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Women's Health > Women's Health Exam #3 > Flashcards

Women's Health Exam #3 Flashcards

1
Q

3 things we need for intact menses

A

Intact HPO axis
Endometrial response to stimulation
Way for blood to exit

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2
Q

Primary amenorrhea

A

Have never had a period
Often due to a genetic abnormality

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3
Q

Secondary amenorrhea

A

Misses 3 cycles or 6 consecutive months
MCC is pregnancy

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4
Q

2nd MCC od secondary amenorrhea

A

PCOS

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5
Q

Sheehan’s syndrome

A

Blood loss during birth leads to pituitary necrosis

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6
Q

Mullerian dysgenesis

A

No internal female sex hormones except for ovaries

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7
Q

Asherman’s syndrome

A

Uterine fibroids cause unable evacuation of blood

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8
Q

Anatomical blockages causing amenorrhea - 2

A

Transverse septum
Imperforate hymen

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9
Q

Dx for asherman’s syndrome

A

Hyerosalpingogram

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10
Q

Progesterone challenge test

A

Give progesterin - if they bleed afterwards they are anovulatory

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11
Q

Estrogen and Progesterone challenge test

A

No bleed afterwards means blockage
Bleading afterwards = hypogonadism

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12
Q

Secondary dysmenorrhea

A

Casued by something demonstrable

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13
Q

Membranous dysmenorrhea

A

Due to passage of a cast of the uterus through the cervix

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14
Q

Primary dysmenorrhea

A

No known cause - MC type of dysmenorrhea

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15
Q

First line tx for dysmenorrhea

A

NSAID - 400-800 with no more than 1200mg per day
May take prophylactically
Acetaminophen less effective
Continuous heat helps - need a break

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16
Q

Erythema ab igne

A

Rash associated with chronic heat pad use

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17
Q

2nd line tx for dysmenorrhea

A

Hormonal contraceptives
Lyletta, Morena - Progesterone IUD

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18
Q

Percent of women with PMS or PMDD

A

75%
Highest in 20s to 30s

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19
Q

Tx for mild to moderate PMS/PMDD

A

Dietary changes - caffeine, alcohol, sodium
Exercise - aerobic
Chasteberry, Calcium carbonate - OTC
NSAID for pain
Spironolactone for bloating
Bromocryptine for breast pain

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20
Q

Tx for severe PMS/PMDD

A

SSRI - 1st line with 50% helped, can be used periodically
2nd line - Hormonal therapy
May consider alprazolam
GnRH agonist - put pt in menopause

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21
Q

Transvaginal US taking

A

Need an empty bladder - see pelvic organs

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22
Q

Transabdominal US taking

A

Full bladder, less visualization of pelvic organs

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23
Q

Sonohysterography

A

Saline injected into intrauterine cavity - increased sensitivity

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24
Q

Gold standard for uterine pathology evaluation

A

Hysteroscopy - camera in the uterus

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25
Q

Tx for Dysfunctional Uterine Bleeding

A

r/o pregnancy or cancer - oral contraceptives, observation if asymptomatic and no cancer
Levonorgestrel IUD, D&C for short term ablation

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26
Q

Postmenopausal DUB

A

MCC - exogenous hormones
Always investigate
May actually be bleeding from vagina

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27
Q

Workup to r/o tumors of reproductive tract in DUB

A

Endometrial sampling

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28
Q

Endometrial ablation

A

Need to take birth control, not want to be fertile
Reduces flow in 70-80%

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29
Q

Pretreatment for endometrial ablation

A

Abx NOT needed
GnRH agonist or D&C to thin out endometrium

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30
Q

CI to endometrial ablation

A

Pregnancy, Desire to have children, Endometrial hyperplasia, Postmenopause, IUD in place

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31
Q

Vaporization endometrial ablation

A

Nd-Yag laser
Early method
Scar endometrium

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32
Q

Roller ball

A

Similar to vaporization
Old method

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33
Q

Endometrial resection

A

Old method - caused a lot of perforation

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34
Q

Hysteroscopic thermal endometrial ablation

A

2nd generation
Heated saline put in uterus
Good for anatomic abnormalities
Higher burn risk

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35
Q

Radiofrequency thermal ablation endometrial ablation

A

2nd gen
No D&C or progesterin needed
Uses a heasted mesh

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36
Q

Thermal + RF Endometrial ablation

A

Brand - Minerva
Silicone contours to shape of cavity
Balloon filled with RF heated Argon gas
Endometrial prep not needed
Higher success rates
2nd gen

