**Repro Blueprints A USMLE 2

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Definition: child at fertilization to 8 weeks: Embryo
Definition: child at 8 weeks to delivery: Fetus
Definition: Softening and cyanosis of the cervix at or after 4 weeks: Goodell's sign
Definition: softening of the uterus (after 6 weeks): Ladin's sign
Definition: first trimester: fertilization to 12 weeks
Definition: second trimester: 12 weeks to 24 weeks
Definition: third trimester: 24 weeks to delivery
Definition: child delivery less then 24 weeks: Priviable
Definition: Quickening: Patient's initial presentation of fetal movement
what are the changes in CO, HR, SV, TPR and BP during pregnancy?: Inc CO, HR, SV

Dec TPR,

Dec BP (returns to nml >24 weeks)
(4) Respiratory changes during pregnancy: Inc Tidal volume,

Inc PaO2 and PAO2,

Dec lung capacity,

Mild Respiratory Alkalosis
(3) GI changes during pregnancy: Inc vomiting,

Dec motility (constipation),

Prolonged gastric emptying (GERD)
(4) Renal changes during pregnancy: Inc kidney size,

Inc GFR (by 50%) leading to...

Dec BUN and Creatinine by 25%,

Inc Renin, Aldosterone and Na absorption
(balanced by Inc GFR)
(4) Blood changes during pregnancy: Inc plasma volume (50%),

Inc RBC (20%),

both percents lead to Dec Hct,
possibly causing Iron deficiency anemia,

Inc Fibrinogen and factors VII - X leading to...
Inc Thromboembolism
what hormones are maintained by the placenta in pregnancy? (4): Estrogen,

hCG,

hPL,

Progesterone (after initial maintenance from corpus luteum)
what causes increased Thyroid Binding Globulin? how does this affect T3 and T4?: Inc estrogen

T3 and T4 inc binding to TBG leading to low serum levels of free T3 and T4
what is the cause of gestational diabetes? how?: hPL

it is an insulin antagoinist
(inc diabetic effect and leading to inc insulin and protein synthesis)
what is the adequate amount of nutrition needed in pregnancy? breast feeding?: Pregnancy: 300 kcal/day

Breast feeding: 500 kcal/day
how often should prenatal visits be?: every 4 weeks until week 28

week 28 - 36: every 2 weeks,

36 to term: every week
when is genetic screening done? what are the (3) main tests?: during second trimester
(usu 15 - 20 weeks)

MSAFP,

b-hCG,

Estriol
which germ cell ovarian tumor has a different treatment method then the others? what is the Tx?: Dysgerminoma

Tx:
Radiation
what is tested in pregnancy b/t 27 and 29 weeks? (3): Glucose Loading Test (for gestational diabetes),

Hematocrit (for iron levels),

Glucose Tolerance Test if GLT is positive
how is the Glucose Loading Test performed? (2): give 50g oral glucose and check in one hour

if > 140 mg/dL, then do GTT
How is a Glucose Tolerance Test performed? What are the blood glucose values for fasting, one, two and three hour intervals?: Fasting glucose:

give 100 g oral glucose and test at 1, 2 and 3 hours

Gestational Diabetes =
Fasting glucose > 105 mg/dL
or
any two values over 180, 155 or 140 respectively
what can dehydration lead to later in pregnancy?: Braxton-Hicks contractions
what causes edema of lower extremities, feet and ankles, and hemorrhoids in pregnancy? Tx?: Compression of IVC and pelvic veins

Tx:
elevating feet
what is the best test for fetal lung maturity? normal levels?: Lecithin/Sphingomyelin ratio

nml > 2
describe a positive Non-Stress Test: 2 increases in FHR in 20 min that are >15 beats above nml and for >15 seconds
describe a positive Oxytocin Challenge Test: 3 contractions in 10 minutes
(5)* categories of the Biophysical Profiles: Test the Baby MAN!:

Fetal Tone,
Fetal Breathing,
Fetal Movement,
Amniotic Fluid volume,
NST

(zero or 2 points each; nml is 8 - 10)
Definition: multiple gestation w/ at least one IUP and at least one ectopic: Heterotrophic Pregnancy
at what b-hCG levels should you detect an IUP on vaginal US?: IUP should be seen on US w/ b-hCG of
1500 â€“ 2000 mIU/mL
at what b-hCG levels should you detect a fetal heartbeat w/ trans-abdominal US?: Fetal heartbeat should be seen w/ b-hCG > 5000 mIU/mL
Tx for Ruptured Ectopic: Exploratory Lap

