Exam 2 Flashcards
Average age that young people have sex for the first time
About 17 (17.4 to be exact)
Work-up for suspicion of testicular cancer: LABS?
- beta-hCG (can have associated hyperthyroidism)
- Alpha fetoprotein (AFP)
- Lactate dehydrogenase (LDH)
Average Age of Menses
- 12.1 for AA
- 12.3 for Hispanics
- 6 for Caucasian girls
Menstrual cycle interval
21-45 days
Menstrual flow length
+/= 7 days
Menstrual product use
3-6 pads/tampons per day
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
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
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
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
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%
Scabies
- travel under the skin
- narrower bug
Crabs
- round
- large body
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)
Prehn’s sign
- lift up the scrotum
- relief of pain if epididymitis
- NO relief if torsion
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
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
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
