OBGYN Flashcards
1
Q
Pre-pubertal causes of vaginal bleeding?
A
- Vulvar lesions
- excoriations
- Foreign body
- Trauma
2
Q
Causes od adolescent vaginal bleeding?
A
- Normal menses
- anovulation
- Pregnancy
- Exogenous hormones
- Infections
- Hematologic abnormalities
3
Q
Causes of anovulation?
A
- PCOD
- Eating disorder
- Excessive physical exercise
- Thyroid disease
- both hypo/er
- Obesity
- Hyperprolactinemia
4
Q
What must be ruled out in a patient with abnormal bleeding in reproductive age women?
A
Pregnancy
5
Q
What exogenous hormones can cause abnormal vaginal bleeding?
A
- Oral contraception
- DMPA (Depo shot)
- Levonorgestrel implant
- Mirena IUD
6
Q
What age group has the highest rate of chlamydial infections and PID?
A
Adolescents
7
Q
What are causes of vaginal bleeding in women of reproductive age?
A
- Abnormal uterine bleeding
- “PALM-COEIN”
- polyps, adenomyosis, leiomyomas, malignancy, coagulopathy, endometrial, iatrogenic, NOS
- Pregnancy related bleeding
- Endocrine causes
- Infections
8
Q
Two most common causes of postmenopausal vaginal bleeding?
A
- Exogenous estrogens
- Atrophic vaginitis
9
Q
Types of management of Abnormal uterine bleeding?
A
- Nonsurgical
- NSAIDS
- Hormonal management
- OCP, progesterone, IUD
- Surgical
- for patients with failed medical therapy
- Hysteroscopy for resection of polyps, myoma, endometrial ablation
- Hysterectomy
10
Q
Normal vaginal secretions? flora? pH?
A
- Secretions
- floccular in consistancy, white, usually in posterior fornix
- Flora
- aerobic; lactobacilli most abundant
- pH <4.5
11
Q
Most common vaginitis in the US?
Cause?
A
- Bacterial vaginosis
- Polymicrobial
- gardnerella
- anaerobic bacteria
- Lactobacillus usually absent
12
Q
Clinical features of BV?
A
- Fishy vaginal odor
- Vagnal secretions are grey and thinly coated walls’ bubbles
- pH>4.5
- Wet prep - Clue cells: “moth eaten cells”
- Positive “whiff test”
13
Q
What is bacterial vaginosis associated with in pregnancy?
A
Associated with preterm delivery/premature rupture of membranes
14
Q
Cause and symptoms of vulvovaginal candidiasis?
A
- Candida albicans
- Sx
- white curd-like discharge
- pruritis
- erythema
15
Q
Predisposing factors to vulvovaginal candidiasis?
A
- Prgnancy
- DM
- Abx
- AIDS
16
Q
Diagnosis of vulvovaginal candidiasis?
A
Vaginal pH <4.5
Wet prep (KOH) - visualization of spores and hyphae
17
Q
Trichomonas vaginalis: transmission? sx? diagnosis?
A
- Sexually transmited
- Profuse purulent green malodorous vaginal discharge
- “strawberry cervix”
- pH > 4.5
- Wet mount - mobile flagellated organisms
18
Q
Hormonal contraception methods?
A
- OCP/ring/patch
- 92% efficacy with typical use; 99% with perfect use
- Lightened and shortened menses
- AE: bleeding, nausea, bloating, moodiness
- Progesterone-based IUD/Implant
- most effective to prevent pregnancy aside from tubal sterilization
- Light to absent period; protective against endometrial CA
- AE: bleedint, bloating, HA, depression
- Depo shot
- less effective than IUD
- Light to absent period; protective against endo CA
- SE: same as IUD + wt gain, decreased bone density
19
Q
HSV:
Where is the latent virus?
Incubation period?
Signs/Symptoms?
Diagnosis?
A
- Lumbosacral root ganglion
- Incubation: 2-7 days
- S/S: vulvar parasthesias, painful - ulcerative lesions, urinary retention, dysuria, and inguinal lymphadenopathy
- Dx: PCR most accurate/sensitive
- also viral culture, Tzank smear, and Ab titers
20
Q
Gonorrhea:
Coinfection with what is common?
Symptoms?
