Term
| What puts a woman at risk for endometrial cancer in regards to age at menarche, # of pregnancies, oral contraceptive use, and chronic dz? |
|
Definition
-early menarche (before age 12 years) is a RF
-Infertility and nulliparity are RFs (multiparity is protective)
-Long term use of estrogen without opposed progestin is a RF (COCP's are considered protective)
-Diabetes is assoc with relative risk of 4.0 (obesity + DM increases risk) |
|
|
Term
| What is a fibroadenoma-like tumor that can become quite large due to its rapid growth and may reoccur after excision. They commonly occur in women between the ages of 40 and 50 years. |
|
Definition
|
|
Term
| What is a breast tumor that is a common benign neoplasm in young women. described as round, rubbery, discrete, relatively mobile, and non-tender. |
|
Definition
|
|
Term
| what type of breast tumor is a malignant tumor of the breast. The tumor usually consists of a nontender, firm or hard mass with poorly defined margins. |
|
Definition
|
|
Term
| What is the karyotype for Turners syndrome? give some common signs and symptoms, what do the ovaries look like? |
|
Definition
-45 X (female only has one X chromosome)
-It causes short stature, webbed neck, widely separated nipples, and some mental retardation. Gonadal dysgenesis leads to amenorrhea
-STREAK ovaries |
|
|
Term
| When a patient is taking COCPs which component suppresses LH and which suppresses FSH? What are the implication of this? |
|
Definition
-the progestin component suppresses LH secretion. Since LH surge is responsible for ovulation- this suppresses ovulation
-estrogen component suppresses FSH as well as provide stability to the endometrium and potentiation of the progestin's actions |
|
|
Term
| What is the most common position of the uterus? |
|
Definition
| anteverted- forward facing |
|
|
Term
| Describe the position of a retroflexed uterus- specifically the position of the cervix |
|
Definition
| When the uterus that cannot be palpated by a bimanual exam but can be felt rectovaginally, it is tilted backwards. A retrodisplaced uterus wherein the cervix is normally positioned |
|
|
Term
| Describe a retroverted uterus- especially the position of the cervix |
|
Definition
| retrodisplaced uterus with a forward facing cervix |
|
|
Term
| What is the most common type of ovarian tumor? |
|
Definition
|
|
Term
| What are risk factors for ovarian cancer in regards to age, pregnancy, menopausal status w/ HRT, OCPs.. |
|
Definition
-risk increases with age
-non-gravida/para women are at higher risk
-post menopausal women on estrogen therapy are at higher risk
-OCP use is PROTECTIVE |
|
|
Term
| What is another name for PCOS? |
|
Definition
|
|
Term
| What is the most common form of bladder cancer in the US? |
|
Definition
| transitional cell carcinoma AKA urothelial carcinoma |
|
|
Term
| Which sex is more affected by bladder cancer? |
|
Definition
| Males are affected more than females |
|
|
Term
| up to ______% of bladder cancers are associated with environmental exposures- what is the most commonaly associated RF? |
|
Definition
|
|
Term
| what is the safest treatment for a pregnant woman with condyloma acuminata? |
|
Definition
|
|
Term
| According to the CDC what is the minimum criteria for initiation of empirical ABX in PID ? |
|
Definition
| lower abd pain, adnexal tenderness, or cervical tenderness in the absence of an est. cause other than PID |
|
|
Term
| What is the most common cause of female infertility? |
|
Definition
|
|
Term
| What is another name for a uterine leiomyoma |
|
Definition
| uterine fibroids OR myoma |
|
|
Term
| what is the most common solid pelvic tumors in women? what is the best study to evaluate them? |
|
Definition
|
|
Term
| What is this clinical presentation: present with a unilateral, sharply marginated, red scaly rash or erythematous crusting affecting the nipple and areola. There may also be an underlying breast cancer such as a mammary duct carcinoma |
|
Definition
|
|
Term
| TSS is commonly assoc with s. aureus infection- describe how this looks on culture |
|
Definition
| coagulase-positive gram-positive cocci |
|
|
Term
| In a patient with trichomonas vaginalis describe what would be seen on a gram stain and cervical smear |
|
Definition
GS: predominant slender gram + rods with rare neutrophils
CS: flagellate protozoa |
|
|
Term
| A pt presents with UTI- the most common causative organism is E. coli- what does this look like on urine culture? |
|
Definition
| lactose-fermenting beta-hemolytic gram-negative rods |
|
|
Term
| Staphylococcus saprophyticus causes upper and lower urinary tract disease and is common in young, sexually active women. What would the urine culture results for this bacteria show? |
|
Definition
| gram-positive cocci that was catalase positive, coagulase negative, and resistant to novobiocin. |
|
|
Term
| When should Pap testing be initiated for all women, regardless of sexual activity? |
|
Definition
|
|
Term
| What is a urethral caruncle? |
|
Definition
| a papillary growth that is highly vascular and results from shrinkage of the vaginal epithelium in estrogen deficient women. |
|
|
Term
| What are the 3 most likely sites for endometriosis implantation? |
|
Definition
| ovaries, cul-de-sac, and uterosacral ligaments |
|
|
Term
|
Definition
| presence of ectopic foci of the endometrial glands and stroma in the myometrium |
|
|
Term
| Describe the 4 stages of ovarian cancer |
|
Definition
1: limited to the ovaries
2: involvement of one or both ovaries with pelvic extension
3: one or both ovaries with intraperitoneal metastases outside the pelvis or positive retroperitoneal nodes or both
4: Distant metastasis |
|
|
Term
| Absence of the uterus occurs to degeneration of which ducts in embryologic development? |
|
Definition
|
|
Term
| what is the most common site of metastasis for ovarian tumors? |
|
Definition
|
|
Term
| What type of tumor of the female genital tract is most sensitive to chemotherapy? |
|
Definition
|
|
Term
| Describe the hormone status of a girl with testicular feminization syndrome. What is the karyotype? |
|
Definition
Both androgens and estrogens are produced but receptors for these steroid hormones are absent.
