Ob/Gyn
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| cells of the cervix | show 🗑
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| show | vulva and vagina = inguinal nodes
internal genitalia = pelvic and abdominal nodes
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| show | FSH, LH, TSH, Prolactin, GH, ACTH
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| show | estrogen levels rise
progesterone stimulates endometrial prostaglandins + shedding
FSH and LH decrease
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| show | Ovary produces estrogen
Egg developes in FOLLICULAR PHASE -- stimulated by FSH
Uterine lining thickens in PROLIFERATIVE PHASE
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| Menstrual Cycle Ovulation Day 13 or 14 | show 🗑
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| show | Mid cycle pain may occur with ovulation
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| Menstrual cycle Secretory (premenstrual)phase Day 15-20 | show 🗑
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| show | Increased GnRH --> Increased FSH
corpus luteum degenerates and progesterone decreases (in no implantation)
estrogen production drops and begins to rise as a new follicle develops
Menstruation starts at approximately day 28 which begins day 1 of the new
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| Menarche age | show 🗑
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| show | no menstrual flow
excessive flow
bleeding from the uterus other than during the menstrual cycle
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| Gyn hx ? | show 🗑
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| show | type of contraception, duration, frequency
current and previous sex hx, partners, genders, types (be specific with teens), dyspareunia?, bleeding? satisfaction.
Pap + results, STI's, tx, sequelae?
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| show | G: gravida (pregnancy)
P: para (births)
a: # of times pregnant
b: # of full term babies
c: # of preterm babies
d: # of abortions (spontaneous or induced)
e: # of living children
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| show | Lithotomy position
WHEN GLOVE TOUCHES SKIN, IT IS CONTAMINATED!
note ext. genitalia, examine bartholin glands (posterolateral portion of labia majora), examine Skene glands (anterior area, near urethral opening), muscle tone, internal genitalia
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| What are the two common infections responsible for bartholin gland abscess? Who would you check muscle tone in? | show 🗑
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| cystocele vs. rectocele vs. uterine prolapse | show 🗑
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| Graves speculum vs. Pedersons Speculum | show 🗑
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| show | pelvic mass
uterine adhesions
pregnancy
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| show | small, white, yellow, raised, round, on cervix
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| show | a) 1st to use, only one to use with pregnant patient. For external area of cervix
b) for endocervix DO NOT USE ON PREGNANT PATIENTS
c) can do both, not for use on pregnant patients
Next: bimanual exam, uterus/adnexa/ovaries/rectovaginal exam
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| show | Pap: onset of sex or 21 (new criteria..used to be 18)
Mammogram: q2yrs age 40, then yearly after 50. Earlier if risk factors:
Osteoporosis: age 65 (or 60 if risk factors)
Colonoscopy or sigmoidoscopy: q3-5 yrs after 50 (earlier if indicated)
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| Current immunization recommendations + lipid panel rubella mmr influenza td pneumoccal HPV HepB lipid panel | show 🗑
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| show | mostly epithelial, peak incidence 70 y/o, av age 63 y/o, s/s: early: asymptomatic late: abd bloating. dx: ct c contrast. Tx: surgery c optimal debulking (leave <1cm), chemo, radiation. No good screening tests: if tvus abn tx ocp, tl, oophrectomy
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| Endometrial Cancer: histiology, avg age, types, s/s, risk factors. | show 🗑
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| show | Dx: *BIOPSY IS THE ONLY DEFINITIVE DIAGNOSIS* biopsy: either - pressure through cervix or D&C
Tx: *surgery*, then radiation (to decrease reocccurance), then systemic therapy if indicated
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| show | Most common female malignancy worldwide. usu squamous cell (rarest=adenocarcinoma), age: 20-30 and again 50-60. risk: young age at coitarche, HPV, smoking, # partners, immunocompromised. screening: Pap could decrease risk by 74%.
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| cervical cancer continued. Dx and Tx | show 🗑
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| show | Rare, risk: low SES, HTN, DM. histeology: squamous mostly followed by melanoma and BCC, s/s: bump, itching, lesion usu unifocal, >6 months. Dx: *BIOPSY*. Tx: surgery (individualize) radiation, chemotherapy. (Melanoma has poor prognosis)
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| show | very rare, but often metastatic. histology: SCC, melanoma, adenocarcinoma. Risk: low SES, HPV, immunocompromised, prior abn pap. s/s: bleeding, dysuria, discharge, pain, dyspareunia **MOST COMMON SITE: POSTERIOR WALL, UPPER 1/3**. Dx: BIOPSY
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| show | clinically staged (melanoma staged using Breslow's scale), tx: Radiation--syed implant, interstitial implant sutured to vulva, surgery, chemotherapy
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| Diagnose pregnancy and it's location (3) | show 🗑
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| Three signs of pregnancy categories: | show 🗑
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| Presumptive Signs of Pregnancy (4) | show 🗑
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| show | 1. globular uterus 2. Piskacek's sign (one cornua (horn) of uterus may enlarge due to implantation of the ovum).
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| show | 1. 12 week doppler for FHR (18 weeks w/fetoscope) 2. Quickening: fetal movement (15-17 weeks multiparous pt, 18-20 weeks primagravida). 3. visualize fetus via US or xray
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| show | Oxytocin: from post pituitary - causes uterine contractions and milk letdown. Prolactin: from anterior pituitary - stimulates milk production
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| show | human chorionic gonadotropin. Produced by placenta to maintain pregnancy. Beta subunits of Hcg is measured in serum pregnancy tests. Begins to rise 8 days after ovulation. Peaks at 60-90 days. hcg maintains corpus luteum and progesterone production.
