GU: CM review questions Flashcards
(132 cards)
1
Q
Which hormones decreases in and after menopause?
A
FSH & estrogen
2
Q
What are the effects of this decrease?
A
Hot flashes, skin dryness, hair loss, loss of libido, vaginal dryness, amenorrhea, etc.
3
Q
What do you NEVER give a woman with a uterus to treat her menopause symptoms?
A
Estrogen alone (unless vaginal cream) bc increased risk of endometrial cancer.
4
Q
What is the main way hormonal contraception prevents pregnancy?
A
Inhibiting the development and release of the egg.
5
Q
What three types of birth control contain estrogen?
A
Combined oral contraceptive pill, Nuva Ring and patch (Ortho Evra)
6
Q
What are the three types of emergency contraception?
A
Paragard IUD, Ella, Plan B
7
Q
Which methods of EC are is most effective and why?
A
Paragard IUD
8
Q
What are the 6 main contraindications for combined hormonal birth control?
A
Hypertension Migraines with aura Previous blood clots/strokes Smoking & over 35 Known thrombogenic mutations Lupus with phospholipid antibodies
9
Q
What must you warn patients about when starting combined hormonal birth control?
A
A = abdominal pain C = chest pain H = headaches E = eye problems S = severe calf/leg pain
10
Q
What is the most common benign breast condition?
A
Fibrocystic breast disease
11
Q
What are breast cysts?
A
Small collections of fluid or a mix of fluid/debris in the breast
12
Q
What are the two most common types of breast imaging?
A
Mammogram and sonogram
13
Q
List 5 risk factors for breast cancer?
A
age, Caucasian, obesity, tall, more exposure to estrogen, family history in 1st degree relatives, BRCA mutation, ionizing radiation to the chest
14
Q
How and when should average risk women be screened for breast cancer?
A
Starting at 21, CBE q 1-3 years; mammograms starting at 40.
15
Q
What breast exam signs and symptoms indicate the possibility of breast cancer?
A
Hard, non-mobile, mass with irregular borders. Peau d’ orange, skin retractions, new onset nipple inversion, unilateral nipple discharge.
16
Q
What are the two main types of atypical hyperplasia?
A
Atypical Ductal Hyperplasia (ADH) & Atypical Lobular Hyperplasia (ALH).
17
Q
If atypical hyperplasia is found on a biopsy, what should happen next?
A
Excisional biopsy/Lumpectomy
18
Q
What is the most common type of breast cancer?
A
Invasive Ductal Carcinoma
19
Q
What is the most aggressive form of breast cancer and its symptoms?
A
Inflammatory breast cancer. Sxs include erythema, swelling, itching, tenderness and lymphadenopathy.
20
Q
What prevents lactogenesis in pregnant women?
A
High progesterone (produced by the placenta)
21
Q
What hormone is released by suckling?
A
Prolactin
22
Q
What are the signs, symptoms and treatment for mastitis?
A
Rubor, Dolor, Calor, Tumor & FEVER; TX = warm compresses & DICLOXACILLIN 500MG PO qid x 10-14 days and keep breastfeeding.
23
Q
What hormone is responsible for preventing ovulation while breastfeeding?
A
Inhibition of GnRH, LH, FSH from SUCKLING & Prolactin release
24
Q
You see a 37 year old patient for a CBE and you note a 1 x 2 cm mass in the upper outer quadrant of her LEFT breast. What do you order?
A
A diagnostic LEFT sonogram and mammogram.
25
Now, the patient goes and gets the imaging and it comes back BIRADS 1 (nothing abnormal).
What do you do next?
Have the patient return for a repeat CBE.
26
She comes back and you still feel the 1 x 2 cm mass in the upper outer quadrant of her LEFT breast. What do you do now?
Send her to a breast surgeon for a consult and let them decide if a biopsy is needed or not.
27
She comes back and you still feel the 1 x 2 cm mass in the upper outer quadrant of her LEFT breast. What do you do now?
Send her to a breast surgeon for a consult and let them decide if a biopsy is needed or not.
28
Describe normal vaginal discharge. Where does it come from?
white or transparent and mostly odorless. This discharge includes vulvar secretions from sebaceous, sweat, Bartholin and Skene glands.
29
What is the normal vaginal pH?
3.8 – 4.5
30
What is the role of lactobacilli in the vagina?
Keeps pH acidic (via production of lactic acid and hydrogen peroxide) which prevents growth of pathogens
31
List the cause, signs and symptoms of cervicitis and PID.
