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2nd midterm Flashcards

1
Q

Define infertiliry

A

no conception after 12 months of intercourse without contraception <35
no conception after 6 months of intercourse without contraception >35

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2
Q

what are 2 types of infertility

A

1º-nulligravida

2º with h/o pregnancy

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3
Q

Causes of female infertility: Pelvic

A

PID, STI, Septic abortion, endometriosis, pelvic tuberculosis.Surgical: dilation and curettage, ruptured
appendicitis, endometriosis, adnexal surgery, fibroids
Contraception and Pregnancy History: prior intrauterine
device use, DES exposure in-utero, ectopic pregnancy,
habitual abortion
Menstrual Cycle abnormalities: secondary amenorrhea,
endometriosis, cyclic abdominal or pelvic pain

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4
Q

Causes of infertility: ovulatory

A

Secondary amenorrhea
abnormal uterine bleeding, luteal phase defet, premature ovarian failure, PCOS, elevated prolactin, hypothyroidism, prior use of ant-estrogens

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5
Q

Other causes of infertility

A

delayed childbearing, insulin resisitance, substance abuse

malabsorption, unexplained

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6
Q

male factor of infertility

A

varicocele, unexplained, obstrusctive azoospermia, undescended testis

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7
Q

evaluation of male

A

semen analyisis after 2-5 days of abstinence. Volume 2-5mL, >20 mil/mL sperm #, motility>50% or >25% rapid, forward motility, 35% normal morphology

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8
Q

Is a cause of infertilty always determined

A

NO

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9
Q

what should you cut down on to achieve a successful pregnancy

A

decrease smoking, alcohol, coffee, BMI

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10
Q

Things that help deal with infertility for the woman

A

stress reduction, acupuncture, diet, therapy, supplements(multivitamin, B12 to regulate menses, arginine for uterine blood flow), antioxidants, decrease smoking, increase AO levels, magnesium, selenium, Vitex(chaste tree), green tea,tribulus, rhodiola, phytoestrogens, progesterone, DHEA

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11
Q

Things that help deal with infertility for the man

A

Antioxidants, Vit C and E for fragmented sperm, folic acid, zinc sulfate, phytoestrogens and the decrease caffein nicotine pot and alcohol. eat fruits and veggies

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12
Q

What are complications of ovarian mass

A

torsion, ruupture, infection, hemorrhage, malignant potential

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13
Q

What are the 3 types of functional cysts

A

Follicular(mc), Corpus luteum(lc), theca lutein

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14
Q

what is the most common ovarian mass

A

functional cysts

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15
Q

What are follicular cysts

A
  • Dominant follicle failing to rupture(persisitent follicle)
  • Immature follicle failing to undergo normal atresia
  • Usually disappears within 1-3 months
  • blood can fill the cavity of the cyst(hemorrhagic/chocolate cyst)
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16
Q

What is significant about luteum cysts

A

clinically more important

associated with endocrine function or prolonged progesterone secretion

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17
Q

What is a corpus luteum cyst

A

-results if the sac doesn’t dissolve but seals off after the egg is released then fluid builds up inside.
-occurs 2-4 days post ovulation
-resolves within a few weeks
-

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18
Q

What is the % chance of recurrence of corpus luteum? How big can they grow?

A

31

4” and may bleed or cause torsion

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19
Q

Decribe Theca Lutein Cysts

A

bilateral

  • asymptomatic
  • caused by prolonged or excessive stimulationof ovaries by endogenous or exogenous gonadotrophins
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20
Q

Do theca lutein cysts resolve spontaneously?

A

typically yes

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21
Q

when are functional ovarian cysts discovered

A

they are often asymptomatic and seen on a routine pelvic exam

  • they can present as unilateral pressure, fullness or pain in lower abdomen
  • dull ache in low back and thighs
  • pain during sexual intercourse
  • producing excess hormones-dysmennorhea, n/v, breast T
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22
Q

When do you refer?

A

-pain with fever and vomiting
-sudden, severe abdominal pain
-fainting, dizziness, or weakness
-rapid breathing or heart rate (tachypnea,
tachycardia)

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23
Q

what is another name for dermoid cyst

A

teratoma

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24
Q

What is a teratoma?

A

monstrous growth, containing all 3 germ layers.
-composed of skin and filled with hair glands,muscle, bone and teeth, cartilage, respiratory/GI
epithelium, thyroid tissue
etc.
Can be benign or malignat

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25
Q

epidemilogy of Teratoma

A 
-Most common ovarian neoplasm in
prepubescent girls &amp; teens 
-50% 25-50 yo
-20% post menopausal are benign
-also discovered on pelvic exam and then removed d/t malignant potential which is low
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26
Q

What is an endometrioma

A

An oma of the endometrium that is dx with US, is painful, and recurs if not completely resected.

