STDs Flashcards
1
Q
Immunodeficiency disorders in which human immunodeficiency virus uses T4 (CD4) cells as a receptor and reservoir for HIV
A
Acquired Immune Deficiency Syndrome (AIDS)
2
Q
Epidemiology: HIV
1. Modes of transmission similar to those of hepatitis B but
specifically: Blood, semen, vaginal secretions, and
breast milk
2. Risk of infection via needle stick is approximately _____
A
1:350
3
Q
Signs/Symptoms: HIV
- _____ ____ symptoms: Think seroconversion (a process of converting from HIV negative to HIV positive; the process takes approximately ___ weeks to 6 months)
- Early s/s include: _____, night sweats, and weight loss
A
- Flu-like
3 weeks - Fever
4
Q
- It is more a constellation of signs/symptoms than any single one that is suspicious for AIDS AIDS = CD4 < ____ cells/uL and/or the presence of an opportunistic infection
A
200
5
Q
Laboratory/ Diagnostics: HIV
1. _____ for initial screening; sensitivity > 99.9%
2. Western Blot test is confirmatory
3. Latest recommended HIV tests:
a. HIV-1/2 antigen/antibody combination immunoassay;
if positive, proceed to:
b. HIV-1/2 antibody differentiation immunoassay
4. Absolute CD4 lymphocyte count: Normal > ____
cells/uL
5. CD4 lymphocyte percentage
a. Risk of progression to AIDS high when < 20%
6. Viral load
a. ____: Based quantitative copies of HIV-branched
DNA or RNA
b. Results correlate closely with the progression of HIV
c. Ideally should be “zero” or “detectable”
A
- ELISA
- 800
- a. PCR
6
Q
Management: HIV
1. Therapy for Opportunistic Infections
a. Treat infection as it occurs
b. Bactrim for ___ _____ pneumonia
prophylaxis
2. Antiretroviral Treatment
a. Combination therapy is standard [____ ____ ____
(__)]
b. When to start AART remains somewhat
controversial.
CDC and UDDHS recommend starting medications
at
the time of HIV+ diagnosis
3. Monitor for the danger of drug resistance: Must be
taken exactly as prescribed!
A
- b. Pneumocystis jirovecii
2. a. Active Antiretroviral Therapy (AART)
7
Q
Cause: Haemophilus ducreyi, a gram-negative bacillus
A
Chancroid
8
Q
Prevalence: Chancroid
- Endemic in many areas of the United States; must be a part of the differential diagnosis for genital ulcers
- Well established as a co-factor for H1V transmission (high rate of HIV identified among individuals presenting with chancroid)
- Estimated up to ___% of patients are also infected with syphilis and HSV
A
- 10%
9
Q
Signs/Symptoms: __________
I. Women: Usually asymptomatic
2. Men: Single (or multiple) superficials, painful ulcer,
surrounded by an erythematous halo
3. Ulcers may be necrotic or seVerely erosive
A
Chancroid
10
Q
Diagnosis: Chancroid
- A probable diagnosis is usually a matter of exclusion
- Involves genitalia and unilateral bubo (or both)
- Painful genital ulcers in absence of ___ ____ and HSV (by inspection or culture) with coexisting tender inguinal lymphadenopathy is suggestive of chancroid
- The definitive diagnosis of chancroid is made morphologically (sensitivity no > 80%)
A
- T pallidum
11
Q
a. _______: The degree to which those Who have a
disease screen/ test positive
A
Sensitivity
12
Q
b. ______: The degree to which those who do not
have a disease screen/test negative
A
Specificity
13
Q
Treatment: Chancroid
- ______ (Zithromax) t gram by mouth x 1 dose or
- Ceftriaxone (Rocephin) 250 mg IM x i dose or
- Ciprofloxacin (Cipro) 500 mg by mouth twice a day × 3 days
A
- Azithromycin
14
Q
A parasitic STD caused by Chlamydia trachomatis that produces serious reproductive tract complications in either sex
A
Chlamydia
15
Q
Signs/Symptoms of Chlamydia: Females: Often asymptomatic 1. Dysuria 2. Intramenstrual spotting 3. Postcoital bleeding 4. Dyspareunia: \_\_\_\_\_ intercourse 5. Vaginal discharge
A
