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159 Cards in this Set
- Front
- Back
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What causes ovulation?
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LH Surge
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What hormone is prominant in the Follicular/Proliferative phase?
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Estrogen
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What hormone is prominant in the Luteal/Secretory phase?
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Progesterone
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When does the Luteal/Secretory phase occur?
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After ovulation
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Most common cause of premenopausal irregular bleeding
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Dysfunctional Uterine Bleeding
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Due to overgrowth of the endometrium, possibly caused by anovulation (unopposed estrogen)
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Dysfunctional Uterine Bleeding
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47 yo female with LMP 42 days ago
Irregular bleeding x2 weeks Endometrial sampling shows "proliferative endometrium" |
Anovulation
(10 days of progesterone) |
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52yo female, BMI 38
Irregular bleeding x3 weeks Endometrial sampling shows "hyperplasia" |
Endogenous estrogen excess
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ANY bleeding in a postmenopausal female
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Investigate
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3 causes of Dysfunctional Uterine Bleeding due to overgrowth of endometrium
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Anovulation
Extreme obesity Perimenopuase |
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5 causes of DUB in pt <16 yo
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Pregnancy
Anovulation Breakthrough bleeding on OCPs STDs/PID Blood dyscrasias |
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Regular periods
Very heavy flow No intermenstural spotting |
Menorrhagia
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2 causes of menorrhagia
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Fibroids
Hyperplasia |
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Normal menses
Spotting between cycles |
Metrorrhagia
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Causes of post-coital metrorrhagia (3)
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Cervicitis
Cervical cancer Endometrial cancer (older) |
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Lack of menstuation by age 16 or age 14 if no secondary sex characteristics
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Primary Amenorrhea
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Lack of menstruation for 6 months or more in woman with previously normal menstruation or for 12 months if previous history of oligomenorrhea
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Secondary Amenorrhea
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MCC of Primary Amenorrhea
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Pregnancy
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Increased estradiol
Decreased FSH |
Ovaries working
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0 estradiol
0 FSH |
Pituitary, hypothalamus not working
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4 causes of primary amenorrhea
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Pregnancy
Imperforate hymen Gonadal dysgenesis (Turner's) HPO axis abnormalities |
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MCC of Secondary Amenorrhea
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Pregnancy
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5 causes of secondary amenorrhea
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Pregnancy
Endometrial atrophy Premature ovarian failure (FSH is high) Pituitary disfunction Anorexia |
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DNC with scarring of the endometrium
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Asherman's
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<40 yo and FSH >40
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Premature ovarian failure
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Pituitary dysfunction necessitating an emergency hysterectomy
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Secondary amenorrhea
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Give 10 days of progesterone and then stop it
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Progesterone challange
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If withdrawal bleeding occurs following a progesterone challenge
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Patient is not ovulating
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Secondary amenorrhea Tx (3)
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OCPs
Cyclic Progesterone Ovulation inducers |
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Pain during menstruation
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Dysmenorrhea
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Pain during menstruation that begins early after menarche
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Primary dysmenorrhea
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New onset pain during menstruation in an older woman
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Secondary dysmenorrhea
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2 causes of Secondary dysmenorrhea
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Endometriosis
Cervial stenosis |
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Most common cause of secondary dysmenorrhea
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Endometriosis
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Nodularity in the cul de sac
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Endometriosis
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Endometriosis Dx
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Laparoscopy with laser ablation (both diagnostic and therapeutic)
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Endometriosis Tx (3)
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GnRH agonists (Leoprolide, Danocrine)
OCPs DMPA |
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GnRH agonists
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Leoprolide
Danocrine |
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2nd most common cancer of the female genital tract
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Endometrial cancer
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Increased age
Unopposed estrogen Obesity/nulliparity |
Endometrial cancer
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MC presenting symptom of endometrial cancer
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Irregular bleeding
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Endometrial cancer Dx
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Endometrial biopsy
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Rectal tissue bulges into vagina as a hernia
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Rectocele
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Bladder herniates into vagina
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Cystocele
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Leading cause of cancer death in women in developing countries
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Cervical cancer
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HPV that causes cervical cancer (5)
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16, 18, 31, 33, 35
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HPV that causes external lesions
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6, 11
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When to get first Pap smear
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Within 3 years of onset of sexual activity or at age 21
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Pap smears every ___ years
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Age 21-30: Every 2 years
>30: If negative for 3 years, every 3 years |
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Annual Pap Smear groups (4)
