OGG all notes Flashcards
when is the best time to do a CBE (clinical breast exam)
5 days post menses
where are the breasts located
between ribs 2-6 and between the sternal edge and midaxillary line
what is the “tail” of the breast that must be included on the exam
UOQ to axilla
which lymph nodes must be included?
cervical, axillary, and super/infra-clavicular
what is the infra-mammary line and why is it important
where the breast lies on the ribs- a common fibrous area due to bras
what is mastalgia
pain/tenderness of the breast
T/F: mastalgia is most common during menopause
false- pre-menopause MC
what are some causes of mastalgia?
hormones, trauma, PMS, infection, (cancer-5%-rare)
is mastalgia cyclical?
it can be cyclical or non-cyclical
what treatments are there for mastalgia
hormone treatment can be done though it could increase symptoms.
T/F: 60-80% of mastalgia cases self remiss
yes
if over 35 and having mastalgia, what is the next step?
consider mamogram
if under 35 with mastalgia and normal CBE, what is next
usually they are OK- watch and wait
10% of women have this benign condition of the breasts
fibroadenoma
describe fibroadenoma
composed of fibrous stroma, size change with cycle, rubbery, firm, smooth, round, mobile, painLESS
___% of fibroadenoma have multiple lesions
20%; some multilobulated also
T/F: fibroadenoma tend to decrease in size over time
true
what is the MC age range for fibroadenoma
15-50yo
tests for fibroadenoma include: (4)
CBE, mammogram, US, needle biopsy
what is the treatment options for fibroadenoma
surgical excision or watch/wait
what 2 conditions are the most common benign causes of breast lumps and occur within the age range of 15-50
fibroadenoma and simple cyst
what is a difference in fibroadenoma and a simple cyst that you would find on CBE
fibroadenoma are painLESS and simple cysts are TENDER
T/F: simple cysts fluctuate cyclically
true
describe simple cyst
fluid filled, soft yet firm, mobile, well circumscribed, unilateral or bilateral, and TENDER
what is a simple cyst hard to ddx from
a solid mass
what tests are used to dx a simple cyst?
mammogram, US, fine needle aspiration
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
60% of women get this common, non-cancerous condition
fibrocystic breast changes
where are fibrocystic breast changes likely to occur
upper outer quadrant (UOQ)
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
what is the main cause of fibrocystic breast changes?
increased estrogen, decreased progesterone. Usually resolved with menopause
T/F: if a mass does not decrease with menses, it should be evaluated sooner
true
what is a good thing to avoid as it increases estrogen and can cause more breast conditions
methylxanthines (coffee, tea, chocolate, etc)
benefits of vitamin E?
relieves PMS symptoms and normalizes hormones
what is mastitis
an infection seen during lactation or when skin disrupted
s/s of mastitis include
fever, localized erythema, pain, induration, N/V, malaise
what is the etiology of mastitis
s. aures, s. epidermis, strep
risk factors for getting mastitis
breast feeding, trauma, breast augmentation
when is the MC time to get mastitis
in the first 2-4 weeks postpartum
T/F: mastitis can become chronic
true
what does chronic mastitis lead to
abcess and nipple retraction
what is galactocele
a blocked duct
when does galactocele happen
usually after lactation
s/s of galactocele
tender/enlarged
tx for galactocele
excise and drain
is nipple discharge (d/c) more commonly associated with benign or maligant disease
benign (10-15%) vs 3-11% maligant
what are some common characteristics of benign nipple discharge
usually bilateral, needs stimulation, multiduct involvement
what are some common characteristics of pathological nipple discharge
usually unilateral, spont./intermittent, can be any kind of d/c (green, grey, blood, etc)
what is a common cause of serous nipple d/c
hormones
MC pathological (but benign) cause of nipple discharge
intraductal papilloma
what is galactorrhea
inappropriate lactation in nonpuerperal (non-lactating) women
s/s of galactorrhea
unilateral or bilateral with milk d/c
MC causes of galactorrhea is
increased prolactin levels due to pituitary tumor (would dx with CT)
what are other causes of galactorrhea besides a pituitary tumor
increased estrogen, psychotropic meds, afferent nerve stim, primary hypothyroidism (usually w/amenorrhea)
what is intraductal papilloma
increased papillary growth in lactiferous duct. #1 cause of nipple d/c (bloody or serous)
T/F tx of intraductal papilloma is to watch and wait
false- surgical excision because of tendency to grow
T/F breast feeding not altered if under 3 ducts are removed
true
what condition is caused by s. aureus and recurrent in women with inverted nipples
subareolar abcess
tx for subareolar abcess includes?
