Reproduction Flashcards
What is Gonadarche
activation of the gonads by the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) secreted from anterior pituitary
what is Menarche? spermarche?
first menstrual cycle
first sperm production
When do girls undergo puberty? Boys?
10-14 girls (secondary: breast/areolar development, menarche 2-3 yrs after beginning of puberty)
11-16 boys (penile growth and pubic hair development)
What breast stage does menarche start at?
Usually 3 or 4
3: elevation of breast and areola, no separation of contours
4: projection of areola and papilla
Stages of penile development
Stages 1 -5
Penis enlarges, testicular size (volume) also increases
Menustral history questions?
Age of menarche, duration, flow, cycle length of menses
Last menstrual period
Gynecologic history (more in detail)
Breast history Last mammogram Previous GYN surgery history of infertility last pap smear (esp if abnormal)
OB History questions.. How do you show number of pregnancies? number of births? what if there are preterm deliveries, abortions, etc.
EX: What does G4P2112 MEAN?
TPAL
G4P2112
4 pregnancies, 1 spontaneous abortion, 1 fetal demise at 23 weeks,
What does G5P3114 mean?
5 pregnancies, 3 term delivers, 1 spontaneous abortion at 12 weeks, 1 live delivery at 35 week gestations
OB History questions (besides pregnancy, number delivered, etc)
Mode of delivery gestational age at delivery maternal complications fetal complications delivery complications contraception method sexual activity number of partneres new partner in last 3 months condum use history of sexual abuse
What is considered a ‘well woman exam’ how often should the aspects of this be done?
1) Pap smear: women over 21 - 65 Abnormal: YEARLY consecutively normal: 3 years consec. normal + negative HPV test: 5 years 2) Mammogram 50 years or earlier
What is a pap smear for? What areas do you sample? Which is important and why?
Screen for cervical cancer C. cancer due to high risk HPV strains.
Ectocerix, endocervix, transitional zone (this has precancerous lesions!!)
What is a pelvic exam?
1) Visual exam
2) Bimanual exam
– inserting index and middle finger into the vagina lifting upward and using other hand to push downward to examine the vagina, uterus and the ovary – Performed on both left and right side
3) Swabs for gonorrhea, chlamydia, wet prep for yeast
What is the classical presentation of ectopic pregnancy? What’s the workup? Treatment?
PRES: Abdominal or pelvic pain with vaginal bleeding
WORKUP: Urine pregnancy, speculum
TREAT: surgery bc of risk of hemorrhage and death
What is the classical presentation of a UTI? Cause? What’s the workup? Treatment?
PRES: Dysuria (pain, burning or discomfort with urination), urinary frequency, urinary urgency, suprapubic pain
CAUSE: E. Coli
WORKUP: Abd exam, Urinalysis
TREAT: Antibiotic
What is considered a ‘well male exam’ how often should the aspects of this be done?
1) Prostate exam and testicular exam not routinely
2) Prostate specific antigen (only if family history indicates)
What are the aspects of a male genital exam?
– Inspection of scrotum, penile shaft, glans, inguinal region – Palpate penile shaft and scrotum (examine for testis, epididymis, spermatic
cord) with thumb and first two fingers – Retract foreskin if present – Palpate inguinal region and examine for hernias – Examine prostate by palpation on digital rectal exam (DRE)
What population do we normally see testicular cancer?
Young males (Dr. A said teens to 30s) normally AGGRESSIVE need to catch early
How do you palpate the prostate
up the butt
actually tho, then press anteriorly, you should feel it
What is the classical presentation of inguinal hernia? Exam findings? What’s the workup? Treatment?
PRES: Pain with increased intra-abdominal pressure (heavy lifting, straining or prolonged standing – May have palpable bulge on affected side
EXAM: Invaginating scrotal skin with index finger into the inguinal canal and have patient coughor perform Valsalva
WORKUP: Ultrasound
TRT: Mild - watch Severe-surgery
What are the 5 P’s of sexual history
1) Partners
– Men, Women or both – New partner – Multiple partners (number of partners in last 12 months)
2) Practices
– How often do used condoms – Anatomic site of exposure
3) Prevention of Pregnancy
4) Protection from STIs and HIV
– Condom use
5) Past history of STI
– Have you ever had an STI? – Have any of your partners had an STI?
What are the risk factors for STIs & STDs
– New sex partner in past 60 days
– Multiple sex partners or sex partner with multiple concurrent sex partners
– Sex with sex partners recently treated for an STI
– No or inconsistent condom use outside a mutually monogamous sexual partnership
– Trading sex for money or drugs
– Sexual contact (oral, anal, penile, or vaginal) with sex workers
– Meeting anonymous partners on the internet
What are some examples of an 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)
What are some complications of untreated STIs?
– Pelvic Inflammatory Disease (more severe infection most commonly due to Gonorrhea or Chlamydia infection)
– Upper genital tract infections
– Infertility
– Chronic pelvic pain
– Cervical cancer (HPV)
– Chronic infection with herpes viruses, hepatitis viruses and HIV
What are STI/STD treatments?
1) Antibiotics
2) Behavioral counseling
3) treatment of partner
What is the classical presentation of gonorrhea? CAUSE? Complications? What’s the workup? Treatment?
PRES:
– Men: penile discharge and dysuria or can be asymptomatic,
– Female: cervicitis, pelvic pain or mucopurulent vaginal discharge
Cause: gram negative intracellular diplococci
COMPLICATIONS: Infertility (scarring of fallopian tube), PID
WORKUP: NAATs
TRT: 1) Antibiotics 2) Partner contact 3) Counseling
What is the classical presentation of syphillis? CAUSE? Complications? What’s the workup? Treatment?
PRES: – Primary – chancre – Secondary - joint pains, fatigue, lymphadenopathy, mucopapular rash – Latent phase – may be asymptomatic – Tertiary – neurosyphilis (confusion, headache, stiff neck, vision loss) cause: Spirochete, t. pallidum COMP: Neurosyphilis WORKUP: Serological testing TRT: Antibiotic (penicillin)
What is the classical presentation of genital herpes? CAUSE? Complications? What’s the workup? Treatment?
PRES: – Single or clusters of vesicles on the genitalia – May have burning, tingling and pain prior to vesicle appearance CAUSE: Herpes Simplex Virus 2 COMP: meningitis, HIV infection WORKUP: serologic testing, PCR MANAGEMENT: antiviral (acyclovir)
What is the classical presentation of trichomonasis (protozoa)? CAUSE?? What’s the workup? Treatment?
PRES: – Can be asymptomatic – Men: most men are asymptomatic but small percentage may have penile discharge – Female: foul smelling thin or purulent vaginal discharge, vaginal pruritus, dysuria
CAUSE: Protoza with flagella
WORKUP: wet mount (aka put the sample on a slide and see if it moves)
TRT antiprotozal medication
What is the classical presentation of HPV (protozoa)? CAUSE?? What’s the workup? Treatment?
PRES: Genital warts CAUSE: human papillomavirus COMP: cancer or oropharyngeal region or lower genital tract WORKUP: routine pap TRT: prevent with vaccination genital wart removal
What is the classical presentation of chlamydia? CAUSE? Complications? What’s the workup? Treatment?
PRES: discharges, pruritus, disuria, pain during sex THINK: men itch, women hurt during sex CAUSE: bacterial COMP: WORKUP: NAATS TRT: Antibiotics (doxy, azith)
