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OB GYN > Test 3 Deck 4 > Flashcards

Test 3 Deck 4 Flashcards

1
Q

Stratifiied squamous epithelium produce __ that’s converted to __ __. In menopause __ production decreases.

A

Glycogen, lactic acid, decrease

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2
Q

Things that can offset the balance of vaginal microflora?

A 
Abx
Douching
Semen
Foreign bodies (tampons, diaphragm)
Hypoestrogenized (atrophic): menopause, high progesterone relative to estrogen (pregnancy/contraception)
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3
Q

What is the MC cause of vaginal discharge?

A

Bacterial vaginosis

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4
Q

What are the diagnosis requirements for bacterial vaginosis?

A

3 of 4

  1. Homogenous discharge
  2. Ph >4.5
  3. Positive whiff test
  4. Clue cells on wet prep
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5
Q

Pt. Presents w/ homogenous, profuse grey milky discharge and strong fishy odor especially after intercourse. What is the treatment?

A

Metronidazole

Metronidazole gel

Clindamycin cream

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6
Q

What is the treatment for chronic/recurrent w/ no prior long term treatment?

A

Vaginosis metrogel/ or metronidazole, oral tinidazole, or vaginal clindamycin for 2 weeks

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7
Q

What is the treatment for recurrent infection with hx of long-term treatment?

A

Vaginal metrogel, oral metronidazole, oral tinidazole, vaginal clindamycin for 2 weeks, then SUPPRESSION 1x weekly metrogel or 2x weekly oral metronidazole, or tinidazole 6 months

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8
Q

What are some consequences w/ BV?

A

Adverse pregnancy outcomes

PROM, preterm delivery, intra-amniotic infection, post-partum endometritis

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9
Q

Pt presents w/ vaginal burning/itching, irritatoion, post-voiding dysuria, odorless thick white cottage cheese discharge. DX?

A

Vuvovaginal candidiasis

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10
Q

What is the diagnosis of candidiasis?

A

Vulvovaginal erythema
Ph <4.5
Budding yeast/pseudohyphae on KOH

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11
Q

What is the treatment for isolated candidiasis infection?

A

Azole or nystatin intravaginal 3-7 days, or single oral dose of fluconazole

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12
Q

Risk factors for candidiasis?

A

Increased estrogen,
DM
Immunosuppressive
Abx

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13
Q

What is the treatment for acute recurrent infection of candidiasis?

A

Local intravaginal thearpy 7-14 days, oral fluconazole 1 pill q 72 hrs x 3 doses, 1,4,7

Suppressive
Oral fluconazole weekly for 6 months

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14
Q

What is considered chronic vaginal candidiasis?

A

> = 4 episodes per year

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15
Q

What is the treatment for recurrent vulvaginal candidiasis non-albicans species?

A

Oral fluconazole

Boric acid

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16
Q

Patient presents w/ frothy green-yellow discharge, odor is strong and musty, they have pain w/ intercourse and sometimes pain w/ peeing. Dx?

A

Trichomoniasis

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17
Q

What is the diagnosis for trichomoniasis?

A 
Frothy discharge, strawberry cervix, 
Ph >4.5 
Trichomonads on wet prep, NAAT is gold standard 
Strawberry cervix
Motile Protozoa w/ flagellum
18
Q

What is the gold standard for dx of trichomoniasis?

A

NAAT

19
Q

What is the treatment for trichomoniaisis?

A

Metronidzaole 500 mg 2 weeks

20
Q

What else do you need to look and see is present if the patient has trichomoniasis?

A

BV and if you don’t treat for it it might not heal

21
Q

What do yo need to do post treatment for trichomoniasis?

A

TOC if prolonged or recurrent infection at 1 month and 6 months

22
Q

Which herpes virus causes more frequent recurrences?

A

HSV-2

23
Q

Patient presents w/ prodrome of tingling, itching, burning, fever, HA , malaise and inguinal lymphadenopathy. DX__ advice for sexual contact

A

Herpes, do not have sex during prodrome

24
Q

Genital warts are caused by what types of HPV?

A

6, 11

25
Q

How is HPV transmitted?

A

Contact, inanimate objects, birth canal to larynx

26
Q

Treatment for genital warts?

A

Provider: trichloroacetic acid, bichloracetic acid

Patient: podofilox or imiquimod

27
Q

What is the dx for primary syphilis?

A

Screening: RPR or VDRL

Confirm: FTA-ABS

28
Q

Pt presents w/ bacteremia 6 wks to 6 mos post painless chancre. The patient has maculopapular rash on palms, soles, mucous membranes. Complaining of fever, malaise. On PE you note lymphadenopathy and condylomata Lata. DX

A

Secondary syphilis

29
Q

What is is considered early latent syphilis and late latent syphilis?

A

<1 yr or >1 year

30
Q

Pt. Present w/ fever, malaise and HA after treatment w/ penicillin for syphilis.

A

Jarisch-Herxheimer Reaction w/ 8 hours of PCN treatment.

31
Q

What is the treatment for syphilis <1 year?

A

Benzathine penicillin 2. 4 million units

32
Q

What is the treatment for syphilis >1 year?

A

Pen G 2..4 million units IM weely x 3

33
Q

What is the folllow up for syphilis and treatment if first fails?

A

Reevaluate at 6 mos intervals for serologic testing and clinical reevaluation. Weekly PCN injections for 3 weeks.

34
Q

Pt. Presents w/ painful erythematous papules that becomes a pustule then ulcerated w/in 24 hours. The edges of the ulcer are erythematous. Dx__ trx__

A

Chancroid (haemophilus ducreyi)

Azithromycin 1 gym orally or ceftriaxone

35
Q

What is the treatment for chlamydia, PCR testing?

A

Azithromycin or doxy

Treat other contacts and test for other STI’s. Abstinence for 7 days and rescreen in 3-4 months

36
Q

What is the treatment for gonorrhea?

A

Ceftriaxone + azithromycin

37
Q

Urethritis or cervicities are associated w/ what STIs?

A

Chlamydia and gonorrhea

38
Q

Diagnostic criteria for PID?

A

Cervical motion tenderness in sexually active you women

Lower abdominal pain

Temp >101

Mucopurulent discharge

Elevated ESR or CRP

Diagnosed w/ chlamydia or gonnorhea

39
Q

Patient presents w/ yellow vaginal discharge and lower abdominal/pelvic pain during/soon after mennstruation. DX__ trx__ concerns__

A

Cover for GC/chlamydia/anaerobes

Inpatient: cefoxitin IV or cefotetan IV plus Doxy IV

Outpatient: ceftrixaxone IM + doxy for 2 weeks +/- metronidazole 2 weeks if concomitant TRICH infection or recent instrumentation

Infertility,ectopic pregnancy, chronic pelvic pain

40
Q

When to admit for PID?

A

Pregnant, adolescents, drug addicts, WBC >15,000

41
Q

PT presents w/ tender inflammatory adnexal mass that results of complication of PID. DX __ treatment__

A

Turbo-ovarian abscess

Broad spectrum abx; surgical if no improvement in 24-48 hours

42
Q

Pt. Presents w/ hx. Of fever, malaise, and diarrhea. This progresssed to a non-painful, non-pruritic rash, and orthostatic hypotension. DX__ trx__

A

Toxic Shock syndrome

Fluids, abx while awaiting cultures, but ultimately none, just want to decrease the chance of recurrence

OB GYN (9 decks)

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