Clinical Care of the Obstetric and Gynecologic Conditions Flashcards
Painful breast masses that are often multiple and bilateral are caused by what?
Fibrocystic changes.
Pain from fibrocystic breast changes typically worsens during what phase of the cycle?
Premenstrual phase
What hormone is the causative factor of rapid fluctuation in fibrocystic mass size?
Estrogen
*Increased risk in alcohol consumption
This is the most frequent lesion of the breast that typically occurs between ages 30-50, and is typically considered to increase the risk of missing a cancer diagnosis.
Fibrocystic changes
Signs and symptoms of fibrocystic changes
Breast pain or tenderness
Discomfort that worsens during premenstrual phase as cysts enlarge
Fluctuation in size of masses
Multiple or bilateral masses
Absence of lymphadenopathy
Ultrasound should be used alone to diagnose fibrocystic changes in patients under what age?
30
What is the diagnostic test for fibrocystic changes?
Core needle biopsy
What is the treatment of fibrocystic changes?
NSAIDs
Refer to primary care for increased pain symptoms.
How do you educate a patient with fibrocystic changes?
Avoid trauma
Wear supportive bras night and day
Decrease dietary fat and eliminate caffeine
400iu of vitamin E daily
Monthly self breast exams just after menstruation because the risk of not detecting cancer is higher.
This is a common benign neoplasm that occurs most frequently in young women, usually 20 years after puberty and more frequently in black women.
Fibroadenoma
Signs and symptoms of fibroadenoma
Round or ovoid, rubbery mass with discrete margins (defined borders) that is relatively moveable and nontender, 1-5cm in diameter.
How do you treat fibroadenoma?
Referral to general surgery and biopsy. No treatment is typically necessary.
*An excision may be necessary for large or rapidly growing fibroadenomas (3-4cm)
This condition appears as a lesion of the breast that produces a mass often accompanied by skin or nipple retraction.
Fat necrosis
*Ecchymosis is usually present.
What are the typical causes of fat necrosis?
Fat injections for breast augmentations.
Trauma (MVA, assault)
Common after segmental resection, radiation therapy, or flap reconstruction after mastectomy.
This is the second most common cause of cancer in women, and the second leading cause of cancer death.
Female breast carcinoma.
What are the risk factors of female breast carcinoma?
Age
-Most significant factor
-Risk rises rapidly until 60s, peaks in 70s, then declines
Family history of breast or ovarian cancer
-Parent, sibling or child
-Especially bilateral breast cancer or premenopausal
Genetics
-BRCA 1 and 2
Reproductive history
-Nulliparous or late first pregnancy after age 30
-Unapposed estrogen is the cause ***
Menstrual history
-Early menarche <12
-Late menopause >55
Previous medical history
-Endometrial cancer
-Cancer in the other breast
What is the most reliable method of detecting non-palpable breast cancer, and how early can it identify it?
Mammography
At least 2 years before the cancer is palpable.
What are the breast cancer screening timing and frequency recommendations?
Age <40
-Not recommended
Age 40-49
-Shared decision making
-If initiating, suggest screening every 2 years
Age 50-74
-Recommend every 2 years, unless otherwise indicated
Age 75+
-Only if life expectancy is >10 years
What are the symptoms of female breast carcinoma?
Painless lump that is typically discovered by the patient
Breast pain, nipple discharge, nipple abnormalities, breast abnormalities (redness, hardness, enlargement or shrinking)
Axillary mass or swelling, back or joint pain, jaundice, weight loss
What are the physical exam findings of female breast carcinoma?
Early:
-Single, nontender, firm to hard mass with ill defined margins
-Mammogram abnormalities and non-palpable mass
Late:
-Skin or nipple retraction
-Axillary lymphadenopathy
-Breast enlargement, erythema, edema and pain
-Fixation of mass to skin or chest wall
What are the laboratory findings of a patient with female breast carcinoma?
Increased alkaline phosphatase caused by liver or bone metastases.
