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102 Cards in this Set
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- Back
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Phase 1: ____________? _____ predominates; stimulated by LH. Builds up the endometrium. Days 1 to _____ |
FOLLICULAR |
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PHASE 2: __________________ Sudden _____ surge causes ovulation. |
OVULATION- Day 14 (MOST FERTILE) |
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Phase 3: ______________ day _________ CL secretes ____________ (predominates) & __________ to protect endometrial lining and secretion. LH decreases during this phase - If pregnancy occurs, the ________ keeps the CL functional- secreting estrogen and progesterone KEEPING ________from sloughing. ____ Maintains the CL. |
LUTEAL - Day 15-22 -blastocyst; endometrium Hcg |
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A) 2ry mound of areola B) Papilla elevation only C) Breast buds palpable; areola enlarge D) Elevation of areola countour E) Adult breast contour |
A) 4 B) 1 C) 2 D) 3 E) 5 |
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A) course and curly B) Extends to thighs C) Extends across pubis D) small amount (long downy hair) E) None |
A) 3 B) 5 C) 4 D) 2 E) 1 |
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1) Absence of period 2) Light flow or spotting 3) Heavy or prolonged bleeding at normal intervals 4) Bleeding b/w cycles 5) Irregular intervals 6) Infrequent 7) Frequent cycle interval |
1) Amenorrhea 2) Cryptomenorrhea 3) Menorrhagia 4) Metrorrhagia 5) Menometrorhagia 6) Oligomenorrhiea 7) Polymenorrhagia |
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DUB = DOE 90% due to _________. 1) Acute severe bleeding 2) Anovulatory 3) Ovulatory 4) Surgery ***diagnosis, intervention, therapeutics |
1) High dose estorgen, OCPS, D&C 2) Ocps, Progesterone, GnRh agonists 3) OCPs, progesterone, GnRh agonist 4) Srg if not responsive. Hysterectomy (last resort) and endometrial ablation |
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Dysmenorrhea 1ry vs 2ry A) Inc prostaglandins 2) Adenomyosis, leiomyomas, endometriosis, PID, adhesions What is Mc in young age vs older?
TX (3)? if meds fail? |
A) Primary B) Secondary
Tx 1) NSAIDS: inhibit prostaglandin 2) OCps: Suppresses ovulation 3) Laparoscopy: if med fails. Endometriosis MC in young age and Adenomyosis in older. |
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PMS occurs during ____ phase which is _____ dayhs before onset of menses. ***Tx? |
1) luteal - 7-14d 2) PMDD- ANGER & IRRITABILITY * Best defines difference -SSRIS (1st LINE)- fluoxetine -OCPs -GnRH (if no response to other 2) -Danazol, Bromocriptine for refractory breast pain -Spironlactone for bloating and tenderness |
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Primary amenorrhea is Failure of Onset of menarche by ____(No sexual characteristics) or ____(with characteristics) 1) Amenorrhea w/ Breast present 3) Breast present, uterus absent -- Secondary amenorrhea is absence of menses for ____ months in a pt w/ previous normal menstruation - LOW FSH = _________ dysfunction |
13- NO characteristics 15- CHECK FSH- 1) Outflow obs: Transverse vaginal septum, Imperforate hymen 2)Mullerian agenesis and androgen insensitivity )46 XX) and (46 XY) Secondary- absence for 3 months Low FSH= hypothalmic dysfunction |
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2) Amenorrhea with breast absent, uterus present - If FSH and LH are elevated the causes are __________46 XX and ________________ 45 Xo
-If FSH and LH and LOW, causes are ______ failure and _____Delay |
1Premature ovarian failure 46xx 2) Gonadal dysgenesis, turners 45xo
3) hypothalamus-pituitary 4) puberty |
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Mc cause of 2ry amenorrhea 2) Tx for hypothalamus dysfunction 3) Pituitary adenoma ___ FSH/LH and ____ Prolactin |
1) pregnancy 2) Clomiphene- FSH 3) Dec and Inc |
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Sx you would see with ovarian disorders. HOW TO DIAGNOSE? |
Estrogen deficiency (menopause) : hot flashes, mood disturbance, vaginal dryness, dysparenuia, dry skin, INC FSH and LH. DEC estradiol. |
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Progesterone challenge test |
POS withdrawal bleeding --> OVARIAN NEG withdrawal bleeding --> Hypoestrogenic |
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Scarring of the uterine cavity; 2ry to Post partum hemorrhage, s/p D&C or endometrial infection.
