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[3b1⃣] Fam Med > Ob/Gyn > Flashcards

Ob/Gyn Flashcards

1
Q

What type of effects does Tobacco and Cocaine have on neonates when taken during pregnancy?

A
  • Tobacco–> low birth wt
  • Cocaine –> low birth wt 2/2 vasoconstrictive placental insufficiency
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2
Q

Name Intrauterine Maternal factors that inhibit fetal growth? - 5

A

Includes Alcohol use

Always consider Gestational Dating may be inaccurate

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3
Q

Name Intrauterine Placental abnormalities that inhibit fetal growth? - 3

A

Always consider Gestational Dating may be inaccurate

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4
Q

Name Intrauterine Fetal abnormalities that inhibit fetal growth? - 4

A

Always consider Gestational Dating may be inaccurate

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5
Q

What office tool (other than LMP) is used to estiamate gestational age?

A

Fundal height (palpate superior aspect of enlarged uterus)

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6
Q

Name Factors that ⬆︎ Risk for Vertical transmission of HIV -6

A
  1. Unprotected Sex during pregnancy (chorioamnionitis and other STI ⬆︎HIV transmission)
  2. Advanced Maternal HIV viral load
  3. Membrane rupture > 4 hrs prior to delivery in Mother not on HAART
  4. Vaginal Delivery
  5. Breastfeeding
  6. Premature Delivery before 37 wks
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7
Q

You’ve just discovered a positive rapid HIV test on pregnant pt in labor

Name Factors that ⬇︎ Risk for Vertical transmission of HIV -3

A
  1. HAART if viral load > 1000 copies
  2. C-section prior to onset of labor and rupture of membranes
  3. NO Breastfeeding
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8
Q

What is the Ballard Tool?

A

Uses Physical and Neuromuscular signs to estimate gestational age

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9
Q

What constitutes a FULL term infant?

A

≥ 37 wks gestation

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10
Q

What clinical problems are associated with SGA (Small for Gestational Age)?-3 …and why?

A
  1. hypOglycemia (⬇︎ glycogen stores and gluconeogenesis)
  2. hypOthermia (⬆︎Surface area and ⬇︎SubQ insulation)
  3. Polycythemia presenting w/Respiratory distress (Chronic hypoxia)
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11
Q

What are the major risk factors for Breast CA - 6

A
  1. 1st degree relative with breast CA
  2. Excess estrogen (menstruating outside of 12-45 y/o range vs utero DES vs HRT)
  3. Genetics (BRCA 1/2 mutation)
  4. Alcoholic
  5. Obesity
  6. Therapeutic radiation

Average Menopause onset = 51

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12
Q

Guidelines for PAP Smear Cervical CA Screening - 3

A
  1. [Age 21 - 65 every 3 years (cytology only)] ≥ 3x
  2. [Age 30-65 can alternatively get Co-HPV Testing every 5 years] ≥ 2x
  3. Risk Groups (immunocompro/CIN2 or 3 hx/CA/utero DES pts/smoking) need more frequent screening
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13
Q

Guidelines for Breast CA screening - 3

A
  1. 45-54 get mammograms every year
  2. > 55 cont mammograms every year OR switch to every 2 years
  3. 40-44 have the option

No mamm in pt < 40 unless known BRCA mutation

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14
Q

What are characteristics of a breast lump that suggest malignancy - 5

A
  1. single
  2. solid (consider US to differentiate from cystic lesion)
  3. immobile
  4. >2 cm
  5. irregular borders
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15
Q

Pregnancy and Breast stimulation are normal causes of nipple discharge

What are pathologic causes? - 5

A
  1. CA (Intraductal/Paget’s/DCIS/Mammary duct ectasia)
  2. Hormone imbalance
  3. Trauma
  4. Abscess
  5. Meds (Antidepressant/Antipsychotics/AntiHTN)
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16
Q

Risk factors for Cervical SQC - 5

A
  1. Early Sexual Intercourse
  2. Large # of lifetime sex partners
  3. utero DES
  4. Smoking
  5. Immunocompro
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17
Q

Dx for Menopause

A

No menstruation for 1 year straight!

