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Reproductive Exam 2 > Benign and Malignant Diseases -Beaton > Flashcards

Benign and Malignant Diseases -Beaton Flashcards

1
Q

What is the most common vulvovagintis seen

A

Bacterial vaginosis

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2
Q

name the 4 types of bacterial vaginosis

A
  1. non-specific vaginalis
  2. gardnerella vaginalis
  3. haemophilus vaginalis
  4. corynebacterium vaginalis
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3
Q

what the s/s of bacterial vaginosis

A
  1. homogenous THIN discharge
  2. White/grey discharge
  3. “fishy” amine smell (especially with a change in pH)
  4. NOT pruritic
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4
Q

What can cause a change in vaginal pH

A

sex and period

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5
Q

What are the OB risks of bacterial vaginosis

A
  1. PROM
  2. premature delivery
  3. chorioamnionitis
  4. C-section
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6
Q

If you have bacterial vaginosis and have a C-section what are you at risk for

A

6x risk of post-cesarean endometritis

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7
Q

What is a GYN risk in presence of B.V

A

increased risk of vaginal cuff cellulitis in post-hysterectomy

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8
Q

How do you diagnose B.V

A
  1. discharge
  2. vaginal pH >5 (becoming less acidic)
  3. Clue cells
  4. sniff and whiff test –> 10% KOH added to discharge emits fishy, amine smell
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9
Q

what is clue cells

A

wet smear of epithelial cells with large # of bacteria on cells surface
-obscuring cell borders –> fuzzy cells

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10
Q

What methods can B.V be treated with

A

oral and topical

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11
Q

What oral meds treat BV

A

metronidazole
500mg BID for 7 days (Preferred) OR
2 grams single dose (less effective)

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12
Q

what should you avoid while taking metronidazole, why

A

alcohol; d/t disulfuram-like rxn –> makes you very sick

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13
Q

What topical treatments are used for BV

A

-Clindamycin cream 2%
once before bed for 7 days

-metronidazole vaginal gel
once before bed for 5 days

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14
Q

How should the partner of BV pt be treated

A

oral metronidazole simultaneously in recurrent cases

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15
Q

What is the 2nd most common vulvovaginitis

A

candidiasis

aka monilial vaginitis

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16
Q

what are the 3 causative agents of candidiasis

A

candida albicans
candida glabrata
candida tropicalis

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17
Q

what are the s/s of candidiasis

A
  1. THICK discharge
  2. white, cottage cheese, or curdish
  3. odorless OR “yeasty”
  4. Vulvar irritation
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18
Q

what symptoms are involved with vulvar irritation

A

erythema, intense pruritis, swelling of the vulvar

- can cause burning on peeing

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19
Q

what condition can candidiasis s/s be confused with

A

Herpes d/t the pain

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20
Q

How do diagnose candidiasis

A

10% KOH added to wet smear reveals HYPHAE under the microscope

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21
Q

what is the most COMMON pre-disposing factor of candidiasis

A

Broad -spectrum antibiotics

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22
Q

what are the other pre-disposing factors of candidiasis

A
  1. corticosteriods
  2. oral contraceptives
  3. Diabetes
  4. Pregnancy
  5. TIght fitting clothes - moisture/heat
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23
Q

how do you treat candidiasis

A

cream and oral

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24
Q

what are the different creams that can be used for candidiasis

A 
butoconazole 
terconazole
tioconazole 
clotrimazole
miconazole
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25
Q

what is the oral treatment for candidiasis

A

Fluconazole (1x dose)

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26
Q

what is the drawback for using just Fluconazole

A

its only effective against 1 of 3 species therefore it should be given with a cream too.