Mgmt? --------------------------------------- when post op/c section patient does not respond to IV abx what do you suspect? |
Asherman's syndrome- AMENORRHEA Dx- Pelvic US: abs. of normal uterine stripe Mgmt: Estrogen tx ------------------------------- SEPTIC PELVIC THROMBOPHLEBITIS |
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Islands of endometrial tissue within the myometrium Dx? Sx? Mgmt |
Adenomyosis Boggy uterus. TENDER. SYMMETRIC. Dx: DOE , MRI. Post-TAH Menorrhagia and Dysmenorrhea Mgmt: TAH*effective Conservative Tx
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Benign smooth muscle tumor. MC benign gyn. lesion. Growth is related to _____ production. regresses w/menopause. WHORLED PATTERNS - Sx? -PE? Dx? Us? Tx? (2) most effective?*** Definitive Tx? |
Leiomyoma (UTERINE FIBROIDS) -Estrogen -Sx: Menorrhagia, Dysmenorrhea -PE: large irregular, lumpy bumpy hard mass in abd or pelvis Dx: Pelvic US: SHADOWING -Mgmt: observation, Progestins (medroxyprogesterone), Leuprolide (most effective) Srg: Myomectomy, Hysterectomy (definitive dx) |
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-Infection of endometrium during pregnancy; PID -MC bug and etiology/ -Sx? |
Endometritis -GABHS, S.aureus -PP fever, tachy , chilss, abd pain, UTERINE TENDERNESS -Tx: C section : Clinda + Gent Vag: Amp +Gent Common manifestations include fever (early maternal post-operative fever suggests infection of the womb), fever, a soft, tender uterus, cervical motion tenderness, and foul lochia. High fever and hypotension shortly after delivery are classically reflective of group B streptococci |
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Fever, abd pain and uterine tenderness esp with C section? Tx? RF: Prolonged rupture of membranes, cesarean delivery, prolonged labor, and multiple cervical examinations |
Endometritis C section: Clinda + Gent Vag: Amp + Gent |
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1) Cyclical PMS pelvic pain 2) Dysmenorrhea 3) Dyspareunia ; dyschezia
What is the MC site of ectopic endometrial tissue? PE? Mgmt? Srg? |
Endometriosis
ovaries -Normal +- fixed tender adnexal mass
- Lap. w/ Bx. Tx: 1) PMS pain: Ocps + NSAIDS 2) Progesterone , 3) Leuprolide: FSH/LH suppress 4) Danazol: testerone 5) Srg: Lap w/ablation (fertile) 6) TAH: nonfertile |
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Endometriosis involving ovaries large enough to be considered a turmor Usually filled w/ chocolate covered cyst time prior to menopause in which the woman’s ovarian hormone output begins to decline, and often begins in the mid-40's - vasomotor symptoms (hot flashes/flushes and night sweats) ? |
Endometrioma PERIMENOPAUSE**** H&P |
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- Continuous INC unopposed estrogen. MC in Postmenopausal women.'Anovulatory pattern w/
1) Menorrhagia, 3) Postmenopausal bleeding Definitive dx? |
Endometrial hyperplasia : 1) TVUS 2) Endometrial BX*** (definitive)
Tx: Endometrial hyperplasia w/o atypia: PROGESTIN. Chronic anovulation. Pcos.
w/atypia- hysterectomy |
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MC gyn malignancy in the US 4th MC malignancy in women More ____ menopausal. RF: Inc ____ exposure: nulliparity, chronic anovulation, obesity, ERT, Tamoxifen, HTN, DM - Abn ______ & Post _________bleeding. Tx? for Stage 1 and 2? *SCIENTIFIC CONCEPTS*
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ENDOMETRIAL CANCER (<5mm thickness- TVUS) -Post menopausal -Estrogen -Abn vaginal bleeding. Stage 2 - TAB-BSO + lymph node excision
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Gravida? Para? Abortus? |
- Times pregnant P- births (viable or nonviable) A: Abortus (miscarriages, abortions) |
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MC cause of post menopausal bleeding? How to Dx? |
Benign: atrophy, polyps, fibroids -Endometrial CA, hyperplasia Dx- TVUS--> Endometrial stripe >4m --> BIOPSY --> Hysteroscopy |
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Menopause: cessation of menses for ______ due to loss of ovarian fxn. Average age? -Most sensitive Initial test? ____ vaginitis: thin yellow d/c. pH >5.5, pruritus _____ FSH and LH; ______ Estrogen - Loss of estrogen's protective effects --> __________ and INC cardio risk Tx? |
1 yr, 50-52, FSH, Atrophic- USE VAGINAL ESTROGEN INC FSH and LH, Dec Estrogen Osteoporosis Estrogen + Progestin in F w/o hysterectomy (COMBO IS BEST) Tx: menopausal hormone therapy (MHT) is the best pharmacological option |
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Menopause mgmt 1) Vasomotor insuff/hot flashes 2) Vaginal atrophy 3) Osteoporosis, prevention |
1) Estrogen, Progesterone, Clonidine, SSRIs, gabapentin. 2) Estrogen 3) Vitamin D and Calcium, bisphosphanates, Calcitonin, Estrogen, SERM (Raloxifene, Tamoxifen) |
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Estrogen vs. Estrogen+Progesterone 1) most effective tx for menopausal sx? 2) Dec heart and stroke risk, Dec osteoporosis and dementia 3) Inc risk of endometrial cancer and thromboembolism 4) Slightly inc risk of Breast cancer and venous thromboembolism 5) No inc risk of endometrial cancer 6) Often used in pts w/ no uterus (s/p TAH) 7) no Inc risk of breast cancer** |
1) Estrogen 2) Est + pro 3) Estrogen 4) Est + Pro 5) Estrogen + pro 6) Estrogen 7) estrogen |
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1) Pelvic pain + Dysparenia + Dysmenorrhea 2) Vaginal bleeding+ abd pain+ amenorrhea 3) Amenorrhea + hirsutism + Obesity |
1) Endometriosis 2) Threatened abortion(MC), ectopic, nonviable 3) PCOS |
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1) Uterine herniation into vagina 2) Posterior bladder herniating into anterior vagina 3) Pouch of douglas into UPPER vagina 4) Distal sigmoid colon into posterior distal vag
- when fetal monitor recordings show that severe variable decelerations or bradycardia occur after membrane rupture. happens most often at 5-cm cervical dilatation and in nonvertex presentations?? |
1) uterine prolapse- kegel, pessary, vaginal hysteroctomy 2) Cystocele- weight loss 3) Enterocele 4) Rectocele CI to Pessary= vaginitis and PID CORD PROLAPSE- RARE |
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Fullness, heaviness, falling out sensation LBP, vaginal bleeding, purulent d/c, urinary freq, urgency, stress incontinence PE: Bulging mass w/Intrabd pressure. Mgmt? |
Pelvic organ prolapse 1) Kegel, weight control 2) Pessaries, estrogen 3) Hysterectomy |
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Failure to conceive for 1 yr Male? Female?
