Gyn, Reproductive and Sexual Disorders Flashcards
The cyclic occurrence in the luteal phase of a group of physical and distressing physical and psychological symptoms that begin 5-7 days before menses and resolves 4 days after onset of menses is considered what?
Premenstrual syndrome (PMS)
PMDD must include at least one of what 4 symptoms?
markedly depressed mood, marked anxiety, marked affective lability, persistent and marked anger
What medications are approved by the FDA for treatment of PMDD?
Drospirenone containing combination hormonal contraceptives and fluoxetine, paroxetine and sertraline
Which dysmenorrhea is pain shortly before the onset of menses, is stimulated by prostaglandin release and rarely begins after age 20?
Primary dysmenorrhea
Which dysmenorrhea can cause pain at anytime during the cycle, is related to underlying pathology and can occur at any age?
Secondary dysmenorrhea
What is the treatment of choice for primary dysmenorrhea and how is it best used?
NSAIDs (mefenamic acid, naproxen sodium, ibuprofen and indomethacin) best if begun 2 days before expected menses or at onset continuing for 48-72 hours
What is a progestin challenge test and what does it indicate?
Progestin daily for 10-14 days which should induce bleeding within 7-14 days which indicates adequate estrogen production and stimulation
If FSH and LH levels are low, what does it indicate the cause of amenorrhea is?
Hypothalamic or pituitary dysfunction
If FSH and LH levels are high, what does it indicate the cause of amenorrhea is?
Ovarian failure and menopause
What are the structural causes of AUB using the acronym PALM?
Polyp, Adenomyosis, Leiomyoma (fibroids), Malignancy/Hyperplasia
What are the non-structural causes of AUB using the acronym COEIN?
Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified
At what age is endometrial evaluation recommended in women with AUB?
40 years
What are two non hormonal medications used for AUB?
NSAIDS and TXA both taken at menses onset for 5 days
High levels of prolactin inhibit ovulation how?
By inhibiting GnRH from the hypothalamus thereby inhibiting LH/FSH production by the anterior pituitary
What are the three components of the Rotterdam criteria for PCOS?
Oligo-ovulation/an-ovulation, clinical/biochemical hyperandrogegism and polycystic ovaries
If pregnancy is desired, what is first line option for patients with PCOS?
Letrozole (Femara)
The presence of endometrial stroma and glands outside of the uterus is what?
Endometriosis
A benign condition in which ectopic endometrium is found within the myometrium is what?
Adenomyosis
What is the first choice of analgesics for adenomyosis and endometriosis?
NSAIDs
What serum prolactin levels are suggestive of a pituitary adenoma?
100-300ng/mL, refer if over 20ng/mL
What pharmacologic agent decreases or stops galactorrhea?
Dopamine Agonist such as bromocriptine
What are some pharmacologic agents to treat fibroids that are growing in size and causing bleeding issues?
GnRH agonist, MPA, IUDs
What diagnostic test is used to evaluate ovarian cyst?
Transvaginal US
How would you manage a functional ovarian cyst?
Refer if greater than 10cm; if less than 10cm and a simple cyst, then repeat serial US every 4-12weeks; if post menopause, consider any cancer risk factors and refer if they are present or cyst is greater than 10cm
What is the most common gynecologic malignancy that usually presents with painless vaginal bleeding, watery leukorrhea that progresses to hemorrhage, and lower abdominal pain?
Endometrial carcinoma
What are the Amsel criteria for diagnosing BV? (3 of 4 must be present)
vaginal pH greater than or equal to 4.5, clue cells on saline wet mount, homogeneous discharge that is white and coats vaginal walls, and a positive whiff test
Increasingly severe dysmenorrhea and heavy bleeding during menses is a common symptom of what?
Adenomyosis
What are the Amsel criteria for diagnosing BV? (3 of 4 must be present)
vaginal pH greater than or equal to 4.5, clue cells on saline we mount,
What is the treatment for BV?
Metronidazole 500mg BID for 7 days
What is used to treat Chlamydia?
Azithromycin 1g PO, single dose; Doxycycline 100mg PO BID for 7 days; avoid intercourse for 7 days
A wet mount with pseudohyphae and pH less than 4.5 is consistent with which vaginal infection and how would you treat it?
Vaginal candidiasis; OTC suppositories or prescription oral fluconazole 150mg in a single dose
What is used to treat Chlamydia?
Azithromycin 1g PO, single dose; Doxycycline 100mg PO BID for 7 days
Postcoital bleeding, inter-menstrual bleeding, vaginal d/c, abdominal pain and symptoms of UTI could be c/w which STI?
