Approach To GU Complaint Flashcards by Radhika Patel

Gonadarche

Activation of gonads fo FSH and LH

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Adrenarche

Increased androgen hormone from adrenal cortex

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Thelarche

Breast tissue develops from E made in ovaries

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Menarche
Spermarche
Pubarche

First menstruation
First sperm production
First pubic hair

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Female puberty

10yo-14yo

Secondary sex characteristics and menarche

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Male puberty

11yo-16yo

Secondary sex and pubic growth

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First sign of puberty in females is

Menarche starts at what tanner stage

Elevation of nipples

Between 3-4 stage

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OB/GYN history

Menstrual H (last mestruation)
GYN H (breasts, mammogram, Surg, Last Pap smear)

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Gravida and para

G = pregnancies
P = viable births
So if a women gets twins : G1P1
Women with 3 children G3P3

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Woman that’s pregnant and has 2 children gravida and para

G3P2

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Women with 4 pregnancies, 1 spontaneous abortion at 14weeks, 1 fetal demise at 28 weeks
G and P

G4P2112

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5 pregnancies , 3 term deliveries, 1 spontaneous abortion 12 weeks, 1 live delivery at 35weeks

G5P3114

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Term
Preterm
Abortion
Live Delivery

> 37 weeks
20-37 weeks
<20 weeks
Live delivery any gestational age

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How often should you get Pap smear

Every year for women without normal Pap smear

Every 5 years with women with normal pap smears and no HPV

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When do you start mammograms

At 50yo or earlier if high risk

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Pap smear

Papanicolaou test
Screen for cervical cancer from HPV
Cells from transition zone or cervix

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Pelvic exam

Inspect external genitalia and internal genitalia

2 fingers into vagina and press down on uterus to feel it and the ovaries

Sx: of ectopic Pregnancy

ABD pain and pelvic pain
With vaginal bleeding
N, breast tenderness can by present
TEST FOR PREGNANCY , if yes = do ultrasonogram, or transvaginal US

UTI Sx:

Dysuria, Polyuria
May have hematuria
*E coli
DO ABD exam
Lloyd’s punch
Urinalysis
Tx: Ab

Well Male Exam

Prostate and testicle exam not yearly done

PSA testing prostate cancer :if FH

Where to palpate during male genital exam

Squeeze top to see urethra
Palpate epididymis and testis and spermatic cord
And invaginate into scrotum to feel external inguinal ring

How to test for enlarged prostate

Digital Rectal Exam

How to feel for inguinal hernia

Put finer invaginating into scrotum and into external ring and tell pt to cough to feel for it
US, CT
If moderate to severe = surgery

5 P’s for the sexual History

Protection from Pregnancy 
Protection from STI
Partners
Practice 
Past STI history

Which hernia can go into scrotum

Inguinal Hernia

STI are what type or illness

Reportable | You have to report this to the health department

How can you test for STI

Microscopy = stain slides to look at Wet Mount = drop of sample under microscope NAAT : PCR methods Serological Testing :blood test to look for Ab

Gonorrhea Sx:

BACTERIA Men : penile discharge , Dysuria (can by asymptomatic) Women : pelvic pain, mucopurulent vaginal discharge ——> can cause PID, scarring of Fallopian tube

What should I order for Gonorrhea | Tx

Test endocervical, urethral, vaginal, pharyngeal, rectal, urine samples Abs (can teat chlamydia also)

Chlamydia Sx

BACTERIA Can by asymptomatic Male : penile discharge, pruritus, Dysuria Female : vaginal discharge, ,vaginal bleeding, sex pain,dysuria ——> can lead to PID (pelvic Infam. Disease)and scarring of Fallopian tube

Chlamydia what should I order | To

NAAT (came as Gonorrhea) ABs Counseling is key for all STIs

Syphilis Sx and 4 phases

BACTERIA (Treponema pallium) 1. Primary : painless genital ulcer 2. Secondary : joint pain, fatigue, enlarged LN, rash, 3. Latent : asymptomatic 4. Tertiary neurosyphilis (confusions headache, stiff neck, vision loss)

what to order for syphilis | Tx

Serological testing, Ab detection , microscopy | Ab penicillin

What do syphilis look like in microscopy

Spiral and like small skinny snakes

Genital Herpes | Sx

VIRUS Single or clustered vesicles on genitals Burn or tingle and pain can occur before vesicles come Virus DNA travels down the axon to the spinal cord ganglion to live ——> can lead to meningitis, PID, Hepatitis, HIV increased risk

Genital Herpes what should I order | Tx:

Serological test PCR from lesion sample Acyclovir (ant-viral)

Trichomonasis

PROTOZOA | Females are more sympathetic (foul discharge, Dysuria), males are not usually

What should I order for Trichomonasis | Tx

Wet mount or NAAT Of vaginal or penile fluids Metronidazole (anti-protozoal)

What do Trichomonasis look like

Has a flagella and is round

HPV Sx:

VIRUS, versatile Genital warts ——> can lead to cancer or lower genital tract, and oropharyngeal region

What do I order for HPV | Tx:

Pap smear (anal or vaginal) Manage with Gardasil vaccine (11yo-26yo) Routine pap smear