Wet smear pseudophyae and spores w large WBC Miconazole Monistat Clotrimazole

Wet smear pseudophyae and spores w large wbc

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Wet smear – pseudophyae and spores w/ large # WBC Miconazole (Monistat), Clotrimazole (Gyne-Lotrimin), Diflucan, Terconazole (Terazol-3) cream If patient on antibiotic daily yogurt or lactobacillus pills Bacterial Vaginosis (BV) Overgrowth of anaerobic bacteria in vagina Unpleasant “fish-like” odor worse after intercourse. Discharge that is copious and has milk-like consistency. Exam shows light gray discharge coating on vaginal walls. No vulvar or vaginal irritation Wet smear – clue cells (squamous epithelial cells w/ lg bacteria), few WBC; Whiff test – KOH applied to sample – smells fishy Vaginal pH >4.5 Metronidazole (Flagyl), Clindamycin cream, Not STD, no partner treatment needed Abstain from sex until treatment complete Trichomonas Vaginitis (Trichomoniasis) Protozoan parasite w/ flagella c/o pruritic, reddened vulvovaginal area, dysuria. Copious grayish-green bubbly vaginal discharge. Partner may have same symptoms Exam: “strawberry” cervix w/ some bleeding Metronidazole (Flagyl) Treat sexual partner; avoid sex until treatment complete Atrophic Vaginitis Lack of estrogen in tissue of urogenital tract Vaginal dryness, itching, pain w intercourse. No discharge, less rugae, pale color, may bleed on physical exam Pap smear shows atrophic changes Elevated FSH/LH Temporary use of topical estrogen cream, if intact uterus, need progesterone Osteoporosis Loss of bone density from estrogen def. “Skinny white woman who smokes and drinks” – seen in Caucasian and Asian women. Affects women and men DXA scan: T-score < -2.5 (Osteopenia - -1.5 to -2.4) Weight-bearing exercises, calcium w/ Vit D (1200/800mg), bisphosphonates: 1 st line – Fosamax (alendronate), Actonel (risedronate), Selective Estrogen Receptor Modulator – Evista (raloxifene) after menopause, Miacalcin (not 1 st line) HET/ERT to increase bone density Pap Smears: Bethesda system Atypical Squamous cells of undetermined significance: Atypical Glandular Cells of Undetermined Significance: Low-grade Squam. Intraepithelial Lesions/ <20yo – repeat in 12 months refer for endometrial biopsy High- grade Squamous epithelial lesions: >21 – oder pap with “reflex” (HPV DNA) HPV testing – refer for colposcopy and biopsy Oncogenic HPV 16, 18 – refer for colposcopy/biopsy
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Oral Contraceptives Combined oral contraceptives o Monophasic pills (Loestrin) – 21 active pills; placebo last 7d o Triphasic (Ortho tri-cyclen) - 21 active pills; placebo last 7d. Hormones wk 3 varies. Good for acne o Extended Cycle (Seasonale) – 84 days active pill w/ 7 free days. 4 periods/yr o Ethinyl Estradiol /Drospirenone (Yaz) – drospirenone as progesterin; great for acne, PCOS, hirsuitism, PMDD. High risk for DT/hyperkalemia. Must check K+ levels if on ACEI/ARB/K+ sparing diuretic Progestin-Only o Micronor – 28 days starting (mini-pill) – safe for breastfeeding o Contraindications: hx DVT, smoker over 35, increase for stroke, acute liver infection, known CAD, pregnancy, reproductive cancers WOMEN’S HEALTH Contraceptive contraindications Absolute contraindications “MY CUPLETS” o Migraines w/ focal neurologica aura o CAD/CVA o Undiagnosed genital bleeding o Pregnant o Liver tumor/active liver disease o Estrogen-dependent tumor o Thrombus/emboli o
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