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37
Q

Water vapor termal endmetrial ablation

A

Seal with baloons and fill with water
2nd gen
Safer

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38
Q

Cryoablation endometrial ablation

A

Less pain but less effective
2nd gen

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39
Q

Theraml balloon endometrial ablation

A

Use balloon to conform to contours of uterus
No longer done in US - too much burning

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40
Q

Sites of endometriosis

A

Other sites in the abdomen
Or distant site outside of the abdomen - can be anywhere

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41
Q

Risk factors for endometriosis

A

Fam hx
Early menarchy
Nulliparity
LOng flow
Heavy periods
Shorter cycles
IE. anything that increases menstrual bleeding

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42
Q

Presentation of endometriosis

A

Dysmenorrhea
Pelvic pain
Dyspareunia
Infertility
May worsen with period
Severity does not corespond to amount of ectopic tissue

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43
Q

PE for endometriosis

A

Tender nodules in posterior vaginal fornyx
Pain with uterine motion
Tender adnexal masses may be felt
May have no findings

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44
Q

Dx for endometriosis

A

Imaging is usually not helpful
Laparoscopy to diagnose definitively

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45
Q

Lesions of endometriosis

A

Powder burns
Chocolate cysts
Red/Purple raspberry spots

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46
Q

Tx for mild/moderate endometriosis

A

NSAID
Progesterone contraceptives

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47
Q

Tx for moderate to severe endometriosis

A

Hormonal - GnRH agonists or antagonists - ie. danazole, letrozole
Gabapentin
TCAs
Surgery

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48
Q

Reason to use surgery for endometriosis

A

Do it when they are wanting to have children b/c they can come back

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49
Q

Danazol

A

Testosterone derivative that acts like progestin
Inhibits gonadotropic release
SE - Oily skin, acne, deep voice

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50
Q

Anastrozole/Letrozole

A

Aromatase inhibitors
Can be used as an adjuvant to Danazol

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51
Q

GnRH agonists

A

Leuprolide, Goserelin, Nafarelin
For endometriosis
Use for max 6 months
Menopause like symptoms

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52
Q

GnRH antagonists

A

Elagolix (Orlissa)
Most studied
Max 6 months at high or 24 months at low dose
Menopause like symptoms

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53
Q

Pelvic inflammatory disease presentation

A

Lower abdominal pain - insidious or acute usually for 2 ish weeks
Oral temp > 101F
Bilateral lower quadrant tenderness
Skene or Bartholin glands around introitus

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54
Q

Fitz-Hugh-Curtis syndrome

A

Liver inflammation with PID

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55
Q

Classic sign of pelvic inflammatory disease

A

Cervical motion tenderness (chandelier sign

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56
Q

Dx for PID

A

Pregnancy test to r/o
WBCs in vaginal fluid
ESR/CRP may be elevated

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57
Q

Imaging for PID

A

May see thickening, tubo-ovarian complex, may be normal

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58
Q

Tx for pelvic inflammatory disease

A

Outpatient abx if they are not too sick and compliant, IV for inpatient
3 Drugs at same time:
Rocephin shot
Doxy
Metronidazole
14 day course overall

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59
Q

Presentation of tubo-ovarian abcess

A

Tenderness and guarding
Mass in abdomen
Multi-loculated lesion on US

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60
Q

Tx for unruptured tubo-ovarian abcess

A

Same abx as PID (Metro, Doxy, Rocephin) but for 4-6 weeks

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61
Q

Tx for ruptured tubo-ovarian abcess

A

Life threatening emergency
TAH (total abdominal Hysterectomy) and BSO (bilateral salpingo-oophorectomy) with aggressive fluid resuscitation

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62
Q

Cystocele

A

Prolapse of the bladder d/t anterior vaginal wall weakness. Visualized through the vagina and better seen when bearing down

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63
Q

Rectocele

A

Rectal prolapse d/t posterior vaginal weakness
Seen in bearing down

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64
Q

Uterine prolapse

A

Uterus slides down towards the introitus

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65
Q

Pelvic organ prolapse stages 0-4
Halfway system

A

0 - Normal
1 - Halfway to hymen
2 - To hymen
3 - Halfway past hymen
4 - Maximal descent

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66
Q

Presentation of pelvic organ prolapse

A

Feeling of heaviness in vagina, urinary symptoms with cystocele
Talk about putting fingers in vagina to brace it when urinating/defecating

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67
Q

Dx for pelvic organ prolapse

A

Pelvic exam with bearing down
Imaging only if worried about secondary problem

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68
Q

Tx for pelvic organ prolapse

A

Pessary - reexamine in 1-2 weeks for first one, then every 2-3 months after that

Kegal exercises

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69
Q

Surgical tx for POP

A

May use mesh or other surgery - mesh can cause irritation

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70
Q

Adenomyosis

A

Endometrial tissue implants in the myometrium
Focal or diffuse

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71
Q

Risk factors for adenomyosis

A

Parity and age

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72
Q

Presentation of adenomyosis

A

More areas of invasion = more s/s
Menorrhagia, dysmenorrhea
Global uterine ENLARGEMENT with uterine softening

