General Gyne Flashcards
What % PID cases are unrecognized?
2/3
What % of reproductive aged females have had at least 1 episode PID?
10-15%
How do you dx BV?
Amsel criteria: need 3/4 for dx Vaginal d/c Elevated pH Positive whiff test Clue cells
What are clue cells? What are they suggestive of?
Vaginal epithelial cells covered with coccobacilli, suggestive of BV
What are the dx criteria for PID?
Minimal criteria: pelvic pain, Adnexal pain, cervical motion tenderness
Additional criteria: oral T >38.3 C, WBC on wet mount slides, Elevated ESR or CRP, lab documentation of chlamydia or gonorrhea
What are 3 definitive ways to dx PID?
Gold standard: laparoscopy showing tubal erythema or pus
Endometrial bx showing endometritis
Imaging shows TOA or thick, fluid-filled tubes
What are the criteria for hospitalizing a pt with PID?
Can't exclude surgical emergency Pregnancy Failed oral tx Pt unable to tolerate oral meds Pt is severely ill TOA HIV Teens
Inpatient tx PID
Cefoxitin 2g IV q6h until 24 h after clinical improvement plus doxy 100mg po BID x 14 days total
Clinda/genta IV then doxy
Levofloxacin +/- flagyl
Outpt tx PID
Ceftriaxone 250mg IM x1 plus doxy x 14 days
Cefoxitin 2g IM + probenecid 1g po + doxy x 14 days
Levofloxacin 500mg po daily +/- flagyl x 14 days
When should women have a bone mineral density scan? (If <50 yo)
Hx fragility fx Prolonged use of steroids Hypogonadism Malabsorption Primary hyperPTH POI <age 45 Pt takes aromatase inhibitors or androgen deprivation therapy
When should women >/= 50yo have a bone mineral density scan?
Anyone >64yo Same things as in younger ppl plus Parental hip fx Vertebral fx Osteopenia Smoker RA, Weighs <60kg Significant EtOH use
