- dermatologic manifestation of Reiter's syndrome (reactive arthritis) - serpiginous annular dermatitis of the glans penis - Reactive arthritis is characterized by nongonnococcal urethritis, conjunctivitis and arthritis

- dilation of the pampiniform plexus within the scrotum - affects ~15-20% of healthy fertile males - much more common in the left testicle than the right - usually asymptomatic but may present as scrotal pain or heaviness - only treat if testicle size is affected, or if they have pain - definitive diagnosis: ultrasound

- Benign cystic accumulation of sperm from the head of the epididymis - Presents as small, freely moveable, and (usually) painless - Typically from the head of the testicle on the superior aspect

- Caused by a defect or irritation of the tunica vaginalis - Presents as soft, painless, fluid anterior mass - Incidence: 0.5-1% of males - 3 types: congenital, noncommunicating, hydrocele of the cord

- nodule or painless swelling of one testicle - 30-40% complain of a dull ache or heavy sensation in the lower abdomen, perianal area, or scrotum - acute pain is presenting symptom in 10% - metastatic disease in approximately 10%, symptoms vary based on site of metastasis - Gynecomastia in ~5%

- travel under the skin - narrower bug

[genital warts] - pearly, filiform, fungating, cauliflower, or plaquelike - smooth (particularly on penile shaft) - verrucous - lobulated - eruptions may seem harmless or have a disturbing appearance (wide variety of appearance)

- lift up the scrotum - relief of pain if epididymitis - NO relief if torsion

- ParaGard - Primary MOA: preimplantation; prevents fertilization 2/2 copper effects - Approved for 10 years of use - Can be used as emergency contraceptive - Labeling: OK for nullips

- Progestin implant - MOA: inhibits ovulation, progestational effects - Etonogestrel 68 mg - Effective for 3 years

Exam 2 Flashcards by Danielle Romero

Average age that young people have sex for the first time

About 17 (17.4 to be exact)

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Work-up for suspicion of testicular cancer: LABS?

beta-hCG (can have associated hyperthyroidism)
Alpha fetoprotein (AFP)
Lactate dehydrogenase (LDH)

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Average Age of Menses

12.1 for AA
12.3 for Hispanics
1. 6 for Caucasian girls

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Menstrual cycle interval

21-45 days

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Menstrual flow length

+/= 7 days

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Menstrual product use

3-6 pads/tampons per day

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Balantis Circinata

dermatologic manifestation of Reiter’s syndrome (reactive arthritis)
serpiginous annular dermatitis of the glans penis
Reactive arthritis is characterized by nongonnococcal urethritis, conjunctivitis and arthritis

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Varicocele

dilation of the pampiniform plexus within the scrotum
affects ~15-20% of healthy fertile males
much more common in the left testicle than the right
usually asymptomatic but may present as scrotal pain or heaviness
only treat if testicle size is affected, or if they have pain
definitive diagnosis: ultrasound

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Spermatocele

Benign cystic accumulation of sperm from the head of the epididymis
Presents as small, freely moveable, and (usually) painless
Typically from the head of the testicle on the superior aspect

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Hydrocele

Caused by a defect or irritation of the tunica vaginalis
Presents as soft, painless, fluid anterior mass
Incidence: 0.5-1% of males
3 types: congenital, noncommunicating, hydrocele of the cord

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Testicular cancer

nodule or painless swelling of one testicle
30-40% complain of a dull ache or heavy sensation in the lower abdomen, perianal area, or scrotum
acute pain is presenting symptom in 10%
metastatic disease in approximately 10%, symptoms vary based on site of metastasis
Gynecomastia in ~5%

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Scabies

travel under the skin

- narrower bug

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Crabs

round

- large body

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Condyloma Acuminata

[genital warts]

pearly, filiform, fungating, cauliflower, or plaquelike
smooth (particularly on penile shaft)
verrucous
lobulated
eruptions may seem harmless or have a disturbing appearance (wide variety of appearance)

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Prehn’s sign

lift up the scrotum
relief of pain if epididymitis
NO relief if torsion

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Levonorgestrel Intrauterine system

aka: LNG IUS
Liletta, Skyla, Kyleena, Mirena
Primary MOA: preimplantation; prevent fertilization 2/2 progestational effects
Release 14-20 mcg levonorgestrel daily
Labeling: approved for nullips (not Mirena)
Approved for 3-5 years of use

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Copper-T IUD

ParaGard
Primary MOA: preimplantation; prevents fertilization 2/2 copper effects
Approved for 10 years of use
Can be used as emergency contraceptive
Labeling: OK for nullips

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Nexplanon

Progestin implant
MOA: inhibits ovulation, progestational effects
Etonogestrel 68 mg
Effective for 3 years

Combined Hormonal Contraception: MOA

Pills, patch, ring
MOA: ovulation suppression, thickening cervical mucus, asynchronous endometrium (taking it out of its natural hormonal cycle to prevent ovulation)

Xulane

Weekly CHC

- 150 mcg norelgestromin; 35 mcg ethinyl estradiol

Daily CHC

10-35 mcg (range 10-50) of ethinyl estradiol + 1 of several progestins

Nuvaring

Monthly CHC

- 120 mcg Etonogestrel/15 mcg Ethinyl Estradiol

ACHES assessment for hormonal contraceptives

[may indicate BP; risk for stroke, clot etc.]

