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Clinical Medicine

Define Endometriosis The presence of endometrial glands and stroma outside the uterus
Define Adenomyosis The presence of endometrial glands and stroma that extends into uterine musculature
Bacterial Vaginosis Diagnosis clue cells on wet prep*
Bacterial Vaginosis treatment Flagyl (Metronidazole)
greenish/yellow, frothy vaginal discharge Trichomonas vaginitis*
"strawberry cervix" Trichomonas vaginitis*
"Cottage cheese" discharge Yeast vaginitis*
Yeast vaginitis Diagnosis clinically, hyphea/ pseudohyphea/ budding on KOH prep*
Yeast vaginitis Treatment oral fluconazole
Neisseria Gonorrhoeae (Gonorrhea) is a gram Gram-negative intracellular diplococci*
USPTF recommends screening yearly for Neisseria Gonorrhoeae (Gonorrhea) from onset sexual activity-26yo
Most common STI Chlamydiae Trachomatis (Chlamydia)*
Syphilis is caused by Treponema pallidum (a spirochete)*
Syphilis treatment PCN G 2.4 mill units IM x 1 dose
Average age in US for menopause 51.5 years
Define menopause no menses >1 yr, or FSH >30mIU/ml
never give unopposed estrogen to a woman with a uterus
Level of uterus at 12 weeks pubic symphysis*
Normal Fetal heart rate 120-160bpm
Define Round ligament pain Sharp, shooting, fleeting pain, unilateral- typically located in the groin
"Mask of pregnancy" Chloasma
Maternal screening AFP screens for open neural tube defects
Pregnancy implantation outside the uterine cavity Ectopic Pregnancy
Treatment for ectopic pregnancy surgery or methotrexate
bleeding, passing "grapelike tissue", partial may present like SAB Gestational trophoblastic neoplasia (GTN or GTD)*
In Gestational trophoblastic neoplasia (GTN or GTD) HCG is over >100,000mU/mL
Diagnosis criteria for Preeclampsia (1)Hypertension, BP>140/90 (2)Proteinuria >300mg/24hrs (3)+/- Edema (often hands and face in addition to legs)
Diagnosis criteria for Eclampsia (1) Hypertension, BP>140/90 (2) Proteinuria >300mg/24hrs (3) +/- Edema (often hands and face in addition to legs) (4) seizures
HA, visual changes, pulmonary edema, elevated LFTs, RUQ/epigastric pain Preeclampsia
Define PROM rupture of membranes prior to onset of labor at or after 37weeks
Define PPROM rupture of membranes prior to onset of labor in patients less than 37 weeks gestation
Premature separation of the normally implanted placenta from the uterus after 20 weeks Placental abruption*
Placenta partially or completely covers the cervical os Placenta previa*
Bright red, painless, recurrent vaginal bleeding, no fetal distress (usually) Placenta previa*
Placenta directly attached to the myometrium Placenta accreta*
Placenta invades the myometrium Placenta increta*
Placenta penetrates the myometrium Placenta percreta*
Follicular/proliferative phase occurs during days Days 1-14
Luteal/ secretory phase occurs during days after ovulation (days after 14)
Short stature, web neck, lacks ovary or uterus Turners syndrome*
'string of pearls' on ultrasound Polycystic ovarian disease
Polycystic ovarian syndrome AKA Stein levanthal syndrome*
MC organism of PID GC*
PID etiology GC, chlamydia, E. coli, mixed anaerobes and myco/ureaplasma
Most common STD Chlamydia*
Treatment for chlamydia Zithromax or doxycycline*
treatment for GC Ceftriaxone, cefixime*
Primary syphilis presents with a chancre*
Secondary syphilis presents with Symmetric rash on palms and soles
Latent/ tertiary syphilis AKA Neurosyphilis
Chancroid caused by H. ducreyi
Painful genital ulcer with fluctuant inguinal adenitis Chancroid
Painless genital ulcer Granuloma Inguinale
PID treatment in pregnancy Clindamycin with gentamycin
Most common metabolic disease in the U.S. Osteoporosis*
