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Patho Test 3 - Reproductive
Powerpoint study
130
Anatomy
Graduate
06/24/2016

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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)
Definition
What are four causes of 1st trimester vaginal bleeding?
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?
Term
Irregular menstrual cycles
Variable timing of ovulation (cycle days 10 – 21)
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
Definition
What is the average length of human pregnancy?
Term
Estimated date of delivery
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
Term
"Morning Sickness"
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
hyperemesis gravidarum
Definition
Term for severe and prolonged vomiting
Term
.5-2%
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
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
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
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
Maternal age
Definition
What is the main risk factor for spontaneous abortions?
Term
10%
Definition
What is the risk of spontaneous abortion at age 20?
Term
60%
Definition
What is the risk of spontaneous abortion at age 45?
Term
UNHEALTHY EMBRYO
Definition
WHAT IS THE MAIN CAUSE OF MISCARRIAGE?
Term
Hormone imbalances
Uterine malformations
Infections
Immunologic problems
Definition
What are four rare causes of miscarriage?
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
Definition
IN A MISCARRIAGE, WHEN DOES EMBRYO DEATH OCCUR?
Term
Intermittent bleeding/spotting
Cramping variable
6-9 weeks gestation
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
Definition
What happens in the second phase of a miscarriage and when does it occur?
Term
Gestational sack expelled
D & C sometimes required
Definition
What happens in the third phase of a miscarriage and when does it occur?
Term
Fallopian tube
Definition
Where are most (95%) of ectopic pregnancies?
Term
Ovarian, infundibular, abdominal, tubal, cervical
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
Normal or low levels
Definition
What will the serum pregnancy test (HCG) show in an ectopic pregnancy?
Term
ULTRASOUND
Definition
WHAT IS ESSENTIAL IN DIAGNOSING AN ECTOPIC PREGNANCY?
Term
MAKE THE DIAGNOSIS BEFORE THE RUPTURE
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
8-12 weeks
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
Definition
How do you treat a unruptured ectopic?
Term
HYDATIDIFORM MOLE
CHORIOCARCINOMA
Definition
WHAT ARE THE TWO TYPES OF GESTATIONAL TROPHOBLASTIC DISEASE?
Term
Hydatidiform mole
Definition
What is the most common form of gestational trophoblastic disease?
Term
a trophoblastic neoplasm
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?
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
1-5%
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?
Term
Gestational hypertension
Preeclampsia-eclampsia
Superimposed preeclampsia

Preeclampsia-eclampsia is most important
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)
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
Eclampsia
Definition
Preeclampsia with grand mal seizure(s)
Term
Prevent eclampsia (bed rest, MgSO4)
Deliver if > 37 weeks
Hospitalize if <37 weeks
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?
Term
Delivery
Definition
What is the ultimate cure of preeclampsia?
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?
Term
Placenta Previa
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)
Definition
What are risk factors for Placenta Previa?
Term
PAINLESS 3RD TRIMESTER VAGINAL BLEEDING
Definition
WHAT IS THE KEY SYMPTOM IN A PREVIA?
Term
Total - completely over the canal
Partial - partially over the canal
Low lying - not over the canal, but close (lower than usual
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
Definition
How do you treat previa?
Term
ABRUPTIO PLACENTA
Definition
PREMATURE SEPARATION OF THE PLACENTA
Term
PAINFUL 3RD TRIMESTER VAGINAL BLEEDING
Definition
WHAT IS THE KEY SYMPTOM IN A ABRUPTIO PLACENTA
Term
Delivery
Definition
How is abruption treated?
Term
PREMATURE LABOR
Definition
WHAT IS THE MOST IMPORTANT CAUSE OF NEONATAL DEATHS AND MORBIDITY?
Term
labor between 21 -36 weeks
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?
Term
Endometriosis
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
Retrograde menstration
Definition
What is the most common cause of endometriosis?
Term
NSAIDS
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
SIZE AND LOCATION
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
HOW COMMON ARE FIBROIDS?
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
Functional cyst
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
Benign Cystic Teratoma
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
Cystadenomas
Definition
Type of ovarian cyst whose cause is unknown and causes discomfort, bloating, mass, and GI disturbances
Term
Surgical excision
Definition
How do you treat Cystadenomas?
Term
Torsion
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
50-85%
Definition
WHAT IS THE LIFETIME RISK OF BREAST CANCER IF YOU TEST POSITIVE FOR BRCA 1 OR 2?
Term
PAINLESS LUMP
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
HPT vaccine (gardasil)
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
POST MENOPAUSAL BLEEDING
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
Menopause
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
Estrogen replacement
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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