Term
| most common cause of cystitis and pyelonephritis in pregnancy, how does it cause damage |
|
Definition
E. coli
releases phospholupase A which makes PGE and fever which causes contractions and preterm labor |
|
|
Term
| what are the normal changes in the kidney in pregnancy 6 |
|
Definition
increase glomerular filtration
increased renal plasma flow
increased CR clearance
decreased peristalsis
ureters dilated
kidneys enlarge |
|
|
Term
| what percent of women will develop a UTI in pregnancy, what percent is cystitis and what percent is pyelonephritis, how many can be prevented |
|
Definition
40% develop UTI
20% pyelonephritis
1-2% SYMPTOMATIC cystitis
70% of pyelonephritis can be prevented |
|
|
Term
| what antimicrobials should you use in UTI (cystitis and pyelonephritis in pregnancy), explain why and what drugs are the best choices |
|
Definition
ampicillun and cephalexin (cephalosporin) are safest and DOC
TMP/SMX: in 3rd trimester sulfa competes with bilirubin for albumin binding in fetus and causes hyperbilirubinemia and kernicterus
nitrofuranotoin: causes hemolysis due to RBC phosphate dehydrogenase deficiency in fetus |
|
|
Term
| what non-antimicrobials should you use in UTI (cystitis and pyelonephritis in pregnancy) and why |
|
Definition
| antipyretics for temp >100.4 because fever can cause contractions and premature labor |
|
|
Term
| when do you change antibiotics in UTI (cystitis and pyelonephritis in pregnancy), why, what monitoring needs to be done |
|
Definition
patient should resound in 48-72h
if not change antibiotics
do a cultute and adjust as needed
beck for renal obstruction (stones) |
|
|
Term
| what percent of pregnancy have cardiac diseae, how often does it cause mortality, what is the most common cause |
|
Definition
1% of pregnancies
50% of pregnancy morbidity and mortality
50% due to rheumatic fever and acquired valve disease |
|
|
Term
| what are 3 cardiovascular changes that are normal in pregnancy |
|
Definition
4% increase in CO
decreased vascular resistance
hypercoaguable state |
|
|
Term
| explain the treatment for renal stones in pregnancy |
|
Definition
cose observation for infection, urine straining
urological consult if unable to pass
HYDRATION IS MANDATORY |
|
|
Term
| 5 heart conditions that have the worst prognosis in pregnancy and percent prognosis |
|
Definition
previous MI: 30% mortality in 3rd trimester
primary pulmonary HTN: BAD
uncorrected tertaology of fallor: BAD
esimenger syndrome: BAD DEATH 50% maternal mortality
peripartum cardiomyopathy: 50% mortality |
|
|
Term
| why does esimenger syndrome have a bad prognosis in pregnancy, what is the tx recommendation |
|
Definition
pulmonary HTN develops from congenital left to right shunt
50% maternal mortality due to thromboembolism
termination recommended |
|
|
Term
| what is mitral stenosis usually caused by |
|
Definition
|
|
Term
| how does mitral stenosis affect pregnancy 3 |
|
Definition
AFib
CHF
increased CO demand on valve (esp in second stage of labor) |
|
|
Term
| tx of mitral stenosis in pregnancy |
|
Definition
prevent tachycardia
allow for ventricle diastolic filling
maintain preload (BB)
DO NOT PUSH IN LABOR TOO MUCH DEMAND ON VALVE! |
|
|
Term
| prognosis of PVT (and other asymptomatic arrhythmias) in pregnancy, causes |
|
Definition
usually do well
associated with exercise and thyroid disease |
|
|
Term
| prognosis of mitral valve prolapse in pregnancy |
|
Definition
5-17% asymptomatic
some have syncope (worse prognosis) |
|
|
Term
| how is peripartum cardiomyopathy diagnosed |
|
Definition
DX OF EXCLUSION
CARDIAC FAILURE IN LAST 4WK GESTATION OF 506MO POST PARTUM
echo shows LV systole dysfunction (depressed shortening fraction or ejection fraction) |
|
|
Term
| causes of peripartum cardiomyopathy 4 |
|
Definition
myocarditis
preeclampsia
twins
hyperthyroid |
|
|
Term
| tx for peripartum cardiomyopathy |
|
Definition
DELIVER NOW
bed rest
hydralazine
digoxin/heparin |
|
|
Term
| what are the 7 high risk groups for HIV contraction |
|
Definition
heterosexuals 61%
IV drug users 36%
CHILDREN DELIVERED FROM HIV POSITIVE MOTHERS 1%
homosexuals
blood transfusion before 1985
prostitutes
black and hispanic urban population |
|
|
Term
|
Definition
elisa: positive after 4 mo, false positive can occur
western blot: identifies HIV core and envelope, 99% SENSITIVE, NEGATIVE BLOT NEGATES POSITIVE ELISA |
|
|
Term
| at what viral load is there the greatest risk of vertical transmission |
|
Definition
|
|
Term
| what is the best way to decrease vertical transmission |
|
Definition
REDUCED RISK FOR C SECTION DONE PRIOR TO RUPTURE OF MEMBRANES OR ONSET OF LABOR
zivudine during pregnancy, labor and delivery, and to neonate |
|
|
Term
| what is the risk to the fetus in parvovirus B19 (4) |
|
Definition
spontaneous abortion
non-immune hydrops fetalis
still birth |
|
|
Term
| when is the fetus at the most risk in a parvovirus B19 infection |
|
Definition
|
|
Term
| what is the risk to the fetus in rubeola/measles 4 |
|
Definition
spontaneous abortion
preterm labor
low birth weight
NO INCREASE IN CONGENITAL ABNORMALITIES |
|
|
Term
| what are the three categories of severity of prognosis in rubella/german measles |
|
Definition
50% GET CONGENITAL RUBELLA SYNDROME FOR THE 1ST 4 WEEKS
25% for tehe first trimester
1% for second and third trimester |
|
|
Term
| what is the treatment for rubella in pregnant women |
|
Definition
NONE
NEVER GIVE MMR VACCINE IN PREGNANCY