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27
Q

What is a Tubo-Ovarian Abcess?

A

infection in tubo/ovarian junction and is usually caused by Gonn/Chlam

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28
Q

What are sx of ubo-Ovarian Abcess?

A 
tubal/ovarian swelling or enlargement
-pelvic pain
-fever
-vaginal discharge
all leading ot infertility and chronic pelvic pain
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29
Q

Does your risk of malignancy go up after menopause with overian mass

A

Yes
post-45%
pre-13%

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30
Q

50% of all GYN cancer deaths are from what?

A

ovarian cancer

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31
Q

what are risk factors for ovarian cancer

A
  • fam hx
  • nullparity
  • early menarch or late menopause
  • fertility promoting drugs
  • N. America, europe
  • ethnicity(A. jews)
  • sedentary
  • high fat diet
  • endometriosis
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32
Q

WHat are the sx of ovarian cancer?

A

Usually there are non until late stage

if any it is LBP, menses abnormal and GI sx

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33
Q

What is the best way to screen for ovarina cancer?

A

CA-125(there are false negatives with fibroids, etc) and transvaginal ultrasound

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34
Q

There are invasive follow up tests for ovarian cancer, after Ca125 and US. They are invasive, but are they necessary?

A

NO, Potential harms outweigh potential benefits of screening

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35
Q

Describe staging and survival rate of ovarian cancer.

A 
Stage 1=75-1oo%
Stage 2=45-60%
*Stage 3 = 15-50%
Stage 4 =5%
*malignant pleural effusion mets to liver and majority of patients with ovarian
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36
Q

what is gold standard test for ovarian mass

A

US
Finding: Cystic, smooth, unilocular, unilateral, small (<5cm) are
likely benign
-Solid or mixed cystic/solid, multilocular, bilateral,
irregular, large (>10cm+) with internal septae or
papillae are suspicious

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37
Q

When do you consider laparoscopy with ovarian mass?

A

> 7-10cm
continue to enlarge
looks suspicious
hx, presentation, PE?

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38
Q

What helps you prevent ovarian cancer?

A

breast feeding, hormonal contraception, BL tubal litigation, prophylactic BL oophorectomy

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39
Q

Who gets small functional cysts 1-2 cm that regress in months?

A

newborns

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40
Q

who gets teratomas/dermoids?

A

premenarchal girls

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41
Q

Who gets functional cysts, endometriomas, tubo-ovarian

abscesses, PCOS, ectopic pg, teratoma?

A

reproductive age women

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42
Q

who must r/o cancer and have increased risk of malignancy (both primary ovarian
carcinoma and metastatic from uterus, breast or GI)

A

post menopausal women

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43
Q

who gets cervical cancer?

A

women who have never been screened, have not been screened within past 5 years, have not received appropriate follow up after an abnormal Pap smear.

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44
Q

How is cervical dysplasia graded?

A

There is organized growth of the cervical cells. when this becomes disorganized you get cervical dysplasia. Disorganization is mild-CIN 1
moderate-CIN2
severe-CIN3 carcinoma in situ

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45
Q

where do you find dysplasia and carcinoma in situ

A

abnormalities are confined to the surface of cervix

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46
Q

WHat are the screening rules for cervical cancer

A
  • screen 21-65 with pap every 3 years

- 30-65 who want to test every 5 years must do pap and HPV test

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47
Q

Who does the USPSTF recommend against screening for?

A

women under 21

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48
Q

WHat is atypia of cervical cells

A

variation of normal, irritation or inflammation

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49
Q

What is ASCUS

A

abnormal squamous cells of undetermined significance

benign changes that should be monitored

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50
Q

What is CIN I: cervical intraepithelial neoplasia

A

mild dysplasia

aka LGSIL: Low grade squamous intraepithelial lesion

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51
Q

What is CIN II: cervical intraepithelial neoplasia

A

moderate dysplasia

aka HGSIL: high grade squamous intraepithelial lesion

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52
Q

CIN III: cervical intraepithelial neoplasia

A

severe dysplasia

aka HGSIL: high grade squamous intraepithelial lesion

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53
Q

CIS: carcinoma in situ

A

Precancer

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54
Q

How long does it take to cause HR-HPV mutations?

A

3y

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55
Q

Is HPV contagious?

A

yes, 70% of adults have it

in teens and early 20s 70% of HR-HPV and 90% LR-HPV regress after 3 y.

