Term
| What predisposes a woman to yeast infections? |
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Definition
| Diabetes, oral conntraceptives, and antibiotics. |
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Term
| What is the most common cause of vaginitis? |
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Definition
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Term
| A patient presents with a 2 day history of vaginal itching and burning. On examination, you note a thin, yellowish green, bubbly discharge and petechiae on the cervix (also known as a "strawberry cervix"). What test do you perform, and what do you expect to find? |
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Definition
| Mix the discharge with saline and view under a microscope. If you see Trichomonas vaginalis (mobile and pear-shaped protozoa with flagella), then the patient and her partner should be treated with metronidazole (Flagyl). |
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Term
| A 20 year old sexually active female presents to your office complaining of a heavy thin discharge with an unpleeasant odor. Adding 10% KOH to the discharge produces a fishy odor. What would you expect to see on microscopic examination? |
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Definition
| "clue cells," which are epithelial cells with bacilli attached to their surfaces. This patient has Gardnerella vaginitis. The patient should be treated with metronidazole (Flagyl). |
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Term
| What is the number one cause of urinary tract infections? |
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Definition
| E. coli. Other causative agents are also gram-negative. |
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Term
| What is the normal pH of hte vagina? |
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Definition
| 3.8 to 4.4 (A vaginal pH greater than 4.9 indicates a bacterial protozoal infection.) |
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Term
| What causes condylomata acuminata (venereal warts)? |
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Definition
| Human papilloma virus types 6 and 11. |
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Term
| What subtypes of HPV are associated with cervical cancer? |
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Definition
| HPV types 16, 18, and 31 are risk factors for cervical dysplasia, which can lead to cervical cancer. Multiple sexual partners and early onset of sexual activity are risk factors for cervical cancer, due to HPV infection. |
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Term
| When should you avoid treating a woman with Flagyl? |
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Definition
| If she is in her first trimester, metronidazole may have teratogenic effects. Clotrimazole (Gyne-Lotrimin) may be used instead. Side effects of Flagyl include nausea, vomiting, and metallic tastes. It acts similarly to disulfiram (Antabuse) and therefore should not be taken with alcohol. |
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Term
| A 30 year old female complains of a painfuls ore on her vulva that resembled a pimple at first. On examination, you find an ulcer with vague borders and a gray base. Probable diagnosis? |
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Definition
| Gram's stain, culture and biopsy (used in combination because of hte high false-negative rates) should show Haemophilus ducreyi causes chancroid. Treatment is erythromycin or ceftriaxone. |
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Term
| Condylomata acuminata frequently occurs in combination with what other STD? |
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Definition
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Term
| What is the most common cause of septic arthritis in young adults? |
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Definition
| Disseminated gonococcal infection. |
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Term
| What is the treatment for gonorrhea? |
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Definition
| Ceftriaxone and doxycycline. The latter is given because half of hte patients infected with gonorrhea are simultaneously infected with chlamydia. |
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Term
| What is the predominant organism in ahealthy female's vaginal discharge? |
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Definition
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Term
| A 34 year old female presents iwht amaculopapular rash on her palms and soles, states that she had a strange vaginal lesion about a month and a half ago. She complains of headaches and general weakness. On examination, you find she has multiple condyloma lata and lymphadenopathy. What is the diagnosis? |
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Definition
| Secondary syphilis. This develops 6 to 9 weeks after the syphilitic chancre, which will have resolved by this time. If it goes untreated, tertiary syphilis will develop. This can affect all the tissues in the body, including the CNS and the heart. Treatment is with penicillin G. |
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Term
| Is the Stein-Leventhal syndrome a unilateral or bilateral phenomenon? |
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Definition
| Bilateral. Both ovaries are cystic and enlarged with a thickened and fibrosed tunica. Patients are often infertile, obese, and hirsute. |
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Term
| What are the risk factors for pelvic inflammatory disease? |
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Definition
| 1. Age less than 20, 2. multiple sexual partners, 3. nulliparity, 4. previous history of pelvic inflammatory disease. |
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Term
| T/F: A woman with PID is likely to have an exacerbation of symptoms when she menstruates. |
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Definition
| True. The breakdown of hte cervical mucus antibacterial barrier allows bacteria to ascend from the lower tract to the upper tract. Pelvic exmaination, intercourse, and exercise can all exacerbate symptoms. |
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Term
| Which patients with PID should be admitted? |
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Definition
| Admit patients who are pregnant, have a temp > 38 C (100.4 F), are nauseated or vomiting (which prohibits oral antibioticsS), have pyosalpinx or tubo-ovarian abscess peritoneal signs, have an IUD, show no response to oral antibiotics, or for whom diagnosis is uncertain. |
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Term
| What are the criteria for diagnosis of PID? |
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Definition
| All of the following must be present: 1. adnexal tenderness, 2. cervical and uterine tenderness, and 3. abdominal tenderness. In addition, one of hte following bmust be rpesent: 1. temp >38 C, 2. endocervix Gram's stain positive form gram-negative intracellular diplococi, 3. leukocytosis > 10,000/mm3, 4. inflammatory mass on ultrasound or pelvic examination, or 5 WBC's and bacteria in the peritoneal fluid. |
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Term
| What percent of patients with PID become infertile? |
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Definition
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Term
| When does an ectopic pregnancy most commonly present? |
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Definition
| 6-8 weeks into the pregnancy. Patients usually present with amenorrhea and sharp, generally unilateral agbdominal or pelvic pain. Rupture of an ampullary ectopic typically occurs at 8 to 12 weeks, allowing adequate time for early diagnosis and treatment prior to rupture in most cases. Isthmic ectopics may rupture earlier at 6 to 8 weeks. |
