Clin Med Flashcards
How do you treat dysfunctional uterine bleeding?
NSAIDs!! (or Mirena IUD)
What are risks to developing urinary incontinence? (4)
- age
- hormonal status
- birthing trauma
- prolapse
How do you treat urinary incontinence?
anti cholinergics (oxybutinin, tolterodine)
How does vaginal neoplasia present?
can be flat, raised, white, red, black multicentric lesions
How do you treat bartholin’s gland cyst?
- none if asymptomatic
- drain w/ ward catheter or massupialize
- excision if recurrent
Patient presents with red/purple lesion on non-hair regions of vulva in HOURGLASS pattern with intense puritis
Lichen sclerosis
What are you at risk for with lichen sclerosis?
squamous cell carcinoma
How do you treat lichen sclerosis?
Stop scratch-itch cycle (steroids, topical high-potency then down titrate)
How do you diagnose bacterial vaginitis?
Amsler Criteria:
- Thin, homogenous vaginal d/c
- FISHY odor (KOH “whiff test”)
- clue cells (>20%)
- Vaginal pH>4.5
Do you want to get a culture to confirm BV?
NO!
How do you treat bacterial vaginitis?
- metronidazole
2. clundamycin
Patient presents with cheesy, white discharge and intense itching with inflamed vagina/vulva.
Candida infectious vaginitis
How do you treat vaginal candidiasis?
mild/moderate:
1.Imidazoles (clotrimazole, miconazole, nystatin) brief
Do you treat male sex partner of someone with vaginal candida?
Only if he has symptomatic balantis
What are common PMS sxs?
- headache
- breast pain
- bloating
- irritability
- attitude change
How do you diagnose PMDD?
- 5+ sxs before final week before menses
- improves after menses
- absent week after menses
- needs to disrupt daily fxns
How do you treat PMS/PMDD?
- limit caffeine, tobacco, etoh, Na
- frequent, high-complex carb meals
- stress management, aerobc exercise
- Chaste Berry, St. John’s Wort
What is a ddx for amenorrhea?
- GnRH defect
- pituitary defect (prolactin, FSH/LH)
- Ovarian defect (PCOS, menopause, dysgenesis)
- Mullerian defects or agenesis (primary)
How do you dx amenorrhea?
Progesterone challenge! (expect withdrawl bleeding) Indirectly determines if ovary is producing estrogen
How do you treat amenorrhea if pregnancy is desired?
Induce ovulation (clomiphene citrate)
How do you treat amenorrhea if pregnancy is not desired?
- OCPs
2. cyclic progesterone (esp. if OCPs contraindicated)
What is prolapsing if you see an anterior wall descent?
bladder
What is prolapsing if you see the posterior wall descending?
rectum
What is prolapsing in a central prolapse?
uterus