-This type of male pseudohermaphrodite carries an XY genotype |
|
|
Term
| What are some RFs for endometritis? |
|
Definition
| prolonged rupture of the membranes (> 24 hours), chorioamnionitis, an excessive number of digital vaginal examinations, prolonged labor (> 12 hours), toxemia, intrauterine pressure catheters (> 8 hours), fetal scalp electrode monitoring, preexisting vaginitis or cervicitis, operative vaginal deliveries, cesarean section, intrapartum and postpartum anemia, poor nutrition, obesity, low socioeconomic status, and coitus near term |
|
|
Term
| What are some common manifestations of endometritis? |
|
Definition
| fever (early maternal post-operative fever suggests infection of the womb), a soft, tender uterus, cervical motion tenderness, and foul lochia. High fever and hypotension shortly after delivery are classically reflective of group B streptococci. |
|
|
Term
| What is the criterion standard for tx of endometritis? |
|
Definition
| clindamycin and gentamicin administered intravenously every 8 hours |
|
|
Term
| What is the first lab test to order in evaluation of a girl who presents with primary amenorrhea and no development of breasts? |
|
Definition
FSH levels
If there are no functional ovaries, FSH will be high; and if there is no FSH, ovaries will not be stimulated.
-lack of breasts mean there is no estrogen, so determining the FSH levels will tell you where the lesion is |
|
|
Term
| Precocious puberty, gradual onset of the hirsutism without virilization in second or third decade, and irregular menstruation in a woman with short stature will lead you to consider late onset ...... |
|
Definition
| CAH (congenital adrenal hyperplasia) |
|
|
Term
| What are 4 diagnostic criterion for bacterial vaginosis? PLus what gram stain would show |
|
Definition
| (1) homogeneous white, noninflammatory discharge; (2) microscopic presence of > 20% clue cells; (3) vaginal discharge with pH greater than 4.5; and (4) fishy odor with or without addition of 10% potassium hydroxide (KOH). Furthermore, gram staining will reveal small, nonmotile, nonencapsulated, and pleomorphic rods. |
|
|
Term
| If imaging of the vessels in an umbilical cord is non-diagnostic on US, what is the next best study? |
|
Definition
| a color Doppler imaging of the umbilical arteries at the level of the fetal bladder can confirm the vessel number. |
|
|
Term
| What are some risk factors for endometritis |
|
Definition
| prolonged rupture of the membranes (> 24 hours), chorioamnionitis, an excessive number of digital vaginal examinations, prolonged labor (> 12 hours), toxemia, intrauterine pressure catheters (> 8 hours), fetal scalp electrode monitoring, preexisting vaginitis or cervicitis, operative vaginal deliveries, cesarean section, intrapartum and postpartum anemia, poor nutrition, obesity, low socioeconomic status, and coitus near term. |
|
|
Term
| What is the MC gynecologic cancer? |
|
Definition
|
|
Term
| What is the #1 sx of endometrial cancer? How often is this sx actually associated with cancer? |
|
Definition
| Inappropriate uterine bleeding, specifically postmenopausal bleeding. Only associated with cancer 20% of the time, but always needs to be worked up |
|
|
Term
| What is the cardinal rule of prescribing estrogen to a women with a uterus? |
|
Definition
| She must also get progestin do protect the endometrial lining |
|
|
Term
| What is the presence of endometrium like glands and stroma outside of the uterus called? |
|
Definition
|
|
Term
| What is the MC age of a pt affected with endometriosis? Reason behind that? |
|
Definition
-nulliparous women in their late 20s and early 30s
-estrogen dependent so it is seen in reproductive aged women
-nulliparous usually d/t 30-40% of these women will be sub fertile |
|
|
Term
| Name some common s/sx of endometriosis? |
|
Definition
-1/3 are asymptomatic
-dysmenorrhea, heavy/irreg bleeding, dyspareunia, gen. pelvic pain, bloating N/V, dyschezia (pain with defecation) |
|
|
Term
| Does the degree of symptomatology of endometriosis correlate with the degree of involvement? |
|
Definition
|
|
Term
| What is the only way to dx definitively endometriosis? |
|
Definition
|
|
Term
| what are two pathognomic findings on laparoscopy of endometriosis? |
|
Definition
chocolate cysts
powder burn lesions |
|
|
Term
| What are uterine leiomyomas? |
|
Definition
-aka fibroids
-benign tumors that arise from the overgrowth of smooth muscle and connective tissue in the uterus |
|
|
Term
| Women with fibroids have an incr. risk of what? |
|
Definition
| endometrial carcinoma. It is also possible for fibroids to undergo malignant transformation (.1-.5%) |
|
|
Term
| what are some s/sx of uterine fibroids? |
|
Definition
-menorrhagia and metrorrhagia (MC)
-pain, fullness
-spontaneous abortions |
|
|
Term
| What will the uterus feel like on PE in a pt with fibroids? |
|
Definition
| -FIRM and enlarged irregular uterine mass, may be tender |
|
|
Term
| What is the #1 mode of diagnostic imaging for a fibroid? |
|
Definition
|
|
Term
|
Definition
-watchful waiting, assuming at menopause they will regress
-hysterectomy, myomectomy, or D and C
-arterial embolization
-progestin only BC may help decr bleeding and get a woman to menopause |
|
|
Term
| What are some signs and sx of endometritis? |
|
Definition
-fever (in OB within 36 hrs of delivery)
-low abd pain
-foul smelling lochia
-dyspareunia
-abdnormal vag bleeding/ DC |
|
|
Term
| what are some signs on PE of endometritis? |
|
Definition
| uterine tenderness, cervical motion tenderness, tachycardia, adnexal tenderness |
