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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
t/f GC uncomplicated infxn single agent is recommended
FALSE | not recommended due to increasing resistance
26
GC treatment
ceftriazoxone 250 mg IM plus Asithromycin 1 G po single dose or Doxycycline 100mg BID for 7 days
27
chlamydial tx
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
28
sporadic uncomplicated fungal overgrowth of candida albicans
vulvovaginal candidiasis
29
RF for vulvovaginal candidiasis
uncontrolled DM or HIV
30
3 main sx of vulvovaginal candidiasis
vulvovaginal pruritis vulvovaginal burning thick cottage chees discharge
31
hyphae and spores on KOH of wet prep
VVC | vulvovaginal candidiasis
32
Rx for VVC
oral fluconazole | terconazole/ butoconazole / nystatin cream
33
3 main changes with GSM
1. vulvar thin and atrophy 2. loss elsasticity of CT (shortening and narrowing of vagina) 3. atrophic changes in urinary tract
34
urinary sx of menopause
urgency, frequency, dysuria, recurrent UTI incontinence
35
thin, pale mucosa, possible urethral caruncle
vuvluar atrophy
36
GSM microscopy findings
pH elevated, increase in WBCs, loss of superficial epithelial cells
37
nulliparous
normal healthy cervix | distinguished by shape of external os small round
38
parous
consistent with vaginal childbirth or at least cervical dilation
39
eversion of the squamocolumnar junction aka
ectropion
40
cervical neoplasms are almost always___
benign
41
cervical polyps are
benign neoplasia / growth
42
most common benign neoplasia..
cervical polyps
43
where do cervical polyps originate
ectocervix or endocervix
44
abnormal bleeding or none post coial bleeding vaginal discharge DDX
1. cervical polyp 2. endometrial polyp 3. prolapsed myoma 4. malignancy
45
tx for cervical polyp
avulse with polyp forceps cautery prn send to pathology
46
nabothian cyst def
mucinous retention or epithelial inclusion cysts on ectocervix
47
tx nabothian cyst
depends none or cautery
48
"vaginal fullness" sensation
nabothian cyst
49
Bartholin gland location
vestibular glands located in the vuvla
50
main function of Bartholin glands
secrete mucus to provide vulvar and vaginal lubrication
51
bartholin gland cyst def
blocked Bartholin duct with accumulation of mucus
52
Bartholin gland abscess
when obstructed duct becomes infected
53
who is at higher risk for Bartholin gland abscess?
women who are also at risk for STIs
54
women can barely walk, acute pain, cannot sit or have intercourse Fever purulent spontaneous drainage possible
Bartholin gland abscess
55
Bartholin gland cyst tx
sx: manage like abscess over 4o biopsy to r/o malignancy otherwise leave it alone of no sx
56
Bartholin gland abscess
spontaneous drainage analgesics or sitz baths Word catherter with I&D
57
do you give abx for Bartholin gland abscess?
only for recurrent abscess MRSA or STI +, high risk of sepsis
58
ex of congenital uterine disorders
uterine septum (bicornate or unicornuate) vaginal septum
59
asherman's syndrome
acquired, intrauterine adhesions from repeated cutterege procedures
60
benign endometritis def
inflammation of the endometrial lining of the uterus
61
what causes benign endometritis
ascending infection from lower genital tract
62
RF for endometritis
``` invasive gyne procedures IUD high risk behavior STI/D douching ```
63
in nonpregnant population____ is the most commonly associated with PID
benign endometritis
64
who typically has benign polyps?
peri and post menopausal women yet sometimes younger populations
65
Dx endometrial polyp
sonohysterogram SHGM
66
SHGM is...
office procedure at time of transvaginal ultrasound small catheter inserted into cervix with installation of saline at same time will show filling defects
67
adenomyosis
benign | presence of ectopic endometrial glands and stroma in myometrium
68
incidence of adenomyosis
parous women | usually 35-50 yo
69
adenomyosis vs endometriosis
adeno glands and stroma are in myometrium and from the basalis zone
70
unique sx of adenomyosis
chronic pelvic pain, dyspareunia
71
diffuse enlarged globular tender uterus
adenomyosis
72
adenomyosis tx
r/o malignancy NSAID Hysterecotmy: UAE, ablation, resection
73
Leiomyomata uteri
benign tumers of smooth muscle origin arise in myometrium
74
most common solid pelvic tumor in women
leiomyomata uteri
75
possible cause of benign adenomyosis
high estrogen levels lead to hyperplasia of basalis layer
76
most frequent indication for benign hysterectomy
leiomyomata uteri | fibroids
77
fibroids
leiomyomata uteri
78
t/f AA have higher rates of fibroids
true
79
pedunculated fibroids have increased risk of__
torsion and necrosis (acute pain)
80
intracavitary or submucosal fibroid are associated with ___
bleeding abnormalities
81
intramural or subserosal fibroids can be___
asymptomatic until they are very very large
82
tx for symptomatic fibroids
give OCP or injectable progestins to correct ovarian dysfunction progestin bearing IUD GnRH agonists: reduce uterine bulk
83
goal sx fibroid tx
minimize unopposed E
84
__ is the only fibroid surgical option for women who want to keep fertility while decreasing myoma bulk
myomectomy
85
endometrial hyperplasia def
overgrowth of proliferative endometrium resulting from protracted E stimulation in the absence of P "unopposed E"
86
RF for endometrial hyperplasia
obesity, nulliparity, early menarche, late menopause onset DM, HTN, hypothyroid, FH ovarian colon or uterine cancer etc
87
pap smear with glandular cells that might be atypical
think endometrial hyperplasia
88
D&C
dilation and curettage
89
endometrial hyperplasia tx without atypia
cyclical progestin therapy continuous progestin therapy repeat endometrial sampling 3-6mo
90
endometrial hyperplasia with atypia
D&C: r/o adenocarcinoma Hysterectomy High dose Progestin LNR-IUD

Repro Med Test 2 (6 decks)

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