Obstetrics & Gynecology Flashcards
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توقف اگر
هیچ وقت ضایعات CIN=> 2 نداشته
و اگر داشته بیشتر از ۲۰ سال گذشته باشه
و
منفی به اندازه کافی داشته باشه ۳تا سایتولوژی منفی طی ۱۰ سال گذشته یا ۲ تا گزارش ترکیبی منفی در طی ۱۰ سال گذشته که جدیدترینش ۵ سال پیش باشد
غربالگری کنسر سرویکس در کسی که توتال هیسترکتومی
توقف
اگر هیچ وقت ضایعات CIN=> 2 نداشته
و اگر داشته بیشتر از ۲۰ سال گذشته باشه
اگر داشته باشد تا ۲۰ سال ادامه غربالگری
غربالگری کانسر سرویکس با توالی بیشتر چه زمانى لازم است؟ (۳ تا)
دی استیل استرول زمان جنینی
نقص ایمنی HIV
سرطان , CIN 2 , 3
Mammo screening فواصل
45-54 y 55 y
1 y 2 y
Dysmenorrhea ttt
NSAID
Fundus of uterus wich lymph node drain
Para Aortic
Most common cause of hereditary breast and ovarian cancers
BRCA mutation
Most common site of breast cancer
Upper outer quadrant
Bilateral breast cancer
Lobular carcinoma
Tamoxifen (for breast cancer) SE
Increase risk Endometrial cancer
Reconstruction of breast with ? muscle, the ? artery maybe injured
Rectus muscle
Inferior epigastric artery
Postmenopausal symptoms reach to diagnosis?
FSH
After delivery unable to breast feed, no milk at all Dx?
Sheehan synd
Intermittent bloody nipple discharge
Most likely Dx
Intraductal papilloma
Self breast exam فواصل
Every month
Suspecting intraductal papilloma
next step?
Excision
Intermittant bloody discharge from one nippel SECOND common cause
Intraductal carcinoma
G P Ab Lc
Gravid چندمين باردارى
Para چندمين زايمان
Abbortion تعداد سقط
Living child تعداد بچه‌های زنده
Pap smear frequency
Every 3 years
Women between 21-65
TVUS
Trans vaginal ultrasound
AFI
Doctors commonly measure the depth of the fluid in four quadrants in the uterus and add them up. This method of measuring amniotic fluid is referred to as the amniotic fluid index (AFI). If the amniotic fluid depth measures less than 5 centimeters, the pregnant woman has oligohydramnios (or polyhydramnios).
ECV
External cephalic version, or ECV, is a maneuver your doctor may use when your unborn baby is set up to come out bottom first or feet first. Those positions are called a breech birth, and they can make a vaginal birth more difficult
اگر شکم بیمار ساعت باشد ساعد گرد می‌چرخانیم
ROM
Tearing or rupture of membranes (ROM) normally occurs during labor. Premature rupture of membranes (PROM) is defined as rupture of membranes before the onset of labor. Membrane rupture that occurs before 37 weeks of gestation is referred to as preterm PROM (PPROM)
CTG
Cardiotocography (CTG) measures your baby’s heart rate. At the same time it also monitors the contractions in the womb (uterus). CTG is used both before birth (antenatally) and during labour, to monitor the baby for any signs of distress
Effaced ?!
When it is 50 percent effaced, it is about two centimeters long. When it is 100 percent effaced, it is “paper-thin.
Chocolate cyst in ovary suggest?
Endometriosis
FHS
Fetal Heart Sound
Choloasma
Also known as melasma or the “mask of pregnancy,” is a pigmentation disorder of the skin characterized by darker skin patches that primarily affect the face and other sun-exposed areas.
Depending on the person, melasma may go away on its own, it may be permanent, or it may respond to treatment within a few months. Most cases of melasma will fade away with time and especially with good protection from sunlight and other sources of light.
Perineal tear
A laceration of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tears mainly occur in women as a result of vaginal childbirth, which strains the perineum. It is the most common form of obstetric injury.
CPD
Cephalopelvic disproportion (CPD) is a medical issue that can arise during childbirth. It occurs when a baby is having trouble getting through the birth canal. The baby may be very large or in a difficult delivery position, or the mom’s pelvis may be too small for the baby to pass safely
Bishop score
Bishop’s score or cervix score, is a pre-labor scoring system to assist in predicting whether induction of labor will be required. It has also been used to assess the likelihood of spontaneous preterm delivery.
