Exam #1 Flashcards
Avg age start of menarche?
12
pubertal delay if no development by what age
13
Avg menstrual cycle length; first yr?
21-35 days; first year 32 days is avg (20-60 day range)
*cycle begins on first day of menstrual bleeding and ends with the last day prior to the beginning of the next menstrual bleed
menstrual flow length on avg; flow amt avg
first yr 2-7 days; typical 4-6 days (<2 or >8 abnormal)
flow amount 20-80ml w/2nd day heaviest
greater than ____ days light or very light spotting prior to onset of heavy flow abnormal
3
endometrial cycle - three parts
menstrual, proliferative, secretory
menstrual portion of the endometrial cycle
Low E and P levels cause disruption of endometrial capillaries; prostaglandins initiate smooth muscle contraction and sloughing
proliferative portion of endometrial cycle
increasing E levels about 4-5 days after onset of menses, endometrium grows and thickens in preparation for implantation (variable time frame)
secretory phase of endometrial cycle
begins at ovulation; progesterone produced by corpus luteum (CL), endometrium dilates (thick, cushiony and nutrient rich); constant time frame; allows for implantation
Ovarian cycle three parts
- follicular
- ovulatory
- luteal
follicular phase of ovarian cycle; effects on cervical mucus? Dominant hormones during this phase?
day 1 of menses to just before ovulation, when follicle mature, usually about 14 days is normal
- effects on cervical mucus: at this stage the follicle secretes estrogen and causes a production of clear mucus that is stretch and lubricative
- days 1-13 of cycle and dominant hormones: FSH + Estradiol
ovulatory phase of ovarian cycle; effects on cervical mucus
LH surge from estrogen levels triggers release of ovum 10-12 hours after peak
- still clear and stretchy until after ovulation
- days 13-15 and dominant hormone: LH
luteal phase of ovarian cycle; effects on cervical mucus?
LH causes ruptured follicle to form corpus luteum “yellow body.” Produces mainly progesterone (w/little estrogen), negative feedback to hypothalamus and AP preventing further ovulation
Starts day 15 and goes until day 28; most commonly lasts 12-14 days
Main hormone: progesterone
*thicker cervical mucus until menstrual bleeding starts
pain that occurs in women during ovulation and characteristics
Mittelschmerz
- one sided
- dull and achy, similar to menstrual cramps
- sharp and sudden
- can be accompanied by slight vaginal bleeding or discharge
- rarely severe
which hormones are released from the hypothalamus, and what do they have an effect on…when do they increase and when do they decreaase
the hypothalamus released GnRH - gonadotropin-releasing hormone and stimulates the anterior pituitary gland to produce FSH and LH (Luteinizing hormone)
GnRH increases mid cycle - think need LH spike for ovulation
GnRH decreases during luteal phase - negative feedback to prevent further ovulation
what hormones does the anterior pituitary produce
the AP produces FSH, LH, prolactin (influences lobular development and milk production), GH (influences lobular development of breasts)
o Ex: Hypothalamus releases GnRH –> stimulates anterior pituitary to release FSH –> follicle stimulates growth of that follicle –> stimulates estrogen –> inc. levels of estrogen –> estrogen levels build-up –> tells anterior pituitary to produce LH –> surge that allows ovulation to occur –> progesterone –> negative feedback –> process occurs again
8All part of a feedback cycle that occurs btwn the gonads (ovaries) – P & E
…
posterior pituitary produces what?
oxytocin (milk ejection in response to suckling)
the ovary produces which hormones
progesterone - prepares endometrium estrogen - produces sudden release LH testosterone - connected to libido inhibin - inhibits secretion of FSH activin - increases FSH binding follistatin -
what is the correct order of a GYN physical exam?
history –> physical assessment –> external pelvic exam –> vaginal/cervical exam with speculum –> cervical smears –> bimanual –> rectovaginal IF needed
primary amenorrhea vs secondary amenorrhea
Primary amenorrhea is the absence of initiation of menses, and secondary amenorrhea is an absence of menses in a previously normal menstruating female
most common causes of primary amenorrhea
primary amenorrhea = at least 15 and haven’t gotten your first period
*most common causes:
Chromosomal or genetic problem with the ovaries (the female sex organs that hold the eggs).
Hormonal issues stemming from problems with the hypothalamus or the pituitary gland.
Structural problem with the reproductive organs, such as missing parts of the reproductive system.
most common causes of secondary amenorrhea
- Pregnancy (which is the most common cause of secondary amenorrhea).
- Breastfeeding.
- Menopause.
- Some birth control methods, such as Depo Provera, intrauterine devices (IUDs) and certain birth control pills.
- Chemotherapy and radiation therapy for cancer.
- Previous uterine surgery with subsequent scarring (for example, if you had a dilation and curettage, often called D&C).
Other causes of secondary amenorrhea can include:
- Stress.
- Poor nutrition.
- Weight changes — extreme weight loss or obesity.
- Exercising associated with low weight.