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DES exposure
HIV or immunocompromised CIN 2, CIN 3 Prior diagnosis of cervical cancer |
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When to D/C Pap smear
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Over 65 if 3 neg Paps or 10 year history of negative paps
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Contraindication of Gardasil
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Allergy to yeast
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HSIL/CIN 2 and 3 Tx
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Colposcopy
LEEP |
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Used for most cervical dysplasias
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LEEP
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Reserved for carcinoma in situ (CIN III)
Involves surgical removal of the entire transformation zone and the endocervical canal |
Cold cone
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Clear cysts
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Functional cyst (normal)
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Normal after ovulation
Typically seen in 1st trimester of pregnancy |
Corpus Luteum Cysts
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Solid, palpable mass on ovary
May or may not be painful Also called "chocolate cysts" |
Endometriomas
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Bad signs in ovarian cysts
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Opaque/solid
Mixed >5 cm Elderly with palpable ovary |
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Benign germ cell tumors
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Dermoids
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Most frequent cause of ovarian torsion
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Dermoids
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Cacifications found on ovaries on US/x-ray
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Dermoids
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Severe sudden onset of pain in pelvis usually associated wtih an ovarian mass
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Ovarian torsion
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Ovarian Torsion Tx
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US with Doppler to look for flow
Surgery to preserve function |
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Herandrogenism (hursuitism)
Anovulation Increase in LH compared to FSH Obesity Large, cystic ovaries on US (string of pearls) |
PCOS
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"String of pearls"
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PCOS
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PCOS Tx (4)
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Weight reduction
OCPs Spironolactone Metformin |
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Ovarian carcinoma Dx (3)
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Pelvic exam
Ca-125 Transvaginal US |
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Typically asymptomatic
Incidental discovery on bimanual or US Vague abdominal/GI complaints Ascites/weight loss |
Ovarian carcinoma
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Due to HPV
Prolonged irritation Nontender ulcers |
Vaginal/Vulva Cancer
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Ulcer on vagina or vulva that does not hurt
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Biopsy
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Vaginal/Vulva Cancer Dx
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Biopsy
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Normal vaginal flora
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Lactobacillus
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pH >4.5
Positive whiff Clue cells Malodorous, grey, frothy discharge |
BV
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Clue cell
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BV
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BV Tx
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Metronidazole
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Frothy, malodorous discharge
Cervical petiechiae (strawberry cervix) |
Trich
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Trich Dx
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Wet smear
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Trich Tx
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Metronidazole
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Vulvar itching
Erythema White, curdy discharge KOH shows hyphae |
Candidal vaginitis
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Strawberry cervix
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Trich
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Hyphae on KOH
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Candidal vaginitis
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Recurrent Candidal Vaginitis
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Screen for DM
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Candidal vaginitis Tx
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-conazoles
Diflucan |
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Causes of PID (4)
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GC
Chlamydia Mixed anaerobes E. coli |
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Criteria for PID Dx (7)
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Abdominal/pelvic pain
Cervical motion tenderness Adnexal tenderness PLUS Elevated ESR or positive CRP Elevated WBC Purulent discharge Temp >101 |
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PID Tx
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Cefoxitin or cefotetan PLUS Doxy
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PID Tx in pregnancy
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CLindaymcin PLUS gentamycin
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BTL and +HCG
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Ectopic pregnancy until proven otherwise
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Menopause criteria
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12 mo of amenorrhea
FSH >40 |
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Menopause Tx
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Estrogen only if no uterus
Both estrogen and progesterone if uterus |
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Where does bone demineralization occur in osteoporosis? (4)
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Trabecular bone:
Thoracic spine Hip Pelvis Wrist |
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-ronates
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Bisphosphonates
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3 bisphosphonates
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alendronate (weekly)
risedronate (weekly) ibandronate (monthly) |
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Dexa osteoporosis score
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<-2.5
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Dexa osteopenia score
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-1.0- -2.5
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Clear, fluid filled cyst in breast
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Fibrocystic breast disease
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Fibrocystic breast disease Dx
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US
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Fibrocystic breast disease Tx (3)
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Vit E
OCPs Danocrine/Lupron |
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Benign solid breast mass
Typically painless or minimally painful |
Fibroadenoma
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Most common etiology of breast lump
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Fibroadenoma
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Second most common cause of death
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Breast cancer
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Painless axillary lymph node
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Breast cancer until proven otherwise
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Breast cancer Dx
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Breast biopsy
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Bad sign on mammogram
