Women's Health

Front 1

What is a common cause of chronic pelvic pain? Up to 79%

Back 1

IBS

Front 2

What is chronic pelvic pain?

Back 2

pain that persists for at least 6 months- intermittent or constant

Front 3

Define Dysmenorrhea

Back 3

Painful menstruation that prevents normal activity & requires meds to TX

Front 4

Primary- dysmenorrhea

Back 4

has no organic cause.
From menses- production of prostaglandins after menarche
Pain may decrease after childbirth or aging

Front 5

Secondary- Dysmenorrhea

Back 5

pathological cause
Endometriosis, fibroids, muscle tumors, ovarian cysts
PID or IUD
Can be associated with ovulatory cycle - Mittlesmirtz
Higher than normal prostaglandin activity
Psychological- family attitude toward pain
Anxiety- academic & social demands

Front 6

Bacterial vaginosis - 3 or 4 criteria are required

Back 6

1. Thin homogeneous discharge
2. pH of >4.5
3. Clue cells - saline wet mount or gram stain of vaginal discharge
4. vaginal discharge +10% KOH
"fish" or Amine-like" odor

Front 7

Primary treatment for bacterial vaginosis

Back 7

Metronidazole 500mg BID x 5 days or 2gram single dose

Metronidazole vag gel QD x 5 days

Always do bi-manual exam and if tenderness, must use oral AB

Front 8

Candidiasis symptoms

Back 8

Thick curd-like discharge- odorless
Epithelial cells and hyphae/pseudohyphae
Intense pruritis of vulva
Erythematous vagina and labia
May have burning and urgency with urination “not uncommon to have bladder infx sx, but have a vaginal yeast infxn, then you need to do a wet mount”
May have dyspareunia
20% asymptomatic

Front 9

Candidiasis Treatment

Back 9

Topical imidazole for 3-7 days “at least 3 days. 1-day monistat is not enough.”
Monistat, Femstat, Gyne-lotrimin, Vagistat
Diflucan 150 mg po- noncompliance “some people need to take once a week for resistant organisms”
Terazol cream- 3 or 7 day
Good choice for resistant strains of C. tropicalis or T. glabrata
Clue- budding yeast on wet smear
Abstain from intercourse for “at least” week of TX “to rest pelvis & decrease irritation”
Gentian violet can help resistant strains “I have painted vaginal areas to get rid of resistant organisms”

Front 10

Chronic Vaginitis treatment

Back 10

Boric Acid capsules twice a week or after intercourse to keep acidic (500mg) “really help some people. Some do for maintenance twice a week. Some pharmacies carry & some don’t.”

Front 11

Atrophic Vaginitis Treatment-

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hormonal
Vagifem- 1 tab PV 2x/wk maintenance
Start 1 tab daily x 2 wks “Do not have sex the first week of tx”
If uterus intact- progestin x 10-14 days/mo

Front 12

Trichomoniasis symptoms

Back 12

Frothy green-yellow discharge- adherent
Bad odor, dysuria, vulvar pruritis, erythema or edema vulva (50% women asymptomatic)
KOH- “Whiff” may be present

Front 13

Trichomoniasis transmission

Back 13

sexual intercourse
Rare- wet towels, washcloths, bathing suits

Front 14

Trichomonas Treatment

Back 14

Metronidazole 2g orally- single dose
90% cure rate
Metronidazole 500 mg BID x 7 days or 250 mg TID x 7 days alternative
Metronidazole vaginal gel is acceptable
Partner TX- single dose TX
DO NOT use in pregnancy - teratogenic

Front 15

Toxic Shock Syndrome organisms

Back 15

Staphylococcus aureus & staph enterotoxins A, B, & C

Front 16

Toxic Shock Syndrome s/s

Back 16

Fever >38.9 degree C (102 degree F)
Nausea & vomiting & diarrhea (GI)
Hypotension <90mm Hg systolic & shock & syncope
from hypovolemia
Diffuse “sunburn-like” macular rash- trunk
Desquamation- palms & soles- after rash
Acute respiratory distress syndrome
Myalgias (muscular) & arthralgias
Conjunctival, oral & vaginal hyperemia (mucous membranes)
Renal insufficiency- oliguria
Thrombocytopenia (Blood)
Disorientation & headache (Neuro)
Periorbital edema- & non-pitting edema

Front 17

TSS Treatment

Back 17

Admit ICU
Aggressive fluid replacement
Remove vaginal FB
Beta lactamase resistant antibiotics IV
Oxacillin
Nafcillin