Average Menopause onset = 51

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18
Q

S/S of Menopause - 4

A
  1. Menstrual irregularity in older female (heavy/last>1 week) = perimenopause
  2. Hot Flashes (last 30 sec - 10 min)
  3. Atrophic vaginitis –> Vaginal Dryness, dyspareunia, urinary sx, smooth vaginal mucosa
  4. Mood Swings
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19
Q

What are risk factors for Osteoporosis? - 9

Bone Mineral Density (T-score) ≥ 2.5 SD BELOW mean

A
  1. ⬇︎Estrogen
  2. LOW BMI (malnutrition/malabsorption)
  3. Sedentary lifestyle
  4. Poor Ca+ intake (body needs 1000mg premenopausal and 1200mg post)
  5. Family or personal hx of osteoporotic fracture
  6. Smoking
  7. EtOH abuse
  8. White race
  9. Steroids
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20
Q

Preventitive measures for Osteoporosis? - 4

Bone Mineral Density ≥ 2.5 SD below mean

A
  1. Dietary Ca+ intake 1200-2500 mg/day
  2. Dietary VitD intake 600 IU/day
  3. Sun > 10 min/day
  4. Weight bearing exercises (walking,jogging,dancing)

Only use supplements WHEN ABSOLUTELY NEEDED

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21
Q

Guidelines for Osteoporosis screening - 2

Bone Mineral Density (T-score) ≥ 2.5 SD BELOW mean

A
  1. Women ≥65 = DEXA
  2. Women < 65 get DEXA if fracture risk is ≥ a 65 yo WHITE woman per FRAX score

Bone Mineral Density (T-score) ≥ 2.5 SD BELOW mean

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22
Q

Guideliness for Chlamydia Screening (Women vs Men)-3

A

Women

  1. ALL sexually active women < 25
  2. Sexually active women > 25 if high risk

Men: Insufficient evidence :-(

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23
Q

What are the major s/s of Pregnancy - 7

A
  1. Amenorrhea (this may be normal in teens)
  2. NV
  3. Breast TTP
  4. Urinary frequency
  5. [Hegar’s Uteral / Goodell’s Cervical Softening]
  7. Uteral Enlargement

Remember to screen sex active women < 25 for Chlamydia

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24
Q

Abortion is legal up to ____ weeks gestation ; How do you calculate Estimated Gestational age (EGA) - 2 options?

A

22 weeks ; [Current Date - date of LNMP] = EGA

OR

serial testing of SERUM βhCG

( LNMP = last normal mentrual period)

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25
Q

Abortion is legal up to ____ weeks gestation ; How do you calculate Estimated Due Date (EDD) - 3?

A

22 weeks ; [date of LNMP] + 1 year - 3 months + 1 week = EDD

  • THIS IS KNOWN AS NAEGELE’S RULE and is [+/- 2 wk accuracy]*
  • Use US to confirm BUT ONLY IN WOMEN < 20 WKS GESTATION*
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26
Q

Which labs do you order initially for newly discovered Prenatal? - 6

A
  1. CBC (detect anemias)
  2. Blood Type & Screen (RH-D = RH neg, and these women need anti-D Ig)
  3. Rubella IgG
  4. Hep B surface antigen
  5. RPR
  6. HIV
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27
Q

What’s the best way to diagnose ectopic pregnancy or miscarriage? - 2

A
  1. SERUM βhCG level trend
  2. Progesterone ( ectopic/miscarriage < 5 - 25 < healthy pregnancy) - not reliable tho
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28
Q

How much and When is [RhoGam Anti-RhD Ig] administered to pregnant women? - 4

A
  1. 50mcg sometime during [< 14 WG: 1st trimester]
  2. 300mcg at 28 WG
  3. unspecificied dose within 72 hrs after delivery
  4. unspecificed dose with any episode of vaginal bleeding

WG = Weeks Gestation

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29
Q

Lab w/u for [1st trimester vaginal bleeding]

