Womens/ STI Flashcards
FSH stimulates eggs into producing estrogen
* ↑ Estrogen, stimulates growth of endometrium
* Around day 14 the woman most fertile
Follicular phase (days 1-14)
LH induces ovulation
Midcycle (day 14): Ovulatory Phase
Helps stabilize endometrial lining
Luteal Phase (days 14-28)
- Estrogen ↓, Progesterone ↓
Menstruation
Safe for breast feeding.
* Should be taken at the same Ame every day.
* Late dose (>3hr) or missed day, use condom.
Proges1n-Only Pills: 9% failure rate “mini pill”
Contraindications for COC
Smoker >35 years old (>15 cigarettes per day)
* History of
* ↑ risk of blood clotting.
* Thromboembolic disorders (DVT): thrombus,
emboli.
* Genetic coagulation defects (factor V Leiden
Disease).
* Prolonged immobility (surgery).
* Inflammation or acute infections of the liver with ↑ LFTs.
* Cardiovascular disease.
* Conditions that increase risk of stroke.
* Migraines, CVAs, TIAs, HTN.
Beneifts of COC (5+ years)
- Decreases risk of ovarian and endometrial
cancers by 40-50%. - ↓ acne, hirsutism.
- Regulates heavy menses, dysmenorrhea,
cramps, ↓ pain with endometriosis. - ↓ risk of ovarian cysts.
What to do if missed 2 days of BC pills?
Missed 2 days of pill: Take 2 pills the next 2 days, use condom.
3-month IM injection.
* Must check for pregnancy before use.
* To be used at least 1 yr. (Not recommended if planning to get pregnant within 12 months)
* Black/Box WARNING: not to be used for more than 3 yrs due to risk bone demineralization
(osteopenia/osteoporosis) .
* Do not use with hx. Anorexia (order DEXA).
* Recommend Vitamin D and Ca, weight bearing exercises.
Depo-Provera
Cause: anaerobe bacterial infec1on in the vagina.
* Risk factors: sexual ac1vity, mul1ple sex partners, douching.
* NOT an STI. Sexual partner does not need to be treated.
* Whiff test: fishy odor.
* Treatment: metronidazole (Flagyl)
* Flagyl educaAon: avoid alcohol.
* Lab findings:
* + Clue cells.
* + Whiff test
Bacterial Vaginosis
Cause: Overgrowth of Candida albicans yeast.
Risk factors: DM, HIV (or any immunosuppression), on abx.
Findings: white cheese-like curd vaginal discharge, severe vulvovaginal
itching, swelling, redness.
Treatment: Miconazole (Monistat), clotrimazole.
Lab findings: Wet Smear Microscopy
* pseudo hyphae and spores w/WBC
Candida Vaginitis
Cause: unicellular protozoan parasite w/ a flagella. Affects male and female. Symptoms include
itching, burning, irritation of vagina/urethra.
Risk factors: multiple sex partners, hx of STI, previous trich, no condom use.
Findings: “strawberry cervix” (punctate hemorrhages), swollen and erythematous vaginal area,
dysuria.
Treatment: Metronidazole (flagyl). Treat sexual partner.
Lab findings: Mobile unicellular organism with flagella, ↑ WBC.
Trichomonas Vaginitis
Cause: chronic lack of estrogen in urogenital tract = atrophic changes in vulva and vagina.
Risk factors: menopause.
Findings: atrophic labia, decreased rugae, fissures, dry, pale vagina.
Treatment: estrogen.
Atrophic Vaginitis
Cause: hormonal changes due to menses, causes painful cysts to enlargein breasts. Cyclical, cysts change size and symptoms vary. Benign.
Risk factors: Common around age 30s. Worst 2 weeks before menses.
Findings: painful/tender mass like growths on one or both breasts that change in size depending on menses cycle.
Treatment: Wear good bra support. Reduce caffeine. Primrose capsules or oil, vitamin E. If cyst continues to bother, may remove fluid to relieve symptoms.
Fibrocystic Breasts
Cause: endocrine disorder in women of reproductive age. Primary
characteristics: hyperandrogenism, anovulation, insulin resistance and
neuroendocrine disruption.
Findings:
* Obesity, facial hair, hyperlipidemia, obstructive sleep apnea, acne,
amenorrhea, infrequent periods. Infertility.
* On transvaginal US: enlarged ovaries with multiple small follicles.
* Elevated hormones: testosterone, dehydroepiandrosterone,
androstenedione.
Treatment: contraceptives, spironolactone, metformin, weight loss.
PCOS
Cause: bone demineralization due to estrogen deficiency from menopause.
Risk factors: menopause, anorexia/bulimia, chronic steroid use, long term use PPIs, gastric bypass, celiac
disease, hyperthyroidism, ankylosis spondylitis, RA, low Ca intake, vitamin D deficiency, inadequate physical
activity, alcoholism, high caffeine intake, smoking.
Findings: older female (>50), being thin, small body frame, family history. White or Asian descent.
Osteoporosis
Tx options for osteoporsosis
Weight bearing exercises, Ca and Vitamin D.
* Bisphosphonates: patient education to drink with full glass of water, don’t lay down. May erode esophagus
Painless breast mass that is hard and irregular. Mass not easily
movable, may have changes to the skin. Nipple retraction, discharge,
bleeding.
* Skin changes: dimpling, rash, redness, “peau d’orange”, swelling, lumps, vascularization.
Risk factors: female, obesity, lack of physical activity, alcoholism, hormone replacement therapy (birth control), early menarche, having children late, nulliparity, older age, family history (5-10%)
Breast Cancer
Intraductal (milk ducts) pre-cancerous or non-invasive abnormal cells arising from the breast.
Stage 0. Rarely produces symptoms, usually found on routine imaging. If left untreated, may develop
into invasive cancer.