|
|
Term
| What are the dx criteria for endometritis in a OB pop and a non-OB pop |
|
Definition
-OB: temp > or = to 38 C in first 10 days post partum of > or = 38.7 within first 24 hours
-non-OB: cervical motion tenderness (or adnexal) and lower abdominal tenderness |
|
|
Term
| Describe the grading 1-4 of uterine prolapse |
|
Definition
1: mild descent of cervix towards vaginal opening with strain
2: cervix comes to vaginal opening with strain
3: cervix comes outside the vaginal opening with strain
4: cervix and uterus live outside of the vagina at all times ("procidentia") |
|
|
Term
| What is the threshold for size of ovarian cysts that can be followed and those that need laparoscopic intervention? |
|
Definition
| follow less than 8cm for 1-2 cycles. if no change or growth then laparoscopy is indicated |
|
|
Term
| what is the role of OCPs in ovarian cyst tx |
|
Definition
| they do nothing for cysts that are already there, but can help prevent the formation of new cysts |
|
|
Term
| What is the MCC of gynecologic cancer deaths?> |
|
Definition
|
|
Term
| What are the MC types of ovarian cancers and the ones that are measured by following CA 125 |
|
Definition
|
|
Term
| What are the two types of genetic ovarian cancer? |
|
Definition
-breast and ovarian cancer (BOC)
-HNPCC (Lynch syndrome) |
|
|
Term
| what percentage of pts with ovarian cancer have a genetic predisposition? |
|
Definition
|
|
Term
| What are the screening recommendations for ovarian cancer? |
|
Definition
-no screening in general pop
-in women with a first degree relative, get a pelvic US annually
-BRCA testing is advised in women with a strong family hx of breast and ovarian cancer |
|
|
Term
| What are some risk factors for ovarian cancer? what has shown to be protective? |
|
Definition
-incr age
-nulliparous
-early menarche or late menopause
-long term contraceptive use has shown to be protective d/t ovulation suppression |
|
|
Term
| What is the work up and plan of care for a pt with ovarian torsion that presents to the ER? |
|
Definition
-US!
-urine pregnancy test
-CONSULT GYN, ADMIT, emergent laparoscopy |
|
|
Term
| what side do most ovarian torsions occur on? |
|
Definition
| the R because on the left the sigmoid colon helps prevent movement of the ovary |
|
|
Term
| There is an increased risk of ovarian torsion in pregnancy d/t what? |
|
Definition
| enlarged corpus luteal cysts (20% occur in pregnancy) |
|
|
Term
| What types of cells line the vagina and the outside of the cervix? What types of cells line the canal of the cervix? What is the term for the area where these two cell types meet and what is significant about this area? |
|
Definition
-squamous cells
-columnar cells
-Transformation zone and it is where 95% of cancers develop |
|
|
Term
| What does CIN stand for and what are the different types? |
|
Definition
Cervical intraepithelial neoplasia
-Cin 1: lower 1/3 of the squamous epithelial cells are abnormal
-2: 2/3 involvement (mod)
-3: involvement into the outer 1/3 (severe) |
|
|
Term
| Which types of HPV are strongly linked to cervical cancer? Which are strongly linked to condyloma acumata? |
|
Definition
|
|
Term
| When should PAP screening begin? |
|
Definition
| at age 21 regardless of first sexual intercourse |
|
|
Term
| What are the two MC clinical signs of a cervicitis? |
|
Definition
1. visible purulent or mucopurulent endocervical exudate in the endocervical canal
2. sustained, easily induced endocervical bleeding when a cotton swab is gently passed through the cervical os |
|
|
Term
| what is the pH of normal vaginal secretions? |
|
Definition
|
|
Term
| What are the common characteristics of trichomonas? |
|
Definition
| frothy gray or yellow-green vaginal dc with pruritus. Cervical petechiae ("strawberry cervix") is classic but seen in less than 2% |
|
|
Term
| What is the tx for chlamydia? |
|
Definition
-Azithromycin 1 g PO in a single dose
OR
-Doxycycline 100 mg BID x 7 days |
|
|
Term
| What is the tx for gonorrhea? |
|
Definition
-Ceftriaxone 250 mg IM one time
PLUS
-tx for chlamydia |
|
|
Term
| What would you rx a patient who was allergic to rocephin who has been dx with gonorrhea? |
|
Definition
| -a single dose injectable cephalosporin and a test of cure in one week |
|
|
Term
| What is the tx for trichomonas? |
|
Definition
metronidazole 2 po one time
OR
tinidazole 2 g PO one time |
|
|
Term
| What is the avg cervical length during the first trimester? at 28 weeks gestation what is a common length? |
|
Definition
->5cm during first trimester
-<34 mm at 28 weeks |
|
|
Term
| Rates of preterm labor incr 4 fold when a woman has a cervical length of < _____ mm at 24 weeks |
|
Definition
|
|
Term
| What is the definition of an incompetent cervix? |
|
Definition
| cervical dilatation without uterine contractions |
|
|
Term
| When a cervix becomes greater than ____ cm dilated, active uterine contractions and rupture of membranes may ensue |
|
Definition
|
|
Term
| describe the grading of pelvic organ proplapse |
|
Definition
1- drops between the normal position and the ischial spines
2- drops between the ischial spines and the hymen
3-drops to within the hymen
4- drops through the hymen |
|
|
Term
| what is the rarest of all gynecologic neoplasms? What is the most common cell type? |
|
Definition
Vaginal and vulvar
Squamous cell carcinomas |
|
|
Term
| in utero exposure to _____ increases the risk of clear cell adenocarcinoma of the vagina |
|
Definition
|
|
Term
| What are some common characteristics on presentation of a pt with BV |
|
Definition
