??

small smooth rounded lump on the cervix

Opaque with yellowish/bluish hue

0.3-3.0 cm

Very common, normal variant

Tx??

Nabothian cyst

NO tx will clear up on its own

if bothersome-electrocautery

??

Reddish ring of tissue surrounding os

usuallly in younger women

under the influence of estrogen-birth control & pregnancy

Since the columnar cells produce mucus because they have not changed to squamous cells, will

produce more mucus & prone to trauma & Chlamydia infx

THEREFORE:

Increased VAGINAL SECRETIONS & occasional POSTCOITAL BLEEDING

??

This is an abnormal protrusion of friable tissue into the endometrial cavity

On US appears as focal thickening of endometrial stripe

What will be seen with Endometrial Polyps??

Usually occurs during the reproductive years & postmenopausal

What is this:

Fingerlike outgrowth on surface of cervix/endocervical canal

Hang from a stalk & push through cervical opening

Which cervical polyp does this describe:

  Endocervial or Ectocervical??

Beefy red, Long pedunculated stalk

Pale, Broad base protrusion

ENDOCERVICAL-Beefy red, Long pedunculated stalk

ECTOCERVICAL-Pale, Broad base protrusion

Cervical Polyps:

symptom

presenting complaint

physical exam

symptom: Coital bleeding/Menorrhagia

presenting complaint: 

Abnormal vaginal bleeding (post sex, douching, b/w periods, menopause)

Abnormal heavy periods (menorrhagia)

White/Yellow discharge (leucorrhea)

physical exam:

Smooth red/purple fingerlike projections on cervical canal

Management of cervical polyps

hint there are 3

Surgical removal-outpatient (electrocautery/laser)

ABX given after removal d/t risk of infx

Biopsy of removal of tissue-most are benign

Regrowth uncommon

What are some causes of Cervical inflammation?

Risk factors??

STI

Result of atrophy

Risk factors:

Early coitus & Multiple partners

Cause: HPV 6 & 11

AKA: Veneral Warts

Condyloma acuminata:

appearance ??

accompanied with??

how is spread ??

appearance:  Soft Fleshy Cauliflower

accompanied with: Trichomonas & other STI

how is spread:  Skin to Skin contact

Symmetrical lesions across midline

"kissing lesions"

Condyloma lata is a secondary lesion of what STI

and what is the appearance??

Secondary lesion of SYPHILLIS/Treponema pallidum

Appears in moist areas

Slightly raised, Platuelike w/ various sizes

Occuring in clusters

Edges slightly indurated, surface moist, & covered w/ gray nectrotic exudate

HIGHLY INFECTIOUS

??

Appears in moist areas

Slightly raised, Platuelike w/ various sizes

Occuring in clusters

Edges slightly indurated, surface moist, & covered w/ gray nectrotic exudate

HIGHLY INFECTIOUS

Condyloma lata

Secondary infection of Syphillus

How are Condyloma latas distinguished from Condyloma acuminata??

Test??

Condyloma lata  have a broad base and flatter appearance

Test: FTA-ABS test for treponeum

In Cervicitis, what is the:

 clinical presentation

etiology

clinical presentation:

COPIOUS PURULENT/MUCOPURULENT vaginal discharge

Pelvic pain

Dyspareunia if severe

etiology:

Chlamydia

Gonorrhea

Herpes Simplex

HPV

Trichomonas

Trichomonas vaginalis

What's the treatment for:

Chlymadia & Gonorrhea

Trichomonas

Herpes

Chlymadia & Gonorrhea: 

Ceftriaxone 125 mg IM single dose followed by Doxycycline 100mg PO BID x7 days

Pregnant- Azithromycin 1 g single dose instead of Doxycycline

Trichomonas:  Metronidazole 2g single dose

Herpes: Acyclovir 200 mg PO 5x/day X 7 days

In Cervical Carcinoma, where are the abnormal cells found?

Most cases are believed to occur because of exposure to what?

Location: 

 Penetration of basement membrane & infiltration of the stroma of uterine cervix

Abnormal cells IN & UNDER basement membrane

High risk:  HPV 16, 18, 31, 33, 35

Mostly SQUAMOUS

Cervical Carcinoma physical findings:

Early

Late

Early:

NORMAL

unusual vaginal bleeding-particularly postcoital

Vaginal discharge & odor

Late:

LE edema

Renal failure

Cervical lesion-large bulky friable

Cervical Carcinoma:

how is it staged

what are the diagnostic tests

management

Staged:  CLINICAL, not surgical

Tests: PAP if abn then COLPOSCOPY then BIOPSY & endocervical CURETTAGE

Management: RADICAL Surgery & PELVIC Irradation

Cervical Neoplastic Disease:

Old term?

Which cells involved & where?

Epidemiology?

Old term: Cervical dysplasia (abnormal cells)

Which cells involved & where:

Squamous

Squamocolumnar junction and Transformation zone

Epidemiology:

Early intercourse

Multiple partners

Early childbearing

Veneral infx

Vulvovaginal candiadiasis

Bacterial vaginosis

Genitals HSV

HPV

Syphillus

CMV

Toxoplasmosis

Hep B & C

NO BREAST FEEDING

breast feeding plays a role in transmission

Firm Punched Out appearance w/ rolled edges

CHANCRE

Heals in 3-9 wks

Low grade fever

HA

Malaise

Sore throat

Anorexia

Generalized lymphadenopathy

ASX MACULOPAPULAR RASH-palms & soles

HIGHLY INFECTIOUS LESIONS

Screen:  VDRL & RPR

Confirmatory/Diagnosis:

FBS-ABS fluroescent treponemal-antibody absorption

Microhemagglutination assay for antibodies to T. pallidum

Syphillis tx:

TOC

Primary/Early latent?

Late latent/duration unknown

Neurosyphillis?

TOC:  Benzathine PCN G or Doxy/tetracycline

Primary/Early latent: 

 PCN G IM

or

Doxy BID x 14 day or Tetra QID x 14 day

Late latent/duration unknown:

PCN G IM weekly x 3 wks

or

Erythromycin x 14 day, Doxy x 14 day

Neurosyphillis:

Aq crystalline PCN G IV

Think G for Gonorrhea & Green/Yellow discharge

Malodorous Purulent discharge from:

Urethra

Skene's glands

Vagina

Anus

What type of organism is Gonorrhea

&

the most common symptoms??

GRAM - diplococci

begins 2-5 days after exposure

Vaginal discharge

Pelvic pain

Dyspareunia

Dysuria/Urgency/Frequency

Asymptomatic

LOCAL:

Conjunctivitis

Pharyngitis

Urethritis

Cervicitis

Proctitis

COMPLICATED:

PID

Bartholin abscess

Gonococcemia-arthritis,dermatitis,endocarditis,perihepatitis