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Summer 24 > Test 2 > Flashcards

Test 2 Flashcards

1
Q

Is it mandatory to have a chaperone in the exam?

A

Yes

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2
Q

Primary purpose of pap smear. Treatment, screening or diagnostic?

A
  • screening used to identify abnormal/atypical cervical cells
  • can identify some infections of cervix and vagina, more definitive tests are needed for diagnosis
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3
Q

Pap screening recommendations

A
  • Less than 21 years-do not screen
  • 21-29 years-Pap every 3 years
  • 30-65 years-Pap every 3 yrs alone, HPV test every 5 yrs alone, or HPV and Pap co-test every 5 yrs
  • Older than 65-do not screen if not at high risk for cervical cancer
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4
Q

Preferred maneuver order for pelvic exam

A
  1. inspection of external genitalia
  2. speculum exam
  3. bimanual exam
  4. rectovaginal exam
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5
Q

Describe normal vaginal discharge

A

white or clear; thin or mucoid

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6
Q

Normal physical exam for nulliparous female.

A
  • cervical os small and round and in center of cervix
  • ovary can be felt in thin, relaxed pt; may be difficult in some pts
  • Ovary size-1.5cm x2.5cm x4cm and weighs 3-6 gm; in ovarian fossa
  • Uterus size and length-6-8 cm; weight 60 gms; larger in parous women
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7
Q

What is the Q-tip check test is and what is it used for? What actions if positive?

A
  • urethral hypermobility
  • positive test is rotation of q-tip greater than 30 degrees
  • management based on cause, severity, and pt expectations
  • avoid caffeine, smoking, alcohol
  • timed voiding, limit fluid intake, bladder diary/training
  • weight loss, pelvic floor muscle exercises, kegel exercises
  • incontinence pessary, pharmacotherapy
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8
Q

What are expected findings of vaginal pH exam less than 4.5?

A
  • Less than 4.5 vulvovaginal candidiasis (typically)
  • Pt c/o vaginal itching, burning, and/or discharge; may be asymptomatic
  • vulvar pruritus, swelling, excoriation, redness
  • S/S: thick or thin, white curd-like (resembling cottage cheese), adherent odorless discharge
  • 3.5-4.5 also associated with normal flora
  • Discharge-white or clear; thin or mucoid
  • No odor or associated s/s
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9
Q

What is a clue cell?

A
  • squamous epithelial cells in vagina covered in bacteria
  • change to fuzzy look when coated w/ bacteria
  • key indicator of BV
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10
Q

Diagnosis criteria for bacterial vaginosis

A

Must have 3 of the 4 to have official diagnosis (Ansel diagnostic criteria

  1. thin white or gray discharge that coats the vaginal walls
  2. fishy odor of the vaginal discharge
  3. Vaginal pH greater than 4.5; (normal vaginal pH range is 4-4.5)
  4. Clue cells on microscopic examination (50% of slide) via wet prep
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11
Q

How is yeast vaginitis diagnosed?

A
  • vaginal pH less than 4.5 vulvovaginal candidiasis (typically); yeast culture
  • Pt c/o vaginal and vulvar itching, burning, irritation, redness, swelling; may be asymptomatic
  • S/S: thick or thin, white curd-like (resembling cottage cheese), adherent odorless discharge
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12
Q

Common causes of non-GYN pelvic pain

A
  • Acute: appendicitis, UTI, gastroenteritis, kidney stones, diverticulitis, trauma
  • Chronic: chronic appendicitis, urinary tract disease, IBS, interstitial cystitis, ulcerative colitis, diverticulosis, neuromuscular disorders
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13
Q

Differential diagnosis for pelvic pain

A

Gyn: ectopic pregnancy, uterine fibroids, ovarian cyst, PID, endometriosis (EUROPE)
GI: appendicitis, bowel obstruction, constipation, IBS
Urinary: cystitis, pyelonephritis, UTI

What is not an appropriate differential?

