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295 Cards in this Set
- Front
- Back
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Hyperplasia without atypia - should have high or low threshold for hysterectomy?
how to tx? |
high - they respond v. well to cyclic progestins! - be sure to repeat bx in 3-6 months
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Pruritis, inflammation, and elevation of vaginal d/c pH - dx?
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trichomonas - NOT BACTERIAL VAGINOSIS/GARDNERELLA!!!
no discomfort with BV |
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primary amenorrhea, bilar ing masses, breast devo but no pubic hair or axillary hair in a female - dx?
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androgen insensitivity syndrome - they need gonadectomy so they don't get cancer and estrogen aroudn teh time of puberty
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Two things that stimulate prolactin
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TRH and serotonin
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Pregnancy luteoma - what is it?
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HCG makes luteal stromal cells replace the normal ovarian parenchyma so they get ovarian masses. More common in AAs. Sx similar to PCOS (virilization, hirsutism).
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what hormone develops breasts?
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estrogen
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primary amenorrhea in a pt with no sex characteristics - first test to order?
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fsh to tell if it is central (hypothal/pit) or gonadal
if high - periph lesion so get a karyotype if low - central lesion so get gnrh stim test |
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work-up of low grade squamous intraepith lesions ( which is mild dysplasia or CIN 1)
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adolescents - repeat pap in 12 months (takes a while to develop anyway)
premenopausal - colposcopy and then biopsy (because they are a hgih risk group) postmenopausal - hpv testing and if positive, colposcopy |
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Tx of vaginal squamous cell ca
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steage 1-2 - localized and <2cm - remove surgically
stage 1-2 - localized and <2cm - radiation over 4cm or extensive - combination chemo |
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ovarian masses that do not produce estrogen or androgens
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dysgerminoma, mature teratoma, serous cystadenoma
NOT GRANULOSA CELL TUMORS! |
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role of alcohol and risk of osteoporosis
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a very serious one - and it is dose dependent
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pt has suspected ___ towards end of pregnancy, don't do vaginal exam!
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placenta previa
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Cause of early decelerations
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fetal head compression leading to a vagal response
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cause of variable decelerations during labor
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umbilical cord compression
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parameters of biophysical profile
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nonstress test (reactive)
fetal tone (flexion or ext of an extrem) fetal movements (at least 2 in 30min) fetal breathing (at elast 20 seconds in 30 minutes) amniotic fluid volume (single pocket >2cm in vertical axis) |
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when to deliver based on biophysical profile
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decreased amniotic fluid - consider it
<=6 and >37wks - if <37 repeat BPP in 24 hours and deliver if not improved <=4 and >26 wks - deliver |
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Kallmann's syndrome - what is it? associated with...?
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congen absence of GnRH secretion
assoc with anosmia |
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mullerian duct leads to devo of...
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proximal vagina and uterus
so blind pouch without it |
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pt has female phenotype but then virilization at puberty - dx?
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5-alpha-reductase deficiency - XY genotype
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pink smooth teardrop lesions on vulva that go away with trichloroacetic acid or podophyllin - dx?
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HPV warts (condyloma acuminata)
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what do clue cells look like in bacterialvaginosis (gardnerella)
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epithelial cells coated with bacteria
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metro safe to use during preg?
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yes
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azithromycin or erthromycin - which safe to use in pregnancy?
AE of erythro? |
azith
eryth can cause acute cholestatic hepatitis |
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post-term pregnancy - definition and what to watch for?
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>42 weeks
watch for oligohydramnios |
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name of plan b? how long out can you give it?
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levonorgestrel
120 hours |
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main organ issue in pts with turner's syndrome
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ovarian dysgenesis
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Tx of candida vaginitis
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fluconazole
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Definition of mild vs. severe preeclampsia
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Mild - proteinuria >0.3g/24h
BP>140/90 Severe - HTN>160/110; >5g/24h, or organ dysfunc |
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Chronic HTN in pregnancy - what is it?
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HTN not due to pregnancy, so before 20th week or present before preggo - if get proteinuria with it, it's called chronic HTN with superimposed preeclampsia
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Tamoxifen - agonist/antag where?
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agonist - endometrium, osteoclasts (so less osteopor risk)
antag - breast no known effect with ovaries |
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when is ionizing radiation most harmful to a fetus?