A Bishop score of 8 or greater is considered to be favorable for induction, or the chance of a vaginal delivery with induction is similar to spontaneous labor. A score of 6 or less is considered to be unfavorable if an induction is indicated cervical ripening agents may be utilized
BPP
A biophysical profile (BPP) is a prenatal ultrasound evaluation of fetal well-being involving a scoring system, with the score being termed Manning’s score. It is often done when a non-stress test (NST) is non reactive, or for other obstetrical indications.
The test combines fetal heart rate monitoring (nonstress test) and fetal ultrasound to evaluate a baby’s heart rate, breathing, movements, muscle tone and amniotic fluid level.
A score of 6/8 or 8/8 is normal. Most fetuses that score ≤ 6/8 need additional monitoring. A complete BPP includes the addition of electronic fetal monitoring (nonstress test) for a total score of 10 points. A score of 8/10 or 10/10 is considered normal. A score of 6/10 is equivocal and ≤ 4/10 is abnormal
Pregnant woman, vaginal itching, whitish vag discharge ttt?
Fluconazole
Vaccine should be given in preconception
Rubella
Forceps indication
Prolonged second stage: This includes nulliparous woman with failure to deliver after 2 hours without, and 3 hours with, conduction anesthesia. It also includes multiparous woman with failure to deliver after 1 hour without, and 2 hours with, conduction anesthesia.
Suspicion of immediate or potential fetal compromise in the second stage of labor.
Shortening of the second stage for maternal benefits: Maternal indications include, but are not limited to, exhaustion, bleeding, cardiac or pulmonary disease, and history of spontaneous pneumothorax.
In skilled hands, fetal malpositions, including the after-coming head in breech vaginal delivery, can be indications for forceps delivery.
Vaccine CI during pregnancy
MMR
Varicella
Live influenza vaccine
BCG
HPV vaccine is not recommended for pregnant women
CI of methotrexate for abortion
Vital sign
Trichomonas ttt
A single 2-g dose of metronidazole, tinidazole, or secnidazole
A schedule of 500 mg of metronidazole, taken twice daily for 7 days
IUFD
Intrauterine fetal demise (مرگ داخل رحمی جنین) is an unpredictable and challenging obstetric complication. Its etiology is multifactorial with more than 60% attributed to the placental cause
The two most common options for women with IUFD are labor induction or removal of the pregnancy (using Dilation and Evacuation, or D&E). In some rare cases, cesarean delivery can be performed
Cystocele
is a condition in which supportive tissues around the bladder and vaginal wall weaken and stretch, allowing the bladder and vaginal wall to fall into the vaginal canal. Usually, the muscles and connective tissues that support the vaginal wall hold the bladder in place
Kegel exercise
strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum.
Make sure your bladder is empty, then sit or lie down.
Tighten your pelvic floor muscles. Hold tight and count 3 to 5 seconds.
Relax the muscles and count 3 to 5 seconds.
Repeat 10 times, 3 times a day (morning, afternoon, and night).
When pregnancy after varicella vaccine
1-3 months
SI transdermal contraceptive compare IUCD and OCP
Because the patch contains a higher dose of hormones than the pill, the side effects may be more intense than with the pill.
It predisposes to coagulation more
What copper IUD side effects (5)
spotting between periods.
irregular periods.
heavier or longer periods.
more or worse cramping during your periods.
pain when your IUD is put in, and cramping or back aches for a few days after.
OCP benefit
it does not interrupt sex
it usually makes your bleeds regular, lighter and less painful
it reduces your risk of cancer of the ovaries, womb and colon
it can reduce symptoms of PMS (premenstrual syndrome)
it can sometimes reduce acne
it may protect against pelvic inflammatory disease
it may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease
Adverse Magnesium sulfate toxicity on pre eclampsia pt
Calcium gluconate
Pounch of douglas
The rectouterine pouch, pouch of Douglas, or rectovaginal pouch is the extension of the peritoneum between the rectum and the posterior wall of the uterus in the human female. Its anterior boundary is formed by the posterior fornix of the vagina.
Culdocentesis
Culdocentesis is a procedure that checks for abnormal fluid in the space just behind the vagina. This area is called the cul-de-sac. During a culdocentesis a long thin needle is inserted through the vaginal wall just below the uterus and a sample is taken of the fluid within the abdominal cavity.
