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84 Cards in this Set
- Front
- Back
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What are the 3 most common forms of vaginitis
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trichomoniasis, bacterial vaginosis, or candidiasis
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What are Sx's, PE and Dx for Trichomoniasis
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pH>4.5, yellow/green frothy adherrent discharge, vulvar pruritus, dysuria
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What are Sx's, PE and Dx for Bacterial vaginosis
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pH>4.5, thin watery white/grey adherent discharge, fishy-amine odor, itching, clue cells
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What are Sx's, PE and Dx for Candida vulvovaginitis
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equal or <4.5pH, cottage cheese discharge, itching, burning sometimes linear excoriations, buddying or hyphae pseudohyphae with KOH prep
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What is atrophic vaginitis
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post mennapausal women with sx's of vaginal dryness, pale, no rugae; Tx with lubricants or vaginal estrogens
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Identify the principal drugs used in the treatment of urethritis and cystitis in women
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azithromycin or doxycycline
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List the drugs of choice for men with gonococcal urethritis and/or Chlamydia
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cefixime, ceftriaxone, ciprofloxacin
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Describe the syndrome of mucopurulent cervicitis
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predictor of gonorrhea or chlamydia Tx should based on microbs, Sxfriable cervix, discharge @ OS
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Identify the three most common pathogens responsible for cervicitis in the absence of vaginitis
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Neisseria gonorrhoeae, Chlamydia, or herpes virus
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Describe how the presence of mucopurulent cervicitis due to GC or Chlamydia is confirmed clinically by:
a. "swab test" b. Gram stain c. culture |
a.Visible mucopurulent b. Sensitive test for dx of gonococcal urethritis c.90-95% sensitivity for urine and >95% for swab to test for chlamydia and gonorrhea
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Describe how the diagnosis of mucopurulent cervicitis due to HSV could be made
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look @ lesion, viral culture, Direct fluorescent antibody staining, PCR using serum
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Define "PID"—include in your definition:
a.the anatomic sites that can be infected b.the possible organisms responsible c.the STD and possible non-STD routes of infection |
polymicrobial infection of upper genital tract associated with N gon, Chlamydia, anaerobes, H flu, gram-negative rods, streptococci
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Identify the major possible sequelae of PID for women of childbearing years
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recurrent infections, px, ectopic preg, infertility, Dyspareunia
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Name the two major surgical problems that must be considered in your diagnosis of a woman with possible PID
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appendisitis, ectopic preg
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GYN: Including STD's
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GYN: Including STD's
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Describe in general terms an appropriate plan for outpatient management of a patient with PID, including drug choices**, follow-up intervals, partner treatment, etc
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1) ofloxacin, levofloxacin, plus metronidazole, 2) single dose of cefoxitin with probenecid, or ceftriaxone, plus doxycycline,
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Describe the role of darkfield microscopy and serology testing in diagnosing syphilis
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Used to detect fluorescing spirochetes
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Are chancroid, LGV, and granuloma inguinale common or uncommon diseases in the USA
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uncommon
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Define condyloma accuminata
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warty growth with cauliflower kind of look; caused by HPV,
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Define condyloma lata
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Similar to condyloma accuminata but more flat
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What are Sx's for Chlamydia
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inflammed friable cervix, spotting, asymptomatic, clear disharce in men
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How do you Dx, Tx chlamydia
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culture, ABX and all partners
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How is chlamydia transmitted
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unprotected anal, oral or vaginal intercourse
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What are Sx's for gonorrhea
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Discharge, px, burning with urination, asymptomatic
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How do you Dx, Tx gonorrhea
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Culture, ABX with all partners
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How is gonorrhea transmitted
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Unprotected anal, oral or vaginal intercourse
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What are Sx's for Trichomoniasis
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frothy, fishy, vaginal discharge, itchy, px with urination, asymptomatic in men
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How do you Dx, Tx trichomoniasis
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Microscope exam of discharge; ABX, treat partners
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How is trichomoniasis transmitted
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Unprotected anal, oral or vaginal intercourse
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What are Sx's of Human Papilloma Virus HPV
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warts, may lead to cervical CA, many people have it but never has sx's or an outbreak of warts
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How do you Dx, Tx HPV
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Visual inspection or PAP test, remove lesions with laser, LEEP, cryotherapy, acids, medicated creams
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How is HPV transmitted
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direct skin to skin contact - highly transmissible
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What are Sx's of Herpes Simplex I & II (HSV)
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asymptomatic, sores, blisters, itching, burning, tingle, px,
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How do you Dx, Tx HSV
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inspection, culture fluid from sore or blood test. Rx to reduce frequency and length, reduce stress - NO CURE
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How is HSV transmitted
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direct skin to skin; type I usually oral cold sore. type II usually in genital area can be sex transmitted. Oral-genital can transmit I to genitals or II to mouth
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What are Sx's of syphilis (Treponema Pallidum)
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Primary: painless canker or shallow ulcer. Secondary: rash on palms of hands, soles of feet.