Increased serum calcium caused by bone metastases.
What is the treatment of female breast carcinoma?
General surgery referral, and depending upon the stage of cancer:
-Surgical resection with axillary node dissection (mastectomy or partial mastectomy)
-Radiation
-Systemic therapy
Local and distant female breast carcinoma recurrences occur most frequently within what time frame?
Patients should be examined how often?
Recurrences most frequently within the first 2-5 years.
During the first 2 years, most patients should be examined every 6 months, then annually thereafter.
What are the general considerations of male breast carcinoma?
It is rare.
Average age is 70.
Increased occurrence in men with prostrate cancer.
First degree relatives of men with breast cancer are at high risk.
BRCA 2 mutation are common.
Prognosis is worse in men.
Signs and symptoms of male breast carcinoma.
Painless lump with or without nipple discharge, retraction, ulceration or erosion
Hard, ill-defined, nontender mass beneath the nipple or stroll
Gynecomastia
Treatment of male breast carcinoma
General surgery referral
Modified radical mastectomy
Radiation
Systemic therapy
Bloody, unilateral nipple discharge is typically due to what?
Carcinoma
Serous nipple discharge is usually due to what?
Benign fibrocystic changes like duct ectasia
What condition can cause milky discharge in a non-lactating woman? What kinds of labs should you draw when evaluating this patient?
Hyperprolactinemia
Serum prolactin levels to rule out pituitary tumor
TSH to rule out hypothyroidism
What class of medications can elevate prolactin levels and cause lactation in men and women?
Antipsychotics
What type of medications can cause clear, serous or milky nipple discharge?
Oral contraceptives or estrogen replacement
A breast abscess may produce what kind of discharge?
Purulent
What is the mean amount of blood loss per cycle?
40mL
Define menorrhagia
Blood loss over 80mL
Define metrorrhagia
Bleeding between periods
Define polymenorrhea
Bleeding that occurs more often than every 21 days.
Define oligomenorrhea.
Bleeding that occurs less frequently than every 35 days.
What are the descriptive terms to denote menstrual bleeding patterns?
Light
Heavy
Menstrual
Intermenstrual
What is PALM-COEIN?
A pneumonic to remember the etiologies of abnormal uterine bleeding. “PALM” are structural in nature.
-Polyp
-Adenomyosis
-Leiomyoma
-Malignancy
-Coagulopathy
-Ovulatory dysfunction most common
-Endometrial
-Iatrogenic
-Not yet classified
What is typically the cause of abnormal uterine bleeding in adolescents?
Anovulation (not yet ovulating)
Considered normal.
Ovulatory dysfunction is the most common cause of anovulation/AUB at what stage of a woman’s life?
When regular menses is established.
AUB in patients 19-39 is often the result of what condition?
Pregnancy
Signs and symptoms of abnormal uterine bleeding.
Painful menstrual cramping.
Spotting.
Signs of anemia.
Diagnosis of AUB is based upon what factors?
History of duration and amount of menstrual flow, associated pain, and relationship to last menstrual period
History of pertinent illnesses such as systemic infections or significant physical or emotional stressors.
A history of what medications is useful in the diagnosis of AUB?
Warfarin
Heparin
Exogenous hormones
*A history of coagulation disorders is also useful
What imaging is useful in the diagnosis of AUB?
Transvaginal ultrasound
-Intrauterine or ectopic pregnancy
-Adnexal or uterine masses
-Endometrial thickness
Sonobysterography or hysterography
How is AUB-O (anovulation) treated?
Hormonally with progestin to oppose estrogen
NSAIDs at normal doses to reduce amount of blood loss
Post menopausal bleeding is defined as vaginal bleeding that occurs how long after cessation of the menstrual cycle?
6 months or more after menopause.
Must have a high suspicion of cancer. Transvaginal ultrasound measurement of the endometrium is an important tool for diagnosis.
This condition is a recurrent variable cluster of troublesome physical and emotional symptoms that develop during the 5 days before onset of menses and subsides within 4 days after menstruation occurs.
