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86 Cards in this Set
- Front
- Back
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estrogen and progesterone therapy in uterine/breast cancers
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progesterone is protective along with estrogen in uterine cancers, but both can increase breast cancers
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azithromycin use in GYN
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chlamydia
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metronidazole use in GYN
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(topical)=bacterial vaginosis or trichomoniasis
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clonidine in post-menopausal women
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relief of hotflashes when hormone replacement not an option. use in low doses
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raloxifene
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selective estrogen modulator (SERM); osteoporosis prevention; can worsen hot flashes
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Tamoxifen and hot flashes
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brings out hot flashes in many patients
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Betamethasone, penicillin, and MgSulf in preterm labor
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stop contraction, allow time for fetal lung maturity, groupB strep prophylaxis
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herpes simplex active during delivary
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C-section
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candidate for emergency contraception
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reproductive age woman with unprotected intercourse within 72 hours of presentation and doesn't desire pregnancy; 2-4 oral contraceptive pills followed by repeat dose in 12 hours; nausea common (take antiemetic 1 hour before each dose); no current established contraindications except currently pregnant
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At risk women for GBS
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GBS in urine culture, preterm <37 weeks, ruptured membranes >18 hours, intrapartum temperature>100.4; positive swab btwn 35-37 weeks
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corticosteroids for possible preterm delivaries
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betamethasone or dexamethasone given to pts btwn 24-34 weeks at risk of delivering in the next 7 days
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post menopausal bleeding differential
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endometrial cancer, endometrial atrophy, endometrial polyps, infection, trauma, coagulopathy, medication exposure
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Intrahepatic Cholestasis (ICP) of pregnancy
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association with still birth; intense pruritus (often worse at night and on palms/soles); labs=abnormal LFTs and elevated bile acids
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VBAC
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uterine rupture in 0.2-1.5% with previous low-transverse incisions; increased risk of infection/morbidity if fail trial of labor and get c-section; when sucessful=less morbidity than elective repeat c-section
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lichen sclerosis exam
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whitish vulvar area with atrophy of both labia majora and monora. lesions sometimes include perianal area in a butterfly-like pattern; Rx potent topical testosterone
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when offer c-dection for macrosomia
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nondiabetic with estimated fetal weight >5,000g or diabetic with estimated fetal weight>4500g
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HELLP syndrome
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hemolysis, elevated liver enzymes, low platelets; should deliver infant and start maternal magnesium to prevent seizure
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placental previa
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placental tissue covering or near the cervical os; majority resolve with 'placental migration'
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clinical preclampsia criteria
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BP>140/90, edema, proteinuria
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lisinopril use in pregnancy
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not used due to potential effects on fetal renal blood flow
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antiphospholipid antibodies associated with 1st trimester miscarriage
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lupus anticoagulant and anticardiolipin
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imperforate hymen
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complain of cyclical lower ab pain that progressively worsens because of uterine and vaginal dysfunction with accumulated obstructed menstrual flow
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testicular feminization syndrome
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scant or absent pubic hair; testicles produce testosterone and target cells in hair follicles are believed to lack androgen receptors
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classical endometriosis symtpoms
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oligomenorrhea, severe menstrual cramping, increased menstrual flow during periods
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uterine fibroids and bleeding
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excessive bleeding with menstrual cycle; oligomenorrhea and dysmenorrhea are unlikely
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urethral diverticulum triad
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dribbling, dyspareunia, dysuria; may have tender suburethral mass; can have hx of frequent UTIs; Dx with urethroscopy or voiding cystourethrogram
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Meig syndrome
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coexistance of hydsrothroax, ascites, and underlying benign tumor, usually a fibroma (due to lymphatic obstruction); excision of ovarian fibroma usually resolves symptoms
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heavy menses with regular timed cycles
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organic lesions=submucous fibroids, endometrial polyps, and adenomyosis
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Category A pregnancy
