GYN/GU Flashcards

1
Q

Candida Vulvovaginitis

A
  • 80-90% caused by candida albicans
  • discharge: white curdy, cottage cheese
  • complaints: itching/burning
  • pH: <4.5
  • usually no odor
  • microscope: mycelia, budding yeast, psuedohyphae w/KOH prep
  • treatment: PO fluconazole (diflucan), topical/vaginal terconazole, miconazole
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2
Q

Bacterial Vaginosis

A
  • caused by overgrowth of normal flora usually g. vaginalis, m. hominis
  • discharge: thin homogenous, white gray, adherent, often increased
  • complaints: discharge, foul odor, itcing present
  • fishy odor, + whiff test
  • high vaginal pH 5-7 (distinct finding)
  • microscopic: >20 clue cells, few or no WBC

Treatment
* topical metronidazole (metrogel)
* PO metronidazole (Flagyl)
* topical clindamycin

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3
Q

Genourinary syndrome of Menopause
(atrophic vaginitis)

A
  • caused by decreased estrogen
  • discharge: scant white-clear
  • complaints: itching, burning, discharge, often without symptoms
  • pH > 5 due to decreased estrogen
  • mricoscope: few or absent lactobacilli
  • treatmetn: topical or vaginal estrogen if symptomatic and/or recrrent UTI
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4
Q

Genital Herpes

A
  • Caused by human herpes virus 2, less commonly HHV-1
  • classic presentation of painful ulcerated lesions, marked lymphadenopathy
  • in women thin vaginal discharge
  • asymptomatic transmission common

Treatment
* serologic test reccomended
* oral acyclovir, famciclovir, valacyclovir
* used for intial, subsequent episode, and outbreak prevention

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5
Q

Nongonococcal urethritis and cervicitis

A
  • Chlamydia thrachomatis- #1 bacterial STI
  • s/s: irritative voiding, occasional mucopurulent discharge, cervicitis common. Often without symptoms regaurdless of gender
  • microscopic: large number of WBCs

Treatment:
* Doxycycline 100mg po BID x7days (1st line)
* azithromycin 1 g PO singel dose (alternative)

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6
Q

Gonococcal urethritis and vaginitis

A
  • neisseria gonorrhoeae (#2 bacterial STI)
  • s/s: irritative voiding, occasional purulent discharge. often without symptoms in either gender
  • microscopic: Lage amnt WBC

Treatment
* Ceftriaxone 500mg IM +doxycycline100mg po BID x7 days chlamydia is not ruled out

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7
Q

Trichomoniasis

A
  • caused by trichomonas vaginalis (protozoan pathogen)
  • s/s: dysuria, itching, vulvovaginal irritation, yellow green discharge, occationaly frothy, cervical petechial hemorrhages (stawberry spots). Often without symptoms in either gender.
  • microscopic: motile organisms and lage number of WBC, alkaline pH

Treatment:
* metronidazole (Flagyl) 500mg PO BID x7 days in females
* metronidazole 2g PO 1 time dose for males
* abstain from alcohol for 24hrs

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8
Q

Treatment of Uncomplicated Acute UTI in women

A
  • usual pathogen: E. coli (gram -) 75%, klebsiella (gram-), S. saprophyticus (gram+)

Primary
* TMP/SMX (bactrim PO BID x3 days if local resistance <20%
* if resistance or sulfa allergry: nitrofurantoin (macrobid) 100mg PO BID x5 days
* add phenazopyridine (pyridium) for symptom control

alternative tx/2nd line
1. Cipro
2. levofloxacin
3. cefdinir

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9
Q

Epididymo-orchitis in men <35

A

upper reproductive tract infection with inflammation of epididymis/testis
* casued by N. gonorrhea, c. trachomatis
* presentation: irritative voiding, fever and painful swelling of epididymis and scrotum
* infertility potential post infection due to scaring of vas defrens

Treatment
* Ceftriaxone 500mg IM + doxycycline 100mg PO BID x10 days
* advise elevation of scrotumto help with symptom relief
* Prehn’s sign - relife of discomfort withscrotal elevation

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10
Q

Epididymo-orchitis in men >35 who have anal intercourse

A

usually caused by enterobacteriaceae (coliforms)
* presentation: irritative voiding, fever and painful swelling of epididymis and scrotum
* infertility potential post infection due to scaring of vas defrens