- Painful
16
Q
Males: Often asymptomatic Chlamydia:
- ______
- Thick, cloudy penile discharge
- Testicular pain
A
- Dysuria
17
Q
Laboratory/Diagnostics: Chlamydia
1. Chlamydia culture is the most definitive test (3 to 9 days
for results)
2. ____ _____ (__) methods preferred (low
cost; 30 to 120 min for results)
A
- Enzyme immunoassay (EIA)
18
Q
Treatment: Chlamydia
1. ______ (Zithromax) 1 gram by mouth x 1 dose OR
2. Doxycycline (Vibramycin) 100 mg by mouth twice a day
x 7 days
3. Alternatives: Erythromycin, Ofloxacin, Levofloxacin
4. Report to the ______ department
A
- Azithromycin
4. health
19
Q
Cause: Human papillomavirus (HPV)
A
Genital Warts (Condyloma acuminata)
20
Q
Prevalence
- The most common viral STD in the United States
- An estimated 3 million cases of HPV (including cervical HPV) are reported annually
A
Genital Warts (Condyloma acuminata)
21
Q
Symptoms: Genital Warts (Condyloma acuminata)
Single (or multiple) soft, fleshy, papillary, or sessile, painless _____ growth around the anus, vulvovaginal area, penis, urethra, or perineum
A
keratinized
22
Q
Diagnosis: Genital Warts (Condyloma acuminata)
- Clinical presentation; perhaps atypical ___ _____ of undetermined significance (ASCUS) or squamous intraepithelial lesion (SIL) on PAP smear
- Colposcopy useful in diagnosing fiat lesions
- May need to biopsy if at risk for cervical intraepithelial neoplasia (CIN)
A
- squamous cell
23
Q
Treatment: Genital Warts (Condyloma acuminata)
- Keratolytic agents: Podophyllin (Pododema), trichloroacetic acid (TCA), or trichloroacetic acid (BCA)
- Referral for cryotherapy, ____ therapy, electrocautery, or excision
A
- laser
24
Q
Prevention
- Gardasil [Human Papillomavirus Quadrivalent (Types __, __, __, and ___) Vaccination]
a. Indicated for females and males ages 9 to 26 years
b. Given in 3 injections - Cervarix [Human Papillomavirus Bivalent (Types 16 and 18) Vaccination]
a. Indicated for females ages 10 to 25 years
b. Same as above
A
6, 11, 16, and 18
25
________
A bacterial STD caused by Neisseria gonorrhoeae (gram-negative diplococci); causative organism may be cultured from the genitourinary tract, oropharynx, and/or anorectal
Gonorrhea
26
Incidence/General Concepts: Gonorrhea
1. Produces _____ in men and cervicitis in women
2. A leading cause of infertility among females in the United States
3. Affects 1 to 2% of the general population
4. Male to female transmission is 80 to 90% after exposure
1. urethritis
27
Incidence/General Concepts: Gonorrhea
1. Produces _____ in men and cervicitis in women
2. A leading cause of infertility among females in the United States
3. Affects 1 to 2% of the general population
4. Male to female transmission is 80 to 90% after exposure
1. urethritis
28
```
Signs/Symptoms: Gonorrhea
Females: Often asymptomatic (80%)
1. Dysuria
2. _____ _____
3. Mucopurulent vaginal discharge (green)
4. Labial pain and swelling
5. Lower abdominal pain
6. ____
7. Abnormal menstrual periods
8. Dysmenorrhea
```
Males: Often asymptomatic
1. Dysuria
2. Frequency
3. White/yellow-green penile discharge
4. _____ ____
5. N and V
Female:
2. Urinary frequency
6. Fever
Male:
4. Testicular pain
29
Treatment: Gonorrhea
1. ______ (Rocephin) 250 mg IM × 1 dose to treat
gonorrhea plus
2. Azithromycin (Zithromax) 1 gram orally × 1 dose to cover chlamydia
3. Report to the health department
1. Ceftriaxone
30
Laboratory/Diagnostics: Gonorrhea
1. Gram stain of discharge smear shows gram-negative diplococci and WBC
2. Cervical culture for ___ ______ using modified Thayer-Martin media
2. N. gononhoeae
31
_______ ___
| Cause: Hepatitis B virus (HBV)
Hepatitis B
32
Prevention: Hepatitis B
1. Two commercially available hepatitis B preventive vaccines administered at ___, ____, _____ months: Recombivax HB and Engerix-B