Dx?****
Mgmt? |
Male- abnormal spermatogenesis Female- Anovulatory cycles or ovarian dysfxn
Dx: Hysterosalpingography- checks for scarring of fallopian tubes
Mgmt: Clomiphene: induces ovulation Intrauterine insemination Invitro fertilization if hysterosalpingography abn --> Laparoscopy |
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1) Intrabdominal pressure from sneezing, coughing, leakage 2) Urgency frequency, small volume voids, nocturia 3) Small volume voids, frequency, dribbling, INC PVR |
1) Stress 2) Urge 3) Overflow |
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Tx options for stress incontinence (Laxity of pelvic florr muscles) |
1) Pelvic floor exercises 2) Alpha agonists: Midodrine, pseudoephedrine (INC urethral sphincter tone) 3) Surgery |
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Urge incontinence Tx? 1st line meds? |
1) Bladder training 2) Anticholinergics- 1st line: Tolterdine, Prophantheline, Oxybutynin, 3) TCAs: Imipramine Mirabegron Surgery |
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Overflow Incontinence Tx? 1st line?
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Bladder atony - 1st line Tx: intermittent or indwelling catheter - Cholinergics: Bethanacol (INC detrusor activity) - BPH: Alpha blockers; Tamsulosin (Smooth muscle relaxation of prostate and bladder neck) |
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RLQ or LLQ pain, Menstrual changes , dyspareunia. Abdominal distention. Unilateral pelvic pain/tenderness. Mobile palpable cystic adnexal MASS Dx? Tx? MC tumor that can lead to ovarian torsion?
MC ovarian mass in pregnancy,
Septations, internal papillations, loculations, solid lesions or cystic lesions with solid components are typical characteristics of a possible_________________ MC type: ___________ MC in preggo: __________ side MC, LEUKOCYTOSIS, LAPAROSCOPY ?? |
Ovarian cysts- CYSTIC ECHO, R/o pregnancy Tx: 1) supportive (most resolve on own) REST NSAIDS, US every 6 wks. 2) OCPs- COMBO
Complications: Ovarian torsion (R side MC, LEUKOCYTOSIS, LAPAROSCOPY) and bleeding
Follicular- MC type Corpus luteum- MC in pregnancy
Malignancy MC tumor that can lead to ovarian torsion? CYSTIC TERATOMAS
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2nd MC gyn cancer with HIGHEST MORTALITY of all GYN cancers -RFs? 3 - protective? Sx? PE? Dx? Tx?
MC site of metastasis for ovarian tumor? Ocps ______________* |
Ovarian cancer 1) Nulliparity 2) Inc ovulation 3) BRCA1 and 2 Sx:Abd fullness, distention, back/abd pain, Urinary freq. PE:abd mass, ascites, sister mary- METS to umbilical lymph nodes, constipation Dx: Transvaginal (Seen in Post menopausal- epithelial)- echogenicity, fluid seen Tx? 1) Early: TAHBSO + Lymphadenoctomy 2) Surgery: Serum CA 125 3) Chemo: Taxol + Cisplatin Ocps protective * MC site of metastasis - OMENTUM
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Bilateral enlarged smooth mobile ovaries OR string of pearls. Amenorrhea. Abn ovarian fxn? Patho? Dx- ___ testosterone ___ LH:FSH ratio Rise in serum _______________ |
PCOS, Insulin resistance. INC INC Hydroprogesterone |
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Tx for PCOS 1) Mainstay? 2_ Hirsutism? 3) Infertility 4) Lifestyle 5) Srg
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1) Mainstay- Ocps to normalize bleeding 2) Anti androgenic agents for hirsutism- Spirinolactone 3) Infertility- Clomiphene and Metformin (abn ratio) 4) Srg- wedge resection Complications: infertility risk, INC risk for endometrial cancer |
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Normal Pap smear -every ___ years starting 21 until _____ -every 3 yrs if >= ________ -_________if HIV, in utero DES exposure, RF D/c at age _____ if last 3 PAPS were normal What allows for visualization of lesions with application of acetic acid? |
2, 21-29 3, 30 YEARLY 60-65 Colposcopy |
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ASC-US(UNDETERMINED SIG) if >25 1) Do ______. If neg_____________, If pos _________ 2) Repeat PAP _________ 3) 21-24. Repeat PAP in ___ yr ASC-H: Higher chance of ____. Dx: ______ LSIL: transient ____ infection. HPV neg - Repeat cytology in __ yr HPV pos- _________________ |
ASC-US(UNDETERMINED SIG) if >25 1) Do HPV testing. If neg rpt PAP and HPV in 3 y, If pos Colposcopy w/biopsy 3) 21-24. Repeat PAP in 1 yr ASC-H: Higher chance of cancer. Dx: Colposcopy w/bx LSIL: transient HPV infection. 25-29: Colposcopy w/bx >30 HPV neg - Repeat cytology in 1 yr HPV pos- Colposcopy w/bx |
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3rd MC gyn cancer (1st- Endometrial, 2nd- _____) HPV associated _. _,_,_ RF: List 4 Which type is most common? Sx? Tx for 1) Stage 0 2) Stage Ia1 3) Stage 2B-IvA 4) Stage IVb |
