GYN/Men's health Flashcards
Secondary amenorrhea
- cessation of menstrual flow after establishment of normal cycle
- pregnancy test, refer for other studies
What grade of abnormal Pap must you refer?
CIN 2 on the Bethesda Classification
Cervical cancer screening guidelines
- Start screening at 21 years old
- Screen every 3 years with cytology, and starting age 30, may start screening every 5 years with cytology and HPV co-test
- Stop screening at age 65
Causes of vulvovaginitis
- trichomonas
- bacterial vaginosis
- candidiasis
Trichomonas: sx, dx, tx
Sx: discharge, pruritis, erythema, “strawberry patches” on cervix and vagina, dyspareunia, dysuria
Dx: microscopy on saline slide
Tx: metronidazole 2gm po x1, or 500mg PO BID x7 days
Bacterial vaginosis: sx, dx, tx
Sx: watery gray discharge, fishy smell, spotting
Dx: microscopy on saline slide shows clue cells, Whiff test (KOH slide)
Tx: metronidazole 2gm PO x1, or 500mg PO BID x7 days, or gel BID x5 days
Candidiasis: sx, dx, tx
Sx: thick, white, curd-like discharge, erythema and pruritis
Dx: microscopy on KOH slide shows pseudo-hyphae (spag&mb)
Tx: topical or oral antifungal
Some common pathogens for pelvic inflammatory disease
Chlamydia trachomatis, Neisseria gonorrhea, E. coli
Symptoms of pelvic inflammatory disease
fever/chills, nausea/vomiting, vaginal discharge, dysuria, dyspareunia, pelvic pain, infertility, positive for cervical motion tenderness, adnexal tenderness, abdominal tenderness
Pelvic inflammatory disease: dx, tx
Dx: STI testing, elevated ESR/CRP, ultrasound
Tx: empiric, broad-spectrum antibiotic coverage recommended
- Regimen A: Ofloxacin, OR Levofloxacin +/- metronidazole
- Regimen B: Cefoxitin + Probenecid + Doxy +/- metronidazole OR
Ceftriaxone + Doxy +/- metronidazole
Primary dysmenorrhea
Occurs in adolescents shortly after onset of menses and no pelvic pathology is identified.
Result of high levels of prostaglandin.
Secondary dysmenorrhea
Occurs in women > age 20. More likely associated with some form of pelvic disease.
How to treat primary dysmenorrhea
Prostaglandin inhibitors (ibuprofen, naproxen, indomethicin), oral contraceptive pills, exercise, high fiber diet and reduction of sugar/caffeine/salt
Oligomenorrhea
infrequent, irregular bleeding
Polymenorrhea
Frequent, irregular bleeding
Menorrhagia
Excessive, prolonged bleeding with regular frequency
Metrorraghia
bleeding between cycles
Menometrorrhagia
prolonged, frequent, excessive, irregular bleeding
Intermenstrual bleeding
Variable quantity between cycles
Diagnostic tests for abnormal uterine bleeding
hCG (r/o ectopic pregnancy), prolactin, TSH, CBC, PAP, STI screen, UA
What is the most common cause of serosanguinous nipple discharge?
Intraductal papilloma (usually benign, requires excisional biopsy)
Fibrocystic breast disease: symptoms, management
Sx: tenderness related to cycle, mobile, nipple discharge usually not present
Tx: warm soaks, low sodium diet
Breast cancer: symptoms
family hx, firm, immobile, painless mass, may have dimpling, nipple retractions, bloody discharge, lymphadenopathy
Normal age span where menopause occurs?
Age 45-55
Definition of menopause/perimenopause
one year after last bleeding episode=menopause
when irregular bleeding/symptoms start=perimenopause
Some body changes that occur with menopause
skin dryness
increased risk CAD
mood changes, depression
vulvovaginal dryness/atrophy
What three factors help make the decision of whether or not to use hormone therapy for menopause symptoms?
Family or personal history of breast cancer?
Family or personal history of MI/CAD? Hyperlipidemia?
Family or personal history of uterine cancer?
