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399 Cards in this Set

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First thing you look at in checking for Preggers
Last menstrual period
Chadwicks Sign
blue discoloration of cervix
Hegars sign
softening of the isthmus of the uterus
Goodells sign
Softening of the cervix
when can you begin to hear fetal heart
8 weeks
Naegeles Rule
add 9 mo and 7 days to LMP for due date
What can you see 5-6 weeks on US
gestational sac
What can you see 6-7 weeks on US
Fetal Pole
What can you see 7-8 weeks on US
Cardiac activity
what is the definition of Labor
Expulsion of products of conception resulting from regular uterine contractions and cervical changes
False labor
contractions with no cervical change
Lightening
presenting part descends into pelvis
4 stages of labor
"Onset of contractions to complete dilation of cervix
what is pelvic station
presenting part in relation (cm) to the ischial spine (at level is 0, above is -, below is +)
Effacement
obliteration of the cervical canal
Steps of delivery
"Internal Rotation
Pre eclampsia triad
"HTN
Indication for C section
"preeclampsia
placenta previa
placenta covers the cervix
tx of overactive bladder
detrol
how does atrophic vagina cause incontinence
estrogen falls, vagina atrophies, pH goes up, UTI sets in
Definition of vaginitis
inflammation irritation or infection of the vagina
Etiology of vaginitis
"Infection
3 most common infectious causes of vaginitis
"Bacterial vaginitis
Normal vagina
"pH 4-4.5
How do yeast and trichomoniasis infections relate to menstrual cycle
"Yeast is before menses
what are you observing during the pelvic exam
Squamo-columnar junction- cancer, cervicitis, cervical motion tenderness
If your pt has cervical motion tenderness what are you thinking she has
STDs- chlamydia and gonorrhea
Tx for vaginitis
"Metronidazole- gel
Pt with normal vaginal pH and vaginitis
Candida
Tx of candida vulvovaginitis
"Diflucan- 1 time pill
Strawberry cervix"
Trichomoniasis
Tx for trichomoniasis
Metronidazole
5 things to think about in relation to pelvic mass
Age, Symptoms, organ of origin, location
Most common pelvic mass
"Myoma
Tests to perform for pelvic mass
HCG, CA125 (<35), MRI, CT, Laparoscopy
What can infect skenes gland
chlamydida, gonnorhea
Tx for fibroids
"childbearing age- remove fibroid
Where does most uterine enlargement occur during pregnancy
Fundus
Your patient wants advice on high impact exercise during pregnancy what do you tell her
up until 12 weeks the uterus is completely hidden in the pelvis and shouldnt be affected by impact
skin changes during preggers
Linea nigra, melasma gravidarum, angiomas and palmar erythema
where does most weight gain come from in preggers
uterus and its contents, breasts, 3rd space fluid
What are maternal reserves
increases in fat, protein and extracellular water
Normal pregnancy glucose status
Fasting hypoglycemia, post-prandial hyperglycemia, and hyperinsulinema
What is an important mineral to watch in pregnant women
"iron- Fe def anemia common
3 functions of pregnancy induced hypervolumemia
"Protect agains orthostatic BP changes
CBC changes in preg
"Dec hem and hct
CV changes
"HR increases by about 10
Increases in progesterone will affect
"respiratory effort will increase
kidney changes in preg
"BUN and Creat fall
most common location of ectopic preg
ampulla
Salpingectomy
removal of the fallopian tube
Salpingostomy
Incision in the tube and remove the pregnancy
High risk for ectopic preg
"TUbal surgery
Ectopic triad
"Amenorrhea
Dx ectopic
Presence of any non cystic extraovarian adnexal mass in the absence of intrauterin pregnancy (98% spec)
Medical intervention of ectopic
Methotrexate
preferred tx for ectopic
"surgery
How do ovaries make estrogen
convert male hormones into estrogen
Commander of the hormones
GnRH
Kallman's Syndrome
"No sense of smell, no periods
what kills GnRH
Dopamine
Mechanism of turning on and off GnRH
adding/subtracting OH from dopamine (converting it to epi)
how do mitochondria factor into the menstrual cycle
