Women's Health Lecture 2 Flashcards
yeast
thick white, cottage cheese discharge. itching. + pseudohyphae. treatment - antifungal topically
BV
milky white, thin discharge. fishy odor worst after sex. clue cells. +whiff. Treatment - flagyl
Chlamydia
Increased or unchanged discharge, light bleeding after sex, burning on urination (always rule out PID), friable cervix. Treatment - zithromax
Trichomoniasis
Yellow or green, frothy, sticky. Painful urination, itchy foul fishy odor. Strawberry cervix. Whiff +. Treatment - Flagyl
Gonorrhea
Mucopurulent or unchanged discharge, Concern for PID, Rochephin treatment
Herpes
unchanged discharge, pain, viral syndrome, painful vesicle lesions, antiviral treatment
Rectovaginal fistula
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
atropic vaginitis
microscopic finding pH > 5
Toxic Shock Syndrome
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.
Removing a tampon
Need to treat for BV. Metrogel/Flagyl intravaginally. Can do Doxy to treat STI if sexually active
PMDD
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
Abortion
terminated pregnancy for any reason < 24 weeks
Spontaneous abortion
15% of pregnancies will abort usually in 1st trimester
Induced abortion
Elective reasons, Maternal indications, Fetal indications
Diagnostic tests for abortion
pregnancy test, US, h&h, blood type – rhogam if Rh negative after procedure, STI screen
Mifepristone
an antiprogestin. Blocks endometrial growth so the embryo will detach
Methotrexate
antifolate, blocks the proliferation of the placental wall
Misoprostol
prostaglandin, induces uterine contractions
Suction and Curettage
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
Dilation and Evacuation Abortion (d&e)
23 weeks. Pulls out baby with long toothed clamp, crush and pull out then suction placenta and remains from the uterus
Justice
duty to be fair
Beneficence
duty to prevent harm and promote good ex “an obligation of the healthcare provider to help the people in need”
Veracity
duty to be truthful
Fidelity
duty to be faithful
Autonomy
duty to respect ones right to their own thoughts and actions
Etiology for infertility can be identified in this percentage of couples
90%
Definition of infertility
1 year of unprotected frequent intercourse that has not resulted in contraception
Factors impacting infertility
maternal age, body weight, smoking, caffeine, alcohol, stress, environmental factors
Reasons for infertility after observing blood work/tests – cycle day 3 FSH, E2, BBT/ovulation kit, lutueal p4, hysterosalpinogram, semen anaysis
reduced ovarian reserve, uterine factor, tubal factor, male factor
semen analysis
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.
Normal semen paramters per the WHO
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
Ovarian function tests
hx, BBT, LH
Ovarian reserve
OOcytes in a women are determined 20 weeks gestation
Antral follicle count
in follicular phase to predict/assess response to medication to induce ovulation
Clomid
Pill PO Stimulates ovulation, titrate up if needed, normal to have cysts when taking this medication
PCOS
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
PCOS workup
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
Treatment PCOS
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
IUI
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.
IVF
In vitro fertilization injecting an egg with sperm to make an embryo then implant that into the female. NJ $13,000 per cycle.
Endometriosis
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.
Endometriosis staging
1-4, minimal, mild, moderate, severe
Meds for endometriosis
Hormones: OCP, Lupron. Meds to manage symptoms. Surgery
US findings of a cyst
free fluid behind cul de sac of the uterus
Patho behind a ruptured cyst
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.
Simple ovarian cysts
Contain fluid but no other content
<5 cm
functional, resolves spontaneously
5-7cm
need follow up in 3-4 months
> 7cm
need refer to GYN
Imaging w Cysts
transvaginal and abdominal
Complex Ovarian Cysts
more substance in the cyst like septum, blood. May not resolve spontaneously. Refer all of them
Ovarian Tumors
benign adnexal masses, benign cystic ovarian tumors, benign solid ovarian tumors, malignant ovarian tumors
Uterine fibroid tumors
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.
Tx fibroid tumors
NSAIDS, OCP, Lupron, ablation – burn uterus, scar tissue wont bleed, surgery hysterectomy
Bartholin cyst
duct gets clogged leading to swelling and possible infection of the labia. Needs OR I&D
GYN cancers
ovarian, vulvar, vaginal, uterine, cervical.
Ovarian cancer
BRACA. Feel for enlargement of ovary. Family hx is a red flag. Abnormal bleeding, pelvic pain or pressure, abd pain, bloating
Cervical cancer
just abnormal bleeding
Uterus cancer
abnormal bleeding, pelvic pain and pressureq
Vaginal cancer
change in bathroom habits, abnormal bleeding
Vulvar cancer
pelvic pain, itching or burning, changes in vulva color or skin such as rash, sores, or warts
dosing hormones for menopausal women
smallest dose for the shortest amount of time possible
estrogen will increase risk for what
MI
Women with a uterus need this hormone med
cannot have unopposed estrogen, need estrogen PLUS progesterone. (Primpro) Estrogen only is Primerin
Tanner Stage 1
Girls - no pubic hair, no breast growth
Boys - preadolescent testes and penis
Tanner Stage 2
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
Tanner Stage 3
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
Tanner Stage 4
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
Tanner Stage 5
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.
Menopause and hormone response
decreases estrogen, so to increase estrogen the body fires LH to increase FSH to increase Estrogen
When does mittelschmerz occur
just before ovulation, the temperature lowers then spikes
Presumptive signs of pregnancy
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
Probable signs of pregnancy
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
Positive signs of Pregnancy
fetal heart tones, XRay of fetus, US Fetus, Birth
Qualitative Hcg level above this is positive
50
should do this within 48-72 hours
double
fetal heart tones heard when
10-12 weeks
uterine size nonpregnant
lemon – mobile, firm, nontender
uterine size 8 weeks
tennis ball (hegar, chadwick, goodell all +)
uterine size 10 weeks
baseball (fht 10-12 weeks)
uterine size 12 weeks
softball & above symphysis pubis
uterine size 16 weeks
halfway to naval + quickening
uterine size 20 weeks
navel
after 20 weeks uterine size (20-36)
one cm per week until term concordant with gestational age plus or minus 1 no more than 3cm
term uterine size
headengaged, ballotment
95% vertex position by what week
36
when can you not do an elective abortion
> 12 weeks
things to help nausea
ginger 500mg/day, peppermint, saltines, Zofran
aneupliody
abnormal number of chromosomes
noninvasive genetic screening starts week
10-12 weeks in the first trimester for chromosomal abnormalities through maternal blood sample to look at DNA from mom and baby
second trimester genetic screening
triple screen, quad screen
GTT
fail 2 out of 3. fasting > 95, 1 hr > 180, 2 hr > 155, 3 hour > 140
cervical cancer stairway to heaven
1) normal pap 2) atypical undetermined significance 3) CIN 3 4) CIN 2 5) CIN 1 6) Cancer
When do you need a colposcopy
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
progesterone challenge test
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.
post menopausal bleeding
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.
