OGG all notes Flashcards
1
Q
when is the best time to do a CBE (clinical breast exam)
A
5 days post menses
2
Q
where are the breasts located
A
between ribs 2-6 and between the sternal edge and midaxillary line
3
Q
what is the “tail” of the breast that must be included on the exam
A
UOQ to axilla
4
Q
which lymph nodes must be included?
A
cervical, axillary, and super/infra-clavicular
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
6
Q
what is mastalgia
A
pain/tenderness of the breast
7
Q
T/F: mastalgia is most common during menopause
A
false- pre-menopause MC
8
Q
what are some causes of mastalgia?
A
hormones, trauma, PMS, infection, (cancer-5%-rare)
9
Q
is mastalgia cyclical?
A
it can be cyclical or non-cyclical
10
Q
what treatments are there for mastalgia
A
hormone treatment can be done though it could increase symptoms.
11
Q
T/F: 60-80% of mastalgia cases self remiss
A
yes
12
Q
if over 35 and having mastalgia, what is the next step?
A
consider mamogram
13
Q
if under 35 with mastalgia and normal CBE, what is next
A
usually they are OK- watch and wait
14
Q
10% of women have this benign condition of the breasts
A
fibroadenoma
15
Q
describe fibroadenoma
A
composed of fibrous stroma, size change with cycle, rubbery, firm, smooth, round, mobile, painLESS
16
Q
___% of fibroadenoma have multiple lesions
A
20%; some multilobulated also
17
Q
T/F: fibroadenoma tend to decrease in size over time
A
true
18
Q
what is the MC age range for fibroadenoma
A
15-50yo
19
Q
tests for fibroadenoma include: (4)
A
CBE, mammogram, US, needle biopsy
20
Q
what is the treatment options for fibroadenoma
A
surgical excision or watch/wait
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
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
23
Q
T/F: simple cysts fluctuate cyclically
A
true
24
Q
describe simple cyst
A
fluid filled, soft yet firm, mobile, well circumscribed, unilateral or bilateral, and TENDER
25
what is a simple cyst hard to ddx from
a solid mass
26
what tests are used to dx a simple cyst?
mammogram, US, fine needle aspiration
27
when would you consider surgical biopsy for what appears to be a simple cyst?
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
28
60% of women get this common, non-cancerous condition
fibrocystic breast changes
29
where are fibrocystic breast changes likely to occur
upper outer quadrant (UOQ)
30
what are common symptoms with fibrocystic breast changes
swelling, pain, tenderness, heaviness, itching of nipple, fluctuation in size cyclically, premenstrual aggravation, come in variety in size
31
what is the main cause of fibrocystic breast changes?
increased estrogen, decreased progesterone. Usually resolved with menopause
32
T/F: if a mass does not decrease with menses, it should be evaluated sooner
true
33
what is a good thing to avoid as it increases estrogen and can cause more breast conditions
methylxanthines (coffee, tea, chocolate, etc)
34
benefits of vitamin E?
relieves PMS symptoms and normalizes hormones
35
what is mastitis
an infection seen during lactation or when skin disrupted
36
s/s of mastitis include
fever, localized erythema, pain, induration, N/V, malaise
37
what is the etiology of mastitis
s. aures, s. epidermis, strep
38
risk factors for getting mastitis
breast feeding, trauma, breast augmentation
39
when is the MC time to get mastitis
in the first 2-4 weeks postpartum
40
T/F: mastitis can become chronic
true
41
what does chronic mastitis lead to
abcess and nipple retraction
42
what is galactocele
a blocked duct
43
when does galactocele happen
usually after lactation
44
s/s of galactocele
tender/enlarged
45
tx for galactocele
excise and drain
46
is nipple discharge (d/c) more commonly associated with benign or maligant disease
benign (10-15%) vs 3-11% maligant
47
what are some common characteristics of benign nipple discharge
usually bilateral, needs stimulation, multiduct involvement
48
what are some common characteristics of pathological nipple discharge
usually unilateral, spont./intermittent, can be any kind of d/c (green, grey, blood, etc)
49
what is a common cause of serous nipple d/c
hormones
50
MC pathological (but benign) cause of nipple discharge
intraductal papilloma
51
what is galactorrhea
inappropriate lactation in nonpuerperal (non-lactating) women
52
s/s of galactorrhea
unilateral or bilateral with milk d/c
53
MC causes of galactorrhea is
increased prolactin levels due to pituitary tumor (would dx with CT)
54
what are other causes of galactorrhea besides a pituitary tumor
increased estrogen, psychotropic meds, afferent nerve stim, primary hypothyroidism (usually w/amenorrhea)
55
what is intraductal papilloma
increased papillary growth in lactiferous duct. #1 cause of nipple d/c (bloody or serous)
56
T/F tx of intraductal papilloma is to watch and wait
false- surgical excision because of tendency to grow
57
T/F breast feeding not altered if under 3 ducts are removed
true
58
what condition is caused by s. aureus and recurrent in women with inverted nipples
subareolar abcess
59
tx for subareolar abcess includes?
