4.1 pt 2 Flashcards
main cause of candida infections
Candida albicans
what color will vaginal discharge be in vulvovaginal candidiasis
white, thick curd-like
what will you see on KOH smear for candidiasis
budding yeast and pseudohyphae
ovarian cysts are also called
adnexal masses
during what age are ovarian cysts most commonly found
reproductive age
most common symptom of ovarian cysts
pelvic pain/pressure
when should you do surgery for ovarian cyst
if greater than 10 cm
implantation of endometrial tissue outside of the uterus
endometriosis
when do symptoms of endometriosis usually improve
during pregnancy and after menopause
most common site for endometriosis
ovaries
biggest risk factor for endometriosis
prolonged estrogen exposure
nulliparity
classic triad of endometriosis
cyclic premenstrual pelvic pain
dysmenorrhea
dyspareunia
initial imaging of choice for endometriosis
pelvic ultrasound
definitive diagnosis for endometriosis
laparoscopy with biopsy
endometriosis involving the ovaries large enough to be considered a tumor, usually filled with old blood appearing chocolate-covered
chocolate cyst/endometrioma
when do symptoms occur for PMS
luteal phase (1-2 weeks before menses)
when are symptoms of PMS relieved
within 2-3 days of onset of menses
benign uterine smooth muscle tumor
uterine fibroids
growth of uterine fibroids depends on what hormone
estrogen
2 risk factors for uterine fibroids
> 35
African American (5x more likely)
most uterine fibroids are asymptomatic, but if they are symptomatic, what is the most common symptom
abnormal uterine bleeding
will uterine fibroid be tender or non-tender on exam? symmetric or asymmetric?
non-tender asymmetric mobile mass
what will you see on transvaginal ultrasound for uterine fibroids
focal heterogenic hypo echoic mass or masses with shadowing
if small and asymptomatic, do you need treatment for uterine fibroids?
no just observation
surgical treatment of choice for women who wish to preserve fertility with uterine fibroid
myomectomy
definitive treatment for uterine fibroids
hysterectomy
most common benign gynecologic tumor
uterine fibroids/leiomyomas
most common type of uterine fibroid
intramural (in the wall of the uterus)
are cystic ovaries bilateral in PCOS
yes
what do people with PCOS have resistance to
insulin
what hormone do people with PCOS have too much of
androgen
describe menstruation for someone w PCOS
amenorrhea
or
oligomenorrhea
can PCOS cause infertility
yes it can
what stimulates excess ovarian androgen production in PCOS
increased LH
what causes insulin-resistant hyperinsulinism
functional ovarian hyperandrogenism
what is a symptom of increased androgen
hirsutism
Bc people with PCOS have insulin resistance, they have increased risk of developing
type 2 DM
obesity
HTN
what skin condition may you see in someone with PCOS
acanthosis nigricans
what type of criteria do you use for diagnosis of PCOS
Rotterdam criteria
how much of Rotterdam criteria must be met to be diagnosed with PCOS
2 of 3
3 Rotterdam criteria to be diagnosed with PCOS
hyperandrogegism (lab or clinical signs)
ovulatory dysfunction (amenorrhea or oligomenorrhea)
cystic ovaries on US
what will the LH:FSH ratio be in PCOS
great than or equal to 3:1
What will you see on pelvic ultrasound for PCOS
bilateral enlarged ovaries and multiple ovarian cysts with a “string of pearls” appearance
first line treatment for PCOS
lifestyle changes
mainstay of treatment for PCOS
combination oral contraceptives
Anti-androgenic agent for PCOS
Spironolactone
3rd most common gynecologic cancer
cervical cancer
most common type of cervical cancer
squamous cell carcinoma (90%)
what is a cofactor in squamous cell carcinoma
smoking
most common symptom in cervical cancer
postcoital bleeding
how to diagnose cervical cancer
colposcopy with biopsy
what is performed after a positive Pap smear to determine the extent and depth of invasion of the cancer
Cervical biopsy and endocervical curettage or ionization
preferred treatment for carcinoma in situ
excision
what cancer has the highest mortality of all the gynecologic cancers
ovarian cancer
most common type of ovarian cancer
epithelial cell cancer (>90%)
What is the biggest environmental risk to getting ovarian cancer
increased number of ovulatory cycles
someone with increased number of ovulatory cycles
nulliparity
infertility
> 50
early menarche
late menopause
genetic risk factors for developing ovarian cancer
BRCA1
BRCA2
Peutz-Jeghers
Turner’s syndrome
Lynch syndrome
What decreases your risk of getting ovarian cancer
combination oral contraception
decreased number of ovulatory cycles
when does ovarian cancer typically become symptomatic
typically late in the disease course
most common symptoms for ovarian cancer
