. | Progesterone |
| Describe the levels of pituitary gonadotropin levels of FSH | FSH secretion begins to rise in the last few days of the previous menstrual cycle; is highest and most important during the first week of the follicular phase |
| Describe the levels of pituitary gonadotropin levels of LH | lowest level reached at beginning of menstruation; when ovary begins producing estrogen, acts on pituitary as negative feedback for FSH, but positive feedback for LH; reaches highest level @ ovulation |
| Describe the levels of pituitary gonadotropin levels of estradiol @ each phase of the reproductive cycle. | reaches its lowest point @ beginning of menses; begins to rise again @ day 4 of cycle; reaches highest level right before ovulation |
| Describe the levels of pituitary gonadotropin levels of progesterone during each phase of the reproductive cycle. | Big surge happens right after ovulation and then descends at same rate as surge |
| Describe the clinical manifestations of hormonal changes during the reproductive cycle on the following: endometrium under estrogen/ estradiol influence | Stimulates cell growth and proliferation of endometrium |
| At what point does the endometrium reach its maximal thickness? | At time of ovulation |
| 5. Describe the clinical manifestations of hormonal changes during the reproductive cycle on the following: endometrium under the influnence of progesterone | Once ovulation occurs, the endometrium get under the influence of progresterone; Converts from proliferative to secretory |
| What does the endometrium look like under progesterone's secretory phase? | Loose, edematous, and blood vessels entering become thick and twisted |
| What happens to the endometrium w/ withdrawal of progesterone at end of luteal phase? | Endometrium undergoes breakdown and sloughs |
| Describe the clinical manifestations of hormonal changes during the reproductive cycle on the following: endocervix under influence of estradiol | The endocervical glands secrete lg quantifies of thin, clear, watery mucus thereby facilitatingsperm capture |
| Describe the clinical manifestations of hormonal changes during the reproductive cycle on the following: endocervix under the influence of progesterone | Endocervical mucus is thick, opaque, and tenacious; impedient to sperm capture |
| Describe the clinical manifestations of hormonal changes during the reproductive cycle on the following: breasts under progesterone | More rounded configuation b/c aciner glands stimulated; venous pattern on surface of brast more prominant and Montgomery glands are accentuated |
| When will more breast complaints during cycle occur and why? | During the luteal phase b/c of progesterone |
| Describe the clinical manifestations of hormonal changes during the reproductive cycle on the following: vagina under estradiol | Estradiol stims vaginal thickening and maturation of surface epi cells of vaginal mucosa; facilitates vaginal transudation (lube) |
| What happens to vagina under the luteal phase (secretory) under the influence of progesterone? | Thickness in vagina remains but secretions dimish markedly |
| Describe the clinical manifestations of hormonal changes during the reproductive cycle on the following: thermoregulating center. | Progesterone shift basal body temp by ~ 1 degree |
| Define dysfunctional uterine bleeding | (blank) |
| What are two CP of Primary Amenorrhea? | Age 15 w/ nl. secondary sex characteristics; age 13 w/ no nl. secondary sex characteristics |
| What's the #1 cause of Primary Amenorrhea? | Turner's |
| Is Amenorrhea a disease? If not, what? | No, not a dz, it is a sx |
| What is the CP of secondary amenorrhea? | No pd for 3-6 mos. |
| What is the MC of Secondary Amenorrhea? | Polycystic Ovarian Dz (PCOD) |
| What is the correlation bet. secondary amenorrhea and Hypothalamus-Pit-Ovarian axis? | When it is secondary amenorrhea, since you have had a pd. before, you know that this axis fxns, but is currently dysfunctional |