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73
Q

Imaging for adenomyosis

A

TVUS
Focal thickening of myometrium on US
Heterogenous texture on US

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74
Q

Tx for adenomyosis

A

NSAIDs for pain
Combo oral contraceptives
Endometrial ablation/resection may help somewhat

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75
Q

Definitive tx for adenomyosis

A

Hysterectomy
Symptoms also get better after menopause - ride out

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76
Q

Leiomyoma

A

Benign neoplasm of the female genital tract - uterine fibroids

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77
Q

Submucous leiomyoma

A

Directly beneath endometrial lining - on the inside!!

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78
Q

Subserous leiomyoma

A

Directly beneath serosal lining - on the outside!!

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79
Q

Intramural leiomyoma

A

Completely within the myometrium

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80
Q

Presentation of leiomyomas

A

Most are asymptomatic
MC symptoms are - Abnormal bleeding, pelvic pressure/pain
May torse - causing pain
May compress nearby organs

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81
Q

PE for leiomyomas

A

Enlarged uterus with irregular contour

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82
Q

Dx for leiomyomas

A

Iron deficiency on labs
US can detect
MRI for more detail
Hysterography/Scopy can also help

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83
Q

Tx for asymptomatic leiomyomas

A

Can monitor with a yearly US - not a big threat to health

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84
Q

Tx for sympomatic leiomyomas

A

NSAIDs or hormonal therapy depending on sx
Regress spontaneously during menopause - menopausal hormone therapy may bring it back

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85
Q

Surgical tx for leiomyomas

A

Total hysterectomy
Myomectomy - just remove fibroid
Embolization - Clot it up - good results

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86
Q

Peak onset for endometrial cancer

A

70s - many cases can occur younger
Obestity increases risk

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87
Q

Precursor to endometrial cancer

A

Endometrial hyperplasia
Excess estrogen!!

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88
Q

MCC of endogenous over production of estrogen

A

Obesity - From the fat!

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89
Q

Other risk factors for endometrial cancer

A

PCOS
Exogenous unapposed estrogen therapy (w/o progestin and no hysterectomy)
More peiords (ie. early menarche, less pregnancies)

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90
Q

Risk reduction for endometrial cancer

A

Progestin or combination contraceptives

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91
Q

MC symptoms of endometrial hyperplasia

A

Abnormal uterine bleeding
Simple or complex atypia (complex more likely to become cancer but progesterone cures both)

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92
Q

Tx for endometrial cancer WITHOUT atypia

A

Progesterone

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93
Q

Endometrial hyperplasia with atypia

A

More concerning that simple/complex
Progesterone will not cure

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94
Q

Type I endometrial cancer

A

Not as aggressive
YOunger patients
Better prognosis

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95
Q

Type II endometrial cancer

A

Less common
Poorer prognosis
Independant of estrogen

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96
Q

Classic endometrial cancer patient

A

Obese
Nulliparous
Infertile
HTN
DM
White

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97
Q

MC type of endometrial cancer

A

Adenocarcinoma

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98
Q

Presentation of endometrial cancer

A

Abnormal bleeding in 80% of patients - postmenopausal bleeding may be an indicator
Vaginal discharge
Cervical os stenosis

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99
Q

PE for endometrial cancer

A

May feel inguinal lymph nodes
Normal in early stages

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100
Q

Imaging for endometrial cancer

A

US with endometrial thickness over 4 mm is high suspicion for cancer
DDx - Biopsy

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101
Q

Other tests that may pick up endometrial cancer

A

D&C - even better than biopsy
Sometimes picked up on pap smear

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102
Q

Tx for endometrial cancer

A

Surgery is mainstay - total hysterectomy with BSO - curative in low risk

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103
Q

Adjuvant pharm for endometrial cancer

A

Radiation, Progesterone, Chemo - Doxyrubicin and Cisplatin

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104
Q

Tx for excess bleeding in endometrial cancer

A

NO IV estrogen like we would with other bleeding
Tamponade and Packing

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105
Q

Functional ovarian cysts

A

Due to cyclic ovarian changes - do not always cause symptoms
Can rupture causing peritonitis
Impinge organs

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106
Q

Dx for ovarian cyst

A

Pelvic US is MC way to dx

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107
Q

Follicular cyst

A

MC type of ovarian cyst
Follicle doesn’t rupture appropriately
Usually asymptomatic
May cause irregular menstual bleeding

