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IPAP > OBGYN Block 3 > Flashcards

OBGYN Block 3 Flashcards

1
Q

What is the MC form of contraception in the world?

What is the MC form used in the US?

A

IUD

PO CHCs

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2
Q

What two forms of contraception are not recommended for PTs w/ HTN?

What form is not recommended for PTs w/ migraine and aura?

A

Depo, CHC

CHCs

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3
Q

What are the 5 tiers of contraception?

What tier would PTs w/ HIV want to avoid?

A

1: implant, IUD, Sterilization
2: Ring Injection Pill Patch
3: Barrier Behavior
4: Spermicide Sponge Cream/Jelly/Foam
No: Plan-B Abortion

4: spermicide

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4
Q

What are the criteria for being reasonably certain PT is not pregnant?

A

<7d after start of normal menses

No intercourse since start of last normal menses

Correct/consistent contraception use

<7 days post-abortion

<4wks post-partum

Breastfeeding >85%, amenorrheic and <6mon post-partum

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5
Q

What form of contraception can HIV PTs use?

Breast feeding PTs should not be given COCs if they are post-partum for how long?

A

All forms, caution w/ spermicide

<1mon PP, no COCs
Use POPs

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6
Q

Tier 1 contraceptives are AKA ?

What are the indications for a PT to receive an IUD?

A

Long Acting Reversible Contraception (LARCs)

Hormone avoidance
Adolescent
Nulliparous
Dysfunctional bleeds- Levon
Stable relationship
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7
Q

What are the 4 brands w/ length of use?

What is their MOA?

? term encompasses the brand names?

A

Mirena- 5yrs
Liletta- 3yrs
Kyleena- 5yrs
Skyla- 3yrs

Prevention of fertilization

Levonorgestrel

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8
Q

Cu IUD

A

Endometrial inflammation
No impact on ovulation

Dec sperm/egg viability, motility
Anti-blastocyst action

Good for:
Breast Ca
Anti-phospholipid Ab syndrome
Thromboembolic dz

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9
Q

What are the s/e of Cu IUD?

How long does it take for fertility to return upon d/c of this form?

A

Menstrual changes- first 3mon
Possible dysmenorrhea or heavier cycles, Tx w/ NSAIDs

Immediately

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10
Q

Levonorgestrel IUDs are used for how long?

The long term progestin release of this form leads to what 3 results?

A

Used up to 5yrs

Dec sperm motility
Inconsistent ovulation inhibition
Endometrial atrophy prevents implantation

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11
Q

What are the s/e of using Levonorgestrel IUDs?

What is a benefit of using these?

A

Spot/irregular bleeds x 6mon
1mon post-insertion- device related infections

Improves dysmenorrhea

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12
Q

What do PTs have to do if Levonorgestrel device is placed >7d after menses started?

When do they need to f/u w/ PCM?

What is done if strings can’t be visualized?

A

Use back up x 7d

6wks

Verify non-pregnancy
Cytology brush to entangle strings and pull into vaginal vault
No strings= US

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13
Q

What are the S/Sxs of PT that has an IUD that has moved into lower uterine segment?

When are IUD expulsions more common?

A

Continued/new pelvic pain or cramps

First month
Placement <6wks post partum
<25y/o

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14
Q

If PT becomes pregnant w/ IUD in place, there is a higher change of ?

If PT has 2nd trimester miscarriage w/ IUD in place there is a higher likelihood for ?

A

Ectopic pregnancy

Infection

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15
Q

MOA of Etonogestrel rod implant

How long is this good for?

This form can’t be seen on ? imaging and is not affected by ? PT Hx

A

Inhibits LH, endometrial atrophy, thickens mucus=
Inhibits ovulation*, implantation and sperm motility

3yrs

Radiopaque
Obesity

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16
Q

What is the MC adverse effect of all progestin-only contraceptives?

What are the two absolute c/is for use?

A

Irregular/heavy uterine bleeds

Current breast Ca
Pregnancy

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17
Q

Nexplanons are placed w/in ? days of menses onset

What if this time limit is not met and device is still inserted?

A

5days

Back up x 7d

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18
Q

How long does it take for fertility to return after removal of Nexplanon?

When is Nexplanon use more preferred?

A

6wks, up to 1yr

Post-partum/abortion
Lactating

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19
Q

How often are Depo shots given?

What is the MOA

A

150mg q3mon IM- delt/glut

Same as progestin only:
Inhibits LH, endometrial atrophy, thickens mucus=
Inhibits ovulation, implantation and sperm motility

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20
Q

What is the non-contraceptive benefit of Depo?

What are the c/is?

What is the absolute c/i?

A

Improves dys/menorrhea, endometriosis pain
Dec risk hyperplasia/cancer
Inc risk functional cysts

Recent breast Ca
Progesterone + Ca
Prior ectopic pregnancy
Pregnant

Current breast Ca

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21
Q

What are the adverse effects of Depo use?

How does this effect post-partum status?

