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N827 > Peds GYN > Flashcards

Peds GYN Flashcards

1
Q

Puberty: Definition

A

The onset of sexual development

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2
Q

Puberty: Males

A
  • Testes begin to produce sperm

- Male puberty complete with the first ejaculation that contains mature sperm

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3
Q

Puberty: Females

A
  • Ovaries begin to release mature ova
  • Female puberty complete at first ovulatory menstrual period
  • Can take up to 1-2yr after menarche
  • Puberty complete when reproduction possible
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4
Q

Androgens in Puberty

A
  • Responsible for skeletal growth spurt and pubic and axillary hair growth, and acne and sebaceous glands
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5
Q

Prepubertal Exam of genitals

A
  • Presence of pubic/body hair
  • Skin lesions
  • Hygiene
  • Anus for cleanliness, excoriation, erythema
  • Tanner stage
  • Clitoris (size)
  • Labia minora
  • any sign of estrgenization (vaginal mucosa should be moist, thin, and red, NOT dull pink)
  • Hymen: Cresent shaped, annular or redundant, may have tags or notches
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6
Q

Adolescent Genital/Puberty Exam

A
  • Acne
  • Tanner stage of breasts and external genitalia
  • Thyroid
  • Hair distribution on face, chest, back, arms, legs, and abdomen
  • External vaginal exam (ONLY internal if PID or pregnancy suspected)
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7
Q

Puberty: Diagnostics

A
  • None routinely
  • wet mount of vaginal secretions
  • Saline: WBC, clue cells, trichomonads, bacteria
  • KOH: yeast/hyphae
  • Urine-based nucleic acid amplification test, cultures, and/or serologic testing for STI (Urine VERY accurate for trich, chlamydia, and gonorrhea)
  • Ultrasound
  • HCG
  • NO PAP <21yr
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8
Q

OCs: Monophasic

A
  • Contain same amount of estrogen and progestin in all of the active pills
  • Alesse, Loestrin, Ortho-Cyclen, Seasonale, Yaz, Beyaz
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9
Q

OCs: BiPhasic

A
  • Changes the amount of hormones estrogen and progestin once during the menstrual cycle
  • Kariva, Mircette, Ortho-Novum 10/11
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10
Q

OCs: Triphasic

A
  • Contains three different levels of hormones in active pills
  • Levels change every seven days during forst three weeks
  • Cyclessa, Ortho TriCyclen, Nortel, Enpresse, Ortho-Novum
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11
Q

OCs: quadraphasic

A
  • hormones change 4 times per cycle

- Natazia is only one

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12
Q

OCs: Only ones approved by Medicaid

A
  • Mircette (desogestrel/ethinyl estradiol tablets)

- Sprintec (Norgestimate and ethinyl estradiol tablets)

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13
Q

Labial Adhesions (Fusion)

A
  • Fusion of the labia minora, usually benign
  • From irritation and lack of estrogen
  • Usually 3mo-6yr
  • May have difficulty voiding and UTI’s
  • Tx: Vaseline w/q-tip and gentle pressure q diaper change; Premarin 1% cream for 3wk with gentle pressure
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14
Q

Vulvovaginitis: Basics

A
  • Inflammation, often w/discharge from infection or irritation
  • Often w/pruritus
  • Usually from poor hygiene, bubble baths
  • Must consider: foreign body, bacteria, candida, pinworms, chemical, mechanical, child abuse
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15
Q

Vulvovaginitis: Hx

A
  • Genital irritation, burning, itching, pain
  • Vaginal dicharge
  • Nighttime perianal itching
  • Urinary complaints
  • Recent ABX use
  • Underlying illness
  • Bubble baths/harsh soaps
  • Tight clothing
  • Super absorbent diapers
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16
Q

Vulvovaginitis: PE

A
  • Erythema
  • Discharge
  • Bacterial culture of secretions
  • Wet mount, KOH
  • Other testing if abuse suspected
17
Q

Vulvovaginitis: Tx

A
  • ABX if bacterial
  • Anti-fungal creams
  • Albendazole (Ignore book, mebendazole no longer available)
  • Handwashing
  • Hygiene
  • Treat STIs
18
Q

Mittelschmerz

A
  • Pelvic pain that occurs during the time of ovulation
  • Dull, achy pain in lower abdomen lasting a few minutes to several hours
  • If very painful, OCs may be used, otherwise oral analgesics (Naproxen, IBU, prostaglandin inhibitors)
19
Q

