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Womens Health Rotation. Flashcards

1
Q

Mammogram schedule

A

every 1-2 yrs from 40-50 yrs old

and annually thereafter

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2
Q

When rectovaginal exam?

A

after 40 yrs

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3
Q

Pap smear schedule

A

Annually for all women who are sexually active.
Or have been in the last 3 yrs or reached 21yrs old.
Can be discontinued around 65 yrs if consistently neg and low risk pt.

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4
Q

Cytology=
ASC-US
what is it, what do you do when you find it?

A

atypical squamous cells of undetermined significance. requires repaet pap at 6 and 12 months. If abnormal then colposcopy.

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5
Q

Cytology=
LSIL
what is it, what do you do with it?

A

low-grade squamous intraepithelial lesion requires colposcopy unless they are teenagers

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6
Q

Cytology=

LSIL in older women?

A

maybe due to low estrogen. Give Premarin

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7
Q 
Cytology=
ASC-H
HSIL
AGC
AIS
squamous cell carcinoma
A

atypical squamous cells cannot exclude HSIL
high grade squamous intraepithelial lesion
atypical glandular cells-neoplastic
adenocarcinoma in-situ
ALL HIGH RISK GROUPS THAT REQUIRE COLPOSCOPY.

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8
Q

How much folic acid should pregnant female take to reduce neural tube defects

A

400 to 800 mcg/day

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9
Q

when should HPV immunizations be offered?

A

women 9 -26 years old

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10
Q

Dysmenorrhea def?
primary
secondary
membranous

A

painful menstration that prevents normal activity.

primary: no organic cause
secondary: pathologic like endometriosis, adenomyosis, PID, fibroids
membranous: endometrium passing through cervix causing cramps

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11
Q 
ednometriosis def
when is pain felt?
how to make dx?
other sx's
tx:
A

abnormal growths of endometrium found outside the uterine lining.
almost exclusively in females of childberaing age
pain stimulated by estrogen progesterone during menstration,
dx= Laparotomy
sx’s=dysparunia, infertility, pelvic pain, lower back pain
tx: NSAIDS, OCP, Depot (medroxyprogesterone acetate) IM, Danazol

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12
Q

Pruritis of external genitalia.
mucopurulent foul smelling vaginal discharge.Burning irritation, dysuria, dysparunia
what do you see on labs?

A

vulvovaginitis
Vaginal ph 4-4.5
wet mount shows (with saline) leukocytosis and candida buds,
(KOH) mount will destroy the cells and leave the candida buds.
vaginal culture

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13
Q

“chocolate cysts”. what are they.

A

Endometriomas are cyst-like structures that contain blood, fluid, menstrual debris on the ovary

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14
Q

pathophysiology of endometriomas

A

Premenstrual pain stimulated by estrogen and progesterone during menstrual cycle
Tissues of implants respond to hormones the same way the endometrium responds  enlarge, become secretory, and bleed
Difference is, fibrotic tissues surrounding implants prevent the expansion and escape of blood  PAIN!

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15
Q

where are endometriomas mostly located ?

A

ovaries

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16
Q

16 y/o female c/o severe dysmenorrhea since menarche at age 13. She frequently has to miss 1-2 days of school every month because of dysmenorrhea, which is also accompanied with nausea and vomiting. She recently became sexually active with her new boyfriend and frequently has to stop activity due to pain with deep penetration.
Tx?

A

NSAIDS.
OCP’s
Progestins
Danazol

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17
Q

32 y/o female c/o “unable to get pregnant” for past year. Also c/o dysmenorrhea, metromenorrhagia, dyspareunia with deep penetration and dyschezia for past 5 years. She has previously been on OCPs which has helped somewhat with dysmenorrhea, but she now wants to start a family
whats your tx?

A

Surgery

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18
Q

give me 5 sx’s of endometriomas

A

1) dysmenorrhea
2) dyspareunia
3) dysuria
4) metrorrhagia
5) infertility

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19
Q

physical exam findings

A

tender, enlarged adnexal masses

retroverted/retroflexed uterus

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20
Q

what tests are usless for work up?
whats the gold standard?
whats worth have a shit?

A 
MRI
CT 
ULS
X-ray
Laparoscopy
CA-125, CBC/ESR, UA, GC/Ch (NAAT)
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21
Q

which birth control method is the best?

worst?

