#9: Women's Health Flashcards

1
Q

When should a pelvic exam not be performed

A

NO pelvic exams when pt is > 20 wks gestation

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2
Q

What should be at top of ddx for post menopausal women w/ vaginal bleeding

A

DDx for for post menopausal women w/ vaginal bleeding

think CANCER!

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3
Q

MC cause of maternal mortality in 1st 12 wks of pregnancy

A

Ectopic pregnancy

  • MC cause of maternal mortality in 1st 12 wks of pregnancy
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4
Q

Vaginal Bleeding: Ectopic Pregnancy

  1. what is the MC site
  2. What is the biggest RF for it
A

Vaginal Bleeding: Ectopic Pregnancy

  1. MC site = fallopian tube
  2. biggest RF = PID (h/o G/C)
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5
Q

Pt presents w/ 1st trimester abd pain, vaginal bleeding, and adnexal mass

Dx?

A

Dx = Ectopic pregnancy

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6
Q

Dx: Ectopic Pregnancy (Vaginal Bleeding)

  1. what test is done serially to confirm pregnancy
  2. what is done to eval hemodynamic stability
  3. what test is done to assess location of preg (IUP, extrauterine, etc)
A

Dx: Ectopic Pregnancy (Vaginal Bleeding)

  1. b-HCG serially to confirm pregnancy (Q2 days)
  2. eval hemodynamic stability–> FAST exam
  3. assess location of preg (IUP, extrauterine, etc) –> TVUS
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7
Q

Dx: Ectopic Pregnancy (Vaginal Bleeding) w/ TVUS

  1. what should be used if TVUS is non-diagnostic
A

Dx: Ectopic Pregnancy (Vaginal Bleeding) w/ TVUS

  1. TVUS is non-diagnostic –> b-HCG discriminatory zone
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8
Q

Dx: Ectopic Pregnancy (Vaginal Bleeding) w/ b-HCG discriminatory zone and TVUS

  1. what b-HCG value should the IUP be visible on US
  2. at how many wks should you see yolk sac (TVUS)
  3. at how many wks should you see cardiac activity (TVUS)
A

Dx: Ectopic Pregnancy (Vaginal Bleeding) w/ b-HCG discriminatory zone

  1. b-HCG value of 2000 –> IUP should be visible on US
  2. see yolk sac at 6 wks w/ TVUS
  3. see cardiac activity at 6.5 wks w/ TVUS
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9
Q

Management of Ectopic Pregnancy (Vaginal Bleeding)

  1. what are option(s) if pt is stable
  2. what are option(s) if pt is unstable
A

Management of Ectopic Pregnancy (Vaginal Bleeding)

  1. stable –> medical or surg
  2. unstable –> surg
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10
Q

Tx of Ectopic Pregnancy (Vaginal Bleeding): Medical

  1. what is the drug given
  2. other than stable/unruptured: what ectopic size and what level b-HCG qualifies for this tx
A

Tx of Ectopic Pregnancy (Vaginal Bleeding): Medical

  1. drug = MTX
  2. other than stable/unruptured: qualifies for this tx
    - ectopic size < 3-4 cm
    - b-HCG < 10, 000
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11
Q

Tx of Ectopic Pregnancy (Vaginal Bleeding): Surgical

  1. for stable pts
  2. for unruptured, future fertility desired
  3. for ruptured, future fertility not desired
A

Tx of Ectopic Pregnancy (Vaginal Bleeding): Surgical

  1. for stable pts –> laparoscopic
  2. for unruptured, future fertility desired –> salpingostomy
  3. for ruptured, future fertility not desired –> salpingectomy
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12
Q

f/u for Ectopic Pregnancy (Vaginal Bleeding): all methods

  1. when can you stop following b-HCG levels
  2. what med often given postop
A

f/u for Ectopic Pregnancy (Vaginal Bleeding): all methods

  1. stop following b-HCG levels once 0
  2. med given postop = MTX
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13
Q

implantation of placenta over the os

A

Placenta previa = implantation of placenta over the os

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14
Q

22 wk preg pt having twins presents w/ painless, bright red vaginal bleeding. She had prior c-sections with her last 2 pregnancies and is a smoker.