antibiotics, drainage, and duct excision
nipple piercings increase your chance of getting what condition
subareolar abscess
what are the stats on breast cancer
1 in women and 1/3 die from it. (lung cancer has most deaths)
what is the most common age for breast cancer
40-55
how and when is screening for breast cancer started?
mammogram 1-2yrs with or without CBE starting at age 40
what is the most common testing sequence for breast exam
mammogram, US, biopsy
what is the problem with mammograms
can give false (+)- though less in annual screens only and radiation exposure
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
US is ineffective in screening for breast _____ but can detect ___ vs ____
ineffective- breast carcinoma, but can detect fluid filled vs solid mass.
what is the difference between fluid filled vs solid mass in breasts
fluid usually benign while solid has malignant potential
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
what is needle aspiration used for
evaluate fluid filled lesions. if bloody get biopsy or if cyst reoccurs within 2 weeks after aspiration
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
T/F: 90% of breast cancer cases have no primary relative with history
true; 75% have no major risk factors!!
s/s of breast cancer
firm/hard mass, irreg contour, immobile, unilateral
late stages of breast cancer s/s
skin/nipple retraction, tenderness, axillary lymphadenopathy, erythema, edema, pain, fatigue
“peau d’orange”
s/s of pagets disease of the breast (adenocarcinoma)
itching/burning skin or nipple, erythema, rash, ulceration
*easy to misdiagnose as dermatitis
what is pagets disease of the breast easily mis-diagnosed as?
dermatitis
T/F: omega 6 fats increase risk of breast cancer
true
T/F: vitamin D helps decrease risk of breast cancer
true
average # of days in menses cycle
21-35 with 7 day flow (ave 3-5)
how many ml/period is average?
80
what is considered day “one” of menses
menses marks day one
what does day 14 of menses mark
ovulation
days 1-14 of menses cycle is considered what phase
follicular
days 14-30 of menses cycle are considered what phase
luteal
the follicular phase is considered the (proliferation/secretory) phase while luteal is considered the (proliferation/secretory) phase
follicular= proliferation; luteal= secretory
GnRH is from what gland
the hypothalamus
GnRh simulates the release of __ and ___ from the ant. pituitary
FSH and LH
what 2 hormones does the ant pituitary release
FSH and LH
what does LH stimulate? (2)
androgen and progesterone (ovulation)
what does FSH stimulate?
etrogen (E2) estradiol
what are s/s of increased estrogen
dysmenorrhea, nausea, edema, menorrhagia, enlarged uterus, uterine fibroids, fibrocyctic breast changes
what are s/s of decreased estrogen
scant menses, mid cycle spotting
T/F: s/s of decreased progesterone are those you would suspect to see in pregnant women
false (increased progesterone)
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
what are s/s of decreased progesterone
prolonged menses, heavy menses, cramps, luteal/break-though bleeding
s/s of decreased progesterone are those you’d see in what other conditions
endometriosis, adenomyosis, endometrial hyperplasia, anovulatory cycles
what are some examples of abnormal bleeding (HINT: cycles (4))
<21 days
>35 days
>7 days menses
spotting
T/F: bleeding post-menopause, though rare, is not clinically important
false- red flag!!
define menorrhagia
hypermenorrhea (heavy flow)
what can cause menorrhagia
pregnancy, infection (STI), uterine fibroids, polyps, hypothyroidism (very common), neoplasm, or dysfunctional uterus
define metrorrhagia
intramenorrhea (breakthru bleeding/ spotting)
define menometrorrhagia
profuse bleeding during menses and between periods
define polymenorrhea
menses with increased frequency (periods <21 days apart
define amenorrhea
absent or abnormal menses present for more than 3 months
define oligomenorrhea
scant menses- periods that occure more than 35 days apart
define dysmenorrhea
painful menses
what are some reasons for contact bleeding
cervical cancer, cervicitis (CT/GON), or period starting
what is mittleschmertz
pain with ovulation (middle of the month pain) typically unilateral (front or back)
define dyspareunia
painful intercourse
____ when chronic will see thick yellow discharge with no bacterial etiology (acute related to STI)
cervicitis
what are some other causes for acture cervicitis other than STI
cervical trauma, polyps, cancer
how would you diagnosis cerviticitis
pap smear and/or biopsy
what are the 2 most common uterine disorders
polyps and fibroids
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.
