LA OB/GYNE Flashcards
HPV types that cause genital warts
6 and 11
1st, 2nd, 3rd most common gyne malignancies
endometrial, ovarian, cervical
high risk HPV
16 and 18
MC kind of cervical cancer and endometrial
squamous cervical
adenocarcinoma endometrial
screening for cervical cancer is at what age
21 yo
endometrial stripe is how many mm
4 mm. worry if larger
abn uterine bleeding most likely what cancer
endometrial
which cancer most commonly mets to local areas
cervical
CA 125 is mainly a marker for what?
epithelial cancer
MC of ovarian cancer and vaginal/vulvar cancer
epithelial ovarian
squamous vagina/vulvar
FH of which cancer is strong
ovarian
OCA use and breastfeeding protect in what cancer
ovarian
ascites can point to what cancer
ovarian
what % of ovarian neoplasms are benign
90
what has a 0.2-2% malignancy potential
dermoid ovarian neoplasm
vaginal bleeding(post coital), watery discharge, and pruritis
think vaginal/vulvar cancer
red/white crusted ulcerative lesions noted
think vulvar cancer
BRCA gene, watch for what 2 cancers
breast and ovarian
MC kind of breast cancer
infiltrative ductal carcinoma
which of the breast cancers has the worse prognosis
inflammatory breast cancer
eczematous itchy, scaley, rash on nipples/areola, bloody discharge
paget ds of breast
which part of the breast are cancers commonly found
upper outer quadrant
where do breast cancer mets to
bone, lung, liver, brain
what age to start screening for breast cancer
40/ brca then at 25
peau d’orange
inflam breast cancer
which breast cancer has no lump
inflam breast cancer
Differential dx for breast mass in order
- fibrocystic disease
- fibroadenoma
- carcinoma
what kind of med is bromocriptine and cabergoline
dopamine agonist
cabergoline decreases prolactin too
MC benign breast tumor
fibroadenoma
breast mass is rubbery, well circumferential, mobile mass, 2-3cm, usually nontender
fibroadenoma
MC benign breast disorder
fibrocystic disease
spironolactone, ketoconazole, theophylline, verapamil, thiazides,
can all cause gynecomastia
which phase is estrogen dominant and progesterone dominent
follicular is estrogen
luteal phase is progesterone
describe the FSH/LH surge
in follicular phase and it induces ovulation, ruptures follicle and releases oocyte
FSH>40 , low estrogen in secondary amenorrhea
ovarian failure
when to do a progesterone challenge
workup of secondary amenorrhea
amenorrhea in a female athlete
functional hypothalmic
decreased estrogen, decreased FSH/LH
pituitary dysfunction
asherman syndrome
acquired scarring, causes uterine dysfunction.
progesterone challenge and there is withdrawal bleeding
she is not ovulating. outflow tract and endometrium nml
what is primary dysmenorrhea
due to high prostaglandins, not a pelvic pathology
menorrhagia vs metorrhagia
menorrhagia: prolonged heavy bleeding, regular intervals, no spotting
metorrhagia: uterine bleeding that occurs frequently and irregular between menses
anovulation
no corpus luteum formation, increased unopposed estrogen
duration of postpartum depression
2 weeks to 12 months, give SSRI
no colposcopy for which lesions of cervix
ASC-US and LSIL in young pt, HPV neg
woman over 45 yo, 12 months amenorrhea, FSH >40, low estradiol
menopause
cancer type in postmenopausal bleeding
adenocarcinoma, endometrial cancer 10%
biggest risk of HRT
75% chance of breast cancer risk
MC metabolic bone disease in US
osteoporosis
recommended CA, Vit D daily
Calcium 1200 mg/day
vit d 800-2000 mg/day
when to screen for osteoporosis
female 50-74 if there is fx risk
dexa in osteoporosis and osteopenia
osteoporosis <-2.5
osteopenia -1 to -2.5
most effective birth control methods
IUD and nexplanon
birth control safe in lactation
progestin mini pill, IUD, nexplanon
avoid estrogen products how long after delivery
6 months
how much % is female and male the cause of infertility
female 65%, male 20-40%
luteal phase is what day when progesterone level < 3 and no ovulation
21
what can hyperstimulate ovulaion
clomiphene citrate
what treats hyperprolactinemia
bromocriptine
GTPAL
of weeks
abortion
premature
full term
abortion under 20 weeks
premature 20-36
full term 37-42
quickening
fetal movement
nullipara 18-20
multi 14-16
chadwicks sign
bluish discoloration of vagina/cervix
hegars sign
softening between fundus and cervix
uterine growth
12 wks
20 wks
38 wks
12: symphysis pubis
20: umbilicus
38: 2-3 cm below xiphoid process
fetal heart tones
10-12 weeks
TV u/s at 5-6 weeks
nml heart rate
120-160
recommended wt gain and calories
20-35 lbs for average woman
increase calories 300 kcal/day
prenatal folic acid and iron
folic acid 0.4 mg
iron 30mg/day
pathogen in unpasteurized food/drinks
listeria
beta HCG in pg
doubles every 48 hours
naegels rule
1st day of last menstrual period+ 7 days - 3 months + 1 year
nml BP in PG
140/90
PAPP-A
PG assoc plasma protein-A low: trisomy 21
nuchael translucency screening test done when
10-13 weeks
amniocentesis can be done when
15-20 weeks
triple screen
and
quad screen
APF, estriol, HCG
quad: inhibin A
Glucose tolerance test done when
26-28 weeks
GBS cultures done when
36-37 weeks
rhogam done when
28-30 weeks
monthly prenatal visits what weeks
weeks 4-28
month 1-7
twice monthly prenatal visits when
weeks 28-36
month 7-9
safe antibx
PCN, ceph, augmentin, clinda, flagyl
antibx to avoid