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| show | + = >25mIU/L 100mIU/l is reached at date of expected menses Urine pregnancy detects >25 (*HOME PREGNANCY TESTS HAVE HIGH FALSE NEGATIVE RATE). Norm preg: hcg levels double q2.2 days. Max = 100,000 at 9 weeks, then drops to 10,000-20,000 for duration
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| serum pregnancy test vs. urine pregnancy test | show 🗑
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| Elevated hcg could mean... (3) | show 🗑
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| show | ectopic pregnancy, or impending spontaneous abortion
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| show | blood volume increase by 45%, protects against blood loss during delivery. Hemoglobin and hematocrit drop + slighly smaller increase in RBCs = PHYSIOLOGIC ANEMIA OF PREGNANCY.
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| show | CO: increase, BP: decrease in mid pregnancy, then rises, P: increases 10-15bpm Systolic murmur present in 90% (probably b/c of h20 increase). Gravida uterus compresses IVC -> supine fall in BP (nausea, dizziness, syncope), hemorrhoids and thrombosis
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| Respiratory changes to pregnancy: O2 consumption, tidal volume, TLC, hyperventailation | show 🗑
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| Endocrine changes in pregnancy: insulin Weight changes: + recommended amounts | show 🗑
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| show | separation of the rectus muscle at the midline of the abdomen. Occurs in later trimesters.
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| show | secretions: more profuse, thick, and white. pH: more acidic b/c lactobacillus acidophillus acts on glycogen in vaginal epithelium. This may help prevent vaginal infections. Uterus: Hegar's, increase fibrous and elastic tissue adds to strength (5 ltr
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| show | 12th week it moves out of the pelvis. Stretching of supportive ligaments causes pain
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| show | painless start 1st trimester, sporadic and unpredictable, increase frequency at end of pregnancy, aka FALSE LABOR
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| show | bloody show: At onset of labor, thick mucous plug in cervix is expelled (not the same as water breaking). "Beading" "ferning" mucous presentation on slide.
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| show | expected date of confinement. measure with modified negal's rule or pregnancy wheel
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| modified negal's rule | show 🗑
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| show | after 24 weeks, htn not previous seen is pregnancy induced htn, if it's seen before 24 weeks, it's chronic hypertension
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| show | 5 lbs. extreme vomiting/nausea = hyperemesis gravida
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| show | start at 20 weeks, should be +,- 2 of gestation weeks (ex 22 weeks, should be 20-24 cm)
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| FHR: early and near term | show 🗑
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| show | True
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| show | common in pretibial area, hands, and face, knee reflexes >2+ after 24 weeks
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| show | 28 weeks
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| show | which part is in FUNDUS?
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| Leopold 2 | show 🗑
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| Leopold 3 | show 🗑
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| Leopold 4 | show 🗑
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| show | ...one that is MEDICALLY APPROPRIATE and used CONSISTANTLY and CORRECTLY by pt. happy with method
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| show | post coital urination, post coital douching, different sex positions
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| show | Perfect: no errors, Typical: #s based on the avg person who doesn't always use it correctly or consistently.
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| show | True
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| show | breast, cervical, endometrial CAs
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| How long is EC effective if patient is not already pregnant? | show 🗑
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| Can EC be substituted with monophasic BCP? | show 🗑
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| show | Day before ovulation LH surge, get 1-2 degree increase in temp (take temp firtst thing in morning while still in bed)
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| 3 methods used in periodic abstinence | show 🗑
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| show | Longest cycle -18 days, shortest cycle -11 - calendar method
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| Diaphragm, fitting, how long before intercourse, how long after, max time in | show 🗑
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| OCP - Combination CA protection | show 🗑
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| 3 ways hormonal contraception works | show 🗑
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| show | A: abdominal pain (sever) C: chest pain- SOB, tachy H: headeache (severe) E: eye problems, blurred vision S: severe leg cramps (may be clots)
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| Risk factors for pulmonary embolism/DVT | show 🗑
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| show | "minipill" x 28 days, ok HTN, smokers, breast feeders. Strict dosing or may fail if late or missed, side effects: irregular menses, spotting
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| show | dose q 11-13wks, s/e spotting, amenorrhea, weight gain, depression excerbated. Post depo amenorrhea (up to 12-18 months). Consider for pts w/ dysmenorrhea, endometriosis, hx of poor complaince
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| show | mandated 2 informed consents, 30 days apart, laproscopic same day surgery, high percentage of patients regret this choice
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| IUD | show 🗑
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| nonoxynol-9 spermicide | show 🗑
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| Physiology of vaginal fluids | show 🗑
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| show | Lactobacillus acidophilus
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| other microbes found in vagina | show 🗑
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| show | Douching, sexual intercourse w/semen (raises pH up to 7.2 for 6-8 hrs), and foreign body (tampon, object)
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| Vaginitis | show 🗑
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| 3 most common vaginal infections | show 🗑
