Reproductive Complaint Flashcards
What is one of the first signs of puberty in females?
Elevation of the nipple
when does menarche start in regards to breast maturation?
Stage 3 or 4
What age do breast development and pubic hair occur?
8-13
Pubic hair and size of male genitalia start growth from ages ____.
9-13.5
What is taken in a thorough OB/GYN history?
- Menstrual history
- Gynecologic history: brest history, mammogram, surgeries,infertility, pap
- Gravida and Para
- TPAL
- Mode of delivery
- Gestational age
- Maternal complications and fetal complications
- Delivery/Operative complications
- Contraceptive/Sexual history
What does this mean: G5P3114
- 5 pregnancies
- 3 term deliveries
- 1 live delivery preterm
- 1 spontaneous abortion at 12 wks
- 4 live delivery at 35 weeks
P is split up into TPAL
- Term delilvery
- Preterm
- Abortion
- Live delivery
What is a well woman exam?
- Pap smear for sexually active women 21-65
- yearly for women with abnormal pap
- Every 3 years with normal pap
- Every 5 with normal pap and negative HPV
- Mammogram at 50 or earlier for women at risk
Where do you get a cervical sample from for a pap?
- Endo and ecto cervix
- Transitional zone
- area btw original SCJ and new SCJ
- Squamocolumnar junction
What is the difference btw a pelvic exam and a pap smear?
Pelvic exam:
- visual inspection
- Bimanual exam: insert index and middle finger into vagina lifting up and using other hand to push down to exam vagina uterus and ovary
- Check for cervical motion and tenderness
- Obtain swabs for infections
Pap smear:
- obtains samples of cervix to look for cervical cell transformation
How does ectopic pregnancy present?
- Abdominal or pelvic pain with vaginal bleeding
- Could have other pregnancy symptoms, nausea breast tenderness etc
How do you workup suspected ectopic pregnancy test?
- pregnancy test
- speculum exam
- transvaginal US
How does UTI present and whats most common cause
- Dysuria, urinary freuency and urgency, suprapubic pain
- Hematuria possible
- E. Coli most common cause
What would be some PE findings for a UTI and the workup and treatement?
- Perform abdominal exam
- Check CVA tenderness Lloyd’s punch
- Urinalysis
- Antibiotics
What is a well male exam?
- Prostate and testicular exam and PSA is NOT recommended routinely
- PSA recommended with Fhx
Male genital exam?
- Inspection of scrotum, shaft, glans, and inguinal region
- Palpate penile shaft and scrotum with thumb and first two fingers
- Retract foreskin
- Palpate inguinal region exam for hernias
- Examine prostate by DRE
- Testicular cancer most common in younger males, important for them to perform self exam
How would inguinal hernia present and what would PE look like? workup?
- Pain with increased intraab pressure
- May have palpable buldge
- Invaginating scrotal skin with index finger into inguinal canal and have patient cough, may help feel hernial
- US
Direct hernia?
- above inguinal ligament close to the pubic tubercle doesn’t go to scrotal area
- Less common than indirect, usually men >40 yrs, rare in women
Indirect hernia?
- Most common, affects all ages and both sexes, often in kids
- above inguinal ligament near midpoint
- Often goes into scrotum
what are the 5 P’s?
- Partners
- Practices
- Prevent pregnancy
- Protection STI and HIV
- Past STI hx
How do you detect STI’s?
- Microscopy
- Wet mount
- Nucleic acid amplification testing
- Serologic testing
What are complications of untreated STI’s?
- PID
- upper Genital tract infections
- Infertility
- Chronic pelvic pain
- Cervical cancer (HPV)
- Chronic infections with herpes, hep, and HIV
How does Gonorrhea present?
Males:
- Penile discharge or asymptomatic
Females:
- Pelvic pain, mucopurulent vaginal discharge
Can cause infection of urogenital, anorectal, or pharyngeal infections
Complications of gonorrhea?
- PID if untreated
- Scarring of fallopian tube
Chlamydia presentation?
gram negative bacteria, chalymdia trachomatis
- Men present with penile discharge,puritus,dysuria
- Women present with vaginal discharge, bleeding, or pain with intercourse, dysuria
- Can cause infection of urogenital, anorectal, conjunctival (neonates), or pharyngeal infections
Complications with Chlamydia?
PID and fertility issues due to scarring of fallopian tubes
Syphilis presentation?
Spirochete, Treponema pallidum
- Primary: chancre (painless genital ulcer)
- Secondary: joint pain, lymphadenopathy, mucopapular rash
- Latent phase: may be asymptomatic
- Tertiary: neurosyphilis
Genital herpes presentation?
Herpes Simplex Virus 2
- Single or clusters of vesicles on genitals
- May have burning, tingling, and pain prior to vesicle appearance
Genital herpes complications and workup?
- Meningitis
- PID
- Hepatitis
- Increase risk of HIV
- Serilogic test and run PCR from lesion
How does herpes persist for life?
Viral DNA travels by axon to spinal cord sensory ganglia
What is Trichomonasis?
Protozoa with flagella
- can be asymptomatic
- Men: mostly asymptomatic but small percent have penile discharge
- Female: foul smelling thin or purulent vaginal discharge, vaginal pruritis, dysruia
How do you workup Trichomonasis?
Wet mount or nucleic acid amplification teests on vaginal fluid or penile fluid
How does HPV present, complications, workup, and prevention?
- Classic presentation is Genital warts
- Complications:
- Most lesions are self limited and high risk strains can lead to cancer of orpopharyngeal region or lower genital tract
- Routine pap smear
- Prevent with Gardasil vaccine