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Controlled studies fail to demonstate fetal risk in first trimester, risk to fetus remote or animal studies don't demonstrate harm nbut no studies in pregnant women
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Category B pregnancy
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Animal studies have not demonstrated fetal risk, but no studies in women or animal reproduction studies show adverse effect, but not confirmed in human studies
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Category C pregnancy
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Animal studies show adverse effect with no studies in humans or animal/human studies not available
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Category D pregnancy
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evidence of fetal harm; benefits may outweight risks
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Category X pregnancy
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fetal abnormalities demonstrated, drug contraindicated
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heavy dysfunctional bleeding
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conjugated estrogen every 6 hours for 7 days followed by slow taper to one pill once daily; medroxyprogesterone acetate less reliable and slower acting
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gonorrhea rx
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ceftriaxone IM (plus doxy for chlamydia)
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Dx trichomonas vaginalis
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wet mount positive 40-80% and culture 95%
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rapid onset virilization
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adrenal/ovarian neoplasm concern; DHEA-S for adrenal r/o along with cortisol; US for ovarian r/o
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PCOS
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onset near puberty, slow, testosterone often elevated, signs of virilization; increase in LH/FSH ratio (not sensitive)
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clue cells
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epithelial cells that have many bacteria speckled around the edges
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bacterial vaginosis characteristics
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clue cells, gray-white color discharge, pH>4.5, foul odor after addition of 10% KOH; Rx Metronidazole tablets or intravaginal cream, clinda intravaginal cream
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uncomplicated gonorrhea Rx
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ceftriaxone, ciprofloxacin
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telogen effluvium
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early/excessive loss of normal club hairs from resting follicles in the scalp due to traumatization of follicles by a stimulus (eg partutition, sx, fever, drugs, traction)
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phases of hair follicle
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anagen, catage, telogen
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inpatient PID (Pelvis inflammatory disease) Rx
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cefoxitin 2 gm IV q6h and doxy IV q12h; alternative=clinda 900mg IV q8h and gentamicin 2 mg/kg loading with 1.5 mg/kg q8h
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Order of stopping postpartum hemorrhage
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1) vigorously massage uterus 2) Oxytocin 3)PG-F2 alpha (vasoconstriction of spiral arteries in myometrium) or methylergonovine (if not hypertensive) 4)Hysterectomy
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PID with gonorrhea vs chlamydia
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Gonorrhea more symptomatic with greater pain, higher temperature, thicker discharge-also tend to start near the end of menses
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Lymphagranuloma venerum
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painless papular lesion on perineum or around introitus; enlarged inguinal lymph nodes (can ulcerate through skin or form a fistula); rare in US
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FEP
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heme precursor-significantly elevated in lead poisoning, mildly elevated in iron deficiency anemia
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folate deficiency anemia
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MCV>100, low retic count, possible hypersegmented neutrophils on peripheral smear, elevated LDH level
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iron deficiency anemia
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low ferritin, MCV<80, significantly eleveated RDW
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appedicitis in pregnancy
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most common extrauterine complication in pregnancy requiring surgery; associated w/preterm labor and spontaneous abortion; frequently misdiagnosed; appendix displaced laterally and upward
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pancreatitis
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N/V with abdominal pain in mid-abdomen radiating to back and lasts several hours; elevated LFTs, lipase, and amylase
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Fragile X syndrome
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x-linked dominant with reduced penetrance in females; 3-base CGG repeat >200 in #
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Huntington's transmission
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autosomal dominant; symptoms after 30 yo
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X-linked recessive diseases
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hemophilia, duchenne muscular dystrophy, G6PD
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infections which should not breast feed with
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active TB, active varicella, active herpes zoster, active herpes simplex
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clogged milk duct presentation
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first 1-2 weeks postpartum; localized, tender mass in one breast that is not erythematous and usually not firm; can be accompanied by fever
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mastitis presentation
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1-5 weeks postpartum, but anytime within first year; sore, reddened area on one breast often accompanied by chills, fever, malaise-a segment of breast becomes hard and erythematous; fever can be high and mother feels ill