(and maintain fluid levels)
what hormone best resembles b-hCG? how?: LH

they also have similar beta units
(in addition to similar alpha)
what is the criteria to use Methotrexate for an ectopic? (2): ectopic must be < 3.5 cm,

w/o heartbeat
what is the progesterone level in a nonviable intra- or extra-uterine pregnency?: < 5 ng/mL
what is the progesterone level in 98% of intrauterine pregnancies?: > 25 ng/mL
what does G5P2124 indicate?: Twins
Definition: Spontaneous abortion time: pregnancy ending < 20 weeks
Type of Abortion: any IU bleeding < 20 weeks w/o dilation or expulsion of POC: Threatened abortion
Type of Abortion: death of embryo of fetus < 20 weeks w/ complete retention of POC (usu leads to complete SAB): Missed abortion
Type of Abortion: no expulsion of POC, but bleeding and dilation of cervix such that viability is unlikely: Inevitable abortion
(2) ways an incomplete abortion can be taken to completion in first trimester: D&C

Prostaglandins (Misoprotol)
causes of abortion in second trimester (4): Congenital abnormalities

cervical / uterine abnormalities,

trauma,

systemic Dz or infection
(3) ways an incomplete abortion can be taken to completion in second trimester: D&E,

Prostaglandins (Misoprostol),

Oxytocin at high doses
Definition: Painless dilation leading to infection, Preterm Premature Rupture of Membranes (PPROM) or PTL: Incomplete cervix
what should be done if patient is in first trimester and has a history of incomplete cervix? when?: Cerclage

12 - 14 weeks
(3) tests to verify if patient has ruptured membranes: Pool - collection of fluid in vagina

Nitrazine - turns blue (alkaline)

Ferning
Definition: Rupture of membranes > 1 hour before onset of labor: Premature Rupture of Membranes
(PROM)
(5) parts of a Bishop score: Dilation,

Effacement,

Station,

Cervical consistency,

Cervical position
Bishop score points zero - 3 for: Dilation: zero: Closed

1 point: 1 - 2

2 points: 3 - 4

3 points: > 5
Bishop score points zero - 3 for: Effacement: zero: 0 - 30%

1 point: 40 - 50%

2 points: 60 - 70%

3 points: > 80%
Bishop score points zero - 3 for: Station: zero: -3

1 point: -2

2 points: -1 to zero

3 points: +1 - +3
Bishop score points zero - 3 for: Cervical consistency: zero: Firm

1 point: Medium

2 points: Soft

3 points: (none)
Bishop score points zero - 3 for: Cervical position: zero: Posterior

1 point: Mid

2 points: Anterior

3 points: (none)
Definition: Lengthening (thinning) of the cervix: Effacement
Definition: relationship of fetal occiput to maternal pelvis: Fetal Position
(4) ways to Induce labor: Pitocin,

Prostaglandins (Cervadil or Misoprostol),

Mechanical dilation of cervix,

Rupture of membranes (Amniotomy)
MC 4 steps to Augment and monitor labor progress: water broke?
if not -> Amniotomy

change?
if not -> IUPC

change?
if not -> Pitocin

change?
if not -> C-section
what does an IUPC measure with respect to contractions? (2): 1. Time of contraction

2. Strength of contractions
Name the (6)* movements of labor in order and what each means: Engagement - biparietal diameter (largest) part of head enters pelvis,
Flexion - smallest diameter of head enters,
Descent - head completely into pelvis,
Internal rotation - from OT to OA or OP,
Extension - vertex passes beyond pubic synthesis; crowning occurs
External rotation - after delivery of the head as the head rotates to face forward
(3) P's of the Active Phase that may cause problems in delivery: Power
(strength of contractions),

Passenger
(size and position of infant),

Pelvis
(shape)
(5) steps of Tx in patient w/ Non-reassuring fetal status: 1. Give mother oxygen mask

2. turn her to Left side to decrease IVC compression

3. D/C Pitocin

4. if due to Hypertonus (long contraction) or Tachysystole (>5 contractions in 10 min), give Terbutaline to relax uterus

5. If 1 â€“ 4 does not work, C-section patient
Dx: Painless vaginal bleeding in the third trimester Tx for perterm patient (<36 weeks)? (3) Tx for term patient?: Placenta previa