d/c is thin, homogenous, malodorous, gray-white or yellow-white in color
-fishy smell |
|
|
Term
| What is the AMSEL criteria for dx of BV? |
|
Definition
Must have 3/4
1. homogenous white adherent dc
2. vag pH >4.5
3. positive whiff test
4. positive clue cells on wet mount |
|
|
Term
| Describe the wet mount findings and pH levels for BV, candidiasis, and Trich |
|
Definition
-BV: clue cells, decr lactobacilli, and absent WBC; pH 5-6
-Candidiasis: hyphae and budding yeast forms; pH <4.5
-Trich: WBCs >10/HPF and trichomonads pH 5-7 |
|
|
Term
|
Definition
Metronidazole 500 mg PO BID x 7 days
*if allergic can do clindamycin 300 mg BID x 7 days |
|
|
Term
|
Definition
|
|
Term
| What is the follicular phase of the cycle |
|
Definition
| -from day 1 (first day of menses) until day 14 |
|
|
Term
| surge in what hormone causes ovulation? |
|
Definition
|
|
Term
| What is the MCC of secondary amenorrhea |
|
Definition
|
|
Term
|
Definition
| symptoms of painful menstruation |
|
|
Term
| what is the pathophysiology of primary dysmenorrhea |
|
Definition
| excessive prostaglandin E2 secretion leads to painful uterine contractions and also smooth muscle contraction (N/V/D) |
|
|
Term
| what is the best treatment for common dysmenorrhea |
|
Definition
| NSAIDs just before expected menses and continued for 2-3 days |
|
|
Term
| for sx to be considered PMS, when must they occur |
|
Definition
| 1-2 weeks before menses (in the luteal phase) and end 1-2 days after menses begins. a monthly symptom free period during the follicular phase must exist |
|
|
Term
| how many months must a woman not have a period for her to be considered as having gone through menopause |
|
Definition
|
|
Term
| Premature ovarian failure is cessation of menses before ______ years of age |
|
Definition
|
|
Term
| level of what hormone is diagnostic of menopause |
|
Definition
|
|
Term
| never prescribe unopposed estrogen to who? |
|
Definition
| any female that still has a uterus |
|
|
Term
| what is the mc pathogen in breast abscesses? Who are the most likely patients |
|
Definition
s. aureus
primigravid breast feeding women |
|
|
Term
| If a patient presents to the clinic or ED with a breast abscess, should you drain it? |
|
Definition
|
|
Term
| what percentage of breast cancer cases are linked BRCA 1 or 2? |
|
Definition
|
|
Term
| Name some risk factors for breast cancer |
|
Definition
-incr age
-early menarche or late menopause
->30 yoa at first live birth or nulliparous
-first degree relative with it
-hx of breast biopsies |
|
|
Term
| what is the MC type of breast cancer? second? |
|
Definition
-ductal carcinoma
- lobular carcinoma |
|
|
Term
| what type of dc from a nipple is concerning for malignancy? milky, clear, pussy, green-yellow, bloody |
|
Definition
|
|
Term
| name concerning physical characteristics of a breast mass |
|
Definition
| hardness, irregularity, focal nodularity, asymmetry with other breasts, fixation to skin or muscle |
|
|
Term
| What is the classic triple assessment for a breast mass? |
|
Definition
-clinical breast exam
-imaging B mammogram and US
-FNA or stereotactic core needle bx (if the imaging warrants) |
|
|
Term
| What are the breast cancer screening recs? High risk patients (>20% lifetime risk according to gayle model)? |
|
Definition
-mammogram Q year starting at 40
-high risk: MRI and mammogram alternating every 6 months
-start getting mammograms 10 yrs before the first degree relative who was affected was dx'd |
|
|
Term
| When someone looks like they have a bad cellulitis in their breast, what is the most important differential diagnosis? |
|
Definition
| inflammatory breast cancer. if there is no improvement with abx, this needs to be worked up ASAP |
|
|
Term
| What are the physical characteristics on exam of a fibroadenoma? |
|
Definition
| round, firm, smooth, discrete, mobile, non tender, rubbery, unilateral |
|
|
Term
| What is the work up for a fibroadenoma? |
|
Definition
| cancer needs to be R/o so US of mass and Bilat mammogram |
|
|
Term
| What is the tx for fibroadenoma |
|
Definition
| expectant/conservative management if it is no trouble to the pt. can be excised if it is disrupting the pt |
|
|
Term
| what is the MC benign breast condition? |
|
Definition
| fibrocystic breast disease |
|
|
Term
| What are some distinguishing characteristics of fibrocystic breast disease that differentiate it from cancer? |
|
Definition
| pain, size fluctuations, multiple lesions, bilateral |
|
|
Term
| When is the best time to do a clinical breast exam on any patient? |
|
Definition
|
|
Term
| What are some possible tx options for women with fibrocystic breast disease |
|
Definition
-decr caffiene
-vit E supp
-decr salt
-HCTZ premenstrually in severe cases |
|
|
Term
| in a breast feeding woman who presents with mastitis, does she need to empty her breasts and keep breast feeding? |
|
Definition
| Yes. the breasts need to be emptied |
|
|
Term
| #1 cause of mastitis (pathogen) and the next 2 MC |
|
Definition
|
|
Term
| what is the only definitive way to diagnose PID? |
|
Definition
|
|
Term
| what are the CDC outpatient recommended treatment regimen for PID? |
|
Definition
| -ceftriaxone 250 mg IM one time blue doxycycline 100 mg BID x 14 days |
|
|
Term
| what are the contraindications for starting someone on OCPs? |
|
Definition
-age greater than 35 and a smoker
-HTN
-migraines with aura
-hx of VTE
-stroke
-heart disease
-hx of breast cancer |
|
|
Term
| What should be screened on every patient on OCPs before represcribing each year |
|
Definition
|
|
Term
| what is the definition of infertility |
|
Definition
