women's health quick review

m/c type of cyst

follicular cyst

failure in ovulation causes this cyst. fluid collects and isn’t reabsorbed, creating the accumulation in follicle space

follicular cyst

pt is asx, can have bleeding and torsion. large cysts cause aching pelvic pain, dyspareunia, AUB bc of disturbed ovulatory pattern

follicular cyst

how to tx follicular cyst

usually disappear spontaneously in 60 days. OCPs to give a nl rhythm. ± aspiration

this cyst aka granulosa lutein cysts. a thin walled single chamber cyst. after nl ovulation, granulosa cells lining the follicle are luteinized. blood accumulates in central cavity, making a corpus hemorrhagicum. resorption of the blood makes it. >3cm considered a cyst.

corpus luteum cyst

persistent corpus luteum cyst causes what sx

local pain or tenderness. amenorrhea, delayed menstruation. sx similar to ectopic pregnancy

how to tx a corpus luteum cyst

laparoscopy or laparotomy needed to control hemorrhage.

hi levels of hCG but the pt is not actually pregnant indicated this type of cyst. in pts with hydatidiform mole or choriocarcinoma in pts with fertility tx. these cysts are usually b/l and are filled with clear, straw colored fluid

theca lutein cyst

pt has dec abdominal sx, ± pelvic heaviness, rupture causes intraperitoneal bleeding, pts get signs and sx of pregnancy, hyperemesis, breast paresthesias

theca lutein cysts

how to tx theca lutein cyst

disappear randomly after termination of the molar pregnancy, tx of choriocarcinoma, or d/c of fertility therapy. surgery for complications liek torsion and hemorrhage

pt has hyperandrogenism, ovulatory dysfxn, polycystic ovaries, insulin resistance. pts have hirsutism M/C, acne, alopecia, irregular menstrual cycles.

PCOS

what happens to the ration between Lh and FSH in pts with PCOS

LH is inc in comparison to FSH

what hormone is elevated in women with PCOS

testosterone

long term complications of women with PCOS

infertility or pregnancy complications, endo hyperplasia and endo cancer

how to tx PCOS

weight loss, metformin to help with infertility, OCP for hirsutism and menstrual irregularities

pt has u/l pelvic pain but has a neg preg test, and has a pelvic mass, and shows a mass on pelvic US. they have lower ab pain/pelvic pain. is sharp, dull, constant, or intermittent. can radiate to abdomen, back, or flank. postmenopausal women complain of a dull constant ache, where premenopausal women describe it as a sharp stabbing pain.

ovarian torsion

what is the imaging of choice to dx an ovarian torsion

US with doppler

what does a whirlpool sign on a US doppler of the ovary indicate

twisting of ovarian vascular pedicle in cross section. to dx ovarian torsion

what is the definitive dx for dx an ovarian torsion

direct visualization during surgery

how to tx ovarian torsion

surgical detorsion using laparoscopic surgery. if postmenopausal then salpingo-oophorectomy

m/c causes of infectious cervicitis

chlamydia #1, gonorrhea, HSV, HPV, trich.

untx cervicitis can cause

PID leading to higher risk of infertility, ectopic pregnancy, or chronic pelvic pain

purulent vaginal discharge, vulvar burning and itching, vaginal bleeding, usually after sexual intercourse. discharge changes per pathogen

acute cervicitis

pt has leukorrhea (constant vag discharge), cervical mucosa is hyperemic and ulcerated. postcoital bleeding. lower abd pain or lower back pain.

chronic cervicitis

malodorous, green-yellow frothy vaginal discharge. pt might have pruritis and irritation, also dysuria and dyspareunia. inflammation and punctate hemorrhages on cervix = strawberry cervix

cervicitis bc of trichomonas

how to dx cervicitis from trich

wet prep, PCT test

how to tx cervicitis from trich

metro

gonorrhea is what kind of organism

gram negative diplococci

pt has UTI/vaginitis like sx of dysuria, inc discharge, vaginal bleeding between periods. they can also have discharge, anal itching, soreness, bleeding, painful bowel movements.