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8-15 weeks
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hormone malfunc in anorexics
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low gnrh and lh, so low estrogen states
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who is most at risk for fetal limb defect when getting chorionic villus sampling
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babies <9-10weeks gestation - so you typically do it btwn 10-12 weeks
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how to assess infertility due to aging -
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early follicular phase FSH level, clomiphene challenge test or inhibin B level
(inhibin inhibits FSH) |
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Chancroid - what is the bug, what does the lesion look/feel like
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ulcer that is deep and purulent and painful lymphadenopathy
caused by haemophilis ducreyi |
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adenopathy with granuloma inguinale?
pain? |
no - painless too
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First step if you suspect fetal compromise?
Fetal demise? |
compromise - NST
demise - ultrasound |
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pt has lichen sclerosis - next step?
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punch bx to make sure there is no SCC
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When to give GBS ppx
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if test positive 2-3 weeks before delivery, had baby with gbs in past, or tested positive in the past
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role of human placental lactogen - other name for it?
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maternal lipolysis and insulin resistance so the baby gets more glucose
chorionic somatomammotropin |
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what causes variable decels
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fetal cord compression
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dysmennorhia, heavy menses, large uterus - dx?
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fibroid uterus
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fsh and lh - low or high with klinefelter's?
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high
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Primary dysmenorrhea - signs/sx, cause, and tx?
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s/s - lower abd pain rad to thighs and back during menstruation
cause - increase prostaglandins during breakdown of endometrium tx - nsaids |
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fixed retroverted uterus should make you think of...
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endometriosus
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is endometriosus a risk factor for infertility?
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yes
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Baby sequalae of maternal diabetes
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polycythemia (due to increase BMR and resultant epo)
macrosomia, hypocalcemia (PTH suppression), hypogly, resp diff, cardiomyopathy, CHF |
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why do we worry about asymp bacteruria in preggo pt?
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can get pyelonephritis --> septicemia, preterm labor and low birth weight babies
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normal 1 hour GTT (50g)
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<140
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in general, baby is going to die, mother is preterm, do a c section or vaginal deliv?
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vaginal
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corpus luteum secretes...
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progesterone, and it is maintained by hcg
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role of progesterone during preg
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inhibit uterine contractions
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hormone that induces prolactin during pregnancy
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estrogen - actually - wait - this might be wrong...
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urinary urgency/freq and chronic pelvic pain - also dysparunia - negative UA - consider which dx?
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chronic interstitial cystitis
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signs of ovulation -
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breast tenderness, midcycle pelvic pain (Mittelschmertz)
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serum inhibin b levels used for...
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determining ovulatory reserve
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Treatment of infertility in pt with PCOS
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metformin and clomiphene
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DES causes...
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clear cell adenocarcinoma of vagina and cervix in the children
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steroids to mature lungs - no benefit after...
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34 weeks
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can ERT help with urine incontinence?
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yes
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when to do uterine artery embolization
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PP hemorrhage but not excessive bleeding and pt wants to maintain fertility (contrast to hysterectomy)
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RFs for uterine atony
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distention of uterus intrapartum or prolonged labor
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oxybutynin - used for which incontinence?
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urge - anticholinergic
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urethopexy - used for what incontinence?
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stress - supports urethra
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w/u of infertility
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1.) check male
2.) assess for ovulation 3.) hysterosalpingogram |
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Pseudocyesis
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conversion disorder - mimics pregnancy in a pt who really wants to become pregnant
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when to screen for gestational DM
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hx of DM - first prenatal visit
all others - btwn 24 and 28 weeks |
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initial screening test for gestational DM
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1 hour 50g glucose tolerance (if >140 - do 3 hours GTT or 2 hour 75g)
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criteria for 3 hour glucose tolerance test
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2 or more are elevated:
fasting >95 1 hour >180 2 hour > 155 2 hour > 140 |
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US - useful to dx placenta previa or abruption?
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previa
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septic abortion - gentle or vigorous curettage?
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gentle - don't want to perforate it.
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next steps of action when BPP is...
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<4 - deliver
4 without oligohydramnios and fetal lungs are not mature - steroids and repeat BPP in 24h 6 without oligohydramnios - contraction stress test oligohydramnios present - deliver |
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woman comes in with PROM at <37 weeks - what to do?
what is <32 weeks |
GBS ppx and let her deliver
if before 32 - give tocolytic and let lungs mature |
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most preventable cause of fetal growth restriction
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smoking
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Tons of N/V in a pt at about 10 weeks gestation - consider what dx?