needed to convert cholesterol into prenenolone (mother hormone)
what happens to pregnenolone
immediately converts into either progesterone or 17 hydroxypregnenolone
the 5 androgens
"testosterone
What hormone is a common stop in all steroids
Androstenedione
What 2 androgens have receptors
"Testosterone
Consequences of giving estrogen to post menepausal women
"Activates undetected breast cancer
What do granulosa cells do
"convert male hormones
What do inhibins do
"decreases FSH
Can thyroid hormone cross placenta
no
Thyroid Binding Globule levels in pregnancy
increase
What thyroid function test do you order in pregnant women
Free T4
how does HcG relate to TSH
hCG acts like TSH in the weeks 10-12 and controls fetal thyroid
Importance of iodine in pregnancy
fetus needs to make own thyroid hormones, if mother is deficient, it cannot make them
Risks of a hypothyroid pregnant woman
preeclampsia, HTN, abruption of placenta, anemia, post partum hemorrhage and small gestational age of newborn
Risks to fetus in hypothyroid state
"impaired neural and somatic growth
Causes of maternal hypothyroid
"hashimoto
Dx maternal hypothyroid
"Free T4
TSH goal in pregnancy
2.5-4 mu/L
Tx for maternal hyperthyroid
"PTU- stops synthesis
What is ectopic breast tissue
breast tissue that forms along the primative milk line, can develop into breast cancers
lots of plasma cells in GU tract"
"chancre from syphillis
Endarteritis
"inlammation of small blood vessels with plasma cell infiltration
scattered small abscess"
granuloma inguinale
Donovan bodies
"small rounded encapsulated bodies in histiocytes
bx: stellate abscess w pale epitheloid cells"
"Lymphogranuloma venereum
Behcet's
autoimmune, vasculitis in vulva
Vulvar Vestibulitis
"Chronic inflammation w lymphocyte infiltration
Bartholin cyst
"infection of bartholin gland (gonnorhea)
Vulvar Vestibularis
"Small glands in the vestibule become inflamed
Lichen Sclerosis
"Most common in elderly pop, if in children suspect abuse
Histology of lichen sclerosis
"atrophy of epidermis
Gross appearence of lichen sclerosis
white dry parchment like patches
Lichen simplex chronicus
"rubbing caused by puritits
Hidradenoma papilliferum
"can arise from ectopic breast tissue
Condyloma acuminata
"benign, branch like projections, fibrous stroma
VIN"
"premalignant
VIN- differentiated variant
"not hpv associated
Risks for vulvar cancer
"lots of sexual partners
Verrucous carcinoma
warty, large, exophytic lesion
extramammary pagets disease
"pruritic crust lesion with sharply demarcated lestion on labia majora
Aggressive angiomyxoma
"young women
VAIN"
"Squamous Cell
Clear Cell adenocarcinoma
"uncommon
histology of HSV cervicitis
multinucleated giant cells and intranuclear inclusions
Tunnel cluster
"proliferation of endocervical glands with side channels growing out
Microglandular hyperplasia
no atypia (diff from tunnel clusters)
Diffuse Laminar endocervical glandular hyperplasia
proliferation of medium sized evenly spaced well differentiated glands separated from the stroma
HPV infection
"infect immature basal cells or immature metaplastic squamous cells
oncogenesis with HPV
E6 and E7 proteins bind to Rb and upregulate cyclin E and interfere with p53
LSIL
"Low grade intrapithelial lesion
HSIL
"high grade intraeptithelial lesion
identifying CIN
staining KI-67 can identify HPV, lead you to SIL dx
most common malignant carcinoma of the cervix
invasive squamous cell carcinoma
sx of invasive squamous cell carcinoma of cervix
"at first asx
adenocarcinoma of cervix
"grossly similar to squamous
minimal diviation adenocarcinoma"
"not differentialed
adenosquamous carcinoma
"adenocarcinoma with well defined squamous component
Pearl Index
"how effective contraception is
Synthetic progestin OC
"induce endometrial atrophy
Ethinyl estradiol OC
suppress FSH, stabilized endometrium
higher risk of blood clots, OC or pregnancy
pregnancy
low dose OC
"no lower risk of DVT compared to 30/35 ug dose
benefit of 24 on 4 off compared to 21 on 7 off OC
24/4 is more effective, less risk of follicle recruit
Plan B
"Levonorgestrel