cervicitis from gonorrhea

how to tx a gonorrhea infxn

1 single dose IM ceftriaxone 500mg.

pt has vaginal discharge, bleeding, abdominal pain, dysuria, maybe cervicitis with discharge. women complain of postcoital bleeding or bleeding between menses

chlamydia infxn

how to dx chlamydia

NAAT test

how to tx gonorrhea

doxy 100mg BID for a week or z pak if preg

inflammation of upper genital tract bc of infxn. is an ascending infxn spreading from the lower genital tract. pt has lower abdominal pain, pelvic pain, vaginal discharge, dyspareunia, abnl vaginal bleeding

PID

m/c PE findings for a pt with PID

lower abdominal pain and fever. n/v, CMT (chandelier sign), friable cervix.

how to tx PID

ceftriaxone 500mg IM 1x AND doxy 100mg BID PO for 2 wks

if pt is preg and has PID hwo to tx

z pak

untx PID can lead to

infertility, peritonitis, fitz hugh curtis syndrome (perihepatitis related to violin sticky strands that invade the liver capsule)

on cervix you see translucent or yellow bumps. nonpainful, can happen after a minor trauma or birth. they usually don’t go away and pts don’t know that they even have them

nabothian cysts

how to tx nabothian cyst

if asx no tx, if painful then ablation

this cyst can be mistakened for Nabothian cyst or bartholin’s duct cyst BUT location and wolffian cells lining the cyst make it different

mesonephric cysts

most common type of HPV is what strain, which is responsible for half of cervical ca

HPV 16

this HPV strain is responsible for genital warts but is non high risk type

HPV 6 & 11

m/c way to identify cervical dysplasia

pap

what is ASCUS on pap

atypical squamous cells of unknown significance. usually from hormonal changes.

what is ASC H on pap

atypical squamous cells cannot exclude high grade squamous intraepithelial lesion. this is pre cancerous

what is LSIL or HSIL on pap

squamous intraepithelial lesions, low grade (nl colposcopy but is prob HPV) or high grade (tx with LEEP)

if a pap comes back as low grade in a young pt what is indicated

surveillance

if a pap comes back as lo grade in an old pt what is indicated

colposcopy

CIN 1

surveillance and repeat pap

CIN 2

cells are inside the cervix and are precancerous

CIN 3

precancerous, going up the uterus. preform LEEP and hysterectomy indicated

women with ASCUS and negative HPV should receive a repeat pap when

both 1 yr later

if pt has ASCUS and a pos HPV then what is indicated

colposcopy

women b/w 21-24 with LSIL should have a repeat pap when

1 yr later

what is the tx for pts with HSIL on pap

LEEP

complications of LEEP

bleeding, cervical stenosis, cervical shortening, inc risk of preterm delivery or spontaneous abortion. after a LEEP your paps are clear for a while… but you still have HPV

pt has non irritating, malodorous, vaginal discharge. thin grey white discharge. vaginal mucosa and epithelium are normal. no CMT or pelvic pain.

BV

how to dx BV

need ¾ of following: thin, white, homogenous discharge, pH >4.5, pso whiff test, CLUE CELLS ON MICROSCOPY

how to tx BV

metro, clinda

yeast vulvovaginitis is due to what pathogen

candida albicans

pt has genital burning, pruritis, dyspareunia, dysuria, thick white curd like or cottage cheese like discharge. friable vaginal mucosa and cervical epithelium. no CMT

yeast vulvovaginitis

what type of yeast infection is this: sporadic or infrequent, mild-moderate, prob c. albicans, in a non immunocomp pt

uncomplicated

what type of yeast infxn is this: recurrent (4 or more eps a year), severe, non albicans sp, women with DM, HIV, debilitated, immunocomp

complicated

what does wet prep show to dx yeast infxn

pseudohyphae

how to tx uncomplicated yeast infxn

OTC topical antifungal OR 1 dose fluconazole

how to tx complicated yeast infection

1-2 wk topical therapy OR fluconazole every 3rd day days 1 4 7

how to tx a severe yeast infxn

topical azole OR 2 dose fluconazole

how to tx non albicans sp yeast infxn

non fluconazole -azole tx

this dz is an inflammatory process occurring in pts with vaginal atrophy, secondary to lack of estrogen during menopause.

