1
Q
Oligospermia
A
Low sperm count
2
Q
Azospermia
A
No sperm count
3
Q
Asthenozoospermia
A
Poor sperm motility
4
Q
Oligoasethenozoospermia
A
Poor sperm motility and low sperm count
5
Q
What dayof menstrual cycle does bleeding start
A
Day 1
6
Q
Whcih day of menstrual cycle does basal body temp start to rise
A
Day 14
7
Q
Which two hormones are elevated around menstural cycle day 14
A
LH and estrogen
8
Q
Wht is predominant hormones during luteal phase
A
Progesterone
9
Q
How long does normal menstrual cycle last
A
24-38 days
Bleeds for 2-7 days
10
Q
How much blood loss in menstrual cycle
A
5-80mL
11
Q
Menopause definitino
A
one year without period
Elevated FSH
Low estradiol
12
Q
Average age of menopause
A
51.5
13
Q
Nulligravida
A
Never preg
14
Q
Primigravidia
A
First preg
15
Q
Secundigravida
A
Second preg
16
Q
Multigravida
A
Pregnant more than once
17
Q
Grand multigravida
A
Preg more than 5 times
18
Q
Ladin’s sign
A
Uterus softening after 6 weeks
19
Q
Hegar’s sign
A
Uterine istmus softening after 6-8 weeks
20
Q
Goodell’s sign
A
Cervical softening 4-5 weeks
21
Q
Chadwick’s sign
A
Blue cervix 8-12 weeks
22
Q
Miscarriage
A
Preg lost up to 20 weeks
23
Q
Second trimester preg loss
A
between 13-20 weeks
24
Q
Stillbirth/fetal death
A
PReg loss occurs >20 weeks or weight >350 grams
25
Blighted ovum
Nonviable preg with gestational sac with no yolk sac or embryo
26
First trimester
1-13 weeks
27
Second trimester
14-27 weeks
28
Third trimester
>28 weeks
29
Gravida
How many conceptions/pregnancies pt has had
Includes miscarriages, preg terminations, ectopic pregnancies
30
Para
Pregnancy outcome
Number of time pt has birthed a chid
Includes stillbirths
31
Naegele's rule
Estimateed day of delivery
First day of last menstrual period plus 9 months and 7 days
32
Prenatal vitamin
folic acid
33
Glans
Head of penis
34
Meatus
Opening of tip of glans where urine and semen exit
35
Prepuce
Foreskin
36
Corpus cavernosa
Two columns of spongy tissue that runs along interior shaft of penis
Stiffens when filled with blood
37
Corpus spongiosum
Column of tissue that prevents urethra from closing during erection
38
Testes
Store sperm
39
Seminiferous tubules
Coiled tues that make up most of testis that are responsible for spermatogenesis
40
Sertoli cells
Part of epithelium cells that line seminiferous tubules that aid in production of hormones that produce sperm
41
Leydig cells
Tissue next to seminiferous tubules that produce male hormones like testosterone and other androgens
42
Vas deferens
AKA Ductus deferens or sperm duct
Runs from epididymitis and connects to urethra through ejaculatory duct
43
Rete testis
Sperm cells travel toward epidymis in this
44
Efferent ducts
Series of tubes that join rete testis to epidiymis that absorb most of fluid to move sperm cels
45
Epididymis
Stores sperm until mature
46
Tunica vasculosa
First thin layer of blood vessels around testes
47
Tunica albuginea
Thick protective layer to protect testes
48
Tunica viginalis
Made up of three layers to further protect testes
49
Layers of tissue that surround testes
TUnic avasculosa
TUnica albuginea
Tunica vaginalis
50
Varicocele presentation
Usually on left side (if on right suspect malignancy)
DIlation of pampiniform plexus of spermatic veins
Scrotal fullness that changes in size depending on position
Bag of worms consistency
Maybe dull ache
51
Most common surgiclaly corrected cause of male infertility
Varicocele
52
Varicocele management
Observation
Surgery in pt with pain, infertility, delayed testicular growth
53
What does sudden onset left-sided vacricocele in older man indicate
Renal cell carcinoma
54
What does right-sided varicocele indidcate
Retroperitoneal or abd malignancy
55
Varicocele initial imaging
Testicular US shownig dilation of pampiniform plexus>2mm
56
Hydrocele
Collection of serous fluid between parietal and visceral layers of tunica vaginalis surrounding testis and spermaticord
57
Hydrocele diagnostic imaging
Testicular US to rule out tumor or orchitis
Can also look at transilumniation
58
Hydrocele presentation
Unilateral r bilateral scrotal fullness, uniform consistency
59
Hydrocele causes
Idiopathic MC
INflammatory conditions
60
Types of hydroceles
Communicating (abd fluid enters scrotum through patent processus vaginalis that failed to close)
Non communicating (fluid from mesothelial lining of tunica vaginalis with no connection to peritoneum
61
Hydroceles treatment
Observation
Surgery if older pt with communicating or if persists beyond year of age in infants
62
Spermatocele
AKA epididymal cyst > 2cm
63
Spermatocele presentation
Localized fullness or firmness in head of epididymis
Typically painless
Round, soft mass, separate from testical
Freely movable masss above testicle that transilluminates
64
Spermatocele diagnostic imaging
Testicular ultrasound
65
Spermatocele treatment
Observation
Surgery if bothersome or painful
66
Epididymitis
Swelling from infection or reflux or urine ususally caused by bacterial infection
67
Epididymits cause
Males 14-35: chalmydia, gonorrhoeae
Males>35: E. coli
Prepubertal males: E. coli
68
Epididymitis presentation
Gradual onset testicular swelling
Unilateral with fever, chills, dysuria, freq, urgency, urethritis
Scrotal swelling and tenderness
Positive prehn sign (relief of pain with scrotal elevation
Positive (normal) cremateric reflex (elevation of testicles after stroking inner thigh
69
Epididymitis diagnostic imgaging
Testicular ultrasound showing enlarged epididymis and increased testicular bloodflow
70
Epididymitis labs
UA with pyuria, positive leuocyte esterase
Nucleic acid amplification testing for gonorrhea and chlamydia
71
Epididymitis Treatment
Scrotal elevatoin
NSIDs
COld compresses
Abx (doxycycline and cephtriaxone) (ceftriaxone and fluoroquinolone for men who do anal)
72
Orchitis cause
mumps virus (paramyxovirus)
73
orchitis presentation
Scrotal pain
Swelling
Tenderness
74
Orchitis treatment
NSAIDs
Bedrest
Scrotal support
Warm/cool packs
75
Testicular cancer risk factors
Cryptochordism
White
Klinefelter's syndrome
Hypospadias
76
Most common type of testicular cancer
Germinal cell tumor
77
Two types of germ cell tumors
Seminomas
Nonseminomas
78
Two types of non germ cell tumors
Leydig
Sertoli
79
Noneminomas types
Embryonal cell carcinoma (yook sac in young boys)
Choriocarcinoma (worse prognosis)
Mixed tumors
80
Seminomas charcteristics
Simple
Sensitive to radiation
Slower growning
Step wise spread
81
Testicular cancer presentation
usually painless hard testicular mass
maybe dull pain
Testicular swelling or heaviness
Bac pain
Breast sensitivity
82
Testicular cancer inital imaging
Testicular US shwong hypoechoic mass in seminoma or cystic nonhomogenous mass in nonseminoma
83
Testicle cancer treatment
Radical orchiectomy
Bleomycin, etoposide, cisplatin for persistant tumor markers after orchiectomy
84
Infertility definition
Inability to achieve child after one year of intercourse without contraceptive use
85
What to do on exam for male infertility
Assess features of hypogonadism
Check testicular size and consistancy
86
Male infertility treatmetn
Educatio on intercourse timing with ovulatory cycle
Lifestyle habits
Fix underlying problem
87
Most common causes of urethritis
Gonococcal
Chlamydia
88
Urethritis presentation
Dysuria
Discharge (usually in morning) (usually in gonocooccal)
Penile pruritis
89
Urethritis diagnostic tsting
NAAT
90
Urethritis treatment
Gonococcal - Ceftriaxone IM
Nongonooccal - Doxycycline or azithromcyin PO x 7 days
In BOTH no sex for 7 days from initiation of terapy
91
Urethral stricture causes
STI or UTI
Trauma
Instrumentation of urethra
Idiopathic
INflammatory conditions
Hypospadias
92
Urethral stricture presentation
Weak urine stream
Incomplete bladder emptying
Recurrent UTIs
Urinary spraying
Diysurea
93
Urethral stricture diagnostic tests
US to meadsure urine in bladder after voiding
Uroflowmetry
Cystourethroscopy
Retrograde urethrogram looking for trauma with dye
Voiding cystourethrogram to see if urine flows back from bladder to kidney
Ultrasound ureofraphy cath placed in urethral meatus ad balloon expanded to form seal and contrast ran into urethra
94
Urethral stricture treatment
Endoscopic dilation
Intermittent catheter dilation
Urinary diversion procedures
Surgical reconstruction
95
Urethral injuries causes
Blunt trauma most common
Physical or sexual assault
96
Urethral injury clinical manifestations
Gross hematuria
Diff urinating
Urinary retention (distended bladder)
Lower abd pain
97
Halmark triad of urethral injury
Blood at urethral meatus
Inability to void
Distended bladder
98
Urethral injury treatment
Catheter and monitor
Surgery in severe with maybe suprapubic catheter
99
Urethral injury imaging
RUG
100
Peyronie disease
Fibrotic changes in tunica albuginea leads to abnormal curvature
101
Peyronie disease pathophys
Trauma
ISchemia
Genetics
102
Peyronie disease treatment
Observation if <30º
Pentoxifylline within 3 months
Collagenase Clostridium histolyticum if >3 months
103
Priapism
Erection lasting over 4 hours
104
Priapism types
