Women's Health Flashcards
Turner Syndrome Summary
Def: genetic abnormality in women
SS: amenorrhea delayed puberty webbed neck small stature poor breast development coarctation of aorta
Txt:
growth hormone
estrogen - during puberty
progestins - later to prevent endometrial hyperplasia
Fibroadenoma
Most common solid mass found in women of reproductive years (15-50)
SS:
firm, round, well circumscribed, mobile mass
eval: classic US appearance and/or needle bx
Tx:
does not require excision, although most women prefer it
Mastitis/Abscess
SS:
pain, swollen, erythematous breast
Tx:
Abx
Lichen sclerosus
Def: inflammatory condition of the valva
Cause: autoimmune
SS: vulvar pruitis vulvar pain dysuria dyspareunia white, wrinkled skin on labia
Eval:
punch biopsy
Txt: Topical steroids (2-3 mths and then weekly)
Lichen simplex chronicus
Def: lichenified skin reaction to chronic scratching
Cause: atopic dermatitis, cadidia, tinea
SS:
progressive pruritis
progressive burning
red papules form scaly plaques
Eval:
clinical
Txt:
underlying cause
antipruritis meds
topical steroids
Lichen planus
Def: inflammatory condition
Cause: autoimmune in older women
SS: chronic pruritis dyspareunia post-coital bleeding red/white, patchy, ulcerative lesions
Eval:
Clinical
Biopsy
Txt:
topical steroids
oral prednisones
Psoriasis
SS:
pruritic
scaly, silvery patch on erythematous base
Eval:
Biopsy
Txt:
Topical steroids
Vestibulitis summary
Def: localized vulvar pain without dermatitis
SS:
severe pain on touch vulva
dyspareunia
small, reddened patchy areas
Eval:
light touch over vestibule recreate pain
Txt: Topical lidocaine notripyline gabapentin abstinence
Bartholin gland cyst summary
Def: obstruction of bartholin glands
SS:
asymptomatic
pain and tenderness
firm swelling of posterior vaginal introitus
Eval:
clinical
Txt:
word catheter
Candidiasis Vaginosis
SS: white, thick discharge intense pruritis dysruria vulvar/labial erythema excoiation often without odor
Eval:
Normal pH
hyphae/spores on KOH, wet prep or culture
Tx:
Oral fluconazole 150mg PO for 1 dose
vaginal hygiene
Bacterial vaginosis
SS:
nonirritating discharge
thin, gray, white/yellow discharge
foul vaginal odor
Eval: Amsel criteria - abnormal discharge - abnormal pH >4.5 - positive whiff test with KOH - clue cells
Tx:
metronidazole 500mg PO bid for 7 days
Trichomoniasis vaginosis
SS: persistent, profuse, frothy discharge vulvar pruritis/foul odor dysuria small petechiae (strawberry spots)
Eval:
motile flagellate
KOH whiff
pH >4.5
Tx:
systemic metronidazole 2 gm PO x 1 or 500 mg PO bid for 7 days, must tx partner
Human papillomavirus
SS: numerous, discrete fleshy lumps smooth velvety surface symmetric coalesce into cauliflower like regions mass, pruritis, burning, bleeding
Dgx: visual inspection (may require acetic acid wash to visualize affected skin)
Tx:
Surgical
chemical destruction
Herpes simplex virus
SS:
small, painful, grouped vesicles develop at site of contact
flu-like symptoms
Dgx:
clinical presentation
tzanck smear
Tx:
acyclovir 200mg PO 5 times/day x 7-10 days
Chlamydia
SS: often asx mucopurulent discharge with cercitis dysuria postcoital bleeding pelvic pain fever
Dgx:
DNA assay
cervical culture
Tx:
azithromycin 1 gm x 1
doxycycline 100mg bid x 7 days
Gonorrhea
SS: can be asx copious mucopurulent discharge dysuria pelvic pain fever
Dgx:
culture
Tx:
ceftriaxone 250 mg IM x 1
azithromycin 1 gm x 1 for chlamydia
Syphilis
SS:
painless, hard, indurated ulcer forms at site of inoculation (chancre)
Dgx: spirochete seen on dark microscopy
Tx:
PenG 2.4 million units IM x 1
PID
SS: often asx low bilateral abdominal pain vaginal discharge dysuria dyspareunia N/V/F/C
Dgx:
clinical
imaging
Txt:
ceftriaxone 250mg IM x 1 plus doxy 100mg PO bid continue for 14 days
Threatened Abortion
S/s: vaginal bleeding painless or mild suprapubic pain closed cervical os products of conception not visualized uterine size appropriate for gestational age
Eval:
Serum HcG
Tx:
Supportive management
Ectopic pregnancy
S/s: abd pain abnormal uterine bleeding pregnancy sx dizziness amenorrhea abd tenderness
Eval:
UPT
hcG
transvaginal US
Tx:
methotrexate
surgery is preferred
Uterine prolapse
sagging of the uterus
S/s: pressure feeling of something bulging urinary incontinence retention cramping low back pain
Tx:
nothing
pessary
hysterectomy
Menopausal transition summary
Def: time frame due to when menstrual cycle length changes to end of LMP
SS:
Stages:
-2 = variable cycle length diff from normal
-1 = > 2 skipped cycles and amenorrhea > 60 days
FSH increases
Intermenstrual interval increases to 40 - 50 days
Eval:
diary
Txt:
symptomatic
Postmenopause summary
Def: 12 months after LMP
Stage:1 - First 5 years after the final menstrual period
* accelerated bone loss
2 - begin 5 years after final period to death
* vaginal symptoms
Txt:
Estrogen/Progesterone
SERMs
Osteoporosis summary
Def: decrease in bone mass with increased risk for fracture
SS: asymptomatic fragility fracture dowager's hump height loss
Eval: CBC Vit D Serum Xray followed by CT FRAX DEXA T > -2.5
Txt: Nonpharm - Diet - smoking - alcohol - weight bearing exercise - fall prevention Pharm - Vit D - Calcium (calcium carbonate 500 mg bid) - SERMS - Bisphosphonates (alendronate 35 mg/wk) - Calcitonin - Teriparatide - Denosumab
