Repro Flashcards
CI IUD
unexplained vaginal bleeding
PID/cervicitis
cervical/uterine CA, 2 atypical paps
hx heart valve or artificial joint replacement
oligomenorrhea
longer time between periods
polymenorhea
frequent < 21 D cycle
menorrhagia
lots of flow
metrorrhagia
bleeding between periods
menometrorrhagia
excessive + irregular bleeding
AUB tx
1) NSAID to decrease blood loss
heavy bleeding - estrogen IV, then DnC
anovulatory bleding - OCP, mirena
21 hydroxylase deficiency
congenital adrenal hyperplasia
ambiguous genitals
salt wasting
“pearl necklace sign”
PCOS
dx PID
lower abd/pelvic pain + 1 of the following:
uterine tenderness
adenexal tenderness
CMT
outpt tx PID
1) rocephin +/- doxy x 14 D
2) levofloxacin x 14D +/- flagyl
inpt tx PID
1) foxy-doxy x 14D
2) clindamycine + gentamicin
most are asx
long/heavy periods, pressure, pain
lumpy bumpy uterus
leiomyoma (fibroids)
estrogen/progesterone sensitive
increase in size w/ pregnancy and decrease in menopause
tx: NSAID, OCP
tx fibroids to stop bleeding vs decrease size myomas
danazol - stop bleeding
Leuprolide (GnRH) - decrease size
MCC endometrial CA
endometrioid
favorable prognosis
assoc w/ unopposed estrogen (tamoxifen use)
type of endometrial CA assoc w/ p53 mutation
serous
poor prognosis
HPV 16 vs 18 association w/ adeno vs squamous cervical CA
Sixteen = Squamous AYE-teen = Adeno
RF cervical CA
STD/HIV
smoking
lots of babies
OCP
ssx cervical CA
metrorrhagia (bleeding between periods)
post-sex spotting
cervical ulceration
CIN 1 treatment
after 2 neg pap at 6 and 12 mon, continue w/ Q1yr
CIN I, II, III w/ negative margins tx
pap at 12 mon +/- cotest
CIN II, III w/ positive margins
pap at 6 mon, consider edocervical curettage
CIN II and III tx or persistent CIN I
ablation = cryotherapy or laser
excision = leep
hysterectomy if really bad
RF vulvar CA
HPV 16, 18, 31
lichen sclerosus
diabetes/obesity/HTN/CAD
what is VIN
vulvar interepithelial neoplasa
PRE-cancerous in PRE-menopausal F
purritus, pain, ulceration of mass
vulvar ca
punch bx
tx: chemo, ablation, vulvectomy
typically found in upper 1/3 vagina
sx: abnormal bleeding, d/c, or post-sex bleeding
vaginal CA
tx: excise
types of pts and types of vaginal CA typical
postmenopause = squamous
young = adeno
DES exposure = clear cell
BRCA 1 > BRCA 2
lynch syndrome
CA 125
ovary CA
1st step: TVUS
tx: TAHBSO w/ omenectomy + lymphadenectomy + chemo post-op
tx precocious puberty
central - leuprolide
MC of all benign breast conditions exaggerated stromal tissue 30-50y/o assoc w/ trauma and caffeine cyclical, bilateral
fibrocystic changes of breast
MC breast lesion in women < 30
do NOT change w/ cycle
fibroadenoma
cystosarcoma phyllodes = large fibroadenoma
bx breast CA
FNA - initial bx
core needle - large sample to check receptor status
tumor markers breast CA
CEA
CA 15-3
CA 27-29
tx breast CA
hormone receptor+: tamoxifen
estrogen receptor-: chemo
HER2/neu: trastuzumab
complications metastatic breast CA
Pleural effusion, edema of arm
CI lumpectomy
large tumor or multiples subareolar fixated to chest wall prior radiation nipple involvement
bHCG levels
peak at 100K at 10 weeks, decreases throughout 2nd trimester, levels of in 3rd
should double Q48H in early prego
used to confirm pregnancy
US - gestational sac seen at 5 weeks
bHCG around 1000-1500
physiologic changes in pregnancy
CO, tidal volume, respirations, blood volume, gastric emptying time - increase
blood pressure, HCT, sphincter tone - decrease
“UNDERage at 18”
trisomy 18
AFP, estriol, b-hcg, inhibin A are ALL low
“2 down, 2 up”
trisomy 21
AFP/estriol - down
b-hcg, inhibin A - up
when to do amniocentesis
> 35 gest age + abnormal quad screen
TORCHES causes
premature delivery CNS abnormalities anemia jaundice hepatosplenomegaly growth retardation
TORCHES pathogens
Toxoplasmosis Other - parvovirus, varicella, listeria, TB, malaria Rubella Cmv HSV/HIV Syphilis
latent vs active 1st stage labor
latent: onset till 3-4cm dilated
active: 4cm till 10
fetal heart rate monitoring components
heart rate
variability
accelerations
decelerations
fetal decelerations
early - normal (head compression from uterine conraction)
late - fetal hyoxemia, uteroplacental insufficeincy
variable - umbilical cord compression
HELLP syndrome
variant of preeclampsia w/ poor prognosis
hemolysis, elevated LFT, low platelet
triad preeclampsia is not just “HyPE”
Htn
Proteinuria
Edema
wood’s screw vs mcroberts maneuvers
wood screw - rotation
mcroberts - leg elevation
frank vs complete breech
complete knees are flexed, frank knees are extended
both have hips flexed
immunity provided in colostrum
secretory IgA
CI breast feeding
maternal HIV
active TB
drug abuse
failure to lactate from low prolactin levels
Sheehan’s
tx mastitis
dicloxacillin
keflex
augmentin
macrolide