Clamydia pregnancy ttt
Erythromycin
Bartholin’s cyst
also called a Bartholin’s duct cyst, is a small fluid-filled sac just inside the opening of the vagina
Experts believe that the cause of a Bartholin’s cyst is a backup of fluid. Fluid may accumulate when the opening of the gland (duct) becomes obstructed, perhaps caused by infection or injury. A Bartholin’s cyst can become infected, forming an abscess
Safe analgesia during pregnancy
Paracetamol
What instrument is used for D&C
In a dilation and curettage, your provider uses small instruments or a medication to open (dilate) the lower, narrow part of your uterus (cervix). Your provider then uses a surgical instrument called a curette, which can be a sharp instrument or suction device, to remove uterine tissue
Curate: a surgical instrument that has a scoop, ring, or loop at the tip and is used in performing curettage. curette. verb. variants: or less commonly curet. curetted; curetting
Post partum psychosis
Postpartum psychosis is a serious mental health illness that can affect someone soon after having a baby. It affects around 1 in 500 mothers after giving birth. Many people who have given birth will experience mild mood changes after having a baby, known as the “baby blues”
Postpartum psychosis requires immediate treatment, usually in the hospital. Treatment may include: Medication. Treatment may require a combination of medications — such as antipsychotic medications, mood stabilizers and benzodiazepines — to control your signs and symptoms.
Most common cause of postmenopausal benign bleeding
Atrophic vaginitis
Colostrum
Colostrum is the first form of milk produced by the mammary glands of mammals immediately following delivery of the newborn. Most species will begin to generate colostrum just prior to giving birth
Your body produces colostrum for up to about five days after your baby is born. It changes to transitional milk around this time, then changes again to mature milk after about 14 days. Traces of colostrum are present in your breast milk for up to six weeks.
Gestational DM may develope to
DM 2
Drinking alchohol during pregnancy
Drinking alcohol during pregnancy increases the risk of miscarriage, premature birth and your baby having a low birthweight. It can also affect your baby after they’re born. Drinking during pregnancy can cause your baby to develop a serious condition called **foetal alcohol spectrum disorder (FASD
Secondry amenorrhea first check? Second check?
Bhcg pregnancy
Prolactin level
Hypothalamic amenorrhea
is a condition in which menstruation stops for several months due to a problem involving the hypothalamus. The hypothalamus is in the center of the brain, controls reproduction, and produces gonadotropin-releasing hormone (GnRH).
Hypothalamic amenorrhea is a condition that causes your period to stop and can lead to health problems. Stress, disordered eating, being underweight, and too much exercise are the main causes of hypothalamic amenorrhea
Cervical incompitence
Cerclage last of first trimester 11-13 week before 14 week
Prolapse uterus
Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken and no longer provide enough support for the uterus. As a result, the uterus slips down into or protrudes out of the vagina. Uterine prolapse can occur in women of any age
A diagnosis of uterine prolapse generally occurs during a pelvic exam. During the pelvic exam your doctor is likely to ask you: To bear down as if having a bowel movement. Bearing down can help your doctor assess how far the uterus has slipped into the vagina. Clinical examination
The only true contraindications to breastfeeding are the following
infants with classic galactosemia (galactose 1-phosphate uridyltransferase deficiency) mothers, in the US, who are infected with human immunodeficiency virus (HIV).
Gestational HTN
Gestational hypertension is a form of high blood pressure in pregnancy. It occurs in about 6 percent of all pregnancies. Another type of high blood pressure is chronic hypertension–high blood pressure that is present before pregnancy begins. Gestational hypertension can develop into preeclampsia
It occurs in about 3 in 50 pregnancies
Chronic hypertension in pregnancy is defined by the American College of Obstetrics and Gynecology (ACOG) as blood pressure ≥140 mm Hg systolic and/or 90 mm Hg diastolic before pregnancy or, in recognition that many women seek medical care only once pregnant, before 20 weeks of gestation, use of antihypertensive
How can one get pregnant with a tubal blockage?
If tubal damage or blockages cannot be corrected through surgery or tubal cannulation, which involves a doctor clearing the blockage with a medical instrument, a woman may still be able to get pregnant through in vitro fertilization (IVF).
Preneal tears degrees
First-degree
Small tears affecting only the skin which usually heal quickly and without treatment.
Second-degree
Tears affecting the muscle of the perineum and the skin. These usually require stitches.
Third- and fourth-degree tears
For some women (3.5 out of 100) the tear may be deeper. Third- or fourth- degree tears, also known as obstetric anal sphincter injuries (OASI), extend into the muscle that controls the anus (anal sphincter). These deeper tears need repair in an operating theatre.
