Reproductive Topics Flashcards
Gonadarche
-activation by FSH and LH
Adrenarche
-increase in androgen hormone
Thelarche
-development of breast tissue due to estrogen
occurs 8-13 years old
Menarche
first menstrual cycle
-usually starts at breast stages 3 or 4
Spermarche
first sperm production
Pubarche
pubic hair development
Puberty
females 10-14 yrs old with menarche 2 years after start of puberty
-males 11-16 yrs old
Tanner Stages Boys
Stage 1: Prepubertal
Stage 2: enlargement of testes and scrotum, skin reddens and changes texture
Stage 3: enlargement of penis and further testes growth
Stage 4: Increased size of penis with growth in breadth and development of glands
Stage 5: Adult genitalia
Tanner Stages Girls
Stage 1: Prepubertal
Stage 2: breast bud enlarges with elevation of breast and papillae
Stage 3: enlargement of breast and areola, no separation of contour
Stage 4: Areola and papilla form secondary mound above level of breast
Stage 5: Mature-projection of papilla only
Tanner Stages Girls and Boys-Pubic Hair
Stage 1: prepubertal
Stage 2: sparse growth of long slightly pigmented hair
Stage 3: Darker coarser more curled hair
Stage 4: Hair adult type but covers smaller area
Stage 5: Adult in type and quantity
OB/GYN History
Menstrual History: age of menarche, duration, flow, cycle, LMP
Gynecological History: Breast history, Previous GYN surgery, last pap smear, History of infertility
Obstetrical History
Gravida: # pregnancies Para: # number of viable births T-term deliveries >37 wks P-preterm 20-37 weeks A-abortion <20 weeks L-live delivery regardless of gestational age
Pap Smear
- yearly if abnormal
- every 3 years with consecutively normal pap smears
- every 5 years with consecutively normal pap smear with negative HPV testing
- no more with hysterectomy for noncancerous reasons
- screens for cervical cancer
- not hereditary
- sample from cervix (ectocervix) and cervical canal (endocervix), transitional zone (bw original SCJ and new SCJ), and squamocolumnar junction (SCJ)
- transitional zone most common place for precancerous lesion and cancer
- abnormal: multi-nucleated obscure cells
Pelvic Exam
- Inspect internal and external genitalia
- Bimanual exam: insert index and middle finger into vagina and lift upwards and use other hand to push downward to examine vagina, uterus, and ovary on R and L side
- check for cervical motion tenderness
- swab for gonorrhea, chlamydia etc
Ectopic Pregnancy
-abdominal or pelvic pain with vaginal bleeding
-may have other pregnancy symptoms
-Complication: hemorrhage, death
-Workup: urine pregnancy, speculum exam, transvaginal ultrasonography if confirmed pregnant
Treatment: surgery
UTI
- dysuria (pain, burning with urination), urinary frequency, urgency
- escherichia coli most common infector
- Physical: abdominal exam, Lloyd’s Punch
- Workup: Urinalysis and pregnancy test (if child bearing age)
- Antibiotics!
Well Man Exam
-Prostate, testicular, Prostate Specific Antigen (PSA) not recommended routinely
-Unless indicated!
Inspect: scrotum, shaft, glands
Palpate: shaft, scrotum with thumb and first 2 fingers
Retract foreskin
Palpate inguinal region and examine for hernias
Examine prostate by palpation on digital rectal exam
Inguinal Hernia
-pain with increased intra-abdominal pressure, palpable bulge
Physical exam: invaginating scrotal skin with index finger into inguinal canal and have pt cough
Workup: ultrasound
Treatment: mild hernia-wait moderate to severe-surgery
5 P’s of Sexual History
- Partners
- Practices
- Prevention of pregnancy
- protection from STI and HIV
- Past history of STI
Conditions considered to be STIs
- chlamydia
- gonorrhea
- herpes simplex 2
- HPV
- Syphilis
- Trichomoniasis
Gonorrhea
-gram neg bacteria
-Men: penile discharge, dysuria or asymptomatic
-Female: pelvic pain, vaginal discharge
Complication: PID and scarring of fallopian tube leading to infertility
Workup: NAATs
Treat: antibiotics and usually also treat for chlamydia and counsel
Chlamydia
-gram neg bacteria
-Most pt are asymptomatic
-Men: penile discharge, pruritus, dysuria
-Female: vaginal discharge, bleeding, pain during intercourse
can cause other infections
COmplication: PID, fertility issues
Treat: antibiotics and counseling
Syphilis
-spirochete bacteria
-Primary: chancre
-Secondary: joint pains, fatigue, rash
-Tertiary: neurosyphilis (confusion, HA, stiff neck, vision loss)
Treat: antibiotic penicillin
Genital Herpes
-virus
-clusters of vesicles on genitalia
persists for life
Complication: meningitis, PID, Hepatitis, risk of HIV
Workup: Serologic test and PCR
Treat: antiviral Acyclovir
