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OBGYN rotation review > vaginal discharge > Flashcards

vaginal discharge Flashcards

1
Q

fever

N/V

bleeding

dyspareunia

purulent endocervical discharge

cervical motion/ uterine/ adnexal tenderness

low abdominal pain after menses

A

PID

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2
Q

gonorrhea treatment

A

azithromycin 1 gm PO x 1

plus

ceftriaxone 250 mg IM

plus

no sex for 7 days after meds are finished

test for other STIs

repeat testing in 3 months

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3
Q

dysuria

urinary frequency

A

urethritis

seen in chlamydia and gonorrhea

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4
Q

what will make candidiasis “complicated”

A

severe or recurrent sxs

non-albicans species

pregnancy

poorly controlled diabetes

immunocompromised

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5
Q

clue cells

A

bacterial vaginosis

seen with saline microscopy

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6
Q

which vaginitis?

risk factors:

sex/ STIs/ not using condoms

black/ Mexican

smoking

douching

A

bacterial vaginosis

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7
Q

complications of gonorrhea

A

disseminated gonococcal infection (DGI)

chorioamnionitis

PID, ectopic preg, infertility, preterm, transmittable to neonate

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8
Q

which HSV is genital

A

2

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9
Q

how do you diagnose bacterial vaginosis

A

Amsel’s Criteria

presence of at least 3/4:

  1. thin, white, homogenous discharge
  2. clue cells on saline mount
  3. vaginal pH > 4.5
  4. positive whiff test
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10
Q

how do you diagnose trichomoniasis

A

Nucleic Acid Amplification Test (NAAT) is gold standard

vaginal/ endocervical/ urine specimens

also you will see motile trichomonads on saline microscopy

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11
Q

if you see cervicitis and urethritis, what do you do next?

A

Nucleic Acid Amplification Test

of vaginal swab/ endocervical swab/ urine

maybe also do a culture if you suspect gonorrhea (abx resistance)

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12
Q

+/- asxs

malodorous, frothy yellow-green discharge

postcoital bleeding

punctuate hemorrhages on vagina/ cervix

A

trichomoniasis

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13
Q

motile protozoa

A

trichomoniasis

seen with saline microscopy

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14
Q

strawberry cervix

A

punctuate hemorrhages on vagina/cervix

seen in trichomoniasis

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15
Q

pruritis

external dysuria

white, thick, curd-like discharge that adheres to vag walls

A

vulvovaginal candidiasis

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16
Q

x 2-4 weeks:

painful genital ulcers

tender inguinal LAD

HA

dysuria

fever

+/- asxs

A

primary infection of HSV

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17
Q

HPV diagnosis

A

visualization

maybe biopsy

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18
Q

HSV diagnosis

A

best= PCR

next best= viral cx

not recommended= serology

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19
Q

how do you determine whether to hospitalize someone w/ PID

A

if they are:

pregnant

high fever

N/V

severe pain

pelvic abscesses

can’t tolerate or be relied on to take meds

20
Q

HSV incubation

A

2-12 days post transmission

(avg 4)

transmitted via mucosal surfaces, genital/oral secretions

21
Q

complications of PID

A

infertility

ectopic pregnancy

peri-hepatitis (Fitz Curtis Syndrome)

22
Q

cervicitis + urethritis =

A

chlamydia OR gonorrhea

23
Q

who are you screening for chlamydia and gonorrhea

A

women under 25

women over 25 w/ bad sex habits/ prior STIs/ prostitutes

24
Q

which vaginitis?

risk factors:

DM

abx use

estrogen

immunocompromised

A

vulvovaginal candidiasis

25
Q

how do you treat bacterial vaginosis

A

only if symptomatic!!

options:

  • metro 500 mg PO BID x 7 days
  • metro gel intravag daily x 5 days
  • clindamycin intravag Q HS x 7 days
  • secnidazole 2 gm PO x 1
26
Q

prodome (ex tingling) followed by mild ulcers, inguinal LAD, HA, dysuria, fever

A

recurrent infections of HSV

27
Q

+/- asxs

fishy smell

thin, white/gray dishcarge

A

bacterial vaginosis

28
Q

how do you treat uncomplicated candidiasis

A

clotrimazole topical x 1-3 days

or

150 mg fluconazole PO

29
Q

complications of chlamydia

A

PROM

PID, ectopic preg, infertility, preterm, transmittable to neonate

30
Q

which vaginitis?

risk factors:

HIV/ other STIs

risky sex behavior

prisons

A

trichomoniasis

31
Q

chlamydia treatment

A

azithromycin 1 gm PO x 1

or

doxycycline 100 mg PO BID x 7 days

*** do not give doxy to a preggo ***

plus

no sex for 7 days after meds are finished

test for other STIs

repeat testing in 3 months

32
Q

how do you treat trichomoniasis

A

treat symptomatic + asymptomatic + sexual partners (EPT)

metronidazole 2 gm x 1

repeat testing in 3 months

33
Q

which vaginitis(s) are STI’s?

which are not?

A
  • are STI’s
    • trichomoniasis
  • NOT STI’s
    • vulvovaginal candidiasis
    • bacterial vaginosis
34
Q

how do you diagnose candidiasis

A

wetmount KOH

see budding yeast/ hyphae/ pseudohyphae

35
Q

perihepatitis

A

PID complication

36
Q

what might you see on a NAAT for suspected PID

A
  • most common
    • c. trachomatis
    • n. gonorrhea
  • emerging
    • mycoplasma genitalium
37
Q

RUQ pain and adhesions

A

Fitz Hugh Curtis Syndrome

aka

peri-hepatitis

(complication of PID)

38
Q

HSV tx

A

val/fam/acyclovir:

  • 1st episode = 7-10 days
  • recurrent episodes = 1-5 days
  • suppression = daily BID
39
Q

HPV tx

A
  • cyclodestructive
    • podofilox
    • trichloracetic acid
    • bichloracetic acid
  • immune mediated
    • imiquimod
    • sinecatechins
  • surgery
    • cryo
    • laser
    • electrocautery
    • excision
40
Q

chandelier sign

A

cervical motion tenderness

seen in PID

41
Q

budding yeast

hyphae

pseudohyphae

A

vulvovaginal candidiasis

seen on wet mount KOH

42
Q

PID tx

A

ceftriaxone 250 mg IM x 1

+

doxy 100 mg BID x 14 days

+/-

metro 500 mg PO BID x 14 day

+

F/U in 48-72 hours

43
Q

which vaginitis(s) have an elevated pH?

which have a normal pH?

A

pH > 4.5

  • bacterial vaginosis
  • trichomoniasis

normal pH (4 - 4.5)

  • vulvovaginal candidiasis
44
Q

treatment of complicated candidiasis

A

clotrimazole topical x 1-2 weeks

or

150 mg fluconazole PO q 72 hours x 2-3 doses

45
Q

PID dx

A

(difficult)

based on sxs and history of gonorrhea/ chlamydia

46
Q

change in vaginal discharge

intramenstrual/ post-coital bleeding

friable/ edematous/ erythematous cervix

endocervical discharge

A

cervicitis

seen in chlamydia and gonorrhea

47
Q

amsels criteria

A

diagnostic determination of

bacterial vaginosis

presence of at least 3/4:

  1. thin, white, homogenous discharge
  2. clue cells on saline mount
  3. vaginal pH > 4.5
  4. positive whiff test

OBGYN rotation review (14 decks)

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