Ischemicc most common (very painful)
Nonisechemic (related to trauma and less hard and painful)
105
Meds that can cause priapism
PDE-5 inhibitors
Trazadone
Antipsychotics
Anticonvulsants
Alpha blockers
106
Priapism diagnostic tesing
Carvenosal blood gas normal in high-flow, hypoglycemic, hypercarbic, and acidemia ain low-flow
Doppler US to see blood flow
107
ischemic preapism treatment
Phenylephrine
Needle aspiration
Terbutaline
Shunt surgery last resort
108
Nonischemic preapism treatment
Usually resolve in hours of days
emobolization or surgical ligation if refrcatory
109
Balantitis
Inflammation of glans
110
Balantitis clinical findings
Inflamed glans
Erythema
Tenerness
Edema
Ulceration
Exudate
111
Balantitis treatment
Topical nystatin (usually caused by candidia)
Oral abx against anaerobes for severe with phimosis (usually bacterial)
112
Phimosis
Inability ot retract foresckin over glans
Not an emergency
113
Phimosis pathophys
Distal scarring of foreskin after trauma, inflammation, or infection
114
Phimosis treatment
Hygiene
Stretching foreskin
4-8 weeks topical CCS (hydrocortisone)
115
Paraphymosis
Retracted foreskin can't go back to normal position
EMERGENCY
116
Paraphymosis treatment
Manual reduction
Pharm therapy
Definitive management
117
Penile fx treatment
Surgicla exploration within 48 hrs
Evacuation of hematoma
Repair lacerations
Ligationo of vasculature
118
Most common penile cancer
Squamous cell carcimnoma
119
What is penile cancer associated with
HPV 6, 16,18
Smoking
Lack of circumsision
HIV
120
Bowen's disease
Leukoplakia on shaft of penis
Associated with HPV 16
Sometimes leads to SCC
121
Penile cancer presentation
Skin abnormality or palpable mass
Painless lump or ulcer
Ulver on penis
Most common on glans or coronal sulcus or prepuse
Lymph node enlargement
122
Penile cancer diagnostic testing
Biopsy
123
Penile cancer treatment
Excision until clear margins
Penile amputation
124
Erectile dysfunction causes
Vascular (atherosclerosis, diabetes, neuro, psycho, prolactinoma, trauma, surgery)
Meds (BB, thiazides, spironolactone, CCB, SSRI, TCA)
125
`Erectile dysfunction diagnosis
History and PE
Testosterone, CMP, CBC, A1C, lipid panel
Nocturnal penile tumescence (sleep erections)
126
Erectile dysfunction treatment
PDE-5 inhibitor (-afil)
Intracavernosal injections
127
How big is a healthy prostate
Walnut
128
What does BPH stand for
Benign prostate hyperplasia
129
BPH pathophys
Mechanical obstruction (intrusion into urethral lumen or bladder neck)
Dynamic obstruction (Prostatic stroma made up of smooth muscle, collaen, and rich adrenergic nerve supply setting the "tone" of urethra)
130
BPH imaging
cystoscopy showing bladder diverticula and trabeculation
131
BPH presentation
Hesitancy (can't start stream)
Decreased force of stream
Sensation of incomplete bladder emptying
Double voiding
Straining to urinate
Postvoid dribbling
UTI
Hematuria
Renal insufficiency
Irritative symptoms (urgency, freq, nocturia)
132
What to do if feel a nodule on prostate
US
Prostate serum
133
BPH lab findngs
UA to exlude infection
PSA (serum) to detect cancer
Urine cytology if worried about bladder carcinoma
134
BPH treatment
AUA 0-7 - Observation
Absolute surgery: Refractory urinary retention, large bladder diverticula, recurrent UTIs, revurrent gross hematuria, bladder stones, CKD
Pts in between: alpha blockers 5-alpha reductase inhibitors, phosphodiesterase-5 inhibitors combotherapy
135
Common side effects of alpha 1 blockers
Orthostatic Hypotension
Retrograde ejaculation
136
Alpha 1 blockers
Used for BPH
Short acting (proosin) need dose titration
Long acting (terazosin) once daily dosing and requires titratino
137
What med for BPH acts quickly
Alpha-1-blockers (-in)
138
What med can lower PSA
5-alpha-reductase inhibitors (-asteride)
139
What size prostate is best to use 5-alpha-reductase (-asteride) against
>30 grams
140
Side effects of BPH treatment
Decreased libido
Decreased volume of ejaculate
Erectile dysfunction
Decrase serum PSA
141
BPH surgery gold standard
Transurethral resection of prostate
142
BPH indications for surgery
Pt not satisfied with med treatment alone
Acute urinary retention
Renal insufficiency
Bladder stones
Recurrent UTI
Recurrent hematuria
143
Transurethral resection of prostate compllications
Bleeding
urethral strictures
Perforation of prostate capsule
Tansurethral resection syndrome
144
Transurethral incision of prostate
More rapid and less morbid than transurethrla resection of prostate
Lower rate of retrograde ejaculation
145
When to do in BPH when prostate is very large
SImple prostatectomy
146
Acute bacterial prostatitis most common causes
E. coli
Pseudomonas
147
Acute prostatitis presentation
Perineal, sacral, or supbubic pain
Fever ad chillls
Irritative voiding complaints
Urinary retention
NV
Warm prostate on DRE (hot and boggy)
148
Acute prostatitis labs
CBC shows leukocytosis with left shift
UA shows pyuria
149
Acute prostatitis imaging
Pelvic CT or transrectal US who don't respong to treatment in 24-48 hrs
150
Acute bacterial prostatitis treatment
Ampicillin and aminoglycoside (IV)
Switch to floroquinolones PO once afebrile for 24-48 hrs
151
When to refer someone with acute bacterial prostatitis
urinary retention or evidence of chronic prostatitis
Signs of sepsis
Need surgical drainage of bladdir prostatic abscess
152
Chronic bacterial prostatitis presentation
Irritative voiding symptoms
Urethral pain
Obstructive urinary sympoms
Low back pain
Perineal pain
Asymptomatic between acute flares
153
Chronic bacterial prostatitis lab findngs
Postprostatic massage voided urine shows leukocytes (>5 per high power field) and bacteria growth when cultured
No imaging needed
154
Chronic bacterial prostatitis treatment
Hospital for febrile
IV ampicillin and gentamycin or third gen ceph or fluoroquinolone
Outpatient: Oral bactrim or fluorquinolone for 4-6 weeks
Symptomatic: Anti-inflammatories (indomethacin or ibuprofen, hot sitz bath, alpha-blockers (sin)
155
Non-bacteria chronic prostatitis lab findings
Increased leuocytes but cultures are negative
156
Non-bacterial chronic prostatitis treatment
ALpha-blockers
157
Prostate cancer presentation
Mostly asymptomatic
Lymph node metastasis
Hard, nodular, irregular prostate on DRE
158
What to do if DRE abnormal to test for prostate cancer
Trans rectal Ultrasound Biopsy
159
Prostate cancer lab findings
PSA >4
Greater means more severe
160
Prostate cancer imaging
CT to see nodal metasteses
MRI to see prostate and regional lymph nodes
PET scan
161
Prostate cancer treatment
Active surveillance for low PSA, small volume, or less than 10 year life expectancy
Radical prostatectomy for T1 and T2 (T4 too far gone)
Radiation (brachytherapy)
162
Brachytherapy
Implantation of permanent or temporary radioactive seeds into prostate
Less risk of getting ED
163
Locally and regionally advanced prostate cancer treatment
Combo therapy with androgen deprivation and surgery or irradiatino
164
Metastatic prostate cancer treatment
Androgen deprivation therapy
Meds that block pituitary, hypothalamus, adrenals, prostate cell
165
Hormone levels in menopause
FSH elevated
Estradiol, progesterone, testosterone, AMH, inhibin B low
Antral follicle count low
166
Early menopausal transition in perimenopause
>7 day change in intermenstrual interval
FSH rises
167
Late menopausal transition in perimenopause
Skiped cycles, amenorrhea episodes
1-3 years before final menstrual period
168
Perimenopause presentation
Irregular cycles
Vasomotor symptoms
Insomnia, fatigue
Depression, anxiety, cognition issues
Vaginal dryness
Decreased libido
bone loss
169
Menopause presentation
Amenorrhea for >12 months
Bone loss
Vaginal dryness
Dyspareunia
Urinary symptoms
More common UTIs
Weight gain
Decreased libido
170
Geniturinary syndrome of menopause
Vulvovaginal atrophy or atrophic vaginitis
Usually appers after vasomotor symptoms
Estrogen deficiency vauses decreased blood flow and decreased sex function
171
Estrogen deficiency long term consequences
Bone loss (osteopenia, osteoporosis)
Increased risk of CVD bc of increased LDLs
172
What age does bone mineral density peak in men and women
30
173
Menopause bone loss preention
Estrogen
Vitamin D, Calcium
Diet
Exercise
Smoking cessation
Pharm therapy with bisphosphonates
174
What is the most common cause of death in women
CVD
175
Supportive labs to diagnose menopause
FSH > 40
Low estradiol
Generally not needed for pts >45
176
Who needs labs for diagnosis of menopause
History of PCOS
Taking COCP (need to stop and measure 4 weeks later)
Had hysterectomy or endometrial ablation need FSH
177
When to stop COCP
Stop oral in 45-49 bc increased risk of VTE
178
What hormones to give menopausal pt with uterus
Estrogen AND progesterone
Unapposed estrogen would cause uterus to grow
179
What hormones to give menopausal pt without uterus
Estradiol
180
Special needs in menopause hormone therapy that have had ovaries removed
Need extra estrogen
181
Heavy bleeding after long symptom-free period in menopause diagnostic studies
