Final Flashcards
1
Q
Asexual
A
Person who experiences little or no sexual attraction or desire for sexual activity
2
Q
Natal sex
A
Label clinician places at birth; based on one’s chromosomes and genitalia
3
Q
Gender identity
A
One’s inner understanding of themselves in regards to gender
4
Q
Sexual orientation
A
Attraction, identity and behavior
5
Q
Transgender
A
Gender identity
6
Q
Cis gender
A
Gender identity same as natal sex
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
8
Q
Benign nipple discharge
A
Bilateral, comes from multiple ducts, white/yellow/green/brown in color
9
Q
Pathologic nipple discharge
A
Non-milky, spontaneous, unilateral, single duct, clear/bloody
10
Q
Breast lump:
Discrete, smooth, round or oval, nontender, mobile
Tissue is dense
A
Fibroadenoma
11
Q
Breast lump:
Discrete, tender, mobile, fluid filled, may fluctuate with menstrual cycle
A
Cyst
12
Q
Breast lump:
Discrete, soft, nontender, may or may not be mobile
Fatty tissue
A
Lipoma
13
Q
Breast lump:
Ill defined, firm, non-tender, non-mobile
Necrotic fat with inflammation
A
Fat necrosis
Due to some kind of trauma
14
Q
Breast lump:
Discrete, firm, round, mobile, large
Skin stretching due to rapid growth
A
Phyllodes tumor
15
Q
Important risk factors for breast CA
A
Family hx, personal hx, early menarche, late menopause, nulliparity, first full term pregnancy >30
16
Q
The vagina keeps itself healthy by
A
Production of lactic acid by lactobacillus species
17
Q
Vaginal pH
A
3.5-4.5
18
Q
BV cells
A
Clue cells
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
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
21
Q
Atrophic vaginitis most common in
A
post-menopausal
peri-menopausal
Lactation
All low estrogen states
22
Q
New cases of STIs per year
A
20 million
23
Q
Prevalence of STI highest in which age group
A
Adolescents
24
Q
Trichomoniasis
A
One celled protozoan with flagellae
Tx: metronidazole 2g PO single dose or tinidazole 2g PO single dose
25
Signs of PID
Adnexal tenderness, abdominal tenderness, uterine tenderness, cervical motion tenderness, cervical friability or mucopurulent cervicitis
26
Most common causes of PID
Gonorrhea and chlamydia
27
Primary syphilis
Chancre--painless papule at the site of inoculation
| Erodes to form a nontender shallow indurated clean ulcer
28
Secondary syphilis
Widespread, symmetrical maculopapular rash on palms of hands and soles of feet and generalized lymphadenopathy
Warts may develop
29
Tertiary syphilis
CV, derm, neuro symptoms
30
Women are at increased risk of UTI due to
Shorter urethra
31
Cystitis
Dysuria with urinary frequency and urgency; may have hematuria
No fever or CVA tenderness
32
Pyelonephritis
Fever, CVA tenderness, flank pain
33
When do you hospitalize for pyelo
pregnancy, vomiting, hypotensive, immunodeficient
34
Muscle of bladder
detrusor
35
Co-morbidities increasing risk for incontinence
Bacterial UTI, diabetes, MS, PD, AD, traumatic spine injury, heart disease and stroke, arthritis, back problems, major depression, smoking, obesity, pregnancy, childbirth
36
Stress incontinence
Involuntary leakage with effort or physical exertion, sneezing or coughing
37
Urgency incontinence
Strong desire to urinate that is difficult to postpone
38
Most common menstrual disorder affecting 81% women
Dysmenorrhea
39
Normal menstrual cycle
Normal cycle: 24-38 days
Normal duration of flow: 4.5-8 days
Normal amount of flow: 5-80mL
40
PALM-COEIN
Abnormal uterine bleeding causes
Polyps, adenomyosis, leiomyomas, malignancy, coagulopathy, ovulatory dysfunction, endometrial, iatroogenic, not yet classified
41
Polyps
Benign growths of the cervix or endometrium
| Bleeding often occurs after sex
42
Most common cause of bleeding pattern that differs from established menstrual pattern
Complication of pregnancy
43
Adenomyosis
Usually affects women >40 and multiparous women
Small areas of endometrial tissue within the myometrium
US and MRI can detect
44
Leiomyoma
Fibroids
Benign tumors in the myometrium
