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73 Cards in this Set
- Front
- Back
normal rate of dilation in nullparous woman in active phase?
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1.2CM/HR = should take 4-12 hrs to dilate last 6 cm's
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how long does it take to call a labor arrested in active phase?
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if >2 hrs in active phase with no progression
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what is ädequate amt of montevideo units / 10 mins?
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"200"although this usually means around 4-5 contractions while adequate # contractions should be anywhere form 2-6
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what type pelvis predisposes baby to posterior occiput position?
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anthropoid
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some progress during active phase but less than the expected (at least 1.2 cm/hr for nulliparious or 1.5cm/hr for multiparous
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= protracted active phase
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how to differentiate bloody show from antepartum bleeding?
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bloody show has thick mucus mixed in with it
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arrested active phase with decreased contractions, tx? with adequate contractions, tx?
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1) tx with oxytocin
2) tx with CS |
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Any woman 7 weeks pregnant with lower abd px and vaginal spotting should be considered what?
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consider an ectopic pregnancy until otherwise proven!!
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what is a risk factor for ectopic preg?
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std's, PID,
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what is threshold after which transvag US may reveal intrauterine gestation?
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when hCG is at least 1500
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IF nothing found on US , AND bHCG levels are below threshold, how determine if normal uterine pregnancy vs abnormal (ectopic) pregnancy?
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check bHCG then check again 48hrs later. If rises by 66% - normal uterine. if rises <20% =she most likely has abnormal pregnancy
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what are best tools for evaluating a possible ectopic preg?
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bHCG (if < 66% rise in 48hrs) and US
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definition of threatened abortion?
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vag spotting (not heavy bleeding = either inevitable or compltee/incomplete abortion) in ist 1/2 of preg
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where is bhcg secreted from?
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chorionic villi
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If intrauterin pregnancy is not seen on US but bHCG levels are over 1500, what is probable?
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ectopic pregnancy
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viable vs non-viable pregnancy using progesterone measurement?
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prog > 25ng/mL =viable
<5ng/mL = non-viable |
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prog <5ng/mL . NSIM?
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Could be ectopic preg or abnmormal preg. Do uterine curettage to assess if pt has a miscarriage (c villi seen) or ectopic preg (no c villi seen).
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if <3.5 cm ectopic preg, tx?
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IM MTX
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NSIM of determined non-viable uterine (not ectopic) pregnancy
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Either:
1) wait 2) D & C 3) Misoprostol (PGE1) |
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effectivity of misoprostol in evacuating uterine miscarriage?
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80%!!
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tx for chlamydia?
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azithromycin (siongle dose),
doxycycline or if with NG, give ceftriaxone |
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tx for bact vaginosis?
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metronidazole
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numerous keratotic papllary fernlike or flat lesions/ processes on surface of labia?
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venereal warts = condylomata acuminata = assoc with HPFV 6, 11
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type of hpv assoc with dysplasia/ scc?
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16, 18
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tx for NG std?
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ceftriaxone
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condylomata lata seen in ?
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secondary syphilis
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tx for trichomonas vaginalis?
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metronidazole for both partners!!
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dysplasia of vulva with HPV 16 association?
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VIN (similar to CIN)
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red, crusted vulvar lesion with PAS positive cells and intraepithelial adenocarcinoma on pathology?
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extra mammary Paget's disease = intraepithelial adenocarc
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red, crusted vulvar lesion with PAS negative cells
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malignant melanoma
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vaginitis with strawberry cervix and firey red vaginal mucosa and greenish, frothy discharge?
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trichomonas vaginalis
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absence of upper vag and uterus and primary amenorrhea?
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RKH
Rokitansky Kuster Hauser syndrome |
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cyst on lateral wall of vag
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Gartner's duct cyst
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DES effects?
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inhibited mullerian differentiation of structures (tubes, ut, cerv, upper third of vag)
adenosis = ridge in upper portion of vag = precursor for clear cell carc |
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DES associated cancer?
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clear cell cancer of upper vag or cervix
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cervical os incompetence caused by exposure to what drug?
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DES
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VIN may progress to what?
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vaginal sq cell carc
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what is primary source of chlamydial conjunctivitis and pneumonia in newborns?
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mother's chlamydial CERVICITIS
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order of management of cervical tests?
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Do pap smear; if visual lesion - do bx
do cytology on rest: if pap +, if high grade = do culposcopy + acetic acid...then if see white patch, do excisional bx and check for borders...if clear, f/u in 6 mo. if + pap smear shows low grade = just observe, w/ f/u later to check for remission (90%) |
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is a cervical polyp seen protruding from cerv os, and causing post-coital bleeding, precancerous?
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no
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pathological sign of hpv infection of sq cells?
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koilocytosis (clear halo containing a wriniled, pyknotic nucleus
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rf's for CIN / cerv cxr?
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MOLESH
Multiple high risk partners OCP's Lack of Immune system (AIDS) Early age intercourse Smoking (synergistic effect) High risk HPV (16, 18) in bx |
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avg age of cervical cxr (notCIN)
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45
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What age/how often to do pap smear?