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gestational trophoblastic dz
NB - will see elevated liver enzymes and amylase and lipase with hyperemesis gravidarum |
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spinal anesthesia - can slow labor if given in the ____ stage
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latent (before cervix is 3-4cm dilated)
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If Rh antibody titers are ___, need Rhogam
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<1:6 (numbers less than 6) - this means the Mom is not sensitized.
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PCOS - LH is high or low?
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high
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What week can you confidently say fetal lungs are mature?
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34
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when to do penicillin desensitization?
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pregnant pt has syphilis - erythromycin won't cross the placenta and help the baby
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role of thyroid hormones and prolactin?
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TRH stimulates prolactin
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tx of variable decels
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due to umb cord compression, so start O2 and change mom's position. if no help, amnioinfusion
if persists below 70bpm for a while, worry abt fetal hypoxia |
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When to try to convert breech to vertex?
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at 37th week - do external cephalic version
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when to give mag sulfate in pt with mild preeclampsia?
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during labor and within 24h of delivery
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When to do C section in a pt with placental abruption
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when there is another indication or fetus or mom is rapidly deteriorating
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some main contraindications to vaginal delivery
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placenta previa, dystocia, breech, prior c/s (for the most part), uterine rupture
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What does ERT do to thyroid hormones?
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more hepatic metabolism of them, more TBG, more volume of distrib of thyroid hormones
so you need to give more L-thyroxine in a ERT pt, just like in pregnancy |
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Raloxifene - what it does, contraindications?
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used to prev osteopor bc it increases bone mineral density. decreases risk of breast CA
it is thrombophilic - contraind with DVT breast and endometrial antagonist, bone agonist |
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tamoxifen increases risk of...
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endometrial CA
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w/u of amenorrhea in premenopausal pt
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1. preg test
2. prolactin and thyroid 3. estrogen status via progestin challenge |
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Asherman's syndrome
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after procedures, lots of scarring and the endometrium fails to respond to estrogen, infertility, etc
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How PCOS affects HPA axis
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abnormal gnrh secretion so lots of lh (which stimulates androgens) and not much FSH
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mucus during ovulation
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abundant, thin, stretches, ferns on microscopic slide
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normal amniotic fluid index
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5-25
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when to do internal podalic version
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twins - to convert the second baby from transverse or oblique to breech
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OCPs in postpartum pt?
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Don't use combined bc the estrogen can affect breast milk production
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Pt has placenta previa and is stable - next course of action?
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SCHEDULED c section with autologous blood available and close monitoring - but don't send them home
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Vagismus what is it and tx?
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very tight perineal muscles - can't have intercourse
tx - kegels, pelvic relaxation, inserting dilators or fingers |
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what causes symmetric vs. asymmetric fetal growth restriction?
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symm - congenital or chromosomal abnormalities or TORCH infections - things before week 28
asymm - HTN, toxins, smoking, etc. shunts blood to important organs (e.g. head) |
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pH of amniotic fluid
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7 - 7.5
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pH of vagina
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3.8 - 4.5
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4 test results in aneuploidy
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estriol - down
inhibin a - up hcg - up AFP - down ***up top HI five*** |
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MCC increased AFP
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inaccurate dates
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in addition to AFP, what else is elevated with neural tube defects?
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acetylcholinesterase
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what to do with pregnant mom who has HIV
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zidovudine to mom during preg and to neonate after birth
do an elective c section |
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do OCPs cause weight gain?
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no
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most reliable measurement on US of fetal weight
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abdominal circ - affected by symm and asymm fetal growth restriction
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autoimmunity or immunodef associated with premature ovarian failure?
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autoimmunity
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placenta accreta - what is it? who is at risk? what surgery might they need?
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placenta abnormally implants too far in uterine wall - common in pts who had c section in the past - they often need hysterectomy to stop the bleeding
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uWISE - 18 y.o. with ASCUS and concerning hx - next step?
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hpv typing - if highly oncogenic, get colpo
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Findings in trichomoniasis
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erythematous cervix, yellow d/c
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cadidiasis in vagina - color of d/c?
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white and cottage cheese
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Justice - ?
