Women's Health / Pregnancy Flashcards
1
Q
What do give patients on Depo need?
Don’t use longer than what?
A
- Ca and Vit D supplement
- 2-5 years
2
Q
What problems are contraindications for COC? Immune problem?
BP?
A
- SLE
- liver disease
- Uncontrolled HTN
- active CA
3
Q
Do minors need consent for STD tx, contraception, or pregnancy care?
A
NO
4
Q
What 2 things do minors need consent for?
A
- Dysmenorrhea tx
- Consult for meds other than contraceptives
5
Q
Always order what if a patient has a GU complaint?
A
HCG
6
Q
What colposcopy result indicate something serious?
A
- CIN 2 and 3
7
Q
What to do with positive ASCUS?
A
- HPV co-testing
8
Q
What does Gardisil prevent?
Which strains are important to know?
A
- HPV
- 16 and 18: cervical CA
- 6 and 11: genital warts
9
Q
Treatment for genital warts?
A
- TCA acid or cryo
10
Q
Risks associated with HRT? (4)
How long to use?
A
- Heart disease, blood clots
- Ovarian CA, Breast CA
- Ideally < 3 years
11
Q
HRT Drugs to use?
Uterus vs. No uterus
A
- Uterus: Estrogen AND progestin – prevents endometrial hyperplasia and CA
- No uterus: Estrogen only
12
Q
SSRI good for menopause?
A
Paxil
13
Q
High risks with ginkgo?
A
Bleeding
14
Q
Does topical estrogen have a cancer risk?
What does it help with? (3)
A
- NO
- UTI protection
- Improve dryness
- Improve pelvic floor functioning
15
Q
PCOS high risk for what? (4)
A
- Insulin resistance
- HLD
- Ovarian CA
- Infertility
16
Q
Diagnostic criteria for PCOS? Rotterdam Criteria
A
- Ovulatory dysfunction
- Increased androgens
- Amenorrhea
17
Q
What med can cause galactorrhea?
Can also result from what?
What lab should we check? Why?
A
- Atypical antipsychotics
- Breast stimulation
- Check prolactin – check for prolactinoma
- Check TSH
18
Q
What is happening in endometriosis?
A
- Tissues that usually grow within the uterus grow outside of it
19
Q
Symptoms of endometriosis? (4)
A
- Painful periods
- Cramping outside of cycle
- Heavy flow (anemia)
- Dyspareunia (painful sex)
20
Q
How to diagnose endometriosis?
A
- Surgery with biopsy
21
Q
Treatment of endometriosis? (2)
Increased risk for what CAs?
A
- COC to decrease growth of endometrial tissues and help prevent endometrial and ovarian CA
- Surgery to remove extra tissue or hysterectomy
22
Q
LT side effects endometriosis (2)
A
- Infertility – refer when want to have kids
- Increase chance of endometrial and ovarian CA
23
Q
PCOS
Total testosterone level?
LH/FSH ratio? What’s normal?
A
- Total testosterone >= 60
- LH/FSH Ratio 2-3 (may be normal: 1)
24
Q
PCOS
What labs to monitor?
A
- LFTs q2 years
- OGTT, A1C
25
How do COC help in PCOS?
What med can help with excess androgens?
- Suppression of the follicles in the ovaries
- Spironolactone
26
Official menopause? Why does it occur?
- Lack of menses for 12 months
- Ovaries are no longer producing estrogen and progesterone
27
Atrophic vaginitis treatment
- Vaginal lubricants
- Estrogen cream
28
Complication d/t lack of estrogen?
- Uterine prolapse
28
Increased risks of what after hitting menopause? (2)
- Heart disease
- OP
29
Labs to Diagnose menopause?
- Serum estradiol
- FSH low
- LH low
30
When to start mammograms?
How often?
When to stop?
USPSTF
- Prior to age 50: assess risk
- Age 50-74: every 2 years
- Age 75+: stop
31
When to start mammograms? How often? ACS
- Age 45 and repeat yearly
32
Most common cause of breast lumps?
What is it related to?
- Fibrocystic Breasts
- Menstrual cycle
33
Fibrocystic breasts
What happens? Symptoms?
What can exacerbate it?
- Enlarge right before period and shrink after
- Tender, sore, firm, moveable lumps
- Caffeine and stress
34
Treatment for fibrocystic breasts?
When to follow up?
- OTC Analgesics
- If the lumps haven’t shrunk after menses
35
BRCA1 and 2: screening
When to start?
