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My Peds Prep > Adolescent and GYN > Flashcards

Adolescent and GYN Flashcards

1
Q

What are the 3 main areas of cognitive development that occur during adolescence?

A

1, Reasoning skills (consequences)

  1. Abstract thought (love/spirituality)
  2. Thinking about thinking (feelings, how others perceive them)
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2
Q

What are the 3 major tasks of adolescent psychosocial development?

A
  1. Autonomy (independent of parents)
  2. Sense of identify (strengths/self-worth)
  3. Ability for future orientation (Career, moral, religious, sexual values)
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3
Q

What are 2 things that are crucial for parents to accept as a healthy step in teen development?

A
  1. Separation

2. Rebellion

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4
Q

What is very important in a young adolescent’s separation from the family?

A

Peer group

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5
Q

Describe the peer group during early adolescence (12-14)

A

Same-sex, concern about how one appears to friends, changes clothing and hairstyle to fit in

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6
Q

Describe the peer group during middle adolescence (15-17)

A

Mixed-sex, finding a mate becomes important

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7
Q

When do adolescents move away from peer groups and into relationships?

A

Late adolescence (18-21)

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8
Q

True or False: Teens who don’t identify with any peer groups (“loners”) have significant psychological difficulties during adolescence

A

True

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9
Q

What do rapid body changes that an adolescent goes through effect?

A

Sense of self

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10
Q

What happens for early maturing boys in high school?

A

Perceived as older and more responsible, better at sports, more popular

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11
Q

If boys mature too early, what can happen?

A

Develop hostility and distress symptoms

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12
Q

What does early pubteral maturation in girls put them at risk for?

A

Conduct problems, depression, early substance use, poor body image, pregnancy, early sexual experimentation

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13
Q

What should be the first thing you do for an adolescent girl or boy who presents with a weight issue?

A

Ask what they think about their weight

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14
Q

True or False: Teens do perceive risk

A

True (but it doesn’t keep them from partaking in the risk-taking behavior)

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15
Q

True or False: Teens seem to gain significant emotional satisfaction from engaging in risk-taking behavior

A

True

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16
Q

Why are adolescents (12-14) more concerned about how they look to their peers than the risk of the behavior?

A

Concrete thinking- lack ability to link cause and effect

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17
Q

What is the leading cause of morbidity and mortality among 16-20 year olds?

A

MVAs

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18
Q

What increases the risks for MVA in 16-20 year olds?

A

Inexperience

Risk taking behavior (speeding, no seat belt, drugs/alcohol, texing/other distractions)

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19
Q

After MVA what are the other 2 major causes of death in 15-19 year olds?

A
  1. Homicide

2. Suicide

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20
Q

What is the hallmark of anorexia nervosa?

A

Inability or refusal to maintain a healthy body weight

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21
Q

What are the 4 criteria to diagnose anorexia nervosa?

A
  1. Distorted body perception
  2. Weight <15% expected
  3. Intense fear of gaining weigh with restriction of energy intake
  4. Absence of 3 consecutive menstrual cycles
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22
Q

What has the highest fatality rate of any mental health disorder?

A

Anorexia nervosa

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23
Q

What is the sign/symptom that is most important in making the diagnosis of anorexia nervosa?

A

Patient thinks they are fat despite weight being normal

*Excessive exercise, depression, dieting, diuretic use are too non-specific

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24
Q

Name 10 indications for hospital admission with anorexia

A
  1. Weight <75% of ideal body weight
  2. Continued weight loss despite intensive outpatient management
  3. Acute weight decline and refusal of food
  4. Hypothermia
  5. Hypotension
  6. Bradycardia
  7. Orthostatic changes in BP or pulse
  8. Electrolyte abnormalities
  9. Arrhythmia
  10. Suicidality
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25
Q

How do you distinguish anorexia from Crohn’s, hypothyroidism, depression, or collagen vascular disease?

A

Lab findings and info given in history

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26
Q

What is an important feature of bulimia nervosa?

A

Binge eating

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27
Q

What is binge eating?

A

The consumption of an amount of food larger than most people would eat in one sitting

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28
Q

What is binge eating in bulimia nervosa often couple with?

A

Induced vomiting

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29
Q

What are some of the physiologic and lab findings seen in bulimia nervosa (name 6)?

A
  • May be a result of vomiting
    1. Salivary gland enlargement
    2. Dental enamel erosion
    3. Bruises or calluses over the knuckles from forced gagging
    4. Low potassium
    5. Low chloride
    6. Metabolic alkalosis
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30
Q

What are 5 indications for hospital admission with bulimia?

