Dunn OB/GYN VII Flashcards
gravidity
how many pregnancies
parity
how many deliveries
TPAL
term, preterm, abortion, living kid
LMP
first day of last menstrual period
dating of pregnancy
most accurate - first trimester ultrasound
gyn hx questions
age at menarche age 1st intercourse pap smears STI history HPV vaccine use of contraception age of maternal menopause fam hx breast/ovarian cancer hx endometriosis, fibroids, pelvic organ prolapse (familial)
painful menses
dysmenorrhea
absence of 3 menstrual periods or no menstruation by age 15
amenorrhea
period interval >35 days or 4-9 periods in a year
oligomenorrhea
heavy menstruation
menorrhagia
> 80cc
bleeding between periods
metrorrhagia
heavy bleeding and between menses
menometrorrhagia - MMR
painful intercourse
dyspareunia
tampon
5cc
EGBUS
external genitalia
bartholins gland
urethra
skenes gland
72yo urinary incontinence and pelvic prolapse
-G5P5
leaks when cough - stress incontinence
stage 4 prolapse of uterus
tx - hysterectomy - uterus removal
cystocele
prolapse of bladder
rectocele
prolapse of rectum
prolapse staging
1 halfway to hymen
2 to hymen
3 past hymen
4 max descent
risk fx for prolapse
postmenopausal
previous pregnancy or vag delivery
difficulty delivery
obesity
tx of prolapse
kegel workout weight loss estrogn cream pessary - push things up bladder sling
stress incontinence
most common bladder control problem in women
pressure on bladder - sphincter should close - reflex
pressure not to sphincter - leak urine
risk fx stress incontinence
genetics**
age
child birth
overactive bladder
urgency (8-10 times a day)
- w/ or w/out urge incontinence
- frequency/nocturia
absence of pathologic or metabolic conditions that might explain these symptoms
diagnosis based on symptoms**
urge incontinence
strong need to urinate - don’t make it to bathroom in time
mixed incontinence
stress and urge
cause of incontinence
DIAPPERS
delirium infection atrophic urethritis pharm - alpha blocker, cholinergics, etc. psych excessive urine production restricted mobility stool impaction
women incontinence
1/3 mixed
1/3 urged
1/3 stress
diagnosis of overactive bladder
hx, symptoms
physical exam
urinalysis
overactive bladder
can lead to diabling conditions
think link to depression
falls and fractures
correlation between overactive bladder
nocturia
patient has to wake at night 1 or more times to void
42yo G2G2 with LMP one week ago
- tubal ligation for BC
- annual exam
- smoker
- hypothyroid
- last PAP 5 years ago
- cervical discharge
do a pap smear
-discharge - wet prep - saline and KOH
atypical squamous cells - high grade
bacterial vaginosis
biopsy - CIN III
loop conization
LGA
> 4,000g
large for gestational age
bacterial vaginosis
no inflammation
fishy odor
pain and itching - concomitant infection
overgrowth of vaginal bacteria
-gardnerella
loss of lactobacilli - change in pH
risk fx bacterial vaginosis
sexual activity
douching - BAD - gets rid of normal flora
amsel criteria
for diagnosis of bacterial vaginosis
need at least 3 1 - white gray discharge 2 - pH > 4.5 3 - positive whiff test -4 - clue cells
gram stain - gold standard - but rarely done
PCR based assay
stippling of epithelial cells
clue cell
gardnerella
bacterial vaginosis complications
PID
post abortal PID
post hysterectomy infections
pregnancy - PROM, premature delivery, chorioamnionitis, endometritis**
tx of bacterial vaginosis
metrondiazole - avoid alcohol
clindamycin
tindazole ($$$)
asymptomatic - recommended to treat
-no partner treatment
avoid alcohol with
metrondiazole
KOH with hyphae
candida albicans
bubbly vaginal fluid
trichomonas vaginalis
motile with flagella**
koilocytes
HPV infection
pap smear
just screening test**
normal vs. abnormal
abnormalities:
high nuclear:cytoplasm ratio
abnormal cell structure
koilocyte changes (HPV)
most common STI
HPV
75% sex active adults in life will be infected
100 types
40 types transmitted sexually
most HPV
latent infection
no visible lesions
diagnosis - DNA hybrid testing
DNA testing
performed in evaluation of abnormal pap smear
undeveloped countries
lots of cervical cancers
bc no screening - paps
colposcopy
visualize under microscope
warts with HPV
condyloma accuminatum
HPV 6 and 11**
in men and women
immunocompromised more risk
cancers with HPV
cervical, vaginal, vulvar
transformation zone
cervical cancer and HPV
HPV infection clears
spontaneously within 2 years
high risk HPV
16, 18, 30
cervical cancer
low risk HPV
6, 11
warts
gardasil
16, 18, 6, 11
HPV vaccine
treating warts
symptoms
cosmetic
psych
freezing, meds, excision, IFN cream
