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Remediation > Woman's Health > Flashcards

Woman's Health Flashcards

1
Q

What is a Bishop score? What is it used for?

A

Scoring of the cervix during/before labor. This helps us determine whether or not the patient is in labor, what phase of labor they’re in and how the labor is progressing. Predictor of whether or not IOL is necessary

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2
Q

Bishop score >8?

A

Vag delivery likely, the cervix will probably do just fine.

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3
Q

Bishop <6?

A

Probably need some kind of induction method

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4
Q

5 Components of a Bishop Score

A

“Call PEDS Fast”

Cervical Position (it kind of retracts for labor
Effacement (thinning)
Dilation 
Softness (consistency)
Fetal Station
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5
Q

Stage I of labor

A

Onset of labor until complete dilation of cervix. Consists of active phase and latent phase

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6
Q

How long does stage 1 take if nullip? Mulltip?

A

Null: 10-12 hrs
Mull: 6-8 hrs

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7
Q

What defines the latent phase of labor?

A

Onset of labor until the cervix is dilated 3-4 cm. Not considered active until 3-4 cm.

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8
Q

When does active phase start? When does it end? How long does this take (null vs mull)

A

Starts at 3-4cm, ends at 9cm.

Null: 1cm/hr
Mull 1.2cm/hr

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9
Q

What are the 3 P’s

A

Power of contractions
Passenger- size and position of the kid
Pelvis/Passage- size/shape of pelvis

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10
Q

What defines stage 2 labor? Length of time null vs mull

A

9cm until the delivery of the infant

Null- >2 hours is considered prolonged. >3 if epidural
Mull- >1 hr is prolonged. >2 if epidural

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11
Q

Repetitive early & variable decels in stage 2 labor?

A

Totally normal! Have to do with contractions. Being repetitive is good

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12
Q

Late decels, bradycardia or loss of variability?

A

NOT OKAY! This is when we consider an urgent cesarean

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13
Q

What defines stage III delivery

A

Delivery of the infant until the delivery of the placenta. Takes 5-30 min

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14
Q

3 signs of placental separation

A

Cord lengthening
Sudden blood gush
Uterine fundal rebound as placenta detaches

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15
Q

First degree tear

A

Vaginal mucosa

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16
Q

Second degree tear

A

Perineal tear. Taint

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17
Q

3rd degree tear

A

Anal sphincter involvement

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18
Q

4th degree tear

A

Tears into the rectum

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19
Q

RF for molar pregnancy

A

Extremes in age. Hx of GTD. Nullip. OCP use

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20
Q

Pathognomonic for molar pregnancy

A

PEC, hyperemesis and hyperthyroidism happening <20 weeks. It’s like pregnancy gone rogue. ALSO HEAVY VAGINAL BLEEDING

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21
Q

PE on molar preg

A

PEC, hyperthyroid, NO FETAL HEART TONES, uterus is MASSIVE for GA, grape like goop coming out of the cervix, theca lutein cysts

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22
Q

Molar pregnancy on US

A

Molar tissue looks like “diffuse mixed echogenc pattern”. Not a fetus, it’s a weird clump of tissue made from chorionic villi and intrauterine blood clots.

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23
Q

Management of a molar pregnancy

A

Immediate removal to prevent persistant/malignant GTD.

Also tx the symptoms
PEC? Anti HTN
HCG induced hyperthyroid? BB to prevent thyroid storm
Done with childbearing? Cut that uterus out

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24
Q

Which type of mole is more likely to lead to persistent GTD

A

Complete

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25
Q

Why do we recommend patients to not have another pregnancy for 6-12 months after a mole pregnancy

A

We do serial HCG levels for months afterwards to watch the levels drop and make sure there’s no persistent disease going on. If the patient is pregnant so soon afterwards there’s A) a chance the mole could happen again and B) HCG levels will be high from that so we won’t know if there’s also something scary going on

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26
Q

What freaky kind of malignant GTD can happen from a complete mole

A

Choriocarcionma

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27
Q

Gestational HTN definition

A

HTN w/o proteinuria that happens after 20 wks. Previously normal BP too.

Lil bitch HTN, >140/90

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28
Q

PEC definition

A

HTN + Proteinuria after 20 weeks.

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29
Q

Proteinuria definition for PEC

A

> 0.3g in a 24hr urine. Remember there should be no proteins

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30
Q

Severe PEC definition

A

> 160/110, and protein >5g in a 24 hr or >3g in a spot, symptomatic HTN. This is pre HELLP and it’s very bad

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31
Q

Superimposed PEC

A

Newonset proteinuria or worsening BP in a woman with prexisting CHTN.

Or if they get HTN symptoms, like HA/scotoma/epigastric pain

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32
Q

Eclampsia definition

A

PEC + Seizures

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33
Q

Management for PEC

A

Delivery! IOL is GS for term moms, unstable moms or any pregnancy that shows lung development

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34
Q

Management for PEC with a stable preterm

A

Bedrest & betamethasone until we can induce

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35
Q

IOL with PEC, let’s talk mag

A

Give Mg (4g loading, 3g/hr maintenance) during labor, & 12-24 hrs PP

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36
Q

Signs of severe PEC

A 
BP >160/110
>5g 24hr or >3g in a spot
Oliguria
Scotoma
Pulm edema/cyanosis
Epigastric/RUQ pain
LFT fuckups
Thrombocytopenia
Fetal growth restriction

This is HELLP waiting to happen

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37
Q

Momma with signs of renal/liver failure/pulmedema/HELLP/DIC?

