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PANCE-Flashcards > Reproductive > Flashcards

Reproductive Flashcards

1
Q

What stimulates release of the ovum from the follicule on day 14 of the menstrual cycle?

A

Luteinizing hormone (LH)

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2
Q

What is the most common type of endometrial cancer?

A

Adenocarcinoma

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3
Q

What is a common risk factor for endometrial cancer? How does it present? How is it dx?

A

RF: unopposed estrogen stimulation (Oral contraceptives can have a protective effect)

S/S: Innappropriate uterine bleeding, including prolonged heavy periods or spotting. Normal pelvic exam

Dx: Pap smear and endometrial bx (should be done for any postmenopausal bleeding)

Pelvic US to r/o fibroids, polyps, and endometrial hyperplasia

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4
Q

what are the most common sites for Endometriosis?

A

Pelvis and ovaries

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5
Q

What is the definitive diagnose for Endometriosis? What would you see on microscopically on a tissue sample?

A

Direct visualization with Laparoscopy is required to make the diagnosis (Chocolate cysts, Powder burns, Raspberry lesions)

Tissue sample: Endometrial glands, stroma, and heomsiderin-laden macrophages

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6
Q

What are RF for uterine prolapse?

A

RF: Increased intrabdominal pressure (Obesity, coughing, heavy lifting)

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7
Q

How do you diagnose Leiomyoma?

A

AKA Fibroids

Pelvic US reveals hypoechogenic areas among normal myometrial material

Pelvic exam reveals irregular, nontender masses

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8
Q

What are the symptoms of Uterine prolapse? how is it tx?

A

Vaginal fullness, lower abdominal ache, low back pain

Sxs worse after prolonged standing or late in the day

Most also have cystocele, rectocele, or enterocele

Tx: Kegal exercises for prevention, Surgery, wt reduction

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9
Q

How do you treat Ovarian Cysts?

A
  • Premenarchal with cysts >2cm: Ex lap
  • Reproductive
    • cysts<6 cm: observe x 6 weeks
    • Cysts >8 cm: Ex lap
  • Postmenopausal with palpable cyst: Ex lap
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10
Q

What tx can be given to women with Polycystic ovarian disease desiring fertility?

A

Clomiphen Citrate

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11
Q

Symptoms/signs of ovarian Cancer; Test of choice?

A
  • Initially asymptomatic
  • Ascites, vague GI sxs
  • PE: Adnexa is tender with fixed pelvic mass
    • fixed, solid bilateral nodules

TOC: Pelvic US

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12
Q

What HPV types are strongly linked to cervical cancer? What is the most common cancer cell type?

A

HPV 16, 18, and 31

Most common cell type is Squamous cell carcinoma

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13
Q

What Cervical cancer cell type is linked to exposure in utero of diethylstillbestrol (DES)?

A

Clear Cell carcinoma (A type of Adenocarcinoma)

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14
Q

What are the different ratings for cervical intraepithelial neoplasms (CIN)?

A

CIN-1 mild dysplasia

CIN-2 Moderate dysplasia

CIN-3 is severe dysplasia

CIS-Carcinoma-in-situ

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15
Q

What is the most classic symptom of Cervical carcinoma?

A

Postcoital bleeding

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16
Q

After abnormalities in PAP smear and other signs, what is the most appropriate technique for histologic evaluation?

A

Colposcopy with biopsy

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17
Q

Follow up testing after Pap smear shows ASC-US?

A
  • ASC-US (Atypical squamous cells of undetermined significance)
  • 20 years or younger: Rpt PAP in 12 months
  • 21 and older: HPV test, or RPT PAP in 6 mo. and 12 mo. or colposcopy
  • postmenopausal: HPV test, RPT pap in 6 mo., and 12 mo. or colposcopy
  • Preg: HPV test or colposcopy (WITHOUT ENDOCERVICAL SAMPLING!) or delay testing until delivery
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18
Q

Follow up testing after abnormal PAP results showing LSIL

A

Low grade squamous intraepithelial lesion (includes HPV and mild dysplasia)

  • <20 y/o: rpt pap in 12 mo.
  • 21 <: Colposcopy
  • Postmenopausal: HPV test, Rpt pap in 6 mo. and 12 mo. or colposcopy
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19
Q