Premenstrual syndrome
What is Premenstrual Dysphoric Disorder?
When emotional or mood symptoms and physical symptoms cause clear functional impairment of work or personal relationships. Typically a complication of PMS.
What is the work up of a patient with PMS/PMDD?
Emotional and physical support to include explanation of issue and reassurance.
Instruct patient to keep a daily diary of all symptoms for 2-3 months to include severity, timing, and characteristics of symptoms.
*If symptoms occur throughout the month (rather than during menses) than she may have depression or behavioral health conditions in addition to PMS/PMDD.
How can you medically treat PMS/PMDD?
Combined oral contraceptives
-Depo-Provera
-Nexplanon
SSRIs can be given for predominating mood symptoms (tension, irritability, dysphoria)
Vaginitis can result from what agents?
Pathogens
Allergic reactions
Vaginal atrophy
Friction during sex
What history should be taken on a patient complaining of vaginitis?
Onset of last menstrual period
Recent sexual activity and any latex products or lubricants used
Use of contraceptives, tampons or douches
Recent changes in medications or antibiotic use
Your patient presents with vaginal irritation or pruritus, pain, and an unusual malodorous vaginal discharge.
Bimanual exam reveals pelvic inflammation, cervical motion tenderness and adnexa tenderness.
What is the diagnosis?
Vaginitis
This type of vaginitis produces an itchy, white “curd-like” discharge. What is it known as, and what are some causative factors?
Vulvovaginal Candidiasis
Pregnancy, diabetes, broad spectrum antibiotics, corticosteroid use.
Heat, moisture, and occlusive clothing.
This type of vaginitis causes pruritus and a malodorous frothy, yellow-green discharge along with diffuse vaginal erythema. Red macular lesions on the cervix called “strawberry cervix” are also common.
What is the diagnosis, and how is it transmitted?
Trichomonas Vaginalis Vaginitis.
A sexually transmitted protozoal flagellate that infects the vagina, scene ducts, and lower urinary tract.
This vaginitis is a chronic polymicrobial disease called ____, typically caused by an overgrowth of what agents?
Bacterial Vaginosis
Gardnerella or other anaerobes
Patient will present with increased malodorous discharge without obvious vulvitis or vaginitis.
What is the treatment of vulvovaginal candidiasis?
Fluconazole (antifungal)
-Single 150mg dose
*Torsades is a common adverse effect that should be considered.
What is the treatment for Trichmonas Vaginalis Vaginitis?
Metronidazole (Flagyl)
-2g PO x 1 OR 500mg BID x 7 days
Recommended to treat both partners.
What is the treatment of bacterial vaginitis?
Metronidazole
Clindamycin vaginal cream
Metronidazole gel
What is the treatment of chlamydia?
Doxycycline 100mg ID x 7 days
What is the treatment of gonorrhea?
Ceftriaxone 500mg IM
What causes pain, swelling and abscess formation of a bartholin duct?
Trauma or infection that causes obstruction of the duct, preventing drainage of its secretions.
*Chronic bartholin gland obstruction (cysts) can occur due to stenosis of the duct outlet with distention.
What are the signs and symptoms of a bartholin gland obstruction?
Periodic painful swelling on either side of the introitus.
Dyspareunia
Fluctuant swelling 1-4cm in diameter on either side of the labium minus.
Tenderness.
What is the treatment of a bartholin gland obstruction?
Manual aspiration or incision and drainage of the abscess.
Antibiotics are only needed if cellulitis or spreading infection is present.
*Marsupialization may be required for frequent reoccurrence, performed by OBGYN.
A presumptive diagnosis of cervical dysplasia is made by what means?
Abnormal Pap smear of an asymptomatic woman with no grossly visible cervical changes.
All visible cervical lesions should be referred to OBGYN.
What age should cervical cancer screenings be initiated for immunocompetent women?