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| show | 10%KOH w/discharge -> amine odor (fishy smell). Seen in BV or Trich
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| show | take sample from posterior fornix + 2 ml saline. BV: look for clue cells, Trich: look for trichomonads, Candida: look for pseudophyphae
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| BV + bacteria involved (3) | show 🗑
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| s/s BV | show 🗑
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| show | homogenous white-gray adherent discharge, pH >4.5, +whiff, clue cells
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| show | Metronidazole or Clindamycin
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| show | 2nd most common cause vaginitis, C. albicans (or c. glabrata). yeast overgrowth, common - many conditions increase risk
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| show | vaginal itching/burning + or - dysuria. Odorless white cheesy discharge sticks to walls, erythema, swelling, Satellite Lesions
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| show | budding yeast, pseudohyphae, - whiff, pH<4.7
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| show | butoconazole, nystatin, fluconazole
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| Trichomoniasis | show 🗑
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| s/s: Trich | show 🗑
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| show | strawberry cervix (petechiae), motile protozoa on wet prep, pH elevated (5-6.5)
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| tx Trich + pregnancy problems | show 🗑
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| show | inflammation from low estrogen, most commonly seen in post-menopausal, s/s *watery discharge*, dysuria, vulvar itching, burning, bleeding, spotting, dyspareunia, pale epithelium, pH>5.5, Pap: immature basal cells Tx: topical estrogen
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| Most common bacterial STI in U.S. | show 🗑
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| s/s chlamydia | show 🗑
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| dx chlamydia | show 🗑
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| Tx chlamydia | show 🗑
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| show | *Erythromycin or Amoxicillin, can cause preterm labor, chorioaminionitis, postpardum endometritis if untreated
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| show | Neisseria gonorrhoeae, gram - diplococcus, affects columnar epithelium (like chlamydia), also can be in pharynx
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| show | frequently asymptomatic, 3-5 days post exposure, same visual finidngs as chlamydia, differnt color discharge, pharyngitis c/ edema and erythema may be present
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| show | gram stain, cuture on Thayer-Martin or Trhansgrow media, DNA hybridization, also NAAT. Screening is necessary in high risk women to control infection (since if often presents as asymptomatic)
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| show | lower genital tract: cefixime or ceftriaxone. also treat for chlamydia, untreated can -> PID, TOA (tuboovarian abscess), ectopic pregnancy,and infertility
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| gonorrhea and pregnancy | show 🗑
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| Syphillis | show 🗑
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| show | darkfield microscope, VDRL and RPR...only looks for autoantibodies NOT SPECIFIC for syphillis. can also get + from TB, MALARIA, PNEUMONOCOCCAL PNEUMONIA, MULTIPLE MYELOMA, etc in VDRL. If VDRL + need FTA-ABS or MHA-TP trep tests. Report to NYS 48 hrs
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| tx syphilis | show 🗑
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| show | HSV. DNA virus, contagious, regular condom use decreases transmission, pregnancy: infant -> microcephaly, MR, seizures, and microphthalmos
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| s/s HSV | show 🗑
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| dx HSV | show 🗑
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| show | supportative, sitz bath + drying, antivirals (-clovir), can use in smaller doses for suppressive therapy once daily, educate on use of condoms, and counseling
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| show | Condyloma Acuminata (veneral warts), types 6 and 11. risk factors: smoking, ocp, multiple partners, early coitarche age.
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| show | painless bumps, pruritis, discharge, cauliflower or plaquelike the same color as skin or red or hyperpigmented
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| dx HPV (warts) | show 🗑
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| tx HPV (warts) | show 🗑
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| show | Chlamydia trachomatis, Neisseria gonorrhoeae, and genital mycoplasms. Definition of PID: ascending spread of microorganisms from vagina and endocervix to endometrium. Problem: chlamydial cervicitis highest rates teens and young adults-usu.asymptomatic
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| show | low abdominal pain, abn discharge, fever, chills, also possible bleeding, dysuria, N/V. PE: NEED 3 tenderness (ABDOMINAL, ADNEXAL, CERVICAL MOTION) and mucopurulent cervicitis ("chandelier sign" want to jump off table and hit chandelier) or another sign
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| show | yes, if you need to differentiate it from other conditions (such as appendicitis)
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| show | 1. severe infections or can't take oral abx (vomiting), 2. possible surgical emergencies, 3. pregnant, 4. already failed oral outpatient tx, TOA, adolescent, WBC off, (>20,000 or <4000), IUD users, complaince problems, immunocompromised
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| show | A: Cefoxitin, Cefotetan, Doxycycline. B: Clindamycin, Gentamicin, doxycycline
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| show | A: Ofloxicin, Levofloxacin, c or s Metronidazole B: ceftriaxone, cefoxitin, probenecid, doxycycline c or s metronidazole
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| show | Rapid dx and tx STI once, routine screening, use sensitive and specific diagnostic tests (ex PCR), idenfify and tx partners to prevent reinfection
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| show | involves tubes, ovaries, other pelvic organs, can be serious/lethal complication of PID. Rupture TOA can cause PERITONITIS which if not quicky dx and tx can be lethal. s/s TOA: tender, inflammatory adnexal mass. dx: US, CT, MRI, drain w/US
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| dx cont'd + Tx TOA | show 🗑
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| show | IV: Clindamycin or Metronidazole + an aminoglycoside or Aztreonam, after clinical improvement: po doxycycline, amoxicillin/clauvanic acid, or metronidazole for at least 1 wk after IV abx.