Chlamydia
What causes condyloma acuminata (anogenital warts)?
HPV
Which HSV type is commonly found in the mouth and accounts for 15% of genital infections?
HSV 1, type 1
What are symptoms of local prodrome of HSV and how long does it appear before lesions?
pruritus, erythema
1-2 days before lesions
Which HSV type causes 85% of genital infections?
HSV Type 2
What is the suppressive therapy regimen for first clinical episode of HSV?
Acyclovir 400mg PO TID for 7-10 days
What is the suppressive therapy regimen for episodic outbreak of HSV?
Acyclovir 400mg PO TID for 5 days
What is the suppressive therapy regimen for recurrent outbreaks of HSV?
Acyclovir 400mg PO TID daily
What are symptoms of local prodrome of HSV and how long does it appear before lesions?
pruritus, erythema
1-2 days before lesions
What are some systemic symptoms that may occur about 1 week after HSV exposure?
fever, malaise, headache
Flesh-colored, white or pink waxy, smooth, firm spherical papules ranging from 2-5mm in diameter is likely what?
Molloscum Contagiosum
What occurs during the primary stage of syphilis and how soon does it occur after exposure?
Primary lesion (chancre) arises at point of entry. Often painless, ulcerated with raised borders. Occurs 10-90 days after exposure
What occurs during the secondary stage of syphilis and how soon after primary lesions does it occur?
Localized or diffuse lesions on palms and soles, condyloma lata with generalized lymphadenopathy and flu like symptoms
4-6 weeks
When does latent phase of syphilis occur and how is it detected?
After spontaneous resolution of secondary stage.
Detected by serologic testing
What are the characteristics of the tertiary stage of syphilis?
Nodular lesions on skin, mucous membranes and viscera. Cardiac and neruo symptoms are also present
What are the initial non-treponemal tests for syphilis?
Venereal disease research laboratory (VDRL) or rapid plasma reagin (RPR)
After a positive non-treponemal test, what do you do next?
Confirm with a treponemal test like FTA-ABS or TP-PA
What medication is prescribed in different doses for the different stages of syphilis?
Benzathine penicillin G
What should titers for syphilis do within 12-24. months?
decline at least four fold
What indicates inadequate treatment or a new infection in terms of titer levels in the case of syphilis?
A fourfold increase in titers
Haemophilus ducreyi is the bacteria that causes what STI and what is the recommended treatment?
Chancroid; Azithromycin 1g PO or Ceftriaxone 250mg IM
What is a STI that presents with painless ulcerations, painful bowel movements, possible flu like symptoms, and blood/pus from the rectum?
Lymphogranuloma Venereum (LGV)
What is the treatment for Lymphogranuloma Venereum (LGV) in non-pregnant and pregnant women?
Doxycycline 100mg PO BID for 21 days for non-pregnant woman; Erythromycin 500mg PO QID for 21 days in pregnant woman
GC and CZ can lead to what if left untreated?
PID
The presence of one or more of what symptoms on a pelvic exam lead to a diagnosis of PID?
cervical motion tenderness, uterine tenderness, adnexal tenderness
An abundance of _____ on a microscopic wet mount correlates with a diagnosis of PID?
WBCs
What are recommended IM/oral regimens for treatment of PID?
Ceftriaxone 250mg IM + Doxy 100mg PO BID for 14 days with or without metronidazole 500mg PO BID for 14 days
When should a follow up examination be performed after treatment of PID is initiated?
72hours
Which vulvar dermatoses presents as thickening of skin in response to chronic rubbing or scratching; may be atopic reaction; sometimes reaction to chronic inflammation from underlying skin condition?
Lichen simplex chronicus
Which vulvar dermatoses presents as an inflammatory skin condition manifested in the vulva, vagina, and other mucous membranes; typically seen in perimenopausal and post menopausal women; flares and remits spontaneously; lasts from several weeks to years; thought to be autoimmune?
Lichen planus
Shiny, erythematous papules/patches, gray-white lace strands of hyperkeratosis overlay patches, vaginal erythema, and loss of vulvovagina architecture is associated with which vulvar dermatoses?
Lichen planus
Physical findings of thickened, leathery plaques on labia majora and possible involvement of other body areas (nape of neck, ankle, forearm) is c/w which vulvar dermatoses?
Lichen simplex chronicus
What are common treatments for vulvar dermatoses?
Skin emollients/protectants, removing irritants and corticosteroids (short or long term)
A chronic vulvar discomfort often described as burning pain occurring in the absence of relevant physical findings that can be generalized or localized is c/w with a diagnosis of what?
