infections

Question 1

what increases discharge normally

Answer 1

estrogen

Question 2

vaginal discharge is abnormal if

Answer 2

i. Increased volume, especially if soiling the clothes
ii. Bad odor
iii. Change in consistency or color
iv. Irritation or pruritis, pain, burning
v. Dyspareunia or dysuria

Question 3

BV tx in pregnant woman

Answer 3

Flagyl or clinda orally best

Question 4

tx for batholin’s abscess

when would you follow up

Answer 4

Clindamycin 300mg po tid x 7 days or Ceftriaxone 250mg IM

FU in 2 weeks

Question 5

primary HSV infection

Answer 5

Valacyclovir 1g po bid x 10 days for primary HSV infection

Question 6

RPR reactive

Answer 6

syphillis

, 1:16; MHA-TP positive

Question 7

what decrease in titers fo you need to see when treating syphillis

Answer 7

Need to see 4-fold decrease in RPR titer over 6 months (1:16 to 1:4 or less) and stays low at 12 and 24 months post-tx

Question 8

HPV warts-provider tx

Answer 8

Cryotherapy
Podophyllin
TCA
Surgical destruction/removal

Question 9

hpv warts home tx

Answer 9

Podofilox

Imiquimod

Question 10

what goes on a KOH smear

Answer 10

1. 10% potassium hydroxide solution on a slide

Question 11

Mycoplasma hominis and Ureaplasma urealyticum

dx and tx

Answer 11

1. Diagnosis by vaginal culture or PCR for identification

2. Treatment is Doxycycline 100mg po bid x 10 days

Question 12

marsupilization would be used for a cyst of abscess

Answer 12

CYST

Question 13

when would you see a decreased in vaginal pH

Answer 13

candidiasis

Question 14

what are non hormonal options for the treatment of hot flashes

Answer 14

clonidine
SSRI
neurotin

Question 15

anbx for bartholon’s abscess

Answer 15

i. Ceftriaxone 250mg IM or Cefixime 400m po
ii. Clindamycin 300mg po x 7 days
iii. Add azithromycin 1gm po if C. trachomatis

Question 16

follow up care for bartholin’s abscess

Answer 16

a. Wear peripad to absorb drainage
b. Pelvic rest (no sex)
c. Sitz baths and mild analgesics 48 hrs
d. Catheter in place 2-4 wks (poss 6 wks)
e. Call for any increase in pain, swelling, fever or unusual vaginal discharge

Question 17

i. Acute salpingitis-peritonitis

Answer 17

PID

Question 18

labs for PID

Answer 18

ix. WBC > 10K and/or elevated CRP
x. Inflammatory mass on exam or US
xi. Gram negative intracellular diplococci
xii. Purulent discharge on culdocentesis
xiii. Elevated ESR

Question 19

who should be admitted for PID

Answer 19

a. Temp >102.2˚F, guarding or rebound tenderness, toxic patients; adolescents and pregnant women

Question 20

i. Most common STD among women

Answer 20

chlamydia `

Question 21

chlamydia tx in pregnant pt

Answer 21

a. Erythromycin 500mg po qid x 7 days or

b. Amoxicillin 500mg po tid x 7 days

Question 22

chlamydia tx in non pregnant

Answer 22

a. Azithromycin 1g po x 1 dose or

b. Doxycycline 100mg po bid x 7 days

Question 23

iii. Most common cause of genital ulcers

Answer 23

HSV

Question 24

with syphilis Primary chancre develops ____ after infection and persists _____

Answer 24

10-90 days after infection,

persists 1-5 weeks and heals spontaneously

Question 25

Cutaneous eruption of secondary syphilis occurs ____after initial lesion

Answer 25

iv. Cutaneous eruption of secondary syphilis occurs 2-6 months after initial lesion, heals spontaneously after 2-6 weeks

Question 26

what does primary syphilis look like

Answer 26

Painless genital chancre: indurated, firm papule or ulcer with raised borders on labia, vulva, vagina, cervix, anus, lips or nipples Painless, rubbery regional lymphadenopathy followed by generalized lymphadenopathy in the 3rd-6th week

Question 27

positive serology for syphilis occurs in

Answer 27

d. Positive serologic tests in 1-4 weeks in 70% of pts

Question 28

b. Condyloma lata

Answer 28

moist papules in perineum, darkfield microscopy positive

Question 29

Viral-like syndrome, diffuse lymphadenopathy is seen with primary, secondary or tertiary syphilis