Remember: this is 25-50% chance of miscarriage

A
  1. Serum βhCG trend WITH Pelvic US
  2. CBC
  3. Wet Mount for trichomonas
  4. GC/Chlamydia PCR
  5. Progesterone ( ectopic/miscarriage < 5 - 25 < healthy pregnancy) - not reliable tho
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30
Q

βhCG levels have to be ____ for pregnancy to be detected via transvaginal US, and usually _____ when transabdominal US can finally detect it

What are βhCG levels during:

A: Ectopic Preg/Miscarriage

B: Molar Pregnancy

A

βhCG levels have to be 1500-1800 for conclusive pregnancy detection via transvaginal US and usually >5000 when transabdominal US can finally detect it

A: Ectopic Preg/Miscarriage = low βhCG

B: Molar Pregnancy = > 100,000 βhCG!!!

βhCG should double every 2 days in normal pregnancy for first 7 weeks

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31
Q

Why are serial βhCG more important than point value βhCG?

A

[βhCG should double every 2 days x first 7 weeks] in normal pregnancy so tracking the velocity trend is important

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32
Q

What are the options for Mngmt of Miscarriage - 3

A
  1. Expectant: Watch waiting for products of conception to expel naturally in 2-6 weeks
  2. Surgical: Dilitation & Curettage (D&C) - cant be done during infection
  3. Medical: 800mcg Vaginal Misoprostol - takes up to 2 weeks for expel

ALL REQUIRE 1 WEEK FOLLOW UP

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33
Q

Why is the TDaP given to ____ week gestation pregnant patients?

A

27-36 week ; Protects BABY from Pertussis

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34
Q

1st trimester is ___ weeks gestation

What are the 3 biggest questions to ask during history taking for these patients? Why?

A

< 14 weeks

  1. NV? - asking because this is treatable
  2. Vaginal Bleeding?
  3. Cramping?
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35
Q

2nd trimester is ___ weeks gestation

What are the 5 biggest questions to ask during history taking for these patients? Why?

A

14 - 27 weeks

  1. Leakage of Fluid? -OOP
  2. Vaginal Bleeding? -OOP
  3. Cramping/contraactions? -OOP
  4. Fetal Movement? -OOP
  5. Anticipatory Guidance [Breastfeeding/Car seats/OCP]

It is a medical emergency when Fetal Movement is not felt by 24 wks!

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36
Q

2nd trimester is ___ weeks gestation

Fetal Movement should be felt when? ; It is a medical emergency when Fetal Movement is not felt by ____

A

14 - 27 weeks

It is a medical emergency when Fetal Movement is not felt by 24 wks!

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37
Q

3rd trimester is ___ weeks gestation

What are the 5 biggest questions to ask during history?

A

28 - 42 weeks

  1. Leakage of Fluid?
  2. Vaginal Bleeding?
  3. Cramping/Contractions?
  4. Fetal mvmnt?
  5. S/S Preeclampsia (HTN/edema/Proteinuria)
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41
Q

What is the normal Fetal Heart Rate and variability of FHR?

A

110 - 160/min (w/variability of 6-25)

Normal Fetus’ should have a reactive NST

43
Q

What does APGAR stand for? ; How is it done? ; How is it used?

A

Appearance, Pulse, Grimace(reflex irritability), Activity(tone), Respiration

Performed at 1 and 5 min postpartum, All scaled from 0 to 2 and then added together

[< 3 = Critical] / [4-6 = fair] / [7-10 = normal]

44
Q

Why shouldn’t you be alarmed if newborn loses weight 2 days after birth?

A

Newborns lose up to 10% of birth weight in first several days, but by 2 weeks should return to original birth weight

Expect wt gain of ounce/day with maternal milk

45
Q

What are the advantages of Group Prenatal care? - 4

A
  1. Educate/support each other
  2. More efficient for provider to give more education (prenatal, labor preparedness, adequacy of prenatal care)
  3. ⬇︎ Preterm delivery (especially in Blacks)
  4. ⬇︎lethal low birth wts in infants that are Preterm –> ⬇︎Racial disparities between black and white infant deaths
47
Q

For Antepartum patients, their NST (Non Stress Test) should be reactive

What does this mean? Does this happen in pts in labor?

