Careless act

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Careless act by Mind Map: Careless act

1. Empiric antimicrobial therapy

1.1. defined as

1.1.1. A medical therapy by which the antimicrobials are given to a person

1.1.1.1. before the specific pathogen causing an infection is known

1.2. it is given

1.2.1. before the results of the culture and sensitivity are available

1.3. the drug is selected based on

1.3.1. the site of infection

1.3.2. the patient’s history

1.4. examples in STDs

1.4.1. Single dose of Azithromycin 1g p.o.

1.4.1.1. when

1.4.1.1.1. unknown

1.4.2. Single dose of Ceftriaxone 1 g i.m./i.v. plus single dose of Azithromycin 1.5 g p.o.

1.4.2.1. when

1.4.2.1.1. there is elevated likelihood of N. gonorrhoeae

2. Pharmacological management of STDs

2.1. bacterial infections

2.1.1. Gonorrhea

2.1.1.1. Drug of choice previously

2.1.1.1.1. ceftriaxone and azithromycin

2.1.1.1.2. Doxycycline is an alternate option

2.1.1.2. current drug of choice

2.1.1.2.1. High dose i.m Ceftriaxone of 500mg or 1g

2.1.1.2.2. in patients with severe cephalosporin allergies

2.1.2. Chlamydia

2.1.2.1. drug of choice

2.1.2.1.1. Azithromycin

2.1.2.1.2. Doxycycline

2.1.2.1.3. In the case of pregnancy

2.1.3. Syphilis

2.1.3.1. drug of choice

2.1.3.1.1. Parenterally-delivered penicillin G for all stages of syphilis

2.1.3.1.2. in case of allergy

2.2. viral infections

2.2.1. HIV/AIDS

2.2.1.1. treatment focuses on keeping HIV levels in check

2.2.1.2. Antiretroviral (ART) drugs are the standard therapy for HIV infection

2.2.2. HSV

2.2.2.1. Antiviral agents that are used

2.2.2.1.1. Acyclovir

2.2.2.1.2. Famciclovir

2.2.2.1.3. Valacyclovir

2.2.2.1.4. side effects

3. Vaginal Microbiology

3.1. Vaginal Microbiota

3.1.1. Community of bacteria, yeasts and viruses

3.1.2. Mainly formed by Lactobacillus

3.1.2.1. functions

3.1.2.1.1. produce lactic acid

3.1.2.1.2. H202

3.1.2.1.3. Bacteriocins

3.1.2.2. maintains low ph in Vagina

3.2. Bacterial Vaginosis

3.2.1. Most common non-STD vaginal infection

3.2.2. imbalance in normal flora

3.2.2.1. Gardenella vaginalis increases

3.2.3. Increase PH of vagina

3.2.4. Causes Whitish discharge and fishy smell

3.3. Vaginal Candidiasis

3.3.1. Yeast infection by Candida Albicans

3.3.2. Monilial Vaginitis

3.3.3. Whitish creamy vaginal discharge

3.4. STD

3.4.1. Caused by

3.4.1.1. Chlamydia

3.4.1.2. N.Gonorrhea

3.4.1.3. Trichomonas vaginalis

3.4.1.4. Treponema pallidum

3.4.1.5. Mycoplasma genitalium

3.4.1.6. Hemophilus ducreyii

3.4.2. Leads to

3.4.2.1. PID

3.4.2.2. Abcesses

3.4.2.3. Infertility

3.4.2.4. Ectopic pregnancy

3.5. Vrial STD

3.5.1. HSV

3.5.2. HPV

3.5.3. HIV

4. Anatomy of perineum and vagina

4.1. perineum

4.1.1. it is everything below the pelvic diaphragm

4.1.1.1. that consists of

4.1.1.1.1. levator ani muscles

4.1.1.1.2. coccygeous muscle

4.1.2. borders

4.1.2.1. anterior

4.1.2.1.1. pubic symphysis

4.1.2.2. posterior

4.1.2.2.1. tip of coccyx

4.1.2.3. superior

4.1.2.3.1. pelvic floor

4.1.2.4. inferior

4.1.2.4.1. skin and fascia

4.1.2.5. lateral

4.1.2.5.1. inferior pubic rami, inferior ischial rami and sacrotuberous ligament

4.1.3. contents

4.1.3.1. anal triangle

4.1.3.1.1. anal aperture

4.1.3.1.2. external anal sphincter muscle

4.1.3.1.3. ischioanal fossae

4.1.3.2. urogenital triangle

4.1.3.2.1. external genitalia

4.2. vagina

4.2.1. distensible muscular tube which extends posterosuperiorly

4.2.2. relations

4.2.2.1. anterior

4.2.2.1.1. bladder and urethra

4.2.2.2. posterior

4.2.2.2.1. rectouterine pouch

4.2.2.2.2. rectum

4.2.2.2.3. anal canal

4.2.2.3. lateral

4.2.2.3.1. ureters

4.2.2.3.2. levator ani muscle

4.2.3. histology

4.2.3.1. mucosa

4.2.3.1.1. stratified squamous epithelium

4.2.3.1.2. elastic lamina propria

4.2.3.2. muscular layer

4.2.3.3. tunica adventitia

5. contraception

5.1. defined as

5.1.1. methods or devices used to prevent pregnancy (and in some cases STDs)

5.2. include

5.2.1. Hormonal contraception

5.2.1.1. oral pills, implants under the skin, injections, patches, IUDs and a vaginal ring.

