OB: STI, breast problems, infertility

Syphillis 

Caused by

• transmission?

Manifestations

• Primary syphillis SX?

• Secondary syphillis:

  • how long after primary syphillis?

  • SX?

• Tertiary syphillis:

  • how long after secondary syphillis?

  • SX?

Tests:

• ?

Medication:

• If pregnant: ___

• If not pregnant: ____

Education

• Get your sexual partner checked/screened for STD

• Crosses through placenta

• enters through broken SQ tissue during sexual activity

• PAINLESS raised fluid-filled chancre in genital area← and its highly infectious

• 6 months

• bilateral rash at palms/soles + sickness SX + swollen nodes

• 1 year

• systemic SX (neuro, heart, musculo-skeletal)

• VLDR serology screening test —> treponomal test (to confirm positive results)

• penicillin

• tetracycline doxycycline

Pelvic inflammatory disease (PID)

Caused by

• which 2 STIs?

• Risk factors: prior STI, sexual activity, 3 weeks after IUD insertion 

***think: the IUD causes inflammation bc its a foreign object in there!!**

Manifestations 

• ?

Tests

• Documentation of prior STI

• Went mount displays elevated WBC and STI bacteria 

Medication

• Pain meds

• Antibody therapy 

Education

• Prevention!

• chlamydia and gonorrhea

• fever, cervical motion tenderness, lower abdominal pain, bleeding after sex,

Human papilloma virus (HPV)

• Primary cause of ____ cancer 

Manifestations

• SX?

• # of lesions increased or decreased with pregnancy?

• Might require C-section based on size 

Medication

• Can resolve by itself 

• Soothing methods: _____

Treatment 

• NON-CURABLE btw

• No sex

• Gardasil vaccine

• Annual pap screening 

• cervical

• PAINLESS soft flat genital warts (can be singlular or clustered); can be in genital or buttocks area

• increased

• oatmeal solution + low heat setting hairdryer + cotton underwear

Human immunodeficiency virus (HIV)

Transmission

• CROSSES PLACENTA = increased transmission risk from mother-baby during delivery

• For non preggo people, transmission risk from ____

• Risk factors: sexual behavior, needle drug use, history of multiple STIs 

Manifestations

• Seroconversion wont occur until ____

  • what does this entail?

• Often asymptomatic but can have what SX?

• Labratory findings?

Tests

• ______

  • Recommended @ ppl with high risk + ALL preggo women 

Treatment 

• If pregnant: _____

• If during labor or prior to C-section:_____

  • why is this treatment best preferred?

Education

• Mode of birth delivery depends on viral load 

  • If viral load ___ = vaginal delivery

  • If viral load ____ = C -section

• After delivery:

  • 2 important things?

• minimum 6 weeks

• so if person gets infected today, the test results will be a false-negative until 6 weeks later

• sickness SX + swollen nodes

• low WBC, low CD4, low Tcells

• Western blot

• Zidovudine

• ART or HAART

• most effective at keeping viral load low

• less than 1000

• more than 1000

• administer the baby Zidovudine ASAP after birth and continue for 6 weeks + NO breastfeeding

Bacterial vaginosis 

Caused by

• Gardnerella vaginalis 

• Presidposing factors: multiple sex partners, douching, lack of vaginal lactobilli (due to increased anaerobic bacteria, altered vaginal pH, or infection)

Manifestations

• ?

Test

• ?

Medication

• ?

• fihsy odor + thin frothy discharge

• whiff test

• metronidazole

Trichomoniasis 

Caused by

• T.vaginallis

Manifestations

• ?

Tests

• ?

Medication

• ?

• fishy odor + green/yellow frothy discharge + strawberry spots on cervix

• nucleic acid amplification test

• metronidazole

Chlamydia

• Most common STI in women and more difficult to diagnose bc of nonspecific SX

Manifestations 

• Asymptomatic usually 

• Bleeding after sex

• Spotting

• Purulent discharge

• Dysuria 

Tests

• Nucleid acid amplification tests 

• Culture (but too expensive)

Medication

• For preggo women and normal person = Azithromycin 

• Doxycycline 

Education

• Both partners should be treated

• Non-preggo women dont need to be rested unless SX continue 

• Preggo women should be retested q3 months 

Gonorrhea

Manifestations 

• ?

Tests

• ?

Medications 

• ?

Education

• NO PROTECTED sex until both partners treated and abcense of SX

• green pus-like purulent discharge INSIDE cervix, painful menstruation, lower abdominal pain, dysuria

• Thayer Martin culture

• Ceftriaxone, Azithromycin, Doxycycline B

Herpes simplex virus (HSV)

• HSV = oral herpes 

• HSV 2 = genital herpes 

• Primary infxn if when u first get it (thus have no pre-existing antibodies)

• Secondary infxn is when you become infected w/ another type of HSV (thus u alr have pre-existing antibodies)

Manifestations

• ?