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56
Q

Whats the bad news about HPV?

A

Rates of progression of carcinoma are 22%-60% and no early signs

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57
Q

The good news about HPV?

A

Vaccine for 9-26yo, 3 injection series, $360 for full series, but only covers 4 strains.
BUT-HPV is slow growing, 70-90% are transient and resolve without intervention
if detected early, tx min invasive.

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58
Q

Your patient has an abnormal pap, what next?

A

colposcopy- Direct magnification and viewing of
cervix, vulva,vagina, and/or perianal
tissue plus biopsy of tissue

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59
Q

Treatment for cervical dysplasia involves cryotherapy, describe it

A

probe is placed against cervix, which
damages the cells by freezing them. These
are then shed over the next month in a heavy
watery discharge.
Has had high failure rate for treating large
areas of dysplasia & areas that extend into
the cervical canal

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60
Q

What is a LEEP?

A 
Uses a fine wire loop with electrical energy
flowing through it
-Tissue that is removed is sent to lab
-Good for treatment and diagnosis
- Done under local anesthesia
- Causes little discomfort
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61
Q

What is conization?

A

Removes a cone-shaped piece of the cervix
 Better for diagnosing, but may have removed all
of the undamaged tissue as well
 High success rate, may interfere with future
childbearing

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62
Q

Whats the deal with DES?

A

Diethylstilbestrol
 synthetic non-steroidal estrogen
 used to prevent miscarriage & other pregnancy
complications from 1938-1971.
Women who took DES during pregnancy have a slightly
higher risk of breast cancer
as well as AI disorders, cx dysplasia. Men exposed have issues with infertility and reproductive tract anomalies

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63
Q

DES daughters screening

A

first pap at onset of menses, 14 y.o. or onset
of intercourse
 Baseline colposcopy after onset of intercourse
 Vaginal and cervical paps every 6-12 months
until 30 y.o.
 Thereafter, yearly cervical and vaginal paps

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64
Q

What is the flow of lymph

A

breast -> axilla ->supraclavicular
 Axillary regions: pectoral, central, lateral, subscapular
 Breast ->supraclavicular nodes
cervical nodes, opposite breastabdominal lymphatics

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65
Q

WHere is the mc site for fibrous cystic change

A

upper outer quadrant
then the inframammary line(from the bra)
If symmetrical and mobile=less worry

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66
Q

When to do a clinical breast exam

A

5 days post menses

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67
Q

What are the borders of the breast?

A

B/t ribs 2-6, b/t sternal edge and midaxillary line, include the “tail” UOQ->axilla

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68
Q

What is mastalgia?

A

breast pain and T, mc in premenopausal women

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69
Q

Is mastalgia a sx of breast cancer

A

rarely, cancer presents with discomfort 5% of time

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70
Q

What causes mastalgia

A

hormones, PMS, trauma, acute infection, m/s, cancer

60-80% spontaneous remission.

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71
Q

What is a fibroadenoma?

A

Benign,

  • affects 10%,
  • fibrous stroma
  • respond to est/progest
  • 15-50yo, not common in menopause unless HRT
  • rubbery firm mobile painless
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72
Q

How do you manage fibroandenoma?

A

CBE, mammogram, US, needle bx
they can regress over time
tx: surgical excision or watch and wait

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73
Q

What are simple cysts?

A

fluid filled lesion that are soft and firm, mobile and cyclic fluctuations. Appear 15-50

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74
Q

How do you manage simple cyst

A

PE: difficult to differentiate from a solid mass
DX: Mammogram, U/S, Fine Needle Aspiration
 Surgical Biopsy: if bloody aspirate, palpable mass doesn’t resolve with
aspiration, multiple recurrence in short period, no fluid aspirated.
CBE after tx, mammogram

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75
Q

Do recurrent large simple cysts have increased risk of cancer

A

yes in some studies

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76
Q

Whats important to know about fibrocystic breast change?

A

Common non cancerous change in breast tissue. 60% of women, swelling pain T.
From increased estrogen and decreased progesterone
often resolves with menopause

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77
Q

What are sx of fibrocystic breast change?

A

cyclic pain, variation in size, heavy, multiple nodules, premense aggravation, swelling, mobile, itschy, UOQ

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78
Q

What has a big impact on reducing sx of fibrocystic breast change?

A

methylxanthines
abstinence =97% improvement
take Vit E(relieves PMS)
EPO increase prostaglandin

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79
Q

What is mastitis?