Benign solid mass, typically painless in breast Fibroadenoma*
Most common reason for fever after the immediate puerperium in nursing mothers Mastitis*
Mastitis caused by S. aureus*
Treatment for mastitis dicloxacillin
Second most common cause of cancer death in women Breast cancer
Most common type of breast cancer Infiltrating intraductal carcinoma
Most common reason for spontaneous abortion Chromosomal abnormalities*
Abruptio placentae Painful vaginal bleeding*
Placenta praevia Painless vaginal bleeding*
oligohydramnios Decreased amniotic fluid levels
polyhydramnios Excess amniotic fluid levels
Strawberry cervix Trichomonas infection*
BRCA genes are associated with Breast and ovarian cancer*
To delineate a solid vs. cystic breast mass, use a Ultrasound
To evaluate for ovarian torsion, use a Color Doppler
Clue cells for diagnosis of Bacterial Vaginosis
UPSTF recommends mammograms every 2 yrs
inhibit ovulation, thicken cervical mucous and alter quality of endometrium Oral contraceptives
Risk factors for oral contraception with female at 35 y/o smoking
Yeast infection treatment Diflucan
The USPSTF recommends biennial screening mammography for women aged 50 to 74 years
Most common cause of cancer death in women? Lung cancer
Pap smear frequency Every 3 years, may cease if all pap smears have been normal until 65; if never tested, stop after two negative smears
When do you do pap smear on a girl? starting at age of 21 and doing every 3 years
USPSTF guideline for breast cancer screening in women USPSTF recommends biennial screening mammography for women aged 50 to 74 years
Contraindications for Oral Contraceptives? Thromboembolic (DVT past or present)
Hegar's Sign softening of the lower uterine segment or uterine isthmus*
Chadwick's Sign is bluish or purplish discoloration of vagina and cervix during pregnancy*
Goodell's sign softening of the cervix*
Cervix becomes soft, blue and swollen when pregnant
pt may need to be hospitalized. Excessive N/V, weight loss of 5% or greater from pre-pregnancy weight. Dehydration, ketones in urine Hyperemesis Gravidum
20 WKS fundal height AT UMBILICUS*
Patient unable to get pregnant, male sperm count ok, give clomiphene citrate
Treatment for Mild Eclampsia bedrest (BP 140/90, Protein +2,+3)
Consistent, Late decelerations are a sign of uteroplacental deficiency
Corpus luteum produces Progesterone
Choriocarcinoma is usually preceded by PREGNANCY
Vaginal bleeding at 12 weeks can lead to Threatened Abortion
lead to chocolate colored ovaries, raspberry colored nodules in the pelvic cavity but NOT cervical stenosis. Endometriosis
contraindications of OCP (estrogen and progesterone) active liver disease
The most common Gyn cancer is endometrial cancer*
Cause Violin String adhesions between liver and abdominal wall (Perihepatitis:) Fitz - Hugh - Curtis Syndrome*
are paraurethral glands that may be related to female ejaculation Skene Glands
Nulliparity is a risk factors for Ovarian Cancer*
is common cause of post partum hemorrhage Uterine Atony*
Mastitis is treated with dicloxacillin*
The rate Dizygotic or "fraternal" twins increases with maternal age
Menopause or peri-menopause have this as first sign/symptom HOT FLASHES
from excess Prostaglandin produced in endometrium Primary Dysmenorrhea
C-section ALWAYS required with hx of previous C-section that had CLASSICAL Incision (vertical incision)
adhesions in the uterine cavity Asherman's syndrome
Fibroids, Fibroadenoma (common benign neoplasm), leiomyomas think bleeding
most common medical abortions medications Mifepristone and Misoprostol
luteal phase corresponds with what phase secretory phase
women with fibroids have an increased risk of endometrial cancer