A 
Bone loss, reversible (supp E secretion)
Irregular bleeding
Weight gain
Amenorrhea
Severe HTN
Prolong anovulation/amenses after d/c

No impairment on milk production

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22
Q

What are POPs AKA and what is the only formula?

A

Norethindrone 0.35mg

Mini-pill

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23
Q

What is the MOA of POPs?

What is a non-contraceptive MOA?

A

Inhibits LH, endometrial atrophy, thickens mucus=
Inhibits ovulation, implantation and sperm motility

Unreliable ovulation inhibition

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24
Q

POPs are mostly used in ? PT population?

What PT education piece has to go with this Rx?

A

Breast feeding
Estrogen c/i PTs

Same 4hr window every day of use back up x 48hrs

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25
Q

What are the absolute c/is for Rx POPs?

What are the three forms of CHCs?

A

Breast Ca
Pregnancy

Ring Patch Pill (CoC)

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26
Q

What is the MOA of CHCs?

A

Suppress LH/FSH release to inhibit ovulation

P: inhibits LH= suppresses ovulation, dec sperm motility, inhibits implantation

E: inhibits FSH release to suppress ovulation, cycle control to prevent bleeding

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27
Q

CHCs contain ? max amount of estrogen?

Why is this?

Progestin component of CHCs have been modified to provide ? benefits

A

<35mcg

Dec risk for thromboembolus

Dec androgenic effect (weight acne hair lipids)

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28
Q

When would a 4th Generation progestin like Yaz be preferred?

What is the adverse effect of Yaz?

A

PTs w/ PMS- breast tenderness,
Inc Na/Water excretion to dec bloat

HyperK+

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29
Q

What are the two types of CHC hormone levels

How does the generation of CHC and amount of progestin differ?

How many days are spent hormone free on this regime?

A

Monophasic- same amount/pill
Multiphasic- estrogen varies 10-50mcg

Later generation= less androgenic effect, inc PE/VT/MI risk

4-7days

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30
Q

What are the benefits of PO CHCs?

What are the risks?

A

No risk Ca
Efficacy not impacted by obesity
Dec bleeding, acne, hair

Inc clot risk

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31
Q

What are the non-contraceptive benefits of PO CHCs?

How long does it take for fertility to return?

A

Dec heavy bleeding/androgen
Improves PMDD Sxs
Improves cycle irregularities

1-2wks for return
6-12mon to regular

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32
Q

What are the PO CHC initiation methods?

A

1st day: day 1 of menses, no back up needed

Sunday: first Sunday after menses starts, back up x 7d
No weekend withdrawal/bleed

Quick: start day Rx, back up x 7d

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33
Q

What chemical in PO CHCs helps improve PMDD Sxs?

A

Drospirenone

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34
Q

What are the absolute c/is to CHCs?

A 
CLIMBED UP PAD TV
CVA
Liver tumor
Ischemic heart dz
Migraine w/ aura
Breast Ca 
Estrogen dependent tumore
Decompensated cirrhosis

UnDx genital bleeding
Pregnancy

Peripartum cardiomyopathy
>35y/o and >15 smokes/day
DM x 20yrs

Thrombogenic states: <21d post partum, DVT/PE, SLE
Vascular dz/uncontrolled HTN

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35
Q

What are the complications that can arise from CHC use?

A 
Benign hepatic tumor
Cholelithiasis
Post-pill amenorrhea
HTN
Mood swings
Thromboembolism
Stroke
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36
Q

What are the s/es in order of prevalence PT experience upon d/c of PO contraceptives?

A 
Irregular bleeds
Nausea
Weight gain
Mood swing
Breast tenderness
HA
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37
Q

What are the 3 forms of continuous PO OCP

A

EE 30mcg + Levon .15mg= 84/7, 4 menses/year

EE 10mcg

Levon 90mcg/EE 20mcg

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38
Q

Where is the patch placed on the body?

What is the down side of patch CHC use?

A

Weekly on butt arm abdomen or torso x 3wks
Not on breast

> 90kg dec efficacy

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39
Q

What is done if patch placement is delayed in 1st wk?

What is done if patch placement is delays in 2nd or 3rd week?

What if the patch becomes detached?

A

Reapply, back up x7d

<2d, no back up
>2d, back up x 7d

<24hrs- replace same patch, no back up
>24hrs- new patch, back up x 7d

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40
Q

What are the advantages of transdermal CHCs?

What are the disadvantages?

A

Avoidance of first pass
Constant plasma hormone
Inc compliance
Immediate fertility return

Inc DCT
Skin rash

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41
Q

How long are these used for?

Why are these poor choices for deployments?

A

3wks in, 1wk out

Refrigeration requirement
Annovera doesn’t require this

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42
Q

When is back up birth control needed w/ CHC rings?

What is done if the ring falls out?

A

Day 1 start- none
Day 2-5: 7d back up

Reinsert <3hrs, none
Out for >3hrs, back up x 7d

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43
Q

What is a non-contraceptive benefit to CHC rings?