give it to her post partum if negative |
|
|
Term
| congenital rubella syndrome: 2 cardiac signs, 3 eye signs, 5 CNS signs, 4 organ/growth signs |
|
Definition
patent ductus arteriosus
pulmonary artery hypoplasia
cararacts
retinopathy
micropthalmia
CONGENITAL DEAFNESS
BRAIN CALCIFICATIONS
microcephaly
panencephalitis
psychomotor retardation
HSM
hepatitis
SYMMETRICAL IUGR (INFECTION IN 2ND TRIMESTER, THE EARLIER THE GROWTH IS AFFECTED THE MORE SYMMETRICAL IT WILL BE) |
|
|
Term
|
Definition
BLOOD TRANSFUSION
SEX
BREAST MILK
URINE
SALIVA
TRANSPLACENTAL |
|
|
Term
| what is the most common cause of congenital viral infection in the US |
|
Definition
|
|
Term
| what percent of children and mothers are seropositive for CMV |
|
Definition
60% of children
50-85% of mothers |
|
|
Term
|
Definition
viral culture of urine or other bodily secretions
IgG or IgM (IGM IS ELEVATED FOR 6MO AFTER INFECTION) |
|
|
Term
| 10-20% of babies with CMV have signs at birth, what are 7 signs |
|
Definition
nonimmune hydrops
symmetrical IUGR
chorioretinitis
microcephaly
cerebral calcifications
hepatosplenomeagly
hydrocephaly |
|
|
Term
| 80% of babies with CMV have signs later after birth, what are 3 signs |
|
Definition
visual impairment
hearing loss
delayed psychomotor development |
|
|
Term
| what are the maternal complications of varicella zoster 2 |
|
Definition
preterm labor
encephalitis
PNEUMONIA |
|
|
Term
| what are the fetal complications of varicella zozter 7 |
|
Definition
limb hypoplasia
cutaneous scars
chorioretinitis
cataracts
cortical atrophy
microencephaly
IUGR |
|
|
Term
| how is varicella zoster treated in pregnancy |
|
Definition
varicella zoster immune globulin (VZIG) within 72h birth
if expectant female is ezposed and is at risk give VZIG
AVOID ZOSTER LESIONS AT DELIVERY |
|
|
Term
| what is the best judgement of wether a hep B infection will transfer to the fetus and be fatal |
|
Definition
mom is HBsAg and HbeAg positive
70-90% transmission |
|
|
Term
| what are the signs of hepB in mom |
|
Definition
asymptomatic hepatitis or acute hepatitis
10% are chronic active carriers
1/1000 adults |
|
|
Term
| what are the signs of HepB in fetus 3 |
|
Definition
premature
low birth weight
neonatal death |
|
|
Term
|
Definition
| hep Ig and vaccination within 48h of delivery |
|
|
Term
| wha are the complications of herpes simplex to the fetus 3 |
|
Definition
spontaneous abortion
preterm labor
IUGR
60% of neonates die and 30% have neurological problems |
|
|
Term
| how is herpes simplex in pregnancy treated |
|
Definition
AVOIDANCE: C-section if lesions present. EXAMINE LOWER GENITAL, VAGINA, CERVIX!
acyclovir if serious symptoms or prophylaxis near term |
|
|
Term
| when do you treat a mom for group B strep |
|
Definition
if positive during labor
if in last pregnancy infant got invasive disorder
IF SHE HAD GBS LAST PREGNANCY BUT THE BABY DID NOT GET DISEASE AND SHE IS NEGATIVE THIS PREGNANCY DO NOT TREAT |
|
|
Term
| what are the early signs (48h) of neonatal GBS 4 |
|
Definition
rapid onset, fulminant course
respiratory distress
pneumonia
meningitis |
|
|
Term
| what are the late onset (4wks) signs of GBS in neonate 2 |
|
Definition
|
|
Term
| what are the complications of GBS in mom 1 |
|
Definition
| cause 20% of endometrosis |
|
|
Term
| what are the complications of a listerosis infection 3 |
|
Definition
spontaneous abortion
preterm labor
chorioamnionitis (infected chorion and amnion) |
|
|
Term
| what are the signs of early onset neonatal syphillis |
|
Definition
nonimmune hydrops
HSM
hepatitis
anemia
thrombocytopenia
skin lesions
osteitis
periositis
pneumonia |
|
|
Term
| what are the late signs of neonatal symphills 4 |
|
Definition
dental abnormalities (hutchinsons/scrwdriver teeth)
saber shins (forward bending of tibia)
destruction of nasal septum (saddle nose)
deafness |
|
|
Term
|
Definition
|
|
Term
| what if mom is allergic to pen G and has syphillis |
|
Definition
| desensitise her, it is the only one that crosses placenta to tx fetus too |
|
|
Term
| what are the effects of lyme disease on a fetus |
|
Definition
| NO TERATOGENIC EFFECT, NO FETAL DEATH, NO PRETERM DELIVERY, NO FETAL MALFORMATIONS |
|
|
Term
| what is the prognosis of toxoplasmosis depending on when it was transmitted in pregnancy |
|
Definition
greater transmission later in pregnancy
earlier infection more severe disease |
|
|
Term
| what are the 3 signs of toxoplasmosis in neonate |
|
Definition
hydrocephalus
intracranial calcifications
chorioretinitis |
|
|
Term
| how does PID cause damage |
|
Definition
| microbes destory columnar epithelium, purulent exudates, close fimbrae, deposit on peritoneium, peritonitis, scaring of pelvic structures |
|
|
Term
| what are the two most common invaders in PID |
|
Definition
| gonorrhea and chalmydia frequently seen together |
|
|
Term
| what is the mos common STD |
|
Definition
|
|
Term
| what microbes often follow gonorrhea and chalmidia in PID |
|
Definition
peptostreptococcus
prevotella
bacteroides fragilis (common)
GBS
enterococcus
E. coli
klebsiella
gardnerella vaginalis
M. hominis - mycoplasm
ureaplasma |
|
|
Term
| what are the clinical criteria for PID diagnosis |
|
Definition
all three: tenderness direct abdominal, adnexal, cervical motion
at least one: gram stain, temo >38, WBC >10,000, pus on culdocentesis or lap, abscess on bimanual or sonogram |
|
|
Term
| what type of bacteria is gonorrhea |
|
Definition
gram negative cocci
intracellular |
|
|
Term
