Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
36 Cards in this Set
- Front
- Back
|
How often do you screen 21-30 year olds?
|
Pelvic exam annually
Pap q 2 years Decreased rate of pap smears because invasive cervical cancer is rare under 21, the immune system clears most HPV infections, lost of sequellae |
|
|
Why do you collect pap smear sample form transformation zone?
|
T-zone is the junction where columnar epithelium transforms into squamous epithelium. It is sensitive to microtrauma and HPV infection. As a women ages, this area regresses into the endocervix canal and is less visible and more protected.
|
|
|
What do you do with an abnormal pap ASC-US result?
|
Ideally, reflexive HPV testing. If +, colposcopy. If - repeat pap q 6 months for 1 year until 2 consecutive normal results. If increases, coloposcopy.
In adolescents, repeat pap in 12 months. If increased from previous, colposcopy. If not, repeat again in another 12 months. HPV is not indicated. In postmenopausal, LSIL or less - colposcopy, HPV testing, repeat pap smear at 6 and 12 months. |
|
|
What do you do with any other abnormal pap result? LSIL, CIN1, HSIL, Cancer?
|
Work up including CBC and Metabolic panel and CA125 (affected by hormonal changes caused by releasing of hormones by GYN cancer – not symptomatic and want a colposcopy. If positive then follow with CT abdominal scan
|
|
|
What do you do after a Colposcopy?
|
If CIN1 with ASC-US, ASC-H or LSIL - HPV at 12 months or a pap at 6 and 12
If CIN1 with high grade cytology - pap smear and colposcopy q6 for 1 year, re-review results, cone biopsy or LEEP If CIN2 or 3 - cone biopsy, LEEP, laser or freezing procedure |
|
|
What labs do you order with Amenorrhea?
|
hCG, TSH, prolactin, chem panel, FSH (checks menopause)
prolactin > 30 and FSH > 40 significant |
|
|
What is the significance of the progestin challenge in amenorrhea?
|
Provera 10 mg/day for 5 days
- bleeding the week after the final dose indicates anovulation, so has sufficient estrogen by hypothalamic-pituitary axis or ovary problem - no bleeding - estrogen deficiency or outflow problem |
|
|
What finding supports the clinical diagnosis of PCO?
|
LH/FSH ratio above 2:1
|
|
|
What is the management for Amenorrhea?
|
Correct underlying etiology.
Chronic anovulation should be managed by periodic progestin withdrawal or OCPs If desires pregnancy - induction of ovulation with clomiphene citrate or injectable gonadotropins May need endometrial biopsy to rule out significant hyperplasia or carcinoma of the endometrium |
|
|
When can hCG be detected?
|
7 to 10 days after conception
At home pregnancy tests - false negatives not false positives Only need serum or urine if done by trained technician/clinician |
|
|
What is the noraml vaginal pH
|
3.8 to 4.2
lactic acid helps to maintain a normal vaginal pH. Lactobacilli produce H2O2 that is a potent microbicide. |
|
|
Vaginitis
|
Discharge, vulvar itching, irritation, odor, patient history, visual inspection, wet mount KOH and NaCl, Whiff test, pH
|
|
|
How does BV compare to yeast and Trich?
|
BV - odor discharge itch, homogenous adherent, thin, milky white, malodorous "foul fishy", pH >4.5, positive KOH whiff test, clue cells with no/few WBCs on NaCl wet mount
Candidiasis - itch, discomfort, dysuria, thick dischage, thick clumpy white cottage cheese, inflammation and erythema, pH <4.5, negative whiff test, few WBCs on NaCl wet mouth and spores visible on KOH wet mount Trich - itch, discharge, frothy, gray or yellow-green, malodorous, cervical petechiae, pH >4.5, positive whiff test, motile flagellated protozoa and WBCs on NaCl wet mount |
|
|
What is the Amsel Criteria?
|
For the diagnosis of BV.
Must have 3 of the following - pH >4.5, presence of "clue cells", positive whiff test, homogenous, non-viscous, milky-white discharge adherent to vaginal walls |
|
|
How do you treat BV?
|
Metronidazole 500 mg bid for 7 days
Metronidazole gel daily for 5 days Clinamycin cream daily for 7 days For multiple recurrences - twice weekly metronidazole gel for 6 months In pregnant women - oral regimens only |
|
|
How do you treat yeast infection?
|
Many options - usually fluconazole 150 mg oral tablet, 1 dose
For recurrent (4> per year) - 7-14 days of topical therapy or 100 mg, 150 mg, or 200 mg oral dose of fluconazole repeated 3 days later For non-albicans - 7-14 of non-fluconazole treatment, 600 mg boric acid in gelatin capsule vaginally once a day for 14 days For pregnant women -- fluconzaole is contraindicated, 7 day topical agents are recommended |
|
|
How do you treat Trich?
|
Treat sex partners
Metronidazole 2 g orally in single dose OR tinidazole 2 g orally in a single dose OR metronidazole 500 mg twice a day for 7 days |
|
|
What is PID?
|
A clinical syndrome associated with ascending spread of microorganisms from the vagina or cervix to the endometrium, fallopian tubes, ovaries, and contiguous structures.
