PAEA OBGYN EOR Topics Questions with Correct Answers, Exams of Nursing

Download PAEA OBGYN EOR Topics Questions with Correct Answers and more Exams Nursing in PDF only on Docsity! PAEA OBGYN EOR Topics Questions with Correct Answers 1. G2 P1001 2. G4 P1111 3. G3 P2103 - Correct answer 1. currently pregnant, 1 term delivery, 1 living child 2. currently pregnant, 1 term delivery, 1 preterm delivery, 1 abortion/miscarriage, 1 living child (cannot tell if it is term or preterm child by formula) 3. currently pregnant, twins at term, 1 at preterm, 3 living children G (# pregnancies) T (# term deliveries at 37 weeks or more including stillbirths) P (# preterm deliveries at 20-37 weeks) A (abortions <20 weeks including miscarriages) L (# living children) a provable fetus is defined as - Correct answer <24 weeks old (varies w/ guidelines) what are the routine test during the first prenatal visit? - Correct answer blood pressure, blood type & Rh, CBC, UA (glucose & protein), random glucose, Haig, Hep C, HIV, syphilis, rubella titer, VZV titer, pap, sickle cell & CF screening diagnosis of pregnancy can be detected by serum B-hCG at ____ days after conception and by urine B-hCG at ____ days after conception - Correct answer serum B-hCG: 5 days after conception urine B-hCG: 14 days after conception how is estimated date of delivery (EDD) determined? - Correct answer Naegele's Rule: from 1st day of LMP 1. subtract 3 mos., add 7 days, add 1 year 2. add 9 mos. & 7 days ex: LMP started 8/7/16 = EDD: 5/14/17 when estimating gestational age on US what measurements can you use? - Correct answer 1. crown rump length (CRL) 2. biparietal diameter 3. head circumference 4. abdominal circumference 5. femur length what physical exam and lab tests should be performed on initial visit of a pregnant patient? - Correct answer full physical exam, BP, pelvic exam w/ pap smear (unless done in last 6 mos.), G/C Cu’s, bimanual exam to check size of uterus and help estimate # weeks into pregnancy, US if unsure of LMP to date # weeks labs: CBC (r/o anemia), blood type & Abs screen + Rh status, RPR, Haig, rubella Abs screen, VZV Abs screen if no h/o chickenpox, UA w/ Cu, blood glucose, HIV, sickle cell/CF screen, PPD in high risk pts, screening for aneuploidy offered (inc or dec free B- hCG, PAPP-A low w/ down syndrome, inc nuchal translucency @10-13 weeks US) what are the screening tests for aneuploidy (including down syndrome)? when are they performed? - Correct answer ALL offered around 10-13 weeks 1. free B-hCG (high or low can be indicative of abnormalities) 2. PAPP-A (usually low w/ DS) 3. nuchal translucency (inc thickness on US) 4. if any above + can be offered chorionic villus sampling (or if they have any RF for aneuploidy such as advanced maternal age/AMA, previous child w/ chromosomal banality, banal US, prior pregnancy losses) but inc r/o spontaneous abortion w/ procedure *amniocentesis offered around 15-18 weeks w/ same indications as CVS (both can diagnose chromosomal abnormalities and have risk of spontaneous abortion) the uterus softening at 6 weeks is what sign? - Correct answer Laden’s sign the uterine isthmus softening after 6-8 weeks gestation is what sign? - Correct answer Hegar's sign bluish coloration of the cervix & vulva around 8-12 weeks is what sign? - Correct answer Chadwick's sign a palpable lateral bulge or softening of the uterine corns (where uterus meets fallopian tubes) at 7-8 weeks gestation is what sign? - Correct answer Piskacek's sign cervical softening of the cervix and vulva around 8-12 wks - Correct answer Goodell's sign what are the # weeks in each trimester? - Correct answer 1st tri: 1-12 2nd tri: 13-27 3rd tri: 28-birth what should be checked at routine first trimester visits? - Correct answer BP, weight, urine dipstick, measurement of uterus/fundal height, auscultation of fetal heart sounds at 10-12 weeks (nml 120-160) what week should the uterus/fundal height measure above the pubic symphysis? midway between pubic symphysis/umbilicus? at umbilicus? 2-3cm below xiphoid process? - Correct answer -above the pubic symphysis? 12 wks what GI changes occur in pregnancy? - Correct answer N/V (>70%), delayed gastric emptying & dec gastro esophageal sphincter tone (= GERD), dec motility of leg bowel (= constipation) what kidney changes occur in pregnancy? - Correct answer -50% inc in GFR -the kidneys inc in size and the ureters dilate (cause of inc r/o pyelonephritis) what are the effects of pregnancy on the endocrine system? - Correct answer -hyper estrogenic state (produced by placenta) -placenta also produces hCG (doubles Q48 hrs in early pregnancy peaking at 10-12 wks) which maintains corpus luteum early on -corpus luteum produces progesterone which maintains uterine lining -human placental lactogenic is produced by placenta and responsible for nutrient supply to fetus but can cause a diabetogenic state (bc insulin antagonist) -prolactin greatly increases -inc in T3/4 while fT4 and TSH remain minimally changed what are the effects of pregnany on the msk system? - Correct answer -change in center of gravity = low back strain -carpal tunnel syndrome is common what are the effects of pregnancy on the dermatologic system? - Correct answer - spider angiomatas -palmar erythema -hyperpigmentation of nipples, umbilicus, abdominal midline (linea nigra), perineum, face (melasma) approximately what increase in calories is recommended in nml BMI pregnant patients? what amount of weight gain is recommended in underweight, nml, and overweight patients? - Correct answer 300 cal per day (500 cal when breastfeeding) -underweight: 28-40 lb -nml: 20-30 lb -overweight: 15-25 lb what nutritional requirements besides caloric intake increase during pregnancy? - Correct answer -protein -iron (IDA common in pregnancy) -folate (prevent NTD) -calcium -other vitamins and minerals what is the most common fetal position inside the womb during the third trimester? what are other potential positions? - Correct answer -MC: cephalic (vertex) -breech (butt or legs down) -transverse -oblique during the first stage of labor what are the most common positions of the fetal head? how can you tell what position is presenting? - Correct answer -OA (occiput anterior best- where baby comes out face down), LOA, ROA -OT and OP are considered malposition -palpate the anterior and posterior fontanels (anterior is bigger and more central) in persistent OT & OP fetal head positions during labor what is the management to prevent prolonged labor or need for c-section? - Correct answer -manual rotation to OA (can