0, 1, and 6
33
Treatment: Hepatitis B
1. Supportive and symptomatic care
2. _____ ___ immune globulin (HBIG) 0.06 ml/kg IM in a single dose within 14 days of exposure (earlier administration may be more effective)
2. Hepatitis B
34
A recurrent viral STD with no cure, associated with painful genital lesions
Herpes
35
Herpes:
_______: Direct contact with active lesions or vires-containing fluid (saliva or cervical secretions)
Transmission
36
Herpes Simplex Virus ___ ___: Associated with infection of lips, face, and mucosa
Type 1
37
Signs/Symptoms:
1. Initial: Fever, malaise, dysuria, painful/pruritic ulcers for usually ___ days
2. Recurrent: Less painful/pruritic ulcers for usually 5 days
3. Herpetic whitlow: HSV-I=60%, HSV-2=40%
1. 12
38
Herpes Simplex Virus ____ ___: Associated with the genitalia
Type 2
39
Management Herpes:
No treatment for curing the disease
Symptomatic treatment with drying and antipruritic agents
_______ (Zovirax) recommended for topical, oral, and IV use FamcMovir
Valacyclovir: Especially useful for asymptomatic viral shedding of HSV2
Acyclovir
40
Laboratory/Diagnostics: Herpes
1. ______ or Tzanck stain
2. The most definitive test is viral culture
1. Papanicolaou
41
Cause:
| Immunotypes L1, L2, or L3 of Chlamydia trachomatis
Lymphogranuloma Venereum (LGV)
42
Signs/Symptoms: Lymphogranuloma Venereum (LGV)
1. ____mm painless vesicle, bubo, or non-indurated ulcer
2. Regional adenopathy follows in approximately one month and is the most common finding
3. Stiffness and aching in groin followed by unilateral
swelling of inguinal region
1. 2 to 3 mm
43
Diagnosis: Lymphogranuloma Venereum (LGV)
1. May be confused with chancroid
2. Definitive diagnosis requires isolating C. _____
from an appropriate specimen
2. trachomatis
44
Treatment: Lymphogranuloma Venereum (LGV)
1. _______ (Vibramycin) 100 mg orally twice a day x 21 days
2. Aspirate buboes to prevent ulcerations
1. Doxycycline
45
Cause: Molluscum contagiosum virus
Molluscum Contagiosum
46
Prevalence: Molluscum Contagiosum
| 1. Occurs infrequently, about 1 for every ____ cases of GC
100
47
Signs/Symptoms: Molluscum Contagiosum
1. Lesions are ______mm, smooth, rounded, firm, shiny flesh-colored to pearly-white papules
2. Commonly seen on the trunk and anogenital region
1 to 5 mm
48
Diagnosis: Molluscum Contagiosum
| 1. Inspection and _____ exam
microscopic
49
Treatment: Molluscum Contagiosum
| 1. ______ with liquid nitrogen: Most popular method; may resolve without scarfing
Cryoanesthesia
50
STD involving multiple organ systems
Syphilis
51
Cause: Syphilis
| Treponema pallidum, a _____ with 6 to 14 regular spirals
spirochete
52
Incidence/General Concepts
1. The third most commonly reported infectious disease in the United States
2. Approximately _____ new cases reported annually
2. 200,000
53
Four Clinical Stages & Syphilis:
_________
Seropositive, but asymptomatic
Latent
54
```
Four Clinical Stages & Syphilis:
___________
a. A chancre is painless
b. Indurated ulcer
c. Located at the site of exposure
```
Primary
55
```
Four Clinical Stages & Syphilis:
_________
a. Flu-like symptoms
b. Highly variable skin rash on palmar and plantar
surfaces; mucous patches
c. Lymphadenopathy
d. Malaise
e. Anorexia
f. Alopecia
g. Arthralgias
```
Secondary
56
```
Four Clinical Stages & Syphilis:
______
a. Leukoplakia
b. Cardiac insufficiency
c. Aortic aneurysm
d. Meningitis
e. Hemiparesis
f. Hemiplegia
```
Tertiary
57
Serologic Tests: Syphilis
1. Nontreponemal: VDRL/RPR
2. Treponemal:
a. _________ treponemal antibody absorption (FTA-
ABS): Confirms positive in 85 to 95% of primary
cases and 100% of secondary cases
Microhemaggluthaation assay for antibody to T.
