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GU Test 2 > GU Test 2 > Flashcards

GU Test 2 Flashcards

1
Q

RTI vs STI are they assymtomatic?

A

Many RTIs are asymptomatic

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2
Q

STI’s: types

A

Trichomoniasis, Chlamydia, Gonorrhea, Syphillis, Pediculosis pubis, HIV, HPV, HSV 1 &2, HBV

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3
Q

Vaginitis:

o Normal Vaginal pH

A

3.8-4.5

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4
Q

pH of Sperm

A

7.5

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5
Q

lactobacilli in vagina

A

Inhibits growth of anaerobes & other organisms

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6
Q

Controls the environment: Low

A

If low → other bacteria (garnerella, Group B strep) overgrow → amino acids production →
increased vaginal pH →squamous cell desquamation → classic discharge

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7
Q

Controls the environment: High

A

Elevated pH kills normal flora (lactobilli) while anaerobes and other bacteria flourish

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8
Q

Most common isVaginitis: (Bacterial Vaginitis)

A

Gardnerella: (Bacterial Vaginitis)

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9
Q

2nd most common vaginalis

A

Candidiasis is 2nd most common: (Yeast Infection)

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10
Q

Are Gardnerella and Candidiasis STI’s

A

Gardnerella and Candidiasis are not STI’s

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11
Q

Trichomonas STI does what?

A

Facilitates transmission of HIV & other STIs

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12
Q

Herpes: Biggest Shedding

A

Asymptomatic viral shedding spreads most HSV (>70%)

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13
Q

Herpes does evveyone require acyclovir

A

NO

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14
Q

Herpes Onset

A

Virus replicates in ganglia→migrates to mucosa→replicates in epithelium→lesions
▪ Onset typically 4 days after sexual contact

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15
Q

Syphillis:

▪Infects

A

Capable of infecting almost any organ and system

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16
Q

Syphilis If not treated

A

If not treated, progresses through 4 stages, over many years (affects behavior)

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17
Q

▪ Primary Syphillis: is called

A

Chancre

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18
Q

Primary Syphillis:

● Chancre is painful or painless?

A

Painless

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19
Q

Secondary Syphillis: Onset

A

2-8 weeks after chancre pts often develop a RASH

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20
Q

Secondary syphilis Where does it go?

A

Rash: Diffuse, macular, popular, combinations
● Diffuse: Palms, soles
● Patterned Hair Loss
● Latent Period:

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21
Q

Syphilis Tertiary (late) stage:

A

Complications: Gummata (sores inside body or skin), CV affects heart & BV’s, Neurosyphilis

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22
Q

Syphilis Diagnosis:

A

Screening antibody testing/VDRL/RPR (for non-specific ‘reagin’ antibody)
o More specific/ confirmation test: FTA-ABS; MHA-TP)

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23
Q

Syphilis Diagnosis: More specific confirmation test

A

FTA-ABS; MHA-TP)

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24
Q

o Pubic Lice: Who is it transmitted?

A

Only STI that can be transmitted

via bedding, clothing

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25
Q

Reiter’s: Associated

A

Chlamydia

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26
Q

Gonorrhoea: associated with

A

ARTHRITIS (can manifest as jt. Pain)

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27
Q

PID: Symtoms

A

May be asymptomatic, not only caused by STI’s, may cause long-term complications, if diagnosed partner must
be screened/treated (if caused by STI)

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28
Q

Reportable Disease in Oregon… Women:

A

Asymptomatic, vaginal discharge, dysuria, dyspareunia, low abdominal pain, CPP, unusual bleeding
(metrorrhagia, menorrhagia)

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29
Q

Reportable Disease in Oregon… Men

A

Asymptomatic, penile discharge, dysuria, burning/pruritis around urethral meatus, pain with
ejaculation, pain and swelling in testicles

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30
Q

HIV: is the MC?

A

Sexually Transmitted (most common)

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31
Q

HIV Life Cycle:

o Entry:

A

HIV binds to CD4rc’s onTcells→ allows virus to enter

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32
Q

HIV Life Cycle:

Enzyme 1—

A

reverse transcriptase (RT):

Once HIV is in host cell, the protective covering degrades and releases RNA
which is converted to dsDNA by enzymatic action of RT

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33
Q

HIV Life Cycle:

Enzyme 2—

A

2—Integrase (IN): HIV DNA inserts into hosts genome by integrase.

