Week 3 pt 2 highlights: 4/16 lecture Flashcards
The rhythm method:
1) ____% effective with perfect use
2) ____% effective with average use
3) Should you follow in lactational amenorrhea? How long is this?
1) 91%
2) 76%
3) Yes; (~3mos (+/- a few mos) if exclusive breastfeeding)
What is the most common form of sterilization in women?
Tubal ligation (BTL)
What method of sterilization for women can cause decreased ovarian cancer risk?
Salpingectomy (removal of tubes)
1) Define vasectomy
2) Is it safer than female procedures? Is it reversible?
3) Is it immediate?
1) Excision and ligation, electrocautery-occlusion of the vas deferens
2) Safer, less-invasive, more effective than procedures done in women
More easily reversed compared to women, however, reversal is still uncertain for outcome
3) Not immediate sterilization
When counseling patients about sterilization:
1) 3% - 25% of women _________their decision to undergo permanent sterilization
2) True or false: Reversals are not guaranteed for either gender
1) regret
2) True
Candidiasis:
1) What are the main Sx?
2) Besides clinical Dx, how can it be diagnosed?
3) What is the etiology?
4) What is typically the first round of Tx?
1) White, thick dc, “cottage cheese” + vulvar pruritis
2) KOH wet prep: Hyphae/budding yeast
3) Candida albicans
4) Diflucan (fluconazole) 150mg po x 1 (safe in preg)
Atrophic Vaginitis/Atrophy:
1) What is a main Sx?
2) Main etiology?
3) When does it usually occur?
1) Dryness
2) Lack of estrogen (hypoestrogenic)
3) Postmenopausal
What atrophic vaginitis med has a black box warning for endometrial cancer or DVT?
(important to know)
Osphena PO
(bc of the estrogen in it)
Loss of labia minora/majora is a Sx of what?
Vaginal atrophy
Allergic Vaginitis:
1) Sx?
2) Tx?
1) Erythema, pruritis, irritation
2) topical steroid, oral steroid/antihistamine
True or false: Anyone can develop an allergy to anything (& sometimes at any point in time)
True
Lichen Simplex Chronicus:
1) Sx?
2) Tx?
1) Persistent itching/scratching of vulvar area
-“an itch that rashes”
-Leads to leathery, thickened appearance
2) Antipruritic meds
-Topical steroids
-Vulvar bx (biopsy
What is also known as “an itch that rashes”?
Lichen Simplex Chronicus
Lichen Sclerosis:
1) Main Sx?
2) Who is it common in?
3) Tx?
1) Tissue paper skin
2) Postmenopausal
3) Topical steroid
Lichen Sclerosis causes an increased risk of what?
Increased risk for SCC (squamous cell carcinoma) of vulva
Lichen Planus:
1) What are the main Sx?
2) Tx?
1) Vulvar-vaginal-gingival syndrome
Purplish Planar Polygonal Pruritic Papules and Plaques
2) Topical steroid
*chronic condition with no cure
1) Treatment for all the Lichens is what?
2) What may you need to perform multiple times?
1) Potent (Category 1) Topical Steroids: Clobetasol 0.05%
2) Multiple biopsies to rule-out SCC
Bacterial Vaginosis (BV):
1) Sx?
2) Is it an STD?
3) Dx?
1) Discharge white or gray, thin, fishy/musty odor
2) Not an STD
3) Amsel Criteria (3 of 4
What is the common vaginal infection in women of childbearing age?
Bacterial Vaginosis (BV)
Bacterial Vaginosis (BV):
1) Etiology?
2) Tx?
1) Gardnerella bacteria
2) Metronidazole (Flagyl) + Topical Clindamycin
Bartholin’s Gland cyst:
1) Who is it most common in?
2) Most common Tx for first time occurrence?
3) What if it occurs >2x?
1) 20-30yo
2) I&D + Word catheter
3) Marsupialization
Vulvar Cancer:
1) What are some main Sx?