| how is gonorrhea diagnosed |
|
Definition
culture on thayer margin
RNA/DNA immunoassay
gram stain: intracellular diplococci gram negative |
|
|
Term
|
Definition
ALWAYS TX GONORRHEA AND CHALMYDIA TOGETHER
DOC ceftriaxone gonorrhea
doxycycline or azithromycin for chalmydia |
|
|
Term
| what should you avoid in gonorrhea and chalmydia tx in pregnancy, what should you use instead |
|
Definition
AVOID QUINOLONES AND TETRACYCLINE
USE AZITHROMYCIN 1GM PO SINGLE DOSE |
|
|
Term
| when should you check for gonorrhea and chalmydia in pregnancy |
|
Definition
| initially then at 36 weeks (PREGNANCY IS THE ONLY TIME YOU RECHECK AFTER TREATMENT) |
|
|
Term
| what are signs of syphillis in first stage |
|
Definition
ASYMPTOMATIC canchre
firm punched out sore
appears 10-60d post infection
heals in 3-9wks |
|
|
Term
| how is syphillis diagnosed in first stage |
|
Definition
dark field exam for spirochetes
flourescent antibody test |
|
|
Term
| what are signs of second stage syphillis |
|
Definition
fever, headache, malaise, sore throat, anorexia, generalized lymphadenopathy
DIFFUSE SYMMETRICAL MACULOPAPULAR RASH ON PLAMS AND SOLES |
|
|
Term
| when is syphilis most infection |
|
Definition
| second stage mucous patches |
|
|
Term
| what are signs of third stage of syphillis |
|
Definition
| GUMMAS: necrotic, destructive, granulomatous on skin, CNS, heart, vessels, few on brain |
|
|
Term
| what are the 2 tests for syphillis |
|
Definition
nontremonemal: vineral disease research lab, rapid plasma regin card test, automatic regin test
treponemal: FLOURESCENT TREPONEMAL ANTIBODY ABSORPTION TEST (FTA-ABS), MICROHEMAGGLUTINATION ASSAY FOR ANTIBODY TO T. PALLIDUM (MHA-TP) |
|
|
Term
| what can give falst positive on syphillis test 4 |
|
Definition
VDRL
atypical pneumonia (mycoplasma)
SLE!!!
CT disorders (scleroderma) |
|
|
Term
| how long does herpes shed |
|
Definition
| up to 3 wks after lesions appear |
|
|
Term
| what are the complications of herpes in pregnancy, how can they be avoided |
|
Definition
ORAL ACYCLOVIR CAN CROSS PLACENTA AND HAS NO BIRTH PROBLEMS but limit use
valcyclovir is a class B drug dont use
use acyclovir near term to prevent need for C-section
IF ACTIVE LESIONS IN LABOR DO C-SECTION
OR COULD CAUSE HEPATIC ENCEPHALITIS IN NEONATE 80% MORTALITY |
|
|
Term
| what types of HPV cause cervical and vulvar cancer |
|
Definition
| 16, 18, 31, 33, 35, 45, 56 |
|
|
Term
| what types of HPV cause benign warts |
|
Definition
|
|
Term
| what does gardisil and cervarix protect against |
|
Definition
gardisil 6, 11, 16, 18
cervarix 16, 18 |
|
|
Term
| what types of birth control have the highest rates of failure and pregnancy |
|
Definition
coitus interruptus has highest rate of failure within that category...
withdrawl: 27% pregnancy
post-coital douche: 40% pregnacy |
|
|
Term
| what is the cervical mucous like at ovulation and post ovulation |
|
Definition
ovulation: clear, thin, stretchy
post: milky, opaque, thick |
|
|
Term
| what is the theoretical effectiveness of birth control methods, what causes the highest failures |
|
Definition
| if you use it 100% correctly it is 100% effective, misuse is the most common cause of failure |
|
|
Term
| what is the family plannin vs calender method of birth control |
|
Definition
family planning: rhythm method, avoid coitus 4d before and after ovulation
calendar method: estimate when ovulation occurs each month, 0.5-1 deg rise in temp. ovulation assumed 14d prior to menses but depends on length of menses |
|
|
Term
| what method provides best non-permanent pregnancy protection and protection from STDs |
|
Definition
| male condoms 15% pregnancy |
|
|
Term
| what are the 4 forms of barrier birth control and their failure rates |
|
Definition
female condom 21%
male condom 15%
diaphragm 16%
cervical caps 18% |
|
|
Term
| what are the changes an IUD makes to prevent pregnancy |
|
Definition
thickens cervical mucous
sterile inflammatory response on endometroim
increase PMN, plasma cells, macrophages
alter tubal transport |
|
|
Term
| paragard: composition, MOA, replacement timing, peroid? |
|
Definition
copper slowly absorbed by endometrium alters local enzymes, DNA, and estrogen uptake
replaced every 10 years, will have period but is heavier |
|
|
Term
| minera: MOA, period?, replacement timing |
|
Definition
prevents ovulation
little to no period, irregular, spotting
replace every 5y |
|
|
Term
| progestasert: composition, MOA, period?, replacement timing |
|
Definition
progesterone slowly released
decreases menstural flow
replaced yearly |
|
|
Term
| what happens if you have an IUD and get pregnant |
|
Definition
50% are ectopic
50% will spontaneously anort
IUD should be removed but if left in place may proceed uneventfully, increased risk of preterm labor, often IUD is expelled spontaneously |
|
|
Term
| what is the best type of hormonal contraception |
|
Definition
| combination of estrogen and progesterone |
|
|
Term
| what does estrogen do to prevent pregnancy |
|
Definition
supresses FSH which stops follicular development
increases progesterone receptors which increases progesterone effects and decreases ovulation |
|
|
Term
| what does progesterone to do prevent pregnancy |
|
Definition
supresses LH stopping ovulation
thickens cervical mucous
thins endometrial lining to stop implantations
alters fallopian peristalsis |
|
|
Term
| what is the MAJOR contraception effector in a combined pill |
|
Definition
|
|
Term
