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OGG all notes Flashcards

1
Q

when is the best time to do a CBE (clinical breast exam)

A

5 days post menses

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2
Q

where are the breasts located

A

between ribs 2-6 and between the sternal edge and midaxillary line

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3
Q

what is the “tail” of the breast that must be included on the exam

A

UOQ to axilla

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4
Q

which lymph nodes must be included?

A

cervical, axillary, and super/infra-clavicular

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5
Q

what is the infra-mammary line and why is it important

A

where the breast lies on the ribs- a common fibrous area due to bras

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6
Q

what is mastalgia

A

pain/tenderness of the breast

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7
Q

T/F: mastalgia is most common during menopause

A

false- pre-menopause MC

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8
Q

what are some causes of mastalgia?

A

hormones, trauma, PMS, infection, (cancer-5%-rare)

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9
Q

is mastalgia cyclical?

A

it can be cyclical or non-cyclical

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10
Q

what treatments are there for mastalgia

A

hormone treatment can be done though it could increase symptoms.

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11
Q

T/F: 60-80% of mastalgia cases self remiss

A

yes

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12
Q

if over 35 and having mastalgia, what is the next step?

A

consider mamogram

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13
Q

if under 35 with mastalgia and normal CBE, what is next

A

usually they are OK- watch and wait

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14
Q

10% of women have this benign condition of the breasts

A

fibroadenoma

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15
Q

describe fibroadenoma

A

composed of fibrous stroma, size change with cycle, rubbery, firm, smooth, round, mobile, painLESS

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16
Q

___% of fibroadenoma have multiple lesions

A

20%; some multilobulated also

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17
Q

T/F: fibroadenoma tend to decrease in size over time

A

true

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18
Q

what is the MC age range for fibroadenoma

A

15-50yo

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19
Q

tests for fibroadenoma include: (4)

A

CBE, mammogram, US, needle biopsy

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20
Q

what is the treatment options for fibroadenoma

A

surgical excision or watch/wait

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21
Q

what 2 conditions are the most common benign causes of breast lumps and occur within the age range of 15-50

A

fibroadenoma and simple cyst

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22
Q

what is a difference in fibroadenoma and a simple cyst that you would find on CBE

A

fibroadenoma are painLESS and simple cysts are TENDER

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23
Q

T/F: simple cysts fluctuate cyclically

A

true

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24
Q

describe simple cyst

A

fluid filled, soft yet firm, mobile, well circumscribed, unilateral or bilateral, and TENDER

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25
Q

what is a simple cyst hard to ddx from

A

a solid mass

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26
Q

what tests are used to dx a simple cyst?

A

mammogram, US, fine needle aspiration

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27
Q

when would you consider surgical biopsy for what appears to be a simple cyst?

A

when get bloody aspirate, if mass doesn’t resolve with aspiration, if multiple re-occurrences in short amount of time, or no fluid with aspiration

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28
Q

60% of women get this common, non-cancerous condition

A

fibrocystic breast changes

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29
Q

where are fibrocystic breast changes likely to occur

A

upper outer quadrant (UOQ)

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30
Q

what are common symptoms with fibrocystic breast changes

A

swelling, pain, tenderness, heaviness, itching of nipple, fluctuation in size cyclically, premenstrual aggravation, come in variety in size

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31
Q

what is the main cause of fibrocystic breast changes?

A

increased estrogen, decreased progesterone. Usually resolved with menopause

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32
Q

T/F: if a mass does not decrease with menses, it should be evaluated sooner

A

true

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33
Q

what is a good thing to avoid as it increases estrogen and can cause more breast conditions

A

methylxanthines (coffee, tea, chocolate, etc)

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34
Q

benefits of vitamin E?

A

relieves PMS symptoms and normalizes hormones

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35
Q

what is mastitis

A

an infection seen during lactation or when skin disrupted

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36
Q

s/s of mastitis include

A

fever, localized erythema, pain, induration, N/V, malaise

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37
Q

what is the etiology of mastitis

A

s. aures, s. epidermis, strep

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38
Q

risk factors for getting mastitis

A

breast feeding, trauma, breast augmentation

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39
Q

when is the MC time to get mastitis

A

in the first 2-4 weeks postpartum

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40
Q

T/F: mastitis can become chronic

A

true

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41
Q

what does chronic mastitis lead to

A

abcess and nipple retraction

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42
Q

what is galactocele

A

a blocked duct

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43
Q

when does galactocele happen

A

usually after lactation

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44
Q

s/s of galactocele

A

tender/enlarged

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45
Q

tx for galactocele

A

excise and drain

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46
Q

is nipple discharge (d/c) more commonly associated with benign or maligant disease

A

benign (10-15%) vs 3-11% maligant

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47
Q

what are some common characteristics of benign nipple discharge

A

usually bilateral, needs stimulation, multiduct involvement

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48
Q

what are some common characteristics of pathological nipple discharge

A

usually unilateral, spont./intermittent, can be any kind of d/c (green, grey, blood, etc)

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49
Q

what is a common cause of serous nipple d/c

A

hormones

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50
Q

MC pathological (but benign) cause of nipple discharge

A

intraductal papilloma

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51
Q

what is galactorrhea

A

inappropriate lactation in nonpuerperal (non-lactating) women

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52
Q

s/s of galactorrhea

A

unilateral or bilateral with milk d/c

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53
Q

MC causes of galactorrhea is

A

increased prolactin levels due to pituitary tumor (would dx with CT)

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54
Q

what are other causes of galactorrhea besides a pituitary tumor

A

increased estrogen, psychotropic meds, afferent nerve stim, primary hypothyroidism (usually w/amenorrhea)

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55
Q

what is intraductal papilloma

A

increased papillary growth in lactiferous duct. #1 cause of nipple d/c (bloody or serous)

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56
Q

T/F tx of intraductal papilloma is to watch and wait

A

false- surgical excision because of tendency to grow

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57
Q

T/F breast feeding not altered if under 3 ducts are removed

A

true

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58
Q

what condition is caused by s. aureus and recurrent in women with inverted nipples

A

subareolar abcess

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59
Q

tx for subareolar abcess includes?