Gold standard for evidence collection for assault victims
DNA
Sources of evidence
Hair, Nail clippings, swabs, fibers, glass, clothing, all trauma
Signs of strangulation
contusions, fingernail marks, abrasions, ligature marks, hyoid fracture, petechiae, dusky brain
Dusky brain
cortical ribbon has dusky salmon color
amount of time to go unconcious from strangulation
10 sec
key feature in court regarding strangulation
10 sec will knock out, trying to hurt person would be longer result in ptechiae and death (3 min)
Person dies from strangulation, no ptechiae
vagal stimulation resulting in disrhythmia
purpose of oxytocic agents
promote labor and delivery
Use of oxytocin
"Labor disorder
Ergonovine and Methylergovine
increase rate and force of contractions
Prostaglandin Agents
"Stimulate uterine smooth muscle contractions
Dinoprostone
used for cervical ripening
use of tocolytics
uterine relaxants used for premature labor
Ritodrene
tocolytic, only IV, Beta2 and some beta1
What causes false negatives on PAP tests
Samping, screening, interpretation errors
When do you start screening for HPV
3 years after onset of vaginal intercourse or at age 21
Protocal for screening
"annual cytology or paps every 2-3
ASCUS
atypical squamous cells of undertermined significance
Managment of ASCUS
"can repeat pap or do colposcopy
Management of CIN
"repeat pap in 6 mo
ASCH
atypical squamous cells high risk
Management of ASCH
"repeat pap at 6 and 12 mo
Managment of HSIL
"LEEP
AGC
"atypical glandular cells
Management of AGC
"colposcopy
where do you find the squamo-columnar junction
moves around into the os and out varying with estrogen levels, post-menopause it retreats to the cervical canal, pregnant- found on ectocervix
How can you make cervical lesions appear more clearly
acetic acid
Lugol's solution
iodine solution, normal cells turn brown, abnormal cells lack glycogen and dont stain
What is mosaicism indicitive of in cervical lesions
vascularized lesion with capillaries
where are most lesions of the cervix
anterior lip
Peau d'orange
orange peel appearing cervix, abnormal blood vessels in the lesion
Most common ovarian cancer
"epithelial
most common GYN malignancy
"uterine
most lethal Gyn malignancy
ovarian cancer
Ovarian cancer risks
"BRCA
Pathogenesis of ovarian cancer
"Don't know
screening for ovarian cancer
"no good screen
managing ovarian cancer
surgery or chemo
chemo for ovarian cancer
carrboplatin, paclitaxel
Gram neg diplos
gonnorhea
where does gonnorhea infect in the female GU tract
endocervix and the fallopian tubes
one is a 8 yo boy one is a 8 yo girl, both have gram neg diplos on grm stain. what do you do"
"call social services for boy
How do you culture for gonnorhea
"thayer martin or chocolate media
gonorrheal syndromes
"urethritis
Tx for gonorhea
"ceftriaxone- DOC 125 mg IM
Dx syphilis
"dark field
tabes dorsalis
"widestance gait- neurosyphilis
#1 reason for false positive RPR
"pregnancy
Tx for syphilis
"2.4 MU PCN IM
Lymphogranuloma venereum
"chlamydia disease
Pediculosis Pubis
"crabs
Molluscum Contagiosum
"DNA virus
Endometrial hyperplasia
"premalignant
how do you determine type of hyperplasia (endometrium)
D and C
Simple hyperplasia without hyperplasia
"best one
simple hyperplasia with atypis
"loss of polarity
Complex hyperplasia without atypia
"crowded bizzare glands, branching, lots of mitosis, epithelium is actually normal
Complex hyperplasia with atypia
"overlaps with well differentiated adenocarcinoma
how does the endometrium progress to carcinoma
always step wise, simple hyperplasia- complex hyperplasia-complex atypical- CA
most common type of endometrial cancer
"carcinoma of the endometrium type 1
Endometroid Cancer
"PTEN, PIK3CA
How does the grading system of endometroid cancer work
"<5% solid mass G1
Carcinoma of the ENdometrium Type 2
"older population
Malignant Mixed Mullerian Tumor
"carcinoma and sarcoma
Most common benign tumor in females
leiomyoma aka fibroid
Morphology of leiomyoma
"well circumscribed grey white masses
when do leiomyoma progress to leiomyosarcoma
NEVER
Leiomyosarcoma
"Solitary, infiltrating, polyploid
