GU Test 2 Flashcards
1
Q
RTI vs STI are they assymtomatic?
A
Many RTIs are asymptomatic
2
Q
STI’s: types
A
Trichomoniasis, Chlamydia, Gonorrhea, Syphillis, Pediculosis pubis, HIV, HPV, HSV 1 &2, HBV
3
Q
Vaginitis:
o Normal Vaginal pH
A
3.8-4.5
4
Q
pH of Sperm
A
7.5
5
Q
lactobacilli in vagina
A
Inhibits growth of anaerobes & other organisms
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
7
Q
Controls the environment: High
A
Elevated pH kills normal flora (lactobilli) while anaerobes and other bacteria flourish
8
Q
Most common isVaginitis: (Bacterial Vaginitis)
A
Gardnerella: (Bacterial Vaginitis)
9
Q
2nd most common vaginalis
A
Candidiasis is 2nd most common: (Yeast Infection)
10
Q
Are Gardnerella and Candidiasis STI’s
A
Gardnerella and Candidiasis are not STI’s
11
Q
Trichomonas STI does what?
A
Facilitates transmission of HIV & other STIs
12
Q
Herpes: Biggest Shedding
A
Asymptomatic viral shedding spreads most HSV (>70%)
13
Q
Herpes does evveyone require acyclovir
A
NO
14
Q
Herpes Onset
A
Virus replicates in ganglia→migrates to mucosa→replicates in epithelium→lesions
▪ Onset typically 4 days after sexual contact
15
Q
Syphillis:
▪Infects
A
Capable of infecting almost any organ and system
16
Q
Syphilis If not treated
A
If not treated, progresses through 4 stages, over many years (affects behavior)
17
Q
▪ Primary Syphillis: is called
A
Chancre
18
Q
Primary Syphillis:
● Chancre is painful or painless?
A
Painless
19
Q
Secondary Syphillis: Onset
A
2-8 weeks after chancre pts often develop a RASH
20
Q
Secondary syphilis Where does it go?
A
Rash: Diffuse, macular, popular, combinations
● Diffuse: Palms, soles
● Patterned Hair Loss
● Latent Period:
21
Q
Syphilis Tertiary (late) stage:
A
Complications: Gummata (sores inside body or skin), CV affects heart & BV’s, Neurosyphilis
22
Q
Syphilis Diagnosis:
A
Screening antibody testing/VDRL/RPR (for non-specific ‘reagin’ antibody)
o More specific/ confirmation test: FTA-ABS; MHA-TP)
23
Q
Syphilis Diagnosis: More specific confirmation test
A
FTA-ABS; MHA-TP)
24
Q
o Pubic Lice: Who is it transmitted?
A
Only STI that can be transmitted
via bedding, clothing
25
Reiter’s: Associated
Chlamydia
26
Gonorrhoea: associated with
ARTHRITIS (can manifest as jt. Pain)
27
PID: Symtoms
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)
28
Reportable Disease in Oregon… Women:
Asymptomatic, vaginal discharge, dysuria, dyspareunia, low abdominal pain, CPP, unusual bleeding
(metrorrhagia, menorrhagia)
29
Reportable Disease in Oregon… Men
Asymptomatic, penile discharge, dysuria, burning/pruritis around urethral meatus, pain with
ejaculation, pain and swelling in testicles
30
HIV: is the MC?
Sexually Transmitted (most common)
31
HIV Life Cycle:
| o Entry:
HIV binds to CD4rc’s onTcells→ allows virus to enter
32
HIV Life Cycle:
| Enzyme 1—
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
33
HIV Life Cycle:
| Enzyme 2—
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
34
HIV Life Cycle:
| Enzyme 3—
3—Protease (PR): cleaves polypeptides into mature, fully functional HIV proteins
35
HIV Life Cycle:
| Exit:
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
36
HIV Infection: Sexual Transmission what cells?
Langerhan’s cells
in mucosa are susceptible to infection
37
5 Bodily Fluids of Transmission: Of HIV
Blood, Semen & pre-seminal fluid, vaginal fluid, breast milk
38
5 Routes of HIV Transmission:
Vagina,Rectum, Mouth, Urethra, Inside of Eyelids
39
Testing: HIV
ELISA if positive→
Western Blot (confirmatory) allows visualization of antibodies
40
Understand the 6 month window: Of HIV
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
41
PCR: HIV
Direct measurement of amount of viral particles present in the blood (95% confidence level for detecting
42
Clinical Symptoms of AIDS:
CD4
43
As Helper T cells deplete decreases in other cell types are seen: AIDS
Macrophages, CD8 cells, NK cells
44
Compliance with drugs is very important (prevents mutation of the virus and more stable for patient’s body)
Reverse Transcriptase
Reverse Transcriptase Inhibitors: AZT
45
Know the common long-term side effects of HIV medications, like Diabetes, Osteoporosis, Cardiovascualr
Disease. Know
| that cancer is not a long-term effect.
46
Condoms prevent transmission of HIV more effectively than transmission of HPV and HSV
Covers the skin
47
Cervical Dysplasia & cancer
| Screening Guidelines
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
48
HPV
Tests; thin prep . sure path transmission sexually, high risk hpv cancer, low risk warts,
Detection
Pap smear
49
Atypia;
variation of normal
50
Ascus
abnormal squamous cells of undetermined significance watch it.
