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PAM Semester 4 > quick notes Clin med repro > Flashcards

quick notes Clin med repro Flashcards

1
Q

Leiomyoma

A

Uterine fibroids (benign)

Very common

Firm, well circumscribed mass

Pain, bleeding

Miscarriages, infertility

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2
Q

Pap smear

A

Screens for cervical cancer

Q3 after 21

Q5 after 65

Over 65, clean, 10y, no need

Q1 if abnormal

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3
Q

Cervical cancer

A

HPV 16,18 (most get HPV and clear it)
2nd most common, 1st most lethal

PAP for screening

Late stage, visible lesion (most are asymptomatic)

Surg, radiation, chemo

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4
Q

Ovarian cancer

A

BRCA 1/2 increased risk

Mostly asymptomatic

Ovarian mass

CA125 80% for mass

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5
Q

Ovarian mass

A

Cysts under 5cm benign

Larger need surg

Hyster/oophor/lymphadnectomy then chemo

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6
Q

Endometrial cancer

A

Most common GYN cancer

Post menopause

Obese, HRT, Tamoxifen

Adenocarcinoma 80%

Abnormal vaginal discharge, leukorrhea

Hyster/bilateral salpingo oophorectomy
Radiation

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7
Q

Irregular uterine bleeding

Mneumonic

A

POLICEMAN

Polyps
Ovulatory dysfunction**
Leiomyoma**
Iatrogenic
Coaguopathy
Endometrial**
Malignancy
Adenomyosis
Not classified
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8
Q

Menstruation

Regularity

A

> 38 days Infrequent

24-38 normal

<24 Frequent

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9
Q

Menstruation

Volume

A

<5ml light

5-80ml Normal

> 80 Heavy

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10
Q

Menstruation

Duration

A

<4.5 days short

4.5-8 Normal

> 8 Long

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11
Q

Amennorrhea

A

No bleeding for 90 days

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12
Q

Primary amenorrhea

A

No menarche by 15

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13
Q

Secondary amenorrhea

A

6 months no bleeding after regular cycles

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14
Q

Precocious Menstruation

A

Begins before 9

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15
Q

Menopause

A

No bleeding 12 months without cause

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16
Q

Post menopause bleeding

A

Always worked up

Polyp, hyperplasia, atrophic vaginitis, atrophy

HRT a common cause

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17
Q

Atrophic vaginitis

A

From decrease in estrogen

loss of thickness, elasticity

PH increases over 5 (lack of lactobacilli)
More prone to infection

irritation, itching, infection, urinary issues

White/yellow discharge

Estrogen cream, ring, tablets, suppositories

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18
Q

Contraception

Tier 1

A

Long term, reversible

IUD
Implant

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19
Q

Contraception

Tier 2

A

Moderately effective

Injection
Pill
Patch
Ring

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20
Q

Contraception

Tier 3

A

Least effective

Condoms
Diaphragms, cap, sponge
Withdrawal
Timing
Spermicides
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21
Q

Emergency contraception

A

Up to 120 hours after (6 days)

Copper IUD
Pills

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22
Q

Smoking and Contraception

A

No restrictions except for CHC

CHC, don’t smoke

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23
Q

Sexual violence

A

1 in 5 females

1 in 38 males

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24
Q

Rape

A

1 in 3 women / 1 in 4 men 11-17

1 in 8 women / 1 in 4 men <10

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25
Q

3 P’s for trafficking protection

A

Prevention
Prosecution
Protection

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26
Q

Sexual assault exam

A

White sheet / woods lamp

Swab cheeks, vaginal wall

Look for injuries

Look for sperm under microscope

Do colposcopy

Pregnancy/STD/HIV

Prophylaxis STD/Tetanus/sedatives/Pain/Hep B/Psych

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27
Q

STD Prophylaxis Sexual assault

A

Gonorrhea – Ceftriaxone 500mg + azithromycin 1 g*

Chlamydia – Azithromycin 1 g*

BV – Metronidazole 500mg BID x 7d

Trichomonas - Metronidazole 500mg BID x 7d

Hep B – if unvaccinated, give first dose (repeat at 1-2 and 4-6 months)