TORCH
"toxoplasmosis
Placental infection
"ascending- more common
Chronic Villitis
"intrauterine growth retardation and stillbirth association
acute funisitis
"acute umbilical cord inflammation
placental infarct
"villous necrosis due to obstruction
gestational trophoblastic disease
Moles
Complete mole
"all paternal DNA
partial mole
"can see embryo (cant in complete)
invasive mole
"usually complete, villi go deep into myometrium
choriocarcinoma
"most aggressive gestational trophoblastic disease
placental site trophoblastic tumor
"rare
First thing you do when ob pt comes into office first time
verify pregnancy
how to calculate EDD
First day of LMP, minus 3 mo + 1 week
where should the fundus be at 20 weeks
umbilicus
When using US to determine due date what kind of freedom exists in believing pt hx or US
"1st trimester- 1 week
how do you determine gestational age using US
CRL
what additional nutrional requirements do pregnant women have
"only about 300-500 kcals more a day
what physical activities should be avoided during pregnancy
scuba diving, anything with lots of weight shifting (aerobics, change in center of gravity creates fall risk)
Prenatal labs
Pap, Gonorrhea, chlamydia, pelvic shape, Type (Rh), cbc, rubella, vdrl/rpr, hepatitis B, HIV, sickle cell, urine CS
1st trimester sequential screen
"11-14 weeks
Nuchal Translucency
"on saggital section US, the area behind the neck, fetus must be in neutral positioning
2nd trimester quad screen
risk for down, edwards, NT defects, AFP, HCG, Estriol and dimeric inhibin A
what does an abnormal AFP mean
"twins? then shes fine
labs showing neural tube defects
only AFP elevated
labs showing down syndrome
"dec AFP
Labs showing trisomy 18
"dec AFP
when is the best time to look at fetal anatomy via US
18-22 weeks
what defines IUGR
below 10th percentile in fetal weight
Fundal Height vs Gestational time
1 cm per week after 20 (umbilicus)
good fetal heart tones
"110-160 with accelerations
At what point does Rh factor start to become important
24-28 weeeks
when do you give a Rh- mother rhogam
24-28 weeks
When does the mom get a second dose of rhogam
postpartum if the baby is Rh+
Tests at Week 36
"Repeat all previous labs
What should labor be like in order to go to the hospital
1 every five minutes lasting about a minute each
Amniocentesis
"done at 16 weeks or neer term
Chorionic Villous Sampling
Done if discrepancy between size and gestational age, sign of placental insuffiency. deliver baby and keep in NICU
Method for kick counts
"lie on side for one hr. need 4+ kicks
Non Stress test
Should have 2 accelerations in FHR in 20 min period
What counts as an acceleration
"if 32+ weeks: 15 beats faster for 15 sec period
AFI
"amniotic fluid index
How does AFI factor into deciding whether to keep mother pregnant
if AFI is in range, can stay pregnant, if low and past or near due date should induce labor
Biophysical Profile
"if have non reative NST
when can you discharge post partum
"everything stable= 24-48 hrs
how long do post partum blues last
"2 weeks
Imitators of gyn pelvic pain
"intestine
Posture in pelvic pain
"anterior pelvic tilt
Normal N/V of pregnancy starts
"1st trimester
Definition of hyperemesis gravidarum
"persistant vomiting not related to other causes
What sx will HG NOT have
"Abd Pain
DDx for HG
"GI issue (almost any)
Hormone theories on HG
"hCG rises and falls along with N/V so possible link
Tx for N/V in pregnancy
"Multivitamin
Aging of the female reproductive tract
"starts at birth
Average age of natural menopause
"51
What defines a menopausal woman
12 consectutive mo of amenorrhea
How can menopause be induced
"surgical
what is early menopause
under 40, premature ovarian insufficiency
What can cause premature ovarian insufficiency
"idiopathic
how to dx premature ovarian insufficiency
age, 2 serial FSH levels a month apart are above 40 mIU/mL
What is perimenopause
3 years before FMP and 1 year after
sx of perimenopause
Vasomotor and vulvovaginal
Vasomotor sx of menopause
hot flashes night sweats
What is the cause of hot flashes
unknown