A

antibiotics, drainage, and duct excision

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60
Q

nipple piercings increase your chance of getting what condition

A

subareolar abscess

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61
Q

what are the stats on breast cancer

A

1 in women and 1/3 die from it. (lung cancer has most deaths)

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62
Q

what is the most common age for breast cancer

A

40-55

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63
Q

how and when is screening for breast cancer started?

A

mammogram 1-2yrs with or without CBE starting at age 40

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64
Q

what is the most common testing sequence for breast exam

A

mammogram, US, biopsy

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65
Q

what is the problem with mammograms

A

can give false (+)- though less in annual screens only and radiation exposure

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66
Q

when would you order an US of breasts (based on mammogram and CBE results)

A

if lump felt but not seen on mammogram or lump with abnormal mammogram

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67
Q

US is ineffective in screening for breast _____ but can detect ___ vs ____

A

ineffective- breast carcinoma, but can detect fluid filled vs solid mass.

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68
Q

what is the difference between fluid filled vs solid mass in breasts

A

fluid usually benign while solid has malignant potential

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69
Q

when would you order an MRI for breasts

A

for patients with breast cancer or history of, dense breasts, to rectify inconclusive mammogram and US, high risk

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70
Q

what is needle aspiration used for

A

evaluate fluid filled lesions. if bloody get biopsy or if cyst reoccurs within 2 weeks after aspiration

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71
Q

What is a common symptom of breast cancer in men

A

nipple d/c (also breast lump, swelling, skin dimpling, pain, red/scaly)…. usually starts under nipple

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72
Q

T/F: 90% of breast cancer cases have no primary relative with history

A

true; 75% have no major risk factors!!

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73
Q

s/s of breast cancer

A

firm/hard mass, irreg contour, immobile, unilateral

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74
Q

late stages of breast cancer s/s

A

skin/nipple retraction, tenderness, axillary lymphadenopathy, erythema, edema, pain, fatigue
“peau d’orange”

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75
Q

s/s of pagets disease of the breast (adenocarcinoma)

A

itching/burning skin or nipple, erythema, rash, ulceration

*easy to misdiagnose as dermatitis

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76
Q

what is pagets disease of the breast easily mis-diagnosed as?

A

dermatitis

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77
Q

T/F: omega 6 fats increase risk of breast cancer

A

true

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78
Q

T/F: vitamin D helps decrease risk of breast cancer

A

true

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79
Q

average # of days in menses cycle

A

21-35 with 7 day flow (ave 3-5)

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80
Q

how many ml/period is average?

A

80

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81
Q

what is considered day “one” of menses

A

menses marks day one

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82
Q

what does day 14 of menses mark

A

ovulation

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83
Q

days 1-14 of menses cycle is considered what phase

A

follicular

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84
Q

days 14-30 of menses cycle are considered what phase

A

luteal

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85
Q

the follicular phase is considered the (proliferation/secretory) phase while luteal is considered the (proliferation/secretory) phase

A

follicular= proliferation; luteal= secretory

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86
Q

GnRH is from what gland

A

the hypothalamus

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87
Q

GnRh simulates the release of __ and ___ from the ant. pituitary

A

FSH and LH

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88
Q

what 2 hormones does the ant pituitary release

A

FSH and LH

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89
Q

what does LH stimulate? (2)

A

androgen and progesterone (ovulation)

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90
Q

what does FSH stimulate?

A

etrogen (E2) estradiol

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91
Q

what are s/s of increased estrogen

A

dysmenorrhea, nausea, edema, menorrhagia, enlarged uterus, uterine fibroids, fibrocyctic breast changes

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92
Q

what are s/s of decreased estrogen

A

scant menses, mid cycle spotting

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93
Q

T/F: s/s of decreased progesterone are those you would suspect to see in pregnant women

A

false (increased progesterone)

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94
Q

what are s/s of increased progesterone

A

(s/s you’d expect to see in pregnant women) edema, bloat, HA, depression, wt gain, fatigue, HTN, varicose veins

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95
Q

what are s/s of decreased progesterone

A

prolonged menses, heavy menses, cramps, luteal/break-though bleeding

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96
Q

s/s of decreased progesterone are those you’d see in what other conditions

A

endometriosis, adenomyosis, endometrial hyperplasia, anovulatory cycles

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97
Q

what are some examples of abnormal bleeding (HINT: cycles (4))

A

<21 days
>35 days
>7 days menses
spotting

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98
Q

T/F: bleeding post-menopause, though rare, is not clinically important

A

false- red flag!!