Vulvodynia
What test is performed to assess for vulvodynia?
Cotton swab test
What are some common topical or oral neuropathic pain medications for treatment of vulvodynia?
Lidocaine, gabapentin (PO or topical), nitroglycerine, amitriptyline (PO or topical)
A chronic, progressive inflammatory skin condition primarily affecting the perineal/perianal are and is most common in menopause is c/w which vulvar dermatose?
Lichen sclerosus
Physical findings of maculopapular lesions, plaques, loss of pigmentation, thin and white epidermis, loss of vulvar architecture and obliteration of clitoris is consistent with which vulvar dermatoses?
Lichen Sclerosus
What kind of catheter can be placed after I&D of bartholin’s gland/cyst, what is its purpose and how long should you leave it for?
Word. 4-6 weeks.
Formation of epithelialized tract and continued drainage of the gland
Prenatal DES exposure is an increased risk for what?
Reproductive abnormalities, infertility and adenocarcinoma of cervix and vagina
What condition occurs with tampon use(less likely with sponges and diaphragms), is caused by S. aureus, presents with a high fever, a rash, and can affect multiple organ systems?
Toxic Shock Syndrome
Addyi, Vyleesi, Viagra, and Intrarosa are all FDA approved drugs for what condition?
Sexual Dysfunction
Anomalies involving an incomplete or complete lack of development of the uterus Fallopian tubes, or upper vagina resulting from the absence of anti-mullerian hormone is termed as ______ abnormalities.
Mullerian abnormalities
A female who only has one X chromosome or an abnormality of an X chromosome along with physical characteristics such as short stature, webbed neck, low neck hairline, short legs, lack of breast development, or scant pubic hair, and absent or streak ovaries most likely has what syndrome?
Turner’s syndrome
Which type of fibrocystic breast change includes a layering of cells; has malignant potential if atypical?
Hyperplasia
Which type of fibrocystic breast change refers to dilation of ducts; may regress with menses, may persist, or may disappear and reappear?
Cystic changes
Which type of fibrocystic breast change refers to a mass that develops following an inflammatory response to ductal irritation?
Fibrous change
A patient that presents with well defined/mobile/tender masses in the breast along with clear or white nipple discharge that is bilaterally most likely has what breast condition?
Fibrocystic Breast Changes
A patient that presents with a breast mass that is firm, freely movable, rubbery, non-tender, and has no nipple discharge or breast skin changes may likely have what breast condition?
Fibroadenoma; these are benign
A patient that presents with blood, serous, or turbid nipple discharge with no palpable mass or skin changes and pain beneath the areola most likely has which breast condition?
Intraductal Papilloma
A periareolar inflammation with mass or abscess in a woman who is not lactating and is most common in reproductive age group is what breast disorder?
Nonpuerperal/periductal mastitis
What organism is commonly related to a dx of Nonpuerperal/periductal mastitis and how is it treated?
Staphylococcus aureus
Oral antibiotics for 10days with abx that covers gram positive organisms (Augmentin, Dicloxacillin, cephalexin)
Dilation of ducts with surrounding inflammation and fibrosis that is most common in women >50 with an increased incidence in smokers is c/w which breast disorder?
Mammary duct ectasia
What kind of discharge would be expected from the breast with mammary duct ectasia?
Green, brown, black. Often bilateral
Menarche before age ____ and menopause after age ____ increases the risk for breast carcinoma.
<12
>55
In breast carcinoma, where is the breast mass most often located?
upper-outer quadrant
A fixed mass, poorly defined, irregular and non tender can be consistent with what breast disorder?
breast carcinoma
What lymph nodes may be enlarged with a breast carcinoma?
axillary, supra-clavicular and infra-clavicular
What do you use to distinguish a sold from cystic breast mass?
ultrasound
What is the most common symptom of vulvar cancer?
Pruritus `
What is the most lethal gynecologic malignancy?
Ovarian cancer
Normal breast development, scant pubic hair, blind vaginal pouch with no palpable uterus or ovaries in a 16 year old would be c/w with which diagnosis?
androgen insensitivity/resistance syndrome
Vaginal cancer is most commonly found in which part of the vagina?
the upper one-third of the vagina
Herniation of the bladder into the vaginal lumen is which pelvic relaxation disorder?
Cystocele
Herniation of the urethra into the vagina is which pelvic relaxation disorder?
Urthrocele
Bulging or herniation of the anterior rectal wall and posterior vaginal wall into the opening of vagina is which pelvic relaxation disorder?
Rectocele
Herniation of a portion of the small intestine into the upper vagina is which pelvic relaxation disorder?
Enterocele