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Term
| What percentage of pregnancies are ectopic? |
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Definition
| 1.5%. Ectopic pregnancies are the leading cause of death in the first trimester. |
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Term
| What is the risk of a repeat ectopic pregnancy? |
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Definition
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Term
| What is the most common site of implantation in an ectopic pregnancy? |
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Definition
| The ampulla of hte fallopian tube (95%). Less common are ectopics in the abdomen, uterine cornua, cervix and ovary. |
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Term
| What are th risk factors for an ectopic pregnancy? |
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Definition
| Prior scarring of the fallopian tubes from infection (i.e., PID or salpingitis). IUDs, a previous ectopic pregnancy, tubal ligation, STDs, changes in circulating levels of hormones, use of fertility medications, and previous abdominal surgery. |
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Term
| How often is an adnexal mass found in women with an ectopic pregnancy? |
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Definition
| Fifty percent of women with an ectopic pregnancy have an adnexal mass on exam. |
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Term
| How do hCG levels differ in women with ectopic pregnancies versus intrauterine pregnancy? |
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Definition
| In 85% of women with ectopic pregnancy, the hCG level is lower than expected. |
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Term
| What is the most common sign of an ectopic pregnancy by transvaginal ultrasound: adnexal mass or absence of intrauterine pregnancy? |
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Definition
| The absence of an intrauterine pregnancy at an hCG level >2,000mIU/mL is highly predictive of an ectopic pregnancy. An adnexal mass or gestational sac in the adnexal is less reliable finding and is not always seen in early ectopic pregnancies. |
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Term
| Does the presence of a thick endometrial stripe on ultrasound indicate an intrauterine pregnancy? |
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Definition
| The endometrium can be thickened due to the hormonal stimulation associated with either an ectopic or intrauterine pregnancy, so this is not a consistent sign of a normal pregnancy. |
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Term
| Does hte presence of a gestational sac always rule out an ectopicc? |
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Definition
| Up to 15% fo women with an ectopic pregnancy can have a "pseudosac" or fluid area (representing blood and mucus) within the cavity. Therefore, it is critical with women at high risk for an ectopic pregnancy to confirm an intrauterine pregnancy with a follow-up ultrasound. This ultrasound will identify the yolk sac ("double ring sign") or fetal pole within the gestational sac. |
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Term
| What are the indications for laparatomy for treatment of ectopic pregnancies? |
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Definition
| Common indications for laparotomy include an unstable patient, large hemoperitoneum, cornual pregnancy, lack of appropriate surgical tools for laparoscopy. Some authors would also include a large ectopic (>6cm) and fetal heart tones in the adnexa as indications for laparotomy. |
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Term
| Who is eligible for methotrexate treatment of an ectopic pregnancy? |
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Definition
| Patients who are hemodynamically stable with unruptured gestations <4cm in diameter by ultrasounnd. |
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Term
| What is the mode of action of methotrexate? |
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Definition
| Methotrexate is a folic acid antagonist. |
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Term
| What criteria are use for assuring the success of methotrexate? |
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Definition
| With a single dose therapy, the hCG levels should fall by 15% between days 4 and 7 after therapy and continue to fall weekly until undetectable. |
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Term
| Why is the Rh status of a pregnant patient important? |
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Definition
| If the mother is Rh negative, and hte fetus is Rh positive, there is a risk of developing Rh isoimmunization and fetal anemia, hydrops, and fetal loss can result. Rh immunoglobulin should be given to all Rh negative patients. The standard dose of Rho GAM is 300mg. |
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Term
| Should Rh negative women with ectopic pregnancies be given Rho GAM? |
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Definition
| Most authors recommend administration of mini-rhogam (50micrograms) with any failed pregnancy up to 12 weeks (with full dose Rhogam after 12 weeks). |
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Term
| The standard 300mg dose of RhoGAM protects against how much fetomaternal hemorrhage (FMH)? |
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Definition
| Approximately <30mL whole blood. Following trauma, FMH should always be considered. Order a quantitative Kleihauer-Betke assay to determine the amount of FMH and then calculate the appropriate RhoGAM dose. RhoGAM must be given within 72 hours of the event. |
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Term
| How much blood does a standard size pad absorb? |
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Definition
| 20 to 30 mL. This is useful to know when trying to estimate blood loss. |
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Term
| When can an intrauterine gestational sac be identified by an abdominal ultrasound? |
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Definition
| In the fifth week. A fetal pole can be identified in the 6th week, and an embryonic mass with cardiac motion in the 7th. |
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Term
| What is the most common non-gynecologic condition presenting with lower abdominal pain? |
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Definition
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Term
| Is appendicitis more comon during pregnancy? |
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Definition
| No (1/850). However, the outcome is worse. Prompt diagnosis is important because the incidence of perforation increases from 10% in the first trimester to 40% in the third. |
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Term
| How is the appendix displaced during pregnancy? |
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Definition
| Superiorly and laterally. Diagnosis of appendicitis in pregnant patients may be further complicated by the fact htat a normal pregnancy can itself cause an increased WBC. The WBC count usually does not increase beyond the normal value of 12,000 to 15,000. In a pregnant patient, pyuria with no bacteria suggests appendicitis. Pregnant patients may lack GI distress, and fever may be absent or low-grade. |
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Term
| What is the treatment of choice for a Bartholin gland abscess? |
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Definition
| Marsupialization with the placement of a word catheter. This prevents recurrences. |
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