Gynecology/Pediatrics Flashcards
Define and differentiate Gynecology and Obstetrics
Gynecology is the study of and maintenance of diseases and health of women, Obstetrics is the branch of health related to women throughout pregnancy
What is the external female genitalia referred to as?
Vulva
What is the tissue separating the vagina and the anus called?
Peritoneum
what is an episiotomy?
Surgical incision of the peritoneum to help facilitate childbirth.
What is the Mons Pubis?
Fatty layer of tissue over the Pubic Symphysis
What are the two sets of labia and where are they located?
Labia Majora and Labia Minora, Majora is located laterally while Minora is more medial
What is the most common cause of non-traumatic abdominal complaint in females?
Pelvic Inflammatory Disease (PID)
What are common signs and symptoms of PID?
Shuffling GaitIntense pain when walkingIn severe cases: Fever, Chills, Nausea, Vomiting, SepsisFoul smelling vaginal discharge, often yellow in color
What are signs and symptoms of ruptured ovarian cysts?
Complaint of unilateral abdominal pain radiating to the backHx of irregular bleeding, Dyspareunia, delayed menstrual periodVaginal Bleeding
What are ruptured ovarian cysts?
Cysts developing independent of ovulation that has ruptured, commonly from intercourse or physical activity
What is Cystitis?
A Urinary tract Infection (UTI) that occurs from bacteria typically entering through the urethra.
What are common signs and symptoms of cystitis?
Abdominal pain above the pubic symphysisPain and complications with urinationLow grade fever
What is Mittelschmerz?
Ovulation accompanied with pain
Common signs and symptoms of mittelschmerz
Mid-cycle spottingLow grade fever, but consider that body temperature rises during ovulationUnilateral lower abdominal pain
What is the vestibule?
Hood that covers the urethra
What is the prepuce?
Fold of the labia minora that covers the clitoris
How long is female urethra?
2 to 3 centimeters in length
How long is the vaginal canal?
9 to 10 cm in length
What are 3 vaginal functions?
Receives penis during intercourse, canal for birth, outlet for menstruation
What is Dysmenorrhea and Dyspareunia?
Dysmenorrhea is painful periodsDyspareunia is painful intercourse
Define and differentiate Parity, Gravida, and Abortion
Parity is live birthsGravida is number of times pregnantAbortion is number of times pregnancy has ended prior to 20 weeks
What time frame is a neonate?
First 28 days of life
Normal V/S for a neonate?
Pulse: 140Resp: 40Always cold
How much body surface area does a neonate’s head cover?
20%, Approximately same as torso
What are common illnesses for neonates?
Jaundice, Vomiting and Respiratory distress
Fever is a common sign with minor illnesses involving neonates. True/False?
False, fever will develop for major illnesses but not minor ones
What percent of runs are usually pediatric?
10% - 20%
On top of taking care of a pediatric patient who else must you be conscious of?
The parent
What are common fears from a pediatric patient during care?
Separation from parentsStrangersBeing HurtMutilation and disfigurement The unknown
What are some common things to keep in mind about a 2 month old?
All they do are sleep, eat and poopCannot tell difference with caregivers and strangersLimited motor ability and poor sight with non-conjugate gazeWell developed hearing
What are some benchmarks for a 2 to 6 month old?
More active (Kick and punching air)Eye contact and recognition of caregiverVigorous cryFollow lights and bright colors
what are benchmarks for a 6 - 12 month old
Learn to sit unsupported and talk/babbleReach for toys and developing coordination@7 - 8 months develops stranger and separation anxietyAble to crawl
If a pediatric patient isn’t active what should be assessed?
Asking the parent if that is normal for the child.
What is a major concern of homeostasis for all pediatric patients?
Heat loss and poor regulation of temperature
For the first approximately 6-8 weeks of life babies are breathing through which airway?
Nasal airway. Babies are obligate nose breathers. Consider nasal airway obstruction from mucous and etc.
As opposed to chest movement babies have what type of movement with respirations?
Belly movement, if c-spining a pediatric patient consider belt placement and ensure it is not over the belly.
When assessing an infant how should the assessment begin and go?
Toe to head to allow the infant to get used to the assessment.Observe, Auscultate and palpate in that order as wellPerform the assessment slowly and calmly
Do not feed infants in pre-hospital setting
Don’t do it
What vital sign is a poor indicator of anything in an infant
Blood pressure.