TVUS and biopsy
182
Nonhormonal treatment of vasomotor symptoms of menopause
SSRI/SNRI
Vaginal lubricants and moisturizers
Gabapentin
183
Vitamin D functions
Ca absorption
Muscle contraction
Bone mineralization, growth, remodeling
Cell growth
Glucose metabolism
Reduction of inflammation
184
Parathyroid hormone job
Control level of Ca in blood
185
Whole PTH
Intact PTH + fragmented PTH
Best assay for end-stage renal
186
Hypercalcemia symptoms
Fragile bones
More freq urination
Increased thirst
NV
Fatigue
Kidney stone
187
Hypocalcemia symptoms
Tingling in fingers/toes
Muscle cramps
Irregular Heartbeat
188
Estradiol characteristics
Strongest
Most common until menopause
Secreted by ovaries
Assissts in lactation
Maintain bone health
189
Estriol characteristics
Weaker than estradiiol
Maintain estrogen during pregnancy
Made by placenta
Causes skin and hair to glow
190
What do low levels of estriol cause
Infertility
Menstrual irregularities
191
Progesterone function
Maintain pregnancy
192
When is progesterone high
Ovulation and preg
193
When is progesterone low
infertility
Placental failure
Menopause
194
What lab can help find cause of abnormal uterine bleeding
Progesterone
195
What does high FSH cause
Hot flashes
Weight gain
Vaginal dryness
Irregular menstration
Sleep disturbance
Bone loss
196
What does low FSH cause
Limited sperm productoion
Infertility
Delays in sex development
197
LH job in males
Signal testes to make testosterone
198
LH jobs in females
Control menstrual cycle
Trigger ovulation
Signal ovaries to make estrogen
199
What's elevated in PCOS
DHEA
200
What can elevated PRL cause
Low male sex drive and erectile dysfunciton
Menstrual irregularities and infertility
201
Tumor marker for ovarian cancer
CA-125 in blood
202
Tumor marker for breast cancer
HER2 in females
203
What to aways screen for if also screening for STI
HIV
Document if pt declines
204
How often to screen men who have sex wit men for STI
Every 3- 6months
205
Trichomoniasis
Protozoan STD
206
Most common nonviral STI worldwide
Trichomoniasis
207
Trichomoniasis clinical fidings
Asymptomatic in men
Vaginal discharge
Vulvovaginal discomfort
Dysuria
Dyspareunia
Abd pain
Vaginitis
Cystitis
Cervicitis
208
Trichomoniasis PE findings
Vaginal discharge
Inflammation of vaginal walls and cervix
Men asymptomatic maybe some urethral discharge
209
Trichomoniasis diagnostic testing
Wet mount microscopy showing organism
210
Trichomoniasis treatment
Metronidazole
211
What to tell people that take metronidazole
NO alcohol
212
Trichomonias complications
Cystitis
Pelvis inflammatory disease
Infertility
Increased risk of HIV or transmission
Prostatitis
Epididymitis
Slowed sperm
213
Trichomoniasis complications in preg
Premature ruptur of membranes
Preterm birth
214
most commmon bacterial STI
Chlamydia
215
Chlamydia clinical findings
Urethritis
Mucoid or watery discharge
Dysuria
Cerivicitis
Vaginal bleeding
216
Chlamydia diagnostic studies
Nucleic acid amplification tests
Gram stain
217
Who to screen. for chlamydia
Sexually active women 25 years or younger or have risk factors
HIV
Gay men
218
Chlamydia treatmnt
Doxycycline
219
What to warn someone taking doxycycline about
Sunburns
220
Chlamydia complications
Reactive arthritis (reiter's syndrome)
221
Gonorrhea clinical findings male
Urethritis
Prurulent discharge
Dysuria
Can involve prostate, epididymis, and periurethral glands
222
Gonorrhea clinical findings female
Cervicitis
Mucopurulent discharge
Dysuria
Increased urinary freq and urgency
223
Gonorrhea conjunctivitis
Direct inoculation to conjunctiva (touch infected genitals then touch eye)
Prurulent drainage
NAAT swab from conunctiva
Refer to opthalmology
Can lose eye if not treated
224
Gonorhea diagnostic test
Nucleic acid amplification testing
225
Gonorrhea treatment
Ceftriaxone IM (resistant to penicillin, doxy, and cipro)
226
Gonorrhea complications
Prurulent arthritis
Rash
Tenosynovitis
Tubo-ovarian abscess
Pelvic inflammatory disease
Urethral stenosis in male
Systemic infection
227
Gonnorhea prevention
Condoms
Doxycycline postexposure prophylaxis
228
Bacterial vaginosis clinical findings
Discharge
Grey color
Fish odor
No inflammation
229
Bacterial vaginosis diagnostic studies
Wet mount with clue cells (adherence of gardnerella vaginalis to epithelial cels
Whiff test (KOH increase fish odor)
pH >4.5
230
bacterial vaginosis treatment
Metronidazole
Alternative: clindamycin
231
HSV pathophys
Virus goes dormant in dorsal root ganglion
Infection lifelong
232
HSV clinical findings
Painful vesicular lesions on genitals
Regional lymphadenopathy
Flu-like symptoms
Dysuria
Neualgia maybe
233
HSV diagnostic studies
PCR best
Direct fluorescent antibody fast
234
HSV treatmnt
acyclovir
235
What to do if preg has HSV and symptoms during labor
DO NOT give vaginal birth
236
What bacteria causes chancroid
Haemophilus ducreyi
237
Chancroid epidemiology
STI usually from carribean or africa
238
Chancroid clinical findings
Deep, painful genital ulcer with well defined irregular borders
Heavy, foul discharge
Erythematous
Painful inguinal lymphadenopathy
Bubeos
239
Chancroid diagnostic studies
Clinical diagnosis
Difficult to culture
Rule out HSV and syphilis
240
Chancroid treatment
Azithromycin
Treat partners
241
Granuloma inguinale (donovanosis) cause
Klebsiella granulomatis (encapsulated G-)
242
Granuloma inguinale (donovanosis) clinical findings
Painless nodules then slough off forming ulcers with granulation and easy bleeding
Can spread from genitalia to lower abd and thigs
Tender lymphadenopathy
243
Granuloma inguinale (donovanosis) lab studies
Wright stain with dark staining of donovan bodies and bacteria encapsulated macrophages
Biopsy if stain negative
244
Granuloma inguinal (donovanosis) treatment
Azithromycin
or doxy
Treat partners
245
What bacteria cauases lymphogranuloma venereum
Chlamydia trachomitis (L1-L3)
246
Lymphogranuloma venereum clinical findings
Self limited ulcer
Buboes
Proctocolitits
Fever, chills
HA
Arthralgia
Abd cramps
247
Lymphogranuloma venereum diagnostic studies
Nucleic acid amplification tests
LGV specific molecular tests
248
Lymphogranuloma venereum treatment
Doxycycline
or erythromycin
Treat partners
249
Bacteria that causes syphilis
Treponema pallidum
250
Primary syphillis clinical finidngs
Chancre (painless ulcer with clean base and firm indurated borders)
Regional lymphadenopathy (painless and rubbery)
251
Secondary syphilis clinical findings
few weeks to 6 months after chancre
Macropopular rash patchy alopecia
Hepatitis
Nephritis
Palms and soles
Arthralgias
Fever
252
Late tertiary syphilis clinical presentation
> 1 year after contact
Without active lesions
Gummatous lesion at skin, bones, viscera, ocular, CNS, CVD
253
Neurosyphilis
Life threatening complication of syphilis
Chronic meningnitis
AMS
Argyll-Robertson pupil
254
Argyll-robertson pupil
Neurosyphilis treatment
Bilateral small irregular pupils that constrict with accomodation but not when exposed to light
255
Syphilis diagnostic testing
Dark field microscopy
Fluorescent treponemal antibody tests confirmatory
256
Syphils treatment
Benzathene Penicillin G IM
Treat recently exposed contacts
257
Condyloma acuminata clinical findings
Warts on perianal skin that can extend into anal canal that can be flat or look like cauliflower
Itching, bleeding, or pain
258
Condyloma acuminata cause
HPV (usually 6 or 11)
259
Condyloma acuminata prevention
HPV vaccine
260
Condyloma acuminata diagnostic studies
Clinical diagnosis
Biopsy if unsure to rule out cancer
261
Condyloma acuminata treatment
Cryotherapy
Surgical excisioon
Trichloroacetic or bichloroacetic acid
262
Pevic inflammatory disease causes
N gonorrhea
C trachomatis
Anaerobes
H influenza
Strep
G- rods
263
Pelvic inflammatory diseas risk factor
Sex
Recent IUD placement
264
Pelvic inflammatory disease clinical findings
Lower abd pain
Uterine bleeding
Vaginal disharge
Fever
Abscess
RUQ pain
265
Pelvic inflammatory disease Pelvic exam findings
Uterine, cervical, or adnexal tenderness
Cervical motion tenderness (chandelier sign)
266
Pelvic inflammatory disease diagnostic testing
ORal temp > 101
Abnormal vervical or vaginal discharge
Increased WBC
Elevated ESR or CRP
Cervical motion tenderness or adnexal tenderness
Rule out preg
Nucleic acid smplification test for (N gonorrheoea or C trachomatis)
267
Pelvic inflammatory disease treatment
Ceftriaxone + doxycycline + Metronidazole
268
Pelvic inflammatory disease surgery indications
Tubo-ovarian rupture or >8cm
Poor response to to abx in 48 hrs
269
What surgery is used for pelvic inflammatory disease with overwhelmic infection
Hysterectomy and bilateral salpingo-oophorectomy
270
Pelvic inflammatory disease complications
Fitz-Hugh Curtis syndrome (perihepatitis and infalammation of liver capsule and peritoneal surface of RUE)
271
Parous
Cervix that is regularly open
272
Nabothian cyst
White/opaque cystic structure on cervix
Normal finding
May come from childbirth trauma
273
Ectropion
Eversion of endocervix exposing columnar epithelium
Could be after childbirth or COCPs
