O'Neils Pointers Flashcards
PAP SMEAR: Age specific guidelines
*Pediatrics
- Screening under 21 not recommended
*Geriatrics
-With adequate hx of screening and no CIN II in last 20 years - should not be screened
——Negative results
——3 Neg ctyology
——2 neg HPV + cytology(1 in last 5 years)
*Pregnancy
-Squamous lesions may progress during but regress after
- colposcopy ONLY to exclusive invasive cancer in high risk women
- unless cancer is ID’d, treatment of CIN is contraindicated
Risk factors for endometrial cancer
- nulliparity
-diabetes (due to anovulation from higher insulin)
-taking unopposed estrogen - tamoxifen use
-rapid weight gain and weight gain in general
——20-50 lb = 3X
——>50 lb: 10X - obesity
-hypothyroidism
-hypertension
-hx of breast or colon cancer
-early menarche(before 11)
-late menopause(after 52)
-estrogen secreting neoplasms - menstrual cycle irregularities and anovulation
-age 35+
Differentials Vaginal Bleeding
- ectopic pregnancy
-pregnancy termination
-placental abruption
-placenta previa
-uterine rupture
-postpartum hemorrhage
-menses
-genitourinary trauma - ovarian torsion or cyst rupture
-endometrial carcinoma/cancers
Antibiotic Treatment: Nongonococcal Urethritis
*Chlamydia trachomatis, ureaplasma and mycoplasma
- Doxy is preferred 100mg BID x 7 days
-Azithromycin 1G one time dose
OR
-Levofloxacin 500mg PO x 7days
Antibiotic Treatment: Gonorrhea
-High dose IM Ceftriaxone 500mg PO x7 days one time + 100 mg Doxy PO BID x7 days
-Gentamicin 240 mg IM once + azithromycin 2G PO one time
-800 mg Cefixime PO one time dose
Antibiotic Treatment: Trichomonas
-Metronidazole 500 mg PO BID x 7 days in females OR Metronidazole 2G PO one time in males
-Tinidazole 2g PO one time dose (No alcohol w/in 24hours)
Antibiotic Treatment: Genital Herpes
-Acyclovir dose dependent
Herpes suppressive therapy
- Valacyclovir 500mg or 1000mg Daily
-Acyclovir 400 mg BID
-Famciclovir 250mg BID
Fragile X Males
-Large testicles
-large body habitus
-learning and behavioral issues
- large forehead and ears
-prominent jaw
-avoids eye contact
-hyperreflexivity of joints
-Mutation of FMR1 gene on X chromosome
Fragile X Females
-less common
-fewer prominent findings
-most common cause of autism in either gender
-Mutation of FMR1 gene on X chromosome
Fragile X Treatment
- Medications for anxiety, ADHD and aggression
-Therapy for social skills, communication and cognitive development
-educational support
-physical therapy for joint hyperlaxity
Vaccines and Pregnancy
- NO LIVE VACCINES
-Tdap with EVERY pregnancy
-Flu shot recommended
Klinefelter Syndrome XXY
-infertility
-hypogonadism
-Phenotypic manifestations
*learning disabilities
*Low testicular Volume
*Hip and Breast Enlargement
*Abnormal body proportions
*Personality impairment
ACA Mammogram
- 40 - 45 optional or high risk
- 45 -55 annual
-55 til estimated within 10 years of life - annual or biannual - high risk
- MRI in addition to mammogram
Antibiotics for Asymptomatic bacteriuria and cystitis in pregnancy: Amoxicillin
Dose:
500 mg PO q8h or 875mg PO q12H
Duration:
5 to 7 days
Notes:
Resistance may limit its utility among gram negative pathogens
Antibiotics for asymptomatic bacteriuria and cystitis in pregnancy: Augmentin
Augmentin - Amoxicillin-clavulanate
Dose
500mg PO Q8H
OR
875mg PO Q12H
Duration
5-7 days
Antibiotics for asymptomatic bacteriuria and cystitis in pregnancy: Cefpodoxime
Dose
100mg PO Q12H
Duration
5 to 7 days
Antibiotics for asymptomatic bacteriuria and cystitis in pregnancy: Cephalexin
Dose
250mg to 500 mg PO Q6H
Duration
5 to 7 days
Antibiotics for asymptomatic bacteriuria and cystitis in pregnancy: Fosfomycin
Dose
3g PO as single dose
Notes:
Doesn’t achieve therapeutic levels in the kidneys so should not be used if pyelonephritis is suspected
Antibiotics for asymptomatic bacteriuria and cystitis in pregnancy: Nitrofrurantoin
Dose
100mg PO Q12H
Duration
5 to 7 days
Notes
-Doesn’t achieve therapeutic levels in kidneys, should not be used if pyelonephritis is suspected
-Typically avoided during 1st trimester and at term; however is appropriate alternative during these periods when other options cannot be used.