How long does it take for fertility to return?

A

Lighter/shorter cycles after 6mon

Rapidly

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44
Q

What are the steps if PT misses one pill but is <48hrs total?

A

Take late/missed pill ASAP

Continue taking remaining pills on schedule

No back up needed

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45
Q

What are the steps taken if PT misses one pill but is >48hrs total?

A

Take most recent missed, toss remaining missed

Continue taking remaining pills on schedule

Use back up

If pills were missed on days 15-21: finish hormone pack, start new pack next day

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46
Q

PO COCs decrease the chances/prevalence of ? two cancers?

What is the only physical assessment required prior to starting CHCs?

A

Ovarian
Endometrial

BP

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47
Q

What are the facts about diaphragms?

How long do cervical caps need to remain in place and what is it AKA?

A 
Require fitting
6hrs prior/post intercourse
Inc UTI risk
Inc efficacy w/ spermicide
Dec risk of STDs

48hrs, higher failure rate
Sailor cap

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48
Q

What are the 4 fertility awareness methods?

A

Standard days- avoid sex day 8-19; must have cycles q 26-32d

Temp rhythm- every morning, 0.4-0.8* inc x 2d

Cervical mucus- high E= prep for ovulation/implant, inc mucus
High P= white/thick mucus to prevent sperm entrance

Symptothermal methods- combo mucus and body temp; reqs 12-17d of abstinence/mon

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49
Q

What are the two cervical mucus methods?

A

Two day- safe if no mucus on/day prior to intercourse

Billings- abstain from menses to 4d after identification of watery/slippery mucus

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50
Q

What are the 3 forms of emergency contraception?

A

PO hormones <72hrs
P only: Levon 1.5mg
COC: EE + Levon 100mcg (Yuzpe regime)

Progesterone antagonist <120hrs (most efficient PO regimen)
Ulipristal 30mg

Cu IUD <120hrs (most effective)

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51
Q

Facts of Lactational Amenorrhea

What form of contraception can be used while breast feeding?

A

Unlikely ovulation 10wks post-delivery
Switch to back up after 6mon
Must feed >85% of time

POP/mini

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52
Q

When is post-partum contraception recommended to begin?

Do not give E/P contraceptives w/in ? after delivery

A

Prior to first menses

4wks d/t inc venous thrombus risk

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53
Q

How long after vasectomy is male considered ‘safe’?

Why is this form of sterilization preferred?

A

3mon/20 ejaculations
Requires confirmation

Safer/more efficacious than tube ligation

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54
Q

What meds are used for elective pregnancy termination and they’re taken on ? day

What are the 3 surgical procedures?

A

Mifepristone/Methotrexate- 1
Misoprostol- 3

Vacuum: 5-6wks
DnC: 6-13wks
Induction: >16wks

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55
Q

Ovulation can return as quickly as ? wks after pregnancy terminations?

Define Fecundity

Define Fecundability

A

2wks

Probability of achieving live birth in single menstrual cycle

Ability to conceive; probability of achieving pregnancy per month of exposure (20%/cycle, 50% in 3mon, 85%/year)

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56
Q

Female fertility if reduced by half during what ages?

What is the ‘conception window’?

What can be done to maximize this window?

A

37-45y/o

5 days prior to day of ovulation

Daily intercourse
Qod 10 days around ovulation

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57
Q

What is the criteria to begin infertility work ups?

How does this change if female is of advanced age?

A

Failure to conceive w/in 12mon w/ regular coitus and w/out contraception

> 35y/o= 6mon

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58
Q

COCs can prevent ovulation from returning x ?mon

Dep can prevent ovulation from returning x ?mon

A

12mon

24mon

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59
Q

What are the 5 etiologies of infertility in order of prevalence?

What has more impact on inability to conceive, under/over weight?

A 
Ovulatory
Male factors
Tubal/uterine
Unexplained
Other

Under, <19

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60
Q

How does smoking induce infertility?

How does alcohol induce infertility?

A

Vascular/endothelial dysfunction do to reduced nitric oxide availability

Dec female fertility/sperm count
Inc male sex dysfunction

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61
Q

How does marijuana/coke induce infertility?

Infertility eval consists of ? and encompasses ? triad

A

M: suppresses HPG axis
C: impairs speratogenesis

Hx/PE both partners
Ovulation
Norm F reproductive tract
Norm semen characteristics

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62
Q

Semen analysis reqs ? days of abstinence?

How many samples are needed?

A

2 days

2 samples 3wks apart

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63
Q

What presenting female PE indicated ovulation is occurring?

Define Mittelschmerz

How does this present

A

Menses q25-35d w/ 3-7d duration

Ovulation pain: unilateral mid-cycle pelvic pain w/ ovulation

Breast tenderness
Acne
Mood swings
Food cravings

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64
Q

What are the luteal phase/PMS Sxs?

At home ovulation kits are made to detect ?

A

Breast heaviness
Dec vaginal secretion
Abdominal bloating
Mild peripheral edema

LH surge prior to fertility window

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65
Q

? test is a more direct and earlier detection of ovulation?