A

neuro intact fetus should have

two heart rate acclerations tht are at least [15 bpm over 15 seconds in 20 min period] ; THIS IS NOT REQUIRED FOR PTS IN LABOR

48
Q

What are the 2 clinical features for diagnosing ACTIVE labor?

A
  1. Strong Regular Contractions every 3-5 min
  2. Cervix Dilation > 6 cm during contractions

Fetal Heart Tracing is IRRELEVANT to diagnosing active labor

49
Q

Criteria for PreEclampsia is Gestational HTN + Proteinuria

What is the pathologic evolution of PreEclampsia? How do you evaluate for this?-3

A

PreEclampsia –> [SEVERE PreEclampsia (HA + vision changes)] –> HELLP and at anytime, Eclampsia is possible

  1. LFTs
  2. Renal Function (spot Urine protein/Creatinine ratio)
  3. CBC (look for thrombocytopenia & hemoconcentration)
50
Q

Criteria for PreEclampsia is Gestational HTN + Proteinuria

How do you clinically diagnose SEVERE PreEclampsia? - 6

A

PreEclampsia –> [SEVERE PreEclampsia (HA + vision changes)] –> HELLP and at anytime, Eclampsia is possible

ANY ONE OF THE FOLLOWING:

  1. Systolic > 160
  2. Diastolic > 110
  3. RUQ pain
  4. Doubling of LFTs
  5. 100 > Platelets > 1.1 mg/dL
  6. Pulmonary Edema
51
Q

Pregnant pt is a Jehovah’s Witness and doesn’t want blood during L & D

What are steps to ⬇︎ Maternal Blood Loss? - 3

A
  1. Give Pitocin after birth to help placenta detach faster
  2. Uterine massage after placenta detaches to stop blood vessels from pumping
  3. Clamp umbilical cord EARLY (2 min after delivery)
52
Q

What are the Stages of Labor - 4

A

1st:

A: Latent Phase = Strong Regular Contractions q3-5 min

B: ACTIVE Phase = Cervix is now 6 cm Dilated, [growing @ 1-2 cm/hr] and effacing

2nd: 10 cm FULLY DILATED Cervix

3rd: Baby is Delivered and then Placenta is Delivered

https://www.youtube.com/watch?annotation_id=annotation_563008&feature=iv&src_vid=Xath6kOf0NE&v=ZDP_ewMDxCo

53
Q

Criteria for PreEclampsia is Gestational HTN + Proteinuria

How do you clinically diagnose Gestational HTN? - 6

A
  1. NO previous HTN
  2. > 20 wks gestation
  3. Systolic > 140
  4. Diastolic > 90
  5. At least 2 readings taken > 6 hrs apart
  6. BP taken in seated or semi-reclined position
54
Q

Criteria for PreEclampsia is Gestational HTN + Proteinuria

How do you clinically diagnose Proteinuria for pregnant women - 3

A
  1. ≥300 mg protein on 24 hr urine

OR

  1. ≥ 30 mg/dL on dipstick
    OR
  2. At least 1+ on dipstick
    * Must occur at least 2 times at least 6 hours apart*
55
Q

Criteria for PreEclampsia is Gestational HTN + Proteinuria

Which demographic are at greater risk for this?

A

Af American Women

greater risk of having PreEclampsia, it being severe and suffering placental abruptio and Eclampsia

58
Q

What are Late Decelerations in Fetal Heart Rate?-2 ; What does this possibly indicate?

A

Decelerations in FHR that

  1. Begin AFTER Contraction starts
  2. Nadir is AFTER peak of contraction

= Hypoxemia during contractions 2/2 Utero-Placental insufficiency

59
Q

What does Early Decelerations indicate? Is this normal or abnormal?

