Women's Health Exam 2

what is the pH of vaginal discharge?

4-4.5

what is the normal amt of vaginal discharge per 24 hours?

1-3 mL

what is vulvovaginitis most commonly caused by? (3)

BV

candida

trich

how does BV clinically present? (3)

thin

grey/white/yellow

fishy odor

a positive "whiff test" is characteristic of what condition?

BV

what is the gold standard dx study for BV?

gram stain

what does amsel's criteria for BV consist of? (3 of 4 needed)

abnormal grey discharge

pH > 4.5

pos whiff test

presence of clue cells

what are the 3 tx's for BV?

metronidazole PO

metronidazole gel

clinda vaginal cream

pts with BV have an increased risk of acquiring what?

HIV and HSV

how does vulvovaginal candidiasis clincally present? (2)

itching

odorless cottage cheese

what is diagnostic of vulvovaginal candidiasis on microscopy? (3)

budding yeast

pseudohyphae

hyphae

what is the tx of uncomplicated vulvovaginal candidiasis? (2)

complicated vulvovaginal candidiasis?

PO fluconazole; topical imidazoles

PO fluconazole (2 doses)

if pt has recurrent vulvovaginal candidiasis, what should be considered? (2)

diabetes or autoimmune disease

many women are prone to vulvovaginal candidiasis after taking abx, so what should be prescribed and when?

fluconazole at the start and end of abx

what is the most common NON-viral STI worldwide?

trich

clinical presentation of what?

- frothy, greenish/grey, foul smelling discharge

- strawberry spots

trich

what is the diagnosis of trich? (3)

pH > 4.5

motile organisms w/ flagella

positive NAAT

how should women be tx for trich?

how should men be tx?

metronidazole x 7 days

metronidazole 1x

repeat testing for trich is indicated in who?

when?

women

3 wks - 3 mos after tx

atrophic vaginitis is a pH of what?

>= 4.7

what is the initial tx of atrophic vaginitis?

what is the subsequent tx of atrophic vaginitis?

nonhormonal vaginal moisturizers

low dose vaginal estrogen

what is the most frequently reported infectious disease in the US?

chlamydia

what is the 1st line tx for chlamydia?

doxy

expedited partner therapy in tx of chlamydia/gonorrhea is indicated for who? (2)

ANY sex partner within 60 days

most recent sex partner if > 60 days

T/F positive chlamydia infections should be reported and will need repeat testing

true

inflammation of what may be present with gonorrhea?

bartholin glands

what is the 1st line tx for gonorrhea?

ceftriaxone IM

what are the causative organisms of PID? (3)

G/C

m. genitalium

if pt has RUQ pain with PID, pt may have what?

perihepatitis (fitz-hugh-curtis syndrome)

what criteria is diagnostic for PID?

cervical motion uterine/adnexal tenderness

what is the tx of PID? (3)

IM ceftriaxone

+

PO doxy

+

PO metronidazole

cervical motion tenderness in PID =

chandelier sign

T/F genital herpes cannot still be spread during asymptomatic shedding

false - can be spread

genital herpes may present as what with initial infection?

flu like syndrome

what is the preferred testing for genital herpes dx?

what is the tx of primary infection of genital herpes?

PCR

antivirals (-clovirs)

complications of what condition?

- aseptic meningitis

- neonatal transmission

- urinary retention

- sacral radiculitis

genital herpes

HPV 1,2,3,4,7,10 =

HPV 6,11 =

HPV 16 =

cutaneous warts

genital warts

highest progression to cancer

when should HPV vaccination begin?

age 11 / prior to sexual activity

t. pallidum gains access via abrasions and established initial ulcerative lesions known as what?

chancre

what is the sx of primary syphilis?

when does it present?

painless chancre

days-weeks after inoculation

if pt has NO hx of syphilis and is NOT pregnant, how is dx made?

VDRL and RPR tests (non-trep testing)

if pt has positive VDRL and RPR tests for syphilis, what should be done?

trep test for confirmation

what is the tx of syphilis?

benzathine PCN G

genital ulcer disease in which there is painless genital ulcers/papules at the site of inoculation

lymphogranuloma venereum

what is the causative organism of lymphogranuloma venereum?

chlamydia

what is the tx of lymphogranuloma venereum? duration?

doxy x 21 days

bacteria that causes a PAINFUL genital ulcer; more common in developing countries

chancroid

what is the causative organism of chancroids?

h. ducreyi

chancroids often have coinfection with what organisms? (2)

HSV or t. pallidum

what is the tx of chancroids?

azithro singe dose

where are bartholin's glands located?