| when would you notwant to use a combined pill and use progesterone only |
|
Definition
estrogen contraindicated (DVT)
breast feeding
women >40yo |
|
|
Term
| what are the down sides to a progesterone only pill |
|
Definition
| MUST be taken at EXACT same time every day 3h could mess it up |
|
|
Term
| what does estrogen do to cholesterol |
|
Definition
|
|
Term
| what does progesterone do to cholesterol |
|
Definition
|
|
Term
| what are the absolute contraindications to hormone birth control |
|
Definition
thrombophlebitis
thromboembolic disease
cerebral vascular disease
coronary occlusion
impaired liver function
known or suspected breast cancer
undiagnosed abnormal vaginal bleeding
known or suspected pregnancy
SMOKER >35YO
congenital hyperlipidemia
HEPATIC NEOPLASM OR DISEASE |
|
|
Term
| what is the most effective non-permanent birth control, why |
|
Definition
depo-provera
due to decreased user error |
|
|
Term
| what are the complications of deop-prevera |
|
Definition
IRREGULAR BLEEDING
AMENORRHEA
DECREASED BONE MINERAL DENSITY (never use >5y)
weight gain
depression
decreased lobido |
|
|
Term
| what are the side effects of norplant |
|
Definition
SC BC
duration 5y
ABNORMAL BLEEDING, difficult to remove |
|
|
Term
| what is the abortion pill |
|
Definition
|
|
Term
| what is the emergency contraception pill |
|
Definition
levonorgestrel plan B
copper IUD placement |
|
|
Term
| how long do you have to give emergency contraception |
|
Definition
| 72h, closer to coitus more effective |
|
|
Term
| how does emergency contraception work |
|
Definition
| drops corpus luteum progesterone production stopping ovulation and changing endometroim so it is unfavorable for implantation |
|
|
Term
| what is the most safe and easiest type of permanent sterilization |
|
Definition
vasectomy
1/3 OF SURGICAL STERILIZATIONS ARE ON MEN
SAFER AND EASIER THAN TUBLE
REVERSAL EASIER |
|
|
Term
| what are 3 ways to do permanent female sterolization laproscopically and the rating of each |
|
Definition
electrocautery: lowest failure, least successful reversal
ring
clip: flischie/hulka: highest failure, more reversible |
|
|
Term
| when is a laparotomy sterilization done, what is the most common method, what is the failure rate |
|
Definition
post partum: small infraumbilical incision
pomeroy 1:500 failures |
|
|
Term
| what is the MOST effective form of sterilization, what is the down side |
|
Definition
hysterectomy
100% almost... effective
high morbidity |
|
|
Term
| what is the most common symptom of vaginitis |
|
Definition
|
|
Term
| how much discharge is normal, what should be smell like |
|
Definition
|
|
Term
| what is the normal pH of the vagina, why |
|
Definition
after puberty estrogen increases level of vaginal glycogen which favors growth of lacrobacilli (doderleins) which break down glycogen to lactic acid which acidifies vaginal
3.5-4.5 |
|
|
Term
|
Definition
discharge with odor that gets worse after intercourse
may be asymptomatic
thin, homogenous, white, adherent discharge |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
increased WBC, RBC
decreased lacrobacilli
CLUE CELLS |
|
|
Term
|
Definition
metronidazole or clindamycin
not STD no need to treat partner |
|
|
Term
| what is the most common cause of BV |
|
Definition
|
|
Term
|
Definition
itching
burning
irritation
thick white discharge cottage cheese like |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| microscopic signs in candidiasis |
|
Definition
|
|
Term
|
Definition
intravaginal synthetic imidazoles or oral flyconazole
ketoconazole |
|
|
Term
|
Definition
frothy discharge
bad odor dysuria
dysparenuria
vulvar itching and burning
yellow-green adherent discharge |
|
|
Term
|
Definition
|
|
Term
| KOH signs in trichomonias |
|
Definition
|
|
Term
| microscopic signs in trichomonias |
|
Definition
normal epithelial cells
increased WBC
trich itself |
|
|
Term
|
Definition
oral metronidazole
tinidazole
TREAT PARTNER TOO, NO SEX DURING TX |
|
|
Term
| symptoms and tx of atrophic vaginitis |
|
Definition
post-menopause
loss of rugae: smooth vaginal mucosa
dryness
vaginal bleeding
dyspareunia
tx estrogen cream |
|
|
Term
| foreign body vaginitis adult: most common cause, signs |
|
Definition
lost tampon
sudden profuse foul smelling discharge
chronic discharge often bloody |
|
|
Term
| foreign body vaginitis adolescent or child: signs, exam |
|
Definition
chronic vaginal discharge
examine with otoscope, hysteroscope, small vaginal speculum
chronic bloody discharge |
|
|
Term
| signs of desqumative inflammatory vaginitis |
|
Definition
perimenopausal or postmenopausal
at least one: discharge, dysparenuria, puritis, burning, irritation
vaginal inflammation: soptted ecchymotic rash, erythema, focal linear erosions
pH >4.5
increased parabasal and inflammatory cells (WBC:epithelial 1:1) |
|
|
Term
| causes of desqumative inflammatory vaginitis |
|
Definition
| overgrowth of gram positive cocci (often strep) and decreased lacrobacillus |
|
|
Term
| TX desqumative inflammatory vaginitis |
|
Definition
|
|
Term
| where are bartholians glands |
|
Definition
| base of each labia majora |
|
|
Term
| what is the difference between bartholians cyst and abscess |
|
Definition
cyst: soft, painless
abscess: soft or firm, painful, erythrma |
|
|
Term
| what is seen microscopically in a bartholians cyst or abscess |
|
Definition
|
|
Term
| TX and management of cartholians cyst or abscess |
|
Definition
incision and drainage (CULTURE INSIDE INCISION!!)