A

Head compression when fetus is low in pelvis; NORMAL

60
Q

How do you manage FHR Late Decelerations? - 4

A
  1. Continuous Fetal Heart Monitoring
  2. Turn pt on side to ⬆︎ IVC venous return
  3. O2 face mask
  4. IV fluid bolus
61
Q

What are alternatives to Epidural for L&D pain mngmt? - 4

A
  1. Water Immersion
  2. Intradermal sterile water injections
  3. Self Hypnosis
  4. Acupuncture
62
Q

What are the 4 major causes of Postpartum Hemorrhage? - 4

A

The 4 T’s!

Tone (Uterine aTony)

Trauma (Perineal vs Cervix lacerations vs Uterine inversion)

Tissue (retinaed/invasive placental tissue)

Thrombin (rare bleeding DO)

63
Q

How long should women breastfeed their newborns?

A

AT LEAST 6 months, followed by [BF + complementary foods up until 12 mo.] (Remember: breast milk may take 2-3 days postdelivery to release)

avoid pacifiers/educate women & partners/feed only on demand/immediate skin2skin contact postdelivery = good breastfeeding techniques

64
Q

What are the 4 biggest things to assess during Postpartum checkup?

A
  1. Help at home?
  2. Rx (Prenatal viamins, other meds)
  3. Diet
  4. Mood
65
Q

Naegle’s Rule is the most accurate for determining gestation

When can you use Ultrasound to determine gestation? - 4

A
  1. Only in Women < 20 wks gestation OR…
  2. For discrepancy > 1 wk between US and another method during 1st trimester
  3. For discrepancy > 2 wk between US and another method during 2nd trimester
  4. For discrepancy > 3 wk between US and another method during 3rd trimester

(the earlier the better!)

66
Q

When is Fundal height used for gestational dating? What are the rules? - 2

A

[28-42 wks: 3rd trimester] ;

  1. At 20 wks gestation, Fundus should be at Umbilicus. It goes ⬆︎ by 1 cm every week after
  2. After 20 wks, fundal ht in cm correlates with wks gestation
67
Q

What is the relationship between Pregnant Women and Hot tubs?

A

They need to avoid them! Maternal heat exposure –> Miscarriage & Neural tube defects

68
Q

Which foods should Pregnant women avoid? - 5

A
  1. Raw Eggs (Salmonella)
  2. Unpasteurized Milk (toxo and listeria)
  3. Soft Cheeses (listeria)
  4. Raw Fish/Shellfish
  5. Unwashed fruits/vegetables (toxo and listeria)
69
Q

What Dietary supplements should Pregnant Women take? - 2

A
  1. [Folic Acid 0.4 - 0.8 mg/day]
  2. [Iron 30 mg/day]
70
Q

During Fetal development, what happens at…

4 weeks?

7 weeks?

27 weeks?

A

4 weeks = Neuro tube closes

7 weeks = Heart starts to beat and fetus moves!

27 weeks = Fetus opens eyes & detects light

71
Q

What are the minimum things to check during Prenatal f/u? - 3

A
  1. Maternal wt
  2. Maternal BP
  3. Fetal HR (heard at 10-12 wks gestation)
72
Q

Which Prenatal Vaccinations should be given? - 3

A
  1. FLU [Dead IM]
  2. [RhoGam Anti-RhD Ig] @ [<14 WG:1st trimester] + [28 WG] + [within 72 hrs after delivery] + [with any episodes of vaginal bleeding] (if indicated)
  3. Rubella after delivery

WG = Weeks Gestation

73
Q

What is Hyperemesis Gravidarum?

A

Persistent NV during pregnancy

Normal NV Starts 4WG until 20WG

74
Q

What are Dietary measures women with Hyperemesis Gravidarum can take? - 4

A
  1. Frequent but small meals
  2. Bland solid foods high in carbs, low in fat
  3. Salty morning foods
  4. Sour liquids > Water
75
Q

When can a fetus have its sex determined via US?

A

[18WG: 2nd trimester]

76
Q

Name the major risk factors for Placental previa? - 4

A
  1. > 35 yo
  2. Smoking
  3. Prior Pregnancy (especially if with twins!)
  4. Previous Uterine surgery like C-section
77
Q

What are the 4 types of HTN in pregnancy?

