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Flashcards in Women's Health Deck (42):
1

lots of thin, yellow green "frothy" discharge at introitus and os
foul-smelling
"strawberry" cervix and/or vaginal/perineum redness
vaginal soreness or dyspareunia
symptoms may be start or worsen during menses

trichomonas vaginalis: protozoan STD

2

wet mount:
motile, flagellated
WBCs

trichomonas vaginalis

3

treatment for trichomonas vaginalis

treat woman AND partner:
metronidazole PO single dose
SCREEN for other STDs

4

recent Abx use/infxn and vaginal discharge

candida vaginitis:
alter vaginal flora
allows overgrowth of fungal organisms

5

woman with DM and vaginal discharge

candida vaginitis

6

thick, white vaginal discharge
no odor
pruritus of vagina and vulva
edema + erythema of vagina/vulva
75% women have at least 1 episode in lifetime

candida vaginitis and/or vulvar

7

need 3/4 criteria:
thin vaginal discharge
vaginal pH >4.5
+ KOH "whiff" test: "fishy" odor (alkaline)
wet mount: clue cells

bacterial vaginosis: excessive anaerobic bacteria + gardnerlla vaginalis replace normal vaginal bacteria
NOT an STD, but multiple sex partners is a risk factor

8

all vaginal discharge is examined via: microscope

wet mount (mix with normal saline): epithelial cells, WBC, RBC, clue cells, motile trichomonads
KOH prep (mix with 10% KOH): hyphae or psuedohyphae of candida

9

cause of vulvovaginal candidiasis

C. albicans

10

vaginal pH: 4-5

candida vaginitis

11

wet mount or KOH prep: budding yeast, pseudohyphae

candida vaginitis: confirms diagnosis

12

treatment of candida vaginitis

vaginal suppository or
fluconazole PO single dose
if recurrent: 10-14 days fluconazole, 6 mo maintenance
treat male if has balanitis

13

risk factors for trichomonas vaginalis

multiple sex partners
pregnancy
menopause

14

treatment of bacterial vaginosis

topical or PO metronidazole or clindamycin
DON'T treat partner

15

why treat asymptomatic pregnant women with BV

reduce incidence of preterm delivery

16

purulent/mucopurulent discharge from endocervix
+/- vaginal discharge, cervical bleeding

chlamydia trachomatis or N. gonorrhoeae
50% gonococcal + 70% chlamydial are asymptomatic

17

diagnosis of chlamydia or gonorrhea

culture of cervical discharge

18

treatment of chlamydia or gonorrhea

gonorrhea: ceftriaxone IM single dose
chlamydia: doxycycline 100 mg PO BID for 7 days or azithromycin 1 g PO single dose
EMPIRIC tx if high prevalence of infection or follow-up unlikely
treat sexual partner

19

cause of:
pelvic peritonitis
endometritis
salpingitis
tuboovarian abscess

PID due to chlamydia, gonorrhea, vaginal or bowel flora

20

lower abdominal tenderness with adnexal and cervical motion tenderness
supportive criteria:
T: >101
abnormal cervical/vaginal dicharge
↑ ESR, CRP
cervical infection with gonorrhea or chlaymdia
- pregnancy test: MUST r/o ectopic pregnancy

diagnosis = PID
definitive diagnosis: surgery, biopsy of endometrium, U/S of tubes

21

treatment of PID (p. 212 case files)

mild: outpatient, IM ceftriaxone + doxycycline PO
if pregnant, HIV +, severe: hospitalize, IV

22

safe sex practices if diagnosed with STD or at risk

LATEX condoms

23

when patient has STD: do following

treat sexual partner
screen for HIV, hepatitis B and C, syphilis (initially asymptomatic infxns)

24

anovulatory (irregular) menstrual cycles
- pregnancy test
infertility
obese, metabolic syndrome, acanthosis nigricans (insulin resistance)
hirsuitism, acne (androgen excess)

PCOS

25

treatment of PCOS

OCP: induce menses with progesterone
weight loss: increase fertility
clomiphene citrate, aromatase inhibitors, gonadotropins: increase fertility
metformin and TZD

26

ABSENCE of menstrual bleeding for 6 or more months when not pregnant

amenorrhea

27

HEAVY menstrual flow or PROLONGED duration of flow (> 7 days) occurring at IRREGULAR intervals

menometrorrhagia

28

HEAVY menstrual flow or PROLONGED duration of flow (>7 days) occurring at REGULAR intervals

menorrhagia

29

bleeding occurring at IRREGULAR intervals

metrorrhagia

30

regular interval for menstrual cycle

21-35 days

31

diff dx for menstrual irregularities

pregnancy
PCOS

32

physiology of menstrual cycle

hypothalmus secretes GnRH → ant. pit secretes FSH + LH
FSH: maturation of ovarian follicle → secrete estrogen: endometrial proliferation, mid-cycle LH surge causes ovulation, follicle is now corpus luteum
CL secretes progesterone: endometrial maturation
if no pregnancy: ↓ progesterone → menses

33

diagnosis of PCOS

2/3 of following:
↑ androgen: hirsuitism, acne, serum total T and SHBP, free serum T
chronic anovulation: no CL to produce progesterone → no sloughing of endometrium
polycystic ovaries on U/S

34

diff dx of excessive bleeding + regular menstrual cycles (menorrhagia)

normal ovulation: no endocrine issues
leiomyomata (fibroids): ↑ endometrial surface →↑ bleeding
endometrial polyps
inherited coagulopathy: von willebrand disease
coagulopathy d/t med: warfarin
liver disease: ↓ PLT

35

diff dx of reduced bleeding + regular menstrual cycles

asherman syndrome: scarred uterine cavity d/t curettage, small uterus
scarred or obstructed cervical os

36

diff dx of abnormal bleeding (timing, flow) + irregular menstrual cycles: dysfunctional uterine bleeding

*normally occurs after menarche (watchful waiting, takes 1-2 years to resolve) and near menopause
*abnormal HPA during child-bearing years: prolactinoma (galactorrhea), serum LH levels
causes anovulation: continuous estrogen exposure with no progesterone→ endometrial hyperplasia →irregular sloughing, ↑ risk endometrial carcinoma
*thyroid: skin, hair, hot or cold intolerance, weight gain/loss
*anorexia nervosa
*cervicitis → cervical bleeding: culture, pap smear
*endometritis: vaginal spotting between periods

37

risk factors for endometrial carcinoma

anovulatory menstrual cycle history
obesity
nulliparity
>35 yo
tomoxifen use or unopposed exogenous estrogen

38

treatment for abnormal uterine bleeding (anovulation)

if

39

teratogenic meds

anticoagulants
phenytoin
antipsychotics
TCAs
steroids

40

vaginal spotting
mildly enlarged + tender uterus
ascending infection of normal vaginal flora (gonorrhea, chlaymydia, ureaplasma urealyticum, gardnerella vaginalis, GBS)

endometritis

41

endometrial biopsy shows plasma cells

endometritis

42

initial workup of anovulation (irregular periods)

TSH
prolactin level
pregnancy test
total serum testosterone
NOT free estrogen