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PCM II Exam 1 > repor > Flashcards

repor Flashcards

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
Q

Technically we do not test on workup currently but I expect you to know for suspected
ectopic pregnancy

A

ALWAYS DO A. PREGNANY TEST

26
Q

someone has STI, what do we do

A

• Pelvic with bimanual exam and swabs

27
Q

UTI most common organism causing this infection

A

Escherichia coli

28
Q

PE and W/U for UTL

A

PE: abdominal exam, check for costovertebral angle tenderness (lloyds punk

W:U: urinalysis

Tx: ABX

29
Q

when do we do prostate/testicular exam and check PSA levels

A

not recommended routinely.

these are done based. on its signs and. sx

30
Q

how to perform male genital exam

A
  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
Q

groin pain broad ddx

A

GU: groin lesion, scrotal mass, hydrocele, UTI, varicocee

MSK: OA., nerve impingement, hip fx

GI: consti, APPY

32
Q

Inguinal Hernia

A

Invaginating scrotal skin with index finger into the inguinal canal and have patient cough
or perform Valsalva, may help feel the hernia

33
Q

Inguinal Hernia w/u

Management

A

imaging, US
- watch if mild
moderate -> severe: srurgey

34
Q
  1. P’s: important sexual history to. obtain
A
  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
Q

Sexually Transmitted Disease (STD) risk factors

A
  1. new partner. in past 60 days
  2. sex w someone recently treated for STI
  3. trading sex for money tdrugs

…

36
Q 
Chlamydia (\_\_\_\_)
• Gonorrhea (\_\_\_\_)
• Herpes simplex 2 (\_\_\_\_)
• Human papilloma vius (HPV) (\_\_\_\_)
• Syphilis (\_\_\_\_\_)
• Trichomoniasis (\_\_\_\_)
A 
bacterial
bacterial
viral
viral
 bacterial
protozoa
37
Q

• Complications of untreated sexually transmitted infections (STIs)

A

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
Q

key. to tx. STD

A
  1. Antibiotics and antivirals

2. behavioral counseling to prevent: treatment. of partner, coupling on sage sex, stress use of condoms

39
Q

_________ is also key in sexually active adolescent to reduce high risk
behaviors

A

behavioral counseling

40
Q

Gonorrhea (bacteria)

• Classic presentation:

A

men: penile discharge, dysuria, some can be asymptomatic

F: infection of urogenital, anorectal, pharyngeal. infections

41
Q

Gonorrhea (bacteria)

W/u

A

Nucleic acid amplification tests (NAATs) on endocervical, urethral, vaginal, pharyngeal, rectal, or urine
samples

42
Q

• Management/Treatment:

Gonorrhea (bacteria)

A

abs
Usually will also treat for Chlamydia infection if patient has Gonorrhea as Chlamydia is often an
asymptomatic co-infection

43
Q

Chlamydia (bacteria)

presentation

A

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
Q

Chlamydia (bacteria)

W/u

A

Nucleic acid amplification tests (NAATs) on endocervical, urethral, vaginal, pharyngeal, rectal, or urine
samples

45
Q

Syphilis (bacteria)

classic presentation

A

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
Q

organisms. of syphallis

A

spirochete

treponema pallidum

47
Q

Syphilis (bacteria)

w/u

A

serologic testing,

antibody detection testing, microscopy etc (nontrepomenal test and treponema test

48
Q 
Genital Herpes (virus)
is

HSV2

presentation

A

Single or clusters of vesicles on the genitalia

– May have burning, tingling and pain prior to vesicle appearance

PERSISTS FOR LIFE

49
Q

HSV2 w/u

A

serologic test

(PCR) of sample from lesion

50
Q

Trichomonasis (protozoa)

organism

A

protozoa with flagella

51
Q

Trichomonasis (protozoa)

presenation

A

M: often asymptomatic but a small percentage can have penile discharge

F: foul smelling thin or purulent vaginal discharge, vaginal pruritus, dysuria

52
Q

Trichomonasis (protozoa)

W/u

A

Wet mount (sample on slide seen under microscope) or

(NAATs) on vaginal fluid or penile fluid

53
Q

Tx tricho

A

– Antiprotozoal medication like metronidazole

54
Q 
Human papillomavirus (HPV) (virus) 
• Organism (virus): human papillomavirus, a group of >100 viruses

classic presentation

A

genital warts (cauliflower-like or flat)

55
Q

HPV. • Workup:

A

papsmear

you.can test. for during routine pap smear

56
Q

• Management/Treatment: HPV

A
  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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