GC &CT; red, inflamed cervix with green/yellow discharge coming out of the os. If additional CMT and/or fever, it is PID. Cervicitis only = no CMT, no fever. Increased WBC on wet mount for CT, GC, cervicitis, PID
32
What are the long term risks with PID?
Scarred tubes = ectopic & infertility
33
What is the appropriate management of PID?
Outpatient = Ceftriaxone 250mg IM once & Doxycycline 100mg PO bid x 14 d and recheck in 24 hours.
34
How and when do we screen women for cervical cancer?
Pap smear & HPV testing, starting at age 21.
35
Which 3 HPV types are most responsible for cervical cancer?
16, 18, 45
36
What is a colposcopy
Microscopic look at cervix
37
Which pap/hpv results warrant a colposcopy?
Anything ASCUS or higher OR HPV HR 16, 18.
38
What are the treatments for cervical cancer?
LEEP, Cold Knife Cone, hysterectomy, chemotherapy
39
What is a leiomyoma?
Fibroid – collection of uterine muscle
40
What are the signs and symptoms of leiomyomas?
Abnormal uterine bleeding, dysmenorrhea, pelvic pressure, fullness, constipation and frequent urination (if pressing on bladder). Cyclic pelvic pain, bad cramps and heavy bleeding during menses. Can also cause infertility.
41
How are leiomyomas treated?
Hormonal contraception, myomectomy
42
What is endometriosis?
Presence of endometrial glands and/or stroma outside the uterus.
43
What are the signs and symptoms of endometriosis?
Pelvic pain, dysmenorrhea, dyspareunia, dyschezia
44
What does endometriosis often cause?
Infertility
45
How is endometriosis treated?
Laparoscopy & ablation or oophorectomy (b/c it relies on estrogen for growth)
46
What is an alarm sign for endometrial cancer?
Abnormal bleeding/spotting AFTER menopause
47
How is endometriosis diagnosed?
Endometrial biopsy
48
List 3 protective factors against endometrial cancer?
Decreased exposure to estrogen (multiparity, late menarche), combined contraception.
49
What is the most common type of ovarian cyst?
Functional
50
Why do functional ovarian cysts occur?
Follicle that doesn’t ovulate
51
List two ways to differentiate ovarian cysts from ovarian cancer.
Sonogram, biopsy, (CA125)
52
What are the signs and symptoms of ovarian torsion?
severe lower abdominal pain, nausea and pelvic tenderness.
53
How and when do we screen women for ovarian cancer?
We don't.
54
List three signs/symptoms of ovarian cancer.
Early satiety, bloating, pelvic or abdominal pain
55
Describe the hormonal abnormalities of PCOS.
androgen excess (increased testosterone), increased LH, insulin resistance.
56
List the signs & symptoms and treatment of PCOS.
Menstrual dysfunction/irregularities - oligomenorrhea (less than 9 periods a year) or secondary amenorrhea (absence of menses for > 3 consecutive months; Hirsutism (coarse, dark hair in a male pattern), acne, androgenic alopecia; Insulin resistance - type II DM, obesity. Treatment = hormonal contraception (if that isn’t enough…. Spironolactone).
57
For women who desire pregnancy, how much folic acid should they take and when should she start? What does this prevent?
0.4mg/day for first trimester; prevents neural tube defects
58
List 5 common drugs contraindicated in pregnancy.
Warfarin, tetracycline, valproic acid, lithium, benzodiazapines
59
List 3 physical exam findings that are common in pregnancy (but not common otherwise).
Systolic heart murmurs, S3, spider angiomas, striae, linea nigra.
60
Describe Chadwick’s sign – what does it indicate and what does it look like?
Bluish color of cervix and vulva around 8-12 weeks gestation.
61
How “high” is the fundus at 20 weeks gestation?
Umbilicus
62
List the 8 labs you need to order on every pregnant woman at her first prenatal visit?
UA, Rh, rubella, syphilis, Hep B, HIV, Gonorrhea & Chlamydia and PPD (if at risk for TB)
63
Describe the genetic screening for the fetus in the first trimester and how it’s done.
Sono (NT thickness); mom free hCG (up = risk Downs); PAPP-A (low = risk Down’s).
64
Describe the genetic screening for the fetus in the second trimester and how it’s done.
Triple screening w/ AFP, beta HcG, Estradiol.
65
List 3 lifestyle modifications that may help morning sickness.
Eat small, frequent meals, avoid spicy or greasy food, protein snacks at night, saltine crackers by bed, room temp sodas.