A
  1. Failure of outpatient treatment
  2. Dehydration
  3. EKG abnormality
  4. Mallor Weiss tears
  5. Suicidal ideation
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31
Q

What is a condition that may be hard to distinguish from bulimia?

A

Achalasia

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32
Q

How do you distinguish between achalasia and bulimia?

A

Achalasia is involuntary vomiting soon after food is ingested

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33
Q

Name 4 times parental consent is not needed

A
  1. Life threatening emergencies (also sexual assault services)
  2. Medical care during pregnancy (also family planning)
  3. Treatment for STDs (also HIV)
  4. Treatment for substance abuse
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34
Q

True or False: In circumstances where parental consent is not needed to treat a minor, confidentially must be maintained if the patient requests it

A

True

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35
Q

What is the exception for maintaining confidentiality in situations that don’t require parental consent?

A

If the patient is a danger to himself or others

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36
Q

True or False: Emancipated minors don’t need parental consent to receive treatment

A

True

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37
Q

What is an emancipated minor?

A

Person under the legal age who is no longer under their parent’s control and regulation and who is managing their own financial affairs

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38
Q

True or False: In cases where parental consent isn’t required, informed consent is still required

A

True

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39
Q

In cases where parental consent isn’t required, who can give informed consent?

A

The patient/minor (instead of the parent)

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40
Q

What is parental consent required for?

A

Virtually all medical and surgical procedures (including blood donation) except:

  1. Life threatening emergencies (also sexual assault services)
  2. Medical care during pregnancy (also family planning)
  3. Treatment for STDs (also HIV)
  4. Treatment for substance abuse
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41
Q

What is Tanner staging now known as?

A

Sexual Maturity Rating

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42
Q

Describe pubic hair, phallus size, and testicular size for SMR 1 (pre-pubertal)

A
  1. Absent
  2. Childlike
  3. Volume <2.5mL
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43
Q

Describe pubic hair, phallus size, and testicular size for SMR 2 (beginning of puberty)

A
  1. Fine hair appears
  2. No change
  3. Increased size/volume, scrotum more textured
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44
Q

Describe pubic hair, phallus size, and testicular size for SMR 3

A
  1. Coarse, curly, and pigmented
  2. Increased phallus size
  3. Increased size
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45
Q

Describe pubic hair and phallus size for SMR 4

A
  1. Dense and curled, but less abundant than adult

2. Close to adult male

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46
Q

Describe pubic hair, phallus size, and testicular size for SMR 5

A
  1. Extends to the inner thigh, adult like
  2. Adult size
  3. Adult size
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47
Q

Describe pubic hair and breast for SMR 1 (prepubertal)

A
  1. Absent

2. No glandular breast tissue

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48
Q

Describe pubic hair and breast for SMR 2 (beginning of puberty)

A
  1. Hair along the labia

2. Small breast buds with glandular tissue

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49
Q

Describe pubic hair and breast for SMR 3

A
  1. Coarse, curly, and pigmented

2. Breast tissue extends beyond the areola

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50
Q

Describe pubic hair and breast for SMR 4

A
  1. Denser and curled, but less abundant than adult

2. Enlarged areola and papilla form a secondary mound

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51
Q

Describe pubic hair and breast for SMR 5

A
  1. Extends to the inner thigh, adult-like

2. No longer a separate projection of the areola from the remainder of the breast

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52
Q

When does the onset of menses occur on average?

A

2 years after thelarche (at approximately age 12-13)

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53
Q

How long and how often do the first few cycles of menarche last and occur?

A
  • Last 2-3 days

- May occur only every 2-3 months

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54
Q

When does the peak height velocity occur for girls?

A

Before menarche

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55
Q

What SMR would a girl be at at the onset of menarche?

A

3 or 4

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56
Q

Menstruation that persists beyond how many days is abnormal and requires a workup?

A

10

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57
Q

True or False: Infrequent menstrual periods during the first 2 years post-menarche don’t generally require a workup beyond reassurance and follow-up

A

True

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58
Q

After menarche, girls are within what range of adult height?

A

4cm or 2in

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59
Q

What is physiologic leukorrhea?

A

White, odorless, mucoid discharge

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60
Q

When does physiologic leukorrhea usually present and how long does it last?

A

Precedes menarche by 3-6 months

Can continue for several years

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61
Q

What is management for physiologic leukorrhea?

A

No intervention

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62
Q

11 year old female who is SMR stage 2 and has bloody vaginal discharge, what is the etiology?

A

Vaginal foreign body

*Onset of menses occurs at SMR stage 3 or 4

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63
Q

What is a common explanation for bloody vaginal discharge in a girl who is SMR 1-2?

