Gyn: Gyn Infections

Front 1

what bacteria maintains acidic environment?

Back 1

lactic acid producing lactobacilli

Front 2

T or F
change in vaginal envir by meds, sex, illness can lead to overgrowth of other bacteria & infection (vaginitis)

Back 2

T

Front 3

T or F
vaginitis can be cz by bacteria, fungal or protozoal (list examples)

Back 3

T
bacterial: polybacterial, Gardnerella
fungal: Candida
protozoa: Trichomonas

Front 4

Vaginitis (bacterial, Trich, Candida) may present with sx;

Back 4

inc vaginal d/c*
vulvovaginal pruritus*, w/ w/o burning sensation or odor

Front 5

DDx

Back 5

UTI, STD, normal phy secretion, malig (d/c w/ cervical ca)

Front 6

which vaginitis infection inc risk of PID

Back 6

bacterial vaginosis

Front 7

if vaginitis occurs during preg, what does it inc the risk of?

Back 7

preterm labor or
preterm rupture of memb

Front 8

Trich main sx

Back 8

profuse, smelly yellow-green FROTHY discharge

Front 9

Yeast main sx

Back 9

pruritus
(so PE shows excoriated, erythema vulva)

Front 10

BV d/c

Back 10

homogenous, gray-wh fishy odor (whiff test on KOH)

Front 11

if test pt's vaginal pH w/ nitrazine paper, which cz of vaginitis will show up basic

Back 11

BV, Trich >4.5

Front 12

What do you see on saline for BV, Trich, Yeast?

Back 12

1. BV: Clue cells (epi cells coat w/ bacteria)
2. Trich: motile trichomonads
3. Yeast: nothing!

Front 13

What do you see on KOH for BV, Trich, Yeast?

Back 13

1. BV--whiff test (fishy)
2. Trich--nothing
3. YEAST! PSEUDOHYPHAE

Front 14

how tx bv, trich, yeast

Back 14

1. bv: metro
2. tri: metro, std! tx partner
3. yeast: topical antifungal or po fluconazole

Front 15

while you worry about vaginitis (bv, trich, yeast), also need to test for which 2 organisms in cervicitis?

Back 15

Neisseria gonorrhoeae
Chlamydia trachomatis

Front 16

most common bacterial STD in US

Back 16

chylamydia trachomatis

Front 17

if tx for chylamydia trachomatis, also tx for what std?

Back 17

neisseria gonorrhoeae

Front 18

chylamydia often asx, but if sx, what?

Back 18

urethritis (dysuria, freq)
mucopurulent cervicitis (vag d/c, bl, dysparenunia)
salpingitis
PID (abd pain, fever)

Front 19

how tx chylamdia

Back 19

doxycycline*
or azithromycin
if preg: erythromycin

Front 20

Sx of gonorrhea for men and women

Back 20

women: green-yellow d/c, pain in pelvis/adnexa
men: purulent urethral dc

Front 21

PID is a variety of acute, subacute, chronic infections of the ascending genital tract, incl...(5)

Back 21

endometrium (endometritis)*
uterine wall (myometritis)*
oviducts (salpingitis)*
ovary (oophoritis)*
parietal peritoneum (peritonitis)*

Front 22

RF for PID

Back 22

early sex
mult partner
unprotected or freq intercourse
mucopurulent cervicitis (chy)
prior PID
IUD use

Front 23

what 2 lowers risk of PID

Back 23

OCP, barrier contraceptive

Front 24

Sx of PID

Back 24

1-3d lower abd pain* w/ w/o f/n/v
hx of recent menses
abn cervical or vaginal dc

Front 25

PE of PID

Back 25

Tenderness: uni or bi lower abd, uterine, adnex, cervical
+/or
purulent cervical discharge

Front 26

DDx of PID

Back 26

appy, diverticulitis, UTI/pyelo, ulcer colitis, regional ileitis
ectopic, endometriosis, adnexal torsion, ovarian tumor or hemorrhagic cyst

Front 27

Dx of PID

Back 27

lower abd pain, adnexal, AND cervical motion tenderness**

Front 28

supportive but not dx of PID

Back 28

f >38C
inc ESR, CRP
WBC >10
+G,C
U/S: pelvic abscess

Front 29

Definitive dx, use what tool, and what will you see?

Back 29

laparoscopy
pus in peritoneal cavity

Front 30

what do you always check in women with abd pains?

Back 30

b-hCG for preg

Front 31

If PID, also run what other bl tests?

Back 31

VDRL/RPR, HIV, LFT (fitz-hugh-curtis)

Front 32

Tx of PID should target common pathogens ie gon, chy, anaerobes

Back 32

INPT IV ABX: cefoxitin (or cefotetan) AND doxy, OR clinda and gent until pt asx for 48hrs; follow doxy po 14d

OUTPT ABX: ceftriaxone+doxy OR ofloxacin+clinda/metro 14d

Front 33

Situations where hospitalize pt:

Back 33

1. pelvic/tubo-ovarian abscess (TOA)
2. peritonitis
3. non-compliance
4. n/emesis prev PO meds
5. hi f
6. hi wbc
7. teenage
8. nulliparous
9. pts not improve after 48-72 hr of outpt tx

Front 34

when to suspect pt w/ TOA

Back 34

sev pain
hi f
n/v
signs of sepsis
peritoneal signs
adnexal mass

Front 35

tx of toa

Back 35

hospitalize for IV abx, hydration (n/v), possible surgery (drain/tahbso)

Front 36

complications of PID

Back 36

toa*, ectopic*, infertility*, chronic pelvic pain, fitz-hugh-curtis (5-10%)

Front 37

Toxic Shock Syndrome cz by what toxin (not organism)

Back 37

preformed Staph Aureus toxin (TSST-1)

Front 38

Sx of TSS

Back 38

*f, *diffuse sun-burn rash
diarrhea, vomit, sore throat, HA, myalgia
could rapid progress to HYPOTENSIVE SHOCK
DESQUAMATION-PALMS, SOLES 1-2WKS

Front 39

Tx of Toxic shock syndrome

Back 39

hospitalize, fluids, pressors, transfusion, ventilation prn
IV anti-staph abx (nafcillin, oxacillin)
steriods dec sx severity