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special pops - women's health > Cervical Disease/STDs/PID > Flashcards

Cervical Disease/STDs/PID Flashcards

1
Q

What are Nabothian cysts?

A
  • Very common, benign cervical cysts
  • Develop when crypts and clefts of columnar epithelium are bridged over and become occluded
  • Yellow or translucent
  • No tx required
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2
Q

Describe cervical polyps

A
  • Small penduculated neoplasms of cervix
  • Common (but rare before menarche)
  • Most are benign but should be removed and biopsied
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3
Q

Types of cervical polyps

A
  • Endocervical: red, flame shaped, fragile

- Ectocervical: pale, smooth, rounded, less likely to bleed

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4
Q

S/S cervical polyps

A

Intermenstrual or postcoital bleeding is MC

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5
Q

Treatment of cervical polyps

A
  • R/o infection w/cultures

- Polypectomy

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6
Q

MC type of cervical polyp

A

Ectocervical

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7
Q

Describe DES exposure in utero

A
  • DES is synthetic non-steroidal estrogen
  • Was used 1940-1971 to prevent premature birth, miscarriages
  • DES passed placenta and caused complications in offspring (increased risk of infertility, complicated pregnancies, vaginal clear cell carcinoma)
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8
Q

What is cervical intraepithelial neoplasia (CIN)?

A

Disordered growth and development of the epithelial lining of the cervix

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9
Q

Classification systems of CIN

A
  • Histologic (based on biopsy results alone)

- Bethesda system (cytologic, based on pap smear results)

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10
Q

Histologic classification of CIN

A
  • CIN 1: mild (disordered growth of lower 1/3 epithelial lining)
  • CIN 2: moderate (lower 2/3)
  • CIN 3: severe (more than 2/3)
  • Carcinoma in situ (full thickness dysplasia)
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11
Q

Bethesda system of CIN

A
  • ASC-US (atypical squamous cells of undetermined significance)
  • ASC-H (high grade lesion can’t be excluded)
  • LSIL (low grade squamous intraepithelial lesion, CIN 1)
  • HSIL (high grade lesion, CIN 2/3)
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12
Q

When is annual pap smear recommended?

A
  • HIV (twice in first year)
  • Hx of CIN 2 or 3 or cancer
  • DES in utero exposure
  • Immunosuppressed
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13
Q

How does CIN relate to cervical cancer?

A
  • CIN can become cancer

- All cancers start as CIN, grows slowly

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14
Q

Primary risk factor for CIN/cervical cancer?

A

HPV (esp 16 and 18)

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15
Q

MC s/s of cervical cancer?

A

Abnormal vaginal bleeding

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16
Q

Signs of late stage cervical cancer?

A

Weakness, wt loss, anemia

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17
Q

Where does cervical cancer MC occur?

A

90% occur within 1 cm of squamocolumnar junction

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18
Q

What is a colposcopy?

A
  • Directed biopsy of cervix
  • Visualizes the extent and location of CIN
  • Acetic acid brings out areas of dysplasia
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19
Q

Treatment of CIN

A
  • Destroy abnormal cells to prevent progression
  • Electrocautery, cryocautery, laser therapy
  • LEEP (loop electrodiathermy excision procedures)
20
Q

When does recurrence of cervical cancer MC occur?

A

Early after initial treatment (so frequent follow up necessary)

21
Q

MC causes of cervicitis

A
  • N. gonorrhoeae
  • C. trachomatis
  • HSV
  • HPV
  • Bacterial vaginosis
22
Q

Primary s/s of cervicitis

A

Purulent vaginal discharge (appearance depends on pathogen)

23
Q

What is cervicitis?

A

Inflammation of the cervix secondary to bacterial infection (MC STD)

24
Q

What is chancroid?

A

STI caused by gram negative rod H. ducreyi

25
Q

How does chancroid present?

A
  • Red papule that evolves into an ulcer surrounded by an inflammatory wheal
  • Multiple lesions may be present
  • Very tender and foul smelling
26
Q

Treatment of chancroid

A
  • Local symptomatic tx (Sitz baths, good hygiene)
  • Abx (azithro, ceftriax, cipro, erythro)
  • Treat partner
27
Q

What is lymphogranuloma venereum?

A

Aggressive type of Chlamydia trachomatis

28
Q

Who is MC affected by lymphogranuloma venereum?

A
  • Tropical and subtropical nations (also SE USA)
  • Men 6:1
  • Strongly a/w HIV
29
Q

Treatment of lymphogranuloma venereum

A

Doxy or erythro

30
Q

Describe syphilis

A
  • Chronic, systemic disease

- Caused by spirochete Treponema pallidum

31
Q

Primary syphilis

A

Painless genital sore (chancre) at site of inoculation a/w painless regional lymphadenopathy

32
Q

Secondary syphilis

A

May involve skin, mucus membranes, eye, bone, kidneys, CNS, liver

33
Q

Tertiary syphilis

A
  • Gummatous lesions involving skin, bones, viscera
  • CV disease
  • CNS and ophtho lesions
34
Q

What is the method of choice for diagnosing syphilis?

A

Serologic testing

  • Non-treponemal is screening test (VDRL and RPR become positive 4-6 wks after infection)
  • Treponemal is more specific
35
Q

Treatment of syphilis

A

-Penicillin G in a single dose

doxy or tetracycline if allergic

36
Q

What is the Jarisch-Herxheimer reaction?

A
  • Fever toxic state that can occur w/treatment of syphilis
  • Caused by a sudden destruction of spirochetes
  • Give antipyretics during 1st 24 hrs of treatment
37
Q

Describe gonorrhea

A
  • Caused by N. gonorrhea (gram negative diplococcus)

- Many women are asymp

38
Q

Treatment of gonorrhea

A
  • Abstain from intercourse for 7 days after therapy begins

- Dual therapy for chlamydia is recommended

39
Q

What is pelvic inflammatory disease (PID)?

A

Combo of endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis

40
Q

Etiology of PID

A

N. gonorrhea and C. trachomatis are MC causes

41
Q

Etiology of PID in the setting of an IUD

A

A. israelii

42
Q

Diagnosis of PID

A

Can be made clinically and empiric tx started if:

  • Pelvic/lower abd pain
  • No other cause identified
  • CMT or uterine or adnexal tenderness
43
Q

Describe tubo-ovarian abscess

A
  • Preceded by PID
  • Usually polymicrobial, unilateral
  • MC in younger females
44
Q

Presence of TOA in a postmenopausal female?

A

Highly suggestive of concurrent malignancy

45
Q

Treatment of TOA

A
  • Unruptured: similar to inpatient tx of PID w/longer duration
  • Ruptured: life threatening, immediate surgery w/abx therapy (TAH-BSO)
46
Q

What is toxic shock syndrome?

A
  • Rare infection caused by S. aureus
  • Primarily menstrual females
  • A/w use of tampons
47
Q

Treatment of TSS

A
  • Supportive therapy (fluids, vasopressors, packed RBCs)

- Abx 10-14 days (empiric is vancomycin and clindamycin IV)

special pops - women's health (11 decks)

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