Leading indication for hysterectomy
45
Anovulatory bleeding
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
46
Iatrogenic
IUDs
TCAs/phenothiazines
Anticoagulants
47
Tx of abnormal uterine bleeding
```
Estrogen therapy
COC
Progesterone--tx chronic heavy bleeding due to anovulation
NSAIDs
Endometrial ablation
Hysterectomy (fibroids)
D+C
```
48
Anovulation
Common causes: thyroid disease, hyperprolactinemia
If left untx, can cause endometrial CA
Tx: induce menses by using progesterone
49
PCOS occurs in how many women
6-15% of women
50
Sx PCOS
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
4 phenotypes of PCOS
Androgen excess + ovulatory dysfunction
Androgen excess + polycystic ovarian morphology
Ovulatory dysfunction + polycystic ovarian morphology
Androgen excess + ovulatory dysfunction + polycystic ovarian morphology
52
Tx for PCOS
Weight loss
COC--treats hyperandrogenism
Antiandrogens such as spirinolactone or finasteride
Metformin
53
Skin cysts on vulva
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
Lichen sclerosus
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
Endometriosis incidence
10% of women
56
Endometriosis
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
Biopsy for vulva
Punch
58
Scope of gynecologic cancers
Most prevalent: endometrial
4th most common: cervical
Vulvar: 4%
Most lethal: ovarian
59
VIN 1 vs VIN 2
VIN 1: Warty, basaloid, mixed; related to HPV; occurs in younger women
VIN 2: Differentiated; older women; associated with vulvar dermatolic conditions
60
What causes cervical cancer
HPV 16 + 18
| Vaccine + pap smears prevent
61
Risk factors for HPV
```
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
Risk factors for endometrial cancer
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
Sx ovarian CA
Silent disease usually
| May have abdominal bloating and discomfort, difficulty eating, early satiety, back pain, changes in bowels/bladder
64
Scope of pelvic pain
1-2% of all healthcare visits made by women
| A number of causes are unrelated to gynecologic origins
65
Acute causes of pelvic pain
PID, ruptured ovarian cyst, ectopic pregnancy, torsion of ovary or fallopian tube
<3 months duration
sudden onset, sharp in nature
66
3 most common causes of chronic pelvic pain
Endometriosis, adhesions, absence of pathologic condition
67
Dx testing for pelvic pain
CBC, ESR, serologic testing for syphilis, UA and culture, pregnancy test, vaginal smears and cultures, stool guaiac, TSH, transvaginal US
68
Most common noncyclic gynecologic causes of chronic pain
Endometriosis, adhesions, ovarian remnant syndrome, pelvic congestion syndrome
69
Lower abdominal pain that increases when peritoneum is stretched, abdominal pain on light palpation, adnexal enlargement
Adhesions
Laparoscopy is diagnostic tool
Surgical lysis not recommended until last resort
70
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
Ovarian remnant syndrome
Tx: high dose progestins or surgery
US diagnostic tool
71
Bilateral lower abdominal and back pain, dysmenorrhea, dyspareunia, abnormal uterine bleeding, chronic fatigue, bulky feeling to uterus when palpated
Pelvic congestion syndrome
transuterine venography is diagnostic tool
Tx: progestin and GnRH agonist
72
Presumptive signs of pregnancy
Subjective
| Amenorrhea, N/V, increased urinary frequency, excessive fatigue, breast tenderness, quickening
73
Probable signs of pregnancy
Objective
| Goodell sign, chadwick sign, hegar's sign, uterine enlargement, braxton hicks, ballottement, positive pregnancy test
74
Positive signs of pregnancy
Diagnostic
| FHR, palpable fetal movement, US
75
Goodell sign
softening of cervix
76
Chadwick sign
blue cervix
77
Hegar's sign
softening of lower uterine segment
78
Where is uterus at 10, 20, and 40 weeks
10 weeks: symphysis pubis
20 weeks: umbilicus
40 weeks: xyphoid process
79
How much does fundus grow on average
1cm per week
80
What major hormones are involved in pregnancy
estrogen, progesterone, relaxin
81
Cardiac changes in pregnancy