PTs w/ irregular menstrual cycles have ? labs drawn for anovulation work ups?

A

Serum progesterone
>4-6ng during mid-luteal phase

TSH/FSH
Testosterone
Prolactin
DHEA-5

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66
Q

Female PT w/ STI Hx may indicate ? anatomic reason for infertility?

What imaging studies are used for assessing tubal patency?

A

Tubal for STI/PID issues

HSG
SIS
Laparoscopy

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67
Q

What imaging studies are used for assessing uterine cavity?

What imaging studies are used for assessing ovaries?

A

All but laparoscopy

All but HSG and Hysteroscopy

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68
Q

What imaging studies are used for assessing for endometriosis/PAD?

What imaging studies are used for assessing for developmental defects?

A

HSG
Laparoscopy

All

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69
Q

What tests are done for suspected ovulatory dysfunction?

What tests are done for suspected uterine factors?

A

Ovulation kit
Antral follicle count
FSH AMH TSH PRL Androgen

HSG
Hystero/Laparoscopy
MRI
TVUS/saline sonography

70
Q

What tests are done for suspected tubal/pelvic dz?

Overall miscarriage risks double by 50% by ? age

A

HSG
Laparoscopy + chromotubation

> 40y/o

71
Q

What is the most cost-effective fertility test ordered?

What other test has become standard practice?

An US antral follicle count below ? indicates poor ovarian response?

If any of the above three ovarian reserve tests are abnormal, what is the next step?

A

Day 3 labs: FSH + Estradiol on cycle day 3

Serum anti-mullerian hormone levels done at anytime, potential earlier predictor

<5-7

Refer

72
Q

What are the ideal/bad levels of he ovarian reserve tests?

What hormone must be below 100pg for FSH to be valid?

A

AMH: 2.0 or higher/<0.5
FSH/E2: <10miu/20 or higher
AFC: 20 or higher/below 5

Estradiol

73
Q

What is the initial Tx for most anovulatory infertile women??

What other medication could be used?

What are two other classes that could be used?

A

Clomiphene on day 3-5

Metformin- inc spontaneous ovulation

Gonadotropin
Aromatase inhibitors

74
Q

Hx Test and Therapy for PTs presenting w/ ovulatory infertility

A

Irregular menses

BBT, LH Progesterone

Clomiphene/metformin

75
Q

Hx Test and Therapy for PTs presenting w/

Uterine infertility

A

Fibroids

HSG

Procedure

76
Q

Hx Test and Therapy for PTs presenting w/

Male infertility

A

Hernia/varicocele/mumps

SA

Procedure/IVF

77
Q

Hx Test and Therapy for PTs presenting w/ Tubal infertility

A

GC/PID

HSG

Laparoscopy/IVF

78
Q

Hx Test Hx Test and Therapy for PTs presenting w/ Peritoneal infertility

A

Dyschezia, -pareunia, =menorrhea

Laparoscopy

Ablation
Excision

79
Q

Pthirus is AKA ?

How is is transmitted and present?

How is it Dx

How is it Tx

A

Crabs

Contact- pruritis excoriation adenopathy

Microscopy/exam

Permethrin
Pyrethrins
Lindane- not if pregnant/infant

80
Q

Sarcoptes is AKA ?

How is this transmitted and present?

How is it Dx

How is it Tx

A

Scabies

Contact- pruritus, dermatitis

Oil scrape/exam

Lindane- not if pregnant/infant
Ivermectin- PO x 2wks
Permethrin

81
Q

What are the S/Sxs of an initial HSV outbreak?

How is it transmitted?

How is it Dx?

A

HA Adenopathy Malaise

Saliva/Contact

Culture/PCR/Serum Abs

82
Q

What causes genital warts?

How is it transmitted?

What is the clinical Dx term

A

HPV 6, 11

Contact Objects
Birth canal to larynx

Condylomata acuminatum

83
Q

How are genital warts Dx

How are they Tx by provider

How are they Tx by PT

A

Acetic acid
Biopsy to test Tx response

Podophyllin T/BCA Cryo

Podofilox Imiquimod- not if pregnant

84
Q

What bacterial spirochete causes Syphilis?

How is it transmitted?

How is it detected and confirmed?

A

Treponema pallidum

Contact
Transplacental

RPR/VDRL
FTA-ABS

85
Q

How does Secondary Syphilis present?

What part of the PT is contagious w/ this Dx?

What other PE finding may be seen?

A

Bacteremia 6wks-6mon
Maculopapular rash on palm/sole

Exanthem- sheds spirochetes

Condylomata lata- broad pink plaques in moist body areas

86
Q

What is the criteria for Early and Late Latent Syphilis

What are the 3 areas of the body that untreated syphilis may reappear in?

What two forms are less likely to occur in females compared to males?

A

Early: <1yr after secondary
Late: >yrs after infection

Cardiovascular CNS MSK

CV/Neuro

87
Q

What syphilis PTs are more likely to present w/ Jarish-Herxheimer reactions?