Once inserted, HIV is called a provirus.
HIV genome translated by host cell into polypeptides which are inactive until cleaved

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34
Q

HIV Life Cycle:

Enzyme 3—

A

3—Protease (PR): cleaves polypeptides into mature, fully functional HIV proteins

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35
Q

HIV Life Cycle:

Exit:

A

Once HIV proteins are synthesized by host cell, the HIV virion is assembled with necessary components & bud
out of host cell to produce new virus particles

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36
Q

HIV Infection: Sexual Transmission what cells?

A

Langerhan’s cells

in mucosa are susceptible to infection

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37
Q

5 Bodily Fluids of Transmission: Of HIV

A

Blood, Semen & pre-seminal fluid, vaginal fluid, breast milk

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38
Q

5 Routes of HIV Transmission:

A

Vagina,Rectum, Mouth, Urethra, Inside of Eyelids

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39
Q

Testing: HIV

A

ELISA if positive→

Western Blot (confirmatory) allows visualization of antibodies

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40
Q

Understand the 6 month window: Of HIV

A

Window” is time it takes to produce antibodies after transmission

**** During this period before antibodies are produced, one can be infected w/ HIV & can infect others, but still test
negative

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41
Q

PCR: HIV

A

Direct measurement of amount of viral particles present in the blood (95% confidence level for detecting

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42
Q

Clinical Symptoms of AIDS:

A

CD4

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43
Q

As Helper T cells deplete decreases in other cell types are seen: AIDS

A

Macrophages, CD8 cells, NK cells

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44
Q

Compliance with drugs is very important (prevents mutation of the virus and more stable for patient’s body)

Reverse Transcriptase

A

Reverse Transcriptase Inhibitors: AZT

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45
Q

Know the common long-term side effects of HIV medications, like Diabetes, Osteoporosis, Cardiovascualr

A

Disease. Know

that cancer is not a long-term effect.

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46
Q

Condoms prevent transmission of HIV more effectively than transmission of HPV and HSV

A

Covers the skin

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47
Q

Cervical Dysplasia & cancer

Screening Guidelines

A

Reg paps for all women who are sexual active and have a cervix at age 21 or 30 years after first boning which ever comes first.

65 against routine screening if 10 yr history is clean and not high risk

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48
Q

HPV

A

Tests; thin prep . sure path transmission sexually, high risk hpv cancer, low risk warts,
Detection
Pap smear

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49
Q

Atypia;

A

variation of normal

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50
Q

Ascus

A

abnormal squamous cells of undetermined significance watch it.

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51
Q

CIN I;

A

cervical intraepthalial neoplasia mild aka LGSIL low grade intraepithelial lesion

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52
Q

CIN II;

A

moderate aka HGSIL high grade

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53
Q

CIN III;

A

severe AKA hgsil

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54
Q

CIS;

A

carcinoma in situ pre-cancerous

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55
Q

Management of abnormal paps

Atypia, ASCUS, CIN I:

A

most go away without treatment paps every 4 months 1 yr every 6 moths 2 yr

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56
Q

Management of abnormal paps

CIN II;

A

treatment recommended, cryo, LEEP, pap test every 4 months 1 yr 6mths 2 yr

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57
Q

Management of abnormal paps

CIN III, CIS, Cancer

A

treatment by gyn oncologist, surgery, LEEP, Conization or laser beam treatment, Hysterectomy in late stages, same pap testing as above

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58
Q

Breast Health

– most common site for fibrous cystic changes (benign) and/or malignancies.

A

Upper Outer Quadrant (UOQ)

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59
Q

Fibrous areas are of less concern if

A

symmetrical, pain-free & mobile.

60
Q

Mastalgia

A

breast pain: must differentiate cyclic from non-cyclic

61
Q

Nipple Discharge

A

most common will be benign, but be concerned if: bloody, associated with mass, unilateral, single duct, spontaneous, post-menopausal, hormone replacement therapy (HRT), prolactinoma

62
Q

Fibrocystic Breast Changes

A

should resolve with menopause

63
Q

Mammogram – every

A

1-2 years after age 40

64
Q

% of patients have no major risk factors

A

75%

65
Q

% do NOT have a primary family member with breast cancer

A

90%

66
Q

• Syphilis update 2015 Oregon

Stats:

A

rates have increased approx 1500% since 2007, from fewer than 30 reported cases to approx 450 reported cases statewide

67
Q

Syphilis

Health care providers should take good sexual history and drug use history

A

for patients at risk: use rapid plasma reagin test (RPR)
-patients should be tested annually, regardless of condom use or number of partners

  • every three months**** if sexually active with multiple partners / at risk patient
  • order a test for HIV (having one STI would increase the possibility of another STI)
68
Q

Gold Standard for diagnosis of breast cancer

A

Biopsy =

69
Q

Who needs to be screened during syphilis epidemic?