(Pap smears)
21, regardless of the age of onset of intercourse because cervical cancer is very rare in women under 21.
What are the cervical cancer screening ages and methods as recommended by the USPSTF?
21-65 years: cytology (Pap smear) every 3 years
30-65: cytology AND HPV testing every 5 years
HPV is not recommended in women under 30
What are the risk factors for Cervical Intraepithelial Neoplasia that require women to be screened more frequently?
HIV infection
Immunosuppression
Previous treatment for CIN 2, 3 or cervical cancer
Findings from a Pap smear to assess for cervical cancer can be described using the “Bethesda” system. What are the categories?
Atypical squamous cells of unknown significance (ASC-US)
Squamous intraepithelial lesions (SIL)
-Low grade or high grade (LSIL/HSIL)
What is the diagnostic procedure to assess for cervical cancer?
Colposcopy.
Women with ASC-US and a negative HPV screening can be followed up in what time frame, for what testing?
1 year
Repeat Pap smear and HPV co-testing.
*If the HPV testing is positive, perform colposcopy. If it is unavailable, repeat Pap in 12 months.
What vaccination can be administered to protect against cervical and other vaginal cancers?
Gardasil
What are the treatment methods of cervical dysplasia?
Cryosurgery
-Effective for noninvasive small lesions
CO2 Laser
-Minimizes tissue destruction and is colposcopically directed
LEEP
-Wire loop is used for excision
Conization of Cervix
-For severe cases or cancer in situ
These are known as the most common benign neoplasm of the female genital tract. They are discrete, round, firm tumors in the uterus. They are composed of smooth muscle and connective tissue and often occur in multiples.
Leiomyoma of the uterus (fibroid tumors)
*They can interfere with pregnancy and cause miscarriages because they interfere with implantation
How do you treat a uterine fibroid tumor?
Surgery may be required for acute torsion of a pedunculated myopia.
LNG IUD can help decrease bleeding associated with the fibroids.
NSAIDs can help reduce menstrual blood loss.
Hormonal therapies can reduce volume, size and menstrual blood loss.
Surgical therapy is the definitive, curative treatment.
What is the presenting sign in 90% of endometrial carcinoma?
Abnormal uterine bleeding
*Pap smear is usually negative and pain is a late symptom
Endometrial tissue is required to confirm diagnosis after a negative pregnancy test is obtained
What is the second most common cancer of the female reproductive tract?
Adenocarcinoma of the endometrium.
Most often occurs in women 50-70.
Nulliparity and polycystic ovaries with prolonged anovulation are two major risk factors because they cause unopposed estrogen.
What is the treatment of endometrial adenocarcinoma?
Total hysterectomy
Bilateral salpingo-oophorectomy
Peritoneal washings for cytology
Lymph node samplings
Radiation and chemo
This condition causes ectopic growth of endometrial tissue outside of the uterus, particularly in the pelvis and ovaries.
It typically manifests with chronic pain and infertility.
Endometriosis
What are the symptoms and physical exam findings of endometriosis?
Symptoms:
-Dysmenorrhea
-Chronic pelvic pain
-Dyspareunia
-AUB
-Infertility
Physical exam:
-Tender nodules in the rectovaginal septum or cul-de-sac
-Cervical motion tenderness
-Adnexal mass or tenderness
What is the definitive diagnostic method of endometriosis?
Histology of lesions removed via laparoscopy.
What are the commonly used hormonal therapy regimens for treating endometriosis?
Low dose combined oral contraceptives for 6-12 months
Contraceptive patch
Vaginal ring
Progestins
Progestin IUD
What is the definitive treatment for patients with intractable pelvic pain or adnexal masses secondary to endometriosis?
Hysterectomy with bilateral salpingo oophorectomy
*Also used for patients with multiple ineffective conservative surgical procedures.
Pelvic Inflammatory Disease is an ascending infection of the upper genital tract commonly associated with what agents? Who does it most commonly occur in?