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| Tx TOA contd surgically | show 🗑
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| show | Infertility, Ectopic Pregnancy (14x more likely for tubal factor infertility, adhesions) 6x more likely ectopic, Endometriosis 10x more likely, Chronic pelvic pain
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| show | lenti RNA virus, related to SIV in chimps, has gp 120 and 41 (stem), and protein p24 (core antigen). gp120 attracts Cd4 on Thelper cell
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| dx HIV via HIV antibody testing (most comonly used to diagnose infection in ADULTS) | show 🗑
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| Dx HIV infants (<18 months | show 🗑
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| Evaluate disease progression by watching these two things | show 🗑
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| show | Phenotype (ability fo HIV virus to grow w/meds (petri dish)), Genotype testing (tells which meds patient's strain of HIV should be sentitve to by evaluating patient's mutations).
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| show | are in childbearing age 30-49, comonly minority women, mostly through heterosexual contact, other STI's increased rate of transmission, as did anal intercourse
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| Clinical Manifestations of AIDS (3) | show 🗑
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| Name an AIDS indicator disease | show 🗑
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| Are other genital cancers more frequent in HIV patients? | show 🗑
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| show | AZT reduced transmission of HIV from mom to infant by 66%. given to women, and at delivery, and to infant x 6 weeks. First dose to infant, must be before 12 hrs of age wtih dosing q8hrs for 6 weeks, PCR birth, 2-4 wks, 4-6 mo, 18mo to see if seroconvert
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| show | Mom cd4 count, mom viral load, prolonged ruptured membranes, vaginal delivery, breastfeeding
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| Prenatal care, initial visit labs (8) | show 🗑
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| Calculate gestational age (4) | show 🗑
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| show | ~36 weeks, diagnona conjugate, promonence of spines, transverse outlet diameter
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| show | Gynecoid (IDEAL), Platypoid, Anthropoid, Android. Max widest cirumference is 12cm
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| How often should fetus move? what to do 1st if they don't? later? | show 🗑
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| When do you do Leopolds? | show 🗑
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| show | 16-20: sonogram, triple screen, amnio (over 35) 24-28: GCT (>135 is abn), 3hr GTT PRN, give Rhogam if Rh-, 36-38: Group Bstrep CBC, VDRL, HSV, Gc/Chl (hi risk pop), 40+: NST 2xwk, Biophysical profile (AFI, fetal breathing, mvmt, tone (ifluid low=no tone)
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| show | Group B. Strept
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| show | q4wks until 28, then q2wks until 36, then weekly until birth. These are ACoG standarrds, do more often if high risk or if doing certain screenings
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| show | Irregular intevals vs Reg, intensity unchanged vs. shortens, no cervical dilation vs. dilates, lower abd discomfort vs. back and entire abd discomfort, relieved by sedation vs. no relief with sedation
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| show | Dilation (cm), Effacement (%, 100=paper thin), Station (-5,0 -ischial spines, +5)
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| Reference baby's occiput | show 🗑
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| Stages of Labor + Friedman's Curve | show 🗑
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| show | Nulli: 20 hrs latent, 12 hrs active, dilation 1.2cm/hr, second stage 2.4 hrs. Multiparous: 14 hrs latent, 2 hrs active, dilation 1.5 cm/hr, second stage 0.5 hrs
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| *Indications for Episiotomy (3) | show 🗑
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| FHR norm | show 🗑
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| FHR Tracing systematic review | show 🗑
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| show | want reactive acclerations (2 or more increase in 15 bpm for at least 15 seconds). EACH LITTLE BOX = 20 sec, EACH BIG = 1 min. Decelerations (3 types)
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| show | 1) early: uniform, norm, nadir (Lowest Point of Deceleration) within 18 seconds of contraction peak, Late: uniform, nadir lag time >18 sec from contraction peak CAUSE OF LATE: UTERINE/PLACENTAL INSUFFICIENCY. Variable: U, C, W shape CAUSE CORD COMPRES
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| show | 1) Mom on L side with 100% O2 through NREbreather.
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| Definition: High risk pregnancy | show 🗑
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| show | 20 weeks
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| show | Premature birth
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| show | Difficult birth, need for C/s, Preeclampsia, increased fluids (poly hydraminos), infection, placenta hormones are anti insulin -> increased risk of diabetic ketoacidosis
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| Maternal Diabetes causes what 4 things in the fetus? | show 🗑
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| show | hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia
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| show | If pt is insulin depended, only glyburide doesn't cross placenta, must be taken off all others and put on insulin
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| show | 75% caused by preeclampsia. s/s bp>140/90, proteinuria, edema, hyperreflexia. Only PIH if seen after 20 wks. Eclampsia= seizure plus preeclampsia
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| show | Rest in lateral position, Evaluate organs (liver, kidney, blood, fetus), allow to get to term or spontaneous labor/inducibility
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| show | hydrate, control BP, magnesium sulfate, deliver. BP >160-180/105-110, hepatonecrosis or thrombocytopenia, renal failure/oligouria, pulmonary edema, fetal concerns (intrauterine growth retardation IUGR), severe proteinuria
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| show | Hemolysis, elevated liver function tests, low platelets
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| what chronic htn drugs to avoid: | show 🗑
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| show | Rh issues, fetus: anemia->hydrops->death. tx. RhoGAM. Amniocentesis: Delta OD450 (to measure bilirubin level, byproductof erythrolysis). can tx. with intrauterine fetal transfusion if needed
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| show | dx: elevated TSH tx: T4 supplement safe b/c it does not cross placenta
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| show | dx: free Tv, tx: surgery, PTU (propothyroid uracil)--only ive a little b/c it does cross--fetal goiter, fetal hypothyroidism. CANNOT DO RADIOACTIVE THYROID TEST
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| Heart Disease | show 🗑
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| Respiratory Disease | show 🗑
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| show | asymptomatic UTI, tx b/c 25% could get pyelonephritis. Dx: GOLD STANDARD: Urine culture C&S. If they have a UTI, ALWAYS do a Test of Cure to make sure you got it.