word catheter or marsupilization
ALWAYS BIOPSY IF RECURRENT OF >40YO COULD BE RISK OF CANCER |
|
|
Term
| signs of atrophic vilvitis/lichen sclerosis |
|
Definition
marking inflammation, epithelial thinning, dermal changes, puritis, pain, benign
bimodal: perpubertal and peri/post menopausal
classic: white atrophic papules coalesce into plaques, fissuring perianally, intralabial folds, around clitoris, introitus has yellow waxy appearance |
|
|
Term
| TX atrophic vulvitis/lichen sclerosis |
|
Definition
corticosteroids
take to OR and push and pull out if obstructed |
|
|
Term
| risk factors for sexual disorders |
|
Definition
depression (w/w/o meds)
breast cancer chemo/mastectomy
radial hysterectomy
irradiation for cervical cancer
MS
HTN
diabetes
sexual abuse |
|
|
Term
| what are the 4 types of sexual disorders |
|
Definition
hypoactive sexual desire disorder
female sexual arousal disorder
female orgasmic disorder
sexual pain disorders |
|
|
Term
| define hypoactive sexual desire disorder |
|
Definition
persistant or recurrent deficiency or absence of sexual fantasies thoughts or desire for or receptivity to sexual activity with PERSONAL DISTRESS
MOST COMMON form of sexual dysfunction
RECEPTIVE TO PARTNERS INTIMATE OVERTURES, PATIENT MUST BE PERSONALLY BOTHERED BY SYMPTOMS |
|
|
Term
| define female sexual arousal disorder |
|
Definition
persistent or recurrent inability to attiain or maintain sufficient sexual excitement causing PERSONAL DISTRESS
missed arousal: lack of subjective mental excitement
genital arousal disorder: locak of physiologic response
generalized arousal disorder: both |
|
|
Term
| define femal orgasmic disorder |
|
Definition
| persistent or recurrent difficulty, delay, or absence or orgasm following sufficient stimulation or arousal which causes PERSONAL DISTRESS |
|
|
Term
|
Definition
| recurrent or persistent genital pain associated with sexual intercourse |
|
|
Term
|
Definition
| recurrent or persistent involuntary spasm of muscles of outer 1/3 of vagina interfering with vaginal penetration causing PERSONAL DISTRESS |
|
|
Term
| define non-coital sexual pain disorder |
|
Definition
| recurrent or persistent genital pain associated with noncoital stimulation |
|
|
Term
| three medications that cause sexual dysfunction |
|
Definition
anti-depressants
anti-HTN (BB)
oral contraceptives |
|
|
Term
| what are the 4 stages of female orgasm |
|
Definition
excitement
plateau
orgasm
resolution |
|
|
Term
| what occurs in excitement |
|
Definition
vaginal lubrication
thicken of vaginal walls
inner vaginal expansion
elevation of cervix and corpus
tumescence of clitoris
nipple erection
skin tension flush |
|
|
Term
|
Definition
orgasmic platform in outervagina
full expansion of inner vagina
bartholins secretions (mucous)
clitoris withdrawl
sex tension flush
carpopedal spasm
skeletal M tension
hyperventilation
tachycardia |
|
|
Term
|
Definition
orgasmic contraction
external rectal and urethral sphinctor contraction
skeletal muscle contraction
hyperventilation
tachycardia |
|
|
Term
| what occurs in resolution |
|
Definition
everything goes back to norma
sweating reaction
hyperventilation
tachycardia |
|
|
Term
| whawhat is made in the adrenal glands 3 |
|
Definition
DHEA
andosterone
testosterone |
|
|
Term
| what is made in the ovaries |
|
Definition
androstenedione
testosterone |
|
|
Term
|
Definition
| testosterone from conversion of androstenedione |
|
|
Term
| where is DHEA made, what percent from where |
|
Definition
90% adrenal
10% ovaries
0% extraglandular |
|
|
Term
| where is androstendione made, what percent from where |
|
Definition
50% adrenal glands
50% ovaries
0% extraglandular |
|
|
Term
| where is testosterone made, what percent from where |
|
Definition
25% adrenal glands
25% ovaries
50% extraglandular |
|
|
Term
| which is more potent; testosterone or DHT |
|
Definition
|
|
Term
|
Definition
within hair follicle and genital skin
conversion of testosterone via 5a-reductase |
|
|
Term
| what is the basis of constututional hirsutism |
|
Definition
|
|
Term
|
Definition
|
|
Term
| how is DHEA related to cortisol |
|
Definition
DHEA is a precursor to cortisol production
deficiency in corticol production decrease DHEA and thus testosterone and androstendione |
|
|
Term
|
Definition
| anterior pituitary > LH > thecaleutin cells > androstendione + testosterone > granulosa cells of ovarian follicles > estrogen |
|
|
Term
| what is the primary cause for virilization |
|
Definition
|
|
Term
| what is testosterone used for |
|
Definition
increases hair growth
libido
acne
regurgitation of genital skin
sebaceous glands |
|
|
Term
| what is the most common cause of increase in androgen in hirstuism |
|
Definition
|
|
Term
|
Definition
unknown, genetics, obesity, basis is LH excess
LH stimulates ovarian theca leutin cells > increase androstenedione > aromatized to esterone in fat cells > estrogens positive feedback on LH and cycle continues on
with increase in androstenedione there is increase in testosterone which causes hirstuism and acne |
|
|
Term
|
Definition
at least 2...