2) What is the most common Sx?
3) Nearly ____% of women with vulvar cancer have no symptoms.
1) Ulcerative lesion, thickening, or lump
2) Itching (most common complaint)
3) 20%
Vulvar Cancer:
1) What area does it most often affect?
2) What is the origin of most vulvar cancers?
3) How common is it? What is it assoc. with?
1) Labia
2) Squamous origin (SCC)
3) Relatively rare
-Has been increasing along with increased HPV
Vulvar Cancer:
1) When does it usually occur?
2) What are 3 risk factors?
1) After menopause (70-80yo most common)
2) Previous HPV infection, smoking, + vulvar intraepithelial neoplasia (VIN; rarely metastasizes)
Vulvar CA: Describe the steps of Dx
1) Pelvic exam
2) Excision and biopsy: punch biopsy
3) Colposcopy
Vulvar CA:
1) What is the cure rate?
2) Is incidence increasing or decreasing?
1) 80%
2) Increasing incidence (possibly due to increasing STD/HPV rate)
Vulvar CA: If irritated, pigmented vulvar lesions, must perform _________________ for definitive treatment
excisional biopsy
List the types of vulvar CA. Which often presents as a pigmented lesion?
1) Squamous carcinoma (90%)
2) Vulvar melanoma (6%; often pigmented)
3) Sarcomas
4) Adenocarcinoma
5) Carcinoma of the Bartholin Gland
Carcinoma of the Bartholin Gland is uncommon, but every new solid Bartholin mass in a women >_________ should be excised
> 40yo
High-grade squamous intraepithelial lesion of the vulva (HSIL):
1) What is it?
2) What is a common social Hx finding?
3) What is the main complaint?
4) What should you use before selective biopsy?
5) What is the goal of Tx?
1) High-grade, HPV-related lesions
2) Smoking
3) Vulvar pruritis
4) Colposcope
5) Quickly and completely remove all involved areas of skin via wide local excision or laser ablation
Give an example of a HSIL
Paget disease
Paget disease (an HSIL):
1) What is the gross appearance?
2) What CA may it be assoc with?
3) ______-______%have other associated but noncontiguous cancers such as of the colon or breast
91
1) Fiery, red background mottled with whitish hyperkeratotic areas
2) Adenocarcinoma
3) 20-30%
Low-grade squamous intraepithelial lesion of the vulva (LSIL):
1) What are 3 etiologies?
2) What does it occur most often in?
3) Dx?
4) Tx?
1) Non-neoplastic, reactive atypia OR due to HPV infection
2) Condylomata acuminata (genital warts)
3) Biopsy
4) Same as condyloma
List the stages of vulvar CA
1) Stage 0
2) Stage 1: 1a + 1b
3) Stage 2
4) Stage 3: 3a, 3b, 3c
5) Stage 4: 4a, 4b
Vulvar Cancer:
1) Treatment?
2) What abt for melanoma specifically?
3) 5-year survival rate for all vulvar carcinomas is what?
1) Surgery or Radiation +/- chemotherapy
2) Early local excision
3) ~70%
Vaginal Cancer:
1) Rare but usually secondary to what?
2) What is the main type?
3) Tx?
1) Cervical or vulvar cancers
2) Squamous cell carcinoma
3) Surgery, radiation, and neoadjuvant chemotherapy options
Vaginal Intraepithelial Neoplasia (VAIN): What are the 3 steps? Which is concerning?
1) VAIN 1
2) VAIN 2
3) VAIN 3: concerning for progression to invasive vaginal carcinoma
Vaginal Intraepithelial Neoplasia (VAIN): How do you definitively Dx?
colposcopy with directed biopsy
What is a key word to assoc. with trichomoniasis?
Frothy
Trichomoniasis:
1) Etiology?
2) Main symptoms?
3) Dx methods? Which is the main one?
