13: Female disorders

Question 0

MCC of Bacterial vaginosis

Answer 0

Gardnerella vaginalis

Question 1

Factors that can change composition of vaginal flora

Answer 1

• Age
• Sexual activity
• Hormonal status
• Hygiene
• Immunologic status
• Underlying skin disease

Question 2

Bacterial vaginosis- dx

Answer 2

• (+) KOH- whiff test

- (+) Clue cells on wet mount

Question 3

Bacterial vaginosis- rx

Answer 3

1: Metronidazole- oral
2: Metronidazole- topical
3: Clindamycin- topical
* Rx not recommended for male partners but female partner (lesbian) should be examined and rx

Question 4

Vaginal candidaiasis- rx

Answer 4

1: Butoconazole
2: Clotrimazole
3: Miconazole
4: Fluconazole
5: other anti-fungal
* routine rx of sex partners is not indicated

Question 5

Trichomoniasis- sx

Answer 5

• Frothy white to greenish discharge with foul odor

- Wet mount: round protozoa; motile, gyrating flagella

Question 6

Trichomoniasis- rx

Answer 6

• Metronidazole or Tinidazole

* Rx of both partners simultaneously is recommended

Question 7

Atrophic vaginitis- cc

Answer 7

Menopause-> Estrogen deficiency-> low production of glycogen in vaginal epithelial cells-> Lactobacilli cannot feed on the glycogen (Lactobacilli lowers vaginal pH to 3.5-4.5)-> predispose the vagina to infection

Question 8

Atrophic vaginitis- lab

Answer 8

• Serum estrogen level (Low)
• Cytologic smear of cells from upper 1/3 of vagina: increase in proportion of parabasal cells
• Microscopic exam and cultures for bacterial, candida and Trichomonas
• Elevated vaginal pH>5

Question 9

Atrophic vaginitis- rx

Answer 9

• Estrogen replacement therapy
• Low-dose transvaginal estrogen (relieve sx)
• Moisturizers and lubricants

Question 10

Pelvic inflammatory disease (PID)- info

Answer 10

Include

• Endometritis (uterus)
• Salpingitis (fallopian tubes)
• Tubo-ovarian abscess & pelvic peritonitis

Question 11

PID- cc

Answer 11

• Chlamydia trachomatis*

- N. gonorrhea*

Question 12

PID- rx

Answer 12

• Cefoxitin+ Doxycycline or Clindamycin+ Gentamycin
• for at least 48hrs after pt improves clinically
• followed by doxycycline for 10-14 days
• if Tubo-ovarian abscess is present, add Metronidazole with Doxycycline

Question 13

PID- complication

Answer 13

• Chronic pelvic pain
• Infertility
• Ectopic pregnancy

Question 14

Polycystic ovarian syndrome (PCOS)- sx

Answer 14

• Insulin resistance
• Dyslidemia, obesity
• Increased pulses of LH and decreased FSH production from anterior pituitary-> increased androgen by ovarian theca cells and decreased estrogen by granulosa cells
• Virilization (high androgen)
• Anovulation (low estrogen)

Question 15

PCOS- dx

Answer 15

at least 2 of the 3

• Oligo-ovulation or anovulation manifested as oligomenorrhea or amenorrhea
• Clinical/biochemical evidence of hyperandrogenism
• Polycystic ovaries on US (>12 small antral follicles in an ovary)

Question 16

PCOS- rx

Answer 16

Weight control
Meds
-OC pills
-Metformin
-Anti-androgens (Spironolactone and Finasteride)
-Clomiphene to induce ovulation

Question 17

Cervical cancer- Pap smears recommendations

Answer 17

• initial age of 21
• intervals: age 21-65: every 3 years
• HPV co-test: 30-65: every 5 years

Question 18

Pap smears- collection methods

Answer 18

1: Cervical broom
2: Cervical scrape and endocervical brush

Question 19

Cervical cancer- dx

Answer 19

Colposcopy: confirmatory
-dysplastic area are seen in white
Cone biopsy (if colposcopic bx inconclusive)

Question 20

Cervical cancer- prevention

Answer 20

• Gardasil quadrivalent HPV vaccine (16, 18, 6, 11)
• Cervarix bivalent vaccine (16, 18)
• Abstinence, Condoms

Question 21

Endometrial cancer- rx

Answer 21

-Total hysterectomy with bilateral salpingo-oophorectomy
-Post-op irradiation
or
-Large doses of progestins (for advanced or metastatic ones)