A

infection seen during lactation or with skin disruption

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80
Q

How does mastitis present

A 
fever/chills
erythema
pain
n/v
You get it from S.aureus, S. epidermis or strep
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81
Q

What are risk factors of mastitis

A

breast feeding, trauma, breast augmentation

mc 2-4 weeks postpartum

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82
Q

What is Galactocele?

A

Blocked/obstructed breast duct after lactation. it is T and enlarged
Tx-excise and drain

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83
Q

What is the most common cause of nipple discharge

A

benign breast disease
10-15% benign
3-11% of malignant dz

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84
Q

how do you recognize benign discharge

A

BL,
nonspontaneus
multiple ducts
serous d/c may be caused by hormones

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85
Q

how do you recognize pathologic discharge

A

unilateral
spontaneous
d/c 2º to breast carcinoma may have color
frank blood, serous, green/grey

86
Q

What is the number one cause of benign nipple d/c?

A

intraductal papilloma
can be bloody or serous
surgical excision

87
Q

Whats galactorrhea

A

inappropriate lactation in nonpuerperal woman(during/after preg)

88
Q

What is a subareolar abscess

A

An abscess from S. aureus or anaerobic organisms
You get yellow crusty discharge
It is recurrent with inverted nipples or nipple piercing
Tx with drainage antibiotic excision

89
Q

What is the mc cancer in women

A

breast

1/3 will die, leading cause in 40-55yo

90
Q

What is recommendation for breast cancer screening

A

Biennial women over 50-74yo

91
Q

IN women over 60 with risks what is screening rec.

A

annual

92
Q

When is screening recommended >40

A

with increased risk-fam hx 1st degree, dense breast

93
Q

US is ineffective as a screening tool for BC. Whywould you order one?

A

Lump felt but not seen on mammography
OR
Lump with corresponding abnormality on mammagram

94
Q

When would you order an MRI for BC

A
  • Those with current or past diagnosis of BrCa
  • dense breasts
  • rectify inconclusive mammogram & U/S
  • high risk
95
Q

When to use needle aspiration

A

Bloody aspiration =biopsy rec.

Cysts that reoccur within 2w and or require >1 aspiration

96
Q

What is the incidence of + bx

A

Increases with age
>50y 20% carcinoma
>70y 33% carcinoma

97
Q

What is definitive step to determine that a mass is benign or malignant

A

BX
Usual sequence: mammogram  U/S  core
biopsy

98
Q

Where do most breast cancers start in men

A

under the nipple and more likely to have nippe discharge

99
Q

T/F 90% of patients with breast cancer do not have a 1º relative with BC

A

T

75% of patients have no major risk factors

100
Q

What are si and sx of early and late stage bc

A

Early: firm, irregular, immobile,unilateral
Late: skin/nipple retraction, T, lymphadenopathy, erythema, pain , fatigue, peau d’orange

101
Q

How does Paget’s disease of breast present

A

adenocarcinoma of nipple, itching burning erythema, ulcerations. Can be confused with tinea or fungal infection

102
Q

What % dx at early stage BC

A

80%

stage 1 2cm or less

103
Q

The incidence of reoccurrence of BC correlates with ?

A

1º tumor size and status
1ºtumor type
previous tx
Reoccurence=worse px

104
Q

What modifiable risk factors increase BC risk

A

hormone use
repro/breast feeding
lifestyle
environ exposure

105
Q

What decrease risk of bc

A 
menarche after 15 and early menoparuse
-3+ pregnancies prior to 30
-prolonged lactation
-healthy diet
-exercise
-minimal HRT/oc
take VIt D
106
Q

Alcohol can increase risk of cancer, T/F

A

T
colon cancer increase with beer consumption
breast - alcohol decrease folate

107
Q

Who has a 60-100%higher risk for BC

A

overweight postmenopause

108
Q

What % of pregnancies are unintended

A

50%

20-24yo most and 40-44yo then 15-19yo

109
Q

What % of women who get prego are on birth control

A

60%
b/c of user reliability
even when perfect use failure rate of 2%

110
Q

How does hormonal contraception work

A 
Suppresses FSH and LH surge
Inhibit follicular maturation; no ovulation
Thicken cervical mucus
    barrier to sperm
Alters endometrial lining
    so implantation unlikely
111
Q

Ortho-Evra the patch

A

20mcg progestin every 24hrs

  • patch changed each week 3x with one week off
  • compliance88%
  • avoid GI and live interference
112
Q

What is disadvantage of orthoevra

A 
Dysfunctional uterine bleeding
 Dysmenorrhea, breast tenderness
 No STD protection
 Application site reactions ~ 17%
 TOO MUCH HORMONE???
Higher rsik of prego
113
Q

