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30 Cards in this Set

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=== MEN'S HEALTH ===

=== MEN'S HEALTH ===

epidydimitis tx?


younger: tx for GC


Older or gay: ceftriaxone and a fluoroquinolone


Other: A 21-day course of a fluoroquinolone antibiotic


non-infectious: scrotal support, application of ice, and NSAIDs

Man with low testosterone and symptomatic. wtd next?
a review of medications should be undertaken; many drugs, including opioids, high-dose corticosteroids, and hormonal therapies, can lower testosterone levels.

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=== WOMEN' S HEALTH ===


=== WOMEN' S HEALTH ===

Hypoactive sexual desire disorder (HSDD) , tx

Individual and couples sex therapy or psychotherapy may be beneficial.




To date, the FDA has not approved any medication for the treatment of female HSDD.

Sexual aversion disorder, tx?

graduated re-introduction of sexual behavior and relaxation exercises,


+/- SSRI

vaginismus tx?

- CBT


- Systematic desensitization teaches deep muscle relaxation, dilators

Imaging for breast mass?

ultrasonography is preferred for pregnant women or women younger than 30 to 35 years;




mammography is preferred for women older than 30 to 35 years.

Workup for breast mass after imaging?

FNA - cystic lesions




Core needle biopsy -better tissue sampling for pathologic examination and hormone receptor status (if positive for cancer) and can distinguish in situ versus invasive cancer. Core needle biopsy is the test of choice for most solid lesions.




Excisional biopsy is used when core needle biopsy is nondiagnostic or when biopsy and imaging studies are not in agreement.

Cyclic mastalgia, medical tx?

- Danazol (100 mg twice daily) - can cause menorrhagia and weight gain (FDA approved)




- tamoxifen (10 mg/d), and treatment-associated hot flushes and menstrual irregularities are relatively infrequent. (off label)

Cyclical mastalgia, non-pharm tx?

Education, reassurance, and the use of a well-fitting bra

Contraindications to OCP combination products

include history of thrombosis, liver disease, breast cancer, migraine with aura, and uncontrolled hypertension

medications that reduce effectiveness of OCP?

-Medications that induce the CYP3A class of liver enzymes


- barbiturates, carbamazepine, many antiseizure medications, rifampin, and certain antiretroviral agents

Long acting contraceptives not recommended in

women desiring pregnancy in the subsequent 2 years after cessation of treatment because of potential contraceptive-associated delayed fertility

IUD for emergency contraception?

The copper IUD may be implanted within 5 days of unprotected intercourse for use as emergency contraception.

4 methods of emergency contraception available in the United States:

- levonorgestrel tablets,


- combined contraceptive tablets,


- copper IUD


- progesterone modulators - mifepristone, ulipristal (abortifacent)

Vaccination for rubella and varicella to nonimmune women should be administered

at least 4 weeks before conception to minimize risks to the fetus

cancer risk with OCP?

Decreased incidence of endometrial, ovarian cancers


Increased risk of cancers of the cervix, liver, breast

Menopause, non-hormone treatment?

- SSRI/SNRI, gabapentin, and clonidine




- Venlafaxine, desvenlafaxine, and paroxetine have been demonstrated to be effective in some women

i. Polymenorrhagia


ii. Oligomenorrhea


iii. Metrorrhagia


iv. Menorrhagia


v. Menometrorrhagia

i. bleeding occurring more than once every 24 days, the lower limit of the average menstrual cycle.

ii. bleeding less frequently than every 35 days,


iii. irregular or intermenstrual bleeding.


iv. refers to regular cycles with excessive bleeding, defined as monthly menstrual loss of more than 80 mL or bleeding for more than 7 days.


v. bleeding at irregular intervals with excessive flow.

Pain that may worsen with menstruation, dyspareunia, dysmenorrhea? tx?

Endometriosis


tx: OCP, gnRH agonist, lap surgery



Dysuria, urgency, frequency, repeatedly negative urine cultures? tx?

interstitial cystitis


tx: Pentosan polysulfate sodium; tricyclic antidepressants; GnRH agonist therapy may be helpful

Dull, chronic pain worsened with prolonged standing, improved by lying down and elevating legs?


tx?

Pelvic Varices


tx: Medroxyprogesterone acetate

bacterial vaginosis, tx

Treatment is with either oral (7 days) or topical (5-7 days) metronidazole or clindamycin (oral or topical).


(metro safe in preg)

trichamonas tx?

single dose metro




test HIV pt for cure

vulvovaginal candidiasis, tx?


i. uncomplicated


ii. pregnant


iii. complicated


iv. recurrent

i. PO diflucan, topical imidazole




ii. 7 days topical




iii. Topical up to 14d or PO diflucan x 2




iv. (topical 14d or PO x 3) + PO qwk x 6mo

1st line tx for primary DYSmenorrhea?

NSAIDS




- if no relief or pt wants contraception then OCP




- if younger, avoid depot (bone problems)