Cervical, 2nd- Ovarian 16, 18, 31, 33 1) early onset partner 2) Smoking 3) CIN 4) DES 5) immunosupp, 6) STI 1) Excision, ablation 2) Surgery 3) XRT and chemo 4) Palliative XRT and chemotx |
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CCancer screening Sx? Every ____ 21-29 Greater than 30): every ___ yr D/c if age ____ . Recommended age: ___ C/I: |
Post coital bleeding, Metrorhagia, - 2yrs 3 60-65, 3 consec negs, 10 yr 6,11,16,18 11-26 C/I: pregnancy, immunosupp or lactating |
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2nd TRIMESTER bleeding. PAINLESS dilation and effacement of cervix. premature cervical dilation in 2nd trimester Mgmt? * |
incompetent cervix, Mgmt: Bed rest, weekly injection of 17 alpha hydroxyprogesterone, Cerclage |
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1) 1% of gyn malignancies .Squamous mc Tx? 2) Pruritus MC presentation w/itching and irritation. Red white, ulcerative crusted lesions. 90% squamous (HPV ___, ___ , ____) ***** Which one is seen in more older population?
Tx? intense pruritus of the vulva, along with lesions that resemble eczema. Pathology also characteristically shows large eosinophilic Paget's cells |
1) Vaginal CA. Asymptomatic. Radiation 2) Vulvar, 16,18,31
Tx: Sr, XRT, cryo, laser chemotx Older population- Vaginal vs. Vulvar in younger - Paget's disease |
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Txfor vulvovaginal atrophy - Bartholin gland cyst tx? |
1) Estrogens (cream, ring, troches) 2) Ospemifene: SERM 3) Moisturizers Both Bartholin cysts and abscesses can be painful. Initial conservative treatment consists of warm compresses to encourage drainage. If this is unsuccessful, incision and drainage is necessary. |
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1) Thin, homogenous, watery, grey white few wbcs MC cause of vaginitis Smell w/ KOH prep pH >______ |
Gardnerella Flagyl X7d Clindamycin
pH>4.5 vs. Candida is <4.5
ComplicationsL PROM, preterm labor, chorioamnniotis |
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Pear shaped flagellated protoza, Vulvar priritus, dyspareunia Frothy yellow green discharge STRAWBERRY cervix Mobile protozoa |
Trichiomoniasis -Metro oral 2g dose OR 500mg X7d -Avoid spermicidal agents. |
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Thick curd like cottage cheese. Hyphae yeast on KOH prep |
Candida overgrowth Fluconazole Intravag. antifungals: clotrimazole, nystatin, butoconazole, miconazole |
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Overgrowth of lactobacilli Dysuria, nonodorous d/c Large # of epi cells |
cytolytic vaginitis d/c tampon Sodium bicarb: sitz baths |
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MC cause of cervicits- which med is safe in pregnancy? PAINLESS genital ulcer Abd pain, PID, pc bleeding, ASYMPTOMATIC LCR test most sensitive |
Chlamydia Azithromycin*preggo 1g PO or Doxy 100mg BID X10d 2nd line: erythromycin, levofloxacin Treat for gonnorhea (co infection ) Avoid intercourse 7d after tx |
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May be asymptomatic, d/c, cervicitis, ferquency, dysuria,
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Gonorrhea- culture, DNA Ceftriaxone 250mg IM Cefixime Treat chlamydia coinfection |
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GNB, PAINFUL genital ulcer, foul d/c PAINFUL INGUINAL LAD ****DIAGNOSIS |
Chancroid- H. ducreyi; uncommon
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16, 18, 31, 33, 35 FLAT PAPULAR pedunculared or flesh colored cauliflower growwth. *****Clinical intervention |
6, 11 for WARTS whitening w/ 4% acetic acid application Tx: trichloroacetic acid, poodophylin, cryotherapy, srg Outpt- podofilox, Imiquimod |
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Lower Abd tenderness, fever, w/ POS _______sign. 1) Abd tenderness 2) Adnexal tenderness 3) Cervical motion tenderness Tx? GS, Pus Pelvic abn --------------------------- What is number one cause of mortality in patients with PID? |
PID Dx: Pelvic US. Laparoscopy Mgmt: Doxy + 2nd gen cephalosporin Comp: fitz hugh, Hepatic scarring or peritoneal involvement, RUQ pain/perihepatitis ------------------- Tuboovarian abscess- rupture |
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High fever, Sudden onset, Tachycardia, N/V/D, pharyngitis. Diffuse erythematous Macular rash, desquamation, |
Dx: CBC, culture Mgmt: Hospital admission, Anti-staph abx (Clinda +Oxa or Nafc) If MRSA( Clinda + Vanc) |
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Mgmt of Cystitis in Pregnancy MC gyn condition in prepubertal children |
Amoxcillin 7-14d, augmentin, cephalexin, Macrobid, Sulfisoxazole (safe except in last days) INC KERNICTURUS. No sulfa if G6Pd. Vulvovaginitis |