Follow up testing for abnormal PAP smear results showing HSIL

A

High grade intraepithelial lesion (includes moderate and severe dysplasia)

  • <20 years: Colposcopy
  • 21 years through postmenopausal: Colposcopy or LEEP
  • Pg: Colposcopy (WITHOUT ENDOCERVICAL SAMPLING!!)
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20
Q

Follow up testing for abnormal PAP smear results showing ASC-H

A

Atypical squamous cells-cannot rule out high grade)

  • For everyone: Colposcopy
  • If pregnant: colposcopy WITHOUT ENDOCERVICAL SAMPLING!
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21
Q

Follow up testing for abnormal PAp smear showing ACG

A

Atypical Glandular cells

  • All subcatagories (except atypical endometrial cells): Colposcopy with endocervical sampling and HPV testing and endometrial sampling (if older than 35)
  • Atypical endometrial cells: Endometrial and endocervical sampling followed by colposcopy and HPV testing
  • If pregnant: Colposcopy and HPV testing (WITHOUT ENDOCERVICAL OR ENDOMETRIAL SAMPLING)
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22
Q

Tx for Gonorrhea and Chlamydia

A

Gonorrhea: Ceftriaxone IM

Chlamydia

  • Azithromycin x 1 or doxycycline x 7days
  • erythromycin in pregnancy
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23
Q

HOw do you treat an incompetent cervix?

A

Cervical cerclage between 16-18 weeks of pregnancy

Remove sutures at 36 weeks

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24
Q

What is a cystocele? What are the sxs? How is it diagnosed? Tx?

A

Protrusion of the bladder into the vagina due to an anterior wall defect

Sxs: Pelvic pressure and stress incontinence (most common) and straining to urinate

Diagnosed by physical exam: bulging in the anterior portion of the vagina

Tx: surgery

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25
Q

What is the most common Vulva/vaginal cancer cell type? How does it diagnosed?

A

Squamous cell carcinoma

Dx: Acetic acid or staining with toluidine blue

vaginal bx by colposcopy

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26
Q

How do you diagnose Secondary Amenorrhea?

A

Absence of menses for 6 months or longer (or 3 missed menstrual cycles)

  1. Pregnancy test
  2. TSH and prolactin levels (to evaluate for hypothyroid and hyperprolactinemia
  3. Progesterone challenge test: to determine presence or absence of estrogen

If Over age 40, would want to r/o ovarian failure as well (LH, FSH, estradiol)

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27
Q

What test is diagnostic for menopause/

A

FSH > 30

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28
Q

WHat is the most common type of breast cancer?

A

Ductal carcinoma (80-85%)

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29
Q

HOw do you screen for breast cancer? How do you establish diagnosis?

A

SCreening: mammography; US if under 30 y/o bc dense breast tissue

Dx: Fine-needle biopsy

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30
Q

What is the most common tumor in women under 25 years old?

A

Fibroadenoma

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31
Q

How do you treat Gynecomastia?

A

Clomiphene: an antiestrogen, approx 50% of pts achiece partial reduction in breast size

Tamoxiflen: effective for recent-onset and tender gynecomastia

Reduction mamoplasty–For patients with macromastia (Breast size >5 cm); or where medical therapy failed

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32
Q

causes of galactorrhea and treatment

A

Usually results from too much prolactin

Causes:

  • Pituitary Adenoma (hyperprolactinemia)
  • Medications: H2 blocker (Cimetidine), Anti-psychotic (Risperdone), Spironolactone
  • hypothyroidism
  • CKD
  • 50% no known cause

Tx: Bromocriptine-DOC

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33
Q

How do you treat Mastitis in the nursng mother?

A

Empty breasts frequently through continued nursing or pumping

Start antibiotics if symptoms are not improving within 12-24 hours or if the woman is ill

Dicloxacillin 500 mg PO QID x 10-14 days

If inpatient: IV nafcillin 2 grams q4 hours

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34
Q

How does Pelvic inflammatory dz present and how is it diagnosed?