atrophic vaginitis

how to tx atrophic vaginitis

vaginal estrogen creams

pt has vulvovaginal dryness, pruritis, dyspareunia, abnl vaginal discharge, post coital pain, recurrent UTIs, urethral pain, hematuria, urinary incontinence

atrophic vaginitis

pt has pain/tenderness at 4 and 8 o clock positions. dyspareunia, hard to walk or adduct the thighs, feeling of a mass in posterior introitus. surrounding erythema, inflamed, fluctuant, tender mass.

Bartholin gland abscess

how to tx a bartholin gland abscess

I&D with marsupialization or balloon cath

intense vaginal pruritis usually in women older than 60. vulvar skin is thin, wrinkled, white, with lichenification and hyperkeratosis. anterior labia minora agglutinates. erosions and fissures from itching

lichen sclerosis

lichen sclerosis is assoc with what antigens and deficiencies

HLA, vit a def

how to dx lichen sclerosis

thin hyperkeratotic layer, thinning epithelial layer, flattening of papillae, homogenization of stroma, deep lymphocytic infiltration

how to tx lichen sclerosis

clobetasol. if it doesn’t work then tacrolimus or retinoids

pt has dystrophy, squamous cell hyperplasia, atopic derm, atopic eczema, and neurodermatitis. benign epithelial thickening and hyperkeratosis from chronic irritation. constantly scratching it causes skin thickening and moist environment causes maceration and raised white lesion.

lichen simplex chronicus

how to tx lichen simplex chronicus

sitz bth and lube. PO antihistamines to dec itch

pt has burning itching and flu sx, then vesicles on genitals develop but erode fast, creating painful erosions or ulcers. each erosion si surrounded by a red halo, dewdrops on a rose petal.

herpes genitalis

gold standard of dx of herpes genitalis

viral culture

if mother has herpes genitalis at time of delivery wat do you do

c section

how to tx herpes genitalis

acyclovir, lesions are self limiting,

involuntary leakage with physical exertion or coughing or sneezing

stress urinary incontinence

how to tx stress urinary incontinence

weight loss, dec ceffiene, timed voiding, surgery like a sling if you’ve had issues for 10 yrs or more

linked with OAB. urgency + frequency + nocturia + incontinence. key in lock syndrome. uncontrollable urge to void when unlocking the door after returning home

urge urinary incontinence

how to tx urge urinary incontinence

bladder training, antimuscarinics (oxybutinin), botulism toxin

stress + urge incontinence at the same time. pts with SUI void too early to avoid a full bladder and then condition to have a lo functioning capacity creating premature bladder voiding

mixed incontinence

involuntary loss of urine assoc with bladder overdistension in absence of detrusor contraction. in men with BPH. pts have loss of urine without awareness or continuous dribbling or wetness feeling

overflow incontinence

pt feels like something is pushing anteriorly on their vagina. you see it on pelvic exam. this is

anterior vaginal ell cystocele

pt feels somethig pushing on theri vagina psoteriorly, you nee mass posteriorly. this is

rectocele

what prolapse is m/c post hysterectomy

enterocele. apical vaginal wall defect where bowel is contained in prolapse

how to reproduce the feelings of the prolapse on physical exam

ask pt to cough

how to tx pelvic organ prolapse

pessary

menopause is dx how

after 12 mo of amenorrhea with no pathologic dz.

what risk factor is assoc with early menopause

smoking

what hormone levels are hi in a pt with menopause

FSH is hi and estrodiol inc to try to push out another follicle

how to tx menopause

combo estrogen/progesterone. vaginal estrogen cream for dyspareunia

what is the most common sx of a pt with preinvasive dz of the vulva

itching