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Repro Midterm > Clinical > Flashcards

Clinical Flashcards

1
Q 
TQ
# of times pt's been preg (twins only counts as 1)
A

Gravidity

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2
Q 
TQ
# of pregs that led to birth at or beyond 20 wks OR weighing >500g
A

Parity

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3
Q

TQ

Baby born at term? (wks)

A

37-42 wks

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4
Q

TQ

Baby born preterm? (wks)

A

20-36 wks and 6 days

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5
Q

TQ

All pregnancy losses before 20 wks is defined as?

A

Abortion

  • Spontaneous Abortion (aka miscarriage)
  • Elected Abortion
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6
Q

How many living kids mom has is defined as?

A

Living

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7
Q

TQ

GPTPAL stands for…

A

Gravidity; Parity; Term; Preterm; Abortion; Living.

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8
Q

TQ
G and Ps?
1) Preg w/ triplets; all delivered pre-term

2) Delivered 39wk male; 2 spont abortions; one living child
3) 1 living child; birth to twins @ 30wks (1 stillborn); had 2 abortions
4) 3 deliveries @ 37, 39, 32 wks; 1 ectopic

A

1) G1P0103
2) G3P1021
3) G3P0121
4) G4P2113

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9
Q

TQ
What is Naegeles Rule?

Apply it…

ex: if LMP- 7/20/2012
EDC?

A

EDC of 4/27/2013

Due date!
Pt knows when LMP was… to get due date:

Subtract 3 mo, add 7 days

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10
Q

Abnormal vaginal bleeding:

  • post-coital?
  • post-meno?
  • Clots?

Dx..

A

Post-coital=cervical ca

Post-meno=endometrial/uterine ca

Heavy bleeding/clots=structural abnormality (fibroids)

Pt reports pain w/ sex…think endometriosis

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11
Q

TQ

When do we give breast exams?

A

Every 1-3 yrs for women 20-39 yo.

Every yr w/ annual mammograms for F >40yo.

Inverted nipples concerning for ca

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12
Q

Menstrual info:

  • Menarche usually b/t what ages?
  • Cycles: 28days +/- 7 (21-35). -Days of Menses: 5-7.
A

12-13 yo

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13
Q

When does the ACOG recommend having your first visit to OB/GYN for screening?

A

13-15 yo

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14
Q

13-18 yo F presents in clinic.

Key info needed during hx?

PE: : 2ndary sex charc, pelvic exam for vag d/c, menstrual disorder, pelvic pain, STIs, abd exam, periodic STI check, HIV

Key eval and counseling for this age group?

Immunizations?

A

Hx: Menarche? FMH? Tobacco, alcohol, Drugs? Sexual abuse/practices?

Eval & Counseling: STI prevention-barrier protection; sex abuse; bullying, tobacco, alcohol, drugs

Immunizations:

  • HPV Vaccine-(b/t ages 9-26) quadrivalent for HPV 6,11,16,18.
  • Diptheria & dTAP vaccine (once b/t 11-18 yo)
  • Also: Hep B. Flu. MMR. Varicella.
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15
Q

19-39 yo F presents in clinic.

Key info needed during hx?

When do you start giving breast exams? Paps?

Labs/tests?

Key eval and counseling?

Immunizations?

A

Hx: FMH? smoke, drink drugs? Sex practices- vag, anal, oral?

Breast exam every 1-3yrs @20 yo.. (first pap @21 yo)

Labs/tests:
Cervical Cytology (test)-
21-39yo: every 3 yrs w/ cytology alone;
@ >30yo screen every 3 yrs w/ cytology alone + co-test w/ cytology & HPV testing every 5 yrs.

HIV!

G&C (25 yo and under).

Eval & Counseling:

  • Repro health plan
  • preconception & genetic counseling
  • STD prevention
  • partner violence
  • rape prevention
  • breast self-awareness
  • smoke, drink, drugs.

Immunizations:

  • Diptheria & dTAP.
  • HPV.
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16
Q

TQ
40-64 yo F presents in clinic.

Key info needed during hx?

Breast exam frequency?

TQ
Labs/tests? (hint colon, mammo)

Key eval and counseling?

Immunizations? (what additional vaccine)

A

Hx: Menopausal sx, pelvic prolapse, FMH, tobacco, alcohol, drugs

PE: Begin annual breast exam.

Labs/tests:
-Cervical Cytology: every 3 yrs cytology alone + co-test w/ cytology & HPV testing every 5yrs.
-Colorectal cancer screening every 10 yrs:
African Americans @45yo, everyone else starts @50yo.
-HIV
-Lipid profile every 5 yrs @45yo
-Mammography yearly after 40yo.
-Diabetes: every 3yrs @45yo

Eval/Counsel:

  • genetic counseling
  • sexually transmitted dz prevention
  • partner violence, advanced directives
  • Tobacco, alcohol drugs
  • +Breast self-awareness.

Immunizations:

  • Tdap boosters every 10 yrs
  • **Varicella Zoster for >60yo.
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17
Q

TQ
>65 yo F presents in clinic.

Key info needed during hx?

Breast exam frequency?

TQ
Labs/tests? (hint discontinue….)

Key eval and counseling?

Immunizations? (what additional vaccine)

A

Hx: Menopausal symp?Pelvic prolapse? FMH? Tobacco, drink, drugs?