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14
Q

Stages of female puberty

A
  1. Thelarche: 8-11 yrs; onset of breast development in around 9 yrs, complete development in 2-4 yrs
  2. Pubarche: 12 yrs; onset of pubic hair growth
  3. Menarche: first occurence of menstrual bleeding, avg 12.5 yrs, about 2.5 yrs following breast development
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15
Q

Precocious puberty

A

Females: breast development or onset of menstruation before 8 yrs (breast, pubic hair, or menstruation)
Males: testicles and penis growth, pubic/facial hair and deeper voice before age 9

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16
Q

Important questions when counseling teens/adolescents

A

“Late periods”-When was LMP start date?, Pattern of menses? Sexually active? Abnormal menstrual patterns?
“Dizziness”-History of fainting spells? History of anemia? Dehydration? Heat exposure?
“Nausea/vomiting”-Food poisoning? Exposure to infection/illness? History of GI issues? Stress/anxiety? Medication/allergies? motion sickness/dehydration? possible pregnancy?

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17
Q

Most likely cause of pelvic pain in adolescent

A

gynecological

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18
Q

Define amenorrhea

A
  • Amenorrhea is the absence of menstruation during reproductive years, it is a symptom not a diagnosis
  • Primary amenorrhea- no menstruation by 16 years regardless of secondary sex characteristics.
  • Secondary amenorrhea- absence of menses for 3 months-6 months (ACOG) in a previously menstruating woman
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19
Q

Most probable causes of primary and secondary amenorrhea

A

Primary: chromosomal or genetic abnormalities (about 50% of cases) i.e. Turner’s, hormonal issues
Secondary: pregnancy most common, birth control, eating disorder, stress, extreme wt gain/loss, thyroid dysfunction

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20
Q

Which amenorrhea is most common?

A

secondary

Primary amenorrhea is less than 0.1%

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21
Q

What is atrophic vaginitis? Who is affected?

A
  • condition that occurs when body produces less estrogen, causing inflammation and thinning of vaginal walls
  • occurs in women experiencing peri/postmenopausal women, lactation, chemotherapy, diabetes
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22
Q

Atrophic vaginitis differentiation

A

Pt c/o:
* vaginal dryness-scant vaginal secretions,
* burning, irritation, itching, discharge-atrophic epithelium pale, smooth shiny with patch erythema,yellow/light brown discharge
* odor
* dysuria, urinary frequency, nocturia, frequent UTIs
* petichiae may be seen on cervix
* elevated vaginal pH (typically greater than 4.5-5.0) and WBCs
* cervical os may be stenoic-unable to insert cytobrush or broom to obtain sample

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23
Q

Describe microscopic findings of atrophic vaginitis

A

Histologic findings
* decreased superficial squamous cells and lactobacilli
* increased parabasal cells and WBCs

  • Wet smears: small, round parabasal cells with denser nuclei
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24
Q

Vaginismus

A
  • involuntary spasms of vaginal muscles
  • penetration painful or impossible
  • pt w/ heightened fear of pain and emotional distress due to vaginal penetration (tampons, intercourse, gyn exam)
25
Q

Management of dyspareunia (painful sex)

A
  • Vaginal infections: antibiotic or antifungal meds
  • Dermatologic: topical corticosteroids
  • Peri/Postmenopausal: vaginal estrogen preparations, nonhormonal medications
  • Vulvodynia: cotton underwear, avoid irritants, avoid self-treatment
  • Pelvic floor PT, cognitive behavioral therapy
26
Q

Is female sexual dysfunction: normal?

A
  • common; 41% of women experience
27
Q

What is the origin of female sexual dysfunction?

A

Medical
* heart disease, neuro, Gyn

Psych
* depression, anxiety
* relationship issues, social stress
* sexual abuse

Meds
* antiepileptics
* heart/blood pressure
* opioids, psych
* NSAIDs
* chemotherapy
* birth control

Hormonal
* menopause, pregnancy, endocrine

28
Q

Can female sexual dysfunction be managed or should it be referred?

