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Gynecology 2021 > First Half > Flashcards

First Half Flashcards

1
Q

What are some signs seen during a pelvic exam for a patient with Desquamative Inflammatory Vaginitis?

A

Vaginal wall is erythematous, inflamed, desuamated, with thick purulent discharge and a white membrane covering the vaginal walls.

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2
Q

How can you manage Desquamative Inflammatory Vaginitis?

A

Topical intravaginal:
2% Clindamycin cream or 10% hydrocortisone
QHS x 4-6 weeks.
Have them come back in few months to check for re-occurrence

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3
Q

What is needed for definitive diagnosis of Adenomyosis?

A

Histology

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4
Q

What is the best way to confirm a suspicion of endometriosis?

A

Direct visualization (laparoscopy / laparotomy)

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5
Q

What are the 4 signs/symptoms that meet the Ansel criteria for bacterial vaginosis?

A

+whiff, homogenous gray/white discharge, clue cells, pH >4.5

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6
Q

What is the difference between vulvodynia and vestibulodynia?

A

Vulvodynia is unprovoked pain that occurs all the time. Vestibulodynia is asymptomatic unless when touched on the vestibule.

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7
Q

Pt presents with vaginal discharge, dysuria and dyspareunia with vaginal pH>4.5. Wet mount does not show any clue cells. Vaginal wall is erythematous, inflamed and desquamated. What is most likely diagnosis?

A

desquamative inflammatory vaginitis

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8
Q

Pt comes in that with pain, inflammation and purulent drainage. She is having difficulty ambulating and does not wish to sit down. What is most likely diagnosis?

A

bartholin duct cyst/abscess

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9
Q

What the three phases of the ovarian cycle?

A

Follicular, Ovarian, Luteal

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10
Q

What is the most important enzyme that the corpus luteam produces and what is the major function of this enzyme?

A

Progesterone; to increase the thickness of the endometrial lining to prepare for a fertilized egg

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11
Q

White, thick, “cottage cheese-like” discharge from a female is typically associated with what infection?

A

Vaginal Candidiasis

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12
Q

Risk factors for bacterial vaginosis

A 
sexually active 
vaginal hygiene (douching, urinate after intercourse, ect)
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13
Q

Whats the treatment for chlamydia?

A

Azithromycin 1 g po once
OR
Doxycycline 100 mg po BID x 7 days

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14
Q

Treatment of desquamative inflammatory vaginitis?

A

Topical - qhs x 4-6 weeks
2% Clindamycin cr
OR
10% Hydrocortisone

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15
Q

How is the length of the menstrual cycle calculated?

A

Day 1 of bleeding from one cycle up until day 1 of the next

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16
Q

What are the risk factors for prolapse?

A 
Parity
Advancing age
Obesity
Hysterectomy
Chronic constipation
Family Hx
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17
Q

which hormone nourishes the endometrium for implantation?

A

progesterone

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18
Q

what can cause delays in menarche?

A

poor nutrition, chronic illness or mental health issues

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19
Q

What medication should be given to the UTI patient who is 10 weeks pregnant?

A

Ampicillin or cephalosporins

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20
Q

What are the long-term complications of PID?

A

Infertility and ectopic pregnancies

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21
Q

What hymen variant should be considered in a post-pubescent but amenorrhagic female?

A

Imperforate hymen

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22
Q

In what ways is estrogen protective?

A

Prevents osteoporosis, arteriosclerosis and atherosclerosis via vasodilation and cholesterol-lowering properties, slows progression of Alzheimer’s

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23
Q

Which of the three “v-dynias” is associated with - unprovoked burning, pain, itching, irritation of the vulva lasting 3+ months with normal PE?

A

Generalized vulvodynia

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24
Q

What is the first line treatment for moderate-severe PMS or PMDD?
What is the second line treatment?

A

1st line: SSRIs

2nd line: hormonal contraception

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25
Q

How many physical and affective symptoms need to be present for a diagnosis of PMDD?

A

at least 5 symptoms with affective symptoms being more severe than physical

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26
Q

Which phase of the menstrual cycle is associated with the formation of the corpus luteum?

A

luteal phase of ovarian cycle

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27
Q

What pathogen is the most common cause of UTIs?

A

E. coli

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28
Q

What causes a tender, large, and boggy uterus?

A

Adenomyosis

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29
Q

What are some factors that could delay menarche?

A

poor nutrition, chronic illness, or mental health issues

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30
Q

What is the medical treatment for bacterial vaginosis?

A

metronidazole PO 500mg x7 days OR gel BID x5 days

alternate: clindamycin

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31
Q

What are gynecologic causes of secondary dysmenorrhea?

A

endometriosis, adenomyosis, fibroids, ovarian cysts, adhesions, endometrial polyps, congenital obstruction, IUD, pelvic congestion syndrome

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32
Q

A patient comes in with a chief complaint of painful sexual intercourse. After further questioning, she reveals that it is penetration that hurts the most, to the point that she cannot endure any sexual penetration. Sometimes she anticipates the pain. There is no burning or itching. What is the most likely diagnosis?

