Women's Health Flashcards
motile protozoa on wetmount
trichomonas vaginalis
treatment of condylomata acuminata
electrocautery, liquid nitrogen, or imiquimod
etiology of condylomata acuminata
HPV
green, frothy discharge
trichomoniasis
the name for a painful genital ulcer with inguinal lymphadenitis
chancroid
what bacteria causes chancroid?
haemophilus ducreyi
treatment of chancroid?
azithromycin and ceftriaxone
thin, grey fishy smelling discharge usually means?
bacterial vaginosis
treatment of BOTH trichomoniasis and bacterial vaginosis?
metronidazole
treatment of choice for N. gonorrhea?
ceftriaxone
treatment of choice for chlamydia?
macrolide (azithromycin) or doxycycline
tzanck smear is the diagnostic of choice for what?
herpes simplex
treponema pallidum causes what?
syphillis
hallmarks of primary, secondary, and tertiary symphilis?
1) painless chancre
2) rash on palms and soles
3) latent; irreversible brain/heart effects
diagnosis and treatment of syphilis?
DX = RPR, VDRL TX = PCN
treatment of dysmenorrhea?
NSAIDS, oral contraceptives
treatment of painful periods secondary to endometriosis?
danzol and GNRH agonists (leuprorelin ie lupron)
which cancer is associated with DES exposure?
vaginal clear cell carcinoma
which HPV strains are associated with cervical cancer?
16, 18, 31, 33
early age of first sex, multiple partners, and smoking are risk factors for which GYN cancer?
cervical
abnormal post-menopausal bleeding should raise concern for what?
endometrial cancer
most common type of endometrial cancer?
adenocarcinoma
which type of GYN cancer is often caught late, and produces signs of abdominal fullness and GI discomfort?
ovarian cancer
what is the tumor marker for ovarian cancer?
CA-125
95 percent of ectopic pregnancies occur where?
fallopian tubes
greatest risk factor for ectopic pregnancy?
prior ectopic
also: PID, IUD
what causes hyperemesis gravidarum?
increasing estrogens
biggest complication of gestational diabetes?
fetal macrosomnia
treatment of choice of gestational diabetes?
insulin
between what weeks do we give an oral glucose tolerance test for test for gestational diabetes?
between 24-26 weeks
HTN + proteinuria + edema = what?
preeclampsia
what is the acronym for the complication of preeclampsia?
HELLP
hemolysis, elevated LFTs, low platelets
pre-eclampsia + seizures = what?
how do we treat?
eclampsia (may also show hyperreflexia)
treat with magnesium sulfate and delivery
PAINFUL third trimester bleeding is often due to?
abruptio placenta
think in coke heads
PAINLESS third trimester bleeding is often due to?
placenta previa
treatment of abruptio placenta and placenta previa?
delivery usually by c-section
WHEN and to whom do we give 300 ug of rhogam to during pregnancy?
give to Rh negative women at 28 weeks gestation and within 72 hours of delivery
why do we give rhogam to Rh negative women?
to prevent hydrops fetalis
days 1-14 of the menstrual cycle are also known as the _____ phase
follicular/proliferative phase
the follicular/proliferative phase are under the influence of which hormone?
estrogen increases to proliferate endometrium and peaks at ovulation
____ and ____ are the hormones that increase at ovulation
FSH and LH increase at ovulation
the luteal and secretory phase are days ___ through ___ are are influenced by _____
days 14-28; influenced heavily by progesterone
progesterone is released in large amounts by what during the luteal and secretory phase?
progesterone released in large amounts from the corpus luteum
what are the two circumstances under which we can diagnose primary amenorrhea?
1) age 14 without secondary sex characteristics
2) age 16 with secondary sex characteristics
what does it mean if a progesterone challenge is positive (bleeding occurs) when working up secondary amenorrhea?
she has estrogen present but is not ovulating (anovulatory)
what does it mean if a progesterone challenge is negative (no bleeding) when working up secondary amenorrhea?
patient has very low estrogen levels OR there is a problem with the outflow tract (adhesions, scarring)
what are two major non-sex hormones released by the pituitary that should be evaluated when working up amenorrhea?
prolactin (high prolactin inhibits ovulation)
TSH (hypothyroid = hyperprolactinemia = amenorrhea)
positive chandeleir sign should make you think what? how do we treat?
PID – treat with ceftriaxone and doxy for 14 days (or azithromycin)
obesity, infertility, insulin resistance, and hirsutism should make you think what?
PCOS
treatment of PCOS?
weight loss, metformin, spironolactone, oral contraceptives
PCOS is caused by an excess of what hormone?
androgen
patients with PCOS are at increased risk for what?
breast and ovarian cancer
menopause is defined as ____ months of amenorrhea, or an FSH greater than what?
12 months of amenorrhea
FSH greater than 40
what is the number one benign neoplasm of the female genital tract?
leiomyoma (fibroid tumor)
how does a leiomyoma (fibroid) usually present?
heavy menstrual flow
diagnosis and treatment of fibroids?
dx = ultrasound tx = surgery, GNRH agonists, OCPS
HCG levels ____ every ____ hours
HCG levels double every 48 hours
when do HCG levels peak? when do they fall off?
peak at 50-75 days
decrease in 2nd and 3rd trimester
when can you detect doppler heart tones in a fetus?
10 weeks
at 12 weeks, where is the fundal height palpated?
pubic symphysis
at 20 weeks, where is the fundal height palpated?
umbilicus
what is chadwick sign? when is it detected?
cervical cyanosis at 37 weeks
what is hagar sign? when is it detected?
cervical softening at 37 weeks
at the 16-20 week apppointment, a ____ level should be obtained. why?
AFP (alpha fetoprotein)
the amount of AFP levels in a pregnant woman can help see whether a baby has problems with spina bifida or ancephaly
at 28 weeks, what test should be ordered on a pregnant woman?
glucose tolerance test
at 28-30 weeks, what should be given if needed?
rhogam
at 33-37 weeks, what should we culture for?
group B strep
a heart rate between ____ and ___ with good accelerations (up to ____ BPM) in 20 minutes is what we look for when monitoring fetal hearttones
heartrate between 120-160 BPM
accelerations up to 15 bpm from baseline in 20 minutes are GOOD
what is the most common breast mass in young women (age 20-30)
fibroadenoma (round, rubbery)
how should you work up a suspected fibroadenoma?
fine needle aspiration to r/o malignancy
painful and tender breast lumps increasing in discomfort with menses should make you think what?
fibrocystic disease
chocolate cysts and retroflexed uterus should make you think what?
endometriosis
what is the most common type of breast cancer?
infiltrating ductal carcinoma
early menarche, late menopause, nulliparty are risk factors for what?
GYN cancers esp breast
where is the most common site for breast cancers to appear?
upper outer quadrant
why do we use ultrasound rather than mammogram when working up breast lumps in patients under 30?
our breasts are more dense and it is hard to pick up images on mammogram
when should we start recommending annual mammogram?
40
when do we start pap smears? how often?
start at 21, do every 3 years under new recommendations
what are the 4 stages of delivery?
1 = onset of true contractions to full dilation (10 cm)
2= full dilation to delivery
3 = expulsion of placenta
4 = hour after delivery
premature rupture of membranes before onset of labor increases risk of what? how should you proceed?
increases risk of infection
deliver within 24 hours
delivery by c-section or when premature rupture of membranes persist for more than 24 hours put you at risk for what?
endometritis
sx = fever, uterine tenderness
dx = WBC over 20k
what is the most common pathogen associated with endometritis? how do we treat?
often due to anaerobic strep
tx with ABX (clindamycin and gentamicin)