A

best? Implants, vasectomy, sterilization, IUD

worst? withdrawal, spermicide

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22
Q

whats the second best birth control

A

injectables, LAM, pills, patch, ring

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23
Q

how does pill work?

what are the oher benefits?

A

estrogen/prgestin induce inhibition of midcycle surg of gonadotropins secretion so that ovulation does not occur.
help treats dysmenorrhea, menorrhagia, acne, ovarian cancer, endometrial cancer

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24
Q

for women with menorrhagia which birth control is recommended?

A

pills

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25
whats the number 1 adverse affect of oral contraception
irregular menstrual bleeding
26
what are 4 contraindications for pills?
previous stroke hormone dependent tumors over 35yo and smoking pregnant
27
cons to progestin only pills?
more break through bleeding | slightly higher failure rate
28
what are the indications for progestin only pill?
previous dx of migraines (no estrogen) over 35yo smoker Hx of thromboembolic dz cardiac dz
29
can a female start the pill anytime? | when should you follow up
must have negative pregnancy test and use condom for 7 days or just start on 1st day on menses f/u in 3mos
30
pros/cons of mini pill?
lower hormones must take it the same TIME everyday if over 3hrs late=use back up
31
Nuvo ring?
worn for 3wks lower hormones improved cycle control
32
patch? how long do you use it?
applied weekly | obesity decreases the efficacy so nobody over 200lbs
33
whendo yo get depot shots? | adverse affects?
injection every 12wks amenorrhea and wt gain may occur do not use over 2 yrs due to risk of osteoporosis
34
Implanon
3yrs.
35
emergency contraception | side effects?
Levonorgestrel can be tahen 120 hrs post intercourse does not interrupt pregnancy but affects implantation side effects include=nausea/vomting
36
whats are a couple big reasons to use IUD?
Lower rates of endometrial cancer, ectopic pregnancy, PID, dysmenorrhea, and symptomatic endometriosis Contraindications are rare
37
difference between Mirena and Copper IUD?
Mirena has less dysmenorrhea and mentraul bleeding
38
Who are indeal candidates for IUD?
Ideal candidates for intrauterine contraception are women who: Are at low risk of acquiring sexually transmitted infections Are not planning a pregnancy for at least one year Want to use a reversible contraceptive Want or need to avoid estrogen-based methods Nulliparous women, women in nonmonogamous relationships, adolescents, breastfeeding women, and women with a history of PID or ectopic pregnancy can all safely use the IUD with appropriate counseling about side effects and prevention of STDs
39
What are contraindications for IUD's?
Relative Contraindications Women at high risk for STDs Nonmonogamous relationships / multiple partners History of STD Women with a history of problems with intrauterine contraception Expulsion, perforation, pain, pregnancy, bleeding Dysmenorrhea or menorrhagia (copper IUD) Hormonal sensitivities (Mirena IUD)
40
Answer these. 1) Adolescent on OCP forgets her pills 2) Young woman getting married wants contraception for a few years or less 3) Woman on Yaz c/o breakthrough bleeding 4) Woman on Ortho Tricyclen c/o PMS sx 5) Woman with PCOS requesting OCP 6) Postpartum woman, breastfeeding 7) G4P3 female does not want any more kids 38 y/o smoker wants contraception
--1)Nuva ring, transdermal implant or shot. --2)IUD --3)Monophasic OCP --4)Minipill --5)Norgestimate --6)Minipill --7)IUD copper/sterilisation --8)IUD, Minipill.
41
DUB is most frequently associated with? | What are the symptoms
chronic anovulation. In women with DUB secondary to anovulation, endometrial blood flow is variable and follows no orderly pattern Common symptoms include heavy menses, prolonged menses, or frequent irregular bleeding.
42
what is a normal cycle length? what is a normal duration? average iron loss?
- 21-35 days, abnormal=under 21days/over35 - 4-6 days, - 16mg
43
1) Prolonged duration of menses (>7 days) and/or Increased amount of bleeding (> 80 ML)? 2) frequent but regularly timed episodes of bleeding with a cycle length of than 35 days apart occurring at regular intervals