A
  1. Chronic HTN (present before 20 WG and persist beyond 12 weeks postpartum)
  2. Gestational HTN (≥140 systolic or 90 diastolic BP without proteinuria in women after 20 WG)
  3. PreEclampsia
  4. Eclampsia
78
Q

What complications do pregnant women with [SEVERE Gestational HTN] and/or PreEclampsia have? - 3

A
  1. PreTerm Delivery ( < 37 WG)
  2. SGA infants (Small for Gestational Age)
  3. Placental Abruptio

Women with mild Gestational HTN do NOT have these complications

79
Q

What complications do pregnant women with Gestational DM have? - 6

A
  1. PreEclmapsia
  2. Fetal Macrosomia
  3. Birth Trauma
  4. C-sections requirement
  5. Neonatal mortality
  6. neonatal hypOglycemia, hyperbilirubinemia
80
Q

Gestational DM is determined via _______ test. According to the the Carpenter Coustan criteria, how is this interpreted?

A

[3-hour glucose tolerance test] (measure pt BP after fasting and then 1,2,3 hrs after 100 gram glucose oral load);

at least 2 of:

  1. Fasting BG ≥ 95
  2. 1 hour BG ≥ 180
  3. 2 hour BG ≥ 155
  4. 3 hour BG ≥ 140
81
Q

What are the common pregnancy rashes?-3 ; How do you treat them? -2

A

Topical Emollients and Steroids

Do not confuse with Cholestasis which –> whole body itching

82
Q

When is Group B Strep screening done for pregnant women?

A

35-37 WG via rectovaginal swab

83
Q

Postpartum contraception can be started when? What are the postpartum contraception options? - 5

A

Start after 6 weeks postpartum for expulsion & breastfeeding purposes..

  1. Progestin pills
  2. [DepoProvera Injectable Progestin]
  3. Progestin implant
  4. [Mirena Levonorgestrel IUD]
  5. Copper IUD (can be inserted immediately postpartum if needed)
84
Q

Postpartum depression affects women during what time periods? What 2 methods are used to screen for this?

A

within 1st year > first 3 mo ;

  1. [PHQ2 –(if both +)–> PHQ9]
  2. Edinburgh Postnatal Depression Scale

Screen prenatal, postnatal and well child

85
Q

Give brief descriptions that differentiate Postpartum

Blues vs Depression vs Psychosis

A
  • Blues = onset right after birth, peaking at postpartum day 5 and subsiding PPD10, worst w/lactation
  • Depression = onset right after birth - 6 months later. Traditional s/s. Previous Depression hx is RF
  • Psychosis = RARE but onsets RAPIDLY after birth
86
Q

At Postpartum visits, what 3 things should be talked about? What is the postpartum f/u for vaginal delivery? C-section?

A

Mood/Contraception/Breastfeeding

Vaginal delivery f/u = 6 wks postpartum

C-section = 2 wks postpartum

87
Q

What is the DDx for Vaginal Bleeding and/or discharge in pregnant women? - 7

A
  1. Placenta Previa (Spontaneous bleeding after 20 WG)
  2. Placental Abruptio
  3. Bacterial Vaginosis
  4. Candidiasis
  5. UTI
  6. Cervical Trauma
  7. PROM (premature rupture of membranes) = fetal membrane rupture prior to labor. Preterm PROM –> premature birth
88
Q

Home pregnancy test can detect Urine βHCG at levels of ____ while serum blood βHCG can be detected at levels of ____.

What is the pattern of βHCG? - 4

A

≥25 ; 5 mIU/mL

1st: βhCG doubles every 2 days for first 7 weeks
2nd: peaks at 12 weeks
3rd: rapidly declines until 22 weeks
4th: gradually rises again until delivery

89
Q

You have a pt who’s newly became pregnant

What are the initial studies to be ordered? - 9

A
  1. Blood Type/Rh status
  2. Hgb/Hct (detects anemia)
  3. GC Chlamydia
  4. HIV
  5. Hep B and C
  6. Varicella hx
  7. Herpes hx (active labia lesions during pregnancy is ctd)
  8. PAP smear
  9. UA (detects proteinuria)
90
Q

What is Prenatal Maternal Quad Serum screening? When is this performed?

