GYN Joy Flashcards
Initially after Depo-Provera injection there may be ___________. This usually resolves in 2-3 months.
unpredictable bleeding
In general, after one year of using Depo-Provera, nearly 50% of users have amenorrhea.
Contraindications to estrogen include
a history of thromboembolic disease
women who are lactating
over age 35 who smoke
develop severe nausea with combined OCPs
__________ should be used with caution in women with a history of depression.
Progestins
Both ___________ can be a potential side effect from using oral contraceptive pills.
hypertension and thromboembolic disorders
After Essure, patients are required to use a back up method of contraception for three months following the procedure until?
a hysterosalpingogram is performed confirming complete occlusion of the tubes.
Decribe “the patch” as controception
releases ethinyl estradiol and norelgestromin steady serum levels for 7 days.
Does not work if over 198 lbs
What is the most effective emergency birth control
copper IUD
pregnant with fever and bleeding with a dilated cervix which are findings seen with ____________
septic abortion.
Threatened abortions clinically have
vaginal bleeding
a positive pregnancy test
cervical os closed or uneffaced.
retention of a nonviable intrauterine pregnancy for an extended period of time
Missed abortions
The management of septic abortion includes?
broad-spectrum antibiotics and uterine evacuation
medical termination is not the best option since prompt evacuation of the uterus is indicated for septic abortion.
___________________ is a laboratory test often used for detection of lupus anticoagulant
Dilute Russell’s viper venom time (dRVVT)
antiphospholipid antibody syndrome treatment is ?
aspirin plus heparin. There is roughly a 75% success rate with combination therapy versus aspirin alone.
What is used in medical abortion
Mifepristone (an antiprogestin) can be administered, followed by misoprostol (a prostaglandin) to induce uterine contractions to expel the products of conception. This approach has proven to be effective (96%) and safe.
Manual vacuum aspiration is more than 99% effective in early pregnancy, which is defined by
less than eight weeks prego
condition where the cavity of the uterus develops scar tissue (adhesions).
Asherman’s syndrome, also known as intrauterine adhesions
increased risk with multiple abortions
Mifepristone, a progesterone receptor blocker, is used for pregnancy termination. It is recommended for use within ________
49 days of the LMP
maybe effective up to nine weeks
______ can be administered orally or vaginally and will induce uterine cramping with expulsion of products of conception. Potential risk factors of use include hemorrhage as well as failure.
Misoprostol
Mifepristone is a _________moa
progesterone receptor blocker,
Symptoms of Lichen sclerosus
Patients typically present with extreme vulvar pruritus and may also present with vulvar burning, pain and introital dyspareunia.
findings of Lichen sclerosus
Early skin changes include polygonal ivory papules involving the vulva and perianal areas, waxy sheen on the labia minora and clitoris, and hypopigmentation.
tell me bout the trich
Diagnosis performed by saline microscopy of vaginal secretionss, ensitivity of only 60% to 70%.
treatment is metronidazole 2 grams orally in a single dose or metronidazole 500mg orally bid for 7 days
The patient’s sexual partner also should undergo treatment prior to resuming sexual relations.
describe Lichen planus
a chronic dermatologic disorder involving the hair-bearing skin and scalp, nails, oral mucous membranes and vulva.
can have progressive adhesion formation and loss of normal architecture, the vagina can become obliterated.
Vestibulodynia (formally vulvar vestibulitis) syndrome consists of ?
symptoms/findings limited to the vulvar vestibule,
- severe pain on vestibular touch or attempted vaginal entry
- tenderness to pressure and erythema
Vestibulodynia treatment
- tricyclic antidepressants to block sympathetic afferent –pain loops
- pelvic floor rehabilitation
- biofeedback
- topical anesthetics.
vestibulectomy reserved for patients who do not respond to standard therapies and are unable to tolerate intercourse.
Lichen simplex chronicus rx
Treatment involves a short-course of high-potency topical corticosteroids and antihistamines to control pruritus.
how do you treat gon and clam
-azithromycin
-doxycycline
for chlamydia
-cephalosporin
-quinolone
for gonorrhea.
herpes ddx and rx
Clinical diagnosis of genital herpes should be confirmed by viral culture, antigen detection or serologic tests.
Treatment consists of antiviral therapy with acyclovir, famciclovir or valacyclovir.
Vulvodynia is?
a chronic pain syndrome that affects the vulvar area and occurs without an identifiable cause.
all other causes of pain must first be excluded, including infectious etiologies as well as other vulvar conditions.
________ has been shown to have alpha-adrenergic properties and may improve urethral tone in the treatment of stress incontinence.
Pseudoephedrine
Kegel exercises are used to strengthen the pelvic floor and decrease urethral hypermobility for the treatment of _______________
stress urinary incontinence.
The parasympathetic system is involved in bladder emptying and works via?
acetylcholine –> stimulates the bladder to contract through muscarinic receptors.
Thus, anticholinergics are the mainstay of pharmacologic treatment. Oxybutynin is one example.
Herpes simplex virus presentation
Initial infection is characterized by viral-like symptoms preceding the appearance of vesicular genital lesions.
Hep B exposure rx
Post-exposure prophlaxis should be inititated ASAP up till
- 7 days after blood contact
- 14 days after sexual exposure
In individuals who are unvaccinated but exposed to persons who are HBsAG positive, recommendations are to?
receive one dose of HBIG (Hepatitis B Immune Globulin) and the HBV (Hepatitis B Vaccine Series).
If exposure is HBsAG negative or unknown status, then?
HBV series is used.
If exposed individual is vaccinated to Hep B and a non-ep responder, then rx is?
HBIG plus HBV or HBIG times two doses is used.
ddx of Acute salpingitis
. Important diagnostic criteria include lower abdominal tenderness, uterine/adnexal tenderness and mucopurulent cervicitis.
rx of covering both gonorrhea and chlamydia.
In pt IV Cefotetan or cefoxitin PLUS doxycycline or clindamycin PLUS gentamicin
out-pt:
-ceftriaxone, cefoxitin, or other third-generation cephalosporin (such as ceftizoxime or cefotaxime)
PLUS
doxycycline WITH or WITHOUT metronidazole.
Acute cystitis in a healthy, non-pregnant woman is considered uncomplicated and is very common and caused by
- escherichia coli 85%
- Staphylococcus saprophyticus
- Klebsiella pneumoniae
- Enterococcus faecalis
- Proteus mirabilis.
Mildly symptomatic or asymptomatic urinary tract infection must be considered in patients who present with
low pelvic pain urinary frequency urinary urgency hematuria new issues with incontinence.
