Lecture 8.1: Female GU (unedited) Flashcards

Question

30

Answer 1

May lead to ↑ risk of tubal ectopic or sterility Primary adenocarcinoma of the fallopian tube Once uncommon, but now thought to be the site of origin for high grade serous carcinoma that was once thought to be from the ovary

Answer 2

Complex endocrine disorder characterized by Hyperandrogenism Menstrual Abnormalities Polycystic ovaries Chronic anovulation ↓ fertility 2) After menarche, in teenagers or young adults Oligomenorrhea Hirsutism Infertility Obesity

Answer 3

1) Epithelium Most common malignant type (90%) More common age >40 Primarily serous, mucinous, or endometroid 2) Sex cord–stromal cells May display differentiation toward granulosa, Sertoli, Leydig, or ovarian stromal cell type. Depending on differentiation, they may produce estrogens or androgens. 3) Germ cells Mostly cystic teratomas Most common ovarian tumor in young women; the vast majority are benign. may differentiate toward oogonia (dysgerminoma), primitive embryonal tissue (embryonal), yolk sac (endodermal sinus tumor), placental tissue (choriocarcinoma), or multiple tissue types (teratoma)

Answer 4

Mean Arterial Pressure = Cardiac Output x Systemic Vascular Resistance Cardiac Output = Heart Rate x Stroke Volume Stroke volume = Contractility x Preload

Answer 5

1) Progesterone: Smooth muscle dilator 2) Placental growth: New vessels are added which effectively increases mean small vessel diameter -Placenta stops growing at ~wk 26

Answer 6

1) Renin/ang/aldo system: aldo  sodium  volume  PRELOAD  stroke volume 2) After week 26

Answer 7

The BP falls until about week 26 due to progesterone and placental growth, then returns gradually to nearly reach baseline before term

Answer 8

By about 10-20 BPM over baseline; tachycardia

Answer 9

1) Amniotic fluid, placenta, fetus, maternal adipose stores 2) If underweight to begin with, gain more to build up adipose stores -If overweight to begin with, gain less; adipose stores are adequate, and weight gain should be due to fluid, placenta, fetus

Answer 10

Diethylstilbestrol Was given for at risk pregnancy Their children got vaginal adenosis/adenoma, sarcoma botryoides (cancer of vagina), clear cell carcinoma (vaginal cancer)

Answer 11

Warfarin Hypoplastic nose Skeletal abnormalities Ocular abnormalities Neonatal bleeding Mental retardation

Answer 12

Weigh risk: drug vs. disease It’s better to come off drugs if mom can Levetiracetam and Lamotrigine Levels will vary throughout pregnancy because estrogen affects their metabolism– must be monitored

Answer 13

1) Phenytoin = severely teratogenic Phenobarbital = severely teratogenic Topiramate = severely teratogenic 2) Valproate = cardiac defects Not indicated for grand mal seizures In other words – it is better for mom to tolerate “minor” seizures than for baby to have side effects; 3) Carbamazepine = Stop it if you can, but this is the only seizure med indicated for tic douloureux Extremely painful; but consider tolerating the illness while pregnant

Answer 14

Hypertension: ACE/ARB both teratogenic Diabetes Only FDA approved drug is insulin If insulin is not an option – second line is metformin

Answer 15

1) Antibiotics Bactrim Fluoroquinolone Tetracycline Acne Isotretinoin Statins Early reports indicated these were teratogenic, but this is currently being reconsidered

Answer 16

Causes hallmark congenital abnormalities: Short palpebral fissure and smooth philtrum Growth Retardation Neurobehavorial disorder

Answer 17

Increased ADHD Increased Autism Spectrum Developmental Delay Intellectual disability Oppositional defiant disorder Conduct disorder Mood disorder: depression, bipolar Impulsive behavior Reactive attachment disorder and PTSD *

Answer 18

Placental abruption Preterm premature rupture of membranes Placenta previa Preterm labor Low birth weight Ectopic pregnancy Possibly Miscarriage

Answer 19

Path Primary hypertension Pt Diagnosis of HTN before becoming pregnant

Answer 20

1) Not well understood Spectrum that begins at gestational HTN  preeclampsia without severe features  preeclampsia with severe features  eclampsia / HELLP 2) HA, vision changes, swelling in face and hands

Answer 21

Gestational HTN  sustained readings of 140/90 after week 20 GET MICROSCOPIC URINE AND LOOK FOR PROTEIN Almost 50% of women with gestational HTN go on to develop preclampsia

