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pediatrics > female reproductive and breast > Flashcards

female reproductive and breast Flashcards

1
Q

Tanner stages is assigned independently to

A 
independently to:
1. genitalia
2. pubic hair 
3. breast 
(person can have Tanner 2 genitalia, Tunner stage 3 pubic hair
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2
Q

Tanner stages - stage I (male and female)

A

PRE-pubertal

female: no sexual hair, flat appearing chest with raised nipple
male: no sexual hair

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3
Q

Tanner stages - stage II (male and female)

A

female: pubic hair appears (pubarche), Breast bub forms (thelarche)
male: pubic hair appears (pubarche), testicular enlargement

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4
Q

Tanner stages - stage III (male and female)

A

female: coarsening of pubic hair, breast enlarges, mound forms
male: coarsening of pubic hair, increase penis size/length

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5
Q

Tanner stages - stage IV (male and female)

A

female: Coarse hair across pubis, sparing thigh, breast enlarges, raised areola, mound on mound
male: Coarse hair across pubis, sparing thigh, increase penis width/glans c

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6
Q

Tanner stages - stage V (male and female)

A

female: Coarse hair across pubis and medial thigh, adult breast contour, areola flattens
male: Coarse hair across pubis and medial thigh, penis and testis enlarge to adult size

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7
Q

Thelarche?

A

onset of female breast development

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8
Q

Pubarche

A

the first appearance of pubic hair in a child

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9
Q

Prostate - lymph drainage

A

Internal iliac

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10
Q

Sex chromosome disorders - mechanism and types

A

Aneuploidy (abnormal number of chromosomes) most commonly due to meiotic nondisjunction

  1. Klinefelter syndrome 2. Turner syndrome
  2. Double Y males 4. Ovotesticular disorder of sex development
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11
Q

Klinefelter syndrome - sex and karyotype

A

male - 47, XXY

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12
Q

Klinefelter syndrome –> presentation

A
  1. Testicular atrophy 2. eunuchoid body shape

3. Long extremities 4. gynecomastia 5. female hair distribution 6. Devopmental delay

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13
Q

Klinefelter syndrome - lab/endocrine profile - mechanism

A
  1. presence of inactivated X chromosome (Barr body)
  2. High FSH (dysgenesis of seminiferous tubuls –> low inhibin B)
  3. high estrogen (abnormal Leydig function –> low testosterone –> high LH –> upregulation of aromatase)
  4. Common cause of hypogonadism seen in infertility work-up
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14
Q

MCC of amenorrhea

A

Turner (45 X0)

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15
Q

Turner syndromes - findings/clinical characteristics (outside and in the body)

A
  1. Short stature (if untreated)
  2. ovarian dysgenesis (streak ovary)
  3. shield chest
  4. bicuspid aortic valve
  5. coartraction (femoral less than branchial pulse)
  6. Lymphatic vessels defects (a. cystic hygroma or wedded neck, b. lymphadema in feet or hands)
  7. horseshoe kidney
  8. amenorrhea (menopause before menarche)
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16
Q

Turner syndrome - lab/endocrine profile

A
  1. no Barr body

2. low estrogen –> high LH, FSH

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17
Q

Turner syndrome - pregnancy

A

possible is some cases (IVF, exogenous estradiol-17β and progesterone) (+donation of an egg or embryo)

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18
Q

Double Y - presentation

A
  1. Phenotypically normal (usually undiagnosed)
  2. very tall
  3. may be associated with severe acne
  4. may be associated with learning disability and autism spectrum disorders
  5. normal fertility
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19
Q

Ovotesticular disorder of sex development - previously called

A

true hermaphroditism

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20
Q

Ovotesticular disorder of sex development (true hermaphroditism) - karyotype

A

46,XX > 46,XY

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21
Q

Ovotesticular disorder of sex development (true hermaphroditism) - manifestation

A
  1. both ovarian and testicular tissue presents (ovotestis)

2. ambiguous genitalia

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22
Q

other disorders of sex development (not chromosomal) - other terms

A
  1. pseudohermaphrodite
  2. hermaphrodite
  3. intersex
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23
Q

other disorders of sex development (no chromosome) - types (and presentations)

A
  1. 46, XX DSD –> ovaries present, but external genitalia are virilized ambiguous
  2. 46, XY DSD –> testes presents, but external genitalia are female or ambiguous
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24
Q

46, XY DSD - mechanism

A

Most common form is androgen insensitivity syndrome (Testicular feminization)

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25
Q

46, XX DSD - presentation

A

ovaries present, but external genitalia are virilized ambiguous

26
Q

46, XX DSD - mechanism

A

due to excessive and iapproriate exposure to androgenic steroids during early gestation (eg. congenital hyperplasia or exogenous administration)

27
Q

Placental aromatase deficiency - mechanism

A

Inability to synthesize estrogens from androgens

28
Q

Placental aromatase deficiency - presentation

A

genitalia)

2. can present with maternal virilozation during pregnancy (fetal androgens cross the placenta)

29
Q

Androgen insensitivity syndrome - karyotype/mechanism

A

46,XY

Defect in androgen receptor resulting in normal-appearing female

30
Q

Androgen insensitivity syndrome - presentation

A
  1. normal-appearing female external genitalia with scant sexual hair, rudimentary vagina
  2. uterus and fallopian tubes absent
  3. normal functioning testes (found in labia majora)
31
Q

5a-reductaes deficiency - mode of inheritance/limited to/mechanism

A

AR
limited to genetic males
inability to convert Testosterone to DHT

32
Q

5a-reductaes deficiency - presentation

A

ambigious genitalia until puberty, when high testosterone causes masculinization and increased growth of external genitalia
normal internal genitalia

33
Q

5a-reductaes deficiency - endocrine profile

A
  • normal testosterone and estrogen levels
  • Testosteron/DHT = 20-60
  • high/normal LH
34
Q

Sarcoma botryoides (embryonal rhabdomyosarcoma variant) - epidemiology and appearance

A

girls under 4. Hist: spindle-shaped cells, desmin (+). Gross: clear, grape-like polypoid mass emerging from vagina

35
Q

MC ovarian tumor in females 10-30

A

Mature teratoma of ovary (dermoid cyst)

36
Q

Mature teratoma of ovary (dermoid cyst) - presentation

A
  1. pain 2ry to ovarian enlargement or torsion

2. a monodermal form with thyroid tissue (stroma ovari) uncommonly presents with hyperthyroidism

37
Q

evaluation of primary amenorrhea

A

pelvic examination or U/S –> Uterus present?

