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OB Exam Two > Ebook chapters > Flashcards

Ebook chapters Flashcards

1
Q

who should be doing breast self exams

A

all women over 20

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2
Q

when should breast self exams be performed

A

it should be performed one week after menstrual cycle and every month to identify changes, can result in a lot of false positives

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3
Q

how is a breast self exam performed

A

lay on back with right arm behind head using pads of three middle fingers on left hand feel for lumps and right breast move around the breast up and down patterns repeat on the left breast lastly stand in front of a mirror with hands firmly pressed down on hips and assess for changes in shape size contour dimpling redness of nipples/breast

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4
Q

who should be getting clinical breast exam

A

All women over 25 should be getting clinical breast exams it should be performed every 1-3 years for 25 to 39 year olds then yearly after age 40

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5
Q

who performs clinical breast exams

A

HCP is needed to perform this because they are trained and specialized in identifying specific breast masses

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6
Q

who gets mamographys and when

A

It is an individual decision with health care provider based on history and risk for women under 50 and after 50 all women should get one the week after menstrual cycle is the best time,

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7
Q

what is the purpose of mamography

A

performed because it can detect things before they are palpable

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8
Q

what is the purpose of papsmear and who gets them

A

Screens for cervical cancer women over 21 to 29 should get one every three years women 30 to 65 should get it every three to five years women over 65 do not need it unless other risk factors are involved

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9
Q

what is amenorrhea

A

absene of menstration

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10
Q

what is primary amenorrhea

A

lack of menstration by age 15

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11
Q

what is secondary ammenorrhea

A

absence of menstral cycle for over 3 months

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12
Q

what could be some causes of ammenorrhea

A

could be pregnancy, postpartum, lactation, menopause, medications, hormonal imbalances, anorexia, excessive exercising, stress, disease so treatment depends on cause

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13
Q

what is dysmenorrhea

A

painful cramping in uterus during menstration

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14
Q

what are the ss of primary dysmenorrhea

A

lower abdominal pain radiating to lower back or legs, headache, n/v, diarrhea, irritability, fatigue, depression

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15
Q

what is secondary dysmenorrhea

A

pain often occurs after age 20 and associated with GYN conditions (endometriosis, fibroids)

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16
Q

what is the treatment for dysmenorrhea

A

relaxation, heat, exercise, NSAIDs

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17
Q

who does PMS normally affect

A

teens

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18
Q

what are the ss of PMS

A

irritability, mood changes, fluid retention

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19
Q

what is the cause of PMS

A

normal fluctuation of estrogen and progesterone, hyperprolactinemia, alterations and carbohydrate metabolism

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20
Q

how do you treat PMS

A

reduce signs and symptoms - 60 minutes or more of physical activity daily, eat well balanced diet, decrease intake of salt, caffeine, sugar, diuretics, NSAIDs, hormonal contraceptives

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21
Q

what is menorrhagia

A

excess bleeding, 80ml or more lasting greater then 7 days

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22
Q

what is metorrhagia

A

bleeding at abnormal times during cycle, vaginal bleeding more often then every 21 days

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23
Q

what is menometrohagia

A

combo of menorrhagia and metororrhagia

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24
Q

what is plymenorrhea

A

bleeding that occurs at short intervals (less then 21 days)

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25
Q

what is oligomenorrhea

A

bleeding occurring less frequently then every 35 days

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26
Q

what is postcoital bleeding

A

bleeding after intercourse

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27
Q

what is spinnberkeit mucus

A

elasticity of cervical mucus increases (as it reaches closer to ovulation) measure between finger – 8-10cm

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28
Q

what is mittelschemerz mucus

A

pain/discomfort in lower abdomen on the side that is releasing ovary/ovulation

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29
Q

what is climacteric phase of cessation of menstrual cycle

A

decline in ovarian function, loss of estrogen and progesterone as age

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30
Q

what is postmenopausal phase of cessation of mensural cycle

A

proceeding menopause, many cycles during perimenopause are anovulatory

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31
Q

what is menopause

A

last menstrual period

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32
Q

what is postmenopausal phase

A

cessation of menstrual cycles for one year usually occurs between 40 and 58 years old

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33
Q

what is peri/postmenopausal characteristics

A

vasomotor instability (hot flashes ,night sweats), vaginal dryness, decrease in pubic and axillary hair, skin changes (hypo/hyper pigmentation, decreased sweat glands, skin and hair thins), bone thinning/ osteoporosis, anxiety, depression, irritability, libido changes, insomnia

