Approach to reproductive topics Flashcards
what is Gonadarche? Adrenarche? Thelarche? Menarche? Spermarche? Pubarche?
Gonadarche activation of the gonads by the FSH and LH secreted from the anterior pituitary
Adrenarche: is the increase in androgen hormone production by the adrenal cortex
Thelarche: is the development of brest tissue due to estrogen from the ovaries
Menarche: is first menstrual cycle
Spermarche: is the first sperm production
Pubarche: is pubic hair development
when does puberty begin for females and males and what are the secondary sexual characteristics
Females: 10-14 years old
- secondary sexual characteristics are breast and areolar development
- menarche 2-3 years after beginning of puberty
Males: 11-16 years old
-secondary sexual characteristics are penile growth and pubic hair development
based on Tanner stages of Seecondary sexual characteristics what are the 5 stages of development of external genitalia for boys?
1: Prepubertal
2: Enlargement of testes and scrotum; scrotal skin reddens and changes in texture
3: enlargement of penis and furthur growth of testes
4: increased size of penis with growth in breath and development of glans; testes and scrotum longer; scrotal skin darker
5: adult genitalia
based on Tanner stages of Seecondary sexual characteristics what are the 5 stages of development of breast development
1: prepubertal
2: Breast bud stage with elevation of breast and papilla; enlargement of areolar
3: furthur enlargement of breast and areola; no seperation of their contour
4: areola and papilla form a secondary mound above the level of the breast
5: mature stage; projection of papilla only, related to recession of areola
based on Tanner stages of Seecondary sexual characteristics what are the 5 stages of development of pubic hair for boys and girls?
1: prepubital (less hair then on your arm)
2: sparse growth of long slightly pigmented hair, straight or curled, at base of penis or along labia
3: Darker, coarser, and more curled hair spreading sparsely over junction of pubes
4: hair adult in type, but covering a smaller area than in adult; no spread to medial surface of thighs
5: adult in type and quanity, with horizontal upper border
when getting OB/GYN history what are important questions to ask?
Menstual history:
- age of menarche, duration, flow, and cycle length of menses
- Last menstrual period (LMP)
Gynecologic history:
- breast history for any disease and use of SBE
- last mammogram
- previous GYN surgery
- history of infertility
- last pap smear
how is the Obstetrical history taken?
gravida (number of pregnancies)
para (number of viable births/offspring)
T: Term deliveries >37 wks
P: Preterm delivery 20 to <37 wks
A: abortion <20 wks
L: live regardless of gestational age
G3P3003
Important questions to ask about contraceptive/sexual history
- Contraception method
- Current sexual active
- Number of partners last 1 year or lifetime
- new partner in last 3 months
- condom use
- history of sexual abuse
when should women perform a pap smear or a mammogram
Pap smear: for women over 21 years to 65 years old
- yearly with abnormal pap smear
- Every 3 years for women with consecutively normal pap smears
- every 5 years with women with consecutively normal pap smear with negative HPV testing
Mamogram: at 50 years or earlier for women with high risk (40)
what are the components of a pap smear and what are they testing for?
help screen for cervical cancer
- 99 percent caused by HPV strains
- sample taken from cervix (ectocervix) and the cervical canal (endocervix)
- also from the transitional zone and squamocolumnar junction (SCJ)
- done using a speculum to visualize the cervix
abnormal pap smear, the cells will have multiple nuclei
if a lady has a historectomy do you still continue the Pap smear?
No furthur pap smear necessary if historectomy for noncancerous resons, if hysterctomy for cervical cancer then continue surveillance for residual cells
what is a pelvic exam?
