GYNECOLOGIC EMERGENCIES

Question 1

Menstrual Cycle

Answer 1

Ovarian Cycle
Uterine Cycle

Question 2

Ovarian Cycle

Answer 2

Follicular phase (1-13)
Luteal phase (14-28)

Question 3

Uterine Cycle

Answer 3

Proliferative Phase (5-14)
Secretory Phase (15-28)

Question 4

Amenorrhea

Answer 4

absence of menses due to pregnancy or stress, anorexia, drop of body fat, excercise

Question 5

Mittelschmerz

Answer 5

ab pain/cramping with ovulation (day 14)

Question 6

Dysmennorhea

Answer 6

ab pain/cramping usualy just before menstruation

Question 7

what is G P A (F P A L)?

Answer 7

Gravida - # of pregnancies
Para - # of live births
Aborta - hx of abortions

Full term
Preterm
Abortions (elective? miscarriage?)
Living

Question 8

Gyenecologic History (things to ask)

Answer 8

Current Symptoms:
Bleeding? Usual Amount? Clots?
Ab Pain? OPQRST
Discharge? Color, amount, odor, itching?
Pregnant?
Sexual activity? Birth control?
Last period?
Pregnancy History (GPA FPAL)
C sections? Other ab surgery?
SAMPLE
Hx of STD?

Question 9

Pelvic Inflammatory Disease

Answer 9

Infection of woman’s reproductive organs (STDs or other types)

Assess:
- diffuse pain thruout lower quadrants, during or after period
- discharge, fever, chills, pain (achy), dysuria

Manage:
- thorough hx, patient’s modesty in mind
- O2 PRN
- IV fluid, volume replace, pain meds PRN

Question 10

Bartholin Abscess

Answer 10

Formation of cyst and infection at bartholin duct

Assess:
- vulvar pain / pain with intercourse / painful lump / uni or bilateral

Manage:
- thorough hx, patient’s modesty in mind
- O2 PRN
- IV fluid, volume replace, pain meds PRN

Question 11

Vaginitis / Vulvovaginitis

Answer 11

broad term - inflammation of vagina due to infection which can move up structurally

Assess:
- can be asymptomatic, itching, irritation, discharge, odor, painful intercourse, lower abdominal pain

Manage:
- thorough hx, patient’s modesty in mind
- O2 PRN
- IV fluid, volume replace, pain meds PRN

Question 12

Vaginal Yeast Infection

Answer 12

caused by candida albicans fungus when the normal acidic environment is not kept (oral contraceptives, menstruation, pregnancy, diabetes, antibiotics, deodorant tampons/sprays, stress)

Assess:
- itching, burning, soreness, swelling, cottage-cheese-like discharge, painful intercourse, dysuria

Manage:
- thorough hx, patient’s modesty in mind
- O2 PRN
- IV fluid, volume replace, pain meds PRN

Question 13

Cystitis

Answer 13

bladder infection cuased by bacteria; can lead to pyelonephritis (infection of kidneys)

Assess:
- suprapubic pain, cloudy urine, urinary frequency, hematuria, dysuria
- fevers, chills, vomiting

Manage:
- thorough hx, patient’s modesty in mind
- O2 PRN
- IV fluid, volume replace, pain meds PRN

Question 14

Ovarian Cyst & Rupture

Answer 14

fluid-filled sac on or in an ovary which can be asymptomatic and usually disappears on its own

Assess:
- gradual onset of symptoms: pelvic discomfort, urinary retention, menstrual irregularities
- if ruptured, asymptomatic –> severe lower abdominal discomfort with radiation to the back; typically unilateral; possible vaginal bleeding

Manage:
- thorough hx, patient’s modesty in mind
- O2 PRN
- IV fluid, volume replace, pain meds PRN

Question 15

Ovarian Torsion

Answer 15

twisting of the ovary; more common to those with hx of ovarian cyst

Assess:
- acute onset of moderate-severe unilateral pain in lower abdomen that worsens over time that may radiate to back, pelvis, thigh
- nausea, vomiting may be present
- tender to palpate and mass may be felt

Manage:
- thorough hx, patient’s modesty in mind
- O2 PRN
- IV fluid, volume replace, pain meds PRN

Question 16

Endometritis

Answer 16

inflammation of endometrium often associated with bacterial infection; more common after birth or miscarriage (within 36hrs)

Assess:
- fever, chills, vomiting, tachycardia, lower abdominal or pelvic pain, cramping, and foul-smelling vaginal discharge

Manage:
- thorough hx, patient’s modesty in mind
- O2 PRN
- IV fluid, volume replace, pain meds PRN

Question 17

Endometriosis

Answer 17

presence of tissue outside the uterus that resembles endometrium in both structure and function;

Assess:
- constant or deep / uni or bilateral / sharp or dull pain
- pain in the lower back, pelvic regions, abdominal regions
- infertility

Manage:
- thorough hx, patient’s modesty in mind
- O2 PRN
- IV fluid, volume replace, pain meds PRN

Question 18

Uterine Prolapse

Answer 18

protrusion of uterus outside the vagina; due to obesity, weakening of pelvic support, increased intra-abdominal pressure from pregnancy, …….

Assess:
- pelvic heaviness or fullness
- lower back pain

Manage:
- thorough hx, patient’s modesty in mind
- O2 PRN
- IV fluid, volume replace, pain meds PRN