Repro Topics Flashcards
Puberty for females
10-14 years old
breast development
menarche 2-3 years after beginning puberty
Puberty for males
11-16 years old
penile growth and pubic hair development
Tanner Stages: boys
1) prepubertal
2) enlargement of testes and scrotum
3) enlargement of penis
4) increased size of penis and growth of glands
5) adult genitalia
Tanner Stages: girls
1) prepubertal
2) breast bud stage with elevation of breast and papilla
3) further enlargement of breast and areola
4) areola and papilla form a secondary mound above level of breast
5) mature stage
Tanner stages: boys and girls pubic hair
1) pre
2) sparse
3) darker, coarser
4) covering smaller area than adult
5) adult in type
When does menarche start in terms of breast stages?
stage 3 or 4
What age does breast development and pubic hair occur?
8-13
When does pubic hair and size of male genitalia begin?
9 to 13.5
Menstrual History
- age of menarche
- last menstrual period
Gyn History
- breast history
- last mammogram
- previous GYN surgery
- history of infertility
- last pap smear
OB History
-gravida = # pregnancies T- term deliveries (>37 wks) P- preterm (20-37 wks) A- abortion (<20 wks) L- live delivery regardless of gestational age -mode of delivery with indication for operative delivery -gestational age at delivery -maternal complications -fetal complications -delivery complication
Contraceptive/Sexual History
- contraception method
- currently sexual active
- # partners in last 3 months
- condom use
- history sexual abuse
Well Woman Exam
- pap smear for women over 21 to 65
- yearly for women with abnormal pap
- every 3 years for women with consecutively normal pap smears
- every 5 years with women normal pap smear with negative HPV testing
- mammogram at 50 years or earlier for women who are at high risk
Pap Smear
- help screen for cervical cancer
- 99% cervical cancer is due to high risk HPV strains
- not hereditary
- sample taken of cervix (ectocervix) and the cervical canal (endocervix) during speculum
Pap Smear Technique
- sample from ecto, endo, transitional zone, and squamocolumnar junction
- transformation zone = area between original SCJ and new SCJ
- transformation zone is important bc most common area of precancerous lesion and cancers
Indications for Pap Smear
- every 3 years if normal pap
- co testing with HPV every 5 years
- if abnormal then every year or less with additional intervention
- no further pap is hysterectomy for noncancerous reason
Pelvic Exam
- examines internal and external genitalia
- visual inspection
- bimanual exam
- insert middle finger into vagina lifting upward and using other hand to push downward to examine the vagina, uterus, and ovary
- performed on both left and right side
- check for cervical tenderness
- obtain swabs for STIs
Broad DDX: GU
UTI
STI
Pelvic Inflammatory Disease
Hernia
Broad DDX: GYN
ectopic pregnancy ovarian torsion ruptured ovarian cyst spontaneous abortions tubo-ovarian abscess uterine fibroid
Broad DDX: GI
appendicitis
constipation
IBS
Ectopic Pregnancy
-abdominal or pelvic pain with vaginal bleeding
-may have other pregnancy related symptoms
-hemorrhage or death = complication
-workup includes urine pregnancy test, speculum exam, transvaginal ultrasonography
-surgical removal
ALWAYS DO PREGNANCY TEST
UTI
- dysuria, urinary frequency, urinary urgency, suprapubic pain
- e coli = main cause
- perform abdominal exam, check for costovertebral angle tenderness (lloyd’s punch)
- workup includes urinalysis
- antibiotic treatment
Well Male Exam
- prostate exam and testicular exam not recommended routinely
- prostate specific antigen (PSA) not recommended routinely
- PSA may be indicated for patient with family history of prostate cancer
- if indicated based on history: inspection, palpation, retract foreskin if present, palpate for hernias, examine prostate by palpation on digital rectal exam (DRE)
Prostate Exam
- palpate prostate gland
- palpate the prostate lobes and median sulcus
Inguinal Hernia
- pain with increased intra-abdominal pressure
- may have palpable bulge on affected side
- physical exam shows invaginating scrotal skin with index finger into the inguinal canal and have patient cough or perform valsalva
- workup includes imaging
- if mild hernia, watchful waiting
- if moderate to severe hernia, surgery to repair
5 P’s in Sexual History
1) Partners
2) Practices
3) Prevention of pregnancy
4) Protection from STIs and HIV
5) Past history of STI
STI risk factors
- new sex parter in past 60 days
- multiple sex partners
- sex with partners recently treated for STI
- no or inconsistent condom use outside a mutually monogamous sexual partnership
- trading sex for money or drugs
Which conditions are considered STI?
- chlamydia (bacteria)
- gonorrhea (bacterial)
- herpes simplex 2 (viral)
- HPV (viral)
- syphilis (bacterial)
- trichomoniasis (protozoa)
- hep B and C (viral)
- HIV/AIDS (viral)
Complications of untreated STIs
- pelvic inflammatory disease
- upper genital tract infections
- infertility
- chronic pelvic pain
- cervical cancer
- chronic infection with herpes viruses, hepatitis viruses, and HIV
Key to Treatment of STIs
- antibiotics and antivirals
- behavioral counseling
Gonorrhea (bacteria)
- gram neg intracellular diplococci
- penile discharge and dysuria
- pelvic pain or vaginal discharge
- can cause pelvic inflammatory discharge if untreated
- scarring of fallopian tube may occur if not treated
- workup includes nucleic acid amplification tests on endocervical, urethral, vaginal, pharyngeal, rectal, or urine samples
- treatment includes antibiotics, counseling
Chlamydia (bacteria)
- gram neg chlamydia trachomatis
- most cases = asymptomatic
- penile charge, pruritus, dysuria
- vaginal discharge, vaginal bleeding, pain during intercourse, dysuria
- can cause infection of urogenital, norectal, conjunctival or pharyngeal infections
- complication includes PID or fertility issues if left untreated
- workup includes nucleic acid amplification tests
- treatment includes antibiotics, counseling
Syphilis (bacteria)
- spirochete, treponema pallidum
- primary = chancre
- secondary = joint pains, fatigue, lymphadenopathy, mucopapular rash
- latent phase = may be asymptomatic
- tertiary = neurosyphilis
- complication may be progression to neurosyphilis
- workup includes serologic testing, antibody detection testing, microscopy
- treat with antibiotics (penicillin)
Genital Herpes (HIV)
- herpes simplex virus 2
- single or clusters of vesicles on the genitalia
- may have burning, tingling and pain prior to a vesicle appearance
- viral DNA travels by axon to the spinal cord sensory ganglion and persists for life
- complications include meningitis, PID, hepatitis, increase risk in HIV infection
- workup includes serologic test, PCR of sample from lesion
- treatment includes antiviral (acyclovir)
Trichomonasis (protozoa)
- protozoa with flagella
- can be asymptomatic
- most men are asymptomatic, but some have penile discharge
- female may have foul smelling thin or purulent vaginal discharge, vaginal pruritus, dysuria
- workup includes a wet mount or NAATs
- treatment includes antiprotozoal medication (metronidazole)
HPV (virus)
- human papillomavirus, a group of >100 viruses
- genital warts
- most lesions are self limited
- high risk strains can lead to cancer or the oropharyngeal region or lower genital tract
- workup includes routine pap smear, intervene if any cervical changes, may test for HPV during routine pap smear
- treatment includes vaccinating with gardasil vaccine, routine pap smear, and genital wart removal