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How do you Dx, Tx syphilis
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RPR, darkfield to look for florescent spirocetes. Pen-G
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How is syphilis transmitted
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sexually
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What is molluscum contagiosum
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viral, painless bumps in genital area, has a "white" umbilicated dot.
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How do you Dx, Tx molluscum contagiosum
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Goes away on it's own
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How is molluscum contagiosm transmitted
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Sexually but can also by close contact
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Describe the current screening recommendations for breast cancer detection
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Premenopausal: Perform BSE 7-8 days after menstrual period. 20-40 yo should have breast exam as part of routine medical care every 2-3yrs. >40yo should have annual breast exams
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Give some risk factors for breast cancer
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age, fam hx, menstrual hx (early menses, late menn) BRCA status, previous CA
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Describe the natural history of breast cancer in women less than 49 years of age
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Mutations of p53 (tumor suppressor gene) have been found in 1% of breast Ca in woman <40yo
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Identify and describe the benefits if any of screening mammography in the following populations of women
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>50yo: Part of the yearly exam. 40 -49 years of age: the preferred method in younger females with dense breasts.
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Identify and discuss the limitations of screening mammography
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it is the most reliable way of detecting breast Ca before a mass can be felt
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Recognize the importance of the clinical breast exam along with mammography in breast cancer detection
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BSE has not shown to improve survival; Mammography is the most reliable means of detecting breast cancer
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Describe the role of Pap smear in cervical cancer detection
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Screening of sexually active adolescents & adult woman should be every 1-3yrs. presumptive Dx is made by abnormal pap smear
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Describe the role of colposcopy in cervical cancer detection
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When HPV (+) a colposcopy should be preformed , any abnormal tissues identified by a Schillers test should have biopsies
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Describe the role of biopsy in cervical cancer detection
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ALL visibly abnormal cervical lesions should have biopsies
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Describe the role of pap smear in endometrial cancer detection
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frequently negative (Abnormal bleeding is the presenting sign in 80% of cases)
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Describe the role of office endometrial biopsy in endometrial cancer detection
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Endocervical & Endometrial sampling is only reliable means of Dx. can be done in office with local anesthesia
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Describe the role of transvaginal ultrasound in endometrial cancer detection
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used to determine thickness of endometrium and indication of hypertrophy or neoplastic change
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Recognize the lack of early symptoms and an effective screening test for ovarian cancer, and its subsequent tendency to present at an advanced stage when finally detected
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Sx: Vague GI discomfort, Pelvic pressure, px or asymptomatic Dx: elevated CA125. transvaginal ultrasound. >75% Dx made in advanced stages, after mets. 17% 5yr survival rate
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Recognize the possible association of HPV with vulvar cancer
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Several subtypes of HPV have been identified in some but not all vulvar cancers
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Define the term: dysfunctional uterine bleeding (DUB)
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Abnormal bleeding occurs at irregular intervals. Usually caused by overgrowth of endometrium due to estrogen stimulation without adequate progesterone
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Identify anovulatory uterine bleeding as a common cause of DUB
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caused by too much estrogen caused by anovulation most commonly in teens, late 30’s-40’s, obese women & polycystic ovary syndrome
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Define primary dysmenorrhea
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functional disturbance not inflammation, new growth or anatomic factors. Pathalogical
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Define secondary dysmenorrhea
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inflammation, infection, tumor or anatomic factors. Organic causes. Endometrosis most common cause
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Define endometriosis
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Aberrant growth of endometrium outside the uterus – particularly in dependent parts of pelvis & ovaries. Ectopic occurrence of endometrial tissue frequently forming cysts containing altered blood
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Define premenstrual syndrome
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regular mo experience of physiologic, emotional distress usually during several days prior menses; characterized by nervousness, depression, fluid retention, weight gain
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Describe the treatment of primary dysmenorrhea with NSAIDs or combination oral contraceptives
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NSAIDS generally helpful. Should be started at onset of bleeding and continued on regular basis for 2-3 days
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List or recognize several common causes of secondary dysmenorrhea
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Endometriosis or PID, submucous myoma, IUD use, cervical stenosis with obstruction or blind uterine horm (rare).