pallidum (MHA-TP)
2. a. Fluorescent
58
Treatment
1. Primary, secondary, or early syphilis of less than 1-year duration
a. _____ _____ G 2.4 million traits IM
1. a. Benzathine penicillin
59
Treatment
2. Late, latent, and indeterminate length; tertiary stage
a. Benzathine penicillin G 2.4 million traits IM weekly x 3
weeks
3. Penicillin allergic
a. _______ 100 mg orally twice a day, or
b. Erythromycin 500 mg orally four times a day
4. Report to the health department
3. a. Doxycycline
60
Tanner staging for girls: breast development
a. ________ breast
b. Breast buds with areolar enlargement
c. Breast enlargement without separate nipple contour
d. _____ and nipple project as a secondary mound
e. Adult breast: Areola recedes, nipples retracts
a. Preadolescent
| d. Areola
61
The absence of menstrual flow
Amenorrhea
62
Absence of menarche by age 16
Primary Amenorrhea
63
Cessation of menstrual flow after the establishment of normal menstrual cycling
Secondary Amenorrhea
64
______ is the most common cause of secondary amenorrhea
Pregnancy
65
Teens experiencing ______amenorrhea should be referred and evaluated for chromosomal defect, anatomic anomalies, hormonal imbalances, tumor ant trauma
primary
66
_______ amenorrhea
a. absence of menarche
b. absence of secondary sex characteristics
c. abnormal growth and development
Primary
67
_______ amenorrhea
| a. absence of expected menses with a history of regular cycles
Secondary
68
Physical examination
1. A complete evaluation to identify etiology
2. _____ _____ to identify any anatomical defects
2. Pelvic exam
69
Diagnostic Tests:
1) Primary
a) Consider _____ test
b) Refer to endocrinologist
2) Secondary
a) Pregnancy test
b) Referral for other studies
1) a) pregnancy
70
______ ____: Abnormal Results
Overview:
1. Detects the presence of abnormal and/ or precancerous cells on the cervix of the uterus
2. Asa screening test, the PAP smear has reduced mortality for cervical cancer by ruffly 50%
3. However, 1/3 of the test have false-negative results; screening as recommended is necessary
4. In the United States, cervical cancer is the third most common GYN cancer
Papanicolaou Test
71
Risk Factors/ Cause: Papanicolaou Test
1) ____; early, multiple sexual partners
2) Mal partner who has had multiple sexual partners
3) Cigarette smoking
HPV
72
Interpretation of Test Results (______ ______ _____)
1) Reporting categories
a) Normal findings: No atypia, no malignancy
b) Infection
c) Reactive or reparative changes
d) Squamous cell abnormality; Bethesda Classification:
Cervical Intraepithelial Neoplasia (CIN)
aa) ASCUS - Atypical Squamous Cell of
Undetermined Significance
bb) Low-grade SIL - CIN 1 (HPV or mild dysplasia)
CIN 2 (Moderate dysplasia)
CIN 3 (severe dysplasia)
CIS (carcinoma in situ)
cc) Squamous cell carcinoma
2) Changes in glandular cells AGCUS, presence of endometrial cells, adenocarcinoma, or other neoplasms
Bethesda Classification System
73
Management:
1. Infection: Treatment based on the causative agent; repeat PAP 3 to 4 months after treatment
2. For specific abnormal findings such as ASCUS:
a) ___ testing
b) repeat PAP smear
c) Colposcopy
3) Refer if CIN 2,3, or CIS
HPV
74
aa) ASCUS - ____ ___ ___ ___ ___ ____
bb) Low-grade SIL - CIN 1 (HPV or mild dysplasia)
CIN 2 (Moderate dysplasia)
CIN 3 (severe dysplasia)
CIS (carcinoma in situ)
cc) Squamous cell carcinoma
Atypical Squamous Cell of
| Undetermined Significance
75
CIN 1 (__ ____ ___ ___)
HPV or mild dysplasia
76
CIS (____ ___ ___)
carcinoma in situ
77
CIN 2 (_____ ___)
Moderate dysplasia
78
CIN 3 (____ ____)
severe dysplasia
79
Top 4 "killers" of adults in the United States
1. _____ ____
2. Cancer
3. Lower respiratory disease
4. ____ (___)
5. Unintentional accidents
1. Heart disease (CAD)
| 4. CVA (Stroke)
80
Cancer in women:
1. Responsible for the highest mortality? _______
2. Leading GYN-associated cancer "killer"? Ovarian
3. Is the highest incidence other than skin cancer? Breast
Lung
81
Cancer in women:
