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.
What does DES exposure increase the risk of?
clear cell adenocarcinoma of vagina and cervix in daughters
Breast cancer in mom who took it
What is semen analysis?
- Volume >1.5mL
- Count > 15 million
Motility >40%
Morphology >4% - semen should have fructose (acidic pH or lack of fructose means obstruction of ductal system)
What is treatment of listeria?
IV ampicillin + gent
OR
batrim
if allergic, then vans
