Test 2 Flashcards
caused by Treponema pallidum
syphilis
primary infection with syphilis
painless chancre that heals spontaneously
secondary infection with syphilis
nonpruritic rash on palms and soles
condylomata lata
gray colored genital warts that occur in syphilis
tertiary infection with syphilis
cardiac, neuro, ophthalmic disease
diagnostic for syphilis
screening with nontreponemal tests (VDRL and RPR); confirmed with treponemal test
trx for syphilis
Benzathine PCN G 2.4 million units IM x1
trx for syphilis if allergic to PCN
doxycycline 100 mg bid x 14 days
Do not give tetracyclines during
pregnancy
f/u for syphilis treatment
serology titers in 3, 6, 9, 12 months. avoid sex until titer has a 4-fold decrease
risk factors for PID
age less than 25, multiple sex partners, IUD
risk for PID is decreased if
taking oral contraception
Most common cause of PID
chlamydia and gonorrhea
s/s of PID
abnormal vaginal bleeding, low back/abd pain for less than 2 weeks, CMT and adnexal tenderness, fever greater than 101
diagnostics for PID
- pregnancy test to r/o ectopic pregnancy
- WBC on vaginal secretion
- elevated ESR or CRP
- endometrial biopsy
treatment for PID
ceftriaxone 250 mg IM and doxycycline 100 mg PO bid x 14 days with or without metronidazole 500 mg PO bid x 14 days
important with PID to
treat sexual partners in last 60 days
f/u with PID
f/u in 48-72 hours, then test for cure in 7-10 days and then 4-6 week after trx
HPV genital warts caused by
HPV 6 and 11
condylomata acuminate
HPV genital warts
painless, smooth, flat, skin-colored warts to fleshy papules that may become cauliflower-like growths.
condylomata acuminate in HPV warts
all women with HPV genital warts should undergo
pap smear for cervical HPV, gonorrhea/chlamydia, and HIV
treatment for HPV warts
Podofilox 0.5% gel; cryotherapy every 1-2 weeks
Mucopurulent cervicitis is caused by
chlamydia
risk factors for mucopurulent cervicitis
women less than 21 years old
Diagnostic for mucopurulent cervicitis
pap smear (make sure to remove discharge prior to specimen collection), NAAT
treatment for mucopurulent cervicitis
azithromycin 1 g PO x 1 or doxycycline 100 mg PO bid x 7 days
Characterized by clear/mucoid discharge and burning on urination.
nongonococcal urethritis
usually asymptomatic in women that can progress to PID
gonorrhea
Diagnostic for gonorrhea
NAAT
treatment for nongonoccoal urethritis
azithromycin 1 g PO x 1 or doxycycline 100 mg PO bid x 7 days
incidence of gonorrhea is highest in
women 15-19 years old
s/s of gonorrhea in men
purulent urethral discharge, dysuria
s/s of gonorrhea in female
often asymptomatic
treatment for gonorrhea
ceftriaxone 250 mg IM x 1 plus azithromycin 1 g PO x1 or doxycycline 100 mg PO bid x 7 days
Characterized by visible, painful genital or anal lesions or grouped vesicles at the site of inoculation and regional lymphadenopathy.
HSV
difference between HSV 1 and HSV 2
HSV1- oral herpes
HSV2- genital herpes
spread of HSV
asymptomatic shedding for up to 3 months
latency of HSV
establishes latency within sensory fibers for life
s/s of HSV
painful vesicles that ulcerate and resolve within 21 days
recurrent infection of HSV
prodrome phase of pain and burning over area prior to vesicle formation
Diagnostic of HSV
culture
treatment for HSV
acyclovir 400 mg PO tid x 7 days
treatment for recurrent HSV
acyclovir 400 mg PO tid x 5 days, start during prodrome or within one day of onset of lesion
transmission of HIV
sexually, injected drug use, blood transfusion, mother-to-baby
when should HIV testing be done
should be offered at least once in all people 13-64 years regardless of risk;
those with high risk should be screened annually
AIDS is diagnosed when CD4 is
below 200
is the best predictor of viral transmission in homosexuals. with HIV
viral load
s/s of early HIV
influenza-like symptoms that is self-limiting followed by an asymptomatic period.
