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84 Cards in this Set

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