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REPRO TEST 3 > PID/PCOS/ENDOMETRIOSUS > Flashcards

PID/PCOS/ENDOMETRIOSUS Flashcards

1
Q

ascending spread of microorganism and contiguous structures from vagina or cervix to endometrium, tubes, ovarious

A

PID

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2
Q

60% of PID is ___

A

subclinical or silent

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3
Q

examples of PID RF

A 
adolescence  
GC or CHL or HX of GC/CT 
Multiple partners 
Inserting IUD 
Demographic SES  
Hx of PID 
Male Partners w/ GC or Chl 
BV 
OCP in some cases
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4
Q

top 2 most common pathogens with PID

A

N. gonorrhoeae

C. trachomatis

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5
Q

what are some sx women with subclinical PID may experience?

A
  1. dyspareunia
  2. irregular bleeding
  3. dysuria
  4. GI sx
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6
Q

what bacteria is implicated with subclinical PID presentation?

A

C. trachomatis

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7
Q

most common sign on pelvic exam in pt with moderate PID

A

uterine, cervical motion, and adnexal TTP

Chandelier sign

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8
Q

what s/s indicate severe PID

A

high WBC and ESR/CRP

very ill: fever, chills, purulent d/c, N/V

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9
Q

risk of ectopic pregnancy is __ higher after PID

A

6-10 times higher after PID

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10
Q

tubal infertility rates after __ episodes of PID

A

1: 8% of women
2: 20% of women
3: 50% of women

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11
Q

what is fitz hugh Curtis syndrome

A

RUQ pain associated with acute salpingitis

indicating perihepatitis

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12
Q

what is fitz hugh Curtis syndrome mistaken for?

A

acute cholecystitis may be suspected but signs of PID show up quickly

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13
Q

PID dx criteria

A

uterine TTP or cervical motion TTP (w/ no other explanation)

Other add on signs:

  1. temp 38.3
  2. abnormal discharge
  3. WBC on saline wet prep
    • Gonorrhea or chlamydia test

Mucopurulent Cervical discharge + test

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14
Q

5 reasons to admit PID pt

A
  1. cant r/o appendicitis ectopic
  2. Pregnancy
  3. No response to output antimicrobial tx 48-72 hrs
  4. severe illness (N/V, fever, TOA)
  5. HIV infxn with low CD4 count
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15
Q

1st line PID tx

A

ceftriaxone 250mg IM + doxy 100 mg BID for 14 days

OR

Ceftriaxone 250mg IM + Metronidazole 500mg BID X 14 days

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16
Q

if choosing cefoxitin instead of ceftriaxone what po med would you pair it with for PID tx

A

cefoxitin 2g IM + Probenecid 1 g PO administered
PLUS
doxy or metronidazole

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17
Q

parenteral PID tx

A

cefotetan 2gIV q 12 hr plus doxy

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18
Q

women with PID sex?

A

no wait until tx is done, sx resolved and partners are treated

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19
Q

all women with PID need to be tested for..

A

HIV, GC, HIV and Chl (NAAT)

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20
Q

PID pts should show improvement with tx in ___

A

72 hrs

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21
Q

all women dx with GC/Chl should be retested ____after tx regardless of whether their partner has been treated

A

3mo

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22
Q

all pregnant women in 1st trimester are screened for___

A

PID

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23
Q

when is screening for chlamydia recommended

A

all women that are active and under 25, and all those active over 25 that are high risk

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24
Q

t/f male partners of women with PID should be examined and tx if they had contact within 60 days prior to sx onset

A

true!

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25
Q

male partners of PID women are often asymptomatic when the bacteria etiology is…

A

c trichamatis and N. gonorrhoaea

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26
Q

how treat PID sexual partners?

A

empirically for c. trachomatis or N. gonorrhoeae

27
Q

t/f gonorrhea and chlamydial is reportable in all states

A

TRUE

28
Q

3 main complications of pID

A
  1. ectopic preg
  2. chronic pelvic pain
  3. Infertility
29
Q

PCOS 3 main characteristics

A

hyperandrogenism
ovulatory dysfunction
polycystic ovaries

30
Q

what are some secondary cause of hyperaldosteronism to r/o before dx PCOS

A
  1. adult onset CAH
  2. Hyperprolactinemia
  3. Androgen secreting neoplasms
31
Q

what is link between hyperinsulinemia and PCOS?

