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Genitourinary Women > MDT's Part 2 > Flashcards

MDT's Part 2 Flashcards

1
Q

What is Premenstrual Syndrome (PMS)?

A

Recurrent variable cluster of troublesome physical and emotional symptoms that develop during the 5 days before the onset on menses and subsides within 4 days after menstruation occurs

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2
Q

What is Premenstrual dysphoric disorder (PMDD)?

A

When emotional or mood symptoms predominate along with physical symptoms and there is clear functional impairment with work or personal relationships
- May be thought of as complicated PMS

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3
Q

What are some general considerations of PMDD?

A
  • Intermittently effects about 40% of premenopausal woman
  • Primarily age 25-40
  • About 5-8% of symptoms are severe
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4
Q

What are signs and symptoms of PMDD?

A
  • Bloating/sense of increased weight
  • Ankle swelling
  • Skin disorders
  • Irritability/aggressiveness
  • Depression/lethargy
  • Libido change
  • Food cravings
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5
Q

Work up for PMS/PMDD?

A
  • Provide emotional/physical support
  • Careful eval of Pt
  • Advise Pt to maintain daily diary of all Sx’s for 2-3 months
  • If Sx’s occur throughout month, Pt may have mental health problem or depression
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6
Q

Treatment for mild to moderate PMS/PMDD?

A
  • Aerobic exercise
  • Reduction of caffeine, salt, and alcohol
  • Increase dietary calcium
  • Vitamin D or magnesium
  • Increase carbohydrate
  • Alternative therapy (acupuncture or herbal treatments)
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7
Q

Medication for PMS/PMDD?

A
  • Combined oral contraceptives (Depro-provera or Nexplanon)

- SSRI’s (either daily or on Sx’s days)

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8
Q

What is Vaginitis?

A

Inflammation and infection of the vagina resulting from:

  • Pathogens
  • Allergic reactions to contraceptives
  • Vaginal atrophy
  • Friction during sex
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9
Q

What Hx should be included for vaginitis?

A
  • Onset of LMP
  • Recent sexual activity and use of any latex products
  • Use of contraceptives, douches, or tampons
  • Recent changes in medication or use of antibiotics
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10
Q

What are some S/Sx’s of vaginitis?

A
  • Vaginal irritation or pruritus
  • Pain
  • Unusual or malodorous discharge
  • Bimanual exam may show:
  • Pelvic inflammation
  • Cervical motion tenderness
  • Adnexal tenderness
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11
Q

What are some differential diagnosis of vaginitis?

A
  • Vulvovaginal Candidiasis (Yeast infection)
  • Trichomonas Vaginalis Vaginitis
  • Bacterial Vaginosis
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12
Q

What are some predisposing factors for vulvovaginal candidiasis?

A
  • Pregnancy
  • Diabetes
  • Use of broad spectrum antibiotics or corticosteroids
  • Heat, moisture, and occlusive clothing
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13
Q

Signs and symptoms of vulvovaginal candidiasis?

A
  • Pruritus
  • Vulvovaginal erythema
  • White curd-like discharge that is NOT malodorous
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14
Q

What is Trichomonas Vaginalis Vaginitis?

A
  • Sexually transmitted protozoal flagellate
  • Women: infects vagina, Skene ducts, and lower urinary tract
  • Men: infects lower GU tract
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15
Q

What are some S/Sx’s of Trichomonas Vaginalis Vaginitis?

A
  • Pruritus
  • Malodorous frothy, yellow-green discharge
  • Diffuse vaginal erythema
  • Strawberry cervix (red macular lesions) in severe cases
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16
Q

What is bacterial vaginosis?

A

Polymicrobial disease that is NOT sexually transmitted

  • Chronic in nature
  • Overgrowth of gardnerella and other anaerobes
  • Increased malodorous discharge without obvious vulvitis or vaginitis
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17
Q

What are some other types of vaginitis?

A
  • Chlamydia
  • Gonorrhea
  • Contact dermatitis
  • Chemical irritation
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18
Q

Labs for vaginitis?

A
  • No labs operationally
  • KOH
  • Wet prep
  • NAAT urine testing
  • Vaginal pH
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19
Q

Treatment of vulvovaginal candidiasis?

