Women's Health Flashcards

Question

Fibroadenoma

Answer 1

Stromal overgrown of the breast tissue, common < 40 Sx: solid, mobile, palpable, pain Dx: mammogram; core bx if suspicious - U/S: well-defined borders, wider than tall, homogenous w/isoechoic Tx: - excision biopsy if suspicion, large in size - surgical intervention unnecessary in most patients

Answer 2

Cysts are well loculated fluid-filled sacs Sx: - changes in size w/hormone changes - soft to palpation - +/- pain Dx: U/S (well-defined borders, anechoic texture) - FNA Tx: no intervention vs. aspiration via FNA (cyst will collapse if serous)

Answer 3

Infection/cellulitis of breast most commonly seen in women who are breastfeeding - may develop into abscess Sx: erythema, warmth, pain, fever Dx: U/S if concern for abscess Tx: abx (Keflex), I/D abscess

Answer 4

Clinical dx of upper genital tract infection and inflammation Minimal criteria: - All: uterine tenderness, adnexal tenderness, CMT - +1: fever, mucopurulent d/c (cervicitis), high WBC, elevated ESR RF: <25yo, multiple partners, non-barrier method, previous PID*, h/o STD*, recent pelvic procedures - condoms and OCPs = protective - MC: gonorrhea, chlamydia - often concurrent BV Sx: lower abd/pelvic pain, possible rebound tenderness - acute or insidious onset w/INC pain, worse w/menstruation - vaginal d/c, possible fever, dysuria - CMT** Complications: - chronic pelvic pain/dyspareunia - adhesions - infertility - ectopic pregnancy - pelvic abscess - death d/t ruptured TOA

Answer 5

Dx: - cervical wet mount - trich, leukocytes, BV - cervical NAAT (GC) - other STI screening - UA/HCG - U/S if palpable mass; CT for abscess or sepsis - blcx if septic Tx: - outpatient: Ceftriaxone 250mg IM + Doxy 100mg BID x14d [add metro to cover anaerobes, BV, recurrent] - f/u 72hr and 3,4d; abstinence inpatient: Ceftriaxone 2g IV + doxy 100mg IV/PO [consider adding clinda or metro] Admit: - pregnancy - abscess - tubo-ovarian mass - severe illness w/systemic sxs - no response to OP - severe I/C

Answer 6

Definition - no pregnancy after 1y of trying - no pregnancy after 6mo of trying if >35yo or suspicion of pre-existing problem - recurrent miscarriage Factors: - male: low/no sperm, low motility [H/P, semen analysis] - female: ovulatory dysfunction*, endometriosis*, tubal disease* [H/P, cultures, endocrine labs, HSG] Tx: - DA Ag: suppress prolactin - SERMs: negative feedback so more FSH produced - Aromatase inhibitors - Metformin for PCOS or IR - Wt loss - HCG injection midcycle to stimulate LH surge Assistive reproductive techniques - IVF - IUI (intrauterine insemination) - ICSI (intracytoplasmic sperm injection)

Answer 7

General: - to term at 37wk - labor: regular uterine contractions leading to cervical change - regular contractions q8-10min + water breaks or significant vaginal bleeding - effacement and dilation* of cervix: 4-5cm dilated and 100% effaced when labor generally begins First Stage (getting ready) - latent phase: hrs-days, 0-4cm dilation - active phase: more rapid cervical change - end: cervix completely dilated Second stage (pushing baby out) - start: complete cervical dilation, pt starts pushing - end: baby delivered - 3-5min between contractions - successive pregnancies are quicker Third stage (delivery of placenta) - start: delivery of baby - end: delivery of placenta - involution* - uterus shrinks to size of grapefruit - abnormal if > 30min* (avg 7-8min) Fourth stage - start: delivery of placenta - end: 24hr later, postpartum, start breastfeeding

Answer 8

labor arrest - not progressing normally for some reason

Answer 9

baby HR increases/decreases and less reaction dx: fetal stress test

Answer 10

increased BG only during pregnancy (starts after 20wk) - usually asx Increased risk of T2Dm later Tx: diet, exercise - if too high, can start insulin

Answer 11

Diseases arising from the placenta Trophoblast: lining of cells of the developing blastocyte providing nourishment that develops into the placenta Hydatidiform mole* - rare: abnormal growth of placental cells caused by fertilization of empty ovum or 2 sperm + 1 ovum - sx: vaginal bleed, hyperemesis Dx: HCG very High - enlarged uterus - U/S: grape-like clusters or snow-storm apperance* - bx to confirm Tx: surgical evacuation by hysteroscopy + Rhogam - no pregnancy for 1yr - follow HCG until negative for 1yr - start on OCPs

Answer 12

Gestational: transient, just during pregnancy - after 20wk Chronic: HTN prior to pregnancy - before 20wk - d/c ACE/ARB and start methyldopa

Answer 13

HTN + 1 of the following: - proteinuria - thrombocytopenia - renal insufficiency - impaired LFTs - pulmonary edema - cerebral/visual sx After 20wk ``` Sxs: w/out severe features - BP < 160/100 - no CNS - normal serum - no pulmonary edema ``` Severe symptoms all opposite

Answer 14

Pre-eclampsia + Seizures Sx: visual/cerebral symptoms can be a sign that a seizure is coming

Answer 15

- smaller babies - at higher risk of everything - delivered earlier than 40wks, requires close observation

Answer 16

Lacerations: cervix, trauma, vaginal wall Still placenta inside: didn't come out intact, get it out! D&C Baggy, soft uterus, not involuting - give meds to make uterus involute, smooth muscle contraction (misoprostol, prostaglandin, epinephrine) Try to tamponade the bleeding: use balloon catheter for uterus, stuff uterus with sponges - blood transfusion or other blood products IR: place catheter, uterine artery embolization Late effort: hysterectomy - pt usually in shock or DIC at this point