adenomyosis is assoc with what s/s
painful menses and enlarged uterus, dysmenorrhea
how would you diagnosis adenomyosis,
pelvic US (looks at thickness of endometrial stripe), hysteroscopy, and EMB (endometrial biopsy)
when are common times to get an EMB (endometrial biopsy)
when abnormal bleeding present, post menopause bleeding, or fertility issues
when would you diagnose with dysfunctional uterine bleeding (DUB)
use if all tests normal (more dx by exclusion)
dysfunctional uterine bleeding is associated with type of cycles
anovulatory- can be long or short
what is the main cause of DUB
overgrowth of the endometrium
what causes overgrowth of the endometrium in DUB
estrogen stimulation without progesterone to stabilize
what are some treatment options for DUB
diet, exercise, botanicals, NSAIDS, progesterone, Lupron, hysteroscopy/ectomy or ablation (destrowed)
what are other names for uterine fibroids
leiomyomata, leiomyoma, fibromyoma, myoma
what is the most common solid tumor in women (most of them are benign) - 25-50% women get it
uterine fibroids
____ causes overgrowth of muscle and CT in walls of uterus and MC indication for surgery (30% of hystorectomies)
uterine fibroids
what are some predisposing factors/ increased risks for uterine fibroids
increase with age (35-45), african descent, genetic, hormones (increased estrogen), no children (nulliparous)
what are characteristics of uterine fibroids
firm (soft to hard), irregular, enlarged uterus, smooth/rounded, non-tender
what must you make sure to rule out first with all uterus conditions
pregnancy
T/F: most women will be asymptomatic with uterine fibroids
true
what are s/s that may be felt with uterine fibroids
pressure, bloat, constipation, fatigue, urinary abnormalities, cramping, back ache, infertility
what is a malignant condition related to <1% of uterine fibroids
leiomyosarcomas (cancer)
infertility is a side effect with uterine fibroids- what % risk?
2-10%
how do you diagnose uterine fibroids
with US
what are 3 surgery options for uterine fibroids
hysterectomy (remove completely), myomectomy (partial), or embolization (preserves uterus)
what is the downside to getting a myomectomy as tx for uterine fibroids
25% have to have repeat surgery due to reoccurance
what is the downside of getting an embolization as tx for uterine fibroids?
causes cramping and scar tissue
adenomyosis is most common in women who …. around age…
parous- have had children and age 35-50
tx options for adenomyosis
progesterone, diet, exercise, ablation, hysterectomy
what are risk factors for endometrial carcinoma
age 50-70, hyperplasia, unopposed estrogen, obesity, family hx
what are factors that help decrease risk of endometrial carcinomas
BC pills, pregnancy, early menopause
what are s/s of endometrial carcinomas
postmenopausal bleeding, postmenopausal PAP with presence of endometrial cells
how would you dx endometrial carcinomas (blood work)
hCG, CBC, serum iron and ferritin, TSH, and free T4
what test is best to ddx endometrial carcinomas from hyperplasia
endometrial sampling
what treatment is there for endometrial carcinomas/hyperplasia
progesterone (remember- unopposed estrogen is main factor)
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?)
what is the management protocol for acute pelvic pain
refer (ER or urgent)
when does pelvic pain become chronic
lasts longer than 6mo
what age group most commonly gets chronic pelvic pain?