oligo-ovulation or ovaluation irregular menses or amenorrhea
hyperandrogenism: clinical or biochemical evidence
polycystic on US (STRING OF PEARLS) |
|
|
Term
| what do hormone studies show in PCOS |
|
Definition
increased LH:FSH radio
estrone > estradiol
androstendione increased
testosterone increased |
|
|
Term
|
Definition
oligomenorrhea/amenorrhea
acne
histurism
infertility
chronic anovulation
impaired glucose tolerance or DM2
lipid profile abnormal (+TG/LDL)
HTN
obesity/metabolic syndrome |
|
|
Term
| treatment of PCOS if pregnancy not desired |
|
Definition
weight reduction
contraceptives
spironolactone
shaving
electrolytes
depilatories |
|
|
Term
| how do contraceptives work in PCOS |
|
Definition
| supress LH > decrease ovarian production of testosterone and androstendione > decrease acne, histurism, and androgenic stimulation of existing follicles |
|
|
Term
| how does spironolactone work in PCOS |
|
Definition
inhibits steroid enzymes
binds androgenic receptors at hair follicle |
|
|
Term
| TX of PCOS if pregnancy desired |
|
Definition
weight reduction
clomid: ovulation induction
metformin: insulin sensitizer |
|
|
Term
| what is hyperthecosis, what is main symptom |
|
Definition
exreme PCOD
same as PCOD with more hyperinsulinemia |
|
|
Term
| normally what does DHEA break down into |
|
Definition
andostendione
testosterone |
|
|
Term
| how is deoxycorticosterone made |
|
Definition
progesterone
12a-hydroxylase
21-hydroxylase |
|
|
Term
| 2 causes of congenital adrenal hyperplsaia |
|
Definition
AR 21-hydroxylase CH6 mutation
deficiency increases progesterone and hydeoxyprogesterone which increases DHEA and thus testosterone
11b-hydroxylase deficiency catalyzes conversion of deoxycorticortisterone to cortisl (increases androgens) |
|
|
Term
| early manifestations of congenital adrenal hyperplsia |
|
Definition
ambigous genitalia
virilized newborn
salt wasting |
|
|
Term
| late manifestations of congenital adrenal hyperplasia |
|
Definition
| puberty andrenarche precedes thelarche |
|
|
Term
| how is congenital adrenal hyperplasia diagnosed |
|
Definition
DHEAS, androstendione, 17-hydroxyprogesterone in follicular phase
associated with MILD HTN AND MILD HISTURISM |
|
|
Term
| how is congenital adrenal hyperplasia treated |
|
Definition
|
|
Term
| what are the 3 tasks of the health care team in sexual assault |
|
Definition
evaluate and treat medically
collect forensic specimines
care for survivors emotional needs |
|
|
Term
| define rape trauma syndrome |
|
Definition
victim realizes she cant escape and has lost control
most serious emotional problem faced by survivor |
|
|
Term
| what are the parts of the acute phase of rape trauma syndrome |
|
Definition
emotionally votile: calm or hysterical
inability to think clearly
retreat to routine activities: cleaning, shopping
safety and regaining control are main emotional needs: depression, anxiety, mood swings
pain, headache, eating, sleep disturbances |
|
|
Term
| what do you do in acute phase of rape trauma syndrome |
|
Definition
| reassure patients immediate safety |
|
|
Term
| signs of delayed or organizational phase of rape trauma syndrome |
|
Definition
appaears to have resolved most issues
radionalized that should could have prevented it or unrealiztic plans to avoid another assult
lengthy, difficult, painful
drastic changes in lifestyle, friends, work |
|
|
Term
| what are the medical steps to every rape |
|
Definition
history
physical
forensic collection
SANE program
emergency contraception
follow up
labs: gonorrhea, chalmydia (all areas swabbed), syphillis, hepatitis, HIV, urinalysis, pregnancy test |
|
|
Term
| medical steps to management of child sexual abuse |
|
Definition
interview apart from parents
exam requires patience, care, experience
may require exam under anesthesia
determine if child is safe at home
report sexual abuse to police and child welfare services |
|
|
Term
| what is the best way to do a vaginal exam on a child |
|
Definition
|
|
Term
| what are the stes in the RADAR approach to domestic violence |
|
Definition
remember to ask all the time
ask directly
document suspected violence
assess patient safety
review referral options |
|
|
Term
| what is the family violence prevention fund 4 steps |
|
Definition
1. survivor safety
2. survivor empowerment
3. perpetrator accountability
4. advocacy for social change |
|
|
Term
|
Definition
| a couples failure to concieve following 1y of unprotected sex |
|
|
Term
| 2 causes of infertility and their prevelance |
|
Definition
anovulation 30%
anatomic defect 30%
abnormal spermatogenesis 40% |
|
|
Term
| what reason should you rule out first for infertility, why |
|
Definition
| abnormal spermatogenesis because it is most likley |
|
|
Term
| what is the easiest way to rule out anovulation |
|
Definition
| regular cycles, probobally ovulating |
|
|
Term
| how can ovulation medically be induced, what percaution needs to be taken |
|
Definition
clomiphene citrate: anti-estrogen blocks receptors at hypothalamic/pituitary levels increasing FSH
clomid 5 days after start of menses
progesterone on day 5
ovulation check 14d later
CLOMID LIMITED USE: THINS CERVICAL MUCOUS DECREASING PREGNANCY |
|
|
Term
| what can you do if there is no ovulation after clomiphene |
|
Definition
| add HCG, FSH, or LH only if you did mature US and found follicle |
|
|
Term
| what is the function of a hysterosalpingogram |
|
Definition
70% diagnostic accuracy in detecting anatomic abnormalities of genital tract
can help open tubes and make pregnancy more likley |
|
|
Term
| when should hysterosalpingogram be done and why |
|
Definition
7th and 11th day
durin menses there is retrograde menses, mid cycle could stop ovum transport, fetilization, or implantation |
|
|
Term
| what should be found on a normal hysterosalpingogram |
|
Definition