A
- Coinfection with chlamydia
- Sx
- purulent cervical discharge
- friable cervix
- however 70% of cases it is asymptomatic
21
Q
Complications of gonorrhea?
What occurs in disseminated infection?
A
- Complications
- Bartholin’s gland absess
- Gonococcal salpingitis
- Infertility, ectopic pregnancy
- Tubal damage can occur within 72 hours
- Disseminated
- more common in women
- pyrexia, vasculitic rash, and unilateral large joint arthropathy
22
Q
Chlamydia vs gonorrhea?
Complications of chlamydia?
A
- Chlamydia is 3x more common and less symptomatic
- Complications
- male - epididymitis
- Reactive arthritis
- Females - salpingitis (infertility/abscess)
- Fitz-Hugh-Curtis syndrome
- peritonitis
- liver capsule inflammation
23
Q
What is Reiters syndrome?
A
- Arthritis
- Conjunctivits
- Uveitis
- Urethritis
24
Q
Primary syphilis:
Incubation?
Symptoms?
A
- 3 weeks
- Chancre –> red papule –> ulceration with serous exudate
- this is single, painless, and not well demarcated
25
Secondary syphilis:
When does this develop?
Symptoms?
* Develops 7-10 weeks after
* Symptoms
* Malaise
* mild fever
* Headache
* Skin rash
* Arthralgia
* Bone pain
* Lesions on palms and soles of feet
26
Tertiary syphilis:
What are the symptoms?
* Neurosyphilis - dectectable in CSF only
* Argyll Robertson pupil - small, constant in size, accomodation present but doesnt react to light
* Tabes dorsalis - sharp back pains
* Gummatous
* mass, granulomas on skin/bone
* Cardiovascular
* Aortic dilation with regurgitation
* Destruction of elastic tissue
* Aortic aneurysm formation
27
Diagnosis and treatment of syphilis?
* Diagnosis:
* Nonspecific test: RPR or VDRL cardiolipin ab tests
* Specific: FTA-ABS flourescent treponemal ab absorption test
* Treatment
* penecillin: one dose for early and multiple for late and tertiary
28
HPV diagnosis? Treatment?
* Mainly clinical
* Biopsy if diagnosis unclear
* Abnormal pap smear
Treatment - cure not really possible: trichloroacetic acid (TCA) surgery, or laser common
(this is assuming youve read a bajillion things on HPV so i left out the SX and such)
29
Molluscum contagiosum:
Type of virus?
With widespread infection it may incidate what is present?
Diagnosis and treatment?
* DNA virus (poxvirus)
* Check for HIV with widespread infection
* Diagnosis - clinical
* Treatment: scraping out lesion, cryotherapy, electrocautery
30
Cause of lymphogranuloma venerum? Defining symptom?
* Chlamydia trachomatis
* Painful
31
Hemophilus ducreii causes what type of lesion?
Painful chancroid
32
What causes granuloma inguinale? Presentation?
Klebsiella granulomatis
Enlarging painless ulcer
33
Definition of PID?
Predisposing factors?
* Definition: infection of tubes, ovaries, and adjacent tissues
* Predisposing factors
* multiple partners
* previous episode
* Chlamydia/gonorrhea infection
34
Etiology of PID?
Signs/symptoms?
* 60% polymicrobial; 30% gonococcal; 30% chlamydia
* Signs/Symptoms
* abdominal, adnexal, and cervical motion tenderness
* Temp \>38deg
* Leukocytosis \>10,000
* Purulent cervical discharge
* Pelvic mass/abscess
35
Complications of PID?
* TOA
* Ectopic pregnancy
* Infertility
* Chronic pelvic pain
36
Causes of acute pelvic pain?
* ovarian torsion
* sudden onset
* associated with abrupt position change
* extremely painful, tender, unilateral adnexa
* N/V
* no doppler flow
* Ruptured ovarian cyst - corpus luteum
37
Endometriosis:
Symptoms?
Causes?
* Symptoms
* pelvic pain
* dysmenorrhea
* dyspareunia
* infertility
* nodularity of uterosacral ligaments
* Causes
* retrograde menstruation
* lymphatic or vascular spread
* metaplasia
38
Endometriosis diagnosis? Treatment?