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34
Q

what is contraceptive behavioral method: natural family planning

A

patient IDs fertile time and avoids intercourse during this time every cycle

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35
Q

what is contraceptive behavioral method: basal body temp

A

body temp changes used to detect fertile period, Take temp when awaken in the morning same time daily, slight drop then slight raise at ovulation and remains elevated for half of cycle, it’s easier to predict when ovulation has already occurred so it’s too late for birth control

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36
Q

what is contraceptive behavioral method: cervical mucus “billings method”

A

track changes in cervical mucus

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37
Q

what interferes with billings method

A

vaginal infection, sexual arousal, recent coitus, antihistamines

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38
Q

what is contraceptive behavioral method: calander/rhythm method

A

based on fact that ovulation occurs every 14 days before menstrual cycle

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39
Q

what is contraceptive behavioral method: Marquette method

A

ovulation predictor kits to assess surge in LH occurring 24 to 36 hours before ovulation

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40
Q

what is contraceptive behavioral method: Coitus interruptus

A

the withdrawal method, a male withdrawing before ejaculation, issues are pre-ejaculation includes sperm, sometimes they can’t withdraw/it’s too late

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41
Q

what is contraceptive behavioral method: Lactational amenorrhea method

A

most effectively used in underdeveloped countries where moms can only exclusively breastfeed, they must meet three conditions: exclusively breastfed, no menstrual period since giving birth, infant is less than six months old, the issue is you won’t know when you’ve ovulated

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42
Q

what is a barrier method and what is an issue with it

A

block sperm from reaching ovum, some can protect from STIs – issue is that it requires pre planning before intercourse, or possible latex allergy

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43
Q

how does a cervical cap barrier method work and what is the teach involved

A

similar to diaphragm but smaller more difficult to place it cannot remain in place for more than 48 hours

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44
Q

how does a contraceptive sponge work and how effective is it

A

a single use vaginal spermicide fits over the cervix it is 73 to 86% effective it is removed before 30 hours

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45
Q

when should you not use a contraceptive sponge

A

do not use during menstruation, immediately after abortion or childbirth, or a history of toxic shock syndrome

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46
Q

what is the failure rate for condoms and what is the teaching involved

A

male condom failure rate is 13%, lubricants you can use with condoms are water soluble, oil based lubricants can break down latex, female condoms are made of polyurethane it is a sheath with rings on each side closed and inserted into vagina and anchored at cervix its failure rate is 20%

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47
Q

what is spermicide and what is the teaching involved

A

gels, creams, foams, films, suppositories inserted into vagina before 10-15min intercourse it is used to destroy sperm failure rate is 20%

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48
Q

how does hormonal methods work for contraceptives

A

works by preventing ovulation, thickening cervical mucus to prevent sperm penetration

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49
Q

how do OCPs work and how effective are they

A

effective 93% of the time take for 21 days and stop or take placebo for seven days

50
Q

how do estrogen only OCPs work

A

prevents release of FSH therefore ovulation prevented

51
Q

how do progestin only OCPs work

A

“minipill” - thickened cervical mucus often used for breastfeeding moms take at same time every day no days off

52
Q

how do estrogen and progestorne OCPs work

A

inhibit LH surge required for ovulation

53
Q

what are side effects of OCPs

A

ACHES: abdominal pain, chest pain/shortness of air, headache sudden or persistent, eye problems, severe leg pain other side effects include hypertension, migraines, sickle cell, gallbladder disease

54
Q

what are contraindications of OCPs

A

smoking and over 35 years old, DM and over 20 years old, migraines known or suspected breast cancer, DVT

55
Q

what should you teach when someone is taking an OCP

A

antibiotics and TB meds decrease effectiveness

56
Q

how effective is a transdermal contraceptive patch and how does it work

A

delivers low levels estrogen and progestin absorbed into skin it’s effective 93% of the time applied once a week for three weeks then one week patch free when you would have a cycle can be applied to abdomen buttocks upper outer arm or upper torso

57
Q

how does a vaginal contraceptive ring and how effective is it

A

estrogen and progestin effective 97% of the time it’s inserted deep into vagina by fifth day of menstrual cycle and remains three weeks and removed one week for menstrual cycle

58
Q

how does injectable hormonal contraceptive work

A

depo-provera - progestin only I am or SQ injection every three months do not massage, first shot within five to seven days of cycle

59
Q

what are some side effects of injectable hormonal contraceptives

A

regular bleeding for a few months then amienorrhea, weight gain, headaches, depression, temporary and reversible decreased bone mineral density

60
Q

how does a subdermal hormonal implant (nexplanon) work and how effective is it

A

affective 99.9% of the time it’s good for three years contains progestin and barium to be able to see on an X-ray insert at any time in the cycle