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Identify the most common symptoms and physical exam findings of endometriosis
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Pelvic px which may be associated with infertility, dyspareunia or rectal px with bleeding
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Describe the treatment of endometriosis with surgery and/or hormonal methods
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Surgery: effective in reducing px and promoting fertility. Hormonal: effective in amelioration of px but no evidence they increase likelihood of pregnancy
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Describe the range of possible symptoms seen in premenstrual syndrome (PMS).
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B: bloated I: irritable T: tired C: , change libido H: hungry (food cravings)
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Describe current approaches to the evaluation and treatment of PMS
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Good hx, tx is mostly empiric
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Define "menopause”
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Final cessation of menstruation either as normal part of aging or result of surgical removal of both ovaries
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Define "Premature ovarian failure" and discuss the possible causes
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Primary hypogonadism before 40. Caused: autoimmune against ovary, X chromosome mosaicism, surgery, radiation therapy, chemotherapy, partial hysterectomy can lead to it, myotonic dystrophy, galctosemia, mumps, familial, idiopathic
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Recognize the subjective patient complaints that would make you include menopause in your differential diagnosis
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Age, depression, irritability, fatigue, insomnia, HA, diminished libido, rheumatologic symptoms, vasomotor instability like hot flushes, cessation of menstruation, vaginal atrophy, osteoporosis
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Describe the laboratory tests and the data interpretation used to identify/confirm menopause
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Serum PRL, FSH, LG, TSH and plasma potassium
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Discuss Tx options for Menopause
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Tx is hormone replacement therapy HRT, tamoxifen and raloxifene, bone protection for prevention of postmenopausal osteoporosis
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Discuss Tx options for Premature Ovarian Failure
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Usually irreversible and tx with estrogen replacement plus progestin if uterus is present
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Describe the hormonal changes that occur in menopause
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FSH and LH levels are elevated. Vaginal cytologic exam shows low estrogen effect with predominantly parabasal cells indicating lack of epithelial maturation due to hypoestrinism
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What infection am I? Virus, white umbilicated painless bump, goes away on own, sexually transmitted or by close contact
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Molluscum Contagiosum
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What infection am I? Yellow frothy protazoan caused, strawberry or friable cervix, pH normal to > 4.5
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Trichomonal vaginitis
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What infection am I? Red, swollen, itchy, cottage cheese discharge, excoriations, hypae on KOH, <4.5
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Candida albicans - Not yo mama's baking yeast...
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What infection am I? watery thin white/gray discharge, amine-fishy odor, pH>4.5
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Bacterial vaginosis
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What infection am I? friable cervix, discharge at OS, possibly caused by chlamydia
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mucupurulent cervisitis
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What infection am I? Painful fluid filled vesicles, Primary fever, flu like sx, secondary recurrent; I - oral, II - genital
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Herpes Simplex Virus I & II
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What infection am I? friable cervix, spotting, asymptomatic, clear dishcharge in men, COMMON
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Chlamydia
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What infection am I? purulent discharge, urethral discharge, sometimes asymptomatic
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Gonorrhea
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What infection am I? abd px, polymicrobial, may need hospitilization for tx
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PID Pelvic Inflammatory Disease
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What infection am I? Primary: painless canker, Secondary: rash palms hands/feet, effects CNS, RPR dark field Dx
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Syphilis (treponema Pallidum)
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