Tx for Preterm:
1. Monitor in hospital
2. Transfusion PRN
3. Tocolytic to prolong until 36 weeks

Tx for Term:
C-section
Dx: Vaginal bleeding, painful contractions, firm and tender uterus Tx?: Placental Abruption

Tx - Delivery
(by C-section if mother or baby is unstable)
Dx: sudden onset of intense abdominal pain assoc w/ pregnancy Tx?: Uterine rupture

Tx - immediate laparotomy
Dx: Vaginal bleeding and sinusoidal FHR pattern MCC? Tx?: Fetal Vessel Rupture

MCC - Velamentous cord insertion

Tx - emergency C-section
Dx: contractions and changes in cervix at < 37 weeks gestation: Preterm Labor
The only Tocolytic approved by the FDA MOA?: Ritrodrine

MOA: Beta-agonist
Tocolytic that acts as a calcium antagonist: Magnesium sulfate
what is the test to determine if patient is near a Magnesium sulfate toxicity?: check DTRs continuously...they are depressed less then the toxic level of 10 mg/dL
what Calcium channel blocker is used as a Tocolytic?: Nifedipine
what NSAID is used as a Tocolytic?: Indomethacin
MC concern w/ PROM?: Chorioamnionitis
when is it common to see maternal hypotension? what can it cause in child? what is Tx for maternal hypotension?: After epidural

causes - Fetal bradycardia

Tx - IV hydration and Ephedrine
Tx for fetal bradycardia lasting for longer then 4 - 5 minutes?: C-section
Monozygotic Twins: separation before the differentiation of trophoblasts: Dichorionic-Diamnionic
Monozygotic Twins: separation after trophoblast differentiation and before amnion formation: Monochorionic-Diamnionic
what type of twins can develop Twin-to-Twin Transfusion Syndrome?: Mono-Di

(one big baby and one small)
Twin type: division of fertilized ovum: Monozygotic
Twin type: fertilization of two ova by two sperm: Dizygotic
Monozygotic Twins: separation after amnion formation: Monochorionic-Monoamnionic

(highest mortality rate)
Dx: pregnant woman with HTN, edema, proteinuria: Preeclampsia
(3) risk factors for onset of Preeclampsia: Nulliparity,

Multiple gestation,

Chronic HTN
Tx for Preeclampsia near term and preterm: Near term:
Delivery

Preterm (and Eclampsia Tx):
Mag sulfate - against seizures
Hydralazine - HTN
with Eclampsia, what percentage of patients have seizures before labor, during labor and after labor?: Before: 25%

During: 50%

After: 25%
what anti-hypertensives are given to mothers with chronic HTN during birth? (2): Nifedipine

Labetolol
what tests should be performed if patient has chronic HTN w/ pregnancy? (2) why?: Baseline ECG,
24-hr urine collection

helps differentiate superimposed preeclampsia
How common is gestational diabetes?: approx 15% of pregnancies
(3) fetal complications of Gestational Diabetes: Macrosomia,

Shoulder dystocia,

neonatal Hypoglycemia
when is a C-section indicated in gestational diabetes?: if fetal weight > 4500g
How is the DM-1 patient managed during pregnancy? Delivery?: Pregnancy - insulin pump

Delivery - insulin drip
What gestational age of onset would you stop considering using a tocolytic agent? A steroid agent? What is done after that?: Tocolytic: >34 weeks

Steroid: >36 weeks

then: Expectant management
how are lower UTIs treated versus pyelonephritis in pregnancy?: Lower UTI - oral Abx

Pyelonephritis - IV Abx
(2) complications of pyelonephritis during pregnancy for mother: Septic shock

ARDS
what can Bacterial Vaginosis cause during pregnancy?: Preterm delivery
Leading cause of Neonatal sepsis Tx?: Group B strep

Tx:
Ampicillin
Dx: maternal fever, uterine tenderness, high WBC, fetal tachycardia Tx? (2): Chorioamnionitis

Tx:
Delivery,
IV Abx
Dx: nausea and vomiting in pregnancy to the extent where the patient cannot maintain adequate hydration and nutrition (3) Tx?: Hyperemesis Gravidarum

Tx:
IV hydration,
Electrolyte repletion,
Antiemetics
Management of women w/ Epilepsy during pregnancy (3): check antiepileptic drug levels monthly,

