Reproductive Flashcards
What happens in phase two of the menstrual cycle?
Ovulation, increase in estrogen (estradiol) leads to increase in LH and ovulation.
First day of menstrual bleeding is what phase?
Follicular
What is phase III of the menstrual cycle?
Luteal, increase in progesterone leads to decrease in LH and FSH and endometrial development.
Describe what happens in dysfunctional uterine bleeding?
Constant non cyclic blood estrogen levels leads to growth and development of the endometrium. Without ovulation and progesterone it overgrows and sloughs off at irregular times.
Treatment for dysfunctional uterine bleeding?
OCP, progesterone x 10 days per month. If ,no Meds work consider endometrial ablation or hysterectomy.
What is the most common gynecological malignancy in the Us.
Endometrial carcinoma. Estrogen dependent.
What are the risk factors for endometrial carcinoma?
Obesity, HTN, DM, nulliparity.
Post menopausal vaginal bleeding…. What do you do?
Always abnormal! Check endometrial bx.
Treatment for endometrial carcinoma?
Hysterectomy and post op radiation.
What is the most common presentation of endometriosis?
Dysmenorrhea and deep dyspareunia.
Definitive dx txt for endometriosis?
Laparoscopic exam with bx.
What is the medical treatment options for endometriosis and how does that t work?
OCP, NSAIDs, danazol, lupron. All suppress estrogen.
What is adenomyosis?
Islands of endometrial tissue within the myometrium. Common exam finding is tender , enlarged boggy uterus. Tx. TAH.
What is a leiomyoma and presenting complaints?
Uterine fibroids. Most common indication of hysterectomy. Present with bleeding, pain and pressure.
Physical exam findings of large, irregular hard pelvic mass with shadowing on ultrasound?
Leiomyoma or fibroids.
How to treat leiomyoma?
Myomectomy. Hysterectomy.
What is metritis? Who is at an increased risk? Common organisms? Treatment?
Post partum uterine infection. Increased risk with c section. Group a strep, staph. Aureus.
Treat with clindamycin plus gent = c section
Amp plus gent after vaginal birth.
What is a cystocele?
Posterior bladder protrudes into vagina
What is a enterocele?
Pouch of Douglas protrudes into vagina.
What is a rectocele?
Rectum into posterior vagina.
Incontinence when you laugh or sneeze and treatment.
Stress. Kegal, estrogen , surgery.
Large incontinence with no event, pos nocturia and urgency. Treatment?
Urge. Anticholinergics.
Small continuous incontinence with fullness, pressure, frequency. Treatment?
Overflow. Catheter, a blocker, anticholinergic.
This is the 5th MC cancer in women and the highest mortality rate.
Malignant ovarian neoplasms.
Presentation and sx of ovarian cancer?
Often asymptomatic until mets. Abdominal fullness, back pain, decreased energy, urinary frequency.
Chemo agent for ovarian ca?
Cisplatin
Patient presents to clinic with infertility, irregular menses, hirsutism, obesity and acne. Dx? Management?
PCOS. Treat with OCPs Metformin, clomid.
What virus is linked to cervical carcinoma?
Human papilloma virus
Patient presents with post coital bleeding, watery discharge and pelvic pain. Think?
Cervical carcinoma.
CIN 1: cancer in _ years.
7
CIN 2: cancer in _ years?
4
If positive Pap smear follow up?
Pap every 6 months x 2 years.
Painless bleeding and vaginal discharge In second trimester?
Incompetent cervix. Treat with bed rest, cerclage.
Describe vaginal ca? Dx, tx?
Rare, usually secondary to other ca. 80% squamous cell carcinoma. Usually asymptomatic. Dx with Pap smear and bx. Treat with radiation.
Describe vulvar cancer. Presentation, dx, tx?
Peak age 70. Most squamous cell carcinoma.
Pt complains of pruritus,red or white ulcerative lesions. Dx with bx.
Treat with surgery, RT, chemo.
Flagyl GETS what bugs?,
Giardia, entomebia, trichomoniasis. And BV.
Toxic shock syndrome caused by?
Staph aureus
This is due to lactobacillus decrease and overgrowth of g. Vaginalis.
BV
Vaginal discharge with bad odor, worse after sex. Thing grey discharge. Positive clue cells and pos Whiff test. Dx? Tx?
BV. Treat with flagyl or clindamycin.
Vaginal Schaffer with rancid odor, frothy green and strawberry cervix. Dx? Tx?
Trichomonas. Flagyl. Treat partner!
Vaginal itching and burning with white cheese like discharge. Dx? Tx?
Yeast infection. Fluconazole. Clotrimazole.
This is a spontaneous ascending reproductive tract infection. Patient presents with pelvic pain, dyspareunia, vaginal discharge, nausea and vomiting. Looks sick.
PID.
Criteria for dx of PID?
Must have : abdominal tenderness, adenexal tenderness, cervical motion tenderness.
Treatment for PID? Inpatient? Outpatient?
Inpatient: cephalosporin plus doxy.