Nuva Ring

A 
15mcg progestin daily
-Vaginal insertion 3 weeks  and 1 week out
for menses (ok for continuous use)
-avoid gi/liver
-left in 21 days
-can be taken out for 3hrs
-can be uncomfortable
-Side effects: HA, vaginitis
114
Q

Injectable Hormones-DMPA, lunelle

A

DMPA inject quarterly
Lunelle inject monthly
-First rule out pregnancy
 Inject within 7 days of normal menses or
 4 weeks postpartum if NOT breast feeding
 6 weeks post partum if breast feeding (DMPA only)
 use alternative BC for the first two weeks
 effective during the first cycle if given as directed
Can take a long time to get your cycle back 12-24 mo
there is a decreased risk of endometrial cancer with this

115
Q

IUS(IUD) progestin only

A 
Mirena good for 5 years
20mcg release of levonorgestrel daily
-thickens cervical mucus
-reduce menses 
-decrease endometrial cancer
116
Q

Implanon

A

rod injected underneath skin of upper arm
-slowly releases progetogenic hormone
recommended d1-5 of menses to be inserted and use back up control for a week

117
Q

Who should be on progestin pills

A

women breast feeding an dhave risk for blood clots

all of these type of pills have hormone,no placebo

118
Q

what are some bonuses to taking oral contraceptives

A

no prego, osteoporosis decrease, decrease colon cancer

  • improve DUB, mood/pms, acne/hirsutism/PCOS, menorrhagia,
  • decrease risk ovarian and endometrial cancer
  • relief of migrain, breast chnge and functional ovarian cysts
119
Q

Disadvantages of hormonal contraception

A

CVD, decrease glucose tolerance, BTB, Vaginitis, N/V, leg cramps, Weight gain, HA, decrease serotonin, Decrease in many vitamins esp. B

120
Q

is there increased risk of breast cancer with hormonal contraception

A

Yawwss

121
Q

Drug interactions with oral contraception

A 
Acetaminophen
 Alcohol
 Antibacterials/ antivirals/
antifungal (diflucan; cipro)
 Anticonvulsants/barbituates
 Beta blockers
 St. Johns Wort
Anti hypertensives
 Bronchodilators
 Corticosteroid
 Hypoglycemics
 Tricyclic antidepressant
 Rifampin (TB med)
122
Q

Contraindications to hormonal contraception

A 
Liver disease
 Pregnancy
 History/current HTN or heart/vascular disease
-Migraine with focal neurological sxs
 Breast cancer
 Smoking >15 cigs and >35yoa
123
Q

What are guidelines for back up contraception when starting OCs?

A

-The 1st Sunday after the first day of menses-needs one week back up
-The first day of the menstrual cycle-no back up
-Cyclical or continuous
Seasonal” is an 84 day OC

124
Q

What is considered a missed pill and then what do you do?

A

A pill not taken within 6 hrs of its normal time.
-Miss 1 pill: take missed pill asap. Normally taken at 6am, but forgets until 1pm:
take 1 pill now, take next pill at 6am next day as
usual
-Miss 2 in a row
read the directions on the pack unless you cant read. Consider using barrier protection, unless you dont know what that is.

125
Q

What are non-hormonal methods of birth control

A 
copper-T IUD(10 years)
Condoms
Spermicides
Cervical cap
diaphragm(not the one you breathe with, that is not considered bc)
126
Q

What does a copper IUD do?

A

reduces the sperms ability to swim, bad rxn b/t copper and sperm
it also prevents the sperm from fertilizing the egg

127
Q

What are early danger signs of IUD

A 
Late/missed period (r/o preg)
 Abdominal pain
 Fever, chills
 Increased discharge
 Odorous discharge
 Big changes in bleeding:
breakthrough bleeding, heavy
periods, clots
128
Q

Contras to copper IUD

A 
Abnormal uterine anatomy
 Enlarged uterus
 Nulliparous
 Current/ past PID
 Hx of ectopic pg
 Known or suspected Pg
 DUB of unknown cause
 Suspected malignancy
 Copper allergy or Wilson's disease
129
Q

What forms of contraception have spermacide

A

condoms, diaphragm and cervical cap

130
Q

what does spermicide do

A

destroy sperm cell membrane, but must insert 30 min prior to sex , may increase risk for UTI or vaginitis and its messy

131
Q

Condoms are effective?

A

for the most part 85% but do not protect from skin to skin HSV, HPV. Protect from HIV GC andCT.

132
Q

when should you not use a diaphragm?

