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Repro. Med 2 > Cervical D/O > Flashcards

Cervical D/O Flashcards

1
Q

What does spinnbarkheit mean? (what is it describing?)

A

The “stringiness” of cervical mucus

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2
Q

What is the DDx for infectious discharge?

A 
Bacterial Vaginosis (BV)
Trichomonas vaginalis (Trich)
Neisseria gonorrhoeae (GC)
Chlamydia trachomatis (Chl)
Vulvovaginal Candidiasis (VVC)
Herpes Simplex Virus 1 or 2 (HSV 1 or 2)
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3
Q

What is the normal pH for the vaginal canal?

Where should you get a sample for the pH test?

A

3.8-4.2

Midway in the vaginal sidewall

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4
Q

What is the most common STD test that is used?

A

NAAT (nucleic acid amplification test)

**get sample before contamination with KY jelly for bimanual exam

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5
Q

What may you be checking for during a bimanual exam?

A

Endometriosis
PID
Tubo ovarian abscess

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6
Q

____ is the most common cause of vaginal discharge in woman of childbearing years

A

BV (bacterial vaginosis)

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7
Q

Describe BV (bacterial vaginosis).

A

A polymicrobial syndrome resulting from replacement of normal flora (lactobacillus) with anaerobic bacteria

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8
Q

What are some sx of BV (bacterial vaginosis)?

A

Patients can be asymptomatic, or they can have watery, white/grey discharge
NO pruritus/UTI sx/Pain
Foul fishy odor

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9
Q

What is the pH for BV (bacterial vaginosis) ?

Would the whiff test be (-/+)?

What would be seen on the wet mount?

A

pH 4.5+

+ Whiff test

Clue cells on saline wt mount

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10
Q

What is the goal of tx for BV (bacterial vaginosis)?

How would this be achieved?

A

Restore vaginal homeostasis

Various preparations with the following meds:
Metronidazole (no alcohol!) –> Antabuse effect
Clindamycin
Tinidazole

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11
Q

What are some pt education tidbits you may tell a pt when treating them for BV (bacterial vaginosis)

A

No alcohol!

Clindamycin can decrease efficacy of condoms and diaphragms

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12
Q

____ is an infection caused by the protozoan T. vaginalis

A

Trichomonas Vaginalis (Trich)

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13
Q

What are sx of Trichomonas Vaginalis (Trich)?

A 
The pt may be asymptomatic 
Copious yellow/gray/green discharge, may be frothy
Possibly mixed with blood
Malodorous
Often have vulvar pruritus and dysuria
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14
Q

Upon exam, how will the cervix look if a pt is infected w/ Trichomonas Vaginalis (Trich)?

A

May have vulvar/vaginal erythema and inflammation

“Strawberry cervix”

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15
Q

What is the pH for Trichomonas Vaginalis (Trich)?

What is seen on the wet prep?

A

pH 4.5+

Wet prep saline w/ numerous WBCs and motile Trichomonads

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16
Q

What can you use to tx Trich?

A

Metronidazol - no alcohol!!
Tinidazole

*partner needs tx too, EPT

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17
Q

___ is the 2nd most commonly reported communicable dz in the US

A

GC

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18
Q

What are the most common ages for GC infection?

What population is at a higher risk for GC infection?

A

Women 20-24 y/o, 15-19 y/o; Men 20-24 y/o

African American >12: 1 Caucasian

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19
Q

___ is the most commonly reported bacterial infection in the US

What are the most common ages to be infected?

A

Chlamydia

Women 15-24 y/o; Men 20-24 y/o
African American 6:1 Caucasian

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20
Q

What are the sx of GC/Chlamydial infections in Males vs. Females?

A

Male: dx usually earlier, urethritis, epididymitis, purulent discharge, dysuria

Females: mucopurulent discharge, asymptomatic, cervical friability or edema

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21
Q

What is seen on a wet prep for GC/Chlamydial infections?

A

++WBC

Bacteria

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22
Q

T/F Routine annual screening is recommended in ALL sexually active females <25y/o for GC and Chlamydia

A

T

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23
Q

T/F Routine screening of all pregnant women in 3rd trimester for GC and chlamydia

A

F; test in 1st trimester

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24
Q

When do you screen women >25 y/o for GC/Chlamydial infections?

A

Screening of sexually active women >25 with risk factors

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25
Q

What are risk factors for GC/Chlamydial infections? (A lot!)

A
  • Sexually active women <25 years old
  • Pregnancy
  • Inconsistent condom use
  • Hx of multiple partners
  • Presence of current STI (Trich, HSV) or sexually associated disease (BV)
  • Partner with culture-proven STI
  • Hx of repeated episodes STI
  • Sex work or drug use
26
Q

What is the tx for GC infections?

A

Ceftriaxone + Azithromycin

*if allergic to Azithromycin –> Doxycycline

27
Q

T/F Doxycyline is contraindicated in pregnancy

28
Q

Chlamydia tx:

A

Azithromycin 1 Gm. po single dose (observed therapy in office)

Doxycycline

29
Q

What are the recommendations for tx of the pt’s partner if they are (+) for GC/Chlamydial infection?

A

EPT—expedited partner therapy appropriate

30
Q

Retesting of GC/Chlamydial infections should occur in what timeframe?

A

3 months or whenever next seek care

31
Q

____ is usually a sporadic, uncomplicated fungal overgrowth caused by Candida Albicans

What is a common risk factor for this infection?