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99
Q

define menorrhagia

A

hypermenorrhea (heavy flow)

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100
Q

what can cause menorrhagia

A

pregnancy, infection (STI), uterine fibroids, polyps, hypothyroidism (very common), neoplasm, or dysfunctional uterus

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101
Q

define metrorrhagia

A

intramenorrhea (breakthru bleeding/ spotting)

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102
Q

define menometrorrhagia

A

profuse bleeding during menses and between periods

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103
Q

define polymenorrhea

A

menses with increased frequency (periods <21 days apart

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104
Q

define amenorrhea

A

absent or abnormal menses present for more than 3 months

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105
Q

define oligomenorrhea

A

scant menses- periods that occure more than 35 days apart

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106
Q

define dysmenorrhea

A

painful menses

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107
Q

what are some reasons for contact bleeding

A

cervical cancer, cervicitis (CT/GON), or period starting

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108
Q

what is mittleschmertz

A

pain with ovulation (middle of the month pain) typically unilateral (front or back)

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109
Q

define dyspareunia

A

painful intercourse

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110
Q

____ when chronic will see thick yellow discharge with no bacterial etiology (acute related to STI)

A

cervicitis

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111
Q

what are some other causes for acture cervicitis other than STI

A

cervical trauma, polyps, cancer

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112
Q

how would you diagnosis cerviticitis

A

pap smear and/or biopsy

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113
Q

what are the 2 most common uterine disorders

A

polyps and fibroids

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114
Q

what is adenomyosis

A

where the endrometrial (inner layer) glands and stroma grow into the uterine wall (the myometrium- middle layer) and create a sponge like effect.

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115
Q

adenomyosis is assoc with what s/s

A

painful menses and enlarged uterus, dysmenorrhea

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116
Q

how would you diagnosis adenomyosis,

A

pelvic US (looks at thickness of endometrial stripe), hysteroscopy, and EMB (endometrial biopsy)

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117
Q

when are common times to get an EMB (endometrial biopsy)

A

when abnormal bleeding present, post menopause bleeding, or fertility issues

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118
Q

when would you diagnose with dysfunctional uterine bleeding (DUB)

A

use if all tests normal (more dx by exclusion)

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119
Q

dysfunctional uterine bleeding is associated with type of cycles

A

anovulatory- can be long or short

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120
Q

what is the main cause of DUB

A

overgrowth of the endometrium

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121
Q

what causes overgrowth of the endometrium in DUB

A

estrogen stimulation without progesterone to stabilize

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122
Q

what are some treatment options for DUB

A

diet, exercise, botanicals, NSAIDS, progesterone, Lupron, hysteroscopy/ectomy or ablation (destrowed)

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123
Q

what are other names for uterine fibroids

A

leiomyomata, leiomyoma, fibromyoma, myoma

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124
Q

what is the most common solid tumor in women (most of them are benign) - 25-50% women get it

A

uterine fibroids

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125
Q

____ causes overgrowth of muscle and CT in walls of uterus and MC indication for surgery (30% of hystorectomies)

A

uterine fibroids

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126
Q

what are some predisposing factors/ increased risks for uterine fibroids

A

increase with age (35-45), african descent, genetic, hormones (increased estrogen), no children (nulliparous)

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127
Q

what are characteristics of uterine fibroids

A

firm (soft to hard), irregular, enlarged uterus, smooth/rounded, non-tender

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128
Q

what must you make sure to rule out first with all uterus conditions

A

pregnancy

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129
Q

T/F: most women will be asymptomatic with uterine fibroids

A

true

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130
Q

what are s/s that may be felt with uterine fibroids

A

pressure, bloat, constipation, fatigue, urinary abnormalities, cramping, back ache, infertility

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131
Q

what is a malignant condition related to <1% of uterine fibroids

A

leiomyosarcomas (cancer)

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132
Q

infertility is a side effect with uterine fibroids- what % risk?

A

2-10%

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133
Q

how do you diagnose uterine fibroids

A

with US

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134
Q

what are 3 surgery options for uterine fibroids

A

hysterectomy (remove completely), myomectomy (partial), or embolization (preserves uterus)

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135
Q

what is the downside to getting a myomectomy as tx for uterine fibroids

A

25% have to have repeat surgery due to reoccurance

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136
Q

what is the downside of getting an embolization as tx for uterine fibroids?

A

causes cramping and scar tissue

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137
Q

adenomyosis is most common in women who …. around age…

A

parous- have had children and age 35-50

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138
Q

tx options for adenomyosis

A

progesterone, diet, exercise, ablation, hysterectomy

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139
Q

what are risk factors for endometrial carcinoma

A

age 50-70, hyperplasia, unopposed estrogen, obesity, family hx

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140
Q

what are factors that help decrease risk of endometrial carcinomas

A

BC pills, pregnancy, early menopause

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141
Q

what are s/s of endometrial carcinomas

A

postmenopausal bleeding, postmenopausal PAP with presence of endometrial cells

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142
Q

how would you dx endometrial carcinomas (blood work)

A

hCG, CBC, serum iron and ferritin, TSH, and free T4

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143
Q

what test is best to ddx endometrial carcinomas from hyperplasia

A

endometrial sampling

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144
Q

what treatment is there for endometrial carcinomas/hyperplasia

A

progesterone (remember- unopposed estrogen is main factor)

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145
Q

what are some tests to try to dx reason for acute pelvic pain

A

beta hCG (R/O pregnancy), CBC (increased WBC? infection?) and vaginal/cervical culture (infection?), ESR/CRP (inflammation), US (ovarian related? fibroids?), or laparoscopy (cyst? endometriosis?)

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146
Q

what is the management protocol for acute pelvic pain

A

refer (ER or urgent)

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147
Q

when does pelvic pain become chronic

A

lasts longer than 6mo

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148
Q

what age group most commonly gets chronic pelvic pain?