4) Main Tx?
1) Parasite
2) Frothy, yellow-green vaginal discharge.
-fishy; Strawberry cervix; many asx
3) NAAT; flagellated protozoans; culture
4) Metronidazole
Hep B & Pregnancy:
1) When do you screen for? Is testing routine?
2) __________ transmission of hepatitis is related to the presence of maternal hepatitis B e antigen (HBeAg)
1) First prenatal visit; Hepatitis B surface antigen (HBsAg).
2) Vertical.
Hep B & Pregnancy:
1) What if a pt is neg w risk factors for Hep B?
2) What if a pt is positive?
1) Should be offered vaccine in pregnancy
2) Infant should receive vaccine and HBIg within 12hrs of birth
Hepatitis B and C:
1) Sx?
2) Etiology?
3) Main Tx?
4) Main points of prevention?
1) Fatigue, jaundice, elevated LFTs, N/V, abdominal pain
2) Blood-borne/sexual contact
3) Antivirals
4) Vaccine for hep B; No preventative measures known to reduce risk of mother-to- child transmission of HCV
1) Is there a way to prevent HBV in newborns?
2) How many doses and when?
3) Is breastfeeding contraindicated in women who are chronic carriers?
1) Vaccine available to prevent HBV
2) 3 doses: first within 24hrs of birth (then +1mo, +6mo)
3) No, as long as their infants have received both the vaccination and HBIg within 12 hours of delivery.
Pubic Lice: Pediculosis Pubis: What is the Tx?
Permethrin 1% OTC topical, rinse off p 10 min
*All linens, towels, etc. must be sanitized in hot water and dried in a hot dryer
HPV:
1) Strains _______ and ________ cause 70% of cervical cancer cases
2) Strains ______ and _____ cause 90% of genital warts (condyloma acuminata) cases
3) Occurs in ______% sexually active women by 50yo
1) 16 and 18
2) 6 and 11
3) 80%
HPV: Condyloma Acuminata:
1) Main Sx?
2) Etiology?
3) Prevention?
1) Flesh- colored growths
2) HPV (strains 6 and 11 primarily)
3) HPV Vaccine (Gardisil):
HSV: Herpes Simplex Virus
1) Main ymptoms?
2) How is clinical Dx confirmed?
3) Etiology?
1) Vesicular rash, blisters with clear fluid, and ulcerated sores around genitals/anus (tender)
2) Viral culture and PCR or Tzanck smear
3) HSV-1 or HSV-2 viruses (majority HSV-2) *no cure
(HSV) Herpes Simplex Virus: Tx of first clinical episode?
1) Acyclovir 400mg po 5x/day (or 800mg TID) x 7-10d
2) Valacyclovir 100mg po BID x 7-10 days
dosing changes for recurrences
3) C-section recommended if HSV lesions on cervix, vagina, or on vulva
Three primary methods of contracting HIV are what?
1) Intimate sexual contact
2) Use of contaminated needles or blood products
3) Perinatal transmission from the mother to child
List 3 ways to reduce HIV transmission
1) Routine screening: first trimester of pregnancy
2) Aggressive therapy at time of delivery (also meds safe to take in pregnancy)
3) Latex condom use/safe sex practices
In ___________ HIV patients, the time between infection with HIV and the development of AIDS ranges from a few months to as long as 17 years (median: _____ years)
untreated; 10
What is a main characteristic of AIDS?
Opportunistic infections
Gonorrhea:
1) Etiology?
2) Main Sx?
3) Tx?
1) Neisseria gonorrhoeae
2) Most asymptomatic
3) Ceftriaxone 500mg IM x 1 (* treat for Chlamydia also*)
-Must treat asap in pregnant woman
Gonorrhea:
1) What may you see on PE?
2) What is a main part of Dx?
1) Cervical motion tenderness /Chandelier sign
2) NAAT (PCR)
Complications of Gonorrhea:
1) High risk for _____.