A

Vaginismus

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33
Q

An elderly woman comes into the clinic with a complaint that she feels like something is “slipping out” of her vagina. To remedy this, she placed an apple up her vaginal canal to keep everything in place. What are your two main concerns for a differential diagnosis?

A

Foreign body and prolapse

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34
Q

What is the first-line treatment for Gonorrhea?

A

Ceftriaxone 500 mg (add Doxy if you cannot rule out chlamydia co-infection)

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35
Q

What are hormone therapy options for Endometriosis management?

A

Combined contraceptives, progestin options, and specialty measures (Danazol and GnRH agonists)

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36
Q

What hormone change causes the release of the oocyte from the follicle?

A

LH surge → from increased levels of estrogen production of dominant follicle

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37
Q

What are two STIs that may cause the cervix to be friable on examination?

A

Chlamydia

Gonorrhea

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38
Q

A patient presents with green, malodorous discharge and a strawberry cervix is seen on examination. What diagnosis is suspected?

A

Trichomoniasis

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39
Q

What are the Ansel criteria to diagnosis BV?

A

+ whiff, homogenous
grey/white discharge
Clue cells
pH >4.5

40
Q

What factors worry you that a UTI may be complicated instead of uncomplicated?

A

uncontrolled diabetes mellitus, pregnant, hospital associated, catheter associated, kidney disease, urinary tract obstruction/defect, immunocompromised

41
Q

What follow up precautions are patients educated about to ensure their PID is not worsening?

A

Worsening pain, fever, masses, inability to tolerate PO

42
Q

What are risk factors for interstitial cystitis?

A

Woman, age > 30, hx of FM or IBS

43
Q

How do you manage a Bartholin abscess?

A
  • send to Gyn/ED for more imaging and pain control
  • I & D with word catheter to prevent refilling
  • If recurrent or complicated, marsupialization
44
Q

How many symptoms must be present to diagnose premenstrual dysphoria disorder?

A

At least 5 present in the last week of the cycle (minimum of one from each group)

45
Q

What is the treatment for interstitial cystitis?

A

Identify and avoid triggers, stress management and dietary changes. Pentosan polysulfate (Elmiron) may help by decreasing permeability to urine solutes, antihistamines may help, hydrodistension (bladder stretching) may alleviate symptoms

46
Q

What is the treatment for vaginal candidiasis?

A

Fluconazole 150mg x1 dose or Topical azoles

47
Q

What is first-line treatment for uncomplicated UTI that does not extend past the bladder?

A

Nitrofurantoin (Macrobid) or TMP-SMX (Bactrim)

48
Q

Most common bacteria associated with pyelonephritis

A

E. coli

49
Q

What is required to avoid while on metranidazole?

A

Alcohol

50
Q

How does HPV appear as a genital lesion?

A

Soft, flesh-like cauliflower lesion

51
Q

A patient comes in and after running some tests she is positive for gonorrhea AND chlamydia. How do you approach treatment?

A

Ceftriaxone 500mg IM once and doxycycline x 1 week

52
Q

what are the two reportable STIs?

A

gonorrhea and chlamydia

53
Q

If a patient presents with 3 sx at least 5 days before menses for at least 3 consecutive days and end within 4 days of menses beginning. What is the most likely diagnosis?

A

Premenstrual syndrome (PMS)

54
Q

21 y/o female presents with yellow discharge, strong odor, and pruritus for the past week after unprotected sex. What is the most likely diagnosis?

A

Trichomoniasis

55
Q

What is progesterone produced by?

A

Corpus luteum

56
Q

28 y/o female presents with profuse vaginal discharge, dysuria, and dyspareunia. Her physical exam reveals her vaginal wall is erythematous, inflamed, and desquamated. What is her most likely diagnosis?

A

Desquamative inflammatory Vaginitis

57
Q

PMS and PMDD are associated with which phase of the menstrual cycle?

A

luteal phase

58
Q

What is the pathophysiology of 1° dysmenorrhea?

How is this related to the first line treatment for 1° dysmenorrhea?

A

2/2 prostaglandins, causing uterine contraction and hypoxia

1st line treatment is NSAIDs, aka COX inhibitors, which will reduce prostaglandin synthesis

59
Q

Common sites for nodules in an endometriosis patient?

A

Ovaries (MC)
GU Organs
Colon

60
Q

Signs and symptoms of endometriosis

A

Infertility, premenstrual pain, dyspareunia with deep penetration, and abnormal bowels & urine.

61
Q

What is mittelschermz?

A

Pain during ovulation that can sometimes have spotting.

62
Q

What is the first line treatment for moderate to severe PMS & PMDD?

A

SSRI

63
Q

What three components are believed to regulate sexual function?

A

the individual’s motivation (desire/libido)
endocrine competence
sociocultural beliefs

64
Q

What is the obstetric history of this woman, G3P1011?