A

20-35yo

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149
Q

T/F: chronic pelvic pain is a dx by exclusion

A

true

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150
Q

what is the most common cause of chronic pelvic pain

A

endometriosis

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151
Q

what are treatment options for chronic pelvic pain

A

hysterectomy or laparoscopies

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152
Q

what are some tests for chronic pelvic pain

A

CBC, ESR, STI DNA, UA, PAP

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153
Q

what are some causes of acute pelvic pain? (there are a lot!)

A

SAB, etopic pregnancy, cervicities, uterine fibroid, TOA, OV torsion, ruptured cyst, appendicitis, IBS, cystitis, obstruction, mittelschmerz

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154
Q

what are s/s of an SAB (spont abortion)

A

crampy, intermittent vaginal bleeding

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155
Q

T/F: with SAB there will show increased WBC and ESR

A

true

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156
Q

what are s/s of an etopic pregnancy

A

unilateral adnexal mass, continuous cramping, vaginal bleeding, pain (s/s of pregnancy)

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157
Q

how do you dx an etopic pregnancy

A

with decreased hCG levels and US (will have normal WBC/ESR)

158
Q

what are risks of an etopic pregnancy

A

hemorrhage, death, future infertility, increased risk complications

159
Q

SAB is loss of fetus before ___ weeks gestation

A

20

160
Q

a threatened aborting will cause spotting/bleeding, but what won’t be present

A

signficant cramps or clots

161
Q

an inevitable abortion causes what s/s

A

heavy bleeding, cramps, decreased hCG, cervical dilation, and “rom”

162
Q

what is a complete abortion vs missed abortion

A

complete = all POC expelled; missed= death of embryo with retained POC

163
Q

how many abortions must one have for it to be considered habitual

A

3 successive pregnancy losses

164
Q

what are s/s of cervicitis

A

dull, aching, radiates, vaginal d/c

165
Q

s/s of tubo-ovarian abcess (TOA)

A

dull, dyspareunia

166
Q

OV torsion s/s

A

sudden, crampy, continuous, nausea/vomiting

167
Q

s/s ruptured cyst

A

sudden onset, unilateral, sharp

168
Q

s/s cystitis

A

dysuria, freq, urgency, flank pain

169
Q

what is the primary difference between adenomyosis and endometriosis

A

both have presence of endometrial glands and stroma, but adenomyosis is IN myometrium and endometriosis is OUT of the uterus

170
Q

what is endometriosis

A

a progressive disease where there is presence of endometrial glands and stroma outside the uterus

171
Q

what is the #1 cause of chronic pelvic pain

A

endometriosis

172
Q

what percentage of women get endometriosis and what is the common age range

A

15% age 25-30

173
Q

what are risk factors for developing endometriosis

A

family history, shorter men. cycle or longer flow, increased estrogen, obesity (increased estrogen), lack of exercise, high fat diet, stress

174
Q

what are s/s of endometriosis

A

pelvic pain, dyspareunia, infertility (asymp- discovered on workup), leg/LB pain, severe dysmenorrhea, irreg/heavy menstruation

175
Q

how do you diagnose endometriosis

A

visual, biopsy, *laparoscopy=gold standard

176
Q

what will be present on laparoscopy if patient has endometriosis

A

blue-grey “powder” burned lesions

177
Q

what are treatment options for endometriosis

A

manage symptoms: NSAIDS, endocrine therapy, surgery

178
Q

what is primary dysmenorrhea vs secondary

A

primary is without underlying pathology- dx by exclusion while secondary has underlying cause

179
Q

if dysmenorrhea is severe, what could be causing it? (4 examples)

A

endometriosis, uterine fibroids, tumors, infection

180
Q

what are signs/symptoms of primary dysmenorrhea vs secondary

A

primary: pain with menses lasts 8-72hrs, headaches, N/V, and diarrhea. secondary: didn’t have pain with menses in past, pain sometimes not with menses, infertility, heavy flow

181
Q

what 2 treatments for dysmenorrhea have a high effective rate? (~90%)

A

birth control and exercise

182
Q

women with dysmenorrhea make 8-13x more ______

A

prostoglandin

183
Q

prostoglandin production and release occur during first 48 hours of menses… why could increased prostoglandin increase pain and cramps?

A

prostoglandin causes uterine contractions which lead to pain and cramps. Hence, women with dysmenorrhea are said to make more prostoglandin and therefore have increased cramps/pain

184
Q

what is PMS

A

Premenstrual syndrome: pain symptoms during luteal phase

185
Q

what is PMDD

A

Premenstraul dysphoric disorder: psychosocial impairment increased s/s during last week of luteal phase. (have 7 days being symptom free in follicular phase)

186
Q

what is the criteria for dx of PMDD (must have 1 of the 4)

A

depression; anxiety/tension; anger/irritable; affective liability

187
Q

what is PMM

A

premenstrual magnification: symptoms never go away and increase during luteal phases

188
Q

what is primary amenorrhea

A

having no secondary sex characteristics by age 14, no menses by age 16

189
Q

what causes primary amenorrhea

A

CNS, hymen membrane block, hypoglycemia, obesity, thyroid, anemia

190
Q

what are causes of secondary amenorrhea

A

R/0 pregnancy! otherwise no period due to weight change, stress, endocrine, drugs, exercise/diet, PCOS, obesity, premature ovarian failure

191
Q

what are long term effects of hypoestrogenic

A

decrease bone density which leads to increased risk of: osteoporosis, dyslipidemia, breast cancer

192
Q

what are long term effects of hyperestrogenic

A

abnormal lipid levels, DM, obesity, breast cancer, endometrial hyperplasia

193
Q

what does progesterone challenge test help dx

A

PCOS

194
Q

when would one suffer from amenorrhea due to exercise?

