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86 Cards in this Set
- Front
- Back
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Cervicitis description
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inflammation of the uterine cervix, characteristically diagnosed by: (1) a visible, purulent or mucopurulent endocervical exudate
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Noninfectious Cervicitis c/b
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local trauma (tampon, cervical cap, pessary, diaphragm), radiation, chemical irritation (douches, contraceptive creams), malignancy, systemic inflammation (Behcet syndrome or Silk Road dz = rare immune-mediated small-vessel systemic vasculitis > presents w/ mucous membrane ulceration and ocular problems)
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Infectious Cervicitis c/b
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(1) Chlamydia trachomatis, (2) Neisseria gonorrhoeae, (3) herpes simplex virus (HSV), or (4) human papillomavirus (HPV)
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Cervicitis categorized as lower genital tract infections
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the female genital tract is contiguous from vulva to the fallopian tubes; > vulvovaginitis and cervicitis overlap; both conditions categorized as lower genital tract infections > Infxns involving endometrium and fallopian tubes categorized as upper genital tract infections
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Chlamydia Cervicitis background
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MC cause of mucopurulent cervicitis and MC bacterial STI in women
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Chlamydia Cervicitis Risk Factors
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sex < 20y/o; multiple sex partners
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Chlamydia Cervicitis presentation
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asymptomatic; MUCOPURULENT cervical discharge; CERVICAL MOTION TENDERNESS
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Chlamydia Cervicitis labs
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GOLD STANDARD: Nucleic acid amplification test; direct fluorescent antibody test, Enzyme-linked immunoassay
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Chlamydia Cervicitis Management
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Azithromycin 1 gm single dose or Doxycycline 100mg PO BID x 7 days; PREGNANCY: 1gm x 1 dose AZITHROMYCIN or AMOXICILLIN TID x 7 days NOTE: Tx sexual partners
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Gonorrhea Cervicitis epidemiology
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Gonorrhea is the second most commonly reported infectious disease in the United States; Often co-infection w/ Chlamydia
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Gonorrhea Cervicitis presentation
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asymptomatic; vaginal itching/burning w/ dysuria or rectal discomfort; PURULENT cervical discharge, CERVICAL MOTION TENDERNESS
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Gonorrhea Cervicitis disseminated infection
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#1 cause of septic arthritis in young, sexually active adults > maculopapular lesions on hand/feet, tenosynovitis, endocarditis, meningitis
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Gonorrhea Cervicitis labs/dx
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GOLD STANDARD: Thayer-Martin media culture; GONAZYME (enzyme immunoassay)
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Gonorrhea Cervicitis management
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Tx for both gonorrhea and chlamydia: Cefixime PO single dose or ceftriaxone IM 250 mg single dose; NOTE: severe cephalosporin allergy, azithromycin 2 g PO in a single dose plus > Test-of-cure in 1 week (with culture, including phenotypic antimicrobial susceptibility); NO FLUOROQUINOLONES d/t resistance > tx partners
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Human Papillomavirus (HPV) Cervicitis background
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MC VIRAL STI in ♀; causes genital warts (condylomata acuminata); INCUBATION: 3months or longer
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Human Papillomavirus (HPV) Cervicitis presentation
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cauliflower-like warts on external genitalia, anus, cervix or perineum
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Human Papillomavirus (HPV) Cervicitis subtypes
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MC BENIGN subtypes: 6 & 11; subtypes assoc w/ cervical and penile CANCER: 16, 18, 31, 33
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Human Papillomavirus (HPV) Cervicitis dx
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HPV DNA testing (13 high risk types including 16, 18, 31, 33); direct visualization or PAP
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Human Papillomavirus (HPV) Cervicitis tx
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small lesions: PODOPHYLLIN, Trichloroacetic acid; Imiquimod > LARGE lesions: Cryosurgery, laser ablation, surgical incision
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Human Papillomavirus (HPV) Cervicitis prevention
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GARDASIL vaccine: ♀/♂ age 9-26 (recommended at 11-12 yrs > 3 DOSES: 1st > 2nd dose = 2 mo's later > 3rd dose = 6 mo's after 1st dose; Protects against 6, 11, 16, 18
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Vagina/Vulva
Vaginitis description |
yeast infection
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Vaginitis c/b
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C. albicans; Predisposing factors: use of abx, DM, and ↓cellular immunity
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Vaginitis presentation
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vulvar and vaginal pruritus, burning, dysuria, dyspareunia, and vaginal discharge; PE: vulvar edema and erythema w/ thick white vaginal discharge
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Vaginitis dx
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branching hyphae and spores on KOH prep > Gram Stain & culture also used in dx
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Vaginitis tx
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azole creams via topical application; or oral fluconazole
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Bacterial vaginosis description
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aka: nonspecific vaginitis, was named because bacteria are the cause and an associated inflammatory response is lacking
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Bacterial vaginosis c/b
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Gardnerella vaginalis, Lactobacillus, Prevotella, and anaerobes: Bacteroides, Eubacterium
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Bacterial vaginosis presentation