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27
Q

How do you treat a preggers with candidiaiss

A

same treatment BUT requires a longer treatment regimen

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28
Q

how do you treat a diabetic with candidiasis

A

you give the antifungals BUT you need to control their blood sugar or else the s/s won’t clear

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29
Q

are candidia and BV infections

A

Nope; they are common inhabitants of the vagina and usually “in balance”

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30
Q

So how does a person get one or the other (bv, candidiasis)

A

its usually a result of an imbalance and an overgrowth of one as compared to the other

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31
Q

Does treating candidiasis and BV totally eradicate them from the body

A

Nope; it just regresses the overgrowth so that it can go back to “checks and balances”

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32
Q

True/False; Trichomonas vaginalis and Chlamydia trachomatis are both true infections and STI

A

True

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33
Q

What are the s/s of Trichomonas vaginalis

A
  1. yellow -grey frothy discharge
  2. malodorous
  3. possible inflammation of vagina and cervix
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34
Q

strawberry cervix can be seen in what

A

Trichomonas vaginalis

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35
Q

how do you diagnose Trichomonas vaginalis

A

flagellated trichomonads on wet mount

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36
Q

how do you treat Trichomonas vaginalis

A

metronidazole
250mg TID for 7 days OR
500mg BID for 7 days OR
2 g 1x dose

all of the above have have equal effectiveness

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37
Q

can you treat Trichomonas vaginalis with creams too

A

NOPE! just oral therapy

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38
Q

when should the partner be treated

A

at the same time

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39
Q

What is the #2 most common STD

A

Chlamydia trachomatis

40
Q

what is the #1 cause of PID

A

Chlamydia trachomatis

41
Q

Chlamydia trachomatis can also commonly cause …

A

acute salpingitis

42
Q

what is the associated syndrome with Chlamydia trachomatis

A

Fitz-Hugh-Curtis Syndrome

43
Q

what is Fitz-Hugh-Curtis Syndrome

A

peri-hepatitis, liver capsule adhering to parietal peritoneum
aka “banjo string adhesion”

44
Q

can Chlamydia trachomatis be transferred to a newborn

A

YES! law requiring erythromycin ointment application to newborn eyes

45
Q

What is a symptom for Chlamydia trachomatis

A

mucopurulent cervicitis - a little more moisture than normal, often unnoticed

46
Q

how do you diagnose Chlamydia trachomatis

A

culture specific for chlamydia

47
Q

Increased of post-partum and post-C-section endometritis

A

Chlamydia trachomatis

48
Q

how do you treat Chlamydia trachomatis

A

Azithromycin (TOC) 1g x1 dose

All other Tx is 7-10 days
Tetracyline
Doxycycline (2nd TOC) - less irritation of GI
Erthromycin

49
Q

What is the most common cause of prepubertal vaginitis

A 
allergic rxn to bubble bath 
#2 is forgein objects
50
Q

if the culture comes back positive for GC, chlamydia or mycoplasma for prepubertal vaginitis what must be considered

A

sexual abuse

51
Q

how should the culture be taken for prepubertal vaginitis

A

with a q-tip, not a speculum

52
Q

what is the primary cause of post-menopausal vaginitis

A

estrogen deficiency (atrophic vaginitis)

53
Q

How do you treat post meno vaginitis

A

replace estrogen (oral or topical)

54
Q

acquired by sexual contact with someone with a reactivation of recurrent infection

A

The herps (herpes genitalis)

55
Q

Type 1 and Type 2 are generally categorized how

A

Type 1 - oral

Type 2 - genitals

56
Q

What are s/s of initial episodes of herps

A

pain, burning with peeing, urethritis, possible urinary retention
-flu sympt

57
Q

What will a primary herpes genitalis infection have

A

a vesicle full of viral particles with a red ring around it

58
Q

what is a complication Beaton talked about with herpes genitalis

A

labia may fuse from inflammation if desquamation occurs

59
Q

When does recurrent herpes outbreaks usually occur

A

common with stress or immune system suppression

60
Q

herpes is known for its prodrome, what s/s is it

A

burning or tingling felt by 60-70% of people at site of recurrence
-then lesion appears 1-3 days after

61
Q

how do you diagnose herpes

A

viral culture for herpes

62
Q

how do you treat herpes

A

valacyclovir or acyclovir (oral tabs) will reduce s/s and length of healing time BUT will not cure herpes