Outpatient: rocephin plus doxy.
What is fitz-Hugh-Curtis syndrome?
Peri hepatitis due to peritoneal involvement from PID. Causes hepatic fibrosis and scaring.
What type of HPV is linked to cervical cancer?
16, 18, 31, 33, 35
MC cause of amenorrhea?
Pregnancy
Causes of primary amenorrhea if breasts present and uterus present?
Imperforate hymen, vaginal septum, anorexia, pregnancy
Causes of primary amenorrhea if breast absent and uterus present?
HP failure, gonadal dysgenesis.
Lab testing and results for dx of hypothalamic pituitary dysfunction?
FSH and LH decreased ( not stimulated by GNRH from post pituitary) , prolactin normal. Treat underlying cause.
Lab test results for amenorrhea caused by ovarian failure?
FSH and LH high. Symptoms of menopause usually present. Dx with progesterone challenge test.
If progesterone challenge test causes withdrawal bleeding?
Patient is anovulatory and treat with hormone replacement therapy.
If progesterone challenge test causes no bleeding or bleeding does not occur?
The patient is hypoestergenic or has an outflow problem. Surgery and hysterscopy required.
Dysmenorrhea?
Painful menstruation.
PMS is elated to what phase of the menstrual cycle?
Luteal. Follicular is sx free.
Describe menopause.
Cessation of menses for one year with increase in FSH and LH.
Contraindications for hormone replacement therapy?
Liver dz, thrombotic events, endometrial or breast ca.
Premenstrual breast pain with multiple well define d mirror images or sheets of dense tissue. Mobile, no axillary involvement or nipple discharge. Dx? Tx?
Fibrocystic disorder. No tx required.
One or two smooth, rubbery, well circumcised breast lumps. Movable no axillary or nipple discharge. Dx?
Fibroadenoma. Can enlarge in pregnancy.
Lactating women with sudden onset fever, chills, body aches with erythema and tenderness to breast. Dx? Tx?
Mastitis. Give dicloxicillin and continue to breastfeed.
Fluctuant mass on breast with pain, fever, swelling? Dx? Tx?
Breast abscess. Surgical drainage. Naficillin, vanc.
Second most common malignancy in women?
Breast cancer
Micro calcification on mammogram?
Suspect malignancy.
How do OCP work?
Inhibit mid cycle LH surge preventing ovulation, thickening the cervical mucosa.
Contraindications doe OCP?
Pregnancy, liver dz, vascular dz, smoker, uncontrolled HTN, thrombophilia.
When can the ultrasound detect the fetus?
5-6 wks
Fetal heart tone by Doppler when?
10-12 wks
Quickening at what time?
16-20 wks.
Cervix with bluish color at 8-12 wks ?
Chadwick’s sign
How do you determine EDD?
First day of LMP plus 7 days minus 3 months.
When to do the glucose tolerance test?
24-28 wks
Uterus at 12 wks?
Pubis
Uterus at 14 wks?
Between pubis and umbilicus.
Uterus at 20-22 wks?
At umbilicus.
Uterus at 38 wks?
Zyphoid.
When do you measure alpha fetoprotien?
15-20 wks. Increased in neural tube defects. Decreased in Down syndrome.
When do you give rhogam?
28 wks and within 72 hrs of delivery
When do you test for group b strep?
32 wks
Describe a non stress test and a positive result.
Measures fetal heart rate for 20 min. Normal (reactive ) shows fetal heart rate acceleration.
Describe a contraction stress test and a normal result.
Measure fetal heart rate in response to uterine contraction. Normal (negative) shows no decelerations.
Spontaneous uterine contractions late in pregnancy with no cervical dilation are?
Braxton hicks.
Fetal head descending into pelvis?
Lightening
Passage of blood tinged mucosa late in pregnancy.
Bloody show.
Active labor?
4 cm dilation
Stage two of labor?
Complete dilation of cervix through delivery of infant.
Stage 3 of labor?
After delivery of infant and ends with delivery of placenta.
Abortion?
Termination of pregnancy prior to 20 wks.
Bleeding prior to 20 wks with closed os and no products of conception passed?
Threatened abortion.
Moderate bleeding with severe abdominal cramping, cervical os dilated but no products passed?
Inevitable abortion
Some products passed prior to 20 wks?
Incomplete abortion
Embryo no viable but retained in uterus, no contractions, bleeding absent?
Missed abortion.
Patient presents with amenorrhea, unilateral abdominal pain, irregular menses?
Assess BHCG. Should double every 24-48 hrs. Ultrasound and surgery. Ectopic pregnancy.
Risk factors for ectopic pregnancy?
Hx of infertility, hx of one in past, hx of tubal ligation, hx of PID, IUd use.
HTN of 140/90 with no other sx?
Gestational HTN.
HTN with protienuria or edema?
Preeclampsia
Preeclampsia with convulsions?
Eclampsia.
Preeclampsia tx?
Bed rest, monitoring, magnesium sulfate, methldopa.
Eclampsia treatment?
Magnesium, delivery
