Adolescent and GYN Flashcards
(251 cards)
1
Q
What are the 3 main areas of cognitive development that occur during adolescence?
A
1, Reasoning skills (consequences)
- Abstract thought (love/spirituality)
- Thinking about thinking (feelings, how others perceive them)
2
Q
What are the 3 major tasks of adolescent psychosocial development?
A
- Autonomy (independent of parents)
- Sense of identify (strengths/self-worth)
- Ability for future orientation (Career, moral, religious, sexual values)
3
Q
What are 2 things that are crucial for parents to accept as a healthy step in teen development?
A
- Separation
2. Rebellion
4
Q
What is very important in a young adolescent’s separation from the family?
A
Peer group
5
Q
Describe the peer group during early adolescence (12-14)
A
Same-sex, concern about how one appears to friends, changes clothing and hairstyle to fit in
6
Q
Describe the peer group during middle adolescence (15-17)
A
Mixed-sex, finding a mate becomes important
7
Q
When do adolescents move away from peer groups and into relationships?
A
Late adolescence (18-21)
8
Q
True or False: Teens who don’t identify with any peer groups (“loners”) have significant psychological difficulties during adolescence
A
True
9
Q
What do rapid body changes that an adolescent goes through effect?
A
Sense of self
10
Q
What happens for early maturing boys in high school?
A
Perceived as older and more responsible, better at sports, more popular
11
Q
If boys mature too early, what can happen?
A
Develop hostility and distress symptoms
12
Q
What does early pubteral maturation in girls put them at risk for?
A
Conduct problems, depression, early substance use, poor body image, pregnancy, early sexual experimentation
13
Q
What should be the first thing you do for an adolescent girl or boy who presents with a weight issue?
A
Ask what they think about their weight
14
Q
True or False: Teens do perceive risk
A
True (but it doesn’t keep them from partaking in the risk-taking behavior)
15
Q
True or False: Teens seem to gain significant emotional satisfaction from engaging in risk-taking behavior
A
True
16
Q
Why are adolescents (12-14) more concerned about how they look to their peers than the risk of the behavior?
A
Concrete thinking- lack ability to link cause and effect
17
Q
What is the leading cause of morbidity and mortality among 16-20 year olds?
A
MVAs
18
Q
What increases the risks for MVA in 16-20 year olds?
A
Inexperience
Risk taking behavior (speeding, no seat belt, drugs/alcohol, texing/other distractions)
19
Q
After MVA what are the other 2 major causes of death in 15-19 year olds?
A
- Homicide
2. Suicide
20
Q
What is the hallmark of anorexia nervosa?
A
Inability or refusal to maintain a healthy body weight
21
Q
What are the 4 criteria to diagnose anorexia nervosa?
A
- Distorted body perception
- Weight <15% expected
- Intense fear of gaining weigh with restriction of energy intake
- Absence of 3 consecutive menstrual cycles
22
Q
What has the highest fatality rate of any mental health disorder?
A
Anorexia nervosa
23
Q
What is the sign/symptom that is most important in making the diagnosis of anorexia nervosa?
A
Patient thinks they are fat despite weight being normal
*Excessive exercise, depression, dieting, diuretic use are too non-specific
24
Q
Name 10 indications for hospital admission with anorexia
A
- Weight <75% of ideal body weight
- Continued weight loss despite intensive outpatient management
- Acute weight decline and refusal of food
- Hypothermia
- Hypotension
- Bradycardia
- Orthostatic changes in BP or pulse
- Electrolyte abnormalities
- Arrhythmia
- Suicidality
25
How do you distinguish anorexia from Crohn's, hypothyroidism, depression, or collagen vascular disease?
Lab findings and info given in history
26
What is an important feature of bulimia nervosa?
Binge eating
27
What is binge eating?
The consumption of an amount of food larger than most people would eat in one sitting
28
What is binge eating in bulimia nervosa often couple with?
Induced vomiting
29
What are some of the physiologic and lab findings seen in bulimia nervosa (name 6)?