use forceps or vacuum as well) -if unable to rotate can attempt vaginal delivery with forceps or vacuum in OP position (50% delivery rate) but not OT (rare vaginal delivery) -if all else fails- do c/s fraternal twins are ____zygotic whereas identical twins are ____zygotic - Correct answer fraternal: dizygotic (2 ova fertilized by 2 different sperm) identical: monozygotic (1 ova fertilized by 1 sperm that divides after fertilization) - inc r/o fetal transfusion syndrome and discordant fetal growth what are the maternal complications of multiple gestations? - Correct answer -preterm labor -spontaneous abortion -preeclampsia -anemia -placenta previa -cervical incompetence -gestational diabetes -postpartum hemorrhage what are the fetal complications that can occur in multiple gestation? - Correct answer -intrauterine growth restrictions (small for gestational age/SGA) -placental abnormalities -breech presentation -umbilical cord prolapse -preeclampsia what labs will be elevated in multiple gestation? - Correct answer -B-hCG -human placental lactogenic (HPL) -material serum a-fetoprotein (MSAFP) APGAR score is performed at ___ & ___ minutes after birth; again at ___ if abnormal - Correct answer 1 & 5 min postpartum; again at 10 min if abnormal a baby is born crying with a pink body but blue extremities, HR of 157, grimaces feebly on stimulation, flexes arms/legs and resists extension; what is the APGAR score? - Correct answer 8 what is the difference between contractions of pregnancy and Braxton-Hicks contractions? - Correct answer Braxton-Hicks are not associated with cervical dilation what are the cardinal movements of labor? - Correct answer 1. engagement 2. flexion 3. descent 4. internal rotation 5. extension 6. external rotation 7. expulsion what are the stages of labor? - Correct answer -*stage I*: onset of labor (true regular cuts w/ cervical dilation until full dilation (10 cm); *latent phase:* cervix effacement with gradual dilation; *active phase:* rapid cervical dilation (usually beginning at 3-4 cm) -*stage II*: time from full cervical dilation to delivery of fetus; *passive phase:* complete dilation to active maternal expulsion efforts; *active phase:* from active maternal expulsion efforts to delivery of fetus -*stage III*: postpartum until delivery of placenta; avg 5 min but can be b/t 0-30 min -*stage IV*: 1-2 hrs postpartum that mother is watched/evaluated for complications what are the 3 signs of placental separation postpartum? - Correct answer 1. gush of blood 2. lengthening of umbilical cord 3. anterior-cephalic mgmt. of uterine fundus (becomes globular and firmer) after placenta detaches cervical examination of a pregnant patient in labor is done by what 5 criteria that make up the Bishop score? - Correct answer ______ of labor is the attempt to begin labor in a no laboring patient, whereas ______ of labor is intervening to increase the already present contractions - Correct answer induction vs augmentation what are the indications for induction of labor? how do you induce? - Correct answer indications: poster pregnancy, preeclampsia, LGA, nonreassuring fetal testing, intrauterine growth restriction, chorioamnionitis, IUFD, etc. labor is induced with prostaglandins (to "ripen" cervix; misoprostol or PGE2), oxytocic agents (oxytocin aka Pitocin), mechanical dilation of the cervix, and/or artificial ROM (amniotomy) -active herpes lesions -at least 2-3 previous c/s (risk of uterine rupture) VBAC (vaginal birth after cesarean)/ TOLAC (trial of labor after cesarean) are common but have a slight risk ~1% of _________ - Correct answer uterine rupture *1% after 1 c/s, 2% after 2 c/s, but after 3 risk goes way up so do a c/s how long should stage 1 of labor last? - Correct answer nulliparous: ~10-12 hrs (~ half a day) multiparous: ~6-8 hrs (~ a 3rd of a day) -but not really considered prolonged unless >20 hrs in null, >12 hrs in multi how long should stage 2 of labor last? - Correct answer nulliparous: 2 hrs or less multiparous: 1 hrs or less -add an extra hour if they have had an epidural -considered prolonged if above these limits spontaneous abortion is classified as before ___ weeks of pregnancy - Correct answer <20 weeks (& it is MC during 1st 7 weeks) Dx/Tx? a pregnant woman comes in at 8 wks GA c/o foul, brownish d/c, F/C, spotting that lead to heavy bleeding; on PE she has cervical motion tenderness; US shows no fetal heart beat - Correct answer -septic spontaneous abortion (retained POC becomes infected and can spread to uterus/organs) -D&E (dilation & evacuation) to remove POC (products of conception) -broad spectrum abx in a missed spontaneous abortion, the fetal demise occurred but the POC (products of conception) are retained in the uterus- usually found by lack of uterine growth, serially falling hCG, and US; what is the Tx? - Correct answer -D&C if in 1st trimester (D&E if not) -misoprostol (stimulate uterine contractions to expel POC) what is the difference between a complete and missed spontaneous abortion? - Correct answer -complete is when all POC (products of conception) are expelled; usually occurs w/ pain, cramps, and bleeding -if mother Rh- need to give Roam in complete abortions what is the difference between incomplete and inevitable spontaneous abortions? tx? - Correct answer -while they both involve cervical *dilation*, bleeding, & cramping, incomplete expels some of the POC (products of conception) while inevitable does not expel any POC. -incomplete tx: Roam (if indicated), Pitocin, D&C in 1st tri, D&E in 2nd tri -inevitable tx: Roam (if indicated), suction curettage aka D&C in 1st tri, D&E in 2nd tri what is the only type of spontaneous abortion where the pregnancy may still be viable? - Correct answer threatened- pregnancy may progress or abortion may follow- just a wait and see issue so you send them home to rest *it is the MC cause of 1st trimester bleeding* in a threatened spontaneous abortion s/sx are bloody vaginal d/c, spotting to profuse bleeding, +/- contractions, uterus size compatible w/ dates, closed cervical os; are there POC (products of conception) expelled? what can you check to see if pregnancy still progressing? - Correct answer -no POC expelled -serial B-hCG to see if doubling -remember to give Roam if indicated what is the MC cause of spontaneous abortion? - Correct answer -fetal chromosomal abnormalities (50%) -others include: maternal infant, uterine defects, endocrine abnormalities, malnutrition, immunologic, physical trauma, smoking, drug use, etc. what types of medical tx for elective/induced abortion are