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Turner syndrome
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streak gonads, swelling of hands and feet (congenital lymphedema), coartation of aorta 15%, low-lying hairline, webbing of neck
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When NOT to breastfeed
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1) street drugs/alcohol abuse 2)infant w/galactosemia 3)HIV infection 4)active TB 5)taking antineoplastic, thyrotoxic, immunosuppressive meds 6)undergoing breast cancer treatment
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US for previas and abruptions
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95% accurate for previa, but only dx 15% of abruptions
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chlamydia Rx options
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Azithromycin 1 g PO; doxycycline 100mg PO BID x7days; erythromycin500mg PO QID x7days; ofloxacin 300mg PO BID x7days
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subchorionic hemorrhage
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cresecent shaped hyoechoic area next to gestational sac
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blighter ovum
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aka missed abortion; empty gestational sac on US and fetal demise has already occured
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penicillin alternatives for syphillis Rx
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tetracycline, doxycycline, erythromycin
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congenital syphilis
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snuffles, rhagades, neurosyphilis; also positive CSF serologies, meningitis, hydrocephalus, optic atrophy, and iritis
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late congenital syphilis
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hutchinson teeth, saber shins, saddle nose; age of 2 and above
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antiphospholipid syndrome requirements
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1 clinical and 1 laboratory criterion:episode of thrombosis, fetal death after 10 weeks, premature birth before 34 weeks, 3 or more spontaneous abortions before 10 weeks PLUS anticardiolipid IgG or IgM antibodies or lupus anticoagulant antibodies
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Management of pregnant patient after resolution of pyelonephritis
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antibiotics initiated and continued for remainder of pregnancy
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IUGR definition
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BW<10%
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Phenylketonuria (PKU)
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autosomal recessive metabolic disorder; deficiency of phenylalanine hydroxylase leading to elevated phenylalanine levels and severe mental retardation-can prevent with dietary changes; risk of children being affected if diet not followed prior to conception (93% menatl retardation, 72% microcephaly)
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tamoxifen reduces breast cancer reoccurance (in hormone positive BCs) by what percent
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50% with 5 years use; longer than 5 years associated with increased endometrial cancers
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autonomic dysreflexia
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hypertension that is associated with headache, cardiac arrhythmias, bradycardia, sweating, flushing, nasal congestion, and occasional resp distress; uteroplacental vasoconstriction may result in fetal hypoxia; triggered by a stimulus and occurs only in incompletely transected spinal cord injuries due to loss of hypothalamic control over sympathetic spinal reflexes
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Hep C detection in donated blood
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fail to detect up to 10% HCV-infected blood; 1 in 3300 may contain HCV
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blood transfusion infection rates
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HCV 1:3300; HBV 1:50000-200000; HIV 1:200000-1000000; 1:6000 ABO incompatibility
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N/V Rx with chemo
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5HT3 receptor antagonists (ondansetron) helpful BEFORE/WITH chemo infusion, don't help after; metoclopramide effective for delayed onset emesis
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vulvar vestibulitits
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severe pain to light touch; high incidence with coexistent fungal vaginitis-may be sensitive to topical antifungal creams; low-dose amitriptyline and imipramine can be effective; HPV can cause=interfuron alpha 18% response rate
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Positive predictive value
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liklihood positive result actually indicated presence of disease
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sensitivity
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proportion who have the disease that test positive (how good a test detects disease)
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specificity
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portion without that test negative (how good a test detects nondiseased)
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Rx HPV-related condylomata
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bichloracetic or trichloroacetic acid application
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endometriosis Rx
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GnRH analogue-supresses pituitary gonadotropin secretion and creates pseudomenopausal state=only use for 6 months due to osteoporosis risk
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urethral syndrome
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symptoms of dysuria and frequency with negative leukocyte esterase, low bacteriuria, and pyuria
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birth control for sickle cell anemia
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Depo shots=can reduce pain crises and doesn't contain estrogen
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PID and infertility
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1 episode 13-21%; 2 episodes 35%; 3+ episodes 55-75%
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elderly hematuria concern
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malignancy=renal parenchymal, in collecting system, or the bladder;
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