5.2.1.2. 2 types of oral birth control pills

5.2.1.2.1. combined oral contraceptive pills

5.2.1.2.2. progestogen-only pills

5.2.1.3. prevent fertilization

5.2.1.3.1. mainly by inhibiting ovulation (thereby pregnancy)

5.2.2. Barrier contraceptives

5.2.2.1. include

5.2.2.1.1. male condoms, female condoms, cervical caps, diaphragms, and contraceptive sponges with spermicide

5.2.2.2. prevent pregnancy by

5.2.2.2.1. physically preventing sperm from entering the uterus

5.2.3. Intrauterine Devices

5.2.3.1. are small devices, often 'T'-shaped devices which are inserted into the uterus

5.2.3.2. 2 types include

5.2.3.2.1. copper IUD

5.2.3.2.2. levonorgestrel IUD

5.2.4. Sterilization

5.2.4.1. For females

5.2.4.1.1. tubal ligation

5.2.4.2. For males

5.2.4.2.1. vasectomy

5.2.4.3. permanent procedure

5.2.4.3.1. although

5.2.5. Behavioral

5.2.5.1. Fertility awareness

5.2.5.1.1. It involves tracking your natural cycle of fertility and the menstrual cycle

5.2.5.2. Withdrawal

5.2.5.2.1. simply withdrawal of penis before ejaculation

5.2.6. Emergency contraceptive

5.2.6.1. work primarily by preventing ovulation or fertilization

5.2.6.2. options include

5.2.6.2.1. high dose birth control pills, levonorgestrel, mifepristone, ulipristal and IUDs

5.2.7. Lactational Amenorrhea method

5.2.7.1. involves the use natural postpartum infertility

5.2.7.1.1. which occurs after delivery and may be extended by breastfeeding.

5.2.7.2. requires

5.2.7.2.1. 1. Amenorrhea

5.2.7.2.2. 2. Breastfeeding

5.2.7.2.3. 3. Time postpartum less than 6 months

6. pathology of lower female genital tract

6.1. cervix

6.1.1. ex

6.1.1.1. Cervicitis

6.1.1.1.1. defined as

6.1.1.1.2. caused by

6.1.1.2. Cervical Intraepithelial Neoplasia (CIN)

6.1.1.2.1. defined as

6.1.1.2.2. caused by

6.1.1.2.3. leads to

6.2. valva

6.2.1. ex

6.2.1.1. Bartholin Cyst

6.2.1.1.1. defined as

6.2.1.1.2. caused by

6.2.1.1.3. leads to

6.2.1.2. Vulvar Carcinoma

6.2.1.2.1. ex

6.3. vagina

6.3.1. ex

6.3.1.1. Vaginitis

6.3.1.1.1. defined as

6.3.1.1.2. caused by

6.3.1.2. Vaginal Carcinoma

6.3.1.2.1. Most common is Squamous Cell Carcinoma

7. PID

7.1. is an infection of the upper female reproductive system, including the uterus, fallopian tubes, and ovaries

7.2. It mostly affects sexually active women aged from 15 to 24

7.3. It is often caused by

7.3.1. some STDs, like chlamydia and gonorrhea

7.4. complications

7.4.1. Tubo-ovarian abscess

7.4.1.1. If pus builds up in the tube and ovary

7.4.2. hydrosalpinx

7.4.2.1. If a watery fluid builds up in a pocket created by scar tissue in the tubes

7.4.3. ectopic pregnancies

7.4.3.1. the oocyte won’t be able to reach the uterus

7.4.4. Fitz-Hugh-Curtis syndrome

7.4.4.1. inflammation from PID spreads to the peritoneum,

7.4.4.1.1. and, from there

7.5. signs and symptoms

7.5.1. pelvic pain

7.5.2. tenderness around the ovaries and fallopian tubes

7.5.3. fever

7.5.4. abnormal vaginal discharge

8. PHYSICAL EXAMINATION

8.1. 1-General Inspection

8.2. Patient position

8.2.1. Supine or sitting

8.3. 2- External genitalia

8.3.1. Pattern of pubic hair distribution

8.3.2. Labia majora, Labia minora

8.3.3. Perineal body

8.3.4. Palpate the Bartholin glands bilaterally.

8.3.5. Position

8.3.5.1. Dorsal lithotomy

8.4. 3-Speculum Examination

8.4.1. Inspect the cervix

8.4.2. Evaluate the volume, color, consistency, and odour of the discharge

8.4.3. Examine the walls of the vagina

8.4.4. Position

8.4.4.1. Dorsal lithotomy

8.5. 4- Rectovaginal examination

8.5.1. To assess retroverted uterus

8.5.2. pelvic mass

8.5.3. Tenderness

8.5.4. malignancy

8.5.5. Position

8.5.5.1. Dorsal lithotomy

8.5.5.2. Left lateral

9. Types of vaginal swabs

9.1. Wet mount.

9.1.1. Looks for bacteria

9.1.2. yeast cell

9.1.3. trichomoniasis (trichomonads)

9.1.4. white blood cells

9.1.5. detect cells that show an infection, or clue cells that show bacterial vaginosis

9.2. Whiff test.

9.2.1. The release a strong fishy odor from the mix means bacterial vaginosis is present.

9.3. NAAT

9.3.1. Detects and amplifies specific bacterial DNA or RNA sequences

9.3.2. Highly sensitive and specific for the detection of

9.3.2.1. C. trachomatis

9.3.2.2. N. gonorrhoeae