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Clin Med > Women's health > Flashcards

Women's health Flashcards

1
Q

Polymenorrhea

A

menses that occur more frequently (menses <21 days apart)

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2
Q

hypermenorrhea

A

menses that involve more blood loss during menses (>7 days)

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3
Q

Menorrhagia

A

prolonged/heavy bleeding; regular intervals

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4
Q

Metrorrhagia

A

uterine bleeding that occurs more frequently and irregularly b/w menses

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5
Q

MC type of breast abscess

A

lactational

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6
Q

MC bacteria in breast abscess

A

S aureus

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7
Q

tx for breast abscess

A

I&D, then dicloxacillin or keflex

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8
Q

should a pt w/ breast abscess continue breastfeeding?

A

yes

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9
Q

20 y/o F w/ Painless, firm solitary (rubbery feeling) well defined unilateral mobile mass in upper quadrant of breast.
* No change w/ menstrual cycle. dx?

A

fibroadenoma

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10
Q

40 y/o F w/ Multiple painful, bilateral, nodular/ropelike, mobile, smooth round or ovoid lumps in breasts
* Pain and size usually ↑ premenstrually
* Waxes and wanes w/ period; pain before menses that usually get better w/ the start of period. dx?

A

fibrocystic changes aka mammary dysplasia

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11
Q

supportive care recs for fibrocystic changes: 2 meds, 2 diet, 2 others pt can do

A

Supportive – observation, supportive bra, warm or cool compresses, NSAIDs
* Avoid caffeine and chocolate
* OCPs can ↓ sxs

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12
Q

suspect _____ if unilateral +/- bloody nipple discharge

A

malignancy

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13
Q

ask about what meds in galactorrhea? (5)

A

SGAs (antipsychotics), cimetidine, TCA’s, OCP’s, depo provera

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14
Q

ask about what condition in galactorrhea?

A

hypothyroidism

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15
Q

tests to order for galactorrhea

A

Prolactin levels (↑ prolactin levels 5x normal)
* T4 and TSH levels (primary hypothyroidism)
* CT or MRI (To identify microadenomas)

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16
Q

Med tx for pitutary adenoma hyper prolactinemia

A

Dopamine agonist: Bromocriptine or cabergonline (to ↓ prolactin levels)

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17
Q

60 y/o M complaining of gynecomastia. ask about what meds? (3)

A

Spironolactone, anabolic steroids, antiandrogens

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18
Q

when is b-hCG high in men?

A

testicular tumor

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19
Q

should a women w/ mastitis continue breastfeeding?

A

yes

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20
Q

Cervical motion tenderness suggests what dx?

A

PID

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21
Q

type of HPV that is most carcinogenic

A

HPV16

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22
Q

age for 1st pap, regardless of sexual activity

A

21

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23
Q

age to stop pap smears if adequate screening prior

A

65

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24
Q

age to add HPV testing on to pap

A

30

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25
Q

age to vaccinate for HPV

A

11-12

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26
Q

spontaneous abortion happens before what poitn in pregnancy

A

before 20 wks

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27
Q

MCC of spontaneous abortion

A

chromosomal abnormalities

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28
Q

what type of spontaneous abortion? Bloody vaginal discharge <20 wks
gestation w/ or w/o uterine contractions in the presence of a closed cervix. Fetal cardiac activity

A

threatened

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29
Q

what type of miscarriage? Death of fetus <20 wks gestation,
w/ products of conception
remaining intrauterine. No fetal
cardiac activity. Os closed

A

missed

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30
Q

what type of miscarriage? Dilated cervical os w/o passage of
tissue <20 wks gestation

A

inevitable

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31
Q

drug to aid in evacuation of POC after miscarriage

A

Misoprostol

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32
Q

should women who are Rh-negative get anti-D Rh immunoglobulin after miscarriage/abortion?