Most common position for the baby in utero Vertex (head first)
the embryo or fetus dies in utero, but products of conception are retained Missed abortion*
deliberate termination of pregnancy Induced abortion
Any uterine cramping or bleeding in the presence of a closed cervix during the first 20 weeks Threatened abortion*
Involves uterine bleeding or pain when the cervix is beginning to efface or dilate Inevitable abortion
Passage of part of the POC through the cervix, cervix is dilated, bleeding is present Incomplete abortion
Passage of all of the POC, with subsequent closure of the cervix and return of the uterus to normal size Complete abortion
Death of a fetus and its retention in utero for 4 weeks or longer Missed abortion
Infection of the uterine contents before, during, or after an abortion Septic abortion
Fever, chills with painful erythema and induration of the breast. due to staph aureus Mastitis*
Normal apgar score At least 7 at one minute and 9 at five minutes
Follicular phase AKA Proliferative phase
Do not give this medication during pregnancy (cat. D) doxycycline
"abnormal bleeding in the absence of an anatomical lesion" Dysfunctional uterine bleeding (DUB)
Bleeding for greater than 35 day intervals oligomenorrhea
Bleeding for less than 21 day intervals polymenorrhea
heavy menses (more than 80 mL) menorrhagia
irr/ heavy bleeding menometrorrhagia
clue cells on wet prep, fishy odor Bacterial vaginosis*
"strawberry cervix" Trichomonas vaginitis*
"Cottage cheese" discharge Yeast vaginitis*
Nagele's rule: EDD= LMP+7days- 3mon
Recurrent AB 3 SABs, or 2 SABs in a row
HELLP Syndrome Hemolysis, elevated liver enzymes, low platelets
Detachment of a normally implanted placenta can cause severe hemorrhage Abruptio placenta
Implantation of the placenta occurs over or near the cervical os Placenta previa
Causes Fitz - Hugh - Curtis Syndrome Neisseria gonorrhoeae
Shoulder Dystocia is common with a fetus of 4,500 grams and up
This becomes soft, blue and swollen when pregnant Cervix
Severe Eclampsia treatment Mag sulfate, antihypertensives (hydralazine, labetalol)
continues to produce ESTROGEN in uterus follicle cyst*
produces Progesterone in uterus Corpus luteum*
Endometriosis does not lead to cervical stenosis
Decent of the bladder into the upper anterior vaginal wall cystocele*
Bulging of the urethra into the lower anterior vaginal wall without urethral dilation urethrocele
Involves prolapse of the rectum into the lower posterior vaginal wall rectocele
Prolapse of a loop of intestine into the upper posterior vaginal wall enterocele
Enteroceles are almost always due to Herniation of the pouch of Douglas
Occurs when sudden increases in intraabdominal pressure such as coughing, sneezing or exercise cause leakage of small amount of urine Stress incontinence
Detrusor instability; involves the loss of large amounts of urine immediately after the urge to void Urge incontinence
Leiomyoma or fibroids are also known as Uterine myoma
Most common benign breast tumors Fibroadenoma
Obstruction of skin lymphatics causing lymphedema and skin thickening on the breast Peau d orange
Intraductal carcinoma that involves the main excretory ducts of the breast Paget's Disease
excess body hair in a male hair pattern often accompanied by acne and oily skin Hirsutism
First stage of labor Onset of labor to complete dilatation of the cervix
Second stage of labor From cervical dilatation until the birth of the infant
Third stage of labor Birth of infant until the delivery of the placenta
Signs of separation of the placenta Sudden gush of blood from vagina, lengthening of the umbilical cord, and firming of the uterine fundus.