How to screen?
Common with who?
- MRI and mammogram – screen 10 years before fam dx
- Ashkenazi Jews
36
Reproductive hx risks for breast CA (4)
- Menarche < 12
- Menopause > 55
- Not having children
- Never breastfed
37
How to diagnose breast CA? older vs younger?
- Younger: US
- Older: Mammogram
38
Refer if no period before what age?
15
39
What is secondary amenorrhea?
Most common cause?
- No menses in 3 months for those with normal periods
- No menses in 6 months for those with irregular periods
- Pregnancy
40
Causes of secondary amenorrhea (6)
- Menopause, contraception
- Thyroid disorders
- Eating disorders
- Stress and obesity
41
Dysmenorrhea diagnostics? (4)
- Check for STIs
- Check to UTIs
- Check for GI issues
- Pelvic exam, even if <25
42
Primary cause of dysmenorrhea?
- Excessive prostaglandins (N/V/spastic uterus)
43
Secondary causes of dysmenorrhea? (3)
- Endometriosis, fibroids, PID
44
Management of dysmenorrhea? (3)
- NSAIDS – premedicate 1-2 days before starting
- Exercise
- Hormonal BC
45
When to stop pap smears?
Age 65
46
Older pap guidelines? When to start?
What if positive ASCUS?
- Start at age 21 and every 3 years or every 5 if HPV contesting
- If ASCUS between 21-25, repeat pap in a year
47
PID most common causes?
- Gonorrhea and chlamydia
48
When to have sex after fluconazole OT tx?
- Delay until symptoms improve
49
What Tanner stage does puberty start?
- Tanner stage 2
50
Quick start BC method?
- Take the first pill whatever day you receive
- Use backup method for 7 days
51
First-Day start BC method?
- Start first day of next period
- No backup method needed
52
Sunday-start BC?
- Start pack on the Sunday following the start of period
- Back up to 7 days
- No weekends menses
53
What if you miss 2 COC pills?
- Take most recent pill, discard other, continue rest of pack with backup method
54
What does the estrogen component of BC cause? (3)
- Breast tenderness, nausea, breakthrough bleeding
55
What does the progestin component of BC worsen?
- Acne d/t increased sebum
56
How long can NuvaRing be out?
< 3 hours
57
Can you use progestin only in active CA or liver disease?
NO
58
How long does Depo suppress ovulation?
Delay fertility?
Common complaints?
- 12-13 weeks at a time
- Up to a year or longer
- Weight gain, acne, depression
59
What is needed before starting IUD?
- Pelvic exam
- STI screening
60
Contraindications for IUD?
- History of ectopic pregnancy
61
Plan B what hormone?
- Progestin only
62
What else can we use for emergency contraception?
Timeframe?
How long to keep?
SE?
- Copper IUD within 7 days
- Up to 10 years
- Heavy bleeding
63
Presumptive signs of pregnancy?
- No period
- No breast tenderness, nausea, fatigue
64
Probable signs of pregnancy?
- HCG = HCG, Hagar’s, Chadwick’s, Goodells
65
What is Hegar’s sign?
Goodells sign?
When do these occur?
- H: Softening of uterine isthmus 6-8 weeks
- G: Softening of cervix with cyanosis: 4 weeks
66
What is Chadwick’s sign?
When does it occur?
- Bluish discoloration of cervix
- 6-8 weeks
67
Positive pregnancy signs?
- PUF: palpation of fetus, US, FHT
68
Most common cause of ectopic pregnancy?
Others?
- Abnormally shaped fallopian tube
- PID, STI, prior ectopic pregnancy, endometriosis
69
Symptoms of ectopic pregnancy? (5)
- Positive HCG
- Abdominal pain, bleeding
- lightheaded, syncope
70
Biggest risk with ectopic pregnancy?
What do we do?
How is it treated?
- Rupture – need to refer!
- Methotrexate or surgery
71
Fundal height at 12 weeks? 20 weeks?
Normal variation?
MacDonald’s rule?
- 12: pubic symphysis
- 20: umbilicus
- +/- 2cm or or down
- Uterine size should match mow many weeks pregnancy
72
What is Naegele’s Rule?
- LMP + 9 months + 7 days
- Calculates due date
73
When do we screen for gestational DM? GBS? AFP?
- DM: 24-28 weeks
- GBS: 36-37 weeks
- AFP: 15-20 weeks
74
How is GBS screened?
Treated?
Need follow up?
