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Women's Health > Final > Flashcards

Final Flashcards

1
Q

Asexual

A

Person who experiences little or no sexual attraction or desire for sexual activity

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2
Q

Natal sex

A

Label clinician places at birth; based on one’s chromosomes and genitalia

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3
Q

Gender identity

A

One’s inner understanding of themselves in regards to gender

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4
Q

Sexual orientation

A

Attraction, identity and behavior

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5
Q

Transgender

A

Gender identity

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6
Q

Cis gender

A

Gender identity same as natal sex

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7
Q

Health disparities unique to LGBTQ population

A

Increased rates of mental health and suicide
Higher rates of substance abuse and tobacco use
Higher risk of CV disease
Increased risk of CA
PCOS increased risk
Increased risk of STI
Reduced access to health insurance

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8
Q

Benign nipple discharge

A

Bilateral, comes from multiple ducts, white/yellow/green/brown in color

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9
Q

Pathologic nipple discharge

A

Non-milky, spontaneous, unilateral, single duct, clear/bloody

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10
Q

Breast lump:
Discrete, smooth, round or oval, nontender, mobile
Tissue is dense

A

Fibroadenoma

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11
Q

Breast lump:

Discrete, tender, mobile, fluid filled, may fluctuate with menstrual cycle

A

Cyst

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12
Q

Breast lump:
Discrete, soft, nontender, may or may not be mobile
Fatty tissue

A

Lipoma

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13
Q

Breast lump:
Ill defined, firm, non-tender, non-mobile
Necrotic fat with inflammation

A

Fat necrosis

Due to some kind of trauma

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14
Q

Breast lump:
Discrete, firm, round, mobile, large
Skin stretching due to rapid growth

A

Phyllodes tumor

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15
Q

Important risk factors for breast CA

A

Family hx, personal hx, early menarche, late menopause, nulliparity, first full term pregnancy >30

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16
Q

The vagina keeps itself healthy by

A

Production of lactic acid by lactobacillus species

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17
Q

Vaginal pH

A

3.5-4.5

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18
Q

BV cells

A

Clue cells

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19
Q

Amsel’s criteria

A 
Used for dx BV
-White, thin adherent vaginal discharge
pH >4.5
Positive whiff/KOH test
Clue cells on microscope
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20
Q

Risk factors for vulvovaginal candidiasis

A

Repeated course of systemic abx, diabetes, pregnancy, obesity, high sugar diet, steroid use, immunosupressed states, post menopausal hormone therapy

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21
Q

Atrophic vaginitis most common in

A

post-menopausal
peri-menopausal
Lactation
All low estrogen states

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22
Q

New cases of STIs per year

A

20 million

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23
Q

Prevalence of STI highest in which age group

A

Adolescents

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24
Q

Trichomoniasis

A

One celled protozoan with flagellae

Tx: metronidazole 2g PO single dose or tinidazole 2g PO single dose

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25
Q

Signs of PID

A

Adnexal tenderness, abdominal tenderness, uterine tenderness, cervical motion tenderness, cervical friability or mucopurulent cervicitis

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26
Q

Most common causes of PID

A

Gonorrhea and chlamydia

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27
Q

Primary syphilis

A

Chancre–painless papule at the site of inoculation

Erodes to form a nontender shallow indurated clean ulcer

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28
Q

Secondary syphilis

A

Widespread, symmetrical maculopapular rash on palms of hands and soles of feet and generalized lymphadenopathy
Warts may develop

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29
Q

Tertiary syphilis

A

CV, derm, neuro symptoms

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30
Q

Women are at increased risk of UTI due to

A

Shorter urethra

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31
Q

Cystitis

A

Dysuria with urinary frequency and urgency; may have hematuria
No fever or CVA tenderness

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32
Q

Pyelonephritis

A

Fever, CVA tenderness, flank pain

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33
Q

When do you hospitalize for pyelo

A

pregnancy, vomiting, hypotensive, immunodeficient

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34
Q

Muscle of bladder

A

detrusor

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35
Q

Co-morbidities increasing risk for incontinence

A

Bacterial UTI, diabetes, MS, PD, AD, traumatic spine injury, heart disease and stroke, arthritis, back problems, major depression, smoking, obesity, pregnancy, childbirth

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36
Q

Stress incontinence

A

Involuntary leakage with effort or physical exertion, sneezing or coughing

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37
Q

Urgency incontinence

A

Strong desire to urinate that is difficult to postpone

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38
Q

Most common menstrual disorder affecting 81% women

A

Dysmenorrhea

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39
Q

Normal menstrual cycle

A

Normal cycle: 24-38 days
Normal duration of flow: 4.5-8 days
Normal amount of flow: 5-80mL