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treat all cases alike
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Contraception options with <1% failure rate
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dop provera, iud, sterilization, implanon
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which immun contraind in pregnancy
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mmr, vz
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when start screening for breast ca
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never earlier than 40
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does RR change during preg?
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NO!!!! but tidal volume does
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plasma osmolality is increased or decreased in preg?
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decreased
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issue with using terbutaline (beta 2 agonist) or alpha agonist to stop uterine contractions?
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increased risk of pulmonary edema
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next step after diagnosing gestational trophoblastic disease
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CXR (lungs are the most common site of metastases)
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Congen dzs Jewish are more likely to have
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Fanconi anemia, Tay-Sach's, Niemann-Pick, CF
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serum marker that distinguishes quad screen from triple
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inhibin a
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pt has gestational DM - tx?
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try diet modificationbefore insulin
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is IUGR associated with gestational DM?
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no, but it is with pre-existing DM
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valproic acid - main AE to think about...
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neural tube defects
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obese woman - how much wt to gain in preg?
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11-20 pounds
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if you place an intrauterina pressure catheter and you get blood - next step?
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assume you perforated the uterus. check the baby's status - if ok, you can put in the monitor
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with use of mg sulfate in mother, what do you worry abt in child?
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respiratory distress after birth
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MCC post-partum fever
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endometritis - espec after a c section
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Time frame for PP blues
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2 weeks - if greater, it may be PP depression
also with PP depression, pt may not care abt the newborn |
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is cmplicated labor and deliv a RF for PP depression
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no
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mother is brestfeeding a baby and she develops very sensitive nipples with feeding, burning pain in breasts. tips of nips are pink and shiny and are peeling at the periph - dx?
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candidiasis - inspect baby's oral cavity.
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pt is hemodynamically unstable and has an abortion - how to get rid of fetus?
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d&c - can only do misoprostol or expectant waiting if hemodyn stable
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when to place cervical cerclage?
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14 weeks
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can you give metro during preg?
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yes
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ot with pulm htn - good prognosis during preg?
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no - very dangerous - 25-50% mortality
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pregnant woman has intermitt chest pain, palpitations; normal ekg - tx?
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beta blockers for her MV prolapse
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can get cxr in preg pt?
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yes
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how to relieve ureteral obstruction in pregnant pt
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double j ureteral stent
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how to tx severe lupus in pregnancy?
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steroids
if mild, nsaids |
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which ssri contraind in pregnancy?
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paroxetine
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Tx of pruritis gravidarum (variant of intrahepatic cholestasis of pregnancy)
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1.) antihistamines
2.) ursodeoxycholic acid |
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how to workup appendicitis in a pregnant pt
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graded compression ultrasound
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hypermagnesemia - common side effect
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resp depression
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pt has severe pre-eclampsia - platelet level < ___ makes you need to dewliver now?
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100k
also deliver if oliguria, harm to fetus, can't control bp with two meds, lfts > 2x normal |
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goal diastolic bp in a pt with severe preeclamp
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90-100
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Test to determine whether there is fetal anemia
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middle cerebral artery peak systolic velocity
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Baby is affected by Rh disease and is getting poor hepatic protein production - what will you see on US?
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fetal hydrops - fluid in body cavities
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delta OD450 measurement of amniotic fluid sample - what does it test for?
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bilirubin - looking for hemolysis
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what to do if baby is having severe hemolytic anemia but at 30 weeks
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intraperitoneal transfusion into umb vein until mature
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are congenital anomalies more common in twins?
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yes
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what kind of twins can get twin-twin transfusion syndrome?
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monochorionic, monozygotic
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biggest issue with multiple gestations
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preterm birth
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things you can use to dilate a cervix before giving oxytocin
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misoprostol or PGE2
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things associated with breech presentation
which kind of hydramnios? |
prematurity, multiple pregs, genetic disorders, polyhydramnios, hydrocephaly, anencephaly, previa, uterine fibroids
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what is a prolonged latent phase?
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before 4cm dilated - >20h if nulliparous and >14 ifmultiparous
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what is prolonged active phase?
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after 4cm dilated and no change in over 2h - tx with amniotomy
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t/f? the more c sections in the past, the higher risk during vbac
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true
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risk factors for placenta accreta
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low, anterior placenta and previous c sections
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can bloody show/mucus plug cause bleeding for a while?
