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42 Cards in this Set
- Front
- Back
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S/S of cervical cancer...
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bleeding, esp post-coital; malodorous vaginal discharge (necrotic tumor), possible flank tenderness (metastasis to ureter),
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RFs for cervical cancer..
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early age of coitus, STDs, early childbearing, low socioeconomic status, HPV, HIV, cigarette smoking, multiple sexual partners
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where do the majority of cervical dysplasia and cancers arise...
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squamocolumnar junxn of cervix
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acetowhite change... what are other physical changes in cervical cancer...
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cervical intraepithelial lesions turn white w/ addition of acetic acid. May also see vascular changes (punctuations- end on end vessels or corkscrew or hairpin vessels)
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treatment for early cervical cancer (still contained in cervix)...
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txd equally with radical hysterectomy or with radiotherpy
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treatment for late cervical cancer...
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best treated with brachytherapy (implants) w/ teletherapy (whole pelvis radiation) along w/ chemotherapy (cis-platinum)
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how does cervical cancer typically spread...
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thru cardinal ligaments toward pelvic walls possibly obstructing ureters.
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most common cause of death in cervical CA...
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bilateral ureteral obstrxn leading to uremia
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next step after abnorm pap smear...
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colposcopy and biopsy to determine full extent of dysplasia
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cervical cytology typically done when...
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3 yrs after onset of sexual activity or by age 21
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when is HPV typing useful in cervical dysplasia...
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in ASCUS but not in higher cervical dysplasia
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in which situations does atypical squamous cells of undetermined significance not need immediate colposcopy or HPV testing...
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in adolesence or pregnant women
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staging procedure for cervical cancer...
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exam under anesthesia, IVP, chest radiograph, barim enema or proctoscopy, cystoscopy
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a visible lesion in the cervix should be evaluated by...
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biopsy (NOT pap smear which is only a screening test)
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Sheehan syndrome S/S, diagnosis, and tx…
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Amenorrhea post-partum complicated by hemorrhage. Usually cannot breastfeed. Bleeding occurs after OCP. Dx based on irresponsiveness to OCPs, low TH, FSH, and LH and cortisol levels. Tx: replace hormones and estrogen/progestin therapy
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Intrauterine adhesions (Asherman) S/S, diagnosis, tx…
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Patient undergoes curettage which results in amenorrhea due to adhesions. No bleeding after OCP. Definitive dx based on hysterosalpingogram. Tx: hysteroscopic resection of scar tissue
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Post partum hemorrhage…
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Bleeding > 500 ml for vag delivery and 1000 for C sxn. Amount of bleeding that threatens or results in HDS if left unabated
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Most common overall cause of amenorrhea in repro yrs is…
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Pregnancy
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PCOS S/S, diagnosis, tx…
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Estrogen excess w/o progestin, obesity, hirsutisim, glc intolerance, amenorrhea, endometrial hyperplasia. Elevated LH:FSH (2:1) and when given progestin, bleeding is induced
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Why is posterior pituitary not involved in Sheehan syndrome…
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Is has a direct arterial supply
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Why should AROM be avoided if fetal head is not engaged…
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Possible umbilical cord prolapsed
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Assessment of fetal bradycardia…
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Digital examination of vagina for fetal cord, if present then get immediate C-sxn while keeping patient in T-burg to relieve pressure from cord
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Management of fetal bradycardia…
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Confirm FHR s maternal, vag exam to assess for cord, place patient on side to move uterus away from great vessels, 100% O2, IV fluid bolus, d/c oxytocin
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Common causes of fetal bradycardia…
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Oxytocin, epidural catheter, misoprostol (due to uterine hyperstim: >5 contxns in 10min)
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Most common signs of uterine rupture…
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Fetal heart rate abnorm such as bradycardia, late decels, deep variable decels
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Risk for umbilical cord prolapsed in frank breech… footling breech or transverse lie…
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Low for frank breech; Higher for footling breech or transverse lie
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MOA of hypothyroidism causing galactorrhea..
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Low TH prodxn increases amt of TRH produced by ant pituitary with induces thalamus to make prolactin
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Common causes of galactorrhea…
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Pituitary adenoma, pregnancy, breast stimulation, chest wall trauma, hypothyroidism
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Pituitary adenoma symptoms…
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Galactorrhea, headache, bitemporal hemianopsia. They will have low levels of serum estrogen
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How determine if a breast secretion is truly galactorrhea…
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Smear under microscope shows multiple fat droplets
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Most sensitive diagnostic tool for pituitary adenoma…
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MRI. TRH is a good test for mildly elevated prolactin (20-60)
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Causes of hyperprolactinemia…
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Drugs (Tranquilizers, TCAs, antihypertensives, narcotics, OCPs), hypothyroid, hypothalamic cuases (crniophryngma, sarcoid, histio, leukemia), pituitary adenomas, hyperplasia of lactotrophs, empty sella, acromeg, renal dx, chest surg or trauma
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What are the reasons why bromocriptine is not used often for tx of hyperprolactinemia… what are alternatives to bromocriptine…
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SEs: othro hypo, fainting, dizzy, N/V and cost. It is mainly used now for women who want to stay fertile. Capergolamine (another D agonist) and exogenous estrogen
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When is progestin used for hyperprolactinemia…
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For women w/ adequate estrogen levels who do not desire pregnancy
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Tx of galactorrhea in face of nml prolactin levels and nml menses…
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Observation
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Ddx of pruritis in pregnancy…
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Cholestasis of pregnancy (no rash), pruritic urticarial papules and plaques of pregnancy (no abdomen and buttocks), Herpes gestationalis (erythematous blisters on abdomen and extremities)
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Intrahepatic cholestasis of pregnancy MOA, S/S, and tx…
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Bile salts not cleared by liver deposit in dermis causing intense itching without lesions. Usually more on extremities then trunk. Begins in 3rd trimester. Diagnosed with increased levels of circulating bile aids. Tx: antihistamines and cornstarch baths, bile salt binders, chelestyramine, ursodeoxycholic acid
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Cholestasis of pregnancy is associated w…
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Incr incidence of prematurity, fetal distress, and fetal loss, usually most prominent when accompanied by jaundice
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Herpes gestationalis MOA, S/S, and tx…
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Autoimmune related w/ presence of IgG abs directed at basement membrane to activate classical complement pathway. Get intense pruritis followed by extensive cutaneous erythema pathes and vesciles and bullae. Limbs more then trunk and commonly in 2nd trimester. Dx made by innumo florescent exam of biopsy specimens.
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Herpes gestationalis associtated with what in birth…
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Fetal growth retardation and stillbirth, neonatal herpes gestationalis. Tx: oral corticosteroids
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Histo findings of PUPPP… tx…
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Perivascular infiltrate of lymphocytes and histiocytes assoc with edema of papillary dermis. Tx is topical steroids and antihistamines.
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Does herpes gestationalis require C sxn… what is affect on baby…
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No, unlike herpes simplex virus. if it gets to baby and causes lesions then they will resolve.
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