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OB/Gyn > Approach to the OB/Gyn Patient > Flashcards

Approach to the OB/Gyn Patient Flashcards

1
Q

What does LMP stand for?

A

Last Menstrual Period.

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2
Q

Important aspects (5) to get when getting a patient’s menstrual history?

A
  1. Age of onset or Menarche.
  2. Length of cycle or the days b/t periods.
    - -Normal cycle is 21-35 days.
  3. Characteristics of cycle:
  4. LMP.
  5. Intermenstrual bleeding.
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3
Q

What is intermenstrual bleeding?

A

Abnormal bleeding between periods.

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4
Q

Important aspects (5) to discuss when getting a patient’s sexual history?

A
  1. Age at first intercourse.
  2. Total number of partners and the timing of those partners (new partners w/in 6 mo, 12 mo, etc).
  3. “Men, Women or Both.”
  4. Practices – type of intercourse?
  5. History of STI – Treated? Test of Cure?
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5
Q

What is the definition of intercourse?

A

Any penetration of the oral, anal or vaginal cavity.

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6
Q

Important aspects to elicit when asking a patient about their contraception history?

A
  1. Current Method:
    - -Type, Length of time used, Compliance, Side Effects, Satisfaction.
  2. Previous methods and why discontinued.
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7
Q

Why is it important to know date of the pt’s last pap smear?

A

It determines the need for cervical cancer screening.

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8
Q

What is the recommended age for cervical cancer screening and what tests are necessary?

A
  1. Starts at 21, regardless of sexual history; repeated every 3 years if normal.
    - -Includes the PAP Smear ONLY (aka Cytology).
  2. At age 30, PAP Smears include HPV Testing (aka Co-testing); repeated every 5 years if normal.
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9
Q

Why is it important to know the date of the pt’s last mammogram?

A

It determines the need for breast cancer screening?

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10
Q

When does breast cancer screening start, repeat, and End?

A

According to the USPSTF, Breast CA screening starts at age 50, every 2 yrs (Biennial) and stops at age 74.

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11
Q

What does USPSTF stand for?

A

U.S. Preventive Services Task Force

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12
Q

When does breast cancer screening (mammogram) start, repeat, and End?

A

According to the USPSTF, Breast CA screening starts at age 50, every 2 yrs (Biennial) and stops at age 74.

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13
Q

What does USPSTF stand for?

A

U.S. Preventive Services Task Force

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14
Q

HPV Prevention?

A

Gardasil vaccine – recommended for ages 9-40, 3-shot series unless started and completed by age 15 yrs, then only 2 shot series.

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15
Q

Who do we screen for Intimate Partner Violence (IPV)?

A

All women of “child-bearing age.”

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16
Q

How do we record Obstetric History?

A

GP(TPAL)

  1. Gravidity – total # of pregnancies.
  2. Parity – total # of pregnancies >20 weeks; detailed further in the TPAL.
17
Q

What does TPAL stand for in regards to Parity?

A
  1. Term (37 wks or greater).
  2. Preterm (36 wks or less).
  3. Abortion (not carried to term for whatever reason).
  4. Live births.
18
Q

What is the obstetric history of a 28 y/o female who is currently 38 wks pregnant. She had an abortion at 8 wks two years ago and delivered a healthy baby boy at 39 wks three years ago?

A

G-3, T-1, P-0, A-1, L-1

19
Q

What is the obstetric history of a women who had a singleton at 40 wks, then twins at 30 wks. No other pregnancies?

A

G-2, T-1, P-2, A-0, L-3

20
Q

Important aspects to get when asking about pregnancy history details and complications?

A
  1. HTN or DM; or other medical conditions.
  2. Placenta previa or Abruptio placenta.
  3. Premature rupture of membranes (PROM).
  4. Intrauterine Growth Restriction (IUGR).
21
Q

What important aspects in regards to delivery history of the OB patient?

A
  1. Delivery Type:
    - -Vaginal (spontaneous, assisted w/vacuum or forceps, after a previous cesarean section).

–Cesarean Section (scheduled or planned, performed after failed vaginal delivery).

22
Q

What does VBAC stand for?

A

Vaginal birth after cesarean.

23
Q

What other aspects of delivery are important to get?

A
  1. Complications – preterm labor, postpartum hemorrhage, retained placenta.
  2. Fetal size – recorded/measured in grams.
  3. Fetal APGAR score – at 1 and 5 minutes.
  4. Fetal Malformations.
24
Q

What does APGAR stand for?

A
  1. Appearance.
  2. Pulses.
  3. Grimace.
  4. Activity.
  5. Respirations.
25
Q

What formula do we use for estimating the due date of a new pregnancy?

A

Naegele’s Rule

**(Date of LMP + 7 days) - 3 months.

26
Q

What does EDC stand for?

A

Estimated date of Confinement.

27
Q

Example: 31 y/o G2T2P0A0L2, with LMP 08/01/2020…

A

EDC = (08.01.20 + 7 days) - 3 months = 08.08.20 - 3 months = 05.08.2021.

28
Q

When do calories increase during pregnancy?

A

the 2nd and 3rd trimester.

  • Avoid alcohol, tobacco, illicit drugs.
  • Avoid King Mackerel, Shark, Swordfish, Tilefish.
29
Q

Examples of medications that are teratogenic?

A
  1. ACEi.
  2. Statins.
  3. Phenytoin.
  4. NSAIDs – be specific.
  5. Tretinoin.
  6. Tetracyclines.
30
Q

What should newly pregnant individuals be taking?

A

A prenatal vitamin; specifically for Folic Acid and Iron.

31
Q

What are the intervals for follow-up visits during pregnancy?

A
  1. ONCE a month for the 1st 28 weeks (7 months).
    - -At 24 wks, test for Gestational Diabetes.
  2. Every 2 weeks from 29-36 weeks.
  3. Every week from 37 weeks to deliver.
32
Q

Why do we screen pregnant patients for IPV?

A

Homicide risk is increased during pregnancy.

33
Q

What vaccines are indicated during pregnancy?

A
  1. TDap – always recommended; b/t 27 and 36 wks.
  2. Flu shot seasonally.
  3. POSSIBLY Indicated – HepA, HepB and Pneumococcal.
  4. MMR and Varicella – NEVER indicated.
34
Q

How often do we screen for IPV?

A

Every visit – homicide risk is increased during pregnancy.

**Homicide is one of the leading causes of death in the pregnancy.

35
Q

How often do we screen men for IPV?

A

When it is suspected.

36
Q

What are some screening options for IPV?

A
  1. HITS – Hurt, Insult, Threaten, Scream.
  2. WAST – Women Abuse Screening Tool.
  3. PVS – Partner Violence Screen.
  4. AAS – Abuse Assessment Screening.
  5. SAFE-T – Suicide Assessment and Five-Step Evaluation and Triage.
37
Q

What are some common breast complaints?

A

Pain, tenderness, lumps, nipple discharge, skin changes, change to size/shape of breast.

38
Q

What are some common aspects to collect when asking about breast complaints?

A
  1. Change with menstruation.
  2. Hx of surgery/biopsy to that breast.
  3. Hx of GYN or Colorectal Cancer?
  4. FH of these cancers or BRCA1/BRACA2?
  5. Previous mammograms or other imaging?
39
Q

What are the characteristic of menstrual flow?

A

Duration, flow amount, associated symptoms (abd. pain, cramping, bloating, HA, mood swings, fatigue, etc).

OB/Gyn (14 decks)

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