What causes this reaction and how does it present?

When do these PTs need to f/u w/ PCM?

A

Secondary

Endotoxin release
Fever Malaise HA

6mon intervals
Re-treat w/ weekly PCN x 3wks

88
Q

? is intracellular bacteria that is ASx in 70% female/50% males?

How does this present?

How is it Dx?

How is it Tx

A

Chlamydia

Ureth/Cervicitis

Culture, Ag, PCR

Azithromycin 1g PO x 1
Doxy 100mg BID x 7d

89
Q

How long do PTs being Tx for G/C need to avoid sex?

What is the only time test for cure is required?

What f/u is needed?

A

7d during ABX

Pregnant post chlamydia

Re-screen in 3-4mon

90
Q

What STD are most females ASx but only 5% of males are ASx

How is it Dx

How is it Tx

A

Gonorrhea

Gram stain
Culture w/ Thayer martin media
PCR

Primary: Ceftriax 250mg IM
Azith 1g PO
Secondary: IM/PO Cephalosporin
Azith 1g PO
Teriatry: IM/PO cephalosporin + Doxy 100mg bid x 1wk
91
Q

Upper PID/genital tract infections are a result of ?

What are the MC microbes

A

Ascending lower tract infections

Chlamydia
Gonorrhea
BV
Mycoplasmas- M hominis U urealyticum M genitallium

92
Q

What are the common/unwanted sequels of female STDs?

What is the triad for PID?

A

Infertility
Chronic pelvic pain
Ectopic

CMT Dysparunia Fever that develop at/soon after menstruation

93
Q

How are inpatient PIDs Tx?

A

Parentaral IV Tx*

Cefotetan or
Cefoxitin w/ Doxy

Clinda w/ Gentamicin

Alt:
Ampicillin/Sulbactam and Doxy

94
Q

Define Tuboovarian abscess

How does it Present

If left untreated, ? occurs

How is it Dx and Tx

A

Infection/inflammation of tube or ovary

PID Sxs + Fever Leukocytosis Abd pain Mass

Rupture and peritonitis

US
Broad IV ABX

95
Q

What causes TSSyndrome

When does it present?

What are the classic Sxs

A

Staph A Exotoxin

2days post surgery or menstruation

Fever Malaise Diarrhea
Non-painful/itchy macular rash

96
Q

What causes TSSyndrome

When does it present?

What are the classic Sxs

A

Exotoxin from Staph A

2days after surgery/menstruation

Fever Malaise Diarrhea
Non-painful/itchy macular rash

97
Q

What are the major criteria needed to Dx TSS

What are the minor criteria that only require 3 for Dx

A 
HOTN
Orthostatic syncope
BP <90
Macular erythroderma
Temp >38.8
Late skin desquamation
Myalgia/Cr 2x inc
AMS
D/V
Elevated bili
Platelets <100K
Mucous membrane erythema
98
Q

What are the major criteria needed to Dx TSS

What are the minors that need 3 for Dx

A 
HOTN
Orthostatic syncope
BP <90
Macular erythroderma
Temp >38.8
Late skin desquamation
D/V
Mucous membrane erythema
Platelets <100K
AMS
Myalgia/Cr 2x inc
Elevated bili
99
Q

What is a normal life cycle for breast epithelial cells?

Young premenopausal women w/ breast growths are usually ?

What is the sequence of working up a suspected breast growth

A

Proliferate in LUTEAL phase
Inc water retention/fullness week preceding menses

Benign

Exam Image Cytology

100
Q

How do fibroadenomas present?

How are these managed?

How are breast cysts Dx?

A

Mobile, well circumcised, non-tender rubbery growth in adolescent/pre-menopause

Biopsy to Dx, if stable/ASx, leave in place
Unstable/growing- excise

Sonography

101
Q

What are the 3 categories of breast cysts and how do they appear?

A

Simple:
Sonolucent/smooth
No special management
Recurrent= Excision

Complicated: 
Aspirate
Culture
Cytology
Core needle

Complex: Co Ex
Core needle
Excise

102
Q

Fibrocycstic breast changes

A

Nodular tissue from dilated ducts/acini w/ dense collagen

Ropy/tender from exaggerated stromal response to hormone/Gfs

No breast Ca risk if alone
Hyperplasia from low progesterone

103
Q

Fibrocycstic breast changes

A

Nodular tissue from dilated ducts/acini w/ dense collagen

Ropy/tender from exagerated stromal response to hormone/Gfs

No breast Ca risk if alone
Hyperplasia from low Progesterone

104
Q

What is the MC benign breast tumor

What is the MC benign breast d/o

A

Fibroadenoma

Fibrocystic changes

105
Q

PTs w/ green nipple d/c indicates ? issue?

What does multi duct d/c after manual expression indicate?

What does serous/spontaneous bloody discharge indicate?