63
Q

what is better for herps, oral or topical

A

oral is way better

64
Q

What else is going to help with reducing s/s of herps

A

boost immune system, rest, nutrition, reduction of stress

65
Q

What are the 3 treatment alternative approaches

A

episodic, suppressive, and prophylactic

66
Q

what do you do when herps is episodic

A

treat when recurs

67
Q

what do you do to suppress herps

A

LONG TERM daily LOW DOSE Tx

-reduce recurrence

68
Q

What do you do as prophylaxis of heprs

A

SHORT TERM daily LOW DOSE Tx

-reduce outbreaks during anticipated stressful times

69
Q

what do you do for preggers how have herps

A

C-section if active lesions at time of labor

70
Q

what is the #1 STD

A

HPV

71
Q

HPV is a causitive agent for what infection

A

Condyloma acuminata (genital warts)

72
Q

HPV is also considered an agent in some cases of what

A

vulvar intraepithlelial neoplasm (VIN)

73
Q

what needs to be done when Condyloma acuminata is obseverd

A

pap smear with culposcopy of vulva, vagina, and cervix

74
Q

how do you treat HPV (im assuming he talking Condyloma acuminata )

A 
laser vaporization 
cryotherapy
5-FU- tpoical 
trichloroacetic acid 
bichloroacetic acid
25% podophyllin
75
Q

Regardless of Tx of Condyloma acuminata, what is the recurrence rate

A

20%

76
Q

How do you Tx Bartholin’s gland

A

incise and drainage
marsupialization
gland excision
AND if infection is present –> antibiotics

77
Q

what is marsupialization

A

incision in abscess to drain and also suture around the opening to keep it open, so it can continuously drain

78
Q

what are some characteristics of vulvar neoplasm

A
  1. hyperplastic OR atrophic lesion
  2. most COMMON –> persistent itch
    - but maybe asymptomatic (stupid)
79
Q

Name three vulvar neoplasia

A

vulvar dystrophy
vulvar intraepitheial neoplasia
vulvar squamous cell carcinoma

80
Q

is vulvar dystrophy benign or malignant

A

Benign

- however foudn to have potential to become CA (again stupid)

81
Q

vulvar dystrophy is hyperplatstic, why

A

mostly d/t local irritation

-raised, erythematous lesion with thickened keratin epithelial d/t acute insult

82
Q

how do you treat vulvar dystrophy

A

topical corticosteriods

83
Q

what is a type of vulvar dystropy mentioned in lecture

A

lichen sclerosis

unknown etiology

84
Q

what are the s/s of lichen sclerosis

A

thin, parchment like skin, itchy**

85
Q

how do you treat lichen sclerosis

A

potent steroid Clobetasol

86
Q

what do you do if tx doesnt work for lichen sclerosis

A

Biopsy

87
Q

is vulvar intraepithelia neoplasm (VIN) benign or malig

A

pre-malignant? (soooo yes?)

88
Q

if these vulvar crap doesn’t go away with Tx, whats the next step

A

BIOPSY

89
Q

name 2 types of VIN

A

paget’s disease and vulvar CIS

90
Q

Everything about Paget’s disease, go!

A

post-meno
red/pink w/ patches of hyperplastic white
looks like severe candidiasis

91
Q

what is the most common VIN

A

Vulvar CIS

92
Q

EVerything about vulvar CIS, GO!

A

happens at ANY AGE
various colors (red, pink, brown, white)
pruritic

93
Q

how is malignancy of vulvar squamous cell carcinoma dealt with

A

usually sent to gyn oncology

94
Q

what s/s is present 50% of the time for vyvlar squamous cell

A

long term pruritis or a lump/mass of vulva

95
Q

how is vulvar squamous cell carcinoma staged

A

0 Carcinoma in situ
1 Lesions < 2 cm
2 Lesions > 2 cm
3 Involves anus, LOWER urethra, vagina, and/or unilateral inguinal nodes
4 Involves UPPER urethra, bladder, rectal mucosa, bilateral inguinal nodes or distant sites

96
Q

how vulvar squamous cell carcinoma treated

A
  1. classical radical vulvectomy
  2. modified radical vulvectomy (via 3 incision apporach)
    - lower morbidity, lower wound breakdown

Reproductive Exam 2 (5 decks)

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