Reproductive Topics Flashcards
What is puberty?
developmental stage characterized by transition from sexual immaturity to sexual maturity
Gonadarche
activation of gonads by FSH & LH secreted from anterior pituitary
Adrenarche
increase in androgen hormone production by adrenal cortex
Thelarche
development of breast tissue due to estrogen from ovaries
Menarche
first menstrual cycle
Spermarche
first sperm production
Pubarche
pubic hair development
When does puberty typically start for females and males?
for females, about 10-14 yo (breast development)
for males, about 11-16 yo (penile growth & pubic hair development)
When does menarche occur in regards to onset of puberty?
1st menstrual cycle will occur 2-3 years after beginning puberty
What are some physical findings to consider in repro exam?
increase in height & weight (varies w/ person)
growth spurt & bone growth
development of facial & axillary hair, voice changes
facial appearance changes
increase size of thyroid
change in skin (acne?)
What is are the first signs of puberty in females?
breast & pubic hair development
Describe stages of breast development
Stage 1: pre-adolescent
Stage 2: breast bud stage
Stage 3: further enlargement & elevation of breast
Stage 4: secondary mound above level of breast
Stage 5: full mature, only nipple projects
Describes stages of pubic hair (females)
Stage 1: no hair
Stage 2: sparse growth of long, slightly pigmented hair (only along labia)
Stage 3: darker & more coarse, curlier hair over pubic symphysis
Stage 4: coarse & curly in adults
Stage 5: hair spreads to medial thighs (not over abdomen)
When does menarche typically occur in relation to breast development?
usually starts @ breast stage 3 or 4
When does pubic hair development & growth of genitalia typically start in males?
9 to 13.5 yo (increase in volume of testicles)
In what stage is male pubic hair coarse & curly but not extended to thighs?
Stage 4
What is stage 2 in male development associated with?
sparse growth of long & slightly pigmented pubic hair, no change in penis size
What is important in OB/GYN history?
menstrual history (LMP)
gynecologic history
obstetrical history
What does a menstrual history include?
age of menarche
duration, flow & cycle length of periods
LMP
What does a gynecologic history include?
breast history last mammogram previous GYN surgery history of infertility last pap smear
What is gravida para?
part of obstetrical history
of pregnancies & # of viable births/offsprings
TPAL
part of obstetrical history to determine # of:
Term deliveries
Pre-term deliveries (20-37 weeks)
Abortions
Live delivery
What would GP be for pt with 4 pregnancies, 1 spontaneous abortion at 14 weeks, 1 fetal demise at 28 weeks?
Pt is 31 yo G4 P2112
What does an obstetrical history include?
mode of delivery gestational age @ delivery maternal complications fetal complications delivery or operative complications
What does a contraceptive/sexual history include?
contraception method current sexual activity # of partners (last yr or lifetime) new partner in last 3 months condom use history of sexual abuse
What does a well woman exam include?
pap smear
mammogram
Describe the guidelines for pap smears
for women over 21yo to 65yo
yearly for women w/ history of abnormal pap
every 3 yrs for women w/ consecutively normal paps
every 5 yrs for women w/ normal paps & negative HPV
Describe the guidelines for mammograms
@ 50 yo or earlier for women who are high risk (depends on family history or other concerns)
What is a pap smear?
test to screen for cervical cancer & checks for abnormal transformation of cervical cells
sample from ectocervix, endocervix, transitional zone & squamocolumnar junction
Why is the transformation zone significant?
most common area of precancerous lesions & cancers
between original SCJ & new SCJ
How is a pelvic exam different from a pap smear?
pelvic exam examines internal & external genitalia (visual inspection & bimanual exam to check for tenderness & swab area for STIs)
pap smear takes sample specifically of cervix by scraping of cells
What do you palpate for during female pelvic exam?
first inspect visually
second bimanual exam to palpate for vagina, uterus & ovaries
How do ectopic pregnancies present?
abdominal or pelvic pain w/ vaginal bleeding
What should you always do with pt who presents w/ pelvic pain (or pelvic complaints)?
perform a pregnancy test
How do UTIs present?
dysuria (pain, burning or discomfort when urinating)
urinary frequency
urinary urgency
suprapubic pain
may have hematuria (pink urine)
What is the major cause of UTIs?
E coli
When is a male exam usually performed?
not recommended regularly unless have specific complaint (or history of prostate cancer)
Describe well male exam
inspect of scrotum, penile shaft, glands, inguinal region
palpate penile shaft & scrotum
retract foreskin if present
palpate inguinal region & examine for hernias
examine prostate w/ digital rectal exam
How do you palpate the penile shaft?
w/ thumb & first 2 fingers
When is testicular cancer a concern?
most common in younger males (teens & 20s)
How does an inguinal hernia present?
pain w/ increased intra-abdominal pressure (as w/ heavy lifting or prolonged standing)
may have palpable bulge on affected side
Where will you find an indirect inguinal hernia?
@ tip of finger (b/c hernia is near midpoint of inguinal ligament)
Where will you find a direct inguinal hernia?
side of finger (b/c hernia is above inguinal ligament & close to pubic tubercle)
What are the 5 Ps of sexual history?
Partners Practices Prevention of pregnancy Protection from STIs & HIV Past history of STI
What are risk factors for STIs?
new partner in past 60 days multiple sex partners or partner w/ many partners sex w/ partners recently treated for STI inconsistent condom use trading sex for money sexual contact w/ sex workers meeting partners on internet
What makes STIs unique?
reportable diagnosis
can report positive result to health department
What is the key to treatment with STIs?
behavioral counseling (treatment of partner, counseling on safe sex, stress use of condoms)
Gonorrhea
bacterial cause
men have penile discharge & dysuria or no symptoms
female have pelvic pain & vaginal discharge
can lead to pelvic inflammatory disease if not treated or lead to fallopian tube scarring (infertility0
Chlamydia
most cases are asymptomatic
men have penile discharge & dysuria while females have vaginal discharge/bleeding or pain w/ intercourse
can lead to PID or fertility issues in women
What are two STIs that are common tested for together?
Gonorrhea & chlamydia
Syphilis
caused by bacterial
may have initial rash, then joint pain & fatigue w/ latent phase where asymptomatic until develop neurosyphilis
What is neurosyphilis?
confusion, headache, stiff neck, vision loss
Genital Herpes
virus
clusters of vesicles on genitalia & may have burning, tingling or pain prior to vesicle/wart appearance
increase risk of HIV infection (if open sores)
Trichomonasis
caused by protozoa w/ flagella
men usually asymptomatic & females will have foul smelling thin or purulent vaginal discharge & itching & dysuria
HPV
virus that causes genital warts
most lesions are self limited, high risk strains can lead to cancer of oropharyngeal region or lower genital tract
How can best screen for HPV?
routine pap smear