- May be a result of vomiting
1. Salivary gland enlargement
2. Dental enamel erosion
3. Bruises or calluses over the knuckles from forced gagging
4. Low potassium
5. Low chloride
6. Metabolic alkalosis
30
What are 5 indications for hospital admission with bulimia?
1. Failure of outpatient treatment
2. Dehydration
3. EKG abnormality
4. Mallor Weiss tears
5. Suicidal ideation
31
What is a condition that may be hard to distinguish from bulimia?
Achalasia
32
How do you distinguish between achalasia and bulimia?
Achalasia is involuntary vomiting soon after food is ingested
33
Name 4 times parental consent is not needed
1. Life threatening emergencies (also sexual assault services)
2. Medical care during pregnancy (also family planning)
3. Treatment for STDs (also HIV)
4. Treatment for substance abuse
34
True or False: In circumstances where parental consent is not needed to treat a minor, confidentially must be maintained if the patient requests it
True
35
What is the exception for maintaining confidentiality in situations that don't require parental consent?
If the patient is a danger to himself or others
36
True or False: Emancipated minors don't need parental consent to receive treatment
True
37
What is an emancipated minor?
Person under the legal age who is no longer under their parent's control and regulation and who is managing their own financial affairs
38
True or False: In cases where parental consent isn't required, informed consent is still required
True
39
In cases where parental consent isn't required, who can give informed consent?
The patient/minor (instead of the parent)
40
What is parental consent required for?
Virtually all medical and surgical procedures (including blood donation) except:
1. Life threatening emergencies (also sexual assault services)
2. Medical care during pregnancy (also family planning)
3. Treatment for STDs (also HIV)
4. Treatment for substance abuse
41
What is Tanner staging now known as?
Sexual Maturity Rating
42
Describe pubic hair, phallus size, and testicular size for SMR 1 (pre-pubertal)
1. Absent
2. Childlike
3. Volume <2.5mL
43
Describe pubic hair, phallus size, and testicular size for SMR 2 (beginning of puberty)
1. Fine hair appears
2. No change
3. Increased size/volume, scrotum more textured
44
Describe pubic hair, phallus size, and testicular size for SMR 3
1. Coarse, curly, and pigmented
2. Increased phallus size
3. Increased size
45
Describe pubic hair and phallus size for SMR 4
1. Dense and curled, but less abundant than adult
| 2. Close to adult male
46
Describe pubic hair, phallus size, and testicular size for SMR 5
1. Extends to the inner thigh, adult like
2. Adult size
3. Adult size
47
Describe pubic hair and breast for SMR 1 (prepubertal)
1. Absent
| 2. No glandular breast tissue
48
Describe pubic hair and breast for SMR 2 (beginning of puberty)
1. Hair along the labia
| 2. Small breast buds with glandular tissue
49
Describe pubic hair and breast for SMR 3
1. Coarse, curly, and pigmented
| 2. Breast tissue extends beyond the areola
50
Describe pubic hair and breast for SMR 4
1. Denser and curled, but less abundant than adult
| 2. Enlarged areola and papilla form a secondary mound
51
Describe pubic hair and breast for SMR 5
1. Extends to the inner thigh, adult-like
| 2. No longer a separate projection of the areola from the remainder of the breast
52
When does the onset of menses occur on average?
2 years after thelarche (at approximately age 12-13)
53
How long and how often do the first few cycles of menarche last and occur?
- Last 2-3 days
| - May occur only every 2-3 months
54
When does the peak height velocity occur for girls?
Before menarche
55
What SMR would a girl be at at the onset of menarche?
3 or 4
56
Menstruation that persists beyond how many days is abnormal and requires a workup?
10
57
True or False: Infrequent menstrual periods during the first 2 years post-menarche don't generally require a workup beyond reassurance and follow-up
True
58
After menarche, girls are within what range of adult height?
4cm or 2in
59
What is physiologic leukorrhea?
White, odorless, mucoid discharge
60
When does physiologic leukorrhea usually present and how long does it last?