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108
Q

Management of follicular cyst

A

Usually resolve in 2 months
OCP can keep cysts from forming
May aspirate or surgically remove - usually not necessary

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109
Q

Corpus luteum cyst

A

Corpus luteum did not regress
Progesterone abnormalities may lead to late period
Torsion, pain, can look like ectopic pregnancy

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110
Q

Tx for corpus luteum cyst

A

Manage symptomatically
OCP questionable
Surgery if problematic
Ring of fire on US

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111
Q

Theca Lutein cyst

A

Caused by elevated hCG
Often bilateral and multiple
Resolve once hCG goes down
May aspirate in pregnancy

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112
Q

Endometriomas

A

Implant of endometrial tissue on the ovary
Endometriosis symptoms - chocolate cysts

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113
Q

Dermoid cyst

A

Filled with improper tissue - fat, teeth, etc.
Not cancer
May rupture

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114
Q

Cystadenomas

A

Cysts that get massive - pain and discomfort
Pop, drain, remove

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115
Q

PCOS

A

Stein Leventhal syndrome
Enlarged ovaries with multiple cysts
Anovulaotry, amennorheic
Obese, overweight patients

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116
Q

Diagnosis of PCOS

A

Pt. with variable periods, obesity, hirsutism, oligomenorrhea
Polycystic ovaries on US - Oyster ovaries

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117
Q

Presentation of PCOS

A

Menstural abnormalities, early pregnancy loss, Pelvic pain/pressure, T2DM
Young endometrial cancer dx
Acanthosis nigricans

118
Q

Hormones in PCOS

A

Mild elevation of androgens
Lower sex hormone binding globulin
Increased LH:FSH ratio

119
Q

US of PCOS

A

Ovary with many cysts in it - look like dark pockets

120
Q

Tx for PCOS - conservative

A

Observe symptoms - should be having at least 8 periods a year
Lifestyle changes -loose weight, well balanced diet

121
Q

PCOS moderate therapy

A

Pregnancy test
COC - if not trying to conceive or ring patch if eligible, helps with hyperandrogenism
Progesterone alone - second line

122
Q

PCOS insulin sensitization

A

Metformin is MC drug - safe in pregnancy
May also use GLP-1 agonist

123
Q

Tx for PCOS hirsutism

A

Takes 6-12 months to work
COC or GnRH agonist
Laser removal, etc.
Spironolactone - androgen antagonist
5 alpha reductase inhibitors - finasterid/dutasteride

124
Q

Vaniqua

A

Expensive hair removal medicine

125
Q

Novel PCOS therapies

A

Myo-inositol
NK34 antagonist

126
Q

PCOS tx for patients who want to get pregnant

A

Weight loss and lifestyle
Letrozole on days 3-7 of period
Not safe once pregnant
(Clomid used to be first line - SERM - blocks estrogen in hypothalamus)

127
Q

MOA of letrozoleand 4 SEs

A

Inhibits aromatoase
SE - hot flashes, dizziness, fatigue, pain

128
Q

Clomid for PCOS

A

causes ovarian enlargement, hot flashes, bloating
Not great

129
Q

FLuid retention of PCOS tx

A

Can be extreme - present with hypovolemia and swelling
MC with Clomid, FSH
LC with Letrozole

130
Q

Surgery for PCOS

A

Ovarian drilling - laparoscopic laser biopsies jump start the ovaries

131
Q

Ovarian torsion

A

Emergent condition like testicular torsion
Often due to enlarged ovaries
May occur in early pregnancy

132
Q

Presentation of ovarian torsion

A

Sudden onset severe, one sided unilateral abd pain
Painful adnexal mass
May radiate to thigh, flank, or groin
Women may be used to abdominal pain!!

133
Q

Dx for ovarian torsion

A

Sonography - dx of choice
Bull’s eye, whirlpool, snailshell pattern
Doppler flow disruption
Do pregnancy test
Transvaginal US may be better

134
Q

Tx for ovarian torsion

A

Laparoscopic detorion ( can do laparotomy)
Remove cyst causing problem
Remove if 12+ hours - obvious necrosis

135
Q

MC source of ovarian cancer

A

Epithelial ovarian cells

136
Q

Ovarian cancer

A

CA-125 marker - from serous cystadenomas
Typical in menopausal patients

137
Q

Other types of ovarian cancer

A

Germ cell tumor - younger patients
Sex cord stromal tumors

138
Q

Risk factors for ovarian cancer

A

Anything that increases cell turnover
Talcum powder

139
Q

Presentation of ovarian cancer

A

Vague early symptoms
Early satiety
Fatigue, back pain
Late - abdominal pain, ascites, solid irregular adnexal mass