| What is included in an amenorrhea work up? | Hx, PE, pregnancy test, TSH/FSH/ Prolactin |
| What are the various causes of Amenorrhea? | A COP: Anatomical defects, Chronic Anvolution, Ovarian failure, Prolactin abnormality |
| What is an example of an anatomical defect that can cause amenorrhea? | Imperforated hymen |
| What can cause chronic anovulation? | Steady state of gonadotropins and sex hormones persistent in ovulation; Increased levels of circulating androgens/ estrogens |
| What can cause ovarian failure leading to amenorrhea? | Gonadal dysgenesis; Premature ovarian failure |
| How can prolactin cause amenorrhea? | Increased prolactin inhibits nl., pulsatile GnRh |
| If estrogen is absent, but pt. has body conture, secondary sex traits, what can be the cause? | Pituitary or ovarian problem |
| How can the cause of absence of estrogen be determined (bet. ovarian and pituitary)? | If FSH is high, the pituitary is fxning; therefore, think ovarian problem; if FSH nl. or low, it would be a pituitary problem |
| What is Asherman's uterus? | Intrauterine adhesions |
| What can cause Asherman's uterus? What can Asherman's uterus lead to? | D&C can cause it; it can cause 2ndary amenorrhea |
| What are the classic Sx's of pituitary failure? | Breast atrophy, failure to lactate, amenorrhea, hypothyroidism, loss of pubic/ axillary hair; usu occur b/c of intrapartum or early post partum hemorrhage |
| Recognize the causes of hypothalamic-pituitary amenorrhea. | Functional causes (wt. loss, excessive exercise, obesity), drug induced, neoplastic, Psychogenic (chronic anxiety), head injur or chronic medical illness |
| Define Sheehan's syndrome. | Post-partum hypo-pituitarism caused by intrapartum or early post partum hemorrhage. |
| What does Sheehan's syndrome cause? | Low TSH and T4, Low FSH, Low Estradiol, LH surge does not occur, low cortisol levels, low prolactin (therefore cannot lactate), able to bleed once administered estrogen/ progesterone OCP |
| How can you definitely i.d. hypothalamic pituitary dysfunction? | Measure FSH, LH, prolactin |
| Recognize the causes of genital outflow tract obstruction. | Muellerian agenesis, imperforate hymen, transverge vaginal septum, Asherman's |
| Describe the diagnostic evaluation for the various etiologies of amenorrhea. | Hx, PE, FSH, TSH, prolactin, Pregnancy test, Progesterone challenge test |
| What does the progesterone challenge test show? | If pt. bleeds after stopping the progesterone, it is known that the cause of amenorrhea is anovulation or oligoovulation; if bleeding does not occur, know that it is genital tract outflow problem (like Asherman's) or hypoestrogenic |
| 7. Define dysfunctional uterine bleeding. | Irregular bleeding unrelated to anatomic lesions of uterus. |
| Recognize the causes of ovarian failure amenorrhea. | IICU: Iatrogenic (chemo), Immunologic (autoimmune), Chromosomal causes (Turner's), Unknown cause (premature menopause) |
| Describe the management of Hypothalamic-Pituitary Dysfunction of amenorrhea. | Replacement of all ant. pit. hormones |
| Describe the management of Obstruction of the genital outflow tract amenorrhea. | Surgery to correct; Estrogen therapy, balloon or IUCD placed in uterine cavity to keep uterine walls apart during healing |
| List specific etiologies for dysfunctional uterine bleeding. | This is an ovulatory bleeding; et: imbalance of hormones (hypothalamic-pituitary axis) caused by excessive exercise, obesity, emotional stress |
| Describe the diagnostic evaluation of dysfunctional uterine bleeding. | You must rule out any anatomic causes of abn. uterine bleeding, pregnancy, run hormone levels (estrogen, progesterone, TSH, FSH) |
| What is the CP of dysfunctional uterine bleeding? | Excessive growth of body hair in a male pattern; changes in pattern or flow of pd. |