Precedes menarche by 3-6 months
| Can continue for several years
61
What is management for physiologic leukorrhea?
No intervention
62
11 year old female who is SMR stage 2 and has bloody vaginal discharge, what is the etiology?
Vaginal foreign body
*Onset of menses occurs at SMR stage 3 or 4
63
What is a common explanation for bloody vaginal discharge in a girl who is SMR 1-2?
Vaginal foreign body- common occurrence in girls around this age period (small pieces of toilet paper can cause local irritation and mild bleeding)
64
What is the most likely reason for not using contraception?
Desire to become pregnant
65
What proportion of pregnancies occur within 6 months of the first time experiencing intercourse
1/2
66
What proportion of pregnancies occur during the first month after the first time experiencing intercourse?
1/5
67
What are other advantages of oral contraceptives besides pregnancy prevention?
1. Decrease risk for ovarian cysts, endometrial and ovarian cancers, colorectal cancers, osteoporosis
2. Reduce free testosterone levels (decrease hirsutism)
3. Reduce risk for salpingitis and ectopic pregnancy
4. Protection against acne and iron deficiency anima
68
Name indications for OCPs besides pregnancy prevention
1. Dysmenorrhea
2. Dysfunctional uterine bleeding
3. PCOS
4. Irregular menses
5. Menorrhagia
69
Name 9 absolute contraindications to OCPs
1. Migraine headache with focal aura or neurologic changes
2. Pregnancy
3. Uncontrolled HTN
4. Liver disease
5. Breast cancer
6. Cerebrovascular disease
7. History of DVT
8. History of PE
9. Known Factor V Leiden mutation or other thrombophillic condition
70
True or False: New IUDs considered to be safer than past (without increased risk for PID or infertility) and are advocated to be the preferred method of contraception for all women regardless of age an parity
True
71
Name 3 other options for birth control besides OCPs
1. IUDs
2. Subcutaneous slow release progesterone
3. Contraceptive intravaginal rings
72
Which types of birth control are considered to be very effective because they don't require daily compliance?
1. IUDs
2. Subcutaneous slow release progesterone
3. Contraceptive intravaginal rings
73
True or False: All contraceptive methods are associated with fewer health risks than pregnancy and delivery
True
74
When should females get their first Pap smear?
Age 21 (regardless of age of first intercourse)
75
What is the definition of primary amenorrhea?
Lack of menses by age 15 or 3 years following breast development
76
Name 2 diagnoses you should consider if you have a teen with primary amenorrhea
1. Androgen Insensitivity Syndrome
| 2. Tuner Syndrome
77
How does androgen insensitivity syndrome present?
Normal breast development in the absence of pubic hair and menstruation
78
What was androgen insensitivity syndrome formerly known as?
Testicular feminization
79
Amenorrheic girl with breast development limited to breast budding and no pubic hair development?
Turner Syndrome
80
Name features of Turner syndrome
1. Short stature
2. Low hairline
3. Low set ears
4. Heart murmur
5. HTN
6. Lymphedema of hands and/or feet
81
What study is indicated if you suspect Turner syndrome?
Karyotype
82
What is the #1 cause of amenorrhea?
Pregnancy
83
True or False: A girl may become pregnant even before her first menstrual period
True (this would be primary amenorrhea)
84
What is secondary amenorrhea?
3 months of amenorrhea after the onset of menarche
85
Name the 3 most common causes of secondary amenorrhea
1. Pregnancy
2. PCOS
3. Exercise-induced amenorrhea
86
What mental health condition can present with amenorrhea?
Anorexia nervosa (amenorrhea precedes weight loss)
87
Name the negative energy triad in female athletes
1. Amenorrhea
2. Osteoporosis
3. Disordered eating
88
What would make you think PCOD?
Any female adolescent with amenorrhea, dysfunctional uterine bleeding, obesity, hirsutism, and acne
89
What are common lab findings in PCOD?
1. LH:FSH >2.5
| 2. Elevated androgen levels
90
What are 3 treatment options for PCOD?