Answer 29

secondary

Question 30

when would you get a Lp for a pt with syphilis

Answer 30

neurologic symptoms, treatment failure, serum non-treponemal titer >1:32, evidence of tertiary syphilis, HIV+ patients

Question 31

Early syphilis tx

Answer 31

Benzathine penicillin G, 2.4 million units IM once Doxycycline 100mg po bid x 14 d if PCN allergic

Question 32

b. Late syphilis or unknown duration tx

Answer 32

Benzathine penicillin G, 2.4 mU IM q wk x 3 wks Doxycycline 100mg po bid x 28 d if PCN allergic

Question 33

when do you repeat testing for pt with syphilis

Answer 33

b. Repeat RPR or VDRL at 0, 3, 6, 12, and 24 months after treatment

Question 34

Condyloma Acuminata dx

Answer 34

7. Biopsy of lesions for definitive diagnosis

Question 35

labs for a pt with dysmenorrhea dyschezia and dysparuneia

Answer 35

FSH, CBC for anemia, Metabolic panel for PCOS, TSH, GC/Chlamydia (for underlying PID), HCG

Question 36

pelvic pain think

Answer 36

``` ectopic pregnancy PID intersittial cystitis adenomyosis ovarian neoplasms pelvic adhesions IBS colon cancer diverticular disease ```

Question 37

dx of endometriosis is most commonly made during

Answer 37

1. 25-35 years old most common Uncommon on pre/post monarchal girls Rare in post menopausal women NOT taking estrogen tall thin asian white

Question 38

RF for endometriosis

Answer 38

``` mullerian anomlaies short menstrual cycles pronlonged menses nulliparity early menarche ```

Question 39

What lowers risk of endometriosis

Answer 39

multiple births extended intervals of lactation late menarche

Question 40

mild enometriosis, superficial implants less than 5 cm in aggreagte, scattered on the peritoneum and ovaries. no significant adhesions

Answer 40

ii. Stage 2

Question 41

exhibits multiple implants, both superficial and invasive, Peritubal and periovarian adhesions

Answer 41

Stage 3:

Question 42

VII. Endometriomas

Answer 42

Contains blood, fluid, menstrual debris lined with endometrial epithelium, stroma and glands

Question 43

how can you detect endometriomas

Answer 43

d. Detected on imaging (US, CT, MRI)

Question 44

endometriomas are part of endometriosis?

Answer 44

stage 4

Question 45

dysmenorrhea with endometriosis

Answer 45

Typically “dull or crampy that begins 1-2 days before menses and can persists during and a few days after, chronic

Question 46

if infertile for ___ laproscopy is indicated

Answer 46

after 12 months surgery is indicated laproscopy

Question 47

MODERATE PAIN, no ultrasound evidence of endometrioma TX

Answer 47

Treat symptomatically -->NSAIDS and monophasic combined hormonal contraceptives (pills, patch or ring, ?LNgIUD, ?Nexplanon)

Question 48

when would you advise taking NSAIDS in a

Answer 48

Starting the NSAIDS a day before their symptoms typically starts seems to help (i.e. if they get cramping the day before their period then starting the NSAIDS 2 days before their period)

Question 49

how do OCPs work for endometriosis

Answer 49

Suppress ovulation and menstruation through hyperestrogenic effect—-seems counter intuitive but it works! Consider continuous regimen with pill free interval to allow for withdrawal bleed every 3-4 months

Question 50

if OCP do not work for endometriosis

Answer 50

POP change to norethidrone acetate 5mg Consider depot medroxyprogesterone acetate 150mg IM

Question 51

MODERATE PAIN, or no response to previous therapies or recurrent symptoms

Answer 51

GnRH agonist with add-back (Depo-Lupron) Add-back helps decrease hypoestrogenic effects (hot flashes, night sweats, vaginal dryness etc.) and preserves bone density

Question 52

Aromatase inhibitors are reserved for women with endometriosis who

Answer 52

who continue to have refractory symptoms despite GnRH agonist treatment

Question 53

when would you get a laproscopy

Answer 53

No response to treatment, refractory symptoms, endometrioma or masses seen on imaging or exam

Question 54

reoccurence rates after laproscopy

Answer 54

1. 10% in 3 years | 2. 35% in 5 years