Term
Nausea & Vomiting
1st trimester vaginal bleeding |
|
Definition
| What are two early pregnancy problems? |
|
|
Term
Benign bleeding of early pregnancy
Threatened spontaneous abortion
Ectopic pregnancy
Gestational trophoblastic disease (GTD) |
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Definition
| What are four causes of 1st trimester vaginal bleeding? |
|
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Term
| Weeks completed since the first day of the last menstrual period, assuming ovulation and conception was on day 14 of that cycle |
|
Definition
| What does obstetrical dating measure? |
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Term
Irregular menstrual cycles
Variable timing of ovulation (cycle days 10 – 21) |
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Definition
| What are two problems with obstetrical dating? |
|
|
Term
266 days after conception (fertilization)
280 days (40 weeks) after 1st day of last menstrual period |
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Definition
| What is the average length of human pregnancy? |
|
|
Term
| Estimated date of delivery |
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Definition
| What is another term for "due date"? |
|
|
Term
First: Conception to 13 weeks
Second: 14-27 weeks
Third: 28-40 weeks |
|
Definition
| Describe trimesters by weeks |
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|
Term
|
Definition
| Common misnomer for early pregnancy nausea & vomiting |
|
|
Term
| None to severe (70-85% with some nausea) |
|
Definition
| What is the spectrum of severity for early pregnancy nausea and vomiting? |
|
|
Term
|
Definition
| Term for severe and prolonged vomiting |
|
|
Term
|
Definition
| What percentage of women experience hyperemesis gravidarum in early pregnancy? |
|
|
Term
Typically begins at 5-7 weeks gestation
Peaks at 8-10 weeks
Abates at around 12 weeks |
|
Definition
| What is the typical time course of pregnancy nausea and vomiting? |
|
|
Term
Multiple pregnancy
Prior motion sickness or migraines
Personal or family history of morning sickness
Social factors |
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Definition
| What are four risk factors for Nausea & Vomiting of Pregnancy? |
|
|
Term
| Counseling rest, avoidance of triggers, diet improvement (smaller meals especially), hydration, and anti-emetic drugs |
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Definition
| How do you treat nausea of pregnancy? |
|
|
Term
Severe dehydration
Can be life-threatening |
|
Definition
| What is the threat of Hyperemesis Gravidarum? |
|
|
Term
| First Trimester Ultrasound |
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Definition
Confirms location of gestation
Can determine viability of embryo
Can detect GTD (molar) pregnancies
Has therapeutic effects |
|
|
Term
| 15 - 20% of clinical pregnancies |
|
Definition
| How common are Spontaneous Abortions (SAB)? |
|
|
Term
|
Definition
| What is the main risk factor for spontaneous abortions? |
|
|
Term
|
Definition
| What is the risk of spontaneous abortion at age 20? |
|
|
Term
|
Definition
| What is the risk of spontaneous abortion at age 45? |
|
|
Term
|
Definition
| WHAT IS THE MAIN CAUSE OF MISCARRIAGE? |
|
|
Term
Hormone imbalances
Uterine malformations
Infections
Immunologic problems |
|
Definition
| What are four rare causes of miscarriage? |
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|
Term
Compassion & concern
Recommend rest and NPV (nothing per vagina)
Order ultrasound
Reassure/counsel appropriately
Arrange follow-up (1-2 weeks) |
|
Definition
| What is the common form of management for a threatened spontaneous abortion? |
|
|
Term
| DEATH OCCURS BEFORE THE MISCARRIAGE BY 2-6 WEEKS |
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Definition
| IN A MISCARRIAGE, WHEN DOES EMBRYO DEATH OCCUR? |
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|
