Gyn Acronyms Flashcards
VB
Vaginal bleeding
LOF
Leakage of fluid
IOL
Induction of labor
FM
Fetal movement
CTX
Contractions
FKCs
Fetal kick counts
GBS
Groups B strep, swab at 35wks
GTT
3hr glucose tolerance test
EFW
Estimated fetal weight
NST
No stress test-fetal HR test
BPP
Biophysical profile
RCS
Repeat c-section
TOLAC
Trial of labor after c-section
R/B/A
Risk, benefits, alternative
ECV
External cephalon version (attempt to turn breech baby)
PET
PreEclampsia
EDD
Estimated delivery date
PNV
Prenatal vitamin
ROM
Rupture of membranes
OBT
OB triage
ROL
Rule out labor
VBAC
Vaginal birth after c-section
NSVD
Natural spontaneous vaginal delivery
PIH
Pregnancy induced hypertension
UPT
Urine pregnancy test
SAB
Spontaneous abortion
PTL
Preterm labor
HROB
High risk pregnancy
MFM
Maternal fetal medicine
GDM
Gestational diabetes
AMA
Advanced maternal age (>35)
BSUS
Bedside ultrasound
BTO
Bilateral tubal occlusion
IUP
Intrauterine pregnancy
FHT
Fetal heart tones
YA
Yolk sac
GS
Gestational sac
CRL
Crown rump length
AGUS
Atypical glandular cells of unk significance
AFI
Amniotic fluid index
AROM
Artificial rupture of membranes
ASCUS
Atypical squamous cells of unk significance
BSO
Bilateral salpingo-oopherectomy
BTL
Bilateral tubal ligation
CIN
Cervical intraepithelial neoplasia
EMB
Endometrial biopsy
GTD
Gestational trophoblastic dz
HELLP
Hemolysis, elevated liver enzymes, low platelets
HGSIL
High-grade squamous intraepithelial lesion
HSG
Hysterosalingogram
IUFD
Intrauterine fetal death
IUP
Intrauterine pregnancy
LEEP
Loop electrical excision procedure
LGA
Large for gestational age
LGSIL
Low grade squamous epithelial lesion
MFM
Maternal fetal medicine
MVU
Montevideo units
PMB
Post menopausal bleeding
PTL
Preterm labor
SBE
Self breast exam
SGA
Small for gestational age
SROM
Spontaneous rupture of membranes
TAH
Total abdominal hysterectomy
TOA
Turbo-ovarian Abcess
TOL
Trial of labor
TVH
Total vaginal hysterectomy
VAVD
Vacuum assisted vaginal delivery
VB
Vaginal bleeding
VAIN
Vaginal intraepithelial neoplasm
VIN
Vulvar intraepithelial neoplasm
Most effective forms of contraception
IUD
Implanon
Sterilization
Moderately effective (9-6 in 100) contraception
Depo shot
Nuvaring
OCP
The patch
Benefit of Monophasic birth control
Good at regulating cycle
Benefit of triphasic birth control pill
Mimics normal hormones
Benefit of continuous birth control pills
Tx dysmenorrhea and anemia
Use birth control with caution in these patients
DM, HTN, smoking under age 35, common migraines, liver dz
Birth control contraindicated in these pts
Uncontrolled DM or htn, CAD, complex migraine, hx thromboembolism, hormone sensitive ca, smoking over age 35
Contraindications to estrogen
Postpartum period, lactation, bx of thromboembolism, bx of CAD, smoking >35yo, classic migraines, liver dysfunction
Additional contraception is needed after starting birth control for how long
5-7 days for most
Black box warning for depo shot
Loss of bone mineral density
*but they regain back all bone density after dc’ing med. Also women lose more bone density breast feeding than on depo
XO karyotype leads to
Ovarian dysgenesis/turner’s syndrome
Important genes on Y chromosome
SRY-sex determining region of Y makes TDF
TDF- testis determine factor which promotes testis defferentiation
Important hormones in embryonic male sex differentiation
Tested are composed of sterilized and leading cells
Sertoli cells secret anti mullerian hormone which degenerates mullerian ducts
Leydig cells secret testosterone which transforms wolffish ducts to make reproductive tract and is converted to dihydrotestosterone which promotes develop emend I’d make external genitalia
Granulosa cells produce
Estradiol stimulates by FSH
Thecal cells secrete
Androgens and progesterone
21-hydroxylase deficiency leads to
Genital ambiguity and adrenal insufficiency
This enzyme is required to synthesize aldosterone and cortisol
5a-reductase deficiency causes
Testes, male internal genitalia, female external genitalia
Complete androgen insensitivity leads to ___________ and is treated by __________
Testes, No internal reproductive tract and female phenotype
Gonadectomy and estrogen therapy
When should puberty begin for girls?
