amboss 7/3 Flashcards
what is the treatment for PID
intramuscular ceftriaxone and oral doxycycline
what is the presentation of trichomonas vaginalis
anaerobic, motile protozoan with flagella. Patients typically have foul-smelling, frothy, yellow-green, purulent vaginal discharge with a pH > 4.5.
hows vaginalis transmitted
Transmission of this disease occurs through unprotected sex.
what is the presentation of gardnerella vaginalis
grey discharge, foul smelling, clue cells and a positive whiff test
what is the whiff test
The Whiff test consists of applying potassium hydroxide to a slide with vaginal discharge, and is positive if this causes a fishy or amine odor.
which strains of HPV genital warts, or condylomata acuminata.
HPV strains 6 and 11 cause 90% of genital warts, or condylomata acuminata.
what is the presentation of atrophic vaginitis or old pussy
Receding pubic hair and a decreasing labial fat pad are typical. dyspareunia and vaginal dryness are usual complaints
what is a risk factor for bacterial vaginosis
vaginal douching
is bacterial vaginosis an STD
no
what increases the risk of relapse for vaginosis
douching, intercourse
first-line treatment for vulvovaginal candidiasis in pregnancy
Intravaginal clotrimazole is a topical antifungal agent. Treatment primarily aims at the relief of symptoms, as candidal vulvovaginitis is not associated with adverse outcomes in pregnancy.
what are the screening recommendations for STDs in women
The USPSTF recommends screening for N. gonorrhoeae and C. trachomatis infections in sexually active women < 25 years old. If they are not diagnosed and treated, these infections may cause pelvic inflammatory disease and potentially infertility.
what is the next step in someone with a positive VDLR and clinical signs of secondary syphilis
confirmatory test, usually with fluorescent treponemal antibody
what is the treatment of choice for syhilis
intramuscular penicillin G
what is the treatment of choice for syphilis in pregnancy
penicillin
what do you do when someone is allergic to penicillin
give them a desensitization dose.
is allergen desensitization safe during pregnancy
yes
what is an alternative to syphilis treatment
doxycycline
what is the first line treatment for chlamydial infection
oral azithromycin
can you use azithromycin in pregnancy
yes
what is the most common cause of unilateral bloody nipple discharge
intraductal papilloma
The combination of a painful breast lump and erythematous overlying skin in a postmenopausal woman should be taken to indicate
a malignancy until proven otherwise!
what is a phyllodes tumor
A large (> 3 cm), rapidly growing (i.e., progression over days-weeks) breast mass raises suspicion for phyllodes tumor. biopsy shows a leaf-like appearance under the microscope
An elevated CA-125 is highly suspicious
for ovarian malignancy in a post-menopausal woman with an adnexal mass.
what is age for ultrasound vs mammogram
- younger is ultrasound, older is mammo
what is first line therapy for people with invasive ductal carcinoma
breast conserving therapy with sentinel node biopsy
what is the treatment for breast cancer in a pregnant woman
surgical resection poses little risk.
chemotherapy can be given after the first trimester
what should be done for patients with a simple breast cyst
if it is symptomatic, then needle aspiration can reduce the symptoms; if asymptomatic then leave alone and reassure
what are the findings for turners syndrome
webbed neck, widely spaced nipples, normal uterus, streak ovaries (gonadal dysgenesis, primary amenorrhea), coarctation of the aorta
what causes congenital edema in turners
Dysfunction of the lymphatic system is characteristic of Turner syndrome and typically leads to congenital lymphedema of the hands and feet starting in the neonatal period
what is the cause of normal breast development, normal vaginal and ovarian development but NO uterus
mullerian duct agenesis
Patients with androgen insensitivity syndrome present
with primary amenorrhea, a blind vaginal pouch, an absent uterus on ultrasonography, and normal breast development. However, patients would not have pubic hair, since the growth of pubic hair is dependent on androgens. Ultrasonography would reveal undescended testicles.
what is the presentation of 5-α reductase deficiency
results in reduced amounts of DHT. thus the genitalia form as masculine-feminine, there is no breast development, no uterus or ovaries. the person is genetically male, but has a vagina
when do girls undergo normal pubertal changes and what are they
between 8-11. they will begin to develop breasts, have pubic and axillary hair, and begin to have oily skin
what is the presentation of aromatase deficiency
Individuals with aromatase deficiency are unable to convert androgens to estrogens. Therefore, karyotypically female (46 XX) patients are born with ambiguous external genitalia and present with female pseudohermaphroditism. They have normal internal genitalia. At the time of puberty, they fail to develop secondary sexual characteristics and typically present with amenorrhea (due to the development of ovarian cysts that impair ovulation) as well as features of virilization due to increased testosterone (e.g., severe acne, hirsutism). Mothers of affected children may develop similar features during pregnancy due to fetal androgens crossing the placenta. In addition to these abnormalities of sex development, female as well as male individuals frequently have a tall stature due to a delayed fusion of the epiphyseal growth plates and signs of osteoporosis (e.g., bone fractures after minor trauma), caused by estrogen deficiency.