3-partial anal sphincter involvemant
4-complete tear of anal sphincter involveing bowel lining
Lamp in breast what does indicate mass is cystic and no need for reevaluation
Clear fluid on FNA aspiration and disappearace of the mass after
Mastitis ttt
Mastitis is an inflammation of breast tissue that sometimes involves an infection. The inflammation results in breast pain, swelling, warmth and redness. You might also have fever and chills. Mastitis most commonly affects women who are breast-feeding (lactation mastitis)
Using the other breast and startingantibiotics
For simple mastitis without an abscess, oral antibiotics are prescribed. Cephalexin (Keflex) and dicloxacillin (Dycill) are two of the most common antibiotics chosen, but a number of others are available
The beta lactamase-resistant penicillins have been recommended in the treatment of mastitis. These include cloxacillin, dicloxacillin, or flucloxacillin.
ECV CI
An ECV isn’t right for you if you’re expecting more than one baby or you need a C-section. It also works best on women with a pear-shaped womb and not those with a heart-shaped womb, called a bicornuate uterus
Placenta previa or abruptio placentae, nonreassuring fetal status, intrauterine growth restriction in association with abnormal umbilical artery Doppler index, isoimmunization, severe preeclampsia, recent vaginal bleeding, and significant fetal or uterine anomalies are also contraindications for ECV
What is the most important thing to check before instrumental delivery?
Head pelvic disproportion
Adenomyosis
occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus. The displaced tissue continues to act normally — thickening, breaking down and bleeding — during each menstrual cycle.
Adenomyosis is considered a benign (not life-threatening) condition, the frequent pain and heavy bleeding associated with it can have a negative impact on a woman’s quality of life.
Heavy or prolonged menstrual bleeding.
Severe cramping or sharp, knifelike pelvic pain during menstruation (dysmenorrhea)
Chronic pelvic pain.
Painful intercourse (dyspareunia)
Pelvic imaging such as ultrasound and MRI can detect signs of adenomyosis, but the only way to confirm it is to examine the uterus after hysterectomy.
Vaginal discharge with fishy odour
it may be caused by a bacterial infection
To treat bacterial vaginosis, your doctor may prescribe one of the following medications: Metronidazole (Flagyl, Metrogel-Vaginal, others). This medicine may be taken as a pill by mouth (orally). Metronidazole is also available as a topical gel that you insert into your vagina
Trichomoniasis
Trichomoniasis is a common sexually transmitted infection caused by a parasite. In women, trichomoniasis can cause a foul-smelling vaginal discharge, genital itching and painful urination. Men who have trichomoniasis typically have no symptoms
Trichomoniasis is caused by a parasite called Trichomonas vaginalis. In women, this parasite mainly infects the vagina and the urethra
Green, yellow, gray, frothy, and/or bad-smelling vaginal discharge.
Blood in your vaginal discharge.
Itching and irritation in and around your vagina.
Swelling around your genitals.
Pain during sex.
When is cholecystectomy done in pregnancy?
Indications for this procedure should include stringent criteria such as unrelenting biliary tract symptoms or the complications of cholelithiasis. If at all possible, when laparoscopic cholecystectomy is indicated, it should be performed either in the second trimester or early in the third
screening for gestational diabetes in pregnancy
Testing for gestational diabetes usually occurs between 24 and 28 weeks of pregnancy. If you have an increased chance of developing gestational diabetes, your doctor may test for diabetes during the first visit after you become pregnant.
The screening test is called an oral glucose tolerance test (OGTT), which takes about 2 hours. It involves having a blood test in the morning, when you have not had any food or drink for 8 to 10 hours (though you can usually drink water, but check with the hospital if you’re unsure).
First sign of puberty female
Thelarce
Thelarche
Adernarche
Pubarache
Menarche
the beginning of adult breast development, marks the onset of puberty in the majority of white women and occurs at a mean age of 10 years
the awakening of the adrenal gland.” The adrenal gland is responsible for making hormones including androgens—sex hormones that cause changes such as the development of pubic hair, oily skin, oily hair and body odor. There is one adrenal gland on top of each kidney.