A

Cholesterol, not infection/Ca

Physiologic

Pathological, concerning if only one duct invovled

106
Q

What is the MC cause of mastitis

On top of warm compresses and continuing to feed, what meds can be added for Tx?

A

Staph

Dicloxacillin
Cephalexen
Augmentin
PCN Allergy- erythromycin
MRSA: TMP/SMX, Clinda, Vanc
107
Q

How is cyclic mastalgia Tx

How is noncyclic mastalgia Tx

A

No eval, Sx Tx w/ NSAID

Exam Image Biopsy

108
Q

How are breast tumors annotated/recorded in records?

What imaging modality is used for focal mass in in PTs <30 or pregnant?

What image is preferred if PTs are older?

A

Left breast, 2.5cm mass, 10:00, 6cm FN

US, differentiates cyst from solid

Mammograms

109
Q

How are neoplasms Dx

A

Biopsy- minimally invasive

Open biopsy: excision

FNA- small masses for cytology

Core needle- Dx w/out excision

110
Q

What eval technique is used for the following:

Palpable cyst

Recurrent cyst/blood fluid

Non-Dx FNA

Solid mass

Non-Dx CNB

A

Needle drainage

Excision

Core/excision biopsy

Core biopsy

Excision biopsy

111
Q

Nulliparous PTs w/ tender, red, hot breast and adenopathy not responding to ABX, what is the next best step?

What are the 4 muscles of the Levator Ani

A

US/Biopsy

Pubococcygeus
Puborectalis
Iliococcygeus
Coccygeus

112
Q

Dx criteria for chronic pelvic pain

A

Non-cyclic pain persisting x 6mon

Pain localized to pelvis, anterior abdominal wall, lumbrosacral back/butt

Pain severe enough to cause functional disability

113
Q

Chronic pelvic pain can be that cause for ? mental dx?

CPP can be comorbid w/ ? 4 somatic syndromes?

A

Depression

Fibromyalgia
Chronic fatigue
Temporomandibular d/o
Migraine

114
Q

Define Allodynia

Define Hyperalgesia

A

Painful response to normally innocuous stimuli

Extreme response to painful stimulus

115
Q

What MSK issues can cause CPP?

How does Pelvic Congestion Syndrome present

A

Kyphodosis
Lorodosis

Worse Sxs pre-menstrual
Ache, pressure, heaviness

Hormone suppression
Ovarian vein embolization
Hyst w/ BSO

116
Q

How is CPP managed?

Define Vulvodynia

How does it present

A

Acetaminophen/NSAIDs
Neuro Pain= SSRI/SNRI Gabapentin

3-6mon vulvular discomfort w/ot visbile/neuro findings
Burning Stinging Itching Pain

117
Q

How is Vulvodynia Tx

Rates of dyspareunia have been linked w/ ?

A

10% spontaneously resolve
TCAs w/ topical lidocaine/gabapentin

CPPs

118
Q

What are the different types of dyspareunia

A

Primary: onset at coitarche

Secondary: after pain free sex

Generalized: all intercourse

Situations: partners/positions

119
Q

Define Myofascial Pain Syndrome

How is Levator Ani Syndrome Tx

A

Hyperirritable area of muscle due to trigger point of taught/ropy bands
Primary- MSK
Secondary- visceral

Local anesthetic injections
Botulinum A injection

120
Q

Define Pudendal Neuralgia

Where does it present?

What makes it better/worse?

A

Sharp severe pain in pudendal nerve distribution area:

Perineal- vulva
Inferior rectal
Dorsal clitoris

Unilateral pain worse sitting
Better standing/sitting on toilet

121
Q

How is Pudendal Neuralgia Dx

How is it Tx

A 
Nantes Criteria:
Pain follow innervation
Worse w/ sitting
No sensory loss
No awakening from sleep
Relieved w/ nerve block

TCA, Gabapentin

122
Q

What are the 4 types of pelvic organ prolapse?

This issue is the 3rd MC cause for ?

A

Cystocele Rectocele Enterocele Procidentia- uterus

Hysterectomy

123
Q

Define prolapse splinting

Define prolapse digitization

A

Manual bolstering of prolapse to improve Sxs

Manual pressure to aid stool evacuation

124
Q

What are the RFs for developing prolapses?

How are prolapses Tx/Managed?

A

Vaginal births, 1.2x/delivery
Forcep delivery
Episiotomy

Post-meno/atrophy- estrogen
ASx/Mild Sxs- kegels
Non-surgical candidate or prolapse w/ urine incontinence- pessary
Surgery

125
Q

Interstitial cystitis and painful bladder syndrome both present w/ ? 3 Sxs

How are they different

A

Frequency Urgency Pain

IC: mucosal changes, dec bladder capacity
PBS: no bladder pathology

126
Q

What PT presentation indicates interstitial cystitis/painful bladder syndrome?

What do these PTs need to avoid?

A

Unexplained chronic pain/voiding Sxs
Dyspareunia/postcoital ache

Cranberry juice

127
Q

How is interstitial cystitis/painful bladder syndrome Tx

What is the only FDA approved med for Tx?