No management unless spotting or discharge
274
Cervical polyps
Small benign peducnculated tissue originating from endocervix
Reddish purple, smooth protrusion orom cervical os with pedicle
Intermenstrual or postcoital bleeding
275
Cervical polyp management
Removal via speculum exam
Large may need to be in OR
276
Most common STI
Human papilloma virus (HPV)
277
What versions of HPV are high risk for cancer
16 and 18
278
What versions of HPV are low risk for cancer
6 and 11
279
How does HPV spread
Sex
Fingers, mouth, skin
Vertical (mother to child)
280
HPV prevention
Vaccine recommended for 11-45 yo
281
HPV presentation
Asymptomatic
Anogenital condylomas (warts)
Abnormal cytology on screening
Vervical, vulvular, anal, oropharyngieal, or rectal cancer
282
Condyloma
Wart
283
Condyloma acuminata
Anogenital warts caused by HPV through anogenital contact
Cauliflower-like
Can be on vulva, vagina, cercvix, oropharynx, perineum, or rectum
284
Condyloma diagnostic studies
Usually clinical
Biopsy if unsure
285
Condyloma acuminata treatment
Limquimoid cream TID FIRST LINE
Podophyllotoxin cream
Cryotherapy, electrosurgery, or trichloroacetic acid
Surgery for large
286
How to screen someone <21 years old for HPV
Don't
287
How to screen someone 21-29 for HPV
Cytology every 3 years
288
How to screen someone 30-60 for HPV
Cytology every 3 years
or
hrHPV every 5 years
or
Both
289
How to test someone >60 for HPV
Don't have to if don't have history
290
How to screen someone with hysterectomy for HPV
Don't have to unless history or history of cancerous lesions on cervix
291
Colposcopy
Looks at entire tissue of cervix
Put acetic acid on cervix and abnormal cells look white
Iodine applied and abnormal cells are yellow
292
Cytologic and histologic findings of HPV
Squamous lesions
Glandular lesions
Cervical neoplasms (scored 1-3)
293
ASC-US
Cervix
Atypical squamous cells of undetermined significance
294
LGSIL
Cervix
Low grade squamous intraepithelial lesion
295
ASC-H
Cervix
Atypical squamous cells, cannot rule outhigh grade changes
296
HSIL
Cervix
High grade intraepithelial lesion
297
ASC-US and high risk of HPV negative treatment
Repeat screening at normal intervals
298
ASC-US and high risk of HPV positive treatment
<25 repeat in 1 year
>25 colopscopy
299
ASC-H treatment
Colopscopy
300
LGSIL treatment
<25 repeat in one year
301
LGSIL and negative high risk HPV treatment
>25 repeat in one year
302
LGSIL and positive high risk HPV treatment
>25 colopscopy
303
HGSIL treatment
Colopscopy
Surgery maybe if >25
304
Atypical glandular cells treatment
Colopscopy
Endometrial sampling if >35 years
305
Adenocarcinoma in citu treatment
Colopscopy
Endometrial sampling if >35 years
306
Endometrial cells on cervical cancer screening treatment
Premenopausal: routine screening
Menopausal: not normal need colposcopy
307
No endocervical cells on cervical cancer screening treatment
Repeat screening at normal intervals
308
Most common cervical cancer
Squamous cell
309
Cervical cancer risk factors
HPV
Smoking
Low socioeconomic status
310
Cervical cancer presentation
Asymptomatic
Visible lesions on pelvic exam
Vaginal bleeding
Postcoital bleeding
Vaginal discharge (water, mucoid, malodorous)
311
Cirvical canver management
Conization for diagnosis and treatment if want to preserve fertility
Hysterectomy preferred
Lymphadenedecomy, radiation, or chemo for greater stage
312
Vulvar lichen simplex chronicus
Benign epithelial thickening and hyperkeratosis from chronic irritation
313
Vulvar lichen simplex chronicus causes
Soaps
Perfumes
Detergent
Pads
Infection
Allergies
314
Vulvar lichen simplex chronicus Presenation
Scratching vulva
Tissue appears thickened
Deep red or white plaques
315
Vulvar lichen simplex chronicus treatment
Identify and stop offending agents
Sitz baths
Lubricants
Oral antihistamines
Topical steroids
316
Lichen sclerosis
Benign, chronic, progressive inflammation of epithelial lining and pruritis
317
Lichen sclerosis causes
Genetics
Maybe autoimmune
Low estrogen (prepubital/postmenopausal)
318
Lichen sclerosis presentation
Pruritis of vulva
Dysuria from fissuring
Dysparunia
Spotting, bleeding
White plaques
Thin white skin
Agglutination f labia minor and clit
319
Lichen sclerosis diagnostic studies
Usually clinical
Biopsy showing thin hyperkeratotis layer, thinning of epithelial layer, and deep lymphocytic infiltration
320
Lichen sclerosis treatment
Hygiene
Stop irritants
Sitz baths
Lubricants
Oral antihistamine
Topical potent steroid
If those don't work:
Tacrolimus cream
Photodynamic therapy
Intralesional steroids
321
Vulvar Lichen planus etiology
Autoimmune related
322
Vulvar lichen planus presentation
Vulvular pain, discomfort, soreness
Burning and dysuria
Spotting or bleeding
Irritating vaginal discharge
Sharply demarcated erythamous erosions glazed
323
Vulvar livhen planus diagnostic studies
Biopsy
Rule out cancer
324
Vulvar lichen planus treatment
No cure
Topical super potent steroids
325
Atrophic vaginitis other name
Genitourinary syndrome of menopause
326
Atrophic vaginitis cuase
Low estrogen decreases bloodflow and lubrication
327
Atrophic vaginitis presentation
Asmptomatic
Dyspareunia
Vaginal dryness
Vulvar irritation
Recurrent UTIs
Pale,dry, shiny epithelium
Maybe fissures
Prominent urethra
328
Atrophic vaginitis diagnostic studies
Clinical
329
Atrophic vaginitis treatment
Lubricants (coconut oil or water based)
Vaginal estrogen
Vaginal moisturizers (hyaluronic acid)
330
Vulvovaginal candidiasis pathogen
Candida albicans
Candida glabarata
331
Vulvovaginal candidiasis risk factors
DM (from SGLT2)
broad spectrum abx
Elevated estrogen levels
Immunosuppression
332
Vulvovaginal candidiasis presentation
Vulvar pruitiss
White discharge
Vulvar erythema
Labia minora edema
Burning after urination
333
Vuluvovaginal caandidiasis diagnostic studies
Microscopy shows candida (budding yeast)
334
Vaginal candidiasis treatment
Oral flucanazole
or Topical terconazole (less side effects)
2nd line: ibrexaafungerp
335
Vulvar cancer risk factor
TOBACCO USE
HPV
336
Vulvar candidiasis in preg treatment
Clotrimazole
Miconazole
Nystatin
337
Vulvar cancer clinical manifestation
Asymptomatic
Vulvar pruritis
Vulvar mass
Bleeding
Pain
Hx of infrequent pelvic exam
338
Vulvar cancer diagnosis
Biopsy
339
Vulvar cancer treatment
Wide excision with inguinal lymph node dissection
340
Vaginal cancer risk factros
HPV
Smoking
DES exposure
341
Most common vaginal cancer
Squamous cell carcinoma
342
Vaginal cancer presentation
Asymptomatic
Vaginal bleeding
Discharge
Mass
343
Vaginal cancer diagnostic studies
Cytology
Colposcopy and biopsy
344
Bartholin gland cyst and abscess most common pathogen
E. coli
345
Bartholin gland cyst presentation
Can be asymptomatic
Painful
Diff sitting, ambulating, intercourse
Clear or white drainage
346
Bartholin gland abscess presentation
Localized severe pain
Edema
Erythema
Fever
Mucopurulent drainage
347
Bartholin cyst treatment
Rule out cancer
Warm compresses and sitz baths for <3cm
Incision and drainage with culture and word catheter or maybe surgical marsupialization for >3cm
348
Bartholins abscess treatment
Incision and drainage and culture
Word catheter for one month
349
Bechets syndrome presentation
Like HSV but tests HSV negative
Oral aphthous ulcers
Vulvar aphthous ulcers
Uveitis
GI disease
Nephritis
Thrombosis
350
Bechet's syndrome treatment
Refer to rheumatology
Corticosteroids for vulvar
351
Imperforate hymen presentation
Budging introitus during infancy
Adolescents with amenorrhea
352
Imperforate hyment diagnostic studies
Ultrasound
353
Imperforate hymen treamtne
Hymenectomy
354
Most common vaginal foreign body
Tampon
355
Vaginal foreign body presentation
Chronic vaginal discharge
Intermittent bleeding or spotting
FOul smelling odor
356
Mittleschmerz
Ovulation pain
357
Most common ovarian cyst
Follicular cyst
358
Types of ovarian cysts
Follicular cysts
Corpus luteal cysts (granulas lutein)
Endometrioma (chocolate cyst)
359
What causes follicular cyst
Failure in ovulation after follicular phase
360
Follicular cyst clinical manifestation
Asymptomatic
Usually incidental finding
Large ones have pelvic pain and dyspareunia
361
What causes corpus luteum cyst
arise from resorption of blood from corpus luteum
362
Corpus luteal cysts presentation
Thin walled unilocular cyst
Local pain and tenderness
Amenorrhea
Delayed menstruation
Torsion of ovary
Rupture has results in peritoneal signs, acute abd, and shock
363
Ovarian teratoma
Dermoid cyst, germ cell tumor, benign ovarian neoplasm
Have hair and teeth tissue
Heavy
364
Ovarian cyst diagnostic studies
Ultrasound
365
Ovarian cyst treament
Usually resolve themself
Ultrasound x3 months for follicular
Remove if problems
366
ovarian torsion causes
Ovarian cyst
OVarian neoplasms
preg
367
Ovarian torsion presentation
Pelvic pain
Ovarian mass
Nasea/vomiting
368
Ovarian torsion diagnostic studies
palpable masses
Pelvic ultrasound show follicular shift
Urine beta HCG
369
Most common cause of infertility
PCOS
370
PCOS pathophys
