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Repro Med Test 2 > Cervical / Vaginal Disorders > Flashcards

Cervical / Vaginal Disorders Flashcards

1
Q

when is physiologic discharge E dominant?

A

mid cycle / periovulatory

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2
Q

when is discharge P dominant?

A

post ovulatory

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3
Q

what does E dominant physiologic discharge look like

A

clear, stretchy, mucus

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4
Q

what does P dom. discharge look like/

A

white pasty or floccular discharge

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5
Q

chandelier sign

A

cervical motion tenderness

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6
Q

a polymicrobial syndrome resulting from replacement of lactobacillus normal flora with anaerobic bacteria

A

bacterial vaginosis

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7
Q

discharge is water, white/ gray

no itchy or urinary sx, no pain

A

bacterial vaginosis

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8
Q

fishy odor smell discharge

A

bacterial vaginosis

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9
Q

3 of 4 things that must be present for amsel criteria test

A
  1. gray white thin discharge at introitus and coat vaginal walls
  2. pH 4.5 or higher
    • whiff test
  4. presence of clue cells on wet mount
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10
Q

vaginal epithelial cells covered in coccobacilli with loss of distinct margins

also no WBC so lack of inflammatory cells

A

clue cells

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11
Q

metrogel intravaginally once per day for 5 days

A

bacterial vaginosis tx

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12
Q

frothy green, yellow, gray discharge

A

trichomonas vaginalis

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13
Q

strawberry cervix with pH over 4.5 or higher

A

trichomonas vaginalis

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14
Q

HIV transmission is enhanced by presence of ___

A

Trichomonas vaginalis

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15
Q

Trichomonas vaginalis

A

Metronidazole 2 gm per 1 dose

or

Tinidazole 2 gm per 1 dose

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16
Q

__ is 2nd most commonly reported communicable disease in US

A

GC

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17
Q

__ is most commonly reported bacterial infection in the US

A

chlamydial

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18
Q

racial ratio for gonorrhea

A

AA to Caucasian

12: 1

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19
Q

racial ratio for chlamydia

A

AA to Caucasian

6:1

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20
Q

acute onset of urethritis sx

purulent penile discharge and dysuria

A

GC/ CHL males

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21
Q

possible sx of cervical friability

A

asymptomatic

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22
Q

ucopurulent discharge on saline wet prep with WBC and bacteria

A

GC/ CHL cervicitis

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23
Q

routine screening for all pregnant women in 1st trimester

A

GC /CHL test

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24
Q

annual screen for all women that are sexually active both over and under age 25

A

GC / CHL

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25
Q

t/f GC uncomplicated infxn single agent is recommended

A

FALSE

not recommended due to increasing resistance

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26
Q

GC treatment

A

ceftriazoxone 250 mg IM
plus
Asithromycin 1 G po single dose or

Doxycycline 100mg BID for 7 days

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27
Q

chlamydial tx

A

3 options:

  1. azithromycin 1 G po dose observed in office
  2. doxy 100 g BID X 7 days
  3. Doxycylcine 200 mg daily for 7 days

Also…
EPT and test other sti / HIV

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28
Q

sporadic uncomplicated fungal overgrowth of candida albicans

A

vulvovaginal candidiasis

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29
Q

RF for vulvovaginal candidiasis

A

uncontrolled DM or HIV

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30
Q

3 main sx of vulvovaginal candidiasis

A

vulvovaginal pruritis
vulvovaginal burning
thick cottage chees discharge

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31
Q

hyphae and spores on KOH of wet prep

A

VVC

vulvovaginal candidiasis

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32
Q

Rx for VVC

A

oral fluconazole

terconazole/ butoconazole / nystatin cream

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33
Q

3 main changes with GSM

A
  1. vulvar thin and atrophy
  2. loss elsasticity of CT (shortening and narrowing of vagina)
  3. atrophic changes in urinary tract
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34
Q

urinary sx of menopause

A

urgency, frequency, dysuria, recurrent UTI incontinence

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35
Q

thin, pale mucosa, possible urethral caruncle

A

vuvluar atrophy

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36
Q

GSM microscopy findings

A

pH elevated, increase in WBCs, loss of superficial epithelial cells

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37
Q

nulliparous

A

normal healthy cervix

distinguished by shape of external os small round

38
Q

parous

A

consistent with vaginal childbirth or at least cervical dilation

39
Q

eversion of the squamocolumnar junction aka

A

ectropion

40
Q

cervical neoplasms are almost always___

A

benign

41
Q

cervical polyps are

A

benign neoplasia / growth

42
Q

most common benign neoplasia..