4 and 8 oclock in the vulvar vestibule

if pt has batholins gland cyst/abscess W/ purulent drainage, what should be done?

culture for G/C

what pts would NOT need tx for batholins gland cyst/abscess?

asymp and < 40 yro

if pts are > 40 yro with batholins gland cyst/abscess, what tx is needed?

biopsy and removal

estrogen-dependent inflammatory disease that affects women during premenarchy, reproductive, and postmenopausal stages

endometriosis

what are the 2 classic sx of endometriosis?

progressive dysmenorrhea**

deep dysparenunia

endometriosis often presents with what type of pain?

when does it increase in severity?

cyclic pelvic pain

2-7 days before menses

what should be suspected in women with dysmenorrhea who do not respond to NSAIDs or OCPs?

endometriosis

what is a definitive dx of endometriosis?

how is it confirmed?

direct visualization during laparoscopy

biopsy

dark red "mulberry" or brown "powder burn" lesions

"chocolate cysts" due to the fluid color inside

dark red or blue "domes"

endometriosis

what is the permanent cure for endometriosis?

what tx has a 10% recurrence of sx?

there isnt one

total hysterectomy w/ B/L oophorectomy

BENIGN tumor of cells surrounded by a pseudocapsule of compressed muscle fibers

uterine leiomyoma

what is the most common indication for a hysterectomy?

uterine leiomyoma

what can induce rapid growth of uterine leiomyomas?

high estrogen states

what type of uterine leiomyoma?

located within the uterine wall; most common

intramural

what type of uterine leiomyoma?

protrude into the uterine cavity; associated w/ miscarriages

submucosal

enlarged, mobile uterus with an irregular contour is a feature of what?

uterine leiomyoma

what is the tx for uterine leiomyomas in pts who are NOT desiring fertility? (4)

if they're anemic?

myomectomy, COCs, IUD, TXA

iron supp

who is uterine prolapse most common in?

multiparous women

bearing down before full dilation of the cervix / when the bladder is not empty is a cause of what?

uterine prolapse

what are the 2 types of uterine prolapse? which is most common**

uterovaginal prolapse**

congenital prolapse

when the muscles/ligaments that support the bladder and vaginal wall weaken or stretch is known as what?

cystocele

device for tx of uterine prolapse that holds the genital tract in position

advised for pts who cannot undergo surgery

pessary (ring and hodge)

what is the most common operation for uterine prolapse?

vaginal hysterectomy

what are the 3 types of functional ovarian cysts?

follicular cyst

CL cyst

theca lutein cyst

follicular cysts are fluid rich in _____ and are lined by _____ cells

estogen

granulosa

what is the tx for most follicular cysts?

what is the tx to suppress development of new cysts?

none - most resolve in 6 weeks

OCPs

type of cyst that fails to degenerate after ovulation and is progesterone-dominant

CL cyst

a large majority of ovarian neoplasms are benign in _____ women

malignant ovarian neoplasms are typically seen in _____ women

reproductive age

postmenopausal

what is a biomarker that can help distinguish benign vs malignant pelvic masses?

CA-125

what is the most common epithelial cell tumor?

serous cystadenoma

what is the 2nd most common epithelial cell tumor that is characterized by is large size (fills entire abd cavity)

mucinous cystadenoma

arise from primary germ cells and can contain hair or bone

MC tumor found in all women

benign cystic teratoma (dermoid cyst)

teratoma that is predominately functioning thyroid tissue

struma ovarii

complete/partial rotation of the ovary on its ligamentous support =

fallopian tube twisting along with the ovary =

ovarian torsion

adnexal torsion

the primary risk factor for ovarian torsion is what?

ovarian mass > 5 cm

what is the tx of ovarian torsion in a postmenopausal pt, a necrotic ovary, or an ovarian mass suspicious for malignancy?

salpingo-oophorectomy

acanthosis nigricans is a symptom of what condition?

PCOS

what is the 1st line tx for hirsutism associated w/ PCOS?

if insufficient response after 6 mos?

COC

+ spironolactone (antiandrogen)

what is the 1st line tx for acne associated w/ PCOS?

for hair loss?

COC

minoxidil

if no desire to conceive, what is the 1st line tx for PCOS?

2nd line?

COC

metformin

what is a tx option for symptomatic perimenopausal women BUT is contraindicated if they have HTN, diabetes, obesity, smoker

OCPs

what is prescribed for women who do NOT have a uterus or is prescribed locally in very low doses for women with vaginal problems?

estrogen therapy

what is prescribed to protect women WITH a uterus from endometrial cancer

EPT

risk of breast cancer increased with EPT after use for how long?

3-5 years

which is better for longer duration of use due to its lower risk for breast cancer, EPT or ET?

ET

lack of urethral mechanical support resulting in insufficient resistance to outflow of urine during INcreased abdominal pressure

urinary incontinence

what is a confirmatory dx for urinary incontinence?

bladder stress test

what is the 1st line tx for urinary incontinence?

2nd line?

lifestyle changes

duloxetine

detrusor overactivity =

urge incontinence