CURRENT DIAGNOSIS AND TREATMENT
OBSTETRICS AND GYNECOLOGY ALAN
PRACTICE QUESTIONS AND DETAILED
SOLUTIONS
◉ What are potential medications for non-pregnant vaginal
bleeding?
Answer: Mild/Moderate: combined OCP's, Progesterone, NSAIDs//
Severe: IV premarin (estrogen), TXA
◉ Diagnosis, Treatment: Middle aged female with "ball coming out
of vagina"
Answer: Uterine prolapse or cystocele// Worse with valsalva// Tx:
pessary or surgery
◉ What patient population has a higher risk of uterine fibroids?
Answer: African-American women
◉ What is the difference between menorrhagia and metrorrhagia?
Answer: Menorrhagia: excessive flow (heavy periods)//
Metrorrhagia: irregular cycles
,◉ Diagnosis, Treatment: Abdominal pain and tenderness, vaginal
discharge, cervical motion tenderness
Answer: Pelvic inflammatory disease (PID)// Cause: C. trachomatis
(MCC), N. gonorrhoeae, polymicrobial// Dx: consider pelvic US to
r/o TOA// Tx: Ceftriaxone IM 500mg, 14 days of doxycycline
(azithro 1g not recommended for PID) and metronidazole// **Note:
They won't always have CMT, but may just have focal uterine or
adnexal pain.
◉ Diagnosis, Treatment: PID with RUQ and shoulder pain
Answer: Fitz-Hugh-Curtis syndrome (perihepatitis): Infection to
perihepatic space causing liver capsule inflammation and adhesions
// MCC: Chlamydia // Dx: TVUS (if concerned for TOA). CT: ±"violin-
string" adhesions (usually normal LFTs) // Tx: 500mg ceftriaxone
IM and 14 days of doxycycline and metronidazole (just like PID)
◉ Most common GYN problem in children
Answer: Vulvovaginitis
◉ Diagnosis, Treatment: Vaginal discharge and clue cells
Answer: Bacterial vaginosis// Cause: Gardnerella/anaerobes// Dx:
Amsel criteria (3 out of 4 means positive test): thin, white d/c, "clue
cells", vaginal pH >4.5, fishy odor (+whiff test)// Tx: metronidazole
(including if pregnant)
, ◉ Diagnosis, Treatment: Vaginal discharge and pseudohyphae on
wet mount
Answer: Candidal vaginitis: overgrowth of normal flora, causing
pruritus// Dx: "cottage cheese" discharge, +wet prep// Tx:
fluconazole x1 week. If pregnant, intravaginal Clotrimazole or
Miconazole.
◉ What other conditions are associated with frequent yeast
infections?
Answer: Diabetes, HIV, pregnancy, antibiotics, steroids, SGLT2
inhibitors (-flozins)
◉ Signs & Symptoms, Diagnosis, Treatment: Vaginal discharge and
"strawberry cervix"
Answer: Trichomoniasis: protozoal infection// SSx: "frothy yellow-
green" discharge// Dx: pH >5, WBCs, motile trichomonads// Tx: PO
metronidazole for patient and partner
◉ What is the definitive treatment for Bartholin's cyst/abscess?
Answer: Marsupialization// In ED: I&D of abscess, place Word
catheter
◉ Diagnosis, Treatment: Early pregnancy with big uterus and high
hCG
OBSTETRICS AND GYNECOLOGY ALAN
PRACTICE QUESTIONS AND DETAILED
SOLUTIONS
◉ What are potential medications for non-pregnant vaginal
bleeding?
Answer: Mild/Moderate: combined OCP's, Progesterone, NSAIDs//
Severe: IV premarin (estrogen), TXA
◉ Diagnosis, Treatment: Middle aged female with "ball coming out
of vagina"
Answer: Uterine prolapse or cystocele// Worse with valsalva// Tx:
pessary or surgery
◉ What patient population has a higher risk of uterine fibroids?
Answer: African-American women
◉ What is the difference between menorrhagia and metrorrhagia?
Answer: Menorrhagia: excessive flow (heavy periods)//
Metrorrhagia: irregular cycles
,◉ Diagnosis, Treatment: Abdominal pain and tenderness, vaginal
discharge, cervical motion tenderness
Answer: Pelvic inflammatory disease (PID)// Cause: C. trachomatis
(MCC), N. gonorrhoeae, polymicrobial// Dx: consider pelvic US to
r/o TOA// Tx: Ceftriaxone IM 500mg, 14 days of doxycycline
(azithro 1g not recommended for PID) and metronidazole// **Note:
They won't always have CMT, but may just have focal uterine or
adnexal pain.
◉ Diagnosis, Treatment: PID with RUQ and shoulder pain
Answer: Fitz-Hugh-Curtis syndrome (perihepatitis): Infection to
perihepatic space causing liver capsule inflammation and adhesions
// MCC: Chlamydia // Dx: TVUS (if concerned for TOA). CT: ±"violin-
string" adhesions (usually normal LFTs) // Tx: 500mg ceftriaxone
IM and 14 days of doxycycline and metronidazole (just like PID)
◉ Most common GYN problem in children
Answer: Vulvovaginitis
◉ Diagnosis, Treatment: Vaginal discharge and clue cells
Answer: Bacterial vaginosis// Cause: Gardnerella/anaerobes// Dx:
Amsel criteria (3 out of 4 means positive test): thin, white d/c, "clue
cells", vaginal pH >4.5, fishy odor (+whiff test)// Tx: metronidazole
(including if pregnant)
, ◉ Diagnosis, Treatment: Vaginal discharge and pseudohyphae on
wet mount
Answer: Candidal vaginitis: overgrowth of normal flora, causing
pruritus// Dx: "cottage cheese" discharge, +wet prep// Tx:
fluconazole x1 week. If pregnant, intravaginal Clotrimazole or
Miconazole.
◉ What other conditions are associated with frequent yeast
infections?
Answer: Diabetes, HIV, pregnancy, antibiotics, steroids, SGLT2
inhibitors (-flozins)
◉ Signs & Symptoms, Diagnosis, Treatment: Vaginal discharge and
"strawberry cervix"
Answer: Trichomoniasis: protozoal infection// SSx: "frothy yellow-
green" discharge// Dx: pH >5, WBCs, motile trichomonads// Tx: PO
metronidazole for patient and partner
◉ What is the definitive treatment for Bartholin's cyst/abscess?
Answer: Marsupialization// In ED: I&D of abscess, place Word
catheter
◉ Diagnosis, Treatment: Early pregnancy with big uterus and high
hCG
