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1
Q

Puberty ages

F:
M:

A

F: 10-14 yo. period begins 2-3 years after
M: 11-16 yo

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2
Q

One of the first sign of

puberty in females

A

female breast/pubic hair development occurs 8-13 yo

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3
Q

Menarche usually starts

at breast stage

A

3 or 4

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4
Q

Pubic hair and size of male
genitalia start from____
years of age

A

9-13

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5
Q

OB/GYN History

how thorough are they?

A

As vague or thorough as required by the setting

• Less details in ENT clinic but more thorough in GYN clinic

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6
Q

what types of history to ask?

A
  1. menstrual history
  2. Gyneocologic history
  3. obstetrical history
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7
Q

menstrual history

A
  1. age of 1st period
  2. duration,
  3. flow,
  4. cycle length
  5. LMP
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8
Q

Gynecologic History

A
  1. breast history: self breast exam (SBE)
  2. last mammogram
  3. Previous GYN surgery
  4. history of infertility
  5. last Pap smear
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9
Q

Obstetrical History

A 
1. G3P3
gravida- number of pregnancies; para(number of viable births.
2. mode of delivery
3. gestational age at delivery
4. complications. for mom
5. complications for bbs
6. delivery. comlications
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10
Q

To be more thorough about a patient OB history you can expand on para

A

TPAL

T: term deliveries >37 weeks gestation
P: preterm delivery 20 - <37 weeks gestation (even if not alive)
A: abortion: before 20 weeks gestation
L: live delivery regardless of gestational age

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11
Q

Prenatal followup who has had 2 term deliveries and currently pregnant

A

28yo G3P2

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12
Q

Prenatal patient with 4 pregnancies, 1 spontaneous abortion at 14 weeks, 1 fetal demise at 28 weeks

A

31yo G4P2112

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13
Q

GYN visit for tubal ligation who has had 5 pregnancies, 3 term delivers, 1 spontaneous abortion at 12
weeks, 1 live delivery at 35 week gestations

A

G5P3114

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14
Q

Contraceptive/Sexual History

A
  1. contraception method
  2. currently. sexual active
  3. numer of partners last 1 year/lifetime
  4. new partners in last 2 months
  5. condom use
  6. history of sexual abuse
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15
Q

who should get a. Pap smear

A

EVERY women over 21 years to 65 years old to check for abnormal cerical cells

• if abnormal: yearly
Normal: every 3 years
Cotest of Normal with - HPV: 5 years

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16
Q

who should get a mammogram

A

W 50 years or if at high risk, earlier

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17
Q

Pap Smear is what

A

helps screen for cervical cancer/ 99% is d/t HPV

NOT heritdary

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18
Q

during Pap smear, sample of what is taken

A
  1. ectocervix from cervix
  2. endocervix (from cervical canal)
  3. . TRANSITIONAL ZONE AND SQUAMOCOLUMNAR JUNCTION (SJC
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19
Q

The _______ is important as it is the most common

area of precancerous lesion and cancers

A

transformation zone

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20
Q

Pap smear Y OR NO

if hysterectomy for noncancerous
reasons,

A

NO.
if hysterectomy for cervical cancer then continue
surveillance for residual cells

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21
Q

Difference Between a pelvic exam and Pap smear

A

both use speculum.

pelvic exam looks at internal and external genetalia. requires visual inspection and bimanual inspection: insert index and middle finger -> lift upwards and using other hand downward to examine vagina, uterus and ovary on both sides

  • cervical motion tenderness caused by pain in bimanual exam
  • get swabs for STDS
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22
Q

Pelvic Pain – Broad DDX based on CC

A

GU: UTI, STI*, PID, hernia

GYN: ectopic preg*, ovarian torsion, ruptured just

GI: APPY. consitpation, IBS

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23
Q

Ectopic Pregnancy classic presentation

comlication>:

A

abdominal/pelvic pain with vaginal bleeding
other pregnancy related sis

hemorrhage, death

24
Q

Ectopic Pregnancy

w/u

A
  1. Female with above symptoms should always be evaluated with urine pregnancy
  2. Speculum exam
    3/ If confirmed pregnant then transvaginal ultrasonography is recommend
25
Technically we do not test on workup currently but I expect you to know for suspected ectopic pregnancy
ALWAYS DO A. PREGNANY TEST
26
someone has STI, what do we do
• Pelvic with bimanual exam and swabs
27
UTI most common organism causing this infection
Escherichia coli
28
PE and W/U for UTL
PE: abdominal exam, check for costovertebral angle tenderness (lloyds punk W:U: urinalysis Tx: ABX
29
when do we do prostate/testicular exam and check PSA levels
not recommended routinely. these are done based. on its signs and. sx
30
how to perform male genital exam
1. Inspection of scrotum, penile shaft, glans, inguinal region 2. Palpate penile shaft and scrotum (examine for testis, epididymis, spermatic cord) with thumb and first two fingers 3. Retract foreskin if present 4. Palpate inguinal region and examine for hernias 5. Examine prostate by palpation on digital rectal exam (DRE): prostate lobes and median sulcus
31
groin pain broad ddx
GU: groin lesion, scrotal mass, hydrocele, UTI, varicocee MSK: OA., nerve impingement, hip fx GI: consti, APPY
32
Inguinal Hernia
Invaginating scrotal skin with index finger into the inguinal canal and have patient cough or perform Valsalva, may help feel the hernia
33
Inguinal Hernia w/u | Management
imaging, US - watch if mild moderate -> severe: srurgey
34
5. P's: important sexual history to. obtain
1. partners: M,W, both, new partner, number in last 12 months 2. practices: how often do you use contoms, anatomic. site. of expposure 3/ prevention of pregnany 4/ prevention from STI/HIV 5. Past hx of STI: ever had STI? Partners ever had STI?
35
Sexually Transmitted Disease (STD) risk factors
1. new partner. in past 60 days 2. sex w someone recently treated for STI 3. trading sex for money tdrugs ...
36
``` Chlamydia (____) • Gonorrhea (____) • Herpes simplex 2 (____) • Human papilloma vius (HPV) (____) • Syphilis (_____) • Trichomoniasis (____) ```
``` bacterial bacterial viral viral bacterial protozoa ```
37
• Complications of untreated sexually transmitted infections (STIs)
Pelvic inflammatory dz more secure infection most commonly d/t: GON or CHLA 2 upper tract infections infertility chronic pelvic pain HPV chronic infections if: herpes, hep, HiV
38
key. to tx. STD
1. Antibiotics and antivirals | 2. behavioral counseling to prevent: treatment. of partner, coupling on sage sex, stress use of condoms
39
_________ is also key in sexually active adolescent to reduce high risk behaviors
behavioral counseling
40
Gonorrhea (bacteria) • Classic presentation:
men: penile discharge, dysuria, some can be asymptomatic F: infection of urogenital, anorectal, pharyngeal. infections
41
Gonorrhea (bacteria) W/u
Nucleic acid amplification tests (NAATs) on endocervical, urethral, vaginal, pharyngeal, rectal, or urine samples
42
• Management/Treatment: | Gonorrhea (bacteria)
abs Usually will also treat for Chlamydia infection if patient has Gonorrhea as Chlamydia is often an asymptomatic co-infection
43
Chlamydia (bacteria) | presentation
most cases: pt is asymptomatic Men: penile discharge, purititis, dysuria F: vaginal discharge, bleeding, pain during sex, dysuria, infection of urogenital, anorectal, pharyngeal. infections
44
Chlamydia (bacteria) W/u
Nucleic acid amplification tests (NAATs) on endocervical, urethral, vaginal, pharyngeal, rectal, or urine samples
45
Syphilis (bacteria) classic presentation
Primary – chancre (painless lesion) – Secondary - joint pains, fatigue, lymphadenopathy, mucopapular rash – Latent phase – may be asymptomatic – Tertiary – neurosyphilis (confusion, headache, stiff neck, vision loss)
46
organisms. of syphallis
spirochete | treponema pallidum
47
Syphilis (bacteria) | w/u
serologic testing, | antibody detection testing, microscopy etc (nontrepomenal test and treponema test
48
``` Genital Herpes (virus) is ``` HSV2 presentation
Single or clusters of vesicles on the genitalia – May have burning, tingling and pain prior to vesicle appearance PERSISTS FOR LIFE
49
HSV2 w/u
serologic test (PCR) of sample from lesion
50
Trichomonasis (protozoa) organism
protozoa with flagella
51
Trichomonasis (protozoa) presenation
M: often asymptomatic but a small percentage can have penile discharge F: foul smelling thin or purulent vaginal discharge, vaginal pruritus, dysuria
52
Trichomonasis (protozoa) W/u
Wet mount (sample on slide seen under microscope) or (NAATs) on vaginal fluid or penile fluid
53
Tx tricho
– Antiprotozoal medication like metronidazole
54
``` Human papillomavirus (HPV) (virus) • Organism (virus): human papillomavirus, a group of >100 viruses ``` classic presentation
genital warts (cauliflower-like or flat)
55
HPV. • Workup:
papsmear you.can test. for during routine pap smear
56
• Management/Treatment: HPV
1. gardisol vaccine from ages 11-26 2. routine Pap smear 3. remove genital warts

PCM II Exam 1 (5 decks)

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