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| show | Hep B, Preeclampsia, Cholestasis ***Pruritis*** increase alk phos only, acute fatty liver (rare)
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| Most common blood problem in pregnancy: | show 🗑
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| Third trimester bleeding | show 🗑
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| Cardinal Rule: 30 week bleeding | show 🗑
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| show | 3 or more spontaneous abortions
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| show | recurrent miscarriage, sever preeclampsia, fetal growth restriction
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| For every extra fetus, how long should you subtract off teh due date? | show 🗑
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| Fetal Growth Restriction can be one of to categories: | show 🗑
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| Incompetent cervix | show 🗑
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| Amnionitis: | show 🗑
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| show | Preterm rupture of membranes
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| Fetal Assessment (7 things) | show 🗑
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| FHR Monitoring | show 🗑
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| Benign Disorders of Vulva (3) | show 🗑
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| show | **Most common cystic lesion of the vulva** Bleow epidermis, occulusion of sebaceous gland. Mobile, non-tender, no tx. unless infection, then I&D usually sufficient, can excise but commonly reoccur
🗑
|
||||
| show | chronic cystic dialationa and occulsion of main Bartholin duct, may be caused by chronic inflammatory reactions or trauma from alcerations. Tx. if symptomatic, MARSUPIALIZATION w/word catheter therapy. local anesthetics, office procedure, excise
🗑
|
||||
| Lichen Scherlosis | show 🗑
|
||||
| show | Inclusion Cyst of Vagina
🗑
|
||||
| Inclusion cyst of vagina | show 🗑
|
||||
| show | Leiomyomas
🗑
|
||||
| Most common reason for gynecological surgeries: | show 🗑
|
||||
| show | Subserosal (feel distortion of comfort, re: how small), Intramural , Subcmucousal (under endometrium, responbile for any intrauterine bleeding). Lastly, pedunculated stalk, torsion and ischemic necrosis may occur.
🗑
|
||||
| s/s leiomyomas: | show 🗑
|
||||
| dx leiomyomas: | show 🗑
|
||||
| Menorrhagia assocated w/leiomyoscarcoma: manage this pt | show 🗑
|
||||
| show | Fibroids
🗑
|
||||
| show | corpus luteum cysts, theca lutien cysts, follicule cyst, dermoid cyst, PCOS, adnexal mass
🗑
|
||||
| show | thin, walled, usu goes away 1-2 months. "tx: ocp 2-3 months to try to decrease symptoms
🗑
|
||||
| show | during pregnancy, gonadotropin stimulation (Hydatidiform mole or chroicocarcinoma, usu bilateral. Regress when gonadotropin levels fall. Tx: obesrvation, surery if complications (torsion, hemorrhage)
🗑
|
||||
| Most common cysts of the ovary? | show 🗑
|
||||
| show | follicle failts to rupture with ovulation, ssx: non eot patient with rupture, menstrual changes. Dx: bimanual exam, US Tx: observe, OC to suppress gonadotropic, cystectomy if needed.
🗑
|
||||
| Most common ovarian neoplasm? | show 🗑
|
||||
| show | us unilateral, dx: US, tx: ystectomy with preservation of ovarian tissue. Cx: chemical peritonitis if it's ruptured.
🗑
|
||||
| show | common cause of ovarian androgen excess and hirsuitism. s/s: hirsutisims, menstural irregularieites, and infertility....also acne, obesity, virillism (male-like fetures), dysfunctiona bleeding. AKA STEIN LEVENTHAL SYNDROME. No midcyclic LH surge.
🗑
|
||||
| show | estrogens produce androgens, which are converted to estrogens, normal follicule development is disrupted. dx: hx, US, biopsy (if irregular bleeding). eval glucose, htn, cad, (increase risks). Anovulation induced if pt. wants pregnancy.
🗑
|
||||
| show | Nabothians Cysts, Cervical polyps
🗑
|
||||
| show | mucous retention cysts, squamous cell epitehlium covers mucousa secreting columnar epithelium.
🗑
|
||||
| Cervical polyps: | show 🗑
|
||||
| Endometriosis: | show 🗑
|
||||
| show | Retrgrade menstruation theory (it floats out of tubes), Mullerian Metaplasia GTheory (transformation of peritoneal mesothelium inot endometrium due to some stimulus). Lymphatic spread theory: taken up by lymphatics
🗑
|
||||
| respond to estrogen? | show 🗑
|
||||
| show | Dysmenorrhea, Dyspareunia, Dyschezia. NO CLEAR CORRELATION BTWN EXTENT OF DISEASE AND SEVERITY OF PAIN.