Abnormal gonadotropin releasing hormone pulse freq
Over production of LH and fSH
Increased testosterone
Hyperinsulinemia
Decreased sensitivity to insulin
371
PCOS presentation
Menstrual irregulariaties
Hyperandogenism (hirstuism, acne, male pattern hair loss)
Polycystic ovaries
Obesity
Infertility
372
PCOS diagnostic criteria
Rotterdam criteria
need 2/3:
Oligo or anovulation
Clinical labs with signs of hyperandrogenism
Polycystic ovaries by ultrasound
373
PCOS diagnostic studies
String of pearls or oyster ovaries seen on US
374
PCOS treatment goals
Fertility
Manage metabolic problems
Imrpove hyperandrogenic features
Prevention of endometrial hyperplasia
375
PCOS treatment
Lifestyle
COCPs (progestin only if COCP contraindicated)
Spironolactone if no improvement (not for preg)
Manage insulin resistance
376
PCOS complications
Endometrial hyperplasia
Endometrial carcinoma
Cardiovascular disease
Diabetes
Infertility
377
Tuboovarian abscess etiology
Ascending polymicrobial infection causing inflammatory mass of fallopian
OFten seen in PID, STI, GI infection, Appendicitis, Bowel surgery
378
Tuboovarian abscess etiology
Multiple sex partners
15-25 yo
Prior hx of PID
Immunosupresion
379
Tuboovarian abscess presentation
Unilateral abd pelvic pain
Fever, chills
NV
380
Ruptured tuboovarian abscess presentation
Abd pain
Peritonitis
Septicemia
Shock
381
Tubuoovarian abscess diagnostic studies
Unilateral mass
US showing complex mass that obliterates normal adnexal architecture
382
Stable tuboovarian abscess treatment
IV broad spectrum abx (ceftriaxone +doxy+metro) then transition to oral
Minimally invasive drainage if >7cm or if concern for malignancy in post-menopausal
383
Ruptured tuboovarian abscess treatment
Surgical laparotomyurgery
Sepsis, >7cm
384
Tuboovarian cyst complications
Adhesions
INfertility (from adhesions)
Ectopic preg
Bowel obstruction
385
Deadliest GYN cancer
Ovarian
386
Most common ovarian cancer
Epithelial
Very serious
387
OVarian cancer presentation
Bloating
Early satiety
Pelvic/abd pain
Urinary freq and urgency
Ascites
Pleural effusion
Bowel obstruction
VTE
388
OVarian cancer diagnostic studies
Adnexal mass on physical exam
US
389
What imaging is best to assess metastasis of ovarian cancer
CT or MRI
390
Ovarian cancer tratment
Surgical resection
Chemo
Radiation
391
Genetic causes of ovarian cancer
BRCA
Lynch
392
Primary ovary insufficiency
Hypogonadism <40 yo
393
Primary ovarian insufficiency causes
Ovarian surgery
Radiation
Chemo
Primary adrenal insufficiency
Autoimmune
Fam history
Fragile
394
Primary ovarian insufficiency symptoms
Oligomenorrhea or amenorrhea
Hot flashes
Night sweats
Vaginal dryness
395
Primary ovarian insufficiency diagnostic studies
Low estradiol
Elevated FSH
Negative TSH
396
Primary ovarian insufficiency treatment
Estradiol PO or patch with progesterone
397
Abnormal uterine bleeding pathophys
Mess up in HPA axis
Anatomic issue
Coagulopathies
398
What to ask about abnormal uterine bleeding
Age (could be cancer in post-menopausal)
Days between cycles
Spotting between cycles
How heavy
Clots? (amount and size)
Pads/tampons per hour
Cramps
399
Abnormal uterine bleeding work up
Physical exam
HCG
TSH
CBC
Pelvic ultrasound
400
Abnormal uterine bleeding diagnosis
Exclusion
401
Abnormal uterine bleeding treatment
Birth control
Transexamic acid
NSAIDs
Myoectomy if want to preserve fertility
Endometrial ablation
Uterine artery embolization
Hysterectomy
402
Endometriosis
Presence of endometrial tissue outsiede uterine cavity
Commonly in pelvis but can occur anywhere
403
Endometriosis presentation
Peritoneal adhesions
Ovarian cysts
Endometriotic nodules (usually between rectum and vagina)
Non classic lesions (red or clear vesicles)
404
Endometriosis etiology
Retrograde menstruation and refluxed menstrual tissue
405
What increases risks of endometriosis
Fam history
Nulliparity
Early menarche
Late menopause
406
Endometriosis symptoms
Chronic pelvic pain
Pressure (throbing, dull, sharp, burning)
Dysmenorrhea
Dyspareunia
Dyschezia
Urinary probs
GI pain
Abnormal uterine bleeding
Diff achieving preg
Infertility
Can be asymptomatic
407
Endometriosis diagnostic studies
Transvaginal US initial
Laparoscopy showing lesions is DIAGNOSTIC
Get biopsy of lesions
408
Endometriosis physical exam findings
Nodules in posterior fornix
Adnexal masses (from chocolate cysts/endometrioma)
Immobility of cervix
Can be normal
409
Endometriosis surgical indications
Pain limits funiction
Medical management doesn't work
Treatment of ovarian cysts, rectovaginal nodules, bladder lesions
410
Fitz Hugh Curtis Syndrome
Adhesions from liver to anterior abdomen
Seen in endometriosis
411
Endometriosis treatment
NSAIDs
Hormonal contraceptives
Refer to fertility specialist if want
2nd
GnRH analogs (leuprolide IM monthly)
Laparoscopy with excision of implants and adhesions
412
Leiomyoma
Noncancerous tumor arising from smooth muscle cells of myometrium
413
Most common pelvic neoplaasm in females
Leiomyoma
414
Leading cause of US hysterectomies
Leiomyoma
415
Leiomyoma presentation
Heavy or prolonged menstrual bleeding
Pelvic pain and pressure
Dyspareunia
Dysmenorrhea
Reproductive dysfunction
Urinary retention or obstruction
Constipation
Could be asymptomatic if small
416
Leiomyoma diagnostics
Transvaginal US
Consider MRI
CBC
417
Leiomyoma treatment
NSAIDs, COCPs, progestin IUDs, TXA
GnRH agonist if those don't work
Uterine artery emobolization if don't care about fertility
Myomectomy
Hysterectomy
418
Tranexamic acid (TXA)
Treatment for leiomyoma
Take only during menses
419
When to use NSAIDs in leiomyoma
Heavy bleeding
Start on first day of menses and continue 2-3 days or until menses end
420
When is hysteroscopic myomectomy indicated
Submucosal fibroids
421
Hysterectomy indications
Abnormal uterine bleeding
FIbroids/leiomyomas
Adenomyosis
Endometriosis
Uterine prolapse
422
When to do abdominal hysterectomy
Very large mass
423
Hysterectomy post-op instructions
Nothing goes into vagina for 6 weeks or until cleared
Don't lift over 13 lbs
424
Adenomyosis
Endometrial glands and stroma present within myometrium
425
Adenomyosis symtoms
Heavy menstrual bleeding
Dysmenorrhea
Chronic pelvic pain
Fertility probs
Can be asymptomatic
426
Adenomyosis physical exam findings
Mobile uterus
Diffusely enlarged and globular
Boggy
Tender
427
Adenomyosis dianostic studies
Trasnvaginal ultrasound initial showing enlarged uterus, asymmetryic thickening of myometrium, myometrial cysts, hyperechoic island of tissue, increased myometrial heterogenety
Pathology is diagnostic
428
Adenomyosis treatment
1st NSAIDs, levonorgestrel IUD
2nd COCPs, GnRH analogs
Hysterectomy if need surgery
429
Who commonly gets endometrial hyperplasia
Perimenopausal or menopausal
430
Benign endohyperplasia diagnostic imaging
Transvaginal ultrasound initial with endometrila stripe >4mm in menopausal
Endometrial biopsy diagnostic
431
Endometrial hyperplasia treatment
Progestin therapy
Dilation and curettage
Hysterectomy
432
Most common gyn malignancy
Endometrial cancer
433
Most common endometrial cencer
Adenocarcenoma
434
Endometrial cancer risk factors
Unopposed estrogen replacement therapy
Tamoxifen
Chronic anovulation
Obesity
Early menarche and late menopause
Lynch syndrome
BRCA carrier
435
What can be protective against endometrial cancers
Oral contraceptives
Increased amount of pregnancies
Breast feeding
436
Endometrial cancer presentation
Abnormal uterine bleeding
Abnormal cervical pathology
Incidental finding on imaging (most asymptomatic)
437
Endometrial cancer diagnostic studies
Transvaginal ultrasound INTIAL with endometrial thickness > 4mm
Biopsy GOLD standard
438
Tumor marker related to endometrial cancer
CA125
439
Endometrial cancer treatment
Hysterectomy
Lymph node evaluation to guide adjunct chemotherapy
440
Asherman syndrome
Intrauterine adhesions
Usually after procedure
441
Asherman syndrome presentation
Secondary amenorrhea
Infertility
442
Asherman syndrome imaging
INITIAL transvaginal ultrasound
GOLD hysteroscopy
443
Pelvic floor dysfunction symptoms
Urologic probs
Gynecologic probs
Colorectal probs
Discomfort
Body image issues
444
Pelvic organ prolapse risk factors
High birth weight, prolonges second phase of labor, maternal age>25
Age (60-70)
Overweight
Constipation
COPD
Lifting jobs
445
Pelvic organ prolapse prevention
Weight loss
Managing constipation or cough
446
Pelvic organ prolapse quantification staging
Stage 1: 1cm above hymenal remnants
Stage 2: 1cm above to 1cm below hymenal remnants
Stage3: > 1cm past hymenal remnants but nt complete eversion
Stage 4: Complee vaginal vault eversion/complete uterine procidentia
447
Pelvic organ prolapse treatment
Nothing if no symptoms or pt okay with symptoms
Conservative 1st (pelvic floor physical therapy, big tampon thing, vaginal pessary)
Vaginal pessary is mainstay
Surgery if refuse (hysterectomy)
448
Vaginal pessary contraindications
Infection
Noncompliance
Mesh exposure
Sexually active and unable to remove
Silicone allergy
449
Vaginismus
Involuntary muscle spasm with vaginal prenetration
450