A

severe prolapse
 allergy to latex or spermicide
 vaginal septa or fistula
 recurrent/chronic UTI
they can also have problems with compliance/efficacy
vaginal irritation, infections, odor, comfort self or partner

133
Q

What is necessary when using a cervical cap?

A

Requires compatible cervix & proper fitting
by physician
Risks: vaginal/cervical abrasion, infection, TSS,
odor, allergy, discomfort
 4% of users will develop an abnormal
pap smear so repap in 3months

134
Q

Contraindications to cervical cap?

A
  • Abnormal PAP
  • Allergy to rubber; spermicide
  • Acute cervicitis; vaginitis
135
Q

What is fertility awareness technique

A

Helps identify days of the month pregnancy is likely, to avoid or encourage pregnancy.
Can be complicated by altered physiology or fever, vaginitis, travel, sleep.

136
Q

What is the most effective way to track fertility awareness technique?

A 
Symptothermal 86% effective
followed by
BBT
Cervical mucus
calendar
137
Q

What is tubal sterilization?

A

Sterilization intended to be a permanent method of birth control
2% failure rate/10yrs

138
Q

What is a vasectomy?

A

surgical procedure severing the vas deferens - the tubes
that carry sperm from the testes
Incision and non incision(freeze) and only 30 min under local anesthetic

139
Q

How do you know a vasectomy worked?

A

Semen produced in seminal vesicles & prostate
 Sperm continue to be made in testes & reabsorbed
 Ejaculation unchanged
 15-20 ejaculations post-op to flush remaining sperm;
alternative method of contraception needed
 After 2-3 mo check to assure no sperm are present.
 Around 1/40-50 men will have their vasectomy
reversed “vasovastostomy”

140
Q

what are side effects of vasectomy?

A
  • pain, stops in a week
  • infection
  • granulomas-result of leakage of sperm from cut end of vas into scrotal tissues
  • epidiymitis
  • abcesses
  • erectile dysfunction
  • prostate cancer
141
Q

When can Plan B or Preven be used?

A

5 days after unprotected sex

you can use IUD as well if inserted within 5 days of unprotected sex

142
Q

What is the mechanism of emergency contraception?

A

inhibits/delays ovulation, alter endometrium, thicken cervical mucus, alter sperm or ovum transport
DOES NOT AFFECT AN ESTABLISHED PREGNANCY

143
Q

are all reproductive tract infections sexually transmitted

A

no

144
Q

Do women suffer longer and have more severe sx with RTIs

A

Yes
They get PID, inferitlity, ectopic prego, chronic pelvic pain, prego loss, preterm birth,c ervical cancer
They are usually asymptomatic

145
Q

Who is more likely to get an STI

woman or man

A

woman

or anyone who is receiving

146
Q

What is the most common gyn complaint?

A

vaginitis
itching, burning, discharge, odor, pain
usually maintained by lactobacilli acidophilus

147
Q

How do you recognize bacterial vaginitis?

A

your first clue cell is that it smells like fish on KOH wet mount.
also homogenous discharge and pH>4.5

148
Q

What agents contribute to vaginitis

A

gardnerella, haemophilus, group B strep, sexually associated in lesbians

149
Q

What is pathogenesis of BV?

A

Lactobacilli control the environment;
 if low other bacteria (gardnerella, Group B strep) overgrow
then amino acids production-> increase vaginal pH(elevated pH kills normal flora) -> squamous cell desquamation leads to classic discharge

150
Q

what are complications of BV?

A

high recurrence rate 60%

  • cervicitis
  • PID
  • post surgical infection
  • increased HIV/STI risk
  • pregnancy
151
Q

what is the recommended tx for BV

A

antibioitics: metronidazole or clindamycin
- lactobacilli-to make H2O2
- lactic acid gel
- Povidone-iodine
- Boric acid

152
Q

What is a yeast infection?

A

overgrowth of a fungus that lives in healthy vaginas

candida albicans

153
Q

what are sx of yeast infection?

A

pruritis, whit-yellow d/c, erythematous tissue, vulvar fissures

154
Q

How do you dx a yeast infection

A

10% KOH wet mount
 pseudohyphae
 budding yeast
 pH of 3.8 to 4.5 (normal)

155
Q

Tx of yeast infections

A 
Treat underlying cause
-antifungal-an azole
-boric acid
-OTC topical steroids for sx relief
-oral/vag acidophilus
sitz bath
diet
TX OF PARTNER NOT NECESSARY
156
Q

What is Trichomoniasis vaginalis?