140
Q

Sister Mary Joseph nodule

A

Belly button nodule due to ovarian cancer

141
Q

CA-125 marker for ovarian cancer

A

Elevated in 50% of ovarian cancer
Associated with many other things - fibroids, endometriosis
More specific for postmenopausal women

142
Q

Dx for ovarian cancer

A

Various markers
Pelvic US w/ solids, separation, ascites
CT/MRI for more exact
Bx for definitive

143
Q

Tx for ovarian cancer

A

Remove omentum, ovaries, uterus
Watch CA-125 to see if cancer resolved

144
Q

Tx for germ cell ovarian cancer

A

Often try to save the uterus - not as aggressive

145
Q

MC GYN malignancy

A

Uterine cancer

Ovarian - 2nd

146
Q

Sexual response stages - 4

A

Desire
Arousal
Orgasm
Resolution

147
Q

Hormones that increase libido

A

Estrogen
Testosterone - uspraphysiologic
Dopamine
Norepinephrine
Oxytocin
Melanocortins

148
Q

Hormones that inhibit libido

A

Serotonin - at high levels
Prolactin
Opioids
Endocannabinoids

149
Q

Average female puberty onset

A

8-13 years old

150
Q

MC sexual dysfunction in women

A

Low sexual desire - 39% of disorders

151
Q

Female arousal/interest disorder

A

Low desire or abnormal arousal - must occur 75%+ of the time, lasts for 6+ months
Causes distress

152
Q

6 criteria for female interest arousal disorder

A

Must report 3:
Absent interest in sex
Reduced fantisizing
Reduced initiation
Reduced interest/arousal to stimuli
Reduced excitment/pleasure
Reduced sensation

153
Q

Genitopelvic pain/Penetration disorder

A

Pain majority of time with sex
TIghtening of muscles
Avoid vaginal sex
Common hx of trauma or abuse

154
Q

Female orgasmic disorder

A

Don’t feel like they finish the way they want to
May be due to neuropathy, partner issues, etc.

155
Q

Medications related to sexual disorders

A

SSRI!
TCA
Benzos
Lithium
Anticholinergic
HTN meds - BB
SERM/Aromatise inhibitors

156
Q

Estrogen for sexual disorders

A

Increases libido, vaginal lubrication, blood flow to genitalia
CI - Blood clots, endometrial cancer
Recommended if more than just libido

157
Q

Androgens for sexual disorders

A

Generally not recommended - may be used in menopause
Cause hirsutism, acne, liver disease
Last line

158
Q

Dosing testosterone for women

A

Much lower dose than used for men

159
Q

Serotonin/Dopamine for sexual disorders

A

Flibanserin - post menopause serotonin agonist/modulator helps with SE of SSRI
CI with alcohol, hypotension

160
Q

Bupropion for sexual dysfunction

A

Helps with norepi and dopamine
Helps with arousal response, etc.
CI in seizures, anorexia, MAOI use

161
Q

PDE-5 inhibitors in womens sexual dysfunction

A

Slidenafil
Most helpful with physiologic problems - ie. vascular, neuro
CI with nitrates

162
Q

Bremelanotide

A

Agonist of melanocortin receptors for sexual dysfunction
New drug -PRN injection stop if no benefit in 6 weeks
CI in liver disease, pregnancy

163
Q

Other tx for female orgasmic disorder

A

Sexual devices
Directed masturbation - usually best for partner not to participate at first
No scientific evidence for genital cosmetic precedures

164
Q

Tx for sexual pain disorders

A

Lubricants and estrogen for vaginal atrophy
PT for pelvic floor if estrogen fails

165
Q

Tx for vaginismus

A

PT, Counseling, Gabapentin/Botox

166
Q

Tx for vulvodynia

A

Lidocaine, TCA, Remove irritants, PT

167
Q

MC symptom of cevicitis

A

Discharge -many are asymptomatic

168
Q

Cervicitis v. Vaginitis

A

Discharge see from cervcle os in cervicitis

169
Q

Strawberry cervix

A

Indicates trichomoniasis

170
Q

Presentation of chronic cervicitis

A

Often asymptomatic
Discharge - less than acute
Vaginal bleeding
Cervical tenderness
Proximal vagina may look okay
Urethritis, pelvic pain

171
Q

Microscopic analysis for cervisitis

A

Gram stain, Wet mounts - clue cells
KOH prep
PCR

172
Q

Pap smear/ Colposcopy for cervicitis

A

Double hairpin capillaries for trichomonas
Excess leukocytes
Cell enlargement - HPV
Multinucleated cells with ground glass cytoplasm - HSV

173
Q

Biopsy where cell properties have changed

A

Indicative of a virus!!

