1
Q
What is gynecology?
A
The branch of medicine that deals with the diseases and routine physical care of the female reproductive system
2
Q
What term refers to the structures of the female reproductive system seen from the outside of the body?
A
Pudendum
3
Q
What is the perineum?
A
The area between the vaginal opening and the anus
4
Q
What are Bartholin glands?
A
Mucous secreting glands just inside the lower vagina that provide lubrication during intercourse.
5
Q
What is discharged during menstruation?
A
25-65 ml of blood, epithelial cells, mucous, and tissue.
6
Q
What are the 2 phases of the menstrual cycle?
A
Ovarian cycle (follicular phase days 1-13, luteal phase days 14-28)
Uterine cycle (proliferative phase days 5-14, secretory phase days 15-28)
7
Q
What is menarche?
A
The onset of the first menses signalling the possibility of fertility.
8
Q
What is menopause?
A
The last menses when a woman has reached the end of childbearing age.
9
Q
What is the climacteric?
A
The period of life following and during the transition of menopause.
10
Q
What are the symptoms of menopause?
A
Diaphoresis
Hair loss
Hot flashes
Cognitive changes
Sexual dysfunction
Sore limbs
Headache
Mood disorder
Fatigue
11
Q
What is Dysmenorrhea?
A
Painful menses
Primary- occurs with advent of menstruation and lasts 1-2 days (80%)
Secondary- pain before, during, and after menstruation
12
Q
What is Amenorrhea?
A
Absence or cessation of menstruation usually due to pregnancy
13
Q
What is menorrhagia?
A
Blood flow lasting several days longer than usual.
14
Q
What is Polymenorrhea?
A
Blood flow occurring more often than a 21 day interval.
15
Q
What is Metrorrhagia?
A
Blood flow or intermittent spotting occurring irregularly but frequently.
16
Q
What is pelvic inflammatory disease?
A
Infection of women’s reproductive organs occurring almost exclusively in sexually active women.
Risk factors include use of an IUD, unprotected intercourse, and untreated STI
17
Q
What is Interstitial cystitis/ chronic bladder condition?
A
A chronic bladder condition with an unknown cause resulting in inflammation or irritation. In severe cases irritation may lead to ulcers in the bladder lining
18
Q
When are ectopic pregnancies diagnosed?
A
Commonly diagnosed between 6-10 weeks of gestation
19
Q
What is an ovarian cyst?
A
A fluid filled sac that grows on or in an ovary. The most common type is the functional cyst developed during menstruation.
20
Q
What is a Tubo-ovarian abscess?
A
An infectious collection in the ovaries or fallopian tubes occasionally leading to peritonitis
21
Q
What is ovarian torsion?
A
Twisting of an ovary, most common in women of reproductive age
22
Q
What is toxic shock syndrome? How does it present?
A
Profound shock caused by bacteria that release a protein called toxic shock syndrome toxin
Initial symptoms include, syncope, diarrhea, vomiting, headache, fever, sore throat, rash, bloodshot eyes.
23
Q
What are 2 of the most common infections that affect women?
A
bacterial vaginitis: normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms
vaginal yeast infections: typically caused by Candida albicans, tiny organisms that live inside the vagina and on the skin. If the vagina becomes less acidic the yeast population grow dramatically causing infection
24
Q
How do Chlamydia and Gonorrhea differ from Genital Heroes
A
Chlamydia and Gonorrhea are caused by a bacteria
Herpes is caused by a virus
25
What does the LORDS TRACHEA mnemonic mean?
Location of pain?
Onset of pain?
Radiate, does the pain radiate
Duration of pain? Constant/intermittent?
Severity of pain?
Timing of the pain?
Relieve, does anything relieve the pain?
Aggravating the pain?
Character of the pain? Crappy/achy/sharp?
Historic precedent?
Eaten anything?
Associated problems?
26
What is the most important thing to look for in a woman with abdominal pain?
Signs of shock
27
What is the ACHES-S mnemonic and when is it used?
Helps remember the adverse effects associated with oral contraceptives?
Abdominal pain
Chest pain
Headache (severe)
Eyes (blurred vision)
Spotting
Severe leg pain
28
What do the terms Gravid and Parity mean?
Gravid is the term for pregnancy
Parity is the term for live delivery
29
How does pelvic inflammatory disease usually present?
Achy pain spread over both quadrants of the lower abdomen, may be made worse by sexual intercourse.
30
What is the most common gynecologic emergency to encounter?
A foreign object that has become stuck in the vagina or anus.
31
What is the first as most common drug used in sexual assaults?