66
About when should a first-time mother feel the baby move?
20 weeks.
67
List the 5 things that should be checked at every prenatal visit?
BP, urinalysis (protein & glucose), weight, uterine size, fetal heart rate
68
What is the purpose of the maneuvers of Leopold?
To determine the fetal position and lie.
69
Describe the differences between the glucose screening test and the glucose challenge test.
Screen = 1 hour, if positive, then move to diagnostic test = glucose challenge test - > 3 hours.
70
What other disease should we screen the mother for between weeks 35 & 37?
Group B strep
71
List the 5 components of a Biophysical profile.
Non-stress testing, fetal breathing, fetal tones/heart rate, amniotic fluid levels, gross fetal movements.
72
Describe a nonstress test and what results are positive and negative.
Nonstress test is when we monitor the fetal heartbeat and the mom indicates when the baby moves and we check the fetal tracing to make sure the heart rate goes up (> 15 bpm from baseline; > 15 seconds) with the movement. If this happens twice in 20 minutes it is considered REACTIVE (which is good). If not, then it is considered NONREACTIVE (not good).
73
Define fetal monitor accelerations & variations and what causes them.
Accelerations are an increase in fetal heart rate in response to fetal movement or uterine contractions. They are considered “good” because they will stop occurring if the fetus is hypoxic. And variations/variability is a difference in heart rate from beat to beat – the normal range of variability is 5-25 bpm difference between beats.
74
Explain fetal monitor decelerations and what they mean, including what makes a positive & negative.
Decelerations are decelerations in the fetal heart rate. There are early decelerations which occur at the same time as contractions and are “normal” in the final stages of labor. There are variable decelerations that have no correlation to the mom’s contractions and are also considered “normal.” And there are late decelerations that occur within 30 seconds of the contractions and signal a period of fetal hypoxia. If there are repetitive late decelerations in the presence of 3 contractions within a 10 minute period, we consider that a POSITIVE test and we should deliver the baby as soon as possible.
75
Describe what causes and the symptoms of lightening, Braxton Hicks contractions and a bloody show.
Lightening = the descent of the fetal head into the pelvis. The fact that the pelvic bone is now supporting some of the weight of the baby means the mom feels like the baby got “lighter,” hence the name. Braxton Hicks contractions are “practice” contractions that occur prior to labor. They are different from regular contractions in that they occur randomly and there is no cervical dilation or effacement. A bloody show is when the cervical mucus plug is released because of the cervical effacement and dilation – it often causes a small amount of bleeding.
76
What is the most common type of female pelvis?
Gynecoid
77
What is the fetal lie? Presentation?
The fetal lie is the relation of the fetus to the longitudinal axis (think of the mother’s spine) of the mother. The lie must be longitudinal (parallel to the spine) in order to have a successful vaginal delivery. The presentation refers to which fetal part is set to come out of the pelvic outlet first.
78
List the 4 stages of labor and identify the “starting” and “ending” point of each stage.
Stage I = onset of “true” labor; starts with cervical effacement and dilation and concludes when the cervical dilation has reached 10 cm.
Stage II = I think of this as the “delivery” stage – the time from complete cervical dilation (10cm) and concludes with the delivery of the fetus. This is when the fetus does the SIX CARDINAL MOVEMENTS.
Stage III = I think of this as the “placenta delivery” stage – starts once the fetus is delivered and concludes with the delivery of the placenta.
Stage IV= The first hour after delivery of the placenta. This is the most common time for a postpartum hemorrhage to occur.
79
How quickly should the cervix dilate?
Once the cervix has reached 3-4 cm, it should begin dilating at a rate of 1-1.2 cm per hour.
80
What is the “best” position for the mother to lie in during stage 1 of labor? And why?
On her LEFT side – this reduces the compression of the liver, hepatic blood flow and vena cava.
81
Describe the difference between cervical effacement and dilation.
Effacement is when the cervix THINS. Dilation is when it opens.
82
List the 6 cardinal movements of labor.
```
1 = engagement
2 = descent
3 = flexion
4 = internal rotation
5 = extension
6 = external rotation
```
83
What is an episiotomy and what are the indications for one?
A cut in the perinium to aid the delivery of the fetus. There are no strict indications for one, but they are often performed when there is difficulty getting the fetal head out of the vagina.
84
List the 3 signs of placental separation.
1) gush of blood; 2) lengthening of the cord; 3) uterus (fundus) becomes firmer
85
If we need to induce labor in a mother with a 30-week fetus. List four key things we must do.
