GYN Flashcards
PMS
- cyclic occurrence in the luteal phase
- begin 5 to 7 days before menses and resolve within 4 days of onset of menses
- disrupt normal activities and interpersonal relationships
Non pharm Tx of PMS
- chaste tree berry
- Aerobic exercise 20 - 30 min 4X/week
- Cognitive therapy
- Avoidance of physical/emotional triggers
RX Tx of PMS
- Spironolactone during luteal phase (reduce swelling/bloating)
- NSAIDs
- COCs
- SSRIs (may choose to only take during luteal phase)
PMDD
- At least 5 PMS-like symptoms severe enough to disrupt normal functioning
- Most if not all menstrual cycles
- Occurs in luteal phase and resolves within 1 week after menses
- Markedly depressed mood, anxiety, anger
- SSRIs (fluoxetine, sertraline, paroxetine)
Which phase of the ovarian cycle is most variable?
Follicular phase
Which phase of the ovarian cycle is most constant?
Luteal phase (14 days)
Is Galactorrhea bilateral?
YES, ALWAYS!
Fibrocystic Breast Changes
- occurs 1-2 weeks before menses
- well, defined, mobile, TENDER
- NO SKIN changes
- upper outer quadrant and axillary tail
Treatment for Fibrocystic Breast Changes
- Tx not necessary
- Aspiration of palpable cysts may be curative
- Supportive bra
- NSAIDs
- Reduce methylxanthines (caffeine, tea, cola, chocolate)
- Hormonal contraception may improve or worsen
Who is most at risk for Fibrocystic Breast Changes?
- Women aged 20 - 50, most common 35 - 50
When do Fibroadenomas develop?
Soon after menarche
What age group is likely to be affected by Fibroadenoma?
Aged 15 to 25
Signs and Symptoms of Fibroadenoma
- painless, single, round rubbery mass
- No nipple D/C
- Does NOT change with menstrual cycle
- NO SKIN changes
Diagnostic Tests for Fibroadenoma
- Fine needle aspiration
- Excisional biopsy
- U/S or mammography (U/S best choice for young women)
Management for Fibroadenoma
- Observe if less than 25
- May be removed to alleviate anxiety
- Annual clinical breast exam
What is the most common cause of pathologic nipple d/c?
Intraductal papilloma
Signs and Symptoms of Intraductal Papilloma
- Bloody, serous, or turbid discharge (not milk)
- D/C may occur spontaneously
- Mass not palpable
- Feeling of fullness or pain beneath areola
How to definitively evaluate Intraductal Papilloma?
- Excisional biopsy
Midwifery Management of Intraductal Papilloma
- REFER
- Excisional biopsy is curative
What age group is most at risk for Intraductal Papilloma?
- perimenopausal age group 35-50 yo
Breast Carcinoma Signs and Symtpoms
- Breast mass, likely upper outer quadrant
- Mass fixed, poorly defined, nontender
- Spontaneous nipple D/C
- Retraction
- Skin Changes
What is the proper follow-up of a patient with galactorrhea who is having regular menses and has normal prolactin and TSH levels?
Yearly prolactin levels
Adenomyosis Signs and Symptoms
- dysmenorrhea, heavy uterine bleeding
- boggy tender uterus
- globular enlargement (may be 8 - 10 weeks gestation size)
Galactorrhea
- bilateral nipple d/c that occurs in women that have not been pregnant or lactating within the last 12 months
- Not caused by breast disease
- often idiopathic
- May be associated with prolactin-secreting pituitary adenomas
Patients with PCOS are at increased risk for:
- endometrial cancer
- diabetes mellitus
- heart disease
What is the treatment for Bacterial Vaginosis?
- Metronidazole 500 mg PO BID X 7d
- Metronidazole gel 0.75% QD X5d
- Clindamycin cream 2% QD X7d
Amsel’s Diagnostic Criteria for diagnosing BV
3 of the following:
- white d/c that coats vaginal walls
- clue cells on microscopic exam
- pH of vaginal fluid >4.5
- +Whiff test
What is found on BV Gram Stain?
Lactobacilli
What is the treatment for vulvovaginal candidiasis?
- OTC or prescription topical “azole”cream
- Fluconazole 150 mg PO 1 time
What is seen on wet prep or gram stain of candidiasis?
- budding yeasts
- hyphae
- pseudohyphae
What is the treatment for Chlamydia?
- Azithromycin 1 g PO single dose
- Doxycycline 100 mg PO BID X7d (not approved for tx in pregnancy)
What are is most sensitive test in diagnosing Chlamydia?
NAAT
What is the treatment for Gonorrhea?
- Ceftriaxone 250 mg IM PLUS Azithromycin 1 g PO single dose
What is the treatment for primary, secondary, and early latent syphilis?
- Benzathine PCN G 2.4 million units IM single dose
What is the treatment for first episode of HSV (herpes)?
Acyclovir 400 mg PO TID X 7-10d
What is the suppressive therapy for recurrent HSV (herpes)?
Acyclovir 400 mg BID
When should suppressive therapy for HSV+ women begin in pregnancy?
36 weeks
What is the suppressive therapy for HSV in pregnant women?
Acyclovir 400 mg PO TID QD
Tx of PCOS in women who do not want to conceive?
- low dose COCs
- progestin contraceptives (irregular bleeding)
Tx of PCOS in women who do not desire pregnancy and who do not want hormonal contraception?
- MPA for 10 days a month induces withdrawal bleeding
- Weight loss
- Insulin sensitizing agents (i.e. metformin)
What are potential causes of galactorrhea?
- hypo/hyperthyroidism
- some medications (opiates, cannabis)
- excessive breast stimulation
- pituitary adenoma
