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Family 1 > O'Neils Pointers > Flashcards

O'Neils Pointers Flashcards

1
Q

PAP SMEAR: Age specific guidelines

A

*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

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2
Q

Risk factors for endometrial cancer

A
  • 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+
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3
Q

Differentials Vaginal Bleeding

A
  • ectopic pregnancy
    -pregnancy termination
    -placental abruption
    -placenta previa
    -uterine rupture
    -postpartum hemorrhage
    -menses
    -genitourinary trauma
  • ovarian torsion or cyst rupture
    -endometrial carcinoma/cancers
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4
Q

Antibiotic Treatment: Nongonococcal Urethritis

A

*Chlamydia trachomatis, ureaplasma and mycoplasma
- Doxy is preferred 100mg BID x 7 days
-Azithromycin 1G one time dose
OR
-Levofloxacin 500mg PO x 7days

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5
Q

Antibiotic Treatment: Gonorrhea

A

-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

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6
Q

Antibiotic Treatment: Trichomonas

A

-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)

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7
Q

Antibiotic Treatment: Genital Herpes

A

-Acyclovir dose dependent

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8
Q

Herpes suppressive therapy

A
  • Valacyclovir 500mg or 1000mg Daily
    -Acyclovir 400 mg BID
    -Famciclovir 250mg BID
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9
Q

Fragile X Males

A

-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

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10
Q

Fragile X Females

A

-less common
-fewer prominent findings
-most common cause of autism in either gender
-Mutation of FMR1 gene on X chromosome

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11
Q

Fragile X Treatment

A
  • Medications for anxiety, ADHD and aggression
    -Therapy for social skills, communication and cognitive development
    -educational support
    -physical therapy for joint hyperlaxity
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12
Q

Vaccines and Pregnancy

A
  • NO LIVE VACCINES
    -Tdap with EVERY pregnancy
    -Flu shot recommended
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13
Q

Klinefelter Syndrome XXY

A

-infertility
-hypogonadism
-Phenotypic manifestations
*learning disabilities
*Low testicular Volume
*Hip and Breast Enlargement
*Abnormal body proportions
*Personality impairment

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14
Q

ACA Mammogram

A
  • 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
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15
Q

Antibiotics for Asymptomatic bacteriuria and cystitis in pregnancy: Amoxicillin

A

Dose:
500 mg PO q8h or 875mg PO q12H

Duration:
5 to 7 days

Notes:
Resistance may limit its utility among gram negative pathogens

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16
Q

Antibiotics for asymptomatic bacteriuria and cystitis in pregnancy: Augmentin

A

Augmentin - Amoxicillin-clavulanate

Dose
500mg PO Q8H
OR
875mg PO Q12H

Duration
5-7 days

17
Q

Antibiotics for asymptomatic bacteriuria and cystitis in pregnancy: Cefpodoxime

A

Dose
100mg PO Q12H

Duration
5 to 7 days

18
Q

Antibiotics for asymptomatic bacteriuria and cystitis in pregnancy: Cephalexin

A

Dose
250mg to 500 mg PO Q6H

Duration
5 to 7 days

19
Q

Antibiotics for asymptomatic bacteriuria and cystitis in pregnancy: Fosfomycin

A

Dose
3g PO as single dose

Notes:
Doesn’t achieve therapeutic levels in the kidneys so should not be used if pyelonephritis is suspected

20
Q

Antibiotics for asymptomatic bacteriuria and cystitis in pregnancy: Nitrofrurantoin

A

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.

21
Q

Antibiotics for asymptomatic bacteriuria and cystitis for pregnancy: Pivmecillinam

A

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

22
Q

Antibiotics for asymptomatic bacteriuria or cystitis in pregnancy: Bactrim

A

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.

23
Q

Parenteral regimens for empiric treatment of pyelonephritis in pregnancy: Mild to moderate Pyelonephritis

A

*Ceftriaxone
1g q24H

*Cefepime
1g Q12H

Aztreonam
1g Q8H

*Ampicillin
1-2g Q6H
PLUS
*Gentamicin
1.5mg/kg Q8H

24
Q

Parenteral regimens for empiric treatment of pyelonephritis in pregnancy: Severe Pyelonephritis w/ impaired immune system
and/or incomplete urinary drainage

A

*Zosyn: Piperacillin-Tazobactam
3.375g Q6H

*Meropenem
1g Q8H

*Ertapenem
1g Q24H

*Doripenem
500mg Q8H

25
Q

Tanner Staging Male: Stage 1

A

*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

26
Q

Tanner Staging Male: Stage 2

A

*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

27
Q

Tanner Staging Male: Stage 3

A

*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

28
Q

Tanner Staging Male: Stage 4

A

*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

29
Q

Tanner Staging Male: Stage 5

A

*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

30
Q

Tanner Staging Female: Stage 1

A

*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

31
Q

Tanner Staging Female: Stage 2

A

*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

32
Q

Tanner Staging Female: Stage 3

A

*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

33
Q

Tanner Staging Female: Stage 4

A

*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

34
Q

Tanner Staging Female: Stage 5

A

*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

35
Q
A

Family 1 (8 decks)

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