HIV consider retroviral prophylaxis if risk for exposure is high

Can use doxy instead of azithro if not pregnant

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28
Q

Para Gard

A

Non hormonal (only IUD)

Prevents implantation

Everything except para gard stops ovulation

29
Q

Emergency contraception options

A

Plan B 1 ppill (0.75mg)

Plan B 1 step 1 pill (1.5mg)

Ella 1 pill

COC
Ogestrel 2 pills
Lo/Ovral 4 pills
Trivora 4 pills
Aviane 5 pills

Paragard (copper IUD)

30
Q

Reportable diseases (STD’s)

A

Aids/HIV

Chancroid / syphilis

Gonorrhea/chlamydia

Hep A/B

Granuloma / Lymphogranuloma

31
Q

Ovarian Torsion

A

80% from cyst over 5cm

Usually from benign cyst

US

Surgery

Oophorectomy if recurrent

Birth control helps with prevention

More common in right

32
Q

Ovarian cancer

A

Most fatal malignancy

High recurrence rate

33
Q

Breast cancer screening

A

ACOG

mammogram after 40 (yearly)

Breast exam after 19 (yearly)

34
Q

Bi Rads

A

Breast cancer nodule likelihood

1 - negative
2 benign
3 probably benign
4 suspicious

35
Q

Ovarian cysts

A

common
Most ovarian masses are cysts

rupture doesn’t have extensive bleeding

Need biopsy/aspiration to tell if malignant

No real treatment (ruptured ones will reabsorb)

Most are asymptomatic

<3cm normal
5-7cm repeat US in 6-12w
>7 MRI/surg

CA125 unreliable

36
Q

Ovarian teratoma

A

Benign tumor (60% of benign tumors)

slow growing

can have other tissues in it

(5-10cm)

37
Q

Solid ovarian mass

A

Benign

Surgery

38
Q

Poly Cystic Ovarian Syndrome

PCOS

A

Common endocrine disorder

Associated with DM 2

Hirsutism, obesity, acne

Clomiphene if want kids
Depo if not

OCP for hirsutism + spironolactone

39
Q

Pelvic organ prolapse

A

Common in women with multiple kids

Cystocele - front
Urethrocele,
Rectocele - back

Supportive tx, weight, limit strain, kegels, pessaries
Surgery

40
Q

Vaginitis

A

Common
Pruritis, irritation, discharge
Malodorous

41
Q

Candidiasis

A

Caused by ABX, preg, DM, immune

Pruritis, thick curd discharge
No odor

KOH - hyphae, budding
PCR

-conazole’s (1, 3, 7, 14 day tx’s)
Weekly if recurrent

42
Q

Trichomonas

A

Protozoa STD

Pruritis, malodorous
Yellow/green/frothy

Motile flagella on scope

Flagyl (treat both partners

43
Q

Bacterial Vaginosis

A

Gardnerella

Not STD

Malodorous, Fishy

Clue cells

Flagyl

44
Q

Endometriosis

A

Endometrial tissue growths

Pain, infertility

Masses can rupture and bleed heavily

Rule out PID, cancer

US/MRI

Surgery/biopsy definitive
Total hysterectomy in no kids desired

NSAIDS for pain
Contraceptives to limit ovulation

45
Q

Galactorrhea

A

Milky discharge from breast

Elevated PRL

Many many causes

Check thyroid, check preg

Correct underlying condition

46
Q

Mastitis (breast)

A

pain, tender, red, fever, swell

2nd week post partum
from milk stasis/infection

Staph A.

