Womens health Flashcards
The secretory phase of the menstrual cycle (day 14-28) is dominated by what hormone?
Progesterone
Is a nulliparous or multiparous woman more likely to get preeclampsia?
Nulliparity is a risk factor for preeclampsia
Wince a genetic cause is the number one reason for primary amenorrhea, what is one very important test?
Karyotype
Purulent cervical discharge should make you think of what diagnosis?
Neisseria gonorrheoeae
A description of a young girl with a web neck or wide shield chest should make you think of what diagnosis?
Turners syndrome
A cervical biopsy comes back as CIN1. What is the next step?
Repeat pap smear in 6 months and repeat colposcopy in 12 months
What is the most common cause of secondary amenorrhea
Pregnancy
What three labs should you order if you are considering secondary amenorrhea?
Beta- HCG, TSH, prolactin
Define premature birth
Delivery before 37 weeks
A unilateral, single, mobile, firm, contender solid breast mass should make you think of what diagnosis?
Fibroadenoma
Define metorrhagia
Bleeding between menstrual cycles
Postmenopausal bleeding is immediately believed to be what diagnosis?
Endometrial cancer until proven otherwise
During what portion of the menstrual cycle does PMS occur?
By definition it is in the second half of menstruation and should receive the symptoms
How do you treat bacterial vaginosis?
Metronidazole x7 days
What location within the pelvis is endometriosis most commonly found?
On an ovary
What lab test is the gold standard for chalmydia?
Nucleic acid amplification test
How do you definitely diagnose endometriosis?
Exploratory laparoscopy
Are fibrocystic breast masses usually bilateral or unilateral?
Bilateral
What is the most common uterine tumor?
Leiomyoma, also known as fibroids
Which ethnic background is at an increased risk of fibroids?
African americans are 5x more likely to have fibroids compared to caucasian women
How do you treat vaginal candida?
Fluconazole po 1 dose or azole cream x1 week
What is the first step of treatment for endometrial cancer?
Total hysterectomy and bilateral salpingo-oophorectomy
If you see the term chocolate cyst, it should make you think of what diagnosis?
Endometrioma
A surge in what hormone leads to ovulation?
Lutenizing hormone
A patient presents with irregular menses, hirsutism, and infertility. What is the most likely diagnosis?
Polycystic ovarian syndrome
What endocrine issue is associated with PCOS?
Insulin insensitivity
You have a patient with PCOS who would like to get pregnant. What are two medications you may start her on?
Metformin and clomid
What is the medical treatment for an early ectopic pregnancy?
Methotrexate
An ovarian cyst that contains hair and teeth should make you think of what diagnosis?
Teratoma
What is the mean age for ovarian cancer?
63, you will need to think of this with an older patient with vague abdominal symptoms
Define the second stage of labor
Fully dilated to delivery
A 66 year old female patient presents with bouts of nausea, weight loss, and vague abdominal pain, what is the most likely diagnosis?
Ovarian cancer
When is it recommended to begin pap smears?
Beginning at age 21 regardless of sexual history
A cervical biopsy comes back as CIN2 or CIN3. What is your next step?
Excision - LEEP, cold knife (worry about incompetent cervix), cryotherapy
List 2 risk factors for cervical cancer
Multiple sexual partners, smoking
How much time has to pass before diagnosing secondary amenorrhea?
If cycles have been normal 3 months, if cycles have been irregular 6 months
What is a cystocele?
A herniation of the bladder into the vagina
What is the treatment for turners syndrome?
Cyclical estrogen and progesterone
What are the 3 treatments for uterine prolapse?
Pessary, Kegel’s maneuver, surgical repair
What is the most common organism to cause mastitis?
Staph aureus
At approximately how many weeks pregnant is the uterus at the level of the umbilicus?
20 weeks
What is the most common cause of postpartum hemorrhage?
Uterine atony
Define missed abortion
No vaginal bleeding, cervix is closed, no products of conception are still inside
At what age is primary amenorrhea diagnosed?
Age 14 if no secondary sex characteristics. Age 16 if some secondary development
What is the first line treatment for mastitis?
Dicloxacillin is first line, cephalexin or erythromycin are second line
Should a breast feeding mother stop breast feeding if she develops mastitis?
Mastitis is not a reason to stop breast feeding, but a breast abscess is
A physical examination revealing a retroverted uterus or uterosacral ligament modularity should make you think of what diagnosis?
Endometriosis
At how many weeks of pregnancy can amniocentesis done?
15-20 weeks
List four risk factors of breast cancer?
BRCA1 or BRCA2 positive, unstopped estrogen, nulliparity, early medicine, late menopause
What is the average age of menopause?
51
Cottage cheese discharge should make you think of what diagnosis?
Vaginal candidiasis
The follicular phase of menstruation is dominated by what hormone?
Estrogen
How much weight should a woman gain during pregnancy
20-35 pounds
Thin, sticky, malodorous vaginal discharge should make you think of what diagnosis?
Bacterial vaginitis
List 2 medications commonly used for hypertension in pregnancy?
Methyldopa and labetalol
Vaginal infection with motile flagellated protozoa should make you think of what diagnosis?
Trichomonas vaginitis
Classic triad for pre-eclampsia?
HTN, edema, and proteinuria
Why is ovarian cancer so hard to diagnose?
There are no good markers and the symptoms are very vague
What are two important things you need to tell your patients before putting them on metronidazole?
Stay out of the sun and avoid alcohol
Define inevitable abortion
Vaginal bleeding, cervix is open, products of conception inside
How is the first day of the menstrual cycle defined
The first day of menstrual bleeding is the first day of the cycle
Karyotype for a patient with turners syndrome?