A

She is currently pregnant, has had one full term delivery, one miscarriage, and has one living child.

65
Q

What is the most important hormone in the luteal phase of the menstrual cycle

A

Progesterone

66
Q

What are common treatment for prolapse if symptomatic

A

Pelvic floor PT, Weight loss, pessary, surgical management

67
Q

what are the 5 main roles of progesterone?

A

stimulate milk producing glands, increased basal temperature at ovulation, nourish endometrium for implantation, suppress ovulation during pregnancy, stimulate contractions at end of pregnancy

68
Q

what is the medical treatment for PID?

A

ceftriaxone 250 mg IM + doxycycline 100 mg PO BID x 14 d

69
Q

25 year old female pt presents with a white curd like discharge, how should you treat her?

A

fluconazole

70
Q

18 year old pt who is newly sexually active and is concerned of new white/creamy vaginal discharge. States her menstrual cycle is about to start in a few days. How should you treat her?

A

with education, this is likely physiologic but can refer for outpatient STI testing due to her new sexual activity.

71
Q

What categories should be included within the ob/gyn health history?

A

Menstrual history, contraceptive history, sexual history, and obstetric history

72
Q

What are the 5 P’s of taking a sexual history?

A

Partners, Planning of Pregnancy, Protection from STIs, Practices, Past History of STIs

73
Q

what is first line treatment for primary dysmenorrhea, and why?

A

NSAIDs and hormonal contraceptives. NSAIDs have anti-prostaglandin effect and hormonal contraceptives causing anovulation will reduce prostaglandins.

74
Q

what is the difference between vulvodynia and vestibulodynia?

A

vulvodynia is generalized and unprovoked, whereas vestibulodynia is localized and provoked by touch/pressure.

75
Q

Which medication adheres to the bladder lining to decrease permeability to urine solutes?

A

Pentosan polysulfate (Elmiron)

76
Q

Endometriosis risk factors include what?

A

FMH, Early menarche, long duration of menstrual flow, menorrhagia, and short cycles

77
Q

For which 2 STI’s can you immediately prescribe expedited partner therapy?

A

Chlamydia and Gonorrhea

78
Q

What is the name of the semicircular membrane that covers the vaginal oriface and can have different configurations?

A

Hymen

79
Q

What are some of the benefits of using progestin only contraceptive?

A
  • less risk of blood clots (good for smokers, HTN…)
  • good for people w/migraines w/aura
  • lessen bleeding (good for heavy/painful periods, + anemia)
80
Q

What is the pathogen for Vaginal Candidiasis? What is the diagnostic test to determine its presence?

A
  • Candida albicans
  • Wet mount (shows hyphae & buds)
  • sometimes diagnosed with PAP
81
Q

Which observable body signs are used in the Sympto-Thermal Natural Family Planning Method?

A

Basal Body Temperature and Cervical Mucus

82
Q

What is the pathogen for Vaginal Candidiasis? What is the diagnostic test to determine its presence?

A
  • Candida albicans
  • Wet mount (shows hyphae & buds)
  • sometimes diagnosed with PAP
83
Q

What is the difference between primary and secondary dysmenorrhea?

A

primary occurs shortly after menarche w/ ovulatory cycles; secondary occurs after having normal menses due to a pathologic cause

84
Q 
Who is most likely to get endometriosis?:
A.	Fertile woman
B.	Woman > 60
C.	Woman w/ diabetes
D.	Infertile woman
A

D. Infertile woman

85
Q

The uterine cycle consists of what 3 phases?

A

Menstruation, Proliferative phase, Secretory phase

86
Q

What questions should you be asking when taking a menstrual history?

A

Menarche, Date of last menstrual period, Approximate length of cycle, # of pads/tampons used on heaviest day, Dysmenorrhea

87
Q

Risk factors for prolapse?

A

Advanced age, Obesity, Hysterectomy, Chronic constipation, family Hx, Parity

88
Q

Management of primary dysmenorrhea?

A 
1st Line: NSAIDs (anti-prostaglandin effect)
Hormonal Contraceptive (anovulation reduces prostaglandins)
89
Q

How would you describe the discharge associated with Chlamydia and Gonorrhea?

A

Copious Mucopurulent Discharge

90
Q

Which two STIs do you retest for reinfection and do partner treatment?

A

Chlamydia and Gonorrhea

91
Q

What Natural Family Planning Model follows a mucus only method?

A

Creighton Model

92
Q

Can you use female and male condoms simultaneously?

A

No

93
Q

True or false: Metronidazole gel is a treatment option for both Trichomonas vaginalis and bacterial vaginosis.

A

False. Gel is only an option for bacterial vaginosis.

94
Q

On laparoscopy, a patient shows violin string adhesions. What is the most likely diagnosis?

A

Perihepatitis

95
Q

What is the average age of menarche?

A

11.5-13.5 years

96
Q

What is the preferred treatment for vaginal dryness?

A

Topical estrogen
and/or
Lubrication

Gynecology 2021 (2 decks)

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