- Ongoing illness or chronic illness.
criteria for satisfactory PAP sample
- do it to see changes in endocervical area
- Use the endocervical spatula THEN the brush. Stay in contact with inner surface of the OS
- Liquid cytology sample can be used for pap test, HPV, Gonorrhea, and Chlamydia testing
GTPAL recording system stands for
G: Gravida/pregnancy = total # of pregnancies
T: Term - pregnancies that result in live birth (37-42 weeks)
P: Preterm birth = pregnancies resulting in birth <37 weeks and/or fetal weight <500g
A: Abortion = spontaneous or induced abortion up to 20 weeks gestation
L: Living children (multiples only count toward living children; ex. full term delivery of twins = G1, T1, Po, Ao, L2)
Domestic abuse victim - risks and common history and PE findings
Populations at higher risk: mental and physical disability, depression, low self-esteem, history of abuse/violence in home, lower education/socioeconomic, poverty, AA and American Indian (higher death rates), adolescents in at risk situations, college age, women veterans, pregnancy, elderly
• Affects more women than men (typically adolescent and adult women)
• Women living with IP of same sex had IPV rate nearly twice that of women living with men
o Common History: victimization of a person with whom the abuser is currently or has been in an intimate, romantic, or spousal relationship. All patients presenting with reported assault are survivors!
Most injuries occur on the face, chest, breast, and abdomen
Screening: Universal screening recommended for women of childbearing age, all prenatal visits
Most common causes of cancer death in women
- lung cancer is the leading cause of death in women followed by breast cancer (colorectal and cervical next)
- skin cancer is the most prevalent cancer diagnosis among women, followed by breast cancer
HPV/PAP ACOG screening guidelines
-Starts age 21 and continues every 3 years until age 29. B/w ages 30-65, PAP smears should be performed every 5 years with HPV DNA testing. If no HPV DNA testing, routine PAP smear recommended every 3 years b/w ages 30-65. After age 65, stop if all prior PAP smears have been normal or total hysterectomy
Chlamydia - what bacteria causes? Who is most at risk? What can it cause? Symptoms M vs W? Treatment?
- PID often caused by chlamydia causes scarring of the fallopian tubes, and can increase the risk of tubal pregnancies
- chlamydia is caused by the bacteria Chlamydia trachomatis, and is the MOST COMMON REPORTABLE STI
- often asymptomatic
- s/s in women: vaginal discharge, postcoital bleeding, dysuria, vague lower abdominal pain; mucopurulent (containing mucus and pus) cervical discharge, bimanual tenderness, WBCs wet mount
- s/s men: white, cloudy or watery discharge from the tip of the penis; pain, discomfort or a “burning sensation” when urinating; inflammation, tenderness or pain in and around the testicles
TREATMENT: AZITHROMYCIN 1 G PO single dose OR DOXYCYLINE (preferred) 100mg PO BID for 7 days;
ALT:
ERYTHROMYCIN 500mg QID 7 days
OR LEVOFLOXACIN 500mg PO QD 7 days
Gonorrhea: caused by what bacteria? causes problems with pregnancy how? presenting s/s? treatment?
- Neisseria gonorrhoeae
- 820,000 new N/ gonorrhoeae/year; 2nd most common reported communicable disease
- can cause PT birth and FGR (fetal growth retardation)
- women s/s: asymptomatic or mucopurulent cervical or vaginal d/c, spotting/bleeding, dysuria, frequency, Bartholin’s, Skene’s tenderness, lower abd tenderness (may not notice symptoms until PID and tubal scarring)
- men s/s: dysuria; white, yellow, or green penile d/c; testicular pain/swelling (less common)
Treatment: one dose Ceftriaxone
<150kg 500mg IM injection
> or equal 150kg = 1 gram IM injection
used to recommend also taking azithromycin 1g orally in single dose, but this is no longer recommended unless co-infection w/chlamydia
Syphilis
- caused by what bacteria?
- treatment?
Treponema pallidum
- for primary, secondary, or latent: tx with benzathine PCN G 2.4 million units IM
- for late latent or unknown duration: 3 doses benzathine PCN G 2.4 million units IM each
- for tertiary with normal CSF: Benzathine PCN G 7.2 million units total, admin as 3 doses of 2.4 million units each at 1 week intervals; Requires ID referral
chancroid caused by what organism? presenting exam? diagnosis? tx?
RARE in US
- organism: Haemophilus ducreyi (gram - bacteria)
- presenting exam: painful genital ulcers + suppurative (pus) inguinal adenopathy
-No FDA approved test, so diagnosis by exclusion. Ask about recent travel to Africa/Caribbean.
Diagnose by exclusion:
-1 or more painful genital ulcers
-with regional lymphadenopathy
-NO evidence of T. pallidum at least 7 days after onset
-HSV PCR or HSV culture of exudate negative
Tx: Azithromycin 1 g PO single dose, OR Ceftriaxone 250 mg IM single dose, OR Cipro 500 mg PO BID 3 days, OR Erythromycin 500 mg PO QID 7 days
Trichomoniasis
- organism?
- presenting exam?
- diagnostic results
- tx?
- organism: Trichomonas vaginalis (anaerobic one-cell protozoan with flagellae)
- S/s: many asymptomatic (70%)
- Men: itching/irritation inside the penis, burning after urination or ejaculation, penile d/c
- Women: STRAWBERRY SPOTS on cervix. Itching, burning, redness, soreness. Elevated vaginal pH & fishy odor w/ KOH.
- Dx: NAAT - GOLD STANDARD PCR TEST (vag swab women, 1st catch urine in men); +Whiff test - d/c + KOH = fishy odor
- Tx: metronidazole 2 g PO in 1 dose OR metronidazole 500mg orally twice a day for 7 days (preferred)
