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What is the classic triad of symptoms for ectopic pregnancy?
Abdominal pain, light vaginal bleeding, amenorrhea
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What are the risk factors for ectopic pregnancy?
PID, Tubal surgeries, IUD, Fertilization
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What are the diagnostic tests for ectopic pregnancy?
- serum quantitative B-hCG
- transvaginal ultrasound
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What are the classifications of spontaneous abortions?
- Complete-all products expelled
- Incomplete-some products remain
- Threatened-Bleeding, cervix closed
- Inevitable-bleeding, cervix dilated
- Missed-fetal death <20 weeks
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What is the most common first trimester complication?
- Spontaneous abortion - no tx necessary
- will require D and E
- must always check mother's blood type
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What is placenta previa?
- Abnormal location of placenta over or in close proximity to the internal cervical os
- PAINLESS until labor
- bleeding is usually maternal in origin
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What are risk factors of placenta previa?
- Previous placenta previa
- Multiparas
- 4+ cesarean sections
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What is placental abruptio?
Premature separation of the implanted placenta from the uterine wall
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What is placental abruptio associated with?
- Maternal HTN
- Hydramnios(excessive amniotic fluid)
- After multiple deliveries
- cocaine use
- trauma
- smoking
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What are signs of placental abruptio?
- PAINFUL vaginal bleeding
- enlarged abdomen
- painful uterus
- fetal distress, HR<100 bpm
- Petechiae
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What is Pre-eclampsia?
- Elevated blood pressure 140/90 or higher
- 20mmHg rise in systolic/10mmHg in diastolic
- Proteinuria
- edema
- headache, visual disturbance, abdominal pain
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What is the work-up of pre-eclampsia?
- UA
- Coagulation studies
- CBC
- Renal and liver function tests
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What is Eclampsia?
Rise in blood pressure just as Pre-eclampsia but with the presense of SEIZURE
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How do you treat eclampsia?
- Hydralazine which preserves uterine blood flow
- Only cure is delivery of baby
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What is PROM?
- Premature Rupture of Membrane
- Leaking of amniotic fluid prior to 37 weeks gestation
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How do you confirm PROM?
- Nitrazine paper - detects pH
- normal vaginal secretions 4.5-5.5
- amniotic fluid is 7.0-7.4
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What are risk factors for pre-term labor?
PROM, placental abruptio, multiple gestation, infection, incompetant cervix, drug abuse
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What are signs and symptoms of pre-term labor?
- Mentrual like cramps
- low-dull backache
- abdominal pressure
- pelvic pressure
- increase in change in vaginal discharge
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What are risk factors of PID?
- STD
- PID
- high # of sex partners
- inconsistent or no use of condoms
- prostitutes
- sex at an early age
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What are signs of PID?
- Bilateral abdominal pain
- vaginal discharge
- low back pain
- irregular vaginal bleeding
- fever, N/V
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What does PID show on exam?
- Lower abdominal is usually non-tender
- Mucupurulent vaginal discharge
- cervial motion tenderness
- uterine tenderness
- adnexal tenderness
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What does the PID workup include?
- Pregnancy test
- Urinanalysis
- GC and Chlamydia test
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Explain the presentation of a ruptured ovarian cyst
- dull, aching or severe, sudden, sharp pain
- lower abdomen, pelvis, vagina, lower back or things
- Constant or intermittent
- Fullness, heaviness, pressure, swelling or bloating in the ab
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What are signs and symptoms of Ruptured ovarian cyst?
- Greatly mimic PID
- bilateral abdominal pain
- vaginal discharge
- low back pain
- irregular vaginal bleeding
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What are the token symptom of a tubo-ovarian abscess?
Symptoms will mimic ovarian cyst but FEVER will be present
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What is Ovarian torsion?
- sx mimic ovarian cyst
- tenderness with rebound and guarding
- shown on US or doppler
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What is dysfunctional uterine bleeding?
- Uterine bleeding that occurs outside the normal menstrual cycle
- 21-45 days cycle
- 1-7 days of bleeding
- determining blood loss can be difficult
- need to get H and H
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Describe Bacterial vulvovaginitis
- "fishy oder"
- + whiff test
- "clue cells" on wet prep
- thin gray-white to yellow discharge
- -preterm labor, PROM
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Describe Trichomonas
- vaginal erythema, frothy malodorous discharge
- wet prep diagnosis
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Explain Candida
- thick "cottage cheese" discharge
- causes severe pruritis, dysuria, dyspareunia
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What is Dysmenorrhea?
- Painful menstuation
- may be primary or secondary
- treat symptoms
- refer to GYN
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What is mittelschmerz?
- Painful ovulation
- vague aching pain 2 weeks before menses
- typically unilateral pain, mild to moderate
- occurs days 14-16
- no tx other than prego test
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What is endometriosis?
- Prescense of endometrial tissue outside of the uterine cavity
- severe dysmenorrhea
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What are sx of endometriosis?
- Dysparunia
- Dysmenorrhea
- chronic pelvic pain
- abnormal uterine bleeding
- infertility
- pelvic mass
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Explain post menopausal bleeding and what it could indicate
- Uterine Cancer
- endometrium should be evaluated via endometrial biopsy or US if unable to obtain biopsy
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