A

Fluconazole

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20
Q

Treatment of Trichomonas Vaginalis Vaginitis?

A
  • Treat both partners

- Metronidazole

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21
Q

Treatment of bacterial vaginosis?

A
  • Metronidazole
  • Clindamycin vaginal cream
  • Metronidazole gel
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22
Q

Treatment of chlamydia?

A

Doxy 100 mg 7 days BID

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23
Q

Treatment of gonorrhea?

A

Ceftriaxone (Rocephin) 500 mg IM

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24
Q

Pt education for vaginitis?

A
  • Avoid nonabsorbent undergarments
  • Avoid douching
  • Delay sex until Tx complete and Sx’s resolve
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25
Q

What is Bartholin’s gland abscess?

A

Trauma or infection of the Bartholin duct causing gland obstruction leading to pain, swelling and abscess formation
- Reinfection causes recurrent tenderness further enlargement of duct

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26
Q

With respect to Bartholin’s gland abscess, what happens to develop a chronic Bartholin’s gland?

A

Persisting of stenosis of duct outlet with distension

- Often benign and aseptic

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27
Q

What are S/Sx’s of Bartholin’s gland abscess?

A
  • Periodic painful swelling on either side of introitus
  • Dyspareunia (Pain with sex)
  • Fluctuant swelling 1-4 cm
  • Tenderness is evidence of active infection
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28
Q

Treatment of Bartholin’s gland abscess?

A
  • Manual aspiration or I&D
  • Antibiotics unnecessary unless signs of cellulitis
  • If suspect G/C, treat for both
  • Frequent warm soaks
  • Marsupialization by OB/GYN if recurrence
  • Women >40, biopsy or removal recommended
29
Q

Follow up for Bartholin’s gland abscess?

A

Refer to OB/GYN for frequent reoccurrences

30
Q

What may infection with HPV lead to?

A

Cellular abnormalities in the cervix

31
Q

The tissue of the cervix can undergo cellular changes during puberty due to what?

A

Hormonal influences and changes in vaginal pH

32
Q

Are there varying degrees of dysplasia?

A

Yes, aka neoplasia

33
Q

What is cervical dysplasia also called?

A

Cervical Intraepithelial Neoplasia (CIN), a grading system applies

34
Q

Are there any specific signs/symptoms of cervical dysplasia?

A

No, often asymptomatic

35
Q

How is a presumptive diagnosis of cervical dysplasia made?

A
  • PAP Smear

- Biopsy/possible therapy by OB/GYN of visible, abnormal cervical lesions

36
Q

When should cervical cancer screening begin in immunocompetent woman?

A

Age 21 regardless of age of onset of sexual intercourse

37
Q

When does USPSTF recommend screening?

A
  • Screening for cervical cancer age 21-65 and cytology (PAP Smear) every three years
    OR
  • Screening in combination with cytology and HPV testing ever 5 yrs in 30-65 assuming negative HPV risk factors
38
Q

When does the USPSTF NOT recommend screening for cervical cancer with HPV testing alone or in combination with cytology?

A
  • In woman younger than 30

- In woman older than 65

39
Q

What are risk factors that require more frequent screening with Cervical Intraepithelial Neoplasia?

A
  • HIV infection
  • Immunosuppression
  • Exposure to diethylstilbesterol (DES) in utero
  • Previous Tx for CIN 2, CIN 3, or cervical cancer
40
Q

What are the two different ways diagnostic findings can be described for PAP Smear?

A
  • Atypical squamous cells of unknown significance (ASC-US)
  • Squamous intraepithelial lesions (SIL)
  • Can be low grade or high grade
41
Q

What are the methods of diagnosing cervical dysplasia?

A
  • PAP Smear
  • Colposcopy
  • Biopsy
42
Q

When is follow up for woman with ASC-US and a negative HPV screening?

A

1 year for repeat PAP and HPV co-testing

43
Q

What are some prevention methods for cervical dysplasia?

A
  • Vaccination
  • Regular Cytologic screening
  • Limit number of sexual partners
  • Use a condom
  • Smoking cessation and avoid second hand smoke
44
Q

Treatment for CIN?