Pubarche is the appearance of sexual hair
Menarche is defined as the first menstrual period in a female adolescent. Menarche typically occurs between the ages of 10 and 16
Postpartum “blues”
are defined as low mood and mild depressive symptoms that are transient and self-limited. [1] The depressive symptoms include sadness, crying, exhaustion, irritability, anxiety, decreased sleep, decreased concentration, and labile mood
Most people experience baby blues 2 to 3 days after the baby is born. They can last up to 2 weeks. They usually go away on their own, and you don’t need any treatment. If you have sad feelings that last longer than 2 weeks, tell your health care provider
Salphingitis
Salpingitis is inflammation of the fallopian tubes, caused by bacterial infection. Common causes of salpingitis include sexually transmitted diseases such as gonorrhoea and chlamydia. Salpingitis is a common cause of female infertility because it can damage the fallopian tube. Treatment options include antibiotics
Common symptoms include fever, unusual vaginal discharge, frequent urination, nausea, vomiting, lower back pain, pelvic pain, as well as pain during menstruation and sexual intercourse. In order to diagnose salpingitis, one will usually undergo clinical and physical examination
Blocked fallopian tubes does not cause irregular menses
How common is death from postpartum hemorrhage?
Globally, postpartum hemorrhage is the leading cause of maternal mortality. The condition is responsible for 25% of delivery-associated deaths, and this figure is as high as 60% in some countries
What causes intrauterine growth restriction?
high blood pressure.
chronic kidney disease.
advanced diabetes.
heart or respiratory disease.
malnutrition, anemia.
infection.
substance abuse (alcohol, drugs)
cigarette smoking.
Chronic hypertension is the most common cause of IUGR. Moreover, the infants of hypertensive mothers have a three-fold increase in perinatal mortality compared with infants with IUGR who are born of normotensive mothers
Pregnancies that have any of the following conditions may be at a greater risk at developing IUGR: Maternal weight less than 100 pounds. Poor nutrition during pregnancy. Birth defects or chromosomal abnormalities.
Often, IUGR happens because the fetus doesn’t get enough nutrients and nourishment. This can happen if there is a problem with: the placenta, the tissue that brings nutrients and oxygen to the developing baby. the blood flow in the umbilical cord, which connects the baby to the placenta.
Which Ig can cross the placenta
Immunoglobulin G (IgG), although it has a high molecular weight, is the only class of immunoglobulins able to cross the placenta and to reach the fetal circulation
Mole
Complete mole is the most common type and does not contain fetal parts, whereas in a partial mole there might be identifiable fetal residues. Complete moles are typically diploid, whereas partial moles are triploid
Complete hydatidiform moles (CHM) are abnormal pregnancies with no fetal development resulting from having two paternal genomes with no maternal contribution. It is important to distinguish CHM from partial hydatidiform moles, and non-molar abortuses, due to the increased risk of gestational trophoblastic neoplasia
They are usually slow growing and benign, although there is a chance a mole can become cancerous. A complete molar pregnancy is much more likely to become cancerous than a partial molar pregnancy
Treatment usually consists of one or more of the following steps: Dilation and curettage (D&C). To treat a molar pregnancy, your doctor will remove the molar tissue from your uterus with a procedure called dilation and curettage ( D&C ). A D&C is usually done as an outpatient procedure in a hospital
Pregnant
1. Painful vaginal bleeding
2. Bleeding with os closed
3. Bleeding with os open
4. Bleeding with os closed + US no fetus
Placenta abortion
Threatent abortion bed rest
Invitable abortion
Compelete abortion
First trimester, second trimester abortion due to
Chromosomal abnormality
Cervical incompetence
Stillbirth
A stillbirth is the death of a fetus in the uterus after week 20 of pregnancy. The reasons go unexplained for 1 in 3 cases. The rest may be caused by problems with the placenta or umbilical cord, high blood pressure, infections, birth defects, or lifestyle choices
Pt hysterectomy has hot flash after surgery ttt
Transdermal estrogen only
Ep treatment
To prevent complications, treatment is needed. In the early stages, medications may be sufficient. Later stages require surgery.
Medication. An early ectopic pregnancy without unstable bleeding is most often treated with a medication called methotrexate, which stops cell growth and dissolves existing cells. The medication is given by injection
Medical procedure
Vacuum aspiration and Dilation and evacuation
Surgery
Laparoscopic surgery
What is the best shape of hip for a woman to deliver her babay
Gynecoid pelvis
So a woman who’s described as having childbearing hips likely has a gynecoid shaped pelvis, which was thought to be most favorable for labor and delivery. Gynecoid happens to be a common pelvic shape, too