(45, X) they are missing one sex chromosome
Give the definition for preterm labor
Contractions that open the cervix before 37 weeks
A patient presents with mucopurlent discharge and cervical motion tenderness, what is the most likely diagnosis?
Chlamydia cervicitis
Which four human papillomaviruses are linked to cervical cancer?
HPV 16, 18, 31, and 33
Clue cells should make you think of which diagnosis?
Bacterial vaginosis
What is the hallmark physical exam finding for placenta previa?
Trick question - NEVER do a physical exam on someone with presumed placenta previa.
What medium do you need to grow out Neisseria gonorrhoeae?
Thayer-martin
What age range is the HPV vaccination recommended for?
9 to 26 years old
A patient with primary amenorrhea and a low FSH should make you think of what diagnosis?
Hypothalamic pituitary insuf ciency
What characteristic of pelvic inflammatory disease will help to differentiate it in a question from ectopic pregnancy, appendicitis, ovarian torsion and ovarian cyst?
It will be bilateral pain. Most other common abdominal complaints have unilateral pain.
List 2 risk factors for ovarian cancer
BRCA1, family history, nulliparity, late menopause, Caucasian, Asian
Define abortion
Delivery of uterine contents before 20 weeks.
Does mastitis tend to be unilateral or bilateral?
Unilateral and only in one quadrant
Define full-term
Delivery at 37-42 weeks
When does quickening occur?
Nulliparous 18-20 weeks, multiparous 14-16 weeks
3 risk factors for placental abruption
HTN, smoking, AMA, cocaine use, PROM
Treatment for ovarian cancer
Total hysterectomy and bilateral salpingo-oophorectomy. Then chemo and radiation.
Bluish discoloration of the cervix, vagina, and labia resulting from increased blood flow. It can be observed as early as 6 to 8 weeks after conception, and its presence is an early sign of pregnancy.
Chadwicks sign
At approximately how many weeks pregnant is the uterus at the level of the symphysis pubis?
12 weeks
A snowstorm appearance on ultrasound should make you think of what diagnosis?
Hydatidform mole
What medication can be used to control bleeding due to uterine atony?
Oxytocin
What is the term for when the placenta has implanted directly over the cervical os?
Placenta previa
At how many weeks of pregnancy can chorionic villus sampling (a test made in early pregnancy to detect congenital abnormalities in the fetus) be done?
10-13 weeks
Why is folic acid given as a prenatal vitamin?
Low folic acid can lead to neural tube defects.
Most common endometrial cancer?
75% are adenocarcinomas
A strawberry cervix with copious yellow/green discharge should make you think of what diagnosis?
Trichomonas vaginitis
What is the #1 cause of septic arthritis in sexually active young adults
Neisseria gonorrhoeae
How many days after conception is beta HCG positive?
8
If the pap smear results come back anything other than negative or ASCUS what is your next step?
Colposcopy and biopsy
List 3 risk factors for ectopic pregnancy
Previous ectopic, scarred tubes (hx of PID or salpingitis), IUD
Grape-like vesicles or a sack of grapes on ultrasound should make you think of what diagnosis?
Hydatidiform moles
What medication is used to increase surfactant levels and help with lung maturity if you are worried about preterm labor?
Betamethasone
What are two tocolytic medications you should be aware of?
Magnesium sulfate and calcium channel blockers
A woman presents to the ER concerned she is in preterm labor. What treatment should you begin before even getting any imaging or lab results?
Give IV uids (most often the patient is suffereing from dehydration).
The pap smear results on a 23 year old patient come back as atypical squamous cell uncertain signi cance (ASCUS). What is your next step?
Repeat pap smear in 12 months although HPV test is acceptable.
What are three ways you can check for ruptured membranes?
Ferning pattern on a slide, visualize leakage from the cervix, pooling in the vagina
What is the normal range of fetal heart rate?
120-160
Define menorrhagia
Heavy prolonged menstruation
What Rh combination for mom and dad might
cause the mother to create antiboides against the baby’s red blood cells?
Mom Rh-negative and dad Rh- positive
At what point during pregnancy is RhoGAM given if it is needed?
28 weeks
Define complete abortion
Vaginal bleeding, cervix open, products of conception have passed
Gestational diabetes puts mom and baby at increased risk of for what three things?
Preeclampsia, macrosomia (traumatic birth), slowing in fetal lung development
Which is associated with painful third trimester bleeding placental abruption or placenta previa?
Placental abruption
What are the three causes for a postpartum hemorrhage?
Uterine atony, genital laceration, retained placenta
Define the third stage of labor
Delivery of baby to delivery of placenta
What medications are used to treat post partum metritis
Clindamycin and gentamycin
What organism is the most common sexually transmitted bacteria
Chlamydia
Interference with work or school is part of which diagnosis, premenstrual syndrome or premenstrual dysphoric disorder?
Premenstrual dysphoric disorder
Which reproductive cancer carries the highest rates of death in women?
Ovarian cancer
What is the most common infection following a c section
Metritis
How do you treat a trichomonas infection
Metronidazole
Define incomplete abortion
Vaginal bleeding, cervix is open, products of conception partially passed
What is the most common site of an ectopic pregnancy?
Within a fallopian tube
Early on in pregnancy serial beta HCG should double over what time period?
Every 48-72 hours
Define procidentia
Uterine prolapse beyond the introitus
What is the more popular term for Stein-Leventhal syndrome?
PCOS
What is the formula for calculating estimated date of con nement or due date?
First day of last menstrual period + 7 days - 3 months
What are the ve components of the biophysical pro le as part of antepartum testing?
A non-stress test, fetal breathing, two gross body movements, fetal tone, amniotic uid index
Define the first stage of labor
Onset of contractions to full dilation of the cervix
A rope like breast mass should make you think of what diagnosis
Fibrocystic breast mass