Gonorrhea and chlamydia
Endogenous organisms to include anaerobes
H. Influenzae
Enteric gram-negative rods
Streptococci
______
Most commonly occurs in young, nulliparous, sexually active women with multiple partners and is a leading cause of infertility and ectopic pregnancy.
PID is more likely to occur in what circumstances?
History of PID
Recent sexual contact
Recent onset of menses
Recent insertion of an IUD
If the partner has an STD
*Acute PID is highly unlikely if no intercourse occurred within 60 days.
What is the diagnostic criteria and symptoms of PID?
Cervical motion, uterine, or adnexal tenderness
Lower abdominal pain
Chills and fever
Menstrual disturbances
Purulent cervical discharge
CMT
Postcoital bleeding, urinary frequency, low back pain
What is the treatment of PID?
Early treatment with antibiotics effective against gonorrhea and chlamydia
-Cefoxitin
-Doxycycline
-Ceftriaxone
-Metronidazole
For severe cases
-Cefoxitin IV and Doxycycline PO or IM
-Continue treatment for 24 hours after patient shows significant improvement, then provide an oral regimen for a total combined course of 14 days.
What is a long term complication of pelvic inflammatory disease that occurs with repeated episodes of associated salpingitis?
Infertility
10% risk after 1st episode
25% after 2nd episode
50% after 3rd episode
What are the leading cause of death from reproductive tract cancers?
Malignant ovarian tumors.
What are the late stage signs in a woman with an advanced malignant ovarian tumor?
Abdominal pain, bloating, palpable abdominal mass with ascites.
What is the treatment of a malignant ovarian mass, and a benign ovarian neoplasm?
Malignant ovarian mass
-Hysterectomy and bilateral salpingo-oophorectomy with omentectomy and selective lymphadenectomy
-Postoperative chemotherapy or watchful waiting
Benign neoplasms
-Tumor removal or bilateral oophorectomy
What is the complication of ovarian cancer?
The fact that 75% of the time, it is diagnosed in the late stages. It has a high mortality rate.
This is a common endocrine disorder characterized by chronic anovulation with abnormal masses, polycystic ovaries, and hyperandrogegism. It is associated with obesity, hirsutism, diabetes and cardiovascular disease.
Polycystic ovarian syndrome
This condition often presents with menstrual disorder, infertility, skin disorders, and insulin resistance.
Polycystic ovarian syndrome
What is the treatment for polycystic ovarian syndrome?
Weight loss and exercise can induce ovulation
Metformin therapy
Treatment of hirsuitism
*If attempting fertility
-Ovarian stimulation with medications or surgery
*If not attempting fertility
-Combine contraceptives
-LNG IUD
What are the two types of dyspareunia?
Vulvodynia - most common type in premenopausal women
-Characterized by pain, burning, itching, stinging, irritation, rawness
-May be constant or intermittent, and focal or diffuse
Vaginismus - Recurrent or persistent involuntary spasm of the muscles of the vagina that interferes with intercourse
-Resulting from fear, pain, sexual violence, or negative attitudes towards sex
What is the treatment of vaginismus?
Sex counseling and education
Botox injections for refractory cases
What is the treatment of a patient with vulvodynia?
Topical anesthetics
TCAs or SSRIs
Gabapentin
Physical therapy
How is infertility defined? At what age does incidence increase?
Lack of pregnancy after 1 year of normal sexual activity (2 times per week at minimum).
Incidence increases in early 30s and accelerates in late 30s.
*Male partner contributes to 40% of cases.
What treatment is offered to couples experiencing unexplained infertility greater than __ years?
Greater than 3 years
Ovulation induction or assisted reproductive technology
This type of contraceptive suppresses ovulation by inhibiting GnRH, LH, FSH, and the mid-cycle LH surge.
Combined oral contraceptives
What are the advantages of combined oral contraceptives?
Lighter menses
Improves dysmenorrhea
Decreases risk of ovarian and endometrial cancer and functional ovarian cysts
Improves acne
Less likely to develop myomas
Beneficial effect on bone mass
What type of contraceptives are contraindicated in patients who are over 35, smoke more than 15 cigarettes per day, or have migraines with auras?