smooth symmetrical endometrial cavity
prodimal tube slender and distal dilated
CONTRAST MEDIAL SHOULD SPILL EASILY FROM FIMBRIA |
|
|
Term
|
Definition
| permanent stop of menses for >12mo following cessation of estrogen production |
|
|
Term
| define premature menopause |
|
Definition
| premature ovarian failure prior to 40yo |
|
|
Term
| what is the average age of menopause |
|
Definition
|
|
Term
| what are the changes in the ovary in menopause |
|
Definition
become atretic (cannot respond to gonadotropins)
androstenedione from ovary or adrenal gland is converted in peripherial fat to esterone (weak extragonadal estrogen) |
|
|
Term
| what are changes in organs other than ovary in menopause |
|
Definition
pelvic organ atrophy
bone loses Ca
decreased skin collagn
neural transmission changes |
|
|
Term
| what is the 1st sign of ovarian failure in 75% of women, how long does it last |
|
Definition
hot flashes
resolve spontaneously in 2-3y |
|
|
Term
| what are the changes in the vagina in menopause |
|
Definition
thin, dry atrophic vaginis, tearing
same occurs in bladder, their derived from same tissue (frequency, nocturia) |
|
|
Term
| what are risk factors for osteoperosis in menopause |
|
Definition
smoking
thin stature
sedentary
white or asian
alcohol
caffiene |
|
|
Term
| what are the changes in fat in menopause |
|
Definition
post: increased LDL and decreased HDL
estrogen increases HDL and decreases LDL
progesterone increases LDL |
|
|
Term
| what is the #1 COD in women in the US, what event increases this |
|
Definition
CV disease
HDL decrease in menopase increases athlerosclerosis, MI, ischemia, HTN, stroke |
|
|
Term
| what are the contrindications to hormone therapy in menopause |
|
Definition
undiagnosed abnormal genital bleeding
known or suspected estrogen dependent neoplasia
active DVt, pulmonary embolism, or hx
active or recent arterial thromboembolic disease (stroke, MI)
LIVER DYSFUNCTION OR DISEASE
known or suspected pregnancy
hypersensitivity to hormone therapy preperations
NEVER USE HORMONE REPLACEMENT IN OSTEOPEROSIS
SMOKER |
|
|
Term
| what hormone replacement do you use if pt has uterus, WHY |
|
Definition
UNOPPOSED ESTROGEN STIMULATES LINING OF UTERUS IT THICKENS AND CAN TURN INTO ABNORMAL CELLS SO PROGESTERONE BALANCES THIS
USE CYCLIC ESTROGEN AND PROGESTERONE |
|
|
Term
| what hormone replacement do you use if pt is perimenopausal |
|
Definition
| CYCLIC THERAPY (LOW DOSE CONTRACEPTIVE) AS LONG AS THERE IS NO RISK FACTORS |
|
|
Term
| what is used to prevent osteoperosis in menopause, MOA, SE |
|
Definition
TAMOXIFEN AND RALOFIXENE: SERM- SELECTIVE ESTROGEN RECEPTOR MODULATORS
AGONIST OF ACTIVITY IN BONE BUT ANTAGONIST IN BREAST
WORSENS HOT FLASHES |
|
|
Term
| what are alternative methods to hormone replacement in menopause |
|
Definition
some herbals help with hotflashes: black cohosh, but are not regulated
increased soy in diet
effexor and clonidine |
|
|
Term
| what is the BEST (according to patient satisfaction) hormone replacement in menopause |
|
Definition
|
|
Term
|
Definition
transition into menopause
very few women 10% go direct into menopause
usually lasts 3-7y |
|
|
Term
| when should a women begin mamograms |
|
Definition
| every 1-2y begining at 40yo, yearly begining at 50yo |
|
|
Term
| when should a women begin mamograms when there is a hx of family breast cancer |
|
Definition
| 5 years earlier than family members diagnosis |
|
|
Term
|
Definition
retrograde menstural flow: direct implantation of endometrial cells
predilection for ovaries and pelvic peritoneum causes endometrosis |
|
|
Term
|
Definition
vascular lymphatic dissemination: distant sites of endometrosis (nodes, kidney, pleural cavity, brain) found in lymph in 20% of patients with distant disease
CYCLIC BLOODY SPUTIM |
|
|
Term
|
Definition
| mullerian coelomic metaplasia: metaplasia of multipotential cells in peritoneal cavity, changes allow cells to develop into functional endometrial tissue causes endometrosis |
|
|
Term
| what is the immunological therory for endometrosis |
|
Definition
immune complex is found in menstural fluid
induces change in SOME susceptible people causing endometrosis |
|
|
Term
| what is the cause of endometrosis |
|
Definition
| a combination of sampsons, halbans, meyers, and immunological theories |
|
|
Term
| what is the ovarian involvement in endometrosis |
|
Definition
bilateral
small vascular hemorrhages
white opaque plaques on peritoneal surfaces
MULBERY SPOTS/POWDER BURNS
puckered lesions from dense scarin or penetration
CHOCOLATE CYSTS: LARGE ENDOMETROSIS
HEMOSERDIN LAIDEN MACROPHAGES |
|
|
Term
| how is endometrosis diagnosed |
|
Definition
history and physical
laproscopic/laporotomy DIRECT VISUALIZATION
biopsy of at least two: endometrial epithelium glands, stroma, HEMOSERDIN LAIDEN MACROPHAGES
pelvic US
colonoscopy
MRI/CT |
|
|
Term
|
Definition
dansol
high dose progestins (depo)
oral contraceptives: low E high P
GnrH agonist: supress FSH/LH
excision, cauterization, ablation - to truly remove you need to do open surgery but lap can cover most |
|
|
Term
| define adenomyosis, age, signs, tx |
|
Definition
endometrial glands found in myometroim
40-50yo
diffuse lesions, tender, symmetrically enlarged uterus, dysmenorrhea
tx: hysterectomy |
|
|
Term
|
Definition
|
|
Term
| what are some secondary causes of dysmenorrhea |
|
Definition
extrauterine: endometrosis, tumor, inflammation, adhesions, psych
nongynecological
intramura: adenomyosis, leiomyomata
intrauterine: leiomyomata, polyps
intrauterine contraceptive
infection
cervical stenosis
cervical lesions |
|
|
Term
| what are the hematological changes in pregnancy |
|
Definition
expansion of plasma volution proportionally GREATER than RBC mass
small RBC volume decreases HCT (THIS IS NOT ANEMIA)
ONE BABY INCREASES PLASMA VOLUME BY 40-50% APPROX 1000ML!!!