A

yes

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33
Q

medical elective abortion can be used up to ___ wks after LMP

A

10

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34
Q

surgical elective abortion can be used up to ___ wks after LMP

A

24

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35
Q

rx for elective abortion

A

Mifepristone followed by misoprostol 24-48 hrs after

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36
Q

Painful vaginal bleeding (dark red) w/in 3rd trimester
* Severe abd and back pain
* Tender rigid uterus.
dx?

A

Abruptio Placentae

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37
Q

MC risk factor for placental abruption

A

maternal HTN

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38
Q

order what tests (3) for suspected placental abruption

A

US, coag studies. type and cross due to heavy bleeding

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39
Q

next step for placental abruption w/ unstable mother/fetus and/or worsening

A

emergency C section

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40
Q

MCC of 3rd trimester bleeding

A

placenta previa

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41
Q

ok to do speculum exam for suspected placenta previa? how about bimanual?

A

gentle careful speculum ok. NO bimanual

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42
Q

Sudden onset of painless vaginal bleeding in 3rd trimester (bright red)
* Absence of abd pain or uterine tenderness
dx?

A

placenta previa

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43
Q

order what tests for placenta previa? (4)

A

US, CBC, type and screen, PT/PTT

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44
Q

placenta previa w/ stopped bleeding and stable at 34 wks. plan?

A

deliver via C section b/w 36-38 wks. home rest.

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45
Q

1st line tx for shoulder dystocia

A

1st line: Nonmanipulative maneuvers
§ McRoberts maneuver: flexion of the maternal hips
§ Suprapubic pressure

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46
Q

MC location for ectopic pregnancy

A

ampulla

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47
Q

leading cause of maternal death in 1st trimester

A

ectopic pregnancy

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48
Q

classic triad of ectopic pregnancy

A

sudden onset unilateral pelvic or lower abd pain + amenorrhea + vaginal bleeding

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49
Q

if beta-hCG does not double every 48 hrs as expected, but is increasing very slowly, suspect ____

A

ectopic preg

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50
Q

TVUS of F w/ abd pain shows hypervascular lesion w/ peripheral vascularity on Doppler. dx?

A

ectopic pregnancy

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51
Q

tx for stable/unruptured ectopic pregnancy

A

methotrexate IM

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52
Q

normal fetal HR

A

b/w 120-160 bpm

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53
Q

1st line med for gestational DM

A

insulin

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54
Q

MC fetal complication in gestational DM

A

macrosomia

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55
Q

when in preg to do DM testing

A

24-28 wks

56
Q

for 50g 1hr glucose challenge test, glucose should be <____. if not, proceed to 100g 3hr test

A

<130

57
Q

pt w/ larger uterus than expected at stage of pregnancy, + very high b-hCG, + painless vaginal bleeding. suspect what dx?

A

molar pregnancy aka gestational trophoblasstic dz

58
Q

Schedule for serum HCG monitoring after evacuation of molar pregnancy

A

test hCG weekly until normal x3 wks, then monthly X6mo

59
Q

definition of gestational HTN

A

BP > 140/90 mmHg after 20 wks gestation that resolves 12 wks postpartum + no proteinuria, edema,
or end organ damage

60
Q

meds for gestational HTN (4)

A

methyldopa, labetalol (pref), nifedipine. can add hydralazine if a 2nd agent is needed

61
Q

classic triad of preecclampsia

A

HTN + Proteinuria + Edema

62
Q

cure for preecclampsia

A

delivery

63
Q

HELLP syndrome is a subtype of _____ and includes ____ (3)

A

preeclampsia. Hemolysis, Elevated Liver enzymes, Low Platelets

64
Q

tx for severe preeclampsia if <34 wks

A

hospitalise. give antenatal steroids. deliver if unstable. consider Mg sulfate to prevent seizure

