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PCM2 Midterm > Reproduction > Flashcards

Reproduction Flashcards

1
Q

Puberty

A

developmental stage characterized by transition from sexual immaturity to sexual maturity

  • females: 10-14
  • -secondary sexual characteristics: breast and areolar development
  • -menarche 2-3 after beginning of puberty
  • males: 11-16
  • -secondary sexual characteristics are penile growth and pubic hair development
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2
Q

gonadarche

A

activation of the gonads by the FSH and L from the anterior pituitary

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3
Q

Adrenarche

A

increase in androgen hormone production in the adrenal cortex

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4
Q

Thelarche

A

development of breast tissue due to estrogen from the ovaries

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5
Q

Menarche

A

first menstrual cycle

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6
Q

Spermarche

A

first sperm production

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7
Q

pubarche

A

pubic hair development

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8
Q

Others things to consider during puberty

A

increase in height and weight may vary by gender from person to person
-development of facial hair, axillary hair, increase length of vocal cords, facial morphologic appearance, increase size of thyroid, skin change, change in skin (acne)

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9
Q

Boys Development of External Genitalia

A

1: prepubertal
2: enlargement of testes and scrotum, scrotal skin reddens and changes in texture
3. enlargement of penis, further growth of testes
4. increased size of penis, growth in breadth and development of glans, scrotum larger and darker
5. adult genitalia

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10
Q

Breast development

A
  1. Prepubertal
  2. breast bud stage with elevation of breast and papilla, enlargement of areola
  3. further enlargement of breast and areola, no separation of contour
  4. areola and papilla form a secondary mound above the level of breast
  5. mature stage; projection of papilla only, related to recession of areola
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11
Q

Pubic Hair Development

A
  1. prepubertal : pubic area may have vellus hair
  2. sparse growth of long, slightly pigmented hair, straight or curled at base of scrotum or along labia
  3. darker coarser more curled hair spreading sparsely over junction of the pubes
  4. hair in adult in type but covering smaller area than in adult. no spread to medial surface of thigh
  5. adult in type and quantity with horizontal upper border
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12
Q

Female Breast/ Pubic Hair Development

A

often 1st sign of puberty in females
menarche usually starts at breast stage 3 or 4
breast development and pubic hair occur 8 to 13 years of age

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13
Q

Male penile and pubic hair development

A

pubic hair and size of male genitalia start from 9-13.5 years of age

testicular size also increase

Stage 1: no pubic hair

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14
Q

Menstrual History

A

age of menarche, duration, flow and cycle, length of menses,
LMP (last menstrual period)

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15
Q

Gyn History

A 
hx of breast disease
last mammogram
previous gyn surgery
history of infertility
last pap smear
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16
Q

OB history

A

gravida (number of pregnancies)
Para (number of viable birth/offsprings)
gestational age of delivery
maternal complications (hypertension, diabetes)
fetal complications such as growth restriction, anomalies, still birth
delivery or operative complications

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17
Q

gravida

A

number of pregnancies

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18
Q

Para

A

number of viable birth/offsprings

G3P3

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19
Q

Term deliveries

A

more than 37 week gestation

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20
Q

Pre-term deliveries

A

20-37 weeks gestation

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21
Q

Abortion

A

less than 20 weeks gestation

22
Q

Contraceptive/Sexual History

A 
contraception method
current sexual active
number of partners last 1 year or lifetime
new partner in last 3 months
condom use
history of sexual abuse
23
Q

well woman exam

A

Pap Smear

Mammogram

24
Q

Pap Smear

A

women 21-65 years old

  • 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
  • –screen for cervical cancer
  • -99% of cervical cancer is due to HPV strains
  • -sample taken of ectocervix and cervical canal (endocervix)
25
Q

Mammogram

A

at age 50 or early for women who are at high risk

26
Q

Pap Smear How To

A

Cervical Scrape
Cervical Broom
Endocervical Brush: scraping

-get sample from ectocervix, endocervix, transitional zone, squamocolumnar junction

27
Q

Transformation Zone

A

area between the original squamocolumnar juction

important as it is the most common area of precancerous lesion and cancers

28
Q

Co-testing

A

pap smear+HPV testing every 5 years

abnormal pap smear: pap smear every year or less with additional intervention as indicated

29
Q

Do you need a pap-smear if you’ve had a hysterectomy for noncancerous reasons?

A

NO

30
Q

Pelvic Exam

A

examines internal and external genitalia

  • visual inspection
  • bimanual exam
  • check for cervical motion tenderness
  • obtain swab for gonorrhea, chlamydia, wet prep for yeast, trichomonas, bacterial vaginosis
  • obtain swab if indicated
31
Q

Bimanual exam

A

insert index and middle finger into the vagina lifting upward and using other hand to push downward to examine the vagina uterus, and ovary

(left and right side)

32
Q

Pelvic Pain Broad DDX

A
  • GU (UTI, STI, PID, HERNIA)
  • GYN (ectopic pregnancy, ovarian torsion, ruptured ovarian cyst, spontaneous abortion)
  • GI (appendicitis, constipation, IBS)
33
Q

Ectopic Pregnancy

A

abdominal or pelvic pain with vaginal bleeding
pregnancy related sx: breast tenderness, nausea
complications: hemorrhage, death