Osteoporosis: risk factors
Female, white, Asian, petite frame, elderly Early menopause or estrogen deficiency Family history Smoking or alcohol abuse Sedentary lifestyle Certain meds/disease: steroids, thyroid
Female athlete triad
- Risk for osteoporosis at young age
1. Eating disorder and/or excessive exercise
2. Amenorrhea
3. Decreased estrogen, resulting in bone loss
Results of the DEXA scan (bone density)
T scores
> -1.0 SD is normal
-1.0 to -2.5 is osteopenia (consider calc w/vit D, wt bearing exercise)
Bone density testing recommendations
All women ≥ 65 years old
All postmenopausal women
Treatment for osteoporosis
Prevention is key: avoid risk factors
weight bearing exercise
Calcium supplementation or increase calcium in diet
Drug therapy: ERT, bisphosphonates
Calcium supplement recommendations
11-24yo: 1200-1500mg/day
25-49yo: 1000mg/day
50-64yo- 1500mg/day (if not on ERT, or 1000mg/day on ERT)
≥65yo: 1500mg/day
Dietary sources of calcium
Dairy products
Sardines, fish with bones
Green leafy vegetables
Vitamin D supplements to increase absorption
Definition of SLE
multisystem, inflammatory disorder that affects primarily women of childbearing age
S/sx of SLE
Fever, anorexia, malaise, weight loss, butterfly rash, alopecia, Raynaud’s, joint symptoms, vasculitis, nephritis, abdominal pains
SLE: dx, tx
Dx: ANA positive in about 95 percent of patients
Tx: bed rest, naps, avoid fatigue, sun protection, NSAID, steroids
UA: presence of nitrate
> Specificity,
UA: presence of esterase
> Sensitivity,
Commonly used antibiotics for lower UTI
Bactrim, Cipro, Augmentin
Other options: amoxicillin, levofloxacin, nitrofurantoin
3 day course is optimal for uncomplicated
Treatment of acute pylenonephritis
14 day course
Bactrim, Cipro, other quinolone, Augmentin, Aminoglycosides (Gentamycin, Tobramycin)
Severe cases or those with nausea/vomiting should be hospitalized
Stress incontinence
urine leakage from activities with increased pressure on bladder (lifting, coughing, sneezing, exercise, laughing)
Urge incontinence
Caused by strokes, infections, stones, neoplasms
urgency, involuntary urinary loss, nocturia, frequency, large amounts
frequently referred to as “Overactive bladder”
Primary amenorrhea
- absence of menarche by age 16
- consider pregnancy test, refer to endocrinology
Management of incontinence
Stress- timed voids, pessary, surgery, “squeeze before you sneeze”
Urge- Kegels, medication, “freeze and squeeze”
Patient teaching: weight loss, fluid management, avoid caffeine
Medications for incontinence
Oxybutynin (Ditropan)
Tolterodine (Detrol)
Tanner staging for girls: breast development
- Preadolescent breasts
- Breast buds with areolar enlargement
- Breast enlargement without separate nipple contour
- Areola and nipple project as secondary mound
- Areola recedes, nipple retracts, adult breast
Tanner staging for boys: Penis
- Preadolescent
- Enlargement and roughen/reddening of scrotum
- Penis enlongates
- Penis enlarges in width and glans develops, rugae appear
- Adult shape and appearance
Epididymitis: causative organisms
35yo, bacteria from bladder
Epididymitis: Sx
symptoms like UTI + scrotal edema (grapefruit)
enlarged, tender epididymis
Positive Prehn’s sign (pain relieved with lifting scrotum)
Epididymitis: Dx, Tx
Dx: STI testing, urine culture, scrotal US
Tx 35yo: Bactrim PO BID x10 days OR
Cipro 250mg PO BID x10days
Acute bacterial prostatitis: causative organisms
Gram negative bacteria (especially E. coli)
In younger men: Chlamydia
Acute bacterial prostatitis: Sx
UTI symptoms + prostate swollen, warm, tender/boggy
Acute bacterial prostatitis: Dx, Tx
Dx: Urine culture
Tx: refer if urinary retention evident; no sex until resolves
Bactrim, Levaquin, Ofloxacin
BPH incidence
By age of 50, 50 percent of men will have
By age of 80, 80 percent of men will have
BPH sx
urgency/frequency, nocturia, dribbling, retention
May have bladder distention
Prostate nontender with enlargement, smooth, rubbery consistency with possible nodules
BPH dx/tx
Dx: UA, PSA, DRE Tx: Refer as needed Alpha blockers (Terazosin, tamsulonsin) 5-alpha-reductase inhibitors (Finasteride, dutaseride) to shrink prostate Saw palmetto effective for some patients
When to start routine DRE
Age 40
When to start routine PSA
Age 50
Prostate cancer sx
Usually asymptomatic, BPH symtpoms, adenopathy, bladder distention, prostate palpates HARDER THAN NORMAL with OBSCURE BOUNDARIES and nodules may be present
Prostate cancer dx/tx
Dx: PSA values >4 is suspicious (watch trend and for spikes) although about 40 percent with prostate cancer present with normal PSA; prostate ultrasound (to check for solid nodules), biopsy
Tx: Refer
Normal PSA values
age 40-49:
Risk factors for prostate cancer
African American
high fat diet may contribute
Top 4 killers of adults in US
- Heart disease
- Cancer (F: Lung, Ovarian; M: Lung, Prostate); M+F: Lung, Colorectal)
- Lower respiratory disease (asthma, COPD, pneumonia)
- CVA
Erectile dysfunction: possible causes
Stress/psychosocial atherosclerosis diabetes recreational drugs/smoking medications (thiazide, beta blocker, H2 blocker, antidepressant, NSAID, antihistamine, antiepileptics, muscle relaxers)
Treatment of ED with PDE
sildanefil (Viagra)- onset 30min, lasts 4hrs, without food
vardenafil (Levitra)- like sildanefil
tadalafil (Cialis)- onset 15min, lasts 36hrs, with/without food
Normal creatitine clearance values in adults
Males
Normal BUN and Creat and BUN/Cr ratio
BUN: 10-20
Creat: 0.5-1.5
BUN/Cr ratio: 10 to 1