2) GC is responsible for 75% of young sexually active adult cases of what? How do you Tx this?
1) PID
2) Septic arthritis
- 2 weeks of IV antibiotics (IV ceftriaxone), washout
Fitz-Hugh-Curtis Syndrome (perihepatitis) can occur due to which STI?
Gonorrhea
Most frequently reported bacterial STI in the US is what?
Chlamydia
Chlamydia:
1) Etiology?
2) PE finding?
3) Main way to Dx?
1) Chlamydia trachomatis
2) Cervical motion tenderness (chandelier sign)
3) NAAT vagina (preferred method)
Chlamydia:
1) Main Tx?
2) What abt in infants?
1) Doxycycline100 mg po bid x 7d (*if pregnant, Azithromycin 1g PO x 1) AND treat for gonorrhea
2) Antibiotic ointment to protect eyes from G/C (and E-coli)
Chlamydia complications:
1) Complications in neonates?
2) Other complications?
1) Neonatal conjunctivitis and pneumonia
2) PID; Reiter’s syndrome; cervicitis, endometritis, urethritis, epididymitis
Reiter Syndrome is a complication of what?
Chlamydia
Chlamydia Complications: Reiter Syndrome:
1) What is the triad?
2) When does it generally occur?
3) What do pts present with?
1) Urethritis, conjunctivitis and arthritis (can’t see, can’t pee, can’t climb a tree)
2) 2-6 wks after a GI or GU infection
3) Malaise, fatigue, and fever, low back pain & heel pain
Syphilis:
1) Etiology?
2) How is it diagnosed? What confirms the Dx?
3) What should you do for suspected neurosyphilis (tertiary)?
4) Tx?
1) SpirocheteTreponema pallidum
2) RPR/VDRL, confirmed with treponemal tests
3) LP
4) Benzathine PCN G 2.4M units IM x 1 (if neurosyphilis: high dose for 14d)
*Reportable disease
List the stages of syphilis and give the main points of each
1) Primary infection: painless chancre.
2) Secondary infection: rash incl. palms and soles of feet.
(Latent Stage: no s/sx; + serologic testing)
3) Tertiary infection: damage to CNS
List 4 important points regarding pts who should be hospitalized for PID
1) Pregnant
2) Does not respond clinically to oral antimicrobial therapy
3) Unable to follow or tolerate an outpatient oral regimen
4) Tubo-ovarian abscess
What is the most common gynecologic reason for ER visits in the U.S.?
Acute Salpingitis & PID
1) The most common serious infection of women aged 16-25 years is what?
2) What are the 2 most common cause of that cause?
1) Acute Salpingitis & PID
2) Chlamydia, Gonorrhea
Most cases of acute salpingitis occur in 2 stages; list them
1) Acquisition of a vaginal or cervical infection
2) Ascent of the infection to the upper genital tract
What is salpingitis?
PID in the fallopian (uterine) tubes
PID:
1) Many women with PID have __________ or ___________ symptoms.
2) Dx (diagnosis) of PID is usually _________.
3) Delay in diagnosis may lead to what?
1) subtle or mild
2) clinical
3) Infertility and increased risk of ectopic pregnancy
Women diagnosed with PID should also undergo testing for what 3 things?
Chlamydial, HIV, and gonorrheal infections
__________ treatment of PID should be initiated in sexually active young women with:
a) pelvic or lower abdominal pain
b) if no cause for the illness other than PID can be identified
c) and if >1 of the following minimum criteria are present on pelvic examination:
1. CMT
2. uterine tenderness
3. adnexal tenderness
Empiric
____% of patients have long term consequences of PID
25%
True or false: N. gonorrhea or C. trachomatis are a criteria for PID Dx
True
CDC Tx Recommendations PID include what 3 meds (simultaneously)?
1) Ceftriaxone
2) Doxycycline
3) Metronidazole
