Pediatric Male/Female Reproductive System Flashcards
All sexually active women age [] should be screened for Chlamydia trachomatis and Neisseria gonorrhoeae.
e.g. nucleic acid amplification testing
All sexually active women age >24 should be screened for Chlamydia trachomatis and Neisseria gonorrhae.
e.g. nucleic acid amplification testing
Congenital hydrocele occurs due to incomplete obliteration of the […] in infants.
Congenital hydrocele occurs due to incomplete obliteration of the processus vaginalis in infants.
Do adolescents seeking pregnancy prevention options (e.g. OCPs, emergency contraception) need parental consent?
No
Fetal macrosomia is associated with increased risk for shoulder […].
Fetal macrosomia is associated with increased risk for shoulder dystocia.
potential complications of shoulder dystocia include clavicle fracture, brachial nerve palsies, and perinatal asphyxia
In […] syndrome a person is genotypically XY but has female external genitalia with male internal genitalia.
In androgen insensitivity syndrome a person is genotypically XY but has female external genitalia with male internal genitalia.
i.e. the presence of the lower vagina, clitoris, and labia with cryptorchid testes
In androgen insensitivity syndrome a person is genotypically XY but has […] external genitalia with […] internal genitalia.
In androgen insensitivity syndrome a person is genotypically XY but has female external genitalia with male internal genitalia.
i.e. the presence of the lower vagina, clitoris, and labia with cryptorchid testes
In 5α-reductase deficiency, a person is genotypically XY but has ambiguous […] genitalia with normal male […] genitalia.
In 5α-reductase deficiency, a person is genotypically XY but has ambiguous external genitalia with normal male internal genitalia.
due to lack of dihydrotestosterone, which is necessary for external genitalia development – at puberty, elevated levels of testosterone cause external genitalia growth
In […] deficiency, a person is genotypically XY but has ambiguous external genitalia with normal male internal genitalia.
In 5α-reductase deficiency, a person is genotypically XY but has ambiguous external genitalia with normal male internal genitalia.
due to lack of dihydrotestosterone, which is necessary for external genitalia development – at puberty, elevated levels of testosterone cause external genitalia growth
Kallmann syndrome presents as infertility in males and amenorrhea in females; […] may be present in both sexes.
Kallmann syndrome presents as infertility in males and amenorrhea in females; anosmia may be present in both sexes.
due to failure of GnRH migration (thus decreased FSH, LH, and testosterone) and olfactory bulb formation
Klinefelter syndrome is characterized by a […],[…] karyotype.
Klinefelter syndrome is characterized by a 47,XXY karyotype.
Maternal hyperglycemia is associated with macrosomia, secondary to fetal […].
Maternal hyperglycemia is associated with macrosomia, secondary to fetal hyperinsulinemia.
Patients with Turner syndrome typically have […] levels of estrogen.
Patients with Turner syndrome typically have low levels of estrogen.
due to ovarian dysgenesis; results in high levels of FSH/LH due to lack of negative feedback
Primary amenorrhea is defined as the absence of menarche by age […].
Primary amenorrhea is defined as the absence of menarche by age 15.
Size and tenderness of a fibroadenoma of the breast typically increases prior to […].
Size and tenderness of a fibroadenoma of the breast typically increases prior to menstruation.
Small for gestational age (SGA) infants have a birth weight that is below the […] percentile for gestational age.
Small for gestational age (SGA) infants have a birth weight that is below the 10th percentile for gestational age.
What hematologic complication may be seen in a newborn with low birth weight and intrauterine growth restriction?
Polycythemia
due to increased erythropoietin secretion in response to fetal hypoxia; other complications include hypoglycemia, hypothermia, and hypocalcemia
What is the first-line treatment for primary dysmenorrhea?
NSAIDs and/or OCPs
treatment preference depends if the patient is sexually active (OCPs) or sexually inactive (NSAIDs)
What is the likely diagnosis in a macrosomic newborn with crepitus over the clavicle and asymmetric Moro reflex?
Clavicular fracture (secondary to shoulder dystocia)
diagnosis is confirmed with X-ray
What is the likely diagnosis in a patient with pelvic cramping during the first few days of menses with a normal physical examination?
Primary dysmenorrhea
due to uterine contractions triggered by prostaglandin release from sloughing endometrium
What is the likely diagnosis in a young girl that presents with breast development and a white, odorless vaginal discharge with an ovarian mass on ultrasound?
Granulosa cell tumor
white, odorless vaginal discharge is indicative of estrogen stimulation
What is the likely diagnosis in an adolescent female that presents with amenorrhea with a non-palpable uterus and normal-size ovaries on ultrasound?
