GINECO Y OBSTE Flashcards
Verdadero o falso, el Síndrome de Mondor es lo mismo que la enfermedad de Mondor
FALSO.
Es Síndrome de Mondor es…
Clostridium perfringens es un bacilo Gram positivo, anaerobio estricto, esporulado, productor de exotoxinas (que producen la acción patógena). Puede causar un cuadro tóxico sistémico grave, caracterizado por la aparición de hemólisis severa, trastornos de la circulación asociados a shock o hipotensión refractaria, CID, acidosis metabólica e insuficiencia renal aguda. A este cuadro clínico también se le conoce como síndrome de Mondor.
La enfermedad de Mondor es…
Una tromboflebitis de las venas superficiales que irrigan las mamas, asociada a esclerosis. También se describió la enf. de Mondor peneana (asociada a escabiosis y masturbación excesiva) y puede ocurrir muy raramente como axillary web syndrome (AWS, post mastectomía total con linfadenectomía, por adherencias), en la ingle, abdomen y brazo.
Para tratar el Síndrome de Mondor se recomienda usar los ATB…
Penicilina G sódica (3-4 millones UI cada 4 horas) asociada a gentamicina o clindamicina (ATB de amplio espectro). La asociación de penicilina y clindamicina (se usa solo si hay alergia a la peni) ha demostrado menor producción de toxina alfa y mejor respuesta.
Las causas de la enfermedad de Mondor son…
- Estasis sanguínea (Ej.: tumores, que es lo mas comun en mama).
- Trauma directo (Ej.: bra ajustado).
- Ejercicio intenso (Ej.: bodybuilders).
En la enfermedad de Mondor mamaria nunca es afectada…
La región superior e interna de la mama.
Factores de riesgo para la enfermedad de Mondor
- Cáncer de mama, mastectomía, extirpación de ganglios o mamoplastías anestésicas (1%).
- Mujeres (relación 3:1 mujer-hombre).
- Edad entre 30 y 60 años.
Pronostico de la enfermedad de Mondor
Bueno, ya que es autolimitada y benigna. Puede indicar un carcinoma oculto.
Esto es….
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La enfermedad de Mondor
Mondor disease has a characteristic clinical picture of a sudden appearance of a linear, cordlike, thrombosed vein. At first, this vein is red and tender, and then, it subsequently changes into a painless, tough, fibrous band. The cord is accentuated by traction, elevation of the breast, or abduction of the ipsilateral arm. It may also be evident as retracted breast skin.
Los dx diferenciales de la enfermedad de Mondor son
- Enfermedad de Paget (enfermedad inflamatorio del seno).
- CA de seno (metastásico).
- Absceso de seno.
- Hernia de Spiegel estrangulada.
- Apendicitis aguda.
- Linfangitis esclerosante no venérea del pene.
- Celulitis.
- Eritema nodoso
- Angioblastoma post radioterapia torácica.
- Linfagiectasia y linfagioma.
Objetivo de la consulta preconcepcional
- Optimizar la salud de la mujer en el embarazo.
- Minimizar los efectos adversos del embarazo sobre la salud de la mujer.
- Identificar condiciones preexistentes que puedan complicar la concepción, el embarazo o ambos.
A las futuras madres se les debe dar asesoría sobre…
- Family planning and pregnancy spacing
- Family history
- Genetic history
- Medical, surgical, psychiatric, and neurologic histories
- Current medications
- Substance use
- Domestic abuse and violence
- Nutrition
- Environmental and occupational exposures
- Immunity and immunization status
- Risk factors for sexually transmitted diseases
- Obstetric and gynecologic history
- Physical examination
- Assessment of socioeconomic, education, and culture context
Vaccinations should be offered to women found to be at risk for or susceptible to…
Rubella, varicella, and hepatitis B.
All pregnant women should be tested for…
HIV infection, unless they decline the test.
An important aspect of prenatal/antepartum care is to educate the mother and her family about the value of …..(1)…..for and managing the unexpected complications that may develop.
- screening.
The conditions with poor maternal and neonatal outcomes are…
Preterm labor and preterm delivery, preterm infection, intrauterine growth restriction, hypertension and preeclampsia, diabetes mellitus, birth defects, multiple gestation, and abnormal placentation.
How to diagnose early pregnancy in women with regular cycles?
- History of one or more missed periods following a time of sexual activity without effective contraception strongly suggests early pregnancy.
- Fatigue, nausea/vomiting, and breast tenderness are often associated symptoms.
- On physical examination, softening and enlargement of the pregnant uterus becomes apparent 6 or more weeks after the last normal menstrual period. At approximately 12 weeks of gestation (12 weeks from the onset of the last menstrual period), the uterus is generally enlarged sufficiently to be palpable in the lower abdomen.
- Other genital tract findings early in pregnancy include congestion and a bluish discoloration of the vagina (Chadwick sign) and softening of the cervix (Hegar sign).
- Palpation of fetal parts and the appreciation of fetal movement and fetal heart tones are diagnostic of pregnancy, but at a more advanced gestational age.
When does the mother start perceiving fetal movement?
