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Genitourinary Women > MDT's Part 3 > Flashcards

MDT's Part 3 Flashcards

1
Q

What is Pelvic Inflammatory Disease?

A

Polymicrobial infection of the upper GI tract

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2
Q

What is PID commonly associated with?

A
  • Sexually transmitted organisms (Chlamydia, Gonorrhea)
  • Endogenous organisms (anaerobes)
  • Haemophilus influenza
  • Enteric gram-negative rods
  • Streptocci
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3
Q

What is the leading cause of infertility and ectopic pregnancy in women?

A

PID

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4
Q

PID is more likely to occur when?

A
  • Hx of PID
  • Recent sexual contact (within 60 days)
  • Recent onset of menses
  • Recent insertion of IUD
  • If partner has STI
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5
Q

What is the minimum diagnostic criteria for PID?

A

Cervical motion, uterine, or adnexal tenderness should be considered to have PID and treated with antibiotics unless there is competing Dx (ectopic pregnancy, appendicitis)

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6
Q

Signs and symptoms of PID?

A
  • Lower abdominal pain
  • Chills and fever
  • Menstrual disturbances
  • Purulent cervical discharge
  • Cervical and adnexal tenderness
  • Post-coital bleeding
  • Urinary frequency
  • Low back pain
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7
Q

Lab findings for PID?

A
  • Endocervical culture for:
  • Chlamydia
  • Gonorrhea
  • Other pathogens
  • Pregnancy test
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8
Q

Imaging for PID?

A
  • Vaginal US

- Laparoscopy

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9
Q

Treatment of PID?

A 
- Cefoxitin IM and Doxy x 14 days
OR
- Ceftriaxzone IM and Doxy x 14 days
OR 
- Metronidazole 500 mg x 14days
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10
Q

Follow up for PID?

A

MEDEVAC if:

  • Has/suspected to have tubo-ovarian abscess
  • Pregnant
  • Unable to follow/tolerate outpatient regime
  • Not respond to treatment within 72 hours
  • Severe illness, nausea and vomiting, uncontrolled fever
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11
Q

General considerations for Ovarian Mass?

A
  • Ovarian mass is common, most benign
  • Malignant ovarian tumors are leading cause of reproductive tract cancer
  • Women with BRCA increases risk for ovarian cancer
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12
Q

Signs and Symptoms for ovarian mass?

A
  • Can be symptomatic or experience only mild nonspecific gastrointestinal Sx’s or pelvic pressure
  • May experience abdominal pain, bloating, and palpable mass with advanced malignant disease
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13
Q

Laboratory findings for ovarian mass?

A
  • Tumor markers
  • Cancer antigen 125
  • HCG
  • Lactate dehydrogenase
  • Alpha fetoprotein
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14
Q

Imaging for ovarian mass?

A

Transvaginal US

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15
Q

Treatment of ovarian mass?

A
  • Malignant ovarian mass
  • surgical evaluation by gyno/oncologist
  • Postop chemo or watchful waiting
  • Benign neoplasm
  • Tumor removal or unilateral oophorectomy
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16
Q

Complications of ovarian mass?

A
  • Ovarian cancer usually Dx’ed after advanced disease present
  • Increased risk for ovarian torsion with mass
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17
Q

What is Polycystic Ovarian Syndrome (PCOS)?

A
  • Common endocrine disorder affecting 5-10% of reproductive age women
  • Characterized by:
  • Chronic anovulation with abnormal menses
  • Polycystic ovaries
  • Hyperandrogenism
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18
Q

Signs and symptoms of Polycystic ovarian syndrome?

A
  • Menstrual disorder
  • Infertility
  • Skin disorders
  • Insulin resistance
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19
Q

Lab findings for PCOS?

A
  • No labs operationally
  • FSH
  • LH
  • Prolactin
  • TSH
  • Hemoglobin A1C
  • Lipid profile
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20
Q

Imaging for PCOS?

A

Transvaginal US

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21
Q

Treatment for PCOS?

A
  • Weight loss and exercise
  • Metformin therapy
  • Ovarian stimulation if attempting fertility
  • Combined contraceptive if not attempting fertility
  • Treatment of hirsutism
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22
Q

Follow up for PCOS?