what are the vulvovaginal sx of menopause
"vaginal dryness
how do you tx mild VMS of menopause
"lifestyle mods
when should HT be started
"as close to actual menopause as possible
what is the difference between SGA and IUGR
"SGA is BIRTH weight under 10th percentile
Etiology of IUGR
"anything that disrupts flow of blood from mom to placenta to baby
Maternal causes of IUGR
anything that clamps down on vasculature
placental causes of IUGR
"1ary mosaicism
Fetal causes of IUGR
"inadequate or altered substrates
how does head/abd ratio change
head is larger than abd up til week 34, then should be 1, after that abd gets bigger
Management of IUGR
"lifestyle mods, diet, drugs, heparin
what do myometrial cysts imply
diffuse adenomyosis
endometrial CA on MRI
thick endometrial stripe
why does fetal heart rate slow down after 6-8 weeks
nervous system is forming an parasympathetics start regulating the heart rate
what is variable deceleration
"look like W and are a result of barometric receptors, increase in rate increase in pressure, slows down as reaction then goes back up w a slight overshoot
when are variable decels bad
last longer than 2 min and less than 10, keep your eye on it and maybe take resusitative measures
Early deceleration
nadir matches with contraction peak, usually head compression (vagal stime) and is benign
late decel
"concerning, onset to nadir is 30 sec with gradual return to baseline, occurs after contraction
variability
"a good thing, want a very jagged strip, shows baby is making adjustments in rate
when does cognition change during menstrual cycle
late luteal phase
progress of baby blues
5 days and tapering off over 2 weeks
the 3 parts of preconception care
protection, managing conditions, and avoiding exposures
how long should a woman wait between pregnancies
18-59 months
definition of infertility
"under 35 failure to concieve after a year
most common female factor in infertility
ovulatory dysfunction
Initial testing for infertility
"ovulation eval
menstrual cycle and infertility tests
"day 3- FSH test
indications for IVF
"tubal disease
after fertilization how long before you implant the eggs
3-5 days
benign breast masses
"cysts
what do cysts look like on US
Clear (fluid filled) single density well circumscribed
fibroadenoma
must be biopsied, well circumscribed and not fixed, clear with accoustic shadow
BI RADS system
"0- inconclusive
when is preterm birth
"20-37 weeks
PROM
"premature rupture of membrane
gold standard for endometrial cancer testing
DnC hysteroscopy or endometrial biopsy
Work up for endometrial cancer
biopsy, hysteroscopy, transvag US
tx for endometrial cancer
Surgery surgery surgery
T score
Bone dense compared to 35 yo
z score
bone density compared to same age
where is bone density measured
hips and spine
antiresorption meds for osteoporosis
bisphosphonates, SERM
Bone formation stimulant
teripartide
placenta invades deep
accreta
placenta goes into muscle
increta
placenta goes thru the uterus
percreta
what is the origin of innervation for the pelvic floor
anterior horn of the spinal cord called the onus nucleus
T11- L1
"sympathetics to kidneys
T10- L1
Upper ureter
L1-L2
Lower portion of ureter
Innervation to the reproductive tract
"Sensory T12-S3
3 steps in BLT
"Disengage- put in position of injury
Turner Syndrome
"45x
ovarian torsion
"pedunculated ovaries
follicular cysts
"unruptured graafian follicles
Luteal cysts
"physiologic
Stein Leventhal Syndrome
Polycystic Ovary Disease
PCOD
"multiple cysts
Pt with anovulation, obesity, hirsutism
PCOD
2nd sx of PCOD
inc LH, inc Est, inc androgen, masculinization
Stromal hyperthecosis
"postmenopause
Most common type of ovarian tumors
surface epithelial
what age group are malignant ovarian tumors more common in
40-65
Risk factors for ovarian cancer
"nulliparity
Most common ovarian tumor
"serous surface epithelial tumor
what is a borderline tumor
technically malignant, but hasnt invaded yet
besides Ovarian cancer what can elevate CA125 levels
any peritoneal irritation
Papillary formations filled with clear straw colored fluid
