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PANCE study guide > Reproductive > Flashcards

Reproductive Flashcards

1
Q

dub tx in adolesc

A

high dose estrogen in acute severe bleed

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2
Q

dub cause in adolesc

A

diagnosis of exclusion

r/o other pathologic causes but unlikely in younger pt/s

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3
Q

DUB cause in postmenopausal women

A 
More likely pathologic
US
Hysteroscopy
endocervical curetage and bx
D&C
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4
Q

Menorrhagia

A

heavy or prolonged bleeding

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5
Q

Metorrhagia

A

bleeding between cycles

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6
Q

Menometorrhagia

A

Irregular cycles w/ heavy/prolonged bleeding

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7
Q

TVUS >___? is indicative of endometrial hyperplasia

A

4mm

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8
Q

Tx for endometrial hyperplasia w/o atypia

A

Progestrin (po or IUD)

Repeat bx in 3-6mo

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9
Q

Endometrial hyperplasia w/ atypia tx

A

TAH +/- BSO

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10
Q

What is the most common gyn Malignancy in the US

A

Endometrial ca

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11
Q

endometrial stripe >4mm indicates what

A

Endometrial hyperplasia

Endometrial ca

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12
Q

Tx for Stage 1 Endometrial ca

A

TAH +/- BSO

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13
Q

Tx for stage 2 endometrial CA

A

TAH + BSO, lymph node excision, post-op rad

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14
Q

MC bening gyn lesion

A

Leiomyoma

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15
Q

What population is mc in leiomyoma

A

African American (5X more common)

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16
Q

Pelvic us sign of leiomyoma

A

“Pelvic shadowing”

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17
Q

Tx for leiomyoma

A

Usually nothing - majority don’t need tx
Medical tx: Progestin, Leuprolide (GnRH inhib),
Surgical: Myomectomy, Ablation, Hysterectomy is definitive tx.

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18
Q

Define Endometritis

A

Infection of endometrium during pregnancy

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19
Q

MC pathogen of endometritis

A

GABHS, S. aureus

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20
Q

What is endometritis called if the pt is not pregnant?

A

PID

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21
Q

MC cause of endometritis

A

retained products of conception (mc w/ c-section)

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22
Q

Infection after c-section tx w/

A

Clinda and gent

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23
Q

Infection after vag delivery or chorioamnionitis

A

Amp and Gent

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24
Q

Classic triad of endometriosis

A
  1. Cyclic premenstrual pelvic pain
  2. dysmenorrhea
  3. Dyspareunia
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25
Q

Defintive dx of endometriosis

A

Laparoscopy w/ bx

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26
Q

What is a “chocolate cyst”

A

Endometrioma

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27
Q

Medical tx of endometriosis

A 
Ovulation suppresion 
1. Pain: OCPS + NSAIDS
2. Prog tx: suppress GnRH, 
3. Leuprolide
4. Danasol
Surg:
1. Cons laparoscopy w/ ablation
2. TAH BSO
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28
Q

Uterine prolapse

A

Uterine herniation into vagina

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29
Q

Cystocele

A

Post. bladder herniating into ant vag wall

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30
Q

Enterocele

A

Pougch of Douglass (sm bowel) into the upper vagina

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31
Q

Rectocele

A

Distal Sig colon (rectum) into the posterior distal vagina

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32
Q

Grade 1: Pelvic organ prolapse

A

Descent into upper 2/3 of vagina

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33
Q

Grade 2 Pelvic organ prolapse

A

Cervix approaches introitus

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34
Q

Grade 3 Pelvic organ prolapse

A

Outside introitus

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35
Q

Grade 4 Pelvic organ prolapse

A

Entire uterus outside of vagina - complete prolapse

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36
Q

Dx of funcitonal ovarian cyst

A

Pelvic US

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37
Q

MC tx for ovarian cysts

A

<6-8 cm functional and usually spontaneously resolve

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38
Q

Most concerning complication of ovarian cyst

A

torsion

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39
Q

Medical tx for ovarian cyst

A

OCP’s

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40
Q

What is the 2nd MC gyn cancer?

A

Ovarian Ca

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41
Q

What gyn cancer has the highest mortality rate?

A

Ovarian ca

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42
Q

Sister mary joseph node

A

Mets to umbilical LN (from ovarian ca)

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43
Q

In reproductive age what % of ovarian neoplasms are benign?

