Womens health

Question 1

bacterial vaginosis:

discharge

Answer 1

thin, watery, off-white or discolored, “fishy” discharge

Question 2

bacterial vaginosis:

symptoms

Answer 2

vaginal irritation, dysuria, and itching

Question 3

bacterial vaginosis:

vaginal pH

Answer 3

increased

Question 4

trichomoniasis:

discharge

Answer 4

copious, malodorous, yellow-green, frothy discharge

Question 5

trichomoniasis:

symptoms

Answer 5

pruritus, vaginal irritation, and dysuria

Question 6

trichomoniasis:

vaginal pH

Answer 6

increased

Question 7

vulvovaginal candidiasis:

discharge

Answer 7

thick, white, odorless, “cottage cheese” discharge

Question 8

vulvovaginal candidiasis:

symptoms

Answer 8

erythema, itching, and vulvar edema

Question 9

vulvovaginal candidiasis:

vaginal pH

Answer 9

normal

Question 10

exclusions for self care of VVC

Answer 10

1. first vulvovaginal episode
2. recurrent VVC (more than three infections per year or an infection in the past 2 months)
3. pregnancy
4. girls < 12 years
5. fever or pain in the pelvic area, lower abdomen, back or shoulder
6. corticosteroids, antineoplastic
7. diabetes, HIV infection

Question 11

products to treat VVC

Answer 11

clotrimazole, miconazole, or tioconazole

Question 12

duration of treatment VVC

Answer 12

1 to 7 days

Question 13

ADE of VVC antifungals

Answer 13

vulvovaginal burning, itching, and irritation

Question 14

DDI of VVC antifungals

Answer 14

miconazole and warfarin

Question 15

symptom relief of VVC

Answer 15

sodium bicarbonate sitz bath, tea tree oil, gentian violet, boric acid, benzocaine + resorcinol

Question 16

sodium bicarbonate sitz bath

Answer 16

provides symptom relief, potentially sooner than antifungal relief

Question 17

tea tree oil

Answer 17

allergic dermatitis risk, antibacterial and antifungal properties

Question 18

gentian violet

Answer 18

used in resistant VVC, soak tampon in dye and insert (1-2 applications per day up to five days), very messy

Question 19

boric acid

Answer 19

used in resistant infections, used 1-2 times daily for 14 days, do not use in pregnancy

Question 20

vagisil cream

Answer 20

can provide relief of itching, but use should be reserved for limited time

Question 21

exclusions for atrophic vaginitis

Answer 21

1. symptoms of severe vaginal dryness, severe dyspareunia, or bleeding
2. symptoms that are not localized
3. vaginal dryness or dyspareunia not relieved by use of personal lubricants

Question 22

treatment of atrophic vaginitis

Answer 22

water-soluble vaginal lubricants

Question 23

examples of lubricants

Answer 23

astroglide, KY jelly, replens

Question 24

use of lubricants

Answer 24

regularly if symptoms primarily chronic, about 2 teaspoons externally and internally, do not use petroleum jelly products

Question 25

primary dysmenorrhea: | age at onset

Answer 25

typically several years after menarche, often girls age 13-17

Question 26

primary dysmenorrhea: | menses

Answer 26

regular with normal blood loss

Question 27

primary dysmenorrhea: | pattern and duration of pain

Answer 27

onset just prior to onset of menses; lasts 2-3 days

Question 28

primary dysmenorrhea: | response to NSAID

Answer 28

yes

Question 29

primary dysmenorrhea: | other symptoms

Answer 29

fatigue, headache, nausea, backache, irritability

Question 30

secondary dysmenorrhea: | age at onset

Answer 30

mid to late 20's or older, usually patients in 30's and 40's

Question 31

secondary dysmenorrhea: | menses

Answer 31

irregular and heavy

Question 32

secondary dysmenorrhea: | pattern and duration of pain

Answer 32

varies; pain outside of menses

Question 33

secondary dysmenorrhea: | response to NSAID

Answer 33

no

Question 34

secondary dysmenorrhea: | other symptoms

Answer 34

varies, but may include dyspareunia and pelvic tenderness

Question 35

exclusions for dysmenorrhea

Answer 35

1. severe dysmenorrhea or menorrhagia 2. symptoms inconsistent with primary dysmenorrhea 3. history of PID, infertility, irregular menstrual cycles, endometriosis, ovarian cysts 4. use of IUD 5. allergy to aspirin or NSAIDs 6. use of warfarin, heparin, or lithium 7. active GI disease 8. bleeding disorder

Question 36

first line treatment for dysmenorrhea

Answer 36

NSAIDS

Question 37

ibuprofen dosage for dysmenorrhea

Answer 37

200-400mg ever 4-6 hours

Question 38

naproxen dosage for dysmenorrhea

Answer 38

220-440mg initially; then 220mg every 8-12 hours

Question 39

other treatments for dysmenorrhea

Answer 39

aspirin, apap, omega-3 fatty acids, vitamin D

Question 40

aspirin

Answer 40

effective for mild symptoms but may increase menstrual flow

Question 41

APAP

Answer 41

effective for mild symptoms, even high doses of 4 grams are less effective than ibuprofen

Question 42

omega-3 fatty acids

Answer 42

lead to decreased production of pro-inflammatory cytokines

Question 43

vitamin D

Answer 43

600 IU daily decreases production of prostaglandins

Question 44

non pharm treatment of dysmenorrhea

Answer 44

topical heat, sleep, regular exercise, and avoid tobacco smoke

Question 45

exclusions for treatment of PMS

Answer 45

1. severe PMS or PMDD 2. uncertain pattern of symptoms 3. onset of symptoms coincident with use of oral contraceptives or hormones 4. contraindications in caffeine/pamabrom with theophylline, MAOI, PUD, insomnia, ammonium chloride

Question 46

non pharm treatment of PMS

Answer 46

aerobic exercise, dietary modifications, and stress management

Question 47

pharm treatment for PMS

Answer 47

pyridoxine, calcium + vitamin D, magnesium, NSAIDS, diuretics

Question 48

pyridoxine

Answer 48

improved mood symptoms, limit dose to 100mg daily

Question 49

calcium + vitamin D

Answer 49

improvement in mood and physical symptoms, may be initial treatment, calcium = 600 mg BID

Question 50

magnesium

Answer 50

may improve irritability, 310-360 mg daily, may cause diarrhea

Question 51

NSAIDs

Answer 51

help with physical symptoms

Question 52

diuretics approved for

Answer 52

bloating, water retention, weight gain, swelling, and the feeling of fullness

Question 53

approved diuretics

Answer 53

caffeine, pamabrom, and ammonium chloride

Question 54

caffeine

Answer 54

considered safe and effective at doses of 100-200 mg every 3-4 hours

Question 55

pamabrom

Answer 55

derivative of theophylline, most common agent in OTC medications, up to 50 mg four times daily

Question 56

ammonium chloride

Answer 56

up to 3g/day in 3 idvided doses for no more than 6 days, contraindicated in renal or liver impairment