- Rectal vaginal swab 36-37weeks
- IV PCN during labor
- No follow up needed
75
Who gets RhoGAM?
When?
Need to repeat when? Always?
- All Rh- patients
- 28 weeks
- Need to repeat 72hr post-delivery if baby is Rh positive
76
When are cephalosporins and Macrobid safe during pregnancy?
What can’t we use at all?
- Second trimester
- Cipro
77
Down Syndrome 3 big risks?
- Alzheimer, hypothyroidism, cervical spine instability
78
Placenta abruption
Symptoms?
When does it occur?
Treatment?
- Painful vaginal bleeding, hard abdomen, contractions
- occurs in 3rd trimester
- STAT C-section
79
Placenta Previa
What is it? Symptoms?
- Placenta covering cervical opening,
- Painless vaginal bleeding
80
Placenta previa treatment?
Does it usually resolve?
- Pelvic rest, monitor with US
- Yes and c-section if not
81
Mastitis unresolved with abx?
- Refer for mammogram and gyn visit
- Don’t stop breastfeeding
82
When to start folic acid supplement? What if hx NTD?
- 1 month before conception
- 4000mcg daily
83
Medications to avoid in pregnancy?
- ACE, fluoroquinolones, statins, methotrexate, Accutane
84
How much weight to gain during pregnancy with normal BMI?
- 25-35lb
85
What are the choices for GM screening?
- One step
- Two step
86
What if patient fails the One Step test?
- They go for a 3-step test
87
First line tx gestational DM? Second?
- 1. Lifestyle changes
- 2. Metformin or insulin
88
Preterm labor occurs when?
Risk Factors?
- Prior to 37 weeks
- Multiple gestation, smoking, UTIs, infection
89
Symptoms of Preeclampsia? (5)
Lab?
- HTN, HA, vision changes, Edema
- Epigastric pain
- Proteinuria
90
When does preeclampsia usually occur?
Treatment?
- After 20 weeks
- Delivery
91
Zika virus spread how? Can cause what?
- Mosquitos
- Microcephaly and brain defects
92
Foodborne illness to worry about?
Prevention?
Foods to avoid?
- Listeria
- Proper food storage, hygiene, wash produce
- Uncooked deli meat, unpasteurized foods, soft cheese
93
What can listeria lead to? Treatment?
- Miscarriage
- PCN
94
What bug is in the litter box?
- Parvo 19
95
Post-partum depression scale? Treatment?
- Edinburg Postnatal Depression scale
- CBTs and antidepressants
96
When does postpartum depression occur?
Screening?
- Up to 1 year after
- Before discharge and at all postpartum and pediatrician visits
97
When should IUD be placed after pregnancy?
- Within 48hr or 4-6 weeks postpartum
98
Placenta abruption
Symptoms?
When does it occur?
- Painful vaginal bleeding, hard abdomen
- Contractions
- 3rd trimester 27 weeks onward
99
Placenta Previa
What is it?
Symptoms?
- Placenta covering cervical opening
- Painless vaginal bleeding
100
What does nucleic acid amplification test for?
- Chlamydia, gonorrhea, trich
101
What is the screening test for HIV?
- HIV 1/2 antibody assay testing
102
What screening test are used for syphilis? (3)
Most specific?
- Rapid plasma reagin (RPR) - least specific
- Venereal disease research (VRDL)
- Fluorescent treponemal antibody (FTA) most specific
103
What does primigravida mean?
- Pregnant for the first time
104
Leopold maneuvers are an example of what kind of pregnancy?
- Positive – can palpate the fetus
105
Is it normal to have some bleeding and spotting in early pregnancy?
- Yes and can occur when next menstrual cycle should be
106
Diagnostic tests for premature rupture of membranes? (2)
- Nitrazine testing
- Fern Test
107
When to get Tdap during pregnancy? How often does this patient get it?
- 27-36 weeks
- With every pregnancy
108
What vaccines are safe during pregnancy?
- Tdap, Hep B, Influenza IM
109
BP diagnostic in preeclampsia? Urine findings?
- BP >140/90
- Proteinuria
110
Normal vaginal pH
- < 4.5
111
pH in candida?
atrophic vaginitis?
BV?
Contaminated?
- Candida: 4.0-4.5
- AV: >5
- BV: >6
- Contaminated: 8.0
112
GBS with allergy to PCN treatment?
- IV clindamycin
113
Melasma can be caused by what?