s/s of late HIV/AIDS
anemia, thrombocytopenia, leukopenia, weight loss, TB
diagnostic of HIV
ELISA that is confirmed with Western blot
Management of HIV
- CD4, viral load, and CBC every 3 months
- TB test annually
immunizations for HIV
Pneumovax every 5 years;
inactivated influenza annually
The role of oral contraceptives
suppress the release of FSH and LH, preventing ovulation
progestin role in contraception
thickens cervical mucus, prevents ovulation
provide a a constant dose of estrogen and progestin in each of the 21 active tablets.
monophasic OCP
phasic OCPs have
altering doses of progestin
women who miss one or two OCP tablets should
take 2 tablets for each missed day
s/s of too much estrogen in OCP
bloating, edema, nausea, breast tenderness
s/s of too little estrogen in OCP
breakthrough bleeding, increased spotting
s/s of too little progestin in OCP
breakthrough bleeding, amenorrhea
s/s of too much progestin in OCP
increased appetite, weight gain
OCPs result in a reduced risk of
ovarian and endometrial cancer, PID, and rheumatoid arthritis
OCPs are contraindicated in women who have
- hx of thrombophlebitis, CVA, CAD, breast cancer;
- active liver disease,
- 20-year hx of DM,
- gallbladder disease,
- older than 25 who smoke
warning sign for OCP (ACHES)
- Abd pain
- Chest pain, SOB
- Headaches, dizziness
- Eye problems
- Severe leg pain
Ortho Evra patch
estradiol and progestin
ortho evra patch application
lower abd, buttocks, upper arm or torso once a week for 3 weeks. 4th week is for bleeding.
Nuvaring contains d
estradiol and progestin
Nuvaring application
inserted into the vagina for 3 weeks, removed on week 4 for bleeding
teaching for Nuvaring
if it’s out for more than 3 hours, use backup contraception for 7 days
When to take emergency contraception
within 72 hours and then repeated 12 hours later
Side effects of emergency contraception
nausea/vomiting, bleeding and spotting
Nonhormonal IUD (Paraguard and Copper T) prevent fertilization by
creating a spermicidal enviornment
IUD can be changed every
5 years
advantage of hormonal vs nonhormonal IUD
hormonal can decrease bleeding whereas nonhormonal can increase bleeding
Mirena contraindications
hx of thromboembolism, acute liver disease, hx of breast cancer.
These women do not tolerate IUDs as well
nulliparous women
Mini pills are
progestin only
Mini pills administration
must be taken everyday
minipills are good option for those women who are
breasfeeding
OCP not associated with thromboembolic events or gallbladder disease
minipills d/t no estrogen
Depo Provera injection is
progestin
Dep Provera administration
IM every 12 weeks
side effects of Depo Provera
irregular period, weight gain, headache
Average return of fertility after d/c Depo Provera
5-7 months
Implanon/Nexplannon is
progestin
Implanon/Nexplannon administration
changed every 3 years
both diaphragms and cervical caps must be used with
spermicidal jelly
teaching with diaphragms
must be in place for 6 hours after intercourse but no more than 24 hours
risk with diaphragms and cervical caps
TSS, UTI
teaching for cervical cap
can be in place for 24 hours
mucus that is produced during fertile periods is
clear, slippery, and stretches
mucus that is produced during periods of infertility is
cloudy, sticky, and breaks when stretched.
Low temps are recorded ___ ovulation and higher temps recorded ____ ovulation.
before; after
dysparenuria involves
vaginismus, vulvar vestibulitis, and vulvodyna.
involuntary spasm of the muscles surrounding the outer third of the vagina brought on by real, imagined, or anticipated attempts at vaginal penetration.
vagismus
chronic vulvar discomfort that may involve complaints of rawness, burning, stinging, or irritation.