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from age 21 or 3 yrs after init of sex intercourse, then every year. until age 30 then if 3 consecutive neg results, don't need anymore
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m/c gynecological cxrs in order?
Mortality? |
EOC = m/c
endom ov cerv OEC = mort |
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m/c cause of death in cerv cxr?
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RENAL FAILURE: post renal azotemia from spread to ureters and obstruction of ureteres causing renal failure; uremia
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why are l/n's not included in staging of cervical cxr?
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b/c classification is clinical, not surgical
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classif of cerv cxr?
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Ia1,2 = microscopic inv
Ib1,2 = macroscopic II a, b = to vag but not beyond III a to lower 1/3 of vag b to pelvic wall IV mets; or invasion to baldder, rectum |
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tx of stages?
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IA1 = simple hyster
IA2 - IIA = rad hyst + chemo/rad IIB-IV = chemo/rad only |
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pap smear f/u timeline for CIN? cerv dysplasia tx?
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6mo; if dysplasia tx'd, f/u is in 3 mo
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ages to give gardasil
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9-26
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20% of cervical cxrs are?
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adenocarcinomas = arise in endocervical glands
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mean age of menarche?
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12.8 yrs
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in the ovary, how is estradiol synthesized?
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from testosterone released from theca cells -> aromatase in granulosa cells turns it into estradiol
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what causes LH surge?
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estrogen surge occuring 24-36 hours before ovul induces POSITIVE feedback to LH, neg to FSH = LH surge
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2 phases in menstrual cycle?
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prolif phase = estrogen mediated
secretory phase= prog mediated |
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endom bx confirming ovulation?
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on DAY 21 = secretory endometrial cells seen
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pregnancy endometrium? menses endometrium?
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preg =exaggerated secretory phase
menses= apoptosis, |
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LH fxn in prolif phase? in secr phase?
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increases 17 Ketosteroids (DHEA and androstenedione) synth which ultimately increases estradiol;
in sec phase = increases 17-OH progesterone |
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where is HCG synthed? what are chagnes it causes in pregnancy?
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in syncytiotrophoblast lining the chor villus; acts as LH analogue by maintinaing corpus luteum --> corp luteum in turn synth's progesteron for 8-10 weeks after fert, then involutes and PLACENTA takes over synthing HCG
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estrogen inhibits what/ prog inhibits what?
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e -- FSH
p -- LH |
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how do OCP's work( 2) ?
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1) baseline levels of est prevent estrogen surge = no LH surge;
2) progesterone arrest prolif stage (first stage) and cause gland atrophy; they also inhibit LH and help prevent LH surge - overall, render cerv mucus hostile to sperm and decr ftube motility |
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type of est produced in menopause?
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estrone = comes from ADRENAL cortex's androstendione aromatization in adipose cells (as opposed to premenopause = est made from DHEA/ androstendione made in theca cells of ovary and converted to estradiol by aromatase in granulosa cells)
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estrogen of pregnancy? where is it primarily made from?
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estriol; made from fetal adrenal, placental, and maternal liver!
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what kid changes in normal preg?
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increased bvol = increased GFR = increased Cre clearance (so Cr serum are lower limit of normal)
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what norm changes in thyroxine/cortisol in preg?
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TBG and transcortin (the binding proteins) are INCREASED so total serum thyroxine and cortisol are increased but FREE = stays the same so no clinical signs of overactivity
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fsh and lh levels in menopause?
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since est and prog are decreasing due to ov fxn decrease, FSH and LH are increased
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PCOS pathophys?
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increased pit synth of LH and decr synth of FSH --> increased estrogen prod --> neg feedback on fsh, pos on LH--> suppressed FSH = follicle degeneration and cyst formation
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clinical sx of pcos?
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oligomenorrhea / amenorrhea (M/C),
hirsutism, infertility, obesity |
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other causes of hirsutism besides PCOS?
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1 obesity, hypothyroidism = due to decr shbg synth = incr free testost
2 Ovarian tumors = incr androgen synth 3 adrenogenital and cushing syndrom |
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m/c causes of abnormal bleeding by age groups?
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(of course, always r/o pregnancy)
prepuberty - vulvovaginitis, std, foreign body menarche - 20 = anovulatory DUB, VWdisease 20-40 = Ovulatory DUB (inadequate lut phase; irreg shedding of endom), PID, hypoth, leiomyomas, adenomyosis, endom polyp, endometriosis 40+ = endom cxr!!!, or hyperplasia |
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ddx of amenorrhea?
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constit delay (m/c cause of primary)
*hypothal/pit disorder *ovar disorder *end-organ defect ie imperf ymen, RKH syndrome Asherman syndrome, *= these have NO w/drawla bleeding after progestin stim b/c endom is not pre- estrogen stimulated, or b/c end organ defect prevents the normal egress of blood |
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what are the only 2 types of amenorrhea that would cause a positive w/drawla bleeding test with progestin challenge?
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MILD hypoth dysfxn
and PCOS all the rest cause neg w/drawal bleeding test, including severe hypoth dysfxn |