available? - Correct answer 1. (safe up to 9 weeks pregnant) *mifepristone* (an anti-progestin) + *misoprostol* 2-3 days later (prostaglandin that causes uterine contractions) 2. (safe up to 7 weeks pregnant) *methotrexate* (antimetabolite) + *misoprostol* 3-7 days later surgical elective/induced abortions can be performed up until ____ weeks pregnant by what procedures? - Correct answer until 24 weeks pregnant -D&C (dilation & curettage w/ or w/o suction) @ 4-12 weeks gestation (1st trimester) -D&E (dilation & evacuation) >12 weeks gestation (2nd trimester) Dx/Tx? painful dark red vaginal bleeding in the 3rd trimester, contractions, fetal bradycardia, possible shock symptoms, tender/rigid uterus - Correct answer -dx: placental abruption (premature separation of placenta from uterine wall) -tx: hospitalization for hemodynamic stabilization, immediate delivery usually bc c/s *DIC (disseminated intravascular coagulation) occurs in 10% of pts what is the MC cause of placental abruption (premature separation of placenta from uterine wall)? - Correct answer -*HTN* -others include: smoking, ETOH, cocaine, folate deficiency, high parity, AMA (advanced maternal age), trauma, chorioamnionitis where is the MC site of ectopic pregnancies? - Correct answer -98.3% in fallopian tubes (especially ampulla) -1.4% in abdomen -0.15% in ovary -0.15% on cervix what are some risk factors for ectopic pregnancy? - Correct answer -previous abdominal surgery (adhesions) -PID -previous ectopic -tubal ligation -endometriosis -IUD use -assisted reproduction what is the classic triad of six’s with ectopic pregnancy? - Correct answer 1. unilateral pelvic/abdominal pain 2. vaginal bleeding 3. + pregnancy (noticed by test or by amenorrhea) how is a ectopic pregnancy (that has not ruptured) diagnosed and treated? - Correct answer -Dx by serial quant *B-hCG that do not double q 1-2 days* & *TVUS* -Tx: *methotrexate* (disrupts cell multiplication) w/ *B-hCG monitoring* for *≥15% drop* OR laproscopic salpingectomy or salpingectomy + Roam if Rh- MTX can be given in single/double or multiple doses (4) w/ *Leucovorin* (med to help protect against harmful s/e of MTX) -single/double dosing: monitor B-hCG on days 0, 4, 7 for a ≥15% drop -multiple dosing (4 doses): monitor B-hCG on days 0, 1, 3, 5, 7 until ≥15% drop on 2 successive draws what are the indications/contraindications for giving MTX to tx an ectopic pregnancy? - Correct answer -indications: hemodynamic ally stable, early gestation <4 cm, B-hCG <5,000, no FHT (fetal heart tones) -contraindications: *ruptured* ectopic, h/o TB, *B-hCG >5,000*, *+FHT*, noncompliant pt Dx/Tx? severe unilateral abdominal pain, dizziness, N/V, signs of shock (syncope, tachycardia, hypotension), vaginal bleeding, cervical motion tenderness, adnexal mass, US showing absence of gestational sac, hCG that isn't doubling q1-2 days - Correct answer -ruptured ectopic pregnancy -Dx by serial quant B-hCG (check for doubling) and TVUS -Tx: laparoscopic salpingectomy to remove ectopic gestation- may need salpingectomy; Roam if Rh- an incompetent cervix/cervical insufficiency is painless dilation and effacement of the cervix usually occurring in the ____ trimester and puts the fetus at risk for... - Correct answer -*2nd* trimester what is the treatment for mild and severe preeclampsia? - Correct answer -mild: delivery if >37 wks gestation; conservative if <34 wks monitoring daily weights, BP and dipstick weekly, bed rest, steroids to mature lungs if elective delivery is planned -severe: prompt delivery is only cure, hospitalize w/ *magnesium sulfate* (prevent eclampsia/seizures), HTN meds (hydralazine, labetalol, nifedipine) what is the difference between preeclampsia vs eclampsia? tx of eclampsia? - Correct answer -eclampsia is preeclampsia + seizures or coma -abrupt tonic clonic seizures 1-2 min -tx: ABCDs (airway, breathing, circulation, disability), *magnesium sulfate* (for seizures- *clonazepam 2nd line*), delivery of fetus once pt is stabilized, HTN control (hydralazine, labetalol) chronic/preexisting HTN in pregnancy is defined as HTN before ___ wks gestation; define moderate & severe HTN; what is the tx of moderate/severe HTN? - Correct answer <20 wks gestation -moderate: ≥150/100 -severe: ≥160/110 -tx: give meds! *methyldopa* (DOC), labetalol, hydralazine, nifedipine what are the 4 types of gestational trophoblastic disease? - Correct answer 1. molar pregnancy (benign) 80% 2. invasive mole 10-15% 3. choriocarcinoma 2-5% 4. placental site trophoblastic tumor <1% what are the risk factors for gestational trophoblastic disease? - Correct answer - extremes in age (<20y or >35y) -prior h/o GTD -null parity -Japanese descent -smoking -infertility -spontaneous abortion -blood group A -h/o OCP use -diet low in B-carotene, folic acid and animal fat what is the difference between a complete vs partial molar pregnancy? - Correct answer -*complete*: empty egg (no DNA/nucleus) fertilized by 1-2 sperm; 46XX w/ all paternal chromosomes w/ no fetus; higher r/o development into choriocarcinoma -*partial*: egg fertilized by 1-2 sperm associated w/ an abnormal fetus what is the pathophysiology of gestational trophoblastic disease? - Correct answer unknown cause but forms placental (aka trophoblastic) proliferation that causes swelling of the chorionic villi appearing as grape-like clusters on US what s/sx can you see with gestational trophoblastic disease? - Correct answer - *painless VB* ~6-20wks -uterine size/date discrepancies (*larger than expected*) -early preen (before 20 wks d/t inc hCG) -hyperemesis gravid arum (occurring early d/t inc hCG) -choriocarcinoma (mets to lungs MC, lower genital tract, pelvic mass) -*B-hCG markedly elevated >100,000* -US showing "snowstorm" or "*cluster of grapes*" & *absent FHT* what is the tx for gestational trophoblastic disease benign and malignant? - Correct answer -*benign*: suction curettage (D&C) asp to avoid malignant development then followed weekly until B-hCG levels undetectable (+ Roam to Rh- mothers & avoidance of pregnancy x1yr) -*malignant*: chemo w/ *methotrexate* (very responsive) &/or hysterectomy when is Roam indicated? - Correct answer in Rh- mothers @ *28 wks* and w/i *72 hrs postpartum* OR if any potential for mixing of fetal blood (spontaneous abortion, vaginal bleeding, amniocentesis, abruption, placenta previa, etc.) will an Rh- mother w/ negative Abs’ (P0) baby be affected? - Correct answer no, mother does not have Abs yet BUT you give Roam to prevent the building of Abs that will attack a future fetus' RBCs what will happen to the