| Describe the management of dysfunctional uterine bleeding. | May req. hospitalization; administer progesterone to convert proliferative endometrium into secretory endometrium (medroxyprogesterone) or via OCP's; in longterm heavy bleeding, endometrial bx, endometrial ablation or hysterectomy |
| What should you think of when pt's cc is hirutism and you find out that pt. has always had irreg. pds? | Polycystic Ovarian Syndrome |
| What should you think of if pt. has a renal abnormality? | Muellerian agenesis (46 XX) |
| What two DDx's do you think of if uterus present and breasts present? | Hypothalamic pituitary or ovarian pathogenesis or Congenital abnormalities of genital tract |
| What should you think if if uterus present and breasts absent? | Goanadal failure/ agenesis |
| What are the differences between Mullerian Agenesis and Androgen insensitivity? | Muellerian Agenesis = 46 XX while Androgen insensitivity is 46 XY; Testerone is @ nl. level w/ Muellerian agenesis but elevated w/ Androgen insensitivity syndrome |
| What complications are found w/ androgen insensitivity? | Infertile and req. gonadectomy |
| What are the complications w/ Muillerian Agenesis? | Renal anomalies |
| What are the long term complications w/ PCOS? | Infertility, Cardiovascular dz, Endometrial hyperplasia, Hirutism, Increased risk for DM, Menstrual irregularities |
| What is pathomnemonic for Prolactinoma? | Loss of peripheral vision |
| If vignette for secondary amenorrhea discusses pt. who exercises hard core, what should you think of? | Hypothalamic Pituitary Amenorrhea |
| What is the MC et. of Abn Uterine Bleeding in childhood? | Vulvovaginitis |
| What are the MC causes of adolescent Abn. Uterine bleeding? | Anovulation, Coagulation defects |
| What is the MC et. of Abn Uterine bleeding in early reproductive age? | Menorrhagia |
| What is the MC et. of Abn Uterine bleeding in older reproductive age | Leiomyomas and endometrial polyps |
| What is the MC et. of Abn Uterine bleeding in perimenopausal women? | Anovulation |
| What are less likely causes of Abn. uterine bleedign in perimenopausal women? | STD's and Pregnancy |
| What is the MC et. of Abn Uterine bleeding in menopausal women? | Endometrial Cancer until proven otherwise |
| Where are fibroids commonly found? | Submucosa (reg. and pedunculated), Subserosal (reg. and pedunculated), and Intramural fibroids |
| Vignette: pt. postcoital bleeding, pelvic pain, afebrile, w/ erythematous cervix and discharge, malodorous what do you think of? | Trichomoniasis |
| Vignette: Post-coital bleeding, afebrile, no stank, no discharge, erythematous mass protruding from cervix into vajj. What do you think of? | Polyp |
| What are some non-gyno causes of Abn. uterine bleeding? | Hypothyroidism, Liver dz, blood dyscrasias, coag abnoromalities, anti-coag meds, rectal or urological bleeding |
| What is the nl. organism count for vaginal flora? | 10 to the 8th |
| What is the nl. ratio of anerobes to aerobes? | 5:1 |
| What is the nl. h2O2 production? | high |
| What is the nl. level of lactobacilis in vaginal flora? | 96% |
| What is the nl. gardnerella level in vaginal flora? | 5-60% |
| What is the nl. level of mobiuncus in vaginal flora? | 0-5% |
| What is the nl. level of mycoplasma hominis in vaginal flora? | 15-30% |
| What are the nl. physiologic vaginal secretions like? | Nl. vaginal secretions have no odor, are approx. 1.5 g. and white, clear and flocculent; Nl. pH 3.8-4.2 |
| What does an increase in vaginal secretions indicate? | Microbiologic cause |
| What happens to vaginal odor with infection? | odorous |
| What organism accounts for the majority of vaginal infections? | Bacterial vaginosis and non-specific vaginitis account for 50% of all vaginal infections |
| What are other causes of vaginal infections? | Fungi and trichamonas account for the other 50%, divided equally |
