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Family Medicine > Women's Health > Flashcards

Women's Health Flashcards

1
Q

lots of thin, yellow green “frothy” discharge at introitus and os
foul-smelling
“strawberry” cervix and/or vaginal/perineum redness
vaginal soreness or dyspareunia
symptoms may be start or worsen during menses

A

trichomonas vaginalis: protozoan STD

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2
Q

wet mount:
motile, flagellated
WBCs

A

trichomonas vaginalis

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3
Q

treatment for trichomonas vaginalis

A

treat woman AND partner:
metronidazole PO single dose
SCREEN for other STDs

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4
Q

recent Abx use/infxn and vaginal discharge

A

candida vaginitis:
alter vaginal flora
allows overgrowth of fungal organisms

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5
Q

woman with DM and vaginal discharge

A

candida vaginitis

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6
Q 
thick, white vaginal discharge
no odor
pruritus of vagina and vulva
edema + erythema of vagina/vulva
75% women have at least 1 episode in lifetime
A

candida vaginitis and/or vulvar

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7
Q 
need 3/4 criteria:
thin vaginal discharge
vaginal pH >4.5
\+ KOH "whiff" test: "fishy" odor (alkaline)
wet mount: clue cells
A

bacterial vaginosis: excessive anaerobic bacteria + gardnerlla vaginalis replace normal vaginal bacteria
NOT an STD, but multiple sex partners is a risk factor

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8
Q

all vaginal discharge is examined via: microscope

A 
wet mount (mix with normal saline): epithelial cells, WBC, RBC, clue cells, motile trichomonads
KOH prep (mix with 10% KOH): hyphae or psuedohyphae of candida
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9
Q

cause of vulvovaginal candidiasis

A

C. albicans

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10
Q

vaginal pH: 4-5

A

candida vaginitis

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11
Q

wet mount or KOH prep: budding yeast, pseudohyphae

A

candida vaginitis: confirms diagnosis

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12
Q

treatment of candida vaginitis

A

vaginal suppository or
fluconazole PO single dose
if recurrent: 10-14 days fluconazole, 6 mo maintenance
treat male if has balanitis

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13
Q

risk factors for trichomonas vaginalis

A

multiple sex partners
pregnancy
menopause

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14
Q

treatment of bacterial vaginosis

A

topical or PO metronidazole or clindamycin

DON’T treat partner

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15
Q

why treat asymptomatic pregnant women with BV

A

reduce incidence of preterm delivery

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16
Q

purulent/mucopurulent discharge from endocervix

+/- vaginal discharge, cervical bleeding

A

chlamydia trachomatis or N. gonorrhoeae

50% gonococcal + 70% chlamydial are asymptomatic

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17
Q

diagnosis of chlamydia or gonorrhea

A

culture of cervical discharge

18
Q

treatment of chlamydia or gonorrhea

A

gonorrhea: ceftriaxone IM single dose
chlamydia: doxycycline 100 mg PO BID for 7 days or azithromycin 1 g PO single dose
EMPIRIC tx if high prevalence of infection or follow-up unlikely
treat sexual partner

19
Q 
cause of:
pelvic peritonitis
endometritis
salpingitis
tuboovarian abscess
A

PID due to chlamydia, gonorrhea, vaginal or bowel flora

20
Q

lower abdominal tenderness with adnexal and cervical motion tenderness
supportive criteria:
T: >101
abnormal cervical/vaginal dicharge
↑ ESR, CRP
cervical infection with gonorrhea or chlaymdia
- pregnancy test: MUST r/o ectopic pregnancy

A

diagnosis = PID

definitive diagnosis: surgery, biopsy of endometrium, U/S of tubes

21
Q

treatment of PID (p. 212 case files)

A

mild: outpatient, IM ceftriaxone + doxycycline PO

if pregnant, HIV +, severe: hospitalize, IV

22
Q

safe sex practices if diagnosed with STD or at risk

A

LATEX condoms

23
Q

when patient has STD: do following

A

treat sexual partner

screen for HIV, hepatitis B and C, syphilis (initially asymptomatic infxns)