Examines the internal and external genitalia of a female
- visual inspection using the speculum
- Bi manuel exam by inserting index and middle finger into vagina and lifting upward while using other hand to push down on pelvis
- checks for cervical motion tenderness
- obtain swabs checking for STIs and yeast
Ectopic pregnancy, classic presentation, complication, workup, treatment
classical presentation:
- abdominal or pelvic pain with vaginal bleeding
- may have other pregnancy related symptoms (nausea, breast tenderness)
Complication: hemorrhage, death
Workup:
- evaluated with urine pregnancy exam
- speculum exam
- transvaginal ultrasonography
treatment: surgical removal
ALWAYS DO A PREGNANCY EXAM
Urinary Tract infection: classic presentation, Physical exam findings, workup, treatment
Classic presentation:
- Dysuria (pain, burning or discomfort with urination), urinary frequency, urinary urgency, suprapubic pain
- may have hematuria
- E coli most common
Physical exam:
- abdominal exam
- check with llyods punch
Workup:
-urinalysis
Treatment:
-antibiotics
Male genital exam
not always performed unless indicated on history or presentation of specific complaint
- inspection of scrotum, penile shaft, glans, inguinal region
- palpate penile shaft and scrotum (examine for testis, epididymis, spermatic cord with thumb and first two fingers
- retract skin if present
- palpate the inguinal region and examine for hernias
- examine prostate by palpation on digital rectal exam
Inguinal hernia: classic presentation, physical exam findings, workup, management/treatment
Classic presentation:
- pain with increased intra-abdominal pressure (heavy lifting or prolonged standing
- may have palpable bulge on affected side
Physical exam findings:
-invagination scrotal skin with index finger into the inguinal canal and have the patient cough
workup: may need imaging via ultrasound
treatment: mild hernia, watchful waiting
moderate to severe, surgery
direct vs indirect hernia
Indirect hernia:
- common in all ages and sexes
- starts above the inguinal ligament and then will course down into the scrotum
Direct hernia:
- less common and typically in males
- start above the inguinal ligament close to the pubic tubercle
- rarely will get into the scrotum, will bulge anteriorly
What are the 5 P’s that are important to get in a sexual history
Partners
- men women or both
- new partner
- multiple partners
Practices
- how often do you use condoms
- anatomic site of exposure
Prevention of pregnancy
Protection form STI and HIV
-condom use
Past history of STI
- have you ever had an STI
- have any of your partners ever had an STI
what are complications of untreated sexually transmitted infections?
- Pelvic inflammatory disease (mainly from gonorrhea or chlamydia)
- Upper genital tract infections
- Infertility
- Chronic pelvic pain
- Cervical cancer (HPV)
- Chronic infection with herpes viruses, hepatitis virus and HIV
What is an important aspect to treating STI
-antibiotics and antivirals used to treat infection
Behavioral counseling is also key in furthur spread and preventing reinfections
- treatment of partner
- counseling on safe practice
- stress condoms
behavior counseling is also key in sexually active adolescents
Gonorrhea, classical presentation, complication, treatment
Bacteria gram negative intracellular diplococci
classical presentation:
- men: penile discharge and dysuria or can be asymptomatic
- female: pelvic pain or mucopurulent vaginal discharge
- can cause infection in urogenital infections
Complications:
- Pelvic inflammatory disease
- scarring of fallopian tubes leading to infertillity
Treatment:
- antibiotics
- also treat for chlamydia because chlamydia is oftern co infection with gonorrhea
Chlamydia: classic presentation, complications, treatment
Organism: gram negative gacteria, chlamydia trachomatis
classic presentation:
- most cases asymptomatic
- men: penile discharge, pruitus, dysuria
- female: vaginal discharge, vaginal bleeding or pain during intercourse (dyspareunia), dysuria
- can cause other infections
complications:
- pelvic inflammatory disease if untreated
- fertillity issues due to fallopian tupe scarring
treatment:
- antibiotics
- babies get eyedrops
Syphilis, classic presentation, complication, treatment
Organism: spirochete, treponema, pallidum
Classic presentation:
- primary: chancre
- Secondary: joint pains, fatigue, lymphadenopathy, mucopapular rash
- latent phase: asymptomatic
- tertiary: neurosyphillis
complication: progression of syphillis
treatment:
-antibiotics
Genital herpes: classic presentation, complications, treatment
herpes simplex Virus 2 (HSV2)
classic presentation:
- single or clusters of vesicles on the genitalia
- may have burning, tingling, and pain prior to vesicle appearance
COmplications: meningitis, PID, hepatitis, increase risk of HIV
treatment: antiviral (acyclovir)
