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PCM II Midterm > Repro Topics > Flashcards

Repro Topics Flashcards

1
Q

Puberty for females

A

10-14 years old
breast development
menarche 2-3 years after beginning puberty

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2
Q

Puberty for males

A

11-16 years old

penile growth and pubic hair development

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3
Q

Tanner Stages: boys

A

1) prepubertal
2) enlargement of testes and scrotum
3) enlargement of penis
4) increased size of penis and growth of glands
5) adult genitalia

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4
Q

Tanner Stages: girls

A

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

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5
Q

Tanner stages: boys and girls pubic hair

A

1) pre
2) sparse
3) darker, coarser
4) covering smaller area than adult
5) adult in type

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6
Q

When does menarche start in terms of breast stages?

A

stage 3 or 4

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7
Q

What age does breast development and pubic hair occur?

A

8-13

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8
Q

When does pubic hair and size of male genitalia begin?

A

9 to 13.5

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9
Q

Menstrual History

A
  • age of menarche

- last menstrual period

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10
Q

Gyn History

A
  • breast history
  • last mammogram
  • previous GYN surgery
  • history of infertility
  • last pap smear
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11
Q

OB History

A 
-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
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12
Q

Contraceptive/Sexual History

A
  • contraception method
  • currently sexual active
  • # partners in last 3 months
  • condom use
  • history sexual abuse
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13
Q

Well Woman Exam

A
  • 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
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14
Q

Pap Smear

A
  • 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
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15
Q

Pap Smear Technique

A
  • 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
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16
Q

Indications for Pap Smear

A
  • 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
17
Q

Pelvic Exam

A
  • 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
18
Q

Broad DDX: GU

A

UTI
STI
Pelvic Inflammatory Disease
Hernia

19
Q

Broad DDX: GYN

A 
ectopic pregnancy
ovarian torsion
ruptured ovarian cyst
spontaneous abortions
tubo-ovarian abscess
uterine fibroid
20
Q

Broad DDX: GI

A

appendicitis
constipation
IBS

21
Q

Ectopic Pregnancy

A

-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

22
Q

UTI

A
  • 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
23
Q

Well Male Exam

A
  • 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)
24
Q

Prostate Exam

A
  • palpate prostate gland

- palpate the prostate lobes and median sulcus

25
Q

Inguinal Hernia

A
  • 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
26
Q

5 P’s in Sexual History

A

1) Partners
2) Practices
3) Prevention of pregnancy
4) Protection from STIs and HIV
5) Past history of STI

27
Q

STI risk factors

A
  • 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
28
Q

Which conditions are considered STI?

A
  • chlamydia (bacteria)
  • gonorrhea (bacterial)
  • herpes simplex 2 (viral)
  • HPV (viral)
  • syphilis (bacterial)
  • trichomoniasis (protozoa)
  • hep B and C (viral)
  • HIV/AIDS (viral)
29
Q

Complications of untreated STIs

A
  • pelvic inflammatory disease
  • upper genital tract infections
  • infertility
  • chronic pelvic pain
  • cervical cancer
  • chronic infection with herpes viruses, hepatitis viruses, and HIV
30
Q

Key to Treatment of STIs

A
  • antibiotics and antivirals

- behavioral counseling

31
Q

Gonorrhea (bacteria)

A
  • 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
32
Q

Chlamydia (bacteria)

A
  • 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
33
Q

Syphilis (bacteria)

A
  • 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)
34
Q

Genital Herpes (HIV)

A
  • 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)
35
Q

Trichomonasis (protozoa)

A
  • 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)
36
Q

HPV (virus)

A
  • 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

PCM II Midterm (11 decks)

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