A

C SECTION TIME

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38
Q

Eclampsia managment

A

Seizure management, BP control, seizure ppx.

They get Mg from the time of diagnosis until 12-24hr pp. This is when it’s okay to load the fetus with Mg

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39
Q

Can we section a seizing mom because baby is having decels?

A

No fucking way. Decels are to be expected. Fix the seizures, fix the decels

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40
Q

What does HELLP stand for

A

Hemolytic anemia
Elevated Liver enzymes
Low Platelets

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41
Q

Signs of hemolytic anemia

A

Elevated LDH
Elevated Bili
Schistocytes on smear

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42
Q

Signs of elevated liver enzymes

A

Elevated AST/ALT

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43
Q

Signs of low platelets

A

thrombocytopenia

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44
Q

What week is the fundus at the umbilicus

A

24 weeks

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45
Q

Nageles rule

A

Subtract 3 months from the LMP and add 7 days

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46
Q

Don’t know the LMP but you want to calculate the EDD?

A

Via US, measure the crown-rump length. If done in the first trimester, this will give you a fairly accurate estimate. Within 3-5 days.

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47
Q

Four steps to leopold maneuvers

A

First- fundus
Second- sides
Third- presenting part
fourth- pubic symphesis

48
Q

Role of leopold maneuvers

A

Way to gage the position of the fetus if you don’t have US

49
Q

Suppressive Tx for HSV

A

1g of PO valcyclovir QD forever

50
Q

Syphilis PE

A 
Chance
LA
Torso, palm, sole rash
AMS on neuro exam
Genitalia, perianal, oral cavity lesion (2nd degree syph_
51
Q

When is serology highest for syp

A

2nd degree

52
Q

Chancre are wicked painful right

A

nah dude

53
Q

Screening for syph

A

Non trep VDRL/RPR test. Titers. this can be your false positive. Need another test to be diagnositic

54
Q

Diagnostic for syph

A

Trep FTABS antibody test. This is diagnostic for syphilis

55
Q

Have a lesion? What test is solidly mediocre for syph

A

Darkfield microscopy for spirochetes

56
Q

When to consider getting a LP for syphilis

A

If they have positive titers and neuro sx like meningitis-like, hearing loss, CN dysf, AMS

57
Q

LP CSF Syph interpertation

A

Pleocytosis (>5WBC)
Inc protein (>45)
+ VDRL/FTABS

58
Q

Syphilis tx lowkey vs high key

A

Lowkey is 2.3 million IM units one dose

Highkey is 7.2 million IM units given in three doses each a week apart

59
Q

What is CIN

A

It is a premalignant condition of the uterine cerxix. It’s the histological result of a pap smear

60
Q

Cytology & Histology matchup

LSIL correlates to?
HSIL?

A

LSIL - CIN 1

HSIL- CIN2,3

61
Q

ASCH Management

A

<25? Pap & colpo every 6 months for 1 yr

>25? Automatic colpo. If it’s lowkey just do cotesting in 12/24 months. Highkey (CIN2,3) LEEP

62
Q

CIN1/LSIL management

A

FU necessary

CIN1 for 2 years straight? Can either keep following up or LEEP

CIN2/3? LEEP

63
Q

CIN 2/3 HSIL management

A

Tx necessary. LEEP right away. Do cotesting afterwards

64
Q

Timing of PMS/PMDD

A

Repetitively in the second half of the menstrual cycle, resolves after menses.

65
Q

Difference between PMS and PMDD

A

PDMD is characterised by anger, irritability, and internal tension. Like a total asshole

66
Q

Tx for PMDD

A

1) SSRI!
2) OCP
3) Maybe low dose alprazolam?
4) GnRH
5) Surg

67
Q

Main causes of primary amenorrhea

A

1) GONADAL DYSGENESIS (Turner, XY, primary ovarian insuff, PCOS)
2) Mullerian agenesis (MRKH)
3 )Constitutional delay
PCOS
Everything else is super rare

68
Q

Main causes of secondary amenorrhea

A

1) PREGNANCY
2) Hypothal
3) Ovarian dysf
Pit

69
Q

Types of hypothalamic dysfunction

A

Constitutional delay
Isolated GnRH def (not common)
functional hypothalamic amen (stress, exercise, anorexia)

70
Q

Labs to get for amenorrhea

A

HCG, FSH, TSH, PRL, Testosterone

71
Q

Women infertility WU

PE

labs?