vulvodynia
Touching the vestibule and the hymen with a moistened cotton swab may elicit the pain of
vestibulitis
Bartholin glands are usually
not palpable
diagnostics for dysparenuina
Pap smear and pelvic exam, wet mount, KOH, culture of vaginal discharge, testing for gonorrhea/chlamydia, HCG to r/o ectopic pregnancy
treatment for vulvar vestibulitis and vulvodynia
TCA or gabapentin
causes of bartholin gland abscess
tight fitting panties, STDs, infection
s/s of bartholin abscess
unilateral, swollen, red mass that is tender and painful
nonpharm trx of bartholin abscess
moist heat, warm sitz bath, I&D
diagnostics for bartholin gland abscess
C&S, test for STDs
medical trx for bartholin abscess
metronidazole, erythromycin, doxycycline.
diagnostic for atrophic vaginitis
increased pH, FSH to confirm menopause, estradiol level.
pharm trx for atrophic vaginitis
low dose estrogen if hysterectomy; estrogen+progesterone if uterus present
estrogen therapy for atrophic vaginitis should be for no more than
3 months
risk factors for candida vulvovaginitis
recent atbx therapy, steroids, pregnancy, DM, hypothyroidism, iron deficiency anemia, oral contraceptives, obesity
s/s of candida vulvovaginitis
thick, white vaginal discharge, itching, no odor
diagnostic for candida vulvovaginitis
KOH- look for hyphae and budding yeast
in candida vulvovaginitis, the vaginal pH is
less than 4.5
prevention of candida vulvovaginitis
cotton underwear, avoid tight clothing, weight loss, unscented soap
treatment for candida vulvovaginitis
fluconzazole 150 mg x1; Miconazole nitrate (Monistat) cream
education for candida vulvovaginitis
avoid sex until symptoms resolve
caused by replacement of the normal, hydrogen-peroxide producing Lactobacillus in the vagina with high concentrations of anaerobic bacteria
bacterial vaginosis
risk factors for BV
multiple sex partners, black
s/s of bacterial vaginosis
odorous thin, white/gray vaginal discharge that is adherent to vaginal walls
Amsel criteria for bacterial vaginosis
pH is greater than 4.5;
“clue cells” on wet mount;
positive whiff test;
milky-white discharge adherent to vaginal walls.
pH in bacterial vaginosis is
greater than 4.5
Treatment for bacterial vaginosis
Metronidazole 500 mg Po bid x 7 days (avoid alcohol); OR
clindamycin cream x 7 days
bacterial vaginosis during pregnancy
can cause low birth weight and preterm delivery
F/U with bacterial vaginosis
f/u in 2-3 weeks and test vaginal pH, whiff test, and wet mount.
normal vaginal pH is
3.8-4.2
avoid prescribing fluconazole for candida vulvovaginitis in
pregnancy and those with Dm who take oral hypoglycemics
s/s of trichomoniasis
yellow-green, frothy discharge; strawberry cervix
the pH in trichomoniasis is
greater than 4.5
trx for trichomoniasis
metronidazole 2 g orally x 1
trichomoniasis in pregnancy
can cause low birth weight and preterm
education in trichomoniasis
treat sexual partners
continuous, or episodic, non-menstrual pain of at least 6 months duration that occurs below the umbilicus, is severe enough to interrupt normal activities of daily life
chronic pelvic pain
risk factors for chronic pelvic pain
sexually abused, PID, ectopic pregnancy, endometriosis, irritable bowel syndrome
Treatment for chronic pelvic pain
NSAIDs, TCA, anticonvulsants, gabapentin
median age of menopause
51
diagnostic for menopause
FSH greater than 40, LH greater than 30.
hormone therapy has been approved for
osteoporosis prevention but NOT treatment
Estrogen therapy increases risk of
endometrial cancer and heart disease
Hormone replacement therapy is approved for
vasomotor symptoms, vaginal atrophy, and prevention of osteoporosis
absolute contraindications of hormone therapy are
vaginal bleeding, liver disease, thromboembolic disorders
medications for menopause symptoms
clonidine, gabapentin, effexor, paxil
this doubles the risk of developing ovarian cysts
smoking
these decrease the risk of developing ovarian cysts
OCPs
function or physiologic ovarian cysts are often asymptomatic and resolve in
60-90 days
s/s of worsening ovarian cysts
unilateral pelvic pain
diagnostic for ovarian cysts
r/o ectopic pregnancy, CBC, trasvaginal US, cervical cultures
treatment for simple ovarian cysts
NSAIDs, rest
pathophys of PCOS
high insulin levels cause ovarian cells to produce more androgens/testosterone. The liver compensates by decreasing secretion of sex hormone binding globulin (SHBG) that bind and excrete free testosterone.