51
CIN I;
cervical intraepthalial neoplasia mild aka LGSIL low grade intraepithelial lesion
52
CIN II;
moderate aka HGSIL high grade
53
CIN III;
severe AKA hgsil
54
CIS;
carcinoma in situ pre-cancerous
55
Management of abnormal paps
| Atypia, ASCUS, CIN I:
most go away without treatment paps every 4 months 1 yr every 6 moths 2 yr
56
Management of abnormal paps
CIN II;
treatment recommended, cryo, LEEP, pap test every 4 months 1 yr 6mths 2 yr
57
Management of abnormal paps
CIN III, CIS, Cancer
treatment by gyn oncologist, surgery, LEEP, Conization or laser beam treatment, Hysterectomy in late stages, same pap testing as above
58
Breast Health
| – most common site for fibrous cystic changes (benign) and/or malignancies.
Upper Outer Quadrant (UOQ)
59
Fibrous areas are of less concern if
symmetrical, pain-free & mobile.
60
Mastalgia
breast pain: must differentiate cyclic from non-cyclic
61
Nipple Discharge
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
Fibrocystic Breast Changes
should resolve with menopause
63
Mammogram – every
1-2 years after age 40
64
% of patients have no major risk factors
75%
65
% do NOT have a primary family member with breast cancer
90%
66
• Syphilis update 2015 Oregon
| Stats:
rates have increased approx 1500% since 2007, from fewer than 30 reported cases to approx 450 reported cases statewide
67
Syphilis
Health care providers should take good sexual history and drug use history
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
Gold Standard for diagnosis of breast cancer
Biopsy =
69
Who needs to be screened during syphilis epidemic?
| Syphilis
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
Contraception:
● Emergency Contraception:
o Plan B does not
does not terminate an already established pregnancy`
71
RU-486 is not a?
is not an emergency contraception. It is used to terminate an already established pregnancy
72
What is Emergency Contraception?
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
Types: Prevention; Plan B does not?
does
| not affect an established pregnancy
74
IUD Paraguard is
non-hormonal. Mirena, Ortho-Erva patch and Plan B are all hormonal
75
Synthetic versions of estrogen &/or progesterone does what:?
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
Vaginal Hormonal Ring: NuvaRing
Releases: 15mcg EE/ 120mcg progestin daily
***o Vaginal insertion 3 weeks and 1 week out for menses
77
Barrier Methods:
Cervical cap, Diaphragm, Condoms
78
Receptacles for spermicide:
o Condoms, Diaphragm, Cervical cap
79
Spermicide: destroys sperm cell membrane When to use?:
Disadvantage:
| ▪ Insertion necessary 30 minutes PRIOR to intercourse
80
Male Condom:
Fluid Transmitting STI protection
o HIV, GT, CT
Advantages: affordable
81
Diaphragm: Contrindication
Severe prolapse;
82
Vasectomy: What is cut?
Epididymis
83
Vasectomy: How many ejaculations do you need to make sure the sperm is clean out
15-20 ejaculations
84
Vasectomy: Side effect
Erectile dysfunction
May be mostly psychological in nature;
Prostate Cancer:
▪ BUT New Zealand study recently found no association with prostate Cancer
85
What conditions may it exacerbate? Adverse side effects?
| Contraindications to Hormonal Contraception:
Liver disease; pregnancy; history/current HTN or heart/vascular disease; Migraine; breast cancer
o Smoking >15 cigs and >35yoa
86
Disadvantages to Hormonal Contraception:
She effects
Decrease glucose tolerance
Decrease serotonin→ depression
87
Non-Hormonal Methods:
| ●
Copper-T IUD
88
IUD:
| ● Contraindications:
```
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
IUD:Early IUD danger signs
```
:Late/missed period;
abdominal pain;
fever, chills;
increased discharge;
odorous discharge;
big changes in bleeding:
breakthrough bleeding,
heavy periods, clots
```
90
IUD Advantage:
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
Know relative failure rates of different types of contraception (don’t need exact percentages)
```
■ 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
Know relative failure rates of different types of contraception (don’t need exact percentages)
■ Male Condoms 14.7% *******
■ Female Condom 21.0% *******
93
Menopause:
| ● Definition: 1
1 year without spontaneous menses. It’s not defined by absence or presence of other symptoms
94
Perimenopause:
Pituitary continues to release hormones (FSH/LH) to stimulate ovaries
95
Rising FSH = marker of perimenopause
(>20) FSH
96
Why FSH Increases: Perimenopause
- Follicles decrease, oocytes no longer mature
▪ Decrease in ovarian production of estradiol
▪ HRT supplementation in premature menopause cannot maintain normal FSH
97
Surgical vs. Natural
Natural:
▪ 1 year since last spontaneous menstrual period
▪ Natural menopause is transition between perimenopause & post menopause
▪ Generally around age 50 ,
98
Levels of Intervention
```
Diet, exercise, stress management (level 1)
▪ Nutritional supplementation (Level 2)
▪ Botanicals (Level 3)
▪ HRT
▪ Other pharmaceuticals
```
99
Level I
| ▪
```
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
▪ 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
```
101
Level II
▪ Nutrients
102
Level III
Botanicals
● Black Cohosh/Red Clover
● Bromelain, Curcumin
● St. Johns Wort, anxiolytics
103
● Consequences of normal menopause estrogen loss: Earl
Early changes—hot flashes (75%), insomnia, irritability, mood changes, low libido, abnormal bleeding
104
Consequences of normal menopause estrogen loss: Intermediate
vaginal atrophy urinary incontinence, skin atrophy, hair thinning, facial hair
105
Consequences of normal menopause estrogen loss: Late
Osteoporosis, CAD, Alzheimer’s dementia, colon cancer, age-related macular degeneration. Insulin resistance
106
What is removed with Surgical Menopause?