A

Vaginal foreign body- common occurrence in girls around this age period (small pieces of toilet paper can cause local irritation and mild bleeding)

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64
Q

What is the most likely reason for not using contraception?

A

Desire to become pregnant

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65
Q

What proportion of pregnancies occur within 6 months of the first time experiencing intercourse

A

1/2

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66
Q

What proportion of pregnancies occur during the first month after the first time experiencing intercourse?

A

1/5

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67
Q

What are other advantages of oral contraceptives besides pregnancy prevention?

A
  1. Decrease risk for ovarian cysts, endometrial and ovarian cancers, colorectal cancers, osteoporosis
  2. Reduce free testosterone levels (decrease hirsutism)
  3. Reduce risk for salpingitis and ectopic pregnancy
  4. Protection against acne and iron deficiency anima
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68
Q

Name indications for OCPs besides pregnancy prevention

A
  1. Dysmenorrhea
  2. Dysfunctional uterine bleeding
  3. PCOS
  4. Irregular menses
  5. Menorrhagia
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69
Q

Name 9 absolute contraindications to OCPs

A
  1. Migraine headache with focal aura or neurologic changes
  2. Pregnancy
  3. Uncontrolled HTN
  4. Liver disease
  5. Breast cancer
  6. Cerebrovascular disease
  7. History of DVT
  8. History of PE
  9. Known Factor V Leiden mutation or other thrombophillic condition
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70
Q

True or False: New IUDs considered to be safer than past (without increased risk for PID or infertility) and are advocated to be the preferred method of contraception for all women regardless of age an parity

A

True

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71
Q

Name 3 other options for birth control besides OCPs

A
  1. IUDs
  2. Subcutaneous slow release progesterone
  3. Contraceptive intravaginal rings
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72
Q

Which types of birth control are considered to be very effective because they don’t require daily compliance?

A
  1. IUDs
  2. Subcutaneous slow release progesterone
  3. Contraceptive intravaginal rings
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73
Q

True or False: All contraceptive methods are associated with fewer health risks than pregnancy and delivery

A

True

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74
Q

When should females get their first Pap smear?

A

Age 21 (regardless of age of first intercourse)

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75
Q

What is the definition of primary amenorrhea?

A

Lack of menses by age 15 or 3 years following breast development

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76
Q

Name 2 diagnoses you should consider if you have a teen with primary amenorrhea

A
  1. Androgen Insensitivity Syndrome

2. Tuner Syndrome

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77
Q

How does androgen insensitivity syndrome present?

A

Normal breast development in the absence of pubic hair and menstruation

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78
Q

What was androgen insensitivity syndrome formerly known as?

A

Testicular feminization

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79
Q

Amenorrheic girl with breast development limited to breast budding and no pubic hair development?

A

Turner Syndrome

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80
Q

Name features of Turner syndrome

A
  1. Short stature
  2. Low hairline
  3. Low set ears
  4. Heart murmur
  5. HTN
  6. Lymphedema of hands and/or feet
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81
Q

What study is indicated if you suspect Turner syndrome?

A

Karyotype

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82
Q

What is the #1 cause of amenorrhea?

A

Pregnancy

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83
Q

True or False: A girl may become pregnant even before her first menstrual period

A

True (this would be primary amenorrhea)

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84
Q

What is secondary amenorrhea?

A

3 months of amenorrhea after the onset of menarche

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85
Q

Name the 3 most common causes of secondary amenorrhea

A
  1. Pregnancy
  2. PCOS
  3. Exercise-induced amenorrhea
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86
Q

What mental health condition can present with amenorrhea?

A

Anorexia nervosa (amenorrhea precedes weight loss)

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87
Q

Name the negative energy triad in female athletes

A
  1. Amenorrhea
  2. Osteoporosis
  3. Disordered eating
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88
Q

What would make you think PCOD?

A

Any female adolescent with amenorrhea, dysfunctional uterine bleeding, obesity, hirsutism, and acne

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89
Q

What are common lab findings in PCOD?

A
  1. LH:FSH >2.5

2. Elevated androgen levels

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90
Q

What are 3 treatment options for PCOD?

A
  1. Weight loss
  2. OCPs
  3. Anti-androgen medications (spironolactone)
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91
Q

True or False: Lack of obesity rules out PCOD

A

False- Obesity is a common association, but isn’t always present

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92
Q

What is the typical presentation for exercise-induced amenorrhea?

A

Female teenage who does heavy athletic training whose periods become lighter then stop

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93
Q

What are lab findings consistent with exercise-induced amenorrhea?