1. Weight loss
2. OCPs
3. Anti-androgen medications (spironolactone)
91
True or False: Lack of obesity rules out PCOD
False- Obesity is a common association, but isn't always present
92
What is the typical presentation for exercise-induced amenorrhea?
Female teenage who does heavy athletic training whose periods become lighter then stop
93
What are lab findings consistent with exercise-induced amenorrhea?
Low serum estradiol (E2)
94
What does low serum estradiol (E2) seen in exercise-induced amenorrhea increase the risk for?
Low bone density and osteoporosis
95
What are patients with exercise-induced amenorrhea at risk for?
Eating disorders (like anorexia nervosa)
96
What is management for exercise-induced amenorrhea?
1. Increase caloric intake
2. Reduce intensity of athletic training
3. Calcium supplements
97
What part of the social history needs to be addressed in exercise-induced amenorrhea?
Smoking- if they are they need to stop because it increases the risk for stress fractures
98
When are OCPs used in exercise induced amenorrhea?
Never- this isn't correct treatment
99
What is delayed puberty associated with?
Low bone density
100
What is crampy lower abdominal pain and pelvic pain that occurs with menses and isn't due to other pelvic pathology?
Primary dysmenorrhea
101
What causes primary dysmenorrhea?
Prostaglandins produced during the ovulatory cycle
102
What is treatment for primary dysmenorrhea?
1. Prostaglandin inhibitors (NSAIDs- Ibuprofen or naproxen)
| 2. OCPs (only if NSAID treatment fails)
103
What is a significant cause of female teens missing or modifying school, work, sports, activities, and social engagements?
Primary dysmenorrhea
104
Under what circumstances is primary dysmenorrhea more common?
Girls with early menarche, heavy menses, family history of dysmenorrhea
105
True or False: Teens who exercise regularly are less likely to experience dysmenorrhea
True
106
What needs to be considered for teens whose dysmenorrhea isn't responding to NSAIDs and OCPs?
Non-gyn causes of pelvic pain (secondary dysmenorrhea)
Ex: IBS
107
What should be considered for management in secondary dysmenorrhea?
Referral for laparoscopy to rule out endometriosis
108
When should the diagnosis of dysfunctional uterine bleeding be considered?
For menstrual bleeding beyond 10 days
109
What is the most common cause of dysfunctional uterine bleeding?
Anovulation during initial onset of menarche
110
Name 8 potential underlying etiologies for a patient with dysfunctional uterine bleeding
1. Tubal pregnancy/Threatened abortion
2. PID
3. Thyroid disease
4. Medications
5. Bleeding disorder
6. PCOS
7. Trauma
8. Systemic disease (diabetes, lupus, kidney disease)
111
What is the treatment for dysfunctional uterine bleeding?
Medical with reassurance and sometimes NSAIDs. Could consider OCPs as an alternative for persistent cases
112
What underlying hematologic problem needs to be considered in dysfunctional uterine bleeding?
Possibility of iron deficiency anemia
113
What is a common cause of DUB in developing countries?
TB
114
What is the term for heavy or prolonged bleeding at regular intervals?
Menorrhagia (or hypermenorrhea)
115
What is the term for irregular vaginal bleeding?
Metrorrhagia
116
What is the term for heavy vaginal bleeding at irregular intervals?
Menometrorrhagia
117
What is the term for frequent vaginal bleeding more often than every 21 days?
Polymenorrhea
118
What should you consider in cases of heavy menstrual bleeding without pain?
Chlamydia
119
What is pink vaginal discharge in an otherwise healthy newborn most likely due to?
Influence of maternal estrogen withdrawal
120
What is done for pink vaginal discharge in an otherwise healthy newborn?
Nothing
121
When would you consider vitamin K deficiency as the cause of pink vaginal discharge in an otherwise healthy newborn?