antibiotics, drainage, and duct excision
60
nipple piercings increase your chance of getting what condition
subareolar abscess
61
what are the stats on breast cancer
#1 in women and 1/3 die from it. (lung cancer has most deaths)
62
what is the most common age for breast cancer
40-55
63
how and when is screening for breast cancer started?
mammogram 1-2yrs with or without CBE starting at age 40
64
what is the most common testing sequence for breast exam
mammogram, US, biopsy
65
what is the problem with mammograms
can give false (+)- though less in annual screens only and radiation exposure
66
when would you order an US of breasts (based on mammogram and CBE results)
if lump felt but not seen on mammogram or lump with abnormal mammogram
67
US is ineffective in screening for breast _____ but can detect ___ vs ____
ineffective- breast carcinoma, but can detect fluid filled vs solid mass.
68
what is the difference between fluid filled vs solid mass in breasts
fluid usually benign while solid has malignant potential
69
when would you order an MRI for breasts
for patients with breast cancer or history of, dense breasts, to rectify inconclusive mammogram and US, high risk
70
what is needle aspiration used for
evaluate fluid filled lesions. if bloody get biopsy or if cyst reoccurs within 2 weeks after aspiration
71
What is a common symptom of breast cancer in men
nipple d/c (also breast lump, swelling, skin dimpling, pain, red/scaly).... usually starts under nipple
72
T/F: 90% of breast cancer cases have no primary relative with history
true; 75% have no major risk factors!!
73
s/s of breast cancer
firm/hard mass, irreg contour, immobile, unilateral
74
late stages of breast cancer s/s
skin/nipple retraction, tenderness, axillary lymphadenopathy, erythema, edema, pain, fatigue
"peau d'orange"
75
s/s of pagets disease of the breast (adenocarcinoma)
itching/burning skin or nipple, erythema, rash, ulceration
| *easy to misdiagnose as dermatitis
76
what is pagets disease of the breast easily mis-diagnosed as?
dermatitis
77
T/F: omega 6 fats increase risk of breast cancer
true
78
T/F: vitamin D helps decrease risk of breast cancer
true
79
average # of days in menses cycle
21-35 with 7 day flow (ave 3-5)
80
how many ml/period is average?
80
81
what is considered day "one" of menses
menses marks day one
82
what does day 14 of menses mark
ovulation
83
days 1-14 of menses cycle is considered what phase
follicular
84
days 14-30 of menses cycle are considered what phase
luteal
85
the follicular phase is considered the (proliferation/secretory) phase while luteal is considered the (proliferation/secretory) phase
follicular= proliferation; luteal= secretory
86
GnRH is from what gland
the hypothalamus
87
GnRh simulates the release of __ and ___ from the ant. pituitary
FSH and LH
88
what 2 hormones does the ant pituitary release
FSH and LH
89
what does LH stimulate? (2)
androgen and progesterone (ovulation)
90
what does FSH stimulate?
etrogen (E2) estradiol
91
what are s/s of increased estrogen
dysmenorrhea, nausea, edema, menorrhagia, enlarged uterus, uterine fibroids, fibrocyctic breast changes
92
what are s/s of decreased estrogen
scant menses, mid cycle spotting
93
T/F: s/s of decreased progesterone are those you would suspect to see in pregnant women
false (increased progesterone)
94
what are s/s of increased progesterone
(s/s you'd expect to see in pregnant women) edema, bloat, HA, depression, wt gain, fatigue, HTN, varicose veins
95
what are s/s of decreased progesterone
prolonged menses, heavy menses, cramps, luteal/break-though bleeding
96
s/s of decreased progesterone are those you'd see in what other conditions
endometriosis, adenomyosis, endometrial hyperplasia, anovulatory cycles
97
what are some examples of abnormal bleeding (HINT: cycles (4))
<21 days
>35 days
>7 days menses
spotting
98
T/F: bleeding post-menopause, though rare, is not clinically important
false- red flag!!