1. Responsible for the highest mortality? Lung
2. Leading GYN-associated cancer "killer"? _______
3. Is the highest incidence other than skin cancer? Breast
Ovarian
82
Cancer in women:
1. Responsible for the highest mortality? Lung
2. Leading GYN-associated cancer "killer"? Ovarian
3. Is the highest incidence other than skin cancer? ____
Breast
83
Cancer in men:
1. Responsible for the highest mortality? _____
2. Other than skin cancer, the 2nd most common cancer in men and #2 cancer "killer"? Prostate
Lung
84
Cancer in men:
1. Responsible for the highest mortality? Lung
2. Other than skin cancer, the 2nd most common cancer in men and #2 cancer "killer"? _____
Prostate
85
Combining cancer in men and women:
1. Leading cancer"killer"? _____
2. Second leading cancer"killer"? Colorectal
Lung
86
Combining cancer in men and women:
1. Leading cancer"killer"? Lung
2. Second leading cancer"killer"? _______
Colorectal
87
Cervical Cancer Screening Guidelines for Average-Risk Women: 2012
a) When to start screening
b) Statement about annual screening
c) American Cancer Society (ACS), American Society for
Colposcopy and Cervical Pathology (ASCCP), and
American Society for Clinical Pathology(ASCP)2
d) Age 21. Women are aged < ____ years should not be screened regardless of the age of sexual initiation for other risk factors. (Strong recommendation)
21
88
Cervical Cancer Screening Guidelines for Average-Risk Women: 2012
a) When to start screening
b) Statement about annual screening
c) U.S Preventive Services Task Force (USPSTF)3
d) Age ___. (A recommendation) Recommend against
screening women aged < 21 years. ( D
recommendation)
d) 21 years
89
Cervical Cancer Screening Guidelines for Average-Risk Women: 2012
a) When to start screening
b) Statement about annual screening
c) American College of Obstetricians and Gynecologists
(ACOG)4
d) Age 21 regardless of the age of onset of sexual
activity. Should be avoided < ___ years. (Level A
evidence)
21 years
90
Cervical Cancer Screening Guidelines for Average-Risk Women: 2012
a) American Cancer Society (ACS), American Society
for Colposcopy and Cervical Pathology (ASCCP), and
American Society for Clinical Pathology (ASCP)2
b) Statement about annual screening?
c) Women of ____ age should not be screened annually
by any screening method. (Strong recommendation)
any
91
Cervical Cancer Screening Guidelines for Average-Risk Women: 2012
a) U.S Preventive Services Task Force (USPSTF)3
b) Statement about annual screening?
c) Individuals and clinicians can use the annual ____
test screening visit as an opportunity to discuss
other health problems and preventive measures.
Individuals, clinicians, and health systems should
seek effective ways to facilitate the receipt of
recommended preventive services at intervals that
are beneficial to the patient. Efforts also should be
made to ensure that individuals are able to seek care
for additional health concerns as they present.
c) Pap
92
Cervical Cancer Screening Guidelines for Average-Risk Women: 2012
a) American College of Obstetricians and Gynecologists
(ACOG)4
b) Statement about annual screening?
c) Physicians should inform their patients that ____
gynecologic examinations may be appropriate.
(Level C evidence)
annual
93
Screening method and interval
a) Cytology( conventional or liquid-based)
b) ACS, ASCCP, ASCP
c) 21-29 years of age - Every ____ years (Strong recommendation)
3 years
94
Screening method and interval
a) Cytology( conventional or liquid-based)
b) ACS, ASCCP, ASCP
c) 30-65 years of age - Every ___ years (Strong recommendation)
3 years
95
Screening method and interval
a) HPV co-test (cytology + HPV test administered
together)
b) ACS, ASCCP, ASCP
c) 21-29 years of age - HPV co-testing should not be used for women aged
c) less 30 years
96
Screening method and interval
a) HPV co-test (cytology + HPV test administered
together)
b) ACS, ASCCP, ASCP
c) 30-65 years of age - For women who want to extend their screening interval, HPV co-testing every ___ years is an option.