Term
Intermittent bleeding/spotting
Cramping variable
6-9 weeks gestation |
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Definition
| What happens in the first phase of a miscarriage and when does it occur? |
|
|
Term
Heavy bleeding and cramps
1-3 weeks after first phase |
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Definition
| What happens in the second phase of a miscarriage and when does it occur? |
|
|
Term
Gestational sack expelled
D & C sometimes required |
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Definition
| What happens in the third phase of a miscarriage and when does it occur? |
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|
Term
|
Definition
| Where are most (95%) of ectopic pregnancies? |
|
|
Term
| Ovarian, infundibular, abdominal, tubal, cervical |
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Definition
| Where can ectopic pregnancies occur? |
|
|
Term
Previous tubal infection (salpingitis)
Prior ectopic pregnancy
Prior tubal sterilization
IUD (intrauterine device) in situ
Cigarette smoking |
|
Definition
| What are 5 Ectopic Pregnancy Risk Factors? |
|
|
Term
| 50% (mostly just bad luck) |
|
Definition
| What percentage of ectopic pregnancy patients will have at least one risk factor? |
|
|
Term
| Vaginal bleeding at 6-10 weeks with pelvic pain (mild at first, but severe when pregnancy ruptures surrounding tissue) |
|
Definition
| What are the first two signs of an ectopic pregnancy? |
|
|
Term
|
Definition
| What will the serum pregnancy test (HCG) show in an ectopic pregnancy? |
|
|
Term
|
Definition
| WHAT IS ESSENTIAL IN DIAGNOSING AN ECTOPIC PREGNANCY? |
|
|
Term
| MAKE THE DIAGNOSIS BEFORE THE RUPTURE |
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Definition
| WHAT IS CRUCIAL IN ECTOPIC PREGNANCY FOR THE HEALTHCARE PROVIDER? |
|
|
Term
Massive intraabdominal blood loss
Severe pain and/or syncope
Emergency transport |
|
Definition
| What is the distinctive presentation of a ruptured ectopic? |
|
|
Term
|
Definition
| When do most ectopics rupture? |
|
|
Term
Surgery - salpingectomy (removal of affected tube)
Blood transfusions |
|
Definition
| How do you treat a ruptured ectopic? |
|
|
Term
Chemotherapy - methotrexate single dose with a close follow up
If that doesn't work surgery |
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Definition
| How do you treat a unruptured ectopic? |
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|
Term
HYDATIDIFORM MOLE
CHORIOCARCINOMA |
|
Definition
| WHAT ARE THE TWO TYPES OF GESTATIONAL TROPHOBLASTIC DISEASE? |
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|
Term
|
Definition
| What is the most common form of gestational trophoblastic disease? |
|
|
Term
|
Definition
| What is a Hydatidiform Mole? |
|
|
Term
Absent embryo
Very high HCG levels |
|
Definition
| How will a hydatidiform mole present? |
|
|
Term
Evacuate the uterus
Monitor HCG levels for one year |
|
Definition
| How do you treat a hydatidiform mole? |
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|
Term
Supine hypotension
Hypertensive syndromes
Placental disorders
Premature labor |
|
Definition
| What are the four major late pregnancy problems? |
|
|
Term
In a normal pregnancy after 20 weeks…
When the woman lies flat on her back on a firm surface…
The gravid uterus can compress her vena cava which…
Reduces blood return to the heart which…
Reduces cardiac output drastically
Anxiety, sympathetic discharge and syncope can result! |
|
Definition
| Describe Supine Hypotension Syndrome |
|
|
Term
| Roll her on her side you idiot |
|
Definition
| How do you treat Supine Hypotension Syndrome? |
|
|
Term
|
Definition
| What is the percentage of chronic hypertension in pregnancy? |
|
|
Term
| Antihypertensive drugs, but some drugs are contraindicated in pregnancy so you'll have to make some changes |
|
Definition