fetus of an Rh- mother w/ +Abs’ untreated w/ Roam in a previous pregnancy - Correct answer Abs’ may cross placenta and attack fetal RBCs resulting in hemolytic anemia, jaundice (from inc bile), kernicterus ("), hepatosplenomegaly, fetal hydrops (fluid accumulation in 2 places: pericardial effusion, ascites, pleural effusion, sub edema), CHF if Rh incompatibility occurs and the fetus suffers erythroblastosis fetalis w/ mod-severe anemia what is the tx? - Correct answer antigen negative RBCs through US guided umbilical vein transfusion what are the 2 main phases of the menstrual cycle? - Correct answer 1. follicular phase (days 1-14) 2. luteal phase (days 14-28) in the follicular phase (days 1-14) of the menstrual cycle, FSH is increasing which causes a _______ to develop which produces ________ to help proliferate the lining of the endometrium; at the end of this phase _______ surges causing ovulation - Correct answer -primary ovarian follicle -estrogen estrogen also causes the *LH* surge = ovulation in the luteal phase (days 14-28), after ovulation, the leftover follicle becomes the _________ which produces _________ which maintains the endometrial lining for fertilization - Correct answer -corpus luteum -progesterone in the luteal phase, the endometrial lining is prepared for fertilization from progesterone from the corpus luteum; the ________ degrades causing a drop in progesterone/estrogen and _________ begins - Correct answer -corpus luteum -menstruation (sloughing of endometrium) in the luteal phase, the endometrium is prepared for fertilization by progesterone from the corpus luteum; if fertilization does occur __________ gets released by the developing trophoblastic/placenta which maintains the __________ to continue making progesterone/estrogen - Correct answer -hCG -corpus luteum light flow or spotting is called - Correct answer crypto menorrhea heavy or prolonged bleeding at normal menstrual intervals is called - Correct answer menorrhagia irregular bleeding between expected menstrual cycles is called - Correct answer metrorrhagia irregular, excessive bleeding between expected menstrual cycles - Correct answer menometrorrhagia infrequent menstruation (prolonged cycle length >35 days but <6 mos.) is called - Correct answer oligomenorrhea frequent cycle interval (<21 days) is called - Correct answer polymenorrhagia absence of menstruation is called - Correct answer amenorrhea what is the range of duration of a normal menstrual cycle? - Correct answer 24-38 what is the difference between abnormal uterine bleeding and dysfunctional uterine bleeding? - Correct answer AUB has specific causes (PALM-COEIN) such as polyps, fibroids or malignancy DUB is a diagnosis of EXCLUSION (90% being anovulatory and 10% ovulatory) after ruling out all AUB causes of abnml frequency/intensity of menses chronic anovulation (90% of DUB) is d/t disruption of the hypothalamus-pituitary axis and usually seen with extremes of age (teens soon after menarche or premenopausal) sx's (of estrogen deficiency): hot flashes, sleep/mood disturbances, dyspareunia dry/thin skin, vaginal dryness/atrophy -progesterone challenge: 10mg medroxyprogesterone/Provera for 10 days; + withdrawal bleeding confirms ovarian dysfxn; - withdrawal bleeding means 1. HPO failure (hypoestrogenic) or 2. uterine dysfxn (as Herman’s or outflow obstruction) what are the hypothalamic dysfxn causes of 2° amenorrhea? - Correct answer - hypothalamic disorders -anorexia (or wt loss 10% below ideal BW) -exercise -stress -nutritional deficiencies -systemic disease what will hormone levels show in amenorrhea 2° to hypothalamic dysfxn? - Correct answer -nml/low FSH/LH -low estradiol -nml prolactin what is the tx for amenorrhea 2° to hypothalamic dysfxn? - Correct answer stimulate gonadotropic secretion: -*Clomiphene* -menotropin/Personal what will the hormone levels of amenorrhea 2° to pituitary dysfxn show? what is the workup and tx? - Correct answer -*inc prolactin* (d/t prolactin-secreting pituitary adenoma) -dec FSH/LH (prolactin inhibits GnRH) -MRI of pituitary sell -tx: transphenoidal tumor removal surgery what are the causes of amenorrhea 2° to uterine scarring (aka Asherman's syndrome)? how is it diagnosed? tx? - Correct answer -postpartum hemorrhage -s/p D&C -endometrial infxn -Dx by pelvic US or hysteroscopy (tx this way too) -tx: estrogen to stimulate endometrial regeneration of the denuded area primary dysmenorrhea (painful periods) is due to? - Correct answer inc prostaglandins that usually causes pain starting 1-2 years after menarche *NSAIDs great for this! what are the causes of secondary dysmenorrhea (painful periods)? tx? - Correct answer -endometriosis, adenomyosis, leiomyomas, adhesions, PID -tx: *NSAIDs* 1st line (inhibits prostaglandins) started before onset of menses, ovulation suppression (OCPs, Depo-Provera, Nuva-Ring) -further workup: laparoscopy to r/o endometriosis and PID; G/C/Trich testing menopause is defined as cessation of menses >____ amount of time d/t loss of ovarian function - Correct answer >1 yr (avg age is 50-52) premature menopause aka premature ovarian failure aka primary ovarian insufficiency is defined as before age ____ - Correct answer 40 what are some sx's of menopause from estrogen deficiency changes? - Correct answer -menstrual cycle alterations -vasomotor (hot flashes, nt sweats) -mood changes -skin/hair/nail changes -inc cardiovascular events -hyperlipidemia -osteoporosis -vaginal atrophy (dryness, dyspareunia) -urinary incontinence what FSH level confirms a woman is in menopause (as long as she is amenorrheic >1 yr)? - Correct answer FSH >30 *also will have inc LH and dec estrogen what are the tx's for menopause symptoms? - Correct answer -vasomotor/hot flashes: estrogen, progesterone, clonidine, SSRIs, gabapentin -vaginal atrophy: topical estrogen -osteoporosis prevention: calcium and vitD, wt bearing exercises, *bisphosphonates*, calcitonin, estrogen, SERMs (tamoxifen) -hormone replacement therapy (HRT): estrogen or estrogen+progesterone what are the risks/benefits of hormone replacement therapy for menopausal sx's? - Correct answer *estrogen:* -risks: inc risk of *endometrial cancer* so often used in s/p hyst pts, thromboembolism, liver dz -benefits: most effective tx, no inc risk of breast cancer *estrogen+progesterone* -risks: thromboembolism, slight inc risk of breast cancer -benefits: effective tx, dec heart/stroke risk, dec osteoporosis, dec dementia, *protective against endometrial cancer* so often used in pts who still have a uterus in what phase of the menstrual