1) Admit and start fetal monitoring
2) Give betamethasone
3) Delay labor by 48 hours, if possible, by giving tocolytics (magnesium sulfate)
4) Give prophylactic antibiotics for GBS
86
Describe how hCG is used to help diagnose early pregnancy loss.
It is used to confirm that a pregnancy is no longer viable – when the hCG is falling at the appropriate rate.
87
Explain the discriminatory zone of hCG and how it is used.
The discriminatory zone occurs at hCG 2500 – at which time you should be able to identify a uterine pregnancy on sonography. If you don’t see a pregnancy in the uterus but the Hcg is 2500 or higher, it is an ectopic pregnancy until proven otherwise.
88
When is it acceptable and when is it NOT acceptable to use expectant management of an early pregnancy loss?
Expectant management can be utilized in a pregnancy that less that 12 weeks – in other words, during the 1st trimester. You can’t utilize expectant management if the pregnancy is greater than 12 weeks OR if there are signs/symptoms of infection.
89
Describe the medical management of an early pregnancy loss and how it is done.
The patient is given one does of mifepristone and then 24 hours later a dose of misoprostol.
90
Explain gestational trophoblastic disease, how it is diagnosed and how it is treated.
It is diagnosed via physical exam (with a mismatch between gestational age and uterine “size”/fundal height) and with hCG (that is exponentially higher than normal). In addition, on sonogram, you might see a “snowstorm” or “cluster of grapes.” It is treated with a surgical D&C and then weekly and monthly hCG monitoring.
91
List the risk factors for ectopic pregnancy.
Previous ectopic, tubal ligation, IUD, history of PID, cigarette smoking, use of reproductive technology.
92
Where is the most common location for an ectopic pregnancy and why?
Fallopian tubes because the fertilized egg’s trajectory is the tubes then the uterus. It is very, very rare to have the egg implant outside of these two areas.
93
List the signs and symptoms of a probable ectopic pregnancy.
Triad = missed period, vaginal bleeding, lower abdominal pain.
94
Describe the signs, symptoms and treatment of acutely ruptured ectopic pregnancy.
Severe abdominal pain, rebound tenderness, dizziness, referred shoulder pain, hypovolemia, shock.
95
Describe the difference in symptoms, diagnosis and treatment of possible vs probable ectopic pregnancy.
Possible = vague symptoms, +/- mild abdominal pain. Exam is usually normal. Probable = missed period, vaginal bleeding and abdominal pain. Exam may have abdominal tenderness or CMT.
96
Describe the cause and treatment of an incompetent cervix.
Cause = too many LEEP procedures; Treatment = cerclage
97
Describe signs and symptoms of abruptio placentae.
PAINFUL cramps & abdominal pain, vaginal bleeding (seen or unseen), Back pain, potential hemodynamic instability, usually always in 3rd trimester.
98
Describe how abruptio placenta is treated.
Immediate delivery of fetus, IV fluids and blood transfusions for the mother, try to stop the bleeding.
99
What do we use to treat women with HTN in pregnancy?
Methyldopa
100
List the two diagnostic criteria for pre-eclampsia.
New onset HTN and new onset proteinuria
101
List the criteria for HELLP syndrome.
Hemolysis, elevated liver enzymes, low platelets.
102
Describe the signs and symptoms of eclampsia and its treatment.
tonic-clonic seizures; managed with Magnesium Sulfate and prevent more seizures and hypertensive medications, but the only treatment is delivery of the fetus.
103
What is the treatment for gestational diabetes and the most common fetal consequence?
Insulin and macrosomia.
104
Differentiate between placenta previa and abruptio placenta.
Placenta previa = the placenta covers part or all of the cervical os. Can cause PAINLESS bleeding/spotting, usually during the 3rd trimester. Abruptio placenta = the placenta detaches from the uterus. Causes PAINFUL bleeding (seen or unseen), most commonly occurs during the 3rd trimester.
105
Define “pre term”
delivery prior to 37+ weeks.
106
List the two diagnostic criteria for preterm labor.
regular uterine contractions (> 4-6/hour) and cervical change (effacement of 80% or dilation of 3cm).
107
Explain the management of preterm labor after 34 weeks and before 34 weeks.
BEFORE 34 WEEKS: Admit, fetal monitoring, give betamethasone and attempt to delay delivery for 48 hours using magnesium sulfate, give ABX for GBS prophylaxis. AFTER 34 WEEKS: admit, monitor, deliver. If 4-6 hours pass with no progression of cervical effacement or dilation, can be discharged.