| Describe the use of laboratory aids that are useful in assessing the complaint of vaginal discharge including the saline wet mount | For BV: shows clue cells |
| 3. Describe the use of laboratory aids that are useful in assessing the complaint of vaginal discharge including KOH | Liberates amines that release odor - + whiff test |
| What is the pH level for BV? | >4.5 |
| Describe the use of laboratory aids that are useful in assessing the complaint of vaginal discharge including culture media. | |
| Describe the etiology of allergic vulvitis and vaginitis | Deordorants found in feminine products/ toilet paper, synthetic or tight-fitting underwear; laundry soap or fabric softener residues |
| What is the CP of allergic vaginitis/ vulvitis? | Diffuse reddening of the vulvar skin accompanied by itching and or burning but without obvious cause |
| What is the management of allergic vaginitis/ vulvitis? | Discontinue use of culprit; suggest granny panties |
| 5. Describe the etiology of atrophic vaginitis | Due to red. estrogen levels |
| What is the CP of atrophic vaginitis? | Pale, thin vaginal mucosa with overlying skin looking reddened, smooth and shiny; pH of discharge >5.5 |
| 5. Describe the diagnostic evaluation of atrophic vaginitis | Bx to test; will show up as hypoplastic |
| What is the Tx of atrophic vaginitis? | Estrogen and Test. possible |
| Describe the etiology of bacterial vaginosis | Symbiotic infection of anerobic bacteria and Gardnerella |
| 6. Describe the Dx bacterial vaginosis | homogenous discharge, pH >4.5, pos. whiff test and presence of clue cells |
| Describe management of bacterial vaginitis? | Oral metronidazole or intravaginal metronidazole cream or clindamycin vaginal cream or supository |
| What is the et. of trich? | Protozoa transmitted via sex |
| What is the CP of trich? | Mild to severe vulvar itching/ burning; copious frothy, foamy discharge w/ rancid odor; dyuria; dysparunia |
| What is the CP of bacterial vaginalis? | Musty or fishy odor w/ increased thin gray white to yellow discharge that may cause vulvar irritation and Tx sex partner |
| What is the Dx tests of trich? | confirmed by micro exam of vaginal secretions suspended in nl. saline showing the organisms |
| What is the Tx of trich? | Oral metronidazole and Tx sex partner |
| What is the et. of candidal vaginitis | ubiquitous air born fungi, Candida albicans accounts for 90% of cause |
| What is the CP of candidal vaginitis? | itching; burning, ext. dysuria, dysparunia, vulva bright red, excoriated; cottage cheese discharge; pH of 4-5 and odorless |
| What is the more typical pt. profile for candidal vaginitis? | Pregnant, diabetic, obese, immunosuppressed, on OCP's, on corticosteroids or Abx Tx |
| How do you Dx Candidal vaginitis? | Hx, PE, confirmed by hyphae and wet mounts made w/ KOH |
| What is the Tx for candidal vaginitis? | Topical application of one of the synthetic imidazole or oral flucanozole |
| What is the CP of herpes genitalis | Painful vesicular and ulcerated lesions found on vulva, vagina, cervix or perieal and perianal skin often extending to buttocks; 3-7 days after exposure; dysuria; primary infections have malaise, low grade fever and inguinal adenopathy |
| What is the Dx of herpes vaginalis | Hx, PE, Most sensitive method is via viral cultures taken by swab from lesions; Stained scraping for immunofluorescence |
| What is the Tx of herpes vaginalis? | Manage local lesions/ symptoms: sitz bath followed by drying w/ heat lamp/ hair dryer; topical anesthetic: Zylocaine jelly; if secondary bacterial infxn: antibacterial cream - neosporin; Acyclovir |
| What is the most common STD? | Chlamydia Trachomatis |
| What is the CP of Chlamydia Trachomatis | Eversion of the cervix with mucopurulent cervicits; acute urethritis, salpingitis |
| How is Chlamydia Dx'd? | PE and cultures; ELISA on cervical secretions and monoclonal fluorescent antibody tests on dried specimens |
