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Gynecology > 6th year > Flashcards

6th year Flashcards

1
Q

HPV vaccines

A
  • Cervarix: 16, 18
  • Gardasil: 6, 11, 16, 18
  • Gardasil 9: 6, 11, 16, 18, 31, 33, 45, 52, 58
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2
Q

Bethesda system

A

Squamous cell cc

  • ASC-US
  • (ASC-H)
  • LSIL
  • HSIL
  • Invasive carcinoma

Adenocc

  • ACG
  • AIS
  • Adenocc
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3
Q

Richard system

A
  • Condyloma
  • CIN 1
  • CIN 2
  • CIN 3
  • Invasive carcinoma
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4
Q

Papanicolou system

A
  • P1: negative
  • P2: some benign aberration
  • P3: pathological cells (inflame vs dysplasia??)
  • P4: suspect malignancy
  • P5: true malignancy
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5
Q

Reagan system (WHO)

A
  • Normal
  • Atypia
  • Mild dysplasia
  • Moderate dysplasia
  • Severe dysplasia
  • Carcinoma in situ
  • Invasive carcinoma
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6
Q

RMI score

A

Risk of malignancy index for ovarian masses
- Menopausal status (pre=1p, post=3p)
- US morphology (multiloculated, solid areas, bilateral, ascites, intraabd metastases. Score 0-1 => U=1p, Score 2-5 => U=3p)
- CA-125 absolute value
MxUxCA125 = ? (over 200 is suspicious)

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7
Q

ROMA score ovarian masses

A
  • HE4
  • CA-125
  • Menopausal status
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8
Q

Treatment ovarian cc

A

Requires surgical exploration and intraop. frozen section
Stage
- IA: TAH-BSO (pregnancy-wish: USO=>fast pregnancy=>TAH-BSO)
- IB: TAH-BSO
- IC: TAH-BSO + peritoneal radioactive phosphorous
- II-IV: TAH-BSO + omentectomy + debulking (cytoreductive surgery) + chemo (paclitaxel+carboplatin)
*Bevacizumab (anti-VEGF) might be added adjuvantly

Germ-cell tumors and Sex-cord stromal tumors: TAH-BSO + staging +/- adjuvant BEP (bleomycin, etopocide, cisplatin)

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9
Q

Treatment uterine cc

A

Stage I-II: TAH-BSO (fertility-sparing: medroxyprogesterone acetate)
Stage III-IV: TAH-BSO + radiation + platinums

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10
Q

Treatment cervical cc

A

Stage Ia1: TAH (fertility-sparing: conization)

Stage IIa: TARH + PLND (fertility-sparing: up to Ib1: radical trachelectomy + PLND)

Stage IIb-IIIb: Radiation + chemo (cisplatin, bleomycin, mitomycin C, methotrexate, cyclophosphamide)

Stage IV: Palliative chemo/radiation/surgery

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11
Q

Types of vaginal prolapse

A
  1. Cystocele: weak pubocervical fascia
  2. Rectocele: weak rectovaginal fascia
  3. Enterocele:
    (4: Urethrocele/urethrocystocele?)
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12
Q

Uterine prolapse defects

A
  • Cardinal ligaments

- Uterosacral ligaments

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13
Q

Treatment vaginal prolapse

A
  • Pelvic floor exercises
  • Pessaries - support in vagina
  • Colporrhaphy (ant/post)
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14
Q

Treatment uterine prolapse

A
  • Pelvis floor exercises
  • Pessaries - support in vagina
  • Hysterectomy with repair of pelvic support structures (colporrhaphy) and suspension of top of vagina
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15
Q

Treatment UTIs

A

Uncomplicated cystitis:
- Nitrofurantoin for 5 days -or- Trimethoprim/Sulfamethoxazole for 3 days

Acute pyelonephritis:

  • 1st line: Ciprofloxacin 7 days & Levofloxacin 5 days
  • 2nd line: TMP/SMX for 14 days
  • Other options if hospitalization: ampi-genta or piperacillin/tazobactam
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16
Q

Treatment PID inpatient

A
  • Lecture: Cefoxitin or Cefotetan + Doxycyclin
    Norge: Cefotaxime + doxycyclin +/- metronidazole
  • Alt: Clindamycin + gentamycin
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17
Q

Treatment PID outpatient

A
  • Lecture: Ceftriaxone + doxycyclin +/-metronidazole
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18
Q

Alkylating agents

A

Cyclophosphamide

  • Ovarian carcinoma
  • Germ cell tumors + (Gestational tumor - choriocc)
  • Scc
  • Breast cc
  • Cervix cc
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19
Q

Antimetabolites

A
  • Methotrexate: hydatidiform mole (with D&C), choriocarcinoma, breast, ectopic pregnancy, abortion (with misoprostol)
  • 5-FU:
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20
Q

Antibiotics

A
  • Actinomycin D: choriocarcinoma
  • Doxorubicin: breast
  • Bleomycin: cervix cc
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21
Q