| How do you manage chronic hypertension in pregnancy? |
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|
Term
Gestational hypertension
Preeclampsia-eclampsia
Superimposed preeclampsia
Preeclampsia-eclampsia is most important |
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Definition
| What are the three types of pregnancy induced hypertension? What is the most important to us? |
|
|
Term
Hypertension (BP >140/90) and…
Proteinuria |
|
Definition
| How do you diagnose preeclampsia? |
|
|
Term
| Mild or severe (no middle ground) |
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Definition
| What are the two types of Preeclampsia? |
|
|
Term
Maternal
Seizures (eclampsia)
Stroke, renal failure, death
Fetal:
Poor growth
Intrauterine death |
|
Definition
| What are the potential complications for Preeclampsia for maternal and fetus? |
|
|
Term
|
Definition
| Preeclampsia with grand mal seizure(s) |
|
|
Term
Prevent eclampsia (bed rest, MgSO4)
Deliver if > 37 weeks
Hospitalize if <37 weeks |
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Definition
| How do you treat mild preeclampsia? |
|
|
Term
Prevent eclampsia
Deliver regardless of gestational age
Delay 24-48 hrs for steroids if <34 wks |
|
Definition
| How do you treat severe preeclampsia? |
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|
Term
|
Definition
| What is the ultimate cure of preeclampsia? |
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|
Term
PLACENTA PREVIA
ABRUPTIO PLACENTA
BOTH PRESENT AS THIRD TRIMESTER VAGINAL BLEEDING |
|
Definition
| WHAT ARE THE TWO PLACENTAL PROBLEMS AND WHAT DO THEY NORMALLY PRESENT AS? |
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|
Term
|
Definition
| placenta has implanted low in the uterus over the cervical canal |
|
|
Term
Uterine scar (C-section)
Hypoperfused endometrium (age, multipartiy)
Enlarged placenta (multiple pregnancy) |
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Definition
| What are risk factors for Placenta Previa? |
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|
Term
| PAINLESS 3RD TRIMESTER VAGINAL BLEEDING |
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Definition
| WHAT IS THE KEY SYMPTOM IN A PREVIA? |
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|
Term
Total - completely over the canal
Partial - partially over the canal
Low lying - not over the canal, but close (lower than usual |
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Definition
| What types of previa are there? |
|
|
Term
Delivery
If total - c section
If partial - vaginal delivery maybe possible
If low lying - vaginal delivery usually possible |
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Definition
|
|
Term
|
Definition
| PREMATURE SEPARATION OF THE PLACENTA |
|
|
Term
| PAINFUL 3RD TRIMESTER VAGINAL BLEEDING |
|
Definition
| WHAT IS THE KEY SYMPTOM IN A ABRUPTIO PLACENTA |
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|
Term
|
Definition
| How is abruption treated? |
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|
Term
|
Definition
| WHAT IS THE MOST IMPORTANT CAUSE OF NEONATAL DEATHS AND MORBIDITY? |
|
|
Term
| labor between 21 -36 weeks |
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Definition
| How is premature labor defined? |
|
|
Term
Prior preterm labor
Multiple gestation
African-Americans
Low socioeconomic status |
|
Definition
| What are the four major preterm labor risk factors? |
|
|
Term
Reduce risk factors
Speed fetal lung maturation with glucocorticoid therapy
Tocolysis to delay delivery 1-2 days |
|
Definition
| What are the treatment goals of preterm labor? |
|
|
Term
| Stimulates maturation of fetal lungs, results in increase of surfactant production |
|
Definition
| When given to the mom with fetuses <34 weeks gestation, what do glucocorticoids do? |
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|
Term
|
Definition
| Endometrial glands and stroma outside the uterus |
