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Primary Care 3 > Women's Health Lecture 2 > Flashcards

Women's Health Lecture 2 Flashcards

1
Q

yeast

A

thick white, cottage cheese discharge. itching. + pseudohyphae. treatment - antifungal topically

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2
Q

BV

A

milky white, thin discharge. fishy odor worst after sex. clue cells. +whiff. Treatment - flagyl

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3
Q

Chlamydia

A

Increased or unchanged discharge, light bleeding after sex, burning on urination (always rule out PID), friable cervix. Treatment - zithromax

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4
Q

Trichomoniasis

A

Yellow or green, frothy, sticky. Painful urination, itchy foul fishy odor. Strawberry cervix. Whiff +. Treatment - Flagyl

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5
Q

Gonorrhea

A

Mucopurulent or unchanged discharge, Concern for PID, Rochephin treatment

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6
Q

Herpes

A

unchanged discharge, pain, viral syndrome, painful vesicle lesions, antiviral treatment

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7
Q

Rectovaginal fistula

A

normal pelvic exam, negative for stds, but negative rectal exam – can feel straight to the vagina. at increase risk for e coli infection. low grade temp, bad odor

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8
Q

atropic vaginitis

A

microscopic finding pH > 5

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9
Q

Toxic Shock Syndrome

A

Colonization of Staph aureus, produces exotoxins, triggers immune response, CDC criteria: fever, hypotension, diffuse erythroderma, desquamation of the palms and soles, and the involvement of 3 or more organ systems. Rapid onset of symptoms. Fever, diarrhea.

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10
Q

Removing a tampon

A

Need to treat for BV. Metrogel/Flagyl intravaginally. Can do Doxy to treat STI if sexually active

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11
Q

PMDD

A

PMS interferring with life. Depressed mood, loss of interest, timing with cycle, cyclical, gets better then comes back same time. Tx SSRIs Paxil Prozac Zoloft – Zoloft 25mg 1 tab PO daily at bedtime, can take for the week then stop or take daily if irregular. Can also preload with Ibuprofen 3 days before period for prostaglandin inhibition

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12
Q

Abortion

A

terminated pregnancy for any reason < 24 weeks

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13
Q

Spontaneous abortion

A

15% of pregnancies will abort usually in 1st trimester

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14
Q

Induced abortion

A

Elective reasons, Maternal indications, Fetal indications

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15
Q

Diagnostic tests for abortion

A

pregnancy test, US, h&h, blood type – rhogam if Rh negative after procedure, STI screen

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16
Q

Mifepristone

A

an antiprogestin. Blocks endometrial growth so the embryo will detach

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17
Q

Methotrexate

A

antifolate, blocks the proliferation of the placental wall

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18
Q

Misoprostol

A

prostaglandin, induces uterine contractions

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19
Q

Suction and Curettage

A

9 weeks. abortion where the uterus is dilated and suction is applied to remove fetus and placenta, a curette then scrapes the uterus to remove excess tissue and the contents are examined to assure all fetal parts are there. Can also give meds and wait to be passed at homje instead and do a d&c

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20
Q

Dilation and Evacuation Abortion (d&e)

A

23 weeks. Pulls out baby with long toothed clamp, crush and pull out then suction placenta and remains from the uterus

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21
Q

Justice

A

duty to be fair

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22
Q

Beneficence

A

duty to prevent harm and promote good ex “an obligation of the healthcare provider to help the people in need”

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23
Q

Veracity

A

duty to be truthful

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24
Q

Fidelity

A

duty to be faithful

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25
Q

Autonomy

A

duty to respect ones right to their own thoughts and actions

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26
Q

Etiology for infertility can be identified in this percentage of couples

A

90%

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27
Q

Definition of infertility

A

1 year of unprotected frequent intercourse that has not resulted in contraception

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28
Q

Factors impacting infertility

A

maternal age, body weight, smoking, caffeine, alcohol, stress, environmental factors

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29
Q

Reasons for infertility after observing blood work/tests – cycle day 3 FSH, E2, BBT/ovulation kit, lutueal p4, hysterosalpinogram, semen anaysis

A

reduced ovarian reserve, uterine factor, tubal factor, male factor

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30
Q

semen analysis

A

2 specimens, one month apart. Check to see that the lab accepts the specimen, Specimen arrival to lab within 30 minutes of ejaculation. Medical history.