A

Education/behavior mods
Pelvic PT
Amitriptyline Cimetidine Hydroxyzine

Elmiron but takes months to take effect

128
Q

What medication can sometimes help with incontinence?

What are the two main types of incontinence?

A

Topical estrogens

Stress: involuntary leakage w/ inc intraabdoinal pressures
Urge: involuntary leakage followed by urge to void

129
Q

What are the DDxs for transient causes of incontinence?

A 
DIAPPERS
Delerium
Infection
Atrophic vagin/urethritis
Pharmaceuticals
Psych
Excess urine output
Restricted mobility
Stool impaction
130
Q

What is the MC cause of transient incontinence in hospitalized PTs?

What meds can cause transient incontinence by gender

A

Derlirum

A-blockers: women
A-agonists: men

131
Q

What part of the NS controls the inferior/superior parts of the bladder?

What muscle helps counteract increased pressure from the abdomen?

A

Inferior: SNS, A adrenergic
Superior: PNS, B/Muscarinic

Levator ani
Vaginal CT

132
Q

What are the characteristics of stress urinary incontinence?

What causes this?

What are the 3 degrees of this issue

A

Cough laugh sneeze causing dribbles, no bladder contraction

Pelvic/urethral weakness- change in urethral angles
HypoEstrogen

1: only w/ severe stress
2: rapid movement, stairs
3: mild stress, standing

133
Q

What are the characteristics of urge urinary incontinence?

What causes this issue?

A

Urgency w/ dec volume

Detrusor instability but not impaired or weak

134
Q

What are the characteristics of incomplete bladder emptying?

What can cause this?

A

Frequency w/ hesitation

Over distension of detrusor
Restricted outlet
CCBs/A-agonists need to be avoided, cause retention

135
Q

What PE test is done to Dx stress incontinence?

How are most cases Tx

A

Q-tip test- change of >30*= hypermobility

Kegels for both
Ca glycerosphate to dec urge/frequency by buffering urine pH

136
Q

What meds are used for managing incontinence

A

Anticholinergics- inhibits muscarinic receptors to dec detrusor contractions

Imipramine- TCA w/ A-adrenergic and anticholinergic effects for Mixed Incontinence

Mirbegron- anti-spasmotic; relaxes smooth muscles and inc bladder capacity for Urge Incontinence

Botulism Injection- Idiopathic detrusor over activity/urge incontinence

137
Q

Sexual expression is determined by ?

What is the sexual response cycle

A 
Psych
Social
Environment
Spiritual
Learned factors

Excite Plateau Orgasm Resolution

138
Q

What part of the sexual response cycle holds the most weight?

What hormones modulate, excite or suppress libido

What are the two forms of d/os?

A

Motivation/emotional willingness to engage

Mod: testosterone
Ex: dopamine
Sup: serotonin

Hypoactivity
Aversion

139
Q

Arousal signals come from what part of the spine?

What part of the NS controls
excitement/arousal?

This part is modulated by ? hormone and is the cause of ?

A

T11-L2, S2-S4

PNS

Estrogen

Sex flush

140
Q

What is the MC cause of excitement/arousal dysfunction?

What is the most treatable sexual phase d/o?

What part of the NS controls this phase?

A

Estrogen deficit

Orgasmic phase

SNS

141
Q

What optimizes orgasmic phase dysfunction

What are the RFs for dyspareunia?

A

Afferent concentration

<50y/o
Hx of abuse
Hx of PID
Depression/Anxiety

142
Q

What age groups are more likely to experience sexual violence?

What ages are least likely?

A

16-24y/o

> 65

143
Q

What is the leading cause of death during pregnancy?

What area of the female genitalia is MC injured during assault?

How long after attack can evidence be collected from PT?

A

Homicide

Posterior fourchete

5days

144
Q

VEAL CHOPS

Which ones require intervention?

A

Variable - Cord compression (MC)
Early - Head compression
Accelerate - OK
Late - Placental insufficiency

Late/Variable

145
Q

Normal fetal heart rate

Reassuring patterns for moderate variability and weeks of gestation

A

110-160

Moderate: 6-25
Two acceleration/20min of:
>32wks: 15bpm x 15sec
<32wks: 10bpm x 10sex

146
Q

Non reassuring patterns

A

Brady <100bpm
Recurrent late/variable
Absent/Minimal variability w/ late/variable Dcells
Sinusoidal

147
Q

How do early Dcells appear on a strip?

What is the most frequent abnormal pattern?

What is the criteria for severe?

A

Mirror image of contraction

Variable Declls

60 FHR decel x 60sec

148
Q

How do variable Dcells appear on a strip?

How are non-assuring FHR patterns managed?