  • yes –> serum FSH: if increased do karyotype, if decreased do cranial MRI
  • no –> karyotype and serum test:
    1. 46, XX, normal female test levels –> abnormal Mullerian development
    2. 46 XY, normal male test levels –> androgen insensitivity syndrome
38
Q

1ry amennorhea means

A

amenorrhea with developed 2ry characteristics is older than 15
amenorrhea without 2ry characteristics older than 13

39
Q

causes of 1ry dysmenorrhea

A

release of prostaglandis from endometrium -> uterus contraction
NORMAL EXAMINATION

40
Q

2ry causes of dysmenorrhea

A
  1. endometriosis
  2. adenomyosis
  3. pelic infection
  4. uterine leiomyomata
41
Q

heavy vaginal bleeding - treatmentin adolescent

A

hemod stable: OCP

unstable: emergency dilation and curretage

42
Q

teenager with suscpected fibroadenoma - next step

A

re-check after period for a decreasing in size or tenderness

43
Q

immature hypothalamic-pituitary-ovarian axis (and treatment)

A

in adolscents who have recently undergone menarche, the immature axis results in anovulation and causes abnormal uterine bleeding
treatment: IV estrogen or high dose of oral estrogen/progestins

44
Q

causes of acute abdominal / pelvic pain in women and U/S findings

A
  1. ectopic pregnancy –> no intrauterine pregnancy
  2. ovarian torsion –> enlarged ovary with decreased blood flow
  3. ruptured ovarian cyst –> free fluid near ovarian cyst
  4. PID –> +/- tubo ovarian abscess
45
Q

confirm ectopic pregnancy with HCG - next step

A

transvaginal U/S

46
Q

emergency contraception options - methods

A
  1. copper IUD
  2. Ulipristal pill
  3. Levonorgestrel
  4. OCPs
47
Q

emergency contraception options - methods and mechanism

A
  1. copper IUD –> inf reaction
  2. Ulipristal pill –> antiprogestin –> delays ovaluation
  3. Levonorgestrel –> progenstin –> delays ovaluation
  4. OCPs –> progenstin –> delays ovaluation
48
Q

emergency contraception options - methods and time after intercourse (hours)

A
  1. copper IUD –> 0-120
  2. Ulipristal pill –> 0-120
  3. Levonorgestrel –> 0-72
  4. OCPs –> 0-72
49
Q

emergency contraception options - methods and efficacy

A
  1. copper IUD –> 99%
  2. Ulipristal pill –> 85 or more
  3. Levonorgestrel –> 85%
  4. OCPs –> 75%
50
Q

MCC of vaginal bleeding in the neonatal period

A

maternal withdrawal of estrogen –> self limited, no treatment, lasts less than a week

51
Q

causes of prepubertal vaginal bleeding

A
  1. maternal withdrawal of estrogen
  2. trauma (sign of abuse, lacerations, genital examination usually unintentional from fall)
  3. malignancy (eg. rhabdomyosarcoma)
52
Q

androgen insesitivity syndrome in 46 XY –> what to do with the testicles

A

bilateral gonadectomt AFTER completion of puberty (vs Turner patients –> earlier gonadectomy)

53
Q

Maternal estrogen effects in newborn

A
  1. breast hypertrofy (girls + boys_
    2, swollen labia
  2. uterine withdrawal bleeding
  3. physiologic leukorrea (whitish vaginal discharge
54
Q

vaginal foreign bodies in children

A
  • fool smelling vaginal discharge and vaginal spotting or bleeding
  • toilet paper is the MC
    removal with calcium alginate swab or irrgation with warmed fluid should be attempted after topical anesthetic has been applied
    sedation and general anesthesia is some cases
55
Q

Disorders of sexual development - types (breast development?)

A
  1. Complete androgen insensitivity - yes
  2. Mullerian agenesis - yes
  3. transverse vaginal septum - yes
  4. Turner - depending on ovarian function
56
Q

transverse vaginal septum

A

malformation of urogenital sinus + Mullerian ducts

normal ovaries, normal uterus, abnormal vagina

57
Q

Disorders of sexual development - types and reproductive organs

A
  1. Complete androgen insensitivity - absent uterus + upper vagina, cryptorchid testes
  2. Mullerian agenesis - absent or rudimentary uterus + upper vagina, normal ovaries
  3. transverse vaginal septum - normal uterus, abnormal vagina
  4. Turner - streak ovaries
58
Q

misoprostol for pregnancy prevention

A

no effect

59
Q

amennorhea with uterus and high FSH

A

karyotype

  • XO is turner
  • XX is 1ry ovarian insuf
60
Q

amennorhea with uterus and normal FSH

A

imperforate hymen

61
Q

amennorhea with uterus and low FSH

A

check TSH and prolactin

  • if both high is hypothyr
  • if both normal is functional hypothalamic amen
  • if only prolactin high is prolactinoma

pediatrics (16 decks)

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