| a couple's inability to conceive after one year of unprotected intercourse |
|
|
Term
| what is the #1 way to date a pregnancy |
|
Definition
|
|
Term
| what is nagele's rule for EDC |
|
Definition
| date of LMP minus three months, +7 days + 1 year |
|
|
Term
| GaPbcde, explain they way to document someones obstetric hx |
|
Definition
G= pregnancies
a= number total
P= deliveries
b= term
c= preterm (before 37 weeks)
d= abortions
e= live children |
|
|
Term
| at what week gestation will the uterus be at the umbilicus |
|
Definition
|
|
Term
| at what week can you start measuring fetal heart tones |
|
Definition
|
|
Term
| what beta HCG level is definitive for when an intrauterine pregnancy can be seen on US? |
|
Definition
|
|
Term
|
Definition
| bluish discoloration of the cervix in a pregnant girl |
|
|
Term
|
Definition
| softening between the fundus and the cervix |
|
|
Term
| when is a cervix fully dilated? |
|
Definition
|
|
Term
| what is effacement of a cervix? |
|
Definition
| cervical softening and thinning out, expressed as percentage and goes up to 100% |
|
|
Term
|
Definition
the presenting part of the fetus
head first is most common |
|
|
Term
| what is the definition of abortion? |
|
Definition
| the termination of pregnancy, by ANY means, before 20 weeks gestation |
|
|
Term
|
Definition
| vaginal bleeding, without cervix open and without any products of conception passed |
|
|
Term
| what is an inevitable abortion? |
|
Definition
| vaginal bleeding with an open cervix but without any products of conception passed, yet there is no way to maintain the pregnancy |
|
|
Term
| what is an incomplete abortion? |
|
Definition
| vaginal bleeding with cervix open and partially passed products of conception |
|
|
Term
| what is a complete abortion? |
|
Definition
| vaginal bleeding with cervix open and all products of conception passed |
|
|
Term
| what is a missed abortion? |
|
Definition
| no vaginal bleeding, no open cervix, no products of conception passed but fetal demise has occurred without symptoms |
|
|
Term
| On pelvic exam of a patient who has just undergone or who is presently undergoing a miscarriage, what does the uterus feel like? |
|
Definition
-the uterus will feel smaller than corresponding gestational age
-the fundus of the uterus may be boggy or tender |
|
|
Term
| when monitoring beta hCG, how quickly should it rise in a normal pregnancy? |
|
Definition
| the value should double every 48-72 hours. as the pregnancy progresses it can take longer for the doubling to occur and the window may increase to 96 hrs |
|
|
Term
| why is serum progesterone measured during pregnancy? |
|
Definition
| it should progressively rise during pregnancy d/t placental production |
|
|
Term
| if a non immunized Rh negative women has an abortion, does she still need to receive rhoGAM? |
|
Definition
|
|
Term
| if the products of conception are not passed naturally after an abortion, what procedure must be performed? |
|
Definition
|
|
Term
| what is the MCC of third trimester bleeding? |
|
Definition
| abruptio placentae (placental abruption) |
|
|
Term
| What are the two types of placental abruption? |
|
Definition
external: more common, less severe. blood escapes from the uterus and exits the vagina
concealed: less common and more severe, where blood is retained between the detached placenta and the uterus |
|
|
Term
| hematologically speaking, what is the most serious sequelae of a placental abruption? |
|
Definition
| liberation of tissue thromboplastin and consumption of fibrinogen activate the extrinsic clotting mechanism and could eventually lead to DIC |
|
|
Term
| what is the #1 sign of a placental abruption? |
|
Definition
| vaginal bleeding, sometimes painful |
|
|
Term
| what time period In terms of gestational age must a placental abruption occur for it to be deemed so? |
|
Definition
| between 20 weeks and birth |
|
|
Term
| how is the dx of placental abruption usually made? is u/s helpful? what is the tx? |
|
Definition
-clinically
-not usually
-delivery is the definitive tx and c-section is the preferred method |
|
|
Term
| what are the leading indications for a c section? |
|
Definition
| previous cesarean, breech presentation, dystocia, fetal distress |
|
|
Term
| vaginal birth after c-section (VBAC) is more likely to be successful if the reason for the first c-section was _________ compared to ____________ |
|
Definition
breech presentation
dystocia |
|
|
Term
| what is a general definition of dystocia? |
|
Definition
| abnormal labor, often due to the cervix failing to dilate progressively over time and the fetus failing to descend |
|
|
Term
| specifically, what is shoulder dystocia? |
|
Definition
| uncommon complication whereby the the fetal shoulders do not deliver as they would routinely after the head has emerged from the mom's introits. occurs when one or both shoulders become impacted against the bones of the maternal pelvis |
|
|
Term
| What are the 3 P's of dystocia? (the most common abnormalities leading to dystocia) |
|
Definition
-pelvis: cephalopelvic disproportion
-powers: inadequate uterine contractions to dilate the cervix and expel the infant
-passenger: cephalopelvic disproportion |
|
|
Term
| what can be given IV to a delivering female if her contractions are not strong enough? |
|
Definition
|
|
Term
| Dystocia is a leading indication for ________ |
|
Definition
|
|
Term
| what is an ectopic pregnancy? what is the MCC cause? Where is the MC site of implantation? |
|
Definition
-implantation of a pregnancy anywhere but the endometrium