Dx?

A

Placenta previa

  • RFs: c-section, multiple gestations, smoker, preg w/twins
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15
Q

partial or complete separation of placenta before delivery

A

placenta abruption

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16
Q

22 wk preg pt who uses cocaine, has HTN, smokes and has hx of fibroids presents w/ painful vaginal bleeding. She has had 1 c-section in past.

Dx?

A

Placenta abruption

  • RFs: cocaine use, HTN, hx of fibroids, smoking, c-section
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17
Q

Dx: of Placenta previa and abruption

  1. how to Dx previa, what should not be done
  2. Placenta abruption
    - what is the classic finding on US
A

Dx: of Placenta previa and abruption

  1. Dx previa w/US , DONT do pelvic exam
  2. Placenta abruption
    - classic finding on US = retroplacental clot
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18
Q

Tx of Placenta previa

  1. what to do until bleed stabilizes
  2. what are the 3 indications for C-section
  3. post care
    - what given for baby when 23-34 wks gestation
    - who to give Rho-gam to
    - when to schedule C-section
A

Tx of Placenta previa

  1. bedrest/hospitalize until bleed stabilizes
  2. 3 indications for C-section
    - life threatening maternal hemorrhage
    - non-reassuring fetal status
    - signif bleed > 34 wks
  3. post care
    - 23-34 wks gestation–> CCS to mature lungs
    - Rho-gam to Rh- mothers
    - sched C-section for 36-37 wks
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19
Q

Tx of placenta abruption

  1. aggressive management of what?
  2. what procedure needed
A

Tx of placenta abruption

  1. aggressive management of hemodynamics
  2. need EMERGENT C-section
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20
Q

Post partum hemorrhage

  1. definition: how much blood loss w/vaginal delivery and w/ c-section
  2. MC cause and Tx
  3. 4 tx options
A

Post partum hemorrhage

  1. definition: > 500m ml blood loss w/vaginal delivery and > 1000 w/ c-section
  2. MC cause = uterine atony, Tx = oxytocin
  3. 4 tx options
    - remove POC
    - Uterine packing
    - embolize pelvic vessels
    - hysterectomy
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21
Q

loss of IUP pregnancy < 20 wks

A

Spontaneous abortion

22
Q

Spontaneous abortion: Types

  1. which 2 have closed cervix + absent HR
  2. which has closed cervix + present HR
  3. which has open cervix + absent HR
  4. which has open cervix + (+/-) present HR
A

Spontaneous abortion: Types

  1. closed cervix + absent HR = missed and complete
  2. closed cervix + present HR = threatened
  3. open cervix + absent HR = incomplete
  4. open cervix + (+/-) present HR = inevitable
23
Q

Spontaneous abortion Tx

  1. tx for threatened
  2. tx for inevitable or missed
A

Spontaneous abortion Tx

  1. tx for threatened = rest, close f/u
  2. tx for inevitable or missed = D&C
24
Q
  1. abn yolk sac
  2. Fetal HR < 100
  3. small/irreg shaped gestational sac
  4. sub-chorionic hemorrahge/hematoma > 25%

US signs and Sxs of what type of spontaneous abortion

A

US signs and Sxs of inevitable spontaneous abortion

  1. abn yolk sac
  2. Fetal HR < 100
  3. small/irreg shaped gestational sac
  4. sub-chorionic hemorrahge/hematoma > 25%
25
Q

25 y/o F w/PMH of PCOS presents w/ acute onset of R sided abd pain w/palpable adnexal mass, N/V and fever. on US you see an 5 cm ovarian cyst in R ovary and no flow occurring to ovary

Dx?