Serum B-HCG increases by how much every 4 hrs doubles
If serum B HCG does not double in 4 hrs. think Ectopic pregnancy
Ectopic triad Abdominal pain, missed period, vaginal bleeding
This accounts for most abortions Chromosomal abnormalities*
Snowstorm pattern Gestational Trophoblastic Disease (Molar Pregnancy)
Vaginal bleeding, enlarged uterus, pelvic pain, increased B-HCG, sever hyperemesis Molar pregnancy (surgical evacuation)
Common cause of dysfunctional uterine bleeding or abnormal bleeding. Anovulation
Most specific sign for a functional ovarian cyst Menstrual irregularity
Most common benign breast tumor Fibroadenoma*
During a colposcopy, a vinegar solution is used to turn abnormal tissue what color? White*
47, XXY Klinefelters
45 X Turner Syndrome
Pregnant patient at term who presents with outbreak of genital herpes, treat with C-section*
What is the most likely site of an ectopic pregnancy within the tube Ampulla*
heterotopic pregnancy is a multiple pregnancy with one normal implantation in the uterus and one ectopic pregnancy
MOA of Methotrexate folic acid antagonist
Postmenopausal bleeding should essentially be considered endometrial cancer
An obese patient with persistent abnormal bleeding unresponsive to medical therapy requires endometrial biopsy to evaluate for endometrial cancer.
Most common GYN malignancy in U.S. Endometrial cancer*
No breast development & elevated FSH Gonadal dysgenesis*
Uterus absent & FSH normal Mullerian agenesis*
Prolactin > 200 CT of Sella pituitary microadenoma
Prolactin < 200 psychotropics
Dysmenorrhea is Painful periods
MCC of secondary dysmenorrhea Endometriosis*
Dyspareunia is Pain with sexual intercourse
Endometriosis presents with Dysmenorrhea, dyspareunia, infertility & pelvic pain
Diagnosis of endometriosis is with Laparoscopy with laser ablation (therapeutic & diagnostic)*
Treatment of endometriosis Laser ablation, excision, electrocautery, hysterectomy
Medical treatment for endometriosis NSAIDs, OCPs, Lupron & Danocrine
GnRH agonists used in endometriosis include Lupron & Danocrine
Treatment for most dysplasias in an abnormal PAP LEEP*
Treatment reserved for carcinoma in situ (CIN III) Cold cone (conization)*
Cold cone (conization) is Surgical removal of the entire transformation zone & the Endocervical canal
This GYN procedure may create an incompetent cervix Conization
Failure of the fluid in an incompletely developed follicle to be reabsorbed Follicle cysts
Chocolate cysts Endometriomas*
Benign germ cell tumor Dermoid
Remove dermoid to avoid Torsion or bleeding
PCOS presents with Hyperandrogenism, Insulin resistance, & anovulation
Cancer of vagina & vulva are due to HPV*
Normal pH of vagina < 4.5
Normal vaginal flora Lactobacillus
Amsel's criteria for BV pH > 4.5, clue cells, (+) whiff test, & malodorous, grey frothy discharge
If recurrent candidal vaginitis screen for Diabetes*
Cervical motion tenderness/ adnexal tenderness PID*
Outpatient PID treatment Ceftriaxone, doxycycline, or metronidazole*
Inpatient PID treatment Cefoxitin or cefotetan with doxycycline OR clindamycin with gentamycin*
PCOS is associated with Insulin resistance*
Intrauterine devices include Paragard (copper) & Mirena
Best users for IUD are Monogamous & have children*
ADR of mirena Light irregular bleeding
ADR of paragard Irregular heavy bleeding & dysmenorrhea
Progesterone only methods include Mini pill, Depo-Provera & Implanon
OCP for breast feeding women Mini Pill*
Contraindications for mini pill DVT, dysfunctional uterine bleeding, liver disease & breast cancer
Fertility is possibly delayed 18 months after discontinuation of this OCP Depo-Provera*
fertility is delayed with Depo-Provera for 18 months*
OCP that is an IM injection Depo-Provera (Medroxyprogesterone acetate)
OCP that is a single thin flexible rod Implanon
Insertion of paragard in emergency contraception is done Within 5 days of intercourse*
Demineralization of osteoporosis occurs in Trabecular bone