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Prevents _________by inhibiting mid cycle LH surge, thickens cervical mucosa, thins _______ - PROS Improves dysmenorrhea, protection vs .osteoporosis. Improves acne - CONS Gallstones, _____fluid retention and thromboembolism. Caution in pts w/______dz, DM and hyperlipidemia. Smokers should STOP ocps at age _______ OCPS ARE PROTECTIVE FOR ______________ |
Combination Ocps ovulation, endometrium Inc, Biliary dz >35 |
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"mini pill";safe during lactation. Can be used in women ______. _____ risk of ovarian and endometrial cancer Less risk of ______ - slightly __ effective vs combo ocps slightly _____ risk of ectopic preg. vs. combo estrogen-free contraceptive options? |
>35, DEC PID LESS MORE estrogen-free contraceptive options for this patient could include progesterone-only pills, all 3 types of IUD, and the depot-medroxyprogesterone acetate injections |
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Implanon- lasts ___ yrs. Same benefits as progestins (if hx of clots- give this!) - Ortho evra is a ____ patch with ____ wk of withdrawal bleeding. Less effective if pt is _____. - Flexible plastic ring w/_____. Withdrawal bleedigng. - Levonorgesterl 2 tabs 12 hours apart. Only beneficial if taken __ hr of unprotected SI. Seek medical attn if no menses initiated at 21 d p tx - Mirena has? How many yrs. Inc risk of ___. - Paraguard is good for ___ yrs. - Tubal ligation has an inc risk of ______. - ____: chem or coils to scar fallopian tube |
3 yrs; transdermal; one; underweight -etonogestrel/estradiol - Plan B; 72. - Levonorgestrel; 5 yrs. PID - Copper, 10 yrs. - ectopic pregnancy - Essure |
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Implantation of fertilized ovum OUTSIDE of uterine cavity. MC- fallopian tube. commonly seen with ________ 1) Unilateral abd pain 2) Vaginal bleeding 3) amenorrhea PE- cervical motion tenderness, adnexal MASS Dx? Mgmt? Stable vs. Ruptured? Stable or unstable? |
Ectopic pregnancy- PID 1) Serial B hcg - lower than usual (should double 24-48 hr) levels > 2,000 2) Transvaginal US- Absence of gestational sac or FETAL POLe 3) culdocentesis: nonclotted blood present.
Mgmt 1) Stable = give Methotrexate 2) Ruptured= Lap. salpingostomy: 1st choice! |
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Abnormal labor progression 1) Power= uterine contraction 2) Passenger= Presentation size or position of fetus 3) Passage = uterus or soft tissue abn Mgmt. of shoulder dystocia 1) Nonmanipulative (1st line) 2) Manipulative? |
Nonmanipulative: 1st line- McRoberts - inc pelvic opening w/hyperflexion of hips 2) Manipulative: corkscrew woods maneuver: 180 shoulder rotation: c section |
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1) Neoplasm due to abn placental development w/trophoblastic tissue prolif. rising from gestational tissue. NONVIABLE pregnancy. _____karyotype, absence of an _____, swelling of all _______. Which vitamin def? 2) Egg with NO DNA fertilized by 1 or 2 sperm. 46____. Higher risk of malignant potential of choriocarcinoma. 3) Egg fertilized by 2 sperm. may be development of fetus but is always malformed but never viable. Extremes of age, Asian. triploid 6_______ - Persistently high HCG after mole removal is indicative of __________________
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Trophoblastic pregnancy 1) Hydatidiform mole- Diploid karyotype, absence of an embryo, swelling of all villi 2) Complete molar pregnancy- 46xx 3) Partial molar pregnancy- 69xxy Molar pregnancy- Retinol or Vitamin A def - Choriocarcinoma |
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1) Painless vaginal bleeding 2) Uterine size/date discrepancies: preelampsia 3) Hyperemesis gravidarum 4) Choriocarcinoma
Dx? What happens to hcg and afp? |
MOLAR PREGNANCY Dx: Markedly elevated Bhcg. Low Afp. US-snowstorm/grape clusters Dx: B Hcg & US to r/o molar pregnancy
Tx: Uterine suction curettage, METS (chemotherapy- MTX) |
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Fetal monitoring Mgmt 1) Non stress test: >2 accelerations in 20 mins w/ INC fetal heart rate. 2) Non stress test: No fetal HR accelerations 3) Neg CST: No late decelerations in the presence of 3 contractions in 10 mins 4) Postive CST: Repetitive late decelerations in the presence of 3 contractions in 10 mins |
1) Rpt weekly or biweekly 2) Vib. stimulation or CST 3) Repeat CST as needed 4) Prompt delivery |
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GDM- screening is ______ wks gestation. - caused by placental release of _____ which antagonizes insulin. Dx? Gold standard? Delivery at? Mgmt? |
24-28; HPL Dx- Screening: 50g OGCT (nonfasting) at 24-28 wks gestation. If >140--> PERFORM 3h OGTT
-Gold standard- 3h GTT. 1h- >180. 2h>155. 3h>140.