Vaginismus diagnosis
Exclusion
Physical exam
Vulvar q tip testing
Check pudendal nerve for neuralgia, compression, or entrapment
451
Vaginismus treatment
Hygiene, stress redcution, lubricant, espom bath
Pelvic floor PT, CBT, sex counseling
TOpical lidocain, estradiol cream
Amitryptyline
Gabapentin
Diazepam suppository
452
Vulvodyna
Vulvular pain of unknown cause of last three months
453
Vulvodynia classifications
Location if localized (vestibulodynia, clitorodynia) or generalized
Can be provoked by contact
454
Vulvodynia presentation
Pain with intercourse, tampon insertion, tight clothes, sitting for long time
455
Vulvodynia treatment
Hygiene, stress redcution, lubricant, espom bath
Pelvic floor PT, CBT, sex counseling
TOpical lidocain, estradiol cream
Amitryptyline
Gabapentin
Diazepam suppository
456
Myofascial pelvic pain syndrome
Chronic pelvic pain
457
Myofascial pelvic pain syndrome diagnosis
Based on phsical exam
Trigger points identified like a clock
458
Myofascial pelvic pain syndrome treatment
Hygiene, stress redcution, lubricant, espom bath
Pelvic floor PT, CBT, sex counseling
TOpical lidocain, estradiol cream
Amitryptyline
Gabapentin
Diazepam suppository
459
Pudendal neuralgia causes
Compression, entrapment, inflammation
Long car rides
Surgery
Bike riding
460
Pudendal neuralgia presentation
Acute, nerve associated pain
461
Pudendal neuralgia treatment
Pelvic floor PT
Pudendal nerve block (lidocaine into area of ischial spine)
Pregabalin
Amitryptyline
462
Dyspareunia
pain with sexual penetration
463
Meds influencing sexual function
Antihypertensives
Anticholinergics
SSRI
Antipsychotics
464
Erectile disorder
Difficulty obtaining an erection or marked decrease in erectile rigidity for > 6 months
465
Erectile disorder underlying etiology
Cardiovascular disease
Prostatectomy
Radiaton
SSRI use
466
Erectile dysfunction treatment
PDE5 inhibitors (-afil)
Vacuum erection devices
Alprostadil injection
Penile prostheses
penile revacularization
467
Premature ejactulation treatment
SSRIs (paroxetine)
Topical anesthetic
468
Female orgasmic disoreder comorbitities
MS
Pelvic nerve damage from hysterectomy
Spinal cord injury
Vulvovaginal atrophy
469
Female orgasmic disorder treatment
CBT
Fibanserin
Bremelanotide
Scream cream
470
Breast mass diagnostic studies
Breast exam
Mammogram with ultrasound if >30yo
Just ultrasound good for <30yo
Biopsy if needed
471
What often causes false negative in mamogram
Denser breasts
472
Mastalgia
Breast pain
Can be related to cycle (worse at ovulation)
Noncyclic likely from mass
Can be referred to chest wall (pec major injury)
473
What to do for bilateral diffuse breast pain
Reassurance
Likely nothing bad
474
What to do for focal breast pain
<30 yo breast US
>30 yo mammogram and breast US
475
When to be more conscerned about nipple discharge
Unilateral or single duct
Bloody
Spontaneous
Or male
476
Meds that can cause nipple discharge
Antihypertensive
GI agents
Hormones
Opiates
Psychotic agents
477
What to labs to test in galactorrhes
Preg test
Prolactin
Renal
Thyroid
478
Nipple discharge workup
Mammogram and US for >30yo
US alone for <30yo
Skin punch biopsy to rule out Paget disease of breast
479
Most common cause of Bloody nipple discharge
intraductal papilloma
480
Intraductal papilloma
Benign. papillary growths in ducts of breeath
Cause bloody nipple discharge a lot of the times
Incidentally found on imaging
481
Intraductal papilloma treatment
Excision bc often find breast cancer
482
Nipple discharge treatment
Stop causing med if possible
Stop manipulating breasts
Treat infection or cancer if present
Surgery for high risk lesion
483
Fibrocystic breast disease
Most common benign breast disorder
Multiple painful or painless breast cyst that may increase/decrease in size with menstrual or hormonal changes
484
Fibrocystic breast disease diagnostic studies
Breast US initial
Fine needle aspiraqtion shows green or straw colored fluid (usually not needed)
485
Fibrocystic breast disease treatment
Reasurance
NSAIDs
sports bra (without wire)
486
Fibroadenoma
Benign solid tumor of glandular and fibrous tissue
Usually nontender
Gradually grow
Don't change in size with menstrual cycle
Firm, nodular, freely-mobile, maybe tender
487
Fibroadenoma diagnostic studies
US if<30 shwoing well defined hypoechoic masses
Mammogram if >30
488
Fibroadenoma treatment
<2cm US every 6 months showing
>2cm or fast growing Excision
489
Phyllodes tumor prsentation
Fibroepithellial breast tumor
Smooth, multinodular, well defined, firm mass that is mobile and painless
Rapidly increasing in size
490
Phyllodes tumor diagnostic studies
US or mammorgram
Biopsy confirmatory
491
Phyllodes tumor treatment
Complete excision of mass
492
Drugs that cause gynecomastia
Spironolactone
H2 blockers
5-alpha reductase
Prednisone
493
Gynecomastia treatment
Stop offending med
Tamoxifen
Surgery if bothersome and present for >6months
494
Mastitis
Inflammation of breast tissue
495
Breast abscess
Localized collection of inflammatory exudate in breast tissue
Complication of mastitis
496
Pathogen most related to mastitis
Staph aureus
497
Mastitis treatment
NSAIDs
Warm/cold compresses
Anti-staph abx (dicloxacillin, cephalexin, or erythromycin)
498
Who is at high risk for periductal mastitis
Smokers
499
Periductal mastitis treatment
Abx/aspiration of abscesses
Repeat episodes need duct excision
500
Breast abscess presentation
Localized, painful, fluctuant mass
Fever
Malaise
501
Breast abscess treatment
US guided aspiration or I&D
502
Abscess complications
Commonly associated with underlying malignancy
503
Galactocele
Milk retension cyst
504
Galactocele presentation
Cystic masses during pregnancy, lactation, or after weaning
505
Galactocele diagnostic imaging
US with well defined lesion with thin echogenic walls and fat/fluid level
Fine needle aspiration diagnostics
506
Epidermal inclusion cyst
Cyst that can be anywhere but someties seen on breast
Skin colored with central punctum
507
Epidermal inclusion cyst treatment
I&D and abx
Excision in high risk of infection
508
Hidradentitis suppurative of the breast
Inflammatory condition of apocrine sweat glands
Associated with infection and abscess formation of axilla or skin of breast
509
Breast hematoma treatment
Ice, tyenol, wear good supportive bra
510
Fat necrosis presentatin
Palpable abnormality/lump often after surgery or trauma
511
Fat necrosis diagnostic imaging
Mammography and ultrasound
May need biopsy to confirm
512
Intertrigo
Inflammation of site of two opposed skin surfaces
Recurrent in women with large ptotic breasts affecting skin of lower half of breasts
Fungal infections often presnt
513
Intertrigo treastment
Nyastatin powder
514
Complex sclerosing lesions/radial scars findings and treatment
Discovered incidentally when radiologic abnormality removed or biopsied
Surgical excision
515
Atypical ductal hyperplasia
Premalignant accumulation of abnormal cells in milk ducts
516
Atypical ductal hyperplasia treatment
Excision
517
Three things that significantly increas pts lifetime risk of breast cancer
Atypical ductal hyperplasia
Atypical lobular hyperplasia
Lobular carcinoma in situ
518
What does hormone replacement cause in the breast
Enlargement
Increases risk of breast cancer slightly
519
What genetic mutation is most linked to breast cancer
BRCA1 and BRCA2
520
Breast cancer presentation
Mass (mostly UOQ)
Discharge usually bloody, rashes, retraction
Edema
Dimpling
Palpable axillary and subclavicular nodes
Pain
Mastalgia
Mass can turn into wound if not treated
521
Pagets disease of the breast presentation
Scaly, raw, vesicular, or ulcerated lesion that starts at nipple and spreads to areol
Pain, burning, and/or pruritis
522
Paget's disease diagnostic studies
Skin punch biopsy
523
Paget's disease management
Nipple-areolar complex and underlying cancer must be excised
524
Inflammatory breast cancer presentation
Warm, swollen, red, itchy breast
Maybe nipple retraction
Papable lump
Satelite lesions
525
Inflammatory breast cancer treatment
Chemotherapy and mastectomy, axillary dissection
526
Breast cancer staging
T: tumor (localized)
N: node (lymph node involvement
M: metastasis
527
Indicators of Breast cancer growth
ER
PR
HER2 (faster growth)
Oncotype
528
Triple negative
Negative for ER, PR, and HER2
Agressive
Less treatment options
529
Breast cancer staging imaging
Stage III needs full body PET or CT scan
Maybe bone scan
530
Breast cancer treatment options
Local: surgery (mastectomy or lumpectomy) or radiatoin
Systemic: hormone, chemo, targeted immune modulating
531
Mastectomy
Removal of entire breast
532
Modifed radical mastectomy
Removal of entire breast and all axillary lymph nodes,
Not pec muscle
533
Tamoxifen use and side effects
Used in pre-menopause to reduce recurrence of breast cancer
Cause hot flashes, mood swings, fatigue, nausea
534
Aromatase inhibitos use and side effects
Used in post-menopause to reduce recurrence of breast cancer
Cause hot flashes, mood swings, fatigue, nausea
535
LNRH agonist use
Treat pre-menopausal breast cancer.