cycle does premenstrual syndrome occur? - Correct answer luteal phase what are the clinical manifestations of premenstrual syndrome? - Correct answer 1. physical- bloating, breast swelling/pain, HA, bowel habit changes, fatigue, muscle/joint pain 2. emotional- depression, hostility, irritability, libido changes, aggressiveness 3. behavioral- food cravings, poor concentration, noise sensitivity, loss of motor senses how is premenstrual syndrome diagnosed and treated? - Correct answer dx: symptoms 1-2 weeks before menses (in luteal phase), sx relief 2-3 days after onset of menses, 7 days sx free during the follicular phase tx: *SSRIs*/SNRIs for emotional sx, *OCPs*, GnRH, spironolactone/calcium carbonate/low salt diet (for bloating/breast tenderness) how is premenstrual dimorphic disorder different from premenstrual syndrome? what is the tx difference? - Correct answer PMDD- severe PMS with functional impairment -tx for PMDD: Drospirenone containing OCPs (instead of just regular OCPs for PMS) dx/tx? frothy, yellow-green discharge and a strawberry cervix - Correct answer -dx: trichomoniasis vaginitis (will see pear shaped flagellated protozoa on wet prep) considered STI -tx: po metronidazole/Flagyl 2g once dx/tx? thin, watery, grey/white discharge with rotten fish smell; clue cells on wet prep; MC cause of vaginitis; fishy odor on KOH prep - Correct answer -dx: bacterial vaginosis (overgrowth of gardnerella vaginalis and dec of lactobacillus) -tx: metronidazole/Flagyl 500mg BID x7d; avoid douching! dx/tx? thick, cottage cheese discharge, vaginal burning/itching, hyphae/yeast on KOH prep - Correct answer -dx: Candia vulvovaginitis -tx: po fluconazole/Diflucan 150mg once or topical antifungals what is the MC cause of cervicitis? - Correct answer chlamydia trachomitis dx/tx of cervicitis secondary to chlamydia trachomitis? - Correct answer -dx by: PCR or Cu -tx: azithromycin 1g po once OR doxycycline 100mg po BID x 10d dx/tx of cervicitis secondary to Neisseria gonorrhea? - Correct answer -dx by: PCR or Cu -tx: ceftriaxone 250mg IM once -tx: supportive- most cysts <8cm are functional & usually resolve spontaneously (rest, NSAIDs, rapt US in 6 wks, OCPs to prevent future cysts, if postmenopausal & >8cm do laparoscopy/laparotomy) what is the MC benign ovarian neoplasm? tx? - Correct answer *dermoid cystic teratomas* -tx: removal (d/t risk of torsion or malignancy development) *90% of ovarian neoplasms are benign in reproductive age women! what age range receives cytology (pap smear) w/o HPV testing for screening Q3yr? what age do you start doing cytology + HPV co-testing? - Correct answer -cytology only: start at age 21 to 29 -cytology + HPV: 30 and up 27yo pt with ASCUS (atypical squamous cells of undetermined significance) on cytology; next step? if she was 23? - Correct answer ≥25 w/ ASCUS do *HPV testing*- if (-) repeat co-testing in *3 yrs*; if (+) *colposcopy + Bx* 21-24 w/ ASCUS- *repeat pap in 1 yr* ...or can do HPV testing but not recommended 22yo w/ ASC-H (atypical squamous cells can't exclude HSIL) on cytology; next step? - Correct answer any age w/ ASC-H = *colposcopy + Bx* 27yo pt with LSIL (low grade squamous intraepithelial lesion) on cytology; next step? if she was 23? if she was 33? - Correct answer 25-29 w/ LSIL do colposcopy + Bx 21-24 w/ LSIL *repeat pap in 1 yr* ≥30 w/ LSIL HPV testing and if (-) rapt pap in 1 yr, (+) do colposcopy + Bx *LSIL includes CIN1* 27yo pt with HSIL (high grade squamous intraepithelial lesion) on cytology; next step? - Correct answer *colposcopy + Bx* at ALL AGES *includes CIN2, CIN3, and carcinoma in situ what is the tx recommendation for a pap with glandular cell abnormalities instead of squamous cell abnormalities? - Correct answer always *colposcopy + Bx* for any glandular cell abnormalities *glandular changes include atypical glandular cells, carcinoma in situ, adenocarcinoma, endometrial cells what region of the cervix has the highest risk for malignancy? - Correct answer transformation zone (squamocolumnar junction)- junction of squamous cell of ectocervix and glandular columnar cells near end of endocervical canal what histology/Bx results of CIN1, CIN2, CIN3 fall under LSIL vs HSIL cytology/pap results? - Correct answer LSIL- CIN1 HSIL- CIN2/3 a pt with LSIL pap results has a Bx showing mild dysplasia contained to the *basal 1/3 of the epithelium*; what CIN level is this? what are the tx options? - Correct answer - CIN1 (cervical intraepithelial neoplasia) -tx: 1. *observation* (75% resolve by immune system w/i 1 yr) 2. *excision*- *LEEP* (loop electrical excision procedure) or *cold knife cervical conization* 3. *ablation* (energy assisted destruction of lesions via cry cautery, laser cautery, or electrocautery) a pt with LSIL pap results has a Bx showing moderate dysplasia including 2/3 thickness of basal epithelium; what CIN level is this? what are the tx options? - Correct answer - CIN2 -tx options: 1. *excision*- LEEP (loop electrical excision procedure) or *cold knife cervical conization* 2. *ablation* (energy assisted destruction of lesions via cry cautery, laser cautery, or electrocautery) a pt with LSIL pap results has a Bx showing severe dysplasia with >2/3 up to full thickness of basal epithelium; what CIN level is this? what are the tx options? - Correct answer -CIN3 (full thickness = Dx of carcinoma in situ) -tx options: 1. *excision*- LEEP (loop electrical excision procedure) or *cold knife cervical conization* 2. *ablation* (energy assisted destruction of lesions via cry cautery, laser cautery, or electrocautery) (tx same as for CIN2) what are the top 3 most common gynecological cancers? - Correct answer 1. endometrial ca 2. ovarian ca 3. cervical ca what strains of HPV are associated with cervical cancer? - Correct answer *16, 18* (70%), *31, 33*, 45, 52, & 58 what are the 2 types of cervical cancer? which is the MC? - Correct answer 1. squamous (90%) 2. adenocarcinoma (10%) what are the MC symptoms seen in a symptomatic cervical cancer pt? - Correct answer -MC: post-coital bleeding/spotting -metrorrhagia -pelvic pain what is the stage and treatment for cervical Bx that comes back as carcinoma in situ? - Correct answer -stage 0 -tx: excision (LEEP vs cold knife conization), ablation (cryotherapy or laser), or TAH- BSO what is the stage and treatment for cervical Bx that comes back as "micro invasion"? - Correct answer -stage Ia1 -tx: conization, TAH-BSO, XRT what is the tx for stage I and IIA cervical carcinoma? - Correct answer -TAH-BSO -XRT + chemo (Cisplatin) what is the stage for cervical cancer that