108
List 3 risk factors for PROM.
vaginal/cervical infection, smoking, multiple gestations, prior preterm delivery.
109
List two methods used to diagnose PROM?
Check for “ferning” or use nitrazine paper to check for alkalinity (amniotic fluid)
110
What should never be put inside a vagina in a woman with PROM?
Anything that is NOT sterile.
111
Explain the difference between PROM and PPROM.
PROM is rupture of membranes at 37+ weeks; PPROM is rupture of membranes prior to 37 weeks.
112
Describe the management of PROM and PPROM.
PROM = admit, fetal monitoring, monitor mom for infection, induce labor if no spontaneous labor after 18 hours. PPROM= admit, fetal monitoring, if 34 weeks or less, GIVE BETAMETHASONE. Can give antibiotics; induce labor after either 48 hours (if less than 34 weeks) or earlier if signs of fetal or maternal distress.
113
Describe dystocia and its management.
Labor that does not progress normally. We manage based on which of the three problems are causing it: Powers (intensity of contractions) -> we give oxytocin to increase force of contractions, Passenger (fetus too big) -> c-section; Passage (maternal pelvis is too small) -> c-section
114
What constitutes an arrest of labor?
No change in cervical dilation or effacement despite 4 hours of adequate (>200 montevideo units) of contractions.
115
Describe shoulder dystocia and its management.
The shoulders won’t come out. Can be managed by maneuvers. If that doesn’t work, break clavicles.
116
Describe breech presentation and its management.
Butt first. It is managed based on the experience of the OB and if they feel confident about delivering a breech vaginally.
117
Describe umbilical cord prolapse and its management.
When the umbilical cord extends beyond the presenting fetal part. It is managed by trying to release the pressure on the cord from the baby’s head.
118
List the four most common indications for c-sections.
dystocia, prior c-section, breech presentation, fetal distress.
119
List the absolute contraindication for a c-section
prior NON-TRANSVERSE uterine incision.
120
Describe uterine rupture, list the signs, symptoms and risk factors and describe the management.
Uterine rupture is when the muscles of the uterus tear apart. The symptoms and signs are extreme pain, absent contractions, bleeding and fetal bradycardia. Risk factors = previous uterine rupture, prior c-section, induction of labor with oxytocin, trauma, previous myomectomy
121
Define postpartum hemorrhage.
Loss of blood greater than 500 mL with vaginal delivery and 1000 mL with c-section.
122
List the four main causes of postpartum hemorrhage.
tone (uterine atony), tissue (retained placental tissue), trauma/lacerations, thrombin (coagulation disorder).
123
List three risk factors for uterine atony.
multiple gestations, fetal macrosomia, prolonged labor, using oxytocin in labor, using magnesium sulfate to manage preeclampsia, uterine leiomyomas (fibroids)
124
What is the treatment for uterine atony.
uterine massage, oxytocin, methylergonovine
125
When is the riskiest “time” for postpartum hemorrhage?
First 1 hour after delivery.
126
What is the treatment for refractory postpartum hemorrhage?
Tamponade, surgical ligation or cauterization of arteries, hysterectomy
127
List three causes of post-partum pain and how to manage it.
afterpains, episiotomy, lacerations, breast engorgement, post-epidural headache. These can be treated with acetaminophen (NOT NSAIDS!), aspirin, codeine
128
Describe colostrum and its purpose.
yellow thick substance that is secreted through the breast in the first weeks postpartum – it carries extra minerals, amino acids and immunoglobulins like IgA to protect the infant from GI infections.
129
List three contraindications to breastfeeding.
taking illicit drugs, excessive drinking, HIV, untreated, active TB, breast cancer treatment, take certain medications.
130
Explain when and how to start contraception after delivery.
should start it immediately after birth as ovulation can occur in as few as 4 weeks.
131
List the contraindications when starting contraception after delivery.
No estrogen for at least the first 12 weeks b/c risk of blood clots; no estrogen while breastfeeding because it decreases milk production.
132
Describe four main differences between post-partum blues and post-partum depression and list the management of both.
Post-partum blues = depressed mood 2-4 days postpartum (up to 10 days) with no thoughts of harming baby. Management includes anticipatiory guidance, recognition and reassurance. Post-partum depression is major depression (including thoughts of harming baby) starting between 2 weeks and 2 months AFTER delivery. Management includes antidepressants and CBT therapy.
