If there is labial fusion due to 21-hydroxylase deficiency what is the treatment? what about if it is because androgen excesS? - Answer- tx: if too
... [Show More] much--> then d/c androgens, if due to 21 hydroxylase: cortisol + reconstructive surgery
How does vaginal atresia present - Answer- primary amenorrhea + cyclic abdominal pain
Tx for vaginal agenesis? - Answer- surgery to creaste neovagina with mcindoe procedure
Lichen sclerosis + atopic ecezema + lichen simplex chronicus are all treated with - Answer- topical steroids. Note 10% associated with cancer
Lichen planus ( purple paules) is treated with - Answer- steroid suppository + surgery for adhesions
vulvar psoriasis is treated with - Answer- topical steroids or UV lights
vaginal adenosis ( red sports in upper 1/3 of vagna) - Answer- close f/u
atrophic vaginitis tx - Answer- topical estrogen
epidermal inclusion cyst tx - Answer- I+D or excision if infected
sebaceous cyst tx - Answer- I+D or excision
apocrine cyst tx - Answer- I+D or excision
gartner duct cyst tx - Answer- excision
What causes the pain associated with fibroids - Answer- fibroid outgrows blood supply
Sx of leiomyomas? - Answer- menorrhagia, pelvic pain, presusre
management of fibroids - Answer- leave alone if asx
temporary shrinkage w/ ↓E (progesterone, danazol, leuprolide) Tx myomectomy if fertility desired
Tx hysterectomy (definitive)
Tx uterine artery embolization if bad surgical candidate
how do endometrial polyps present? - Answer- vaginal bleeding between periods
mgmt of endometrial polyps - Answer- dx: pelvic ultrasound and treatment is d/c + bx to r/o to cancer
Risk and protective factors for endometrial hyperplasia - Answer- Risk factors: ↑E levels - unopposed E therapy (↑E w/o P) tamoxifen use (weak E)
obesity/HTN/DM (↑aromatase in fat cells) PCOS/chronic anovulation (↑E w/o P) nulliparity (↑total cycles)
early menarche/late menopause (↑total cycles) granulosa cell tumor (↑E synthesis)
Protective factors: COC/POP/combination HRT (↑P) multiparity (↓total cycles)
diet and exercise (↓fat cells)
Endometrial hyperplasia tx - Answer- Management: Dx endometrial bx or D+C → Tx progestins for 3 mo + repeat endo bx; hysterectomy if complex/atypia
What is considered a high risk ovarian mass? - Answer- premenerchal, postmenopausal, greater than 8cm or a mass that persists >60 days. Tx ex lap for cancer
What is the difference between follicular cysts, corpus luteam cysts, theca-lutein cyst, chocolate cyst, and PCOS? - Answer- 1. Follicular cysts: MC ovarian cyst, due to unruptured follicle, usually asx
2. Corpus luteum cysts: due to hemorrhage into persistent corpus luteum, presents as dull abd pain (unruptured) or acute abdomen (ruptured) M
3. Theca-lutein cysts: multiple/bilateral due to FSH/LH stimulation; associated w/ moles and choriocarcinoma
4.Chocolate cysts: ovarian endometriosis
PCOS: enlarged ovaries w/ multiple subcortical cysts
The three "D" symptoms of endometriosis? - Answer- dysmenorrhea (hallmark = cyclic pelvic pain, worst 1-2 days before menses)
dyspareunia
dyschezia (due to endometrial implants in pouch of Douglas)
Physical exam of endometriosis - Answer- Physical exam: uterosacral nodularity on rectovaginal exam, fixed retroverted uterus
Management of endometriosis - Answer- Dx requires direct visualization → temporary relief w/ ↓E (progesterone, danazol, leuprolide) + NSAIDs
Tx surgical ablation if fertility desired
Tx hysterectomy + LOA + removal of implants (definitive)
What is adenomyosis? physical exam finding? how does it present? and how do we manage it? - Answer- Adenomyosis: extension of endometrial tissue into myometrium
Sx: dysmenorrhea, menorrhagia, or both
Physical exam: diffusely enlarged, boggy uterus
Management: Dx pelvic U/S → temporary relief w/ ↓E (progesterone, danazol, leuprolide) + NSAIDs
Tx hysterectomy (definitive)
UTI etiology - Answer- Etiology: E. coli (MCC), S. saprophyticus (#2), Enterococcus (#3), other GNB
Candidiasis dx and tx - Answer- Dx budding yeast + pseudo- hyphae on KOH prep → Tx fluconazole (Diflucan)
Chancroid dx and tx - Answer- painful chancre + inguinal LN- opathy
Dx "school of fish" on Gram stain → Tx azithromycin or ceftriaxone
Progression of syphillis - Answer- 1° syphilis: painless chancre + inguinal LN-opathy
2° syphilis: palmar/plantar rash, fever, LN-opathy, condyloma lata
3° syphilis: neurosyphilis (tabes dorsalis), CV syphilis, gummas
Treatment for syphillis - Answer- Tx IV penicillin G
HSV daignosis - Answer- Tzanck smaer or viral cx
HSV tx and dx - Answer- Dx Tzanck smear or viral cx → Tx ACV/VACV + palliative care