extends locally beyond the cervix? if it extended to the lower 1/3 of the vagina? if there were local METS (bladder, rectum)? what is the tx for all of these stages? - Correct answer -stage II: extends locally beyond cervix -stage III: extends to lower 1/3 of vagina -stage IVA: local METS (bladder, rectum) -tx for stage IIB-IVA: XRT + chemo (Cisplatin +/- 5FU) *NO SURGERY* what is the stage and treatment for cervical carcinoma that has distant mets? - Correct answer -stage IVB -tx: palliative XRT + chemo (Cisplatin +/- 5FU) what age is the Gardasil vaccine recommended in? what strains does it protect against? - Correct answer age 11-26 (not FDA approved outside these ages) -6, 11, 16, 18 *Gardasil 9 targets 6, 11, 16, 18, 31, 33, 45, 52, 58 getting immunized with Gardasil with only 2 doses (at least 6 mos. apart) is available in what ages? what is the schedule for the 3 dose vaccination? - Correct answer 11-14 *15-26 = 3 doses at 0, 2, and 6 mos. (have to give the doses over a minimum of 6 mos.) dx? chronic, eczematous itchy, scaling rash on the nipples and areola that may ooze + an underlying lump - Correct answer paget's disease of the nipple dx? red, swollen, warm, itchy breast, often w/ peau de orange and nipple retraction, often w/o lump - Correct answer inflammatory breast cancer *pic showing peau de orange on MMG L breast shows *micro calcifications & speculated masses*; what are you suspicious for? - Correct answer malignancy (bra ca) how is a breast lump worked up? - Correct answer US is 1st, then diagnostic MMG, then if suspicious, Bx (FNA Bx, large needle core Bx, or excisional Bx) what is the management/tx of breast cancer? - Correct answer 1. lumpectomy- followed by XRT 2. mastectomy- if ca diffuse, leg tumor, or prior XRT to breast 3. removal of regional axillary lymph nodes to determine if METS present adjunctive: 4. XRT after lumpectomy or mastectomy 5. in bra ca stage II-IV and inoperable dz, especially ER (-) bra ca w/ *Doxorubicin, Cyclophosphamide, Fluorouracil, Docetaxol* neoadjuvant (hormone/endocrine) therapy- (in bra ca that are ER (+), progesterone receptor (+) or HER2 (+) 6. anti-estrogen (*Tamoxifen*)- in ER (+) ca- binds/blocks ER in breast tissue 7. aromatase inhibitors- useful in PMP ER (+) bra ca by reducing production of estrogen (*Letrozole, Anastrozole*) 8. monoclonal Abs tx- useful in HER2 (+) bra ca (more aggressive) (*trastuzumab/Herceptin*) s/e: cardiotoxicity what neoadjuvant medication could be given to a 55yo w/ ER (+) breast cancer? - Correct answer 1. *Tamoxifen* (anti-estrogen) binds ER and blocks them 2. aromatase inhibitors (*Letrozole, Anastrozole*) that reduce production of estrogen (best used in PMP women) what neoadjuvant hormone therapy could you give to a pt with HER2 (human epidermal growth factor receptor) (+) breast cancer? - Correct answer monoclonal Abs tx- (trastuzumab/Herceptin) but s/e are cardiotoxicity how often should clinical breast exams, self breast exams, and screening MMGs take place? & in what age group? - Correct answer -clinical breast exam: q3y age 20-39, annually @ age ≥40 -self breast exam: monthly ≥20yo right after menstruation -MMG: annually ≥40yo or 10y before 1st deg relative Dx is there preventative tx available for breast cancer? - Correct answer -SERM (Tamoxifen, Raloxifene) in PMP women or >35y @ high risk x5 yr -aromatase inhibitors (Letrozole, Anastrozole) -prophylactic mastectomy what is the difference b/t congestive and infective mastitis? - Correct answer - congestive: bilateral breast enlargement 2-3 days postpartum -infective: usually unilateral in lactating women d/t nipple trauma (especially primagravida) w/ *s. aureus*, strep, candida w/ tenderness, swelling, warmth, & nipple discharge what is the difference between infectious mastitis vs breast abscess? - Correct answer -mastitis is usually redness, swelling, warmth, and tenderness in one quadrant of the breast -breast abscess is more localized induration w/ fluctuance and is rare what are the tx recommendations for infectious mastitis vs congestive mastitis vs breast abscess? - Correct answer -infectious mastitis: warm compress, *cont. pumping/nursing*, *anti-staph abx* (Dicloxacillin, Nafcillin, Cephalosporin) -congestive mastitis: if want to cont. breast feeding then manually empty breast after each feed, warm compress, analgesics; if want to stop breast feeding then ice packs, tight-fitting bras, analgesics and avoid breast stimulation -breast abscess- *I&D*, *d/c breastfeeding* from affected breast dx/tx? bilateral, often tender, multiple, mobile, well demarcated lumps in breast tissue that may inc/dec in size w/ menstrual hormonal changes - Correct answer -dx: fibrocystic breast d/o (can do US or FNA that reveals straw-colored fluid aka no blood) -tx: supportive *MC breast d/o dx/tx? a smooth, well-circumscribed, nontender, mobile, rubbery lump composed of glandular & fibrous tissue (collagen arranged in "swirls") that does not usually wax/wane in size w/ menstrual cycle - Correct answer -dx: fibroadenoma of breast -tx: no tx- usually resolve over time what are the 3 etiologies of a dystocia in labor? - Correct answer 1. *p*owner- uterine contractions aren't strong enough 2. *p*passenger- too big or position not cephalic 3. *p*assuage- pelvis, uterus or soft tissue abnormalities what are the non-manipulative and manipulative maneuvers for a shoulder dystocia? - Correct answer -non-manipulative: *Robert’s maneuver* (hyper flex hips- knees to chest to open pelvis) + *suprapubic pressure* -manipulative: *Woods "Corkscrew"* maneuver 180 degree shoulder rotation *c-section if cannot fix w/ maneuvers what are the risks of a prolonged shoulder dystocia? - Correct answer -umbilical cord compression or fetal asphyxiation -damage to C5/6 nerve roots = Ergs palsy what are some risk factors for having premature rupture of membranes? - Correct answer -STDs -smoking -prior preterm delivery -multiple gestation how can you diagnose premature rupture of membranes? tx? - Correct answer - pooling test on speculum exam -nitrazine paper (will turn blue if pH>6.5 aka amniotic fluid) -ferning appearance of amniotic fluid on a microscopic slide -US to check the amniotic fluid index (AMI) or fluid levels -tx: await spontaneous labor and monitor for infection (chorioamnionitis or endometritis) after water has broken or amniotomy performed it is important not to do what that may cause the umbilical cord to prolapse past the head - Correct answer do not elevate fetal head from pelvis to release more amniotic fluid umbilical cord prolapse is an