A

STI, Protozoal flagellate Trichomonas vaginalis
-associated with the presence of other STIs
-Facilitates the transmission and acquisition of HIV &
other STI

157
Q

Dx of Trich

A

Normal saline mount, motile organisms with flagella and increased PMNs

158
Q

What is the presentation of Trich

A

Vaginitis, cervicitis, urethritis
Affecting vagina, skene’s ducts and lower UTI.
asymptomatic for years

159
Q

Who gets a strawberry cervix and yellow/green discharge

A

Patients with TRICH
be sure to tx partner
metronidazile or tinidazole

160
Q

Chlamydia and gonorrhea are both bacteria that infect genital columnar cells but have different presentions what are they?

A

Both can be asymptomatic and have cervicitis, urethritis and PID but chlam gives you reiter’s and gon give you pharyngitis and arthritis

161
Q

MC reported STI in oregon?

A

Chlam followed by gonn

162
Q

Who is more likely to get the gonn

A

African american women 5x

163
Q

What are signs of the chlam and the gonn in women?

A 
ASYMPTOMATIC
vaginal discharge
dysuria
dyspareunia
low ab pain-CPP
unusual bleeding
164
Q

What are signs of the chlam and the gonn in men?

A 
ASYMPTOMATIC
penile discharge
dysuria
burning/pruritus
pain with ejaculation
pain and swelling of testes
165
Q

What are recommendation for CT/NG

A

annual screening of sexually active females<25
or >25 with risk factors
rescreen women 3-4 months after treatment d/t high prevalence of repeat infection

166
Q

is it possible that lactobacillus may prevent NG/CT infection?

A

yes

167
Q

How do you recognize epididymitis?

A 
scrotal pain and swelling
fever
penile discharge
chills
ab pain
pelvic pain
frequent urge to pee
dysuria
hematuria
painful ejaculation
168
Q

Dx epidiymitis

A

DNA prob for GC and CT, LCR urine test
examination of 1st void urine for WBCs
test and treat partner

169
Q

What is interesting about prostatitis

A

50% of men experience disorder during their
lifetime.
Most common urological disorder > 50 third most
common disorder in men younger than 50.
-Escherichia coli
- Klebsiella
- NG/CT

170
Q

Risk factors of prostatitis

A 
Bladder outlet obstruction (stone, tumor, BPH)
 Diabetes mellitus
 Suppressed immune system
 Urethral catheterization
 STI’s
 Unprotected anal/vaginal intercourse 
 bacteria
enters urethra, prostate
171
Q

what do we need to know about proctitis

A 
Anoscopic
 Specimen collection for HSV, NG, CT, syphilis
 Painful perianal or
mucosal ulceration on
anoscopy
 presumptive therapy for
HSV
172
Q

How does HPV (condyloma accuminata) present?

A

visible genital warts
subclinical infection
oropharyngeal infection

173
Q

Who has HSV

A

50% of americans HSV 1

1 in 5 have HSV-2

174
Q

Do condoms prevent HSV infection

A

Not necessarily, asymptomatic viral shedding spreads most HSV>70%

175
Q

What is 1º herpes

A

First infection with either HSV 1 or 2
Most severe symptomatic form
presents as erythematous papule vesicle, pustule, ulceration, encrustation
also include regionals lyphadneopathy as well as fever malaise arthralgia HA

176
Q

First episode non primary herpes is?

A

Initial genital infection in a patient who has already

experienced infection with the other HSV type

177
Q

How long does transmission take for HSV

A

avg 4 days can be 2-20 days
Virus replicates in ganglia  migrates to mucosa 
replicates in epithelium  lesions or symptoms

length of viral dormancy varies

178
Q

Are recurrent herpes as dramatic as primary herpes?

A

No usually milder and shorter
systemic and neuro sx rare
Patients get prodrome: local paresthesia, itching, pain.
triggers are: stress, fatigue, intercourse, menstruation, diet/lifestyle, menopause

179
Q

what is lab dx for HSV

A

viral culture
 Only if in pustular stage; (most sensitive)
 Tzank smear*
Only if in pustular stage
 antigen detection tests (direct fluorescent antibody test)

180
Q

If you have HSV can you transmit it to your baby?

A

Perinatal transmissionis highest in undx mothers
50% born thru 1º lesions become infected
<3% born thru non 1º lesion become infected

181
Q

Can syphilis infect any organ in the body?

A

yes treponema pallidum can, its a blood born pathogen. spirochete

182
Q

What does the last stage of syphilis cause?

A

heart disease, brain

damage, spinal cord damage, blindness, and death

183
Q

What does 1º syphilis entail?