A

body fat below 15-19% (BMI <18)

often includes nutrition deficiency

195
Q

what is premature ovarian failure

A

menopause before 40

196
Q

what causes premature ovarian failure

A

autoimmune disorder, chemo, family history, surgical removal, chromosomes (fragile X or Turners)

197
Q

what is PCOS

A

polycystic ovarian syndrome

198
Q

are polycystic ovaries required for dx of PCOS

A

no

199
Q

what is the criteria for PCOS (3)

A

oligomenorrhea; hyperandrogenism; dx by exclusion

200
Q

what are common signs/symptoms of PCOS

A

hirsutism, amenorrhea, obesity, abnormal uterine bleeding, infertility (other s/s inc: hair growth or loss (alopecia), and acne)

201
Q

what is alopecia

A

patterned hair loss

202
Q

what are the hormonal implications of PCOS (ex: constant stim of ___ leading to cysts..)

A

LH stimulation leads to cysts; hyperplasia and anovulation due to decreased progresterone, they have increased estrone in body fat and suppressed pituitary FSH

203
Q

what are treatment options for PCOS

A

progesterone, (metformin, spironolactone)

204
Q

what are complications of ovarian neoplasms

A

can be malignant (or benign), cause torsion, infection, hemorrhage

205
Q

are ovarian neoplasms solid or fluid filled

A

can be either

206
Q

____ are benign and the most common ovarian masses

A

functional cysts

207
Q

what are the 3 types of functional cysts

A

follicular (MC), corpus luteum (most clinically important) and theca lutein cysts (rare)

208
Q

what causes a follicular functional cyst

A

due to dormant follicle failing to rupture OR an immature follicle failing to undergo normal process of atresia. usually disappear in 1-3 months

209
Q

what causes a corpus luteum functional cyst

A

sac doesn’t dissolve but seals off after egg released. leads to fluid build up and resolves in a few weeks but may bleed or cause torsion and there is a 31% reoccurance

210
Q

what causes a theca lutein cyst (functional cyst)

A

due to prolonged or increased stimulation of ovaries by endo/exogenous. resolve spontaneously

211
Q

what are signs/symptoms of functional cysts

A

usually asymptomatic or have dull pain/pressure

212
Q

what is another name for teratoma

A

dermoid cyst; adnexal calcification (50%)

213
Q

what is a dermoid cyst

A

monstrous growth that continues thru all 3 germ layers. composed of skin and filled with hair, glands, msl, bone, teeth, cartilage, etc

214
Q

what is the treatment protocol for dermoid cyst

A

removal due to malignant potential

215
Q

what is an endometrioma

A

endometrial tissue in/on ovary- blood filled cyst. can be painful or painless and may reoccur in not fully removed

216
Q

what is the treatment choice for endometrioma

A

laparoscopy

217
Q

what is an infection in the tubo-ovarian junction called

A

TOA: tubo-ovarian abcess

218
Q

what causes a TOA

A

MC gonorrhea or chlamydia

219
Q

what are signs/symptoms of a TOA

A

tubal/ovarian swelling and enlargement, pelvic pain, fever, vaginal discharge

220
Q

what are long terms signs/symptoms of TOA and the reason for them (2)

A

infertility (due to scarred uterine tubes), chronic pelvic pain (due to adhesions)

221
Q

___ is the 5th leading cancer and does not have sign/symptoms til late stages (MC age 60-65)

A

ovarian

222
Q

what is the best test for ovarian cancer

A

US

223
Q

what are 2 things that decrease risk of ovarian cancer

A

breast feeding and hormonal contraceptives

224
Q

what are things that increase risk of ovarian cancer

A

fam history, nulliparity, early menarche, late menopause, fertility promoting drugs

225
Q

what is the most common ovarian mass for newborns

A

small functional cyst

226
Q

what is the most common ovarian mass for premenarchal

A

teratomas/dermoid

227
Q

what are the most common ovarian masses for reproductive age

A

functional cyst, endometrioma, TOA, PCOS, etopic pregnancy, and teratoma

228
Q

what must you R/O with an ovarian mass in a post-menopausal women

A

cancer

229
Q

where does cervical dysplasia most commonly happen

A

in transitional zone

230
Q

with bethesda classification of PAPS what are the 6 main classifications

A

normal, atypia, ASCUS, CIN, SIL, CIS, and cancer

231
Q

with bethesda classification of PAPS: what does ASCUS stand for

A

abnormal squamous cell of undetermined significance

232
Q

with bethesda classification of PAPS: what does CIN stand for

A

cervical intraepithelial neoplasm

233
Q

with bethesda classification of PAPS: what does SIL stand for

A

squamous intraepithelial lesion

234
Q

with bethesda classification of PAPS: what does CIS stand for

A

carcinoma in situ (precancer)

235
Q

with bethesda classification of PAPS: what does CIN l/LGSIL stand for

A

cervical intraepithelial neoplasm/ low grade squamous intraepithelial lesion. there is also HG (high grade)

236
Q

with bethesda classification of PAPS:what is the difference between CNI, CNII, and CNIII/CIS/CX and treatment

A

CNI- self resolve or become CNII; CNII dont go away- tx is cyrotherapy; CNIII treatment is surgery, LEEP, laser, or hystorectomy

237
Q

what does colposcopy help view and when to use it

A

direct magnification and viewing of cervix, vulva, vagina, and can take biopsy. use when abnorm PAP, persistent cervical bleeding or inflammation shows on PAP