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Calcifications
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Most common type of breast cancer
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Infiltrating intraductal carcinoma
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Most lethal type of breast cancer
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Inflammatory
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Infiltrating intraductal mass in the nipple and ducts of nipple
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Paget's disease
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Itching or burning of the nipple
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Paget's disease of breast
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Nonhealing eczematous lesion of the breast
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Paget's disease of breast
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Meds causing Galactorrhea (4)
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Psychotrophics
Cimetidine TCAs OCPs, Depoprovera |
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Bloody nipple discharge (3)
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Papilloma
Carcinoma FBD/ectasia |
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Bloody nipple discharge Dx
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Mammogram and pap smear of discharge
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Mastitis
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S. aureus
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Mastitis in nonlactating women
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Think cancer
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16-20 week OB visit
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Fundal heights
TS-AFP US |
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28 week OB visit
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GTT, H&H
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34-36 week OB visit
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Strep B screen
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+Strep B screen in pregnancy
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Start penn at time of active labor
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Bleeding or cramping with closed cervix
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Threatened abortion
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Bleeding or cramping with dilation of the cervix
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Inevitable abortion
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All products of conception have been expelled
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Complete abortion
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POC remain in uterus (bleeding 2 weeks later)
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Incomplete/Missed abortion
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Blighted ovum
Once present fetal HR at end of first trimester is gone |
Anembryonic pregnancy
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3 or more abortions in succession
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Habitual abortion
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+HCG
Spotting Unilateral pelvic pain |
Ectopic pregnancy
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Ectopic Pregnancy Tx
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Surgery
Methotrexate |
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When do you give Rhogam?
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28 weeks
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Bleeding
Hyperemesis Large for dates uterus HCG markedly high for LMP |
Molar/hydatidiform pregnancy
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Molar Pregnancy Tx
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No pregnancy for one year
Follow SHCG to zero every week, then repeat monthly for one year Methotrexate |
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Pregnancy induced HTN Tx (4)
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Methlydopa
Hydralazine Spironolactone BB (pindolol) |
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Do not use in Pregnancy induced HTN (3)
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Loops
Thiazides ACEi |
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Edema
HA RUQ pain Blurred vision |
Preeclampsia
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HTN
Proteinuria Hyperreflexia High uric acid Low S. albumin Abnormal LFTs Increased BUN/Crea |
Preeclampsia
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Eclampsia Tx
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Magnesium
Delivery |
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Hemolytic anemia
Elevated liver enzymes Low platelet count |
HELLP Syndrome
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HELLP Tx
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Delivery
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1 hour oral glucose test
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O'Sullivan
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When to screen for GDM?
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28 weeks
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GDM Tx
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Diet/exercise
Insulin |
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Most common reason for preterm delivery
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Pyelonephritis
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Leading cause of fetal M&M
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Preterm (<37 weeks) Premature rupture of membranes
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Complication of PROM
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Intrauterine infection
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Premature Rupture of the Membranes Dx
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Nitrazine (pH paper)
Fern test |
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Ferning
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Amniotic fluid
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If membranes are ruptured and patient is not in active labor
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Do not perform DE
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Single course of steroids to hasten lung maturity time period
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24-31 weeks
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Painful vaginal bleeding in pregnancy
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Abruptio placentae
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Painless vaginal bleeding in pregnancy
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Placenta praevia
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Placenta Paevia contraindications (3)
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No pelvic/cervical DE
No intercourse No vigorous exercise |
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Symmetric IUGR
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Chromosomal abnormality
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Assymetric (brain is spared) IUGR
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Pregnany induced HTN/toxemia (placenta disfunction)
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Deficiency of amniotic fluid
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Oligohydramnios
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Excess of amniotic fluid
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Polyhydramnios
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Early decelleration
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Cord compression
Have mom lie on side |
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Late decelleration
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Bad
Increased HR |
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Cervical dialation and effacement
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1st Stage of Labour
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Delivery of fetus
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2nd Stage of Labour
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Delivery of placenta
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3rd Stage of Labour
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