1) menorrhagia 2) polymenorrhagia 3) menometrorrhagia 4) Oligomennorhea
44
Ddx of anovulatory bleeding?
Age-related:peri-menarche, perimenopause Estrogen excess:unopposed endogenous or exogenous estrogen Androgen excess: or polycystic ovary syndrome (PCOS) Prolactin excess: -prolactinoma, medication ``` Coagulation disorders Hypothyroidism Liver disease Cirrhosis Chronic renal failure Malnutrition Stress ```
45
causes of anovulation? Hyperandrogenic anovulation: - Hypothalmic anovulation: - Hyperprolactinemia
Hyperandrogenic anovulation:PCOS, adult onset Adrenal Hyperplasia (AH) - Hypothalmic anovulation: stress, weight loss - Hyperprolactinemia
46
how long is it ok to bleed postpartum?
4-6wks
47
endometrial polyp can present as ?
postcoital bleeding
48
fetal macrosomia is when a newborn weighs more than?
newborn more then 4000 grams= 8.81 pounds
49
leiomyomas?
fibroids, estrogen dependent, grow larger at pregnancy, most common indication for pelvic surgery
50
how is the dx of pre-eclmpsia made?
diastolic b/p= over 90 after 20wks gestation systolic b/p is over 140 proteinuria over 0.3 grams
51
when and what is preterm labor? | What is postterm pregnancy?
contraction 5 minutes apart before 37wks | -pregnant after 42wks
52
What are the congenital infections?
``` T=toxoplasmosis O=other, like syphlis R= rubella C= cytomegalovirus H=Herpes, HIV ```
53
SAB. when, who, percentage, dx test? | cardinal sign
``` usually under 20wks advanced aged moms, smokers, previous sab 8-20% ultrasound cardinal sign=vaginal bleeding ```
54
sx's of ectopic? when? dx?
abdo pain with vaginal bleeding, CMT, fever, adnexal mass. typically 6-8wks after LMP ultrasound or Beta hcg not doubling
55
Name some medical complications in pregnancy and tx.
``` anemia= Hgb under 11. tx=iron 800mg Asthma= can fck up the fetus. tx= inhaler DM= Mc ```
56
difference between spinal block and epidural?
spinal for c-section. immediate relief | epidural for most common in 2nd stage, epidural HA and hypotension, longer duration
57
3 top bloodborne viruses?
HIV, Hep B, Hep C
58
when to suction the baby?
prolonged second stage of labor baby's head is out maternal exhaustion fetal distress
59
female with menstrual irregularities and male pattern baldness. what test do you want?
glucose tolerance test (PCOS)
60
best test for post term pregnancy?
ultrasound or non-stress test
61
drug of choice for HTN in pregnancy?
Methyldopa= Alpha 2 adrenergic agonist
62
CIN 1 (Grade I) LSIL
The least risky type, represents only mild dysplasia, or abnormal cell growth.[3] It is confined to the basal 1/3 of the epithelium. This corresponds to infection with HPV, and typically will be cleared by immune response in a year or so, though can take several years to clear.
63
CIN 2 HSIL
Moderate dysplasia confined to the basal 2/3 of the epithelium
64
CIN 3
Severe dysplasia that spans more than 2/3 of the epithelium, and may involve the full thickness. This lesion may sometimes also be referred to as cervical carcinoma in situ.
65
primary amenorrhea def? | secondary amenorrhea def?
menstration never occurs | menstration ceases
66
how to treat placenta previa? | How to treat placenta abruption?
- bed rest and scheduled c-section | - immediate delivery
67
sx's of pregnant female with fatigue, anorexia, dyspnea and edema?
anemia
68
UTI tx in pregnancy?
nitrofuritonin, ampicillin
69
bartholin cyst tx?
asymptomatic heal on their own. | I and D with inwelling cath
70
pt with positive ASC-US but negative HPV?
1 year follow up
71
how to dx endometrial cancer?
Endometrial sampling is the gold standard for evaluation for endometrial neoplasia. For postmenopausal women, transvaginal ultrasound evaluation of endometrial thickness may be used as an initial study to evaluate for endometrial neoplasia in selected women
72
sx's attributed to leiomyomas? How to get relief. test?
pelvic pain or pressure, reproductive dysfunction, abnormal uterine bleeding, Relief of symptoms related to fibroids usually occurs at the time of menopause, when menstrual cyclicity stops and steroid hormone levels wane. Most, but not all, women have shrinkage of leiomyomas at menopause. test include= ultrasound or sonohysterography
73
Depot side effects?
menorrhagia anovulation osteoporosis wt gain

OB/GYN (3 decks)

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