A

PE BMI, sex characteristics, breast/pelvic exam, thyroid exam

Labs: TSH, PRL, STI screen, genetic

72
Q

Ovarian evaluation for an infertility woman WU

A

Confirm ovulation is happening (secretory phase, prog levels)

Ovulation reserve testing (FSH and estradiol, antral follicle count)

73
Q

Uterine evaluation for a woman’s infertility WU

A

Lots of scope options
Pelvic US
Hysterosalpingogram

74
Q

Oligospermia

A

Most frequent cause of male infertility. it’s when there’s a low concentration of sperm in ejaculate

75
Q

Azoospermia

A

Total abcense of sperm. Bilateral obstruction

76
Q

Asthenospermia

A

Abnormal motlity “asthens, athens, hermes movement”

77
Q

Teratospermia

A

Abnormal morphology. Teratogenic

78
Q

Two methods of infertility tx

A

Ovulation induction (clomid) and controlled ovarian stimulation

79
Q

When to do/start a CBE

A

Age 20-40 q2-3 yrs

>40? yearly

80
Q

Who should do a BSE

A

High risk patients

81
Q

Mammo guidelines?

A

ACOR recommends starting @ 40, ending at 75. q1-2 yr

82
Q

Mammo and age

A

<50? Less sensitive since breast tissue is still pretty dense
>50? More sensitive. Most of the breast tissue has been replaced with fat

83
Q

Suspicious lesion found on mammo?

A

1) US. Find out if it’s cystic or solid
2) Biopsy or aspirate

Types of biopsies: open excisional, MRI guided, core, stereotactic

84
Q

Cystic mass on US?

A

Aspirate in office and send to cyto

85
Q

Mammo findings suggestive of cancer

A

Microcalcifications in a linear distribution, spiculated irregular mass

86
Q

Non palpable mass found on mammo?

A

Stereotactic bx

87
Q

Palpable mass found on mammo?

A

Core biopsy

88
Q

WHAT DOES EVERY MASS GET

A

BIOPSY. YOU CANNOT RULE OUT MALIGNANCY BASED ON PE

89
Q

Most common type of breast cancer

A

infiltrating ductal carcinoma

90
Q

Signs of poor prognosis in BC

A 
Age
Menopause
Tumor size (>2cm)
LN status (sentinel LN is sampled first to avoid axillary LN dissection)
ER/PR status
HER-2 overexpression
91
Q

What’s really the only option for triple negative BC

A

chemo. Yikes

92
Q

Targeted BC tx?

A

Trastuzumab. It’s a monoclonal ab that works against HER2 overexpression. Given with conventional chemo, it has dramatically increased the survival rate in HER-2+ BC

93
Q

Hormonal Tx for BC

A

Aromatase inhibs and SERM. These work against ER/PR + tumors. It’s why they’re so curable

94
Q

ER/PR + and pre menopausal?

A

Tamoxifem/SERM

95
Q

ER/PR + and post menopausal?

A

Aromatase inhibitors (aromasin, arimidex)

96
Q

Indications for chemo in BC

A

LN +
ER/PR -
Good/used regardless of HER status

Meant to eliminate micro mets and reduce recurrence

97
Q

What is neoadjuvent chemo and why might we give it

A

Given before surgery to help reduce tumor size. Gives us a shot at possibly resetion an inoperable tumor.

Given before resection. It’s a “new” idea to give chemo before surgery

98
Q

Taxane chemo drugs– especially rad for what type of BC

A

Paclitaxel, doxetaxel. Esp rad for HER2 overexpression

99
Q

Rotterdam criteria for PCOS

A

2/3 of the following

Ovulatory dysf (oligo/anovulation)
Hyperandrogenism
Polycystic ovaries on US
100
Q

Sx of PCOS

A

irregular menses
acanthos nigrans
Hyperandrogen sx
mood changes

101
Q

Sx of hyperandrogenism

A

acne
hirtuism
male patterned balding
high serum T

102
Q

PCOS pt pursuing pregnancy

A

Clomid
Letrozole
metformin (weird but helps regulate menses)

103
Q

PCOS pt not pursing pregnancy, sx management

A

Irregular menses -> Hormonal BP or metformin
Insulin res -> metformin
HyperA –> Hormonal BC or spironolactone
Acne -> Hormonal BC and topical creams

104
Q

First line for obesity in PCOS

A

diet and exercise

105
Q

Uterine cycle

A

Proliferation
Secretory (post ovulation)
Menstruation

106
Q

Ovarian cycle

A

Follicular phase

Luteal phase

107
Q

What day does menses end

A

Day 7

108
Q

Theca cells

A

LH and make androgens

109
Q

Granulosa cells

A

FSH and convert androgens into E. Also makes E

110
Q

What produces Prog

A

Corpus luteum

111
Q

When does estradiol peak

A

Day 14, it drops right after ovulation and then the CL makes prog

112
Q

What hormone surge causes ovulation

A

LH

113
Q

Low E levels after the corpus luteum becomes the corpus albicans triggers the hypothal to do what

A

Release GnRH

114
Q

GnRH triggers the ant pit to do what

A

release FSH and LH

115
Q

FSH and LH triggers what

A

the granulosa cells and thea cells to dump estrogens and androgens, eventually leading to the LH dump that causes ovulation

116
Q

Repetitive granulosa stimulation triggers what

A

Inhibition of FSH and GnRH release. Only LH is going now

Remediation (2 decks)

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