Reproductive JB Flashcards
MCC vaginitis
Bacterial vaginosis
bacterial vaginosis etiology
gardnerella vaginalis
Bacterial vaginosis dx
Amsels criteria: Clue cells pH>4.5 thin, homogenous watery grey white discharge \+ whiff test
Bacterial vaginosis tx
metronidazole
safe in pregnancy, may use gel or PO
clindamycin
Bacterial vaginosis need to tx partner?
no
Breast cancer dx
mammogram
US - initially for <40yo
FNA w/ bx
Breast cancer preventative measures
Mammogram annually >40yo or 10yrs prior to 1st degree relative diagnosis
Breast exam (clinical) 20-39yo q 3yrs. >40yo annually
Self exam: monthly >20yo, after menstruation or day 5-7
Breast cancer tx
Anti estrogen (tamoxifen) for ER positive tumors aromatase inhibitors (letrozole, anastrozole) for postmenopausal with ER + breast cancer monoclonal ab (trastuzamab or Herceptin) for HER2 positivity
Breast cancer preventative medication
SERM (tamoxifen or raloxifene) for postmenopausal or >35yo w/ high risk of breast cancer.
use for 5y
Vulvular cancer sx
DES exposure
pruritic (MC)
MC type vulvular cancer
BCC
Vulvular cancer dx
Pap w/ cytology
colposcopy w/ bx
Cervical cancer associated with:
HPV 16, 18
MC type cervical cancer
SCC
Cervical cancer w/ DES exposure
clear cell carcinoma
MC sx of cervical cancer
post coital bleeding
Cervical cancer prevention
HPV vaccine (Gardasil 9)
Contraception safe during lactation
Progestin only OCPs
Most effective form of contraception besides abstinence
IUD
IUD risk
increased risk of PID
dysfunctional uterine bleeding tx
hormone tx
IUD
tx underlying
eclampsia dx
preeclampsia + seizures or coma
abrupt tonic clonic seizures 1-2m
post ictal hyperreflexia
eclampsia tx
ABCDs magnesium sulfate for seizures lorazepam 2nd line if refractory Deliver fetus once pt stabilized hydralazine
endometrial cancer PE
postmenopausal bleeding
endometrial stripe >4mm on transvaginal US
endometrial cancer dx
bx pelvic exam D&C transvaginal US CT/MRI Labs: CA-125 (both endometrial and ovarian cancer)
combo OCPs are protective against
ovarian and endometrial cancer
endometrial cancer MC sx
postmenopausal bleeding
Endometriosis sx
Triad: cyclic premenstrual pelvic pain +/- low back pain, dysmenorrhea, dysparenuria
infertility
endometriosis dx
laparoscopy w/ bx definitive
endometriosis tx
combined OCP + NSAID
progesterone, leuprolide, danazol
surgery: laparoscopy w/ ablation if fertility desired. TAH-BSO if no desire for conception
endometritis risk factor
C-section
PROM >24h
vaginal delivery
D&C
Endometritis tx
infection post c section: clindamycin + gentamicin. May add ampicillin for group B strep coverage. Zosyn is alternative
infection after vaginal delivery or chorioamnionitis: ampicillin + gentamicin
What herniates in enterocele
pouch of Douglass herniates into upper vagina
Fibrocystic breast disorder dx
US
FNA: straw colored fluid
Gestational diabetes dx
Screening: 24-48 wks gestation w/ 50g oral glucose challenge (non fasting)
Confirmatory: 3h 100g OGTT gold standard. done in the morning after overnight fast
Gestational diabetes tx
Labor induction at 38wks if uncontrolled
delivered at 40wks if controlled/no macrosomnia
insulin TOC
glyburide safe in pregnancy and metformin
gestational HTN tx
methyldops 1st line chronic/preexisting HTN
labetalol, hydralazine, nifedipine
Molar pregnancy (gestational trophoblastic dz) sx
Painless vaginal bleeding
uterine size/date discrepancies
preeclampsia before 20wks
hyperemesis gravidarum
Molar pregnancy tests
bHcG >100,000
low AFP
US: snowstorm/cluster of grapes. no fetal heart sounds or feta lparts
gynecomastia tx
clomiphene
tamixifen
danazol
hyperemesis gravidarum tx
doxylhamine + pyridoxine FDA approved metaclopramide diphenhydramine zofran (cleft palate risk) promethazine
Hypothalamic amenorrhea labs
normal/decreased FSH and LH
decreased estradiol
normal prolactin
hypothalamic amenorrhea tx
clomiphene
menopause dx
FSH assay most sensitive initial test (increased FSH) increased LH decreased estrogen same androstenedione levels estrone predominant
menorrhagia tx
OCP
Progesterone
GnRH agonist: leuprolide w/ add back progesterone
Molar pregnancy tx
surgery. suction curettage mainstay asap, weekly bHcG levels hysterectomy rhogam avoid pregnancy for 1y high risk of choriocarcinoma
Mucopurulent cervicitis tx
STD
Obtain culture
Tx w/ ceftriaxone + azithromycin + metronidazole +/- doxycycline pending result
Ovarian cancer tx
Early: TAH-BSO + selective lymphadenectomy
Surgery: monitor w/ CA-125
chemo: taclitaxel + cisplatin or carboplatin
placenta previa dx
pelvic US, do not do pelvic exam
PCOS sx
triad: amenorrhea, obesity, hirsutism
PCOS labs
decreased FSH, increased LH, increase testosterone, increased estrogen, low SHBG, high androstenedione
PCOS tx
combo OCP mainstay. avoid norgestrel and levonorgestrel
hirsutism: spironolactone, leurprolide, finasteride
infertility: clomiphene
wedge resection
preeclampsia sx
HTN + proteinuria +/- edema after 20wks, up to 6wks postpartum
hyperreflexia
Rectocele tx
prophylactic: kegal, weight control
Nonsurgical: pessary (sx relief), estrogen tx (for atrophy)
Surgical: hysterectomy, ligament fixation