8-13yo
First sign of female puberty
Thelarche-breast development
Female athlete triad
Osteoporosis
Disordered eating
Amenorrhea
The average menstrual cycle duration
24-38 days
3-8days of menses
Define primary amenorrhea
Absence of menses by age 15 in presence of normal secondary sexual characteristics or 13 without secondary sexual characteristics
MC cause of primary amenorrhea
Gonadal dysgenesis/primary ovarian insufficiency
Kallman’s syndrome
Congenital absence if GnRH
Abdominal and lack of pubertal development
Swyer syndrome
Mutation of SRY gene leads to infertile XY female
General order of female sexual development
Boobs, pubes, grow, flow
MC cause of secondary amenorrhea
PREGNANCY
Risk factors for Asherman’s Syndrome
Postpartum hemorrhage
Endometrial infection
D&C or other instrumentation
Structural and PCOS causes of AUB are most common in
Reproductive age women
Anovulatory bleeding is most common
At the extremes of age (puberty and menopause)
*also consider endometrial hyperplasia and cancer is menopausal women
When to get an EMB
Postmenopausal: any with bleeding
45-menopause: heavy, frequent, or prolonged ovulatory AUB
<45: AUB that is persistent, accompanied by risk factors for unopposed estrogen or failed medical therapy
When does primary dysmenorrhea pain occur?
Just before or just after onset of mensuration and last 12-72 hr
*caused by prostaglandins released when endometrial tissue lysis
Tx for primary dysmenorrhea
Heat Lower abdominal message Exercise/yoga NSAIDs Hormonal Contraceptives
What age group do we commonly see primary dysmenorrhea?
14-22/young women
What age group do we commonly see secondary dysmenorrhea?
30-40
PMS and PMDD sx occur when?
Before menses/luteal phase
Lifestyle/supplements for PMS/PMDD
Exercise/yoga
Calcium and magnesium
Decrease salt, caffeine, and alcohol
First line medical therapy for PMDD
SSRI
FSH level that indicates menopause
> 30mIU/ml
When do maternal hCG LEvels peak?
9-12wk gestation
Causes of abn hCG levels
Hydatidiform mole: rises more slowly but continues after 10wk
Ectopic: rises slower than normal
Fetal death: fall with a half life of 24hrs
Why does uterus become more excitable/Braxton-Hicks occur in 3rd trimester?
Decreased inhibition from progesterone
Fetus releases this hormone to develops lungs and trigger the beginning of labor
Cortisol
How does prolactin prevent ovulation?
Inhibits GnRH release
Inhibits GnRH action on pituitary
Antagonizes LH and FSH at ovary
NT scan occurs at
11-13wk
AFP scan occurs at
16-27wk
US anatomy scan occurs at
20wk
GCT and Rh test occurs at
24-28wks
GBS pregnancy screen occurs at
35-36wks
DOC induced labor
Oxytocin/pitocin
Live vaccines that are contraindicated is pregnancy
MMR and varicella
When TDap given during pregnancy?
32-34 wk
Chadwick’s sign
Blue to purple tint of vaginal walls indicating pregnancy
Hegar’s sign
Palpable softening of isthmus indicating pregnancy
Food to avoid in pregnancy
Seafood-high in mercury
Raw meat/eggs-infection risk
Deli meat/hot dogs/unpasteurized milk-listeriosis
Caffeine->200mg linked to miscarriage
How much weight should a normal weight woman gain during pregnancy?