- Glucosuria
MGMT 1) Insulin- tx of choice. Goal - FBS <95 2) Glyburide- Doesn't cross placenta (eclampsia risk) 3) Early del. at 38 wks.
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Blues vs. Depression 1) 2-4 days PP 2) Resolves in 3-14 months 3) 2wks - 2 months PP 4) May have thoughts of harming baby 5) Mild insomnia, anhedonia, fatigue,depressed mood |
1) Blues 2) Depression- may need antidep. 3) Depression 4) Depression 5) Blues |
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RFs of Rupture of chorioamniotic membrane before labor onset Dx? Mgmt?****** Mc complication of PROM |
1) Rfs: STDs, smoking, prior preterm delivery, multiple gestations - Nitrazine test: amniotic fluid pH >7.1 - Fern test: crystallization of estrogen and amniotic fluid -Sterile spec. exam
Mgmt: GIVE ABX & OXYTOCIN 1) Await for spontaneous labor/induction - with oxytocin and prostaglandin gel 2) Monitor infxn |
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Regular uterine contractions w/ progressive cervical changes before____ wks gest. -Cramps, uterine contractions, back pain, pelvic pressure, vag. discharge. -PTL is likely ______cm or ______% effacement. - fetal fibronectin at ------- -Ls ratio is ______ Mgmt? What suppresses contractions? |
37, 3cm, 80% Ff at 20-34wks Ls < 2:1 for FLM
1) Tocolytics: suppress contractions 2) Beta 2 agnoists: terbutaline (Pulm edema), Ritodrine 3) Mg sulfate: admit (calcium antag) or CCB 4) Indomethacin
- ANTENATAL CS to enhance FLM - Abx: GBS prophylaxis
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1) N/V upto 16 wks 2) excessive severe form of morning sickness (1st or 2nd trimester) Mgmt? HOW MUCH FOLIC ACID, CALCIUM, IRON, VITAMINS IN PRENATAL VITAMINS? |
1) Morning sickness 2) HEG Mgmt- 1) Fluids, electrolyte repletion.High protein foods, 2) Antiemetics: Pydridoxine (B6) doxylamine promethazine, dimenhydrinate 400 micrograms folic acid (NEURAL TUBE DEFECTS) .400 IU of vitamin D.200 to 300 milligrams (mg) of calcium.70 mg of vitamin C.3 mg of thiamine.2 mg of riboflavin.20 mg of niacin.6 mcg of vitamin B12.10 mg of vitamin E.15 mg of zinc.17 mg of iron.150 micrograms of iodine |
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1) MC cause of 1st trimester bleeding. Pregnancy may be viable/abortion 2) ____ POC expelled from uterus 3) Cervical OS is ___________ 4) Sx? 5) Mgmt? |
1) Threatened 2) NO 3) Closed 4) Blood d/c, plus or minus uterine contractions 5) Mgmt: supportive, Serial BhcG
bout 75% of abortions occur before the 16th week of gestation. In a threatened abortion, bleeding and cramping occur, but the cervix is not dilated. The pregnancy continues. |
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1) Pregnancy not salvageable 2) ______ POC expelled 3) Progressive Cervical dilation ____ cm; effaced 4) Mod bleeding for ___ days 4) Uterus side is comparative to _____ 5) Tx? |
Inevitable NO 3 7 dates 2nd trimester- Dilation and Evacuation 1st- suction curettage |
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1) Dilated cervical os *only one* 2) ____ POC expelled 3) ____ tissue; ____ uterus 4) Pregnancy _____ salvagable |
Incomplete Some POC retained ; boggy NON Tx: D&C- 1st, D&E-after , Pitocin, RhIg |
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Pain, cramps, bleeding ALL poc Expelled Cervical OS is usually ______________ |
COMPLETE Tx: RhIg if indicated |
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__________ NOT viable but retained in uterus ______ POC expelled Cervical os - ____________ When Retained POC becomes infected? |
MISSED embryo, NO CLOSED D&C - 1st trimester infected would be septic |
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Elective induced abortion _____________ + ________________ (9 wks) _____________+ ________________ (7 wks) Mifeprostone (anti ___________) on Day 1 OR Mtx Misopristol on day ___ if abortion doesn't occur Surgical : Upto _______ wks after LMP D&C ____________ wks gestation D&E ____________ wks gestation |
Mifeprostone + Misoprostol MTX + Misoprostol Antiprogestin 3 24 5-13wks after 13 |
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3rd trimester- SUDDEN onset of PAINLESS bleeding SOFT nontender uterus NO Fetal distress Rate of congenital abn is ___ X |
Placenta previa (transabd US) - NO DIGITAL VAGINAL EXAM! FHR- normal Mgmt: 1) Hospitalization- CBC, T&S 2) Stabilize fetus a) tocolytics- Mg sulf b) amniocentesis : steroids for FLM 3) Delivery stable : vaginal if partial, C section if complete when mature Rate of congenital abnormality DOUBLES |
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3rd trimester- SUDDEN onset of PAINFUL bleeding - DARK red Fetal Bradycardia -Tender and rigid uterus -RFs? placenta attaches to the myometrium? |
Placenta abruptio -Mgmt: Hospitalization & Immediate C SECTION delivery OXYTOCIN INDUCED (10% chance of DIC-hypofibrogen) -Maternal HTN. Smoking, EtoH, cocaine, folate def, high parity, inc age. -Placenta Acreta |
