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MY Midwifery > GYN > Flashcards

GYN Flashcards

1
Q

PMS

A
  • cyclic occurrence in the luteal phase
  • begin 5 to 7 days before menses and resolve within 4 days of onset of menses
  • disrupt normal activities and interpersonal relationships
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2
Q

Non pharm Tx of PMS

A
  • chaste tree berry
  • Aerobic exercise 20 - 30 min 4X/week
  • Cognitive therapy
  • Avoidance of physical/emotional triggers
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3
Q

RX Tx of PMS

A
  • Spironolactone during luteal phase (reduce swelling/bloating)
  • NSAIDs
  • COCs
  • SSRIs (may choose to only take during luteal phase)
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4
Q

PMDD

A
  • At least 5 PMS-like symptoms severe enough to disrupt normal functioning
  • Most if not all menstrual cycles
  • Occurs in luteal phase and resolves within 1 week after menses
  • Markedly depressed mood, anxiety, anger
  • SSRIs (fluoxetine, sertraline, paroxetine)
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5
Q

Which phase of the ovarian cycle is most variable?

A

Follicular phase

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6
Q

Which phase of the ovarian cycle is most constant?

A

Luteal phase (14 days)

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7
Q

Is Galactorrhea bilateral?

A

YES, ALWAYS!

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8
Q

Fibrocystic Breast Changes

A
  • occurs 1-2 weeks before menses
  • well, defined, mobile, TENDER
  • NO SKIN changes
  • upper outer quadrant and axillary tail
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9
Q

Treatment for Fibrocystic Breast Changes

A
  • Tx not necessary
  • Aspiration of palpable cysts may be curative
  • Supportive bra
  • NSAIDs
  • Reduce methylxanthines (caffeine, tea, cola, chocolate)
  • Hormonal contraception may improve or worsen
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10
Q

Who is most at risk for Fibrocystic Breast Changes?

A
  • Women aged 20 - 50, most common 35 - 50
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11
Q

When do Fibroadenomas develop?

A

Soon after menarche

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12
Q

What age group is likely to be affected by Fibroadenoma?

A

Aged 15 to 25

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13
Q

Signs and Symptoms of Fibroadenoma

A
  • painless, single, round rubbery mass
  • No nipple D/C
  • Does NOT change with menstrual cycle
  • NO SKIN changes
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14
Q

Diagnostic Tests for Fibroadenoma

A
  • Fine needle aspiration
  • Excisional biopsy
  • U/S or mammography (U/S best choice for young women)
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15
Q

Management for Fibroadenoma

A
  • Observe if less than 25
  • May be removed to alleviate anxiety
  • Annual clinical breast exam
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16
Q

What is the most common cause of pathologic nipple d/c?

A

Intraductal papilloma

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17
Q

Signs and Symptoms of Intraductal Papilloma

A
  • Bloody, serous, or turbid discharge (not milk)
  • D/C may occur spontaneously
  • Mass not palpable
  • Feeling of fullness or pain beneath areola
18
Q

How to definitively evaluate Intraductal Papilloma?

A
  • Excisional biopsy
19
Q

Midwifery Management of Intraductal Papilloma

A
  • REFER

- Excisional biopsy is curative

20
Q

What age group is most at risk for Intraductal Papilloma?

A
  • perimenopausal age group 35-50 yo
21
Q

Breast Carcinoma Signs and Symtpoms

A
  • Breast mass, likely upper outer quadrant
  • Mass fixed, poorly defined, nontender
  • Spontaneous nipple D/C
  • Retraction
  • Skin Changes
22
Q

What is the proper follow-up of a patient with galactorrhea who is having regular menses and has normal prolactin and TSH levels?

A

Yearly prolactin levels

23
Q

Adenomyosis Signs and Symptoms

A
  • dysmenorrhea, heavy uterine bleeding
  • boggy tender uterus
  • globular enlargement (may be 8 - 10 weeks gestation size)
24
Q

Galactorrhea

A
  • bilateral nipple d/c that occurs in women that have not been pregnant or lactating within the last 12 months
  • Not caused by breast disease
  • often idiopathic
  • May be associated with prolactin-secreting pituitary adenomas
25
Q

Patients with PCOS are at increased risk for:

A
  • endometrial cancer
  • diabetes mellitus
  • heart disease
26
Q

What is the treatment for Bacterial Vaginosis?

A
  • Metronidazole 500 mg PO BID X 7d
  • Metronidazole gel 0.75% QD X5d
  • Clindamycin cream 2% QD X7d
27
Q

Amsel’s Diagnostic Criteria for diagnosing BV

A

3 of the following:

  • white d/c that coats vaginal walls
  • clue cells on microscopic exam
  • pH of vaginal fluid >4.5
  • +Whiff test
28
Q

What is found on BV Gram Stain?

A

Lactobacilli

29
Q

What is the treatment for vulvovaginal candidiasis?

A
  • OTC or prescription topical “azole”cream

- Fluconazole 150 mg PO 1 time

30
Q

What is seen on wet prep or gram stain of candidiasis?

A
  • budding yeasts
  • hyphae
  • pseudohyphae
31
Q

What is the treatment for Chlamydia?

A
  • Azithromycin 1 g PO single dose

- Doxycycline 100 mg PO BID X7d (not approved for tx in pregnancy)

32
Q

What are is most sensitive test in diagnosing Chlamydia?

A

NAAT

33
Q

What is the treatment for Gonorrhea?

A
  • Ceftriaxone 250 mg IM PLUS Azithromycin 1 g PO single dose
34
Q

What is the treatment for primary, secondary, and early latent syphilis?

A
  • Benzathine PCN G 2.4 million units IM single dose
35
Q

What is the treatment for first episode of HSV (herpes)?

A

Acyclovir 400 mg PO TID X 7-10d

36
Q

What is the suppressive therapy for recurrent HSV (herpes)?

A

Acyclovir 400 mg BID

37
Q

When should suppressive therapy for HSV+ women begin in pregnancy?

A

36 weeks

38
Q

What is the suppressive therapy for HSV in pregnant women?

A

Acyclovir 400 mg PO TID QD

39
Q

Tx of PCOS in women who do not want to conceive?

A
  • low dose COCs

- progestin contraceptives (irregular bleeding)

40
Q

Tx of PCOS in women who do not desire pregnancy and who do not want hormonal contraception?

A
  • MPA for 10 days a month induces withdrawal bleeding
  • Weight loss
  • Insulin sensitizing agents (i.e. metformin)
41
Q

What are potential causes of galactorrhea?

A
  • hypo/hyperthyroidism
  • some medications (opiates, cannabis)
  • excessive breast stimulation
  • pituitary adenoma

MY Midwifery (3 decks)

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