99
define menorrhagia
hypermenorrhea (heavy flow)
100
what can cause menorrhagia
pregnancy, infection (STI), uterine fibroids, polyps, hypothyroidism (very common), neoplasm, or dysfunctional uterus
101
define metrorrhagia
intramenorrhea (breakthru bleeding/ spotting)
102
define menometrorrhagia
profuse bleeding during menses and between periods
103
define polymenorrhea
menses with increased frequency (periods <21 days apart
104
define amenorrhea
absent or abnormal menses present for more than 3 months
105
define oligomenorrhea
scant menses- periods that occure more than 35 days apart
106
define dysmenorrhea
painful menses
107
what are some reasons for contact bleeding
cervical cancer, cervicitis (CT/GON), or period starting
108
what is mittleschmertz
pain with ovulation (middle of the month pain) typically unilateral (front or back)
109
define dyspareunia
painful intercourse
110
____ when chronic will see thick yellow discharge with no bacterial etiology (acute related to STI)
cervicitis
111
what are some other causes for acture cervicitis other than STI
cervical trauma, polyps, cancer
112
how would you diagnosis cerviticitis
pap smear and/or biopsy
113
what are the 2 most common uterine disorders
polyps and fibroids
114
what is adenomyosis
where the endrometrial (inner layer) glands and stroma grow into the uterine wall (the myometrium- middle layer) and create a sponge like effect.
115
adenomyosis is assoc with what s/s
painful menses and enlarged uterus, dysmenorrhea
116
how would you diagnosis adenomyosis,
pelvic US (looks at thickness of endometrial stripe), hysteroscopy, and EMB (endometrial biopsy)
117
when are common times to get an EMB (endometrial biopsy)
when abnormal bleeding present, post menopause bleeding, or fertility issues
118
when would you diagnose with dysfunctional uterine bleeding (DUB)
use if all tests normal (more dx by exclusion)
119
dysfunctional uterine bleeding is associated with type of cycles
anovulatory- can be long or short
120
what is the main cause of DUB
overgrowth of the endometrium
121
what causes overgrowth of the endometrium in DUB
estrogen stimulation without progesterone to stabilize
122
what are some treatment options for DUB
diet, exercise, botanicals, NSAIDS, progesterone, Lupron, hysteroscopy/ectomy or ablation (destrowed)
123
what are other names for uterine fibroids
leiomyomata, leiomyoma, fibromyoma, myoma
124
what is the most common solid tumor in women (most of them are benign) - 25-50% women get it
uterine fibroids
125
____ causes overgrowth of muscle and CT in walls of uterus and MC indication for surgery (30% of hystorectomies)
uterine fibroids
126
what are some predisposing factors/ increased risks for uterine fibroids
increase with age (35-45), african descent, genetic, hormones (increased estrogen), no children (nulliparous)
127
what are characteristics of uterine fibroids
firm (soft to hard), irregular, enlarged uterus, smooth/rounded, non-tender
128
what must you make sure to rule out first with all uterus conditions
pregnancy
129
T/F: most women will be asymptomatic with uterine fibroids
true
130
what are s/s that may be felt with uterine fibroids
pressure, bloat, constipation, fatigue, urinary abnormalities, cramping, back ache, infertility
131
what is a malignant condition related to <1% of uterine fibroids
leiomyosarcomas (cancer)
132
infertility is a side effect with uterine fibroids- what % risk?
2-10%
133
how do you diagnose uterine fibroids
with US
134
what are 3 surgery options for uterine fibroids
hysterectomy (remove completely), myomectomy (partial), or embolization (preserves uterus)
135
what is the downside to getting a myomectomy as tx for uterine fibroids
25% have to have repeat surgery due to reoccurance
136
what is the downside of getting an embolization as tx for uterine fibroids?
causes cramping and scar tissue
137
adenomyosis is most common in women who .... around age...
parous- have had children and age 35-50
138
tx options for adenomyosis
progesterone, diet, exercise, ablation, hysterectomy
139
what are risk factors for endometrial carcinoma
age 50-70, hyperplasia, *unopposed estrogen*, obesity, family hx
140
what are factors that help decrease risk of endometrial carcinomas
BC pills, pregnancy, early menopause
141
what are s/s of endometrial carcinomas
postmenopausal bleeding, postmenopausal PAP with presence of endometrial cells
142
how would you dx endometrial carcinomas (blood work)
hCG, CBC, serum iron and ferritin, TSH, and free T4
143
what test is best to ddx endometrial carcinomas from hyperplasia
endometrial sampling
144
what treatment is there for endometrial carcinomas/hyperplasia
progesterone (remember- unopposed estrogen is main factor)
145
what are some tests to try to dx reason for acute pelvic pain
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?)
146
what is the management protocol for acute pelvic pain
refer (ER or urgent)
147
when does pelvic pain become chronic
lasts longer than 6mo
148
what age group most commonly gets chronic pelvic pain?
