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69 Cards in this Set

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42 long standing DM and complains of small amount of constant dribbling of urine loss with coughing or lifting, Single best therapy?
neurogenic bladder leading to overflow incontinence. Tx intermittent self catheterization. Also seen in MS and spinal cord injuries
39 feels as though she needs to void but cannot make it to the restroom in time.
Urge incontinence Tx behavioral frequent voiding 1-2 hrs anticholinergic Oxybutynin
35 4 vaginal deliveries, urinary loss with coughing or sneezing. Denies dysuria or urge to void
Stress Incontinence, Tx urethroplexy
55 constant wetness from vagina following histerectomy
fistula, surgical repair.
differentiate urge from stress incontinence
cystometric or urodynamic evaluation
approach to health maintenance questions
1) cancer screenings 2) immunizations 3) addressing common disease in this group
Screeing
Cancer in women
3 yrs after sex or >21 Cervica until 70 and >50 Colon and Breast
Immunizations
Tetanus and Hep B,
>6 mths annual influenza
>60 Zoster
>65 pneumococcal
other diseases
>45 Cholesteral every 5 yrs
and Fasting blood sugar every 3 yrs


>50 TSH every 5 yrs
>65 Bone Mineral Density
Most common cause of mortality
>13 MVA, mal neoplasia
>19 Malignant neoplasia, accident
>40 Cancer, Cardiovacular
>65 Heart Dz, Cancer, Stroke
20 yr old sexual intercoars 3 yrs ago
Pap smear
46, pap smear last yr
Fasting blood sugar, and cholesterol
59, mild osteoarthritis
Pap smear, Colon Ca Screening, Breast Ca, Cholesteral, Fasting BS, bone density scan
71 yr old
DO EVERTHING
31 G4P3 uneventful vaginal delivery, slight lengthening of the cord, along with a gush of blood per vagina. As placenta is being delivered, a shaggy, reddish, buldging mass is noted at the introitus around the placenta. Diagnosis, Complication?
Uterine Inversion, post partum hemorrhage (shaggy around the placent is endometrial surface) Tx Manually replace the uterus, if shock tx the hypovolemic shock.
Placental implantations would most likely predispose to an inverted uterus?
Fundal
Next step after a 20 min 3rd stage of labor?
attempt manual extraction of placenta.
risk factor for uterine inversion
Atonic Uterus
physician attempts to replace the utereus but the cervis is tightly contracted? Best therapy for the px?
Halothane anesthesia, relaxes the uterus, best initial therapy
premature ovarian failure
<40 years old younger than 30 look for autoimmune or karyotypic abnormalities
49 irregular menses, feeling of inadequacy, sleeplessness, episodes of warmth and sweating. MLD? NSD?
Climacteric (premenopausal state) ~51, NSD: FSH and LH levels (dec inhibin inc FSH dec Estradiol)
Perimenopausal associated dz
Hypothyroid, DM, HTN, Breast Cancer, Depression
51 oligomenorrhrrhea and hot flashes, mechanism?
Ovarian Failure
22 nonpregnant with galactorrhea and hyperpolactinemia
Hypothalamic Dysfunction
25 slightly obese, hirsute, long history of irregular menses , mechanism?
Estrogen Excess, progestins will induce vaginal bleeding
18 infantile breast development has not started her menses. Webbed neck, mechanism?
Ovarian Failure
19 nonpregnant marathon runner with amenorrhea
hypothalamic Dysfunction
33 not started her menses since vaginal delivery 1 yr previously complicated postpartum hemorrhage, she is unable to breast feed, mechanism?
pituitary dysfunction
cornerstone in osteoporosis prevention
weight bearing exercise, calcium and vit D
28 102', myalgias, hypotension, confusion, sunburn like rash, hemoconcentration and renal insufficiency Dx NST
TSS toxic shock syndrome,NST Isotonic IV fluids, nafcillin, monitor urine and blood pressure, support blood pressure with dopamine if needed.
minimal mean arterial bp for brain profussion
65, which is where you must maintain this persons bp MAP = 2xSBP+DBP / 3
Cornerstone for septic shock
support blood pressure, remove nidus of infection, antibiotic therapy monitor perfusion and organ function
Clinical approach to labor
assessment based on cervical changes versus time, abnormal labor 3 P's Power, Passenger, Pelvis
adecuate uterine contractions
2-3 min lasting 40-60 sec
in general labor
Latent <4 cm and active > 4 cm
Latent Phase <4
Null <20hrs Multi <14hrs
Active Phase >4
Null >1.2 cm/hr Mulit >1.5cm/hr
Second Stage >10cm
Null <3hrs Multi<2hrs
Third Stage
<20min
31G2P1 39 weeks complains of painful uterine contractions that are occuring every 3-4 min. Her cervix has changed only from 1cm to 2 cm dilation over 3 hrs. NSM?