The patient’s initial perception of fetal movement (called “quickening”) is not usually reported before 16 to 18 weeks of gestation, and often as late as 20 weeks in first-time mothers.
To diagnose pregnancy, it’s only needed the presence of signs and symptoms?
No, a pregnancy test is needed to confirm the diagnosis.
Home urine pregnancy tests have a low…..(1)……rate but a high…..(2)…..rate.
- false-positive.
- false-negative.
All urine pregnancy tests are best performed on early-morning urine specimens, which contain the highest concentration of hCG.
Serum pregnancy tests are more specific and sensitive because they test for the unique β-subunit of hCG, allowing detection of pregnancy very early in gestation, often before the patient has missed a period.
Ultrasound examination can detect pregnancy early in gestation but, how early?
With an abdominal ultrasound, the ultrasound transducer is placed on the maternal abdomen, allowing visualization of a normal pregnancy gestational sac 5 to 6 weeks after the beginning of the last normal menstrual period (corresponding to β-hCG concentrations of 5000 to 6000 mIU/mL) Transvaginal ultrasound often detects pregnancy at 3 to 4 weeks of gestation (corresponding to β-hCG concentrations of 1000 to 2000 mIU/mL).
Detection of fetal heart activity (“fetal heart tones”)
is also almost always evidence of a viable intrauterine pregnancy. With a traditional, nonelectronic, acoustic fetoscope, auscultation of fetal heart tones is possible at or beyond …1…. of gestational age. The commonly used electronic Doppler devices can detect fetal heart tones at approximately…..2….of gestation.
- 18 to 20 weeks.
2. 12 weeks.
At the initial prenatal appointment, a comprehensive history is taken, focusing on past pregnancies, gynecologic history, medical history with attention to chronic medical issues and infections, information pertinent to genetic screening, and information about the course of the current pregnancy. A complete physical examination is performed, including…
Breast and pelvic examinations, as well as routine first-trimester laboratory studies. The patient is given instructions concerning routine prenatal care, warning signs of complications, whom to contact with questions or problems, and nutritional and social service information.
The initial obstetric pelvic examination also includes a description of the various diameters of the bony pelvis, assessment of the cervix (including cervical length, consistency, dilation, and effacement), and size (usually expressed in weeks), shape, consistency (firm to soft), and mobility.
When the uterus grows in size so that it exits the pelvis, the fundal height in centimeters represents…
The gestational age of the fetus from that time to about 36 weeks.
Embarazos de alto riesgo están dados por personas con…
- Menores de 16 y mayores de 35 años.
- Antecedentes médicos: Colagenopatías , diabetes mellitus pregestacional, hipertensión arterial (HTA), epilepsia, enfermedad crónica cardiovascular, cáncer, hipo e hipertiroidismo, asma, enfermedades tromboembólicas y trombofilias, tuberculosis o trastornos psiquiátricos.
- Infectologías: VHB, VHC, TBC, Chlamydia (cribado si <25 años o factores de riesgo), gonorrea (si riesgo de enfermedad de transmisión sexual), herpes genital (serología específica si pareja infectada), toxoplasmosis y enfermedad de Chagas.
- Historia familiar o hijos con alteraciones genéticas y cromosómica, estructurales, metabólicas, neurológicas, retraso mental, fibrosis quística, etc. En caso de estar indicado se realizará consejo y estudio genético.
- Antecedentes obstétricos: parto pretérmino, RCIU, aborto habitual, muerte fetal intrauterina, cesárea anterior, gran multípara y esterilidad previa.
- Abuso de alcohol.
- Abuso de drogas.
- Riego laboral.
- Entorno familiar.
El laboratorio preconcepcional incluye…
LABORATORIO: hemograma, hepatograma, glucemia, uremia, creatinina, orina completa, hormonas tiroideas, valorar ETS (HIV, Hep. B, Hep C, VDRL), grupo sanguíneo, factor Rh, toxoplasmosis, Chagas.
- Urocultivo.
- Citología cérvico vaginal o detección de HPV.
- Ecografía ginecológica y mamaria.
- Interconsulta con otros profesionales de la Salud: Odontólogo/a , Nutricionista, Psicólogo/a.
Gestational age is…
The number of weeks that have elapsed between the first day of the last menstrual period (not the presumed time of conception) and the date of delivery. Its use lies in the determination of the estimated date of delivery (EDD).
Cual regla se usa para calcular la fecha de parto.
La regla de Naegele:
An easy way to calculate the EDD: add 7 days to the first day of the last normal menstrual flow and subtract 3 months. In a patient with an idealized 28-day menstrual cycle, ovulation occurs on day 14; therefore, the conception age of the pregnancy is actually 38 weeks. “Normal” pregnancy lasts 40 ±2 weeks, calculated from the first day of the last normal menses (menstrual or gestational age).
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TRUE OR FALSE: Obstetric ultrasound examination is the most accurate measurement available in the determination of gestational age.
TRUE.
Normal intervals for antenatal care
For a patient with a normal pregnancy, periodic antepartum visits at 4-week intervals are usually scheduled until 28 weeks, at 2- to 3-week intervals between 28 and 36 weeks, and weekly thereafter.