A
  • Performed by OB/GYN
  • Biopsy should precede treatment
  • Cryosurgery
  • CO2 Laser
  • LEEP
  • Conization of Cervix (reserved for severe cases)
45
Q

Follow up for CIN?

A
  • All Pt’s with abnormal Pap, refer to physician sup or OB/GYN
  • close f/u after colposcopy and biopsy due to possibility of recurrence within 2 yrs
46
Q

What are some general considerations of Leiomyoma of the uterus?

A
  • Most common benign neoplasm of female genital tract

- May cause miscarriage and pregnancy complications

47
Q

What is Leiomyoma of the uterus?

A

Discrete, round, firm, often multiple uterine tumor composed of smooth muscle and connective tissue

48
Q

What are signs/symptoms of Leiomyoma of the uterus?

A
  • Frequently asymptomatic
  • Pelvic pressure
  • Abnormal uterine bleeding
  • Pain
49
Q

What are labs for Leiomyoma of the uterus?

A
  • CBC

- Iron deficiency anemia

50
Q

Imaging for Leiomyoma of the uterus?

A
  • Transvaginal US

- MRI with contrast

51
Q

Emergent treatment of Leiomyoma of the uterus?

A

Surgery may be required for acute torsion of a pedunculated myoma

  • Treat anemia prior to surgery
  • LNG IUD can help decrease bleeding associated with fibrosis
52
Q

What is the specific treatment for Leiomyoma of the uterus?

A
  • Asymptomatic managed expectantly
  • NSAIDS decrease menstrual blood loss
  • Hormonal therapies
  • Surgical therapy definitive treatment
53
Q

Follow up for Leiomyoma of the uterus?

A
  • Refer to gynecologist

- MEDEVAC for suspected torsion of fibroid and hemorrhage

54
Q

What are some general considerations for carcinoma of the endometrium?

A
  • AUB present in 90%
  • Pap smear frequently negative
  • Pain usually late Sx
55
Q

What is the second most common cancer of the female reproductive tract?

A

Adenocarcinoma of the endometrium

56
Q

What are some risk factors of carcinoma of the endometrium?

A
  • Obesity
  • Nulliparity (unopposed estrogen)
  • Diabetes
  • Polycystic ovaries with prolonged anovulation
  • Unopposed estrogen therapy
  • Extended use of tamoxifen for Tx of breast cancer
  • FamHx of colorectal cancer
57
Q

Signs and symptoms for carcinoma of the endometrium?

A
  • AUB present in 90%

- Pain generally occurs late in disease with metastases or infection

58
Q

Imaging for carcinoma of endometrium?

A
  • Vaginal US

- Hysteroscopy

59
Q

Treatment of carcinoma of endometrium?

A
  • Surgery
  • Post-operative radiation
  • Chemotherapy
60
Q

Surgical options for carcinoma of endometrium?

A
  • Total hysterectomy
  • Bilat salpingo-oophorectomy
  • Peritoneal washing for cytology
  • Lymph node sampling
61
Q

Prognosis for carcinoma of endometrium?

A
  • Overall 5 year survival: 80-85%
  • Less than 66% invasion: 98%
  • > 66% invasion: 78%
62
Q

What is endometriosis?

A

Ectopic growth of endometrium outside the uterus, particularly in parts of pelvis and ovaries

63
Q

What are signs and symptoms of endometriosis?

A
  • Dysmenorrhea
  • Chronic pelvic pain
  • Dyspareunia
  • AUB
  • Infertility
  • May be asymptomatic
64
Q

What may the physical exam show for endometriosis?

A
  • Tender nodules in cul-de-sac or rectovaginal septum
  • Cervical motion tenderness
  • Adnexal mass or tenderness
65
Q

Definitive diagnosis for endometriosis?

A

Laparoscopy

66
Q

Treatment for endometriosis?

A
  • NSAIDS
  • Hormonal therapy
  • Inhibit ovulation for 4-9 months
67
Q

Surgical options for endometriosis?

A
  • Laparoscopic ablation of endometrial implants

- Hysterectomy

68
Q

Who to refer for endometriosis?

A

OB/GYN

Genitourinary Women (7 decks)

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