Syphilis

A

Men who have sex with men, people with HIV, people of either sex who use illicit, people of either sex who engage in sex work or exchange sex for money or other things of value, people who have or have had other bacterial or viral sexually transmitted infections, people who have been
exposed to syphilis

Pregnant women screening: once at first prenatal visit, beginning of third trimester and at delivery - do testing more often if at risk patient

70
Q

Contraception:
● Emergency Contraception:
o Plan B does not

A

does not terminate an already established pregnancy`

71
Q

RU-486 is not a?

A

is not an emergency contraception. It is used to terminate an already established pregnancy

72
Q

What is Emergency Contraception?

A

PREVENT PREGNANCY after unprotected intercourse
▪ Often referred to as the morning after pill
▪ Plan B or Prevention
▪ Alternative: (OCP/hormones taken in high doses within 120hours)
o IUD can be used as EC (inserted within 120 hours of unprotected sex0
o 99% effective

73
Q

Types: Prevention; Plan B does not?

A

does

not affect an established pregnancy

74
Q

IUD Paraguard is

A

non-hormonal. Mirena, Ortho-Erva patch and Plan B are all hormonal

75
Q

Synthetic versions of estrogen &/or progesterone does what:?

A

o Suppresses FSH and LH surge
o Inhibit follicular maturation; no ovulation
o Thicken cervical mucus (barrier to sperm)
o Alters endometrial lining (so implantation unlikely)

76
Q

Vaginal Hormonal Ring: NuvaRing

A

Releases: 15mcg EE/ 120mcg progestin daily

***o Vaginal insertion 3 weeks and 1 week out for menses

77
Q

Barrier Methods:

A

Cervical cap, Diaphragm, Condoms

78
Q

Receptacles for spermicide:

A

o Condoms, Diaphragm, Cervical cap

79
Q

Spermicide: destroys sperm cell membrane When to use?:

A

Disadvantage:

▪ Insertion necessary 30 minutes PRIOR to intercourse

80
Q

Male Condom:

A

Fluid Transmitting STI protection
o HIV, GT, CT
Advantages: affordable

81
Q

Diaphragm: Contrindication

A

Severe prolapse;

82
Q

Vasectomy: What is cut?

A

Epididymis

83
Q

Vasectomy: How many ejaculations do you need to make sure the sperm is clean out

A

15-20 ejaculations

84
Q

Vasectomy: Side effect

A

Erectile dysfunction
May be mostly psychological in nature;

Prostate Cancer:
▪ BUT New Zealand study recently found no association with prostate Cancer

85
Q

What conditions may it exacerbate? Adverse side effects?

Contraindications to Hormonal Contraception:

A

Liver disease; pregnancy; history/current HTN or heart/vascular disease; Migraine; breast cancer

o Smoking >15 cigs and >35yoa

86
Q

Disadvantages to Hormonal Contraception:

She effects

A

Decrease glucose tolerance

Decrease serotonin→ depression

87
Q

Non-Hormonal Methods:

●

A

Copper-T IUD

88
Q

IUD:

● Contraindications:

A 
Abnormal uterine anatomy;
 enlarged uterus;
 nulliparous; current/past PID; known or suspected Pg; 
Hx of ectopic
pregnancy;
 DUB of unknown cause;
 suspected malignancy; 
copper allergy or Wilsons disease
89
Q

IUD:Early IUD danger signs

A 
\:Late/missed period;
 abdominal pain; 
fever, chills; 
increased discharge; 
odorous discharge;
 big changes in bleeding:
breakthrough bleeding,
 heavy periods, clots
90
Q

IUD Advantage:

A

o 10 years of contraception, easy and often no hassle
o Just as effective as surgical sterilization
o Most cost-effective when cost is over 10 years

91
Q

Know relative failure rates of different types of contraception (don’t need exact percentages)