A

high levels of insulin in blood lead to low levels of sex hormone binding globulin

this increases levels of free androgens = hyperadnrogenism

32
Q

3 main U/s findings of PCOS

A

12+ follicles in each ovary
follicles 2-9mm in diameter
high ovarian volume over 10 mL

33
Q

TX PCOS menstrual irregularities

A
  1. Combined OCP
  2. Progestins also option
  3. Insulin Sensitizing agents
34
Q

what DM meds good for PCOS

A

Biguanides (metformin)
OR
thiazolidinediones (pioglitazone, rosiglitazone)

35
Q

what dose of combined OCP is best for PCOS?

A

low dose for insulin sensitivity etc

36
Q

tx for hirsutism

A

laser therapy, combo therapies

medical methods will help as well - spironolactone with OCP

37
Q

what OCP do you not want to give with spironolactone

A

one that contains drospirenone

from spironolactone family as well.. retain too much K+?

38
Q

how does spironolactone help with PCOS sx?

A
  1. androgen receptor antagonist
  2. competes for androgen receptors on follicles
  3. inhibits 5 aphla reducatse
39
Q

what does 5 alpha reducatase do?

A

converts testosterone into dihydrotestosterone

40
Q

what is dihydrotestosterone?

A

DHT

Responsible for male sexual maturation and secondary sexual characteristics

41
Q

what do flutamide and finasteride do for PCOS?

A

for hirsutism.. yet high risk of teratogenicity

42
Q

Eflornithine role

A

FDA med for female facial hirsutism

ADR: stinging, burning, erythema,

43
Q

is laser or electrolysis better for hirsutism?

A

laser therapy

adding eflornithine on top of laser is even better as well

44
Q

benign condition, endometrial glands and stroma present outside uterus

A

endometriosus

45
Q

typical endometriosus pt

A

30s, nulliparous, infertile but can present throughout reproductive yrs

46
Q

endometriosus is found in ___ fraction of women with chronic pelvic pain

A

1/3

47
Q

3 theories of endometriosus pathology

A
  1. Retrograde menstration: fragments transport out via fallopian tubes during menses
  2. Mullerian metaplasia theory: metaplastic transformation of pelvic peritoneum
  3. lymphatic spread: substances released/shed from endometrial induce formation of endometriosus
48
Q

what is sampsons therory

A

retrograde menstration - endometriosus

49
Q

what is Meyers theory

A

mullerian or coelomic metaplasia theory for endometriosus

50
Q

what is halbans theory

A

lymphatic spread theory of endometriosus

51
Q

where is most common location of endometrial deposits?

A

ovary (chocolate cysts)

52
Q

classic triad of endometriosus

A

dysmenorrhea, dyspareunia, dyschezia

53
Q

DX of endometriosus

A

direct visualization: laparotomy or laproscopy

histologic and gross findings consisitent with dx

54
Q

US findings for endometriosus

A

adnexal mass of complex echogenicty, internal echos consistent with blood

55
Q

ca125 test

A

for endometriosus.. not sensitive or specific

56
Q

1st line tx for endometriosus

A

NSAIDS, OCP, Progestins trial for 3-6mo

57
Q

2nd line tx for endometriosus

A

levonorgestrel (mirena IUD), GnRH agonist (Lupron), high dose progestin, danazol

58
Q

what is important about using Lupron for tx

A

do no give w/o laparoscopy first.. relief of pain does not make the dx

ADR: hotflashes, bone loss, depression

59
Q

what is danazol

A

2nd line tx option endometrioses

androgenic derivative suppresses LH and FSH

60
Q

previously the gold standard for endometriosus

A

danazol

not anymore due to ADR: weight gain, hirsutism, acne, deep voice, pseudomenopause - anovulation and hypergonadism

61
Q

how to protect fertility for endometrioses pt

A
  1. laparoscopic w/ ablation of implants / adhesions

2. should remove endometrioses over 3 cm in diameter

62
Q

most definitive tx endometrioses

A

hysterectomy ..yet still risk of reoccurrence

63
Q

how decrease risk of endometrioses

A

min. menses flow and suppress ovarian cycling

REPRO TEST 3 (7 decks)

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