A

Dx = ovarian torsion
- US –> no flow to ovary

RFs = cyst > 4cm, R ovary, menstruating females, PCOS

26
Q

Dx of Ovarian Torsion

  1. what is best imaging study for it
  2. what is gold std for Dx
A

Dx of Ovarian Torsion

  1. best imaging study = US
  2. gold std for Dx = surgery
27
Q

tx of ovarian torsion

  1. why is it an emergency
  2. Tx for premenopausal
  3. tx for postmenopausal
A

tx of ovarian torsion

  1. emergency - preserve ovarian function
  2. Tx for premenopausal = laparoscopic
  3. tx for postmenopausal =salpingo-oophorectomy
28
Q

Ovarian Cysts

  1. which type occurs when follicle doesnt shrink and likely produce sxs
  2. which type occurs when follicle doesnt rel egg and likely to be Asx
  3. gold std for Dx
A

Ovarian Cysts

  1. follicle doesnt shrink, Sxs = corpus luteum cyst
  2. follicle doesnt rel egg, Asx = follicle cyst
  3. gold std for Dx = abd or TV US
29
Q

Pt presents w/ abd pressure, bloating, and swelling as well as pain in the L lower abdomen. on abd US you see a mass

Dx?

A

Dx = Ovarian cyst

30
Q

Ovarian Cyst Tx

  1. what to do if Asx or incidental finding
  2. what can be given to decr freq of it
  3. consider surgical intervention if:
    - doesnt resolve in ____
    - what size
    - what type
A

Ovarian Cyst Tx

  1. what to do if Asx or incidental finding –> observe
  2. what can be given to decr freq of it –> OCPs
  3. consider surgical intervention if:
    - doesnt resolve in 3 mo
    - > 5-10 cm
    - complex cyst
31
Q

Pt presents w/ acute onset of RLQ abd pain after having sex. Pt’s BP is 90/56. On US you see free fluid in pouch of Douglas

Dx?

A

Dx = Ovarian cyst rupture

32
Q
  1. Unstable (HoTN, tachycardia)
  2. no relief in 48 hrs
  3. possible torsion
  4. increasing hemopertineum
  5. decreasing Hemoglobin

indications for what type of Tx for ovarian torsion

A
  1. Unstable (HoTN, tachycardia)
  2. no relief in 48 hrs
  3. possible torsion
  4. increasing hemopertineum
  5. decreasing Hemoglobin

indications for laparascopy for ovarian torsion

33
Q

Pt presents w dysuria and fishy, malodorous d/c that smells worse after sex. She has no dyspareunia. On pelvic exam pt has mild cervical tenderness and you see a gray, thin d/c. On wet mount you see clue cells, + whiff test

Dx?
Tx?

A
Dx = BV 
Tx = Metronidazole PO
34
Q

Pt presents w/ frothy yellow/green very malodorous d/c, post coital bleeding, dyspareunia, pruritus and dysuria. On exam you see strawberry cervix and on wet mount you see a motile organism.

dx?
tx?

A
Dx = Trichomoniasis 
Tx = Metronidazole PO
35
Q

Tx of Trichomonas

  1. who must you tx
  2. when giving metro PO what should you warn the pt about
A

Tx of Trichomonas

  1. must tx partners
  2. when giving metro PO –> no EtOH for 24 hrs
36
Q

What is the MC cause of vaginitis

A

Candida = MC cause of vaginitis

37
Q

Pt w/ recent ABX use presents w/ pruritus/vulvar burning, excoriations, vaginal rash and yellow/white “ccottage cheese” looking d/c. On exam you see thick d/c that adheres to wall. pH is acidic. On wet mount you see pseudo-hyphae.

dx?