s/s of PCOS
hirsutism (acne, alopecia);
irregular menstrual cycles;
infertility
diagnostics for PCOS
LH/FSH ratio greater than 2.5:1;
high testosterone;
high prolactin;
high insuiln
treatment for PCOS
oral contraceptives- suppress LH to reduce testosterone secretion ;
Metformin, Clomid
Spironolactone
ovarian cancer is more common in women
greater than 60 years old
risk factors for ovarian cancer
hx of breast cancer or BRCA gene; nulliparity; pregnancy after 30, family hx; estrogen
s/s of ovarian cancer
bloating, dyspepsia, abd pressure/pain, irregular vaginal bleeding
Diagnostics for ovarian cancer
transvaginal US
Treatment for ovarian cancer
total hysterectomy, radiation/chemo
median age of endometrial cancer
61
Type I endometrial cancer is associated with
excess estrogen that is unopposed by progesterone
common presenting sign of endometrial cancer
perimenopausal woman has more frequent and heavier periods
diagnostic of endometrial cancer
endometrial thickening greater than 5 mm; endometrial biopsy
treatment for endometrial cancer
total hysterectomy, chemo
high correlation of endometrial cancer with
breast and colon cancer
Pap smear guidelines
21-29 every 3 years;
30-65 Pap + HPV every 5 years or Pap alone every 3 years.
next step for ASC-US
HPV DNA testing or repeat pap in 1 year
next step for ASC-H
colposcopy and biopsy
next step for LSIL and HSIL
colposcopy and biopsy, with LEEP for abnormal findings
Paps may be stopped at age 65 if
prior 3 normal paps, no hx of genital tract cancer
cervical cancer is associated with
HPV 16 and 18
the normal endocervix is covered with
columnar epithelium
cervix in cervical cancer
enlarged (barrel cervix), friable tumor on cervix
risk factors for breast cancer
age greater than 50, first degree relative, early menarche, late menopause, nulliparity, obesity
s/s of breast cancer
painless, firm, fixed mass;
clear nipple discharge;
Peau d’orange appearance;
nipple retraction
mammogram guidelines
every 1-2 years starting at 40, annual screening at 50
s/s of fibrocystic breasts
smooth, moveable rope-like masses; breast tenderness that goes away after menses
treatment for fibrocystic breasts
cold compresses, wear bra 24 hours a day, sodium and caffeine restriction.
fibroadenoma most common in
women 20-30
s/s of fibroadenoma
single, nontender, moveable mass
diagnostics for fibroadenoma
US for women less than 35, mammogram for women older than 35
intraductal papilloma mostly occurs at
age 40-50
s/s of intraductal papilloma
bloody or serous nipple discharge
treatment for intraductal papilloma
surgical excision
causes of mastitis
Staph aureus or strep
s/s of mastitis
breast tenderness, fever, erythema
treatment for mastitis
warm compress, frequent nursing
Meds for mastitis
Bactrim or clindamycin
important teaching with mastitis
don’t stop breastfeeding
for those who don’t respond to atbx for mastitis, consider
mammogram to r/o inflammatory breast cancer
causes of amenorrhea
lactation induced; hypothyroidism, eating disorders, hyperprolactinemia
management for amenorrhea
prevent bone loss, education that pregnancy can still occur
s/s of dysmenorrhea
crampy, pelvic pain, back/thigh pain, N/V
secondary dysmenorrhea occurs
women 30-40 years old
causes of secondary dysmenorrhea
endometriosis, uterine fibroids, PID, ovarian cysts
diagnostics for dysmenorrhea
pregnancy test, STD testing, pelvic US
treatment for dysmenorrhea
NSAIDS (Cox-2) and oral contraceptives
PMS and PMDD occurs mostly during the
luteal phase (5-11 days before menses)
Treatment for PMS and PMDD
Vitamin B6, vitamin E, calcium, and Mg;
NSAIDs;
OCP
Breast MRI is done to
localize staging of breast cancer
MRI is not a screening tool for breast cancer because
it is expensive and labor intensive
BRCA gene is
autosomal dominant, so only one defected gene is needed
if BRCA gene present, then this should be done
annual mammograms and transvaginal ultrasound;
semiannual breast MRI and CA-125 starting at age 25
Important teaching for endometrial biopsy
notify for any temp elevation as it may activate PID
endometrial biopsy can be used to diagnose for
uterine cancer
essential for a pelvic ultrasound
full bladder
This is state mandated, but patient can opt out
HIV testing for prenatal visit
Pregnancy should not be attempted for __ days after rubella vaccine.