A

Refer to physician sup or gynecologist if PCOS suspected

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23
Q

What is Dyspareunia?

A

Type of sexual pain disorder with recurrent or persistent genital pain associated with sexual intercourse that is not associated with lack of lubrication or vaginismus

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24
Q

What is the most common cause of dyspareunia in menopausal women and what is it characterized by?

A

Vulvodynia

  • Sensation of burning
  • Pain
  • Itching
  • Stinging
  • Irritation
  • Rawness
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25
Q

What is vaginismus?

A

Type of sexual pain disorder with recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina

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26
Q

What does vaginismus result from?

A
  • Fever
  • Pain
  • Sexual violence
  • Negative attitude towards sex
27
Q

What is the treatment for vaginismus?

A
  • Sexual counseling and education on lubrication

- Botox injections in refractory cases

28
Q

What is the treatment for vulvodynia?

A
  • Topical agents with topic anesthetics
  • Tricyclic antidepressants
  • SSRI’s
  • Gabapentin
  • Physical Therapy
29
Q

Referral for vaginismus or dyspareunia?

A

Physician supervisor or gyeno for further eval

30
Q

When is a couple said to be infertile?

A

If pregnancy does not result after one year of normal sexual activity (2x/week) without contraceptives

31
Q

What is the initial testing for infertility?

A
  • Private consultation with each partner
  • Hx of STI
  • Prior pregnancies
  • Alcohol/Tobacco/Drug use
  • Use of saunas or hot tubs
  • Tight underwear
  • Gynecologic Hx (menstrual pattern, contraceptive use)
32
Q

When may couples with unexplained infertility be offered ovulation induction or assisted reproductive technology (IVF)?

A

If they do not achieve pregnancy within 3 years

33
Q

What are the different types of contraceptives?

A
  • Combined Oral contraceptives
  • Progestin minipill
  • Contraceptive injections and implantations
  • Patches
  • Intrauterine device
  • Condoms
  • Emergency contraceptives
  • Abortion
34
Q

What is the mechanism of action for combined oral contraceptives?

A

Suppression of ovulation by inhibiting GnHR, LH, FSH, and mid-cycle LH surge

35
Q

When should combined oral contraceptives be started?

A

On first day of menstrual cycle, but can be started anytime

* can take 1 month to take effect if began on 1st day

36
Q

What should be done if a combined oral contraceptive pill is missed?

A

No intercourse in past 5 days:
- two pill taken immediately and back up method used for 7 days
Intercourse in past 5 days:
- emergency contraceptive taken immediately and resume pill next day

37
Q

Contraindications for combined oral contraceptive?

A
  • Pregnancy and breast feeding
  • Thromboembolic events
  • Stroke/CAD
  • Cancer of breast
  • Undiagnosed vaginal bleeding
  • Age >35 and smoking >15 cig/day
  • Migraine with aura
38
Q

Mechanism of action for Progestin minipill?

A
  • Renders endometrium less suitable for implantation
  • Thickens cervical mucus
  • Impairment of normal tubular mobility and peristalsis
39
Q

Method of use for progestin minipill?

A

Must be consistent

  • taken within same 3 hour window everyday
  • no placebo week
40
Q

Advantages of progestin minipill?

A
  • Safe for lactating mothers

- Safe for Pt’s over 35

41
Q

Contraindications for progestin minipill?

A
  • Bleeding irregularities
  • Ectopic pregnancies are more frequent
  • Minor side effect of weight gain and mild HA
42
Q

General considerations for injectable contraceptive?

A
  • Associated with reversible bone mineral loss
  • Users commonly have irregular bleeding initially and develop amenorrhea
  • Ovulation may be delayed after discontinuation
43
Q

How is injectable progestin-DMPA given?

A

IM or subcutaneous every 3 months (11-13 weeks)

44
Q

What are some general considerations for Nexplanon?

A
  • Single rod progestin implant
  • Inserted in proximal aspect of arm
  • Effective for 3 years
  • No delay in return to fertility
  • Irregular bleeding most common reason for discontinuation
45
Q

What are some general considerations for the transdermal contraceptive patch?

