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69 Cards in this Set
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- Back
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42 long standing DM and complains of small amount of constant dribbling of urine loss with coughing or lifting, Single best therapy?
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neurogenic bladder leading to overflow incontinence. Tx intermittent self catheterization. Also seen in MS and spinal cord injuries
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39 feels as though she needs to void but cannot make it to the restroom in time.
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Urge incontinence Tx behavioral frequent voiding 1-2 hrs anticholinergic Oxybutynin
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35 4 vaginal deliveries, urinary loss with coughing or sneezing. Denies dysuria or urge to void
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Stress Incontinence, Tx urethroplexy
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55 constant wetness from vagina following histerectomy
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fistula, surgical repair.
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differentiate urge from stress incontinence
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cystometric or urodynamic evaluation
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approach to health maintenance questions
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1) cancer screenings 2) immunizations 3) addressing common disease in this group
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Screeing
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Cancer in women
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3 yrs after sex or >21 Cervica until 70 and >50 Colon and Breast
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Immunizations
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Tetanus and Hep B,
>6 mths annual influenza >60 Zoster >65 pneumococcal |
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other diseases
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>45 Cholesteral every 5 yrs
and Fasting blood sugar every 3 yrs >50 TSH every 5 yrs >65 Bone Mineral Density |
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Most common cause of mortality
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>13 MVA, mal neoplasia
>19 Malignant neoplasia, accident >40 Cancer, Cardiovacular >65 Heart Dz, Cancer, Stroke |
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20 yr old sexual intercoars 3 yrs ago
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Pap smear
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46, pap smear last yr
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Fasting blood sugar, and cholesterol
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59, mild osteoarthritis
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Pap smear, Colon Ca Screening, Breast Ca, Cholesteral, Fasting BS, bone density scan
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71 yr old
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DO EVERTHING
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31 G4P3 uneventful vaginal delivery, slight lengthening of the cord, along with a gush of blood per vagina. As placenta is being delivered, a shaggy, reddish, buldging mass is noted at the introitus around the placenta. Diagnosis, Complication?
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Uterine Inversion, post partum hemorrhage (shaggy around the placent is endometrial surface) Tx Manually replace the uterus, if shock tx the hypovolemic shock.
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Placental implantations would most likely predispose to an inverted uterus?
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Fundal
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Next step after a 20 min 3rd stage of labor?
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attempt manual extraction of placenta.
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risk factor for uterine inversion
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Atonic Uterus
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physician attempts to replace the utereus but the cervis is tightly contracted? Best therapy for the px?
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Halothane anesthesia, relaxes the uterus, best initial therapy
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premature ovarian failure
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<40 years old younger than 30 look for autoimmune or karyotypic abnormalities
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49 irregular menses, feeling of inadequacy, sleeplessness, episodes of warmth and sweating. MLD? NSD?
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Climacteric (premenopausal state) ~51, NSD: FSH and LH levels (dec inhibin inc FSH dec Estradiol)
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Perimenopausal associated dz
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Hypothyroid, DM, HTN, Breast Cancer, Depression
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51 oligomenorrhrrhea and hot flashes, mechanism?
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Ovarian Failure
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22 nonpregnant with galactorrhea and hyperpolactinemia
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Hypothalamic Dysfunction
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25 slightly obese, hirsute, long history of irregular menses , mechanism?
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Estrogen Excess, progestins will induce vaginal bleeding
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18 infantile breast development has not started her menses. Webbed neck, mechanism?
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Ovarian Failure
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19 nonpregnant marathon runner with amenorrhea
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hypothalamic Dysfunction
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33 not started her menses since vaginal delivery 1 yr previously complicated postpartum hemorrhage, she is unable to breast feed, mechanism?
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pituitary dysfunction
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cornerstone in osteoporosis prevention
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weight bearing exercise, calcium and vit D
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28 102', myalgias, hypotension, confusion, sunburn like rash, hemoconcentration and renal insufficiency Dx NST
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TSS toxic shock syndrome,NST Isotonic IV fluids, nafcillin, monitor urine and blood pressure, support blood pressure with dopamine if needed.
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minimal mean arterial bp for brain profussion
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65, which is where you must maintain this persons bp MAP = 2xSBP+DBP / 3
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Cornerstone for septic shock
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support blood pressure, remove nidus of infection, antibiotic therapy monitor perfusion and organ function
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Clinical approach to labor
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assessment based on cervical changes versus time, abnormal labor 3 P's Power, Passenger, Pelvis
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adecuate uterine contractions
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2-3 min lasting 40-60 sec
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in general labor
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Latent <4 cm and active > 4 cm
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Latent Phase <4
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Null <20hrs Multi <14hrs
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Active Phase >4
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Null >1.2 cm/hr Mulit >1.5cm/hr
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Second Stage >10cm
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Null <3hrs Multi<2hrs
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Third Stage
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<20min
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31G2P1 39 weeks complains of painful uterine contractions that are occuring every 3-4 min. Her cervix has changed only from 1cm to 2 cm dilation over 3 hrs. NSM?