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yes - e.g. 30 min
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threatened abortion - can have it in 2nd or 3rd trimester?
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no - only first
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definition of preterm labor
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regular uterine contractions LEADING TO CERVICAL CHANGE!!!
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terbutaline and ritodrine - class of drug and purpose?
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beta2 agonist - stop premature contractions
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mg sulfate - contraind with what condition?
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myasthenia gravis
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side effects of mg sulfate
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LOSS OF DEEP TENDON REFLEXES, resp depression, cardiac depression - things are less active
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benefits of betamethasone for the baby
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lung maturity, less incidence of intracerebral hemorrhage and necrotizing enterocolitis in the newborn.
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best part of fetal fibronectin test -
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great negative predictive value - if negative, the mom will almost definitely not deliver in the next 14 days.
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cutoff for when you can give indomethacin
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only before 32 weeks
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biggest risk factor for PROM
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genital tract infections - especially BV
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what can give you 7 days of latency prolongation in a pt who had PROM
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antibiotics
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tender fundus is a sign of...
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chorioamnionitis - probably want to deliver if you see it.
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what does positive phosphatidylglycerol mean?
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fetal lung maturity is there - can assume it is positive at 34 weeks.
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what is better marker in amniotic fluid of infxn - low glucose or presence of leukocytes?
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low glucose
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what to do when you first see late decels and mom seems ok
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move her to left lateral decubitus
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is chorioamnionitis a risk factor for uterine atony?
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yes - so is big uterus,general anes, prolonged labor
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what is an agent that increases uterine contractions but is contraindicated in pts with HTN/preeclampsia
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methylergonovine
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definition of post partum hemorrhage
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>500cc vaginal or 1L c section
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first steps in management of PP hemorrhage
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make sure uterus is firm, no retained placental tissue, look for lacerations
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risk factors for retained placenta
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prior section, fibroids, previous curettage of uterus, and succenturiate lobe of placenta.
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IM - never IV!!!
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how to administer PGF2 or methylergonovine
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which artery can you ligate before you try hysterectomy in a pt with PPH
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hypogastric (internal iliac)
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can breast engorgement cause fever?
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yes
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can you take sertraline during preg?
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no
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does sertraline get in teh breast milk?
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yes - but not in the baby
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when in the cycle does premenstrual dysphoric disorder happen?
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luteal phase - towards the end of it
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things associated with postterm pregnancy
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placental sulfatase deficiency, fetal adrenal hypoplasia, anencephaly
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postterm preg associated with polyhydramnios or oligo?
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oligo
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when to do amnioinfusion?
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not if there is meconium stained fluid, but rather if you see repetitive variable accelerations
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tests to order when baby stops growing (3)
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NST, amniotic fluid volume (bad if it is low), and systolic to diastolic umb artery pressures (bad if it is high - means lots of PVR in the baby)
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is polycythemia associated with IUGR?
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yes
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IUGR is a risk factor for the baby developing...
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CVDisease, chronic htn, copd, diabetes
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is poorly controlled pre-existing DM a risk factor for congenital anomalies?
|
yes - but gestational DM is not.
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boundaries of laceratsions - 1st to 4th
|
1 - vaginal mucosa
2 - vaginal fascia and perineum 3 - rectal partial or complete transection of the rectal sphincter 4 - sphincters and mucosa. |
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definition of macrosomia
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>4kg in diabetic and >4.5kg in non-diabetic
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complications more likely to happentwith vacuum delivery vs. forceps
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cephalohematoma (scalp dislocates off head), jaundice, lateral rectus paralysis.
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when does irreg bleeding end after depo?
|
2-3 months
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female sterilization is associated with reduced risk of...
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ovarian cancer - not sure why
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contraceptive patch - estrogen or progestin?
|
ethinyl estradiol and norelgestromin - so both
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prolonged dilute russel viper venom - what does that mean?
|
antiphospholipid antibody syndrome - tx is asa and heparin
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what has more blood loss - surgical elective termination or medical?
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medical
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when to do d&c vs. d&e
|
<16wks - d&c
16-24 weeks - d and evac |
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how late can you do manual vacuum aspiration
|
<8wks
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lichen sclerosis - signs/sx
|
polygonal ivory papules or figure of 8
vulvar pruritis fissures/erosions itch-scratch-itch cycle introital stenosis |
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lichen planus - signs/sx
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involves more than the vagina
remissions and flares can involve the vaginal canal (contrast to sclerosis) - more than the introitus |
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tx of vulvar vestibulitis
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tricyclic antidepressants, pelvic floor rehab, topic anesthesia
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lichen simplex chronicus
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chronic scratching/rubbing - often pruritis is worse at night
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abx to tx chlamydia? gonorrohea?