20-35yo
149
T/F: chronic pelvic pain is a dx by exclusion
true
150
what is the most common cause of chronic pelvic pain
endometriosis
151
what are treatment options for chronic pelvic pain
hysterectomy or laparoscopies
152
what are some tests for chronic pelvic pain
CBC, ESR, STI DNA, UA, PAP
153
what are some causes of acute pelvic pain? (there are a lot!)
SAB, etopic pregnancy, cervicities, uterine fibroid, TOA, OV torsion, ruptured cyst, appendicitis, IBS, cystitis, obstruction, mittelschmerz
154
what are s/s of an SAB (spont abortion)
crampy, intermittent vaginal bleeding
155
T/F: with SAB there will show increased WBC and ESR
true
156
what are s/s of an etopic pregnancy
unilateral adnexal mass, continuous cramping, vaginal bleeding, pain (s/s of pregnancy)
157
how do you dx an etopic pregnancy
with decreased hCG levels and US (will have normal WBC/ESR)
158
what are risks of an etopic pregnancy
hemorrhage, death, future infertility, increased risk complications
159
SAB is loss of fetus before ___ weeks gestation
20
160
a threatened aborting will cause spotting/bleeding, but what won't be present
signficant cramps or clots
161
an inevitable abortion causes what s/s
heavy bleeding, cramps, decreased hCG, cervical dilation, and "rom"
162
what is a complete abortion vs missed abortion
complete = all POC expelled; missed= death of embryo with retained POC
163
how many abortions must one have for it to be considered habitual
3 successive pregnancy losses
164
what are s/s of cervicitis
dull, aching, radiates, vaginal d/c
165
s/s of tubo-ovarian abcess (TOA)
dull, dyspareunia
166
OV torsion s/s
sudden, crampy, continuous, nausea/vomiting
167
s/s ruptured cyst
sudden onset, unilateral, sharp
168
s/s cystitis
dysuria, freq, urgency, flank pain
169
what is the primary difference between adenomyosis and endometriosis
both have presence of endometrial glands and stroma, but adenomyosis is IN myometrium and endometriosis is OUT of the uterus
170
what is endometriosis
a progressive disease where there is presence of endometrial glands and stroma outside the uterus
171
what is the #1 cause of chronic pelvic pain
endometriosis
172
what percentage of women get endometriosis and what is the common age range
15% age 25-30
173
what are risk factors for developing endometriosis
family history, shorter men. cycle or longer flow, increased estrogen, obesity (increased estrogen), lack of exercise, high fat diet, stress
174
what are s/s of endometriosis
pelvic pain, dyspareunia, infertility (asymp- discovered on workup), leg/LB pain, severe dysmenorrhea, irreg/heavy menstruation
175
how do you diagnose endometriosis
visual, biopsy, *laparoscopy=gold standard
176
what will be present on laparoscopy if patient has endometriosis
blue-grey "powder" burned lesions
177
what are treatment options for endometriosis
manage symptoms: NSAIDS, endocrine therapy, surgery
178
what is primary dysmenorrhea vs secondary
primary is without underlying pathology- dx by exclusion while secondary has underlying cause
179
if dysmenorrhea is severe, what could be causing it? (4 examples)
endometriosis, uterine fibroids, tumors, infection
180
what are signs/symptoms of primary dysmenorrhea vs secondary
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
what 2 treatments for dysmenorrhea have a high effective rate? (~90%)
birth control and exercise
182
women with dysmenorrhea make 8-13x more ______
prostoglandin
183
prostoglandin production and release occur during first 48 hours of menses... why could increased prostoglandin increase pain and cramps?
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
what is PMS
Premenstrual syndrome: pain symptoms during luteal phase
185
what is PMDD
Premenstraul dysphoric disorder: psychosocial impairment increased s/s during last week of luteal phase. (have 7 days being symptom free in follicular phase)
186
what is the criteria for dx of PMDD (must have 1 of the 4)
depression; anxiety/tension; anger/irritable; affective liability
187
what is PMM
premenstrual magnification: symptoms never go away and increase during luteal phases
188
what is primary amenorrhea
having no secondary sex characteristics by age 14, no menses by age 16
189
what causes primary amenorrhea
CNS, hymen membrane block, hypoglycemia, obesity, thyroid, anemia
190
what are causes of secondary amenorrhea
R/0 pregnancy! otherwise no period due to weight change, stress, endocrine, drugs, exercise/diet, PCOS, obesity, premature ovarian failure
191
what are long term effects of hypoestrogenic
decrease bone density which leads to increased risk of: osteoporosis, dyslipidemia, breast cancer
192
what are long term effects of hyperestrogenic
abnormal lipid levels, DM, obesity, breast cancer, endometrial hyperplasia
193
what does progesterone challenge test help dx
PCOS
194
when would one suffer from amenorrhea due to exercise?