Observe, Normal Latent Phase up to 14 hrs
26 G2P1 41 weeks pushing for 3 hrs without progress completely dilated, effaced and 0 station with the head in the occiput posterior position.
3 hrs 2nd stage. Arrest of Decent, Anthropoid Pelvis (ant post diameter greater than transverse diameter with prominent ischial spines and narrow anterior segment)
31 G2P1 40 weeks, 5 to 6cm dilation over 2 hrs.
protracted active phase (some progress but less than expected)
24 G2P1 39 weeks, painful uterine contractions. Complains of dark, vaginal blood mixed with mucus. What is this?
Bloody Show, loss of cervical mucus plug
18 G1P0 7 weeks gestation by LMP. 2 days spotting and lower abd pain. Denies sexually transmitted dz. Pelvic exam 4 week size, hCG 700. Transvag reveals empty uterus. NSM?
follow up hCG 48 hrs, considered ectopic until proven otherwise.
1-trans vag no good hCG<1500.
If hCG rises >66% normal intrauterine preg.
<66% most likely ectopic.
<3.5 cm ectopic pregnancy tx methotrexate finally RhoGAM
Risk factore for Ectopic Preg?
Chlamydial Infections
32 diagnosed with ectopic pregnancy based on hCG levels that plateaued 1400 and no chorionic filli found on uterine curettage. 5 days later complains of lower abdominal pain. BP and HR normal, abdomen shows guarding and rebound. b
immediate laparotomy
18 ER vaginal spotting and lower abdominal pain. Abd and pelvic exam are normal, hCG is 700 and transvag US shows no intrauterine gest sac and no adnexal masses. Diagnosis
Insufficient information to draw a conclusion
22 pregnant at 5 weeks severe lower abdominal pain. BP 86/44 and HR 120, tender abdomen, guarding. HCG 500 transvag shows nothing. Free fluid in the cul de sac. NSM?
Surgery, most likely a ruptured ectopic pregnancy
placenta accreta, increta and percreta
attached to myometrium, Incretta- IN the myometrium and Percreta Penetrate Past the myometrium.
risk factors for placenta accreta
Down's, Placenta Previa, uterine scars or curettage, low placenta.
22 nulliparous vaginal discharge and postcoital spotting NSM
rull out ectopic pregnancy or threatened abortion, do a pregnancy test.
18 yellowish vaginal discharge. Cervix is erythematous and dicharge reveals numerous leukocytes. Etiology?”
Chlamydial cervicitis mcc of mucopurulent cervical discharge
34 vaginitis “fishy odor”. Cervix is normal in apperance. Etiology?
bacterial vaginosis, gardnerella
21 sexually transmitted pharyngitis, Etiology?
Gonococcal Pharyngitis, dx swabbing the throat
28 multiple painful pustules erupting throughout the skin of her body. Etiology?
disseminated gonococcal infection, gram stain and culture from pustule
Maternal cervical infection that causes blindness?
Both Chlamydia and Gono can cause conjunctivitis and blindness.
abortion
<20 weeks
threatened abortion
closed cervix, no passage of tissue
inevitable abortion
open cervix, no passage of tissue
incomplete abortion
open cervix, partial passage of tissue
competed abortion
closed cervix, passage of all tissue
missed abortion
closed cervix, no passage of tissue, no symptoms, diagnosed on ultrasound D&C or expectant management.
19 G1P0 18 weeks, prior cervical conization, felt no abdominal cramping. Dilation of 3 cm and effacement of 90%
Incompetent Cervix
33 10 weeks gestation, vaginal bleeding, passage of whitish substance along with something meat like. Continues to have cramping. Cervix is 2 cm dialated.
incomplete abortion, still cramping
20 G2P1 12 weeks gestation, no problems with pregnancy. No fetal heart tones on Doppler, US reveals embryo 10 weeks, no fetal cardiac activity.
missed abortion
28 G3P2 22 weeks getstation, vaginal spotting, fetal heart tones in 140-145.
antepartum bleeding, >20 weeks
Hysterectomy, 2 days later compains of flank pain. Right costovertebral angle tenderness. NSM
IVP or CT, right ureteral obstruction or injury. Cardinal ligament injury is common in hysterectomy.
Risk factor for endometrial cancer
DM, HTN, Family, early menarche, late menopause, obesity, chronic anovulation, estrogen secretting tumor, unopposed estrogen