Normal Dexa score is T score of (+) 1.0 to (-)1.0
T score of (-) 1 to (-) 2.5 Osteopenia
T score of < (-) 2.5 Osteoporosis
Osteoporosis treatment Calcium, Vit D, weight bearing exercise, estrogen & Bisphosphonates
Bisphosphonates include Alendronate, Risedronate, Ibandronate, calcitonin, forteo*
Selective estrogen receptor modulator (SERMC) is Raloxifene (Evista)*
Drug that increases bone density and decreases risk for breast cancer Raloxifene (Evista)*
MCC of fever after the immediate puerperium in nursing mothers Mastitis*
Mastitis presentation Flu-like with HAs & myalgias, unilateral pink area on breast
Treatment for mastitis Antibiotics, keep breastfeeding*
If mastitis in non-lactating woman think Cancer
Causes of Galactorrhea Psychotropics, cimetidine, TCAs, OCPs, Depo Provera, hypothyroidism & pituitary Microadenoma
MCC of bloody nipple discharge Papilloma*
This is indicated in bloody nipple discharge regardless of cause Excision of bloody duct system
Differential of a breast mass Fibrocystic disease of the breast, fibroadenoma, carcinoma
Treatment of fibrocystic breast disease Wear supportive bra, NSAIDs, acetaminophen, OCPs, Danocrine/ Lupron
MCC of breast lump Fibroadenoma*
Definitive diagnosis of solid breast tumor with Excisional biopsy*
MC site of Mets in breast cancer Lymph nodes*
Sites of metastases of breast cancer Lymph nodes, lung, pleura, liver, bone, brain
MC type of breast cancer Infiltrating ductal carcinoma*
Most lethal type of breast cancer Inflammatory*
Peau d' orange Inflammatory breast cancer*
Infiltrating intraductal carcinoma in the nipple & ducts of nipple Paget's disease of the breast
First symptom of Paget's disease Itching or burning of the nipple*
Herpes zoster vaccine given after 60 is Zostavax
Screening at 16 - 20 weeks Fundal heights, QS-AFP, US
Screening at 24 - 28 weeks 1 Hour GTT, H&H
Screening at 34 - 36 weeks Group B strep screen
Prenatal vitamins 800 mcg folic acid
Foods that contain folic acid Green leafy vegetables, orange, cantaloupe, banana, milk, grains & organ meats*
Anembryonic pregnancy Blighted ovum, embryonic sac with no tissue
Risk factors for ectopic pregnancy Previous ectopic or PID, BTL, hx of pelvic surgery, current IUD, infertility & assisted reproductive technology
Presentation of ectopic pregnancy Unilateral pelvic pain, spotting, (+) HCG, US
Management of ectopic Check Rh & type, surgery, methotrexate
RhoGam is given at 28 weeks or after complications
Heterotopic pregnancy is Co-existence of intrauterine pregnancy with an ectopic pregnancy
Pre-eclampsia in first or second trimester is pathognomic for Molar pregnancy*
Complications of molar (hydatidiform) pregnancy Metastasize to the lungs, choriocarcinoma*
After a molar pregnancy, unable to get pregnant for 1 year (follow sHCG weekly to zero)*
Gestational HTN BP > 140/90 at or after 20 weeks gestation
Treat gestational HTN with Labetalol/ methyldopa*
This signals magnesium toxicity Absence of DTRs*
If loss of DTRs Delivery
Treatment of HELLP Delivery
Treatment of premature rupture of membranes Antibiotics, corticosteroids, tocolysis, delivery
Contraction stress test is looking for Presence or absence of late fetal heart rate decelerations in response to uterine contractions
Variable decelerations are due to Cord compression, oligohydramnios
Components of the biophysical profile include Non-stress test, fetal breathing movements, fetal movements, fetal tone & amniotic fluid index
Risk factors of shoulder dystocia Fetal macrosomia (>4500g), maternal diabetes*
Maternal complications of shoulder dystocia Post-partum hemorrhage, 4 degree laceration
Fetal complications of shoulder dystocia Brachial plexus palsies, clavicle fractures, fetal death*
Meds associated with reduced risk of post-menopausal osteoporosis Diuretics*
Meds that decrease risk of ovarian cysts OCPs*
Drug to cause uterine relaxation in order to turn the fetus from outside Terbutaline (Brethine)
Created by: duanea00