Repro part II Flashcards
Common infection s/o C-Section?
Matritis
Cottage cheese discharge?
Vaginal candidosis
First step of tx for endometrial cancer?
Total Hysterectomy and bilateral Salpingo-oophorectomy
HPV vaccine, age?
9-26 years
Med used to control bleeding due to uterine Atony?
Oxytocin (Pitocin)
Snowstorm appearance on US?
Hydatidiform mole
Gestation Diabetes puts baby and mother at risk of?
- Pre-eclampsia
- Macrosomia
- slow fetal lung develop
Most common Endometerial cancer?
75% are ADENOCARCINOMA
Vaginal Candida Tx?
Fluconazole PO 1 dose or azole cream for x1 week
Full term?
Delivery at 37-42 weeksw.
Pain and cramping during the menstrual cycle that interferes with normal daily activities?
Dysmenorrhea
Dysmenorrhea has 2 classifications?
Primary = no obvious cause Secondary = due to endometeriosis, fibroids, cervical stenosis, or pelvic adhesions
Tx of Dysmenorrhea?
Primary= NSIADS and OCP Sedondary= Endometeriosis: OCP, danazol, surgery Cervical stenosis: cervical dilation Pelvic Adhesions: NSAIDS, OCP, surgery
PMS
Occurs during 2 half of menstrual cycle
SS PMS
Somatic complaints, Emotional complaints, Behavoiral complaints
TX PMS?
NSAID, OCP, Depression med
Menopause?
48-52, before 40 = premature
What happens during menopause?
- diminished estrogen
- increased FSH/LH
- —> looses benefits of Estrogen on lipid profle and vascular endothelium
TX for PMS?
Hormone therapy maybe
Progesterone in combo with estrogen therapy which helps decrease endometrial hyperplasia and cancer
Breast Abcess?
Many abcesses are Lactational usu due to Staph Aureus
Tx Breast abcess
I &D
abx
Bx check for Ca
Breast cancer screening guidlines
Routine screening of average-risk women should begin at age 50, instead of age 40.
Routine screening should end at age 74.
Women should get screening mammograms every two years instead of every year.
Breast self-exams have little value, based on findings from several
Clustered microcalcifications in 50 something year old?
DCIS
Not seen on mammo, age 40 somethings?
Lobular
Simple Mastectomy
removal of breast tissue, nipple-areolar complex, and skin
Modified radical mastectomy
Removal of breast tissue, n-a complex, skin, pectoralis fascial and axil LNs
Radical mastectomy
Removal of everything else plus pectoralis major and minor muscles
Breast swelling, pain and tenderness in a 3-40 year old
Think fibrocystic disease
Mastitis?
Tx with Dicloxacillian
-Cont to breast feed or pump, prevent accum of infected material
PID?
A serious complication of STD
- N gonorrhea or C trachomatis
- abdominal or pelvic pain, increased vag discharge, burning, cramping, stabbing pain
PE of PID?
lower abdominal tenderness, cervical motion tenderness
Chandelier’s sign
Def dx of PID
Laparascopy
TX of PID
Cehpalosporins
or give linda Clinda or Gentamycin
Effectivness of condom method?
10-15% failure rate
Only method that protects against HIV
Failure rate of the Diaphragm?
5-20%
Can be fitted and replaced every 5 years of if pt gains or loses 10 pounds
Risk of Staph Aureus Toxic Shock Syndrome
Cervical cap fail rate?
5-20%
Nonoxynol-9?
Spermadice used in Contra sponge
IUDs?
Very low fail rate 1-3%
Absolute contraind to IUD
- Current preg
- Abn vaginal bleeding
- Acute cervical or uterine infxn
Relative -Nullparity -Prev ectopic preg -Mod to severe Dysmen -
OCP/Patch?
Messes up FSH/LH and suppresses ovulation. Changes the endometrium makes it hard to implant
OCP Contraindicated in?
Over 35 and who smoke
Norplant?
Low fail rate 0.09-0,2%
Makes endometrium unstable for implantation. Released slowly over 5 years
Depo-Provera?
Progestin IM over 3 months. Very low fail rate 0.3% May take up to 18 months to get back to normal after DC use
Infertility
Innablility to conceive after one year of unprotected sex, many causes
Get sperm count first
check a bunch of other stuff if needed
Female infertility?
Try induce ovulation with Clomiphene which stim release of Gonadotropin releasing hormone which stim FSH and LH release
Nagele rule?
EDC date of last menstrual period minus 3 months plus 7 days
Fetal quickening?
16-20 weeks
Fetal heart tones
10 weeks by Doppler
20 weeks by non-electrical fetoscope
SS of Pregnancy
Chadwick’s —>bluish discolaratoin of cervix
Goodell’s sign—>softening and cyanosis of cervix after 4 weeks
Breast swelling, tenderness
palmar erythema
bunch of other stuff
First trimester?
Until 14 weeks
Second trimester?
14-28 weeks
Third trimester?
28 weeks until delivery
12 weeks?
12 weeks: above pubic symphysis
20-22 weeks: Umbilicus
38-40 weeks: Below the Xiphoid process
Screening US?
Offered between weeks 18-20
OGTT?
during second trimester if screening tests positive for DM
Determine phase of labor and labor progression on cervical exam?
1) Dilation
2) Effacement
3) Station
4) Cervical positon
5) Cervical consistency
Contraindications to Inducuction?
Prostaglandin use Maternal asthma Glaucoma more than one prior C section unstable fetus status
Induction?
Ammniotomy or Pitocin via cont IV infusion
Amniotomy ?
Rupture of Amniotic sac with a hook thing
Baseline fetal heart rate?