(A recommendation)
5 years
97
Screening method and interval
a) Primary HPV testing
b) ACS, ASCCP, ASCP
c) For women aged 30-65 years, screening by HPV
testing alone is ___ recommended in most clinical
settings. (Weak recommendation)
c) not
98
Screening method and interval
a) USPSTF
b) Cytology( conventional or liquid-based)
c) 21-29 years of age - Every __ years (Strong recommendation)
3 years
99
Screening method and interval
a) USPSTF
b) Cytology( conventional or liquid-based)
c) 30-65 years of age - Every __ years (Strong recommendation)
3 years
100
Screening method and interval
a) USPSTF
b) HPV co-test (cytology + HPV test administered
together)
c) 21-29 years of age - Recommend against ___ co-testing women aged < 30 years.
(D recommendation).
HPC
101
Screening method and interval
a) USPSTF
b) HPV co-test (cytology + HPV test administered
together)
c) 30-65 years of age - For women who want to extend their screening interval, HPV co-testing every ___ years is an option.
(A recommendation)
5 years
102
Recommends against screening for cervical cancer with HPV testing (alone or in combination with cytology) in women aged < ___ years. (D recommendation)
30 years
103
```
Screening method and interval
a) ACOG
b) Cytology( conventional or liquid-based)
c) 21-29 years of age - Every ___ years.
(Level A evidence)
```
3
104
Screening method and interval
a) ACOG
b) Cytology( conventional or liquid-based)
c) 30-65 years of age - May screen every __ years with a history of 3 negative cytology tests. (Level A evidence)
3
105
Screening method and interval
a) ACOG
b) HPV co-test (cytology + HPV test administered
together)
c) ___ years of age - HPV co-testing should not be used for women aged <30 years.
21-29 years
106
Screening method and interval
a) ACOG
b) HPV co-test (cytology + HPV test administered
together)
c) ____ years of age - Every 5 years (Strong recommendation); this is the preferred method (Weak recommendation)
c) 30-65 years
107
Between 65-70 years of age with __ consecutive normal cytology tests and no abnormal tests in the past 10 years (Level B evidence).
An older woman who is sexually active and has multiple partners should continue to have routine " screening.
3
108
1. Screening post-total hysterectomy
a) Women who have had a total hysterectomy (removal
of the uterus and cervix,) should ____ screening
unless the hysterectomy was done as a treatment for
cervical pre-cancer or cancer. Women who have had
a hysterectomy without removal of the cervix (supra-
cervical hysterectomy) should continue screening
according to guidelines.
stop
109
1. Screening post-total hysterectomy
a) Recommend against screening in women who have
had a hysterectomy with removal of the cervix and
who do not have a history of a high-grade
precancerous lesion (_____ or ___) or cervical
cancer. (D recommendation )
CIN2 or CIN3
110
1. Screening post-total hysterectomy
a) If removal for benign disease and no history of high-
grade CIN or worse may ______ screening.
(Level A evidence) Women with whom a negative
history cannot be documented should continue to be
screened. (Level B evidence)
discontinue
111
1. Inflammation or infection of the vulva and vagina most
commonly caused by bacteria, protozoa, and/or fungi
2. Trichomoniasis, bacterial vaginosis, and candidiasis are commonly responsible for _________. Only trichomonas, often asymptomatic in men, are considered to be sexually transmitted.