Level 2 Ultrasound at 19 - 20 weeks,

supplement w/ Vitamin K from 37 weeks to delivery
what do women w/ mild renal dz have a risk of getting during pregnancy? (2 pregnancy problems): Preeclampsia,

IUGR
Leading cause of maternal death: Pulmonary emboli
Tx for pregnancy-related DVT and PE: Heparin
Management for Hyperthyroidism in pregnant woman (3): Thyroid-stimulating immunoglobulins (TSI) should be screened.

if elevated, screen for fetal goiter and IUGR

continue w/ PTU medication
Management for Hypothyroidism in pregnant woman: Synthroid

(Increased Synthroid requirements during preg for somone already on meds)
(3) common problems that can occur in the pregnant SLE patient. what (3) meds can be used in these patients as prophylaxis?: Risk for:
Pregnancy loss,
IUGR,
Preeclampsia

Meds:
Low-dose aspirin,
Heparin,
Corticosteroids
how are Lupus flares and Preeclampsia differentiated in pregnancy?: Complement levels
SLE and Sjogren mothers with anti-Ro and Anti-La antibodies have risk of developing what fetal problem?: Fetus w/ Congenital Heart Block
Dx: infant is delivered and has growth restriction, CNS problems, cardiac defects and abnormal facies: Alcohol abuse during pregnancy
(FAS)
Pregnancy Risk: Caffeine > 150 mg/day: Spontaneous abortions
Pregnancy Risk: Cigarette smoking (4): Growth restriction,

Abruptions,

Preterm delivery,

Fetal death
Pregnancy Risk: Cocaine (2): Placental Abruption,

CNS defects in children
what is best for the pregnant woman on Heroin during pregnancy?: Quitting outright will endanger fetus--need to be enrolled in a methadone clinic, then quit after delivery
(2) central issues in the immediate postpartum period for the patient: Pain management,

Wound care
when do diaphragms and cervical caps need to be refitted postpartum?: 6 weeks
what are the (3) hormonal contraceptives of choice postaprtum? Why?: Depo-provera,

Norplant,

Progesterone-only minipill

b/c they are less likely to decrease milk production in breast-feeding patients
What are the causes of postpartum hemorrhage? (6)*: Coagulation Defect;
Atony;
Rupture;
Placenta (POC) retained;
Implantation site bleed;
Trauma
what are the steps in managing a postpartum hemorrhage? (4 steps): 1. R/O cervical/vaginal lacerations

2. if still bleeding:
give Uterotonic agents (Oxytocin)

3. if still bleeding:
D&C

4. if still bleeding:
Laparotomy w/ bilateral O'Leary sutures to tie off uterine arteries
Dx: fever, high WBC, uterine tenderness 5 - 10 days post C-section Tx? (2): Endomyometritis

Tx:
D&C
broad-spectrum Abx until afibrile for 48 hrs
what is the underlying cause of labial fusion?: excess Androgens
MC form of enzymatic deficiency assoc w/ ambiguous genitalia what is deficient?: Congenital Adrenal hyperplasia

(21-hydroxylase deficiency)
Dx: hyperandrogenism, salt wasting, hypotension, hyperkalemia, hypoglycemia, ambiguous genitalia: Congenital Adrenal Hyperplasia

(21-hydroxylase deficiency)
what main lab is elevated in Congenital Adrenal Hyperplasia? what is Tx?: 17-alpha-hydroxyprogesterone

Tx: Cortisol
(and a mineralcorticoid if pt is salt-wasting)
what is the name of the fertilized oocyte 2 - 4 days after fertilization? what is it called in the next stage?: Blastomere / Morula

next:
Blastocyst
Dx: patient at puberty w/ primary amenorrhea and cyclic pelvic pain, lower abdominal girth: Imperforate hymen
Definition: build-up of blood behind the hymen in person with imperforate hymen Tx?: Hematocolpos

Tx: surgery
(2) causes of Vaginal Agenesis: Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH)

Androgen Insensitivity
Dx: normal female karyotype w/ ovaries and secondary sexual characteristics, but congenital absence or hypoplasia of vagina, cervix, uterus and fallopian tubes: Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH)
what is the Tx for Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH)?: Create vagina:

w/ dilators
or
McIndoe procedure
(surgically creating vagina w/ skin grafts)
Dx: woman w/ scant pubic hair and small breasts w/ vaginal agenesis or absence and absence of uterus cause?: Androgen Insensitivity

cause:
nonfunctioning androgen receptors
(normal levels of Testosterone)
Dx: symmetric white, thinned skin on labia, perineum and perianal region. Shrinkage and agglutination of labia w/ occasional pruritis or dysparunia Tx?: Lichen Sclerosis