20-35yo
T/F: chronic pelvic pain is a dx by exclusion
true
what is the most common cause of chronic pelvic pain
endometriosis
what are treatment options for chronic pelvic pain
hysterectomy or laparoscopies
what are some tests for chronic pelvic pain
CBC, ESR, STI DNA, UA, PAP
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
what are s/s of an SAB (spont abortion)
crampy, intermittent vaginal bleeding
T/F: with SAB there will show increased WBC and ESR
true
what are s/s of an etopic pregnancy
unilateral adnexal mass, continuous cramping, vaginal bleeding, pain (s/s of pregnancy)
how do you dx an etopic pregnancy
with decreased hCG levels and US (will have normal WBC/ESR)
what are risks of an etopic pregnancy
hemorrhage, death, future infertility, increased risk complications
SAB is loss of fetus before ___ weeks gestation
20
a threatened aborting will cause spotting/bleeding, but what won’t be present
signficant cramps or clots
an inevitable abortion causes what s/s
heavy bleeding, cramps, decreased hCG, cervical dilation, and “rom”
what is a complete abortion vs missed abortion
complete = all POC expelled; missed= death of embryo with retained POC
how many abortions must one have for it to be considered habitual
3 successive pregnancy losses
what are s/s of cervicitis
dull, aching, radiates, vaginal d/c
s/s of tubo-ovarian abcess (TOA)
dull, dyspareunia
OV torsion s/s
sudden, crampy, continuous, nausea/vomiting
s/s ruptured cyst
sudden onset, unilateral, sharp
s/s cystitis
dysuria, freq, urgency, flank pain
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
what is endometriosis
a progressive disease where there is presence of endometrial glands and stroma outside the uterus
what is the #1 cause of chronic pelvic pain
endometriosis
what percentage of women get endometriosis and what is the common age range
15% age 25-30
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
what are s/s of endometriosis
pelvic pain, dyspareunia, infertility (asymp- discovered on workup), leg/LB pain, severe dysmenorrhea, irreg/heavy menstruation
how do you diagnose endometriosis
visual, biopsy, *laparoscopy=gold standard
what will be present on laparoscopy if patient has endometriosis
blue-grey “powder” burned lesions
what are treatment options for endometriosis
manage symptoms: NSAIDS, endocrine therapy, surgery
what is primary dysmenorrhea vs secondary
primary is without underlying pathology- dx by exclusion while secondary has underlying cause
if dysmenorrhea is severe, what could be causing it? (4 examples)
endometriosis, uterine fibroids, tumors, infection
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
what 2 treatments for dysmenorrhea have a high effective rate? (~90%)
birth control and exercise
women with dysmenorrhea make 8-13x more ______
prostoglandin
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
what is PMS
Premenstrual syndrome: pain symptoms during luteal phase
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)
what is the criteria for dx of PMDD (must have 1 of the 4)
depression; anxiety/tension; anger/irritable; affective liability
what is PMM
premenstrual magnification: symptoms never go away and increase during luteal phases
what is primary amenorrhea
having no secondary sex characteristics by age 14, no menses by age 16
what causes primary amenorrhea
CNS, hymen membrane block, hypoglycemia, obesity, thyroid, anemia
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
what are long term effects of hypoestrogenic
decrease bone density which leads to increased risk of: osteoporosis, dyslipidemia, breast cancer
what are long term effects of hyperestrogenic
abnormal lipid levels, DM, obesity, breast cancer, endometrial hyperplasia
what does progesterone challenge test help dx
PCOS
when would one suffer from amenorrhea due to exercise?
body fat below 15-19% (BMI <18)
often includes nutrition deficiency
what is premature ovarian failure
menopause before 40
what causes premature ovarian failure
autoimmune disorder, chemo, family history, surgical removal, chromosomes (fragile X or Turners)
what is PCOS
polycystic ovarian syndrome
are polycystic ovaries required for dx of PCOS
no
what is the criteria for PCOS (3)
oligomenorrhea; hyperandrogenism; dx by exclusion
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)
what is alopecia
patterned hair loss
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
what are treatment options for PCOS
progesterone, (metformin, spironolactone)
what are complications of ovarian neoplasms
can be malignant (or benign), cause torsion, infection, hemorrhage
are ovarian neoplasms solid or fluid filled
can be either
____ are benign and the most common ovarian masses
functional cysts
what are the 3 types of functional cysts
follicular (MC), corpus luteum (most clinically important) and theca lutein cysts (rare)
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
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
what causes a theca lutein cyst (functional cyst)
due to prolonged or increased stimulation of ovaries by endo/exogenous. resolve spontaneously
what are signs/symptoms of functional cysts
usually asymptomatic or have dull pain/pressure
what is another name for teratoma
dermoid cyst; adnexal calcification (50%)
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
what is the treatment protocol for dermoid cyst
removal due to malignant potential
