Womens Health Tx

Question 1

Bacterial Vaginitis

Answer 1

Metronidazole either orally or vaginal application

or clines cream/ovule daily

Question 2

Candidal vaginitis

Answer 2

anti fungal vaginal creams
-conazole 1-7 nights
or Fluconazole orallyx1

Question 3

Trichimonas

Answer 3

Metronidazole orally and treat the partners

Question 4

Condylomata acuminata

Answer 4

podophyllin, electrocautery, liquid nitrofen, imiquimod cream

Question 5

Chancroid

Answer 5

Azithromycin 1g po

or Ceftriaxone IM

Question 6

Cervical dysplasia

Answer 6

Cautery, cryosurgery, CO2 laser, loop resection, conization

Question 7

cervical carcinoma

Answer 7

stage, hysterectomy, +/- chemotx/radiation

Question 8

Chlamydia

Answer 8

Azithro 1gPO or Doxycylcline or erythromycin or quinolone

Question 9

Gonorrhea

Answer 9

ceftriaxone IM plus either azithro or doxy

Question 10

Herpes Simplex

Answer 10

5-10 days

acyclovir or famciclovir or valacyclovir

Question 11

Syphilis

Answer 11

Benzathine penicillin G IM or Doxy

Question 12

PID

Answer 12

OutPt: Ceftriaxone IM and Doxy BID for 14 days
InPt: Clindamycin and Gentamycin loading, then doxy for 14d outpatirnt

Question 13

Endometriosis

Answer 13

Hormonal- OC, progestins, GnRH agonists (lupin)

Surgical- excision vaporization and coagulation of the tissue, hysterectomy option

Question 14

Leiomyoma

Answer 14

OC, Prgestin IUD, GnRH analogs, surgical options

Question 15

Endometrial Cancer

Answer 15

TAH/BSO- total hysterectomy and bilateral sapling-oophorectomy

Question 16

PCOS

Answer 16

weight loss first line, OCP, Depo, metformin, spironolactone for the hirsutism

Question 17

Ovarian CArcinoma

Answer 17

Surgical excision, chemo,

- most are mets by diagnosis

Question 18

Oral contraceptions

Answer 18

• usually progesterone and estrogen
  advantage- reduce endometrial and ovarian cancers, improve acne, decrease dysmenorrhea
  disadvantage- pills daily, no STI protection, cardio risks- DVT, PE, MI, Stroke

Question 19

Progestin only mini pill

Answer 19

best for breastfeeding women, fewer complcuications, higher risk of BTB, amenorrhea, breast tenderness

Question 20

IUD

Answer 20

copper (can be postcoital) and progesterone

Question 21

COntaindications or contraceptives

Answer 21

Absolute- previous PE/DEVT, hx of estrogen-dependent tumor, pregnancy, active live dz, undiagnosed abnormal bleeding, hypertriglyceridemia, over 35y and smokes over 15cigs/day
Realtive- poorly controlled HTN, patients on anticonvulsant therapy, over 35 with migraines, any age with aura and migraines, diabetics may need insulin increase

Question 22

Menopause

Answer 22

vasomotor sx- estrogen (no uterus), progesterone/ estrogen, SSRI, SNRI, gabapentin, clonidine
Vaginal Atrophy- estrogen intravaginally
Osteoporosis- exercise, daily calcium and Vit D

Question 23

Fibrocystic Breast Disease

Answer 23

avoid caffeine and chocolate, Vit E? OCP?

Question 24

Mastitis

Answer 24

continued expression of milk, heat, antibiotic

Question 25

Breast Cancer

Answer 25

surgery- lumpectomy, mastectomy radiation hormonal therapy- tamoxifen (anti estrogen) chemotherapy- Doxorubicin (Adriamycin)

Question 26

Ectopic Pregnancy

Answer 26

Labroscopy, methotrexate if early. test Rh!

Question 27

Hyperemesis of Pregnancy

Answer 27

hospitalize if needed, IV fluids, Vitamin B6 (pyridine, +/- TPN

Question 28

Gestational Diabetes

Answer 28

diet- 30kcal/kg/day and exercise, insulin NPH and regular. Oral- not endorsed but glyburide use becoming more prevalent - metformin appears to be safe in 2nd and 3rd trimesters

Question 29

Pre-eclampsia

Answer 29

after 20wks, up to 2wks post bedrest, AntiHTN (hydrazine, labetalol), fetal monitoring. if severe- hospital, MafSO4 (seizure prophylaxis), steroids, delivery if over 36wks (also antiHTN and fetal monitoring)

Question 30

Eclampsia

Answer 30

MagSO4 and delivery, consider Diazepam

Question 31

Placenta abrptio and Previa

Answer 31

delivery- cesarean

Question 32

Gestational Trophoblastic Disease

Answer 32

surgical removal of mole, chemotherapy, methotrexate- prevents subsequent molar pregnancy