Alcohol
32
How many follicles are stored in each ovary?
Each ovary contains 200 000 follicles, each one has an oocyte (egg) inside it.
33
What are the 3 layers of tissue comprising the fallopian tubes?
Serosa (outer layer)
Muscularis
Internal Mucosa (inner layer)
34
Explain the release of FSH, GnRH, and LH
Follicle stimulating hormone stimulates maturation of an oocyte
Gonadotropin-releasing hormone stimulates release of FSH
Leteinizing hormone stimulates the process of ovulation
35
What are the 3 parts of the uterus?
Fundus- dome shaped top
Body- tapered and narrow
Cervix- narrowest portion that opens to the vagina
36
What are the 3 layers of tissue making up the uterus?
Perimetrium (outer layer)
Myometrium
Endometrium (inner layer)
37
What is an episiotomy?
An incision in the perineal skin to avoid tearing and complications during delivery.
38
What does the egg do after it’s fertilized?
It’s now called a blastocyst and will implant in the endometrial wall one week after conception
39
What happens in the third week of gestation?
The egg becomes an embryo and starts to develop body systems
40
What happens during the 4th week of pregnancy?
The placenta begins to develop
41
What is the volume of the amniotic sac at the end of term?
1L
42
What is the size of the uterus before and after pregnancy?
Before: 8cm long, 5cm wide, and 2cm thick
End of term: weigh as much as 1kg, and have a capacity of 5L
43
How much blood increase is there in a pregnant woman at term?
40-50%
44
How much bleeding is considered normal during delivery?
<500 ml
45
What ekg changes are considered normal during pregnancy?
HR increase of 15-20 bpm
Ectopic beats and SVT may be normal
46
Define the following terms
Primigravida
Primipara
Multigravida
Multipara
Nullipara
Primigravida- pregnant for the first time
Primipara- only had 1 delivery
Multigravida- having had 2 or more pregnancies
Multipara- having had 2 or more deliveries
Nullipara- a women that has never delivered
47
What does the time between contractions tell you?
How imminent delivery is
>5 min., may be able to make it to the hospital
<2 min., birth is imminent
48
Who is most susceptible to Pre-eclampsia?
Women younger than 18 and older than 35 as well as African-Canadian women
49
What are the symptoms of pre-eclampsia?
High blood pressure (greater than 160/90)
Impaired liver and renal function
Pulmonary Edema
Seizures (eclampsia)
50
What is Hyperemesis Gravidarum?
Persistent nausea and vomiting during pregnancy (much more serious than morning sickness)
Most common in first time pregnancies with multiple gestations and obese women
51
How much go women’s kidneys grow during pregnancy?
They lengthen by up to 2 cm
52
What effect does epilepsy have on vaginal bleeding?
Women with epilepsy tend to have increased risk of vaginal bleeding during and after pregnancy.
53
What is Cholestasis and it’s symptoms?
A disease of the liver that occurs during pregnancy
Symptoms include painful itching of the hands and feet
54
What are the 3 major causes of antepartum hemorrhage?
Abruptio Placenta (early separation from the uterine wall)
Placenta Previa (placenta implants too low in the uterus)
Uterine Rupture
55
What are Tocolytics?
Drugs used to delay labour
56
What does a placenta look like?
One side should by grey, shiny, and smooth. The other side should be dark maroon with a rough texture.
57
Who is at the greatest risk of uterine rupture?
Women who have had many children and women that have a scar on their uterus from a previous cesarean section.
58
What is the difference between an infant and neonate?
Infant: first 24 hours after birth
Neonate: First month after birth
59
Define preterm, term, and postterm?
Preterm < 37 weeks
Term 37-42 weeks
Postterm > 42 weeks
60
What may be caused by delaying clamping the umbilical cord?
Polycythemia
61
What are the signs of respiratory distress in a newborn?
Intercostal retractions, nasal flaring, and grunting
62
What may be indicated by a newborn with respiratory distress, heart sounds shifted to the right, decreased breath sounds on the left and bowel sounds in the chest?
Diaphragmatic Hernia
63
What is the difference between primary apnea and secondary apnea?
Primary apnea: may be fixed by drying and stimulating the baby
Secondary apnea: PPV or intubation is required
64
What are the 4 major types of seizures and how are they distinguished?
Subtle Seizure: eye deviation, blinking, sucking, and pedalling movement
Tonic seizure: persistent posturing of one limb, the neck, or trunk with eye deviation
Clonic seizure: jerking of one or more extremity
Myoclonic seizure: rapid jerking without rhythm
65
What is considered hypoglycemia in full or pre term newborns?