Plant alkaloids

A

Paclitaxel: breast, ovarian, vaginal/vulvar cc

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22
Q

Platinum chemo

A
  • Cisplatin: cervix cc, vaginal/vulvar cc

- Carboplatin: ovarian cc, uterine cc

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23
Q

Cell-cycle specific chemo

A
  • G1: Actinomycin D
  • S: Antimetabolites (mtx, 5-fu), doxorubicin
  • G2: Bleomycin, etoposide
  • M: taxanes, vinca alkaloids
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24
Q

Normal sperm and semen

A
  • 2-5 ml semen
  • > 20 million sperm/microliter
  • > 30 % normal morphology
  • > 50 % motile
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25
Q

Prenatal visits (GP)

A
  • From gw 4 - 28: once a month
  • GW 28 - 35: once every 2 weeks
  • From gw 35: every week
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26
Q

Naegles rule

A

First day of LMP + 7 days - 3 months (+ add a year)

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27
Q

Trimesters

A

First: gw 1-12
Second: gw 13-26
Third: gw 27-40
*Litt forskjellig overalt

28
Q

GTPAL

A 
History taking
G: Gravidity (total no of pregnancies)
Parity (TPAL)
T: Term (total no of term deliveries
P: Premature deliveries
A: Abortions
L: Living children
29
Q

hCG positivity serum and urine + doubling

A
  • Serum: 8-9 days after conception
  • Urine: 28 days after first day LMP
  • Doubles every 2nd day until 10 weeks
30
Q

First obstetric visit tests

A
  • Height, weight, BMI
  • (BP?)
  • Pelvic exam
  • Labs: Blood type, irregular Ab, infections, fasting glucose
  • hCG, urine culture
  • Dental examination
31
Q

Peptide hormones pregnancy

A
  • hCG: 8d-10wk, maintain corpus luteum (pregnancy)
  • hPL: glucose availability to fetus (atg to mother insulin)
  • CRH: stimulate fetal ACTH => DHEA-S (gives estrogen)
  • Prolactin: stimulated by mat. estrogen => milk production
  • Relaxin: peak gw 10, promote implantation (and some softening of cervix)
32
Q

Steroid hormones pregnancy + others

A
  • Progesterone: endometrium for implantation, decidual changes and smooth muscle relaxant (no uterine contr)
  • Estrogen: DHEA-S => estrone => testosterone => estradiol. Estriol prod in placenta
  • Other: Oxytocin: uterine contractions, milk ejection
33
Q

Functions estrogen

A
  • Increase uterine blood flow
  • Prepare breast tissue for lactation
  • Stimulate hormone binding globulin from liver
34
Q

Phases of parturition

A
  • Phase 1: Quiescence (inactivity, inhibited myometrial contractions, progesterone)
  • Phase 2: Activation (last 6-8 wks of pregnancy, myometrial activation from stretch or fetal HPA-axis => ACTH => cortisol => surfactant. Fetal lung: SP-A.)
  • Phase 3: Stimulation (fetal cortisol and DHEA-S, increasing maternal estrogen => CAPs (connexin 43, oxytocin and prostaglandin R´s => contractions)
  • Phase 4: Involution (puerperium, oxytocin increase => placental separation)
35
Q

Mississippi class system HELLP

A 
LDH > 600n U/L + ASAT/ALAT > 40 U/L +
Platelets:
- Class I: < 50000 /microL
- Class II: 50000 - 100000 /microL
- Class III: 100000 - 150000 /microL
36
Q

Normal weight gain pregancy

A

9-14 kg

37
Q

Estimation of gestational age

A
  • Clinical: Naegle´s rule
  • US at first prenatal visit! (gw 11-13+6 og gw 6-7?) - crown-rump length (evt. femur length, biparietal diameter, abd/head circumference)
38
Q

Lab tests done each trimester

A
  • CBC
  • Urine sediment or culture
  • Vaginal smear (for bacterial vaginosis)
39
Q

Triple marker screen test

A 
Gw 15-20
- aFP
- Estriol
- hCG
Screen for Downs, Edwards SY, NT defect
40
Q

Screening strep B

A

Vaginal and rectal gw 35-37

41
Q

Screening chlamydia, gonorrhea

A

In high-risk patients

- 1st and 3rd trimester

42
Q

False labor contractions

A

Braxton Hicks contractions

43
Q

Contraction freq and intensity in normal labor

A

Stage 1

  • Latent: 60-90 sec every 15 min (50 mmHg)
  • Active: 45 sec every 3 min (50 mmHg)

Stage 2
- 45 sec every 3 min (75 mmHg)

44
Q

Active phase labor abnormalities

A 
Protraction disorder (slower)
or active phase arrest (no dilation for 2 hrs)
45
Q

Second phase labor disorders

A
  • Disproportion of fetus and pelvis

- Maternal pushing efforts

46
Q

Types of uterine labor dysfunctions

A
  1. Hypotonic uterine dysfunction
    - Pressure unsufficient to give cervical dilation
  2. Hypertonic uterine dysfunction
    - Colicky uterus
    - Hyperactive lower segment
47
Q