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
Epulis of pregnancy
Hypertrophy of the gums leading to bleeding
83
Nagel's rule
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
BHCG
Doubles every 48 hours from conception until 13 weeks then decreases
85
Blood tests for all women in each pregnancy at initial visit
CBC, blood type and Rh factor, antibody screen, rubella titer, Hep B surface antigen, HIV, syphilis
Urine culture and G/C
86
How common is N/V in pregnancy
91% of women
87
How common is first trimester bleeding/pregnancy loss and most common cause
25% experience trimester bleeding
| 30% of all implanted embryos and 15% of clinically recognized pregnancies miscarry
88
Nuchal translucency
US evaluation of thickness of fetal nuchal fold
Detects increased risk of aneuploidy, fetal anomalies
10-14 weeks gestartion
89
Noninvasive prenatal testing
Cell free DNA
| 10+ weeks gestation
90
Quad screen
Assesses for HCG, AFP, estriol and inhibin A
Detects risk for neural tube defects, trisomy 13, 18, 21
15-22 weeks gestation
91
Infections that go through the placenta
```
Cytomegalovirus
Parvovirus (fifth disease)
Toxoplasmosis
Rubella
Varicella
GBS
```
92
Cytomegalovirus in pregnancy
Herpes virus type
Most women acquire through children in daycare
Can result in mental retardation, hearing loss, CP in baby
93
Parvovirus B19
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
Toxoplasmosis
Foodborne or cat litter
| Fetal effects: vision or hearing loss, neurologic delays, seizures
95
Rubella
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
Varicella
Risk of infection is decreased if VZIG is administered within 96 hours of exposure
97
GBS
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
Pregnancy increases risk of UTI due to
Decreased urinary tract peristalsis
| Most common agents: GBS and E coli
99
Gonorrhea in newborn manifests as
ophthalmic neonatorium and sepsis
100
Chlamydia in newborn manifests as
Neonatal conjunctivitis 5-12 days after birth; afebrile pneumonia 1-3 months after birth
101
Hyperemesis gravidarum
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
Threatened abortion
Symptoms present, products of conception intact
minimal bleeding, abdominal cramping, uterine size equal to dates, cervical os closed
Possible pregnancy loss
103
Inevitable abortion
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
Incomplete abortion
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
Complete abortion
Products of conception expelled completeley
Minimal bleeding, prior cramping subsided, uterus is pre-pregnancy size, os is closed or dialted
Pregnancy loss
106
Missed abortion
Products of conception retained for up to 6 weeks following symptoms
Vaginal bleeding did occur, subsided and reoccurs
Pregnancy loss
107
Increased risk of ectopic
Age 15-19 or >35, racial minorities, previous ectopic, previous tubal surgery, PID hx, infertility hx, IUD, assisted reproduction, history of therapeutic abortions
108
Preterm labor
Between 20 0/7 and 36 6/7
109
What are risks of polyhydramnios
Multiple gestation, maternal hyperglycemia, decreased fetal swallowing, fetal cardiac abnormalities
May complicate descent
110
Placenta previa
Painless vaginal bleeding
Complete: can not complete birth vaginally
Partial: unlikely to occur vaginally
Marginal and low lying: birth may occur vaginally
111
Abruptio placentae
Painful bright red bleeding with abdominal pain
112
When should women first be contacted post partum
1 week by phone
113
Involution
Uterus returns to pre-pregnancy state
114
Stages of lochia
Rubra: dark red, days 2-5
Serosa: lighter red, days 3-10
Alba: white to yellow, weeks 2-8
115
Vagina and vulva are expected to heal in
3-4 weeks
116
Common early postpartum concerns
Afterbirth pains, diuresis/diaphoresis, constipation, hemorrhoids, perineal discomfort, breast engorgement
117
Mastitis
Inflammation, unilateral localized erythema, breast tenderness, flu like sx
Keep breastfeeding/pumping
Tx: amoxicillin
