Walls Gynecology Flashcards
What is Lymphogranulom venereum ?
from chlamydia trachomatis
- incubation: 1-4 wks
single painless flat pastule/vesicle
tender suppurative lymph nodes
- “groove sign”=clinical sign, double genitocrural fold
ddx: culture, PCR
Tx: Doxycycline x 21d
What is chancroid?
2/2 haemophilus ducreyi (more common in males)
-incubation 2-6 days
PAINFUL papule/pustule (1-5 of them)
- red undetermined margins, yellow/gray base
- purulent, hemorrhagic secretions
ddx: culture/gram stain (“school of fish pattern”, PCR
- Tx: Erythromycin x 7d
What is syphilis?
2/2 Treponema pallidum
- incubation 10-60 days
- papule (1-2 of them)
- raised margins, red smooth base
- serous secretions
- ddx: dark field, immuno-floresence PCR
What is granuloma inguinale?
2/2 Calymmato-bacterium granulomatis
- seen in tropics, aka DONOVANOSIS
- incubation 8-12 wks
- painless papule
- ROLLED, ELEVATED MARINS w/ red rough base
- lymph nodes: pseudoadenopathy
- lasts weeks
- ddx: Giemsa staining W/ DONOVAN BODIES
- tx: azithro
What are medication related hot flushes?
- Lupron
- Tricyclic antidepressants
- Monoamine oxidase inhibitors (depression, isocarboxazid, phenelzine, selegiline, and tranylcypromine)
- Calcium channel blockers
- SSRI
What is Baden Walker evaluation of prolapse?
Grade 0 - no defect
Grade 1 - halfway to hymen
Grade 2 - To hymen
Grade 3 - Halfway past hymen
Grade 4 - Max descent noted
What are depo lupin facts?
Pregnancy category X=contraindicated
- amenorrhea in 90% women after 2 doses
- need contraception for 2 months
- anaphylaxis (tx=epi 1:1000 0.5mL)
uterus shrinks more than fibroids
- 5% will have bone loss within 6 months of tx
- flare response=3 weeks after 1st dose administered
What is pediculosis pubis?
Crab louse ewww 2/2 Pthirus Pubis
- MOST CONTAGIOUS STD
- CONSTANT ITCHING
Tx: Permethrin (Nix), Lindane - not for pregnant/lactating/kids under 2
What is scabies (itch mite)?
2/2 Sacoptes Scabei
- severe INTERMITTENT itching
Tx: Permethrin (Nix), Lindane - not for pregnant/lactating/kids under 2
What is molluscum contagiosum (pox virus)
mildly contagious, “water wart”
- mature nodules have umbilicate center
- intracytoplasmic molluscum bodies with Wright’s or Giemsa stain confirm diagnosis!
- complication=bacterial superinfection
- Tx: local anesthesia + evacuate material and excuse nodule. use electrocautery.
What is condyloma acuminatum?
HPV! Most common viral STD
What is genital herpes?
resides in latent phase in dorsal root ganglia of S2-4.
- Type 1: 55% recurrence rate in 1 yr
- Type 2: 80% recurrence rate in 1 yr
- ddx: viral cultures and PCR (most accurate)
- ddx recurrent herpes: Western blot
What is screening for syphilis?
non-specific, nontreponemal: VDRL, RPR
- Specific, antitreponemal Ab tests: FTA-ABS, MHA-TP
- If positive treponema test, stays positive for life.
What are stages of syphilis?
- Primary: hard, painless chancre, heals in 3-6 wks
- Secondary: SYSTEMIC dz: rash on palms/soles, vulvar condyloma w/ painless LAD
- latent: 20 years
- Tertiary: 33% of untreated patients. Sx=optic atrophy, tabes dorsaleis, gammas of skin
What is syphilis treatment?
- Primary, secondary and 1st year latent: benzathine PCN G 2.4million units IM. If allergic, tetracycline
- Pregnancy: PCN G 2.4M units IM
- Late latent or Tertiary: 7.2M units
- Neurosyphilis: Aqueous crystalline PCN G
- If positive for syphilis, check for HIV! If HIV pos, desensitize and then PCN G.