-secondary to adhesions that occlude the fallopian tube
-MC location is the fallopian tube |
|
|
Term
| What is the classic clinical triad of ectopic pregnancy? |
|
Definition
-abd pain
-amenorrhea
-vag bleeding |
|
|
Term
| what is the most important lab value for diagnosing, following and ectopic pregnancy? |
|
Definition
| beta hCG, it should double about every 48 hours. in an ectopic it will not rise this quickly and it will also not be the same level as an intrauterine pregnancy at the same gestation |
|
|
Term
| what imaging modality is accurate in dx 90% of ectopic pregnancies? |
|
Definition
|
|
Term
| at what beta hCG level will you be able to see a intrauterine pregnancy on vaginal ultrasound? |
|
Definition
|
|
Term
| what is the criterion standard for diagnosing an ectopic, yet rarely used first line due to morbidity? |
|
Definition
|
|
Term
| What type of patient can be expectantly managed with an ectopic? |
|
Definition
-no evidence of rupture or HD instability
-reliable
-declining beta hCG
-extremely close follow up |
|
|
Term
| what is the drug of choice used to terminate and ectopic pregnancy? what should their hcG be less than? |
|
Definition
methotrexate
beta hCG less than 5000 |
|
|
Term
| what is the normal fetal heart rate? |
|
Definition
|
|
Term
| heart rate accelerations of _____ bpm above baseline for ____ seconds denote fetal well being and are reassuring |
|
Definition
|
|
Term
| Early decelerations are considered to be harmful or benign? what do they denote? |
|
Definition
benign
denote fetal head compression during contractions and are often present as a female approaches the second stage of labor |
|
|
Term
| what are the three most common asphyxial distresses placed on a fetus during labor? |
|
Definition
-insufficiency of uterine blood flow
-insufficiency of umbilical blood flow
-decr. in uterine arterial oxygenation |
|
|
Term
| what should be the first steps taken if a non-reassuring HR is present during delivery of a fetus? |
|
Definition
-stop oxytocin (if applicable)
-change maternal position
-give oxygen via face mask
-measure fetal scalp pH |
|
|
Term
| how do we screen for gestational diabetes and how do we make a diagnosis? |
|
Definition
-non-fasting 50 g glucose challenge test, followed by serum glucose level 1 hour later--> if levels greater than 130 mg/dL then move onto the 3 hour glucose tolerance test
-100 g glucose load is given in the AM to a fasting patient, then the serum glucose level is measured at 1,2,and3 hrs after load. If 2 or more readings are abnormal than dx is made |
|
|
Term
| What is the tx for gestation diabetes? |
|
Definition
-careful control with diet and exercise
-if FBS >105 mg/dL or postprandials >120 may need to consider insulin
-NEVER use oral hypoglycemics |
|
|
Term
| what are the 4 categories of HTN DOs in pregnancy? |
|
Definition
-chronic HTN
-PIH
-preeclampsia-eclampsia
-preeclampsia superimposed on chronic HTN |
|
|
Term
|
Definition
| pregnancy induced hypertension is HTN that presents after 20 weeks gestation without any other symptoms |
|
|
Term
|
Definition
| HTN that presents after 20 weeks gestation and classically accompanied by the rest of the triad: proteinuria and edema. Edema is NOT necessary for diagnosis though |
|
|
Term
| when is pharmacologic intervention indication in chronic HTN or PIH during pregnancy? |
|
Definition
| when systolic >160 or diastolic > 100-105. |
|
|
Term
| what are the rec'd drugs of tx for PIH or chronic HTN during pregnancy? what are contraindicated? |
|
Definition
-labetalol, propranolol (BBs which release least into breast milk)
-methyldopa, nifedipine, MgSO4
-CONTRA: ACEIs and ARBs |
|
|
Term
| pts with PIH or chronic HTN during pregnancy get monthly US to check for what? |
|
Definition
|
|
Term
| preeclampsia can be divided into mild and severe based on what factors? |
|
Definition
| BP, creatinine, urine protein, liver enzymes, uric acid, assoc. signs and symptoms |
|
|
Term
| what are some concerning s/sx associated with preeclampsia that would deem it "severe" |
|
Definition
blurred vision
HAs
scotomas
clonus
RUQ pain |
|
|
Term
| what are some RFs for preeclampsia? |
|
Definition
<18 or >35 yoa
black
obese
hx of preeclampsia
chronic HTN
DM |
|
|
Term
| What are the two most serious sequelae of preeclampsia? |
|
Definition
Eclampsia- severe preeclampsia with seizures
HELLP syndrome- severe preeclampsia with hemolysis elevated liver enzymes low platelets |
|
|
Term
| what labs need to be ordered to make the dx of preeclampsia and monitor preeclampsia progression |
|
Definition
urine protein
cbc, fibrinogen, PT/PTT
CMP: liver enzymes, creatinine, uric acid |
|
|
Term
| what is the tx for preeclampsia? |
|
Definition
-ultimately its delivery
-but for mild cases and reliable patients they can be monitored until 37 weeks when delivery is induced
-severe preeclampsia/eclampsia: indication for surgery |
|
|
Term
| Name the drugs given to prevent seizure, treat HTN, and promote lung maturity before delivery in preeclamptic women? |
|
Definition
-MgSO4 for seizure prevention, continue for 24 hrs after delivery
-Hydralazine or Labetalol for HTN
-betamethasone for lung maturity |
|
|
Term
| what are the four types of gestational trophoblastic disease? Which is the MC? |
|
Definition
-hydatidiform mole (MC)
-choriocarcinoma
-invasive mole
-placental site trophoblastic tumor |
|
|
Term
| hydatidiform moles are benign or malignant? |
|
Definition
|
|
Term
| describe the two types of hydatidiform moles |
|
Definition
-complete: characterized by an empty egg and a "snowstorm" or "grape like vesicle" pattern on US, 20% become malignant