A
  • Management: encourage communication w/ partner, lifestyle habits, refer for counseling, vaginal lubricants/stimulation devices, estrogen therapy, androgen therapy (testosterone), Addyi (antidepressant, can help w/ low desire), Vyleesi (injection)
  • When interpersonal and sociological factors such as relationship conflict, sexual abuse, strict religious upbringing, and stress involved-collaborate with mental health/sex therapist
29
Q

Hypoactive sexual desire disorder

A
  • most common FSD; more common in men than women
  • low libido or lack of sexual desire that causes personal distress
30
Q

Female sexual arousal disorder

A

inability to develop or maintain adequate genital response (vulvovaginal lubrication, engorement/sensitivity of genitalia) for a minimum of 6 months

31
Q

Female orgasmic disorder

A
  • recurrent, distressing compromise of orgasm pleasure, intensity, frequency and/or timing (PIFT)
  • minimum of 6 months
32
Q

Primary orgasmic dysfunction

A

female who has never had an orgasm
*subcategory of female orgasmic disorder

33
Q

What is the normal presentation of trichomonas and how is it diagnosed?

A
  1. yellow to green, purulent, may be bloody
  2. “musty” odor
  3. vulvovaginal itching, irritation, burning
  4. dysuria, cloudy urine
  5. dyspareunia, postcoital bleeding
  6. “strawberry spots” or tiny petechiae on cervix or vaginal walls; may bleed on contact
  7. elevated pH-greater than 5.0
  8. Wet mount: one-celled flagellate trichomonads, increased WBCs, strong amine odor
34
Q

What medication is used to treat trichomonas?

A
  • Metronidazole 2g orally in single dose
35
Q

What is the presumptive treatment for gonorrhea and chlamydia for non-pregnant patients?

A
  • Gonorrhea: Ceftriaxone 500 mg IM in single dose
    If cephalosporin allergy: gentamicin 240 mg IM
    single dose PLUS azithromycin 2gm orally
    single dose
  • Chlamydia: Doxycycline 100 mg orally twice daily for 7 days
    Alternative: Alternative: Azithromycin 1 g oral
    single dose OR Levofloxacin 500 mg orally
    once daily for 7 days
36
Q

What are the primary and alternative treatments for chlamydia?

A
  • Doxycycline 100mg orally 2 times/day for 7 days
    Alternative regimens: azithromycin 1 g orally in a single dose
    OR Levofloxacin 500mg orally once daily for 7 days
  • If PREGNANT: Azithromycin 1g orally in a single dose
    Alternative regimen: amoxicillin 500mg orally 3 times day for 7 days
37
Q

What are the new CDC recommendations for gonorrhea and chlamydia treatment for pregnant patients?

A
  • Gonorrhea-Ceftriaxone 500 mg single IM dose, if allergic referral to infectious disease
  • Chlamydia-Azithromycin 1gm single oral dose
    Alternative: Amoxicillin 500 mg orally 3X daily for 7 days
38
Q

What education should be given to a patient with chlamydia?

A
  • sexual partners in the past 60 days should be referred for testing and possible treatment
  • Women should be advised to abstain from sex until their sexual partners are treated
  • wait 7 days after single dose treatment or until completion of a 7-day regimen before resuming sexual activity
39
Q

What is the treatment for condyloma?

A

Pt-applied: Ointment, cream, gel
Provider-applied: Cryotherapy, surgical removal, TCA

40
Q

What education would you provide to a patient with newly diagnosed Herpes?

A
  • No sex during outbreaks or if you feel the prodrome; keep affected area clean/dry
  • Use condoms, limit sexual partners
  • Avoid creams, lotions, or powders on lesions unless instructed
  • If urination is painful, pour water over the genital area while urinating
  • Notify provider if pregnant
41
Q

How does herpes present?

A
  1. pts can be asymptomatic
  2. painful, itchy, ulcerated or crusted blisters around genitals, rectum, or mouth (outbreak)
  3. blisters break and leave painful sores-up to 1 wk or more to heal
  4. flu-like symptoms (fever, body aches, or swollen glands) during first outbreak
  5. repeated outbreaks are shorter and less severe and can recur in same location
  6. lifelong infection; # of outbreaks decrease over time
42
Q

Discuss recurrent HSV infections. What happens with and w/o treatment?