COC
113
Do you treat the partner if positive for trich? Need follow up testing?
- Yes treat partner
- No follow-up needed
114
Most common STD worldwide?
Trich
115
Treatments for BV? (3)
- Flagyl
- Vaginal flagyl
- Clindamycin cream
116
Short cervix has risk for what?
- Premature labor
117
What to order if COC have not improved cramping?
- Over TVUS to rule out cysts or masses
118
When can a pregnant patient have Macrobid?
- Second trimester 14-26 weeks
119
Second line treatment for mastitis
Keflex, Clinda
120
Most common cause of sore and painful nipples when breastfeeding?
Poor latch
121
Contraindications to breastfeeding? (4)
- Maternal HIV
- TB
- Active HSV lesion on the breast
- Varicella between 5 days before delivery and 2 day postpartum
121
HPV vs. Pap smears reliability
- HPV testing is very reliable, so they don’t need completed as often
- HPV more reliable than pap smear
122
What do BV cells look like?
- Vaginal epithelial cells with blurred margins
122
When is first DTaP given to babies?
Then when?
- 2 months
- 2 additional doses at 4 and 6 months
123
Threatened abortion occurs when?
- Before 20 weeks
124
What diagnosis increases risk for NAFLD?
- PCOS
125
When are appointments during pregnancy?
- Every 4 weeks until 28weeks
- Every 2 weeks 28-36 weeks
- Every week until delivery
126
Tests to order with galactorrhea? (3)
- Prolactin
- Pregnancy test
- TSH
126
Mastitis and breastfeeding
- Continue to feed or dump to avoid milk stasis
127
Smoking contraindications with COC?
- Smoke > 15 cigs/day AND age > 35
128
1 hour OGTT 60 min after 50g sugar
– what number indicates DM?
- >140
129
What to do if pregnant and exposed to Erythema Infectiosum?
Then what?
- Obtain Parvovirus B19 antibodies to assess immunity status
- Collect again in 4 weeks
130
What labs to determine viable pregnancy?
- HCG plus progesterone levels
131
Postmenopausal woman with T score between -1.0 and -2.5 treatment?
- Fosamax
132
Breast CA treatment if caught early?
- Lumpectomy with radiation
133
Patients with moderate to high risk of breast CA should have what kind of screening? (3)
Breast exams how often?
Mammograms how often?
MRIs how often?
- Professional breast exams q6-12mo
- Mammograms yearly (not before 30)
- MRIs yearly (not before 25)
134
HRT not recommended for what age?
Why?
- >60 d/t risk of clots
135
When is varicella given?
- 12 months
- 4-6 year
136
Seizure/psych med contraindicated with COC?
Lamictal
137
Complication of untreated gestational DM? (2)
First line tx if lifestyle changes don’t work?
- Preeclampsia and Macrosomia
- Insulin
138
Blood thinner safe during pregnancy?
When to stop?
- Lovenox
- Need to stop 18-24hr before spinal or epidural anesthesia
139
COC cancer risks
Increased risk for what?
Decreased risks for what?
- Slightly higher chance of cervical and breast CA
- Decrease risk of ovarian and endometrial CA
140
What happens during an inevitable abortion?
Possible to carry?
- When there is dilation of the cervix, ROM, but passage of fetus hasn’t occurred
- Nothing we can do, refer to OB for follow-up care
141
Can you treat STDs with exposure?
- Yes, treat a presumptive positive
142
Can you have HRT with endometriosis? What if you smoke?
- No with endometriosis
- Yes, smoking is not a complete contraindication
- no with breast CA, liver disease
143
Trich findings on a wet mount?
- Flagella
144
Distinguishing factor between mastitis and inflammatory breast CA?
- Fever only present in mastitis
- Nipple discharge can be present in both
145
What to do if sexually assault within the last 5 days?
Refer to ED
146
You should never feel what in a post-menopausal patient?
- Ovary -> refer for TVUS
147
What is primary amenorrhea?
No period before age 15
148
Cervical motion tenderness can mean what?
Ectopic pregnancy or infection
149
Management of preeclampsia before delivery?
Bed rest with bathroom privileges
Weight and BP monitoring
Closely follow urine protein as well as serum protein, creat, and PLTS
150
Criteria to diagnose PID
Cervical motion tenderness
Adnexal tenderness
Uterine tenderness
151
Which breast cancer mimics mastitis!
Inflammatory breast CA
152
What diagnostic test confirms breast CA after mammogram?
Tissue biopsy
