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Primary Care II > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Average age that young people have sex for the first time

A

About 17 (17.4 to be exact)

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2
Q

Work-up for suspicion of testicular cancer: LABS?

A
  • beta-hCG (can have associated hyperthyroidism)
  • Alpha fetoprotein (AFP)
  • Lactate dehydrogenase (LDH)
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3
Q

Average Age of Menses

A
  • 12.1 for AA
  • 12.3 for Hispanics
    1. 6 for Caucasian girls
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4
Q

Menstrual cycle interval

A

21-45 days

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5
Q

Menstrual flow length

A

+/= 7 days

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6
Q

Menstrual product use

A

3-6 pads/tampons per day

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7
Q

Balantis Circinata

A
  • 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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8
Q

Varicocele

A
  • 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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9
Q

Spermatocele

A
  • 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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10
Q

Hydrocele

A
  • 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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11
Q

Testicular cancer

A
  • 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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12
Q

Scabies

A
  • travel under the skin

- narrower bug

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13
Q

Crabs

A
  • round

- large body

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14
Q

Condyloma Acuminata

A

[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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15
Q

Prehn’s sign

A
  • lift up the scrotum
  • relief of pain if epididymitis
  • NO relief if torsion
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16
Q

Levonorgestrel Intrauterine system

A
  • 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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17
Q

Copper-T IUD

A
  • 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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18
Q

Nexplanon

A
  • Progestin implant
  • MOA: inhibits ovulation, progestational effects
  • Etonogestrel 68 mg
  • Effective for 3 years
19
Q

Combined Hormonal Contraception: MOA

A
  • Pills, patch, ring
  • MOA: ovulation suppression, thickening cervical mucus, asynchronous endometrium (taking it out of its natural hormonal cycle to prevent ovulation)
20
Q

Xulane

A
  • Weekly CHC

- 150 mcg norelgestromin; 35 mcg ethinyl estradiol

21
Q

Daily CHC

A
  • 10-35 mcg (range 10-50) of ethinyl estradiol + 1 of several progestins
22
Q

Nuvaring

A
  • Monthly CHC

- 120 mcg Etonogestrel/15 mcg Ethinyl Estradiol

23
Q

ACHES assessment for hormonal contraceptives

A

[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
24
Q

Progestin only pills (POP)

A
  • MOA: ovulation suppression, progestational effects
  • 35 mg norethindrone or norgestrel
  • No placebo week
  • Timing: midday
25
Q

Depo-Provera

A
  • Progestin-only contraceptive
  • DMPA injection (depot medroxyprogesterone acetate)
  • IM q 3 months
  • MOA: ovulation suppression, progestational effects
26
Q

Blood work to screen for Gynecomastia

A
  • FSH
  • LH
  • hCG
  • LFT’s
  • TSH
  • Estradiol & Testosterone
27
Q

Mastitis treatment

A
  • 1st line: Cephalosporin or Bactrim if suspicions for MRSA
  • 2nd line: Erythromycin
  • May need incision & drainage
28
Q

AUB: Diagnostics

A

(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
29
Q

AUB: Moderate bleeding - Treatment

A
  • 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
30
Q

AUB: with active bleeding - Treatment

A

“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)
31
Q

Severe AUB - Treatment

A
  • 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
32
Q

Amenorrhea: Diagnostic labs

A
  • Pregnancy test
  • TSH
  • Prolactin
  • LH, FSH, estradiol
  • Testosterone, DHEA-S, 17-OH, Progesterone
  • Comprehensive metabolic profile
  • A1c
33
Q

Progestin challenge

A
  • 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
34
Q

Amenorrhea with elevated FSH/LH

A
  • Premature ovarian failure
  • Do: karyotype analysis (unless hx of irradiation or chemo)
  • Rule out: Autoimmune disorder
35
Q

Amenorrhea with decreased FSH/LH

A
  • Hypothalamic suppression or CNS tumor

- Consider: Head MRI

36
Q

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

A
  • Testosterone (free and total), serum

- DHEAS (>600 ug/dl in tumor), serum

37
Q

PCOS: Diagnostic tests to r/o CAH

A
  • 17-Hydroxyprogesterone, serum
38
Q

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

A
  • 24 hour urine Free Cholesterol
  • Salivary cortisol (screener)
  • Dexamethasone suppression (Gold standard)
39
Q

PCOS: Pharmacotherapy

A
  • 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)
40
Q

Allergic rhinitis: Pharmacotherapy

A
  • 1st line: Intranasal corticosteroids (Nasacort, Flonase)

- 2nd line: 2nd gen. antihistamines (Zyrtec)

41
Q

DEET

A
  • 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
42
Q

Permethrin

A
  • Contact pesticide
  • Spray clothes (not skin)
  • Treated clothes should be dried before wearing
  • Can remain effective for many hours
43
Q

Picaridin

A
  • Plant based oil of eucalyptus

- Can provide protection for 2-12 hours

Primary Care II (2 decks)

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