A

Sxs: lower abdominal pain and pelvic pain

PE: cervical motion tenderness (Chandelier’s sign); purulent cervical discharge

Adnexal mass if tubo-ovarian abscess is present

dx:

  • Definitive diagnosis made by laparoscopy
  • Transvaginal US (?)
  • Gram stain and culture
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35
Q

Treatment of PID

A

Broad spectrum cephalosporins: Cefoxitin, Cefotetan, and doxy

If allergic to cephalosporins: Clindamycine plus gentamycin

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36
Q

What drug promotes ovulation and when do you take it?

A

Clomiphene citrate–days 3, 4, 5 of the cycle

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37
Q

What is the bishop score? What do you use it for?

A

Used to determine if a cervix is favorable

Favorable >8

Used to decide if labor should be inducted in a nonlaboring patient. Success related to bishop score. Scores less than 5->not ready for induction

prepare patient for induction by prostaglandings to ripen the cervix

38
Q

What do you use to induce labor?

A

IV pitocin: stimulates contractions

39
Q

describe the first stage of labor

A

Stage one begins with regular uterine contractions and ends with complete cervical dilation at 10 cm

6-20 hours for nulliparous and 2-14 hours for multiparous

Divided into two stages: Latent and active

  • Latent stage: cervical effacement and early dilation
  • Active phase: occurs when dilation has reached 4 cm or greater
40
Q

Describe the second stage of labor:

A

begins with complete cervical dilation and ends with delivery of the fetus

30 minutes to 3 hours nulliparous

5 min to 1 hour for multiparous

41
Q

Describe the third stage of labor

A

Time period between the delivery of the fetus and the delivery of the placenta and fetal membranes

42
Q

Describe the 4th stage of labor

A

After delivery of the placenta, in which mother’s stability is monitored and lacerations and hemorrhages are treated (1-6 hours)

43
Q

When can an internal fetal monitor be used?

A

Cervix must be dilated to 2 cm and membranes ruptured

43
Q

In fetal HR monitoring, What are accelerations?

A

An increase of 15 bpm x 15 seconds above the normal baseline

44
Q

Fetal HR monitoring: what are Early decelerations?

A

begin and end at the same time as teh contraction

Often present as a woman approaches the second stage of labor

45
Q

What are variable decelerations?

A

Benign if mild and infrequent; Rapid drop in fetal heart rate

Occur with cord compression

46
Q

What are LATE decelerations

A

Always worrisome!!

Fetal heart rate drops during the second half of the contraction; Denote uteroplacental insufficiency

If this happens, stop oxytocin, change maternal position, administer oxygen

47
Q

What is a perfect apgar score? What would that entail?

A

Perfect apgar score: 10

Active movement, Pules >100 bpm, Sneezes/coughs/pulls away, Pink all over, Respiration good (with crying)

48
Q

How do you calculate expected date of confinement using Nagele’s rule?

A

Subtract 3 months, add seven days, and add 1 year

49
Q

When can you hear fetal heart tones?

A

At 10 to 12 weeks by doppler

Normal is 120-160

50
Q

When should you start feeling fetal movements?

A

18 to 20 weeks

51
Q

What labs show an increase risk of trisomy 21?

A

Low pregnancy-associated plasma protein A (PAPP-A) and abnormally high free Beta-hCG

52
Q

When do you scren for gestational diabetes?

A

24-28 weeks

53
Q

When do you do a vag-rectal culture for Group B strep?

A

35-37 weeks

54
Q

Describe the types of abortion

A
  • Defn: Termination of pregnancy before 20 weeks gestation
  • Incomplete abortions:
  • Expulsion of some but not all of the products of conception
  • Vaginal bleeding, open cervix

• Inevitable abortion:

  • Dilation of the cervix without expulsion of the products of conception Vaginal bleeding; no products of conception have been released but there is no way to maintain pg—Pg will not continue

• Threatened abortion
o Intrauterine bleeding prior to 20 weeks with a closed cervix
o Cervix closed; could be a normal pregnancy
• Missed abortion
o Fetal demise without symptoms; No products of conception have passed
o No bleeding, closed cervix
May need D&C for incomplete or missed abortion

55
Q

What is the most common cause of third trimester bleeding?

A

Abruptio placentae

56
Q

What is abruptio placentae and when does it commonly occur? classic sx? dx? tx?

