OB GYN and peds Flashcards
Breast Cancer
Common malignancy in females, fam hx with BRCA marker
Breast lump, retraction of nipple, edema, axillary node enlargement, sanguinous nipple discharge, tethering of skin
Biopsy, excision, chemo –> Breast specialist
Fibroadenoma:
Common benign breast mass
Painless, freely mobile lesion w/o axillary node involvement
Mammography to exclude cancer –> Breast specialist
Fibroadenosis/fibrocystic disease of the breast:
Common benign breast condition
Multiple painful lumps in both breasts worse in PMS and disappears after menses
Mammography to exclude cancer –> Breast specialist
Inflammatory breast cancer:
Rare + aggressive MC in African American women in 50’s
Warm, red, swelling >1/3 of breast + peau d’orange and nipple retraction
Biopsy confirms diagnosis, refer to breast specialist
Mastitis:
Acute inflammation of breast during lactation caused by Staph aureus entering cracked nipples
Hot, painful and swollen breast
M.D. or hospital fr antibiotics
Paget’s disease of the nipple:
Uncommon
Eczematous (red oozing, crusting) rash of nipple w/underlying breast cancer
Biopsy confirmatory refer to breast specialist
Cryptomenorrhea
Menstruating with no external evidence
Metorrhagia
Intermenstrual bleeding
Parity vs gravidity
# of times a woman has delivered a child # of times a woman has been pregnant
Pap smear recommendations:
Begin @21, every two years in 30’s if 3 normal pap smears in a row every 3 years, or women with hysterectomies who still have a cervix
Asherman’s syndrome:
Caused by rigorous curettage for incomplete abortion in which most of the endometrial tissue has been removed and uterine cavity is replaced by fibrous tissue
Amenorrhea following D&C
Refer to gynecologist –> Dx confirmed by hysterctomy
Cystocele:
Herniation of bladder into anterior wall of vagina in older women with numerous children due to stretching of fascia supports of pelvic organs
Presents with feeling of heaviness in vulvar region, stress incontinence and bulge in anterior wall of the vagina
Refer to gynecologist
Dysfunctional uterine bleeding:
Irregular bleeding in absence of clinical or ultrasonographic evidence of structural abnormalities, inflammation or pregnancy MC blamed on hormone imbalances in women in 30-40’s
Prolonged bleeding during menstruation with clots
Refer to gynecologist (dx of exclusion) co-manage after
Rectocele:
Herniation of rectum into posterior wall of vagina in older woman with numerous children due to stretching of fascial supports of pelvic organs
Feeling of heaviness in vulvar region, urge to defecate and bulge in posterior wall of vagina
Refer to gynecologist
Sheehan’s syndrome:
Endocrine condition caused by death of anterior pituitary lobe associated with severe postpartum hemorrhage
Failure to lactate after delivery + amenorrhea, later loss of axillary and pubic hair and fatigue, low prolactin, FSH, LH, TSH confirm
Refer to endocrinologist
Turner syndrome:
Absence of one X in makeup of female pt
Short stature, web neck, underdeveloped breasts with widely spaced nipples, infantile genitalia
Gynecologist
Bluish discolouration of cervix and vagina
Chadwick’s sign
Chloasma
Brownish discolouration over cheeks and nose (mask of pregnancy)
Softening of the intravaginal portion of the cervix
Goodell’s sign
Softening of region between uterine body and cervix
Hegar’s sign
McDonald’s sign
Easy flexibility of the uterus on cervix
Enlarged sebaceous glands in the aerola in pregnancy
Montgomery’s tubercles
Piscacek’s sign
Softening at the site of implantation
EDC
Estimated date of confinement
Gestational age is from?
Last menstrual period
HELLP synrome
Hemolysis, elevated LFT, low platelets associated w/pre-eclampsia
Naegele’s rule?
