GU F MDT s/s and tx Flashcards
Tx for Ectopic pregnancy
Surgical
-Laparoscopy When patient is unstable or rupture has occurred
Meds
-Methotrexate 50mg/m2 IM in single or multiple doses
(Stops cells from growing ending pregnancy)
Male partner contributes about what percentage of infertility cases.
40%
S/S of what?
Early symptoms
–70% of patients present with a (usually) painless lump
—-About 90% of these are discovered by the patient
(b) Less frequent symptoms
–Breast pain
– Nipple discharge
–Erosion, retraction, enlargement, or itching of the nipple
–Redness, generalized hardness, enlargement, or shrinking of the breast
(c) Rarely
–Axillary mass or swelling
–Back or joint pain
–Jaundice
–Weight loss
Female breast carcinoma
What issue?
(a) Products of conception are completely expelled.
(b) Pain ceases, but spotting may persist.
(c) Cervical os is closed, some blood in the vaginal vault
Complete abortion ( a competed miscarriage)
Signs and symptoms of what issue?
(1) Vaginal irritation or pruritus
(2) Pain
(3) Unusual or malodorous discharge
(4) Bimanual exam may show
—(a) Pelvic inflammation
—(b) Cervical motion tenderness
—(c) Adnexal tenderness
Vaginitis
What issue?
(a) Sexually transmitted protozoal flagellate
(b) Infects the vagina, Skene ducts, and lower urinary tract in women
(c) Infects the lower genitourinary tract in men
(d) Pruritus and a malodorous frothy, yellow-green discharge occur, along with diffuse vaginal erythema.
(e) Strawberry cervix- red macular lesions on the cervix in severe cases
Trichomonas Vaginalis Vaginitis
What issue?
(a) The pregnancy has ceased to develop, but the conceptus has not been expelled.
(b) Symptoms of pregnancy disappear.
(c) There may be a brownish vaginal discharge but no active bleeding.
(d) Pain does not develop. The cervix is semi firm and slightly patulous;
(e) The uterus becomes smaller and irregularly softened;
(f) The adnexa are normal.
(g) Women may be indicated for abortifacient and correttage.
Missed abortion
PCOS patients require regular laboratory monitoring of
what?
METABOLIC SYNDROME
lipids,
glucose
Hgb A1C
Any female with vaginal bleeding, positive hCG and abdominal pain is WHAT until proven otherwise.
Ectopic Pregnancy
Treatment AUB
(1) All patients with abnormal uterine bleeding should be referred to OB-GYN
(2) For premenopausal patients treatment depends on etiology of the AUB
(3) AUB secondary to certain causes may require definitive treatment
(4) AUB-O
—(a) Treated hormonally with progestin to oppose estrogen
—(b) NSAIDS at normal doses can reduce the amount of blood loss
Treatment for breast cancer
(a) All breast masses should be referred to General Surgery for further evaluation and work up
(b) Depends on the stage of cancer
—1) Surgical resection, with axillary node dissection
—2) Radiation
—3) Systemic therapy
Treatment PMDD/PMS
Mild to moderate symptoms
Lifestyle changes
(a) Aerobic exercise
(b) Reduction of caffeine, salt and alcohol
(c) Increase in dietary calcium (1200mg/day)
(d) Vitamin D or magnesium
(e) Increase complex carbohydrates
(f) Alternative therapies (acupuncture or herbal treatments)
Signs and symptoms of what issue?
(a) Breast pain or tenderness
–1) May be asymptomatic and found on accident
(b) Discomfort often worsens during premenstrual phase of cycle as cysts are enlarging
(c) Fluctuation in size of masses
(d) Multiple or bilateral
(e) Absence of enlarged or tender lymphadenopathy
Fibrocystic condition AKA “Fibrocystic Changes”
Specific treatment for fibroids
1) Asymptomatic myomas can be managed expectantly
2) NSAIDs decrease menstrual blood loss
3) Hormonal therapies can reduce volume, size, and menstrual blood loss
4) Surgical therapy is definitive treatment and curative.
Labs to consider off ship for PCOS
-FSH
-LH
-Prolactin
-TSH
-Hemoglobin A1C (Hgb A1C)
-Lipid profile
Treatment
(1) Malignant ovarian mass
(a) Surgical evaluation and staging by a gynecologic oncologist
(b) Followed by combinations of hysterectomy and bilateral salpingooophorectomy with omentectomy and selective lymphadenectomy
(c) Postoperative chemotherapy. Or watchful waiting
Treatment PID with severe disease
Cefoxitin (Mefoxin) 2g IV Q6H and doxycycline 100mg PO or IV Q12H
——-1) Continued for a minimum of 24 hours after the patient shows significant clinical improvement.
——-2) Then, an oral regimen should be given for a total course of antibiotics of 14 days.
Treatment
Trichmonas vaginalis Vaginitis
Treatment of both partners is recommended
Metronidazole (Flagyl) Dose: 2 g PO x1 or 500 mg BID x7 days
(is an antibiotic with cytotoxic effects towards anaerobic organisms)
S/S of what issue?
(1) Most women with both benign and malignant neoplasms are either symptomatic or experience only mild nonspecific gastrointestinal symptoms or pelvic pressure.
(2) Women with advanced malignant disease may experience abdominal pain and bloating, and a palpable abdominal mass with ascites is often present
Ovarian tumor
Definition of what issue?
(1) Lesion of the breast
—(a) Produces a mass (often accompanied by skin or nipple retraction)
(2) Usually indistinguishable from carcinoma even with imaging studies
(3) Commonly seen after fat injections to augment breast size or fill defects after breast surgery
(4) Trauma is presumed to be the cause
(5) Ecchymosis is occasionally present
(6) If untreated, the mass gradually disappears
Fat necrosis
What issue?
(a) Pregnancy, diabetes, and use of broad spectrum antibiotics or
corticosteroids predispose patients to this issue.
(b) Heat, moisture, and occlusive clothing also contribute to the risk.
(c) Pruritus, vulvovaginal erythema, and a white curd-like discharge that is NOT malodorous.
Vulvovaginal Candidiasis (yeast infection)
Initial testing for infertility includes what?
(1) Private consultations with each partner.
(2) Pertinent history:
(3) Gynecologic history
(4) Basic labs
PID It is most common in what demographic?
It is a leading cause of what?
-young, nulliparous, sexually active women with multiple
partners
-leading cause of infertility and ectopic pregnancy
Treatment PMS/PMDD
Medications that prevent ovulation such as _______ may lessen symptoms.
hormonal contraceptives
Imaging for Ectopic pregnancy
Transvaginal Ultrasound
_______ often presents with
–(a) Menstrual disorder
——-1) Ranging from amenorrhea to menorrhagia
–(b) Infertility
–(c) Skin disorders
——-1) Secondary to increased androgens
–(d) Insulin resistance
Polycystic ovarian syndrome (PCOS)
Treatment for
Fibrocystic condition AKA “Fibrocystic Changes”
a) NSAIDS
b) More severe pain should be referred to primary care for further evaluation.
c) Patient education