What is the formula for a systolic blood pressure?
70 + (2x age)
By 1 - 4 years of age what are some benchmarks?
Rapid growth, most can run and communicateNo sense of dangerThey are center of their worldConcrete thinkers, learn by trial and errorAfraid of strangers
Children typically fall on what while falling?
Head due to the large size
While assessing toddlers and preschoolers what are some considerations?
Toe to headGet on childs level both physical and mentalAllow child to stay in caregivers lapUse childs nameUse caregivers helpPraise the childNEVER LIE TO PATIENTS OR PARENTS
What are common toddler and preschooler illnesses?
CroupAsthmaPoisiningAuto accidentsBurnsChild AbuseIngestion of foreign bodiesDrowningFebrile SeizuresMeningitis
What are benchmarks for school age kids age 5 - 9 years?
TalkativeAnalytical, understands cause and effectHave wrong ideas about their ideas about bodiesCan understand simple explanationsAnatomy and Physiology closer to adult by 8 years
What is the Central Ohio Poison Center phone number?
1-800-222-1222
What are considerations for a school age child assessment?
Explain procedures to the childProvide privacyDo not negotiateUse judgement when choosing toe to head or head to toe assessmentInclude child and caregiver for history
What are common injuries in school age kids?
Trauma: falls accidents, sports injuries, fractures
What are benchmarks and considerations for adolescent patients
Just like toddlers, more mobile not much senseRational, understand cause and effect and are able to express themselvesFeels indestructible, shifts from relying family to relying on friendsStruggle with independence, loss of control, body image, sexuality and peer pressure
Regardless of age what happens when a female is determined to be pregnant?
Legally they are considered an adult
What are considerations for adolescent assessments
Provide complete information, and explanation Speak directly and show respectPatient may prefer that parent or caregiver is present for examUse friends to help comfort or persuade
What are common illnesses and injuries for adolescents
MononucleosisAsthmaAuto AccidentsSports injuriesDrug and alcoholSuicidal gesturesSexual abuseSTD’s
What is the common pneumonic for pediatric assessments?
C: Chief complaintI: Immunizations/IsolationsA: AllergiesM: MedicationsP: PMHE: Events surroundingD: Diet/DiapersS: Symptoms
What is Pediatric Triangle Assessment?
AppearanceWork of BreathingCirculation
For a pediatric patient, their blood pressure will remain stable or at a hypertensive state what amount of blood loss will cause hypotension?
1/3 of blood volume
Cerebrospinal Fluid will have a sugar reading, true or false?
True
What does rash indicate in a pediatric patient and what are two considerations to have with rashes?
Indicative of patient being septic, mask up and check rash for blanching
What is Petechiae and Purpura?
Rashes that do not blanch
What is the primary reason a child goes into arrest?
Airway/Respiratory related
What are some significant considerations for kids upper airways?
Huge headsSmall nasal passagesLarger tonguesFloppy epiglottisDeciduous teeth
What is the exclusive intubation route for children?
Oral intubation
What are reasons to not nasally intubate a child?
Adenoids are very vascularNares may be too smallCauses increased intracranial pressureCricoid is higher and anterior making nasal intubation more difficult
What kind of response would you expect from intubating a child?
vagal response
How do you measure pediatric size equipment?
Length based resuscitation tapeEstimate based on pinky finger(Age+16)/4
If unable to intubate a pediatric what is a good fall back airway?
BVM with OPA
If unable to intubate and unable to ventilate what is a good fall back airway?
Cricothyrotomy
In children <10 years of age what do we use for cricothyrotomy?
Needle Cricothyrotomy
Define and differentiate between Distress, Failure and Arrest
Distress is compensatedFailure is uncompensatedArrest means there is no effort at all
What is croup?
Infection of the Upper Airway
What are common signs and symptoms associated with croup?
Mild cold until the evening, After dark seal-like bark occursInspiratory stridorNasal FlaringTracheal tugging or retraction
Cool air helps relieve what airway infection?
Croup
What is epiglottitis?
Acute infection and inflammation of the epiglottis
What is the usual bacterial infection that causes epiglottis?
Haemophilus Influenzae Type BNote: due to the availability of H. Influenza vaccines epiglottis has become an uncommon occurence
What are common signs and symptoms with epiglottitis?