FQ, fluconazole, bactrim, macrolides
lightening
fetal head descending into the pelvis
stage 1 of labor
onset of contractions to full dilation
* primi 6-20 hours
* multi 2-14 hours
stage 2 of labor
full dilation to baby delivery
* primi 30 min to 3 hrs
* multi 5-6 min
effacement
softening of cervix
100% means thin
station
babys head at level of ischial spine
-3 to 3
when to get Tdap shot
1 dose during later 2nd or 3rd trimester (after 20 weeks)
high fever, erythroderma(sunburn) desquamation
toxic shock syndrome
replace fluids
vanco(or linezoid) plus clinda
painful vag bleeding and abd pain, dark red 3rd trimester
abruption placenta
when to avoid digital exam and speculaum
placenta previa and abruption placenta, PROM
hypertonic uterus
abruption placenta
painless bright red bleeding, no abd pain
placenta previa
waiter’s deformity
shoulder dystocia
termination of PG due to medical or elective reason called what
induced abortion
termination of PG due to mother endangerment or fetus dead called what
therapeutic abortion
which abortion has a chance of being viable
threatened abortion
vaginal bleeding occuring before 20 week without cervical dilation and indicating spontaneous abortion occured
threatened abortion
MOA of progesterone receptor antagonist
leads to dilation and softening of cervis, causes placenta separation
what is a prostagladin E analog
misoprostol, causes uterine contraction
all RH ___ should receive anti D RH immunoglobulin at the time of abortion
negative
which abortions is the cervix open
inevitable and
complete
which abortion has no vaginal bleeding
missed
anembryonic PG
blighted ovum
% of spontaneous abortions due to chromosomal abnormalities
60
components of umbilical cord
2 veins and an artery
vein fx in cord
carries oxygenated blood/nutrients from placenta to fetus
artery fx in cord
carries deoxgenated blood/waste from uterus to placenta
no fetal heart rate
uterine rupture, bradycardic fetus
% of breech babies
3-5
% #s as PG goes forward
<28 weeks
32 week
at birth
<28 weeks 25%
32 weeks 7-16%
at birth 3%
MC breech position
frank, both hips flexed and knees extended
when to move a breech baby
at 37 weeks
% of c sections
32
anti prophylaxis in c sections
cefazolin
alternative: clinda, genta
nml length of uterus
30cm
transvaginal u/s shows funneling of cervix, <25mm
cervical insufficiency
cerclage can be done when
`36 weeks
cervical insufficiency has difficulty maintaining gestation at what week gestation
20
MC characteristics of ectopic population
age over 35 and non white
ectopic MC location
ampulla of fallopian tube
abd pain, vag bleeding, amenorrhea
ectopic PG
transvaginal u/s: ring of fire, sperical mas
ectopic PG
pre-eclampsia before 20 weeks is what
molar PG
non stress testing >2 accelerations in 20 minutes and HR increase at least 15 bpm from baseline lasting >15 seconds
good, fetus well being
non stress testing is nonreactive, no fetal HR accelerations or <15 bpm increase lasting <15 seconds.
bad result, get a contraction test
contraction shows no late decels in presence of 2 contractions in 10 min
negative test. good result
contraction test shows repetitive late decels
bad, prompt delivery
RH incompatibility occurs when
(mom/baby)
Rh NEG mom carries a Rh POSITIVE baby
RH incompatibility occurs when
(mom/dad)
Rh NEG mom and Rh POSITIVE dad
Rh
AB titer is unsensitized
No Rh antibodies
Rh
AB titer is sensitized
Rh antibodes present
prevention in Rh AB mom
Rh immunoglobulin at 28 weeks and within 72 hours of delivery
when to do the 3 hour glucose tolerance gest
if FBS >130 with 1st test at 24-28 weeks
when to need insulin when PG
if FBS >105 or 2 hr post prandial >120
what insulin for gestational dm
NPH/regular
PG vomiting ok up to how many weeks
16
what ABG to expect with hyperemesis gravidum
metabolic alkalosis
HELLP
hemolysis
elevated liver enzymes
low platelets
moderate and severe gestional HTN
moderate: 150-159/100-109
severe: Over 160/110
concerning proteinuria, platelets, serum creatinine
preeclampsia
protein >0.3 or 2+ on dipstick
platelets <100,000
creatinine >1.1
other symptoms to be concerning with preeclampsia
severe HA, visual problems, pulm edema
RUQ pain, blurred vision, photophobia, hyperreflexia
watch for eclampsia
when to deliver with HELLP
34 week
magnesium sulfate for what
protect CNS, prevent seizures
aspirin ok for PG when
eclampsia, …
identical twins called what
monzygotic
splitting of one zygote
increased AFP, fundal height > gestation date, extra fetal heart tones
multiple gestations
1 cause of maternal deaths worldwide
postpartum hemorrhage
___ ml for postpartum hemorrhage
at least 1000
1 reason for postpartum hemorrhage
uterine atony
severe preeclampsia, amniotic fluid embolism, placental abruption
DIC
uterus soft and boggy, signs of shock
postpartum hemorrhage
tx for uterine atony
fundal massage, meds(Iv oxytocin, misoprostol), replenish IV fluids
menses returns to nml when if not breastfeeding
6-8 weeks
what is Chorioamnionitis
Chorioamnionitis, also known as amnionitis and intra-amniotic infection, is inflammation of the fetal membranes, usually due to bacterial infection.
pooling after 37 weeks
PROM
PROM does what to nitrazine paper? + what test
blue
fern test
preterm labor occurs when
before 37 weeks
findings on exam with preterm labor
> 3 cm dilated and >80% effacement
