Office Complaints Flashcards
1
Q
Fits-Hugh Curtis
A
when purulent tubal d/c from POD ascends to RUQ causing peri hepatitis and RUQ pain
2
Q
Reasons to Admit for Inpatient Tx PID
A
- Severity of symptoms (ex- high fever)
- Peritoneal signs or poss TOA (see on US)
- If nausea and vomiting prevents oral medication use
- Pregnant
- If need to r/o appendicitis
3
Q
3 Main Types Vaginitis
A
- BV = homogenous, white d/c, + whiff (amines w/ KOH);clue cells (shaggy)
- Candida = heterogeneous, white d/c (cottage cheese); normal pH (<4.5)
- Trich = frothy green d/c and strawberry cervix; flagellated trich
4
Q
Syphilis (primary, secondary, tertiary)
A
- Primary - painLESS chancre + painLESS inguinl lymphadenopathy; appears w/in 3 wks exposure then gone in 2-6 wks
- Secondary - systemic including maculopapular rash on hands and feet; usually 9 wks after ulcer
- Tertiary - optic problems, tabes dorsalis (posterior columns - unsteady gait), aortic aneurysm, Argyll Robertson pupils
5
Q
Syphilis Diagnostic Tests
A
- screen w/ non-treponemal test (RPR or VLDR) then confirm w/ dark field microscopy
- Initial RPR or VLDR is antibody / tiger measurement so decreases w/ treatment
- Test of cure at 6 and 12 mo; if no dec in titers than suspect neurosphyilis
6
Q
Syphilis Tx
A
- If < 1 yr then 1 dose IM PCN
* If > 1 yr then 3 doses IM PCN (1 wk apart)
7
Q
HSV
A
- Presentation
- Primary episode more likely systemic (fever and malaise)
- Prodrome of numbness and tingling –> vesicle on red base
- Dx - viral cx or PCR
- Tx - oral acyclovir
8
Q
Chancroid
A
- Painful vulvar ulcer w/ ragged edges and necrotic base + painFUL lymphadenopathy
- H ducreyi (gram neg rod) - school of fish on gram stain
- Dx - biopsy / cx
- Tx - oral axithromycin or IM ceftriaxone
9
Q
How do fibroids present?
A
- excess menstrual bleeding, compressive symptoms, uterus is irregular, midline, firm, mobile and moves w/ cervix
- Can also have anemia secondary to menstrual blood loss
10
Q
Fibroid Tx
A
- 1- MEDS (NSAIDS, progesterone
- 2- If non-responsive to meds and want to shrink before surgery then give 3 mo GnRH agonist (leuprolide); will reverse as soon as you stop drug
- 3- Hysterectomy (indicated if still symptomatic despite medical treatment)
- Myomectomy if desire future pregnancy
11
Q
Concerning Fibroid Features
A
Rapid growth and hx pelvic radiation makes you suspicious of leiomyosarcoma
Do ex lap w/ hysterectomy
12
Q
Common Breast Complaints in Young Female (2)
A
Fibrocystic Change
- Mult irregular lumps and painful engorgement usually right before menstruation +/- serous or green d/c
- Tx - dec caffeine, use NSAIDs, tight fitting bra or OCPs
Fibroadenoma
- Benign smooth muscle tumor
- Firm, rubbery, mobile, solid w/o menstrual change
- Must do some sort of biopsy - FNA (cytology) or core needle
13
Q
Differential for Amenorrhea
A
- Hypothalamus - Hypothyroid or hyper-prolactin both dec GnRH pulsating release –> dec FSH / LH OR due to stress, exercise, wt loss
- Pituitary
- Sheehan - anterior pituitary hemorrhagic necrosis (common in labor)
- Radiation or surgical damage to pituitary
- Ovaries
- Premature ovarian failure (if < 40 yo);
- PCOS (will shed when given progesterone challenge)
- R/o pregnancy
- Outflow Problems
- Cervical stenosis - leads to retrograde menstruation which can present as cramps abdominal pain 5-7 days / mo
- Asherman - adhesions after a uterine curettage - endometrium does not respond to hormones
14
Q
Diagnosis and Treatment of Asherman
A
No response to progesterone therapy; no withdrawal bleeding
- Diagnose by hysterosalpingogram, saline infusion sonogram of uterine cavity or hysteroscopy
- Tx - operative hysteroscope and lysis of adhesions; may leave pediatric foley or IUD in place to prevent recurrence of adhesions
15
Q
What is the #1 cause of unilateral serosanguinous nipple d/c?
A
Intraductal papilloma
