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Reproductive Exam 2 > Benign and Malignant Diseases -Beaton > Flashcards

Benign and Malignant Diseases -Beaton Flashcards

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1
Q

What is the most common vulvovagintis seen

A

Bacterial vaginosis

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2
Q

name the 4 types of bacterial vaginosis

A
  1. non-specific vaginalis
  2. gardnerella vaginalis
  3. haemophilus vaginalis
  4. corynebacterium vaginalis
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3
Q

what the s/s of bacterial vaginosis

A
  1. homogenous THIN discharge
  2. White/grey discharge
  3. “fishy” amine smell (especially with a change in pH)
  4. NOT pruritic
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4
Q

What can cause a change in vaginal pH

A

sex and period

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5
Q

What are the OB risks of bacterial vaginosis

A
  1. PROM
  2. premature delivery
  3. chorioamnionitis
  4. C-section
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6
Q

If you have bacterial vaginosis and have a C-section what are you at risk for

A

6x risk of post-cesarean endometritis

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7
Q

What is a GYN risk in presence of B.V

A

increased risk of vaginal cuff cellulitis in post-hysterectomy

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8
Q

How do you diagnose B.V

A
  1. discharge
  2. vaginal pH >5 (becoming less acidic)
  3. Clue cells
  4. sniff and whiff test –> 10% KOH added to discharge emits fishy, amine smell
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9
Q

what is clue cells

A

wet smear of epithelial cells with large # of bacteria on cells surface
-obscuring cell borders –> fuzzy cells

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10
Q

What methods can B.V be treated with

A

oral and topical

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11
Q

What oral meds treat BV

A

metronidazole
500mg BID for 7 days (Preferred) OR
2 grams single dose (less effective)

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12
Q

what should you avoid while taking metronidazole, why

A

alcohol; d/t disulfuram-like rxn –> makes you very sick

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13
Q

What topical treatments are used for BV

A

-Clindamycin cream 2%
once before bed for 7 days

-metronidazole vaginal gel
once before bed for 5 days

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14
Q

How should the partner of BV pt be treated

A

oral metronidazole simultaneously in recurrent cases

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15
Q

What is the 2nd most common vulvovaginitis

A

candidiasis

aka monilial vaginitis

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16
Q

what are the 3 causative agents of candidiasis

A

candida albicans
candida glabrata
candida tropicalis

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17
Q

what are the s/s of candidiasis

A
  1. THICK discharge
  2. white, cottage cheese, or curdish
  3. odorless OR “yeasty”
  4. Vulvar irritation
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18
Q

what symptoms are involved with vulvar irritation

A

erythema, intense pruritis, swelling of the vulvar

- can cause burning on peeing

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19
Q

what condition can candidiasis s/s be confused with

A

Herpes d/t the pain

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20
Q

How do diagnose candidiasis

A

10% KOH added to wet smear reveals HYPHAE under the microscope

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21
Q

what is the most COMMON pre-disposing factor of candidiasis

A

Broad -spectrum antibiotics

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22
Q

what are the other pre-disposing factors of candidiasis

A
  1. corticosteriods
  2. oral contraceptives
  3. Diabetes
  4. Pregnancy
  5. TIght fitting clothes - moisture/heat
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23
Q