increasing abdominal girth
weight loss
back or abdominal pain
early satiety
What will you see on PE for ovarian cancer
palpable abdominal or ovarian mass (solid, fixed, irregular)
ascites
pleural effusion
initial test of choice for ovarian cancer
pelvic ultrasound
what can be used to monitor progress of ovarian cancer
Serum CA-125
What bacteria causes toxic shock syndrome
staphylococcus aureus
clinical illness characterized by rapid onset of fever, rash, hypotension, and multi organ system involvement
toxic shock syndrome
what type of toxins are produced by staphylococcus aureus
exotoxins
50% of menstrual causes of toxic shock syndrome
tampon use
non menstrual causes of toxic shock syndrome
surgical and postpartum wound infections
burns
contraceptive sponge use
what type of conjunctivitis do we commonly see in toxic shock syndrome
nonpurulent conjunctivitis
how does multi systemic involvement manifest in toxic shock syndrome
hypotension
is detection of staphylococcus aureus required for diagnosis of toxic shock syndrome
NO
another common organism that can cause toxic shock syndrome
group A strep
what indicates renal failure in toxic shock syndrome
creatinine great that or equal to 2 mg/dL
what indicates coagulopathy in TSS
platelets less than or equal to 100,000/mm
what will you see on the skin of someone with TSS
erythroderma — resembles sunburn
does erythroderma include the palms and soles in TSS
YES
what happens to erythroderma after 1-2 weeks in TSS
desquamation
most common cause of UTI/cystitis
E. coli (>80%)
what will you see on urinalysis for UTI/cystitis
pyuria (>10 WBCs/hpf)
definitive diagnosis for UTI/cystitis
urine culture
clean catch or first catch for UTI
clean catch
having what in your urine usually indicates you have a UTI?
nitrites
an inflammatory mass involving the Fallopian tube, ovary, and occasionally the adjacent pelvic organs (bowel, bladder)
tubo-ovarian abscess
what age of patients are most commonly affected by tube-ovarian abscess
reproductive age
risk factors for tube-ovarian abscess (same as for PID)
multiple sex partners
age between 15-25
prior history of PID
what is a common complication of PID
tubo-ovarian abscess
classic presentation of tubo-ovarian abscess
acute lower abdominal pain
fever
chills
vaginal discharge
patients with a ruptured TOA typically present with
acute abdominal pain
signs of sepsis
first line for diagnosing TOA
ultrasound
capacity to have a live birth
fecundity
probability of achieving a pregnancy in a single menstrual cycle
fecundability
permanent state of infertility
sterility
after how many months of regular, unprotected sexual intercourse is someone considered to be infertile
12 mos
most common cause of infertility
failure to ovulate
what is the female athlete triad
eating disorders
amenorrhea
bone disorders (osteoporosis)
in female athlete triad, what hormone is deficient
estrogen
islands of ectopic endometrial tissue within the myometrium
uterine adenomyosis
between what ages does uterine adenomyosis commonly present
35-50
common clinical manifestations of uterine adenomyosis
chronic pelvic pain
dysmenorrhea
menorrhagia (heavy/prolonged)
on physical exam, will the uterus be symmetrically or asymmetrically enlarged in uterine adenomyosis
symmetrically enlarged
will the uterus be boggy or hard in uterine adenomyosis
boggy
will the uterus be mobile or not in someone with uterine adenomyosis
mobile
Overall, describe what you will see on PE in someone with uterine adenomyosis
symmetrically enlarged
soft/boggy
mobile uterus
first line for diagnosis of uterine adenomyosis
transvaginal ultrasound
more accurate and useful tool for diagnosing uterine adenomyosis if transvaginal ultrasound isn’t helpful
MRI
conservative treatment of uterine adenomyosis
IUD (hormonal)
definitive treatment for uterine adenomyosis
total abdominal hysterectomy
most common gynecologic malignancy in US
endometrial cancer
what is the most common type of endometrial cancer
adenocarcinoma
who does endometrial cancer mainly affect
post menopausal women
risk factors for endometrial cancer
increased estrogen exposure
PCOS
Tamoxifen
What protects against ovarian and endometrial cancer
combination oral contraceptives
clinical manifestations of endometrial cancer
abnormal uterine bleeding
postmenopausal bleeding
Definitive diagnosis of endometrial cancer
endometrial biopsy
what STIs are reportable in every state
syphilis
congenital syphilis
gonorrhea
chlamydia
chancroid
HIV
within how many days must all STIs be reported
2 weeks
within how many days must HIV be reported
7 days
expedited partner therapy can be used for which STIs
chlamydia
gonorrhea
all sexual partners within how many days can use the expedited partner therapy
60 days