65
Q

deliver at what gestational age in mild preeclampsia

A

37+ wks

66
Q

tx for seizure in eclampsia

A

Mg sulfate

67
Q

MCC of maternal morbidity and mortality worldwide

A

postpartum hemorrhage

68
Q

MCC of postpartum hemorrhage

A

uterine atony

69
Q

1st line to try for uterine atony hemorrhage

A

bimanual uterine (fundal) massage

70
Q

1st line med for postpartum hemorrhage d/t uterine atony

A

IV oxytocin or misoprostol or methergine

71
Q

Preterm Premature Rupture of Membranes (PPROM): Rupture of amniotic membranes before labor
begins < __ wks

A

<37

72
Q

PPROM <34 wks. give ___ for fetal lungs

A

Betamethasone

73
Q

3 times in which to give RhoGAM

A

at 28 wks gestation + w/in 72 hrs of delivery of a Rh-positive baby + After any potential
mixing of blood

74
Q

MCC of infertility

A

anovulation

75
Q

try what med to induce ovulation in infertility: 1st and 2nd line

A

1 — letrozole
2 — Clomiphene

76
Q

F are considered to be post-menopausal after ___ w/o a period

A

12 mo

77
Q

why is progesterone given w/ estrogen in HRT

A

to decrease risk of endometrial cancer

78
Q

1st line for hot flashes if not on HRT

A

SSRIs and SNRIs (paroxetine, venlafaxine)

79
Q

can a F w/ CVD take HRT?

A

no

80
Q

can a F w/ hx of DVT or PE take HRT?

A

no

81
Q

combo OCPs are CI in ____ (4)

A

women >35 y/o who smoke, hx of blood clots, breast cancer, or migraines w/ auras

82
Q

2 major downsides to depo provera

A

weight gain, decreased bone denis

83
Q

major downsides to depo provera

A

weight gain, decreased bone denisity

84
Q

most effective emergency contraception

A

copper IUD w/in 5 days

85
Q

OTC levonorgestrel for emergency contraception should be taken when?

A

w/in 3 days, but asap

86
Q

does HRT increase or decrease the risk for breast CA

A

increase

87
Q

MC presentation of breast CA

A

Painless, hard fixed immobile lump in upper outer quadrant

88
Q

best imaging for breast mass in F <40

A

US

89
Q

can you do receptor testing on a fine needle aspiration of a breast mass?

A

no. need a large needle/core bx

90
Q

most common sx of cervical cancer

A

Post coital bleeding or spotting

91
Q

blood test to order for suspected ovarian CA in postmenopausal OR premeno + suspicious U/S

A

CA-125 levels

92
Q

for suspected endometrial CA, a thickness of >___mm on TVUS reqs biopsy

A

> 5mm

93
Q

most common sx of vulvar CA

A

vaginal pruritis

94
Q

MC type of ovarian cyst

A

follicular

95
Q

in PCOS, be concerned about ____ that you can cheeck for w/ a blood test

A

DM

96
Q

1st line tx for PCOS

A

combo OCPs

97
Q

what DM med might improve menstrual freq in PCOS

A

metformin

98
Q

gold standard for dx of ovarian torsion

A

laparoscopy

99
Q

tx for syphillis

A

IM Benzathine Penicillin G

100
Q

painful ulcers on genitals. suspect what dx?

A

herpes (HSV)

101
Q

tx for 1st HSV outbreak

A

acyclovir 400mg tid OR valacyclovir 1g bid X 7-10 days

102
Q

3 options for genital warts tx, and preferred option in preg

A

podofilox bid X 3 days, 4 d off X 1 month
imiquimod or sinecatechins/Veregen X max 4 months
pregnant: TCA weekly for 4-6 wks.

103
Q

Cervical petechiae (strawberry cervix). dx?

A

trich

104
Q

positive whiff test could be which 2 dx?

A

trich, BV

105
Q

wet prep of trich will show what?

A

flagellated protozoa

106
Q

tx for trich

A

Metronidazole 500mg PO BID x 7 Days

107
Q

MC bac STI

A

chlamydai

108
Q

tx for STI w/ vaginal discharge, dysuria

A

IM ceftriaxone 500mg + oral doxycycline 100mg BID x 7 days

109
Q

BV wet mount will show what?