A

Shoulder/deep drop off

D/c oxy/pitocin
Put PT on L side/all 4s
Cervical exam, r/o entrapment
O2/Fluids

149
Q

6 cardinal movements of labor

A 
Descent
Flexion
Internal rotation
Extension
External rotation/restitution
Expulsion
150
Q

Define Caput Succedaneum

Define Cephalohematoma

Define Subgaleal hemorrhage

A

Boggy head, crosses suture lines

Does not cross sutures, associated w/ jaundice

Crosses sutures, jaundice and blood loss

151
Q

Indications to do vaginal operative delivery

As soon as baby is delivered, what is given to mother and when/why?

A

Breech- forcep only
Compromise
Prolonged 2nd stage
Shorten 2nd stage for maternal benefit

Placental delivery=
Oxytocin/Pitocin- PPH
ABX x 24-48hrs

152
Q

Define Chorioamnionitis

This is not an indication for ?

A

Infection of membrane/fluids around fetus

C-section

153
Q

Define Turtle Sign

Define HELPERR acronym

A

Retraction/recoiling of fetal head toward perineum despite pushing

Help
Eval for episiotomy
Legs hyperflexed: McRoberts
Pressure
Enter: rotation/remove
Roll onto all 4s- Gaskin maneuver
154
Q

What part of HELPERR acronym has the highest success rate?

4 severity of episiotomy

A

Step 5: removal of posterior arm

1: skin
2: skin, subcutaneous
3: skin, sub-cutaneous, anal sphincter
4: All and rectal mucosa

155
Q

How long are post-MVA PTs monitored to r/o abruption?

They can only be d/c if ? criteria is met?

A

4hrs

Contracting <1 q10min
No bleeding/abdominal pain
FHR reassuring
No visible bruising

156
Q

4 causes of PPH

Why is this so scary

A

Tone Tissue Trauma Thrombin

P/BP don’t change until large amounts have been lost

157
Q

What PE finding indicates lack of uterine atony/possible PPH

MC cause of mortality from PPH

A

Boggy/soft uterus on bimanual exam

Atony

158
Q

What two drugs will be pushed during PPH Tx

A

Oxy/Pitocin 10U IM

Methergine 0.2mg IM- not if pre-clamptic/HTN

Hemabate- not if asthma, cardiac/renal/liver dz, seizure

Failure/c/i- mesoprostol

159
Q

What happens to the brain if too much blood is loss?

What are the different types of PID

A

Sheehan Syndrome- pituitary failure/infarct causing hypothyroid issues

Silent- ASx woman
Dx PT w/ tubal infertility w/out Hx of UTIs

Acute: Sxs develop after menstruation
CMT/Dysparunia/Fever

160
Q

What happens to the brain if too much blood is loss?

What is the ‘classic’ hemorrhage disaster?

A

Sheehan Syndrome- pituitary failure/infarct causing hypothyroid issues

Uterine inversion

161
Q

Mastitis may be AKA

What are 3 DDx for mastitis in non-pregnant/feeding woman

A

Puerperal breast infection

Inflammatory Ca- image and biopsy

Peripheral abscess- drain, ABX

Subareolar abscess- duct/tract excision and biopsy

162
Q

What are the names of the lesions seen on cystoscopy of IC/PBS?

These findings are indicative of ? Dx

A

Hunner ulcers

Interstitial cystitis

163
Q

Urgency incontinence Tx

Stress incontinence Tx and medication avoidance

A

Schedule
Anticholinergics Detro/Ditro
Kegels

Collagen injection
Topical estrogen
Imipramine/Duloxetin
Pessary/Kegels

Avoid: AAntagonists

164
Q

What meds are avoided in overflow incontinence

What is a normal sexual response during pregnancy and menopause?

A

AAgonists
Anticholinergics
CCBs

Preg: dec desire
Meno: inc dysfunction

165
Q

What are the 3 phases of sexual response?

What is the most intense reaction experienced during sexual assault?

A

Desire- libido
Excitement- arousal
Orgasm- climax

Fear of dying

166
Q

What are the two phases of Sexual Trauma Syndrome

A

Acute disorganization: shock disbelief shame blame anger

Reoganization: vulnerable, despair guilt shame
Somatic Sxs Anxiety Depression

167
Q

How long do narcotics affect fetal respiration?

What sedatives are used during false labor?

A

Fentanyl 20-60min
Morphine 1-2hrs
Meperidine 4-6hrs

Promethazine
Hydroxyzine
Zolpidem

168
Q

What is the regional analgesia procedure of choice?

Microbes associated w/ chorioamnionitis

A

Lumbar epidural

Bacteroides
E Coli
Anaerobes
Mycoplasma
Strep
169
Q

RFs for shoulder dystocia

Risks to mother and baby

A

Hx Macrosomia DM Obesity

Mother: PPH Atony 4th* lacs
Fetus: Hypoxic Erbs Fx

170
Q

Criteria for high risk atony

Criteria for mod risk atony

A

Prolonged labor
Over distended uterus
Grand multiparity

Multiple gestations
Polyhydrammnios
Fetal macrosomia

171
Q

PPH management

A 
Help/examine
Uterine massage
Meds
IV fluids
Bimanual compression

IPAP (212 decks)

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