A. Abdominal cramping
C. Chest pain
H. Headache
E. Eyes - visual disturbances
S. Severe leg pain/ severe mood change

Progestin only pills (POP)

MOA: ovulation suppression, progestational effects
35 mg norethindrone or norgestrel
No placebo week
Timing: midday

Depo-Provera

- Progestin-only contraceptive - DMPA injection (depot medroxyprogesterone acetate) - IM q 3 months - MOA: ovulation suppression, progestational effects

Blood work to screen for Gynecomastia

- FSH - LH - hCG - LFT's - TSH - Estradiol & Testosterone

Mastitis treatment

- 1st line: Cephalosporin or Bactrim if suspicions for MRSA - 2nd line: Erythromycin - May need incision & drainage

AUB: Diagnostics

(1st line) - Pregnancy test - CBC w/ retic - STI testing (2nd line) - thyroid functions - LH, FSH - PT/PTT (if abnormal 2x, VWF) - If signs of hyperandrogenism: 17-OH Progesterone, DHEA-S, Androsterone, DHEA, and total free testosterone

AUB: Moderate bleeding - Treatment

- Monophasic OCP: one pill q6-12 hours for 24-48 hours until bleeding stops, then taper - 1x/day for 5 days - then begin a new 28 day packet - continue daily OCP for 3-6 months - treat iron if anemic

AUB: with active bleeding - Treatment

"4-4, 3-3, 2-2, 1" - one pill quid for 4 days, then - one pill tid for 3 days, then - one pill bid for 2 days, then - one pill/day - once bleeding stops use OCP for 3-6 months (consider continuous OCP use w/ no placebo for 3 months)

Severe AUB - Treatment

- If HgB <9.0 with heavy, active bleeding and/or hemodynamic instability, - May need hospitalization - IV estrogen 20 mg IV q4 hours until bleeding controlled - add progesterone within 24-48 hours - Transfusion rarely needed, but consider it

Amenorrhea: Diagnostic labs

- Pregnancy test - TSH - Prolactin - LH, FSH, estradiol - Testosterone, DHEA-S, 17-OH, Progesterone - Comprehensive metabolic profile - A1c

Progestin challenge

- Oral medroxyprogesterone 5-10 mg for 5-10 days - Bleeding suggests adequate estrogen levels and anovulation - No withdrawal bleeding = cycle on estrogen and progestin - Still no bleeding = end-organ problem - (+) Bleeding = check LH, FSH

Amenorrhea with elevated FSH/LH

- Premature ovarian failure - Do: karyotype analysis (unless hx of irradiation or chemo) - Rule out: Autoimmune disorder

Amenorrhea with decreased FSH/LH

- Hypothalamic suppression or CNS tumor | - Consider: Head MRI

PCOS: Diagnostic tests to r/o Androgen-producing tumors

- Testosterone (free and total), serum | - DHEAS (>600 ug/dl in tumor), serum

PCOS: Diagnostic tests to r/o CAH

- 17-Hydroxyprogesterone, serum

PCOS: Diagnostic tests to r/o Cushing's syndrome

- 24 hour urine Free Cholesterol - Salivary cortisol (screener) - Dexamethasone suppression (Gold standard)

PCOS: Pharmacotherapy

- Ovarian suppression: Combo oral contraceptive - Androgen blockade: Spironolactone (50-200 mg/day BID) - Reduce hyperinsulinism: Metformin (not approved, stop if vomiting or NPO due to lactic acidosis risk)

Allergic rhinitis: Pharmacotherapy

- 1st line: Intranasal corticosteroids (Nasacort, Flonase) | - 2nd line: 2nd gen. antihistamines (Zyrtec)

DEET

- bug spray - 5-30% - provides 2-6 hours of protection - Can damage synthetic clothes - 2 month or older no more than 30% - None under 2 months - Do not use repellents on any skin, clothing, or mosquito nets that child can suck

Permethrin

- Contact pesticide - Spray clothes (not skin) - Treated clothes should be dried before wearing - Can remain effective for many hours

Picaridin

- Plant based oil of eucalyptus | - Can provide protection for 2-12 hours