🗑
|
||||
| what is an uncommon symptom of endometriosis? | show 🗑
|
||||
| show | nodules may be found, lg. tender, noncystic mass, tender fixed adnexal mass may be noted on the bimanual exam. Uterus may be fixed and retroverted, PE may be normal. D/x: H&P, Laproscopy is the definitive diagnosis.
🗑
|
||||
| show | surgical: take it out. If you want kids, laparoscopic or abdominal surgery to only destoy implants and remove adhesions. Preoperatie Therapy with GnRH agonists 3-6 months prior to surgery increases success of surgery. Medical: Danazol (inhibits GnRH)
🗑
|
||||
| show | OCP and progesterone are used to tx pelvic pain from endometriosis by drecreasing size of implants. Medroxyprogesterone acetate oral or IM given for us to 6 months. GnRH agonists suppress ovarian estrogen production,
🗑
|
||||
| Adenomyosis: | show 🗑
|
||||
| show | Dysmehnorrhea, Menorrhagia.
🗑
|
||||
| tx: Adenomyosis: | show 🗑
|
||||
| show | Specificity: HIGH Sensitivity: LOW (get some false +)
🗑
|
||||
| show | types 16 and 18, by Pap smears
🗑
|
||||
| show | where the majority of the cancers are found b/c there is a lot of regeneration here. In a yonger person columnar epithelium -> squamous epithelium is larger. As we start to age TZ migrates inward, so by age late 30s-> menopause have less visible TZ.
🗑
|
||||
| show | Timing: mid cycle, 3 months since last one, nothing in vagina 48-72 hrs before, spray fixture ASAP
🗑
|
||||
| Frequency of Screening | show 🗑
|
||||
| Reporting system | show 🗑
|
||||
| show | infection, reactive (fought off old infection, but not yet completely healed.
🗑
|
||||
| cell abnormalities | show 🗑
|
||||
| Other diagnostic procedures after Pap | show 🗑
|
||||
| tx:abn pap | show 🗑
|
||||
| Definition Chronic Penvic Pain | show 🗑
|
||||
| show | diffuse aching. Triggered by stretch, inflammation, ischemia.
🗑
|
||||
| show | abdomen, pelvic, back PE, labs? cbc, esr, cutlture of vaginal d/c, hcg to r/o ectopic pregnancy, urine to r/o infection. US, TVUS. **LAPROSCOPY IS THE ULTIMATE METHOD TO DX ETIOLOGY OF CPP** **CPP IS MOST COMMON INDICATION FOR LAPROSCOPY
🗑
|
||||
| show | Size of lesion does NOT correlate with pain
🗑
|
||||
| Chronic PID | show 🗑
|
||||
| Ovarian cysts, | show 🗑
|
||||
| Uterine pain | show 🗑
|
||||
| show | Do NOT cause pain unless degenerating, undergoing torsion or pressing in nerves
🗑
|
||||
| Pelvic Congestion Syndrom | show 🗑
|
||||
| GU s/s cystitis | show 🗑
|
||||
| show | nerve, musculoskeletal, PSYCHOLOGICAL
🗑
|
||||
| show | try OCP, tr y GnRH-agonists for pain related to cycle or ovarian pathology (cysts), NSAID, Antidepressants (increase NE, serotonin). Only surgical if pathology discovered
🗑
|
||||
| show | menstrual flow at intervals >35 days
🗑
|
||||
| show | newborn withdrawl bleeding, trauma, assault, 50% involve lesions of the GU tract. Pelvic exam should be performed
🗑
|
||||
| show | ANOVULATION is not the most likely cuase of abn bleeding in this age group
🗑
|
||||
| what is the most likley cuase of abn bleeding in childbearing yrs? | show 🗑
|
||||
| show | r/o pregnancy 1st, then look at coagulopathy, pelvic lesions, malignancy, thryoid, dysfunctional uterine bleeding. Older pts be sure to r/o cancers, esp endometrial. Post menopausal bleeding is CA until proven otherwise!
🗑
|
||||
| Severe bleeding | show 🗑
|
||||
| show | OCP may be used, D&C, ablation, or hysterectomy may be needed if bleedign does not stop
🗑
|
||||
| show | abn uterine bleeding in women between menarache and menopause. Not attributed to ther cause. Dx. of exclusion
🗑
|
||||
| most common cause of DUB in adolescents? | show 🗑
|
||||
| show | Decline in estrogen
🗑
|
||||
| show | cyclic progestins if bodie's estrogens can balance, OCP, shorter cycle, then bleed, repeat 3-6 months to try to establish normal cycle
🗑
|
||||
| If medical therapies fail | show 🗑
|
||||
| show | no spontaneous uterine bleeding by age of 16 w/normal secondary sex characteristic, or 14 if pts shows signs of abn sexual characteristics
🗑
|
||||
| show | absence of menstrual period for 6 months in a woman who had periods previously
🗑
|
||||
| show | excess testosterone by adrenal tumors
🗑
|
||||
| show | 45XO, primary amenorrhea, abn gential development, webbed neck, increase carrying angle, no breast development, streak ovaries, infertility, amenorrhea
🗑
|
||||
| show | has internal organs of one sex with external physical characteristics of the opposite sex
🗑
|
||||
| show | enzyme deficit in testesterone synthesis. Presents as sexually premature phenotypic girl with male genotype 45 XY, ext genitalia is female, no uterus, intraabdominal tests, tx as infertile hypogonadal woman
🗑
|
||||
| show | genetic and gonadal female XX with partial masculinization. Ambigous genitalia, normal internal genitalia.