what is an endometrioma
endometrial tissue in/on ovary- blood filled cyst. can be painful or painless and may reoccur in not fully removed
what is the treatment choice for endometrioma
laparoscopy
what is an infection in the tubo-ovarian junction called
TOA: tubo-ovarian abcess
what causes a TOA
MC gonorrhea or chlamydia
what are signs/symptoms of a TOA
tubal/ovarian swelling and enlargement, pelvic pain, fever, vaginal discharge
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)
___ is the 5th leading cancer and does not have sign/symptoms til late stages (MC age 60-65)
ovarian
what is the best test for ovarian cancer
US
what are 2 things that decrease risk of ovarian cancer
breast feeding and hormonal contraceptives
what are things that increase risk of ovarian cancer
fam history, nulliparity, early menarche, late menopause, fertility promoting drugs
what is the most common ovarian mass for newborns
small functional cyst
what is the most common ovarian mass for premenarchal
teratomas/dermoid
what are the most common ovarian masses for reproductive age
functional cyst, endometrioma, TOA, PCOS, etopic pregnancy, and teratoma
what must you R/O with an ovarian mass in a post-menopausal women
cancer
where does cervical dysplasia most commonly happen
in transitional zone
with bethesda classification of PAPS what are the 6 main classifications
normal, atypia, ASCUS, CIN, SIL, CIS, and cancer
with bethesda classification of PAPS: what does ASCUS stand for
abnormal squamous cell of undetermined significance
with bethesda classification of PAPS: what does CIN stand for
cervical intraepithelial neoplasm
with bethesda classification of PAPS: what does SIL stand for
squamous intraepithelial lesion
with bethesda classification of PAPS: what does CIS stand for
carcinoma in situ (precancer)
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)
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
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
what is LEEP
a fine wire loop with electroenergy- removes tissue that can be sent to lab- good for treament and diagnosing; use anesthetic
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
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
T/F: most HPV strains don’t cause symptoms, are transient and resolve
true (70-90%)
T/F: RTIs are sexually transmitted
they may or may not be
T/F: most RTIs are asymptomatic
true
what are some examples of RTIs that are sexually transmitted
trichomoniasis, chlamydia, gonorrhea, syphillis, pediculosis pubis, HIV, HPV, HSV
what is pediculosis pubis
lice
what causes vaginitis
imbalance of normal flora
signs/symtpoms of vaginitis include..
itching, burning, discharge, odor, pain
what is the most common agents behind vaginitis
bacterial vaginosis (aka gardnerella) 40-50% and candidiasis 20-25%
what is the normal vaginal pH
less than 4.7 (3.8-4.5)
what is lactobacillus acidophilus
the normal flora in the vagina
is bacterial vaginitis an STI
no- due to overgrowth of normal flora
what causes the fishy odor assoc with bacterial vaginitis
amine induced from overgrowth of normal flora
clinical criteria for diagnosis of bacterial vaginitis includes 3 of 4 things
pH >4.7; (+) whiff test; (+) clue cells; homogeneous discharge
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
what is treatment for bacterial vaginitis
antibiotics (metronidazole or clindmycin)
what can cause atrophic vaginitis
low estrogen
what is candida vulvovaginitis
yeast infection due to overgrowth of fungus that lives in healthy vagina
what is the MC fungus that causes a yeast infection
candida albicans
is yeast infection/candida vulvovaginitis an STI
no
what are signs/symptoms of candida vulvovaginitis
pruritis, white/yellow discharge, erythema (skin red), fissures
how do you diagnosis candida vulvovaginitis
with a wet culture/mount
what are some pre-disposing factors for candida vulvovaginitis
diabetes, pregnancy, antibiotics, HIV, occlusive clothing, diet, unprotected intercourse (due to semen pH)
treatment of candida vulvovaginitis
antifungals (end in azole- clotrimazole or micronazole), boric acid, sitz bath, acidophilus, diet
what is trichomoniasis vaginalis
STI that is also assoc with presence of other STIs
what does trichomoniasis vaginalis infect
vagina, scene ducts, lower urinary tract
what are signs/symptoms of trichomoniasis
can be asymptomatic in men/women for years. classic signs are yellow/green frothy discharge, strawberry cervix, malodorous
how to diagnosis trichomoniasis
wet mount will show motile organism with flagella and increased PMNs
what are treatment options for trichomoniasis
metroridazole, tinidazole
what 2 STIs are bacteria, infection genital columnar epithelium and can be asymptomatic or cause cervicitis, urethritis, and PID
chlamydia and gonorrhea (=CT/GON)
T/F gonorrhea can cause arthritis
true
what are signs and symptoms of PID
cervicitis, adnexal tenderness, disturbed menses, fever, chills, increased ESR and WBC
what are 4 common genital ulcer causing diseases
HSV, syphillus, chancroid, and LGV
what is another name for HSV
herpes
herpes causes sores- what is type 1 vs type 2
type 1 causes cold sores (oral) and type 2 causes genital
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)
what is secondary syphilis signs/symptoms
called “great mimicker” causes rash, diffuse, macular, papular, combo, and patterned hair loss
late stages of syphilis causes..