RBC MASS INCREASES BY 25% |
|
|
Term
| WHAT HAPPENS TO HCT IN PREGNANCY |
|
Definition
| IT DECREASES!! THIS IS NOT ANEMIA! |
|
|
Term
| what is the definition of anemia in pregnancy, why are all pregnancy women confused with anemia |
|
Definition
HCT <30% ot Hb < 10g/dL
50% of pregnant women have HCT <32 or Hb <11 |
|
|
Term
| what is the 1-2 most common causes of anemia in pregnancy |
|
Definition
1. Fe deficiency
2. folate deficiency |
|
|
Term
| what is the effect on blood vessels in Fe deficiency anemia |
|
Definition
| microcytic hypochromatic anemia |
|
|
Term
| what are the daily requirements of folate in pregnant women |
|
Definition
800ug/d
(>50-100mg more than normal!) |
|
|
Term
| causes of folate deficiency |
|
Definition
oral contraceptives
anticonvulsants
sulfa drugs
multiple gestations |
|
|
Term
| what is the amount of folate supplement pregnant women should take, and if they have acute issue, or if their on anticonvulsant, OPC, sulfa, multifetal? |
|
Definition
normal 400mg daily
acute 1mg/d
risk group 4mg/d |
|
|
Term
| what is the benifit of folic acid in pregnancy |
|
Definition
| reduced risk of neural tube defects in fetus |
|
|
Term
|
Definition
|
|
Term
| what is the timeline of HbF levels |
|
Definition
12-24wks ir is primary
3rd trimeser: it decreases and permanent nadir months after birth, production of a and b increase |
|
|
Term
| what does thalassemia do to RBC |
|
Definition
microcytic hypochromatic anemia
normal Fe and total Fe binding capacity
HbA2 is elevated >3.5% |
|
|
Term
| what are the 2 types of a thalassemia and they symptoms |
|
Definition
3 copies: asymptomic
2 copies: trait, mild anemia
2 copy: hemolytic anemia
2 copies: HbBart, hydrops/IUFD |
|
|
Term
| what are the 2 types of B thalassemia and their symptms |
|
Definition
minor: mild to moderate desease, no risk of abnormal perinatal outcome
major: ususlly do not survive reproductive years |
|
|
Term
| when do you do genetic testing for thalassemia |
|
Definition
| if mom is monir then test dad and warn of risk of homozygous baby |
|
|
Term
|
Definition
AR point mutation in B globin (valine -> glutamic acid)
causes HbS which is unstable and sickles in low O2 conditions esp in small vessels causing vasoocclusive crisis |
|
|
Term
| sickle cell trait: what genetic testing and advice, what symptoms |
|
Definition
parent is asymptomatic
partner must be evaluated to get fetus risk factor and offer termination |
|
|
Term
| sickle cell anemia disease: lab signs, genetic testing and davice |
|
Definition
no a chains
if dad and mom have trait must offer termination |
|
|
Term
| symptoms in sickle cell anemia disease |
|
Definition
hemolysis
VASOOCCLUSION
INFECTION
severe anemia: megaloblastic crisis, sequestration, splenic infarcts, painful crisis, preeclampsia, choleycisitis, pyelo, pneumonia, pulmonary embolism |
|
|
Term
| 4 fetal complications of sickle cell disease |
|
Definition
IUGR
low birth weight
fetal distress
intrauterine death |
|
|
Term
|
Definition
oxygen
HYDRATION
rx of infection
transfusions: RESERVED FOR COMPLICATIONS LIKE CHF, SC DISEASE CRISIS UNRESPONSIVE TO HYDRATION AND ANALEGESICS, SEVERE LOW HB |
|
|
Term
| what happens to TSH, TBG, T4 total, T4 free, T3 total, T3 free in normal pregnancy |
|
Definition
TSH normal
TBG increased
total T4 increased
free T4 normal
total T3 increased
free T3 no change |
|
|
Term
| what happens to TSH, TBG, T4 total, T4 free, T3 total, T3 free in pregnancy with hyperthyroidism |
|
Definition
TSH DECREASED
TBG no change
total T4 increased
free T4 INCREASED
total T3 increased
free T3 INCREASED |
|
|
Term
| what is the big indicator in hormone levels of hyperthyroidism in pregnancy |
|
Definition
TSH DECREASE
IT SHOULD BE NORMAL LEVELS IN PREGNANCY |
|
|
Term
|
Definition
nervousness
palpitations
tachycardia
tremor
hypereflexia
heat intolerance
weakness
exophthalmos
diarrhea
failure to gain weight
skin and hair changes
GOITER MAY OR MAY NOT BE PRESENT |
|
|
Term
| signs of hyperthyroidism in fetus |
|
Definition
IUGR
PREECLAMPSIA
CHF
STILL BIRTH |
|
|
Term
| TX of hyperthyroidism in pregnancy and MOA |
|
Definition
propylithiouracil (PTU)
reduces conversion ot T4 to T3
crosses placenta lass
no fetal mental or physical defects or risk in breast feeding |
|
|
Term
| what is the goal of treatment in hyperthyroidism in pregnancy |
|
Definition
maintain free T4 or free TI in high normal range with lowest dose to minimize fetal exposure
FREE T4 1.2-1.8 NG/DL |
|
|
Term
| why would a thyroidectomy be done in pregnancy, what is the best method |
|
Definition
after medical control of thyroidtoxicosis in noncompliant patient, medical therapy suboptimal or thyroid storm
ABLATION WITH THERAPUTIC RADIOACTIVE IODINE IS CONTRAINDICATED DURING PREGNANCY |
|
|
Term
| what is a thyroid storm and the cause |
|
Definition
| hypermetabolic condition due to surgery infection or labor |
|
|
Term
| complications of thyroid storm, what are some risk factors |
|
Definition
high risk maternal heart failure
more common with preeclampsia, anemia, multiple gestation |
|
|
Term
| tx of hypothyroidism in pregnancy, how often should they be monitored, what are you monitoring |
|
Definition
levothyroxine
normalize TSH, check every 4wks until stable then check every trimester |
|
|
Term
| what are the risks of hypothyroidism in pregnancy |
|
Definition
PREECLAMPSIA
PLACENTAL ABRUPTION
LOW BIRTH WEIGHT
CONGENITAL CRETINISM |
|
|
Term
| what is congenital cretinism |
|
Definition
growth failure
MR
neuropsychological defects
can occur in short time if hypothyroidism not recognized |
|
|
Term
| what is the risks of SLE in pregnancy |
|
Definition
preeclampsia
heart block
iugr
renal function
antepartum surveillance when fetus visible (24-25wks)
pt should try and get pregnant in remission
increased spontaneous abortion due to lupus anticoagulant and anticardiolipin antibodies |
|
|
Term
| how can risk of heart block in lupus be avoided |
|
Definition
| check anti-RHO and anti-LA |
|
|
Term
|
Definition
| Anti estrogen that binds receptors at hypo/pituitary and increases fsh |
|
|