• Complication = ?

Testing 

• BEST METHOD = _____ 

Medications 

• Acyclovir 

• Pain meds 

• Cleanse with normal saline 

Education 

• HSV increases susceptibility for contracting ____

• HSV can worsen HIV patient’s ____

• Vaginal delivery if ____

• C-section if ____

• fluid-filled blisters that crust over after bursting + sickness SX + lymphadenopathy

• miscarriage in 1st trimester + neonatal herpes

• HIV

• risk for infection

• no lesions present

• lesions present

Viral hepatitis 

HepA

• Transmission: fecal-oral route

HepB

• Transmission: sexual contact + body fluid + mother to baby

HepC

• Transmission: direct blood-to-blood contact (ex: sharing needles)

Candidiasis 

Manifestations 

• Itching

• Dysuria 

• Cottage cheese discharge

Medication

• ?

Group B streptococcus

• Normally found in flora of non-pregnant women

• HIGH RISK for neonatal death 

Tests

• ?

Medication

• ?

• recto-vaginal culture during 2nd trimester

• Penicillin every 4 hrs during labor until baby gets delivered

TORCH 

An acronym for a group of vertically transmitted infxns (so yes, crosses placenta)

• Toxoplasmosis

• Other (syphillis, zika, HIV, etc…)

• Rubella 

• Cytomegalovirus

• Herpes simplex virus

____: benign solid mass in breast UNRELATED to menstrual cycle

• Mainly seen @ adolescents

• SX: Painless, smooth, firm, mobile

• fibroadenoma

____: bilateral lumpiness DIRECTLY related to menstrual cycle (so it worsens before u start period)

• SX?

• Diagnosis method?

  • which step is to determine if solid or fluid-filled?

  • If cyst is fluid-filled —> need to use fine needle aspiration 

• Management: 

  • STOP smoking and alcohol

  • use oral contraceptives (helps control hormone fluctuations)

• fibrocystic changes

• fullness, heavy, tender

• breast exam —> ultrasound —> mammogram —> biopsy

• ultrasound

____: inflamed infected breasts due to clogged ducts 

Caused by:

• incomplete breast emptying @ breastfeeding women 

• sore and cracked nipples 

• Breast trauma

• Poor nutrition

Manifestations

• ?

***obv bc this is an infxn so it manifests as infxn***

Treatment:

• Antibiotics

• Warm or cold compress?

• Breast pump OR having ur partner suck out the blocked duct LMAOOO

• mastitis

• painful swollen breast + sickness SX (fever, chills, body ache, vomit)

• warm (to get things flowing!!!)

Mammary duct ectasia

• Seen @ _____

• SX?

• perimenopausal smokers or diabetics

• sickness SX + nipple inversion + green nipple discharge

Galactorrhea 

• SX?

• Usually an issue with which endocrine gland?

• Tests: prolactin and thyroid levels 

  • Usually this condition due to high levels of _____

• milky nipple discharge

• anterior pituitary gland

• prolactin

_______

• SX: seroanguinous or bloody nipple discharge 

intraductal papilloma

____: infection of breast skin/SQ tissue

• SX: pain, tender, redness, swelling

• Can occur with or without abcess

• cellulitis

Breast cancer

NON-modifiable risks

• what age?

• Women higher risk than men

• Early or late menarche?

• First child is born after age ___

• Length of time on oral contraceptives

• which specific gene?

• note: Not all pateints with family history are at risk!

Risk assessment tool:  

• involves which 6 things?

• 50+

• early menarche

• 40

• BRCA 1 and 2

• age + age that you delivered ur first born child + number of first-degree relatives with breast cancer + number of breast biopsies + if any breast biopsy results had abnormal hyperplasia

Breast cancer

Manifestations 

• Nipple retraction

• Skin dimpling (peau de orange)

• Inflamed axillary lymph nodes

• Redness w/pitting edema ← suggests advanced + aggressive breast cancer

Screening guidelines 

• Staging cancer progress using what acronym?

• BEST site for palpating breast cancer lumps is?

• Breast self exam ← no longer recommended method

• _____ ← GOLD STANDARD for breast cancer screening

  • if mammogram results are suspicious → biopsy via fine needle biopsy performed

• acronym

  • T = TUMOR size and location

  • N = Lymph NODE involvement

  • M = METASTASIS present or not

• upper outer quadrant of breast

• mammogram

Breast cancer

Pathophysiology of 2 types of breast cancer

1. ____: originates in lactating ducts → invades surrounding area

• SX:___

• the most common breast cancer

2. ____: originates in lobules (milk-producing ducts)

• SX: ___

More info

• Invasion results in PALPABLE irregular tumor border

• Peau de orange due to tumor fibrosis 

• Lymphatic invasion results in tumors at which lymph nodes?