A

clue cells

110
Q

tx for BV

A

Metronidazole 500mg PO BID x 7 Days

111
Q

counsel pt about _____ if rx metronidazole

A

do not consume alcohol

112
Q

RFs to ask about w/ vaginal candidiasis (4)

A

DM, immunosuppresion, recent abx use, combined OCPs

113
Q

tx for candiaisis in preg

A

Imidazole, clotrimazole, terconazole cream/suppository x 7 days. No PO

114
Q

MCC of PID

A

chlamydia

115
Q

triad of PID

A

pelvic pain + ↑ purulent vaginal discharge + fever

116
Q

PID tx

A

Ceftriaxone 500mg IM once + doxycycline 100mg bid X 14d + metronidazole 500mg BID x 14 day

117
Q

ACE-i ok in preg?

A

no

118
Q

doxy ok in breastfeeding?

A

no

119
Q

stage 1 of labor is from onset of contractions to ____

A

full dilation

120
Q

stage 2 of labor is from ____ to ____

A

full dilation to baby delivery

121
Q

1st line tocolytic (medications used to suppress premature labor) for < 32 wks

A

indomethacin

122
Q

1st line tocolytic (medications used to suppress premature labor) for > 32 wks

A

nifedipine

123
Q

serum HCG can detect pregnancy as early as __days after conception

A

5

124
Q

urine HCG can detect pregnancy as early as __days after conception

A

14

125
Q

formula for Naegle’s Rule

A

LMP + 7 days – 3 months + 1 year

126
Q

prenatal Visits ___ until 24-28 wks, then_____, then _____ at 36 wks.

A

Visits monthly until 24-28 wks, then 2 wks, then weekly at 36 wks.

127
Q

folic acid rec for preg

A

Folic acid 400-1000 mcg or 0.4mg before conception or 4mg for secondary prevention

128
Q

3 Ds of endometriosis

A

Dysmenorrhea, dyspareunia, dyskesia (painful bowel movements)

129
Q

initial test for suspected endometriosis

A

US

130
Q

1st line tx for endometriosis

A

combo OCPs

131
Q

MC sx of uterine fibroids

A

Bleeding is most common sxs (menorrhagia or irregular)

132
Q

2 imaging options for uterine fibroid

A

TVUS, MRI

133
Q

MC indication for hysterectomy

A

uterine fibroids

134
Q

Deliver at __ weeks in severe preeclampsia

A

34

135
Q

A 52 year-old obese patient with persistent heavy menses undergoes an endometrial biopsy and is diagnosed with atypical adenomatous hyperplasia. What is the next step in the management of this patient?

Total abdominal hysterectomy

Observation and endometrial biopsy in 3 months

Endometrial curettage followed by progesterone daily

Oral progesterone days 16-25 of the month for 6 months and repeat biopsy

A

TAH
Atypical adenomatous hyperplasia contains cellular atypia and mitotic figures in addition to glandular crowding and complexity. This has a 20-30% risk of progression to endometrial cancer and the recommendation is hysterectomy.

136
Q

A 40 year-old female presents with a Pap smear abnormality revealing atypical glandular cells (AGUS). What is the most appropriate intervention?

HPV DNA testing

Colposcopy with endometrial curretage (ECC)

Repeat Pap smear in 3 months

Colposcopy and endometrial sampling

A

Colposcopy and endometrial sampling

Colposcopy and endometrial sampling are important to perform in patients with AGUS Pap results because glandular cells are associated with squamous and glandular precursor lesions and carcinoma.

137
Q

Which of the following is the earliest and most reliable clinical manifestation of pre-eclampsia?

onset of proteinuria

elevation of blood pressure

excessive weight gain and edema

headache and visual distrubance

A

elevation of blood pressure

Clin Med (14 decks)

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