* Diagnosis
* laparoscopy with biopsy
* "powder burn" lesions: black, dark brown, bluish lesions
* Clear or red lesions
* Treatment
* observation, medical, surgical
39
What is the cause of primary dysmenorrhea?
What is it?
Treatment?
* This is caused by increased endometrial PG production
* Pain beginning prior to or just after the onset of menstrual period
* Treatment: NSAID or OCPs (relief in 90% of pts)
40
What is adenomyosis?
symptoms?
Treatment?
* Definition: ingrowth of endometrium into uterin musculature
* Symptoms
* dysmenorrhea
* very heavy or prolonged period
* Treatment
* NSAIDs
* OCP
* Hysterectomy
41
What is the most common benign uterine tumor?
Who is it more common in?
Leiomyoma (diagnosed by physical or imaging)
African american women
42
Signs and symptoms of a leiomyoma?
* Abnormal bleeding, pain, pressure
* Fewer than half are symptomatic with:
* urinary frequency
* infertility
* prolapse of pedunculated fibroid through cervix
* pelvic pressure or pain
* dyspareunia
43
Treatment options for leiomyoma?
* Observation
* Surgical
* myomectomy or hysterectomy
* Angiography embolization
* obstruction of BF to fibroid
* Depo
44
What is stress incontinence? What is it caused by and how is it treated?
* Leaking of urine with activity
* Caused by an increase in intrabdominal pressure that exceeds urethral sphincter closure pressure
* Tx: pelvic floor PT, pessary (??), or surgery
45
What is urge incontinence?
What is it triggered by?
Treatments?
* Leaking of urine accompanied with urgency (spontaneous contraction) with frequent, involuntary loss of urine
* nocturia is common
* Triggered by daily routines
* Treatment:
* antimuscarinics
* Alpha agonists
* Pelvic floor PT
46
What is interstitial cystitis also known as? Signs/symptoms?
* Painful bladder syndrome
* Pelvic pain
* Pain with intercourse
* Pain on bladder filling
* Urinary frequency and urgency
* Nocturia
47
Intersititial cystitis cycle?
Bladder insult --\> epithelial layer dysfunction --\> potassium leak into interstitium --\> activation of C-fibers and release of substance P --\> mast cell activation and histamine release --\> more inflammation --\> bladder insult
48
Menopause definition? What occurs?
* Definition: cessation of ovarian follicular function with absence of menstrual bleeding for greater than or equal to one year
* vaginal atrophy
* pelvic relaxation
* skin changes
* vasomotor instability
* sleep disturbances
* osteoporosis
* CV changes
49
Osteoporosis: what are osteoblasts responsive to?
Osteoblasts responsive to estrogen and in estrogen deficienct state: osteoclasts dominate
50
What are advantages and disadvantages of HRT?
* Advantages
* Increased HDL, decreased LDL
* Improved memory and bone health
* Decreased vaginal dryness and menopausal sx
* Decreased risk for colon cancer
* Disadvantages
* increased risk for CV disease
* Increased risk for stroke/PE/DVT
* Increased breast cancer risk
51
Contraindications of HRT?
* Breast or endometrial cancer
* Active liver disease
* Acute vascular thrombosis
* Pregnancy
* Unexplained vaginal bleeding
52
Benign and malignant examples of breat disease?
* Benign
* fibroadenoma
* papilloma
* fibrocystic breast disease
* fat necrosis
* mastitis
* Malignant
* ductal carcinoma
* lobular carcinoma
* inflammatory breast cancer
53
What is a fibroadenoma? Who is it usually found in?
* Painless, solitary mass
* Can be bilateral
* Typically in younger women
54
Fibrocystic breast disease: signs/symptoms?
* Diffuse and described as "lumpy"
* Can be tender - cyclical breast pain associated with menses
* Can increase in size before menses and crease afterwards
55
What is mastitis? What is it associated with? Treatment?
* Erythematous, edematous area of the breast
* fever is common
* Associated with pregnancy
* Treatment: dicloxicillin
56
Signs and symptoms of inflammatory breast cancer?
When is it commonly misdiagnosed?
* Diffuse erythema and edema
* "Peau d'oirange" with dimpling
* Can be misdiagnosed as mastitis during pregnancy
57