LGV is what bacteria - Answer- Chlamydia trachomatis,
primary secondary and tertiary LGV - Answer- 1° LGV: transient, painless ulcer
2° LGV: painful LN-opathy
3° LGV: anogenital syndrome (proctocolitis, rectal stricture, rectovaginal fistula, elephantiasis)
LGV treatment - Answer- doxycycline
Condyloma acuminata which subtypes - Answer- HPV 6/11
chancroid bug - Answer- Haemophilus ducreyi
dx of chacroid and tx? - Answer- Dx "school of fish" on Gram stain → Tx azithromycin or ceftriaxone
Lymphogranuloma venereum bug and progression - Answer- Chlamydia trachomatis,
L1-L3 serotypes
1° LGV: transient, painless ulcer
2° LGV: painful LN-opathy
3° LGV: anogenital syndrome (proctocolitis, rectal stricture, rectovaginal fistula, elephantiasis)
Lymphogranuloma venereum dx and tx - Answer- Dx PE or complement fixation → Tx doxycycline
Genital warts is due to... and how do we treat? - Answer- Condyloma acuminata
Dx PE → Tx removal
Molluscum contagiousum appearance, dx and tx - Answer- domed papule w/ umbilicated center
dx: PE and tx: removal
thin homogenous discharge, fishy odor - Answer- bacterial vaginosis
Dx and Tx of BV? - Answer- Dx "clue cells" on wet prep → Tx metronidazole
green-gray frothy discharge, odor, strawberry cervix (petechiae) - Answer- Trichomoniasis
Tx and dx of tichomoniasis - Answer- Dx mobile trichomonads on wet prep → Tx metronidazole
Gonorrhea tx - Answer- Tx: cef
chlamydia tx - Answer- Tx azithromycin (± ceftri
Jarisch-Herxheimer rxn - Answer- acute febrile rxn s/p syphilis tx (MC w/ 2° syphilis), due to dead spirochetes → endotoxin release
tx of endometritis - Answer- Tx clindamycin + gentamicin
PID tx preg vs non-pregnant - Answer- Tx clindamycin + gentamicin (pregnant)
Tx ceftriaxone + doxycycline (not pregnant)
PID dx and tx - Answer- Dx pelvic/abd pain + cervical, adnexal, or uterine motion tenderness → Tx clindamycin + gentamicin (pregnant)
Tx ceftriaxone + doxycycline (not pregnant)
Tubo-ovarian abscess treatment - Answer- Tx admit + IV abx → drainage if unresponsive
Toxic shock syndrome management - Answer- Management: Dx clinical judgment → Tx admit + stabilize + IV nafcillin (prevents recurrence, not current toxin-mediated illness)
HIV patho - Answer- retroviral virus that infects CD4 and TH cells
HIV progressio - Answer- Primary HIV infx: presents as mono-like syndrome ± maculopapular rash
Latent stage: CD4+ >500, asymptomatic
Symptomatic stage: CD4+ 200-500, mild HIV sx
AIDS: CD4 + <200 or presence of AIDS OI
Tx of HIV - Answer- Tx HAART (2 NRTIs + 1 NNRTI or PI) + OI tx/ppx
1-4 Prolapse - Answer- 1° prolapse: in upper 2/3 of vagina
2° prolapse: down to introitus
3° prolapse: protrudes outside vagina (partial)
4° prolapse: entire structure outside vagina (complete)
Tx for prolapses cystocele? rectocele? procidentia? vaginal vault prolapse? - Answer- nonsurgical tx (Kegel exercises, pessaries, E replacement)
cystocele → anterior colporrhaphy rectocele → posterior colporrhaphy procidentia → hysterectomy
vaginal vault prolapse → vaginal suspension
Normal Continence--sympathetic vs parasympathetic - Answer- sympathetic--detrusor relazation and int sphinceter ocnstriction
parasym: detrusor constriction ad int sphincter relaxation
somatic: ext sphicter constriction
First step in Management of any incontinence - Answer- first step is always to get UA/UCx to r/o UTI
Management of stress inconteincen - Answer- surgery to stabilize hypermobile urethra (best), Kegel exercises, pessaries
Management of urge incontinence - Answer- anticholinergics (oxybutinin), TCAs (imipramine)
Management of overflow incontinence - Answer- intermittent self-cath, cholinergics (↑bladder contactility) + α1-blockers (↑urethral resistance)
Management of Bypass incontience, and dx - Answer- Dx methylene blue or indigo carmine dye → Tx surgery to repair fistula
Management of functional incontinence - Answer- Tx underlying cause
Hypothyroidism and infertility mechanism- tx - Answer- ↓T3/T4 → ↑TRH → ↑prolactin → ↓GnRH; Tx replacement T3/T4 (Synthroid)
Hyperprolactinemia and infertility mechanism and tx - Answer- Hyperprolactinemia × infertility: ↑prolactin → ↓GnRH; Tx dopamine analogs (cabergoline, bromocriptine) vs. surgery
average age for menopause - Answer- 51
Management of menopause - Answer- Tx lowest dose HRT (estrogen + progesterone) for only 6-12 months
hrt BENEFITS vs risks - Answer- HRT benefits: prevention of osteoporosis, relief of menopausal sx
HRT risks: ↑risk of endometrial hyperplasia/cancer
HRT contraindications: h/o clotting dz, liver dz, pregnancy, estrogen-dependent neoplasm, undiagnosed vaginal bleeding [Show Less]