A

Vulvovaginal Candidiasis (VVC)

Recent abx use, which may alter normal bacterial flora of vagina

32
Q

Complicated VVC is a chronic or recurrent infection, may be caused by other Candida species (C. glabrata) and/or may be associated w/ underlying disease such as ___ or ___

A

Uncontrolled DM or HIV

33
Q

What are some sx of Vulvovaginal Candidiasis (VVC)?

A

Vulvovaginal pruritis
Vulvovaginal burning
Thick white odorless “cottage cheese” discharge

34
Q

What is the pH for Vulvovaginal Candidiasis (VVC)?

What is seen on wet prep?

A

pH is normal

Yeast on wet prep (spores and/or hyphae)

35
Q

What is the success rate for OTC tx option for women with Vulvovaginal Candidiasis (VVC)?

A

80% cure rate

Butoconazole/Clotrimazole/Miconazole/Tioconazole

36
Q

What Rx can you use to tx a woman w/ Vulvovaginal Candidiasis (VVC)?

A

Oral Fluconazole

Terconazole/Butoconazole/Nystatin Cream or Suppository

37
Q

What are some symptomatic tx options that can be provided to a woman with Vulvovaginal Candidiasis (VVC)?

A

Combined topical steroid and antifungal for vulvar inflammation

Sitz bath w/ bicarbonate of soda

Avoid contact w/ other contact irritants

38
Q

___ is a viral infxn acquired by skin-to-skin contact or mucous membrane contact during periods of active shedding (is considered a STI)

A

HSV 1 or 2

39
Q

Genital HSV previously mostly HSV ___related

Genital HSV __ shift related to increase in oral-genital contact

A

HSV 2

HSV 1

40
Q

Primary infection becomes latent in the ____ and can reactivate, causing a ____

A

dorsal root ganglia

recurrent infection

41
Q

T/F Neonatal herpes is not a serious issue because it can be treated easily

A

F: Neonatal herpes comes with serious consequences

42
Q

What are S/s of HSV 1 and 2 (Cervicitis/Vaginitis)?

A

Wide spectrum from asymptomatic to painful genital ulceration to rare systemic complications

Cervical involvement can be isolated & present with profuse vaginal discharge

Vulvovaginal and cervical vesicular lesions/discharge

43
Q

What can you use to dx HSV 1/2 (Cervicitis/Vaginitis)?

A

DNA polymerase chain rxn (PCR)

44
Q

T/F Topical acyclovir is a very effective tx option for HSV 1/2 (Cervicitis/Vaginitis)

A

F, it is not

45
Q

What can be used for tx of symptomatic HSV 1/2 (Cervicitis/Vaginitis)?

A

Oral acyclovir/famciclovir/valacyclovir

Topical comfort: Anesthetic—2% lidocaine gel, warm saline baths, urinate in tub, avoid contact irritants

46
Q

What are S/s of vaginal FB?

A

Malodorous, bloody discharge

47
Q

___ is due to decreased Estrogen stimulation of the vulva, vagina, and lower urinary tract resulting in thinning and dryness

A

Genitourinary Syndrome of Menopause (GSM)

48
Q

What is Genitourinary Syndrome of Menopause (GSM)

associated w/?

A
  • Vulvar thinning and atrophy
  • Loss of elasticity of CT resulting in shortening and narrowing of vagina
  • Atrophic changes in urinary tract
49
Q

What are sx of Genitourinary Syndrome of Menopause (GSM)?

A

Vaginal: Dryness, pruritus, burning, discharge, spotting, dyspareunia, thin gray or yellow discharge

Urinary: Urgency, frequency, dysuria, recurrent UTI, incontinence

50
Q

What does vaginal atrophy look like?

A 
Thin
Pale mucosa
Possible urethral caruncle
Erythematous with petechiae,
Erosions --> contact bleeding
Pelvic irgan prolapse
51
Q

What is seen on microscopy of Genitourinary Syndrome of Menopause (GSM)?

A

pH elevated
Increase in WBCs
Loss of superficial epithelial cells

52
Q

What are Genitourinary Syndrome of Menopause (GSM) tx options?

What are non-pharm tx options?

A

Topical

  • Intravaginal Estrogen cream
  • Tablet (VagiFem)
  • Slow-release ring (EstRing)

Systemic
- Estrogen or combination HRT

Non-pharm
- EVOO (Extra virgin olive oil)

53
Q

What does Nulliparous mean?

What does Parous mean?

A

nulliparous = no childbirth/dilation of the cervix, cervix would appear small and round

parous = vaginal childbirth has occurred, cervical dilation, slit-like cervical opening

54
Q

Is eversion of the SCJ (squamocolumnar junction) a normal or abnormal cervical variant?

When is it commonly seen?

A

Normal variant

During pregnancy

55
Q

___ are the most common form of benign neoplasia and originate in ectocervix or endocervix.

A

Cervical polyps

56
Q

What are some sx associated with cervical polyps?

A

Can be asymptomatic
Abnormal bleeding
Post-coital bleeding
Vaginal discharge

57
Q

DDx of cervical polyps

A

Endometrial polyp
Prolapsed myoma
Malignancy

58
Q

What is the tx of cervical polyps?

A

Avulse w/ polyp forceps
Cautery prn

Send for pathology

59
Q

___ is a mucinous retention of epithelial inclusion cysts on the ectocervix

A

Nabothian cyst

60
Q

What are the sx and tx for a Nabothian cyst?

A

Usually asymptomatic, possibly vaginal fullness if large

No tx required, or cautery

Repro. Med 2 (12 decks)

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