Tx:
Topical steroids (Clobetasol)
Dx: localized thickening of the vuvlar skin from edema w/ chronic pruritis, possible raised white lesion on labia majora or clitoris: Squamous cell hyperplasia
Dx: multiple shiny, flat, purple papules usu on the inner aspects of the labia minora, vagina and vestibule. Often erosive and causing pruritis and mild inflammation: Lichen Planus
Dx: Thickened white epithelium, slight scaling, usually unilateral and circumscribed on vulva, w/ pruritis (2) Tx?: Lichen Simplex Chronicus

Tx:
Ultraviolet light
Topical steroids
Dx: Red, moist and sometimes scaly lesions on vulva, which may also be found on scalp, axilla, groin and trunk: Vulvar Psoriasis
Dx: palpable red granular spots and patches in the upper third of the vagina on the anterior wall: Vaginal Adenosis
how are vulvar lesions Dx?: Biopsied
MC benign tumor on the vulva: Epidermal Inclusion cysts
Definition: Dz that causes occlusion of the sweat glands on mons pubis and labia majora, causing cyst formations Tx?: Fox-Fordyce Dz

Tx: I&D
how do you differentiate an epidermal cyst from a sebaceous cyst?: Epidermal - solitary cyst

Sebaceous - collection of cysts
where are the Skene glands located?: Paraurethral
where are the Bartholian glands located?: Bilaterally at 4 and 8 o'clock on labia majora
what is first step in Tx if a Bartholian cyst first appears in woman over 40yo?: Biopsy to R/O Bartholian gland carcinoma
Tx of a Bartholian Abscess what is Tx for recurrent Bartholian Abscesses?: Tx:
I&D w/ placement of Word catheter

Recurrent:
Marsupialization
Definition: Cervical dilated retention cysts: Nabothian cysts
Definition: Cervical cysts that lie deep in the stroma and are from remnants of Wolffian ducts: Mesonephric cysts
even though cervical polyps are not premalignant, why are they removed?: to avoid masking bleeding from other sources and to avoid misidentification for an endometrial polyp
MC Uterine formation anomaly cause?: Septate uterus

cause:
Problems w/ fusion of Paramesonepheric ducts
what are anomalies of the uterus assoc with (non-gyn medical)? (2): Urinary tract anomalies

Inguinal hernias
Dx: amenorrhea or dysmenorrhea, dyspareunia, cyclic pelvic pain, infertility or recurrent pregnancy loss or premature labor: Uterine anatomic anomalies
(Septate uterus)
Dx: small uterine cavity, second-trimester pregnancy loss, malpresentation and possible premature labor: Bicornuate uterus
Tx of Septate and Bicornuate uteri: Surgical removal of septum
Definition: Benign, estrogen-sensitive smooth muscle tumors of the uterus found in what percentage of reproductive-age women?: Fibroids
(Uterine Leiomyomas)

in 20 - 30% of reproductive-age women
Incidence of Fibroids in Black women (3) causes to increase risk of developing fibroids: 3 - 9 x higher in Black

Risks:
Non-smoking,
Obese,
PeriMenopausal
what distinguishes a Fibroid from adenomyosis?: Fibroid has a Pseudocapsule
Top (2) MC Sx in patient w/ Fibroids: Asymptomatic (50 - 65%)

(MC otherwise is Prolonged bleeding)
Drug Tx for Fibroids (3) MOA of these drugs collectively: Provera,

Danzol,

GnRH agonists (Lupron)

MOA - shrink fibroids by reducing circulating Estrogen
If drugs dont work, what is the name of the surgical Tx for Fibroids? Only Difinitive Tx?: Myomectomy
(removal of one or more Fibroid surgically)

Only Difinitive Tx:
Hysterectomy
what causes Endometrial Hyperplasia?: continuous endogenous or exogenous Estrogen in absence of Progesterone
In endometrial hyperplasia, what proliferates in endometrium? (2): Glandular and Stromal elements of endometrium
Risk factors for getting Endometrial Hyperplasia (9): CLONED PHD:

Chronic Anovulation,
Late Menopause (> age 55),
Obesity,
Nulliparity,
Estrogen-producing tumors (granulosa-theca cell tumor),
Diabetes,
PCOS,
Hypertension,
Drugs - Tamoxifen
Dx: long periods of Oligomenorrhea or amenorrhea followed by irregular or excessive uterine bleeding: Endometrial Hyperplasia
main Dx evaluation used to Dx Endometrial Hyperplasia what is second choice?: Endometrial Bx

(or D&C...second choice)
Risk of malignant transformation from Endometrial Hyperplasia in: 1. Simple Hyperplasia 2. Complex Hyperplasia 3. Atypical Simple Hyperplasia 4. Atypical Complex Hyperplasia: Simple = 1%

Complex = 3%

Atypical Simple = 8%

Atypical Complex = 29%
what is the initial Tx for all types of endometrial hyperplasia in child-bearing patient? Non-child bearing patient?: Child bearing:
Progestin therapy for 3 months
(followed by resampling of Endometrium)

Non-child bearing:
Hysterectomy
MC functional Ovarian cyst; usu unilateral what can they lead to? Tx?: Follicular cyst

leads to:
Ovarian torsion

Tx:
resolve spontaneously
MCC of infertility in USA: PID
Dx: patient w/ abdominal pain, adnexal tenderness and cervical motion tenderness, possible ESR, Inc WBC, fever, or purulent cervical discharge: PID
how is the tuboovarian abscess rupture treated in PID?: Removal of infected tube
Antibiotic Tx for outpatient versus inpatient w/ PID: Outpatient:
Ceftriaxone + Doxycycline

Inpatient:
Clindamycin + Gentamycin
Bug that causes PID in pt w/ intrauterine device: Actinomyces Israelii
Dx: nodularities on Broad ligament and a retroverted uterus w/ abdominal pain Tx?: Endometriosis

Tx:
birth control pills
MCC of infertility in menstruating woman over age of 30 w/o PID?: Endometriosis
How is chlamydia Tx in pregnant patient?: Erythromycin
Dx: ovarian cyst that can cause a missed period or dull lower quadrant pain; can rupture to cause acute abdominal pain and intraabdominal hemorrhage Tx?: Corpus Luteum cyst

Tx:
resolve spontaneously
(or oral contraceptives if recurrent)
Dx: large, bilateral ovarian cysts filled w/ clear, straw-colored fluid; high b-hCG: Theca-Lutein cyst
First step in management for a cystic adnexal mass in premenarchal and postmenopausal patients: Exploratory Lap
(due to high risk on cancer in those age groups)
what percent of ovarian masses in women of reproductive age are functional cysts? non-functional neoplasms?: functional cysts = 75%

non-functional neoplasms = 25%
First Dx evaluation for Ovarian cysts: Pelvic Ultrasound...wait 6 - 8 weeks then repeat
in reproductive-aged woman who has an ovarian cyst seen on ultrasound, what management steps are taken if the cyst size is: 1. < 6 cm 2. 6 - 8 cm 3. > 8 cm: 1. observe for 6 - 8 weeks ->
start on oral contraceptives ->
repeat US

2. if Unilocular = repeat steps above;
if multilocular or solid on US =
Exploratory Laparoscopy

3. Exploratory Laparoscopy for cystectomy
if ovarian cysts do not resolve with oral contraceptives in 60 - 90 days, what is next step?: Cystectomy via Laparoscopy
Definition: Endometriosis in the ovary: Endometrioma
Risk factors for endometriosis (2): First-degree relatives
(mothers AND Sisters)

autoimmune disorders
how is endometriosis detected on rectovaginal exam?: Uterosacral nodularity
Instead of using oral contraceptives for endometriosis, what else can be used? (2) what do they do?: GnRH agonists in steady state
(Leuprolide)

or

Danazol
(inhibits gonadal steroid synthesis)

they supress FSH and LH
what are the drawbacks to Danazol therapy for Endometriosis?: Androgen-related anabolic side effects:

Acne, Oily skin, weight gain, deep voice, Hirsutism
AE of GnRH agonists: Estrogen deficiency

Menopausal symptoms:
hot flashes, loss of bone density, HA, vaginal atrophy and dryness
what intraabdominal problem can endometriosis lead to?: Adhesion formation -> bowel obstructions
what is the drug management of Endometriosis in the woman wanting to conceive?: None