| How is Chlamydia Tx'd? | Doxy and Z; partners should be treated |
| What is the CP of uncomplicated gono | |
| What is PID? | Infection of upper female genital tract fr. initial infection of the cervix |
| What are the major organisms involved in PID/ | Chlamydia and gono |
| In what dz is mucopurulent cervicits more common in? | Chlamydia |
| What limits PID? Why? | OCP's because it changes the endocervical mucus to look like it would under progesterone's influence |
| What is the CP of gono? | Greenish yellow discharge, pain/ tenderness/ fever chills, elevated WBC |
| How is gono Dx'd? | Culture on Thayer-martin agar plate kept in CO2 rich environment obtained from cervix, urethra, anus and pharynx |
| What is the Tx for gono? | tailored to site of infxn; Do not wait for cultures if clinically suspicious - empirically Tx; Ceftriaxone IM |
| If a pt. comes in w/ sore throat what STD should be on your DDx if not responsive to Tx? | Gono |
| What two STD's should be tested for simulatenously? | Gono and chlamydia |
| What is the CP of PID? | On PE, pt. may have muscular guarding, CMT &/ or rebound tenderness, purulent cervical discharge is often seen, and the adnexa usu. moderately to exquisitely tender w/ mass or fullness possibly palpable |
| What is the Dx test for PID? | endometrial Bx, transvaginal sonography or MRI showing hydrosalpinx formation |
| What are the indications to hospitalize pt. w/ PID? | PID UP IN EAST P: Pregnancy, IUD, DDx complicated; Unreliable pt., Prev. tx failure; Immunocompromised, Nulliparity; Elevated wbc count, Adolescents, Significant gi complaints, Tuboovarian abscess; Peritonitis |
| What is the outpt. Tx for PID? | Cefo |
| What are the complications of PID? | Increased ectopic pregnancy, infertility, Tuboovarian Abscess, Chronic pain, recurrent PID |
| What strains of HPV are assoc. w/ cervical neoplasia? | 16, 18, 45, 56 |
| What strains of HPV are mostly commonly assoc. w/ condylomas or venereal warts? | 6 and 11 (not 711) |
| What is the CP of HPV? | Soft, fleshy growths on vulva, vagina, cervix, urethral meatus, peritoneum and anus |
| What are kissing lesions in HPV? | Symmetrical lesions across the midline spread by direct skin to skin contact |
| How is HPV dx'd? | PE or bx |
| How is HPV Tx'd? | Chemical cautery (trichloraoacetic acid), cryosurgery, interferon injections, and immuno treatment |
| What are the reportable STD dzs? | PID (its MC organisms) and Syphillis |
| What is the et. of syphillis? | A spirochete: Treponema pallidum |
| What is the CP of primary syphillis? | Painless chancres and possibly adenopathy |
| What is the CP of secondary syphillis? | Sore throat, Headache, Anorexia, Malaise; Fever, Rash, Adenopathy, Condyloma lata |
| What STD is known as the great imitator? | Syphillis |
| What is the of CP of late/ latent. | Destructive, necrotic granulomatous lesions - gummas, aorititis, iritis, deafness |
| How is syphillis Dx'd? | Darkfield microsocy mor more commonly VDRL and RPR |
| How latent syphillis Dx'd? | CSF analysis |
| How are primary, secondary and early latent syphillis Tx'd? | Benzathine penicillin G |
| How is suspected neurosyphillis Dx'd? | Lumbar puncture w/ VDRL |
| When should one include neurosyphillis in DDx? | Dementia |
| What is the Tx for neurosyphillis? | Penicillin G IV q 4 hrs x 10-14 days |
| Define Menopause | When a woman over the age of 40 has not menstruated for 12 consecutive mos. |
| What is the FSH level in childhood? | <4 |
| What is the FSH level in prime reproductive years? | 6-10 |
| What is the FSH level in perimenopause? | 14-24 |
| What is the FSH level in menopause? | >30 |
| Describe the characteristics of the menstrual cycle of the perimenopausal woman | Shortening or lengthening of her cycles; luteal phase remains constant @ 13-14 d. Variations in cycle length due to follicular phase changes; ovulation decreases eventually to 3-4 x's per yr. |