If there are other signs like petechiae
122
True or False: Vaginal adhesions are commonly seen during infancy and in pre-school girls
True (similar to adhesions seen in foreskin in males)
123
True or False: Vaginal adhesions usually resolve spontaneously if asymptomatic
True
124
What are symptoms of vaginal adhesions?
Dysuria or a secondary bacterial infection
125
If there are symptoms from vaginal adhesions, what should you do for treatment?
Estrogen cream
126
How does imperforate hymen present?
Girl who reached full sexual maturity in absence of menarche. May have cyclical abdominal pain, midline abdominal mass, and/or bluish bulging hymen
127
What is a condition that needs to be differentiated from imperforate hymen?
Tubo-ovarian abscess
128
How can you distinguish between a tubo-ovarian abscess and imperforate hymen?
Tubo-ovarian mass can present with intermittent abdominal pain (like imperforate hymen), but the mass isn't usually palpable midline (imperforate hymen does have a midline abdominal mass)
129
What is hydrometrocolpos?
Collection of fluid in the uterus (can be due to imperforate hymen and retained menstrual fluids)
130
What is the next most appropriate step in evaluation of a patient with signs and symptoms consistent with imperforate hymen and/or hydrometrocolpos
PE of the external genitalia
131
How does vulvovaginitis present?
Vaginal irritation, pain, and pruritus
| Can also present as dysuria
132
What are non-STD causes of vulvovaginitis?
1. Enterobius vermicularis (pinworms)
2. Group A beta hemolytic strep
3. Staph
4. Candida
133
What are STD causes of vulvovaginitis?
1. Gonorrhea
2. Chlamydia
3. Trichomonas Vaginalis
4. Herpes Simplex
134
What are some features that can lead to vulvovaginitis?
Poor hygiene, chemical irritants (bubble bath), tight clothing
*Could be sexual activity in teens or sexual abuse in kids, but above are more likely on boards
135
What should you consider with vaginitis in a young girl?
May be due to a foreign body (like toilet paper)
*This could include discharge and a foul odor
136
What could be a cause of vaginitis in a young girl with recent antibiotic use?
Candida infection
137
What are 2 things you should think of with green vaginal discharge?
1. Neisseria gonorrhea
| 2. Beta hemolytic strep infection
138
Milk curd vaginal discharge that is itchy?
Candida vaginitis
139
How do you treat candida vaginitis?
Topical clotrimazole
140
What does condyloma acuminata look like?
Flat popular lesions which are often pedunculated in the genital and/or anal mucosa
141
How does transmission of condyloma acuminate occur?
Almost always via sexual contact
142
What virus causes veneral warts (condyloma acuminata)?
HPV (human papiilomavirus)
143
Describe HPV lesions (veneral warts)?
Non-tender and bleed with minor trauma
144
True or False: Anogenital warts due to HPV infection are often asymptomatic in males
True
145
What are veneral wards due to HPV a risk factor for?
Development of cervical cancer
146
True or False: Anogneital warts have a high spontaneous resolution rate
True
147
What is a treatment option for anogenital warts?
Observe for 1-2 years before treatment (because anogenital warts have a high spontaneous resolution rate)
148
What are the treatments for anogenital warts?
1. Observation is initial management
2. Medical treatment with chemical cauterization (use podophyllin or podofilox)
3. Surgical excision
149
True or False: Vaccination is still recommended even if a patient already has veneral (HPV) warts
True- the vaccine would protect against strains other than the one contracted by the patient
150
Name 3 lesions that could be confused with condyloma acuminata
1. Molluscum contagiosum
2. Bartholin cysts
3. Condyloma lata
151
Describe genital molluscum contagiosum lesions
Smaller (compared to HPV warts), rarely genital, smooth, flesh colored, central umbilication
152
What is a large and tender genital lesion that may present as a fluctuant mass on the vaginal wall?
Bartholin cyst
153
When is condyloma lata seen?
Part of secondary syphillis
154
Describe condyloma lata
Whitish-gray papules that have coalesced in the genital area (flatter than condyloma acuminate)
*This will also have systemic symptoms like fever
155
What is the recommendation for a child with benign vulvitis (Mild perianal and vaginal pruritus and dysuria)?