Mullerian agenesis (Mayer-Rokitanksy-Kuster-Hauser syndrome)
primary amenorrhea due to lack of uterine development; still have normal ovaries with normal axillary and pubic hair
What is the likely diagnosis in an adolescent patient with a unilateral, mobile, well-circumscribed mass in the outer quadrant of the breast that becomes tender prior to menstruation?
Fibroadenoma
fibroadenoma is the most common cause of breast mass in an adolescent
What is the likely underlying etiology of painless, irregular, heavy menses in an adolescent girl that started menstruation one year ago?
Immaturity of the hypothalamic-pituitary-ovarian axis
results in anovulatory cycles, which causes abnormal uterine bleeding
What is the most common cause of vaginal bleeding in the neonatal period?
Maternal withdrawal of estrogen
typically manifests as a white vaginal discharge mixed with blood within the first 2 weeks of life
What is the most effective emergency contraceptive?
Copper IUD
copper IUD > ulipristal pill > levonorgestrel pill (plan B) > OCPs
What is the next step in management for a macrosomic newborn with a clavicular fracture secondary to shoulder dystocia?
Reassurance
neonatal clavicular fractures usually heal spontaneously within 7 - 10 days
What is the next step in management for a newborn male with a cystic testicular mass that is transilluminated with light?
Reassurance and observation
most cases spontaneously resolve by 12 months of age; those that persist should be surgically removed to decrease the risk of inguinal hernia
What is the next step in management for a newborn that presents with bilaterally enlarged mammary glands and whitish vaginal discharge?
Reassurance
breast hypertrophy and leukorrhea are due to transplacental maternal estrogen exposure
What is the next step in management for an adolescent female that presents with nausea/vomiting and RLQ abdominal pain with an unknown last menstrual period?
[…]
Urine pregnancy testing (e.g. hCG)
transvaginal ultrasound may help distinguish between different etiologies after pregnancy testing
What is the next step in management for an adolescent girl that presents with primary amenorrhea and absent breast development with a uterus present on ultrasound?
Measure serum FSH level
helps distinguish between central (low FSH) and peripheral (high FSH) causes; absent breast development indicates a lack of estrogen, thus estrogen levels do not need to be measured
What is the next step in management for an adolescent girl with primary amenorrhea with a uterus present on ultrasound and high FSH levels?
Karyotyping
high FSH is indicative of a peripheral cause, such as hypogonadotropic amenorrhea (e.g. Turner’s syndrome)
What is the next step in management for an adolescent girl with primary amenorrhea with a uterus present on ultrasound and low FSH levels?
Brain MRI
low FSH is indicative of a central cause, such as hypothalamic or pituitary abnormalities
What is the next step in management for an adolescent that presents with a tender breast mass a few days prior to menstruation?
Follow-up after menses
if the breast mass decreases in size and/or tenderness, it is likely a fibroadenoma and the patient can be reassured
What is the preferred imaging modality for the initial evaluation of a patient with primary amenorrhea?
Pelvic ultrasound
useful for evaluating internal female anatomy (e.g. uterus, ovaries), which helps distinguish underlying etiologies
What is the underlying cause of hand and foot swelling in a newborn patient with Turner syndrome?
Abnormal development of the lymphatic system (congenital lymphedema)
What kidney abnormality is associated with Turner syndrome?
Horseshoe kidney
What musculoskeletal pathology is associated with Turner syndrome?
Osteoporosis
estrogen deficiency leads to increased bone resorption (estrogen typically inhibits osteoclast-mediated bone resorption)
When should patients with androgen insensitivity syndrome have bilateral gonadectomy?
After puberty
gonad-stimulated puberty helps attain adult height (the testes still produce testosterone); cryptorchid gonads have a small risk of developing into a dysgerminoma or gonadoblastoma after puberty and thus should be removed
Which sex chromosome disorder is associated with gynecomastia, female hair distribution, tall/long extremities and eunuchoid body shape in a male?
Klinefelter syndrome (47,XXY)
Which sex chromosome disorder is associated with short stature, primary amenorrhea, and absent thelarche in a female?
Turner syndrome
other characteristic features include webbed neck, shield chest, cystic hygroma, horseshoe kidney, bicuspid aortic valve, and streak ovary
[…] is the failure of the testicle to descend into the scrotal sac.
Cryptorchidism is the failure of the testicle to descend into the scrotal sac.
if not descended by 6 months, orchiopexy is performed before 1 year of age to prevent testicular torsion, improve fertility, and decrease risk of testicular malignancy
Kallmann syndrome is characterized by a defective migration of […] cells and defective formation of the olfactory bulb.
Kallmann syndrome is characterized by a defective migration of GnRH cells and defective formation of the olfactory bulb.
results in delayed/absent puberty and anosmia with a normal karyotype