PE: annual breast exam

Labs/tests:

  • Can stop cervical cytology if no hx (neg. 3 yrs or 2yrs + co-test)…otherwise 20 yrs
  • Colorectal screening every 10 years if>50yo unless African American (45yo)
  • **-Bone Mineral Density Screening: no risk factors then every 2yrs.
  • Lipid profile: every 5 yrs @45yo.
  • Yearly mammography

Eval: Sexual fxn., STI, partner violence, advanced directives, brest-awareness, etc

Immuno:
+ Pneumococcal Vaccine for >65yo.

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18
Q

TQ
High risk factors for ALL ages require what earlier screening…

<127lbs, history of fractures, smoker, alcoholic, RA.

A

Bone Mineral Density

19
Q

TQ
High risk factors for ALL ages require what earlier screening…

<40 yo if history of breast ca, family history of ca, + BRCA mut, hi-risk biopsy results.

A

Mammography

20
Q

TQ
High risk factors for ALL ages require what earlier screening…

<45yo if history or family history of CAD, AAA, PAD, Obesity, DM, PVD, Hyperlipidemia, premature CV dz.

A

Lipid Profile

21
Q

TQ
High risk factors for ALL ages require what earlier screening…

History or family history of colorectal ca, polyps, IBD.

A

Colorectal

22
Q

TQ
High risk factors for ALL ages require what earlier screening…

25, 1st degree relative w/ DM, hi-risk race (Native American, Latino), gestational DM, PCOS.

A

Diabetes

23
Q

TQ
High risk factors for ALL ages require what earlier screening…

<50yo if family history of thyroid dz

A

Thyroid

24
Q

TQ
High risk factors for ALL ages require what earlier screening…

History of multiple sex partners/infxs, sexual contact with STI partner, sexually active adolescents

A

STI

25
Q

TQ
High risk factors for ALL ages require what earlier screening…

  • Adults with anatomic/fuctional ASPLENIA
  • 1st yr college/dorm + military,
  • travel to endemic areas
A

Meningococcal Vaccine

26
Q

TQ

What is Chloasma?

A

Pigmentation over bridge of nose that may indicate preg (or pt may be on birth control)

27
Q

T/F

1/8 women are diagnosed w/ breast cancer

A

TRUE

28
Q

TQ
Breast exam
Quadrants: Upper inner, Upper outer, lower inner, lower outer.

MC site for ca to occur?

  • Have pt lean fwd–ca may cause adherence to body.
  • Breast ca may show dimpling.
  • Breast ca is PAINLESS.
A

MOST CANCERS OCCUR UPPER OUTER!

29
Q

Best time to perform breast exam?

A

Best time is 1 wk after cycle

30
Q

Pelvic exam:

  • Make sure butt barely off end of table (dorsal lithotomy position)
  • Aim speculum at top of vagina @ 45 degree angle
  • What do you do if cervix out of view?
A

DO NOT PULL SPECULUM OUT if cervix is not in view immediately

May be in ant/post fornix so angle superior/inferior

31
Q

TQ
What type of speculum should you use?

1) 1st pelvic exam or younger pt
2) Nulliparous (no preg) women.
3) Multiparous (multiple preg) or obese females
4) ER setting

A

1) Pediatric Speculum: narrow bladdes.
2) Pederson Speculum: narrower blades
3) Graves Speculum: wider blades.
4) Plastic Speculum-

32
Q

TQ
You see the cervix…what type of cervix are these?

1) looks like perfect circle (conical).
2) “Bass-mouth” (flat/wide) can see past damage

A

1) Nulliparous Cervix

2) Multiparous Cervix

33
Q

TQ

What is Chadwick’s Sign?

A

a bluish hue to cervix indicates preg cervix

34
Q

TQ
Dx?
-“Strawberry cervix” w/ fishy, malodorous odor, w/ yellowish green d/c esp after intercourse

A

Trichomomas vaginalis (STD)

35
Q
  • Most common vaginal infection.

- Foul smelling thin grey homogenous discharge

A

Bacterial Vaginosis

36
Q

White adherent discharge

A

Yeast Vaginitis

37
Q

When swabbing for G/C, how long should you leave the swab in for?

A

45 seconds!

38
Q

TQ
What is this called?

1) Spatula first to scrape exctocervix then
2) Cytobroush second to obtain endocervical cells. Note rugae.

A

PAP Exam

39
Q

How can we prepare cervical cytology? (2)

A

RARE: Wipe 1/2 slide w/ spatula; wipe cytobrush on other 1/2 of slide.

OR MORE COMMON:
Thin-prep:
Pop off end of cytobrush, send whole thing in (can test for more than just cytology-HPV, etc)

40
Q

TQ

Which form of HPV is associated with cancer?

A

16 and 18

41
Q

TQ

What are you checking during an internal bimanual exam?

A

Cervix, uterus, ovaries

Palpate vaginal walls for cysts, nodules masses/growths.

Cervix:

  • cervical consistency: non-preg feels like tip of nose; preg= softer.
  • Cervical motion tenderness w/ exam=indicative of PID.

Uterus (post-fornix):
- Hegar’s sign-softening of uterus

Ovaries (right lateral fornix):
-walnut size; often difficult to palpate.

42
Q

To assess anal sphincter, rectal walls, uterosacral nodularity (endometriosus).

Check walls for masses, polyps, strictures, tenderness.

Should feel smoothe.

Usually done in older pts.

A

Rectovaginal exam

helps to dx rectocele vs enterocele

43
Q

Uterus normally at 45 degree angle. What are some other positions?

A 
Anteverted
Anteflexed
Retroverted
Retroflexed
Midposition

Repro Midterm (8 decks)

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