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31
Q

Normal semen paramters per the WHO

A

volume > 1.5, pH 7.2-7.8, counter > 15 million per mL, motility > 32%, Forward progression > 2 on 0-4 scale, Morphology greater than 30 percent normal oval heads, midpiece and tail… check for bullets in the chamber after vasectomy

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32
Q

Ovarian function tests

A

hx, BBT, LH

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33
Q

Ovarian reserve

A

OOcytes in a women are determined 20 weeks gestation

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34
Q

Antral follicle count

A

in follicular phase to predict/assess response to medication to induce ovulation

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35
Q

Clomid

A

Pill PO Stimulates ovulation, titrate up if needed, normal to have cysts when taking this medication

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36
Q

PCOS

A

4-10% reproductive age women. Classic features: obese, oligomenorrheic (missing periods), hirsutism, acne, acanthosis nigricans from insulin resistance, polycystic ovaries on US, hyperndogenism, oligoovulation or anovulation, insulin resistance

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37
Q

PCOS workup

A

Hx and PE, Labs: FSH, LH, FSH/LH ratio, testosterone free and total, DHEA-S, 17 hydroxyprogesterone, CBC, Chem 18, fasting insulin. Best to refer if possible to endocrine/GYN

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38
Q

Treatment PCOS

A

Weight loss and ADA Diet, Metformin 50mg titrate to 1500mg a day x 5 weeks and assess for ovulation every 6 months, Clomid to induce ovulation, remember to have PNV on board

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39
Q

IUI

A

Intra Uterine Insemination. drugs are given to assist in ovulation, take sperm and wash it and insert through a tube through the top into the uterus, cutting out the issues with traveling through the vagina all together. 6 treatments.

40
Q

IVF

A

In vitro fertilization injecting an egg with sperm to make an embryo then implant that into the female. NJ $13,000 per cycle.

41
Q

Endometriosis

A

Common benign gynecologic disorder characterized by endometrial glands and stroma outside the endometrial cavity. 3rd leading cause of endometrial hospitalization. ONLY diagnosed via laproscopy. Can affect fertility.

42
Q

Endometriosis staging

A

1-4, minimal, mild, moderate, severe

43
Q

Meds for endometriosis

A

Hormones: OCP, Lupron. Meds to manage symptoms. Surgery

44
Q

US findings of a cyst

A

free fluid behind cul de sac of the uterus

45
Q

Patho behind a ruptured cyst

A

Follicles get bigger as ovulation occurs, one becomes dominent and takes off toward the uterus those behind can enlarge and rupture. BC pills stop ovulation with combo of estrogen and progesterone. Progesterone only think youre always pregnant - depo provera shots.

46
Q

Simple ovarian cysts

A

Contain fluid but no other content

47
Q

<5 cm

A

functional, resolves spontaneously

48
Q

5-7cm

A

need follow up in 3-4 months

49
Q

> 7cm

A

need refer to GYN

50
Q

Imaging w Cysts

A

transvaginal and abdominal

51
Q

Complex Ovarian Cysts

A

more substance in the cyst like septum, blood. May not resolve spontaneously. Refer all of them

52
Q

Ovarian Tumors

A

benign adnexal masses, benign cystic ovarian tumors, benign solid ovarian tumors, malignant ovarian tumors

53
Q

Uterine fibroid tumors

A

Nonmalignant. Leiomylomas that grow in the smooth muscle lining and have more estrogen/progesterone receptors than other tissues in the area. Gets bigger and bleeds a lot. Most common reason for a hysterectomy.

54
Q

Tx fibroid tumors

A

NSAIDS, OCP, Lupron, ablation – burn uterus, scar tissue wont bleed, surgery hysterectomy

55
Q

Bartholin cyst

A

duct gets clogged leading to swelling and possible infection of the labia. Needs OR I&D

56
Q

GYN cancers

A

ovarian, vulvar, vaginal, uterine, cervical.

57
Q

Ovarian cancer

A

BRACA. Feel for enlargement of ovary. Family hx is a red flag. Abnormal bleeding, pelvic pain or pressure, abd pain, bloating

58
Q

Cervical cancer

A

just abnormal bleeding

59
Q

Uterus cancer

A

abnormal bleeding, pelvic pain and pressureq

60
Q

Vaginal cancer

A

change in bathroom habits, abnormal bleeding

61
Q

Vulvar cancer

A

pelvic pain, itching or burning, changes in vulva color or skin such as rash, sores, or warts

62
Q

dosing hormones for menopausal women

A

smallest dose for the shortest amount of time possible

63
Q

estrogen will increase risk for what

A

MI

64
Q

Women with a uterus need this hormone med

A

cannot have unopposed estrogen, need estrogen PLUS progesterone. (Primpro) Estrogen only is Primerin