A

90

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44
Q

PCOS traid

A

Amenorreha, hirsutism, and Obseity (insulin resistance)

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45
Q

Labs for PCOS

A

Inc testosterone, Inc LH:FSH ratio,

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46
Q

TX of PCOS

A

OCP’s (mainstay) to normalize bleeding and tx hirsutism,
Anti-andronergic agents for hirsutism-Spironolactone
Infertility tx: Clomid
Lifestyle changes
Surgical

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47
Q

routine pap screen

A

Start at age 21 q2y until age 29
age 30 q3-5y if hx of 3 neg cytology
Yearly HIV
stop at age 65-70

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48
Q

If age >25 w/ + HPV what are the two options

A
  1. Cyt and HPV tesiting in 12mo
    OR
  2. Genotype for HPV 16,18
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49
Q

ASCUS + > 25yo follow up

A
  1. HPV testing if neg repeat w/ cotest q3y or HPV testing + –> colopscopy w/ b
    OR
  2. Repeat Pap in 1 year if neg resume Pap if pos Colpo
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50
Q

21-24 ACUS or LSIL f/u

A

Repeat pap in 1 y or HPV testing

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51
Q

<21 ASCUS f/u

A

Repeat Pap in 1 year

52
Q

ASC-H F/u

A

Colposcopy

53
Q

LSIL 25-29 f/u

A

Colpo q/ BX

54
Q

LSIL >30yo f/u

A

HPV neg –> repeat cytology in 1 year

HPV + –> Colpo w/ bx

55
Q

What CIN grade is LSIL assoc. w/

56
Q

HSIL f/u

A

Colpo w/ bx in all ages

57
Q

HSIL CIN grade assoc.

A

CIN II, III, and CA in situ

58
Q

TX for CIN1

A

Obs. (75% self resolve).

LEEP, or conization

59
Q

Tx for CIN2 & 3

A

EXcision and ablation mainstay of TX for CIN 2 and 3.

60
Q

MC etiology for cervical ca

A

HPV (99.7%) esp, 16,18, 31, 33

61
Q

Is smoking protective or a risk factor for Cervical CA?

62
Q

MC type of cerv. ca.

63
Q

1st sing of cervical ca?

A

poscoital bleeding/spotting

64
Q

Define incompetent cervix

A

cervical dilation esp in 2nd trimester

65
Q

Is vaginal cancer rare or common?

A

Rare Less than 1%

66
Q

What risk factor exists for Vag ca?

A

DES exposure

67
Q

MC presentation of vulvar ca

68
Q

Dx of vulvar ca

A

Red/white ulcerative, crusted lesions

69
Q

Etiologies of vaginitis

A

ID: BV, Trich, Candida, Cytolytic
Atrophy: post menopause, allergies

70
Q

Tx for vulvovaginal atrophy

A

Creams
Ospemifene
moisturizers

71
Q

BV D/c

A

Thing, homogenous, watery, grey-white “rotten fish” smell

72
Q

BV Microsocopic

A

Clue cells

Few WBC’s

73
Q

TX for BV

A

Metronidazole

Clinda

74
Q

Trich d/c

A

Frothy yellow green

Strawberry cervix

75
Q

Trich micro

A

Mobile protozoa on wet mount

WBC present

76
Q

Tx of Trich

A

Metronidazole

Tinidazole

77
Q

Candida d/c

A

Thick, curdlike/cottage ch

78
Q

Candida micro

A

Hypae, yeast, on KOH prep

79
Q

Tx CAndida

A

FLuconazole

80
Q

Define Dysmenorrhea

A

Painful mestruation that affects AODl

81
Q

TX for dysmenorrhea

A

NSAIDS
OCPs
Laparoscopy if meds fail

82
Q

Premenstrual syndrome

A

Cluster of physical

behavior sx. during clyclic occurance of luteal phase

83
Q

PMDD

A

Severe PMS w/ functional impairment

84
Q

Tx of PMDD

A

OCP”s
SSRI
GnRH
Refractory breast pain (danazole, bromocriptine)
Sprinolaction and calcium carbonate for bloating

85
Q

Define Primary amenorrhea

A

Failure of onset of menarche and secondary sex characteristics by age of 13
or
Failure of onset of menarche (with secondary sex ch.) by age of 16

86
Q

MC cause of secondary amenorrhea

87
Q

Causes of secondary amenorrhea other than pregnancy

A 
Hypothalamic dysfunction
Pituitary dysfunction
Ovarian d/o (PCOS)
Uterine do (ashermans,)
88
Q

MC pathogen of mastitis

89
Q

Tx for mastitis

A

Supportive, warm compress, pump
Dicloxacillin, Nafcillin, cephalosporin
Continue to nurse or use pump

90
Q

Tx for breast abscess

A

stop breast feeding from affected side

I&D

91
Q

Painless, hard, fixed, lump is descriptive of?