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HTN no proteinuria at 20 wks gestation. Resolves 12 wks PP. |
Transitional HTN may withold meds. Plus or minus hydralazine or labetalol |
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HTN + Proteinuria + Edema at 20 wks gestation - HTN, HA, visual sx. DEC oncotic pressure. Mild: __________________
1st line- _____________ ORDER ___ urine for dx |
PREECLAMPSIA Mild- delivery ONLY cure @34-36 wks; steroids. ortive- BP and dipstick weekly, bed rest >140/90
Severe- > 160/110 delivery ONLY cure @34-36 wks. Hospitalization, Low salt, Mg Sulfate. 1st line methyldopa - 24 hour urine |
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Seizure/coma; life threatening. Abrubt tonic clonic seizures. HA, visual change, CP arrest. What underlying process should be suspected if preeclampsia develops in the first trimester of pregnancy |
Eclampsia Tx: ABCDs - mg Sulf for seizures, Lorazepam 2nd line - Fetus delivery once stable -Hydralazine, Labetalol Molar pregnancy |
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HTN before 20wks gestation. Persists >6wk PP. HA, visual sx. BP >140/90 (2 sep occ. 6 h apart)
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Chronic HTN Mild- Monitory delivery at 39-40wks - SEVERE >150/100- METHYLDOPA, labetalol, Nifedipine, Avoid AceI and diuretics |
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- Serum Hcg ____ d after conception -Urine Hcg: ____d after conception -1) Uterine softening 6 wks 2) Uterine isthmus softening 6-8wks gest 3) Palpable lateral bulge or softening 7-8 wks gest 4) Cervix softening 4-5 wks gestation 5) Cervix and vulva bluish 8-12 wks 6) FHT: 10-12 wks. Normal : _________ 7) Pelvic US: fetus at ____ wks 8) Fetal movement: ________ weeks (QUICKENING) the widest portion of the fetal head has successfully passed through the pelvic inlet |
5 14 days 1) Ladins 2) Hegars 3) Piscacek 4) Goodell 5) Chadwick 6) 120-160 7) 5-6 8) 16-20 the widest portion of the fetal head has successfully passed through the pelvic inlet - Fetal head is ENGAGED |
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EDD Formula Example: LMP 1/12/02 |
1st day of LMP + 7d -3m + 1 yr LMP: 1/12/02 +1 wk: 1/19/02 -3m: 10/19/01 +1yr 10/19/02 |
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Triple screening: _____ wks 1) Afp 2) Bhcg 3) Estradiol A) HIGH Hcg, Low AFP and estradiol _________ wks: 1_ BP 2) Edema 3) Urine gluc and protein 4) Fundal height 5) Glucose tolerance _________wks Group B strep |
15-20 wks A) Down syndrome- flat face, simian hand creasing, protruding tongue, almond eyes, cardiac and GI defects B) ONTD (spina bifida/ multiple gest) 24-28 wks 32-37 wks |
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INTRAPARTUM 1) spontaneous uterine contractions late in pregnancy; assoc w/cervical dilation 2) Fetal head descends into pelvis; sensation that baby is lighter 3) sudden gush of liquid 4) Passage of blood-tinged mucus late in preg. Cervix begins THINNING 5) Contractions felt of fundus with radiation to LB and abdomen |
1) Braxton hicks 2) lightening 3) Ruptured membrane 4) Bloody show 5) True labor |
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Labor stages 1) period 2 hours after delivery 2) PP until placenta delivery 3) Onset of labor to full dilation (10 cm) 4) Cervical dilation until delivery of neonate |
1) Stage 4 2) Stage 3 3) Stage 1 4( Stage 2 |
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POST PARTUM 1) When does uterus size return to normal? 2) When does the pinkish brown bleeding esp after PP 4-10d resolve? 3) PP milk days ______ |
6 weeks PP 2) Lochia serosa- 3 wks 3) 3-5 d |
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MCC of maternal dath w/i 24 hrs delivery Bleeding ________ vaginal _______________ ml C section MC cause of hemorrhage Tx? |
PP hemorrhage 500mL 1000mL Uterine atony (UTERUS unable to contract to stop the bleeding) RF- rapid labor, overdistended uterus, C section Tx: 1) Oxytocin, Misoprostol 2) Bimanual UTERINE massage |
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UNILATERAL Breast pain, tenderness, wartmth, d/c, Which medication can be considered to halt lactation in women with poorly controlled infection, severe symptoms, instability or wide spread nipple excoriation? |
MASTITIS Infectious: Breast pump, warm compress + abx (Dicloxacillin, nafcillin, cephalosporin) Constinue to Nurse or use breast pump Congestive: ice packs, tight bra, analgestics if NOT breast feeding. If breast feeding, empty manually Abscess: I & D; stop BF F |
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MC breast d/o Multiple mobile well demaracated areas (often tender) Menstrual changes ****management and H&P |
Fibrocystic breast d/o Dx: US- Bx shows straw colored fluid (no blood) Mgmt: FNA If warranted (fluid) |
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2nde MC benign breast d/o (collagen arranged in a swirl) BENIGN DUCTAL CELLS WITH DENSE STROMA SMOOTH, well circumscribed, mobile RUBBERY lump no axillary/nipple d/c . DOES NOT wax or wane with menstruation |
