quick notes Clin med repro Flashcards
Leiomyoma
Uterine fibroids (benign)
Very common
Firm, well circumscribed mass
Pain, bleeding
Miscarriages, infertility
Pap smear
Screens for cervical cancer
Q3 after 21
Q5 after 65
Over 65, clean, 10y, no need
Q1 if abnormal
Cervical cancer
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
Ovarian cancer
BRCA 1/2 increased risk
Mostly asymptomatic
Ovarian mass
CA125 80% for mass
Ovarian mass
Cysts under 5cm benign
Larger need surg
Hyster/oophor/lymphadnectomy then chemo
Endometrial cancer
Most common GYN cancer
Post menopause
Obese, HRT, Tamoxifen
Adenocarcinoma 80%
Abnormal vaginal discharge, leukorrhea
Hyster/bilateral salpingo oophorectomy
Radiation
Irregular uterine bleeding
Mneumonic
POLICEMAN
Polyps Ovulatory dysfunction** Leiomyoma** Iatrogenic Coaguopathy Endometrial** Malignancy Adenomyosis Not classified
Menstruation
Regularity
> 38 days Infrequent
24-38 normal
<24 Frequent
Menstruation
Volume
<5ml light
5-80ml Normal
> 80 Heavy
Menstruation
Duration
<4.5 days short
4.5-8 Normal
> 8 Long
Amennorrhea
No bleeding for 90 days
Primary amenorrhea
No menarche by 15
Secondary amenorrhea
6 months no bleeding after regular cycles
Precocious Menstruation
Begins before 9
Menopause
No bleeding 12 months without cause
Post menopause bleeding
Always worked up
Polyp, hyperplasia, atrophic vaginitis, atrophy
HRT a common cause
Atrophic vaginitis
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
Contraception
Tier 1
Long term, reversible
IUD
Implant
Contraception
Tier 2
Moderately effective
Injection
Pill
Patch
Ring
Contraception
Tier 3
Least effective
Condoms Diaphragms, cap, sponge Withdrawal Timing Spermicides
Emergency contraception
Up to 120 hours after (6 days)
Copper IUD
Pills
Smoking and Contraception
No restrictions except for CHC
CHC, don’t smoke
Sexual violence
1 in 5 females
1 in 38 males
Rape
1 in 3 women / 1 in 4 men 11-17
1 in 8 women / 1 in 4 men <10
3 P’s for trafficking protection
Prevention
Prosecution
Protection
Sexual assault exam
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
STD Prophylaxis Sexual assault
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
Para Gard
Non hormonal (only IUD)
Prevents implantation
Everything except para gard stops ovulation
Emergency contraception options
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)
Reportable diseases (STD’s)
Aids/HIV
Chancroid / syphilis
Gonorrhea/chlamydia
Hep A/B
Granuloma / Lymphogranuloma
Ovarian Torsion
80% from cyst over 5cm
Usually from benign cyst
US
Surgery
Oophorectomy if recurrent
Birth control helps with prevention
More common in right
Ovarian cancer
Most fatal malignancy
High recurrence rate
Breast cancer screening
ACOG
mammogram after 40 (yearly)
Breast exam after 19 (yearly)
Bi Rads
Breast cancer nodule likelihood
1 - negative
2 benign
3 probably benign
4 suspicious
Ovarian cysts
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
Ovarian teratoma
Benign tumor (60% of benign tumors)
slow growing
can have other tissues in it
(5-10cm)
Solid ovarian mass
Benign
Surgery
Poly Cystic Ovarian Syndrome
PCOS
Common endocrine disorder
Associated with DM 2
Hirsutism, obesity, acne
Clomiphene if want kids
Depo if not
OCP for hirsutism + spironolactone
Pelvic organ prolapse
Common in women with multiple kids
Cystocele - front
Urethrocele,
Rectocele - back
Supportive tx, weight, limit strain, kegels, pessaries
Surgery
Vaginitis
Common
Pruritis, irritation, discharge
Malodorous
Candidiasis
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
Trichomonas
Protozoa STD
Pruritis, malodorous
Yellow/green/frothy
Motile flagella on scope
Flagyl (treat both partners
Bacterial Vaginosis
Gardnerella
Not STD
Malodorous, Fishy
Clue cells
Flagyl
Endometriosis
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
Galactorrhea
Milky discharge from breast
Elevated PRL
Many many causes
Check thyroid, check preg
Correct underlying condition
Mastitis (breast)
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
Breast abscess
uncommon
PO/IV abx Broad
Surg drainage last resort
if >48hrs refer to breast surg
Cellulitis (breast)
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
Acute mastitis in non lactating women
Staph or strep
3rd gen ceph
if >48hrs refer to breast surg
if >30 need follow up mammogram
Hidradenitis suppurativa
Infection of sweat glands (apocrine)
Recurrent, chronic, abscesses, scarring
Incision and drainage, (lance and pack)
Outpatient, very painful
Pain meds (opioids)
No abx needed
Nipple discharge
Bilateral not concerning
Unilateral can be linked to cancer
Bloody higher risk of cancer
Mammogram and fluid analysis
Fibrocystic breast disease
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
Fibroadenoma (breast)
Common
Benign mass
Biopsy for Dx
Excise
Phyllodes tumor (breast)
Fibroadenoma like tumor
Grows rapidly
Benign or malignant
Excise
Mets to lungs
Breast cancer
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
Paget’s (breast)
Eczematoid eruption and ulceration of nipple
Associated with adenocarcinoma
if palpable (50%), probably invasive cancer
uncommon, but frequently misdiagnosed
Inflammatory carcinoma (of breast)
Aggressive
Diffuse brawny edema with erysiploid border
Has palpable mass
35% have METs
Not Derm
Breast cancer during pregnancy or lactation
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
Bilateral breast cnacer
Rare
cancer in one breast increases risk in other
Mammography
Imaging of choice
Only screening found to reduce mortality
Use US after mammogram
MRI best of all
DX of breast cancer
requires biopsy
Fine needle safest
Core more definitive
Breast cancer labs
May see hypercalcemia
LFTs due to needing multiple meds
CBC,CMP,LFT,PREG,Tumor markers
Checking for METS in breast cancer
Not usually necessary
CT/MRI/PET
Guidelines for screening for breast cancer
ACOR
Mammogram yearly over 40
ACOG
Mammogram Q1-2 years >40, yearly >50
Breast cancer treatment
Radical mastectomy
Everything
Modified radical mastectomy
Everything except muscle and some nodes
Lumpectomy
Chemo
Hormone therapy
most common
cause of death for women during pregnancy.
postpartum haemorrhage (PPH)
AMTSL
Acute management of third stage of labor
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
Infertility, defined as
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