|
|
Term
3-10% of women aged 20-44
More common in infertile women |
|
Definition
| How common is endometriosis overall? What factor makes it more common? |
|
|
Term
May be none
Pelvic pain
Dysmenorrhea
Dyspareunia
Constant deep seated pelvic and/or rectal pain
Infertility in advanced cases |
|
Definition
| Symptoms of endometriosis |
|
|
Term
| VISUALIZE THE LESIONS (laparoscopy, open surgery) |
|
Definition
| HOW DO YOU DIAGNOSE ENDOMETRIOSIS? |
|
|
Term
Benign variant
Aggressive variant |
|
Definition
| What are the two severity types of endometriosis? |
|
|
Term
Later age onset (>30)
Lesions superficial
Progression slow |
|
Definition
| What are the key features of the benign variant of endometriosis? |
|
|
Term
Early onset (<25)
Invasive lesions
Rapid progression |
|
Definition
| What are the key features of the aggressive variant of endometriosis? |
|
|
Term
|
Definition
| What is the most common cause of endometriosis? |
|
|
Term
|
Definition
| How do you treat mild or benign endometriosis? |
|
|
Term
Surgery through the laproscope, destruction of the endometriosis implants
Ovarian suppression |
|
Definition
| How do you treat more significant or aggressive endometriosis? |
|
|
Term
| removal of uterus (hysterectomy) and both ovaries (oophorectomy) |
|
Definition
| How would you treat a person who has had longstanding and severe endometriosis? |
|
|
Term
| Uterine Leiomyoma (“Fibroids”) |
|
Definition
| Benign tumor(s) of uterine smooth muscle |
|
|
Term
|
Definition
| WHAT ARE THE KEY FACTORS RELATED TO THE SYMPTOMS OF UTERINE LEIOMYOMA (FIBROIDS)? |
|
|
Term
| VERY COMMON (40-50% OF WOMEN BY AGE 50) |
|
Definition
|
|
Term
Heavy menstrual bleeding (menorrhagia)
Abdominal & pelvic pressure discomfort or pain
Painful menstrual periods (dysmenorrhea)
Acute abdominal pain |
|
Definition
| What are four major fibroid symptoms? |
|
|
Term
| Estrogen (after menopause, most fibroids shrink and nearly go away) |
|
Definition
| What are fibroids dependent on? |
|
|
Term
Maybe nothing (expectant management)
Medical treatment (estrogen reduction or block, anti-progesterone therapy)
Radiologic embolization
Surgery |
|
Definition
| What is the treatment of fibroids? |
|
|
Term
|
Definition
| Type of ovarian cyst that is very common, results from an ovulation abnormality, and usually spontaneously regresses |
|
|
Term
| Polycystic Ovarian Syndrome (PCOS) |
|
Definition
| Type of ovarian cyst that is caused by Chronic anovulation (failure of ovulation) with excessive ovarian androgen production |
|
|
Term
Reduce androgens & manage oligo-amenorrhea
Treat metabolic abnormalities
Restore fertility by inducing ovulation |
|
Definition
| How do you treat Polycystic Ovarian Syndrome (PCOS)? |
|
|
Term
|
Definition
| Type of ovarian cyst that is very common, can reach large sizes and weight, and looks malignant but is not |
|
|
Term
| GROWTH OF AN UNFERTILIZED EGG |
|
Definition
| WHAT CAUSES A BENIGN CYSTIC TERATOMA? |
|
|
Term
Ultrasound to diagnose
Surgical excision to treat |
|
Definition
| How do you usually diagnose and treat a benign cystic teratoma? |
|
|
Term
|
Definition
| Type of ovarian cyst whose cause is unknown and causes discomfort, bloating, mass, and GI disturbances |
|
|
Term
|
Definition
| How do you treat Cystadenomas? |
|
|
Term
|
Definition
| What is the special risk for all types of ovarian cysts? |
|
|
Term
Acute onset of severe pain
Often with associated nausea/vomiting |
|
Definition
| What are the symptoms of ovarian torsion? |
|
|
Term
| Ultrasound followed by laparoscopy |
|
Definition
| How do you diagnose ovarian torsion? |
|
|
Term
| Surgery to untwist the cyst |
|
Definition
| How do you treat ovarian torsion? |
|
|
Term
| The risk of getting breast cancer steadily rises with age. It is rare before 40 |
|
Definition
| How is breast cancer linked with age? |
|
|
Term
Age
Estrogen
Genetics
Environment |
|
Definition
