Female GU Flashcards
Tanner Stages
1 to 5
1: small nub of breast, not pubic hair
2. elevation of breast (small mound), sparse long pigmented hair
3. Further engagement without separation of breast and areola / Dark, coarse curled hair spread over mons
4. Secondary mound of areola and papilla above the breast / Adult type hair, abundant but limited to mons
5. Recession of areola to contour of breast / adult type spread in quantity and distribution
Back pain a symptom of…
Macro-mastia (sp?)
White women
Higher incidence of breast cancer
Black women
More likely to die from breast cancer, more likely to have it before age 45 and to avoid seeing Dr.
Biggest risk factor for breast cancer is…
AGE
Breast Cancer (Red Flags)
Spontaneous discharge, Age > 40, Unilateral discharge, Blood or guaiac-positive discharge, Palpable mass, Male sex
Genetics
1st degree relatives doubles risk
Bacterial Vaginosis (BV)
Fishy odor, clear discharge, can itch (though not as likely). Often times they are caused by douche (sp?), really strong soaps, or detergent. Can be recurrent
Too many bad bacteria, not enough “good” bacteria. BV is usually a mild problem that may go away on its own in a few days. But it can lead to more serious problems - so it’s a good idea to go to the Dr.
Unsure what causes the unbalance between bacteria. Things that increase your chance of getting it include: sex with more than one partner, douche
Trich
Greenish colored discharge, pain with sex, fever (if advanced). Pay see if on pap smear
STD caused with a parasite. You get it through intercourse with an infected partner. Many people do not have any symptoms. Those that do, usually see the symptoms 5-28 days after being infected.
S/S:
- Yellow/green/or gray discharge from the vagina
- Discomfort during sex
- Vaginal odor
- Painful urination
- Itching in or near the vagina.
Lab tests diagnostic. Treatment is antibiotics.
Candida
Cottage cheese, thick white discharge. A lot of itching (“I want to take a crush to my vagina”). Can be cause by prior/recent antibiotic use, and more common in patients who are immunocompromised. // Easy to treat.
HSV
Can start with clear, watery discharge. Very painful, will have lesions.
Gonorrhea / Chlamydia
Differentiate between Gonorrhea and Chlamydia with test. Will treat the same so no need to wait for results.
Macromastia
Rare medical condition of the breast connective tissues in which breasts become excessively large.
Patients complain of low-back pain
Gynecomastia
Enlargement of breasts in men (1/4 of men between 50 and 80). 2+ cm in adult
Mammogram Screening
40 - 49 informed decision making with PCP. 50 - 74 q 2 years
Pelvic Exam
Not required for BC, annual physical, or when screening for cervical cancer. They should NOT be preformed in asymptomatic, non-pregnant women, and should NOT be preformed for STI screening
Dysfunctional Uterine Bleeding
Most common cause is fibroids - but you have to rule out cancer before you get there
PCOS
Presence of 2 confirms diagnosis
- Hyperandrogenism: hair on the face
- Oligo-ovulation and / or anovulation
- Polycystic ovaries on ultrasound
- Exclusion of other androgen excess disorders
Pelvic pain
1 cause is tubal pregnancy
Ectopic Pregnancy. 40% are missed on 1st presentation to ED. It is really important to keep on your list of differentials. If it ruptures, inter-abdominal hemorrhage
UA analysis
Nitrates / Leuks… tending toward UTI
Pap Smear Guidelines
Not before 21 21 - 65 every 3 years 30+65 (Pap + HPV test q 5 years) Total hysterectomy - no need to screen Same guidelines, even if they have had HPV
“Clear thin discharge with a fishy odor”
BV. Typically want to treat them for that. CLUE CELL
Trichomonas
They are moving around. Look for movement!
Clue Cell
Peppery appearance. Sign of BV
Hyphae
Yeast, generally
“Urinary frequency, 1 week”
Differentials: UTI, kidney stone, diabetes, pregnancy
Case 1. 34 YO female, “urinary frequency x 1 week” / not currently sexually active, no vaginal discharge, no lesions, no fever, no nausea. Recent onset of lower back pain.
UA: + for trace of blood, + for leukocytes, no nitrates
Dx: UTI
Possible PID (R/O CVA tenderness)
Case 1 continued… she was treated with antibiotic recently
Makes this a complicated UTI.
UA: culture and sensitivity (with complicated UTI). Usually treat with cipro
Case 1 continued… she was treated with antibiotic recently
Makes this a complicated UTI.
UA: culture and sensitivity (with complicated UTI). Usually treat with cipro “something with bigger guns”
Case 2. 19 YO Female, CC of “1 week history of vaginal discharge and itching.” Discharge is clear, with a fishy odor. Currently she is sexually active with 1 male partner, uses condoms “most of the time.” No fever, dysuria, back pain or abdominal pain. No lesions in vaginal area, to Hx of STI, no pain with sex (LMP 3 weeks ago)
BV
Talk to her about safer sex practices, HPV vaccine
Check for clue cells (would confirm BV)
Case 3. 15 YO Female presents with CC of “vaginal discharge.” Currently sexually active with 2 male partners, denies any use of ETOH or drugs. Denies violence.
Rapid screen shows + chlamydia
Minor for STI concerns, you can treat in confidence (interesting, you can not see a minor for any other illness than STI. Could not treat her for strep throat).
Case 4. 42 YO Female, CC “abdominal and pelvic pain, radiates to groin, x 1-2 days. Comes in waves. Pain is 10/10 at its worst, lasts about 30-60 minutes. Usually comes in the morning.” No change in urination, no blood in urine, no vaginal discharge, no fever. But she does experience some chills and nausea when the pain is severe. Currently she is asymptomatic.
Likely kidney stones.
Dehydration, calcium, hyperglycemia - increases chances of kidney stones.
Check to see if she’s still making urine.
Atrophic Vaginitis
Older women, post menopausal. Pain, or no interest in sex.
Incontinence
Urge vs. Stress. Dx dependent on history.
Stress: run, laugh, sneeze, cough. Most common: post-partum, elderly
Urge: when you feel you have to pee all the time. Overactive bladder, severe UTI
Endometriosis
“Pain with their period”
Dx with ultrasound or referral to OBGYN
Ovarian Cancer
Bloating, weight loss, vague abdominal pain
Main thing with UTI…
Is it complicated or not? Complicated:
Men, Pregnant women, someone with a recent infection, fever
Syphilis
Often diagnosed on an STI panel. Rarely have people come in and suspect it. “I want to be screened for STIs” / Painless ulcer (culture lesion), rash on the hands
Yeast Infections
Thick white discharge, itching, recent anti-biotic use, DM
BV
Fishy odor, “clue cells”