EDC = LMP + 7 days - months + 1 year
Clinically important and dangerous infections in pregnancy:
Toxoplasmosis - sporozoan type of protozoa spread by handling infected cat feces
Others/HIV
Rubella: single stranded enveloped icosahedra Toga RNA virus; droplet infxn
CMV - Double stranded DNA herpes type 5 virus; close intimate contact
Herpes: double stranded enveloped DNA herpes 2; close intimate contact
Syphilis: faintly gram - flexible spirochete; STI
Leopold’s maneuvers
> 20 weeks to establish fundal height (approximate gestation), location of back of fetus and brow, ID presenting part (Pawlick’s grip)
Abruptio placenta
Premature separation of normally implanted placenta from uterus during late pregnancy; idiopathic
Sudden painful vaginal bleeding, ab pain with tender uterus
HOSPITAL for transab US
Anemia of pregnancy
Cuz hemodilution and iron/folate deficiencies
Pale mucous membranes and fatigue
CBC confirm co-manage w/obstetrician
Antepartum hemorrhage:
Bleeding per vaginum >24th week of gestation
Painless (due to placenta previa) or painful (abruptio placenta)
Cal 911
Herpes Gestiatonis:
Florid infection of vulva/vagina not from Herpes 1/2, maybe autoimmune
Itching papules –> vesicles –> bullae in genital area
Refer to obstetrician for immunofluorescence exam
Hydatidiform mole:
Proliferation of trophoblastic tissue
In early pregnancy with larger uterine size vomiting and nausea w/o fetal heart beat and high bHCG levels
Refer to obstetrician
Placenta Previa:
Implantation of placenta over/near internal os more common if multiple pregnancies or pts with uterine surgery
Painless bright red vaginal bleeding, vaginal exam contraindicated
Call 911 need US
Pre-eclampsia:
HTN >140/90, proteinuria, after 20th week gestation
Stages of Labour:
1: Onset of contraction to 10cm dilation of cervix
2: Full dilation to delivery of infant
3: Delivery of infant to delivery of placenta
Involution: reduction of size of uterus after expulsion of placenta
Cardinal movements during normal labour of a vertex presentation:
Engagement, descent, flexion, internal rotation, extension, external rotation (L occiput ant), expulsion
Colostrum is rich in?
IgA
Dystocia:
Difficult labour: large fetus, small pelvis, shoulder/brow presentation
Lightening:
Fetus drops two weeks before birth into pelvic inlet
Placenta accreta:
Placenta invades uterine musculature, doesn’t separate at time of birth
Who is more likely to have a premature rupture of membranes?
Teens, single women + smokers
Lochia:
Discharge of blood, mucus, tissue from uterus after delivery
Puerperium:
7 week period after expulsion of fetus and placenta
Puerperal sepsis:
Blood borne infection in postpartum period
Spread of infection from mastitis, pneumonia, UTI or endometritis
Fever, bacteria in blood
Hospital for IV antibiotics
APGAR score
Appearance, pulse rate (absent, <100, >100), grimace, activity, respiratory effort
Rooting reflex?
Sucking reflex?
Tonic neck reflex?
Stroking corner of mouth causes mouth to open and infant turn to that side
Nipple in mouth of newborn stimulates sucking (survival)
Head of supine baby rotated ipsilateral arm and leg extend while contralateral arm and leg flex
Umbilicus falls off within?
Holds head/closure of posterior fontanelle by?
7-10 days
3 months
Infants smile by?
Can hand grip by?
Get their first tooth by?
Eat their first food by?
8 weeks
4-6 months
6-8 months
6 months
Babies can use assisted walking by? Unassisted?
First words by? Able to feed by and closure of anterior fontanelle?
Use three word sentenced by?
10-14 months, 12-18 months
18 months
3 years
Acyanotic heart disease:
VSD, ASD, PDA no cyanosis at birth
Cri du chat:
Deletion of short arm of chromosome 4/5 - laryngeal defect, mental retardation, microcephaly
Edward syndrome:
Trisomy 18 (triplication), GI and facial and CVS malformations
Asperger vs autism
Impaired social skills, rep behaviours, no language problem
Impaired social interactions, communication and behaviour in a child
Kwashiokor vs Marasmus vs Pellagra
Disease caused by diet deficient in proteins (red hair, swollen ab and legs with dry wrinkled skin and flaky paint dermatitis) Calorie deficiency (loss of subcutaneous tissue, ribs, facial bones prominent loose thin skin) Niacin (B3) deficiency
Botulism:
Flaccid muscle paralysis from clostridium botulinum (honey) prevents ACH release at NMJ
Drooling, dysphagia, constipation
Refer to hospital - stool testing
Diptheria:
C. Diphtheriae from droplet infection
Fever, sore throat with dirty grey pseudomembrane, arrhythimas or diplopia
Hospital for throat swab
Pertussis:
Bordetella pertussis droplet infection
Runny eyes (catarrhal phase) then paroxysms (cough and whoop) and vomiting
Refer to pediatrician
Wilms’ tumor:
MC intra-ab tumor in children - nephroblastoma
Large mass in abdomen
Pediatric oncologist after biopsy confirms (CT or MRI)