serous ovarian tumor
Most common malignant ovarian tumor
serous adenocarcinoma
mucinous ovarian tumor
"cystic, bilateral, middle adults, mostly benign or borderline
Endometrioid tumor of the ovary
"good prognosis
Clear cell carcinoma of the ovary
"premenopausal- 40-50
hobnail cytoplasm
clear cell carcinoma of the ovary
cystadenofibroma
"cyst, glandular, and fibrotic component
Coffee bean like nuclei
brenner tumor
Brenner tumor
"cells look like transitional cells
Acute Mastitis
"only associated with lactation
Duct ectasia
"older F, lots of pregnancy
Granulomatous Mastitis
"rare, dx of exclusion
Benign non proliferative dz
"Fibrocystic
Fibrocystic Change
"25-45 whites
Nonproliferative vs proliferative fibrocystic change
"Nonprolif- apocrine snouting, single layer
school of fish appearence of epithelial cells
Florid duct hyperplasia
Looks like a glomerulus
florid duct hyperplasia
atypical duct hyperplasia
"lose streaming appearance
DCIS
Precursor to breast cancer
Roman bridges
DCIS
How do you tell when DCIS has progressed to ductal carcinoma
loses myoepithelial layer
Atypical lobular hyperplasia
"raises cancer risk
Intraductal Papilloma
"bloody nipple discharge
Lactating adenoma
"reprod age
Stromal tumor
"found in preggers (gets bigger)
who do you test for BRCA
"ashkenazis
most common location for breast cancer
upper lateral quadrant
most common invasive breast cancer
Ductal Carcinoma
puckering of breast tissue
Ductal Carcinoma
Appearence of ductal carcinoma in pleural fluid
"cannonball, Ecadherin makes them stick together
LCIS
does not have ecadherin and has bridging lesions
Lobar Carcinoma
"high rate of bilateral
Tubular Carcinoma
"well differentiated
Mucinous carcinoma
"well circum
medullary carcinoma
"very common
Invasive papillary carcinoma
"papillary projections
Inflammatory Breast cancer
"peau de orange
Paget's disease
"inflammatory appearence
malignant phylloides tumor
"very aggressive
angiosarcoma of the breast
post radiation for breast cancer
Breast cancers with favorable prognosis
"tubular
Breast cancers with poor prognosis
"signet ring
Distinguish DCIS from atypical ductal hyperplasia
DCIS has necrosis
Mature teratoma
"most common teratoma
monodermal teratoma
one predominant tissue type, can have sx related to that tissue
struma ovarrii
thyroid tissue, might have hyperthyroidism
immature teratoma
"seen in young population
dysgerminoma
"bulky soft fleshy yellow
endodermal sinus tumor
"aka yolk sac
choriocarcinoma
placental origin, aggressive to LLB,
granulosa theca tumor
"postmenapause
Call exner bodies
"neoplastic cells producing gland like structure
Paraneoplastic effects of granulosa theca cell tumors
produce lots of estrogen, inhibin
Fibroma-Thecoma
"unilateral solid mass, hard, grey white, has intact serosa
Meige Syndrome
"Ascites, Hydrothorax, Rt sided pleural effusion, increased abd girth
Sertoli-Leydig Cell tumor
"20-30s
Krukenberg Tumor
"most common met to ovary
How does blood volume increase in pregnancy
chorionic blahblahblah stims renin, renin stims angio1->angio2->aldosterone increase Na... increase
how does BP stay the same as CO rises to compensate for decrease hct
SVR drops because blood is shunted to the placenta and baby, a low resistance system
why does bp rise towards the end of pregnancy
baby and placenta begin to have resistance to be ready for birth
trend of CO during pregnancy
increases all the way
trend for BP during preg
lowers then rises
3 catagories for all troublesome heart conditions during pregnancy
"Left ventricular function
How can you quickly test a pts left heart function
PMI, should be the size of a finger pad
Sound of the heart with stenosis
no S2
Real heart problems during preg
"aortic stenosis
Drugs to manage heart in preg
"NONE
definition of preeclampsia
"HTN after 20 weeks
Severe preeclampsia
"5 grams on 24 hr urine
HELLP syndrome
"hemolysis
higher incidence of preeclamp in
"twins
widely used tx for preeclamp
mag so4
what diuretic used in preeclamp
"nooooone dont do it
best drug for preeclamp
"labetolol... only if you really really need it tho