Combined oral contraceptives
This type of contraceptive effects the endometrium rendering it less suitable for implantation, prevents sperm from entering the cervix, and impairs tubal motility.
Progestin minipill
What type of contraceptive is safe to use during lactation and for women who are over 35?
Progestin minipill
Injectable progestin is a contraceptive that is given how often?
Every 3 months
What type of contraceptive is Nexplanon, and what are its benefits?
Single rod progestin implant (Etonogestrel)
Effective for 3 years
No delay in return to fertility
This contraceptive is a soft flexible ring that is placed in the vagina for 3 weeks, removed, and replaced 1 week later.
NuvaRing
This IUD causes thickening of the cervical mucus, prevents endometrial thickening, and inhibits ovulation.
LNG-releasing IUD
In what way can a copper IUD be used as a postcoital contraceptive?
It can be placed within 5 days of a single episode of unprotected sex.
What are complications of IUDs?
Pelvic inflammation
-Increased risk during 1st month following insertion
Menorrhagia or severe dysmenorrhea
-Copper IUD can cause heavier bleeding and cramping and is not suggested for women who already experience these symptoms
Missing IUD strings
-Must be referred to gynecology if string cannot be visualized on pelvic exam.
What is the only female contraceptive that protects against pregnancy and STDs?
Female condoms
How soon must emergency contraceptives be used after unprotected sex?
What are the types of medications used?
As soon as possible, within 120 hours (5 days)
-Levonorgestrel “Plan B” 1.5mg single dose
-Combination of oral contraceptive containing ethinyl estradiol and levonorgestrel given twice in 12 hours
-Ulipristal 30mg single dose
-Copper IUD insertion within 5 days
Spontaneous abortion typically occurs before which week of pregnancy?
20th week
What are the references governing the use of DOD funding for abortions, and what are the instances when DOD funds may be used?
BUMEDINST 6300.16
OPNAVINST 6000.1
Prohibited to use DOD funding EXCEPT:
-Life of the service member would be endangered if fetus is carried to term.
-Pregnancy is the result of rape or incest.
Is urinary catheterization a sterile procedure?
Nope.
What references govern the management of sexual assault?
SECNAVINST 1752.4
BUMEDINST 6310.11
COMNAVSURFPACINST 6000.1
COMUSFLTFORCOM 6310.2
What platforms can receive sexual assault victims that are MEDEVAC’d?
Large deck amphibs, aircraft carriers, and other platforms identified by TYCOM.
In port, refer victims to MTF or civilian ER.
What are the two phases of rape trauma syndrome?
Immediate/acute
-Shaking, sobbing, restlessness
*Lasts a few days to few weeks
-Anger, guilt or shame
*May repress these emotions
Late/chronic
-Problems may develop weeks or months later
-Lifestyle and work patterns may change
-Sleep disorders or phobias often develop, and loss of self esteem can lead to suicide
What labs are necessary for a sexual assault victim?
HCG: if menses is missed
HIV: 2-4 months
RPR: 16 weeks
GC/Chlamydia
What treatment must be given to all patients newly diagnosed as pregnant?
Prenatal vitamins
What is “Quickening”
Perception of the first movement of the fetus noted at the 18th week.
Softening of the cervix occurs around what week?
Week 7
The uterine fundus is palpable above the pubic symphysis by what week?
12-15 weeks from the last menstrual period.
When can fetal heart tones be heard by Doppler?
By weeks 8-10.
What are the patient education topics for pregnancy?
Prenatal vitamins
Avoid supplements not meant for pregnant women
Reduce caffeine to 0-1 cups per day
Avoid raw and rare meat, and fish with high mercury levels
Eat fresh fruits and vegetables
Only take medications given by the OB
Abstain from alcohol, tobacco, drugs
Define this abortion:
Bleeding or cramping occurs, but pregnancy continues.
