Genitourinary and Gynecologic problems

Question 1

White, clear, flocculent leukorrhea describes what?

Answer 1

normal vaginal discharge

Question 2

Which diagnosis is found to have white, curdy, cottage cheese discharge with vagina pruritus and burning?

Answer 2

Vulvovaginitis 2/2 candida albicans

Question 3

What treatment is prescribed for vulvovaginitis 2/2 candida?

Answer 3

oral "zole"
diflucan/ fluconazole
or 
vaginal miconazole / monistat
terazol

Question 4

What vaginal dysfunction is characterized by >20 clue cells found on microscopic exam and foul, gray/white, homogenous discharge ?

Answer 4

Bacterial Vaginosis BV
polymicrobial likely
POSITIVE WHIFF TEST
fishy odor
TX- metronidazole
flagyl
clindamycin
cleocin

Question 5

What presents as painful ulcerated lesions, lymphadenopathy, and in women you may see a thing vaginal discharge associated with vaginal lesion ?

Answer 5

Caused by the organism herpes simplex virus HHV-2 type 2

recurrence symptoms vary from above

asymptomatic transmission is possible

Question 6

What is the treatment for herpes simplex type 2 or HHV-2 ?

Answer 6

acyclovir, famciclovir, valacyclovir VALTREX

dx herpes select PCR blood test

Question 7

What is the presentation of chlamydia trachomatis and ureplasma urealyticum and mycoplasma genitalium?

Answer 7

nongonococcal urethritis and cervicitis
irritating voiding symptoms and /or mucopurulent discharge or recurrent UTI

cervicitis common in women ***

microscopic look at discharge = LARGE NUMBER OF WBC

Question 8

TREATMENT FOR CHLAMYDIA

Answer 8

AZYTHROMYCIN 1G PO X 1 DOSE

ALT= DOXYCYCLINE , ERYTHROMYCIN, LEVOFLOXACIN = MORE THAN 1 DAY OF THERAPY

Question 9

WHO DO YOU SCREEN FOR CHLAMYDIA

Answer 9

16-24 YEARS OLD, THOSE SEXUALLY ACTIVE OR HAVE A NEW PARTNER

Question 10

GHONORRHEA PRESENTATION

Answer 10

IRRITATIVE VOIDING SYMPTOMS (SIMILAR TO CHLAMYDIA**)
COULD BE WITHOUT SYMPTOMS - OCCURS OFTEN

MICROSCOPIC EXAM = LARGE NUMBER OF WBCS

Question 11

What is the first line therapy for gonorrhea ? a gram NEGATIVE bacteria

Answer 11

IM ceftriaxone 250 mg ONE TIME DOSE plus azithromycin 1 g PO x 1 dose

ALTERNATE would be cefixime 400 mg PO with azithro dose

Question 12

A patient presents with yellow GREEN vaginal discharge, may be frothy, cervical petechiae hemorrhage or strawberry cervix, what is your diagnosis?

Answer 12

Trichomoniasis vaginitis

Question 13

First line trichomoniasis therapy?

Answer 13

Metronidazole 2 g PO 1 time dose
AVOID ALOCHOL x 24 hours
no cough syrups

alternative = tinidazole

Question 14

What is syphillis?

Answer 14

Baterium infection with CHANCRE. firm, roun, painless genital anal ulcers
indurated margins
accompanied localized lymphadenopathy

2nd stage = nonpruritis skin rash of PALMS, SOLES, MUCOUS PAM SELLS MUSTARD

Question 15

what is pelvic inflammatory disease

Answer 15

could be –> gonorrheae, trachomatis, enterbacteriaceae, streptococci

key = cervical motion tenderness, CHANDELIER SIGN

PID shuffle = hard to walk, pain, guarding

50% of all ectopic pregnancy is linked to PID

get culture and CBC

Question 16

First line treatment for PID

Answer 16

Ceftriaxone 250 mg IM single dose, PLUS doxycycline 100 mg PO BID x 14 days
with or without metronidazole 500 mg PO BID x 14 days

Question 17

What is clotrimazole cream used for?

Answer 17

Candida vulvovaginitis

Question 18

What is oral metronidazole and metronidazole gel used for

Answer 18

gel = vaginosis 
oral = vaginosis and trich

Question 19

Treatment for syphillis

Answer 19

bicillin or injectable penicillin

Question 20

What is imiquimod used to treat?

Answer 20

external genital warts

HPV

Question 21

Is TCA or trichloroacetic acid safe in pregnancy?

Answer 21

yes

imiquimod is not

Question 22

What is CLUE CELLS associated with

Answer 22

Bacterial vaginosis

Question 23

what is pseudohyphae w/ KOH prep associated with ?

Answer 23

candida vulvovaginitis

Question 24

What is obliterated medial sulcus a sign of ?

Answer 24

Benign prostatic hyperplasia

Question 25

What effect may oxybutynin have on a patient who is taking it?

Answer 25

anticholinergic effects | antimuscarinic medication - control of detrusor muscle contraction

Question 26

What is the treatment for acute UNCOMPLICATED UTI in non pregnant patient?

Answer 26

TMP/SMX- DS PO BID x3 days if e. coli resistant to TMP then Nitrofurantoin MACROBID 100mg PO BID x 5 days can also use levofloxacin, ciprofloxacin, moxifloxacin but growing concern about Floroquinoloine resistance

Question 27

What is the likely dx of a male who complains of irritative voiding symptoms, suprapubic pain, perineal pain, fever, boggy prostate, and is at a low risk for STI?

Answer 27

acute bacterial prostatitis cause- likely e. coli tx- ciprofloxacin 500mg PO BID

Question 28

Prehns sign

Answer 28

relief of scrotal pain with elevation

Question 29

What is the treatment for a gonorrheal or trachomatis infection in a male patient ?

Answer 29

Ceftriaxone 250 mg IM as a single dose plus doxycycline 100 mg PO BID x 10 days

Question 30

What is the US preventative services task force recommendations for cervical cancer screening in woman

Answer 30

initial screening at age 21 21-29- cytology alone q3 years aged 30-65 - primary HPV testing alone every 5 years cease testing at age 65 or greater

Question 31

What are the recommendations of the American Cancer Society from 2020 for Cervical Cancer screening in average-risk women?

Answer 31

Start screening at AGE 25 (differs from USPSTF saying 21) | also recommend NOT SCREENING 21-24

Question 32

What is the recommended treatment for gonorrhea or trachamotis in PID?

Answer 32

Ceftriaxone 250 mg IM 1 time plus doxycyline 100 mg PO x 10 days

Question 33

What is the recommended treatment for gonococcal urethritis or vaginitis?

Answer 33

ceftriaxone 250 mg IM as a one time dose plus azithromycin 1 g PO x 1 dose

Question 34

Breast cancer symptoms / history

Answer 34

NON TENDER painless mass asymptomatic symptoms LATER = pain, erythema, dimpling, ulceration, nipple retraction

Question 35

Fibrocystic breast disease symptoms

Answer 35

Breast tenderness related to cycle nodularity with cyst formation / enlargment may be breast discharge

Question 36

What is the difference between fibrocystic breast disease exam and breast cancer exam?

Answer 36

``` fibrocystic = mobile mass, breast cancer = fixed or firm fibrocystic = no discharge, breast cancer = may have discharge, may be bloody fibrocystic = no lymphadenopathy, breast cancer = may have lymphadenopathy ```

Question 37

What is your breast cancer risk if a 1st degree relative has had it ?

Answer 37

INCREASES 2 TO 4 FOLD

Question 38

What is the lifetime risk for breast cancer in women ?

Answer 38

1:8 women have breast cancer