body fat below 15-19% (BMI <18)
| often includes nutrition deficiency
195
what is premature ovarian failure
menopause before 40
196
what causes premature ovarian failure
autoimmune disorder, chemo, family history, surgical removal, chromosomes (fragile X or Turners)
197
what is PCOS
polycystic ovarian syndrome
198
are polycystic ovaries required for dx of PCOS
no
199
what is the criteria for PCOS (3)
oligomenorrhea; hyperandrogenism; dx by exclusion
200
what are common signs/symptoms of PCOS
hirsutism, amenorrhea, obesity, abnormal uterine bleeding, infertility (other s/s inc: hair growth or loss (alopecia), and acne)
201
what is alopecia
patterned hair loss
202
what are the hormonal implications of PCOS (ex: constant stim of ___ leading to cysts..)
LH stimulation leads to cysts; hyperplasia and anovulation due to decreased progresterone, they have increased estrone in body fat and suppressed pituitary FSH
203
what are treatment options for PCOS
progesterone, (metformin, spironolactone)
204
what are complications of ovarian neoplasms
can be malignant (or benign), cause torsion, infection, hemorrhage
205
are ovarian neoplasms solid or fluid filled
can be either
206
____ are benign and the most common ovarian masses
functional cysts
207
what are the 3 types of functional cysts
follicular (MC), corpus luteum (most clinically important) and theca lutein cysts (rare)
208
what causes a follicular functional cyst
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
what causes a corpus luteum functional cyst
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
what causes a theca lutein cyst (functional cyst)
due to prolonged or increased stimulation of ovaries by endo/exogenous. resolve spontaneously
211
what are signs/symptoms of functional cysts
usually asymptomatic or have dull pain/pressure
212
what is another name for teratoma
dermoid cyst; adnexal calcification (50%)
213
what is a dermoid cyst
monstrous growth that continues thru all 3 germ layers. composed of skin and filled with hair, glands, msl, bone, teeth, cartilage, etc
214
what is the treatment protocol for dermoid cyst
removal due to malignant potential
215
what is an endometrioma
endometrial tissue in/on ovary- blood filled cyst. can be painful or painless and may reoccur in not fully removed
216
what is the treatment choice for endometrioma
laparoscopy
217
what is an infection in the tubo-ovarian junction called
TOA: tubo-ovarian abcess
218
what causes a TOA
MC gonorrhea or chlamydia
219
what are signs/symptoms of a TOA
tubal/ovarian swelling and enlargement, pelvic pain, fever, vaginal discharge
220
what are long terms signs/symptoms of TOA and the reason for them (2)
infertility (due to scarred uterine tubes), chronic pelvic pain (due to adhesions)
221
___ is the 5th leading cancer and does not have sign/symptoms til late stages (MC age 60-65)
ovarian
222
what is the best test for ovarian cancer
US
223
what are 2 things that decrease risk of ovarian cancer
breast feeding and hormonal contraceptives
224
what are things that increase risk of ovarian cancer
fam history, nulliparity, early menarche, late menopause, fertility promoting drugs
225
what is the most common ovarian mass for newborns
small functional cyst
226
what is the most common ovarian mass for premenarchal
teratomas/dermoid
227
what are the most common ovarian masses for reproductive age
functional cyst, endometrioma, TOA, PCOS, etopic pregnancy, and teratoma
228
what must you R/O with an ovarian mass in a post-menopausal women
cancer
229
where does cervical dysplasia most commonly happen
in transitional zone
230
with bethesda classification of PAPS what are the 6 main classifications
normal, atypia, ASCUS, CIN, SIL, CIS, and cancer
231
with bethesda classification of PAPS: what does ASCUS stand for
abnormal squamous cell of undetermined significance
232
with bethesda classification of PAPS: what does CIN stand for
cervical intraepithelial neoplasm
233
with bethesda classification of PAPS: what does SIL stand for
squamous intraepithelial lesion
234
with bethesda classification of PAPS: what does CIS stand for
carcinoma in situ (precancer)
235
with bethesda classification of PAPS: what does CIN l/LGSIL stand for
cervical intraepithelial neoplasm/ low grade squamous intraepithelial lesion. there is also HG (high grade)
236
with bethesda classification of PAPS:what is the difference between CNI, CNII, and CNIII/CIS/CX and treatment
CNI- self resolve or become CNII; CNII dont go away- tx is cyrotherapy; CNIII treatment is surgery, LEEP, laser, or hystorectomy
237
what does colposcopy help view and when to use it
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
what is LEEP
a fine wire loop with electroenergy- removes tissue that can be sent to lab- good for treament and diagnosing; use anesthetic
239
what is conization
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
high risk strains of HPV can cause cancer... what about low risk strains
cause cervical changes that are less likely to be precancerous but can cause venereal warts
241
T/F: most HPV strains don't cause symptoms, are transient and resolve
true (70-90%)
242
T/F: RTIs are sexually transmitted
they may or may not be
243
T/F: most RTIs are asymptomatic
true
244
what are some examples of RTIs that are sexually transmitted
trichomoniasis, chlamydia, gonorrhea, syphillis, pediculosis pubis, HIV, HPV, HSV
245
what is pediculosis pubis
lice
246
what causes vaginitis
imbalance of normal flora
247
signs/symtpoms of vaginitis include..