* In situ: ”in place”, abnormal cells have not moved out of the mammary ducts into the surrounding tissues.
* Screening: mammogram, biopsy, cytopathology.
* Treatment: lumpectomy.
Ductal Carcinoma In Situ
chronic scaly erythematous rash that looks like eczema, starts on the nipple and
spreads to the areola. It is a type of cancer. Rash may be itchy, inflamed, nipple may be
inverted. If left untreated, develops into a larger affected area with crusting, ulceration and or
bleeding nipple.
* Nipple discharge: straw-colored or bloody.
* Sensation: burning, tingling, pain, may feel a lump/bump underneath
affected area.
* Screening: mammogram, biopsy, cytopathology.
* Treatment: lumpectomy, mastectomy, chemo, radiation…
Paget’s Disease
A mutation in either genes, which are tumor suppressor
genes. These can be harmful and produce hereditary breast-ovarian cancers.
* 5-10% breast cancers are attributed to BRCA mutations.
* 5x’s higher risk of breast cancer, 1—30x higher risk of ovarian cancer.
* Risk factors: family history before age 50, male breast cancer, triple negative breast cancer
before age 60, ovarian and other types of GYN cancers. Ashkenazi Jews.
* Referral: breast specialist, genetic counseling.
* Tests: genetics, MRI, mammograms…
BRCA 1 or BRCA 2
Aggressive, fast occurring form of breast cancer.
* Findings: acute onset (weeks to months) of erythematous, breast
swelling, warm area in the breast, peau d’orange, nipple retraction,
itching. Can happen at any age. Don’t confuse with mastitis. Often no
mass (may not be detected in mammography or US).
* Test: biopsy, MRI, mammo/US.
* Treatment: lumpectomy, mastectomy, radiation, chemo
Inflammatory Breast Cancer
Prevalence: middle age to older woman
* Findings: asymptomatic in early stage. Vague symptoms of abdominal bloating and
discomfort, low back pain, abdominal fullness, pelvic pain, changes in bowel habits, loss of
appetite/weight loss.
* ⚠ a palpable ovary is abnormal, r/o ovarian cancer. Order intravaginal US.
* Risk factors: family history, BRCA mutation, Ashkenazi Jewish, nulliparity.
* Birth control lowers risk of ovarian cancer.
* Treatment: surgery, chemotherapy.
Ovarian cancer
- Cervical screening test.
- Brush/spatula is inserted to collect cervical cells.
- Do not preform if menstruating. Done every 3 years
(21-29), 3-5 years (30-65) stop >65 years of age. - Not preformed <21 year of age.
Pap Smear
What to do if Pap Shows Atypical Squamous Cells of Undetermined Significance +
: repeat in 12 months.
What to do if Pap Shows Atypical Glandular Cells:
premalignancy or malignancy. + endometrial cells,
refer for biopsy.
What to do if Pap Shows … High-Grade Squamous Intraepithelial Lesions:
higher risk of malignancy.
Colpo with biopsy, excision.
What to do if Pap Shows Low-Grade Squamous Intraepithelial Lesions:
mildly abnormal cells. Usually caused by HPV. Repeat (21-24), colpo/biopsy (25-29).
Microscope used to view the cervix. Diagnostic test for cervical ca. is biopsy.
Colposcopy
Devise used like a scalpel to cut through the cervix to
treat cervical cancer.
Loop Electrosurgical Excision Procedure
Bacterial Vaginosis test.Positive if strong fish like odor is released after two drops of KOH added to
a sample of BV discharge.
Whiff test
To evaluate herpetic infection (oral, genital, skin).A positive smear will show large abnormal nuclei in squamous epithelial cells.
Tzanck Smear
HPV DNA test
HPV types 16 & 18 cause 70% of all cases of cervical
cancers.Gardasil and Cervarix vaccination available for ages 9-26.
Cause: bacterial infection caused by Chlamydia trachomatis. Infects both women and men.
Risk factors: < 25 years of age, multiple sex partners, not using a condom, history of STIs.
Findings/Symptoms: May be asymptomatic. Genital pain, discharge.
Treatment: Must treat sexual partner. Azithromycin or Doxy (for complicated).
Test: Nucleic acid amplification test (NAATs), vaginal swabs. Preferred for men is urine NAAT
Chlamydia
Cause: Neisseria gonorrhoeae bacterium.
Risk factors: Multiple sexual partners, new partner <3 months, inconsistent condom use.
Findings: (dependent on site). Mucopurulent, pain, bleeding, dysuria, penile discharge, testicular
pain, pelvic pain, purulent discharge, PID, epididymitis, prostatitis…
Treatment: Always co-treat for chlamydia. Ceftriaxone and Azithromycin or Doxy.
Test: Nucleic acid amplification test (NAATs), vaginal swabs. Preferred for men is urine NAAT.
Gonorrhea
Cause: Treponema pallidum bacterium.
Risk factors: Sexual activity, passed on mother to baby.
Findings:
* Primary: chancre (firm, painless, non-itchy ulceration that has a clean base with well
demarcated indurated margins).
* Secondary: condyloma lata (white papules look like warts), diffuse non-itchy rash,
usually hands and soles of feet.
* Tertiary: gumma (non-cancerous growths), neurological problems, heart symptoms.
Treatment: Penicillin G.
Test: RPR or VDRL for screening. If positive, confirm with FTA-ABS.
Syphillis
Firm, painless, non-itchy ulceration that has a clean base with well
Primary Syphillis
condyloma lata (white papules look like warts), diffuse non-itchy rash, usually hands and soles of feet.
Secondary Syphillis
gumma (non-cancerous growths), neurological problems, heart symptoms
tertiary Syphilis
How to tx Syphilis
PCN G