what can obesity cause
precocious puberty
what is the typical developmental course for females
thelarche, pubarche, menarche
tits, pits, mits, lips
what is the presentation of central precocious puberty
secondary sex charcterisitics, elevated bone age with a positive GnRH stimulations test.
what is the next step after diagnosis of central precocious puberty
MRI brain
what are the treatments fo choice for central precocious puberty
MRI brain, luprolide to suppress testosterone and estrogen then excision of the tumor
Recurrent midcycle, unilateral, lower abdominal pain in an adolescent girl is suggestive of
mittelschmerz.
what is the presentation of congenital adrenal hyperplasia
can also lead to peripheral precocious puberty as the excess adrenal androgens are aromatized to estrogen in the ovaries. However, due to a general excess in androgens, females are often born with ambiguous or male external genitalia, and virilization during puberty is common. This girl has normal external genitalia and no evidence of virilization (e.g., male-pattern hair growth).
what is precocious puberty without central findings
granulosa cell tumor
what are the two types of emergency contraception
include levonorgestrel or ulipristal acetate.
what is the most effective emergency contraception
copper-containing IUD.
what is the drawback of a copper IUD
typically only given when the woman does not want to get pregnant
what is the appopriate work up for primary amenorrhea
pregnancy test, ultrasound, FSH and LH
what are the treatments for primary dysmenorrhea
NSAIDs and OCPs
what is first line therapy for abnormal uterine bleeding
conjugated estrogen
what is second line therapy for AUB
tranexamic acid
what is the flow of diagnostics for a patient with precocious puberty
must determine bone age first. sifters greater than a year difference then look to LH/FSH. if equivocal or low then GnRH for determining central vs peripheral
IF LH/FSH is HIGH, then MRI
Can you give Bactrim to breast feeding women?
no…due to the risk of kernicterus
what do you treat mastitis with
can use cefalexin, dicloxacillin
what is the most likely cause of mastitis
MSSA
what is the initial treatment for mastitis
cold compresses, NSAIDs, continue breast feeding
what is the treatment for fat necrosis of the breast
reassurance, no further workup
what is the presentation of fat necrosis
presence of a lump, oil cysts, foamy cells with multinucleated giant cells
what is first line therapy for PCOS patients to achieve pregnancy
letrozole therapy
what is the treatment for bartholin gland abscess
I and D; fistulization with a Word catheter is also an appropriate treatment
what is the first line test for AUB
endometrial biopsy
wha tis the treatment of choice for lichen sclerosis
rule out cancer and then treat with topical corticosteroids or clobetasol
what is the presentation of lichen sclerosis
postmenopausal with dyspareunia and pruritis with white vulvar plaque
what is the cause of exercise-induced amenorrhea
functional hypothalamic amenorrhea. there is reduced GnRH release from the hypothalamus
what is the treatment for premenstrual dysmorphic syndrome
SSRIs
what is the second line therapy for premenstrual dysmorphic syndrome
OCPs
what is the presentation of PMD
recurrent episodes of headaches, sleeping and concentration problems, and mood swings. These symptoms occur every month around the same time, preceding her menstrual period, which indicates premenstrual syndrome. Behavioral changes severe enough to cause a disturbance of her daily functional capacity suggests a diagnosis of premenstrual dysphoric disorder (PMDD).
what is given to women with leiomyomas
luprolide to reduce the size prior to surgery
is CT used in the diagnosis of endometriosis
no.
what is the diagnostic work flow for endometriosis
pelvic exam, ultrasound, laparoscopy
what is physiologic leukorrhea
non-purulent and does not have a strong odor. It is not irritating and therefore does not cause pruritus. Physiologic leukorrhea is typically seen at the onset of puberty (due to a surge in the levels of estrogen), around the time of ovulation (due to a peak in estrogen levels), prior to menstruation (due to pelvic congestion), and during pregnancy.
in a patient > 24 years old with atypical squamous cells of undetermined significance (ASC-US) detected on Pap smear, what is the next step
HPV testing is the recommended next step in management.
what is the presentation of adenomyosis
a benign disease characterized by the presence of endometrial tissue within the uterine wall. Typical symptoms include dysmenorrhea, menorrhagia, and chronic pelvic pain that worsens during menstruation. The displaced endometrial tissue can be seen as uniform uterine enlargement and diffuse thickening of the myometrium on transvaginal ultrasound and MRI.
what is endometrial hyperplasia
An abnormal thickening of the uterine lining caused by the proliferation of endometrial glands due to estrogen stimulation and insufficient progestin stimulation. Characterized by abnormal uterine bleeding. Suspected when endometrial thickness is > 5 mm on ultrasound in a postmenopausal woman.