174
Q

Cervicitis prevention and screening

A

Barrier contraception
Routine screening in 19-25
Remove cervix with hysterectomy

175
Q

Incompetent cervix

A

Cervix shortens before 28 weeks gestation
Painless

176
Q

Risk factors for cervicle insufficiency

A

Cervical conization or Hx of previous episode

177
Q

Presentation of cervical insufficiency

A

2+ cm dilation with minimal contractions
2nd trimester

178
Q

Screening for cervical insufficiency

A

US at 14-16 weeks
Look for funneling and shortening abnormalities
No way to predict

179
Q

4 cervical insufficiency abnormalities

A

TYVU - Trust Your Vaginal Ultrosound
Shape of cervix -increasing risk and progression from T to U

180
Q

Tx for cervcal insufficiency

A

Circlage

181
Q

3 things to look for before circlage -Contraindications

A

Make sure fetus is still viable 1st
Rupture of membranes
Look for infection - treat first

182
Q

Pharm tx for cervical insufficiancy

A

Adjunct to circlage - progesterone

183
Q

Nabothian cysts

A

Blocked glands on the cervix
Smooth rounded, whitish area that does not hurt
Benign!!

184
Q

CIN I-III

A

I - 1/3
II - 2/3
III - In theory entire cervix

185
Q

When do we NOT treat CIN I and II

A

Pregnant women - wait for delivery
Adolescents - observe at first

186
Q

Main risk factor for cervicle dysplasia

A

HPV!!!

187
Q

Pap smear screening

A

Start at 21 3 years
Every 3 years or PAP+HPV every 5 years 30-65

188
Q

Pap screening after 65

A

Stop screening if:
No hx of mod-severe dysplasia/cancer
3 negative Pap or 2 neg PAP+HPV

189
Q

ASC-US cells on pap smear

A

Undetermined significance

190
Q

ASC-H cells on pap smear

A

Cannot exclude a high grade lesion

191
Q

LGSIL/LSIL on pap smear

A

Corresponds to CIN I

192
Q

HGSIL or HSIL on pap smear

A

Corresponds to CIN II or III

193
Q

Atypical glandular cells

A

Rare - cells from endocervix - MAY indicate cancer, may not

194
Q

Management for ASC-US

A

2 pap smears over 6 months - send for colposcopy if abnormal
Might try vaginal estrogen

195
Q

Management for anything that is NOT ASC-US

A

Send for colposcopy

196
Q

Colposcopy

A

Low power magnification of cervix - uses camera
Add acetic acid to light up abnormal areas
Bx abnormal areas

197
Q

Indications for colposcopy - 5

A

Abnormal pap smear
Clinically abnormal cervix
Unexplained bleeding
Vulvar/Vaginal neoplasia
Hx of in utero DES exposure

198
Q

Tx for CIN II-III after biopsy

A

Surgery with evaluation afterwards

199
Q

Management of cervical dysplasia - cryotherapy

A

Probe to blanch tissue in cervical os - 7mm margin
Makes it hard to visualize for later colposcopy

200
Q

Carbon dioxide laser for cervical dysplasia

A

More often in operating room
Very precise
More depth of excision
Can biopsy

201
Q

Loop electrosurgical excision procedure

A

LEEP - Small wire loop to remove with electrical generator
Can biopsy
Best procedure
For cervical dysplasia

202
Q

Cold knife

A

Cervical displasia
For large areas
No risk to being able to biopsy

203
Q

Prognosis for cervical dysplasia

A

80-90% success rates for any method

204
Q

Risk factors for cervical dysplasia recurrence -4

A

Large lesions
Gland involvement
Positive margins
Positive endocervical curretage

205
Q

MC type of cervical cancer

A

Squamous cell carcinoma

206
Q

Presentation of cervical cancer

A

MC symptom = Abnormal vaginal bleeding
Bloody leukorrhea, spotting, postcoital

207
Q

Late signs of cervical cancer

A

Fistula to recum or bladder leading to incompetence
Radiating pain
Weight loss, fever

208
Q

Signs of cervicle cancer

A

Cervix appears abnormal
Ulceration

209
Q

Endophytic cervix

A

Barrell shape, enlarged - cancer

210
Q

Exophytic cervix

A

Friable, bleeding, cauliflower lesions

211
Q

Dx for cervical cancer

A

Cancer may be present despite negative cytology - if the cervix look suspicious, still suspect