Shut down ovaries to stop estrogen production
536
What meds to use for HER-2 breast cancer
Trastuzumab
537
What lumpectomy margins do we want
>2mm
538
Fecundability
Probability of achieving pregnancy in one menstrual cycle
539
Sterility
Ability to achieve pregnancy
540
Most common cause of infertility in women
Ovarian dysfunction
PCOS most common of that
541
Most appropriate initial step in evaluation for infertility
History and physical exam of both partners
542
Infertility definition
No conception after 12 months of unprotected sex
543
Infertility treatment for anovulatory woman
Clomiphene citrate
544
Infertility treatment for womana with abnormal postcoital test
Artificial insemination
545
Infertility treatment for woman with PCOS
Glycemic index diet, exercise, weight loss
Metformin
546
Infertility treatment for woman with endometriosis
Laparascopic removal of adhesions
547
INfertility treatment for woman with uterina anomalies
Hysteroscopic resection
548
What types vaccinations are contraindicated in pregnancy
Live
549
CMV presentation in preg and treatment
Cytomegalovirus
Gancyclovir
550
Toxoplasmosis presentation in preg and treatment
Intracranial calcifications
Hydrocephalus
Sulfadiazine + leucovorin
551
Syphilis presentation in preg and treatment
Maculopapular rash on palms and soles, sniffles, periostitis
Penicillin
552
Rubella presentation in preg and treatment
Cataracts, deafness, heart defects, PDA
No treatment
553
How long is full term pregnancy
>37 weeks
554
How long is preterm pregnancy
20-36 weeks
555
How llong is post-term pregnancy
>42 weeks
556
What HCG levels is a sign of pregnancy or possibly ectopic pregnancy
>1500
557
Exercise restrictions in pregnancy
No supine exercises (kinks IVC)
30 mins/day good
558
Cardiac changes in pregnancy
Cardiac output increases by 50% by week 8 (20% of that goes to uterus)
Increases risk of post-partum hemorrhage
Diastolic BP increases in 7th week up to 10mmHg
Pulse increases 10-18bpm
Diastolic murmur NOT normal
S2 split and S3 galop normal
559
Respiratory changes in preg
Diaphragm elevated 4cm
50mL O2/min (20% greater than normal)
Dyspnea normal but should be evaluated
560
Hematologic changes in preg
Increase in plasma volume (50%)
RBC, WBC, and coag factors increase
Hgb should be monitored for anemia
561
Renal changes in preg
Kidneys dilate
Serum Cr and BUN decrease
Increase in urine freq from bladder compression
Urinary incontinence common
562
GI changes in preg
Smooth muscle relaxation from progesterone decreases LES tone, decreased motility, adn impaired gallbladder contractility
Increased gallstones and cholestasis of bile salts
Hemorrhoids common
Alk phos levels doubled from placenta
Cholesterol increases
563
What causes morning sickness
Elevated progesterone, hCG, and relaxation of smooth muscle of stomach
564
Endocrine changes in preg
Euthyroid state
Thyroid gland enlarges
Reduced response to insulin (check for gestational diabetes 24-48 weeks)
565
MSK changes in preg
Relaxin and progesterone relaxes ligaments
Pubic sympysis separates at 28-30 weeks
Lumbar lordosis common in late preg
Serum caclium decreases and PTH increases but no bone loss
566
Skin changes during preg
Spider angiomata
Palmar erythema
Striae gravidarum
Hyperpigmentation
Melasma
Lower abdomen linea alba darkens to be come linea nigra
567
Reproductive changes in preg
Increased discharge (leukorrhea)
Breasts get bigger
568
Where does oxygenation of fetal blood happen
Placenta
Goes from placenta to umbilical vein that goes into portal system of fetus
569
Fetal circulation
Oxygenated blood flos into IVC then right atrium
Flows across to left atrium through foramen of ovale
Then goes into ascending aorta to rest of body
Then enters right atrium and flows into right ventricle to bypass lungs and through ductus arteriosus into descendng aorta into umbilical arteries back to placenta
570
Common symptoms during preg
Headache (treat with tylenol)
Edema
NV (treat with ginger, bonjesta, or B6 and doxylamine)
Heartburn (treat with tums)
571
When and how to screen for down syndrome, trisomy 18, and trisomy 13
First trimester
NIPTs
Nuchal transparency on ultrasound and hCG and preg-associated plasma protein A
572
Amniocentesis
Taking out 20-3mL of amniotic fluid transabdominally with US guidance to
diagnostic for trisomies and neural tube defects after screening detects
573
How often do we see pregnant for antenatal visits
4 weeks until 28 weeks
2 weeks 28-36 weeks
1 week 36 weeks-delivery
574
Antenatal tests/procedures for 6-12 weeks
Confirm preg and uterine size
Urine culture
Pap smear for 21 or older screening for chlamydia and gonorrhea
Random blood glucsose
Blood group and Rh
RPR, HPV, Hep B
Rubella antibody
Varicella immunity
575
Antenatal tests/procedures for 16-20 weeks
Fetal ultrasound
Cervical length measurement
Genetic testing
576
Antenatal tests/procedures 24-28 weeks
Gestational diabetes screening
1 hour 50 gram glucola test if >140 test fasting 3 hour 100gram glucola
577
Antenatal tests/procedures 28 weeks
Rh(d) immune globulin (Rhogam) if Rh negative
Hgb or CBC for screening Determine fetal position and presentation
Ask about movement
578
Antenatal tests/procedures 36 weeks
Group B strep screen (single culture from vagina and rectum) give penicillin INTRAPARTUM if positive unless urine culture positive, then treat now
Begin cervical checks
Discuss labor indicators
579
Antenatal tests/procedures 41 weeks
Cervical exam to see probability of induction
Induction facorable if cervix >2cm, 50% effaced, certex and -1station, soft cervix, and midpositoin
Do stress test if cervix not favorable
580
Antenatal tests/procedures 42 weeks
Induction performed no matter what
581
Goal BP for preg
<140/90
582
When is fundus of uterus at umbilicus
20 weeks
583
Normal fetal HR
110-160
584
Leoplold maneuvers
palpating to determine baby's position
585
Non-stress test
Evaluates HR in response to fetal activity
You want HR to accelerate
586
Constraction stess test
Measures response of fetal HR to stress of uterine contraction
We don't want HR to react, it shows baby can't compensate for increase of pressure
587
Biphysical profilse
Dne if nonstress test is positive to see prence of fetal movement and tone
588
Rupture of membranes
Water breaks
Can be slow trickle or large gush
Can happen before or during labor
589
What to note when water breaks
Time
Color
Odor
Amount
Fetal response
590
How to confirm rupture of membranes
pH >7
Pooling on speculum blade
Fern test (poling fluid looked under microscopy)
591
Meconium
Thick, black, tarry substance
Made of amniotic fluid, lanugo, bile, fetal skin, and intestinal cells
Neonates "first stool"
592
First Stage of labor
Lasts 10-14 hours for first preg
Onset of true contractions through complete dilation and effacement of cervix
Regular contractions at first then irregular and slow dilation
593
Second stage of labor
Lasts 1-2 hours for first pregnancy
From dilation and effacement and ends with delivery of baby
594
Third stage of labor
Lasts 5-15 mins
starts with birth and ends with delivery of placenta
595
Episotomy
Cut the gooch to avoid bad tear
596
Three signs of placental separation
Uterus rises in abdomen becoming firm
Gush of blood
597
Fourth stage of labor
First hour postpartum
Perineal pads used to monitor blood loss
Check BP and pulse
598
Contraindications of breastfeeding
Women with HIV
Women with active untreated TB
Chemo
Glactosemia of infant
Illegal drug use
599
Meds contraindicated in breastfeeding
Lithium carbonate
Tetracycline
Bromocriptine
Methotrexate
Any radioactive substance
600
Colostrum
Made first 5 days postpartum and slowly replaced by maternal milk
Contains more mineral but less fat and sugar than maternaal milik
Contains immunoglobulin A
601
Lochia
Discharge after delivery that can last several weeks
1. lochia rubra
2. lochia serosa
3. lochia alba
602
Lochia rubra
Menses like bleeding first few days post partum
603
Lochia serosa
Lighter discharge with less
604
Lochia alba
White discharge tat can occur for few weeks
605
Postpartum depression tretment
SSRI or TCA
606
Postpartum psychosis treatment
Inpatient hospitalization
