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PCM 4 > Repro > Flashcards

Repro Flashcards

1
Q

beta-hCG value of 2000 milli-units/mL or more can be indicative of an ____.
What test is gold standard to determine this - and what results indicative?

A

ectopic pregancy

If no products of conception are detected within the uterine cavity by transvaginal ultrasound (gold standard radiology in this case).

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2
Q

ACE inhibitors are contraindicated in what type of female?

A

pregnant

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3
Q

All are DDx of what?

  1. Ectopic Pregnancy
  2. Aborting uterine pregnancy/hydatidiform mole
  3. Ovarian Torsion
  4. Ovarian cyst
  5. Appendicitis
  6. Urinary tract calculi
  7. Endometriosis
  8. Adhesions/obstruction
  9. PID
  10. IBD (CD)
A

RLQ abdominal pain in F

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4
Q

What is the GPA system? GTPAL?

A

Gravida/Para/Abortus

Gravida/Term/Para/Abortus/Live

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5
Q

Failure of serum hCG to ____ every two days indicates possibly what?

A

fails to double, ectopic pregancy

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6
Q

Abdominal distention and mild paralytic ileus are often present in ___

A

ectopic pregnancy

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7
Q

what type of ectopic pt?

3.5 cm in largest dimension and unruptured, with no active bleeding and no fetal heart tones.

A

stable

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8
Q

**Tx of stable v. unstable ectopic pregancy pt.

A

Stable, tx with methotrexate. Unstable = surgery!

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9
Q

**Methotrexate is CI in what pt?

A

UNstable ectopic pregnancy!

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10
Q

Initial surgical procedure in ectopic pregnancy.

A

diagnostic laparoscopy

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11
Q

**When should Rho(D) IMMUNE THERAPY be given to pts?

A

if they are Rh(-)

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12
Q

OA and AA, S2-S4 pelvic splanchnic are PSNS reflexes for ___ and ___

A

Ovaries and testes

S2-4 for uterus/prostate/genitalia

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13
Q

T10-L2 is SNS for __ and __

A

uterus and cervix

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14
Q 
What is this? 
Chronic anovulation (irregular periods: amenorrhea to menorrhagia)
Hyperandrogenism (hirsutism)
Polycystic ovaries
Obese woman with Hyperlipidemia
A

PCOS

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15
Q

Increased risk of what three things if a woman has PCOS.

A

Increased risk of DM2 (insulin resistance), CVD, and metabolic syndrome

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16
Q

What drug is beneficial for PCOS?

A

methotrexate

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17
Q

PID, IUD, smoking at the time of conception, previous C-section - all are risk factors for…

A

ectopic pregnancy

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18
Q

When do you give whole blood?

A

can consider in trauma, when needs all components including clotting factors

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19
Q

When do you give PRBC?

A

Usually the first choice for transfusion due to decreased risk of reaction as compared to whole blood

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20
Q

What is endometriosis?

A

ECTOPIC ENDOMETRIAL TISSUE

21
Q

99% of women with endometriosis associated pelvic pain who report sx before 15 (and before 20.2years) also had what?

A

dysmeorrhea

22
Q

Endometriosis is associated iwth higher incidence of what sensitivity?

A

multiple allergic sensitivities

23
Q

What SD should prompt you to look further into pelvic/endometriosis related dz?

A

Extended lumbar type II dysfunctions are frequently the product of segmental muscle contraction that results from a viscerosomatic reflex and should prompt the search for visceral disease and dysfunction

24
Q

What sx indicate possible endometriosis rupture?

A

abrupt increase in severity and radiation

25
Q

Women who have a sister or mother with endometriosis are more likely to have _____ endometriosis.

A

severe rather

than mild or moderate

26
Q

The genetic predisposition for endometriosis is more

consistent with ______ than with a single mutant gene

A

polygenic and multifactorial inheritance

27
Q

Ruptured ovarian cysts may mimic ovarian malignancy bc…

A

It causes extremely high serum CA-125

28
Q

In a patient suffering from hemoperitoneum, active bleeding as depicted on CT by the active ____ with a measured attenuation value higher than that of free or clotted blood is indicative _____.