🗑
|
||||
| show | Pregnancy
🗑
|
||||
| show | Tx w/estrogen replacement therapy
🗑
|
||||
| show | *Pregnancy. Also, PCOS, obesity, hypothyroidism, cushing's disease (inc adrenalin), Asherman's syndrome (uterine adhesions)
🗑
|
||||
| Progestational challenge | show 🗑
|
||||
| Dysmenorrhea | show 🗑
|
||||
| show | no readily identifiable cause, age 17-22 usu. Usually during ovulatory cycles within 6-12 months of menarche. Prostaglandins relaeased, tx: NSAIDS, OCP, topical heat, low fat meat decrease diet, if no response consider secondary with work up
🗑
|
||||
| show | underlying cause, usu 30-40 y/o usu associated with dyspareunia, infertility of abn uterine bleeding. endometriosis, fibroids/adenomyosis, PID, pelvic congestion
🗑
|
||||
| workup secondary dysmenorrhea | show 🗑
|
||||
| show | luteal phase, 80% experience it, severe=Premenstrual dysphoric disorder PMDD. Tx: vitamin (ca/mg), mild diuretic (spironolactone), anti anxiety meds (Buspirone), SSRI antidepressants (prozac) in luteal phase, GnRH agonist (Lupron), NSAIDS
🗑
|
||||
| 95% ectopic pregnancies occur where? most often in which part? | show 🗑
|
||||
| show | yes
🗑
|
||||
| show | both in tube and in uterus
🗑
|
||||
| show | ectopic pregnancy
🗑
|
||||
| show | increased incidence of PID, and increase # tubal surgeries in a conservative leave slighlty damaged tubes in place. Previous ectopic pregnancy increases risk, so does G3, African america/hispanic, IUD usage
🗑
|
||||
| Problems with ectopic pregnancy | show 🗑
|
||||
| show | 1. rupture, 2. reabsorb b/c of inadequate blood supply 3. aborted into the peritoneal cavity
🗑
|
||||
| Classic triad of symptoms in ectopic pregnancy | show 🗑
|
||||
| show | dizzy, hemorrhage, sever abd pain, ipsilaterla shoulder pain if blood irritates the phrenic nerve, LOC, shock, rebound tenderness/guarding, cervical motion tenderness
🗑
|
||||
| D/x ectopic pregnancy | show 🗑
|
||||
| which antibody does serum pregnancy test looks for of hcg? | show 🗑
|
||||
| show | hemaglobin/hematocrit, urine or serum test for hcg, TVUS
🗑
|
||||
| show | >25, <15, <5
🗑
|
||||
| show | pouch of douglass through posterior vaginal wall
🗑
|
||||
| ddx ectopic pregnancy (7) | show 🗑
|
||||
| show | stable: laparoscopy. if unstable: laparotomy to access bleeding site (also appropriate if patient has adhesions)
🗑
|
||||
| show | only if tube is severely damaged and les than 6 cm of functional tube remains
🗑
|
||||
| show | partial salpingectomy and reapproximate tube later
🗑
|
||||
| show | incision that gets closed, opening that is allowed to heal by itself. USE SERIAL HCG TO SEE IF ANY HORMONE PRODUCING CELLS REMAIN
🗑
|
||||
| show | Methotrexate: folic acid antagonists used for hemodynamically stable patients
🗑
|
||||
| show | 15%
🗑
|
||||
| show | ~age 37
🗑
|
||||
| A fertile couple trying to get pregnancy with appropriate timing what percentage of a success rate? | show 🗑
|
||||
| The most common causes of infertility (6) | show 🗑
|
||||
| Most common cause of female infertility? | show 🗑
|
||||
| Dx. infertility workup (6) | show 🗑
|
||||
| 3 ways to treat infertility: | show 🗑
|
||||
| meds for ovulation induction: | show 🗑
|
||||
| IVF embryonic transfer is done with a full bladder, T/F? | show 🗑
|
||||
| what is PGD? | show 🗑
|
||||
| Domestic Violence | show 🗑
|
||||
| Abuse | show 🗑
|
||||
| What 7 categories can abuse fit? | show 🗑
|
||||
| What three steps are in the cycle of violence theory? | show 🗑
|
||||
| show | 1 out of every two homes, 25-33% are in ER for domestic violence related injuries and/or issues
🗑
|
||||
| Domestic Violence risk is decreased in teenagers. T/F | show 🗑
|
||||
| show | True
🗑
|
||||
| Why doesn't survivor disclose or leave? | show 🗑
|
||||
| Pregnancy and DV: are they twice as likey to miscarry? are babies 4x more likely to have low birth weight? are babies 40x more likely to die in the first year? | show 🗑
|
||||
| show | while exiting, while pregnant
🗑
|
||||
| show | 1) critical BMI sets it off or 2) aging neural tissue triggers it
🗑
|
||||
| show | breast development, pubic hair
🗑
|
||||
| show | Tanner staging.