Endometrial hyperplasia with atypia can progress to
endometrial cancer.
endometrial hyperplasia Confirmed with endometrial biopsy showing
glandular proliferation and a > 50% gland-to-stroma ratio.
when are combined OCPs contraindicated
in women over 35 that smoke
what can be used to treat HER2 positive cancer
trastuzumab
what should be done before initiating treatment for breast cancer
echocardiogram
what is the next step if there is a high grade lesion on pap smear
colposcopy
when is LEEP used
in an older patient with high grade lesion >24
what is the presentation of adenomyosis
boggy tender uterus that is increased in size
what is the presentation of endometritis
fever, abdominal pain, tender uteruse
what is the presentation of vaginal clear cell carcinoma
red fleshy pedunculated lesions that have cells with large clear cytoplasm
what is the best known risk factor for vaginal clear cell carcinoma
Diethylstilbestrol (DES) is a synthetic estrogen
this was given to pregnant mothers and their daughters developed cancer in the next generation
what is a risk factor for squamous cell carcinoma of the vagina
cigarette smoking
genitopelvic pain/penetration disorder (penetration disorder) is characterized by
persistent or recurrent difficulties during sexual intercourse. Characteristic symptoms include difficulty with vaginal penetration, vulvovaginal or pelvic pain during intercourse, anticipatory anxiety, and pronounced tightening of the pelvic floor muscles during attempted vaginal penetration.
what is the difference btetwqeen genitopelvic pain disorder and psychogenic dyspareunia
there is pelvic floor muscle tightening in genitopelvic pain
what is the most common type of vaginal cancer
squamous cell carcinoma 75%
what are the high risk HPV types
`16 and 18
what is the next step after a positive pregnancy test
need to have a quantitative beta to determine how long pregnancy. must confirm proper uterine pregnancy with transvaginal ultrasound.
what is the beta hCG threshold for transvaginal ultrasound
2500
what is the beta hCG threshold for abdominal ultrasound
6500
how much does b-hCG increase
doubles every 2.5 days
when is an HIV test recommended
once between the ages of 13-64
Screening for high blood pressure should be performed
annually in patients > 40 years and for those who are at an increased risk of developing hypertension.
A Pap smear should be conducted to screen for cervical cell dysplasia every
3 years starting at 21 years or every 5 years at 30 years, if combined with HPV testing.
Blood glucose levels are only routinely checked
in obese individuals aged 40–70 years.
Individuals at increased risk of cardiovascular disease should have a
screening serum lipid profile in adults of age 45–75 year.
Mammography is usually performed every
2 years in women between 50–74 years of age to look for suspicious nodules.
To screen for colorectal cancer,
either colonoscopy every 10 years, an annual fecal occult blood test, or sigmoidoscopy every 5 years is indicated in every adult ≥ 50 years of age.
A DEXA scan for osteoporosis should be performed
in postmenopausal women younger than 65 years who have at least one risk factor for osteoporotic fractures.
what are the risks of OCPs
hypertension, hepatic adenoma, thromboembolism, hyperlipidemia
are fine needle aspirations performed on ovaries
no. they are absolutely contraindicated in ovarian masses to avoid the risk of spreading malignancy in the perineum
what is a luteoma
Luteomas are rare benign tumors that develop from androgen-producing lutein cells. Although the majority of patients are asymptomatic, luteoma can manifest with features of virilization such as facial acne and hirsutism,
they are often bilateral multi nodular ovarian masses and often go away after birth
what is the most common cause of prolonged postpartum bleeding
uterine atony
what is the treatment for uterine atony
massage, oxytocin, and tranexamic acid, uterine tamponade can be used iff medical therapy does not work
what is diminished ovarian reserve
characterized by a decline in functioning oocytes and is most often a normal part of aging, although it can also be the result of an underlying disease or injury to the ovaries. DOR is present in about 10% of women who undergo IVF and does not cause any symptoms, although a shortening of the menstrual cycle is sometimes observed.
what is ashermans syndrome
sherman’s syndrome is characterized by endometrial adhesions and/or fibrosis mostly caused by dilation and curettage.
what is the test for PCOS
progesterone withdrawal test. if bleeding, then most likely anovulatory
when should HPV vaccination be given
As a part of the routine immunization schedule, 2 doses of HPV vaccine should be administered 6 months apart to all individuals 11–12 years of age. Current guidelines also recommend vaccination with 3 doses of nine-valent HPV vaccine for all unvaccinated female patients 13–26 years of age. Although the FDA has approved the HPV vaccine for patients up to age 45, it is not routinely recommended for patients > 26 years old by the CDC.
what is vaginismus
Sharp intracoital pain on attempted penetration (e.g., intercourse, tampon insertion) in an otherwise healthy young female suggests genito-pelvic pain disorder (vaginismus).
what is the treatment for Genito-pelvic pain syndrome
physical therapy
what should be done for a 21-24 year old with a low grade squamous intraepithelial lesion
Pap smear should be repeated twice at 12-month intervals in patients 21–24 years of age whose previous Pap smear has shown LSIL.
is weight gain a SE of OCP
no.
what can be done for acne in women
OCPs have shown effectiveness in treating acne
In women > 24 years of age with HSIL cytology next step
an immediate loop electrosurgical excision is generally acceptable.
what is a contraindication for LEEP
pregnancy
what are the treatments for hyemesis gravidarum
pyridoxine and doxylamine (H1 antagonist)
