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Maternity > Alterations in Women's Health and STIs > Flashcards

Alterations in Women's Health and STIs Flashcards

1
Q

Normal Menstrual Characteristics

A

Cycle length: 21-35 days, day 1 = first day of menses

Amount of flow: average 25-60ml

Variations are normal (typically 3-5 days but may last up to 7 days)

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2
Q

Amenorrhea: Primary

A

Menstruation has not been established by age 13-14 and no secondary sexual characteristics noted

Or no menses by age 16 in the presence of secondary sexual characteristics

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3
Q

Amenorrhea: Secondary

A

No menses in 6 months for a woman who has had a previously established (longer than 3 months) menses

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4
Q

Causes of Amenorrhea

A

Hypothalamic dysfunction: often stress or weight loss induced (runners, dancers/athletes with low BMI)

Pituitary dysfunction: pituitary adenoma, psych meds can impact prolactin levels

Chronic anovulation or ovarian failure: PCOS, thyroid or adrenal issues

Anatomic abnormalities: structural issues like congenital absence of uterus, ovaries or vagina or imperforate hymen

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5
Q

Amenorrhea: Dx and Tx

A

H&P
Pregnancy test
Pelvic exam (or u/s) esp for those that have never menstruated
Blood tests (prolactic, FSH, TSH)

Tx: depends on cause

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6
Q

Menstrual Disorders

A

Oligomenorrhea: irregular infrequent interval >40 days

Menorrhagia: heavy and/or prolonged length but at normal intervals
-common causes: fibroids, polyps, infection, IUDs

Metrorrhagia: normal amount of bleeding but at irregular intervals
-common causes: cancerous or benign tumors of the uterus, IUD’s, OCP use, cysts, trauma, polyps, cervicitis, cervical dysplasia

Menometrorrhagia: excessive in amount and duration and at either regular/irregular intervals

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7
Q

TSS

A

Cause: Staphylococcus aureus

S/Sx: fever, shock, rash on trunk then palms/soles, vomiting, watery diarrhea, severe myalgia, CNS changes, renal/hepatic/CBC changes

Early dx and tx is vital

Preventative Ed: tampon use, contraceptives

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8
Q

Dysmenorrhea: Primary

A

Cramps w/o underlying disease

Begin 12-24 hours prior to onset of menses and lasts x 12-24hrs.

Caused by increased endometrial production of prostaglandins (myometrial stimulant and vasoconstrictor) which increase uterine contractility and decease uterine artery blood flow causing ischemia

usually resolves after a first pregnancy

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9
Q

Dysmenorrhea: Secondary

A

pain occurs at any point in the menstrual cycle

related to: endometriosis, pelvic adhesions, fibroids, IUD’s, pelvic tumors, residual PID, cervical stenosis

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10
Q

Dysmenorrhea: Tx

A
  • non-steroidal anti-inflammatory drugs (prostaglandin inhibitors)
  • oral contraceptives (inhibit ovulation)
  • regular exercise and rests
  • heat/ warm bath
  • good nutrition
  • biofeedback
  • acupuncture
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11
Q

PMS

A

behavioral and physical changes

occurs in luteal phase of menstrual cycle (2 days to 2wks prior menses after ovulation and symptoms subside with menses)

exact cause is unknown (suspect hormonal changes)

may have affective or somatic sx

occurs in at least 3 consecutive menstrual cycles

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12
Q

PMDD

A

premenstrual dysphoric disorder

cause unknown
marked by 5 or more sx each month, more severe than PMS

sx relief w/ menstruation

sx occur during most cycles

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13
Q

Chronic Pelvic Pain

A

pain in pelvic region that lasts >6 months or longer resulting in functional or psychological disabilities

S/Sx: sharp, crampy, pressure, dyspareunia, pain with bowel movements, intermittent or steady

tx: pain management, hormones, antibiotics, antidepressant, nutritional therapy

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14
Q

PCOS

A

polycystic ovarian syndrome

complex disorder, no clear etiology

elevated estrogen, testosterone, and LH, decrease in FSH, multiple follicular cysts on ovaries leading to ovulatory and menstrual dysfunction, hyperandrogenemia, and polycystic ovaries

Sx:

  • menstrual dysfunction (amenorrhea or oligomenorrhea)
  • androgen excess (hirsutism and acne)
  • obesity
  • hyperinsulinemia, glucose intolerance, insulin resistance
  • infertility
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15
Q

Endometriosis

A

chronic inflammatory disease in which the presence and growth of endometrial tissue is found outside of the uterine cavity (ovaries are the most common sites)

the tissue is estrogen dependent, most common during the reproductive years

cause is unknown

sx: pelvic pain, pressure, pain with defecation, dyspareunia, abnormal uterine bleeding, infertility
dx: laparoscopy

tx: interrupt cyclic ovarian hormone production (OCP’s, depo, danazol which stops GmRH), pain meds (NSAIDs)
- surgical: laparoscopy, hysterectomy
- complementary and alternative medicine (CAM)