itching, burning, discharge, odor, pain
248
what is the most common agents behind vaginitis
bacterial vaginosis (aka gardnerella) 40-50% and candidiasis 20-25%
249
what is the normal vaginal pH
less than 4.7 (3.8-4.5)
250
what is lactobacillus acidophilus
the normal flora in the vagina
251
is bacterial vaginitis an STI
no- due to overgrowth of normal flora
252
what causes the fishy odor assoc with bacterial vaginitis
amine induced from overgrowth of normal flora
253
clinical criteria for diagnosis of bacterial vaginitis includes 3 of 4 things
pH >4.7; (+) whiff test; (+) clue cells; homogeneous discharge
254
what are some complications that can arise with bacterial vaginitis
high reoccurance, cervicitis, pelvic inflammation disease, post surgery infection, increased risk HIV/STI, pregnancy complications
255
what is treatment for bacterial vaginitis
antibiotics (metronidazole or clindmycin)
256
what can cause atrophic vaginitis
low estrogen
257
what is candida vulvovaginitis
yeast infection due to overgrowth of fungus that lives in healthy vagina
258
what is the MC fungus that causes a yeast infection
candida albicans
259
is yeast infection/candida vulvovaginitis an STI
no
260
what are signs/symptoms of candida vulvovaginitis
pruritis, white/yellow discharge, erythema (skin red), fissures
261
how do you diagnosis candida vulvovaginitis
with a wet culture/mount
262
what are some pre-disposing factors for candida vulvovaginitis
diabetes, pregnancy, antibiotics, HIV, occlusive clothing, diet, unprotected intercourse (due to semen pH)
263
treatment of candida vulvovaginitis
antifungals (end in azole- clotrimazole or micronazole), boric acid, sitz bath, acidophilus, diet
264
what is trichomoniasis vaginalis
STI that is also assoc with presence of other STIs
265
what does trichomoniasis vaginalis infect
vagina, scene ducts, lower urinary tract
266
what are signs/symptoms of trichomoniasis
can be asymptomatic in men/women for years. classic signs are yellow/green frothy discharge, strawberry cervix, malodorous
267
how to diagnosis trichomoniasis
wet mount will show motile organism with flagella and increased PMNs
268
what are treatment options for trichomoniasis
metroridazole, tinidazole
269
what 2 STIs are bacteria, infection genital columnar epithelium and can be asymptomatic or cause cervicitis, urethritis, and PID
chlamydia and gonorrhea (=CT/GON)
270
T/F gonorrhea can cause arthritis
true
271
what are signs and symptoms of PID
cervicitis, adnexal tenderness, disturbed menses, fever, chills, increased ESR and WBC
272
what are 4 common genital ulcer causing diseases
HSV, syphillus, chancroid, and LGV
273
what is another name for HSV
herpes
274
herpes causes sores- what is type 1 vs type 2
type 1 causes cold sores (oral) and type 2 causes genital
275
primary syphilis can affect any part of body- what are some common signs/symptoms
lymphadenopathy, causes chancres (painless ulcers with clean base, indurated borders anywhere on body)
276
what is secondary syphilis signs/symptoms
called "great mimicker" causes rash, diffuse, macular, papular, combo, and patterned hair loss
277
late stages of syphilis causes..
most destructive- cardivascular and neuro symptoms and gummata (small soft swelling in connective tissue of vital organs)
278
what are some diagnostic testing you can do for syphilis
antibody testing VDRL
279
____ causes syphilis by spirochete itself
treponema pallidum
280
what causes chancroid
haemophilus ducreyi
281
s/s of chancroid
painful! causes ulcers on genitalia and associated with inguinal lyphadenitis
282
t/f chancroids can co-exist with herpes simplex or chlamydia
true
283
what is LGV
lymphogranuloma venereum
284
what causes LGV
a specific strain of chlamydia
285
s/s of LGV
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
which STI affects langerhans cells
HIV
287
if HIV left untreated will lead to...