238
Q

what is LEEP

A

a fine wire loop with electroenergy- removes tissue that can be sent to lab- good for treament and diagnosing; use anesthetic

239
Q

what is conization

A

removes cone shapped peice of cervix for better diagnosis. downside is that it can remove healthy tissue leading to issues with childbearing in future

240
Q

high risk strains of HPV can cause cancer… what about low risk strains

A

cause cervical changes that are less likely to be precancerous but can cause venereal warts

241
Q

T/F: most HPV strains don’t cause symptoms, are transient and resolve

A

true (70-90%)

242
Q

T/F: RTIs are sexually transmitted

A

they may or may not be

243
Q

T/F: most RTIs are asymptomatic

A

true

244
Q

what are some examples of RTIs that are sexually transmitted

A

trichomoniasis, chlamydia, gonorrhea, syphillis, pediculosis pubis, HIV, HPV, HSV

245
Q

what is pediculosis pubis

A

lice

246
Q

what causes vaginitis

A

imbalance of normal flora

247
Q

signs/symtpoms of vaginitis include..

A

itching, burning, discharge, odor, pain

248
Q

what is the most common agents behind vaginitis

A

bacterial vaginosis (aka gardnerella) 40-50% and candidiasis 20-25%

249
Q

what is the normal vaginal pH

A

less than 4.7 (3.8-4.5)

250
Q

what is lactobacillus acidophilus

A

the normal flora in the vagina

251
Q

is bacterial vaginitis an STI

A

no- due to overgrowth of normal flora

252
Q

what causes the fishy odor assoc with bacterial vaginitis

A

amine induced from overgrowth of normal flora

253
Q

clinical criteria for diagnosis of bacterial vaginitis includes 3 of 4 things

A

pH >4.7; (+) whiff test; (+) clue cells; homogeneous discharge

254
Q

what are some complications that can arise with bacterial vaginitis

A

high reoccurance, cervicitis, pelvic inflammation disease, post surgery infection, increased risk HIV/STI, pregnancy complications

255
Q

what is treatment for bacterial vaginitis

A

antibiotics (metronidazole or clindmycin)

256
Q

what can cause atrophic vaginitis

A

low estrogen

257
Q

what is candida vulvovaginitis

A

yeast infection due to overgrowth of fungus that lives in healthy vagina

258
Q

what is the MC fungus that causes a yeast infection

A

candida albicans

259
Q

is yeast infection/candida vulvovaginitis an STI

A

no

260
Q

what are signs/symptoms of candida vulvovaginitis

A

pruritis, white/yellow discharge, erythema (skin red), fissures

261
Q

how do you diagnosis candida vulvovaginitis

A

with a wet culture/mount

262
Q

what are some pre-disposing factors for candida vulvovaginitis

A

diabetes, pregnancy, antibiotics, HIV, occlusive clothing, diet, unprotected intercourse (due to semen pH)

263
Q

treatment of candida vulvovaginitis

A

antifungals (end in azole- clotrimazole or micronazole), boric acid, sitz bath, acidophilus, diet

264
Q

what is trichomoniasis vaginalis

A

STI that is also assoc with presence of other STIs

265
Q

what does trichomoniasis vaginalis infect

A

vagina, scene ducts, lower urinary tract

266
Q

what are signs/symptoms of trichomoniasis

A

can be asymptomatic in men/women for years. classic signs are yellow/green frothy discharge, strawberry cervix, malodorous

267
Q

how to diagnosis trichomoniasis

A

wet mount will show motile organism with flagella and increased PMNs

268
Q

what are treatment options for trichomoniasis

A

metroridazole, tinidazole

269
Q

what 2 STIs are bacteria, infection genital columnar epithelium and can be asymptomatic or cause cervicitis, urethritis, and PID

A

chlamydia and gonorrhea (=CT/GON)

270
Q

T/F gonorrhea can cause arthritis

A

true

271
Q

what are signs and symptoms of PID

A

cervicitis, adnexal tenderness, disturbed menses, fever, chills, increased ESR and WBC

272
Q

what are 4 common genital ulcer causing diseases

A

HSV, syphillus, chancroid, and LGV

273
Q

what is another name for HSV

A

herpes

274
Q

herpes causes sores- what is type 1 vs type 2

A

type 1 causes cold sores (oral) and type 2 causes genital

275
Q

primary syphilis can affect any part of body- what are some common signs/symptoms

A

lymphadenopathy, causes chancres (painless ulcers with clean base, indurated borders anywhere on body)

276
Q

what is secondary syphilis signs/symptoms

A

called “great mimicker” causes rash, diffuse, macular, papular, combo, and patterned hair loss

277
Q

late stages of syphilis causes..

A

most destructive- cardivascular and neuro symptoms and gummata (small soft swelling in connective tissue of vital organs)

278
Q

what are some diagnostic testing you can do for syphilis

A

antibody testing VDRL

279
Q

____ causes syphilis by spirochete itself

A

treponema pallidum

280
Q

what causes chancroid

A

haemophilus ducreyi

281
Q

s/s of chancroid

A

painful! causes ulcers on genitalia and associated with inguinal lyphadenitis

282
Q

t/f chancroids can co-exist with herpes simplex or chlamydia

A

true

283
Q

what is LGV

A

lymphogranuloma venereum

284
Q

what causes LGV

A

a specific strain of chlamydia

285
Q

s/s of LGV

A

small pimple/lesion that usually goes unnoticed- goes to lymph nodes and usually will cause inflammation and swelling of lymph glands and they will bleed