A
  • Combined estrogen and progestin
  • Applied to lower abdomen, upper torso, or buttock for 3 consecutive weeks ( followed by 1 wk off)
  • MOA, Side effects, and efficacy similar to oral contraceptives
  • Discontinuation for side effects more common
46
Q

General considerations for contraceptive vaginal ring (Nuva ring)?

A
  • Soft, flexible ring placed in upper vagina for 3 weeks, replaced 1 week later
  • May experience an increased incidence of vaginal discharge
47
Q

What are the types of intrauterine devices?

A
  • Levonorgestrel (LNG) releasing
  • Copper bearing (Paragard)
  • Must be inserted by specially trained provider
48
Q

General considerations for IUD’s?

A
  • Highly effective with failure rates similar to surgical sterilization
  • Nulliparity not a contraindication
  • Adolescents are also candidates for IUD
49
Q

Contraindications and complications for IUD’s?

A
  • Pregnancy
  • Copper IUD can be placed as emergency contraceptive within 5 days of single coitus
  • Not inserted into pregnant uterus
  • Increased risk of pelvic infection in first month
  • Copper IUD can cause menorrhagia or severe dysmenorrhea
50
Q

What happens for missing IUD strings?

A
  • Concern for migration of IUD if no string visualization on pelvic exam
  • Pelvic US
  • Gynecology referral
51
Q

General considerations for male condoms?

A
  • Barrier method
  • Failure rates around 18% for perfect use
  • Latex and polyurethane condoms offer protection against STI’s
  • Disadvantage: Spillage of semen possible
52
Q

General considerations for female condoms?

A
  • Polyurethane and synthetic nitrile
  • 5-21% failure rates
  • Only female controlled birth control offering protection from pregnancy and STD’s
53
Q

What are the methods of contraception based on awareness of fertility periods?

A
  • Symptothermal natural family planning
  • Calendar Method
  • Basal Body temperature method
54
Q

What are the methods of emergency contraception?

A
  • Must be administered ASAP or within 120 hrs (5 days)
  • Levonorgestrel (Plan B)
  • Combination oral contraceptive containing:
  • Ethinyl estradiol and levonorgestrel
  • Given twice within 12 hours
  • Ulipristal
55
Q

What references cover abortions?

A
  • BUMEDINST 6300.16

- OPNAVINST 6000.1

56
Q

General considerations for abortions?

A
  • Usually before 20th week
  • Spontaneous: naturally occurring miscarriage
  • Induced: electively performed
  • DOD prohibits use of DoD facilities and funds to perform abortions except:
  • Life of service member endangered
  • cases where pregnancy was result of rape or incest
57
Q

General information of male sterilization?

A
  • Vasectomy
  • Safe, simple procedure
  • Vas deferens severed and sealed through a scrotal incision
  • Follow up semen analysis at 3 months for sterility
58
Q

General information of female sterilization?

A
  • Most often achieved with tubal ligation
  • Prevents ovulated ovum from reaching uterus
  • Tubes can be clipped, clamped, cauterized, tied, and/or cut
59
Q

What are the references for sexual assault patient?

A
  • SECNAV 1752.4
  • BUMEDINST 6310.11
  • 6000.1
  • COMUSFLTFORCOM 6310.2 series
60
Q

How does the navy define sexual assault?

A

Intentional sexual contact characterized by the use of force, threats, intimidation, or abuse of authority, or when the victim does not or cannot consent

61
Q

The term “sexual assault” includes what UCMJ offenses?

A
  • Rape
  • Sexual assault
  • Aggravated sexual contact
  • Abusive sexual contact
  • Forcible sodomy (oral or anal)
  • Attempts to commit these acts
62
Q

Treatment of sexual assault?

A

MEDEVAC

  • Serious/life-threatening injuries MUST be treated first
  • Encourage Pt to not shower or change clothes if possible
63
Q

Complications of sexual assault?

A
  • Physiological
  • STD’s
  • Pregnancy
64
Q

Follow up for sexual assault?

A
  • Continued psychological support
  • Repeat labs:
  • hCG (menses missed)
  • HIV 2-4 months
  • RPR 16 wks
  • Gonorrhea/chlamydia

Genitourinary Women (7 decks)

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