Cervix is not dilated.
Threatened abortion (increased risk of miscarriage)
Define this abortion:
Products of conception are completely expelled
Pain stops, spotting may persist
Os is closed, but some blood is in the vaginal vault
Complete abortion (completed miscarriage)
Define this abortion:
Cervix is dilated
Some portions of conception remain in the uterus
Mild cramps
Bleeding is persistent and excessive
Incomplete abortion
Define this abortion:
Pregnancy ceased to develop, but the conceptus has not been expelled
Symptoms of pregnancy disappear
Brownish vaginal discharge with no active bleeding
No pain
Cervix is semi firm and slightly patulous
Uterus becomes smaller and softened
Adnexa are normal
What is indicated for these patients?
Missed abortion
Women may be indicated for abortifacient and correttage.
A patient presents with vaginal bleeding, positive HCG, and abdominal pain with cervical motion tenderness. What is the diagnosis and treatment of this patient?
Ectopic pregnancy
If stable and early ectopic:
-Methotrexate IM
If unstable or a rupture occurred:
-Laparoscopy
What are the risk factors for ectopic pregnancy?
Infertility
PID
Ruptured appendix
Prior tubal surgery
What are the symptoms of an ectopic pregnancy?
Sudden onset of stabbing pain that does not radiate and may be intermittent
Backache may be present during attacks
Adnexal tenderness
Shock may occur
Abnormal menstruation may occur
What is indicated in a nonlactating breast affected by mastitis if it does not respond to antibiotics?
Biopsy
Signs and symptoms of mastitis
Begins 3 months after delivery in a breastfeeding woman
Starts with engorged breast and sore or fissured nipple
Cellulitis is typically unilateral and breast is red, tender and warm
Fever and chills are common
What is the medical treatment for MSSA and MRSA mastitis?
MSSA
-Cephalexin 500mg PO
OR
-Clindamycin 300mg PO
MRSA
-Bactrim 160mg PO
OR
-Clindamycin 300-450mg PO
What is the non-antibiotic treatment of mastitis?
Regular emptying of the breast (safe for infants to nurse from it)
NSAIDs for pain (Motrin is preferred)
What are complications of mastitis?
Abscess
-Requires I&D
Sepsis
How is secondary amenorrhea defined?
Absence of menses for 3 consecutive months in women who have passed menarche (have had their first period).
Menopause usually occurs after __ months of amenorrhea.
6
What is the most common cause of secondary amenorrhea in premenopausal women?
Pregnancy
What causes functional amenorrhea?
Hypothalamic-Pituitary conditions
Causes low levels of GnRH which affect FSH and LH
What ages do early menopause and premature menopause occur?
(Types of premature ovarian failure)
Early: before 45
Premature: before 40
Frequently familial and irreversible.
Nearly 70% of ovarian torsions occur on which side?
Right
What are the symptoms of an ovarian torsion?
Sudden onset of severe unilateral lower abdominal pain
May develop after exertion or athletics
What is the treatment of an ovarian torsion?
Surgical emergency, requires prompt gynecological surgical procedure and ovarian conservation with cystectomy.
Most ovaries are viable even if they have some necrosis at the time of surgery.
What are the indications for a urethral catheterization?
Diagnostic or therapeutic drainage of the bladder
Need for reliable and frequent assessment of urine output (shock treatment, etc)
What are contraindications for a urethral catheterization?
Known or suspected urethral injury
-High riding prostate
-Blood at meatus
-Perineal hematoma
How many swabs are required to catheterize a female patient, and how do you swab them?
4-5 swabs of antiseptic
Clean labia front to back with two successive swabs
Cleanse urethral meatus with another two swabs
How many swabs are required to catheterize a male patient?
3-4 swabs
What is the most common mistake in catheterization of a female patient?
Missing the urethral meatus and entering the vagina.
No urine will return.
Leave catheter in place as a marker.
Repeat catheterization with new equipment.
Remove incorrect one.
