Vaginal Bleeding + Vaginitis Flashcards

1
Q

Non-Ob DDx of vaginal bleed

A

Trauma
Cervical polyp or cancer
Vaginitis
Hemorrhagic cyst
Perineal lesion
Vulvar varicosities

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2
Q

Ob DDx of vag bleed

A

Physiologic
Abnormal pregnancy (ectopic, molar)
Abortion

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3
Q

Types of spontaneous abortion

A

Spontaneous: pregnancy loss >20w
Inevitable (cervix dilated, no products expelled)
Incomplete (some expelled, retained products)
Complete (products expelled)
Missed (fetal demise but no uterine activity)
Recurrent (>3)
Septic (complicated by uterine infection)

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4
Q

RF for spontaneous abortion

A

advanced age, thrombophilia, autoimmune disease (antiphospholipid antibody syndrome), infection (BV, HSV, GC, CT, HIV, CMV), IUD

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5
Q

Ix for ?abortion

A

Ix: bHCG (66% rise in 48hrs = viable), group and screen, US

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6
Q

Management of spontaneous abortion

A

Expectant
Medical: misoprostol 800mcg vaginally then repeated 24hrs later if no bleeding
RhoGAM if Rh negative (<12w = 120mcg, >12w 300mcg)
Surgical: vacuum aspiration

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7
Q

Counselling with miscarriage

A

Acknowledge + dispel guilt
Acknowledge + legitimise grief
Assess grief
Counsel how to tell others
Include partner
Provide comfort + support
Reassure about future
Warn about anniversary phenomenon

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8
Q

Pre-abortion counselling

A

Pregnancy options: abortion, term pregnancy, adoption
Abortion methods
Risks: bleeding, cramping, GI sx, HA, may need SA
Supports, confirm decision is voluntary
Emotional needs
Contraception

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9
Q

Process for medical abortion

A

If >49d pregnant, Rh neg = give RhoGAM 24hr prior to MA
Mifepristone 200mg PO then 24hrs later misoprostol 800mcg
FU day 14

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10
Q

What is the Apt test?

A

positive = fetal blood, negative = maternal blood

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11
Q

Sx lichen sclerosus

A

Sx:
Pruritis
Dyspareunia
Dysuiria
PV bleeding
White, polygonal papules that turn to plaques, shiny porcelain appearance, can obliterate labia minora

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12
Q

Dx + rx of lichen sclerosus

A

Dx: biopsy
Management:
Asymptomatic = nothing
Symptomatic = topical steroids (clobetasol)

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13
Q

What demographic is most at risk + what types of cancer cause vulvar cancer?

A

Women >65
Squamous + melanoma

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14
Q

Sx, dx + rx of vulvar cancer

A

Long term pruritus, lumps or masses
Dx: biopsy
Management: surgery, RT

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15
Q

Sx + rx of thrush (acute + recurrent)

A

Vulvovaginal: asymptomatic, itchy, dysuria, dyspareunia, white DC
Acute: clotrimazole 500mg PV x 1 dose + fluconazole 150mg PO
Recurrent: fluconazole 150mg PO Q3D x 3 doses then q1week for 6 months

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16
Q

Management of vaginal atrophy

A

Quit smoking
Regular sex
Moisturiser + lubricants
Systemic estrogen or local
Premarin 0.625mg QHS x2w then q3d x6mo
Estring in upper vagina x3mo
Vagifem 1 tab PV q3d

17
Q

Causes of abnormal uterine bleeding

A

endometrial polyp, endometriosis, endometrial hyperplasia, uterine sarcoma, endometrial cancer, bleeding disorder

18
Q

What tests to do in abnormal uterine bleeding?

A

Endometrial biopsy, pap, colposcopy

19
Q

RF of HRT

A

VTE, stroke, breast cancer after 5 yrs, CAD, endometrial cancer

20
Q

Recurrent culture negative UTI?

A

Interstitial cystitis

21
Q

Non hormonal pain relief for endometriosis

A

NSAIDs, aromatase inhibitors, GnRH antagonists

22
Q

CI to GnRH antagonists

A

postmenopausal, under 18