24
Q 
anovulatory (irregular) menstrual cycles
- pregnancy test
infertility
obese, metabolic syndrome, acanthosis nigricans (insulin resistance)
hirsuitism, acne (androgen excess)
A

PCOS

25
Q

treatment of PCOS

A

OCP: induce menses with progesterone
weight loss: increase fertility
clomiphene citrate, aromatase inhibitors, gonadotropins: increase fertility
metformin and TZD

26
Q

ABSENCE of menstrual bleeding for 6 or more months when not pregnant

A

amenorrhea

27
Q

HEAVY menstrual flow or PROLONGED duration of flow (> 7 days) occurring at IRREGULAR intervals

A

menometrorrhagia

28
Q

HEAVY menstrual flow or PROLONGED duration of flow (>7 days) occurring at REGULAR intervals

A

menorrhagia

29
Q

bleeding occurring at IRREGULAR intervals

A

metrorrhagia

30
Q

regular interval for menstrual cycle

A

21-35 days

31
Q

diff dx for menstrual irregularities

A

pregnancy

PCOS

32
Q

physiology of menstrual cycle

A

hypothalmus secretes GnRH → ant. pit secretes FSH + LH
FSH: maturation of ovarian follicle → secrete estrogen: endometrial proliferation, mid-cycle LH surge causes ovulation, follicle is now corpus luteum
CL secretes progesterone: endometrial maturation
if no pregnancy: ↓ progesterone → menses

33
Q

diagnosis of PCOS

A

2/3 of following:
↑ androgen: hirsuitism, acne, serum total T and SHBP, free serum T
chronic anovulation: no CL to produce progesterone → no sloughing of endometrium
polycystic ovaries on U/S

34
Q

diff dx of excessive bleeding + regular menstrual cycles (menorrhagia)

A

normal ovulation: no endocrine issues
leiomyomata (fibroids): ↑ endometrial surface →↑ bleeding
endometrial polyps
inherited coagulopathy: von willebrand disease
coagulopathy d/t med: warfarin
liver disease: ↓ PLT

35
Q

diff dx of reduced bleeding + regular menstrual cycles

A

asherman syndrome: scarred uterine cavity d/t curettage, small uterus
scarred or obstructed cervical os

36
Q

diff dx of abnormal bleeding (timing, flow) + irregular menstrual cycles: dysfunctional uterine bleeding

A

*normally occurs after menarche (watchful waiting, takes 1-2 years to resolve) and near menopause
*abnormal HPA during child-bearing years: prolactinoma (galactorrhea), serum LH levels
causes anovulation: continuous estrogen exposure with no progesterone→ endometrial hyperplasia →irregular sloughing, ↑ risk endometrial carcinoma
*thyroid: skin, hair, hot or cold intolerance, weight gain/loss
*anorexia nervosa
*cervicitis → cervical bleeding: culture, pap smear
*endometritis: vaginal spotting between periods

37
Q

risk factors for endometrial carcinoma

A 
anovulatory menstrual cycle history
obesity
nulliparity
>35 yo
tomoxifen use or unopposed exogenous estrogen
38
Q

treatment for abnormal uterine bleeding (anovulation)

A

if

39
Q

teratogenic meds

A 
anticoagulants
phenytoin
antipsychotics
TCAs
steroids
40
Q

vaginal spotting
mildly enlarged + tender uterus
ascending infection of normal vaginal flora (gonorrhea, chlaymydia, ureaplasma urealyticum, gardnerella vaginalis, GBS)

A

endometritis

41
Q

endometrial biopsy shows plasma cells

A

endometritis

42
Q

initial workup of anovulation (irregular periods)

A 
TSH
prolactin level
pregnancy test
total serum testosterone
NOT free estrogen

Family Medicine (21 decks)

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