A
  • Chancre within 3 weeks-90days, contagious
  • chancre is painless, firm with indurated borders and can appear anyhwere on body
  • regional lymphadenopathy
184
Q

2º Syphilis-GO

A 
2-8 weeks after chancre Patient develops rash on palms and soles
-fever less than 101º
-sore throat
-weakness
-patchy hair loss
-weight loss
lymphadenopathy
-nervous system sx-neck stiff, HA, irritabiity, paralysis, unequal reflexes, irregular pupils
185
Q

what is latent stage of syphilis

A

if untreated- After secondary-stage rash goes away, no symptoms =
latent period; may be as brief as 1 year or range from 5
to 20 years.
A person is contagious during early part of latent stage
may be contagious even when no symptoms are
present.
must do blood test to dx

186
Q

What is 3º stage syphilis

A

most destructive
-If untreated, tertiary stage may begin as early as 1
year after infection or at any time during a
person’s lifetime.
-Gummata large sores inside the body or on skin.
 Cardiovascular affects heart and blood vessels.
 Neurosyphilis affects brain or related structures.

187
Q

How do you dx syphilis

A

screening antibody testing/VDRL/RPR
 for non-specific ‘reagin’ antibody
 screening test (false positives common)
-flourescent treponemal antibody absorption (FTA- ABS),
microhemagglutination test (MHA-TP)

188
Q

What is a chancroid?

A

STI caused by infection with bacterium

Haemophilus ducreyi

189
Q

Where do you get chancroids?

A

causes one or more ulcers on genitalia and are associated with inguinal lymphadenitis
they may progress to abcess formation.

190
Q

Do chancroids co exist with other STI

A

Yes, HSV, the chlam, syph

191
Q

Are chancroids painful

A

Yes can be single or multiple painful circumscribed nonindurated ulcers

192
Q

Can you go to tropical islands and get a chancroid?

A

Yes, incubation 1-7 days, lesion appears 2-3 days-1 mo after exposure. can be aymptomatic

193
Q

LYMPHOGRANULOMA VENEREUM

A

STI involving inguinal lymph glands caused by a specific strain of chlamydia. Incidence is highest among sexually active people living in tropical or subtropical climates

it starts small then spreads to lymph nodes 3-30dys after exposure

194
Q

What is granuloma inguinal?

A 
 Klebsiella
Granulomatous
 s/sx vascular leasion
prone to easy
bleeding
 Dx clinical with
confirmation of KG on
stained culture
195
Q

How long can pediculosis pubis live on fomite?

A

1 month

196
Q

How do you get pediculosis pubis?

A

sex, shared bed, shared clothing

then it lays eggs(nits) at base of hair shaft. Eggs hatch 7-9 days

197
Q

What is a viral STI that has small painless papules on genitals, inner thighs, and butt?

A

Molluscum contagiosum

it spontaneously resolves by 6 months or take antivirals

198
Q

What cells are most affected by HIV

A

activated T cells

199
Q

Which cells are susceptibel to HIV infection

A

langerhans

200
Q

How can you get HIV?

A

sexual contact, contaminated blood, bone donor tissue, occupational risks, mother to child delivery, breast milk

201
Q

What body fluids can be infected with HIV

A
  1. Blood 2. Semen and pre-seminal fluid 3. Vaginal fluid 4. Breast milk 5. Sweat 6. Saliva 7. Tears
202
Q

What body fluids transmit HIV

A
  1. Blood 2. Semen 3. pre-seminal fluid 4. Vaginal fluid 5. Breast milk
203
Q

What are the routes of transmission of HIV?

A
  1. Vagina 2. Rectum 3. Mouth 4. Urethra 5. Inside of eyelids
204
Q

Can HIV concentration vary in different body fluids?

A

Yes

205
Q

How do you dx HIV?

A

ELISA-screening test(sensitive)

Western Blot-confirmatory test(specific)

206
Q

Do HIV screening test detect the virus?

A

No they detect antibodies. This is a drawback because of the window of time it takes to produce antibodies after transmission. New technology you can test within 3-5 weeks.

207
Q

What HIV test detects the virus itself?

A

PCR, but not first line of testing, not specific

208
Q

When are the largest # of HIV infected cells detectable?

A

6-12 weeks post infection and after 15 y

209
Q

WHen is the onset of AIDS?

A

T4 cells fall below 200 per cu mm,cell proportion <14% virus titers rise rapidly and immune activty drops. loss of immune competence enables opportuistic microbes to cause infections

210
Q

What is the major cause of death in late stage AIDS

A

candidiasis, pneumocystis carnii, mycobacteria avium complex

GU (3 decks)

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