Vulvovaginitis
112
___ _____, frothy flay yellow-green
| discharge pruritus, vaginal erythema, "strawberry patches" on cervix and vagina, dyspareunia, dysuria
Trichomonas Malodorous
113
____ _____: Watery, gray, "fishy" smelling discharge, vaginal spotting
Bacterial vaginosis
114
_______: Thick, white, curd-like discharge; vulvovaginal erythema with pruritus
Candidiasis
115
Wet prep:
| _______: Normal saline mixture shows motile trichomonads
Trichomonas
116
Wet prep:
| _____ _____: Normal saline mixture showed clue cells
Bacterial vaginosis
117
Wet prep:
| ______: KOH mixture shows pseudohyphae
Candidiasis
118
Trichomonas management is _____ (__) 2 grams by mouth single dose or 500 mg by mouth twice a day for 7 days
Metronidazole (Flagyl)
119
Bacterial vaginosis management is ____ (___) 500 mg by mouth twice a day for saving days or 2 grams by mouth single dose or gel ( 0.75%) 5 grams intravaginally twice a day for five days
Metronidazole (Flagyl)
120
_______ (___) vaginal vream (2%) 5 grams intravaginally at bedtime X7 days or 300 mg by mouth twice a day X7 days
Clindamycin (Cleocin)
121
Candidiasis
| a) ____ (__) or clotrimazole (Gyne- Lotrimin) (1%) 5 grams intravaginally at bedtime X 7 days
Miconazole (Mono-star)
122
Candidiasis
| b) _____ (___) 80 mg suppository, 1 suppository at bedtime X 3 days Butaconazole: 3 applications
Terconazole (Terazol)
123
The general term for inflammation and infection involving the uterus, fallopian tubes, ovaries, and surrounding tissues
Pelvic Inflammatory Disease (PID)
124
Pelvic Inflammatory Disease (PID): Most prevalent, polymicrobial causative agents include C. trachomatis, ___ ______, E. coli, G. vaginalis, H. influenza, and Streptococcus agalactiae
N. gonorrhoeae
125
Symptoms/ history of PID:
a) Fever/ chills
b) _______
c) Vomiting
d) ____ _______
e) dysuria
f) Dyspareunia
g) ____ _____ ____
h) Inferitlity
b) Nausea
d) Vaginal discharge
g) Lower abdominal pain
126
Physical Examination: PID
a) Positive cervical motion tenderness (CMT)
b) _____ tenderness
c) Abdominal tenderness
d) Fever > 38 degrees celsius
b) Adnexal
127
Diagnostic Test: PID
a) ____ testing
b) Elevated ____ or C- reactive protein
c) Ultrasound documentation of ovarian cyst
a) STD
| b) ESR
128
Management: PID
a) Empiric, broad-spectrum antibiotics coverage recommended
b) Outpatient management
aa) Regimen A:
i) _______ (______) 250 mg IM once single
dose plus
ii) Doxycycline (Vibramycin) 100 mg twice a day by
mouth x 14 days with or without Metronidazole 500
mg by mouth twice a day x 14 days
b) i) Ceftriaxone (Rocephin)
129
Management of: PID
a) Outpatinet management
bb) Regimen B:
i) Cefoxitin (Mefoxin) 2 gm IM plus
ii) Probenecid (Benemid) 1 gm oral single dose plus
iii) _____ (___) 100 mg orally twice a
day x 14 days with or without Metronidazole 500
mg orally x 14 days
Doxycycline ( Vibramycin)
130
Cramping pain occurring with menstruation
Dysmenorrhea
131
________: dysmenorrhea occurs in adolescent women as a result of a high level of __________
a) Pain begins after the onset of menses and no pelvic pathology is identified
Primary
| prostaglandin
132
_______: dysmenorrhea occurs in women > 20; more likely associated with some form of pelvic disease
Secondary
133
Symptoms/ History:
1) ___________ Dysmenorrhea
a) Cramping that radiates to the back and upper thighs
b) Headache
c) Diarrhea
d) Fatigue may be present
e) Occasional nasuea with vomitins
f) Self- limited to 72 hours
Primary
134
Symptoms/ History:
1) ___________ Dysmenorrhea
a) Pain in regard to etiology
Secondary
135
Physical Examination:
| 1) ______: Normal pelvic exam with the exception of uterine tenderness during menses
Primary dysmenorrhea
136
Physical Examination:
| 2) ________: Exam findings related to etiology
Secondary dysmenorrhea
137
Manamgnet: dysmenorrhea
1) Primary
a) Prostaglandins synthetase inhibitors (PGSIs)
i) Ibuprofen (Advil, etc.)