A 
■ Vasectomy 4.1 %
■ Tubal Ligation 1.9%
■ Male Condoms 14.7% *******
■ The Pill 8.1%
■ The Patch 1.3%
■ IUD 2.0%
■ Female Condom 21.0% *******
■ Cervical Cap 20.0%
92
Q

Know relative failure rates of different types of contraception (don’t need exact percentages)

A

■ Male Condoms 14.7% ***

■ Female Condom 21.0% ***

93
Q

Menopause:

● Definition: 1

A

1 year without spontaneous menses. It’s not defined by absence or presence of other symptoms

94
Q

Perimenopause:

A

Pituitary continues to release hormones (FSH/LH) to stimulate ovaries

95
Q

Rising FSH = marker of perimenopause

A

(>20) FSH

96
Q

Why FSH Increases: Perimenopause

A
  • Follicles decrease, oocytes no longer mature
    ▪ Decrease in ovarian production of estradiol
    ▪ HRT supplementation in premature menopause cannot maintain normal FSH
97
Q

Surgical vs. Natural

A

Natural:
▪ 1 year since last spontaneous menstrual period
▪ Natural menopause is transition between perimenopause & post menopause
▪ Generally around age 50 ,

98
Q

Levels of Intervention

A 
Diet, exercise, stress management (level 1) 
▪ Nutritional supplementation (Level 2) 
▪ Botanicals (Level 3)
▪ HRT
▪ Other pharmaceuticals
99
Q

Level I

▪

A 
Exercise
● Benefits
● Disease Prevention
● Aerobic: gain stamina and energy (40-50 minutes 4-5 x’s weekly)
● Weight training
▪ Dietary Interventions
● SOY:
o 40% reduction in vasomotor symptoms
o Improves lipid profile
o Slows bone loss
o Improved CV function
o Estrogenic effect on vaginal epithelium-minimal
▪ Reduces risk of breast cancer
100
Q

▪ Dietary Interventions

● SOY:

A 
o 40% reduction in vasomotor symptoms
o Improves lipid profile
o Slows bone loss
o Improved CV function
o Estrogenic effect on vaginal epithelium-minimal
▪ Reduces risk of breast cancer
101
Q

Level II

A

▪ Nutrients

102
Q

Level III

A

Botanicals
● Black Cohosh/Red Clover
● Bromelain, Curcumin
● St. Johns Wort, anxiolytics

103
Q

● Consequences of normal menopause estrogen loss: Earl

A

Early changes—hot flashes (75%), insomnia, irritability, mood changes, low libido, abnormal bleeding

104
Q

Consequences of normal menopause estrogen loss: Intermediate

A

vaginal atrophy urinary incontinence, skin atrophy, hair thinning, facial hair

105
Q

Consequences of normal menopause estrogen loss: Late

A

Osteoporosis, CAD, Alzheimer’s dementia, colon cancer, age-related macular degeneration. Insulin resistance

106
Q

What is removed with Surgical Menopause?

A

Ovaries bilaterally

107
Q

What is premature Menopause

A

Premature if before age 40. Average age = 50 y/o

108
Q

Menopause what happens to FSH

A

FSH increases

109
Q

Know general screen guidelines for different age groups

Paps, Mammograms

A

(over 40), ,

110
Q

Know general screen guidelines for different age groups

DEXA

A

(over 65)

111
Q

Know general screen guidelines for different age groups

COLONOSCOPY

A

COLONOSCOPY

OVER 50

112
Q

Vaginal Atrophy

A

Intravaginal treatment, vaginal lubricants

113
Q

Menopausal women are at risk for what diseases/conditions?

A

endometriosis is a condition that primarily

affects women of reproductive age

114
Q

Cardiovascular Disease in Women:

● MI in women: women or men more likely to die?

A

Women More likely to die of a first MI

115
Q

Do not present the same as they do in men ( MI IN women)

A

Atypical presentation

116
Q

Coronary Heart Disease

o CHD = is what?

A

Leading cause of death in American women
▪ CHD risk increases with age
▪ 1 in 2 women will die from CHD/stroke

117
Q

Screening for CHD

A

HDL 50
o Negative risk factor

● LDL 2 risk factors

118
Q

Risk Factors: for CHD

A

Positive Primary Family History

▪ Hypertension, Hyperlipidemia, Diabetes Mellitus, Smoker, Obesity, CAD or atherosclerosis Hx

119
Q

CHD causes what?