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Observe, Normal Latent Phase up to 14 hrs
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26 G2P1 41 weeks pushing for 3 hrs without progress completely dilated, effaced and 0 station with the head in the occiput posterior position.
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3 hrs 2nd stage. Arrest of Decent, Anthropoid Pelvis (ant post diameter greater than transverse diameter with prominent ischial spines and narrow anterior segment)
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31 G2P1 40 weeks, 5 to 6cm dilation over 2 hrs.
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protracted active phase (some progress but less than expected)
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24 G2P1 39 weeks, painful uterine contractions. Complains of dark, vaginal blood mixed with mucus. What is this?
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Bloody Show, loss of cervical mucus plug
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18 G1P0 7 weeks gestation by LMP. 2 days spotting and lower abd pain. Denies sexually transmitted dz. Pelvic exam 4 week size, hCG 700. Transvag reveals empty uterus. NSM?
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follow up hCG 48 hrs, considered ectopic until proven otherwise.
1-trans vag no good hCG<1500. If hCG rises >66% normal intrauterine preg. <66% most likely ectopic. <3.5 cm ectopic pregnancy tx methotrexate finally RhoGAM |
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Risk factore for Ectopic Preg?
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Chlamydial Infections
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32 diagnosed with ectopic pregnancy based on hCG levels that plateaued 1400 and no chorionic filli found on uterine curettage. 5 days later complains of lower abdominal pain. BP and HR normal, abdomen shows guarding and rebound. b
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immediate laparotomy
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18 ER vaginal spotting and lower abdominal pain. Abd and pelvic exam are normal, hCG is 700 and transvag US shows no intrauterine gest sac and no adnexal masses. Diagnosis
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Insufficient information to draw a conclusion
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22 pregnant at 5 weeks severe lower abdominal pain. BP 86/44 and HR 120, tender abdomen, guarding. HCG 500 transvag shows nothing. Free fluid in the cul de sac. NSM?
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Surgery, most likely a ruptured ectopic pregnancy
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placenta accreta, increta and percreta
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attached to myometrium, Incretta- IN the myometrium and Percreta Penetrate Past the myometrium.
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risk factors for placenta accreta
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Down's, Placenta Previa, uterine scars or curettage, low placenta.
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22 nulliparous vaginal discharge and postcoital spotting NSM
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rull out ectopic pregnancy or threatened abortion, do a pregnancy test.
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18 yellowish vaginal discharge. Cervix is erythematous and dicharge reveals numerous leukocytes. Etiology?”
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Chlamydial cervicitis mcc of mucopurulent cervical discharge
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34 vaginitis “fishy odor”. Cervix is normal in apperance. Etiology?
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bacterial vaginosis, gardnerella
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21 sexually transmitted pharyngitis, Etiology?
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Gonococcal Pharyngitis, dx swabbing the throat
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28 multiple painful pustules erupting throughout the skin of her body. Etiology?
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disseminated gonococcal infection, gram stain and culture from pustule
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Maternal cervical infection that causes blindness?
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Both Chlamydia and Gono can cause conjunctivitis and blindness.
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abortion
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<20 weeks
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threatened abortion
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closed cervix, no passage of tissue
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inevitable abortion
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open cervix, no passage of tissue
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incomplete abortion
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open cervix, partial passage of tissue
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competed abortion
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closed cervix, passage of all tissue
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missed abortion
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closed cervix, no passage of tissue, no symptoms, diagnosed on ultrasound D&C or expectant management.
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19 G1P0 18 weeks, prior cervical conization, felt no abdominal cramping. Dilation of 3 cm and effacement of 90%
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Incompetent Cervix
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33 10 weeks gestation, vaginal bleeding, passage of whitish substance along with something meat like. Continues to have cramping. Cervix is 2 cm dialated.
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incomplete abortion, still cramping
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20 G2P1 12 weeks gestation, no problems with pregnancy. No fetal heart tones on Doppler, US reveals embryo 10 weeks, no fetal cardiac activity.
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missed abortion
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28 G3P2 22 weeks getstation, vaginal spotting, fetal heart tones in 140-145.
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antepartum bleeding, >20 weeks
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Hysterectomy, 2 days later compains of flank pain. Right costovertebral angle tenderness. NSM
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IVP or CT, right ureteral obstruction or injury. Cardinal ligament injury is common in hysterectomy.
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Risk factor for endometrial cancer
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DM, HTN, Family, early menarche, late menopause, obesity, chronic anovulation, estrogen secretting tumor, unopposed estrogen
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