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Vaginal odor is the most common sx; recognized after sexual intercourse & menses (d/t alkalinity of semen > causes a release of volatile amines from vaginal discharge > cause a fishy odor), ↑ mild to moderate vaginal discharge, Lack of significant vulvovaginal inflammation
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Bacterial vaginosis Risk Factors
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Recent antibiotic use, ↓estrogen production of the host, (IUD), Douching
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Bacterial vaginosis PE
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thin, gray, and homogeneous
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Bacterial vaginosis dx labs
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CLUE CELLS on a saline smear; WHIFF TEST (+) 70% (mixing vaginal fluid with a drop of KOH on a microscope slide or speculum after the vaginal examination)
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Bacterial vaginosis tx
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Asymptomatic = do not need treatment; SYMPTOMATIC = Clindamycin: cream intervaginally x 7 d; Metronidazole (Flagyl) 500 mg BID or 750 q D PO x 7d or metronidazole gel intervaginally x 5 d
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Trichomonas vaginalis description
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sexually transmitted infection (STI) caused by the motile parasitic protozoan Trichomonas vaginalis
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Trichomonas vaginalis Risk Factors
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Sexual activity
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Trichomonas vaginalis complications
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associated with adverse pregnancy outcomes, infertility, postoperative infections, and cervical neoplasia and increases the risk of HIV transmission in both men and women
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Trichomonas vaginalis presentation
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women: asymptomatic or frothy yellow-green vaginal discharge and vulvar irritation, MEN: nongonococcal urethritis but are frequently asymptomatic
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Trichomonas vaginalis dx
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Microscopy: Motile flagellated protozoa
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Trichomonas vaginalis tx/Rx
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NOTE: TOC: Oral metronidazole (Flagyl) 2 g po x 1 dose; or Tinidazole 2 g x 1; first-line agent ineffective > HIGH doses of metronidazole; NOTE: Topical metronidazole: NOT efficacious>do NOT use; WARNING: metronidazole (Flagyl) > AVOID ETOH and sun exposure
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Trichomonas vaginalis tx/management
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Treatment started immediately and tx all sexual partners > Both patient and partner should abstain from sex until pharmacological treatment has been completed and they have NO SYMPTOMS
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Cystocele description
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decent of a portion of the posterior bladder well and trigone into the vagina d/t trauma of parturition
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Cystocele presentation
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small = asymptomatic; large = vaginal pressure or protruding mass; sx aggravated w/ prolonged standing, coughing or straining; urinary incontinence
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Cystocele Dx
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clinical by PE: relaxed vaginal outlet w/ thin-walled, smooth bulging mass involving the anterior vaginal wall; w/ straining the mass may project through the vaginal introitus
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Cystocele tx
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PREVENTION: Kegel exercises; vaginal pessary, Kegel exercises and estrogens> Surgery seldom indicated unless large = colporrhaphy
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Vaginal Neoplasm description
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Primary vaginal cancers are defined as arising solely from the vagina, with no involvement of the external cervical os proximally or the vulva distally
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Primary Vaginal Neoplasm c/b
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MC= epithelial; NOTE: ↑risk of clear cell adenocarcinoma of the vagina w/ exposure to DES
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Vaginal Neoplasm peak onset
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women in 50's
Vaginal Neoplasm presentation - asymptomatic > vaginal discharge, bleeding and vaginal pruritus |
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Vaginal Neoplasm dx
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Screening by colposcopy and confirmed by biopsy
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Vaginal Neoplasm tx
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Surgical resection and radiation; 5yr survival: varies on staging
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Rectocele description + c/b
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herniation of the rectum into the vaginal vault d/t injury of the endopelvic fascia of the rectovaginal septum
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Rectocele presentation
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small = asymptomatic; LARGE = vaginal pressure, rectal fullness & incomplete evacuation; PE: soft, thin-walled rectovaginal septum projecting into the vagina
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Rectocele dx
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clinical based on H&P
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Rectocele tx
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fluids & laxatives; surgical intervention = posterior colpoperineorrhaphy
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Mastitis description
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Postpartum mastitis is a localized cellulitis caused by bacterial invasion through an irritated or fissured nipple;
occurs after the second postpartum week and may be precipitated by milk stasis |
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Mastitis c/b
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mc: Staphylococcus aureus; but Staphylococcus epidermidis and streptococci are occasionally isolated
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Mastitis sx
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unilateral erythema, edema, tenderness; usually on 1 quadrant of breast affected, fever & chills
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Mastitis mgmt
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1st line: Dicloxacillin or erythromycin > ALTERNATE: clindamycin > continue feeding on affected side
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Breast Abscess