25-35lb
First trimester
1-12wks
Second trimester
13-26wk
3rd trimester
27-40wks
When does “quickening” occur?
18-20wk
3rd trimester Fetal kick counts should be?
10 kicks/rolls/flutters within 2hrs
Uterine fundus should be to pubic symphysis by…
12wk
Uterine fundus should be to umbilicus by…
20wks
What is lightening and when does it occur?
Fetus dropping into the pelvis making it easier to breath suddenly
Occurs after 36-38wks
How do you interpret 1hr GCT?
<140 pass
>140 reflex to 3hr test
>200 automatic fail
How do you interpret a 3hr GCT?
Normal values Fasting <95 1hr <180 2hr<155 3hr<140
*2 abn values is a fail and any value >200 is a fail
Describe a reactive(reassuring) NST
Minimum of 2 FHR acceleration by 15bpm for at least 15seconds
Elements of a BPP
Fetal movement
Fetal muscle tone
Fetal breath movements
AFI
(NST)
3 tests for rupture of membranes
Fern testing
Amniosure
Nitrazine
Adequate labor
3-5 contractions in 10min averaged over 30min
*200MVu
Macro sonic infant is ________grams
> 4,500
Signs of true labor
Regular intervals and increasing intensity
Cervical dilation
Back pain
Not altered by analgesia
Normal fetal HR
110-160bpm, highly variable with periodic changes
Aspects of APGAR score
Activity/muscle tone Pulse Grimace/reflex irritability Appearance-skin color Respirations
Immunoglobulin in breast milk
IgA
C/I to breastfeeding
Alcohol/drug abuse HIV TB Ongoing Chemo Herpatic breast lesion Infant galactosemia
Physiologic jaundice
Presents after 24hr of life
Pathological jaundice
Presents in first 24hrs or after 2wks
When does anterior fontanelle close?
Between 7-19months
When does posterior fontanelle close?
By 2months
Infant should be able to fixate on objects by
1 month
Frenulum
Connection under tongue
Omphalitis
Infection of umbilical cord stump
Most umbilical hernias resolve by
1yr
Syndactyly
Webbed fingers
Polydactyly
Extra digits
Rooting reflex is present during this time
3-4months
Palmar grasp reflex is present during this time
4-6months
Define SAB
Spontaneous abortion/miscarriage
Loss occurs prior to 20wks
MC complication of pregnancy
Complete v. Incomplete abortion
Based on passage or retention of POC
Define threatened abortion
Closer cervical os
Bleeding during pregnancy
Define inevitable abortion
Open cervical os and bleeding
Define missed abortion
Absent heart tones
Cervix closed and no bleeding
Define recurrent abortion
> 2 consecutive losses prior to 20wks
MC site of ectopic pregnancy
Fallopian tubes
When will ectopics in the Fallopian tubes rupture?
6-8wk in isthmic
8-12wk in ampulla
Progesterone level in early pregnancy
<5ng is abnormal/poss. Ectopic
>20ng is normal
Double ring and fetal pole should be seen on TVUS by this time?
5-6wk
Medication for ectopic pregnancy
Methotrexate 50mg
When does ectopic need to be managed surgically?
> 3.5cm
hCG >5000
Cardiac activity present
Ruptured
How long should hCG be monitored after a hydatidiform mole?
6-12months
Choriocarcinoma tx
Methotrexate
Chemo if Mets
How does Rh alloimmunization affect the 1st + baby?
Mild anemia and elevated bilirubin at birth
Dx of preeclampsia
> 140 systolic or >90 diastolic
AND
> 300 protein in 24hr or 2+ on dip
(Higher values, end organ damage, and fetal growth restrictions indicate severe)
Anti hypertensives that are safe in pregnancy
Labetalol, nifedipine, and hydralazine
If preterm delivery is indicated when are glucocorticoids indicated?
<37wk gestation
TORCH infections
Toxoplasmosis Other (syphilis and varicella) Rubella Cytomegalovirus Herpes
Aspects of BPP
Fetal tone Movement Breath NST AFI
How should GDM pts be tested postpartum?