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16
Q

UTI and Older Woman

A

older women are more susceptible to UTIs d/t:

  • suppressed immune system
  • weakened muscles of the bladder that increases the risk for incomplete emptying of the bladder
  • decreased levels of estrogen which can alter the normal vaginal flora allowing for growth of E.coli which can spread to the urinary track

don’t present w/ common signs of UTI such as fever. If fever is present = serious UTI that needs immediate tx

can cause confusion and abrupt changes in behavior, agitation, poor motor skills, falling

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17
Q

Pyelonephritis

A

edema of renal parenchyma, swelling of ureter

temporary suppression of urinary output

sx: sudden onset w/ chills, fever, CVA tenderness or flank pain, n/v, malaise, frequency/urgency/burning w/o urination, decreased output
tx: antibiotics, urinary analgesic (Pyridium), pain management, antipyretic, bed rest, possible catheterization

Pregnancy risk: increased risk of PTL, PTD, adult RDS, septicemia

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18
Q

Uterine Fibroids

A

aka leiomyomas

most common benign disease entity in women

RF: early menarche, low parity, obesity

s/sx: pelvic pressure, dysmenorrhea, pelvic pain, urinary frequency, urgency, palpation of tumor

dx: pelvic u/s
tx: myomectomy, hysterectomy, GnRH agonist, uterine artery embolization

19
Q

Endometrial Cancer

A

most common female genital tract cancer

RF: white, older, obesity, nulliparity, hx infertility, hx menstrual irregularities, hx DM, long term use unopposed estrogen, early menarche and late menopause

sx: postmenopausal bleeding
dx: endometrial bx

high cure rate w/ early detection

20
Q

Ovarian (Adnexal) Masses

A

common ovarian abnormality (mostly benign)

ovarian cysts (>50% functional cysts) can be fluid, blood or cell filled

Risks for ovarian cancer:

  • no relationship between benign masses and cancer
  • most fatal of all female cancers
  • older, nulliparity, hx of breast ca, early menarche, late menopause, gene mutation

Sx of ovarian cancer: bloating, increasing abdominal size, difficulty eating, abdominal or pelvic pain, urinary sx (urgency/frequency)

Dx: u/s, laparoscopy or laparotomy

21
Q

Cervical Abnormalities

A 
Cervicitis
Cervical Cancer (2nd most common female cancer):
-RF: IC before 16 multiple partners, exposure/hx of STIs/HPV, long term OCP use, smoking
22
Q

Abnormal Paps: How are they managed?

A
  • Bethesda system for specimen
  • evaluation of abnormal cytology
  • colposcopy-visualization of cervix with a microscope
  • ECC
  • surgical tx (Leep)
23
Q

Disorder of Pelvic Support

A

factors that contribute to relaxation:
-childbirth, deterioration w/ age, prolonged lifting, chronic coughing, chronic constipation, obesity

types of pelvic relaxation:

  • cystocele: downward displacement of bladder
  • rectocele: anterior wall of rectum protrudes forward
  • uterine prolapse
24
Q

GYN Surgeries

A

hysterectomy: removal of uterus d/t leiomyomas, endometriosis, uterine prolapse

D&C
Uterine ablation
Salpingectomy
Oophorectomy
Vulvectomy
25
Q

Benign Breast Conditions

A
  • Fibrocystic breast changes
  • Fibroadenoma (2nd most common breast lesion)
  • Galactorrhea (various causes, generally nonsignificant but can occur w/ OCP use, fibrocystic changes, psych meds, and HRT)
26
Q

Malignant Breast Disease

A

Predisposing factors: age, female gender, prior breast ca, known gene mutation, fam hx, >5yrs HRT, overweight, ETOH use, no pregnancies, or first pregnancy >30YO, never breastfed, early menarche and late menopause, hx high dose radiation to chest, physical inactivity

50% originate in upper outer quadrant

27
Q

Vaginitis

A

inflammation of the vagina d/t disruption of the vaginal ecosystem

sx: vaginal burning, itching, or irritation, and may have a malodorous discharge
types: bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis

28
Q

VVC

A

RF: hormonal changes, pregnancy (d/t increased estrogen), depressed cell-mediated immunity (suppressed immune system, steroid use), antibiotic use

Sx: thick, white, cheesy vaginal discharge, severe itching, dysuria, and dyspareunia

Dx: wet prep or culture

Tx: cream (ending in -zole)

29
Q

BV

A

most common vaginal infection caused by disruption in vaginal flora

RF: new sexual partner, multiple sexual partners, douching, antibioticcs

Sx: thin, watery, milky, white-gray discharge, “fishy” vaginal odor

Dx: wet prep, culture

Tx: flagyl orally or intravaginal gel, clindamycin

can cause preterm labor and endometritis if pregnant

30
Q

Risk of Untreated STI’s

A 
cervical cancer
PID
infertility
ectopic pregnancy
chronic pelvic pain
31
Q

Trichomoniasis

A

Protozoan

s/sx: asymptomatic or mild sx
-yellow or green frothy vaginal discharge, malodorous discharge, vaginal wall inflammation, “strawberry cervix”, vulvar itching

dx: wet prep and culture

tx: metronidazole or tindamax
- both partners avoid intercourse until cured
- implications in pregnancy

