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28 Cards in this Set
- Front
- Back
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155. Vaginitis?
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a. A spectrum of conditions that cause vulvovaginal symptoms such as itching, burning, irritation, and abnormal discharge.
b. Most common causes are: 1. Bacterial vaginosis 2. Vulvovaginal candidiasis 3. Trichomoniasis |
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156. 2 types of normal vaginal discharge?
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a. Mid cycle estrogen surge: clear, elastic, mucoid secretions
b. Luteal phase/pregnancy: thick and white secretions; adhere to the vaginal wall |
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157. Presentation of bacterial vaginosis?
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a. Odor, ↑ Discharge
b. Mild Vulvar irritation c. Grey-White Homogenous discharge with Fishy/stale odor!!!! |
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158. Diagnosis of bacterial vaginosis?
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a. Clue cells “multi-nucleated epithelial cells coated with bacteria
b. Shift in vaginal flora (↑ cocci, ↓ lactobacilli). c. KOH prep: + Whiff test (fishy smell) |
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159. 2 treatment options for bacterial vaginosis?
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a. PO or vaginal metronidazole or clindamycin
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160. Presentation of Trichomonas vaginitis?
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a. ↑ Discharge
b. Pruritus c. Dysuria d. Strawberry petechiae the upper vagina/cervix (rare) e. Profuse, malodorous, yellow-green frothy discharge |
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161. Trichomonas on Wet Mount?
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a. Motile trichomonads (flagellated organisms that are slightly larger than WBCs)
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162. Treatment of Trichomonas?
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a. Single-dose PO metronidazole or Tinidazole
b. Treat partners; test for other STDs |
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163. Risk factors for candidal vaginitis?
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a. DM
b. Broad-spectrum antibiotic use c. Pregnancy d. Steroids e. HIV, OCP use, IUD use, young age at 1st intercourse, ↑ Frequency of intercourse. |
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164. Presentation of Candida vaginitis?
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a. Pruritus, dysuria, burning
b. Thick, white, curdy discharge without odor. c. KOH prep: Hyphae |
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165. Treatment of Candida vaginitis?
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a. PO fluconazole or topical azole.
b. Oral azoles should be avoided in pregnancy!!!! |
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166. Criteria for clinical diagnosis of bacterial vaginosis?
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a. 3 of 4 are required
1. Abnormal whitish-grey discharge 2. Vaginal pH >4.5 3. Positive amine “whiff” test 4. Clue cells comprise >20% of epithelial cells on wet Mount . |
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167. Cervicitis?
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167. Cervicitis?
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168. Most common causes of cervicitis?
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a. Infectious is most common:
1. Chlamydia 2. Gonorrhea 3. Trichomonas 4. HSV 5. HPV b. Non-infectious: Trauma, radiation, malignancy |
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169. Presentation of cervicitis (Hx/PE)?
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a. Yellow-green mucopurulent discharge
b. (+) Cervical motion tenderness!!! c. Absence of other signs of PID!!! |
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170. PID?
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a. A polymicrobial infection of the upper genital tract that is associated with:
i. Neisseria gonorrhea (1/3 of cases) ii. Chlamydia trachomatis (1/3 of cases) iii. Endogenous Aerobe/anaerobes |
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171. Do IUDs↑ the risk of PID?
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a. NOOO. IUDs do not ↑ the risk of PID.
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172. Presentation of PID?
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a. Lower abdominal pain
b. Fever!!! c. Chills d. Menstrual disturbances e. Purulent cervical discharge f. Cervical motion tenderness (chandelier the sign!!!) g. Adnexal tenderness |
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173. Diagnosis of PID?
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a. The presence of acute lower abdominal or pelvic pain plus one of the following:
1. Uterine tenderness 2. Adnexal tenderness 3. Cervical motion tenderness b. Order β-hCG and U/S to r/o pregnancy and to evaluate for the possibility of tubo-ovarian abscess. c. Ultrasound is a noninvasive means of diagnosing PID |
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174. What to look for with ultrasound for PID?
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a. Thickening or dilation of the fallopian tubes
b. Fluid in the cul-de-sac c. Multicystic ovaries d. Tubo-ovarian abscess |
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175. WBC count with PID?
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a. Note: a WBC count >10,000 has POOR positive and negative predictive value for PID!!!
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176. Treatment of PID?
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a. Antibiotic treatment should not be delayed while waiting for cultures!!!!!
b. Can use Outpatient regimens A or B c. Or d. Inpatient regimens. |
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177. Outpatient regimens A and Regimen B for PID Rx?
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a. Regimen A: ofloxacin or levofloxacin x 14 days ± metronidazole x 14 days
b. Regimen B: 1. Ceftriaxone IM X 1 dose OR Cefoxitin 2. plus 3. Probenecid 4. Plus 5. Doxycycline x 14 days 6. ± Metronidazole x 14 days. |
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178. 2 Inpatient antibiotic regimens for PID?
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a. Cefoxitin or Cefotetan
b. Plus c. Doxycycline x 14 days d. Or e. Clindamycin plus gentamicin x 14 days |
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179. When is surgical drainage of a tubo-ovarian/pelvic abscess in PID appropriate?
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a. If the mass persists after antibiotic treatment
b. Is >4-6 cm c. The mass is in the cul-de-sac in the midline and drainable through the vagina. d. If the abscess is dissecting the rectovaginal septum and is fixed to the vaginal membrane, colpotomy drainage is appropriate. e. If the patient's condition deteriorates, perform exploratory laparotomy f. Surgery may range from TAH/BSO with lysis of adhesions in severe cases to conservative surgery for women who desire to maintain fertility. |
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180. Complications of PID?
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a. Some 25% of women with acute disease develop repeated episodes of infection, chronic pelvic pain, dyspareunia, ectopic pregnancy! Or infertility!
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181. What may RUQ pain indicate with PID?
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a. Fitz-Hugh-Curtis syndrome-an associated perihepatitis
b. Look for abnormal liver function and shoulder pain |
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182. Note: mild and subclinical PID is a major cause of tubal factor infertility, ectopic pregnancy, and chronic pelvic pain due to pelvic scarring
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182. Note: mild and subclinical PID is a major cause of tubal factor infertility, ectopic pregnancy, and chronic pelvic pain due to pelvic scarring
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