obstetric emergency and is tax’s by - Correct answer emergent delivery- assisted vaginal or stat c-section (whichever will be quicker) can do maneuvers in the meantime to elevate fetus off of cord if in fetal distress preterm labor is defined as regular uterine contractions (>4-6/hr) with *progressive cervical changes* (effacement/dilation) before ____ weeks gestation - Correct answer <37 wks *it is the MC cause of perinatal mortality what degree of dilation & effacement is preterm labor likely? - Correct answer 2-3cm dilation 80% effacement besides, nitrazine/pooling/ferning tests what other test can be performed between 20-34 weeks to determine if ROM has occurred? - Correct answer fetal fibronectin (a protein that keeps amniotic sac "glued" to uterine lining- if found means it has likely detached and chances of PTL are higher) if preterm labor is suspected what tests/tx should be started? - Correct answer -r/o infxn: UTI, GBS, G/C, active HSV what is normal discharge/bleeding in the postpartum/puerperium period? - Correct answer -especially days 4-10, pinkish brown vaginal bleeding called *lochia serosa* that should cease by *3-4 weeks* postpartum T/F: lactating/breast feeding mothers remain anovulatory - Correct answer *true* but still use back up contraception just in case when do regular menses return postpartum? - Correct answer 6-8 weeks (if not breastfeeding) a cystocele is the (anterior or posterior?) bladder herniating into the (anterior or posterior?) vaginal wall; how is it tax’s? - Correct answer -*posterior* bladder through *anterior* vaginal wall -kegels, wt control, pessary, anterior colporrhapy (reinforce fascia w/ sutures) a rectocele is the (anterior or posterior?) rectum herniating into the (anterior or posterior?) vaginal wall; how is it tax’s? - Correct answer -*anterior* rectum into *posterior* vaginal wall -kegels, wt control, pessary, posterior colporrhapy (reinforce fascia w/ sutures) an enterocele forms when small bowel descends into _______ herniating into the upper vaginal wall - Correct answer pouch of Douglas what are the risk factors for uterine prolapse? - Correct answer weakness of pelvic support structures (MC after childbirth, multiparity, obesity, repeated heavy lifting) explain grades I-IV of uterine prolapse - Correct answer -I: descent into upper 2/3 of vagina -II: cervix approaches introitus -III: outside introitus -IV: entire uterus outside of vagina- complete prolapse symptoms of pelvic organ prolapse include: pelvic/vaginal fullness/heaviness, "falling out" sensation, lower back pain, vaginal bleeding, purulent discharge, urinary frequency/urgency, stress incontinence; what PE maneuver can be done to check? - Correct answer valsalva to inc abdominal pressure and produce a bulging mass on exam what are the tx options for pelvic organ prolapse? - Correct answer -kegels/PT to strengthen pelvic floor -weight loss -peccaries -estrogen tx (improves atrophy) -hysterectomy -colporrhaphy (reinforcement of fascia w/ sutures) -uterosacral or sacrospinous ligament fixation a 33 yo women comes in with acute R pelvic pain, adnexal mass; Ddx? workup? - Correct answer -Ddx: ovarian torsion, ectopic pregnancy, ruptured ovarian cyst/abscess, appendicitis, etc. -w/u: pelvic US ovarian torsion is usually seen in women of reproductive age with acute unilateral pelvic pain and adnexal mass; how is it tax’s? - Correct answer -DE torsion and ovarian conservation -only perform salpingo-oopherectomy if PMP or necrotic ovary abstaining from sex during the fertile period as a means of contraception is called __________ and uses what signs to monitor this window? - Correct answer -natural family planning -signs: body temp, cervical mucus, calendar, urine progestin test -failure rate is up to 25% coitus interrupts (withdrawal of penis from vagina before ejaculation) has a ____% failure rate d/t sperm being in pre-ejaculatory fluid - Correct answer 20% what is the chemical in spermicide called? what is the failure rate of spermicide? - Correct answer -nonoxynol-9 -27% failure rate do female or male condoms have a higher failure rate? - Correct answer male- 20% female- 21% a rubber cuplike device that holds spermicide against cervix - Correct answer - diaphragm: failure rate of 15% -must remain in place 6-24h after intercourse -requires pelvic exam & fitting what barrier methods of contraception can increase risk for developing toxic shock syndrome? - Correct answer diaphragm, fem cap, contraceptive sponge what barrier method of contraception is similar to a diaphragm but does not require fitting by a health care professional or the use of spermicide? they also have similar failure rates of ~15% - Correct answer fem cap emergency contraception (plan B) is what drug/dose? - Correct answer levonorgestrel in either dose: 1. 2x 0.75mg tablets 12 hrs apart 2. 1.5mg x 1 dose what is the failure rate of emergency contraception? how is its effectiveness best timed? - Correct answer -up to 25% failure rate -best if taken w/i 72h of unprotected sexual intercourse what is the most effective form of contraception besides sterility and abstinence? - Correct answer IUD what IUD contraceptives are progesterone (levonorgestrel) releasing? how many years do they last? as with any progesterone contraceptive what is a big ADR? - Correct answer -Mirena (strongest) 5yr -Skylar 3yr -Killeen 5yr -ADR: breakthrough (irregular) bleeding *Skylar & Killeen are best for nulliparous pts bc they are smaller Paraguarí is an IUD that uses _________ to act as a spermicide within the uterus; how long does it last? s/e? - Correct answer -copper -10yr -s/e: 50% increase in menstrual bleeding sterilization can be done by what methods? what do these put patients at risk for? - Correct answer -bilateral tubal ligation (BTL) or assure (chemicals or coils to scar portion of fallopian tubes) -risk of: ectopic pregnancy and difficult reversal of fertility how do combination (estrogen + progesterone/synthetic progestin) OCPs work as contraceptives? - Correct answer -act on anterior pituitary to *prevent release of LH/FSH* therefore *preventing ovulation* -secondarily *increases cervical mucus* and *thins endometrium* making it less habitable for implantation -body is in a "pseudo-pregnancy state" combination OCPs (estrogen + progesterone/synthetic progestin) have what positive effects on the body besides their contraceptive action? - Correct answer -improves dysmenorrhea -controls menstrual cycle irregularity -helps prevent osteoporosis -protective against ovarian cysts (formed from ovulation), ovarian