28
vaccines not recommended during pregnancy
MMR, varicella, smallpox, herpes zoster, live attenuated influenza, HPV
Category C, D, and X
fluoroquinolones, lithium, tetracycline, warfarin, methotrexate
softening of the isthmus of the uterus
Hegar’s sign
softening of the cervix
Goodell’s sign
dark blue to purplish-red color of vaginal mucosa
Chadwick’s sign
painless uterine contractions that occur every 10-20 min after the 3rd month of pregnancy and do not represent true labor.
braxton hicks
soft blowing systolic murmur heard down at the sides of the uterus.
uterine souffle
the number of pregnancies (including the current one)
gravida
Number of births (regardless if living) after 20 weeks gestation.
para
GTPAL
Gravida, Term, Preterm, Abortion, Living
Born at term is after
37 weeks
Nagele’s rule
LMP minus 3 months + 7 days = EDC
The BP is lowest in the
second trimester
GI effects from pregnancy
increased acidity of gastric contents, relaxation of LES, prolonged emptying of gallbladder
endocrine changes from pregnancy
TSH decreases, T4 increases, increased cortisol
testing for Rh blood type
If mother is Rh negative, then check father. If he is Rh+, then an indirect coomb’s test is done to look for Rh antibodies
If indirect coomb’s test is negative, then
recheck in 28-30 weeks and at 36 weeks
If indirect coomb’s test is positive
then RHOGAM is given to mother at 28 weeks and then 72 hours after delivery or abortion.
HBsAg generally indicates active
active Hep B infection.
If a woman’s rubella titer is _____, she has immunity to rubella
greater than 1:10 to 1:20
If a woman’s rubella titer is ___ she has no immunity to rubella
less than 1:8
If woman’s rubella titer is low, then
she should get immunization before pregnant or after delivery
Qualitative beta hCG testing is
rapid pregnancy test
Quantitative hCG testing is
more accurate pregnancy test
This pregnancy test is more accurate because hCG levels are higher
serum hCG
Cystic fibrosis screening should be done in
there is a family hx, caucasian or jewish descent
Tay Sachs and Cystic fibrosis is
autosomal recessive (baby would need to receive both genes)
Normal weight gain in pregnancy is
25-35 lbs
follow up visits for prenatal care
every 4 weeks until 28 weeks;
every 2 weeks between 28 and 36 weeks
every week after 36 weeks
folic acid requirements
0.8-1.0 mg
first ultrasound/sonogram at
20 weeks
should be done in 15-21 weeks
screen for neural tube defects and down syndrome
should be done in 24-28 weeks
1 hour glucose screen, repeat CBC and RPR; draw indirect Coombs or administer Rhogam
should be done at 36 weeks
repeat CBC, chlamydia, RPR
Group B beta strep should be done at
35-37 weeks
Leopold’s maneuver to determine fetal position is usually done at
36 weeks
In true labor, discomfort begins in this area
back and radiates around abd
Breastfeeding should be done for the first
6 months to 1 year
Breastfeeding has been associated with a decreased risk of
SIDS
A newborn should have up to this many feedings in 24 hours
8-12
The stool in a newborn will start off ____, then become ____
dark and tarry; yellow and milky
For the first week of life, the number of stools and the number of voids should approximately match ____
the infants age in days.
Infants may lose up to ___ of the body weight in the first week of life.
8-10%
For irritated nipples, breastfeeding should be held for ____; and the mother should pump every ____.
24 hours; 3 hours
Breast engorgement can be minimized by
frequent feedings
nonpharm options for nausea during pregnancy
vitamin B6, increase intake of nuts and protein
pharm option for nausea during pregnancy
doxylamine or H1 blockers + vitamin B6; zofran
pharm options for constipation during pregnancy
psyllium, MOM, prune juice.