most destructive- cardivascular and neuro symptoms and gummata (small soft swelling in connective tissue of vital organs)
what are some diagnostic testing you can do for syphilis
antibody testing VDRL
____ causes syphilis by spirochete itself
treponema pallidum
what causes chancroid
haemophilus ducreyi
s/s of chancroid
painful! causes ulcers on genitalia and associated with inguinal lyphadenitis
t/f chancroids can co-exist with herpes simplex or chlamydia
true
what is LGV
lymphogranuloma venereum
what causes LGV
a specific strain of chlamydia
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
which STI affects langerhans cells
HIV
if HIV left untreated will lead to…
AIDS
how do you diagnose HIV
antibody tests, ELISA, western blot
what is zidovudine
can give to pregnant women to decrease risk of transmission of HIV/AIDs to baby
what is another name for HPV
condyloma accuminata
what is another name for syphilis
condyloma lata
what does progesterone do that allows it to be used as a contraceptive
thickens cervical mucous and alters endometrial lining
what is semen’s kryptonite
copper
T/F IUD can be used as emergency contraceptive
true
a non-surgical abortion Ru486 mimics what
SAB via mifepristone (antiprogestern). causes cramps nausea and bleeding
what is leopold’s maneuver
external palpation of uterus to determine position- done every visit during pregnancy
signs that labor is soon includes feeling like baby dropped lower into pelvis- this is called
lightening
what is a significant indication of labor that does not happen with prodromal labor
cervical changes don’t occur (have contractions though)
what is prodromal labor
false labor
what is amniotomy
artificial rupture of membrane
what is “presentation “ with reference to fetopelvic relationship
part of fetus presenting to pelvic outlet
what is the most common “presentation” with reference to fetopelvic relationship
vertex (occiput/head first)
what are the 3 common “presentations” with reference to fetopelvic relationship
vertex, mentum (face), and breech (sacrum)
what is “attitude” with reference to fetopelvic relationship
relationship of fetus parts to each other
what is “denominator” with reference to fetopelvic relationship
point on presenting part used to determine position (usually occiput)
what is “position” with reference to fetopelvic relationship
relationship of denominator to front/back/side of mother’s pelvis
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
why is LOA the most common “position”
due to liver
what is frank breech
bum facing outlet in pike position
what is the order of cardinal movements (EDIERAP)
engagement, descent, internal rotation, extension, restitution (rot 90), anterior shoulder, posterior shoulder
what are some signs of stage 1 labor
cervix dilation 0-10cm, 0% effacement, thinning cortex
at what dilation is stage 2 labor
10cm to birth (inc crowning)
what are signs of stage 3 labor
separation/expulsion of placenta
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
what is turtle sign
shoulder dystocia- where shoulders are behind pelvic bone. usually use corkscrew maneuver but may cause Erb palsy
what is placenta previa
placenta blocking baby’s escape (painless) requires c-section. causes bright red bleeding late in pregnancy
what is placental abruption
placenta separates from wall early- painful
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)
___ can happen during labor. Very painful, MC with previous c-section
uterine rupture- tearing of uterine msl
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
what is lochia
vaginal discharge post partum
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)
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
what is diastasis recti
separation between left and right rectus abd muscles
T/F anemia of mother can be long term
true; screen for 4-6 weeks
with newborns you want to check what? (APGAR)
appearance, pulse, grimace, activity, and respiration
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
what does the ballard scale measure
actual age of neonate at birth determined by neuromuscular development
what is newborn molding
where sutures fold in on each other causing cone head shape
what is cephalohematoma
where there is blood between periosteum and skull (doesn’t cross suture lines)
what is caput succeolenum
edema of scalp- crosses suture lines
what is craniosynostosis
premature fusion during development (will need surgeries or cranial bands)
