Women's health Flashcards
1
Q
Polymenorrhea
A
menses that occur more frequently (menses <21 days apart)
2
Q
hypermenorrhea
A
menses that involve more blood loss during menses (>7 days)
3
Q
Menorrhagia
A
prolonged/heavy bleeding; regular intervals
4
Q
Metrorrhagia
A
uterine bleeding that occurs more frequently and irregularly b/w menses
5
Q
MC type of breast abscess
A
lactational
6
Q
MC bacteria in breast abscess
A
S aureus
7
Q
tx for breast abscess
A
I&D, then dicloxacillin or keflex
8
Q
should a pt w/ breast abscess continue breastfeeding?
A
yes
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
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
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
12
Q
suspect _____ if unilateral +/- bloody nipple discharge
A
malignancy
13
Q
ask about what meds in galactorrhea? (5)
A
SGAs (antipsychotics), cimetidine, TCA’s, OCP’s, depo provera
14
Q
ask about what condition in galactorrhea?
A
hypothyroidism
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)
16
Q
Med tx for pitutary adenoma hyper prolactinemia
A
Dopamine agonist: Bromocriptine or cabergonline (to ↓ prolactin levels)
17
Q
60 y/o M complaining of gynecomastia. ask about what meds? (3)
A
Spironolactone, anabolic steroids, antiandrogens
18
Q
when is b-hCG high in men?
A
testicular tumor
19
Q
should a women w/ mastitis continue breastfeeding?
A
yes
20
Q
Cervical motion tenderness suggests what dx?
A
PID
21
Q
type of HPV that is most carcinogenic
A
HPV16
22
Q
age for 1st pap, regardless of sexual activity
A
21
23
Q
age to stop pap smears if adequate screening prior
A
65
24
Q
age to add HPV testing on to pap
A
30
25
age to vaccinate for HPV
11-12
26
spontaneous abortion happens before what poitn in pregnancy
before 20 wks
27
MCC of spontaneous abortion
chromosomal abnormalities
28
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
threatened
29
what type of miscarriage? Death of fetus <20 wks gestation,
w/ products of conception
remaining intrauterine. No fetal
cardiac activity. Os closed
missed
30
what type of miscarriage? Dilated cervical os w/o passage of
tissue <20 wks gestation
inevitable
31
drug to aid in evacuation of POC after miscarriage
Misoprostol
32
should women who are Rh-negative get anti-D Rh immunoglobulin after miscarriage/abortion?
yes
33
medical elective abortion can be used up to ___ wks after LMP
10
34
surgical elective abortion can be used up to ___ wks after LMP
24
35
rx for elective abortion
Mifepristone followed by misoprostol 24-48 hrs after
36
Painful vaginal bleeding (dark red) w/in 3rd trimester
* Severe abd and back pain
* Tender rigid uterus.
dx?
Abruptio Placentae
37
MC risk factor for placental abruption
maternal HTN
38
order what tests (3) for suspected placental abruption
US, coag studies. type and cross due to heavy bleeding
39
next step for placental abruption w/ unstable mother/fetus and/or worsening
emergency C section
40
MCC of 3rd trimester bleeding
placenta previa
41
ok to do speculum exam for suspected placenta previa? how about bimanual?
gentle careful speculum ok. NO bimanual
42
Sudden onset of painless vaginal bleeding in 3rd trimester (bright red)
* Absence of abd pain or uterine tenderness
dx?
placenta previa
43
order what tests for placenta previa? (4)
US, CBC, type and screen, PT/PTT
44
placenta previa w/ stopped bleeding and stable at 34 wks. plan?
deliver via C section b/w 36-38 wks. home rest.
45
1st line tx for shoulder dystocia
1st line: Nonmanipulative maneuvers
§ McRoberts maneuver: flexion of the maternal hips
§ Suprapubic pressure
46
MC location for ectopic pregnancy
ampulla
47
leading cause of maternal death in 1st trimester
ectopic pregnancy
48
classic triad of ectopic pregnancy
sudden onset unilateral pelvic or lower abd pain + amenorrhea + vaginal bleeding
49
if beta-hCG does not double every 48 hrs as expected, but is increasing very slowly, suspect ____
ectopic preg
50
TVUS of F w/ abd pain shows hypervascular lesion w/ peripheral vascularity on Doppler. dx?
ectopic pregnancy
51
tx for stable/unruptured ectopic pregnancy
methotrexate IM
52
normal fetal HR
b/w 120-160 bpm
53
1st line med for gestational DM
insulin
54
MC fetal complication in gestational DM
macrosomia
55
when in preg to do DM testing
24-28 wks
56
for 50g 1hr glucose challenge test, glucose should be <____. if not, proceed to 100g 3hr test
<130
57
pt w/ larger uterus than expected at stage of pregnancy, + very high b-hCG, + painless vaginal bleeding. suspect what dx?