Answer 22

Preeclampsia without  sustained readings of 140/90 after week 20 + proteinuria GET MICROSCOPIC URINE AND LOOK FOR PROTEIN Protein to creatinine ratio: positive if > 0.3 More than 300 mg protein on 24-hour collection

Answer 23

Dx Cont. Preeclampsia with  sustained readings of 160/110 + any one Platelets < 100 AST or ALT 2x UNL RUQ or epigastric pain Cr > 1.1 or 2x baseline Pulmonary edema HA or vision changes Items 2, 3, and 4 are the beginning of HELLP Syndrome (stay tuned)

Answer 24

HELLP  Preeclampsia + Elevated Liver Enzymes AND Low Platelets Eclampsia  Preeclampsia + Seizure

Answer 25

1) Fertilization between Rh-negative female and an Rh-positive male 2) If baby inherits Rh + gene from father, baby will be Rh + 3) Baby’s blood does not leave the placenta Mom’s immune system is unaware that there is any Rhesus antigen present in baby’s blood Nor is there any natural immunity that occurs against Rhesus antigen Therefore, in order for Mom’s immune system to become primed against Rhesus antigen, she must be exposed

Answer 26

Delivery Loss Procedures Trauma IgM Antibodies Against Rhesus antigen > IgG Antibodies Against Rhesus antigen

Answer 27

Extramedullary hematopoiesis Remember that RBCs are made primarily in bone marrow But Bone marrow cannot keep up Liver and Spleen attempt to aid in production These organs hypertrophy  hepatosplenomegaly

Answer 28

Hemolysis  Increased bilirubin Kernicterus: infant brain damage resulting from high levels of bilirubin in blood Fetal Demise

Answer 29

Prevention: Prevent mom’s immune system from exposure! Routine screening establishes Rh status If Mom is Rh positive, you’re DONE If Mom is Rh negative, determine dad’s status If Dad is Rh negative, you’re DONE If Dad is Rh positive or unknown give Rhogam

Answer 30

How does Rhogam work? Mom Rh- and antibody - AND baby Rh+ Give anti rhesus antigen D immune globulin This is IgG to the rhesus antigen Yes, the same thing that kills baby #2 Given at the correct time it destroys any Rhesus antigen cells in mom’s blood stream before her immune system ever recognizes them

Answer 31

1) Toxoplasmosis: protozoan toxoplasma Gondii Pregnant woman in contact with Cat feces (changing litter box) or consumes undercooked lamb or pork -Virus passed to fetus through placenta during first 6 months of pregnancy 2) Usually asymptomatic, but may have LAD and flu-like symptoms 3) Congenital toxoplasmosis

Answer 32

TORCH and: 1) Chorioretinitis: Inflammation of choroid and retina seen on fundoscopic exam -White and yellow cotton-like scars 2) Hydrocephalus: ICF accumulates and enlarges ventricles  macrocephaly 3) Intracranial calcifications: White spots on CT

Answer 33

1) Spirochete: treponema pallidum  sexual contact 2) Chancre: Labia, anal region, cervix 3) (2-10 weeks): Enters blood stream, generalized LAD -Maculopapular rash  including palms and soles -Condyloma lata (smooth wart like genital / anal warts) 4) >10 weeks: Granulomatous lesions -Cardiovascular and Neuro syphilis

Answer 34

TORCH + Hydrops fetalis: accumulation of excess fluid in soft tissues  still birth

Answer 35

Early signs: first two years Maculopapular rash  including palms and soles “Snuffles”: rhinorrhea (lots of treponema in these secretions) Late Signs: after two years Frontal bossing: bulging of frontal skull Saddle nose Short maxilla Hutchinson teeth: small notched teeth Saber shins: bending of LE long bones Damage to CN VIII: deafness

Answer 36

1) Rubella virus; “German Measles” -Transmitted to mom via respiratory droplets; we vaccinate for this as part of MMR -Given 12-15 mo; therefore, mom will probably be unvaccinated 2) Fever and maculopapular rash > starts at head and spreads down -Post-auricular LAD; Polyarthritis (at least 5 joints) 3) TORCH and: a) Congenital rubella syndrome b) Deafness c) Cataracts d) Congenital heart defects (PDA)