cancer and endometrial cancer (keeps lining thin) -improves acne -less PID & ectopic pregnancy risk -helps with bloating -can help with mood (as in PMDD) what are some contraindications to combination (estrogen + progesterone) OCPs bc of estrogen? - Correct answer -smokers >35y -postnatal insulin-resistant hyperinsulinism (either genetically programmed or as a result of obesity) the pathophysiology of PCOS is from excess/unopposed estrogen which is driven by? - Correct answer *increased LH levels* which are driven by *increased insulin levels* what lab/radiology results will a pt with PCOS have? - Correct answer -*inc testosterone*, ≥3:1 LH:FSH ratio (nml is 1.5:1), inc lipid panel, in blood glucose, pelvic US with bilateral enlarged ovaries with peripheral cysts aka *"string of pearls"* appearance -turns out LH:FSH ratio is BS according to Up-to-date but it’s on PPP so who knows... what do you need to make the diagnosis of PCOS? - Correct answer Rotterdam Criteria: *2 out of 3* 1. polycystic ovaries on US 2. clinical hyper androgenic signs (hirsutism, acne, male-pattern hair loss) 3. oligo and/or anovulation/amenorrhea what other conditions do you need to rule out when diagnosing PCOS? - Correct answer -thyroid dysfxn (can cause menstrual irregularities) -pituitary adenoma -ovarian tumors -Cushing’s syndrome (r/o w/ dexamethasone suppression test) -no classical congenital adrenal hyperplasia (NCCAH) (r/o w/ GnRH stimulation test resulting in rise in serum hydroxyprogesterone) -DM (& check lipids too) how is PCOS treated? - Correct answer -mainstay of tx: *combination OCPs* (normalizes bleeding and suppresses androgen) -anti-androgenic agents for hirsutism (*spironolactone*, leuprolide, finasteride) -infertility 1st line: *clomiphene* (SERM) -*metformin*: helps with insulin resistance, fertility, hirsuitism, and menstrual irregularity -life style changes: wt loss by diet/exercise -surgical (wedge resection of ovary): to restore fertility when clomiphene fails what are some complications of untreated PCOS? - Correct answer -infertility -endometrial hyperplasia/cancer risk d/t unopposed estrogen thickening lining -insulin resistance = DM, HL, HTN, CAD, MI risks what is the MC benign gynecological lesion? it is a benign uterine smooth muscle tumor - Correct answer leiomyoma (uterine fibroids) aka fibromyoma leiomyomas (fibroids) grow with what hormone? - Correct answer estrogen- this is why they regress after menopause what pt population are leiomyomas (fibroids) most commonly seen in? - Correct answer >35y/o 5x MC in AA while most leiomyomas (fibroids) are asymptomatic, the most common symptoms are... - Correct answer -*menorrhagia* (MC) -dysmenorrhea -abdominal pressure/pain -bladder frequency/urgency -large palpable uterine mass during bimanual exam how are leiomyomas worked up and treated? - Correct answer -w/u: pelvic US (focal heterogenic masses w/ shadowing) -tx: 1. observation (only tx if sx's are bad) 2. medical (inhibition of estrogen to dec endometrial growth)- *leuprolide* (GnRH agonist) shrinks endometrium up to 50%; progestins cause endometrial atrophy and dec bleeding 3. surgery- *hysterectomy* for definitive tx (fibroids/HMB are MC reason for hyst); *myomectomy* to preserve fertility; *endometrial ablation*; *artery embolization* what is an adenomyosis? - Correct answer an island of endometrial tissue w/i the myometrium *muscular layer of the wall) when comparing leiomyomas (fibroids) and adenomyosis signs of uterine symmetry, hard/softness, and tenderness, what is the difference? - Correct answer -leiomyomas: asymmetrical, firm, nontender uterus -adenomyosis: symmetrical, soft, tender uterus *both present with menorrhagia and dysmenorrhea how is adenomyosis diagnosed? treated? - Correct answer *diagnosis of exclusion!* -cannot see on US so must do *MRI* or post-TAH examination of uterus -tx: only effective is TAH but can do OCPs/NSAIDs to preserve fertility what are the risks of untreated adenomyosis? - Correct answer induces hypertrophy/hyperplasia of surrounding myometrium where ectopic endometrial tissue is implanted screening for intimate partner violence (IPV) is suggested when? - Correct answer - initial visit -pregnant women -ED visits -suspicious signs (inconsistent explanation of injuries, delay in seeking tx, missed appts, frequent ED visits, late prenatal care, inappropriate affect, overly attentive partners, reluctance to be examined) how is intimate partner violence (IPV) managed? - Correct answer -emotional support -f/u visits -referral to counseling or psych -give domestic violence hotline, group or social worker info -careful documentation -only required to report if pt is *disabled, elderly, under 18, or weapons involved* what all should be evaluated/treated in a sexual assault pt? - Correct answer - psychological assessment -evaluation of areas of trauma -examination of breast, pelvic, and anorectal areas -colposcopy to detect genital trauma -use of evidence collection kit -labs: pregnancy test, STI testing, drug screening -prophylactic STD tx (ceftriaxone 250mg IM for gonorrhea, azithromycin 1g po for chlamydia, metronidazole 2g po for trich) -hep B vaccine, HPV vaccine for those not previously immunized -prophylactic HIV tx w/ antiretroviral (controversial) -post-coital contraception (plan B) -offer acute crisis counseling what is urinary incontinence due to increased abdominal pressure (sneezing, laughing, coughing, running, etc.) known as? what is it due to? - Correct answer *stress incontinence*- d/t laxity of pelvic floor muscles (childbirth, surgery, postmenopausal, post prostatectomy) what is the tx for stress incontinence (d/t inc abdominal pressure)? - Correct answer - *pelvic floor exercises* (kegel, biofeedback w/ sensor detecting pressure changes of kegels); 87% improvement -*alpha agonists* (midodrine, pseudoephedrine) inc urethral sphincter tone and flow resistance; 19-74% improvement -*surgery* (artificial sphincter) inc urethral outlet resistance; 88% improvement -*anti-incontinent devices*: vaginal cones help to strengthen pelvic floor muscles, peccaries -*estrogen*: cream or estradiol-impregnated vaginal ring to help with atrophy what is urge incontinence? what is the cause? sx? - Correct answer -urine leakage accompanied by or preceded by urge -caused by *detrusor muscle over activity* by muscarinic acetylcholine receptors; "overactive bladder" -sx: urgency, frequency, small volume voids, nocturnal how is urge incontinence treated? - Correct answer -*bladder training* (timed frequent voids and dec fluid intake)