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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
What are risk factors for GC/Chlamydial infections? (A lot!)
- 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
What is the tx for GC infections?
Ceftriaxone + Azithromycin *if allergic to Azithromycin --> Doxycycline
27
T/F Doxycyline is contraindicated in pregnancy
T
28
Chlamydia tx:
Azithromycin 1 Gm. po single dose (observed therapy in office) Doxycycline
29
What are the recommendations for tx of the pt's partner if they are (+) for GC/Chlamydial infection?
EPT—expedited partner therapy appropriate
30
Retesting of GC/Chlamydial infections should occur in what timeframe?
3 months or whenever next seek care
31
____ is usually a sporadic, uncomplicated fungal overgrowth caused by Candida Albicans What is a common risk factor for this infection?
Vulvovaginal Candidiasis (VVC) Recent abx use, which may alter normal bacterial flora of vagina
32
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 ___
Uncontrolled DM or HIV
33
What are some sx of Vulvovaginal Candidiasis (VVC)?
Vulvovaginal pruritis Vulvovaginal burning Thick white odorless “cottage cheese” discharge
34
What is the pH for Vulvovaginal Candidiasis (VVC)? What is seen on wet prep?
pH is normal Yeast on wet prep (spores and/or hyphae)
35
What is the success rate for OTC tx option for women with Vulvovaginal Candidiasis (VVC)?
80% cure rate Butoconazole/Clotrimazole/Miconazole/Tioconazole
36
What Rx can you use to tx a woman w/ Vulvovaginal Candidiasis (VVC)?
Oral Fluconazole | Terconazole/Butoconazole/Nystatin Cream or Suppository
37
What are some symptomatic tx options that can be provided to a woman with Vulvovaginal Candidiasis (VVC)?
Combined topical steroid and antifungal for vulvar inflammation Sitz bath w/ bicarbonate of soda Avoid contact w/ other contact irritants
38
___ is a viral infxn acquired by skin-to-skin contact or mucous membrane contact during periods of active shedding (is considered a STI)
HSV 1 or 2
39
Genital HSV previously mostly HSV ___related Genital HSV __ shift related to increase in oral-genital contact
HSV 2 HSV 1
40
Primary infection becomes latent in the ____ and can reactivate, causing a ____
dorsal root ganglia | recurrent infection
41
T/F Neonatal herpes is not a serious issue because it can be treated easily
F: Neonatal herpes comes with serious consequences
42
What are S/s of HSV 1 and 2 (Cervicitis/Vaginitis)?
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
What can you use to dx HSV 1/2 (Cervicitis/Vaginitis)?
DNA polymerase chain rxn (PCR)
44
T/F Topical acyclovir is a very effective tx option for HSV 1/2 (Cervicitis/Vaginitis)
F, it is not
45
What can be used for tx of symptomatic HSV 1/2 (Cervicitis/Vaginitis)?
Oral acyclovir/famciclovir/valacyclovir Topical comfort: Anesthetic—2% lidocaine gel, warm saline baths, urinate in tub, avoid contact irritants
46
What are S/s of vaginal FB?
Malodorous, bloody discharge
47
___ is due to decreased Estrogen stimulation of the vulva, vagina, and lower urinary tract resulting in thinning and dryness
Genitourinary Syndrome of Menopause (GSM)
48
What is Genitourinary Syndrome of Menopause (GSM) | associated w/?
- Vulvar thinning and atrophy - Loss of elasticity of CT resulting in shortening and narrowing of vagina - Atrophic changes in urinary tract
49
What are sx of Genitourinary Syndrome of Menopause (GSM)?
Vaginal: Dryness, pruritus, burning, discharge, spotting, dyspareunia, thin gray or yellow discharge Urinary: Urgency, frequency, dysuria, recurrent UTI, incontinence
50
What does vaginal atrophy look like?
``` Thin Pale mucosa Possible urethral caruncle Erythematous with petechiae, Erosions --> contact bleeding Pelvic irgan prolapse ```
51
What is seen on microscopy of Genitourinary Syndrome of Menopause (GSM)?
pH elevated Increase in WBCs Loss of superficial epithelial cells
52
What are Genitourinary Syndrome of Menopause (GSM) tx options? What are non-pharm tx options?
Topical - Intravaginal Estrogen cream - Tablet (VagiFem) - Slow-release ring (EstRing) Systemic - Estrogen or combination HRT Non-pharm - EVOO (Extra virgin olive oil)
53
What does Nulliparous mean? What does Parous mean?
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
Is eversion of the SCJ (squamocolumnar junction) a normal or abnormal cervical variant? When is it commonly seen?
Normal variant During pregnancy
55
___ are the most common form of benign neoplasia and originate in ectocervix or endocervix.
Cervical polyps
56
What are some sx associated with cervical polyps?
Can be asymptomatic Abnormal bleeding Post-coital bleeding Vaginal discharge
57
DDx of cervical polyps
Endometrial polyp Prolapsed myoma Malignancy
58
What is the tx of cervical polyps?
Avulse w/ polyp forceps Cautery prn Send for pathology
59
___ is a mucinous retention of epithelial inclusion cysts on the ectocervix
Nabothian cyst
60
What are the sx and tx for a Nabothian cyst?
Usually asymptomatic, possibly vaginal fullness if large No tx required, or cautery

Repro. Med 2 (12 decks)

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