OB/GYN Flashcards
leading cause of CA death in women worldwide
breast CA
USPSTF screening breast CA
b/l screening mammography for women at normal risk at 50 years and repeating q 2 years until pt is 74 years old
“high risk” for breast CA
first degree relative w breast CA
Hx of radiation therapy to the chest btwn ages 10 and 30
ancestry associated w increased incidence of BRCA1 and BRCA2
known hereditary breast or ovarian CA syndrome
Hx of breast, ovarian, peritoneal, tubal CA
Screening recs for breast CA for high risk
annual MRI o the breasts
MC type of breast CA
invasive ductal carcinoma
infiltrating lobular carcinoma (2nd)
classic presentation of breast CA
hard, immobile breast mass
advanced dz:
axillary lymphadenopathy
skin changes (dimpling or ulceration)
RF for breast CA
advanced age
obesity
high estrogen
dense breast tissue
insulin resistance
in utero exposure to diethylstilbestrol (DES)
hormone replacement therapy after menopause
pregnancy at advanced age
nulliparous women
MC benign breast condition
fibrocystic breast disease
who does fibrocystic breast disease usually affect
premenopausal women between 30 and 50
characterization of fibrocystic breast disease
multiple painful, swollen, mobile, lumpy, and well-circumscribed masses in both breasts that appear before menses and resolve with the start of the menstrual cycle
may have serous nipple discharge
aspiration of fibrocystic breast disease
straw-colored fluid without blood
only FDA approved tx for fibrocystic breast disease
Danazol
fibroadenoma
MC breast tumor in young women
painless, solitary, smooth, firm, mobile, rubbery, well-defined mass
does not wax and wane w menstruation
imaging for nontender breast mass in pts < 30 – basically if breast mass is unknown but not necessarily suspicious for malignancy - what should you do first
US (of whichever breast)
when do HPV infections usually resolve
within 12 mos - if longer, more likely cancerous or precancerous
RF cervical CA
early age of sexual activity
multiple partners
hx of STI
hx or vaginal or vulvar neoplasia/CA
low socioeconomic status
immunosuppression (think HIV)
two major types of cervical CA
squamous cell (MC)
adenocarcinoma
progesterone only options contain
Levonorgestrel
Norethrindrone
cystocele
posterior bladder wall herniates through the anterior wall of the vagina
sx cystocele
feeling of fullness/bulge in vaginal area worse w abdominal pressure (valsalva) and better w rest
urinary incontinence
more frequent UTI
pt may leak urine if asked to cough
tx for cystocele
supportive if sx don’t bother pt
pessary if sx bother patient
surgery is definitive
menorrhagia
blood loss > 80 mL
what should be considered in ppl w menorrhagia
coagulation studies
PALM-COEIN
PALM = structural
COEIN = nonstructural
Polyps
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
Ovulatory dysfunction
Endometriosis
Iatrogenic
Not yet classified
prenatal visits
q 4 weeks from 4-28 weeks gestation
q 2 weeks from 28-36 weeks gestation
weekly after 36 weeks
what should be assessed at each prenatal visit
weight
BP
fetal heart rate
urinalysis
glucose
presence of fetal movement
presence of vaginal bleeding
when do you assess fundal height
at each visit starting at 20 weeks
screening for defects
15-24 weeks gestation
6-12 weeks gestation testing
random blood glucose
CBC
serologic test for syphilis, rubella antibody titer, varicella antibody titer, HIV testing, ABO and RH typing with antibody screen, Hep B surface antigen, sexually transmitted infection screening for chlamydia
maternal quad screen
alpha fetoprotein
hCG
estradiol
inhibin A
when is anatomical US performed
18-20 weeks
screening for gestational DM and anemia
24-28 weeks
pts who are RH negative
anti-D immunoglobulin at 28 weeks
unopposed estrogen in a women with intact uterus
increased risk of endometrial CA and endometrial hyperplasia
severe critical PID
high fever
N/V
severe pain
abscess
perihepatitis
pregnancy
combo therapy PID
one time IM injection of Ceftriaxone
14 days of oral doxy and metronidazole
tx PID if doxy not well tolerated
7 day course Azithromycin
cystocele versus rectocele
cystocele - smooth mass w vaginal rugae protruding from the anterior vaginal wall
rectocele - smooth mass w vaginal rugae protruding from the posterior vaginal wall
spontaneous abortion
pregnancy loss before 20 weeks of gestation
RF spontaneous abortion
> 35
prior pregnancy loss
substance use (tobacco, caffeine, alcohol, illicit substances)
subchorionic hemorrhage
stress
DM
obesity’ thyroid disease
inherited thrombophilias
presence of IUD during pregnancy
sx spontaneous abortion
crampy lower abdominal pain
uterine bleeding
what is recommended for all women undergoing a spontaneous abortion
uterine US
serial quantitative beta-human chorionic gonadotropin levels
threatened spontaneous abortion
cervical os closed
no passage of fetal tissue
inevitable spontaneous abortion
cervical os opened
no passage of fetal tissue
incomplete spontaneous abortion
cervical os open
there is passage of fetal tissue (some still remain in uterus)
complete spontaneous abortion
cervical os is closed
complete passage of fetal parts and placenta
uterus contracted
missed spontaneous abortion
in utero death
cervical os closed
non passage of fetal tissue
septic spontaneous abortion
infection of uterus
open with purulent cervical discharge and uterine tenderness
no passage (may be incomplete)
trichomoniasis
protozoan parasite trichomonas vaginalis
sx trichomoniasis
increased malodorous discharge
dysuria
urinary frequency
dyspareunia
vaginal itching/irritation
greenish/yellow vaginal discharge
friable cervical mucosa (strawberry cervix)
wet mount (saline microscopy) trich
flagellated motile trichomonads
ph > 5
tx trichomoniasis
Metronidazole 2 g PO single dose or 500 mg twice daily for 7 days
Bacterial vaginosis
vaginal discharge that is thin, milky, white-gray and a fishy odor
saline wet mount for BV
epithelial cells covered by bacteria (clue cells)
tx bacterial vaginosis
metronidazole 500 mg twice daily for 7 days (safe in pregnancy)