-partial: have a nonviable fetus, <5% become malignant |
|
|
Term
| give some s/sx of hydatidiform mole |
|
Definition
-abnl vag bleeding
-uterine size greater than dates
-hyperemesis gravidarum
-pre-eclampsia like sx before 20 weeks |
|
|
Term
| the beta hCG level in a complete hydatidiform mole is usually > ____? |
|
Definition
|
|
Term
| what is seen on US of a complete hydatidiform mole? |
|
Definition
| grape like vesicles or a snowstorm appearance consistent with swelling of the chorionic villi |
|
|
Term
| what is the basis of tx for all gestational trophoblastic disease? |
|
Definition
|
|
Term
| name two drugs that can cause multiple gestations |
|
Definition
clomiphene
human menopausal urine preparation (HMG) |
|
|
Term
| Dizygotic twins will always have separate…. |
|
Definition
| amnions, chorions, and placentas. they are always dichorionic and diamniotic |
|
|
Term
| What are the variations of monozygotic twins in terms of chorions and amnions |
|
Definition
-mono/mono
-monochorionic/diamniotic
-di/di |
|
|
Term
| what is a placenta previa? |
|
Definition
| implantation of the placenta over the cervical os |
|
|
Term
| describe the three types of placenta previa |
|
Definition
-complete: complete implantation over the os
-partial: placental edge partially covering the os
-marginal: placenta approaches the border of the os |
|
|
Term
| what is the hallmark sx of placenta previa |
|
Definition
| painless vaginal bleeding |
|
|
Term
| if a pt has a known placenta previa, should anything be inserted in the vagina? |
|
Definition
-no digital exam
- tRANSABDOMINAL US can be used to assess (NOT TRANSVAG!)
-no penetration |
|
|
Term
| what is the preferred method of delivery in the case of a placenta previa? |
|
Definition
|
|
Term
| give some definitions of post partum hemorrhage |
|
Definition
-blood loss requiring transfusion, or a >10% decr in hematocrit between admission and post delivery
->500 mL blood loss after vag delivery or >1000 mL after c section |
|
|
Term
| What is early PPH and what are the MC causes of early PPH? |
|
Definition
-occurs <24 hours after delivery
-abnormal involution of the placental site, lacerations, retained portions of the placenta |
|
|
Term
| what is late PPH and what are the MCCs of late PPH? |
|
Definition
-occurs >24 hours after delivery
-subinvolution of the uterus, retained products of conception, endometritis |
|
|
Term
|
Definition
| uterine atony- failure of the uterus to contract and retract after delivering a baby |
|
|
Term
| what are the 4 T's of PPH (ways to remember the causes) |
|
Definition
-Tone: uterine atony
-Tissue: retained placenta
-Trauma: damage to the genital tract
-Thrombosis |
|
|
Term
| over the course of pregnancy maternal blood vol incr by how much> |
|
Definition
|
|
Term
| how can you detect retained placenta in the uterus in a pt with PPH? |
|
Definition
|
|
Term
| what are the tx options for PPH |
|
Definition
| uterine massage and compression first if stable, then IV oxytocin, ergonovine to incr uterine contraction |
|
|
Term
| how will a sub involuted uterus feel on exam? |
|
Definition
|
|
Term
| what is PROM, PPROM, SPROM, and Prolonged ROM? |
|
Definition
-PROM: ROM after 37 weeks but before signs of active labor
-PPROM: ROM before 37 weeks
-SPROM: ROM after or with the onset of labor
-Prolonged ROM: any ROM that persists for >24 hours prior to the onset of labor |
|
|
Term
| WHat is the major risk associated with PROM and PPROM? |
|
Definition
| infection (chorioamnionitis and endometritis) and this risk incr with time of ROM before labor |
|
|
Term
| how can the diagnosis of ROM be made? |
|
Definition
| sterile speculum exam (visualization of pooling) then use nitrazine paper and the fern test. |
|
|
Term
| should a digital exam be done to a patient with PROM or PPROM? |
|
Definition
| not unless totally necessary. want to prevent infection |
|
|
Term
|
Definition
| if expectant management is feasible then hospitalize patient and monitor fetus. THen use oxytocin or prostaglandin cervical gel to induce delivery |
|
|
Term
| what is the tx for PPROM? |
|
Definition
-hospitalize the patient and put on bed rest
-<34 weeks give betamethasone
-abx to prevent infection and decr fetal mortality
-NST and BPP regularly
-induce |
|
|
Term
| when is Rh incompatibility an issue? |
|
Definition
| when the mom is Rh - and the baby is Rh + |
|
|
Term
| What is the tx for Rh incompatibility? |
|
Definition
| for all nonimmunized Rh - women who are pregnant, a 300 mg dose of Rh IgG (RhoGAM) at 28-30 weeks and another within 72 hours after delivery |
|
|
Term
| what is the MC Rh factor involved in Rh incompatibility (there are many) |
|
Definition
|
|
Term
| what is the MCC of Rh incompatibility? |
|
Definition
| Rh - pregnant mom is exposed to Rh + fetal RBCs secondary to fetomaternal hemorrhage during the course of pregnancy from spontaneous or induced AB, trauma, invasive OB procedures, or normal delivery |
|
|
Term
| give three tests that you can use to work up the status of a patient's Rh incompatibility? |
|
Definition
-Rosette screening test: can detect alloimmunization caused by very small amounts of fetomaternal hemorrhage
-Kleihaur Betke acid elution test: used when large (>30 mL) of fetomaternal hemorrhage are present and can help determine how much extra RhoGAM should be given
-Direct Coombs: detects antibody induced hemolytic anemia |
|
|
Term
| what hormone produced by the placenta maintains the corpus luteum of pregnancy? |
|
Definition
|
|
Term
| What hormone can be used to treat endometrial hyperplasia? Why? |