61
Q

what are some side effects of subdermal hormonal implant

A

bleeding irregularly for a few months then amenorrhea, weight gain, headache, nausea, abdominal pain, loss of libido, vaginal dryness

62
Q

how do intrauterine devices work and how effective are they

A

devices inserted into uterus for five to 10 years effective 99% of the time, they create a hostile environment for sperm can be inserted anytime in the cycle (Skyla inserted first seven days of cycle

63
Q

what are some contraindications of intrauterine devices

A

contraindications include active pelvic infection, endometritis, pelvic tuberculosis

64
Q

how long after can you use plan b

A

120 hours

65
Q

what are side effects of emergency contraceptives

A

include bleeding, n/v, headaches, dizziness, fatigue usually resolves in 24 hours you have a 1.2 to 2.1% of still getting pregnant

66
Q

how does a vasectomy work

A

small incision and scrotum, vas deferens ligated to interrupt passage of sperm, semen no longer contains sperm, can you use this as only contraceptive for one to three months need 2 ejaculations samples without sperm this performed in an office under local anesthesia with minimal complications

67
Q

what are the effects of STIs

A

fallopian tube blockage, increased risk for ectopic pregnancy, chronic pelvic pain, increased liver cancer, death it affects one in five Americans

68
Q

what are risk factors of STIs

A

sexual interaction, drug use, blood exchange

69
Q

what is the most common STI and what is it known to cause

A

Chlamydia most common STI causing preventable infertility an ectopic pregnancy as well as pelvic inflammatory disease and increased risk for HIV

70
Q

what are ss of chlamydia

A

asymptomatic, abnormal vaginal bleeding, frequent urination, dysuria, dyspareunia, postcoital bleeding, cervictis

71
Q

what are maternal/fetal effects of chlamydia

A

opthalmia neonatorum (Blindness why we give emycin ointment prophylactic at birth)

72
Q

how do you diagnose chlamydia

A

nucleic acidamplification testing

73
Q

what is the treatment for chlamydia

A

zithromycin 1dose or doxycycline for 7 days

74
Q

what is the teaching for chlamydia

A

No intercourse for treatment and seven days after, all partners need to be treated

75
Q

what is the second most common type of STI

A

gonorrhea

76
Q

what are ss of gonorrhea

A

asymptomatic, dysuria, vaginal bleeding, irregular menstrual cycle, low back ache, urinary frequency, post coiital bleeding

77
Q

how are people diagnosed with gonorrhea

A

screening women 25 years or younger at increased risk (Previous gonorrhea infection, current STD, multiple partners

78
Q

what is treatment for gonorrhea

A

ceftriaxone 500mg IM plus azithromycin 1 g PO 1 dose or doxycycline 100mg po BID for 7 days

79
Q

what are maternal newborn effects of gonorrhea

A

transfer of chlamydia and gonorrhea may occur during childbirth causing eye infection, scalp absence, rhinitis, anorectal infection

80
Q

what is pelvic inflammatory disease

A

acute infection of uterus and fallopian tubes untreated can cause scarring which can cause infertility and tubal pregnancy treated with combined drug therapy

81
Q

what are the risk factors for pelvic inflammatory disease

A

history multiple sex partners, new partner in past six months, lower age at first intercourse, lower economic status, vaginal douching, smoking

82
Q

what are the ss of pelvic inflammatory disease

A

asymptomatic, severe abdomen/uterine/ovarian pain and tenderness, abnormal bleeding/discharge, low back pain, n/v, fever, chills, elevated white blood cell, ESR

83
Q

what is the risk for syphilis

A

unsafe sexual practices, history of STD’s, positive syphilis sex partner, incarceration, sex trades

84
Q

what is the primary stage of syphilis

A

10-90 days painless appears at point of contact can heal within four to six weeks

85
Q

what is secondary stage of syphilis

A

six weeks to six months fever, sore throat, weight loss, skin rash on trunk and extremities, headache, malaise, mucous patches on genitals and mouth, lymphadenopathy, hair loss, moist flat warts and genital and anal areas heals within two to 10 weeks

86
Q

what is latent phase of syphilis

A

having infection over two years without clinical evidence

87
Q

how do you diagnosis syphilis

A

RPR,VDRL

88
Q

what is the treatment for syphilis

A

penicillin G

89
Q

what are the maternal/newborn effects of syphilis

A

syphilis can cause serious fetal anomalies, can have congenital syphilis from maternal to fetal transmission

90
Q

what are the risk for Trichomonas Vaginalis

A

unsafe multiple sexual partners, previous history of STD’s, history working in sex trade, recent incarceration, poor hygiene, substance abuse