Only Tx in these patients is Conservative surgical therapy by removal of lesions laparoscopically
what percent of women with Adenomyosis also have Endometriosis? Fibroids?: Endometriosis - 15%

Fibroids - 50%
Incidence of Adenomyosis?: 15% of women in late 30s - early 40s
Dx: pelvic exam reveals a diffusely enlarged globular uterus and secondary dysmenorrhea: Adenomyosis
What is the first Dx test for Adenomyosis? What is the only definitive Dx test? What is the Tx?: Ultrasound

(if suggestive, then MRI to distingiush b/t it and Fibroids)

Definitive means of Dx and Tx:
Hysterectomy
Tx for Adenomyosis (3 meds or one procedure): NSAIDs and analgesics,
Oral Contraceptives,
Progestins

Definitive Tx:
Hysterectomy
Dx: fever, rash and desquamataion of palms and soles of feet, hypotension: Toxic Shock Syndrome

(s.aureus)
how is HIV screened and confirmed?: screened w/ ELISA

confirmed w/ Western blot
Dx: Cottage cheese-like discharge, pruritis, burning, dysuria, vulvar edema what is Dx test and result? Tx?: Candida Albicans

Test:
branching hyphae and spores on KOH prep

Tx:
Topical OTC Azole cream
Dx: diffuse, malodorous, gray-green, frothy discharge from vagina what is Dx test and result? Tx?: Trichomonas Vaginalis

Test:
Bugs swimming under microscope; Wet prep

Tx:
Metronidazole (Flagyl) 2g orally in single dose
Dx: vaginal discharge that is thin, yellow and has a "fishy" amine odor what is Dx test and results? Tx?: Bacterial Vaginosis
(Gardnerella)

Test:
Clue cells on Wet prep,
Whiff test exaggerates the odor w/ KOH

Tx:
Metronidazole (Flagl) 500mg orally BID for 7 days
Dx: Painless cancre what is the Hystological Dx test and results? Tx?: Syphilis (stage 1)

Test:
Spirochetes on Dark-field Microscopy

Tx:
Penicillin
Dx: maculopapular rash extending to the palms and soles and/or moist papules on the skin or mucous membranes: Syphilis (stage 2)
Dx test for HSV Tx?: Tzanck smear

Tx:
Acyclovir
Dx: painful, demarcated, non-indurated ulcer located anywhere in the anogenital region; painful inguinal lymphadenopathy: Chancroid
(Haemophilus Ducreyi)
Dx: STD that causes LGV (2) possible Tx?: Chlamydia
(MC STD)

Tx:
Doxycycline 100mg orally BID for 7 days,
1-time dose of Azithromycin
Dx: mucopurulent cervicitis; gram-negative bug Tx?: N. Gonorrhea

Tx:
Ceftriaxone 250mg IM
Dx: small, 1 - 5mm domed papule w/ umbilicated center, can occur all over body what is Dx test and results? Tx?: Molluscum contaginosum

Tests:
waxy material and intracytoplasmic inclusions on Wright stain or Giemsa stain

Tx:
Cryotherapy
Dx: Pruritis, iritated skin, vesicles and burrows confined to pubic area Tx?: P. Pubis (Pediculosis)
["Crabs"]

Tx:
Lindane (Kwell) shampoo to pubic hair
what is the protrusion of the vaginal vault secondary to the loss of support structures post hysterectomy?: Vaginal Vault Prolapse
Initial Tx for pelvic relaxation or Stress Incontinence? If that doesn't work, what is the Tx?: Kegel exercises

if not:

Vaginal Pessaries

(and/or Estrogen replacement)
Dx: Urine loss w/ exertion or straining (coughing, exercise, etc) cause?: Stress incontinence

cause:
Pelvic relaxation and displacement of the Urethrovesical junction
Dx: urine leakage due to involuntary and uninhibited bladder contractions cause?: Urge Incontinence

cause:
Detrusor instability
Dx: continuous urine leakage cause?: Total Incontinence

cause:
Urinary fistulas from birth trauma or pelvic surgery / radiation
Dx: incomplete voiding, urinary retention and overdistention of the bladder cause?: Overflow Incontinence

cause:
poor or absent Bladder Contractions due to meds or neurological dysfunction
what are (2) easy office Dx evaluations for incontinence?: Standing stress test