Hypoechoic US

All purpose nipple ointment

if not better look for abscess

47
Q

Breast abscess

A

uncommon

PO/IV abx Broad

Surg drainage last resort

if >48hrs refer to breast surg

48
Q

Cellulitis (breast)

A

uncommon

Red, tender, lymphangitis

Refer to breast surg

Biopsy to rule out cancer

no labs needed

Usually Beta hemolytic strep

if >48hrs refer to breast surg

49
Q

Acute mastitis in non lactating women

A

Staph or strep

3rd gen ceph

if >48hrs refer to breast surg

if >30 need follow up mammogram

50
Q

Hidradenitis suppurativa

A

Infection of sweat glands (apocrine)

Recurrent, chronic, abscesses, scarring

Incision and drainage, (lance and pack)

Outpatient, very painful

Pain meds (opioids)

No abx needed

51
Q

Nipple discharge

A

Bilateral not concerning

Unilateral can be linked to cancer
Bloody higher risk of cancer

Mammogram and fluid analysis

52
Q

Fibrocystic breast disease

A

common
30-50y

due to estrogen imbalance

multiple, bilateral mobile masses
Tender, comes and goes

US/mammogram
Biopsy if suspicious

Home remedies
Medical - danazol and change HRT in menopausal

53
Q

Fibroadenoma (breast)

A

Common

Benign mass

Biopsy for Dx

Excise

54
Q

Phyllodes tumor (breast)

A

Fibroadenoma like tumor

Grows rapidly

Benign or malignant

Excise

Mets to lungs

55
Q

Breast cancer

A

Most common cancer in women
2nd cause of death cancer

1 in 8

No pregnancy or other cancers has higher risk

TNM scale

Found on mammograms (90%)
if palpable not painful

discharge, pain, erosion, retract, enlarge, itch
Asymmetry

56
Q

Paget’s (breast)

A

Eczematoid eruption and ulceration of nipple

Associated with adenocarcinoma

if palpable (50%), probably invasive cancer

uncommon, but frequently misdiagnosed

57
Q

Inflammatory carcinoma (of breast)

A

Aggressive

Diffuse brawny edema with erysiploid border

Has palpable mass

35% have METs

Not Derm

58
Q

Breast cancer during pregnancy or lactation

A

Occurs in first post partum year or during preg
anytime during lactation

pregnancy termination does not improve outcome

can get chemo in 2/3 trimesters
no radiation

59
Q

Bilateral breast cnacer

A

Rare

cancer in one breast increases risk in other

60
Q

Mammography

A

Imaging of choice

Only screening found to reduce mortality

Use US after mammogram

MRI best of all

61
Q

DX of breast cancer

A

requires biopsy

Fine needle safest

Core more definitive

62
Q

Breast cancer labs

A

May see hypercalcemia

LFTs due to needing multiple meds

CBC,CMP,LFT,PREG,Tumor markers

63
Q

Checking for METS in breast cancer

A

Not usually necessary

CT/MRI/PET

64
Q

Guidelines for screening for breast cancer

A

ACOR
Mammogram yearly over 40

ACOG
Mammogram Q1-2 years >40, yearly >50

65
Q

Breast cancer treatment

A

Radical mastectomy
Everything

Modified radical mastectomy
Everything except muscle and some nodes

Lumpectomy

Chemo
Hormone therapy

66
Q

most common

cause of death for women during pregnancy.

A

postpartum haemorrhage (PPH)

67
Q

AMTSL

Acute management of third stage of labor

A

Uterotonic (oxytocin)
Delayed cord clamping (1-3 mins)
CCT (Controlled Cord traction)
Post partum vigilance (assess/reassess/massage)
Oxytocin quality and supply (cool, constant)

The most important AMTSL component was the administration of a uterotonic

68
Q

Infertility, defined as

A

failure to achieve pregnancy within 12 months of unprotected intercourse or therapeutic donor insemination in women younger than 35 years or within 6 months in women older than 35 years,
affects up to 15% of couples

PAM Semester 4 (7 decks)

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