212
Q

Tx for cercal cancer

A

Radical hysterectomy with lymphadenectomy
Chemo is mostly palliative

213
Q

Normal vaginal flora

A

Aerobes, anaerobes, yeast
Lactobacilli that make it acidic

214
Q

Normal vaginal pH before and after menopause

A

Before - 4-4.5
After - 6.5-7

215
Q

Things that can alter vaginal flora

A

Low estrogen - decrease
Menses - Increase
Abx
Pregnnacy, Hysterectomy
Foreign substances
DM/Poor diet - worse

216
Q

Candidal vulvovaginitis presentation

A

Often in DM
Pruritis
THick white cottage cheese discharge
Minimal odor

217
Q

Dx for vulvovaginal candidiasis

A

Normal pH
Branching filaments and psudohyphae on wet prep/KOH

218
Q

Pharm tx for vulvovaginal candidiasis

A

Azole - 1st line ie. fluconazole
May extend therapy for recurrent cases

219
Q

Alternative vulvovaginal candidiasis tx

A

Boric acid
Gentian violet

220
Q

Vaginal antifungal administration

A

Administer at night

221
Q

MOA of azoles

A

Inhibit enzyme for cell membrane synthesis

222
Q

MOA of nystatin

A

Increase permeability of cell walls

223
Q

Ibrexafungerp MOA

A

Inhibits glucan synthesis - cell wall production
DO NOT TAKE with an azole

224
Q

MOA of boric acid

A

Interferes with metabolism
CI in pregnancy

225
Q

Gentian Violet MOA

A

May inhibit protein synthesis
Not many drug interactions

226
Q

Presentation of bacterial vaginosis

A

Milky, homogenous, malodorous discharge
No inflammation
Malodorous esp. after intercourse - fishy

227
Q

Dx of bacterial vaginosis

A

Vaginal pH 5.5-7
Clue cells - covered in bacteria
Fishy odor on KOH prep - wiff test

228
Q

Tx for Bacterial vaginosis

A

Metronidazole or Clinda

Can also use an expensive -azole

229
Q

MOA of metronidazole

A

Bind to and deactivate enzymes
Dizziness, HA, Fatigue
Disulfiram reaction

230
Q

Clindamycin MOA

A

Binds to ribosomes
C diff - and not with imodium

231
Q

Vaginal douche

A

Washing out of vagina - only for bacterial vaginosis - NOT for regular cleaning

232
Q

Presentation of trichomonal vaginitis

A

Frothy, copious green, foul smelling vaginal discharge
Strawberry cervix

233
Q

Dx for trichamoniasis

A

pH 5-5.5
Motile wet prep - look at right away before they die
Culture = Best test

234
Q

Tx for trichomonal vaginitis

A

Metronidazole or other ~idizole’s
Cross reactivity to alcohol
Liver disease

235
Q

Presentation of gonorrhea

A

80-85% asymptomatic
Copious mucopurulent discharge

236
Q

Dx for gonorrhea

A

Nucleic acid probe
Or culture of discharge

237
Q

Tx for gonorrhea

A

One shot IM rocephin
Treat partners

238
Q

CHlamydia presentation

A

Cervicitis, dysuria, bleeding
May progress to PID or lymphogranuloma venereum

CERVIX MAY LOOK NORMAL

239
Q

Dx for chlamydia

A

Culture
Immunoassay
Pap smear

240
Q

Tx for chlamydia

A

Doxycycline
ALT: Zmax

241
Q

Noninfectious vaginitis

A

Irritants, Allergens (latex), Atrophic, Excess sexual behavior

242
Q

Presentation of noninfectious vaginitis

A

Itching with no bacteria detectable - get a good hx

243
Q

Tx for noninfectious vaginitis

A

Lubricants
SERM
Sitz bath
Steroid if very painful/inflamed

244
Q

Alternitive tx for vaginitis

A

White vinegar - better option
Herbals
Iodine
Tea tree oil

May kill of good bacteria!

245
Q

Presentation of genital herpes

A

Vescicles that become painful erosions or ulcers
My have a buringing prodrome with inguinal lymphadenopathy

246
Q

Dx for genital herpes

A

Most often clinical
Tzank smear

247
Q

Initial tx for herpes outbreak

A

7-10 days valacyclovir, Famcyclovir, Acyclovir
1-5 days for recurrent
Same drugs for prophylaxis

248
Q

Condyloma acuminatum MC strains

A

MC HPV 6-11

249
Q

Presentation of condyloma

A

Culiflower growths - can be anywhere
May also be flat with rough surface

250
Q

Before tx analysis for condyloma

A

PAP smear and biopsy

251
Q

Tx for condyloma

A

Cryotherapy
Podofilox, Imiquimod, Interferon

252
Q

Molluscum contagiousum cause

A

Pox virus

253
Q

Presentation of molluscum contagiosum

A

Up to 1cm sized umbilicated papules
Inclusion bodies in cell cytoplasm

254
Q

Tx for molluscum contagiosum

A

Dessication, Freezing, Imiquimod
May observe - can cause scarring when removed

255
Q

Presentation of syphillis - 3 stages

A

1 - Painless sore
2 - Palm and sole rash
3 - Involves heart, brain, etc.

