Women's Health EOR Exam Questions and Answers(SCORED A+)
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Women\'s Health EOR
Institution
Women\'s Health EOR
causes and risk factors for post partum depression - ANSWER-cause is not totally known, hypothryoidism is a cause is in some cases so screen if appropriate, women who had depression before or who have poor support systems are more likely to develop severe depression, psychotic features are possible...
Women's Health EOR Exam Questions and Answers(SCORED A+)
causes and risk factors for post partum depression - ANSWER-cause is not totally known, hypothryoidism is a cause is in some cases so screen if appropriate, women who had depression before or who have poor support systems are more likely to develop severe depression, psychotic features are possible
treatement for postpartum depression - ANSWER--consult psych for psychotherapy
-antidepressant medication
-support groups
-involvement of services to relieve child care burden
presentation of postpartum depression - ANSWER--does not devote usual amount of attention to newborn
postpartum blues features and presentation - ANSWER--within 2 weeks of delivery, at heigh of hormonal change
-common (50-85%), typical depressive emotions (plus elation?)
-unrelated to the health of mother or baby, social situation,
-more common in cultures where emotions are expressed and with family support
postpartum blues course and tx - ANSWER--usually self-limiting
-lasts a few days to 2-3 weeks
-20% will go on to develop depression in first postpartum year
-tx consists of support from family, provider, and other mothers
when does postpartum Depression develop - ANSWER-weeks to months after delivery
how is postpartum depression diagnosed - ANSWER-standardized self report or physician screen
when is the most likely time in a women's life to develop new onset psychosis? - ANSWER-postpartum
most women with gonorrhea are (symptomatic / asymptomatic) - ANSWER-
asymptomatic carrieres
microbilogy of gonorrhea - ANSWER-gram negative diplococcus
oxidase positive colonies
ferments glucose
-grows in Thayer-Martin or Martin-Lester medium gonorrhea sx - ANSWER-purulent vaginal discharge
urinary frequency and dysuria
rectal discomfort
sx of disseminated gonorrhea - ANSWER-triad of polyarthralgia, tenosynovitis, and dermatitis, or purulent arthritis without dermatitis
may be septic
the major complication of gonorrhea in females - ANSWER-salpingitis
prevention and tx of gonorrhea - ANSWER--abstain from sexual activity for 7 days after tx is started
-re-examine after 3 weeks to rule out tx failure or reinfection
-use condoms
tx with 250mg ceftriaxone and (1g azithromycin or 100mg doxycycline bid x 7 days)
tx for disseminated gonorrhea - ANSWER--admit
-ceftriaxone 1g IM or IV q24h or cefotaxime or ceftizoxime 1g IV q8h
-penicillin allergic spectinomycin 2g IM q12h
tx for infant born to untreated mother with gonorrhea - ANSWER-ceftriaxone 25-50mg/kg IV or IM NTE 125mg once
the most commonly reported notifiable disease in the US - ANSWER-chlamydia
microbiology of chlamydia - ANSWER-obligate intracellular microorganisms
cell wall similar to gram negative
contain both DNA and RNA
divide by binary fission but grow intracellularly like viruses
can only be grown by tissue culture
risk factors for chlamydia - ANSWER-obvious stuff - younger age, sexually active without barrier protection, lower status
OCP use INCREASES risk?
sx of chlamydia infection - ANSWER-may be asymptomatic
-mucopurulent cervical discharge
-hypertrophic cervical inflammation
appearance of PID on US - ANSWER-ACUTE - "cogwheel sign" - incomplete septation of the tubal wall
CHRONIC - "beaded string" - thin tubal wall
microbiology of syphilis - ANSWER-treponema pallidum
spirochete primary syphilis presentation - ANSWER-treponemes enter mucous membrane or broken skin
10-90 days after, painless chancre develoeps
indurated, firm, painless papule or ulcer with raised borders
persists for 1-5 weeks and heals spontaensously
secondary syphilis presentation - ANSWER-2 weeks to 6 months (average 6 weeks) after chancre appears
generalized cutaneous eruption heals spontaneously after 2-6 weeks
may involve palms and soles, macular, maculopapular, papular, or pustular
patchy alopecia
Condyloma Lata - moist papules in perineal area
tertiarty syphilis presetnation - ANSWER-4-20 years after primary
testing for syphilis - ANSWER-darkfield microscopy of lesion or immunoflurescence serologic tests (VRDL) (RPR) every week for 6 weeks or until positive (usually 3-6 weeks after infection or 2-3 weeks after chancre)
Treponemal antibody tests - FTA-ABS or MHA-TP are more sensitive and specific, but remain positive despite therapy
presentation of latent syphilis - ANSWER-infectious in first 1-2 years of latency
early latent < 1 year, late latent > 1 yr
possible asymptomatic neurosyphilis (CSF examination recommended)
neurosyphilis prestnation - ANSWER-most common during latent syphilis
opthalmic and auditiory
CN palsy, meningeal signs
CSF for cell count, protein, VDARL and FTA-ABS
syphilis during pregnancy - ANSWER-the earlier in pregnancy the fetus is exposed, the more severe to fetal infection, greater the risk of premature delivery or stillbirth
tx the same except no doxy, use penicillin despite allergy, consider inpatient
syphilis treatment - ANSWER-tx any pt who had been exposed or is symptomatic despite serological tests
Primary, secondary, and early latent all tx the same
-Benzathine penicillin G 2.4 million units IM once
alternative - doxycycline 100mg bid x 14 days
when should pregnant women be tested for syphilis - ANSWER-at first visit
repeat between 28 and 32 weeks in high risk areas
tx for late latent syphilis - ANSWER-for over 1 year or unknown duration except neurosyphilis
-Pen G 2.4 million unites IM weekly for 3 weeks alternative - doxycycline 100mg bid x 14 days
tx for congenital syphilis - ANSWER-Pen G 50,000 U/kg IM once for asymptomatic
give aqueous crystalline pen G bid/tid for 10-14 days if symptomatic or neurosyphilis
Jarisch-Herxheimer reaction - ANSWER-febrile reaction in 50-75% of pts with early syphilis tx with penicillin
occurs 4-12 hours after injection, complete by 24 hours
generally benign but may trigger labor or fetal distress
three most common causes of infectious vaginitis - ANSWER-trichomonas
bacterial vaginosis
candidiasis
microbiology of bacterial vaginosis - ANSWER-corynebacterium vaginale
gardnerella vaginalis
small nonmotile, nonencapsulated, pleomorphic rod
stains variably
fish odor due to anerobic bacteria
clinical criteria for dx of bacterial vaginosis - ANSWER--homogeneous white noninflammatory discharge
-clue cells > 20% (small dark particles)
-pH > 4.5
-fishy odor with or without KOH
tx for bacterial vaginosis - ANSWER-tx high-risk pregnancy or pre-op abdominopelvic surgery even if asymptomatic
metronidazole 500mg bid x 7 days
alternative metronidzole 2g single dose
Pregnant - 250mg tid x 7 days or clindamycin 300mg bid x 7 days
trichomonas microbiology - ANSWER-unicellular flagellate protozoan
larger than PMN but smaller than epithelial cells
the most prevalent nonviral STD in the US - ANSWER-trichomonas
trichomonas presentation - ANSWER-persistent vaginal discharge with or without secondary vulvar pruritis
profuse, extremely frothy, greenish, foul smelling
pH > 5.0
"strawberry spots" multiple small petechiae
dx of trichomonas - ANSWER-wet mount shows PMNs with motile flagellates in 50-70%
Culture is the gold standard
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