Women's Health (Exam Practice Questions) A+ Graded

Women's Health (Exam Practice Questions) A+ Graded
VAGINITIS DIAGNOSIS AND TREATMENT
Organism Discharge Odor Microscopy pH Treatment
Bacterial vaginosis Thin, gray, homogeneous Fishy with positive "whif test" Clue cells
>4.5 Metronidazole 500 mg BID × 7 days or clindamycin 300 mg BID × 7 days or topical
metronidazole 1 applicatorful intravaginally daily × 5 days (lower success rate)
Candida Adherent, white, "cottage cheese" like Neutral Pseudohyphae but only 65-85%
sensitive <4.5 Fluconazole oral, topical clotrimazole, miconazole, etc.
Trichomonas Copious yellow, gray, green, foamy. Friable "strawberry" cervix
Malodorous Trichomonads >4.5
Metronidazole 2 g PO once (recommended), or 500 mg
BID × 7 days (alternative) -
HELPFUL TIP:
The most recent evidence points to insulin resistance as the underlying cause of PCOS,
and these patients may have acanthosis nigricans. Insulin resistance can be quantified
by calculating the ratio of fasting glucose to insulin. A ratio of less than 4.5 indicates
insulin resistance. Insulin resistance stimulates ovarian androgen production, which
leads to anovulation.
HELPFUL TIP:
As with other STIs, a patient with Trichomonas should have her partner tested and
treated (or just treated depending whether or not this is allowable under your state law).
HELPFUL TIP:
While it makes sense that single-dose azithromycin would work better in treating
Chlamydial cervicitis because of compliance issues, the cure rate is the same whether
azithromycin or the doxycycline is used. There is about a 3% failure rate with
azithromycin which isn't seen with doxycycline.
HELPFUL TIP:
For hirsutism associated with PCOS, spironolactone is usually first-line therapy unless
the patient has a contraindication; traditional hair removal techniques will still be
required for the existing hair growth. Since spironolactone can result in feminization of a
male fetus, patients taking spironolactone must be using reliable birth control.
HELPFUL TIP:
Not all women with PCOS are obese and hirsute. Many patients may be thin with
sparse body hair and present with menstrual irregularities and fertility concerns.

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