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progression from mastitis
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Breast Abscess sx
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same as mastitis w/ addition of: localized mass + systemic signs of infxn
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Breast Abscess management
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I&D; Nafcillin/oxacillin IV or cefazolin plus metronidazole; ALTERNATE: Vancomycin, stop breast feeding on affected side
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Fibrocystic Breast dz description
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mc benign CONDITION of the breast
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Fibrocystic Breast dz onset
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20-50 y/o
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Fibrocystic Breast dz sx
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PAINFUL cyclic BILATERAL breast pain (usually premenstrual); size of cysts FLUCTUATE during the menstrual cycle
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Fibrocystic Breast dz PE
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bilateral cysts that vary in size
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Fibrocystic Breast dz dx
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Sonogram shows fluid filled cysts
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Fibrocystic Breast dz management
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REDUCE CAFFEINE INTAKE, ↑ ORAL VITAMIN E; oral contraceptives, SEVERE symptoms: BROMOCRIPTINE, TAMOXIFEN (not common)
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Breast fibroadenoma description
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benign breast tumors composed of stromal and epithelial elements commonly seen in young women. Multiple or complex fibroadenomas may indicate a slightly increased risk for breast cancer
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Breast fibroadenoma sx
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PAINLESS UNILATERAL lump
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Breast fibroadenoma PE
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mobile, firm, smooth, rubbery lump
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Breast fibroadenoma dx
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US, smooth, uniform, solid breast mass; FINE-NEEDLE ASPIRATION shows solid vs fluid
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Breast fibroadenoma tx
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SMALL = clinical observation; LARGE: surgically removed
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Breast CA description
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MC cancer in women/ 2nd MC cause of cancer DEATH (lung CA #1)
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Breast CA c/b
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prolonged unopposed estrogen, early menarche, late menopause, late first pregnancy, nulliparity, over 40 y/o, hyperplasia w/ fibrocystic dz, high fat diet, obesity
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Breast CA risk factors:
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BRAC1 and 2 (40 -80% risk of Breast CA); UNOPPOSED estrogen: early menarche, late menopause, late first pregnancy, nulliparity, > 40y/o
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Breast CA sx
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MC= upper outer quadrant (70%), PAINLESS lump, nipple discharge, erosion, itching of the nipple, bldy/clr fluid discharge from nipple, skin dimpling, change in skin color or texture; pulling in of the nipple
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Breast CA dx
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90% found by pt; US > differentiates solid from cystic; MAMMOGRAM=mc screening for non-palpable mass; fine needle aspiration-bldy fluid more likely cancer than clr fluid; open bx = definitive dx for breast dz
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MAMMOGRAM screening AVERAGE risk:
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start 40y/o > Ages 40-49 = repeat every 1-2 yrs; AGE 50: repeat every year
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MAMMOGRAM screening for Breast CA with GENETIC Risk Factors
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START 25-35 y/o; consider MRI
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Breast CA Tumor types
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(1)INFILTRATING DUCTAL (invasive ductal)MC 80%: PAINLESS stony hard unilateral mass, begins as ductal CA in situ;(2) INFILTRATING LOBAR (10%) frequently BILATERAL; (3) INFLAMMATORY (2%) (peau d'orange) = poor prognosis; (4) PAGET'S DZ (1%)= PRURITIC, SCALY RASH ON NIPPLE
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Breast CA Tumor symptoms
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painless mass, MC in upper outer quadrant, nipple discharge, erosion, itching of the nipple
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Breast CA diagnosis
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90% found by pt, (1) US: differentiates solid from cyst, (2) Mammogram: MC screening for non-palpable mass, (3) fine needle aspiration: bloody fluid more likely cancer vs clear fluid, (4) DEFINITIVE dx: open biopsy
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Breast CA surgery
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(1) lumpectomy w/ sentinel lymph node bx: indicated for small tumors, unilateral (2) modified radical mastectomy: indicated for bilateral or large tumors
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Breast CA ONCOTYPE Dx test
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used to determine need for chemo in Stage I and II hormone receptor + cancer; LOOKS AT 21 GENES in tumor to determine likelihood of metastasis; Low likelihood of mets: < 20; High likelihood of mets: > 20
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Breast CA management RADIATION
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ALWAYS after lumpectomy, can be used before or after surgery in advanced dz
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Breast CA management CHEMOTHERAPY
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non-estrogen sensitive receptor tumors and most pt w/ hormone tx, single agent-node-negative CA < 1 cm; Multiple agents-node metastases or primary CA larger than 1 cm
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Breast CA management Hormone therapy indication
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ALWAYS use for estrogen or progesterone positive receptor tumors;
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Breast CA management Hormone therapy
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TAMOXIFEN: used after chemo and/or during radiation; hormone tx for METASTATIC cancer; ZOLEDRONIC Acid (Zometa-a bisphonate) given to ↓ reoccurrence of endocrine responsive breast CA
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