92
Q

MC side of breast mass?

93
Q

Breast ca screening should start when?

A

Annually after age 40

94
Q

MC cause of PID

A

N. gonorrhea

Chlamydia

95
Q

Out pt tx for PID

A

Doxy and ceftriaxone

96
Q

In pt tx for PID

A

Doxy and 2nd gen cephalosporin (cefoxitin)

97
Q

w/u for ectopic pregnancy

A

Serial BHCG should doulble q 24-48h, in ectopic serial B HCG fails to double, if inital value <1500 repeat in 2-3d.

98
Q

Unruptured ectopic tx.

A

Methotrexate

99
Q

ruptured ectopic tx

A

Lap salpingostomy

100
Q

BHCG markedly elevated indicative of?

A

Molar pregnancy

101
Q

US findings in molar pregnancy

A

Snowstorm or cluster of grapes

102
Q

When is glucose testing done during preg?

103
Q

Testing level indicative of GDM and f/u

A

> 140mg/dL after 1 hr –> do 3hr gtt

104
Q

Indicates for 3hr GTT

A

1hr >180 ; 2h >155, and 3h>140

105
Q

When does RH alloimmunization occur?

A

When Rh neg mom carries an Rh pos fetus

106
Q

Tx of Rh incompatability

A

Preventative: 300ug RhoGAM in Rh neg mom w/ Rh pos dad or unknown at 28wks and then again at 72h after deliver of Rh pos fetus

107
Q

R/F for PROM

A

STDs
Smoking
Prior pre term deliver
Multiple gestations

108
Q

Threatened Ab

A

CLosed OS, bloody vag discharge, no POC expelled

109
Q

Inevitable Ab

A

No POC expelled, progressive cervical dilation, PROM

110
Q

Incomeplete Ab

A

Some POC expelled, OS dilated, boggy uterus

111
Q

Complete Ab

A

All POC expelled, OS usually closed

112
Q

Missed Ab

A

No POC expelled, OS closed, embryo not viable but retained in the uterus

113
Q

TX for Missed Ab

A

D&C if 1st trimester

Or Misoprostol

114
Q

Septic Ab

A

retained POC becomes infection, some POC retianed, Closed OS w/ CMT

115
Q

Placenta previa is Painfull or painless?

A

Painless bleeding

116
Q

Abruptio placenta is Painful or painless?

A

Painful bleeding

117
Q

Tx for placenta previa

A

tocolytics (stop labor)

118
Q

Tx for abruptio placenta

A

Immediate delivery

119
Q

Define Gestational HTN

A

HTN without sx, no proteinuria, after 20 wks

120
Q

Define Preeclampsia

A

HTN + Proteinuria after 20 wks gestation, NO SEIZURES but HA, Visual sx
MILD BP >140/90
Severe: BP >160/110
HELLP Syndrome is of concern here

121
Q

HELLP syndrome

A

Hemolytic anemia, elevated liver enzymes, Low plateltels

122
Q

Tx for Preeclampsia

A

Deliver is the only cure

Severe: Mg sulfate, BP meds when BP >180/110 (hydralazine)

123
Q

Eclampsia definition

A

Preeclapsia + seizures

124
Q

Tx of eclampsia

A

ABCD’s
Mg sulfate for seizure
Deliver of fetus once stabilized
BP meds Hydrazlazine, labetaolol

125
Q

Chronic HTN during pregnancy

A

Occurs before 20 wks

126
Q

Tx of mild chronic HTN during preg.

A

Monitor and deliver baby at 39-40wk

127
Q

Tx of severe chronic HTN during preg

A

(BP>150/100) Methyldopa is tx of choic, Labetalol, nifedipine (AVOID ACI & diuretics)

PANCE study guide (14 decks)

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