| Define perimenopause? | 5-10 yrs before menopause |
| Describe the clinical manifestations of ovarian failure | Hot flashes, vasomotor instability, sleep disurbances, night sweats, vaginal dryness, genital tract atrophy, dypareunia, mood changes, skin thins, increased facial hair, osteoporosis, increased cholesterol, nails thin and brittle |
| What is the MC sx of impending ovarian failure? | Hot flashes |
| 5. Discuss the biologic significance of ovarian failure on the reproductive system | Marks end of reproductive years |
| Effect of ovarian failure on cardio system? | Increased LDL, HDL decreases |
| 5. Discuss the biologic significance of ovarian failure on the skeletal syst. | Osteoporosis |
| 6. List the risk factors for osteoporosis | OSTEO CAN bReak : Osteoporosis hx, Smoking, Taking in lil calcium, Early menopause, Oophorectomy; Caffeine intake, Alcohol intake, Nulliparity; (b)Reduced wt. for ht. (eak) |
| Describe the clinical presentation of osteoporosis | intense back pain secondary to compression fracture or intense groin/ thigh pain secondary to pathologic fx of the hip |
| Describe appropriate diagnostic studies for osteoporosis | Gold std: DEXA: Dual Energy Xray Absoptiometry |
| 9. Describe the prevention and management modalities used for osteoporosis | Estrogen and calcium (1,000 to 1500 mg); bisphosphonates or SERMS (like Tamoxifen) |
| Identify causes of premature ovarian failure. | CLASS GH: Chemo, Low body wt., Autoimmune dz, Smoking, Savage's syndrome; Genetic factors, Hysterectomy |
| Identify the indications for initiating estrogen replacement therapy in the menopausal woman. | Tx of mod. to severe hot flashes, Tx of mod to severe Sx's of vulvar and vaginal atrophy, prevention of post-menopausal osteoporosis |
| List therapeutic options currently in use for managing the symptoms of menopause. | Besides estrogen, SSRI's, aerobic exercise, avoiding spicy foods, caffeine and ETOH |
| Describe the treatment regimens generally used for estrogen replacement therapy | Continuous estrogen replacement w/ cyclic progestin administration (will get period)or daily administration of both an estrogen and low-dose progestin |
| List the benefits and risks of estrogen replacement therapy. | Benefits of Estrogen include: Mac SUC Mac HAC O!: Macular degeneration; Skin integrity, Urogenital integrity, Cardiovascular; Memory And Congnition, Hearing, Alzheimers, Colon cancer; Osteoporosis |
| What are the risks of estrogen therapy? | Unopposed, could cause endometrial hyperplasia leading to endometrial Ca, increased risk of breast Ca |
| 15. List the benefits and risks of estrogen-progesterone replacement therapy. | The combo will avoid the risk of endometrial hyperplasia; Risks: heart attack, stroke, thromboembolic dz |
| Given a patient case study, select the appropriate management of menopause. | Know that estrogen is contraindicated in women w/ hx of breast or endometrial Ca; know that in those patients could use therapeutic Tx, SSRI's, possibly a combo Tx; know that if pt. comes in 10-15 yrs post meno, not going to admin. HRT |
| 1. Define premenstrual syndrome | Constellation of emotional, behavioral, and physical Sx's that occur @ luteal phase of menstrual cycle and resolve after start of menses must have a Sx free interval |
| Discuss the various etiology theories used to explain premenstrual syndrome including diet. | High intake of salt and carbs leading to premenstrual hypoglycemic episodes |
| Discuss the various etiology theories used to explain premenstrual syndrome including endrophin basis | Endorphin basis states that there's a relative dec. in endorphin levels during the luteal phase; PMS Sx's mimick Sx's of opiate withdrawal |
| Discuss the various etiology theories used to explain premenstrual syndrome including serotonin basis | Lower levels than control pts. |