ii) ________ (Naprosyn)
iii) Indomethacin (Indocin)
ii) Naproxen
138
Management: dysmenorrhea
| 2) Oral ________ pills
2) contraceptive
139
Management: dysmenorrhea
| 3) ______
3) exercise
140
Management: dysmenorrhea
| 4) High _____ diet and reduction of sugar, caffeine, and salt
fiber
141
______ ______ _______
Overview
1. Abnormal uterine bleeding is usually the result of endocrine dysfunction.
2. Heavy bleeding episodes may also be the result of other problems such as polycystic ovarian disease, in, mature hypothalamic-pituitary-ovarian axis (adolescents), resistant follicular stimulation (perimenopause), and others
Abnormal Uterine Bleeding.
142
Symptoms/History: Abnormal Uterine Bleeding
1. Extremely _____ _____ of variable duration
2. Variable frequency of bleeding
3. Infrequent and irregular bleeding
heavy bleeding
143
Abnormal Uterine Bleeding:
___________: Infrequent, irregular; frequency >
40 days
Oligomenorrhea
144
Abnormal Uterine Bleeding:
________: Frequent, irregular; frequency < 18
days
Polymenorrhea
145
Abnormal Uterine Bleeding:
____________: Regular frequency but bleeding
excessive and prolonged
Menorrhagia
146
Abnormal Uterine Bleeding:
| _________: Bleeding between cycles
Metrorrhagia
147
Abnormal Uterine Bleeding:
___________: Prolonged, frequent, excessive,
irregular bleeding
Menometrorrhagia
148
Abnormal Uterine Bleeding:
| _________: Variable quantity between cycles
Intermenstrual
149
Diagnostic Test for abnormal uterine bleeding:
1) Initial: HCG (quantitative)
a) Prolactin
b) ____ ____ (__)
c) CBC
d) PAP
e) STD screening
f) _______
b) Thyroid functions (TSH)
| f) urinalysis
150
Somatic and affective symptoms which occur 7 to 10 days prior to menstruation and ends with the onset of menses
Premenstrual Syndrom (PMS)/ Premature Dynsphori disorder (PDD)
151
Overview:
1) PMS incidence slowly increases from adolescence; peaks during the 30s; quickly decreases after age ___
2) Precise etiology is unknown
41
152
Symptoms/ History: Premenstrual Syndrome (PMS)
1) _______: Body aches, breast tenderness, feeling of bloating, beaches, food cravings, poor coordination
2) Emotional: Hypersensitigy, irritability, mood swings, depressive symptoms, anxiety, tension, fear of loss of control, confusion
1) Somatic
153
Physical examination: Premenstrual Syndrome (PMS)
1) Exclude other possible complications causes
2) Diagnosis made by ____ (menstrual/ PMS diary)
history
154
PMS is management is:
a) A variety of strategies have been posed to assist with symptom management include: Bromocriptine (Parlodel), alprazolam (______), buspirone (BuSpar), tricyclic antidepressants (Nortipriyline, Pamelor), clomipramine HCL (Anafranil), serotonin reuptake inhibits, atenolol (Tenormin), oral contraceptive pills, progesterone
Xanax
155
Dietary Premature Syndrome (PMS)/ Premature Dysphoric Disorder (PDD):
1) Dietary
a) _______ restriction may play a role since caffeine
can increase anxiety, tension, depression, and
irritability
b) Others: Vitamin E, salt restriction, vitamin B6,
exercise
1) a) Caffeine
156
Abnormal metabolism of androgens and estrogen; results in ovarian cysts
Polycystic Ovarian Syndrom (PCOS)
157
Overview: Polycystic Ovarian Syndrome (PCOS)
a) The most common cause of ______in some and one of the most common endocrine orders of reproductive-age women
b) Age of won't typically pre-menopause but diagnosis may be delayed due to unmasking of symptoms during menopause; cause unknown but genetic thought to play a role
infertility
158
Symptoms/ History: Polycystic Ovarian Syndrome (PCOS)
1) menstrual irregularity
2) Infertility
3) ________
4) Obesity and metabolic syndrome
5) Acne
3) Histutism
159
Associated Conditions: Polycystic Ovarian Syndrome (PCOS)
1) Diabetes, metabolic syndrome
2) Heart and blood vessel complications
3) _______ cancer
4) Sleep apnea
Uterine cancer