|
Definition
| Progestins, they inhibit and reverse endometrial hyperplasia |
|
|
Term
| what is the difference between a fourth and third degree vaginal laceration after child birth? |
|
Definition
A third degree tear involves the vaginal mucosa, fascia, perineal body and muscles, and the anal sphincter
A fourth degree tear also involves the rectal mucosa |
|
|
Term
| bleeding or cramping in the first 20 weeks of pregnancy is known as a _________/________ |
|
Definition
|
|
Term
| What is the most common cause of nipple discharge in a non-lactating woman? |
|
Definition
| fibrocystic changes with ectasia of the ducts |
|
|
Term
| what are the blood pressure parameters for preeclampsia to be considered severe |
|
Definition
| SBP >160 and/or DBP >110 mmHg |
|
|
Term
| what is a more serious path report from a PAP… ASCUS or AGUS? |
|
Definition
| AGUS needs immediate colposcopy (take into account HPV results) and ASCUS can be repeated before going to colposcopy (taking into account HPV results) |
|
|
Term
| when a pt presents with itching of the vulvar area what is the highest on your differential and must be ruled out? |
|
Definition
| vulvar cancer, often the first symptom is pruritus |
|
|
Term
| if mifepristone and misoprostol are used for a medical abortion, what is the MOA of each? |
|
Definition
-mifepristone: blocks progesterone resulting in the shedding of the uterine lining
-misoprostol: makes the uterus contract |
|
|
Term
| medical abortion is appropriate up to how far along in a pregnancy? |
|
Definition
|
|
Term
| what is the more common complication during a pregnancy where the mother is affected with gestational diabetes… polyhydraminos or oligohydraminos? |
|
Definition
Polyhydraminos affects 25% of GDM pregnancies.
Oligohydraminos is MUCH less common |
|
|
Term
| when a pt is on COCPs, what is the estrogen responsible for suppressing and what is the progestin responsible for suppressing... |
|
Definition
-Progestin suppresses LH and prevents ovulation by blocking the LH surge
-Estrogen suppresses FSH |
|
|
Term
| what is the largest risk factor for endometrial cancer? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| both placenta previa and placental abruption present with bleeding. differentiate the two more |
|
Definition
previa is painless after 20 weeks
abruption is PAINFUL and usually in the third trimester |
|
|
Term
| when you hear port wine colored amniotic fluid, you should think….. |
|
Definition
|
|
Term
| what are the three criteria to be able to give methotrexate during an ectopic pregnancy? |
|
Definition
hCG <5000
mass <3.5 cm on US
prior to fetal heart activity |
|
|
Term
| when diagnosing ROM, what will the pH of the pooling liquid be? What is the fern test? |
|
Definition
ph >6.5
fluid placed on a prepared slide will show a ferning pattern |
|
|
Term
| when do you screen a woman, who does not have RFs, for GDM? |
|
Definition
|
|
Term
| what is the sign during delivery that is associated with shoulder dystocia? |
|
Definition
|
|
Term
| at 6 weeks post partum describe the uterus, status of lochia, cervix, and vag |
|
Definition
| uterus normal size, no lochia, cervix slit like after a vag delivery, and vagina is completely involuted |
|
|
Term
| when does a non lactating woman start to ovulate? Does breastfeeding prevent pregnancy? |
|
Definition
| -6-10 weeks after but can be as early as 3 weeks. longer for breast feeding women. breastfeeding does not prevent pregnancy, so need to discuss BC options for these women after the 6 week postpartum period |
|
|
Term
| cervical intraepithelial neoplasia (CIN) is basically what? |
|
Definition
| abnormal growth of cells on the surface of the cervix and is considered a precancerous condition |
|
|
Term
| what is the difference between monitoring ovarian cysts in pre- vs. postmenopausal women? |
|
Definition
-premenopausal women with cysts <8 cm can be watched for 2-3 cycles
-post menopausal: all cysts are cancerous until proven otherwise |
|
|
Term
| what is the normal FSH/LH ratio? What will be seen in a pt with PCOS? |
|
Definition
NL is 2:1
in PCOS the LH will be much greater than the FSH, so the ratio is reversed |
|
|
Term
| what will be classically seen on US in a patient with PCOS? |
|
Definition
| string of pearls appearance |
|
|
Term
| what is the basic pathophys of PCOS |
|
Definition
| it is a dysfxn of the hypothalamic pituitary ovarian axis where there is excess LH causing stimulation of the ovaries to produce many underdeveloped follicles that cannot be released, resulting in multi cystic development |
|
|
Term
| what is the normal interval of menses? |
|
Definition
|
|
Term
| what is the normal amount of blood loss during menses, anything less than…. |
|
Definition
|
|
Term
|
Definition
| prolonged OR excessive bleeding (either in number of days or amount of blood lost) |
|
|
Term
|
Definition
| bleeding between menstrual cycles, usually not excessive (abnormal interval) |
|
|
Term
| what is menometrorrhagia? |
|
Definition
| prolongation of the menstrual cycle, typically excessive with irregular intermenstrual bleeding |
|
|
Term
| what is polymenorrhea and oligomenorrha? |
|
Definition
poly cycles <21 days
oligo cycles >35 days |
|
|
Term
| what is the one time dosage of diflucan for a yeast infection? |
|
Definition
|
|
Term
| what is the one time dosing of metronidazole for trich? |
|
Definition
|
|
Term
|
Definition
| 250 mg IM of rocephin plus 1 g azithro PO x 1 |
|
|
Term
|
Definition
| either 1 g Po azithromycin one time, OR 100 mg BID x 7 days of doxy |
|
|
