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Women's Health EOR
| Question | Answer |
|---|---|
| HcG comes from | trophoblastic tissue |
| Serum HcG detection | 5-7 days after conception, or 20-22d after LMP |
| HcG peak | 10-12w after conception |
| Urine HcG detection | 14d after conception |
| Ladin Sign | uterus softening after 6w |
| Heager sign | uterus isthmus widening and softening after 6-8w gestation |
| Piskacek sign | palpable lateral bulge or softening of uterine cornus at 7-8w gestation |
| Leukorrhea | vaginal discharge containing epithelial cells and cervical mucus |
| Goodell's sign | cervical softening due to increased vascularization ~4-5w gestation |
| Chadwick's sign | bluish coloration of the cervix ad vulva ~8-12w |
| When fetal heart tones become detectable w doppler | 10-12w gestation |
| Normal fetal HR | 110-160 |
| When cardiac activity becomes detectable w TVUS | 6w |
| Limb bud development | 7-8w |
| Finger and limb movement | 9-10w |
| Gravida | Number of times pregnant |
| Para | Number of births |
| Abortions | Number of pregnancies lost |
| How far along when the height of the fundus is at the umbilicus | 20-22w |
| How far along when the height of the fundus is at the xiphoid process | 36w |
| Normal things that increase during pregnancy | blood volume, cardiac output, stroke volume, tidal volume, HR |
| Normal things that decrease during pregnancy | Residual capacity, systemic vascular resistance, BP second trimester |
| EDD | crown to rump, Naegele's rule, Calander |
| Neagle's rule | minus 3m from month of LMP and add 7d to start of LMP |
| Multiple gestation signs | rapid weight gain and increasing size of the uterus, rapidly rising b-hCG and a-FP |
| Dizygotic twins | fraternal |
| Maternal twins | identical |
| Identical twin risk to fetus | fetal transfusion syndrome and discordant fetal growth |
| Maternal risk with twins | Preterm labor, spontaneous abortions, pre-e, anemia |
| Fetal risk as twins | IGR, placental abnormalities, breech, umbilical cord prolapse, pre-e |
| Variable deceleration | Sharp drop on fetal monitor w quick recovery |
| Variable deceleration likely cause | Cord compression |
| Patho of Variables on FHRM | occur due to fetal baroreceptors response to umbilical cord compression |
| 1st management of variables FHRM | trade to left lateral decubitus then right lateral decubitus |
| 2nd management of variables on FHRM | amnioinfusion to take pressure off the cord |
| 3rd management of variables on FHRM | C-section |
| Earlies likely cause | Head compression |
| Early decelerations | dips in fetal HR that occur with contractions |
| Patho of Earlies on FHRM | Vagal response from fetal head compression |
| Early decel management | Likely benign labor progress |
| Acceleration on FHRM | >15s but <2m |
| Patho of acceleration on FHRM | movement by baby |
| Late decel likely cause | Poor fetal oxygen during uterine contractions associated with uteroplacental insufficiency |
| Late decel management | interventions- mom move, IV fluids, O2, stop pit, possible C |
| Infective lactational mastitis | Infection of the breast in women who lactate secondary to nipple trauma |
| Most common bacteria causing breast infections | Staphylococcus |
| Bugs causing breast infections | Staph, MRSA, Strep, Candida |
| Signs and symptoms infectious mastitis | pain, tender, warmth, swelling, erythema, flu-like symptoms |
| Infective mastitis signs and symptoms | one side, red, hot, tender, flu like symptoms |
| Mastitis diagnostic studies | Clinical diagnosis |
| Mastitis rx | Continue breastfeeding, complete emptying of ducts, pain control with heat and NSAIDS, abx if systemic symptoms |
| Antibiotics for mastitis | Dicloxacillin, flucloxacillin, or cephalexin |
| Most common bugs of mastitis | Staph, MRSA, Strep, Candida |
| Number 1 causing bug of mastitis | Staph |
| Post menopausal breast inflammation | Cancer until proven otherwise |
| Breast abscess signs and symptoms | Unilateral, hot, tender, erythematous, may have nipple discharge, induration and fluctuance from pus |
| Breast abscess diagnostic studies | Clinical diagnosis, but could do ultrasound |
| Complication of acute mastitis | Breast abscess |
| Breast abscess rx | Continue breast feeding, I and D or aspirate, antibiotics |
| Antibiotics for breast abscess | Dicloxacillin or cephalexin, if MRSA or penicillin allergy clindamycin or Bactrim |
| Most common bugs of breast abscesses | Staph, MRSA, Strep, Candida |
| Congestive mastitis signs and symptoms | Bilateral breast enlargement and pain |
| Congestive mastitis diagnostic studies | Clinical diagnosis |
| Congestive mastitis comes from | Milk supply coming in |
| Fibrocystic breast changes signs and symptoms | Noncancerous fluid filled cysts, change in size with hormones, bilateral, mobile, ill-defined |