A

The premature separation of a normally implanted placenta after the 20th week of gestation but before birth

Most occur after 30 weeks

Sxs: **Painful (severe) **Vaginal bleeding, abnormal FHR, uterine hypertonus

Associated with h/o cocaine use, abdominal trauma, maternal HTN, multiple gestation, and polyhydraminos

Dx: US NOT diagnostic; Need to monitor fetus and fetal stress testing

Tx: delivery

57
Q

What is placenta previa? what is c/i? How is it diagnoseD?

A

When the placenta partially or completely covers the cervical os

Sxs: Painless 3rd trimester vaginal bleeding (No abdominal discomfort, normal FHR, no significant maternal hx)

DO NOT PERFORM DIGITAL EXAMINATION

diagnosed before 20 weeks gestation by US

58
Q

How do you treat placenta previa?

A

Tx: Large Bore IV, watchful waiting if patient is stable (may resolve on its own)

C-section is preferred method of delivery

59
Q

Define Preterm labor

A

Delivery of a viable infant before 37 weeks gestation

Regular uterine contractions (>4 to 6/hr) between 20 and 36 weeks of gestation and one or more of the following:

  • Cervical dilation of 2 cm or > at presentation
  • Cervical dilation of 1 cm or > on serial examinations
  • Cervical effacement of >80%
60
Q

Name drugs used in Preterm labor to prevent or stop

A
  • Magnesium sulfate–inhibits myometrial contractility
    • Give calcium gluconate if mg toxicity
  • beta mimetic adrenergic agents: relax smooth muscle to decrease uterine contractions–>reduce incidence of delivery within 24 and 48 hours of administration.
  • CCB: inhibit smooth muscle contractility

If history of Preterm delivery:

  • 17 alpha hydroxyprogesterone-weekly injections from 16-36 weeks

Give steroids to mom for fetal lung maturity

61
Q

When does Endometritis occur? What organism is commonly involved? What is first line tx?

A

Commonly occurs after C section or when membranes are ruptured >24 hours before delivery

  • Presents 2-3 days postpartum with high fever and uterine tenderness

COmmon organism: Anaerobic streptococci

First-line Tx: Clindamycin plus gentamycin

  • Add ampicillin if no response in 24-48 hours
  • Metronidazole if septic
62
Q

How is ectopic pregnancy diagnosed?

A

If serum hCG is lower than expected (serum hCG normally doubles every 48 hours)

Transvaginal US–diagnostic in 90%, reveals adnexal mass

If no mass seen, but still strongly suspected, follow patient with serial beta-hcg levels

63
Q

How do you treat an ectopic pregnancy?

A

Methotrexate-if early diagnosis

  • Criteria: serum hcg

Laparoscopy

64
Q

How do you diagnose gestational diabetes?

A

Screen at 24-28 weeks:

  1. 1 hour non fasting glucose challenge
  2. If >130 at 1 hour-administer a 3 hour glucose tolerance
  3. After overnight fast–>check glucose level
  4. Administer 100 gm glucose load and then check at 1,2,and 3 hours
  5. If 2 or more abnormal values—>Diagnosis
65
Q

Complete vs. partial hydatidaform moles

A

Gestational trophoblastic disease–>A group of diseasea arising from Placenta

Complete: Most common; Empty egg, “grapelike vesicles” or “snowstorm pattern” on US-20% progress to malignancy

Partial: Fetus is present, but nonviable, less than 5% progress to malignancy

66
Q

How do you diagnose a molar pregnancy? clinical presentation?

A

s/s: abnormal vag bleeding, uterine size > dates, hyperemesis gravidarum (due to very high hCG levels), preeclampsia sxs befoer 20 weeks gestation

Dx: hCG level >100,000 mU/mL

Tx: Chemo/surgery

67
Q

What is the defn of gestational HTN? how is it monitored/treated?

A

HTN present AFTER 20 weeks gestation but no other sxs

Tx: 1. monthly US, serial BP and urine protein, weekly NST during 3rd trimester

  1. Methyldopa for severe cases
68
Q

What is the classic triad for preeclampsia?

What is HELLP syndrome?

What is Eclampsia?

A
  • Preeclampsia: HTN, Edema, Proteinuria
    • Edema no longer needed for dx
    • sxs must occur after 20 weeks and up to 6 weeks postpartum
  • Eclampsia: severe preeeclamsia with seizures
  • HELLP: severe preeclampsia PLUS hemolysis, elevated liver enzymes, and low platelets
69
Q

What is the first line for inpt tx to decrease chance of seizures in pts with preeclampsia? What other meds are used in preeclampsia?

