when does the follicular phase occur
day 1-14
what happens during follicular phase
FSH, LH receptors upregulate
ptrogesterone levels low
estrogen is dominant hormone
when does ovulation cocur
14 days prior to menses
why does ovulation occur
estrogen induced LH surge
when is luteal phase
days 15-28
what happens during luteal phase
corpus lutuem develops and protuces progesterone and estrogen
endometrial vascularity and secretory action increase
what is dominant hormone in luteal phase
estrogen
what is menses
sloughing of endometrium due to withdrawal of progesterone and estrogen
average age of onset of premenstrual syndrome
26 years
during which phase do premenstrual symptoms occur
luteal phase
premenstrual syndrome tx
NSAIDs
diuretics
SSRIs
oral contraceptives
when does primary dysmenorhea occur
after menarche
underlying patho of primary dysmenorrhea
endogenous prostaglandins
toxic shock syndrome pathogens
s. aureus
group a strep
toxic shock syndrome presentation
high fever
hypotension
vomiting
diarrhea
rash on hands and feet
muscle aches
first line tx of toxic shock syndrome
clindamycin IV
primary amenorrhea is
absence of menstruation by age 16
primary amenorrhea with breast development but no axillary hair -- what dx
androgen insensitivity
normal secondary sexual characteristics but no period -- what dx
imperforate hymen
vaginal septum
mullerian agenesis
incomplete development of sexual characteristics -- what dx
hypothalamic or pituitary tumor
premature ovarian failure
hypothryoidism
hyperprolactiemia
labs for diagnosis of primary amenorrhea
quant beta hcg
FSH
prolactin
thyroid panel
estrogen, progesterone
women who who previously menstruated with absence of menses for 6 months or longer -- what possible dx
asherman's syndrome
PCOS
MC cause secondary amenorrhea
pregnancy
menopause patho
decrease in ovarian function and estrogen production
increase in gnrh and fsh production
onset of menopause before age 40 is
premature ovarian failure
diagnosis of menopause
FSH > 30
decrased estradiol
how does HRT help
relieves vasomotor sxs
prevents/slows osteoporosis
alleviates atrophy, psych sxs
prevents colorectal cancer
HRT contraindications
increased triglycerides
undiagosed vaginal bleeding
endometrial CA
hx breast CA
estrogen sensitive CA
hx CVD, DVT, PE
leiomyoma
solid, noncancerous mass of uterine wall
leiomyoma presentation
abnormal uterine bleeding, pelvic pressure or pain
MC surgical tx leiomyoma
hysterectomy
endometriosis presentation
dyspareunia
dyschezia
dysmenorrhea
MC symptoms of endometriosis
abnormal bleeding and pelvic pain
endometriosis pain occurs
just before or during menses
most common GYN maliganncy
endometrial cancer
endometrial cancer occurs because
excessive endogenous or exogenous estrogen unopposed by progestin causes increased endometrial lining and histologic changes
endometrial cancer presentation
abnormal bleeding
lower abdominal pain
increased bloating
pelvic heaviness
follicular cysts
thin walled, unilocular lined with granulosa cells
follicular cysts tx
conservative
most resolve in 6-12 weeks
follocular cysts monitoring
monitor with u/s in 6-8 weeks
corpus luteum cyst MC site
right side due to increased luminal pressure from IVC
when does corpus luteum cyst rupture
day 20-26 of cycle
polycystic ovaries look like
string of pearls
struma ovarri tissue
adult thyroid tissue most predominant
endometriomas presentation
pelvic pain
dyspraeunia
infertility
endometriomas histology
endometrial glands
stroma
hemosideren laden macrophages
MC type of ovarian neoplasm
dysgerminoma
tumor marker for ovarian cancers
CA-125
HPV strains responsible for most cervical cancers
HPV 16 and 18
ASCUS on pap -- what is next step
repeat in 6-12 months
HPV testing
colpo
ASCUS HPV negative on pap -- what is next step
repeat pap in 12 months
ASCUS HPV postiive on pap -- what is next step
colpo
ASCUS cannot excluse HSIL on pap -- what is next step
colpo
LSIS on pap -- what is next step
colpo
LSIL if not pregnant or no lesion seen on colpo -- what is next step
ECC sampling
LSIL if colpo unsatisfactory -- what is next step
ECC sampling
LSIL if pregnant -- what is next step
colpo but no bx
if colpo negative, f/u 6 weeks post partum
HSIL -- waht is next step
colpo with ECC or LEEP
trichomonas presentation
copious frothy-grey-white to yellow-green malodorous discharge
dysuria, dyspareunia, post-coital bleeding
trichomonas dx
wet prep shows flagellated protozoa
trichomonas tx
oral metronidazole
gonorrhea presentation
prurulent vaginal discharge
abdominal pain
dyspareunia
gonorrhea dx
gram stain or vaginal cultures or PCR
gonorrhea tx
ceftriaxone
chlamydia presentation
clear vaginal discharge
dysuria, dyspareunia, postcoital bleeidng
lower abdominal pain
chlamydia dx
vaginal cultures or PCR
chlamydia tx
azithromycin 1 dose or doxy BID for 7 days
PID tx
ceftriaxone or cefoxin plus doxy
PID exam
significant cervical tenderness
chancroid pathogen
haemophilus ducreyi
chancroid presentation
painful ulcerative lesions with sharply defined borders
chancroid tx
azithromycin or erytrhomyicn
ceftriaxone
cipro
syphillis pathogen
spirochete trponema pallidium
