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GYN > infections > Flashcards

infections Flashcards

1
Q

what increases discharge normally

A

estrogen

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2
Q

vaginal discharge is abnormal if

A

i. Increased volume, especially if soiling the clothes
ii. Bad odor
iii. Change in consistency or color
iv. Irritation or pruritis, pain, burning
v. Dyspareunia or dysuria

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3
Q

BV tx in pregnant woman

A

Flagyl or clinda orally best

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4
Q

tx for batholin’s abscess

when would you follow up

A

Clindamycin 300mg po tid x 7 days or Ceftriaxone 250mg IM

FU in 2 weeks

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5
Q

primary HSV infection

A

Valacyclovir 1g po bid x 10 days for primary HSV infection

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6
Q

RPR reactive

A

syphillis

, 1:16; MHA-TP positive

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7
Q

what decrease in titers fo you need to see when treating syphillis

A

Need to see 4-fold decrease in RPR titer over 6 months (1:16 to 1:4 or less) and stays low at 12 and 24 months post-tx

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8
Q

HPV warts-provider tx

A

Cryotherapy
Podophyllin
TCA
Surgical destruction/removal

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9
Q

hpv warts home tx

A

Podofilox

Imiquimod

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10
Q

what goes on a KOH smear

A
  1. 10% potassium hydroxide solution on a slide
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11
Q

Mycoplasma hominis and Ureaplasma urealyticum

dx and tx

A
  1. Diagnosis by vaginal culture or PCR for identification

2. Treatment is Doxycycline 100mg po bid x 10 days

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12
Q

marsupilization would be used for a cyst of abscess

A

CYST

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13
Q

when would you see a decreased in vaginal pH

A

candidiasis

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14
Q

what are non hormonal options for the treatment of hot flashes

A

clonidine
SSRI
neurotin

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15
Q

anbx for bartholon’s abscess

A

i. Ceftriaxone 250mg IM or Cefixime 400m po
ii. Clindamycin 300mg po x 7 days
iii. Add azithromycin 1gm po if C. trachomatis

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16
Q

follow up care for bartholin’s abscess

A

a. Wear peripad to absorb drainage
b. Pelvic rest (no sex)
c. Sitz baths and mild analgesics 48 hrs
d. Catheter in place 2-4 wks (poss 6 wks)
e. Call for any increase in pain, swelling, fever or unusual vaginal discharge

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17
Q

i. Acute salpingitis-peritonitis

A

PID

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18
Q

labs for PID

A

ix. WBC > 10K and/or elevated CRP
x. Inflammatory mass on exam or US
xi. Gram negative intracellular diplococci
xii. Purulent discharge on culdocentesis
xiii. Elevated ESR

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19
Q

who should be admitted for PID

A

a. Temp >102.2˚F, guarding or rebound tenderness, toxic patients; adolescents and pregnant women

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20
Q

i. Most common STD among women

A

chlamydia `

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21
Q

chlamydia tx in pregnant pt

A

a. Erythromycin 500mg po qid x 7 days or

b. Amoxicillin 500mg po tid x 7 days

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22
Q

chlamydia tx in non pregnant

A

a. Azithromycin 1g po x 1 dose or

b. Doxycycline 100mg po bid x 7 days

23
Q

iii. Most common cause of genital ulcers

A

HSV

24
Q

with syphilis Primary chancre develops ____ after infection and persists _____

A

10-90 days after infection,

persists 1-5 weeks and heals spontaneously

25
Q

Cutaneous eruption of secondary syphilis occurs ____after initial lesion

A

iv. Cutaneous eruption of secondary syphilis occurs 2-6 months after initial lesion, heals spontaneously after 2-6 weeks

26
Q

what does primary syphilis look like

A

Painless genital chancre: indurated, firm papule or ulcer with raised borders on labia, vulva, vagina, cervix, anus, lips or nipples

Painless, rubbery regional lymphadenopathy followed by generalized lymphadenopathy in the 3rd-6th week