• which 3 hormones have effect on breast cancer growth?

• what is Triple negative breast cancer?

• what is Paget’s disease?

  • SX?

  • Often seen @ older individuals  

  • Diagnosis?

• Inflammatory breast cancer

  • SX?

• ductal

• PALPABLE solid mass + immobile + non-tender

• lobule

• NON-PALPABLE + hard to detect on mammogram due to diffused thickening of breast tissue

• breast and axillary lymph nodes

• estrogen, progesterone, HER2

• due to estrogen, progesterone, HER2

• basically nipple cancer; a type of ductal carcinoma

• bleeding oozing crusty nipple

• skin punch biopsy

• red rash at breasts

Mastectomy types

Lumpectomy: removing the single lump

Total simple mastectomy: removal of _____

Modified radical mastectomy: removal of _____

Skin and nipple sparing mastectomy: _____

Nursing post-mastectomy

• AVOID taking BP measurements, injections, or blood draws on AFFECTED side of mastectomy

• Keep affected arm elevated

• Encourage ROM to reduce lymphedema of affected area

• breast + nipple + areola

• breast + nipple + areola + axillary lymph nodes

• breast + nipple + areola BUTTTTT reserving the skin for reconstructive purposes

Other treatments

• Radiation: performed after tumor removal to remove any leftover potential micromestatic tissue at original tumor site

• Adjuvant systemic therapy: given after tumor removal to destroy cancer cells that might have spread throughout the body

Infertility types

• ____: 12 months of unprotected sex without conception but CANT get preggo…

• ____: couple has conceived before, but concieving AGAIN is difficult 

Different causes of infertility in women

Hormonal/ovulatory

• Primary an-ovulation: person has never had regular ovulation before

  • due to immature puberty OR hypothalamus or ant.pituitary issue OR adrenal gland issue (when egg doesnt release)

  • Often seen @ adolescents

• Secondary an-ovulation: person had normal ovulation before, but its now abnormal (ex: irregular cycles, etc…)

  • Often seen @ young-midlife women 

• Obesity 

• Thyroid dysfunction

• PCOS

• Early menopause 

• Nutritional issue 

• Cancer + chemotherapy 

• Depression

• Smoking, environmental toxins, inflammation, oxidative stress

• High consumption of alcohol or caffeine 

• Hyperprolactinemia: due to side effect of certain medications, pituitary issues, physical stress, severe emotional distress

• Amenorrhea after getting off ur oral contraceptive

Tubal and peritoneal

• Loss of tube mobility/patency

  • Caused by infxn, adhesions, endometriosis, tumors, absence of tubes

  • STI are a major cause of these!!

Uterine factors

• Infxns

• Congenital uterine defects/tumors

Vaginal/cervical

• pH of vaginal secretions 

  • Clear and thin = GOOD for sperm

• pH of vagina itself

• Anti-sperm antibodies

Diagnosis procedures for women infertility

• Determination of ovulation:

  • Ovulation kit: tests for LH surge 24-36 hrs before ovulation (positive LH surge indicates ovulation is abt to happen)

  • Progesterone levels 1 week before of menses (high progesterone indicates recent ovulation occured)

  • Basal body temp

  • Cervical mucus quality

• Hormone analysis 

• Ultrasonography (transvaginal ultrasound)

• ____: insertion of dye into uterus and fallopian tubes thorugh the cervix entry 

  • for detecting ____

• _____: visualization of uterine cavity via cervix entry 

  • GOLD STANDARD for detecting ____

• _____: visualization of pelvic structure 

• hysterosalpinography

• blockages

• hysteroscopy

• detecting fibroids

• laparoscopy

Different causes of infertility in men

• Low testosterone 

• Structural issue (cryptorchidism, hypospadias, blocked vas deferens

• Varicoele: enlarged vein in spermatic cord resulting in constricted spermatic cord 

• Low sperm count, sperm inactive, immature or abnormal sperm

• Infections 

  • STI

  • STD

  • Mumps (inflamed salivary glands which also results in inflamed testes)

• Radiation 

• Exposure to high temps (hot tubs, tight underwear)

• Cancer + chemotherapy 

• Obesity 

• Substance use (steroids, certain meds, alcohol, smoking)

Diagnosis procedures for men infertility

• Semen analysis: to assess sperm

• Ultrasonography of scrotum: to idenyify vessels and abnormalities of spermatic cord 

• Genetic testing

• Hormone analysis 

• Testicular biopsy