Mood stabilizer or atypical antipsychotic
Psychotherapy
607
Date rape drug examples
Gamma hydroxybutyrate
Rhoypnol (ruffies)
608
Paraphilia
Intense and persistent sexual interest other than genital stimulation
609
Voyeristic disorder
6 months
Observing nonsuspecting person who is naked
Acted on sexual urges or it bothers functionality
Must be 18yo
610
Exhibitionistic disorder
6 months
Arousal from exposing yourself to unsuspected person
Acting on it or bothers functionality
611
Exhibitionistic disorder comorbidities
Antisocial history
Antisocial personality disorder
Pedophilic disorder
Childhood abuse
Alcohol use disorder
Sexual preoccupation
612
Frotteuristic disorder
6 months
Sexual arousal from rubbjng on nonconsenting person
Acted on it or has caused distress
613
Frotteuristic disorder risk factor
ANtisocial behavior
Sexual occupation
614
Transvestic disorder
6 months
Sexual arousal from cross dressing
Only during sexy time
615
Fetishistic disorder
6 months
Arousal from nongenital body parts
Causes distress/impairment
616
Sexual masochism disorders
6 months
Sexual arousal from being humiliated, beaten, bound, or made to struffer
Causes significant distress or impairment of functioning
617
Sexual sadism disorder
6 months
Sexual arousal from sufering of another person
Acted on with nonsenting person
Causes significant distress or impairment of funciton
618
Ssexual masochism and sadism disorders risk factor
Porn showing these things
619
Pedophilic disorder
6 months
Recurrent intense, arrousing fantasies of child (13 or younger)
Acted on
Person is at least 16 and 5 years older than child
620
pedophilia risk factors
Child porn
Antisocial personality disorder
Childhood sexual abuse
621
Paraphilic disorder treatment
FIRST LINE: Psychotherapy
Alternative: SSRI
Antiandrogen
622
Ectopic pregnancy treatment
Methotrexate stops the growth
Surgery when mom unstable (salpingostomy or salpingestomy)
622
Spontaneous abortion
miscarriage
Absence of any medical or surgical intervention
623
Threatened abortion
Patient is bleeding in early pregnancy without clear diagnosis of pregnancy loss
624
Inevitable abortion
Cannot be avoided bc cervix is open
Heavy bleeding
Abd cramping present
625
Incomplete abortion
Persistent pregnancy tissue in uterus after diagnosis of preg loss
Cervix can be open or closed
Some products have passed out of uterus and some is still there
626
Complete abortion
Pregnancy spontaneously passes all contents of uterus
Cervix closed and empty
627
Missed abortion
Retnetion of failed intrauterine pregnancy for extended period
628
Recurrent pregnancy loss definitino
Three consecutive pregnancy losses
629
What to check woman with recurrrent preg loss for
Ashermans syndrome (hyesteroscopy shows scarring)
630
What normaly causes first trimester pregnancy loss
Genetic anomoly
631
What normally causes second trimester pregnancy loss
Anatomic abnormalities like uteri or fibroids.
Cervical insufficiency
632
What mom needs Rh D immunoglobulin shots
Rh negative
Bc will kill Rh positive baby
633
Placenta previa
Placenta location is close or over cervical OS
634
Placenta previa presentation
Painless bleeding
635
Placenta previa diagnostic studies
Transvaginal ultrasound
636
Placenta previa delivery
C section
637
Placenta previa risk factors
Previous CS, >35yo, multiparity, smoking
638
how to reduce risk of bleeding in placenta previa
No digital exam
No avoid sexual activity that may lead to orgasm
639
Placental abruption
Premature separation of placenta from implantation site
Bleeding in decidua basalis causes separation of placenta
640
Placental abruption presentation
Abd pain and bleeding
Could be concealed (no blood coming out)
641
Placental abruption risk factors
Chronic HTN, preeclampsia, multuiple gestation, >35yo
642
Placental abruptino management
Watch vitals
Fluids
Delivery for severe hemorrhage
643
Which twin is bigger in multiple gestation
Recipient twin is bigger than donor twin
644
Hydatidiform mole
Molar preganncy
Occurs when normal placental trophoblastic tissue is replaced by hydropic placental villi
645
Partial hydatidiform mole
Fertilization of normal ovum by two sperm
Results in triploid
HCG usually low
646
Complete hydatidiform mole cause
Sperm fertilizess blighted ovum (no DNA)
HCG usually high causing hyperemesis
647
Molar pregnancy on ultrasound
Snow storm
No fetal parts
648
Molar pregnancy presentation
Hyperemesis
Size large for dates
HTN
Vaginal bleeding
649
Molar pregnancy treatment
Uteruine evacuation by dilation of cervix and suction currettage
Monitor for 6-12 months
Birth control to avoid preg for 12 months
Rh negative need rhogam
650
Malignant gestational trophoblastic disease
HCGs never fall to 0 after pregnancy (normal or molar)
Can be localized or metastatic
651
Types of malignant gestational trophoblastic disease
Invasive mole
Choriocarciinoma
652
Malignant gestational trophoblastic diagnostic imaging
Pelvic ultrasound
Xray
653
Malignant gestational trophoblastic disease treatment
Etoposide, methotrexate, actinomycin D, cyclophoamide, vincristine
654
Hyperemesis gravidarium
Most severe form of preg associate nausea and vomitting
655
Gestational diabetes pathophys
Pregnancy comes with insulin resistance
Pancreatic function doesn't respond well to resistance
656
What BP in pregnant is concerning
>140
657
Gestational diabets management
Insulin GOLD
Better diet
Education about uncontrolled glucose
658
What size baby in gestational diabetes needs C section
>4500 grams
659
Preeclampsia
HTN with proteinuria after 20 weeks gestation and maybe end-organ dysfunction
660
Preeclampsia risk factors
Nulliparity
Multifetal gestations
>40yo
Chronic HTN
Nrphropathy and other renal disease
Obesity
African american
In vitro fertilization
661
Diagnostic citeria for severe preeclampsia
BP > 160/110 on two occasions at least 4 hours apart
Progressive renal insufficiency
Cerebral of visual disturbances
Pulmonary edema
RUQ pain
Hepatic dysfunction
662
Preeclampsia presentation
Persistant edema in upper extremities and sacral region
Vasonstriction and retinal blood vessels
663
What to do for preeclampsia babies >34 weeks
Induce birth
664
Preeclampsia management
Magnesium sulfate to prevent eclamptic seizures
665
What meds to use for preeclampsia HTN
Labetalol
Hdralazne
Nifedipine
Methyldopa
666
Eclampsia
Seizure activity in pregnancy without history of seizures
Life threatening for mom and baby
Can happen before, during, or after labor
667
HELLP syndrome
Hemolysis
Elevated Liver functions
Low Plateletes
Type of preeclampsias
668
Fetal fibronectin
Cervicovaginal specimen that predicts if pt will deliver in next 7 days (not valid if had sex in past 48 hrs)
669
Preterm labor treatment
CCS for lung maturity
Tocolytics (mag sulfate, beta-adrenergic terbutaline) to prolong pregnancy
670
When to admit preterm labor
Cervix dilated to 2cm before 34 weeks
Contractions occur causing cervical change
Rupture of membranes
671
Premature rupture of membrane diagonsis
pH > 7.1
Fern test (looks like fern on microscope)
672
Premature rupture of membranes treatment
Betamethasone for lungs
Prophylactic abx (ampicillin, amoxicillin, azithromycin
673
Chorioamnionitis
Intraamniotic infection
Give ampicillin and gentamicin
674
Umbilical cord prolapse treatment
STAT delivery via C section
675
Types of breech presentations
Frank (butt, most common)
Incomplete (footling)
Complete
676
Breech presentation diagnosis
Leopold's first maneuver
Fetal heart tones in upper quadrant
Vaginal exam doesn't show head
Ultrasound confirms
677
What to do if baby is breech presentation
C section
678
Shoulder dystocia
Fetal shoulder behind symphysis pubis during vaginal delivery.
Baby starts coming out then slides back in like a turtle
More likely to happen in >4000g
679
Shoulder dystocia treatment
suprapubic pressure
Mcroberts maneuver (legs to chest)
Rubin's maneuver (Rotation or delivery of posterior arm)
Gaskin's maneuver (mom on hands and knees)
680
What can be used in operative vaginal delivery
Forceps and vacuums
681
Number one cause of postpartum hemorrhage
Uterine atony
682
Postpartum hemorrhage management
Oxytocin infusion after delivery
Uterine management