AIDS
288
how do you diagnose HIV
antibody tests, ELISA, western blot
289
what is zidovudine
can give to pregnant women to decrease risk of transmission of HIV/AIDs to baby
290
what is another name for HPV
condyloma accuminata
291
what is another name for syphilis
condyloma lata
292
what does progesterone do that allows it to be used as a contraceptive
thickens cervical mucous and alters endometrial lining
293
what is semen's kryptonite
copper
294
T/F IUD can be used as emergency contraceptive
true
295
a non-surgical abortion Ru486 mimics what
SAB via mifepristone (antiprogestern). causes cramps nausea and bleeding
296
what is leopold's maneuver
external palpation of uterus to determine position- done every visit during pregnancy
297
signs that labor is soon includes feeling like baby dropped lower into pelvis- this is called
lightening
298
what is a significant indication of labor that does not happen with prodromal labor
cervical changes don't occur (have contractions though)
299
what is prodromal labor
false labor
300
what is amniotomy
artificial rupture of membrane
301
what is "presentation " with reference to fetopelvic relationship
part of fetus presenting to pelvic outlet
302
what is the most common "presentation" with reference to fetopelvic relationship
vertex (occiput/head first)
303
what are the 3 common "presentations" with reference to fetopelvic relationship
vertex, mentum (face), and breech (sacrum)
304
what is "attitude" with reference to fetopelvic relationship
relationship of fetus parts to each other
305
what is "denominator" with reference to fetopelvic relationship
point on presenting part used to determine position (usually occiput)
306
what is "position" with reference to fetopelvic relationship
relationship of denominator to front/back/side of mother's pelvis
307
what is the most common "position" with reference to fetopelvic relationship
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
why is LOA the most common "position"
due to liver
309
what is frank breech
bum facing outlet in pike position
310
what is the order of cardinal movements (EDIERAP)
engagement, descent, internal rotation, extension, restitution (rot 90), anterior shoulder, posterior shoulder
311
what are some signs of stage 1 labor
cervix dilation 0-10cm, 0% effacement, thinning cortex
312
at what dilation is stage 2 labor
10cm to birth (inc crowning)
313
what are signs of stage 3 labor
separation/expulsion of placenta
314
what is crowning
"ring of fire" happens during stage 2. widest part of baby's head is at the vulvar ring without retraction between contractions
315
what is turtle sign
shoulder dystocia- where shoulders are behind pelvic bone. usually use corkscrew maneuver but may cause Erb palsy
316
what is placenta previa
placenta blocking baby's escape (painless) requires c-section. causes bright red bleeding late in pregnancy
317
what is placental abruption
placenta separates from wall early- painful
318
what is pre-eclampsia signs/symptoms
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
___ can happen during labor. Very painful, MC with previous c-section
uterine rupture- tearing of uterine msl
320
there are 4 degrees of lacerations... what are they
1st: vaginal mucosa, forchette, perineal/labial skin
2nd: vaginal mucosa, bulbocaldernous msl
3rd: external anal sphincter
4th: anterior anal wall
321
what is lochia
vaginal discharge post partum
322
what are the 3 kinds of lochia
rubra (red blood- last few days); serosa (pink with serum and WBC); alba (white/brown with RBC, cervix mucous, tissue debris)
323
what are 3 depressive states following pregnancy
baby blues- 2-3days after birth
depression 2wks-6months
psychosis- less than 2 weeks- causes manic like behavior and may require therapy
324
what is diastasis recti
separation between left and right rectus abd muscles
325
T/F anemia of mother can be long term
true; screen for 4-6 weeks
326
with newborns you want to check what? (APGAR)
appearance, pulse, grimace, activity, and respiration
327
what are signs of perinatal oxygen deprevation
birth-12hrs: decreased movements, poor tone, apneic spells
12-24hrs: above jitterness and weakness
after 24hrs: brainstem signs and poor feeing
328
what does the ballard scale measure
actual age of neonate at birth determined by neuromuscular development
329
what is newborn molding
where sutures fold in on each other causing cone head shape
330
what is cephalohematoma
where there is blood between periosteum and skull (doesn't cross suture lines)
331
what is caput succeolenum
edema of scalp- crosses suture lines
332
what is craniosynostosis
premature fusion during development (will need surgeries or cranial bands)
333
what is kernicterus
brain damage that happens with babies with severe jaundice (due to hemolytic disease of newborn)
334
T/F it is normal for newborns to have jaundice