32
Q

Chlamydia

A

most common bacterial infection in US

transmission: vaginal sex, can be in urethra and live in throat and rectum

s/sx: 50% of women are asymptomatic

  • mucopurulent d/c from cervical os, easily induced bleeding, edema in the area of ectopy
  • can cause impaired fertility

dx: NAAT test/endocervical swab, urine
tx: antibiotics, avoid intercourse until cured, implications of pregnancy

33
Q

PID

A

acute infection of the upper female genital tract (involving the uterus, fallopian tubes, ovaries and can spread to the peritoneum).

  • most cases caused by more than 1 organism (most common organism = chlamydia, gonorrheoea, BV)
  • occurs w/ ascending spread of microorganisms at the end of or following menses (open cervical os, lack of cervical mucus barrier)

RF: younger than 25, multiple partners, hx of STIs, douching

Consequences: post-infection tubal damage associated with infertility and ectopic pregnancy risk is 10x greater, chronic pelvic pain

34
Q

PID: Sx

A

bilateral severe abdominal, uterine and ovarian pain

fever >100.4
chills
mucopurulent cervical or vaginal discharge
irregular bleeding
n/v

*can also be asymptomatic

35
Q

PID: Dx

A 
lab tests (CBC, sed rate, cultures)
"chandelier sign"

Tx: antibiotics
hospitalization for pregnant women, severely ill, with IV fluids, pain meds
-tx sexual partner
-reevaluate after 48-72hours and if PID responds to tx f/u in 4-6wks

36
Q

Herpes Simplex

A

viral organism - HSV-1 and HSV-2
-recurrent lifelong infection

Transmission: vaginal, anal, or oral sex

  • skin-to-skin contact with an infected site
  • incubation period of 2-20 days

Primary Outbreak:

  • blister-like vesicles
  • difficult urination, urinary retention
  • enlargement of inguinal lymph nodes
  • flu-like sx, genital pruritus, tingling

Dormant phase: after lesions heal, enter dormant phase and residing in nerve ganglia of affected area

Dx: clinical appearance, culture, PCR

Tx: antiviral therapy, no cure

Implications in Pregnancy: SAB in 1st trimester, IUGR, PTL and neonatal infection if occurs in late 2nd to 3rd trimester, prophylaxis 36+wks

37
Q

Syphilis

A

bacterial organism

transmission: vaginal, oral, anal sex
- exposure to exudate from infected individual, transplacental transmission can occur during pregnancy

Early stage: painless, discrete enlargement of painless lymph nodes,

Secondary stage: symmetric papillosquamous eruptions on palms, soles, mucous membranes, and trunk

Tertiary: bacteria spreads throughout the body and sx are r/t damage of the organs

Dx: early primary = microscopic exam of chancre

  • labs
  • antibody titers

Tx: penicillin G

Implications in pregnancy:
-IUGR, preterm birth, and stillbirth

38
Q

HPV

A

viral organism

causes cervical and anorectal cancers

transmission: vaginal, oral, anal sex (skin to skin contact)

not 100% preventable w/ condoms

sx: painless genital warts, pruritis, mostly asymptomatic
tx: therapies for wart removal, surgical removal, vaccines

39
Q

Pubic Lice

A

parasite

transmission: intimate sexual contact, sharing towels, bed linens

Sx: inflamed skin and small red or bluish irritations caused by lice bites and defecation, intense itchiness of infected area

Dx: naked eye or magnifying glass, or under microscope for louse or egg

tx: cream

40
Q

Scabies

A

parasite

transmission: intimate sexual contact
sx: itching, erythematous, papular lesions or furrows, worst at night or when they are warm
tx: cream

41
Q

Viral Hepatitis: Types

A

Type A: fecal-oral, contaminated food or water

  • immunization available
  • not chronic

Type B: blood/body fluids

  • immunization available
  • chronic

Type C: blood/blood products

  • NO immunization
  • chronic

Type D: blood/body fluids

  • NO immunization
  • chronic

Type E: fecal-oral

  • NO immunization
  • not chronic
42
Q

Viral Hepatitis: Sx

A 
jaundice
anorexia
n/v
malaise
fever
arthritis
arthralgia in B, C, D
43
Q

HIV

A

transmission: exchange of body fluids

seroconversion occurs w/in 6-12 wks after HIV enters body

Seroconversion is usually w/o sx, may have flu-like sx of fever, HA, nigh sweats, nausea, diarrhea, weight loss, sore throat and rash

44
Q

AIDS

A

develop over months to years with estimated median time of 11 yrs.

can be fatal in absence of tx

alters presentation of STIs

complicates tx of STI

fetal implications: w/ antiretroviral use and delivery at 38wks via c/s the transmission risk drops to <2%

Maternity (13 decks)

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