Genitourinary and Gynecologic problems Flashcards
White, clear, flocculent leukorrhea describes what?
normal vaginal discharge
Which diagnosis is found to have white, curdy, cottage cheese discharge with vagina pruritus and burning?
Vulvovaginitis 2/2 candida albicans
What treatment is prescribed for vulvovaginitis 2/2 candida?
oral "zole" diflucan/ fluconazole or vaginal miconazole / monistat terazol
What vaginal dysfunction is characterized by >20 clue cells found on microscopic exam and foul, gray/white, homogenous discharge ?
Bacterial Vaginosis BV polymicrobial likely POSITIVE WHIFF TEST fishy odor TX- metronidazole flagyl clindamycin cleocin
What presents as painful ulcerated lesions, lymphadenopathy, and in women you may see a thing vaginal discharge associated with vaginal lesion ?
Caused by the organism herpes simplex virus HHV-2 type 2
recurrence symptoms vary from above
asymptomatic transmission is possible
What is the treatment for herpes simplex type 2 or HHV-2 ?
acyclovir, famciclovir, valacyclovir VALTREX
dx herpes select PCR blood test
What is the presentation of chlamydia trachomatis and ureplasma urealyticum and mycoplasma genitalium?
nongonococcal urethritis and cervicitis
irritating voiding symptoms and /or mucopurulent discharge or recurrent UTI
cervicitis common in women ***
microscopic look at discharge = LARGE NUMBER OF WBC
TREATMENT FOR CHLAMYDIA
AZYTHROMYCIN 1G PO X 1 DOSE
ALT= DOXYCYCLINE , ERYTHROMYCIN, LEVOFLOXACIN = MORE THAN 1 DAY OF THERAPY
WHO DO YOU SCREEN FOR CHLAMYDIA
16-24 YEARS OLD, THOSE SEXUALLY ACTIVE OR HAVE A NEW PARTNER
GHONORRHEA PRESENTATION
IRRITATIVE VOIDING SYMPTOMS (SIMILAR TO CHLAMYDIA**)
COULD BE WITHOUT SYMPTOMS - OCCURS OFTEN
MICROSCOPIC EXAM = LARGE NUMBER OF WBCS
What is the first line therapy for gonorrhea ? a gram NEGATIVE bacteria
IM ceftriaxone 250 mg ONE TIME DOSE plus azithromycin 1 g PO x 1 dose
ALTERNATE would be cefixime 400 mg PO with azithro dose
A patient presents with yellow GREEN vaginal discharge, may be frothy, cervical petechiae hemorrhage or strawberry cervix, what is your diagnosis?
Trichomoniasis vaginitis
First line trichomoniasis therapy?
Metronidazole 2 g PO 1 time dose
AVOID ALOCHOL x 24 hours
no cough syrups
alternative = tinidazole
What is syphillis?
Baterium infection with CHANCRE. firm, roun, painless genital anal ulcers
indurated margins
accompanied localized lymphadenopathy
2nd stage = nonpruritis skin rash of PALMS, SOLES, MUCOUS PAM SELLS MUSTARD
what is pelvic inflammatory disease
could be –> gonorrheae, trachomatis, enterbacteriaceae, streptococci
key = cervical motion tenderness, CHANDELIER SIGN
PID shuffle = hard to walk, pain, guarding
50% of all ectopic pregnancy is linked to PID
get culture and CBC
First line treatment for PID
Ceftriaxone 250 mg IM single dose, PLUS doxycycline 100 mg PO BID x 14 days
with or without metronidazole 500 mg PO BID x 14 days
What is clotrimazole cream used for?
Candida vulvovaginitis
What is oral metronidazole and metronidazole gel used for
gel = vaginosis oral = vaginosis and trich
Treatment for syphillis
bicillin or injectable penicillin
What is imiquimod used to treat?
external genital warts
HPV
Is TCA or trichloroacetic acid safe in pregnancy?
yes
imiquimod is not
What is CLUE CELLS associated with
Bacterial vaginosis
what is pseudohyphae w/ KOH prep associated with ?
candida vulvovaginitis
What is obliterated medial sulcus a sign of ?
Benign prostatic hyperplasia
What effect may oxybutynin have on a patient who is taking it?
anticholinergic effects
antimuscarinic medication - control of detrusor muscle contraction
What is the treatment for acute UNCOMPLICATED UTI in non pregnant patient?
TMP/SMX- DS PO BID x3 days
if e. coli resistant to TMP then
Nitrofurantoin MACROBID 100mg PO BID x 5 days
can also use levofloxacin, ciprofloxacin, moxifloxacin but growing concern about Floroquinoloine resistance
What is the likely dx of a male who complains of irritative voiding symptoms, suprapubic pain, perineal pain, fever, boggy prostate, and is at a low risk for STI?
acute bacterial prostatitis
cause- likely e. coli
tx- ciprofloxacin 500mg PO BID
Prehns sign
relief of scrotal pain with elevation
What is the treatment for a gonorrheal or trachomatis infection in a male patient ?
Ceftriaxone 250 mg IM as a single dose plus doxycycline 100 mg PO BID x 10 days
What is the US preventative services task force recommendations for cervical cancer screening in woman
initial screening at age 21
21-29- cytology alone q3 years
aged 30-65 - primary HPV testing alone every 5 years
cease testing at age 65 or greater
What are the recommendations of the American Cancer Society from 2020 for Cervical Cancer screening in average-risk women?
Start screening at AGE 25 (differs from USPSTF saying 21)
also recommend NOT SCREENING 21-24
What is the recommended treatment for gonorrhea or trachamotis in PID?
Ceftriaxone 250 mg IM 1 time plus doxycyline 100 mg PO x 10 days
What is the recommended treatment for gonococcal urethritis or vaginitis?
ceftriaxone 250 mg IM as a one time dose plus azithromycin 1 g PO x 1 dose
Breast cancer symptoms / history
NON TENDER painless mass
asymptomatic
symptoms LATER = pain, erythema, dimpling, ulceration, nipple retraction
Fibrocystic breast disease symptoms
Breast tenderness related to cycle
nodularity with cyst formation / enlargment
may be breast discharge
What is the difference between fibrocystic breast disease exam and breast cancer exam?
fibrocystic = mobile mass, breast cancer = fixed or firm fibrocystic = no discharge, breast cancer = may have discharge, may be bloody fibrocystic = no lymphadenopathy, breast cancer = may have lymphadenopathy
What is your breast cancer risk if a 1st degree relative has had it ?
INCREASES 2 TO 4 FOLD
What is the lifetime risk for breast cancer in women ?
1:8 women have breast cancer
