OFFICE Flashcards
Preconception Counseling: Purpose
The goal of prepregnancy care is to reduce the risk of adverse health effects for the woman, fetus, and neonate by optimize health, address modifiable risk factors, and provide education about healthy pregnancy
Oligomenorrhea (definition)
Cycles >35 in length of between 3-9 cycles per year
Amenorrhea
What is Hirsutism
Hirsutism is the growth of excessive male-pattern hair in women after puberty. It affects facial and body areas dependent on androgens, namely mustache and beard, pubic hair, buttocks, and thighs.
Lichen Simplex Chronicus: definition
common form of chronic dermatitis that presents as dry, patchy areas of skin that are scaly and thick.
Aura for migraines
sensory disturbance - vision changes - sparks, loss of vision, halos
tinnitus
olfactory
inability to speak clearly
Aura duration
usually up to 1 hr prior to the migraine
Complications of POP
vaginal bulge and pressure,
voiding dysfunction,
defecatory dysfunction,
sexual dysfunction, which may adversely affect quality of life.
Support structures of Pelvic Organs
how do you treat hirsutism?
what is PCOS?
What labs do you get for PCOS Work up?
Inpatient criteria for PID
1) Pregnancy
2) Failed outpatient management
3) inability to tolerate outpatient treatment (nausea/vomiting)
4) Severe illness - n/v/high fever
5) TOA
Stage III prolapse description
most distal prolapse more than 1 cm below hymen and no less than 2 cm TVL
microscopic hematuria - who needs work up?
if 35-50 and > 25 RBC per HPF (and never smoked)
How do you work up urinary incontinence?
History and physical exam, urinalysis, cough stress test for SUI and evaluating urethral mobility, PVR, urinalysis
When are urodynamics needed?
rarely. Unclear diagnosis
prior incontinence surgery
persistent incontinence
complex conditions present
Normal PVR
<150 ml
Benefits of breastfeeding > 1 year
decreased risk cancers: breast, ovarian
DM and HTN heart disease
Breast feeding contraindications
Substance abuse (cocaine, PCP)
HIV Positive
Untreated TB or varicella (pump and feed)
HSV on breast (do not feed until lesions resolve)
what are androgens?
Testosterone, DHEA, DHEAS, androsterone
How do you diagnose PID?
Sexually active female
One: adnexal or uterine pain, CMT
+
Fever, mucopurulent VD, WBC on saline wet mount, GC/C, leukocytosis, CRP/ESR elevated
Clomiphene Citrate
Dose
MOA
Monitor
LH surge
Side Effects
Risk Multiples
CD between 2-5, 50 mg x 5 days or increasing to 100
MOA: SERM –>low estrogen stimulates increased GNRH secretion/FSH/LH release = follicles
Monitor: OPK and cycle day 21 progesterone
LH surge: 5-12 days after last dose
Intercourse 5 days after last dose
A/E: hot flashes, mood swings, headache, pelvic pain
9% risk of multiples
*discontinue if HA and vision changes
Femara
Dose
MOA
Side Effects
Risk Multiples
CD 3-7, 2.5 mg/d, increase to 5 mg
MOA:suppresses estradiol secretion from ovary and thus negative feedbacks at the pituitary and increases FSH
A/E: hot flashes, fatigue, dizziness
Risk multiples: 5%
What are criteria for Metabolic Syndrome? How do you evaluate?
Obtain lipid panel and view BP. Need 3 of these criteria
1) EBP > 135/80
2) Waist > 35
3) HDL<50
4) Glucose > 100
4) TG >150
What is congenital adrenal hyperplasia?
What does it cause?
Inheritance?
Pathophys?
Phenotype?
MCC cause of ambiguous genitalia
Autosomal recessive, 21 hydroxyls def
Blocks cortisol production, no negative feedback to switch off ACTH… high levels 17 OHP
female fetus with ambiguous genitalia
What are events of puberty?
Gonadarche- activation of gonads by FSH/LH
Adrenarche- increased androgens produces by adrenal cortex
Femara vs. Clomid
Femara has high rates of mono follicular development (lower multiple risk), lower risk of teratogenicity (due to shorter half life) and no direct anti-estrogenic effect on endometrium
HRT contraindications
Pregnancy
Breast cancer
Estrogen sensitive tumor
CVA/TIA
Coronary heart disease
HX DVT/thrombophilia
Undx VB
What is not CIN with HRT?
HTN, smoking, migraine with aura ARE NOT CONTRAINDICATED, transdermal preferred!
Methotrexate MOA
Dose
Contraindication
Uterine Artery Embolization
Benefits
Complications
Benefits:
shorter hospital stays,
quicker return to work
more unscheduled visits
complications
Complications: fevers
bleeding or hematoma at arrteriotomy site
myometrial necrosis
perforation of arterial site or uterus, with resultant bowel injury
Jehova’s witness and refusal of blood products. Is cell saver an option?
1) Confirm refusal of blood products and types
2) Plasma expanders like albumin may be used
3) No as this required circulation of the patients blood into her body from an external source
