Gynecology Board ReviewFebruary 2009

RAPID FIRE

Review of the Review……

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

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

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

What we got here???? Infancy / preschool Sx

Dysuria Bacterial Infxn

Vulvovaginitis Recurrent UTIs

Resolve spontaneously 1-2 yrs

Treatment???? Estrogen cream

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

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

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

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

What is shown here?? Urethral Prolapse More common

in…? African American Obese

Treatment?? Estrogen cream BID

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

What are the reportable STDs? Chlamydia Gonorrhea HIV Syphilis

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

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

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

Oral Contraceptives Absolute Contraindication

Breast Cancer CAD CVA DVT / PE / Thrombotic

Dz Hepatic Disease Elevated Lipids Pregnancy

Relative Contraindications HTN Depression Migraines Drugs

GO OUT AND CUREHAVE A GREAT AFTERNOON!!!!