reproductive system Flashcards
cigarette smoking women with stdss
An etonogestrel implant (Nexplanon) is the best option for this patient. It is a progesterone-only method. The 35-year-old patient is a smoker, so she cannot take oral contraceptives, which contain estrogen/progesterone. An IUD (copper or progestin) is contraindicated until the patient is retested (4–6 weeks after treatment) to ensure that her gonorrhea and chlamydia infections are gone. The vaginal ring (NuvaRing) contains estrogen and progesterone; it is contraindicated for this patient.
theatened abortion
Threatened abortion is defined as vaginal bleeding and cramping without the presence of cervical dilation.
fundal height normal and abnormal
Between 20 and 35 weeks, the fundal height is equal to the number of weeks of gestation plus or minus 2 cm. Fundal height is measured as the distance between the pubic bone and the uterine fundus. For example, a woman who is at 30 weeks’ gestation who has a fundal height of 29 cm is within normal limits. But if the fundal height is 27 cm (3 cm difference), it is abnormal. Next step is to order a fetal ultrasound
placenta previa presentation
Placenta previa occurs when the placenta implants abnormally, partially, or wholly in the lower segment of the uterus or over the internal os. A classic presentation is painless bright-red vaginal bleeding in the second and/or third trimester. Do not perform any digital cervical exams in any pregnant woman with bleeding until the position of the uterus is known (abdominal ultrasound). Avoid vaginal exam, sexual intercourse, or rectal exam if placenta previa is suspected.
primary and secondary amenorhea
Secondary amenorrhea is defined as no menses for more than three cycles or 6 months in a female who already has a menstrual cycle. The most common cause is pregnancy. Others are ovarian disorders, stress, anorexia, and polycystic ovary syndrom
testicular torsion intervention
hese symptoms are an indication of testicular torsion, which is a medical emergency. Since all blood for the testicle comes through the spermatic cord, the blood supply is cut off with a twist. The testicle will shrink (atrophy) if the blood supply is not restored within 6 hours. The spermatic cord needs to be untwisted (detorsion) to restore the blood supply. An equivocal diagnosis may be resolved by immediate imaging, if available. Color Doppler ultrasonography of the scrotum is preferred and needs to be performed immediately. Radioisotope scrotal scanning is also diagnostic but takes longer and is less useful. Immediate manual detorsion without imaging can be attempted during the initial examination with variable success. Because testes usually rotate inward, for detorsion the testis is rotated in an outward direction (e.g., for the left testis, detorsion is clockwise when viewed from the front, underneath the testis). More than one rotation may be needed to resolve the torsion. If detorsion fails, immediate surgery is indicated, because exploration within a few hours offers the only hope of testicular salvage. One study found that nearly three in four patients require testicle removal (orchidectomy) if surgery is delayed past 12 hours
testicular torsion symptoms
Testicular torsion presents with a sudden onset of pain in the scrotum/ testicles, and initially it may be felt in the abdomen and groin. The scrotum will be swollen, in severe cases acute hydrocele is present, and the affected testicle is higher than the unaffected one. Severe nausea and vomiting are common features. The cremasteric refl ex is missing, not present. If not corrected within 24 hours, 100% of testicles become gangrenous and must be surgically removed. Hematuria and pyuria are not symptoms of testicular torsion, and urinalysis is generally normal.
reiters syndrome
Reiter’s syndrome is an immune-mediated reaction secondary to chlamydia that causes red, swollen joints; ulcers on the skin of the glans penis; and urethritis. It resolves on its own. Treatment is NSAIDs and comfort measures. Treatment with antibiotics will address the underlying cause, which is chlamydia. LNA is used in the treatment of ankylosing spondylo
trichomoniasis
Oral metronidazole (Flagyl).
Trichomoniasis symptoms include dysuria, severe vaginal pruritus, and malodorous vaginal discharge. Wet prep microscopic examination should show trichomonads that are pear shaped and have several flagella (whiplike tails) at one end. The Centers for Disease Control and Prevention (CDC) recommendation for treatment is metronidazole. A single dose is effective treatment in most cases of trichomoniasis infections
types of abortion
Inevitable abortion is defined as vaginal bleeding with pain, cervical dilation, and/or cervical effacement. Threatened abortion is defined as vaginal bleeding with absent or minimal pain and a closed, long, and thick cervix. Incomplete abortion involves moderate to diffuse vaginal bleeding, with the passage of tissue and painful uterine cramping or contractions.
vaginal atrophy
Vaginal atrophy (atrophic vaginitis) is thinning, drying, and inflammation of the vaginal walls that may occur when the body has less estrogen, as with postmenopausal women.
vericocele
Palpation of varicose veins, described as a “bag of worms,” in the scrotum is a classic symptom of a varicocele, an abnormal tortuosity and dilation of the veins of the pampiniform plexus within the spermatic cord. It is most common on the left side and may be associated with pain. It occurs in boys and young men and is associated with reduced fertility. The condition is often visible only when the patient is standin