Reassurance and sitz baths
*Make sure to rule out sexual abuse, trauma, or signs of pinworms
156
Describe the primary lesion (initial infection) with HSV
Painful with tender inguinal nodes
157
Describe subsequent lesions with HSV
Ulcerative
158
What is the treatment of primary HSV infection?
Oral acyclovir
| Could also use famciclovir or valacyclovir
159
History of unprotected sexual intercourse several weeks ago, now with vesicular lesions on the penis... best diagnostic test to do initially?
Viral culture for herpes simplex
160
Why is the tzanck test not the best diagnostic test to initially do when you suspect herpes?
- Tzanck test has a sensitivity less than 50%
| - Doesn't differentiate herpes from varicella
161
What does a Tzanck test detect?
Multinucleated giant cells (will pick up herpes and varicella)
162
What is the medical term for genital crabs?
Pediculosis pubis
163
How do patients with pediculosis pubis present?
Red, crusted suprapubic macules
164
What should you consider if someone has blue-gray dots in their pubic area?
Maculae cerulea- Pediculosis pubis (crabs)
165
How is crabs (pediculosis pubis) spread?
Primarily by close contact (especially sexual contact)
166
Why does pediculosis pubis require close contact for spread?
They are slow moving and sluggish
167
How long do peduiculosis pubis last without a meal?
1-2 days (the meal is blood)
168
Where can pediculosis pubis be found?
Pubic area
Anal hairs
Facial hair
Eyelashes
169
What should you be suspicious of in any child with pubic lice?
Sexual abuse
170
What are the treatment options for pediculosis pubis?
1. Permethrin 1% or 5%
2. Pyrethrin with piperonyl butoxide
3. Malathion
171
What can be done for pediculosis pubis in the eyelashes?
Apply petroleum jelly several times per day for 10 days
172
What is the drug that you can use as second line treatment for pedulosis pubis and which populations can you not use this in?
Lindane
Cannot use in neonates or pregnant women
173
What is bacterial vaginosis due to?
Gardnerella vaginalis
174
What is bacterial vaginosis associated with?
The use of anything that disrupts the normal balance of the vaginal flora (antibiotics, IUDs, ect.)
175
True or False: Bacterial vaginosis is not necessarily an STD
True- Gardnerella vaginalis is a part of normal vaginal flora, but more common in those who are sexually active
176
How is bacterial vaginosis diagnosed?
1. Whiff test- Tests for presence of amines after addition of KOH (malodorous fishy/amine odor)
2. Clue cells
177
What is the triad of bacterial vaginosis?
1. Copious grey-white vaginal discharge
2. Vaginal pH >4.5
3. Clue cells under microscopy
178
What is estimated to be the most prevalent nonviral STD in US teens?
Trichomoniasis
179
True or False: Trichomonas is a reportable STD
False- "True" numbers for prevalence aren't known
180
What are the symptoms of trichomoniasis in males?
None- they are asymptomatic
181
What are the symptoms of trichomoniasis in females?
Burning, itching, abnormal vaginal odor, dyspareunia
182
Flagellated organisms on wet mount
Frothy yellow discharge
Strawberry cervix/Petechia (due to friable mucosa)
Trichomonas vaginalis
183
What is the treatment for trichomonas?
Metronidzole (Flagyl)
184
What is important to remember for trichomonas treatment?
Partners need to be treated
185
True or False: Gonorrhea is most commonly asymptomatic
True
186
What do you need to consider for any adolescent with arthritis?
Gonorrhea
187
What STD may present with sore throat, fever, and cervical adenopathy?
GC pharngitis
188
What is the most common reportable STD?
Chlamydia
189
What is the second most common reportable STD?
Gonorrhea
190
How does gonorrhea present in males?
Dysuria and discharge
191
If gonorrhea progresses to epididymitis, what is the presentation?
Unilateral pain and swelling of the scrotum
192
How does gonorrhea present in females?