286
Q

which STI affects langerhans cells

A

HIV

287
Q

if HIV left untreated will lead to…

A

AIDS

288
Q

how do you diagnose HIV

A

antibody tests, ELISA, western blot

289
Q

what is zidovudine

A

can give to pregnant women to decrease risk of transmission of HIV/AIDs to baby

290
Q

what is another name for HPV

A

condyloma accuminata

291
Q

what is another name for syphilis

A

condyloma lata

292
Q

what does progesterone do that allows it to be used as a contraceptive

A

thickens cervical mucous and alters endometrial lining

293
Q

what is semen’s kryptonite

A

copper

294
Q

T/F IUD can be used as emergency contraceptive

A

true

295
Q

a non-surgical abortion Ru486 mimics what

A

SAB via mifepristone (antiprogestern). causes cramps nausea and bleeding

296
Q

what is leopold’s maneuver

A

external palpation of uterus to determine position- done every visit during pregnancy

297
Q

signs that labor is soon includes feeling like baby dropped lower into pelvis- this is called

A

lightening

298
Q

what is a significant indication of labor that does not happen with prodromal labor

A

cervical changes don’t occur (have contractions though)

299
Q

what is prodromal labor

A

false labor

300
Q

what is amniotomy

A

artificial rupture of membrane

301
Q

what is “presentation “ with reference to fetopelvic relationship

A

part of fetus presenting to pelvic outlet

302
Q

what is the most common “presentation” with reference to fetopelvic relationship

A

vertex (occiput/head first)

303
Q

what are the 3 common “presentations” with reference to fetopelvic relationship

A

vertex, mentum (face), and breech (sacrum)

304
Q

what is “attitude” with reference to fetopelvic relationship

A

relationship of fetus parts to each other

305
Q

what is “denominator” with reference to fetopelvic relationship

A

point on presenting part used to determine position (usually occiput)

306
Q

what is “position” with reference to fetopelvic relationship

A

relationship of denominator to front/back/side of mother’s pelvis

307
Q

what is the most common “position” with reference to fetopelvic relationship

A

LOA: left occiput anterior - ie: baby’s occiput is presenting, baby’s back is against mother’s anterior, and baby is lying on left side

308
Q

why is LOA the most common “position”

A

due to liver

309
Q

what is frank breech

A

bum facing outlet in pike position

310
Q

what is the order of cardinal movements (EDIERAP)

A

engagement, descent, internal rotation, extension, restitution (rot 90), anterior shoulder, posterior shoulder

311
Q

what are some signs of stage 1 labor

A

cervix dilation 0-10cm, 0% effacement, thinning cortex

312
Q

at what dilation is stage 2 labor

A

10cm to birth (inc crowning)

313
Q

what are signs of stage 3 labor

A

separation/expulsion of placenta

314
Q

what is crowning

A

“ring of fire” happens during stage 2. widest part of baby’s head is at the vulvar ring without retraction between contractions

315
Q

what is turtle sign

A

shoulder dystocia- where shoulders are behind pelvic bone. usually use corkscrew maneuver but may cause Erb palsy

316
Q

what is placenta previa

A

placenta blocking baby’s escape (painless) requires c-section. causes bright red bleeding late in pregnancy

317
Q

what is placental abruption

A

placenta separates from wall early- painful

318
Q

what is pre-eclampsia signs/symptoms

A

usually happens 3rd trimester. presentation: hypertension, 4lb/wk weight gain, edema, HA, visual disturbances, and RUQ abd pain. can be mild or life threatening with rapid progression. complications include HELLP (hemolysis, elevated liver enzymes, low platelets)

319
Q

___ can happen during labor. Very painful, MC with previous c-section

A

uterine rupture- tearing of uterine msl

320
Q

there are 4 degrees of lacerations… what are they

A

1st: vaginal mucosa, forchette, perineal/labial skin
2nd: vaginal mucosa, bulbocaldernous msl
3rd: external anal sphincter
4th: anterior anal wall

321
Q

what is lochia

A

vaginal discharge post partum

322
Q

what are the 3 kinds of lochia

A

rubra (red blood- last few days); serosa (pink with serum and WBC); alba (white/brown with RBC, cervix mucous, tissue debris)

323
Q

what are 3 depressive states following pregnancy

A

baby blues- 2-3days after birth
depression 2wks-6months
psychosis- less than 2 weeks- causes manic like behavior and may require therapy

324
Q

what is diastasis recti

A

separation between left and right rectus abd muscles

325
Q

T/F anemia of mother can be long term

A

true; screen for 4-6 weeks

326
Q

with newborns you want to check what? (APGAR)

A

appearance, pulse, grimace, activity, and respiration

327
Q

what are signs of perinatal oxygen deprevation

A

birth-12hrs: decreased movements, poor tone, apneic spells
12-24hrs: above jitterness and weakness
after 24hrs: brainstem signs and poor feeing

328
Q

what does the ballard scale measure

A

actual age of neonate at birth determined by neuromuscular development

329
Q

what is newborn molding

A

where sutures fold in on each other causing cone head shape

330
Q

what is cephalohematoma

A

where there is blood between periosteum and skull (doesn’t cross suture lines)

331
Q

what is caput succeolenum

A

edema of scalp- crosses suture lines

332
Q

what is craniosynostosis

A

premature fusion during development (will need surgeries or cranial bands)

333
Q

what is kernicterus

A

brain damage that happens with babies with severe jaundice (due to hemolytic disease of newborn)

334
Q

T/F it is normal for newborns to have jaundice

A

true- for 2-4days- usually occur after 24hrs

335
Q

what is eugoryement

A

secondary swelling and tenderness to excess milk production. usually happens day 3-5