A

Dx = Candidiasis

RF = ABX use

38
Q

Tx of Candidiasis

  1. what are 2 options for non-preg pts
  2. what is tx for preg pts
A

Tx of Candidiasis

  1. 2 options for non-preg pts
    - fluconazole PO x 1
    - azole vaginal creams
  2. what is tx for preg pts
    - azole vaginal creams
39
Q

RFs for PID

  1. sexual RF
  2. what age range
  3. H/o _____
  4. what device (small risk)
A

RFs for PID

  1. unprotected sex w/ several ppl
  2. age 15-25 MC
  3. H/o prior PID
  4. IUD (small risk)
40
Q

IUD and RF for PID

  1. when is the only time it incr pts risk
  2. does removal usu improve tx
  3. when should it be removed in pts w/PID
A

IUD and RF for PID

  1. only time it incr pts risk = 1st 3 wks after insertion
  2. removal does NOT usu improve tx
  3. no improvement in 58-72 hrs –> remove it
41
Q

Pt presents w/ dyspareunia, abn vaginal bleeding post coital, vaginal d/c, LLQ pain, peritonitis and signs of shock. On exam you note CMT.

Dx?

A

PID

42
Q

What 3 signs on PE and lower ab/pelvic pain needed to Tx empirically for PID

A

need lower abd/pelvic pain and 1+ to be present to Tx empirically for PID

  1. CMT
  2. Uterine tenderness
  3. adenexal tenderness
43
Q

Tx of PID

  1. what 2 meds for outpt tx (and consider adding what)
    - length of tx
  2. what are 2 tx options for inpt (2 drugs each)
A

Tx of PID

  1. 2 meds for outpt tx (and consider adding what)
    - Ceftriaxone + Doxycycline
    - +/- Metronidazole
    - Tx for 14 days (ceft = x 1)
  2. 2 tx options for inpt
    - Doxy + Cefoxitin/Cefotetan
    - Clindamycin + Gentamicin
44
Q
  1. TOA or pelvic abscess
  2. pregnant
  3. vomiting, high fever, failed outpt tx
  4. poor compliance/ follow up

when consider admission for ______

A

when consider admission for PID

  1. TOA or pelvic abscess
  2. pregnant
  3. vomiting, high fever, failed outpt tx
  4. poor compliance/ follow up
45
Q

PID Tx

  1. rules for txting partners
  2. abstain from sex til
  3. retest in 3 mo if + for _____
A

PID Tx

  1. txting ALL partners in last 60 days or last partner
  2. abstain from sex til tx done, Sxs resolve, partners txted
  3. retest in 3 mo if + for G/C
46
Q

Bartholin Cyst vs Abscess

  1. which forms when duct obstructed
  2. which forms when gland infected

note function of gland = lubrication

A

Bartholin Cyst vs Abscess

  1. duct obstructed = Cyst
  2. gland infected (or cyst infected) = Abscess
47
Q

Bartholin Cyst

  • 3 causes, which is MC
A

Bartholin Cyst causes

  1. thickened mucus
  2. infection
  3. MC = swelling that blocks the gland
48
Q

Pt presents w/ painless lump in posterior 2/3 of vulva, redness + swelling of vulva and discomfort while walking/sitting/sex. Sxs developed over 2 weeks

Dx?
Tx needed when?

A

Dx = Bartholin Cyst

Tx = observe
- need tx if infected

49
Q

Pt presents w/ painless lump in posterior 2/3 of vulva, redness + swelling of vulva and discomfort while walking/sitting/sex. Pt also has fever, and mucopurulent drainage. Sxs developed over 3 days.

Dx?

A

Dx = Batholin abscess

50
Q

Tx of Bartholin Abscess

  1. what is 1st line tx
  2. what is other non-surgical Tx
A

Tx of Bartholin Abscess

  1. what is 1st line tx = sitz bath/warm compress
  2. other non-surgical Tx = PO abx
51
Q

Tx of bartholin Abscess: surgical

  1. what is 1st line
  2. 2nd line and best for preventing recurrence
  3. last line
A

Tx of bartholin Abscess: surgical

  1. 1st line = I&D w/ word catheter
  2. 2nd line = marsupilization (best for preventing recurrence)
  3. last line = Gland incision
52
Q

Emergency Contraception

  1. which is MC
  2. which is Most effective
  3. names of 2 SERM drugs
A

Emergency Contraception

  1. MC = Plan B (progestin)
  2. most effective = copper IUD
  3. 2 SERM drugs
    - ullipristal
    - mifepristone