One or more of the following - uterine tenderness, adnexal tenderness or cervical motion tenderness Additional criteria - temp, mucopurulent discharge, presence of abundant WBCs, elevated sed rate or C-reactive protein, gonorrhea or chlamydia |
|
|
What is the treatment for PID?
|
Hospitalization if: inability to exclude surgical emergency (peritonitis), pregnancy, non-responsive to oral therapy, inability to tolerate an outpatient oral regimen, severe illness - nausea, vomiting, high fever or tubo-ovarian abscess, HIV infection
Oral regimen - ceftriaxone 250 IM in a single dose, doxy 100 mg orally bid for 14 days, metronidazole 500 mg bid for 14 days Follow-up - patient should demonstrate substantial improvement within 72 hours, consider re-screening for CT and GC 4-6 weeks after tx Partners should be examined and treated if they had sexual contact with the patient during the 60 days preceding the onset of symptoms. tx with regimens against both |
|
|
When should you screen for chlamydia?
|
annually for sexually active women 25 and under and sexually active women over 25 at high-risk
screen pregnant women in 1st trimester |
|
|
What is the treatment for dysmenorrhea?
|
NSAIDS - start 24 hours before onset of menses and take continuously
if after 3 months no improvement - oral contraceptives or depo-provera, try 3 cycles and add NSAIDS If no improvement refer |
|
|
What do you do if there is a severe, unilateral pain?
|
REFER TO ED for workup - torsion or ectopic pregnancy
|
|
|
What are the symptoms of an ovarian cyst?
|
dyspareunia
constipation micturition irregular menses precocious puberty abdominal fullness indigestion, heartburn, or early satiety |
|
|
How do you manage a potential ovarian cyst?
|
CA125
transvaginal US transabdominal US MRI or CT if US indeterminate Aspiration prn Asymptomatic simple cysts 10 cm or less with a CA125 less than 35 may be managed with close follow-up |
|
|
What do you look for during a clinical breast examination?
|
Asymmetry
Skin changes - look for dimpling, edema, ulcerations, erythema, or eczematous appearance such as scaly, thickened, raw-appearing skin Nipples - assess for symmetry, inversion or retraction, nipple discharge or crusting Best if done 1 week after menses |
|
|
What is the difference between cyclic and non-cyclic mastalgia?
|
cyclic - bilateral, poorly localized, "dull, tenderness, fullness", timed premenstrual, resolved upon onset of menses, onset usually 3rd or 4th decade
non-cyclic - unilateral, more localized, "sharp or burning", not typically relieved by menses, possible association with stress or anxiety |
|
|
What is mastalgia treatment?
|
caffeine restriction and vit E - no evidence, might help individually
Phytotherapies!! - evening primrose oil - 3 gm daily divided bid may take 6 mos to see response - agnus castus - inhibits the release of excess prolactin OCPS NSAIDs Endocrine treatment! - for severe - tamoxifen 10 mg for 3-4 months - danazol - synthetic testosterone - bromocriptine - dopaminergic agonist |
|
|
What is fibrocystic breast condition
|
tender, lumpy breasts - variant of mastalgia but with lumps
usually between 30-50 may be associated with cyclic accumulation of fluid and cell debris over years appears that estrogen is contributory indistinguishable from carcinoma, multiple and bilateral breast masses, may fluctuate with menstrual cycle reassess after menses, if mass persists - follow breast mass recommendations and treat pain with mastalgia recommendations |
|
|
What is the deal with fibroadenomas?
|
rubbery, non-tender, mobile mass
1 cm to 5 cm typically UOQ treatment - monitoring with mammogram and us sometimes requires excision |
|
|
What are possible etiologies of mastitis?
|
superfiical abscess, mammary ducts associated inflammatory diseases
antibiotics should a lot of etiologies for at least 10-14 dys -cilins, clindamycin, erthromycin, vanco, bactrim - no sulfa for nursing babies |
|
|
When does a breast abscess require excision
|
if non-lactating - also must r/o inflammatory carcinoma
if lactating usually caused by staph |
|
|
What are possible etiologies of nipple discharge?
|
hyperprolactinemia due to drugs, hypothyroidism, chronic renal disease or pituitary tumor - galactorrhea, bilateral
ductal extasia & fibrocystic change - multiductal, provoked, bloody or non-bloody, bilateral - green, yellow or brown intraductal papilloma, ductal carcinoma in situ, paget's disease - uniductal, bloody or occult blood, provoked or sponaneous |
|
|
What is the nipple discharge evaluation?
|
TSH, prolactin, pregnancy test
breast imaging hemocult cytology refer to surgeon |
|
|
Breast Mass evaluation
|
Breast exam - classic characteristics of cancer - single lesion, hard, immobile or fixed, irregular borders
If positive breast exam - fine needle aspiration and/or US & mammo US first line for women <30 or if pregnant TRIPLE TEST - breast exam, imaging mammo w/ or w/o US, tissue sampling (FNA, core biopsy) If all neg considered benign (90% are) If equivocal - excisional biopsy |
|
|
How do you screen for breast cancer?
|
women 40+ should have a mammo every year
women in 20s and 30s should have a breast exam every 3 years, after 40 a breast exam every year breast self-exam in 20s |
|
|
How do you screen for breast cancer with a family history?
|
Breast imaging screening (MRI and mammo) should begin 5 years before the age the relative developed the disease or at age 40 whichever is lower
multiple relatives w/ bCa - screening is recommended to begin 10 years before the youngest relative was diagnosed. |
