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?
 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
Discharge
Physiologic
pH Wet mount
<4.5 Epithelial cells
BV
>5
Clue cells
Gray-white
+ Whiff test
Trich
>5
Motile flagella
Green-gray
Frothy
Strawberry cervix
Candida
<4.5
Pseudohyphae
White
Cottage cheese
Clear / white
Prepubertal—mixed flora
Pubertal--lactobacillus
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 organsims
Metronidazole 2 g x 1
Frothy yellow malodorous d/c ****Treat partner
Strawberry cervix
Dyspareunia
Gonorrhea
Asymptomatic
Joint pain (disseminated)
RUQ pain
Ceftriaxone 125 mg IM x 1
Cefexime, Cipro
Chlamydia
Treated for if + sx for
Gonorrhea
Zithromax or Doxy
Herpes
Painful genital ulcers
Multinucleated 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
 Relative Contraindications
 Breast Cancer
 HTN
 CAD
 Depression
 CVA
 Migraines
 DVT / PE / Thrombotic Dz
 Drugs
 Hepatic Disease
 Elevated Lipids
 Pregnancy
GO OUT AND CURE
HAVE A GREAT AFTERNOON!!!!