65
Q

Tanner Stage 1

A

Girls - no pubic hair, no breast growth

Boys - preadolescent testes and penis

66
Q

Tanner Stage 2

A

Girls - breast budding, areolar hyperplasia with a small amount of breast tissue, pubic hair long, downy near the labia
Boys - enlargement of the testes, pigmented scrotal sac, Sparse growth of pigmented hair usually slightly curly mainly at the base of the penis

67
Q

Tanner Stage 3

A

Girls - enlargement of beast and areola with no separation of the contours, the hair is darker, coarser and curlier and spreads over the junction of the pubes
Boys - Testis and scrotum enlarge further, the penis grows mainly in length but also in breadth. The hair is darker, coarser and curlier and spreads over the junction of the pubes

68
Q

Tanner Stage 4

A

projection of areola and papilla to form a secondary mound above the level of the breast, the hair spreads covering the pubes
Boys - Scrotum, testis and penis grow further with development of the glans and further darkening of the scrotal skin. The hair spreads covering the pubes

69
Q

Tanner Stage 5

A

Girls - recession of the areola to the general contour of the breast with projection of the papilla only. the hair extends to the medial surface of the thighs and is distributed as an inverse triangle
Boys - adult stage with spreading of the hair to the medial surface of the thighs.

70
Q

Menopause and hormone response

A

decreases estrogen, so to increase estrogen the body fires LH to increase FSH to increase Estrogen

71
Q

When does mittelschmerz occur

A

just before ovulation, the temperature lowers then spikes

72
Q

Presumptive signs of pregnancy

A

amenorrhea, nausea, vomiting, frequent urination, breast changes, vaginal changes, fatigue and skin changes, are not that conclusive enough because these are just physical symptoms which can also be felt by regular women

73
Q

Probable signs of pregnancy

A

A positive pregnancy test is not 100% reliable since there are some factors that may contribute to a positive test like the urine being too diluted during the test or when the instructions are not carefully followed. Enlarged abdomen could be probable signs of pregnancy but for some cases there are medical conditions involving enlargement of the abdomen without them getting pregnant

74
Q

Positive signs of Pregnancy

A

fetal heart tones, XRay of fetus, US Fetus, Birth

75
Q

Qualitative Hcg level above this is positive

A

50

76
Q

should do this within 48-72 hours

A

double

77
Q

fetal heart tones heard when

A

10-12 weeks

78
Q

uterine size nonpregnant

A

lemon – mobile, firm, nontender

79
Q

uterine size 8 weeks

A

tennis ball (hegar, chadwick, goodell all +)

80
Q

uterine size 10 weeks

A

baseball (fht 10-12 weeks)

81
Q

uterine size 12 weeks

A

softball & above symphysis pubis

82
Q

uterine size 16 weeks

A

halfway to naval + quickening

83
Q

uterine size 20 weeks

A

navel

84
Q

after 20 weeks uterine size (20-36)

A

one cm per week until term concordant with gestational age plus or minus 1 no more than 3cm

85
Q

term uterine size

A

headengaged, ballotment

86
Q

95% vertex position by what week

A

36

87
Q

when can you not do an elective abortion

A

> 12 weeks

88
Q

things to help nausea

A

ginger 500mg/day, peppermint, saltines, Zofran

89
Q

aneupliody

A

abnormal number of chromosomes

90
Q

noninvasive genetic screening starts week

A

10-12 weeks in the first trimester for chromosomal abnormalities through maternal blood sample to look at DNA from mom and baby

91
Q

second trimester genetic screening

A

triple screen, quad screen

92
Q

GTT

A

fail 2 out of 3. fasting > 95, 1 hr > 180, 2 hr > 155, 3 hour > 140

93
Q

cervical cancer stairway to heaven

A

1) normal pap 2) atypical undetermined significance 3) CIN 3 4) CIN 2 5) CIN 1 6) Cancer

94
Q

When do you need a colposcopy

A

any CIN 3, 2, 1 , Cancer, HPV. The test puts vinegar on cervix and tests for abnormal cells which turn white then get biopsied – biopsy is the definitive diagosis

95
Q

progesterone challenge test

A

if on a supplement, stop the supplement take progesterone for ten days and then stop, should have a bleed. Good if no period for 1 year to shed excess.

96
Q

post menopausal bleeding

A

need GYN referal. Never normal. Can be from too thick of a lining in the uterus, do the challenge to shed lining, If too thin then ned local endometrium to get estrogen for the tisue. Biopsy to dx with cancer.

Primary Care 3 (29 decks)

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