primary syphilis presetnation
single painless chancre of genetalia
seocndary syphilis presentation
skin rash on palms and soles
mucous membranes lesions
tertiary syphilis prresentation
neurologic sequelae
syphilis dx
RPR or VRDL
confirm with FTA via dark field microscopy
syphilis tx if had for < 1 yr
PCN G one dose
doxy or azithromycin if PCN allergic
syphilis tx for pregnant pt allergic to PCN
desensitize and tx with PCN
vaginal herpes presentation
multiple painful, shallow ulcers
fever, swollen lymph nodes, flu like sxs
vaginal herpes dx
viral culture of ulcer
serum antibody levels HSV 1 or 2 IgG and IgM
condyloma acuminata pathogens
HPV types 6 and 11
condyloma acuminata presetnation
small flesh colored cauliflower like bumps on external genetalia, vaginal mucosa, cervix, anus
candida vaginitis pathogen
fungal species that overgrows at pH of <4.5
candidia vaginitis presetnation
clumpy or cheesy vaginal discharge
pruritis
dysuria
burning
dyspareunia
candidia vaginitis dx
wet prep shows +KOH or vaginal cultures show hyphae
candida vaginitis tx
fluconazole 150mg PO x1
bacterial vaginosis presentation
green or yellow fishy discharge
burning
dysuria
pruritis
bacterial vaginitis dx
wet prep showing epithelial celsl with bacteria coating surface
"clue cells"
+Whiff test
bacterial vaginosis tx
oral or topical metronidazole
uterine prolapse diagnosis
evaluation of bladder emptying and post void residual
cystocele
descent of anterior vaginal wall alongw ith bladder into vaginal canal
cystocele presentation
perceived or discovered bulge into vagina
pelvic pressure
urinary dysfunction
cystocele dx
voiding studies
urodynamic studies
rectocele
dsecent of posterior vaginal wall along with rectum into vaginal canal
rectocele presentation
perceived or discovered bulge into vagina
problem with defecation
low back pain
Mastitis MC pathogen
s. aureus
MC cause of breast abscess
s. aureus
breast abscess diagnosis
breast U/S and mammo in non-lactating women
breast abscess tx
I&D with abx
must continue to express milk
MC breast tumor in adolescent women
fibroadenoma
fibroadenoma presentation
painless, firm, rubbery, solitary well defined mobile or slow growing lumps
fibroadenoma dx
U/S and/or mammogram
breast bx to r/o CA
fiboradenoma tx
most masses are needle bx
excision bx with removal of entire tumor
many are left and monitored
fibrocystic breast disease
painful, swollen, lumpy breasts prior to or during mesnes
cause of fibrocystic breast disease
ovarian hormones
fibrocystic breast dz dx
U/S and/or mammogram
MC breast cancer
ductal carcinoma
gold standard screening for breast cancer
mammo
causes of galactorrhea
excessive breast stimulation
medications
disorders of pituitary gland
galactorrhea dx
prolactin, TSH, beta-hcg
analysis of discharge
u/s and/or mammo
MRI to r/o pituitary tumor
when can you do CVS
between 10-12 weeks
when can you do amniocentesis
15-18 weeks
nagele's rule to determine due date
1st day of LMP + 7 days - 3 months + 1 year
when should initial visit be done for pregnancy
6 weeks after LMP
when should U/S be able to detect fetal heart activity
1-2 weeks after 1st missed cycle
first stage of labor
regular contractions with dilation of cervix until fully dilated
second phase of labor
first stage
latent - 1-3 cm
active - 4-10 cm
second stage of labor
from complete dilation to delivery of fetus
shoulder dystocia maternal complications
hemorrhage
4th degree lacerations
neonatal complications of shoulder dystocia
brachial plexus injury
fracture of clavicle and humerus
outcome for fetus if untreated Rh icompatability
immune hydrops
chronic HTN in pregnancy definition
BP > 140/90 prior to 20 wks gestation
gestational HTN definition
BP > 140/90 after 20 weeks into pregnancy
HTN meds safe in pregnancy
methyldopa
hydralazine
beta blockers
CCBs
preeclampsia presentation
HTN
proteinuria
edema
ecclampsia presentation
preeclampsia + seizure
preeclampsia tx
delivery
seizure prophylaxis for preeclampsia
mag sulfate
how to treat extremely high BP in pregnancy
IV labetalol or hydralazine
when to perform glucose tolerance test
28 weeks
premature rupture of membranes
leak of amniotic fluid at least 1 hour prior to onset of labor
how to dx premature rupture of membranes
nitrazine and fern test
premature rupture of membranes at < 32 weeks tx
tocolysis
metamethasone injections
abx
incompetent cervix presentation
recurrent 2nd trimester miscarraiges
incompetent cervix tx
cervical cerclage at 14-16 weeks
Risk factors for ectopic pregnancy
prior pelvic infection or ectopic pregnancy
ectopic pregnancy presentation
missed menses, bleeidng, pelvic pain
suboptimal rise in beta-hcg
ectopic pregnancy tx
methotrexate, surgical tx
abruptio placenta patho
premature separation of normally implanted placenta from uterine wall
abruptio placenta presentation
painful vaginal bleeding
uterine contractions
fetal distress
abruptio placenta tx
prepare for hemorrahge or preterm delivery
placenta previa patho
implantation of placenta over cervical os
placenta previa presentation
painless vaginal bleedign
placenta previa tx
delivery via c-section
MC cause post partum hemorrhage
uterine atony