Reproduction Flashcards
At what breast stage does menarche typically begin?
3-4
*breast development and pubic hair occur 8-13
At what stages do men develop pubic hair?
stage 4 and 5
OB/GYN History includes…
- first menarche, duration, flow, cycle length, LMP
- Breast history
- Previous GYN surgery
- history of infertility
- Last pap smear
What is gravid? para
- number of pregnancies
2. number of viable births/offspring
What is TPAL?
- T – Term deliveries >37 wks gestation
- P – Preterm delivery 20 to <37 wks gestation
- A – Abortion <20wks gestation
- L – Live delivery regardless of gestational age
What is included in a Well Woman Exam?
- Pap smear (women 21-65)
2. Mammogram (50+ or earlier with high risk)
How often should a woman get a pap smear?
- Yearly for women with abnormal pap smear
- Every 3 years for women with consecutively normal pap smears
- Every 5 years with women with consecutively normal pap smear with negative HPV testing
What is a pap smear?
- Papanicolaou (Pap) test (cytology) to help screen for cervical cancer
- Sample taken of the cervix (ectocervix) and the cervical canal (endocervix) during a speculum exam
Where should you get a sample during the pap smear?
ectocervix, endocervix, the transitional zone and squamocolumnar junction (SCJ)
Is cervical cancer hereditary?
Nope - 99% caused by high risk HPV strains
Where do we typically find cancer cells in the cervix?
transitional zone
What does a pelvic exam include?
Pelvic exam
– Examines the internal and external genitalia
• Visual inspection
• Bimanual exam
– Check for cervical motion tenderness (pain with bimanual exam)
– Obtain swabs for gonorrhea, chlamydia and wet prep for yeast, trichomonas or bacterial
vaginosis
What does an ectopic pregnancy present with?
- abdominal or pelvic pain with vaginal bleeding
- may have other pregnancy related symptoms
*start with a pregnancy test, speculum exam, and then determine if its ectopic
If a woman comes in with pelvic pain and is under 55, what should you begin with?
pregnancy test
How does a UTI present?
- dysuria, urinary frequency, urinary urgency, suprapubic pain
- may have hematuria
*perform abdominal exam, Lloyd’s punch
What does a well male exam include?
•Prostate exam and testicular exam is not recommended routinely.
•Prostate Specific Antigen (PSA) is not recommended routinely.
– PSA may be indicated for patient with family history of prostate cancer
•These exams or lab are performed based on patient signs and symptoms from history
What population is more at risk of testicular cancer?
younger men
What is the classical presentation of an inguinal hernia?
– Pain with increased intra-abdominal pressure (heavy lifting, straining or prolonger standing
– May have palpable bulge affected side
What conditions are considered STI?
- Chlamydia (bacterial)
- Gonorrhea (bacterial)
- Herpes simplex 2 (viral)
- Human papilloma vius (HPV) (viral)
- Syphilis (bacterial)
- Trichomoniasis (protozoa)
- Hepatitis B and C (viral)
- HIV/AIDS (viral)
Gonorrhea -
Presentation
- – Men: penile discharge and dysuria or can be asymptomatic
– Female: pelvic pain or mucopurulent vaginal discharge
What are the 5 Ps?
Partners, Practices, Prevention of Pregnancy, Protection from STIs/HIV, Past history of STI
Gonorrhea -
Complication
– Pelvic inflammatory disease (PID) if untreated
– Scarring of the fallopian tube may occur if the infection is left untreated, which can lead to infertility.
Gonorrhea - Work up
– Nucleic acid amplification tests (NAATs) on endocervical, urethral, vaginal, pharyngeal, rectal, or urine
samples
Gonorrhea - Management/Tx
– Antibiotics
– Usually will also treat for Chlamydia infection if patient has Gonorrhea as Chlamydia is often an asymptomatic co-infection
– Counseling patient to make sure to contact partner and have them also get treatment
– Counseling safe sex practices i.e. condom use
Chlamydia - classic presentation
– Men: penile discharge, pruritus, dysuria
– Female: vaginal discharge, vaginal bleeding or pain during intercourse (dyspareunia), dysuria
Chlamydia - complication
– Pelvic inflammatory disease (PID) if untreated
– Fertility issues due to scarring of the fallopian tube if left untreated
Chlamydia - management/tx
– Antibiotics i.e. azithromycin or doxycycline
– Counseling patient to make sure to contact partner and have them also get treatment
– Behavioral counseling safe sex practices i.e. condom use
Syphilis - presentation
– Primary – chancre
– Secondary - joint pains, fatigue, lymphadenopathy, mucopapular rash
– Latent phase – may be asymptomatic
– Tertiary – neurosyphilis (confusion, headache, stiff neck, vision loss)
Syphilis - complication
progression to neurosyphilis
Syphilis - tx
antibiotic (penicillin)
Genital Herpes - presentation
– Single or clusters of vesicles on the genitalia
– May have burning, tingling and pain prior to vesicle appearance
Genital herpes - complication
– meningitis, PID, Hepatitis, increase risk of HIV infection (possible due to the open sores)
Genital Herpes - management/tx
antiviral (acyclovir)
Syphilis - work up
serologic testing, antibody detection testing, microscopy etc (nontrepomenal test and treponemal test)
Trichomonasis (protozoa) - classical presentation
– Men: most men are asymptomatic but small percentage may have penile discharge
– Female: foul smelling thin or purulent vaginal discharge, vaginal pruritus, dysuria
Trichomonasis (protozoa) - work up
– Wet mount (sample on slide seen under microscope) or Nucleic acid amplification tests
(NAATs) on vaginal fluid or penile fluid
Trichomonasis (protozoa) - management/tx
– Antiprotozoal medication like metronidazole
HPV - presentation
– Genital warts (papules, cauliflower-like lesions or flat)
HPV - complication
– Most lesions are self limited
– high risk strains can lead to cancer of the oropharyngeal region or lower genital tract (cervix, penile, or
anorectal)
HPV - work up
– Routine pap smear, intervene if there are any cervical changes
– May test for HPV during routine pap smear
HPV - Management/tx
– Prevention by vaccinating
– Routine pap smear for surveillance
– Genital wart removal