| Fibrocystic breast studies | US, Mamogram, Aspirate |
| Number one diagnostic studies of fibrocystic breasts | US |
| fibrocystic breast changes rx | Observation, reassurance, OCPs, caffeine reduction, fine needle aspiration |
| Most common breast mass in reproduction | Fibrocystic breast changes |
| Causes of fibrocystic breast changes | exaggerated changes from hormones |
| Fibrocystic breast changes may look like | breast carcinoma or fibroadenoma |
| Intraductal papilloma signs and symptoms | Typically bloody nipple discharge |
| Intraductal papilloma diagnostic studies | Mammogram, US, MRI, or core biopsy |
| Intraductal papilloma rx | May need excision based on size, symptoms, and cancer risk |
| Intraductal papilloma | Tumors involving the lining of the breast duct |
| Fibroadenoma signs and symptoms | Benign solid tumor, round, mobile, nontender, does not change size w cycle |
| Fibroadenoma diagnostic studies | Clinical diagnosis, US, aspirate |
| Definitive diagnostic for fibroadenoma | Aspiration |
| Fibroadenoma rx | Observe, reassurance, and follow up, could do excision if large, cryo if <4cm |
| Second most common benign breast mass | Fibroadenoma |
| Gynecomastia signs and symptoms | Palpable rubbery mass of tissue, bilateral, and tender |
| Gynecomastia diagnostic studies | Clinical diagnosis, but can test testosterone and mammogram if concern for cancer |
| Risk factors for gynecomastia | Hormones and idiopathic |
| Periods of life where men may have gynecomastia | Infants, adolescent, older |
| Gynecomastia rx | Supportive- stop offending agents, tamoxifen, testosterone replacement, surgical |
| Tamoxifen | estrogen antagonist of breast |
| Gynecomastia | Enlargement of glandular breast tissue and adipose tissue in males from increased estrogen or decreased androgens |
| Infiltrative ductal carcinoma | Cords and nests of cells w differing amounts of glands |
| Most common type of breast cancer | Infiltrative ductal carcinoma |
| Common mets with infiltrative ductal carcinoma | lymph |
| Infiltrative lobular carcinoma | Small cells infiltrate the mammary stroma and adipose tissue |
| Ductal carcinoma in-situ | Confined to breast ducts and lobes |
| Inflammatory carcinoma | Rapidly progressing, tender, firm, enlarged, skin findings |
| Skin findings of inflammatory carcinoma | erythema, itching, warm, peau d'orange |
| Types of inflammatory carcinoma | Medullary, mucinoid, tubular, papillary, metastatic |
| Paget disease of the breast | Ductal carcinoma, eczematous nipple, may have a lump, may have discharge |
| Paget disease spreads through | lymph |
| Lobular carcinoma | Premalignant, increased risk of invasive breast cancer |
| Cervical insufficiency signs and symptoms | asymptomatic, painless cervical dilation and effacement in the second trimester, may have contractions, may have bleeding or discharge |
| Clinical insufficiency diagnostic studies | Clinical diagnosis, wide internal os, possible budging membranes, TVUS |
| Risk factors for cervical insufficiency | Previous cervical trauma- LEEP, D+C, DES exposure |
| Cervical insufficiency rx | Cervical cerclage and bed rest, may add weekly Alpha-hydroxyprogesterone |
| Cervical insufficiency | inability to maintain pregnancy secondary to premature cervical dilation |
| Cervical cancer signs and symptoms | AUB, post coital bleeding, pelvic and back pain |
| Most common symptom of cervical cancer | Post coital bleeding |
| Cervical cancer diagnostic studies | PAP, Colpo w biopsy |
| Cervical cancer RF | HPV- 16 or 18, early sexual exposure, multiple partners, smoking, immunosuppress |
| Stage 0 cervical cancer rx | excision |
| Stage 1A, 1B, and 2A cervical cancer rx | excision and radiation |
| Locally advanced cervical cancer rx | Radiation and chemo |
| Advanced/metastatic cervical cancer rx | Systemic chemo |
| 3rd most common gynecologic cancer | Cervical cancer |
| Most common age of diagnosis of cervical cancer | 40-50s |
| Cervicitis signs and symptoms | Vaginal discharge and friable cervix |
| Cervicitis is typically caused by | STD- Gonorrhea and Chlamydia |
| Cervicitis may progress to | PID |
| Vaginitis is typically caused by | pH imbalance- BV, candidia, trich |
| Gonorrhea and Chlamydia signs and symptoms | Mucopurulent discharge and friable cervix |
| Gonorrhea and Chlamydia testing | NAAT |
| Gonorrhea rx | Ceftriaxone 500mg IM |
| Chlamydia rx | Doxycycline 100mg bid 7d |
| BV signs and symptoms | gray fishy smelling discharge, from a pH disturbance |
| BV test via | wet mount or MVP |
| BV rx | Fluconazole |
| Trich signs and symptoms | Yellow/green, malodors discharge, strawberry cervix (petecia) |
| How to test for Trich | NAAT |
| Trich rx | Metronidazole |
| HSV | Ulceration/sloughing of cervix |
Created by:
kendallmk