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c - azithro or doxy
g - ceftriaxone |
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recurrent genital herpes infxn - more likely hsv1 or 2?
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2
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bladder contracts while filling - what sort of incontinence?
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urge
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pt has urethral sphincteric deficiency - tx options?
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urethral bulking is first, do an artificial sphincter last line.
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colpocleisis - what is it?
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procedure where the vagina is surgically obliterated but you can do it under local. good for vaginal/uterine prolapse
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post menopausal pt has ovarian mass - next step?
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exploratory surgery
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tx ovarian torsion?
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surgery
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tx of infertility caused by endometriosis
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1.) clomiphene +/- IUI
2.) laparoscopy to remove lesions |
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young pt has history concerning of endometriosis - failed nsaids and ocps - next step?
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laparoscopy
don't do gnrh agonist until you confirm the dx of endometriosis |
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clomiphene mech of action
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estrogen antag at pituitary so there is no negative feedback
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what is pelvic congestion?
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chronic pelvic pain due to pelvic varicosities
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mech of action of danazol in treating endometriosis
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testosterone deriv - suppresses lh and fsh mid cycle surges so no estrogen release
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best way to measure prolactin?
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fasting - and touching the breast can elevate the level
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___can increase pain during cyclic mastalgia due to fibrocystic breast changes
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caffeine
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if breast mass has bloody discharge, next step?
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excision biopsy!!!
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abx for mastitis
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1.) dicloxacillin
2.) erythromycin if they are pen allergic |
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if you do FNA of a breast mass and it comes up negative, next step?
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excisional biopsy - FNA often can have false negatives
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what is adrenarche?
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hair growth
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3 things that can delay puberty
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low weight, poor sleep, little sunlight exposure
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what happens if you have partial deletion of the long arm of chrom x?
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premature ovarian failure
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how to tx precocious puberty
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gnrh agonist - only treat if they are pretty far from "normal"
e.g. 8 year old - treat |
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normal age for menarche
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9-17
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tx of congenital adrenal hyperplasia
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steroid replacement
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mullerian agenesis - signs/sx
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absent uterus and cervix, primary amenorrhea, XX karyotype, RENAL ANOMALIES!!!
therefore the test to confirm is a renal ultrasound |
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with anorexia - what happens to levels of gonadotropins
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hpa dysfunction so low fsh and lh
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pt has amenorrhea after stopping ocps - what part of history is important?
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cycles before ocps - she may have post-pill amenorrhea if they were irregular before then.
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does CAH cause hirsutism?
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yes
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high estrogen level withdrawal after preg can lead to what cosmetic issue?
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hair loss
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sertoli-leydig cell tumors - where are they found?
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can be found on an ovary
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what is hyperthecosis?
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a more severe form of PCOS
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long term side effect of leuprolide
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osteoporosis - so don't use it over 6 months
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what is dysfunctional uterine bleeding?
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irreg/increased menstrual bleeding without a clear etiology
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how do OCPs relieve primary dysmenorrhea?
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progestin sheds the endometrium, and that is what makes prostaglandins
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steps in treatment of dysmenorrhea in a yonug pt
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ibuprofen
ocps depo laparoscopy looking for endometriosis or gnrh agonist |
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first line medical tx for adenomyosis
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gonadotropin releasing agents
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can you tx osteoporosis without a dexa scan?
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yes - e.g. had a pathologic fracture
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raloxifene - will it improve hot flashes?
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no - may actually worsen them
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what does HRT do for serum lipids?
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good things - less LDLs, more HDLs
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test of choice to eval for mets after early detection of endometrial ca
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cxr
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AE of imipramine
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hyperprolactinemia
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how can you confirm exercise induced amenorrhea
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check estrogen levels (should be low)
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use of clomiphene challenge test
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to determine ovarian reserve - good if old lady isn't fertile
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deficiencies of what vitamins can increase PMS?
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A, E, B6
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whic is worse, PMS is PMDD?