Avoid PEG
pharm options for GERD during pregnancy
antacids
Increased mucus formation by the cervix in response to elevated estrogen levels in the 1st trimester causes
leukorrhea
Nasal congestion and epistaxis during pregnancy results from
increased estrogen
trx for round ligament pain during pregnancy
heating pad to abd, knee-chest position
if mother c/o decreased fetal movement, then
order a non-stress test
When the patient presses a button that marks the tracing of fetal monitor every time she feels fetal movement.
non-stress test
Reassuring or reactive non-stress test shows at least ___ accelerations in fetal heart rate lasting at least ____ in a ____ period
15 beats per min; 15 seconds; 20 min
common indications for non-stress test
decreased fetal movement, PIH, DM, post-date after 40 weeks, IUGR
elements of biophysical profile
- fetal tone
- gross body movements
- breathing
- amniotic fluid volume
Scoring in biophysical profile
each is worth 2 points.
8-10 is reassuring
anemia in pregnancy is Hgb less than
11
Premature separation fo the placenta form the uterine wall.
placenta abruptio
s/s of placenta abruptio
board like uterus, uterine tenderness
management of placenta aburptio
emergency
characterized as abnormal development of placenta that causes severe N/V at 12-16 weeks gestation with brown discharge
molar pregnancy (gestational trophoblastic disease)
mangaement for molar pregnancy
immediate evacuation of uterus
incompetent cervix management
refer to have cerclage placed by 12 weeks
management for prolapsed umbilical cord
emergency– place pt in knee chest position or trendelenberg, apply oxygen
spontaneous abortion occurs
before 20 weeks gestation
Treatment for preeclampsia is
methyldopa with or without hydralazine or labetalol
PIH/preeclampia is BP
greater than 150-160/90-100
HELLP syndrome
hemolysis
elevated liver enzymes
low platelet count
neonates of gestational diabetes can have
hypoglycemia, hypocalcemia, polycythemia, jaundice
diagnostics of gestation diabetes
done at 24-48 weeks;
50-g glucose tolerance test;
1 hour glucose > 130
treatment of gestational diabetes
insulin, glyburide
common sign in ruptured ectopic pregnancy
pain radiating to shoulder
trx for ectopic pregnancy
if not ruptured, methotrexate.
if ruptured, laparoscopy
caused by implantation of the placenta near or across the cervical os. It
placenta previa
s/s of placenta previa
painless bleeding at end of 2nd trimester
This should not be done if placenta previa suspected
vaginal exam
risk factors for placenta previa
age > 35, multiparity, previous c-section
Defined as uterine contractions that cause cervical change and dilation before 37 weeks gestation.
preterm labor
injectable steroids for preterm labor is given at
24-32 weeks
When does the mother feel “quickening”?
20 weeks
More common in primigravidas, with age extremes (teen or >35), and Blacks
PIH or preeclampsia
A variant of PIH with abnormal LFTs and poor clotting
HELLP
Caused by chronic uteroplacental insufficiency (UPI)
IUGR
Characterized by PAINLESS bright bleeding, associated with prior C/S and multipartiy
Previa
these can lead to preterm labor
BV, trich, and UTI
In OCT or contraction stress test, a positive result is ____ with ___ contractions.
more than 2 fetal heart rate decelerations; 3
the “rule of thumb” is that number of _____ = the number of ______ plus or minus 3 cm.
weeks gestation; centimeters of fundal height
the rule of thumb only applies during weeks
20-36
if the uterus is too large, then consider that the
EDC is wrong and get a sonogram
FHTs are best heard from
the fetus’s back
it is normal for this lab value to be elevated during pregnancy
WBC
a non-stress test can be done after
28 weeks
After a progestin challenge, a woman with PCOS will
bleed since they have a lot of estrogen
potential effect in Yaz and Yasmin
hyperkalemia
IUD care with PID
do not have to remove IUD, atbx
most common sign of chlamydia
post-coital spotting
most common s/s in HSv
dysuria, pain/tenderness
when does woman need to have c-section with HSV?
active lesions
Involution of the uterus postpartum should be at
6 weeks
