gynecology board review february 2009 rapid fire review of the review……
TRANSCRIPT
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Gynecology Board ReviewFebruary 2009
RAPID FIRE
Review of the Review……
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The Newborn 1 day old infant with enlarged breast tissue on
exam Is this normal?
Yes Maternal estrogens has influence 2 days - up to 3
weeks
What other associated findings may be present? Galactorrhea, pink vaginal discharge
Management? Reassurance
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4 yo female with pain with urination.Exam—erythematous labia & perineum, no
discharge, no foreign objects…. What are some causes vulvovaginitis?
Non-sexually transmitted Chemical bubble baths Poor hygiene, tight clothing Foreign objects (foul odor) Pinworms Infectious
Sexually transmitted Gonorrhea Chlamydia Trichomonas Herpes cim
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Vaginal Secretions
pH Wet mount Discharge
Physiologic
<4.5
Epithelial cellsPrepubertal—mixed floraPubertal--lactobacillus
Clear / white
BV >5 Clue cells Gray-white+ Whiff test
Trich >5 Motile flagella Green-grayFrothyStrawberry cervix
Candida <4.5
Pseudohyphae WhiteCottage cheese
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What we got here???? Infancy / preschool Sx
Dysuria Bacterial Infxn
Vulvovaginitis Recurrent UTIs
Resolve spontaneously 1-2 yrs
Treatment???? Estrogen cream
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14 yo female, tanner 5 breast, no menses yet with cyclical abdominal pain?????
Dx? Imperforate Hymen
What are common findings? Hydrometrocolpos—retained menstrual
fluids Bluish bulging hymen Midline abdominal mass
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17 yo female severe intermittent LL abdominal pain x 1 day. Radiates lower leg. Associated nausea and vomiting
Dx?
Ovarian Torsion
How do we dx? Doppler Pelvic U/S Laparoscopic exam Diagnostic +
Therapeutic DO NOT DELAY w/CT or MRI
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PID
Triad? Lower abdominal tenderness+ Adnexal tenderness
+ Cervical motion tenderness
Treatment? Outpatient
Ceftriaxone 250 mg IM x 1 + Zithromax 1 gram x 1
Alternative: Ceftriaxone + Doxy 100 mg PO x 14 d Inpatient
Cefotetan 2 gram Q12 hr + Doxy 100 mg IV/PO Q12 Pain Persist….GET ULTRASOUND r/o TOA
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Female teenager with RUQ pain + N/V. Meds include OCPs. Best initial step to dx?
Possible Dx? Fitz Hugh Curtis
Perihepatitis LFTs normal
Diagnosis with? Cervical cultures Gonorrhea or
Chlamydia
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What is shown here?? Urethral Prolapse More common
in…? African American Obese
Treatment?? Estrogen cream BID
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The STDs
Bug Buzzwords Treatment
Trich Flagellated organsimsFrothy yellow malodorous d/cStrawberry cervixDyspareunia
Metronidazole 2 g x 1****Treat partner
Gonorrhea
Asymptomatic Joint pain (disseminated)RUQ pain
Ceftriaxone 125 mg IM x 1Cefexime, Cipro
Chlamydia
Treated for if + sx for Gonorrhea
Zithromax or Doxy
Herpes Painful genital ulcersMultinucleated giant cells
Acyclovir x 7 d
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What are the reportable STDs? Chlamydia Gonorrhea HIV Syphilis
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HPV What types are associated with genital warts?
6, 11 Cervical cancer?
16, 18, 31, 33, 35 What types do the vaccine (Gardisil) protect
against? 6, 11, 16, 18
When vaccine given? 3 shots Ages 9 – 26 years 0, 2, 6 mos
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14 yo female presents with malodorous vaginal discharge. She reports that she is not sexually active.
What do you suspect? Bacterial vaginosis
What do you expect the wet mount to look like? Ph >4.5, epithelial cells + bacteria = clue cells + Whiff Test
Treatment? Metronidazole 500 mg BID x 7d
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Pap Smear Indications
Sexually Active? Any age Every year What else??
Urine PCR for Gonorrhea and Chlamydia
Not sexually active? At age 18 Repeat Q3 yrs
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Oral Contraceptives Absolute Contraindication
Breast Cancer CAD CVA DVT / PE / Thrombotic
Dz Hepatic Disease Elevated Lipids Pregnancy
Relative Contraindications HTN Depression Migraines Drugs
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GO OUT AND CUREHAVE A GREAT AFTERNOON!!!!