what is kernicterus
brain damage that happens with babies with severe jaundice (due to hemolytic disease of newborn)
T/F it is normal for newborns to have jaundice
true- for 2-4days- usually occur after 24hrs
what is eugoryement
secondary swelling and tenderness to excess milk production. usually happens day 3-5
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
estrogen during follicular phase causes ____ which leads to ovulation
LH surge
there are carrier tests available for what conditions
sickle cell, tay sach, thalassemias, cystic fibrosis
where does conception occur
fimbria or ampulla
when is hCG produced
once egg burrows into endometrium
once egg released, how long is it viable for
24hrs
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
what conditions could cause increased hCG on pregnancy test (besides pregnancy)
ovarian tumor, testicular cancer
s/s of septic abortion
increased bleeding, malodorous d/c, pain, fever, leukocytes
what is a blighted ovum
egg gets fertilized and implants but doesn’t develop
what causes a blighted ovum
due to chromosomal abnormality (anembryonic preg)
what is a hydatidiform mole
occurs when there is an over production of placental cells with abnormally high hCG levels
what are signs/symptoms of molar pregnancy
large for gestational age, bleeding/pain, no fetal movements, more nausea than normal, no FHT
what are causes for SAB during 1st trimester
chromosomal abnormality, reproductive hazards
what are causes for SAB during 2nd trimester
incompetent cervix, uterine septum, trauma
hydratidiform mole increases risk for developing what
choriocarcinoma
prostaglandins are present in which bodily fluids
semen, menstrual blood, amniotic fluids
what does prostaglandins do
ripens cervix and induces constractions
progesterone, secreted by the corpus luteum during early pregnancy will then be secreted by the ____. helps maintain pregnancy and promotes _____ growth
placenta; breast gland
what is E3 (estriol)
the dominant form of estrogen throughout pregnancy
____ develops alveolar and glandular cells to help promote lactation and produce lactose and lipids
prolactin
what is the “contractor hormone” that is excreted from the posterior pituitary
oxytocin
what does oxytocin do
express milk, stimulate uterus, induce labor
what is piskacek’s sign
asymmetrical enlargement of body of pregnant uterus (indicates pregnancy)
what is goodell’s sign
cervical softening (indicates pregnancy)
what is hegar’s sign
uterine softening (indicates pregnancy)
what is chadwicks sign
bluish discoloration- increased vascularity of vagina walls (indicates pregnancy)
____ inhibits egg maturation
progestin
____ preserves the corpus luteum
hCG
what are montgomery’s tubercles and what do they do
small glands around nipples that secrete oils that lubricate and protect against infection
what is a common GI conditions that arises in pregnant women
cholestasis
define parturient
IN labor
define puerpera
has just given birth
define gravid
currently pregnant
define gravida
has been pregnant
define nulligravida
never pregnant
define primigravida
1st time
define para
carried fetus to viability
define primipara/multipara
carried one/multiple to viability
when is a diabetes screen performed
24-28weeks
when does the uterus become an “abdominal organ”
1st day 2nd trimester
when are FHT (fetal heart tones) first heard via stethoscope
20 weeks (with dopple at 12wks)
T/F pregnant women can travel safely at 18-32 weeks
true
what is anasarca
generalized edema (pitting)
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
what are some prominent STIs that are communicable in utero (6)
syphillus, herpes (HSV), CMV, mycoplasma, HIV, HepB
what are some prominent STIs that are communicable via birth canal (5)
NG/CT (gonorrhea), GBS, HSV, CMV, HPV
how is HIV communicable to baby(3)
in utero, delivery, via breastfeeding
hepatosplenomegaly is a trademark sign of which STI
CMV
congenital form of rubella can cause what 3 serious complications/impairments
deafness, heart disease, developmental delays
1st sign of fetal movement is called
quickening
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)
what should you check for with gush ROM
check for prolapsed cord and monitor FHT
vernix caseosa and lanugo indicates that the baby is (older or younger)
younger
foot creases indicated the baby is (older or younger)
older
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