A

cervical polyps

43
Q

where do cervical polyps originate

A

ectocervix or endocervix

44
Q

abnormal bleeding or none
post coial bleeding
vaginal discharge

DDX

A
  1. cervical polyp
  2. endometrial polyp
  3. prolapsed myoma
  4. malignancy
45
Q

tx for cervical polyp

A

avulse with polyp forceps
cautery prn
send to pathology

46
Q

nabothian cyst def

A

mucinous retention or epithelial inclusion cysts on ectocervix

47
Q

tx nabothian cyst

A

depends none or cautery

48
Q

“vaginal fullness” sensation

A

nabothian cyst

49
Q

Bartholin gland location

A

vestibular glands located in the vuvla

50
Q

main function of Bartholin glands

A

secrete mucus to provide vulvar and vaginal lubrication

51
Q

bartholin gland cyst def

A

blocked Bartholin duct with accumulation of mucus

52
Q

Bartholin gland abscess

A

when obstructed duct becomes infected

53
Q

who is at higher risk for Bartholin gland abscess?

A

women who are also at risk for STIs

54
Q

women can barely walk, acute pain, cannot sit or have intercourse

Fever
purulent spontaneous drainage possible

A

Bartholin gland abscess

55
Q

Bartholin gland cyst tx

A

sx: manage like abscess
over 4o biopsy to r/o malignancy

otherwise leave it alone of no sx

56
Q

Bartholin gland abscess

A

spontaneous drainage analgesics or sitz baths

Word catherter with I&D

57
Q

do you give abx for Bartholin gland abscess?

A

only for recurrent abscess MRSA or STI +, high risk of sepsis

58
Q

ex of congenital uterine disorders

A

uterine septum (bicornate or unicornuate)

vaginal septum

59
Q

asherman’s syndrome

A

acquired, intrauterine adhesions

from repeated cutterege procedures

60
Q

benign endometritis def

A

inflammation of the endometrial lining of the uterus

61
Q

what causes benign endometritis

A

ascending infection from lower genital tract

62
Q

RF for endometritis

A 
invasive gyne procedures 
IUD 
high risk behavior 
STI/D 
douching
63
Q

in nonpregnant population____ is the most commonly associated with PID

A

benign endometritis

64
Q

who typically has benign polyps?

A

peri and post menopausal women

yet sometimes younger populations

65
Q

Dx endometrial polyp

A

sonohysterogram SHGM

66
Q

SHGM is…

A

office procedure at time of transvaginal ultrasound
small catheter inserted into cervix with installation of saline at same time

will show filling defects

67
Q

adenomyosis

A

benign

presence of ectopic endometrial glands and stroma in myometrium

68
Q

incidence of adenomyosis

A

parous women

usually 35-50 yo

69
Q

adenomyosis vs endometriosis

A

adeno glands and stroma are in myometrium and from the basalis zone

70
Q

unique sx of adenomyosis

A

chronic pelvic pain, dyspareunia

71
Q

diffuse enlarged globular tender uterus

A

adenomyosis

72
Q

adenomyosis tx

A

r/o malignancy
NSAID
Hysterecotmy: UAE, ablation, resection

73
Q

Leiomyomata uteri

A

benign tumers of smooth muscle origin

arise in myometrium

74
Q

most common solid pelvic tumor in women

A

leiomyomata uteri

75
Q

possible cause of benign adenomyosis

A

high estrogen levels

lead to hyperplasia of basalis layer

76
Q

most frequent indication for benign hysterectomy

A

leiomyomata uteri

fibroids

77
Q

fibroids

A

leiomyomata uteri

78
Q

t/f AA have higher rates of fibroids

A

true

79
Q

pedunculated fibroids have increased risk of__

A

torsion and necrosis (acute pain)

80
Q

intracavitary or submucosal fibroid are associated with ___

A

bleeding abnormalities

81
Q

intramural or subserosal fibroids can be___

A

asymptomatic until they are very very large

82
Q

tx for symptomatic fibroids

A

give OCP or injectable progestins to correct ovarian dysfunction
progestin bearing IUD

GnRH agonists: reduce uterine bulk

83
Q

goal sx fibroid tx

A

minimize unopposed E

84
Q

__ is the only fibroid surgical option for women who want to keep fertility while decreasing myoma bulk

A

myomectomy

85
Q

endometrial hyperplasia def

A

overgrowth of proliferative endometrium resulting from protracted E stimulation in the absence of P “unopposed E”

86
Q

RF for endometrial hyperplasia

A

obesity, nulliparity, early menarche, late menopause onset

DM, HTN, hypothyroid,
FH ovarian colon or uterine cancer etc

87
Q

pap smear with glandular cells that might be atypical

A

think endometrial hyperplasia

88
Q

D&C

A

dilation and curettage

89
Q

endometrial hyperplasia tx without atypia

A

cyclical progestin therapy
continuous progestin
therapy

repeat endometrial sampling 3-6mo

90
Q

endometrial hyperplasia with atypia

A

D&C: r/o adenocarcinoma
Hysterectomy
High dose Progestin
LNR-IUD

Repro Med Test 2 (6 decks)

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