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pms = premenstrual syndrome
pmdd = premenstrual dysphoric disorder - this one is worse |
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tx of pms
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OCPs (suppresses the HPA axis)
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risk factors for PMS
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vit A, E, b6, calcium or mg deficiency. fam hx. other mood disorders. increasing age
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risk factors for molar pregnancies
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asian, <20 or >40, low folic acid or beta carotene intake
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best test to rule out molar preg
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quant hcg
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treatment of a molar preg
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suction curettage
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describe a partial mlar preg?
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69XXY - fetus is present in there and lower risk of developing post-molar GTD
partial - fetus is there - it's not all molar |
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how quickly can you get pregnant again after a molar preg?
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6 months after hcg reaches 0 - should take ocps in the meantime - you don't want to confuse a new pregnancy with a recurrence of teh molar
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how to treat recurrent trophoblastic disease
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chemotherapy
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should you biopsy a lesions suspicious for metastatic choriocarcinoma?
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no - very vascular. just get quant hcg instead
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vulvar intraepithelial neoplasia is associated with what virus?
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hpv
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what is trichloroacetic acid used for?
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warts (note - not VIN!!!)
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paget's disease of the vulva - what does it look like? any risk factors?
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fiery red background with bague white hyperkeratotic areas
assoc with breast ca |
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how often to do paps in woman with hiv
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twice in the first year - if normal, annual after that
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what is an ectropion
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typically with cervix - area of columnar epithelium that has not yet undergone squamous metaplasia
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what do you do if there is a lesion extending into endocervical canal?
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bx with cold knife cone
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if there is huge difference btwn pap smear results and bx results - next step?
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cervical conization - need to be aggressive
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when is cervical conization indicated?
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cervical bx shows severe dysplasia, CIS, or a positive endocervical curettage
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main sx associated with fibroids
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menorrhagia
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how to tx fibroids symptomatically?
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gnrh agonists can be good bc the fibroid is estrogen responsive - so this is useful in a pt who is going to get surgery soon or will have menopause soon
6 months max can always try nsaids first, too |
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what to do for an infertile pt who has fibroids
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myomectomy
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risk factors for ovarian ca
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family, white, more periods in lifetime
NOT SMOKING!!! |
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do ocps reduce risk of ovarian ca?
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yes
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which is typically bigger - serous cystadenoma or functional cyst?
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serous cystadenoma - pt may have increasing abdominal girth
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serous cystadenoma or mucinous - which tend to be multilocular?
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mucous
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difference btwn stage and grade
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stage - most important for ovarian ca -
grade - histology |
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standard of care - after you resect an ovarian cancer, next step?
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chemotherapy - even if you got all of it
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most common tumor in women of all ages
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dermoid - on ultrasound there will be cystic and solid components
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use of oral progesterone in a postmenopausal pt
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decrease hot flashes
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young girl is on abx and now has linear abrasions on her vulva - dx?
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yeast infection - give antifungals
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course of action when you have an adult rape victim
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offer abx prophylaxis, screen for STDs, offer emergency contraception, colect forensic specimens, preg test
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shockwave lithotripsy - ok in pregnancy?>
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NO!!!
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McCune-Albright syndrome - what is their puberty like?
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early - gonadotropin independent
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test to get ifg you are suspecting gestational trophoblastic disease
|
quant hcg
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|
adequate cervical length?
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>25mm at 24 weeks
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prolacting suppresses ___
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gnrh
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Tx of DUB
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mild - iron
mod with no active bleeding - progestin mod with active bleeding - estrogen severe and unstable - D&C and transfusion |
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mcc DUB
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anovulation - it is a diagnosis of exclusion
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tx of postpartum endometritis
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gent and clinda - polymicrobial
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when in menstrual period should a benign breast lump go aaway?
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after the period is over
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mech of action of epidural causing hypotension
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sympathetic fiber block --> vasodilation --> blood pooling in veins - especially in lower extremities
no cns involvement - all peripheral |
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tx of mag sulfate overdose
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stop the mg sulfate and calcium gluconate
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anesthesia can prolong labor if given in the ____ stage
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latent
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endometritis - more3 common after vaginal deliv or c section?
|
c section
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steps when thinking of arrest of labor
|
membranes ruptured?
give ptocin - adeequate contractions via IUPC? |
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terbutaline and ritodrine contracindicated in pts with...
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diabetes
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