Ovaries bilaterally
107
What is premature Menopause
Premature if before age 40. Average age = 50 y/o
108
Menopause what happens to FSH
FSH increases
109
Know general screen guidelines for different age groups
| Paps, Mammograms
(over 40), ,
110
Know general screen guidelines for different age groups
| DEXA
(over 65)
111
Know general screen guidelines for different age groups
| COLONOSCOPY
COLONOSCOPY
| OVER 50
112
Vaginal Atrophy
Intravaginal treatment, vaginal lubricants
113
Menopausal women are at risk for what diseases/conditions?
endometriosis is a condition that primarily
| affects women of reproductive age
114
Cardiovascular Disease in Women:
| ● MI in women: women or men more likely to die?
Women More likely to die of a first MI
115
Do not present the same as they do in men ( MI IN women)
Atypical presentation
116
Coronary Heart Disease
| o CHD = is what?
Leading cause of death in American women
▪ CHD risk increases with age
▪ 1 in 2 women will die from CHD/stroke
117
Screening for CHD
HDL 50
o Negative risk factor
● LDL 2 risk factors
118
Risk Factors: for CHD
Positive Primary Family History
| ▪ Hypertension, Hyperlipidemia, Diabetes Mellitus, Smoker, Obesity, CAD or atherosclerosis Hx
119
CHD causes what?
Causes more death than Breast Cancer (1 in 25)
120
Testosterone & DHEA Side effects
Acne, hair thinning, irritability;
raise LDL,
tg’s,
lower HDL
121
HRT: Risks
Risk DVT:
122
Osteoporosis:
Risk factors for osteoporosis,
including smoking,
low estrogen
123
Risk factors Osteoporosis Non-Modifiable:
```
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
Risk factors Osteoporosis Modifiable:
```
Modifiable:
▪ Smoker
▪ 1 year)
▪ Low calcium intake
▪ Increased homocysteine
▪ Alcoholism
▪ Poor eyesight
▪ Recurrent falls
▪ Inadequate physical activity
▪ Prescription meds
▪ Protein intake
```
125
Osteoporosis Work up Lab?
DEXA
126
There are 2 questions on intrapelvic manipulation
This is sensitive work, i.e. chance for women to be uncomfortable, malpractice suits, etc..
127
There are 2 questions on intrapelvic manipulation Always have a patient
o Always have the patient sign an informed consent prior to treatment.
128
There are 2 questions on intrapelvic manipulation
Do not
o Do not do intrapelvic work on pregnant women, a women with an infection or women with IUDs
129
There are 2 questions on intrapelvic manipulation
Do you need special training
o Specialty training is needed to do this work on patients.
130
There are 2 questions on intrapelvic manipulation
Whats it used for?
o Intrapelvic work is useful for treating pelvic pain, pelvic adhesions, dysmenorrheal.
NOT cervical dysplasia.
131
Valvular Disorders and Pelvic Prolapse:
Pelvic prolapse
Procidentia
prolapse or falling down Mostly female patients
> 50% have at least some evidence of prolapse on PE
132
Definition: protrusion of:
| Uterus
Faling down Uterus
133
Definition: protrusion of:
| Bladder -
cystocele
134
Definition: protrusion of:
| Urethra (rare)
urethrocele
135
Definition: protrusion of:
| Rectum (80-90% female)
rectocele
136
Definition: protrusion of:
| Intestine (rare)
enterocele
137
Uterine prolapse: Cause
ligament laxity
138
Uterine prolapse: 3rd degree
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
Pelvic prolapse: predisposing factors
Multiparous women - A lot of children (stretch)
Menopause
- Genital atrophy d/t low estrogen plays important
Obesity
Smoking
140
Prolapse: diagnosis
- 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
Prolapse: Treatments
: Pelvic PT
Pessary Surgery
Bladder/uterus “slings” hysterectomy
142
CYSTOCELE: Bladder
|
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
RECTOCELE RECTUM: MC Complaint
most common complaint is constipation or the need to apply digital pressure in the vagina in order to defecate
144
ENTEROCELE (Intestine)
(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
URETHROCELE (Urethra) MC Symptom
:Vaginal bleeding is the most common presenting sx; upon examination, round doughnut-shaped mucosa is observed protruding from the urethral opening.