true- for 2-4days- usually occur after 24hrs
335
what is eugoryement
secondary swelling and tenderness to excess milk production. usually happens day 3-5
336
colustrum vs milk
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
estrogen during follicular phase causes ____ which leads to ovulation
LH surge
338
there are carrier tests available for what conditions
sickle cell, tay sach, thalassemias, cystic fibrosis
339
where does conception occur
fimbria or ampulla
340
when is hCG produced
once egg burrows into endometrium
341
once egg released, how long is it viable for
24hrs
342
what does hCG do to progesterone
triggers the corpus luteum to secrete progesterone past normal 14 days; secretes progesterone for 12-16 weeks until placenta takes over
343
what conditions could cause increased hCG on pregnancy test (besides pregnancy)
ovarian tumor, testicular cancer
344
s/s of septic abortion
increased bleeding, malodorous d/c, pain, fever, leukocytes
345
what is a blighted ovum
egg gets fertilized and implants but doesn't develop
346
what causes a blighted ovum
due to chromosomal abnormality (anembryonic preg)
347
what is a hydatidiform mole
occurs when there is an over production of placental cells with abnormally high hCG levels
348
what are signs/symptoms of molar pregnancy
large for gestational age, bleeding/pain, no fetal movements, more nausea than normal, no FHT
349
what are causes for SAB during 1st trimester
chromosomal abnormality, reproductive hazards
350
what are causes for SAB during 2nd trimester
incompetent cervix, uterine septum, trauma
351
hydratidiform mole increases risk for developing what
choriocarcinoma
352
prostaglandins are present in which bodily fluids
semen, menstrual blood, amniotic fluids
353
what does prostaglandins do
ripens cervix and induces constractions
354
progesterone, secreted by the corpus luteum during early pregnancy will then be secreted by the ____. helps maintain pregnancy and promotes _____ growth
placenta; breast gland
355
what is E3 (estriol)
the dominant form of estrogen throughout pregnancy
356
____ develops alveolar and glandular cells to help promote lactation and produce lactose and lipids
prolactin
357
what is the "contractor hormone" that is excreted from the posterior pituitary
oxytocin
358
what does oxytocin do
express milk, stimulate uterus, induce labor
359
what is piskacek's sign
asymmetrical enlargement of body of pregnant uterus (indicates pregnancy)
360
what is goodell's sign
cervical softening (indicates pregnancy)
361
what is hegar's sign
uterine softening (indicates pregnancy)
362
what is chadwicks sign
bluish discoloration- increased vascularity of vagina walls (indicates pregnancy)
363
____ inhibits egg maturation
progestin
364
____ preserves the corpus luteum
hCG
365
what are montgomery's tubercles and what do they do
small glands around nipples that secrete oils that lubricate and protect against infection
366
what is a common GI conditions that arises in pregnant women
cholestasis
367
define parturient
IN labor
368
define puerpera
has just given birth
369
define gravid
currently pregnant
370
define gravida
has been pregnant
371
define nulligravida
never pregnant
372
define primigravida
1st time
373
define para
carried fetus to viability
374
define primipara/multipara
carried one/multiple to viability
375
when is a diabetes screen performed
24-28weeks
376
when does the uterus become an "abdominal organ"
1st day 2nd trimester
377
when are FHT (fetal heart tones) first heard via stethoscope
20 weeks (with dopple at 12wks)
378
T/F pregnant women can travel safely at 18-32 weeks
true
379
what is anasarca
generalized edema (pitting)
380
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
gestational diabetes. S/S inc excessive thirst, hunger, fatigue
381
what are some prominent STIs that are communicable in utero (6)
syphillus, herpes (HSV), CMV, mycoplasma, HIV, HepB
382
what are some prominent STIs that are communicable via birth canal (5)
NG/CT (gonorrhea), GBS, HSV, CMV, HPV
383
how is HIV communicable to baby(3)
in utero, delivery, via breastfeeding
384
hepatosplenomegaly is a trademark sign of which STI
CMV
385
congenital form of rubella can cause what 3 serious complications/impairments
deafness, heart disease, developmental delays
386
1st sign of fetal movement is called
quickening
387
what is the "zero station"
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
what should you check for with gush ROM
check for prolapsed cord and monitor FHT
389
vernix caseosa and lanugo indicates that the baby is (older or younger)
younger
390
foot creases indicated the baby is (older or younger)
older
391
what does TORCH stand for
refers to a group of maternally acquired communicable diseases. toxoplasmosis, other (HIV, mumps, parovirus, varicella), rubella, cytomegalovirus (CMV), and herpes