75g 2hr OGTT at 6wk
Define preterm labor
Regular CXT after 20wk but before 37wk
What do variable decelerations indicate?
Cord compression
What do late decelerations indicate?
Uteroplacental insufficiency/hypoxia
Describe treponema pallidum
Gram negative spirochete, obligate intracellular
Describe neisseria gonorrheae
Gram negative kidney bean shaped diplococus
Tx of gonorrhea
3rd gen cephalosporins
Describe chlamydia trachomatis
Intracellular gram negative cocci
Tx for chlamydia
Azithromycin or tetracycline
Chancroid is more common in these countries
Tropical
Tx for chancroid
3rd gen cephalosporins
MC causative organism of vulvovaginal candadiasis
C albicans
Why is it important to recognize c glabrata in candadiasis?
Resistant to fluconazole
How does candidiasis affect caginal pH?
It doesn’t
How does BV and trich affect vaginal pH?
Elevated (>4.5)
Tx for uncomplicated candida
Short course (1-3D) topical azole
OR
Single 150mg fluconazole dose
Tx of severe/recurrent candida or candida in prego/dm/immunocomp
7-14topical azoles (pregos)
OR
150fluconazole repeat q72hr x2-3doses
Tx for BV
500mg flagyl bid for 7d OR Metrogel 0.75% intravaginally daily for 5d OR Clindagel 2% intavaginally nightly 7d
Strawberry cervix and postcoital bleeding should make you think of this
Trich
Tx for trich
2g metronidazole once
Antibiotic resistance is particularly concerning in this common sti
Gonorrhea
Percent of women that are asympyomatic with chamyldia
At least 85%
Tx for chlamydia
Azithromycin 1g oral (pregos)
OR
foxy 100mg bid 7d
Tx for gonorrhea
Ceftriaxone 250mg IM PLUS azithromycin 1g oral
Emerging cause of PID
Mycoplasma genitalium
Tx for PID
Ceftriaxone 250IM PLUS doxy 100 bid 14d
F/u in 48-72hr!!!!
Safe allergy treatment in pregnancy
Lora radon’s
Benadryl(diphenhydramine)
Chlorpheniramine
Zyrtec (cetrizine)
Safe constipation treatment in pregnancy
Fiber Colace (docusate na) 100mg 1-2xd
Safe cough treatment in pregnancy
Cough drops
Robitussin DM (dextromephorphan)
Mycinex(guaifenesin)
Safe diarrhea treatment in pregnancy
Clear liquids for 24hr
BRAWT diet
Then immodium (loperamide) up to two doses
Safe fever treatment in pregnancy
Tylenol (325q3hr or 650q6hr or 500q4hr)
- max 3000mg daily
- go to ER if temp >100 for over 2hr
Safe headache/pain treatment in pregnancy
Tylenol (325q3hr or 650q6hr or 500q4hr)
Safe treatment of heartburn in pregnancy
Pepcid (famotidine)
Prevacid (lansoprazole)
Tums
Zantac (ranitidine 150mg)
Safe treatment of hemorrhoids in pregnancy
Anusol cream
Sits bath
Preparation h
Tucks medicated pad
Safe treatment of nausea in pregnancy
Ginger/peppermint candy or tea
B6 (pyridoxine) 25mg tid
Unisom(doxylamine only) 1/2tab at bedtime
Safe treatment of sinus congestion in pregnancy
Steam, saline nasal sprays, Sudafed PE (phenylephrine 5-10mg c/I with htn)
MC strains of HPV
6 and 11
HIV targets these cells
CD4 T (helper) cells
Presentation of primary/acute HIV
Flu/mono like sx, rash on trunk, mucocutaneous ulcers
Oral hairy leukoplakia should make you think of
HIV
Kaposi’s sarcoma should make you think of
HIV
How is AIDS dx’d?