336
Q

colustrum vs milk

A

colustrum is less volume, high in Ab, protein, and easy to digest. Milk is more sugar and fat. usually dev milk 3-5 days

337
Q

estrogen during follicular phase causes ____ which leads to ovulation

A

LH surge

338
Q

there are carrier tests available for what conditions

A

sickle cell, tay sach, thalassemias, cystic fibrosis

339
Q

where does conception occur

A

fimbria or ampulla

340
Q

when is hCG produced

A

once egg burrows into endometrium

341
Q

once egg released, how long is it viable for

A

24hrs

342
Q

what does hCG do to progesterone

A

triggers the corpus luteum to secrete progesterone past normal 14 days; secretes progesterone for 12-16 weeks until placenta takes over

343
Q

what conditions could cause increased hCG on pregnancy test (besides pregnancy)

A

ovarian tumor, testicular cancer

344
Q

s/s of septic abortion

A

increased bleeding, malodorous d/c, pain, fever, leukocytes

345
Q

what is a blighted ovum

A

egg gets fertilized and implants but doesn’t develop

346
Q

what causes a blighted ovum

A

due to chromosomal abnormality (anembryonic preg)

347
Q

what is a hydatidiform mole

A

occurs when there is an over production of placental cells with abnormally high hCG levels

348
Q

what are signs/symptoms of molar pregnancy

A

large for gestational age, bleeding/pain, no fetal movements, more nausea than normal, no FHT

349
Q

what are causes for SAB during 1st trimester

A

chromosomal abnormality, reproductive hazards

350
Q

what are causes for SAB during 2nd trimester

A

incompetent cervix, uterine septum, trauma

351
Q

hydratidiform mole increases risk for developing what

A

choriocarcinoma

352
Q

prostaglandins are present in which bodily fluids

A

semen, menstrual blood, amniotic fluids

353
Q

what does prostaglandins do

A

ripens cervix and induces constractions

354
Q

progesterone, secreted by the corpus luteum during early pregnancy will then be secreted by the ____. helps maintain pregnancy and promotes _____ growth

A

placenta; breast gland

355
Q

what is E3 (estriol)

A

the dominant form of estrogen throughout pregnancy

356
Q

____ develops alveolar and glandular cells to help promote lactation and produce lactose and lipids

A

prolactin

357
Q

what is the “contractor hormone” that is excreted from the posterior pituitary

A

oxytocin

358
Q

what does oxytocin do

A

express milk, stimulate uterus, induce labor

359
Q

what is piskacek’s sign

A

asymmetrical enlargement of body of pregnant uterus (indicates pregnancy)

360
Q

what is goodell’s sign

A

cervical softening (indicates pregnancy)

361
Q

what is hegar’s sign

A

uterine softening (indicates pregnancy)

362
Q

what is chadwicks sign

A

bluish discoloration- increased vascularity of vagina walls (indicates pregnancy)

363
Q

____ inhibits egg maturation

A

progestin

364
Q

____ preserves the corpus luteum

A

hCG

365
Q

what are montgomery’s tubercles and what do they do

A

small glands around nipples that secrete oils that lubricate and protect against infection

366
Q

what is a common GI conditions that arises in pregnant women

A

cholestasis

367
Q

define parturient

A

IN labor

368
Q

define puerpera

A

has just given birth

369
Q

define gravid

A

currently pregnant

370
Q

define gravida

A

has been pregnant

371
Q

define nulligravida

A

never pregnant

372
Q

define primigravida

A

1st time

373
Q

define para

A

carried fetus to viability

374
Q

define primipara/multipara

A

carried one/multiple to viability

375
Q

when is a diabetes screen performed

A

24-28weeks

376
Q

when does the uterus become an “abdominal organ”

A

1st day 2nd trimester

377
Q

when are FHT (fetal heart tones) first heard via stethoscope

A

20 weeks (with dopple at 12wks)

378
Q

T/F pregnant women can travel safely at 18-32 weeks

A

true

379
Q

what is anasarca

A

generalized edema (pitting)

380
Q

what is a common complication of pregnancy that is screened for at 24-28 weeks and could lead to HTN, resp distress, SAB, dystocia, preterm, etc

A

gestational diabetes. S/S inc excessive thirst, hunger, fatigue

381
Q

what are some prominent STIs that are communicable in utero (6)

A

syphillus, herpes (HSV), CMV, mycoplasma, HIV, HepB

382
Q

what are some prominent STIs that are communicable via birth canal (5)

A

NG/CT (gonorrhea), GBS, HSV, CMV, HPV

383
Q

how is HIV communicable to baby(3)

A

in utero, delivery, via breastfeeding

384
Q

hepatosplenomegaly is a trademark sign of which STI

A

CMV

385
Q

congenital form of rubella can cause what 3 serious complications/impairments

A

deafness, heart disease, developmental delays

386
Q

1st sign of fetal movement is called

A

quickening

387
Q

what is the “zero station”

A

where the head is at the middle of the pelvis at the line of the sacroiliac spines (increased # indicates head is further below pelvis)

388
Q

what should you check for with gush ROM

A

check for prolapsed cord and monitor FHT

389
Q

vernix caseosa and lanugo indicates that the baby is (older or younger)

A

younger

390
Q

foot creases indicated the baby is (older or younger)

A

older

391
Q

what does TORCH stand for

A

refers to a group of maternally acquired communicable diseases. toxoplasmosis, other (HIV, mumps, parovirus, varicella), rubella, cytomegalovirus (CMV), and herpes

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