Urethritis, cervicitis, dysuria, malodorous discharge
193
True or False: Gonorrhea infection can ascend to any part of the female reproductive tract
True
194
What are 2 locations gonorrhea infection can spread outside of the reproductive tract?
1. Peritoneum causing peitonitis
| 2. Liver capsule causing peri-hepatitis (Fitz-Hugh-Curtis syndrome)
195
True or False: LFTs will be elevated in Fitz-Hugh-Curtis symdrome
False- This is peri-hepatitis (not hepatitis) and LFTs will be normal
196
What % of cases does disseminated GC infection occur?
1-2%
197
True or False: Local symptoms of gonorrhea are not usually present once dissemination becomes apparent
True
198
What are potential symptoms of disseminated gonorrhea?
Fever, arthritis, rash, meningitis, endocarditis
199
How is diagnosis of disseminated gonorrhea usually made?
Gram stain with intracellular gram-negative diplococci
200
What is the gold standard for diagnosis of disseminated gonorrhea?
Culture
*But empiric treatment if often indicated prior to culture results
201
What do you need to remember when counseling patients with gonorrhea?
Partners need to be treated
202
What else do patients who are being treated for gonorrhea need to be treated for?
Chlamydia
203
What are minimal criteria for diagnosis of PID?
Lower abdominal or pelvic pain along with uterine, adnexal, or cervical motion tenderness
204
Besides the minimal criteria for PID name 5 additional criteria that aid in the diagnosis
1. WBC in vaginal secretions
2. Temp >38.3C
3. Elevated ESR or CRP
4. Lab evidence of GC or chlamydia
5. Abnormal cervical or vaginal mucopurulent discharge
205
Adolescent with lower abdominal pain, shuffling gait, denies sexual activity?
Consider PID
206
What are findings on the pelvic exam in PID?
Extremely painful cervical motion tenderness (chandelier sign)
207
What specimens/testing do you need to obtain during a pelvic exam for PID?
1. Chlamydia/GC cultures
2. Trichomoniasis
3. Bacterial vaginosis
208
Besides GC and chlamydia, what else can PID be caused by?
1. Anaerobes
| 2. Gram-negative rods
209
Besides GC/Chlamydia, Trichomoniasis, and Bacterial Vaginosis, what 2 other things do patients with PID need testing for?
1. Syphilis
| 2. HIV
210
What 2 things is PID a risk factor for?
1. Ectopic pregnancy
| 2. Infertility
211
What vaccine should you counsel patients with PID on?
HPV vaccine (also need to look for evidence of HPV)
212
Asymptomatic sexually active female...most appropriate STD screen?
Urine PCR for chlamydia or gonorrhea
| along with appropriate blood tests for HIV and syphilis
213
When do you treat for suspected PID?
Empirical treatment for all sexually active females at risk for STIs who present with lower abdominal/pelvic pain and meet criteria
214
Outpatient treatment for PID?
1. Parenteral cephalosporin (Cefoxitin IV/Cefotetan IV/Ceftriaxon 250mg IM)
2. Doxycycline 100mg BID x14 days
3. +/- Metronidazole 500mg BID x14 days
215
In what timeframe do patients with PID need to be re-checked?
Within 72 hours of starting antibiotics
216
What do you need to counsel patients with PID on regarding their partner?
- Notify partner so they can be treated
| - No sex until both are treated
217
Name indications for inpatient treatment of PID?
1. If follow-up isn't assured
2. Symptoms don't improve in 48 hours
3. Can't tolerate outpatient management
4. Severely ill
5. Pregnant
218
What needs to be done if pain persists after treatment for PID?
Abdominal US (to evaluate for a tubo-ovarian abscess)
219
What 2 bugs can cause Fitz Hugh Curtis?
1. Chlamydia
| 2. Gonorrhea
220
Female teenage with RUQ pain, nausea, vomiting. Only medication is OCPs. Best initial step to make correct diagnosis?
Cervical cultures
221
What is Fitz Hugh Curtis syndrome?