| What factors contribute to the risk of breast cancer? |
|
|
Term
|
Definition
| WHAT IS THE LIFETIME RISK OF BREAST CANCER IF YOU TEST POSITIVE FOR BRCA 1 OR 2? |
|
|
Term
|
Definition
| WHAT IS THE USUAL PRESENTATION OF BREAST CANCER? |
|
|
Term
| Mammography (proven value for women aged 50-70) |
|
Definition
| What is the best screening technique for breast cancer currently? |
|
|
Term
Surgery (mastectomy or "lumpectomy")
Radiation
Cytotoxic Drugs (chemo)
Endocrine modulation (anti-estrogen)
Immune modualtion (antibody against epidermal growth factor receptor) |
|
Definition
| How do you treat breast cancer? |
|
|
Term
| It commonly has late recurrence after 5 years, depends on the severity |
|
Definition
| Describe breast cancer prognosis |
|
|
Term
PREGNANCY
ORAL CONTRACEPTIVE USE |
|
Definition
| WHAT FACTORS REDUCE THE RISK OF OVARIAN CANCER? |
|
|
Term
Age
Genetic: familial, BRCA-1&2, Ashkenazi
High fat diet, PCOS |
|
Definition
| What factors increase the risk of ovarian cancer? |
|
|
Term
Epithelial origin
Germ cell origin
Stromal/sex cord origin
EPITHELIAL |
|
Definition
| What are the three ovarian cancer origins? What is the most common |
|
|
Term
| Surgery followed by chemotherapy |
|
Definition
| What is the treatment for ovarian cancer treatment? |
|
|
Term
| Good if caught early, but it is rarely caught before symtomatic |
|
Definition
| What is the prognosis of ovarian cancer? |
|
|
Term
| HUMAN PAPILLOMAVIRUS (HPV) |
|
Definition
| WHAT IS THE MAIN CAUSE OF CERVICAL CANCER? |
|
|
Term
|
Definition
| How do you prevent cervical cancer? |
|
|
Term
Conventional Pap smear
Liquid-based medium (ThinPrep) (becoming method of choice)
HPV testing |
|
Definition
| How do you screen for cervical cancer? |
|
|
Term
Radical hysterectomy and lymph node dissection
Radiation therapy
Chemotherapy (adjunctive) |
|
Definition
| How do you treat cervical cancer? |
|
|
Term
Estrogen exposure
Insufficient progesterone
Genetic factors |
|
Definition
| What increases the risk of endometrial cancer? |
|
|
Term
Oral contraceptive use
Progestin use |
|
Definition
| What decreases the risk of endometrial cancer? |
|
|
Term
OVARIAN CANCER
ENDOMETRIAL CANCER |
|
Definition
| WHAT TWO TYPES OF CANCER HAVE REDUCED RISK OF INCIDENCE IF THE WOMAN IS TAKING ORAL CONTRACEPTIVES? |
|
|
Term
|
Definition
| WHAT IS THE MOST COMMON SYMPTOM OF ENDOMETRIAL CANCER |
|
|
Term
| Ultrasound (thickness of the wall easily distinguished) |
|
Definition
| What is a valuable diagnostic tool for endometrial cancer? |
|
|
Term
| Radiation therapy, surgery, hormonal (progestins and anti-estrogens), chemotherapy |
|
Definition
| How do you treat endometrial cancer? |
|
|
Term
|
Definition
| Cessation of menses for 6-12 months preceded by the "climacteric" |
|
|
Term
Genetics
Smoking history
Body mass index |
|
Definition
| What factors affect the age of onset of menopause? |
|
|
Term
| OVARIAN EGG SUPPLY REACHES ZERO |
|
Definition
| WHAT IS THE KEY TRIGGERING EVENT OF MENOPAUSE? |
|
|
Term
| ESTROGEN (ESTRADIAL) PRODUCTION DECREASES DRAMATICALLY |
|
Definition
| WHAT IS THE KEY CONSEQUENCE OF MENOPAUSE? |
|
|
Term
Amenorrhea
Vasomotor flushes (“hot flashes”, “hot flushes”)
Decreased vaginal lubrication
Reduced pelvic support for bladder & uterus
Accelerated calcium loss |
|
Definition
| What are the five main symptoms of menopause? |
|
|
Term
| First 3-5 years after menopause (usually gradually declines thereafter? |
|
Definition
| When is the peak incidence of the hot flush symptom of menopause? |
|
|
Term
|
Definition
| What has the greatest efficacy in vasomotor flush treatment? |
|
|
Term
Increased risk of cardiovascular incidents (maybe)
Increase in breast cancer risk
Increase in DVT's |
|
Definition
| What are the problems some studies have found with HRT (hormone replacement therapy, estrogen replacement) |
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|