CD4<200
OR
1 of 27 AIDS defining conditions
PCP tx
Bactrim DS
MC intracranial lesion in HIV
Toxoplasmosis (also causes encephalitis)
MC retinal infection in HIV
CMV
When should you start prophylaxis for PCP in an HIV pt?
CD4<200
When should you start prophylaxis for MAC in an HIV pt?
CD4<50
Syphillitic chancre takes how long to resolve?
4-6wk
Secondary syphillis presentations
Rash on palms and soles
Condyloma lata
Mucous patches
Tx for syphilis
Benzathine pen G 2.4 my IM (additional doses required if present for >1yr)
*azithro or doxy if pcn allergic
Tx for lymphogranuloma venereum (LGV)
Erythromycin or doxy
Tx for chancroid
Azithromycin, ceftriaxone or cipro
Define menopause
Permanent cessation if menses for 12 consecutive months
Sx of perimenopause
Irregular menses
Hot flashes/night sweats
Mood sx
Vaginal dryness
How do you choose appropriate HRT therapy?
Intact uterus:estrogen and progestin
Hysterectomy: estrogen only
When to stop HRT?
After 5yr therapy or age 60
Risks of HRT
Thromboembolic dz and breast ca
C/I of HRT
Breast ca CAD he thromboembolic dz Acute liver dz Unexplained vb TIA
Pathophysiology of lichen sclerosis
Autoantibody attach of extra cellular matrix and basement membrane
Spread of lichen sclerosis
Periclitorally to perineal skin
Cancer associated with lichen sclerosis
SCC (5%)
First line to lichen sclerosis
Temovate 0.05% steroid OINTMENT
Empiric abx therapy for bartholin cyst
Keflex or doxy
What is unique about vulvodynia?
Pain is limited to vestibule
*associated with anxiety and mood disorders
Vulvodynia tx
Sitz bid followed by petroleum jelly
Vaginal estrogen\testo
Nortriptylin or gaba
Standard tx for VINU
surgical-CO2 laser, local wide excision, or vulvectomy
Where does most invasive vaginal cancer originate?
Endometrium, ovary or cervix
MC type of vaginal cancer
SCC
Characteristics of benign adnexal masses
Thin walled
<3cm (or <1 after menopause)
Thin walled adnexal mass with homogenous echos
Endometrioma
Thin walled hyperechoic nodule with distal acoustic shadowing
Teratoma
Thin walled adnexal mass with network of linear or curvilinear pattern
Hemorrhagic cyst
Characteristics of malignant adnexal masses
Thick >2mm septations
Solid modular or papillary component
Blood flow
Bilateral cysts with clear/straw colored fluid and elevated hCG
Theca lutein cysts
Theca lutein cysts are associated with these 3 conditions
Hydatidiform mole
Choriocarcinoma
Clinic therapy(? Idk)
Mature teratomas most often originate from this germ layer
Ectoderm (hair teeth)
Thin walled locust cyst filled with gelatinous mucin
Serous/mutinous cystadenoma
High-grade serous carcinoma of the ovary originated from where?
Fallopian tube
Ovarian germ cell tumors often produce these blood markers
Alpha fetopeotein
HCG
Blood marker for epithelial ovarian cancer
CA-125
What type of cancer is HPV 16 associated with?
Cervical SCC
What type of cancer is HPV 18 associated with?
Cervical adenocarcinoma
Who needs annual PAP smears?
HIV + pts Immunocompromised Hx of cervical ca Hx CIN II/III Exposure to DES in utero
When to stop cervical cancer screening?
At 65 if
3 negative cytology
2 negative co tests
No hx CIN II in 20 yr
ASCUS or LSIL follow up
Repeat in 1yr
HSIL or ASCH follow up
Colposcopy
Fibroids are more common in this population
African Americans
Diffuse globular uterine enlargement
Adenomyosis
Pathophysiology of adenomyosis
Proliferation of glandular uterine tissue
Pathophysiology of leiomyoma/fibroids
Proliferation of uterine muscle
Most important risk factor for endometrial hyperlasia
OBESITY
*any thing associated with unopposed estrogen is a risk factor
MC type of endometrial cancer
Adenocarcinoma