Answer 37

1) Sexual contact or organ transplant Passed to fetus via placenta 2) Usually asymptomatic, may have “mono” type sx Fever, LAD, sore throat 3) TORCH and: Deafness and eye abnormalities Seizure and intellectual disability Microcephaly Periventricular calcifications

Answer 38

Direct contact with infected area of skin or mucous membranes Spread to baby during childbirth through contact with infected vaginal secretions Pt Mom: Genital vesicular lesions on erythematous base 3) Vesicular lesions everywhere; often on scalp, eyelid margins, oral mucosa Leads to MENINGIOENCEPHALITIS! Lethargy, irritability, seizures (Less of a TORCH presentation, because it’s usually contracted at delivery)

Answer 39

1) Varicella zoster Respiratory droplets Direct contact with oral or skin lesions Rash (chicken pox)  secondary reactivation (shingles) Mom is unvaccinated with no history of infxn Transmits to baby through placenta during 1st or 2nd trimester Low rate of 2% transmission

Answer 40

Mom: fever, weakness, popular pruritic Baby: congenital varicella syndrome Often fatal before 13 weeks  13-20 wks = congenital syndrome  after 20 weeks, less serious Limb hypoplasia Ciatriccal limb lesion (combination of scar and edema) Low birth weight Microcephaly Eye defect: cataract Neurological: cortical atrophy  intellectual disability

Answer 41

1) Respiratory droplets Vertical transmission to baby Pt: Pregnant mother: arthritis Small joints hands, wrists, knees, feet Symmetrical Fetus Decreased production of RBCs  Red blood cell aplasia Anemia  Increased HR  Increased fetal blood pressure  Hydrops fetalis If baby survives there are rarely any long-term effects

Answer 42

1) Bacteria listeria monocytogenes -Infection occurs after contaminated foods (unpasteurized milk or deli meet) -Transmitted to fetus through placenta > spontaneous abortion 2) Fever, fatigue, GI sx: diarrhea/vomiting/abdominal cramps -Amnionitis: infection of the amniotic fluid -Sepsis 3) Sepsis, Meningitis, Fatal

Answer 43

Path: Mom is chronic carrier  transmits virus during delivery Baby becomes chronic carrier because neonatal immune system cannot clear the infection Pt: Baby: asymptomatic carrier that develops cancer later in life

Answer 44

Transmission via blood Vertical transmission can occur, there’s nothing we can do about it C-Section Doesn’t help

Answer 45

Path: HIV retrovirus Pt: Mom with HIV Now baby has HIV Tx: Start with a screen Tx = PPx

Answer 46

1) Mosquito born teratogen Endemic areas: South America (Brazil), India, Caribbean 2) Zero symptoms 3) Serious birth defects: Microcephaly Decreased brain development Spontaneous abortion

Answer 47

1) Path: GBS is normal vaginal flora for adult woman Can be transmitted to baby causing severe complications 2) Sepsis > death 3) Screened during prenatal visit at 36 weeks

Answer 48

Diabetes Meletus: The type II diabetes that mom already had before she became pregnant May be referred to as “pregestational diabetes” Gestational Diabetes: Diabetes that arose during pregnancy

Answer 49

Path: Type 1 Beta islet destruction  now there’s no insulin Type 2 Too much sugar  insulin resistance develops  pancreas has to work too hard to make up the difference, and eventually breaks too * Genetics also plays a role Pt: Known history of diabetes Dx: Hgb A1C obtained before conception that shows elevation > 6.5 = diabetes < 5.7 = NOT diabetes In between these two values = prediabetes

Answer 50

Neonatal hypoglycemia Path: Immediately after delivery, baby is getting much less glucose But there is a lot of insulin on board Blood sugar tanks Tx: Treat with glucagon to oppose insulin and dextrose to support baby while insulin levels are high

Answer 51

1) Symptoms affecting the breasts are evaluated primarily to determine if malignancy is present. 2) Regardless of the symptom, the underlying cause is benign in the majority of cases. 3) Breast cancer is most commonly detected by screening or by palpation of a mass in younger women and in unscreened older women

Answer 52

Sometimes painful breast mass May fluctuate in size May be simple, complicated or complex The “simpler the better” However, most cysts or all types are usually benign

Answer 53

BRCA 1 & BRCA 2 Classic tumor suppressor genes Encode proteins that are required to repair certain DNA damage BRCA 1-associated with triple negative cancers BRCA 2-associated with ER mutations Most carriers will develop breast or ovarian cancer by age 70