91
Q

what are the ss of Trichomonas Vaginalis

A

asymptomatic profuse frothy grey or yellow-green vaginal discharge with foul odor, dysuria, strawberry cervix, dyspareunia

92
Q

how do you diagnose Trichomonas Vaginalis

A

wet prep

93
Q

what is the treatment for Trichomonas Vaginalis

A

metronidazole (flagy) 2g po 1 dose, or 500mg po BID for 7 days

94
Q

what is the teaching for trichomonas vaginalis

A

partner needs to be treated, avoid drinking alcohol until 24 hours after flagy therapy

95
Q

what are the maternal and newborn risks of trichomonas vaginalis

A

baby LBW, increased risk for PROM&P TL

96
Q

what is HPV caused by

A

cervical cancer

97
Q

what are the ss of HPV

A

asymptomatic, warty cauliflower like growths in vaginal area or mouth, tongue, throat, lips it is painless

98
Q

what are the risk factors for HPV

A

multiple sex partners, early age of sexual activity, tobacco and alcohol use, pregnancy, weak immune system

99
Q

how do you diagnose HPV

A

visual confirmation of lesions

100
Q

what is the treatment for HPV

A

medicated ointment, cryotherapy, electrodesiccation, laser treatment to burn off warts, usually about three months of treatment, encourage pap testing related to risk of cervical cancer

101
Q

how do you prevent HPV

A

prevention females 9 to 26 year olds and males 11 to 21 year old should receive Gardasil vaccine

102
Q

how does someone get herpes

A

causes genital (type 2), oral (type 1) herpes infection transmitted by genital or saliva secretions type one is usually transmitted in childhood via nonsexual contacts like cold sores virus lays dormant until time of immunocompromised or stressful periods

103
Q

what are the ss of herpes

A

minimal to none, first outbreak is usually most severe with flu like symptoms, dysuria, painful blisters on genitals, itching, vulvar edema, hevery watery or purulent vaginal discharge

104
Q

how is herpes diagnosed

A

patient history and physical exams or serological testing

105
Q

what is the treatment for herpes

A

treatment is antivirals they end in VIR

106
Q

what are the maternla/newborn effects of herpes

A

cause fatal infection of herpes lesion and genital tract during childbirth

107
Q

what are the 3 modes of transmission of HIV

A

Three modes of transmission direct serum exposure (Iv stick, Iv drug use), unprotected intercourse, maternal/fetal transmission – transmitted by blood, semen, vaginal secretions, breast milk

108
Q

how do you screen for HIV

A

CDC recommends Opt-out testing (screening everyone unless the opt out) consent must be obtained verbally, ACOG recommends screening women 19-64 and targeted screening for women with risk factors outside the age range

109
Q

how is HIV diagnosed

A

ELISA confirmed with westerb blot test there is no cure can do HAART

110
Q

what is lactobacillus

A

the dominant bacterial genus maintains vaginal Ph balance (3.8-4.2 during reproductive years)

111
Q

what are the causes for alterations in vaginal enviorment

A

: stress, douching, feminine hygiene products, harsh hoops, increase in sugary/caffeine, sexual intercourse, barrier, mathods of contraceptives, synthetic underwear, scented wipes, chronic metabolic conditions (DM)

112
Q

what are the maternal/fetal effects of bacterial vaginosis

A

PTL,LBW

113
Q

how is bacterial vaginosis diagnosed

A

wet mount, wiff test – amine odor when discharge sample combined with 10% (KOH)

114
Q

what are the ss of bacterial vaginosis

A

symtptomatic, thin white or gray discharge with fishy amine odor gets worse with intercourse, or menstral cycle, pain, buring, itching, dysuria

115
Q

what is the treatment for bacterial vaginosis

A

metronidazole PO or vaginally – no flagyl with seizures, no alcohol use 24 hours before or after meals, no use during 1st trimester contraindicated in breast feeding

116
Q

what is an effective abortion

A

patient request, easier and safer if done in 1st trimester

117
Q

what is a therapeutic abortion

A

performed for maternal or fetal health or disease

118
Q

what are the differnt methods of abortion

A
  • 1st trimester- vaccum aspiration may need cervical dilation with laminaria 2-24 hours before procedure or mechanical cervical dilation needed between 8-12 weeks, can also do meds like methotresate (7-9weeks)
119
Q

what are the side effects of abortion

A

cramping 20-30min following procedure

120
Q

what are the complications of abortion

A

uterine perforation, cervical lacerations, hemorrhae, infection, 2nd trimester- cervical dilation and evacuation

121
Q

what lab value needs to be taken after abortion

A

Hcg

OB Exam Two (8 decks)

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