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Gynecology Board Review February 2009

Gynecology Board Review February 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?

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Gynecology Board Review February 2009

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  1. Gynecology Board ReviewFebruary 2009 RAPID FIRE Review of the Review……

  2. 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

  3. 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

  4. Vaginal Secretions

  5. What we got here???? • Infancy / preschool • Sx • Dysuria • Bacterial Infxn • Vulvovaginitis • Recurrent UTIs • Resolve spontaneously • 1-2 yrs • Treatment???? • Estrogen cream

  6. 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

  7. 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

  8. 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

  9. 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

  10. What is shown here?? • Urethral Prolapse • More common in…? • African American • Obese • Treatment?? • Estrogen cream BID

  11. The STDs

  12. What are the reportable STDs? • Chlamydia • Gonorrhea • HIV • Syphilis

  13. 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. 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

  15. 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

  16. Absolute Contraindication Breast Cancer CAD CVA DVT / PE / Thrombotic Dz Hepatic Disease Elevated Lipids Pregnancy Relative Contraindications HTN Depression Migraines Drugs Oral Contraceptives

  17. GO OUT AND CUREHAVE A GREAT AFTERNOON!!!!

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