Term
| what are the 5 major types of tests for chromosomal abnormalities in prenatal care |
|
Definition
1. quad screen
2. amniocentesis
3. papaa + nuchal thickness
4. cell free dna
5. chorionic villus sampling |
|
|
Term
| when can you complete each of the 5 tests for chromosomal abnormalities |
|
Definition
1. nuchal transluc +papaa+hcg in first tri
2. cell free fetal dna 9wks on
3. cvs 10-13 weeks
4. amnio 15-20weeks
5. quad 15-20weeks |
|
|
Term
| which test is the gold standard for chromosomal abn |
|
Definition
|
|
Term
| what are the 2 types of chorionic villus sampling, main diff twix the 2 |
|
Definition
transabdominal
transcervical has a higher risk of miscarriage (.5-5%) |
|
|
Term
| whats the main problem with cell free dna testing even tho its the least invasive |
|
Definition
it is ONLY screening
NOT recommended in anyone who is not at high risk
false +s |
|
|
Term
| whats the diff twix quad screen and papaa/hcg/nuchal |
|
Definition
| they are equivalent in accuracy. however the papaa/hcg/nuchal test can be completed 11-14 weeks where as quad screen has to wait until 15-20 weeks |
|
|
Term
| which women should be screened for chromosomal abnormalities, what tests offered? |
|
Definition
| all women should be offered. those that are older or at high risk should be really encouraged to get it. start with either the quad or papaa/hcg/nuchal |
|
|
Term
| what are the quad results in a pt with pregnancy with downs |
|
Definition
| elevated hcg, elevated inhibin, low afp, low estriol |
|
|
Term
| what are the results of the quad screen in people with pregnancy with turners |
|
Definition
| same as downs, elevated hcg and elevated inhibin (usually even more elevated than downs) |
|
|
Term
| what are the results of the quad screen in pts whos pregnancy has Edwards syndrome |
|
Definition
| LOW hcg, LOW estriol, normal everything else |
|
|
Term
| what are the results of the quad screen in a woman whos pregnancy has pataus |
|
Definition
|
|
Term
| def of abnormal uterine bleeding |
|
Definition
| cycle <21 days or more than 35 days |
|
|
Term
| management of abnormal uterine bleeding post menopausal |
|
Definition
1. physical exam/risk for cervical cancer
2. if they have a hx of any hormonal use in last year, obs them for another year
3. if they have not used hormones in last year, do a D&C.
4. if DC is normal try to tx with hormones, if it still bleeds do hysteroscopy with biopsy |
|
|
Term
| if someone has abnormal uterine bleeding, what is your chain of investigation |
|
Definition
1. pregnancy
2. iatrogenic/med causes
3. systemic causes
4. genital tract pathology |
|
|
Term
| what are the 3 possible outcomes with abnormal uterine bleeding and + preg test |
|
Definition
1. normal preg
2. ectopic
3. trophoblastic disease |
|
|
Term
| main iatrogenic causes of abnormal uterine bleeding? |
|
Definition
meds:
1. hormones, IUDs, tamoxifen
2. antipsychotics, ssris
3. anticoagulants
4. steroids
5. herbals |
|
|
Term
| what are the main systemic causes of abnormal uterine bleeding |
|
Definition
1. endocrine: TSH, Cushings, CAH, PRL/pituitary adenoma, PCOS, hypothalamic suppression
2. liver disease (causing coag)or kidney disease
3 coagulopathy |
|
|
Term
| what is hypothalamic suppression |
|
Definition
| happens 2/2 stress, weight loss, anorexia, exercise |
|
|
Term
| what are the genital tract pathology causes of abnormal uterine bleeding? |
|
Definition
(think going up the whole tract)
1. cervical dysplasia
2. cervicitis/endometritis (infection)
3. endocervical polyps
4. uterine fibroids, endometrial cancers
5. ectopic/tubal preg
6. ovarian tumors |
|
|
Term
| who is at high risk for endometrial cancers |
|
Definition
obese
nulips
endometrial hyperplasia
over 35
tamoxifen use
anovulation |
|
|
Term
| test for endometrial cancer |
|
Definition
| transvag u/s to look for thickened endometrial stripe |
|
|
Term
| normal endometrial stripe thickness and management of thickened stripe |
|
Definition
<5mm is ok
>5mm : hysteroscopy with biopsy |
|
|
Term
| so after you've ruled out pregnancy, iatrogenic and systemic causes of abnormal uterine bleedings what are the first tests you do to look at genital tract lesions |
|
Definition
1. pelvic/pap/gc/chlam to look for cervical lesions and infection
2. bimanual to look for enlarged uterus and ovaries...maybe need u/s |
|
|
Term
| if you've ruled out preg, iatrogenic causes, systemic causes of abnormal uterine bleeding. your cervical exam is normal (r/o cerv cancer, cervicitis etc) and you don't see enlarged uterus or adnexa...what do you do next? |
|
Definition
now you have a dx of DUB
-if pt is at low risk for endometrial cancer you can do trial of hormones to see if that helps
-if pt is high risk for endometrial ca do biopsy |
|
|
Term
| triad of cholestasis of pregnancy |
|
Definition
-bile salt elevated
-elevated LFT
-pruritis |
|
|
Term
| #1 and #2 tx for mastitis |
|
Definition
|
|
Term
| what is the active compound in nexplanon and how many years does it last |
|
Definition
etonogestrel (progesterone ONLY)
and 3 years |
|
|
