Female GU

Question 1

Tanner Stages

Answer 1

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

Question 2

Back pain a symptom of…

Answer 2

Macro-mastia (sp?)

Question 3

White women

Answer 3

Higher incidence of breast cancer

Question 4

Black women

Answer 4

More likely to die from breast cancer, more likely to have it before age 45 and to avoid seeing Dr.

Question 5

Biggest risk factor for breast cancer is…

Answer 5

AGE

Question 6

Breast Cancer (Red Flags)

Answer 6

Spontaneous discharge, Age > 40, Unilateral discharge, Blood or guaiac-positive discharge, Palpable mass, Male sex

Question 7

Genetics

Answer 7

1st degree relatives doubles risk

Question 8

Bacterial Vaginosis (BV)

Answer 8

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

Question 9

Trich

Answer 9

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.

Question 10

Candida

Answer 10

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.

Question 11

HSV

Answer 11

Can start with clear, watery discharge. Very painful, will have lesions.

Question 12

Gonorrhea / Chlamydia

Answer 12

Differentiate between Gonorrhea and Chlamydia with test. Will treat the same so no need to wait for results.

Question 13

Macromastia

Answer 13

Rare medical condition of the breast connective tissues in which breasts become excessively large.

Patients complain of low-back pain

Question 14

Gynecomastia

Answer 14

Enlargement of breasts in men (1/4 of men between 50 and 80). 2+ cm in adult

Question 15

Mammogram Screening

Answer 15

40 - 49 informed decision making with PCP. 50 - 74 q 2 years

Question 16

Pelvic Exam

Answer 16

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

Question 17

Dysfunctional Uterine Bleeding

Answer 17

Most common cause is fibroids - but you have to rule out cancer before you get there

Question 18

PCOS

Answer 18

Presence of 2 confirms diagnosis

1. Hyperandrogenism: hair on the face
2. Oligo-ovulation and / or anovulation
3. Polycystic ovaries on ultrasound
4. Exclusion of other androgen excess disorders

Question 19

Pelvic pain

Answer 19

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

Question 20

UA analysis

Answer 20

Nitrates / Leuks… tending toward UTI

Question 21

Pap Smear Guidelines

Answer 21

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

Question 22

“Clear thin discharge with a fishy odor”

Answer 22

BV. Typically want to treat them for that. CLUE CELL

Question 23

Trichomonas

Answer 23

They are moving around. Look for movement!

Question 24

Clue Cell

Answer 24

Peppery appearance. Sign of BV

Question 25

Hyphae

Answer 25

Yeast, generally

Question 26

“Urinary frequency, 1 week”

Answer 26

Differentials: UTI, kidney stone, diabetes, pregnancy

Question 27

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

Answer 27

Dx: UTI

Possible PID (R/O CVA tenderness)

Question 28

Case 1 continued… she was treated with antibiotic recently

Answer 28

Makes this a complicated UTI.

UA: culture and sensitivity (with complicated UTI). Usually treat with cipro

Question 29

Case 1 continued… she was treated with antibiotic recently

Answer 29

Makes this a complicated UTI.

UA: culture and sensitivity (with complicated UTI). Usually treat with cipro “something with bigger guns”

Question 30

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)

Answer 30

BV

Talk to her about safer sex practices, HPV vaccine

Check for clue cells (would confirm BV)

Question 31

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.

Answer 31

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).

Question 32

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.

Answer 32

Likely kidney stones.

Dehydration, calcium, hyperglycemia - increases chances of kidney stones.

Check to see if she’s still making urine.

Question 33

Atrophic Vaginitis

Answer 33

Older women, post menopausal. Pain, or no interest in sex.

Question 34

Incontinence

Answer 34

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

Question 35

Endometriosis

Answer 35

“Pain with their period”

Dx with ultrasound or referral to OBGYN

Question 36

Ovarian Cancer

Answer 36

Bloating, weight loss, vague abdominal pain

Question 37

Main thing with UTI…

Answer 37

Is it complicated or not? Complicated:

Men, Pregnant women, someone with a recent infection, fever

Question 38

Syphilis

Answer 38

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

Question 39

Yeast Infections

Answer 39

Thick white discharge, itching, recent anti-biotic use, DM

Question 40

BV

Answer 40

Fishy odor, “clue cells”