molar pregnancy aka gestational trophoblasstic dz
58
Schedule for serum HCG monitoring after evacuation of molar pregnancy
test hCG weekly until normal x3 wks, then monthly X6mo
59
definition of gestational HTN
BP > 140/90 mmHg after 20 wks gestation that resolves 12 wks postpartum + no proteinuria, edema,
or end organ damage
60
meds for gestational HTN (4)
methyldopa, labetalol (pref), nifedipine. can add hydralazine if a 2nd agent is needed
61
classic triad of preecclampsia
HTN + Proteinuria + Edema
62
cure for preecclampsia
delivery
63
HELLP syndrome is a subtype of _____ and includes ____ (3)
preeclampsia. Hemolysis, Elevated Liver enzymes, Low Platelets
64
tx for severe preeclampsia if <34 wks
hospitalise. give antenatal steroids. deliver if unstable. consider Mg sulfate to prevent seizure
65
deliver at what gestational age in mild preeclampsia
37+ wks
66
tx for seizure in eclampsia
Mg sulfate
67
MCC of maternal morbidity and mortality worldwide
postpartum hemorrhage
68
MCC of postpartum hemorrhage
uterine atony
69
1st line to try for uterine atony hemorrhage
bimanual uterine (fundal) massage
70
1st line med for postpartum hemorrhage d/t uterine atony
IV oxytocin or misoprostol or methergine
71
Preterm Premature Rupture of Membranes (PPROM): Rupture of amniotic membranes before labor
begins < __ wks
<37
72
PPROM <34 wks. give ___ for fetal lungs
Betamethasone
73
3 times in which to give RhoGAM
at 28 wks gestation + w/in 72 hrs of delivery of a Rh-positive baby + After any potential
mixing of blood
74
MCC of infertility
anovulation
75
try what med to induce ovulation in infertility: 1st and 2nd line
1 — letrozole
2 — Clomiphene
76
F are considered to be post-menopausal after ___ w/o a period
12 mo
77
why is progesterone given w/ estrogen in HRT
to decrease risk of endometrial cancer
78
1st line for hot flashes if not on HRT
SSRIs and SNRIs (paroxetine, venlafaxine)
79
can a F w/ CVD take HRT?
no
80
can a F w/ hx of DVT or PE take HRT?
no
81
combo OCPs are CI in ____ (4)
women >35 y/o who smoke, hx of blood clots, breast cancer, or migraines w/ auras
82
2 major downsides to depo provera
weight gain, decreased bone denis
83
major downsides to depo provera
weight gain, decreased bone denisity
84
most effective emergency contraception
copper IUD w/in 5 days
85
OTC levonorgestrel for emergency contraception should be taken when?
w/in 3 days, but asap
86
does HRT increase or decrease the risk for breast CA
increase
87
MC presentation of breast CA
Painless, hard fixed immobile lump in upper outer quadrant
88
best imaging for breast mass in F <40
US
89
can you do receptor testing on a fine needle aspiration of a breast mass?
no. need a large needle/core bx
90
most common sx of cervical cancer
Post coital bleeding or spotting
91
blood test to order for suspected ovarian CA in postmenopausal OR premeno + suspicious U/S
CA-125 levels
92
for suspected endometrial CA, a thickness of >___mm on TVUS reqs biopsy
>5mm
93
most common sx of vulvar CA
vaginal pruritis
94
MC type of ovarian cyst
follicular
95
in PCOS, be concerned about ____ that you can cheeck for w/ a blood test
DM
96
1st line tx for PCOS
combo OCPs
97
what DM med might improve menstrual freq in PCOS
metformin
98
gold standard for dx of ovarian torsion
laparoscopy
99
tx for syphillis
IM Benzathine Penicillin G
100
painful ulcers on genitals. suspect what dx?
herpes (HSV)
101
tx for 1st HSV outbreak
acyclovir 400mg tid OR valacyclovir 1g bid X 7-10 days
102
3 options for genital warts tx, and preferred option in preg
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
Cervical petechiae (strawberry cervix). dx?
trich
104
positive whiff test could be which 2 dx?
trich, BV
105
wet prep of trich will show what?
flagellated protozoa
106
tx for trich
Metronidazole 500mg PO BID x 7 Days
107
MC bac STI
chlamydai
108
tx for STI w/ vaginal discharge, dysuria
IM ceftriaxone 500mg + oral doxycycline 100mg BID x 7 days
109
BV wet mount will show what?
clue cells
110
tx for BV
Metronidazole 500mg PO BID x 7 Days
111
counsel pt about _____ if rx metronidazole
do not consume alcohol
112
RFs to ask about w/ vaginal candidiasis (4)
DM, immunosuppresion, recent abx use, combined OCPs
113
tx for candiaisis in preg
Imidazole, clotrimazole, terconazole cream/suppository x 7 days. No PO
114
MCC of PID
chlamydia
115
triad of PID
pelvic pain + ↑ purulent vaginal discharge + fever
116
PID tx
Ceftriaxone 500mg IM once + doxycycline 100mg bid X 14d + metronidazole 500mg BID x 14 day
117
ACE-i ok in preg?
no
118
doxy ok in breastfeeding?
no
119
stage 1 of labor is from onset of contractions to ____
full dilation
120
stage 2 of labor is from ____ to ____
full dilation to baby delivery
121
1st line tocolytic (medications used to suppress premature labor) for < 32 wks
indomethacin
122
1st line tocolytic (medications used to suppress premature labor) for > 32 wks
nifedipine
123
serum HCG can detect pregnancy as early as __days after conception
5
124
urine HCG can detect pregnancy as early as __days after conception
14
125
formula for Naegle’s Rule
LMP + 7 days – 3 months + 1 year
126
prenatal Visits ___ until 24-28 wks, then_____, then _____ at 36 wks.
Visits monthly until 24-28 wks, then 2 wks, then weekly at 36 wks.
127
folic acid rec for preg
Folic acid 400-1000 mcg or 0.4mg before conception or 4mg for secondary prevention
128
3 Ds of endometriosis
Dysmenorrhea, dyspareunia, dyskesia (painful bowel movements)
129
initial test for suspected endometriosis
US
130
1st line tx for endometriosis
combo OCPs
131
MC sx of uterine fibroids
Bleeding is most common sxs (menorrhagia or irregular)
132
2 imaging options for uterine fibroid
TVUS, MRI
133
MC indication for hysterectomy
uterine fibroids
134
Deliver at __ weeks in severe preeclampsia
34
135
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
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
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
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
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
elevation of blood pressure