| Discuss the various etiology theories used to explain premenstrual syndrome including fluid retention | Alterations of Renin Angiotensin Aldosterone axis have been suggested as basis for PMS |
| Discuss the various etiology theories used to explain premenstrual syndrome including Vit. basis | Deficiencies of A, B,E and Calcium; B 6 is cofactor in production of serotonin |
| What is the CP of PMS | MAD: Mood swings, Anxiety, Depression, Headache, cravings, wt gain, cramping, bloating, breast tenderness/ swelling |
| What is the diagnostic eval. of PMS | Ask pt. to keep Sx diary during two consecutive menstrual cycles; to confirm PMs, pt. must demonstrate symptom free follicular phase |
| Discuss the diagnostic criteria for Premenstrual Dysphoric Disorder that must always be present | Req's all of these: 1). Not an exacerbation of underlying psych disorder, 2). Document w/ prospective charting x's 2 mos., 3. must interfere w/ ADL's and then 5 of 11 other Sx's |
| What are considered "core" sx's of PMDD? | MAD Anger & Irritability: Mood swings, Anxiety, Depression, Anger, and Irritability |
| What is the minimum # of core Sx's req'd for dx of PMDD? | 1 |
| What are the other Sx's of PMDD? | SIF E CAP: Sleep changes, Interest loss, Feeling overwhelmed, Energy loss, Concentration decrease, Appetite change, Physical Sx's (bloating, headache, breast tenderness) |
| 5. Discuss the management of premenstrual syndrome to include the use of diet | Fresh, not processed foods; lots of fruits/ veggies; avoid fats and refined sugars; frequent small meals, minimal salt intake, no caffeine |
| 5. Discuss the management of premenstrual syndrome to include the use of Exercise | Relaxation, reflexology, helps to increase endogenous endorphin production |
| 5. Discuss the management of premenstrual syndrome to include the use of Vitamin Therapy | B 6, E, Calcium, and Mg |
| 5. Discuss the management of premenstrual syndrome to include the use of pharmacotherapy | NSAID's, diuretics, OCP's, anxiolytics and SSRI's (PECS Flu) |
| What is the CP of fibrocystic breast changes? | Induration and pain MC present as cyclic, bilateral pain and engorgement, pain is diffuse w/ radiation to shoulder or upper arms; sometimes well localized pain if rapidl expanding; on PE may be feel like fluid-filled balloon |
| What is the Tx for fibrocystic breast changes? | FNA of palpable or ultrasound i.d.'d cysts or diet modifications |
| What is the CP of of fibroadenomas? | Firm, painless, mobile under 3 cm; these are not cyclical |
| What is the management of of fibroadenomas? | FNA to r/o malignancy and would excise if painful or growing rapidly; otherwise: observation |
| What is the CP of of intraductal papilloma? | Bloody serous or cloudy nipple discharge; this is non-palpable |
| What is the management of intraductal papilloma | Excisional bx to r/o malignancy |
| What are the MC of all benign breast conditions? | Fibrocystic changes |
| When are fibrocystic changes most common and why? | Happen as exaggerated response to hormones MC during reproductive years or HRT postmenopausal |
| What can inappropriate application of force during Stage III lead to? | Inversion of the uterus |
| What is the danger in inversion of the uterus? | assoc w/ profound blood loss and shock |
| What is the appropriate technique to take during Stage III labor? | Wait for spontaneous extrusion of the placenta sometime up to 30 minutes later; as placenta passes into lower uterine segment, press the uterus fundus gently & apply gentle traction on umbi cord |
| How many arteries and veins should be present on the umbi cord? | 2 Arteries and 1 Vein |
| What are the relative contraindications for OCPs? | Severe HTN, Severe vascular headache, Epilepsy, DM, Obesity (morbid), Gallbladder dz |
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doggiekylesmom