256
Q

Tx for Syphillis

A

PCN 1st line
ALT: Doxy

257
Q

Bartholin gland disease

A

Glands near vaginal orifices get infected or plugged
Red flag post menopause

258
Q

Presentation of bartholin gland disease

A

Tenderness - have to duck waddle
Fluctuant tender mass
Systemic signs of infection

259
Q

Tx for bartholin gland disease

A

Draining won’t help
Catheter inflation
Marsupialization - create a pouch
Check for cancer post menopause

260
Q

Abx for Bartholin gland disease

A

Usually not needed - may still use for prophylaxis

261
Q

Lichen sclerosis

A

MC non-neoplastic epithelial vulvar disorder
Usually women over 60

262
Q

Presentation of lichen sclerosis

A

Pruritis is MC sx
May see pain, white lesions, dyspareunia

263
Q

Progression of lichen sclerosis

A

Erythema w/ no response to yeast tx
White plaques develop
Scratching worsens and inflammation does

264
Q

Chronic presentation of lichen sclerosis

A

Ciggarette paper
Phimosis of clitoral hood
Labial fusion
General loss of structure

265
Q

Complication of lichen sclerosis

A

SCC - send for biopsy

266
Q

Tx for lichen sclerosis

A

Potent steroid - Clobetasol with a taper BID to QD eventually PRN for life

267
Q

Adjuncts for lichen sclerosis

A

Antihistamine, Tacrolimus, Methotrexate

268
Q

Lichen Simplex Chronicus

A

Due to a specific trigger or chrinic irritation
No loss of structure like in Lichen Sclerosis
Lots of itching

269
Q

Dx of LSC

A

Biopsy of lesion

270
Q

Tx for LSC

A

Hygeine and Sitz bath
Medium potency steroid - fluocinolone, triamcinolone)

271
Q

Lichen planus

A

Flat white plaques on vagina
Papules on skin
Send to GYN for biopsy
Steroids

272
Q

Dark non cancer vulvar lesions

A

Melanosis lentigo, etc.

273
Q

Vulvar varicosities

A

Common in pregnancy, concerning in elderly or non-pregnant
Sclerosing agent to tx

274
Q

Preinvasive vulvar disease

A

Strong association with HPV
White hyperkeratotic papules with pruritis
Dx through biopsy

275
Q

Tx for preinvasive vulvar disease

A

More aggressive for higher grade
Excision, ablations, laser

276
Q

Paget’s disease - vulvar

A

Itching, soreness
Red velvet cake presentation with white plaques
Can cause structural breakdown

277
Q

Tx for paget’s disease

A

WIDE local excision - need to recheck
Stop as soon as possible
Very poor prognosis if mets to lymph nodes

278
Q

Vulvectomy

A

Partial or radical
Removes area of skin +/- lymph nodes
Not great - last resort for cancer

279
Q

Vulvar cancer

A

90% SCC
Older patients with chronic inflammation or HPV

280
Q

Presentation of vulvar cancer

A

Itching or macerous skin lesion
May just be a “weird spot” w/ no sx

281
Q

Tx for vulvar cancer

A

Remove tumor - excise
Rad vulvectomy - may radiate to reduce
Pelvic exenteration if widespread

282
Q

Pelvic exenteration

A

Removal of everything in the pelvis - diversion of GI and GU tracts

283
Q

Vaginal Intraepithelial Neoplasia

A

Vagina rather than vulva
Colposcopy andbx to dx
Condylomatous lesions or flat and granular

284
Q

Tx for Preinvasive vaginal disease

A

Resection, 5FU not as effective
Difficult to get everything out

285
Q

True vaginal cancer

A

Not spread from the cervix
HPV, Smoking are RF

286
Q

Vaginal SCC

A

Exophytic or ulcerative lesions in the upper 1/3 of vagina

287
Q

Vaginal adenocarcinomas

A

MC vaginal primary tumor in young patient

288
Q

Vaginal sarcoma

A

Highly aggressive with grape like masses
Older pts -upper vaginal wall

289
Q

Vaginal melanoma

A

Usually towards the distal vagina

290
Q

Tx for vaginal cancer

A

Exenteration, Radiation
Poor prognosis

Women's Health (3 decks)

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