27
Q

positive serology for syphilis occurs in

A

d. Positive serologic tests in 1-4 weeks in 70% of pts

28
Q

b. Condyloma lata

A

moist papules in perineum, darkfield microscopy positive

29
Q

Viral-like syndrome, diffuse lymphadenopathy

is seen with primary, secondary or tertiary syphilis

A

secondary

30
Q

when would you get a Lp for a pt with syphilis

A

neurologic symptoms, treatment failure, serum non-treponemal titer >1:32, evidence of tertiary syphilis, HIV+ patients

31
Q

Early syphilis tx

A

Benzathine penicillin G, 2.4 million units IM once

Doxycycline 100mg po bid x 14 d if PCN allergic

32
Q

b. Late syphilis or unknown duration tx

A

Benzathine penicillin G, 2.4 mU IM q wk x 3 wks

Doxycycline 100mg po bid x 28 d if PCN allergic

33
Q

when do you repeat testing for pt with syphilis

A

b. Repeat RPR or VDRL at 0, 3, 6, 12, and 24 months after treatment

34
Q

Condyloma Acuminata dx

A
  1. Biopsy of lesions for definitive diagnosis
35
Q

labs for a pt with dysmenorrhea dyschezia and dysparuneia

A

FSH, CBC for anemia, Metabolic panel for PCOS, TSH, GC/Chlamydia (for underlying PID), HCG

36
Q

pelvic pain think

A 
ectopic pregnancy
 PID
 intersittial cystitis
 adenomyosis
ovarian neoplasms 
 pelvic adhesions
 IBS
 colon cancer
 diverticular disease
37
Q

dx of endometriosis is most commonly made during

A
  1. 25-35 years old most common

Uncommon on pre/post monarchal girls
Rare in post menopausal women NOT taking estrogen

tall thin
asian
white

38
Q

RF for endometriosis

A 
mullerian anomlaies
short menstrual cycles
pronlonged menses
nulliparity
early menarche
39
Q

What lowers risk of endometriosis

A

multiple births
extended intervals of lactation
late menarche

40
Q

mild enometriosis, superficial implants less than 5 cm in aggreagte, scattered on the peritoneum and ovaries. no significant adhesions

A

ii. Stage 2

41
Q

exhibits multiple implants, both superficial and invasive, Peritubal and periovarian adhesions

A

Stage 3:

42
Q

VII. Endometriomas

A

Contains blood, fluid, menstrual debris

lined with endometrial epithelium, stroma and glands

43
Q

how can you detect endometriomas

A

d. Detected on imaging (US, CT, MRI)

44
Q

endometriomas are part of endometriosis?

A

stage 4

45
Q

dysmenorrhea with endometriosis

A

Typically “dull or crampy that begins 1-2 days before menses and can persists during and a few days after, chronic

46
Q

if infertile for ___ laproscopy is indicated

A

after 12 months surgery is indicated

laproscopy

47
Q

MODERATE PAIN, no ultrasound evidence of endometrioma

TX

A

Treat symptomatically –>NSAIDS and monophasic combined hormonal contraceptives (pills, patch or ring, ?LNgIUD, ?Nexplanon)

48
Q

when would you advise taking NSAIDS in a

A

Starting the NSAIDS a day before their symptoms typically starts seems to help (i.e. if they get cramping the day before their period then starting the NSAIDS 2 days before their period)

49
Q

how do OCPs work for endometriosis

A

Suppress ovulation and menstruation through hyperestrogenic effect—-seems counter intuitive but it works!

Consider continuous regimen with pill free interval to allow for withdrawal bleed every 3-4 months

50
Q

if OCP do not work for endometriosis

A

POP change to norethidrone acetate 5mg

Consider depot medroxyprogesterone acetate 150mg IM

51
Q

MODERATE PAIN, or no response to previous therapies or recurrent symptoms

A

GnRH agonist with add-back (Depo-Lupron)

Add-back helps decrease hypoestrogenic effects (hot flashes, night sweats, vaginal dryness etc.) and preserves bone density

52
Q

Aromatase inhibitors are reserved for women with endometriosis who

A

who continue to have refractory symptoms despite GnRH agonist treatment

53
Q

when would you get a laproscopy

A

No response to treatment, refractory symptoms, endometrioma or masses seen on imaging or exam

54
Q

reoccurence rates after laproscopy

A
  1. 10% in 3 years

2. 35% in 5 years

GYN (13 decks)

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