A

Causes more death than Breast Cancer (1 in 25)

120
Q

Testosterone & DHEA Side effects

A

Acne, hair thinning, irritability;

raise LDL,

tg’s,

lower HDL

121
Q

HRT: Risks

A

Risk DVT:

122
Q

Osteoporosis:

A

Risk factors for osteoporosis,

including smoking,

low estrogen

123
Q

Risk factors Osteoporosis Non-Modifiable:

A 
Personal Hx of fracture as an adult
▪ Hx of fracture in first degree relative
▪ Caucasian, fair skin, blond hair
▪ Advanced age
▪ Female sex
▪ Dementia
▪ Poor health/frailty
▪ Years of estrogen deficiency
▪ Impaired neuromuscular function
124
Q

Risk factors Osteoporosis Modifiable:

A 
Modifiable:
▪ Smoker
▪ 1 year)
▪ Low calcium intake
▪ Increased homocysteine
▪ Alcoholism
▪ Poor eyesight
▪ Recurrent falls
▪ Inadequate physical activity
▪ Prescription meds
▪ Protein intake
125
Q

Osteoporosis Work up Lab?

A

DEXA

126
Q

There are 2 questions on intrapelvic manipulation

A

This is sensitive work, i.e. chance for women to be uncomfortable, malpractice suits, etc..

127
Q

There are 2 questions on intrapelvic manipulation Always have a patient

A

o Always have the patient sign an informed consent prior to treatment.

128
Q

There are 2 questions on intrapelvic manipulation

Do not

A

o Do not do intrapelvic work on pregnant women, a women with an infection or women with IUDs

129
Q

There are 2 questions on intrapelvic manipulation

Do you need special training

A

o Specialty training is needed to do this work on patients.

130
Q

There are 2 questions on intrapelvic manipulation

Whats it used for?

A

o Intrapelvic work is useful for treating pelvic pain, pelvic adhesions, dysmenorrheal.

NOT cervical dysplasia.

131
Q

Valvular Disorders and Pelvic Prolapse:

Pelvic prolapse
Procidentia

A

prolapse or falling down Mostly female patients

> 50% have at least some evidence of prolapse on PE

132
Q

Definition: protrusion of:

Uterus

A

Faling down Uterus

133
Q

Definition: protrusion of:

Bladder -

A

cystocele

134
Q

Definition: protrusion of:

Urethra (rare)

A

urethrocele

135
Q

Definition: protrusion of:

Rectum (80-90% female)

A

rectocele

136
Q

Definition: protrusion of:

Intestine (rare)

A

enterocele

137
Q

Uterine prolapse: Cause

A

ligament laxity

138
Q

Uterine prolapse: 3rd degree

A

Leading edge of prolapse 1 cm beyond hymen w/ valsalva

 75% women w/ stage III are aware of protrusion; may not be symptomatic until protrusion extends > 2 cm

139
Q

Pelvic prolapse: predisposing factors

A

Multiparous women - A lot of children (stretch)

Menopause
 - Genital atrophy d/t low estrogen plays important
Obesity
Smoking

140
Q

Prolapse: diagnosis

A
  • Exam with straining
    - Pelvic exam (atrophy/prolapse)
  •  Rectal exam (fecal impaction)
  •  Neurological exam (perineal sensation and sphincter tone/reflex)
  •  UroGyn referral (OHSU Women’s Health Center)
141
Q

Prolapse:  Treatments

A

:  Pelvic PT
 Pessary  Surgery

Bladder/uterus “slings”  hysterectomy

142
Q

CYSTOCELE: Bladder

A

Small and some large cystoceles often causes no sx  “something is falling out”
 Backache
 Fullness or bulging sensation in the vagina
 Incontinence the #1 sxs

143
Q

RECTOCELE RECTUM: MC Complaint

A

most common complaint is constipation or the need to apply digital pressure in the vagina in order to defecate

144
Q

ENTEROCELE (Intestine)

A

(herniation of the pouch of douglas) into the rectovaginal septum, essential a cul-de-sac hernia. Usually ASXS, can have vaginal pressure and aching discomfort. Almost always a component of uterine prolapse

145
Q

 URETHROCELE (Urethra) MC Symptom

A

:Vaginal bleeding is the most common presenting sx; upon examination, round doughnut-shaped mucosa is observed protruding from the urethral opening.

GU Test 2 (1 decks)

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