Drugs for general anesthesia in emergency c-section

A

Thiopental + succinylcholine + N2O + O2

48
Q

Maneuvers shoulder dystocia

A
  1. McRoberts maneuver: flex legs and pressure over pubic symphysis
  2. Rubin maneuver: rocking shoulder back and forth
  3. Wood corkscrew maneuver: grab posterior shoulder and rotate baby
  4. Gunn-Zavanellie: push baby head back and -section
  5. Cleidotomy, symphysiotomy
49
Q

Maneuvers breech

A
  1. Bracth maneuver: pull over symphysis gently
  2. Müller maneuver: unknown
  3. Maurice-Smellei-Veit: grab face right hand and other hand hook shoulders/push occiput
50
Q

Tests ROM

A
  1. Nitrazine paper: turn blue (alkaline)
  2. Fern test: NaCl cryztallize (microscope) in a fern pattern in the presence of estrogen (as in amniotic fluid or before ovulation - not after when progesterone predominates)
  3. AmniSure test: measure PAMG-1 (placental alpha-microglobulin a)
51
Q

TORCHeS

A
  • Toxoplasmosis: cat, intracerebral calcifications, chorioretinitis, hydrocephalus
  • Other (VZV, Parvovirus B19, HIV, zika)
  • Rubella: cataract, deafness, PDA, (rash, jaundice, mental)
  • CMV: Microcephaly, IUGR, mental ret, Periventricular calcifications, Sensoryneural hearing loss
  • Syphilis: Hutchinsons triad: hutchinsons teeth, deafness and interstitial keratitis
52
Q

Infectious diseases in pregnancy, not TORCHes

A
  • Listeria monocytogenes
  • Chlamydia
  • Gonorrhea
  • Strep B (agalactie)
53
Q

TORCH syndrome

A

In utero transmission of congenital infection

  • Hepatosplenomegaly, Jaundice
  • Fever, Lethargy, Difficulty feeding
  • Anemia, petechiae, purpura
  • Chorioretinitis
  • Hearing impairment
54
Q

Biophysical profile

A
  1. NST: over 2 good accellerations in 20-40 min
  2. Breathing: one or more rhythmic episodes lasting over 30 sec within 30 min
  3. Movements: more than 2 movements in 30 min
  4. Tone: 1 episode of extension + flexion (eg opening+closing of hand)
  5. AFI: One or more pockets of at least 2 cm
55
Q

Uterine and cervical changes puerperium

A
  • Uterine involution: 1000 gr to 50-100 gr (6 wks pp)
  • Endometrial lining degenerates day 16
  • Lochia 4-8 wks pp (rubra, serosa, alba)
  • Eschar sloughs off 1-2 wks pp (blood loss ca 250 ml)
  • 1 wk pp, cervix is back to normal
56
Q

Endometritis puerperium

A
  • Foul-smelling lochia

- Wash with iodine

57
Q

3 reasons for puerperial fever

A
  1. Mastitis
  2. UTI
  3. Thrombosis
58
Q

Perineum, abdominal wall puerperium

A
  • Perineum: swelling down after 1-2 wks, muscle tone after 6 wks
  • Abdominal wall soft and poor tone for many weeks
59
Q

Urinary tract puerperium

A

Ureters and pelvis return to normal after 2-6 wks pp

60
Q

Cardiovascular system puerperium

A
  • Immediately after delivery increase in peripheral vascular resistance
  • CO and plasma volume return in 2 wks
  • Leukocytosis and thrombocytosis occur during and after labor
61
Q

Return of menstruation after delivery

A
  • Not breast feeding: 6-8 wks pp

- Breast feeding: longer due to prolactin

62
Q

Treatment genital warts (HPV)

A
  • Imiquimod cream
  • Podophyllotoxin
  • Cryotherapy
63
Q

Non-treponemal tests (non-specific)

A
  • RPR: rapid plasma reagin
  • VDRL: Venereal disease research laboratory
  • TRUST: Toluidine red unheated serum test
64
Q

Treponemal tests (specific)

A
  • FTA-ABS: fluorescent trep antibody absorption
  • MHA-TP: microhemagglutination test for ab t.pallidum
  • TPPA: t.pall particle agglutination assay
  • TP-EIA: t.pall enzyme immunoassay
  • CIA: chemiluminescence immunoassay
65
Q

Sexually transmitted diseases du ikke kan navnet på

A
  • Lymphogranuloma venereum: L1-L3 chlamydia, painless ulcer, painfull LN, Tx: doxycyclin or erythromycin (som chlamydia)
  • Granuloma inguinale: klebsiella granulomatis (donovan), painless ulcer, Tx: azithromycin, ciprofloxacin, or erythromycin
  • Chancroid/ulcus molle: H. Ducreyi, painfull ulcer, Tx: azithromycin and ceftriaxone (som gonorrhea)
  • Pediculosis pubis, Tx: permethrin scrub

Gynecology (4 decks)

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