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40
Q

PALM-COEIN

A

Abnormal uterine bleeding causes
Polyps, adenomyosis, leiomyomas, malignancy, coagulopathy, ovulatory dysfunction, endometrial, iatroogenic, not yet classified

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41
Q

Polyps

A

Benign growths of the cervix or endometrium

Bleeding often occurs after sex

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42
Q

Most common cause of bleeding pattern that differs from established menstrual pattern

A

Complication of pregnancy

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43
Q

Adenomyosis

A

Usually affects women >40 and multiparous women
Small areas of endometrial tissue within the myometrium
US and MRI can detect

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44
Q

Leiomyoma

A

Fibroids
Benign tumors in the myometrium
Leading indication for hysterectomy

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45
Q

Anovulatory bleeding

A

Characterized by lack of progesterone in luteal phase, leads to unstable, excessively vascular endometrium
Woman always in follicular phase and proliferative phase
Pathologic causes: PCOS, anorexia, hyperprolactinemia, radiation/chemo, thyroid disorders, primary pituitary disorders
Estrogen increases the thickness of endometrium–unopposed estrogen will lead to heavier bleeding

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46
Q

Iatrogenic

A

IUDs
TCAs/phenothiazines
Anticoagulants

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47
Q

Tx of abnormal uterine bleeding

A 
Estrogen therapy
COC
Progesterone--tx chronic heavy bleeding due to anovulation 
NSAIDs
Endometrial ablation
Hysterectomy (fibroids)
D+C
48
Q

Anovulation

A

Common causes: thyroid disease, hyperprolactinemia
If left untx, can cause endometrial CA
Tx: induce menses by using progesterone

49
Q

PCOS occurs in how many women

A

6-15% of women

50
Q

Sx PCOS

A

Hirsutism, acne, alopecia, menstrual irregularity, subfertility or infertility, dyslipidemia, metabolic syndrome, obesity, increased risk of endometrial CA, type 2 DM, CV disease (all due to unopposed estrogen)
Most are anovulatory; LH levels higher; insulin resistance common

51
Q

4 phenotypes of PCOS

A

Androgen excess + ovulatory dysfunction
Androgen excess + polycystic ovarian morphology
Ovulatory dysfunction + polycystic ovarian morphology
Androgen excess + ovulatory dysfunction + polycystic ovarian morphology

52
Q

Tx for PCOS

A

Weight loss
COC–treats hyperandrogenism
Antiandrogens such as spirinolactone or finasteride
Metformin

53
Q

Skin cysts on vulva

A

Folliculitis
-Infected hair follicles
Warm compresses/topical antibacterial

Epidermoid/Sebaceous cysts

  • Slow growing, rarely drain, resolve spontaneously
  • Do not squeeze

Hidradenitis Suppruative

  • Chronic, relapsing inflammatory disorder of hair follicles
  • Occurs under breasts and in axillae
  • tx: metformin, antibiotics, antiandrogens, immunosuppressants
54
Q

Lichen sclerosus

A

Chronic disorder characterized by inflammation, epithelial thinning and de-pigmentation and dermal changes
Woman has itching and burning and irritation
Depigmented tissue has cigarette paper appearance
Tx: high topical steroid (clobetasol)

55
Q

Endometriosis incidence

A

10% of women

56
Q

Endometriosis

A

Presence of endometrial glands and stroma outside of the uterus
May have cyclic or noncyclic pain that severely impairs quality of life, increased risk of infertility and poor pregnancy outcomes
Tx: ovulation suppression is primary target (COC, progestins)
Definitive tx is hysterectomy

57
Q

Biopsy for vulva

A

Punch

58
Q

Scope of gynecologic cancers

A

Most prevalent: endometrial
4th most common: cervical
Vulvar: 4%
Most lethal: ovarian

59
Q

VIN 1 vs VIN 2

A

VIN 1: Warty, basaloid, mixed; related to HPV; occurs in younger women
VIN 2: Differentiated; older women; associated with vulvar dermatolic conditions

60
Q

What causes cervical cancer

A

HPV 16 + 18

Vaccine + pap smears prevent

61
Q

Risk factors for HPV

A 
Early age at first intercourse
Multiple sexual partners
Smoking
Immunosupression
5+ years of COC
High parity
Genetics
Diets low in fruits and vegetables
Poverty
62
Q

