Female GU

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Author:
wackojacko
ID:
182456
Filename:
Female GU
Updated:
2012-11-08 13:36:34
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GU
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Female GU
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  1. most common cz sepsis in elderly
    acute cystitis
  2. -may occur along with urethritis
    -most common bacterial infection in women
    acute cystitis
  3. -unresolved after TX due to obstructions, ATB resistant bacteria, mult bacteria strains
    Chronic cystitis
  4. cystitis that recurs within 2 weeks
    recurrent cystitis
  5. indwelling caths, comorbidities, pregnancy
    complicated cystitis
  6. if a 62yr old woman cam ein with vaginal bleeding what would you do?
    refer for endometrial BX
  7. TX for STD's
    1. Chlamydia
    2. Gonorrhea
    3. Syphilis
    • 1. Zithromax
    • 2. Ciprofloxacin
    • 3. PCN
  8. Name all reproductive hormones (5)
    • 1. estrogen
    • 2. progesterone
    • 3. FSH
    • 4. GnRH
    • 5. LH
  9. LMP means what?
    1st day started bleeding, not last day of period
  10. sequence of menses, hormones, etc
    Follicular phase (from 1st day of period to ovulation)--LH--ovulation--14 days go by--start bleeding
  11. other hormones that have affect on reproductive system (3)
    • prolactin (breaks cycle, common during pregnancy and after birth)
    • testosterone (produced by adrenal cortex)
    • TSH
  12. Anovulation:
    • adolescence/early cycle
    • perimenopause (worry about family planning)
    • hormone use
    • hypothyroidism
    • PCOS (metabolic syndrome)
    • anorexia (low adipose)
  13. Anovulation:
    SX-
    • sx-
    • amenorrhea
    • DUB
    • galactorrhea
    • pregnancy
  14. Anovulation:
    DX-
    • dx-
    • TSH, FSH, LH, estradiol, testosterone levels
    • pelvic U/S (PCOS)
  15. Dysfunctional uterine bleeding:
    cz by what?
    most frequent during?
    • cz by dysfunction of hypothalmic-pituitary-ovarian axis, may be cz by OCP's
    • frequent during menarche
  16. post menopausal DUB requires:
    endometrial BX
  17. menorrhagia
    metrorrhagia
    • menorrhagia- heavy
    • metrorrhagia- irregular
  18. Amenorrhea:
    Primary (disorder)
    Secondary
    • primary-
    • absence of menarche by age 16; cz- outflow, ovary, anterior pituitary, hypothalamus
    • secondary-
    • absence of menstruation for >3months; cz- pregnancy, hormone contraception, elevated prolactin (pituitary adenoma), stress, wt loss, anorexia, menopause, hypothyroid, chronic dz, PCOS
  19. Amenorrhea:
    DX
    progesterone challenge (10mg x10days, after 3rd dose should be bleeding by now), progesterone/estrogen challenge, pelvic U/S, labs, MRI of sella turcica
  20. PCOS:
    cz's
    • formerly Stein-Leventhal syndrome
    • hypothalamic- pituitary- ovarian axis disorder
    • elevated LH
    • low FSH
    • elevated estrogen (constant)
    • androgen overproduction
    • 5-10% occurence
    • usually dx w/fertility failure
  21. PCOS:
    sx
    • anovulation leads to amenorrhea/DUB
    • hirsutism
    • infertility
    • acne
    • alopecia
    • acanthosis nigricans (dark neck looks dirty)
  22. PCOS:
    DX
    • lab testing
    • pelvic U/S (may not be conclusive)
    • basal body temp charting w/endometrial BX to confirm anovulation
  23. PCOS:
    TX
    • TX-
    • OCP's (if fertility not desired)
    • androgen-lowering agents
    • infertility hormones/surgery
  24. Dysmenorrhea:
    most common cz-
    TX-
    • cz- prostaglandin increase at onset of menses
    • may indicate endometriosis, PID, fibroids, etc...
    • TX-
    • OTC RX analgesics (Aleve, motrin)
    • OCP's
    • heat
  25. Endometriosis:
    • proliferation of endometiral tissue on sites other than the uterine lining
    • almost exclusively found on premenopausal women
    • genetics
  26. Endometriosis:
    sx
    • sx-
    • dysmenorrhea
    • dyspareunia
    • infertility
    • constant pelvic or LBP unrelated to menstrual cycle
  27. Endometriosis:
    DX
    • DX-
    • exam- normal
    • exam- fixed uterus d/t adhesions, pain w/uterine movement, nodules on the posterior vaginal fornix, adnexal tenderness
    • laparoscopic surgery and BX
  28. mastodynia/mastalgia:
    definition...
    happens most commonly during...
    R/O?
    TX-
    • painful breasts
    • usually cyclic during luteal phase
    • R/O CA (most cancerous lesions are nontender)
    • TX-
    • avoid methylxanthines (coffee, tea, chocolate, cola)
    • mild diuretic
  29. Mass/swelling at the introitus:
    • malignancies
    • infections
    • benign cysts (inclusion, Gartner duct)
    • varicosities
    • prolapsed uterus, bladder, or rectum
    • pertinent HX
  30. Bartholin's gland cyst:
    sx-
    • common
    • consider malignancy if postmenopausal
    • sx-
    • extremely painful mass on either side of introitus
    • inflamed and fluctuant
    • easily visualized
    • systemic sx are rare
  31. Bartholin's gland cyst:
    DX
    TX
    • dx-
    • PE
    • C&S of drainage rarely done
    • BX if malignancy suspected
    • tx-
    • I&D/word catheter
    • ATB's
  32. Vaginal discharge:
    • infection
    • pregnancy
    • malignancy
    • pertinent HX
  33. normal vaginal microscopy:
    • epithelial cells
    • lactobacilli (gram + rods)
    • rare WBC's
    • variable RBC's
    • normal vaginal pH 4-4.5

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