2.6 mmol/L or less
66
What is the most frequently fractured bone in newborns?
The clavicle
67
Explain the difference between endometritis and endometriosis?
Endometritis: inflammation of the endometrium (uterine lining) usually caused by infection. May be caused by an std, gynecologic surgery, abortion, use of an IUD, or postpartum.
Endometriosis: results when endometrial tissue grows outside the uterus, generally on the surface of the abdomen and pelvic organs. This condition is one of the leading causes of infertility.
68
What is an ectopic pregnancy? Where is it most often found?
Occurs when a fertilized egg implants somewhere besides the uterus. In 97% of cases the egg is fertilized inside the fallopian tube. May lead to rupture causing pain and life threatening bleeding.
69
Define dermatoid cysts, endometriomas, cystadenomas, and hemorrhage cysts?
Dermatitis cyst: growth of formation all tissue such as teeth and hair, may become very large and painful
Endometrioma: occurs when uterine tissue grows on the ovaries in women who have endometriosis
Cystadenoma: cyst that forms on the outer surface of the ovary, usually filled with thick mucus and they can grow large and painful
Hemorrhage cyst: forms when a blood vessel bursts in the cyst wall and blood fills the sac, may rupture and cause bleeding and pain in the abdominal cavity
70
What is Chancroid?
A bacterial infection causing painful soft margin ulcers in the genitals, swollen and painful lymph glands, women may be non-symptomatic.
Highly contagious but curable.
71
What is chlamydia?
A bacterial infection and the most common std in Canada. Symptoms are mild but may include, lower abdominal pain, low back pain, nausea, fever, pain during intercourse, discharge or bleeding.
72
What is genital herpes?
Viral infection caused by the herpes simplex virus, type 2 is typically associated with tingling or sores on the genitals, buttocks, and thighs. Other symptoms include, fever, muscle aches and pains, headache, dysuria, vaginal discharge, and swollen glands in the groin area.
73
What is gonorrhea?
A bacterial infection that can grow rapidly in the warm and moist areas of the reproductive tract, including the cervix, uterus, fallopian tubes, and the urethra. Symptoms are usually more severe in men and may include, burning or itching, yellow or bloody vaginal discharge, foul odour, nausea, cramping, and vomiting.
74
What are genital warts?
Growths that develop in the genital areas caused by human papillomavirus (HPV), some people have no symptoms, others may develop growths in the vagina, vulva, cervix, or anus in women or the penis, scrotum, and anus in men.
75
What is syphilis?
A bacterial infection with 3 phases (primary, secondary, and late). Transmission occurs through direct contact with sores that tend to appear on the genitals, anus, rectum, lips, or mouth.
First stage symptoms: a single or a few sores at the site of contact for 3-6 weeks
Second stage symptoms: mucous membrane lesions and a skin rash, fever, Swollen glands, sore throat, patchy hair loss, headaches, weight loss, and muscle fatigue
Late stage symptoms: can be fatal and may lead to, dementia, parasthesia, paralysis, altered behaviour, and blindness
76
What is Trichomoniasis?
An infection caused by a single cell protozoan parasite that is transmitted through sexual contact. An infected person may be asymptomatic or present with frothy yellow/green vagina discharge with a strong fishy odour. May also cause itchiness or irritation of the genital area, discomfort during intercourse or lower abdominal pain.
77
What is Lymphogranuloma venereum (LGV)?
An infection that usually affects the rectum causing, rectal bleeding, pain, mucus discharge, fever, and constipation
78
What’s the most important thing to assess in a woman with abdominal pain?
Signs of shock
79
What are the 3 types of abdominal pain presentation?
Visceral pain: poorly localized, diffuse, typically near the midline
Parietal pain: described as steady aching pain
Referred pain: pain that seems to radiate or travel
80
What is the corpus luteum?
What’s left of the follicle after the egg has been released becomes the corpus luteum. It secretes estrogen, progesterone, and inhibin for up to 90 days after the egg is released.
81
What is the gestational period and how long is it?
The time that it takes for the infant to develop in utero, normally 38 weeks
82
What is gestational hypertension?
Hypertension that develops during or after the 20th week of pregnancy in women with previously normal blood pressure and resolves spontaneously postpartum. Most commonly experienced my women who are obese or glucose intolerant.
83
How is pre-existing (chronic) hypertension defined in pregnant women?
Blood pressure of 140/90 or greater that exists prior to pregnancy, occurs before the 20th week, or continues to persist postpartum.
Diastolic pressure higher than 110 mmHg place the patient at increased risk for stroke or cardiovascular changes
84
What are the symptoms of hypothyroidism?