Antibiotics for asymptomatic bacteriuria and cystitis for pregnancy: Pivmecillinam
Dose
185mg pivmecillinam base PO TID (dose approved in US)
Duration
3- 7 days
Dose
400mg pivmecillinam HCL PO TID (dose recommended in some European countries)
Duration
3 to 5 days
NOTES
-Don’t use if pyelonephritis is suspected
-Use in preg may result in false-positive test for isovaleric acidemia for newborn screening
Antibiotics for asymptomatic bacteriuria or cystitis in pregnancy: Bactrim
Bactrim; Trimethoprim-sulfamethoxazole
Dose
800/160 mg (1 double strength tablet) Q12H
Duration
3 days
Notes:
-Typically avoided during 1st trimester and at term; however its an appropriate alternative during these periods wehn other options cannot be used.
Parenteral regimens for empiric treatment of pyelonephritis in pregnancy: Mild to moderate Pyelonephritis
*Ceftriaxone
1g q24H
*Cefepime
1g Q12H
Aztreonam
1g Q8H
*Ampicillin
1-2g Q6H
PLUS
*Gentamicin
1.5mg/kg Q8H
Parenteral regimens for empiric treatment of pyelonephritis in pregnancy: Severe Pyelonephritis w/ impaired immune system
and/or incomplete urinary drainage
*Zosyn: Piperacillin-Tazobactam
3.375g Q6H
*Meropenem
1g Q8H
*Ertapenem
1g Q24H
*Doripenem
500mg Q8H
Tanner Staging Male: Stage 1
*Age of Onset of Male Sexual Maturity
-9 years and younger
*Linear growth
-5-6 cm/year
*Testis(gonadarche)
-<4 mL or <2.5 cm
*Penis
-Same size as early childhood
*Pubic Hair (pubarche)
-None Present
*Puberty
-Mean age of pubertal onset: 11.5 years
-Range: 9-14 years
*spermarche
-11-15
-avg: shortly after attainment of peak height velocity
*Race modifications
-White Pt: Stage 2 may begin 1 year earlier
Black Pt: Stage 2 may begin 2 years earlier
Tanner Staging Male: Stage 2
*Age of onset male sexual maturity
-9-11 years
*Linear Growth
-5-6 cm/year
*Testis (gonadarche)
-4 mL or 2.5 - 3.5 cm; scrotum becomes red and textured
*Penis
-Not yet enlarged
*Pubic Hair (pubarche)
-Sparse, lightly pigmented, straight along base of penis 12 (9.9-14.0) years
*Puberty
-Ages 11-15
-avg: shortly after attainment of peak height velocity
*Race Modifications
- White: Stage 2 may begin 1 year earlier
-Black: Stage 2 may begin 2 years earlier
Tanner Staging Male: Stage 3
*Age of Onset Male sexual maturity
-11-12.5 years
*Linear Growth
- 6-7 cm/year
*Testis(gonadarche)
- 12mL or 3.6 cm
*Penis
-Enlargement and lengthening
*Pubic Hair (pubarche)
- On pubis; more pigmented, coarse, curled, abundant 13.1(11.2-15.0)years
*Puberty
-Precocious onset: prior to 9 years (testicular develpment)
-late onset: 13-14 years
*Spermarche
-Ages 11-15
-avg: shortly after attainment of peak height velocity
*Race Modifications
-White: stage 2 may begin 1 year earlier
-Black: stage 2 may begin 2 years earlier
Tanner Staging Male: Stage 4
*Age of onset male sexual maturity
-12.5 - 14 years
*Linear growth
-10 cm/year
-peak height velocity 13.5 yr
*Testis(gonadarche)
-4.1-5 cm
*Penis
-increased size and breadth
*Pubic Hair(pubarche)
- Adult-like and abundant over smaller area than fully mature adult 13.9(12-15.8)years
*Puberty
-Precocious onset: prior to 9 years (testicular development)
-late onset: 13-14 years
*Spermarche
- ages 11-15
-avg: shortly after attainment of peak height velocity
*Race Modifications
- white: stage 2 may begin 1 year earlier
-Black: stage 2 may begin 2 years earlier
Tanner Staging Male: Stage 5
*Age of onset male sexual maturity
-14 years and older
*linear growth
-ceases after age 17
*Testis(gonadarche)
-fully matured in shape > 4.5 cm
*Penis
-fully matured in size and length: 16.5 years
*pubic hair(pubarche)