110-160 BPM
worrysome if greater than 160
Decelrations
Fetal scalp electrode
Used to sense depolarizaoins of the fetal heart rate
Don’t use with fetal thrombocytopenia, maternal Hep or HIV
Abruptio Placentae?
Most occur after 30 weeks gestation
Present with THRID trimester vaginal bleedin and SEVERE abd pain.
Prepare for delivery and for shock, DIC etc
Ectopic preg?
Unilateral pelvic pain and vag bleeding
Beta HCG levels low for gest age
Methrotrexate can be used for stable ectopic preg
OK to use Oral Hypoglycemics in preg?
No, agents cross over to the placenta casuing taratogenic effects
Most common cause of postpartum bleeding?
Uterine Atony
Preg induced HTN?
BP greater than 140/90 in obstetric pt
Pre-eclampsia?
- Typically seen in 3 trimester
- Edema
- Proteinuria
- HTN
Delivery is the ultimate tx!! Magnesium Sulfate is started to decrease risk of seizures. May use Hydralazine in severe instances for BP
Elcampsia?
Siezures in a pre-eclamptic pt
Tx with Mg sulfate for seizures and Hydralazine for BP
HEELP syndrome?
Subcategory of sever eclampsis
Hemolytic anemia
Elevated liver fxn
Low platelets
Delivery is def tx
PROM?
Leaking of vaginal amniotic fluid from vagina, usu PH .8 indicates Amniotic fluid. Tx with IV abx for poss infxn of amniotic fluid by Group B strep
RhoGAM is given at 28 weeks gestation and then again postpartum if neonate is Rh positive.
Whatever
What organism is the most common sex transmitted dz?
Chlamydia
Purlulent cervical discharge?
N Gonorrhoeae
Rope like breast mass?
Fibrocystic breast mass
First line for Mastitis
Docloxacllin
cephalexin or EMYCN 2 line
Mucopurlulet discharge andcervical motion tenderness?
Chlamydia—Cervicitis
66 yo female presents with bouts of nausea, wt loss, and vague abd pain, what is proab. dx?
Ovarian Cancer
Avg age of menopause?
51
5 components of biophysical profile as part of antepartum testing?
1) Non-stress test
2) fetal breathing
3) Two gross body movements
4) Fetal tone
5) Amniotic fluid index
Secretory phase of menstrual cycle (day 14-28) what hormone dominates?
Progestosterone
A surge in what leads to ovulation?
LH
A pt with PCOS who would like to get pregnant, what 2 meds should you start her on?
Metformin and Clomid
HCG doubles? Early in pregnancy
every 48-72 hours
What endocrine tissue is associated with PCOS?
Insulin insensitivity
Pap comes back with atypical squamous uncertain significance (ASCUS), what is next step?
Repeat PAP in 4-6 months
What 4 HPV linked to cervical cancer?
HPV 16,18,31,33
3 factors of etopic pregnancy?
1) Prev ectopic
2) Scarred tubes (hx of PID or salpingitis)
3) IUD
Cervical bx comes back as CiN2 or CIN3, what is next step?
Excision–> LEEP, Cold Knive, Cryotherapy
3 labs to order if you are considering secondary amenorrhea?
1) Beta Hcg
2) TSH
3) Prolactin
How do you defin. diagnosis ENDOMETRIOSIS?
Exp LAP
Term when the placenta has implanted directly over the cervical Os?
Placenta Previa
A unilateral, single, mobile, firm, nontender solid breast mass should make you think of what dx?
Fibroadenoma
Fetus at level of Umbilicus at?
20 weeks
Should a breast feeding mother stop breast feeding if she develops mastitis?
No, if she has an abcess yes but just Mastitis, NO!!!
3 treatments for Uterine Prolapse?
Pessary
Kegels
Surgical repair
2 meds used to induce labor
1) Cervicil (prostaglandin gel applied to the cervix—>encourages cervical ripening
2) Oxytoxin IV—>encourages contractions
Folic acid during prenatal?
Prevent neural tube defects
Interference with work or school with PMS?
Premenstrual dysphoric disorder
Primary amenorrhea and low FSH should make you think?
Hypothalmic Pituatary insufficiency
Procidentia?
Uterine prolapse beyond the introitus
During what part of the menstrual cycle does PMS occur?
second half and menstration should relieve sxms
Threatened abortion?
Vaginal bleeding, closed cervix, products of conception are still inside
Strawberry cervix with copious yellow/green discharge should make you think of?
Trichomonas
Medical tx for early ectopic pregnancy?
Methotrexate
Incomplete abortion?
Vaginal bleeding, cervix is open, products of conception partially passed
Genetic cause is the number one reason for primary amenorrhea, what is one very important test?
Karotype
Premature birth?
Delivery of unterine contents between 20-36 wks
What medium do you need to grow out Neisseria gonorrhea?
Thayer Martin
Normal fetal heart rate?
120-160
The follicular phase of menstration is dominated by what hormone?
Estrogen
What are tow tocolytic meds you should be aware of?
Mg sulfate
CCBs Tocolytics—> stop labor
Woman presents to the ER concerned she is in preterm labor. What tx should you begin even before anything else?
Give IV fluids, most are suffering from dehydration
At how many weeks of preg. can an amniocentesis be done?
15-20 weeks
4 risk factors of endometrial cancer?
Chronic unopposed estrogen, nullparity, early menarche, late menopause, HTN, Tamoxifen, DM, Obesity, HTN, breast ca, ovarian ca`
Tx for Turners syndrome?
Cyclical estrogen and progesterone
what meds used to tx a postpartum metritis?
Clindamycin and Gentamycin together Metritis—>Inflammation of the uterus.