Treatment:
Ceftriaxone 500mg one time + levofloxacin 500mg PO x10 days

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11
Q

Acute bacterial prostatitis in men <35

A

caused by N. gonorrhoeae or C. trachomatitis
* S/S: irritative voiding, suprapubic, perineal pain (pain when sitting), fever, tender boggy prostate, leukocytosis

Treatment
* Ceftriaxone 500mg IM OR cefixime 400mg PO once, then doxycycline 100mf PO BID x10 days

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12
Q

Acute bacterial prostatitis in men with low risk of STI

A

caused by enterobacteriaceae
* S/S: irritative voiding, suprapubic, perineal pain (pain when sitting), fever, tender boggy prostate, leukocytosis

Treatment
* Ciprofloxacin OR
* Levofloxacin OR
* TMP/SMX DS
* 10-14 days

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13
Q

Urge incontinence

A
  • most common form of incontinence in older adults
  • strong sensation of needing to empty th ebladder that cannot be suppresed, often coupled with involuntary loss of urine

Tx
* behavioral therapy
* antimuscarinics (anticholinergics): tolterodine (detrol), oxybutinin (ditropan), solifenacin succinated (vesicare),
* ADE: drymouth, sedation, mental status change inhigher doses
* Alternative: B3-agonist: mirabegron (mybetriq), vibegron (gemtesa)
* botulinum toxin injections

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14
Q

Stress Incontinence

A
  • most common form in women, rare in men, occasionally noted post prostate/bladder surgery
  • loss of urine with activity that causes increase intra-abdominal pressure such as coughing, sneezing, exercise.

Treatment:
* Support to the area with vaginal tampon, urethral stents, periurethral bulking agent injections, pessary use.
* Kegel and PT helpful in younger, premenopausal pt
* pelvic floor rehab with biofeedback, electrical stim, and bladder training.
* surgical intervention

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15
Q

Ovarian cancer

A

Risk factors
* post menopause, obesity, nulliparity or first birth >35, some fertility drugs, use of estrogen after menopause (>5-10yrs), family hx and genetic mutation (BRCA), shared etilogy with breast cancer

Clinical presentation
* minimal non specific symtoms in early stage
* bloating, bladder pressure, constipation, vaginal bleeding, indigestion, SOB, lethargy, weight loss

Diagnostics
* CT with contrast abd/pelvis, US, MRI
* Tumor marker CA125 (not specific)
* Fine needle aspiration or percutaneous BX not reccomended due to delay in treatmetn

Treatment
* surgery follwed by chemotherapy

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16
Q

Cervical cancer

A

Risk factors
* Virtually all caused by HPV (70% by 16, 18)

Clincial presentation
* abnormal vaginal bleeding, vaginal discomfort during intercourse, malodorus discharge, dysuria
* with routine screening, typically asymptomatic with first abnormal pap

Dx
* pap test followed by colposcopy, and biopsy
* Pelvic CT and/or MRI, or Pet scan can be used to guide treatment

Treatment
* based on stage
* surgery for early invasive disease
* radiation and/or chemo for advanced/disseminated disease

17
Q

Endometrial Cancer

A

Risk factors
* older age, estrogen therapy, nulliparity, obesity, tamoxifen use, Hx of breast or ovarian ca, PCOS, T2DM, family hx

Presentation
* abnormal vaginal bleeding (postmenopausal, or heavy frequent menstral periods, or intermenstrual bleeding in pre/perimenopause)

Dx.
* Transvaginal US
* hysteroscopy
* Endometrial Bx
* Fractional D&C

Treatment
* surgery followed by chemo with or without RT

18
Q

HPV associated cancer screening

A
  • average risk women: begin at 21. Q3-5 years. Stop at 65 with adequate negative cytology. HPV Vaccination considered average risk
  • WMN at higher risk: more frequent testing. Includes women HIV+, immunosupressed, or exposed to DES
  • Women with hysterectomy: total hysterectomy with removal of cervix for benign reasons can stop. Cervix intact, of Hx of cervical cancer, or pre-cancer (CIN2/3) continue Pap
  • Women with CIN2/3: continue screening for at least 20yrs following abnormal.
  • Anal Pap only in high risk populations: HIV+, recieve anal sex, Hx of anal warts, women with hx of cervicle or vulvar cancer. Test every 2-5yrs