Front 18

Chlamydia - time of exposure until symptoms

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1-3 weeks after exposure

Front 19

Gonorrhea - time of exposure until symptoms

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2-10 days after exposure

Front 20

Treatment- Chlamydia

Back 20

Azithromycin 1 g po- single dose “better compliance. 4 pills at once or else 1 gm powder in a liquid & you just drink it”
Often given in clinic- liquid form
or Doxycycline 100 mg BID x 7 days
Med commonly stocked in public health clinics
Pregnancy- Erythromycin 500mg QID x 7 days or Amoxicillin 500 mg po TID x 7 days

Front 21

Genital Herpes Symptoms

Back 21

80% asymptomatic
Or don’t recognize SX’s
1st episode worse
2-10 days after exposure
Persists for 2-3 weeks
Fever, headache, muscle aches, painful or difficult urination, vaginal discharge, swollen glands in groin area
Early signs:
Itching or burning sensation, pain in legs, buttock, or genital area, vaginal discharge, pressure abdominal region
Later signs:
Red bumps- turn into blisters- become painful ulcers- swelling may occur
Lesions crust over & heal without scarring

Front 22

Threatened AB

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vaginal bleeding without cervical dilation prior to 20 weeks gestation

Front 23

Complete AB

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spontaneous expulsion of all fetal and placental tissue prior to 20 weeks gestation

Front 24

Incomplete AB

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some (but not all) of fetal/placental tissue has passed – Most commonly seen

Front 25

Inevitable AB

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cervix is dilated and tissue may be present at cervical os

Front 26

Intrauterine pregnancy should be visible by TVS when Quant HCG?

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>1500-2000

Front 27

Treatment for ectopic PG

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Methotrexate – can help body reabsorb ectopic PG
Stable, no hemoperitoneum, able to return for follow-up, unruptured mass<3.5 cm, no fetal cardiac motion, BHCG<15,000
Contraindications: breastfeeding, immunodeficiency, liver disease, blood dyscrasia, active pulmonary disease, renal dysfunction
Surgical: salpingostomy or salpingectomy
Laparoscopy if patient is stable
Laparotomy if patient is unstable

Front 28

Gestational Trophoblastic Disease (molar or hydatidiform Clinical signs

Back 28

vaginal bleeding, enlarged uterus, theca lutein ovarian cysts, anemia, hyperemesis gravidarum, hyperthyroidism, preeclampsia at <20wks gestation, passage of hydropic tissue (looks like grapes)

Front 29

Malignant Gestational Trophoblastic Disease can end up with what type of cancer?

Back 29

Choriocarcinoma

Front 30

Placenta previa s/s

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will have bleeding, no pain

Front 31

Placenta abruption s/s

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will have pain/bleeding

Front 32

Risk factors for Placenta abruption

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cocaine use, TRAUMA, smoking, thrombophilia

Front 33

What is Preeclampsia?

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hypertension with proteinuria

Front 34

HELLP

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hemolysis, (hemolytic anemia)
elevated liver enzymes,
low platelets

Front 35

When do you type and screen a PG woman?

Back 35

first visit and at 28 weeks

Front 36

Rh incompatibility - mother? fetus?

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Mom Rh negative
Fetus Rh positive

Front 37

When do you screen a PG woman for group B strep?

Back 37

35-37 weeks

Front 38

what does +nitrazine test, ferning on microscopic evaluation indicate?

Back 38

Premature rupture of membranes

Front 39

Preterm Labor definition

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regular uterine contractions resulting in cervical dilation in patients prior to 37 weeks gestation

Front 40

A negative Fetal fibronectin test means?

Back 40

99% chance that won't go into labor in the next 7 days

Front 41

why do you hydrate the patient in preterm labor?

Back 41

to shut off pituitary from releasing oxytocin

Front 42

What is Precipitous delivery?

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Refers to delivery which occurs within 30 minutes of presentation to hospital

Front 43

Complications of shoulder dystocia

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Brachial plexus injury
Clavical fracture
Neurologic compromise
Fetal death

Front 44

Postpartum hemorrhage criteria

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>500 mL of blood loss during vaginal delivery, or >1000 mL in cesarean delivery

Front 45

Treatment for Postpartum hemorrhage

Back 45

Uterine massage, oxytocin, methergine, hemabate

Front 46

the only PPI that can be used in PG

Back 46

protonix

Front 47

what is Metrorrhagia?

Back 47

Bleed between menses
Ovulatory bleed

Front 48

Polymenorrhea

Back 48

Menstrual bleeding too frequent
Bleed restarting <28 days
Every 1-3 weeks

Front 49

Dysfunctional Uterine Bleeding

Back 49

Most anovulatory- Dysfunction of hypothalmic-pituitary-ovarian axis…continued estrogenic stimulation of endometrium…outgrows it’s blood supply, partially breaks down & sloughed irregular manner

Front 50

Ages seen with Dysfunctional Uterine Bleeding

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20% adolescents & 40% >40 yo