A

Measures 4 chemical markers for fetal anomalies and down syndrome- 81% accuracy (QUAD = BUAD):

  1. βHCG
  2. Unconjugated EsTriol
  3. AFP
  4. Dimeric inhibin A - only in QUAD screen

Performed [15-21 WG: 2nd Trimester]

91
Q

When is routine ultrasound for fetal anomalies performed?

A

[18-21 WG: 2nd trimester]

92
Q

Desribe the 3 components of a physical exam for abnormal uterine bleeding

A
  1. Pelvic: Look for vulvar/vaginal lesions, assess size & mobility of uterus since fixed uterus=uterine CA
  2. Neck: Assess Thyroid since thyroid dz–>uterine bleeding
  3. Skin: Look for abnormal bruises (bleeding DO) and jaundice (liver dz–>bleeding DO)
93
Q

Risk factors for Endometrial CA -7

A
  1. Excess Estrogen (HRT, neoplasm, [menstruation outside of 12-52])
  2. Tamoxifen
  3. Obesity
  4. Anovulation/abnormal menstruation
  5. Nulliparity
  6. Other Disease (HTN, DM, Breast CA)
  7. Age > 35 yo

Smoking and Progestin OCP ⬇︎Endometrial CA Risk

94
Q

Osteoporosis etx

A

⬇︎ Trabeculae bone density despite NORMAL mineralization

95
Q

Name the most common locations for osteoporotic fractures? - 4

A
  1. Hip
  2. Vertebrae
  3. Distal Radius
  4. Proximal Humerus
96
Q

Based on DEXA, when is a pt classified as having Osteoporosis? What about Osteopenia?

A

OSTEOPOROSIS = Bone Mineral Density (T-score) ≥ 2.5 SD BELOW mean of Bone Mineral Density in Young health person

osteopenia = BMD Tscore between 1 - 2.5 BELOW mean

Normal = 0-1 below mean

97
Q

DDx for Abnormal uterine bleeding - 8

A
  1. CERVICAL POLYPS = MOST COMMON IN postpartum/PERImenopausal
  2. Endometrial Hyperplasia
  3. Hormone-producing Ovarian tumors
  4. Endometrial CA
  5. Endometrial Proliferation 2/2 estrogen stimulation (Premenopausal)
  6. Thyroid disease
  7. Steroids
  8. SSRIs
98
Q

What tools are used for diagnosing AUB (Abnormal Uterine bleeding) in women, and why?

A
  1. Transvaginal US = evaluates endometrial thickness (<5mm = ok), leiomyoma fibroids, ovaries
  2. Endometrial biopsy = gold standard for AUB in women w/high risk for endometrial CA
  3. CBC = looks for anemia/thrombocytopenia
  4. TSH = Thyroid dz –> AUB
  5. FSH & LH = In menopause, FSH/LH⬆︎ due to lack of inhibin
99
Q

What are the Benefits-3 and Risk-4 of Estrogen Hormone Replacement Therapy?

There is no right answer for whether women should use HRT

A

Pros

  1. Prevents Osteoporosis
  2. ⬇︎Menopausal sx (Atrophic vaginitis, Hot flashes)
  3. ⬆︎Cognitive/mental status

Cons:

  1. ⬆︎Breast CA risk if combined Estrogen/Proges is used >3 years
  2. ⬆︎Endometrial CA risk with Excess Estrogen
  3. STARTING HRT > 60 yo–> CAD
  4. HRT ⬆︎Stroke risk within first 2 years of use
100
Q

Osteoporosis tx - 4

A
  1. Bisphosphonates (Bone resorption inhibitors)
  2. Calcitonin
  3. Estrogen HRT
  4. PTH synthetic - cant use for > 2 years
101
Q

What are alternative treatments for postmenopausal sx? - 4

A
  1. Yoga
  2. Acupuncture
  3. Tai Chi
  4. Qi Gong

[3b1⃣] Fam Med (2 decks)

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