🗑
|
||||
| stage 1 | show 🗑
|
||||
| show | breat bud stage
🗑
|
||||
| stage3 | show 🗑
|
||||
| show | areola and nipple forms secondary mound
🗑
|
||||
| stage5 | show 🗑
|
||||
| show | sexual maturity rating. pubic hair development
🗑
|
||||
| how many stages for pubic hair development, when does axillary hair start? | show 🗑
|
||||
| age, first visible sign, sex interests for early adolescence | show 🗑
|
||||
| show | usu 21/2 hrs after beginning of puberty, average age is 12.4, ALWAYS AFTER PH 5 IS REACHED
🗑
|
||||
| ages, smr, sexual interest in middle adolescence | show 🗑
|
||||
| age, smr, sex interest of late adolescence | show 🗑
|
||||
| t/f menses is often irregular for the first year, anovulatory possible for 1st year, however can get pregnant before menarche? | show 🗑
|
||||
| show | developing sex characteristics before age 8. Do a thorough endocrine evaluation
🗑
|
||||
| show | increase fsh and lh
🗑
|
||||
| peripheral causes of precocious puberty | show 🗑
|
||||
| 5 indications for pediatric pelvic exam | show 🗑
|
||||
| show | True
🗑
|
||||
| show | 11-12
🗑
|
||||
| show | emergency situations, emancipated minors, pregnancy related care, provision of bc, sexual assault, hiv, abortion, reportable contagious diseases, drug or etoh abuse/treatment, mental health tx.
🗑
|
||||
| T/F chlamydia is NOT reportable in NYS | show 🗑
|
||||
| show | Any sexual act performed by one person on another without that person's consent
🗑
|
||||
| T/F date rape is more common among teens and college students | show 🗑
|
||||
| 3 basic types of rape episodes | show 🗑
|
||||
| show | Acute, and Post acute phases or post traumatic stress disorder
🗑
|
||||
| physicl and psychological concerns of acute phase? | show 🗑
|
||||
| show | infection, pregnancy, trauma/scars, nightmares, can't dissociate, wants to escape, difficulty with sex, flashbacks
🗑
|
||||
| show | during PTSD phase, it occurs when the pt comes in expressing certain concerns they'll attribute to something else when it may be related to the trauma they survived
🗑
|
||||
| you should ask long winded and brief direct questions to a survivor? T/F | show 🗑
|
||||
| Generally, how long do you have from the time of an assault for the physical and evidence exam to be legally valid? how long do you have in NYS? | show 🗑
|
||||
| should you use a traumagram? | show 🗑
|
||||
| explain the "chain of evidence" | show 🗑
|
||||
| show | to look for semen
🗑
|
||||
| name some things you'll order labs for? | show 🗑
|
||||
| what labs are followed up? | show 🗑
|
||||
| show | yes he/she has up to 5 days
🗑
|
||||
| show | within 30 days
🗑
|
||||
| show | 1 year without menses
🗑
|
||||
| show | 40 y/o
🗑
|
||||
| how long before final menstruation does perimenopause begin? | show 🗑
|
||||
| show | True, suprises many patients. Estrogen levels are fluctuating
🗑
|
||||
| show | hot flashes, interrupted sleep, urinary symptoms, atrophic vaginitis, loss of bone density
🗑
|
||||
| show | True
🗑
|
||||
| show | 30-50%
🗑
|
||||
| show | lifestyle changes, estrogen (most effective, but highest risk), progestins ("got my period back"), methyldopa (anti HTN centrally acting, safe in pregnancy), Clonidine (anti HTN, CNS acting as well), SSRIs, Gabapentine (neurontin, antiseizure) & bio agent
🗑
|
||||
| Is hot flashes a disease? | show 🗑
|
||||
| show | dry mouth, fatigue, dizziness, depression
🗑
|
||||
| show | decrease SEVERITY and INCIDENCE of hot flashes, usu need less dose than that needed for depression
🗑
|
||||
| effects of menopause on the lower urinary tract (3) | show 🗑
|
||||
| show | decrease elasticity, appears pale and dry, **increase pH-> increase bacterial vaginitis
🗑
|
||||
| show | topical estrogen
🗑
|
||||
| Is topical estrogen safe to use? | show 🗑
|
||||
| show | 40
🗑
|
||||
| T/F amenorrhea from ANY cause decreases bone density | show 🗑
|
||||
| show | weight bearing exercise (swimming is NOT effective), calcium (1500mg qd+800vitD), stop smoking, stop excessive etoh intake, counsel pt if amenorrhea is due to low body weight or strenous exercise
🗑
|
||||
| Screening requirement for osteoporosis | show 🗑
|
||||
| So, is osteoporosis an early sign of menopause? | show 🗑
|
||||
| show | goal: prevent fractures: estrogen (decreases bone absorption), calcitonin (decreases rate of bone turnover THINK Calci-BONE-IN), biphosphates (fosomax) decreases osteoclastic activity
🗑
|
||||
| unopposed estrogen (without progestin) increases risk for what cancer? so which patients could it be used on? | show 🗑
|
||||
| addition of progestins can cause what? what's the difference between cyclic and continuous progestins? | show 🗑
|
||||
| Relative Contraindications to Estrogen Therapy | show 🗑
|
||||
| ABSOLUTE CONTRAINDICATIONS to estrogen therapy | show 🗑
|
||||
| What did the women's health initiative show re: estrogen replacement therapy? | show 🗑
|
||||
| show | med hx, PE + breats exam, Pap, mammogram
🗑
|
||||
| show | tx symptoms effectively, increase risk Breast CA, increase risk for heart disease
🗑
|
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mcdemarc