Perihepatitis
*Manifestation of gonococcal and chlamydial infections
222
What is treatment for Fitz Hugh Curtis?
Same as PID
1. Parenteral cephalosporin (Cefoxitin IV/Cefotetan IV/Ceftriaxon 250mg IM)
2. Doxycycline 100mg BID x14 days
3. +/- Metronidazole 500mg BID x14 days
223
When should the RUQ pain (perihepatitis) resolve in Fitz Hugh Curtis?
Within 2 days after treatment
224
Name 2 causes of pelvic pain that aren't due to PID
1. Ovarian cyst
| 2. Ovarian Torsion
225
Teenage with unilateral abdominal discomfort occurring mid-cycle...
Ovarian cyst
226
What is the US finding you will likely see with an ovarian cyst?
Fluid-filled cyst on the ovary
227
What is management of an ovarian cyst based on?
Size
228
What is the size cut-off for an ovarian cyst requiring follow-up US v. laparoscopic cyst aspiration?
6cm
<6cm- Follow-up US
>6cm/significant symptoms beyond discomfort- Laparoscopic cyst aspiration
229
Sudden lower abdominal pain which radiates to the back, side, or groin/leg on the same side, nausea, vomiting?
Ovarian torsion
230
How is an ovarian torsion diagnosed?
Doppler US
*This shouldn't delay surgical consultation if US access isn't immediately available
231
Who is usually the perpetrator in sexual abuse?
Someone close to or known by the family
232
What behavior is a red flag for sexual abuse in a child?
Child who acts out by describing explicit adult sexual behavior
*Kid may have observed or experienced inappropriate sexual behaviors
233
True or False: Size of the hymen is not a good way to assess sexual abuse or molestation in the absence of supporting history and other physical findings
True- Hymen can be damaged in other ways like riding a bike
234
What is a common variant in hymen findings?
Lacks tissue about 3/9 position
*This finding is nonspecific and doesn't confirm sexual abuse
235
True or False: Labial adhesions and some abrasions can be normal findings in certain injuries
True (bicycle seat injury)
236
Name 6 findings that are normal variants in girls who have not been abused
1. Gaping hymenal orifice
2. Vaginal discharge
3. Labial adhesions
4. Friability of the posterior fourchette
5. Linea vestibularis
6. Vestibule pallor
237
What is an example of when vaginal bleeding in young girls may not represent abuse?
Urethral prolapse
238
African American girls, 3-8 years old, hyperemic doughnut-shaped mass in the vaginal region?
Urethral prolapse
239
What is the management for urethral prolapse?
Warm sitz baths
| Follow-up with urology
240
Child with a foul odor from vagina?
Consider a foreign body (toilet paper)
*Look out for clues indicating suspicion of abuse
241
What should you think with vaginal discharge in a child on antibiotics?
Yeast infection
242
What is something that should be on your differential for white vaginal discharge?
Physiological leukorrhea
243
What causes physiological leukorrhea?
Due to desquamation of epithelial cells under influence of estrogen
244
What age group do you see physiological leucorrhea in?
11 (just prior to menarche)
245
True or False: Neisseria gonorrhea infection on genital, rectal, and pharyngeal secretions cultures should be strongly considered a result of sexual abuse
True
246
What are 2 ways chlamydia can be transmitted?
1. Sexually
| 2. Vertically during birth process (and persist in positive cultures for months)
247
What is the age after which rectal and vaginal chlamydia infection transmitted at birth no longer persist?
18 months
248
True or False: Sexual abuse should be considered in any prepubertal child beyond infancy who presents with vaginal, urtheral, or rectal chlamydia infection
True
*Remember chlamydia has vertical transmission too
249
True or False: Anogenital warts (congenital condyloma acuminata) can be transmitted through a contaminated birth canal
True
250
If anogenital warts are transmitted through the birth canal, by what age do they usually manifest?
1 (some say up to 3)
251
After what age would new onset of condyloma genital warts be likely due to child abuse?
3