A
  • antivirals can treat and reduce symptoms, recurrences, and transmission
  • after use, antivirals do not cure or impact frequency or severity of recurrences
43
Q

Differential diagnosis of Syphilis chancres

A

Herpes simplex, herpes zoster, chancroid, genital warts, HIV, scabies, varicella and drug eruptions or reactions

44
Q

What is secondary syphilils and how to differentiate?

A
  • generalized maculopapular rash, nonpruritic, copper colored, palms of hands/soles of feet
  • erythematous or scaly, mucus patches; painless white, mucus membrane lesions
  • generalized lymphadenopathy; flu-like syndrome, fever, headache, sore throat, malaise; patchy alopecia

Primary: chancre w/ min pain or painless, min exudate, regional lymphadopathy
Tertiary: locally destructive granulomatous tumors involving various organs or systems, CV and neuro involvement
Latent: asymptomatic

45
Q

What is the best test for diagnosing syphilis? What can yield false positives?

A

presumptive diagnosis of syphilis requires two laboratory serologic tests: a nontreponemal test (screening) and a treponemal (confirmation) test
Nontreponemal-VDRL and RPR-faster
Treponemal-TPHA and FTA-Abs

False positive nontreponemal d/t pregnancy-common, IV drug use, HIV, lupus, increased age, RA, vaccinations

46
Q

What is the CDC recommended syphilis treatment for pregnant women?

A
  • Penicillin G 2.4 million units IM single dose; second dose can be administered 1 week after initial dose
  • if allergic to PCN, desensitive and treat
  • based on stage of infection
  • additional therapy recommended to treat congenital syphilis
47
Q

What education should be given to patients with syphilis?

A
  • adherence to monthly serologic testing to assess treatment; condoms until treatment successful
  • avoid sexual contact until chancre healed
  • notify at-risk partners: Primary-3 months plus the duration of symptoms; Secondary-6 months plus duration of symptoms; Latent-1 year plus the duration of symptoms
48
Q

At what stage can neurosyphilis occur?

A

at any stage of syphilis infection

49
Q

Which serologic titers should prompt concern about syphilis treatment failure or reinfection?

A
  • Fourfold rise or failure of a fourfold decrease of titer within 6-12 months suggests reinfection or treatment failure
  • Nontreponemal antibody titers usually decrease at least fourfold during the 12 months after syphilis treatment
50
Q

How to determine GTPAL

A

Gravida: # of times a woman has been pregnant regardless of outcome and including current pregnancy
Term: # of deliveries after 37 wks
Preterm: # of pregnancies between 20-36 6/7 wks regardless of outcome
Abortions: # of fetal losses before 20 wks (spontenous miscarriages and elective terminations)
Living Children: # of children born and are alive

51
Q

Nullipara

A

a woman who has not carried a pregnancy to 20 weeks

Parity (para)-# of pregnancies completed or at 20 weeks or greater

52
Q

Primigravida

A

completed one pregnancy at 20 weeks or greater

Primi=first; Gravida=pregnancy

53
Q

Multipara

A

completed two or more pregnancies at 20 weeks or greater

Multi=many

54
Q

Who and what testing is recommended for women without risk factors for osteoporosis?

A
  • All women 65 and older
  • bone mineral density (BMD) via DEXA (DXA) scan
55
Q

What age is recommended for osteoporosis screening in women?

A

65

56
Q

Most common occurring cancer in females (U.S.)

A

Breast

57
Q

Leading cause of cancer mortality in females (U.S.)

A

Lung cancer

58
Q

What cancer screenings are routinely recommended in 50-year-old women? (which is not recommended?)

A
  1. Breast cancer screening-yearly mammograms
  2. Colorectal cancer screening every 10 years
  3. Cervical cancer screening-HPV and Pap co-test every 5 yrs, Pap alone every 3 yrs, or HPV alone every 5 yrs
  4. Risk assessment for BRCA testing

Summer 24 (5 decks)

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