how do you treat candidiasis

A

cream and oral

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24
Q

what are the different creams that can be used for candidiasis

A 
butoconazole 
terconazole
tioconazole 
clotrimazole
miconazole
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25
what is the oral treatment for candidiasis
Fluconazole (1x dose)
26
what is the drawback for using just Fluconazole
its only effective against 1 of 3 species therefore it should be given with a cream too.
27
How do you treat a preggers with candidiaiss
same treatment BUT requires a longer treatment regimen
28
how do you treat a diabetic with candidiasis
you give the antifungals BUT you need to control their blood sugar or else the s/s won't clear
29
are candidia and BV infections
Nope; they are common inhabitants of the vagina and usually "in balance"
30
So how does a person get one or the other (bv, candidiasis)
its usually a result of an imbalance and an overgrowth of one as compared to the other
31
Does treating candidiasis and BV totally eradicate them from the body
Nope; it just regresses the overgrowth so that it can go back to "checks and balances"
32
True/False; Trichomonas vaginalis and Chlamydia trachomatis are both true infections and STI
True
33
What are the s/s of Trichomonas vaginalis
1. yellow -grey frothy discharge 2. malodorous 3. possible inflammation of vagina and cervix
34
strawberry cervix can be seen in what
Trichomonas vaginalis
35
how do you diagnose Trichomonas vaginalis
flagellated trichomonads on wet mount
36
how do you treat Trichomonas vaginalis
metronidazole 250mg TID for 7 days OR 500mg BID for 7 days OR 2 g 1x dose all of the above have have equal effectiveness
37
can you treat Trichomonas vaginalis with creams too
NOPE! just oral therapy
38
when should the partner be treated
at the same time
39
What is the #2 most common STD
Chlamydia trachomatis
40
what is the #1 cause of PID
Chlamydia trachomatis
41
Chlamydia trachomatis can also commonly cause ...
acute salpingitis
42
what is the associated syndrome with Chlamydia trachomatis
Fitz-Hugh-Curtis Syndrome
43
what is Fitz-Hugh-Curtis Syndrome
peri-hepatitis, liver capsule adhering to parietal peritoneum aka "banjo string adhesion"
44
can Chlamydia trachomatis be transferred to a newborn
YES! law requiring erythromycin ointment application to newborn eyes
45
What is a symptom for Chlamydia trachomatis
mucopurulent cervicitis - a little more moisture than normal, often unnoticed
46
how do you diagnose Chlamydia trachomatis
culture specific for chlamydia
47
Increased of post-partum and post-C-section endometritis
Chlamydia trachomatis
48
how do you treat Chlamydia trachomatis
Azithromycin (TOC) 1g x1 dose | All other Tx is 7-10 days Tetracyline Doxycycline (2nd TOC) - less irritation of GI Erthromycin
49
What is the most common cause of prepubertal vaginitis
``` allergic rxn to bubble bath #2 is forgein objects ```
50
if the culture comes back positive for GC, chlamydia or mycoplasma for prepubertal vaginitis what must be considered
sexual abuse
51
how should the culture be taken for prepubertal vaginitis
with a q-tip, not a speculum
52
what is the primary cause of post-menopausal vaginitis
estrogen deficiency (atrophic vaginitis)
53
How do you treat post meno vaginitis
replace estrogen (oral or topical)
54
acquired by sexual contact with someone with a reactivation of recurrent infection
The herps (herpes genitalis)
55
Type 1 and Type 2 are generally categorized how
Type 1 - oral | Type 2 - genitals
56
What are s/s of initial episodes of herps
pain, burning with peeing, urethritis, possible urinary retention -flu sympt
57
What will a primary herpes genitalis infection have
a vesicle full of viral particles with a red ring around it
58
what is a complication Beaton talked about with herpes genitalis
labia may fuse from inflammation if desquamation occurs
59
When does recurrent herpes outbreaks usually occur
common with stress or immune system suppression
60
herpes is known for its prodrome, what s/s is it
burning or tingling felt by 60-70% of people at site of recurrence -then lesion appears 1-3 days after
61
how do you diagnose herpes
viral culture for herpes
62
how do you treat herpes
valacyclovir or acyclovir (oral tabs) will reduce s/s and length of healing time BUT will not cure herpes
63
what is better for herps, oral or topical
oral is way better
64
What else is going to help with reducing s/s of herps
boost immune system, rest, nutrition, reduction of stress
65
What are the 3 treatment alternative approaches
episodic, suppressive, and prophylactic
66
what do you do when herps is episodic
treat when recurs
67
what do you do to suppress herps
LONG TERM daily LOW DOSE Tx | -reduce recurrence
68
What do you do as prophylaxis of heprs
SHORT TERM daily LOW DOSE Tx | -reduce outbreaks during anticipated stressful times
69
what do you do for preggers how have herps
C-section if active lesions at time of labor
70
what is the #1 STD
HPV
71
HPV is a causitive agent for what infection
Condyloma acuminata (genital warts)
72
HPV is also considered an agent in some cases of what
vulvar intraepithlelial neoplasm (VIN)
73
what needs to be done when Condyloma acuminata is obseverd
pap smear with culposcopy of vulva, vagina, and cervix
74
how do you treat HPV (im assuming he talking Condyloma acuminata )
``` laser vaporization cryotherapy 5-FU- tpoical trichloroacetic acid bichloroacetic acid 25% podophyllin ```
75
Regardless of Tx of Condyloma acuminata, what is the recurrence rate
20%
76
How do you Tx Bartholin's gland
incise and drainage marsupialization gland excision AND if infection is present --> antibiotics
77
what is marsupialization
incision in abscess to drain and also suture around the opening to keep it open, so it can continuously drain
78
what are some characteristics of vulvar neoplasm
1. hyperplastic OR atrophic lesion 2. most COMMON --> persistent itch - but maybe asymptomatic (stupid)
79
Name three vulvar neoplasia
vulvar dystrophy vulvar intraepitheial neoplasia vulvar squamous cell carcinoma
80
is vulvar dystrophy benign or malignant
Benign | - however foudn to have potential to become CA (again stupid)
81
vulvar dystrophy is hyperplatstic, why
mostly d/t local irritation | -raised, erythematous lesion with thickened keratin epithelial d/t acute insult
82
how do you treat vulvar dystrophy
topical corticosteriods
83
what is a type of vulvar dystropy mentioned in lecture
lichen sclerosis | unknown etiology
84
what are the s/s of lichen sclerosis
thin, parchment like skin, itchy****
85
how do you treat lichen sclerosis
potent steroid Clobetasol
86
what do you do if tx doesnt work for lichen sclerosis
Biopsy
87
is vulvar intraepithelia neoplasm (VIN) benign or malig
pre-malignant? (soooo yes?)
88
if these vulvar crap doesn't go away with Tx, whats the next step
BIOPSY
89
name 2 types of VIN
paget's disease and vulvar CIS
90
Everything about Paget's disease, go!
post-meno red/pink w/ patches of hyperplastic white looks like severe candidiasis
91
what is the most common VIN
Vulvar CIS
92
EVerything about vulvar CIS, GO!
happens at ANY AGE various colors (red, pink, brown, white) pruritic
93
how is malignancy of vulvar squamous cell carcinoma dealt with
usually sent to gyn oncology
94
what s/s is present 50% of the time for vyvlar squamous cell
long term pruritis or a lump/mass of vulva
95
how is vulvar squamous cell carcinoma staged
0 Carcinoma in situ 1 Lesions < 2 cm 2 Lesions > 2 cm 3 Involves anus, LOWER urethra, vagina, and/or unilateral inguinal nodes 4 Involves UPPER urethra, bladder, rectal mucosa, bilateral inguinal nodes or distant sites
96
how vulvar squamous cell carcinoma treated
1. classical radical vulvectomy 2. modified radical vulvectomy (via 3 incision apporach) - lower morbidity, lower wound breakdown

Reproductive Exam 2 (5 decks)

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