Risk factors for endometrial cancer

A

Estrogen therapy, tamoxifen, early menarche, late menopause, history of infertility or nulliparity, obesity, chronic anovulation, diabetes, high fat diet, ovarian CA, increased age, sedentary, endometrial hyperplasia

63
Q

Sx ovarian CA

A

Silent disease usually

May have abdominal bloating and discomfort, difficulty eating, early satiety, back pain, changes in bowels/bladder

64
Q

Scope of pelvic pain

A

1-2% of all healthcare visits made by women

A number of causes are unrelated to gynecologic origins

65
Q

Acute causes of pelvic pain

A

PID, ruptured ovarian cyst, ectopic pregnancy, torsion of ovary or fallopian tube
<3 months duration
sudden onset, sharp in nature

66
Q

3 most common causes of chronic pelvic pain

A

Endometriosis, adhesions, absence of pathologic condition

67
Q

Dx testing for pelvic pain

A

CBC, ESR, serologic testing for syphilis, UA and culture, pregnancy test, vaginal smears and cultures, stool guaiac, TSH, transvaginal US

68
Q

Most common noncyclic gynecologic causes of chronic pain

A

Endometriosis, adhesions, ovarian remnant syndrome, pelvic congestion syndrome

69
Q

Lower abdominal pain that increases when peritoneum is stretched, abdominal pain on light palpation, adnexal enlargement

A

Adhesions
Laparoscopy is diagnostic tool
Surgical lysis not recommended until last resort

70
Q

Lateral pelvic pain sharp and stabbing or dull and not radiating; pelvic mass felt during bimanual exam; vulva and vagina may remain in persistent estrogenized state

A

Ovarian remnant syndrome
Tx: high dose progestins or surgery
US diagnostic tool

71
Q

Bilateral lower abdominal and back pain, dysmenorrhea, dyspareunia, abnormal uterine bleeding, chronic fatigue, bulky feeling to uterus when palpated

A

Pelvic congestion syndrome
transuterine venography is diagnostic tool
Tx: progestin and GnRH agonist

72
Q

Presumptive signs of pregnancy

A

Subjective

Amenorrhea, N/V, increased urinary frequency, excessive fatigue, breast tenderness, quickening

73
Q

Probable signs of pregnancy

A

Objective

Goodell sign, chadwick sign, hegar’s sign, uterine enlargement, braxton hicks, ballottement, positive pregnancy test

74
Q

Positive signs of pregnancy

A

Diagnostic

FHR, palpable fetal movement, US

75
Q

Goodell sign

A

softening of cervix

76
Q

Chadwick sign

A

blue cervix

77
Q

Hegar’s sign

A

softening of lower uterine segment

78
Q

Where is uterus at 10, 20, and 40 weeks

A

10 weeks: symphysis pubis
20 weeks: umbilicus
40 weeks: xyphoid process

79
Q

How much does fundus grow on average

A

1cm per week

80
Q

What major hormones are involved in pregnancy

A

estrogen, progesterone, relaxin

81
Q

Cardiac changes in pregnancy

A

CO increases by 30-50%
Hemodilution due to increase in plasma
WBC increases
Clotting factors increase
May have systolic murmurs
Systolic BP decreases 2-8mmHg in 2nd trimester
Diastolic BP decreases 5-15mmHg in 2nd trimester

82
Q

Epulis of pregnancy

A

Hypertrophy of the gums leading to bleeding

83
Q

Nagel’s rule

A

Take first day of LMP and add 7 days, minus 3 months, add 1 year
Do not use if patient does not remember LMP or has irregular periods

84
Q

BHCG

A

Doubles every 48 hours from conception until 13 weeks then decreases

85
Q

Blood tests for all women in each pregnancy at initial visit

A

CBC, blood type and Rh factor, antibody screen, rubella titer, Hep B surface antigen, HIV, syphilis
Urine culture and G/C

86
Q

How common is N/V in pregnancy

A

91% of women

87
Q

How common is first trimester bleeding/pregnancy loss and most common cause

A

25% experience trimester bleeding

30% of all implanted embryos and 15% of clinically recognized pregnancies miscarry

88
Q

Nuchal translucency

A

US evaluation of thickness of fetal nuchal fold
Detects increased risk of aneuploidy, fetal anomalies
10-14 weeks gestartion

89
Q

Noninvasive prenatal testing

A

Cell free DNA

10+ weeks gestation

90
Q

Quad screen

A

Assesses for HCG, AFP, estriol and inhibin A
Detects risk for neural tube defects, trisomy 13, 18, 21
15-22 weeks gestation