Fibroadenoma- common in teens Mgmt: resorb w/time |
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BRCA 1 and 2 associated with ____ & ____ -RFs? - MC type of BC? - PAINLESS, HARD, NON MOBILE LUMP, MC in _______ quadrant -______lateral nipple d/c. -__________ redness, dimpling. Peau de orange due to _____________ obstruction. POOR prognosis -Oozing, chronic eczematous, scaly rash on nipples and areola: ___________dz Dx: - Microcalcifications/spiculated mass for malignancy - Rec. Initial modality - FNA w/biopsy |
1_ Ovarian and breast Rfs: Lifteime, 1st degree relative, Age >65, INC number of menstrual cycles, early menarche, late menopause, never breastfed, Inc estrogren exp. -Right upper -Unilateral -asymmetric -lymphatic -pagets -Mammogram for microcalcifications - US -MOST COMMON: Ductal carcinoma |
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Self exam: monthly ____ years of age immeiately after menstruation. -Clinical breast exam q____ yrs in 20-39; annually at _____yrs UNDER 30 and mass, always do ____ FIRST Prevention in High Risk? |
20 3 2 10y prior to age 1st degree relative was dx ULTRASOUND 1st if <30 prevention- Tamoxifen/Raloxifene |
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Fever, purulent drainage Intra-amniotic infection with PROM Risk factors: preterm labor (<37 wks, premature rupture of membranes, prolonged rupture of membranes GBS infection ↑ at 18 hrs Tx? |
Rx: ampicillin + gentamicin + INDUCE + corticosteroids CHORIOAMNIOTIS- complication of preterm rupture of membranes |
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1 hr _____g glucose at ______ wks gestation If 1 hr is > _________, then a ___ hr ______g should be performed within a wk to CONFIRM. ___- fasting ___- 1 hr ___- 2hr ____ - 3hr |
50g at 24-28 weeks gestation 180- 1 hr 155- 2hr 140- 3hr |
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yolk sac (YS) within a gestational sac (GS), intrauterine fetal pole, or intrauterine fetal heart activity seen on transvaginal ultrasound > 38 days after LMP or ß-hCG > 1500 seen on abdominal ultrasound > 45 days after LMP or ß-hCG > 4000 : Present at 5 to 6 weeks with b-hCG > 2000; first definitive sign of IUP Double decidual sign distinguishes between IUP and a pseudogestational sac |
Intrauterine pregnancy |
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12 weeks: ____________ 20 weeks: _______ 20-32 weeks: height (cm) above symphysis = ______ 36weeks? |
12 weeks: pubic symphysis 20 weeks: umbilicus 20-32 weeks: height (cm) above symphysis = gestational age (weeks 36-xiphoid |
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Common vaccines SAFE in pregnancy |
SAFE 1) Hep B 2) Tdap 3) Flu CI 1) MMR 2) Hep A 3) Varicella 4) IPV |
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A) consists of small testes, azoospermia, gynecomastia, sparse body hair, high pitch voice, above-average height, eunuchoid body proportions, long legs and arms, and low testosterone levels and high levels of FSH and LH. B) second most common trisomy, and presents more commonly in female patients. intellectual disabilities, ventricular septal defects, patent ductus. duodenal atresia, imperforated anus, diaphragmatic hernia, polydactyly, microcephaly and microphtalmia, and rocker bottom feet. Most of them die in the 1st year of life. C) primary amenorrhea, unexplained growth failure, pubertal delay, webbed neck, preductal coarctation of the aorta, bicuspid aortic valve or hypoplastic left heart, low hairline, low-set ears, edema of the hands or feet, and elevated levels of FSH D) Deletion of the short arm of chromosome 5 first described in 1963 by Lejeune et al., translates to "cry of the cat". A high-pitched cry is heard in affected neonates. Patients have multiple nonspecific characteristics, such as low birth weight, poor muscle tone, microcephaly, language difficulties, and profound retardation. Facial characteristics are round face, hypertelorism, low-set ears, micrognathia, a prominent nasal bridge, epicanthal folds, and facial hypotonia. E) Features include hypotonia, brachycephalic head, epicanthic folds, flat nasal bridge, upward slanting, low implantation ears, single transverse palmar crease, and variable degrees of intellectual disability. There may also be defects of the endocardial cushion, Hirschsprung disease, and duodenal atresia. |
A) 47XXY (Klinefelter Syndrome), B)Trisomy 18 (Edward Syndrome C) 45X0 (Turner Syndrome) D) (Cri du chat syndrome), E) Trisomy 21 (Down syndrome)- BEST TEST = Free fetal DNA screening |
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A) buttocks are pointing downward with the legs folded at the knees and feet near the buttocks .B) buttocks are aimed at the birth canal with its legs sticking straight up in front of his or her body and the feet near the head. C): In this position, one or both of the baby’s feet point downward and will deliver before the rest of the body. |
Complete breech: Frank breech: Footling breech: |