-adult in type and quality, with horizontal distributio; extends to thighs
*puberty
-Precocious onset prior to 9 years (testicular development)
-Late onset: 13-14 years
*Spermache
-Ages 11-15
-avg shortly after attainment of peak height velocity
*Race Modifications
-White: stage 2 may begin 1 year earlier
-Black: stage 2 may begin 2 years earlier
Tanner Staging Female: Stage 1
*Age of Onset Female Sexual Maturity
-10 yrs and younger
*Linear Growth
-5-6cm/year
*Breasts(thelarche)
-Prepubertal; papilia elevated above chest wall
*Pubic Hair(pubarche)
-none present
*Puberty
-Mean age of pubteral onset: 10.5 years
-Range: 8-12 years
*Menarche
-12.7 years (10.8-14.5 years) after breast, pubic and underarm hair begin to grow
-Avg: 2.6 years after onset of puberty and 0.5 years after peak height velocity
*Race modifications
- White: Stage 2 may begin 1 year earlier
-Black: stage 2 may begin 2 years earlier
Tanner Staging Female: Stage 2
*Age of onset female sexual maturity
- 10.9 ( 10.2-11.3) years
*Linear Growth
- 7-8 cm/year
*Breasts(thelarche)
-Breast and papilia form small mound; areola increases in diameter; marks start of puberty; precedes menarche by 24 months
*sparse, lightly pigmented; straight along boarder of labia (9-13.4 years)
*Puberty
-mean age of puberty onset 10.5 years
-Range: 8-12 years
*Menarche
- 12.7 years( 10.8-14.5 years) after breast pubic and underarm hair begin to grow
Avg: 2.6 years after onset of puberty and 0.5 years after peak height velocity
*Race modifications
- White: stage 2 may begin 1 year earlier
-Black: Stage 2 may begin 2 years earlier
Tanner Staging Female: Stage 3
*Age of onset female sexual maturity
-11.9 (9.9-13.9)years
*Linear Growth
-8 cm/year
*Breasts(thelarche)
-Breast and areola enlarge;no separation in contours
*Pubic Hair(pubarche)
-On mons pubis: more pigmented, coarse, curled, abundant (9.6-14.1 years)
*puberty
-Precocious onset: prior to 8 years (breast development)
-Lane onset: 12-13
*Menarche
-12.7 years (10.8-14.5 years)after breast, pubic and underarm hair begin to grow
-Avg 2.6 years after onset of puberty and 0.5 years after peak height velocity
*Race modifications
-white: stage 2 may begin 1 year earlier
-black: stage 2 may begin 2 years earlier
Tanner Staging Female: Stage 4
*Age onset female sexual maturity
-12.9(10.5-15.3)years
*Linear Growth
-7 cm/year
*Breast(thelarche)
-Secondary mound formed by areola and papilla, about level of breast
*Pubic Hair(pubarche)
-Adult like and abundant over smaller area than in fully mature adult (10.4-14.8 years)
*Puberty
-Precocious onset: prior to 8 years(breast development)
-late onset: 12-13 years
*Menarche
-12.7 years (10.8-14.5 years) after breast pubic and underarm hair begin to grow
-avg: 2.6 years after onset of puberty and 0.5 years after peak height velocity
*Race Mod
-white: stage 2 may begin 1 year earlier
-black: stage 2 may begin 2 years earlier
Tanner Staging Female: Stage 5
*age of onset female sexual maturity
-15 years and older
*Linear growth
-ceases 2-2.5 years after menarche
*Breasts(thelarche)
-Adult breast: nipple projects; areola becomes part of contour of breast
*pubic hair(pubarche)
-Adult in type and quantity with horizontal distribution as inverse triangle; extends to thighs
*Puberty
-Precocious onset: prior to 8 years(breast development)
-Late onset: 12-13 years
- Menarche
-12.7 years(10.8-14.5 years) after breast pubic and underarm hair begins to grow
-avg: 2.6 years after onset of puberty and 0.5 years after peak height velocity
*race mod
-white: stage 2 may begin 1 year earlier
-black: stage 2 may begin 2 years earlier