Cotton swab test
what class of meds are used to help Tx Stress Incontinence?: Alpha Adrenergic agents
what class of meds are used to Tx Urge Incontinence?: Anticholinergics

(help w/ detrusor stability)
how is Total Incontinence treated?: Surgical repair of the fistula
what drug class increases bladder contractility?: cholinergics
what drug class lowers urethral resistance?: alpha-adrenergic agents
what is the Tx for Overflow Incontinence? (1 procedure or 2 possible meds): Self catheterization

or Meds:
Cholinergics,
Alpha-adrenergic agents
what is the order of the (5) stages of Puberty in females?: All Girls Think Puberty's Messy:

Adrenarche (Androgen production),
Gonadarche (GnRH production),
Thelarche (Breast production),
Pubarche (pubic hair),
Menarche
what is stage 4 of Thelarche?: Areolar mound

(in stage 5, mound disappears again)
what is the first phenotypic sign of puberty?: Thelarche

(breast production)
when does menarche occur in relation to thelarche?: about 2.5 years after the development of breast buds
what (2) phases of the menstrual cycle describe the ovary? the endometrium?: Ovary:
Follicular phase,
Luteal phase

Endometrium:
Proliferative phase,
Secretory phase
when does the placenta begin to develop its own estrogen and progesterone?: at 8 - 10 weeks gestation
Definition: the termination of the reproductive phase in a woman's life: Climacteric

(menopause, the final menstruation, marks the cornerstone event of the climacteric)
what during menopause leads to the hot flashes, mood changes, insomnia and depression?: fall in Estrogen production
what is the average age of menopause?: 48 - 52
what occurs with respect to the CV system during menopause?: Affects lipid profiles, leading to atherosclerosis and increased risk of CAD
Dx: severe pain w/ menses that cannot be attributed to an organic cause, is usually dx before 20 yo: Primary Dysmenorrhea
what is believed to be the reason of Primary Dysmenorrhea? Tx? (3): Increased levels of Prostaglandins

Tx:
NSAIDs,
OCPs,
and/or
TENS
(Transcutaneous Electrical Nerve Stimulation)
Dx: HA, weight gain, bloating, breast tenderness, mood fluctuation, anxiety, irritability in the second half of the menstrual cycle: Premenstrual Syndrome
(PMS)
what is the Dx criteria for PMS? (2): symptoms of PMS in the second half of the menstrual cycle with at least 7-day symptom-free interval during the first half;
symptoms must occur in two consecutive cycles
Dx: regularly timed menses, but an unusually heavy or prolonged flow: Menorrhagia
How many days is the flow suppose to last in the normal menstrual cycle? how much blood loss?: days: 3 - 5

blood loss: 30 - 50mL
Definition: idiopathic heavy and/or irregular bleeding that cannot be attributed to another cause: Dysfunctional Uterine Bleeding
(DUB)
Dx: regularly timed menses but unusually light amount of flow: Hypomenorrhea
Dx: bleeding that occurs b/t regular menstrual periods: Metrorrhagia
Dx: excessive (greater then 80mL) or prolonged bleeding at irregular intervals: Menometrorrhagia
Dx: irregular periods greater then 35 days: Oligomenorrhea
Dx: frequent periods that occur less then 21 days apart: Polymenorrhea
(3) of the MCC of Oligomenorrhea: PCOS,

Chronic Anovulation,

Pregnancy
when is DUB most common? (in General and list 4 times): when she is "Anovulatory":

Adolescence,
Perimenopause,
Lactation,
Pregnancy
When does pathologic Anovulation related to hormones occur? (3): Hypothyroidism,

Hyperprolactinemia,

Hyperandrogenism
if a woman > 35 yo has abnormal uterine bleeding, what is the next step?: Endometrial Bx to r/o cancer
Drug Tx for DUB (Anovulatory vs. Ovulatory)? Tx for Acute Hemorrhage / Heavy bleed from uterus?: Anovulatory DUB:
Progestins to stimulate withdrawal bleeding

Ovulatory DUB:
NSAIDs

Acute hemorrhage/heavy bleed:
IV Estrogens to stop bleeding
what is the metabolic goal of pregnancy?: Increase availability of Glucose for the fetus, while mother utilizes lipids
MCC of postmenopausal bleeding: Endometrial and/or Vaginal Atrophy

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Number of cards 250