Similar signs and symptoms with croupCherry red and swollen epiglottis (note: DO NOT visualize the airway)Tripod positionDrooling
On pediatric patients with epiglottitis, what should you AVOID doing?
IV sticks, blood pressure checks and rough handling of the child. Stress can cause a complete airway obstruction from spasms
What is bacterial tracheitis?
Bacterial infection of the subglottic airway.
What are signs and symptoms of bacterial tracheitis?
Similar to croupProductive cough of pus and mucous
What is the management and treatment of a pediatric patient with a foreign body obstruction?
DO NOT attempt to visualize the airwayIf the obstruction is partial, position of comfort with humidified oxygenIf obstruction is complete, perform BLS foreign body removal, if unsuccessful remove with magill forceps, intubate.If intubation and BLS airway support fails consider cricothyrotomy
Define Asthma
Chronic inflammatory disease of the lower airwayCharacterized by bronchospasm and excessive mucous production
Once a child has been exposed to a trigger for asthma it begins a two phase reaction, what are those two phases?
Phase one: Release of chemical mediators like histamines that cause bronchoconstrictions and bronchial edema.Phase two: If asthma attack is not resolved, bronchioles become inflamed and inhaled bronchodilators are no longer effective, anti-inflammatory drugs are required at this point
What would be the proper management of a pediatric patient with Asthma?
OxygenAlbuterol/Atrovent Metered Dose Inhaler
What would be two good questions for a pediatric patient suspected to have asthma?
If they normally wheeze and cough beforeMedications they take (particularly albuterol and metered dose inhalers)
Define status asthmaticus
Prolonged asthma attack unbroken by aggressive pharmacological treatment
Define Bronchiolitis
Infection of the medium sized airways, the bronchioles, do not confuse with bronchitis which is infection of the larger bronchi
What causes bronchiolitis?
Viral infection, most commonly respiratory synctial virus (RSV) that affects the lining of the bronchioles
What are signs and symptoms of bronchiolitis?
Expiratory wheeze and clinically resembles asthma
Define pneumonia
infection of lower airway and lungs,either by bacterium or viral.
What are signs and symptoms of pneumonia?
Crackles, RhonchiLowgrade feverChest painDecreased breath sounds
Define a febrile seizure
seizure caused by fever
When a child is suspected of seizing what is the best assessment to be performed?
Assess eye movements in the child, children typically burn up enough sugars while seizing that they will be unable to move extremities.heavily active eye movements indicate seizure.
What is an appropriate fluid bolus amount for a child?
20ml/kg
Hypovolemia can typically occur in what medical emergencies in pediatrics?
Diarrhea, Burns, DKA or Vomiting
What is the formula for fluid iv bolus for a pediatric?
20 ml per kg normal saline up to 3 boluses
Define gastroenteritis
Inflammation of the GI tract caused by bacterial, viral or parasitic agenttypically caused by viral diarrheaAntibiotic TherapyCystic FibrosisMilk AllergyLactose deficiency
What causes bradycardia in pediatric patients?
02 deficiencyOverdoseHypothermia
How is bradycardia treated in pediatric Patients?
Manage airway and breathingCompressions if HR <60 with poor perfusionAdminister Epi 1:10,000 0.01 mg/kg IV or IO max dose 1mg
If pediatric patient does not respond to epi first what else can we try?
Atropine, however most kids will not respond because they are not bradycardic from vagal response
What is a good vagel maneuver for a child in SVT
Tell a child to blow the plunger out of a 10 ml syringealso can try ice pack applied to face
What is the rate for synchronized cardioversion in a pediatric paitent.
1j/kg for first shock, 2j/kg for second shock and keep at 2 j
What is given to treat SVT and dose in a pediatric patient
Adenosine 0.1 to 0.2 mg/kg Rapid Iv Push
If you have a pediatric patient in v-tach what treatment is it for unstable v-tach?
Synchronized cardioversion at 1j/kg first shock and then 2nd shock at 2j/kg
What is antiarrythmic therapy for a pediatric in v-tach?
Amiodarone 5mg per kg or Lidocaine 1 mg per kg
For absent pulses in a pediatric patient what is treatment
CPREpi 1:10,000 0.01 mg/kg iv push every 3 - 5 minutesPacingCorrecting causes