91
Q

Infections that go through the placenta

A 
Cytomegalovirus
Parvovirus (fifth disease)
Toxoplasmosis
Rubella
Varicella
GBS
92
Q

Cytomegalovirus in pregnancy

A

Herpes virus type
Most women acquire through children in daycare
Can result in mental retardation, hearing loss, CP in baby

93
Q

Parvovirus B19

A

Fifth disease
1/2 of all pregnant women immune
Virus can cause body to stop making RBC–Causes aplastic crisis, hydrops fetalis, congenital anemia, pure red cell aplasia, persistent anemia

94
Q

Toxoplasmosis

A

Foodborne or cat litter

Fetal effects: vision or hearing loss, neurologic delays, seizures

95
Q

Rubella

A

Greatest risk of congenital infection ocurring during first 12 weeks
most serious consequences: miscarriage, stillbirth, deafness, eye defects, PDA, microcephaly

Hearing impairment most common defect
Screen all women at first prenatal visit

96
Q

Varicella

A

Risk of infection is decreased if VZIG is administered within 96 hours of exposure

97
Q

GBS

A

Most common cause of neonatal sepsis and meningitis in the US
Screen women between 35 and 37 weeks gestation–if + give intrapartum antibiotic prophylaxis

98
Q

Pregnancy increases risk of UTI due to

A

Decreased urinary tract peristalsis

Most common agents: GBS and E coli

99
Q

Gonorrhea in newborn manifests as

A

ophthalmic neonatorium and sepsis

100
Q

Chlamydia in newborn manifests as

A

Neonatal conjunctivitis 5-12 days after birth; afebrile pneumonia 1-3 months after birth

101
Q

Hyperemesis gravidarum

A

Occurs in 0.5-2% of all pregnancy
N/V with weight loss >5% of pre-pregnancy weight
Dx: assess for ketonuria, dehydration, electrolyte imbalance, weight loss

102
Q

Threatened abortion

A

Symptoms present, products of conception intact
minimal bleeding, abdominal cramping, uterine size equal to dates, cervical os closed
Possible pregnancy loss

103
Q

Inevitable abortion

A

Symptoms increased in severity to include cervical dilation; products of conception intact
Moderate bleeding, moderate cramping, uterine size equal to dates, cervical os dilated
Poor prognosis

104
Q

Incomplete abortion

A

Symptoms present including cervical dilation; partial products of conception expelled
Heavy bleeding, moderate to severe cramping, uterine size equal to dates, cervical os dilated
Poor prognosis

105
Q

Complete abortion

A

Products of conception expelled completeley
Minimal bleeding, prior cramping subsided, uterus is pre-pregnancy size, os is closed or dialted
Pregnancy loss

106
Q

Missed abortion

A

Products of conception retained for up to 6 weeks following symptoms
Vaginal bleeding did occur, subsided and reoccurs
Pregnancy loss

107
Q

Increased risk of ectopic

A

Age 15-19 or >35, racial minorities, previous ectopic, previous tubal surgery, PID hx, infertility hx, IUD, assisted reproduction, history of therapeutic abortions

108
Q

Preterm labor

A

Between 20 0/7 and 36 6/7

109
Q

What are risks of polyhydramnios

A

Multiple gestation, maternal hyperglycemia, decreased fetal swallowing, fetal cardiac abnormalities
May complicate descent

110
Q

Placenta previa

A

Painless vaginal bleeding
Complete: can not complete birth vaginally
Partial: unlikely to occur vaginally
Marginal and low lying: birth may occur vaginally

111
Q

Abruptio placentae

A

Painful bright red bleeding with abdominal pain

112
Q

When should women first be contacted post partum

A

1 week by phone

113
Q

Involution

A

Uterus returns to pre-pregnancy state

114
Q

Stages of lochia

A

Rubra: dark red, days 2-5
Serosa: lighter red, days 3-10
Alba: white to yellow, weeks 2-8

115
Q

Vagina and vulva are expected to heal in

A

3-4 weeks

116
Q

Common early postpartum concerns

A

Afterbirth pains, diuresis/diaphoresis, constipation, hemorrhoids, perineal discomfort, breast engorgement

117
Q

Mastitis

A

Inflammation, unilateral localized erythema, breast tenderness, flu like sx
Keep breastfeeding/pumping
Tx: amoxicillin

Women's Health (2 decks)

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