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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
How does chancroid present?
- Red papule that evolves into an ulcer surrounded by an inflammatory wheal - Multiple lesions may be present - Very tender and foul smelling
26
Treatment of chancroid
- Local symptomatic tx (Sitz baths, good hygiene) - Abx (azithro, ceftriax, cipro, erythro) - Treat partner
27
What is lymphogranuloma venereum?
Aggressive type of Chlamydia trachomatis
28
Who is MC affected by lymphogranuloma venereum?
- Tropical and subtropical nations (also SE USA) - Men 6:1 - Strongly a/w HIV
29
Treatment of lymphogranuloma venereum
Doxy or erythro
30
Describe syphilis
- Chronic, systemic disease | - Caused by spirochete Treponema pallidum
31
Primary syphilis
Painless genital sore (chancre) at site of inoculation a/w painless regional lymphadenopathy
32
Secondary syphilis
May involve skin, mucus membranes, eye, bone, kidneys, CNS, liver
33
Tertiary syphilis
- Gummatous lesions involving skin, bones, viscera - CV disease - CNS and ophtho lesions
34
What is the method of choice for diagnosing syphilis?
Serologic testing - Non-treponemal is screening test (VDRL and RPR become positive 4-6 wks after infection) - Treponemal is more specific
35
Treatment of syphilis
-Penicillin G in a single dose | doxy or tetracycline if allergic
36
What is the Jarisch-Herxheimer reaction?
- 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
Describe gonorrhea
- Caused by N. gonorrhea (gram negative diplococcus) | - Many women are asymp
38
Treatment of gonorrhea
- Abstain from intercourse for 7 days after therapy begins | - Dual therapy for chlamydia is recommended
39
What is pelvic inflammatory disease (PID)?
Combo of endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis
40
Etiology of PID
N. gonorrhea and C. trachomatis are MC causes
41
Etiology of PID in the setting of an IUD
A. israelii
42
Diagnosis of PID
Can be made clinically and empiric tx started if: - Pelvic/lower abd pain - No other cause identified - CMT or uterine or adnexal tenderness
43
Describe tubo-ovarian abscess
- Preceded by PID - Usually polymicrobial, unilateral - MC in younger females
44
Presence of TOA in a postmenopausal female?
Highly suggestive of concurrent malignancy
45
Treatment of TOA
- Unruptured: similar to inpatient tx of PID w/longer duration - Ruptured: life threatening, immediate surgery w/abx therapy (TAH-BSO)
46
What is toxic shock syndrome?
- Rare infection caused by S. aureus - Primarily menstrual females - A/w use of tampons
47
Treatment of TSS
- 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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