Dysmennorrhea: Basics

A
  • Painful menstruation with cramping in lower ABD or pelvis
  • Primary: Caused by exaggerated response to prostaglandins resulting in uterine contractions and vasoconstriction
  • Secondary: Caused by endometriosis. ovarian cysts, infection, uterine abnormalities
20
Q

Dysmennorrhea: Hx

A
  • Onset: usually 6-24mo after menarche
  • Begins with menses and lasts 2-3 days
  • Usually lower ABD and radiating to back and thighs
  • Associated Sx: N/V, diarrhea, HA, fatigue, nervousness, dizziness, urinary frequency
  • # of missed school days
  • Sexual Hx: dyspareunia, menorrhagia, infections, discharge
  • Family Hx: Endometriosis
21
Q

Dysmennorrhea: PE

A
  • External genitalia

- rule out hymenal abdnomality (imperforate or transverse hymenal septum (suspect in pubertal female s menses))

22
Q

Dysmennorrhea: Tx

A
  • NSAIDs
  • OCs
  • Thiamin
  • VitE
  • Mag
  • Topical heat
  • Reduce caffeine and salt intake
  • Increase fiber and water
  • Exercise
  • Smoking cessation
  • Refer if intervention not successful or if suspect secondary causes
23
Q

Adolescent Pregnancy

A
  • Always ask about rape
  • Ask about partner
  • Referral for WIC, medicaid, country services
  • Start prenatal vitamins ASAP
24
Q

Amenorrhea: Basics

A
  • Lack of menses
  • Primary: absence of menarche by 16yrs of age with normal pubertal development or absence of menarche by 14yr in absence of secondary sex characteristics
  • Secondary: Absence of menses for 3 cycles of more than 6mo in females with established menses
25
Q

Amenorrhea: Etiology

A
  • Disorders of the outflow tract or uterine target organ: vaginal septum, imperforate hymen
  • Disorders of the ovary: gonadal dysgenesis, PCOS
  • Disorder of anterior pituitary
  • Disorder of hypothalamus
  • Pregnancy
26
Q

Amenorrhea: Dx

A
  • Hcg
  • TSH
  • FSH, LH
  • Prolactin
  • Karyotype
  • Consider androgens
27
Q

Amenorrhea: Management

A
  • Provera 10mg q day x 7d

- Menses should occur, then follow this with OCs to establish regular menses

28
Q

Dysfunctional Uterine Bleeding: Basics

A
  • Abnormal uterine bleeding that is excessive, prolonged, or unpatterned
  • NL menses: q 21-45d, last 3-7d; 10-15 soaked pads/tampons per cycle
29
Q

Dysfunctional Uterine Bleeding: etiology

A
  • estrogen production continues without the balancing decrease in FSH which would suppress estrogen
  • Endometrium thickens and sheds in a orderly fashion
  • Anovulation is the most common cause in adolescents
30
Q

Dysfunctional Uterine Bleeding: Dx

A
  • Hcg
  • CBC
  • Retic
  • ESR
  • CRP
  • Coags
  • TSH
  • FSBS
  • Prolactin
  • Free testosterone levels
  • US of pelvis
31
Q

Dysfunctional Uterine Bleeding: Tx (Mild)

A
  • shortened cycle or menses longer that NL with slight increase in flow and Hgb >12
  • Observe and keep calendar
  • Fe supplement
  • OCs for 3-4mo
  • Use NSAIDs to reduce heavy bleeding
  • Reassess in 3mo
32
Q

Dysfunctional Uterine Bleeding: Tx (moderate)

A
  • Shortened (1-3wk), irregular cycle with moderate-to-heavy bleeding and Hgb 10-12
  • 35mcg monophasic OCs
  • Use same day start if not bleeding
  • If bleeding, start with one OC BID x3-4d until bleeding stops, then continue with q day until pack finished, skip placebo, and start next pack without withdrawal bleeding
  • May go up to 4 pills per day
33
Q

Dysfunctional Uterine Bleeding: Tx (Severe)

A
  • irregular, prolonged, heavy bleeding and Hgb <10
  • refer to GYN
  • If not actively bleeding, may manage as moderate DUB
34
Q

Endometriosis: Basics

A
  • Proliferation of ectopic endometrial tissue outside of the pelvic cavity
  • Manifested by dysmenorrhea that progressively worsens
  • May have acyclic pain, pelvic pain, GI complaints, dyspareunia

N827 (19 decks)

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