Fatigue
Forgetfulness
Constipation
Bradycardia
Feeling cold
Muscle and joint aches
85
What is a molar pregnancy?
Molar pregnancy arises when a malfunction of the egg or sperm creates a problem at the fertilization stage resulting in an abnormal placenta.
Examples include: progression of pregnancy with no fetus present or 2 sperm fertilizing the same egg resulting in an abnormal chromosome count instead of twins
86
What are the signs of a threatened miscarriage?
A threatened miscarriage is a miscarriage that is attempting to take place. It’s generally characterized by vaginal bleeding during the first half of pregnancy, abdominal discomfort or menstrual cramps.
Severe pain is rarely a presenting issue.
87
What are the 8 types of miscarriages?
Spontaneous: occurs naturally affecting 1/5 pregnancies
Abortion: induced termination of pregnancy brought on intentionally
Threatened: a miscarriage that is attempting to take place
Inevitable: a spontaneous miscarriage that cannot be prevented
Incomplete: when part of the products of conception is expelled, but some remains in the uterus
Complete: has occurred when all of the products of conception have been expelled
Missed: if a fetus dies in the first 20 weeks of gestation but stays in utero
Septic: occurs when the uterus becomes infected
88
What are the3 stages of labour?
First stage: begins with the onset of labour pains, early contractions come at 5-15 min. intervals.
Second stage: occurs when the head of the fetus enters the birth canal and the head of the baby puts pressure on her rectum making her feel like she needs to move her bowels, contractions are 2-3 minutes apart.
Third stage: the period that involves separation of the placenta from the uterine wall, lasts from delivery of the newborn until the placenta has been expelled.
89
What are the appropriate actions to take after a birth?
Take the woman’s vitals
Place a sanitary pad in front of the vagina
Monitor closely for hemorrhage, seizures, or resp. distress
Cover with a blanket to prevent hypothermia
90
Explain Shoulder Dystocia, Breech Presentations, and Prolapsed Umbilical Cord?
Shoulder dystocia: occurs when the infant becomes trapped between the pubic symphysis and the sacrum because the shoulders are larger than the head
Breech presentation: another part of the body other than the head is the first to exit the birth canal, usually the buttocks
Prolapsed umbilical cord: the cord emerges from the uterus before the fetus. The cord is compressed with each contraction cutting off the fetus oxygenated blood supply
91
What is meconium staining?
Meconium refers to the infants first stool. In cases of fetal distress the fetus may void the meconium into the amniotic fluid. The fluid from the amniotic sac will appear yellow or greenish-black.
92
What is Supine Hypotensive Syndrome?
When a Gravid woman lays supine the uterus compresses the inferior vena cava and the blood return to the heart is diminished or in some cases occluded.
93
How much blood is lost during the third stage of labour?
Average blood loss during the third stage of labour is 150ml
94
What’s the normal range for a fetal heart rate?
120-160 bpm
Less than 120 or greater than 160 likely means fetal distress
95
What part of the female genitalia is homologous to the penis?
The clitoris
96
What is Mittelshmerz?
ovulation pain or Mittelshmerz is a benign lower abdominal pain that occurs midcycle (between days 7 and 24) in women.
97
How much blood does a tampon absorb?
20 ml
98
What percentage of ectopic pregnancies present with typical symptoms?
50%
99
Where does fertilization of the egg occur?
In the fallopian tube
100
What role does the umbilical vein play in oxygenation?
The umbilical vein carries oxygenated blood from the placenta to the fetus
101
Bright red bleeding from the vagina in the 33rd week of pregnancy may indicate what?
Placenta previa
102
A normal abdomen is … during pregnancy?
Not rigid
103
What is the primary source of heat production in a neonate?
Nonshivering thermogenesis
104
What are the Antepartum (before birth) risk factors?
Multiple gestation No prenatal care
Age <16 or >35 Chronic maternal illness
Preterm <37 weeks or postterm >42 weeks Maternal use of drugs
Toxemia, gestation hypertension, or gestational diabetes Bleeding during pregnancy
Premature rupture of the amniotic sac Decreased fetal movement
Fetal anomalies
105
Explain the series of events during transition that enable a newborn to breath?
The umbilical cord is clamped and systemic circulation pressure increases
The newborn begins breathing and the lungs expand and vascular resistance drops
Blood flows to the lungs for gas exchange
Diversion of blood flow to the fetus lungs is a critical part of fetal transition
106
A shift of heart tones and severe respiratory distress is a sign of what medical problem?
Pneumothorax
Criti Care EMS
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