ALWAYS RULE OUT PREGNANCY
speculum exam
if pregnancy confirmed, transvaginal ultrasonography
Tx: surgical removal

34
Q

STI

A

pelvic pain, foul smelling vaginal discharge, inconsistent use of condoms,

-pelvic with bimanual exam and swabs

35
Q

Urinary Tract Infection

A

Dysuria: pain, burning, discomfort with urination, urinary frequency, urinary urgency, suprapubic pain
possible hematuria

*E. Coli is the most common organism causing infection
abdominal exam
lloyd's punch
urinalysis 
antibiotic
36
Q

Well Male exam

A

prostate exam and testicular exam is not routinely reccommended

PSA: not a routine recommendation

inspect scrotum, penile shaft, scrotum
palpate penile shaft and scrotum: examine for testis epididymis, spermatic cord, with thumb and first 2 fingers
-retract foreskin if present
-palpate inguinal region and examine for herinas
DRE (examines prostate)

37
Q

Testicular Cancer

A

most common in younger males

38
Q

Groin Pain

A

GU: groin lesion, scrotal mass, epidiymitis, hydrocele, testicular cancer, testicular torsion, UTI, varicocele, inguinal hernia, kidney stone
MSK: OA, Nerve impingement, avascular necrosis, hip fracture
GI: appendicitis, Constipation

39
Q

Inguinal Hernia

A

pain with increased intra-abdominal pressure (heavy lifting, straining, prolonged standing)
-palpable bulge on affected side
PE exam findings: invagination scrotal skin with index finger, into the inguinal canal….patient cough or perform valsalva

imaging or ultrasound
management/treatment : mild hernia; wait. Sever hernia; surgery

40
Q

Herpes Simplex Virus 2

A

lesion on external genitalia..some burning and pain before lesion presented on penis
ROS: denies penile discharge,

41
Q

Important Sexual History

A

Partners:

  • men, women, both
  • new partner
  • multiple partners (number in last 12 months

Practices:

  • how often do you use condoms?
  • anatomic site of exposure

Prevention of Pregnancy

Protection from STIS and HIV
-condom use

Past History of STI

  • have you ever had an STI?
  • Have any of your partners ever had an STI?
42
Q

STI Risk factors

A
  • new sex partners in past 60 days
  • multiple sex partners or sex partner with multiple concurrent sex partners
  • sex with partners recently treated for an STI
  • no or inconsistent condom use outside of a mutually monogamous sexual partnership
  • trading sex for money/drug
  • sexual contact with sex worker
  • meeting anonymous partners on the internet
43
Q

STI diseases

A 
Chlamydia
Gonorrhea
HSV 2
HPV
Syphilis 
Trichomonoiasis (protozoa)
Hep B and C (viral)
44
Q

Complications of STI

A
  • PID (gonnorhea or chlamydia)
  • upper genital tract infections
  • infertility
  • chronic pelvic pain
  • cervical cancer
  • chronic infection with herpes virus, hep virus and HIV
45
Q

Treatment for STI

A

antibiotics and antivirals
behavioral counseling: treatment of partner, counseling safe sex practices, stress use of condoms

**behavioral counseling is key in sexually active adolescent to reduce high risk behaviors

46
Q

Gonorrhea

A

bacterial infection: gram -

presentation:
male: penile discharge or dysuria, often asymptomatic
female: pelvic pain or mucopurulent vaginal discharge
- –can cause infection of urogential, anorectal, or pharyngeal infections

complications: PID, Scarring of the fallopian tube may occur–infertility

Workup: nucleic acid amplification test on endocervical, urethral etc

47
Q

Do you treat or Chlamydia if the patient has Gonorrhea?

A

Yes. Chlamydia is often an aysmptomatic co-infection with gonorrhea

48
Q

Chlamydia

A

gram negative bacteria: diplococci
male: penile discharge and dysuria possible asymptomatic
female: pelvic pain or mucopurulent dischage
complication: PID or scarring of fallopian tube–infertility
workup: NAATs for a variety of anatomical samples
Management and Tx: antibiotics:
treat for gonorrhea
behavioral counseling

49
Q

Syphilis

A

spriochete, treponema pallidium

primary: chancre
secondary: joint pain, fatigure, lymphadenopathy, mucopapular rash
- -can be asymptomatic in latent phase
tertiary: neurosyphilis

workup: serologic testing

**penicilin

50
Q

Genital Herpes

A

HSV 2
Single or clusters of vesicles on the genitalia
burning, tingling, pain prior to vesicle appearnace

(viral dna travels by Axon to the spinal cord sensory ganglion and persists for life)

Complications: menigitis, PID, Hepatitis, Increased risk of HIV due to open sores

PCR or serologic testing

manage via acyclovir

51
Q

Trichomoniasis

A

Protozoa with flagella

men: asymptomatic some have penile discharge
female: foul smelling thing purulent vaginal discharge vaginal pruruitis, dysuria

workup: wet mount or nucleic acid amplification test
anti protozoa: metronidazole

52
Q

HPV

A

classical presentation: genital warts
most lesions are self limiting, high risk strains lead to cancer (also possible for oropharyngeal region)
May test for HPV with routine pap smear

vaccination with gardasil received by ages 11-26

PCM2 Midterm (8 decks)

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