A

arterial extravasation of intravenous contrast

of the need for prompt surgical intervention

29
Q 
Sx for...
DYSMENORRHEA
- PELVIC PAIN
o DUE TO INTRAPELVIC BLEEDING AND PERIUTERINE ADHESIONS
- MENORRHAGIA
- HORMONE DEPENDENT
- DYSPAREUNIA
- LUMBAGO
- RECTAL PAIN
- DYSCHEZIA
- INFERTILITY
- INCREASED ALLERGIC REACTIONS
- POSITIVE FAMILY HISTORY
A

endometriosis

30
Q

exam findings for endometriosis

A 
BEST PERFORMED DURING EARLY MENSES
- PELVIC TENDERNESS
- NODULES FOUND ON BIMANUAL EXAM
o ON UTEROSACRAL LIGAMENT
o IN POSTERIOR CUL-DE-SAC
- DECREASED UTERINE MOBILITY/RETROVERSION
- TENDER/FIXED NODULAR ADNEXAL MASSES
- OSTEOPATHIC FINDINGS
o SOMATIC DYSFUNCTION LUMBAR SPINE
o CHAPMAN’S POINTS
- LESS COMMON - HEMORRHAGIC CYSTS OBSERVED ON CERVIX
31
Q

Endometriomas look like what on transvaginal sono?

A

homogenous cysts

32
Q

Best way to dx endometriosis

A

surgical confirmation - laparoscopic biospy and visual lesions.

33
Q

what are the classic visual and biopsy findings in endometriosis?

A

Biopsy - endometrial glands and stroma

Visual - black powder burns

34
Q

Potential complications of endometriosis

A

PROGRESSIVELY WORSENING COURSE

o IMPLANTS SPREAD TO PELVIS, GI TRACT, URINARY TRACT, ILIOPSOAS MUSCLES, LUMBAR SPINE

35
Q

What is the coelom?

A

CAVITY BETWEEN SPLANIC AND SOMATIC MESODERM IN THE EMBRYO FORMS THE LINING OF THE GENERAL BODY CAVITY IN THE ADULT DERIVES FROM MESOTHELIUM

36
Q

how is coelomic metaplasia of multipotential cells in the peritoneal cavity a possible etiology of endometriosis?

A
  • A single layer of flattened cells forming an epithelium that lines serous cavities; e.g., peritoneum, pleura, pericardium
  • From which Mullerian ducts and endometrium originate
37
Q

How is metaplasia a possible etiology of endometriosis?

Most common etiology of etiology is retrograde flow*

A

MESONEPHRIC REMNANTS MAY UNDERGO ENDOMETRIAL DIFFERENTIATION AND GIVE RISE TO ECTOPIC ENDOMETRIAL TISSUE - mesoephros or mullerian ducts

38
Q

two cancers with increased incidence with endometriosis

A

Clear cell ovarian cancer, endometrioid cancer.

39
Q

Significant genetic mutations in endometriosis

A

PTEN, ARID1A

40
Q

Sx of?
Lower abd pain, pain during or shortly after menses, new vaginal discharge, dyspareunia, abnormal bleeding, pain with jarring movement.

A

PID

41
Q

2 most important sexually transmitted organisms associated with acute PID

A

Chlamydia trachomatis, Neisseria gonorrhoeae

42
Q

Indications for hospitalization in PID

A

Pregnancy, lack of response to tx, nonadherence, inability to take oral meds due to N/V, severe clinical illness
(fever, severe pain, vomiting), complication with abscess, possible need for surgical intervention or exploration.

43
Q

What is this?
infection of liver capsule and peritoneal surfaces of the
RUQ, minimal stromal hepatic involvement. Patchy purulent fibrinous exudate – “violin string” adhesions

A

Fitz-Hugh Curtis Syndrome - a complication of PID, 10% of PID pts have perihepatitis

44
Q

Long term sequelae of PID

A

infertility, ectopic pregnancy, chronic pain

45
Q

STD risk factors that increase risk of developing PID

A

young age at first sex, nonbarrier contraception, multiple sexual partners

46
Q

What do these factors do?

Previous PID, Sex during menses, vaginal douching, BV, IUD

A

potentially facilitate PID

47
Q

Tx of PID

A

Second generation cephalosporin and doxycycline (Azithromycin also has activity against C. Tracomatis and is
sometimes used in place of doxycycline). Other options include: clindamycin and gentamicin combination.

48
Q

Buzzword: IUD - think what bug?

A

anaerobic actinomyces

49
Q

What complication of PID has to be tx inpatient with clindamycin or metronidazole(anaerobic coverage: “below the diaphragm”) OR outpatient tx - anaerobic coverage.

A

pelvic abscess

PCM 4 (4 decks)

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