A

IV MgSO4; continue for 24 hours after delivery to prevent seizures

other Tx:

Hydralazine or labetalol

Betamethasone if fetus is

70
Q

When is Rho-gam given?

A
  1. 300 mg given to all RH negative mothers at 28 weeks gestation
  2. Within 72 hours of delivery if Rh positive infant
  3. anytime blood mixing may occur
71
Q

Which type of ovarian cyst is associated with ovulation? Pregnancy? Molar pg?

A

Follicular: associated with ovulation

Corpus Luteum: associated with pregnancy, may rupture and bleed->“Chocolate syrup cyst”

Thecal: often bilateral, results from excess hCG secretion in molar pregnancy

72
Q

What is methotrexate?

A

Folic acid antagonist–kills embryo

73
Q

What are the top 4 causes for vaginal bleeding in the adolescent?

A
  • Anovulation
  • pregnancy
  • exogenous hormone use
  • coagulopathy
74
Q

What is the most common gynecologic cancer in the US?

A

Endometrial Cancer

75
Q

What can be used to control the heavy bleeding associated with fibroid tumors?

A

Intermittent progestin supplementation (depot methodroxyprogesterone acetate 150 mg IM every 28 days)

76
Q

What is the medical treatment used to treat myomas in symptomatic patients?

A

2 to 3 month course of leuprolide acetate (Lupron Depot), a Gn-RH analog

These produce a continous release of Gn-RH on the pituitary, resulting in decrease release of pituitary gonadotropins (and therefore decreased production of estrogen from the ovaries)–>The myomas growth is stimulated by estrogen

77
Q

What is the best way to diagnose nonpalpable breast lesions seen on the mammogram?

A

With nonpalpable lesions, core needle or excisional bx is preferred over FNA biopsy

78
Q

What is a rectocele? What is the primary sx of a rectocele?

A

Due to defect in the posterior vaginal wall

Sxs: difficulty defecating, feeling of pressure or as if somethign is protruding from the vagina

79
Q

WHat tx can be used for a vaginal yeast infxn in a pregnant woman?

A

Miconazole cream

80
Q

What are the qualifications for accelarations in a NORMAL Fetal stress test?

A

Two or more accelerations in 20 minutes

81
Q

What is responsible for 50% of postpartum hemorrhages? (bleeding after the baby is delivered)

A

Uterine Atony

82
Q

How is anemia defined in the pregnant patient?

A

Hgb below 10 g/dL (esp. in the 2nd trimester)

In the first trimester and at term most healthy pg women have hgb of 11 g/dL or greater

(nonpregnant pt -less than 12 g/dL)

83
Q

Define the 3 trimesters

A

1st trimester: 0 to 12 weeks

2nd trimester: 13 to 27 weeks

Third trimester: 28 to 40 weeks

84
Q

What studies establish the diagnosis of ovarian failure?

A
  1. Serum FSH level
  2. Serum LH level
  3. serum estradiol
85
Q

When should Serum testosterone and DHEAS levels be ordered?

A

In secondary dysmenorrhea if the pt shows symptoms of androgen excess (acne, hirsutism, male pattern baldness, clitoromegaly) or HTN

86
Q

What is the primary effect of OCPs?

A

Suppression of FSH and LH

87
Q

What can be done for a pt on OCPs who has break through bleeding during the third week of the cycle?

A

Change a pill with a higher progestin component.

When breakthrough bleeding occurs during the third week of the cycle, its due to a lack of progestin.

88
Q

How is gardasil administered?

A

3 doses: o months, 2 months, 6 months

89
Q

When can a woman stop getting annual PAP smears? mammograms?

A
  • 70 y/o with 3 consecutive normal PAP smears and no h/o pre-invasive lesions

OR

  • any age if undergone a hysterectomy and no h/o invasive dz

Mammograms may be stopped at 70 y/o also.

90
Q

How do you treat Trichomoniasis? bacterial vaginosis?

A

Trich–>Metronidazole single 1 gram dose PO

BV–>Metronidazole 500 mg

PANCE-Flashcards (11 decks)

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