A

Low serum estradiol (E2)

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94
Q

What does low serum estradiol (E2) seen in exercise-induced amenorrhea increase the risk for?

A

Low bone density and osteoporosis

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95
Q

What are patients with exercise-induced amenorrhea at risk for?

A

Eating disorders (like anorexia nervosa)

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96
Q

What is management for exercise-induced amenorrhea?

A
  1. Increase caloric intake
  2. Reduce intensity of athletic training
  3. Calcium supplements
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97
Q

What part of the social history needs to be addressed in exercise-induced amenorrhea?

A

Smoking- if they are they need to stop because it increases the risk for stress fractures

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98
Q

When are OCPs used in exercise induced amenorrhea?

A

Never- this isn’t correct treatment

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99
Q

What is delayed puberty associated with?

A

Low bone density

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100
Q

What is crampy lower abdominal pain and pelvic pain that occurs with menses and isn’t due to other pelvic pathology?

A

Primary dysmenorrhea

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101
Q

What causes primary dysmenorrhea?

A

Prostaglandins produced during the ovulatory cycle

102
Q

What is treatment for primary dysmenorrhea?

A
  1. Prostaglandin inhibitors (NSAIDs- Ibuprofen or naproxen)

2. OCPs (only if NSAID treatment fails)

103
Q

What is a significant cause of female teens missing or modifying school, work, sports, activities, and social engagements?

A

Primary dysmenorrhea

104
Q

Under what circumstances is primary dysmenorrhea more common?

A

Girls with early menarche, heavy menses, family history of dysmenorrhea

105
Q

True or False: Teens who exercise regularly are less likely to experience dysmenorrhea

A

True

106
Q

What needs to be considered for teens whose dysmenorrhea isn’t responding to NSAIDs and OCPs?

A

Non-gyn causes of pelvic pain (secondary dysmenorrhea)

Ex: IBS

107
Q

What should be considered for management in secondary dysmenorrhea?

A

Referral for laparoscopy to rule out endometriosis

108
Q

When should the diagnosis of dysfunctional uterine bleeding be considered?

A

For menstrual bleeding beyond 10 days

109
Q

What is the most common cause of dysfunctional uterine bleeding?

A

Anovulation during initial onset of menarche

110
Q

Name 8 potential underlying etiologies for a patient with dysfunctional uterine bleeding

A
  1. Tubal pregnancy/Threatened abortion
  2. PID
  3. Thyroid disease
  4. Medications
  5. Bleeding disorder
  6. PCOS
  7. Trauma
  8. Systemic disease (diabetes, lupus, kidney disease)
111
Q

What is the treatment for dysfunctional uterine bleeding?

A

Medical with reassurance and sometimes NSAIDs. Could consider OCPs as an alternative for persistent cases

112
Q

What underlying hematologic problem needs to be considered in dysfunctional uterine bleeding?

A

Possibility of iron deficiency anemia

113
Q

What is a common cause of DUB in developing countries?

A

TB

114
Q

What is the term for heavy or prolonged bleeding at regular intervals?

A

Menorrhagia (or hypermenorrhea)

115
Q

What is the term for irregular vaginal bleeding?

A

Metrorrhagia

116
Q

What is the term for heavy vaginal bleeding at irregular intervals?

A

Menometrorrhagia

117
Q

What is the term for frequent vaginal bleeding more often than every 21 days?

A

Polymenorrhea

118
Q

What should you consider in cases of heavy menstrual bleeding without pain?

A

Chlamydia

119
Q

What is pink vaginal discharge in an otherwise healthy newborn most likely due to?

A

Influence of maternal estrogen withdrawal

120
Q

What is done for pink vaginal discharge in an otherwise healthy newborn?

A

Nothing

121
Q

When would you consider vitamin K deficiency as the cause of pink vaginal discharge in an otherwise healthy newborn?

A

If there are other signs like petechiae

122
Q

True or False: Vaginal adhesions are commonly seen during infancy and in pre-school girls

A

True (similar to adhesions seen in foreskin in males)

123
Q

True or False: Vaginal adhesions usually resolve spontaneously if asymptomatic

A

True

124
Q

What are symptoms of vaginal adhesions?

A

Dysuria or a secondary bacterial infection

125
Q

If there are symptoms from vaginal adhesions, what should you do for treatment?

A

Estrogen cream

126
Q

How does imperforate hymen present?

A

Girl who reached full sexual maturity in absence of menarche. May have cyclical abdominal pain, midline abdominal mass, and/or bluish bulging hymen

127
Q

What is a condition that needs to be differentiated from imperforate hymen?

A

Tubo-ovarian abscess

128
Q

How can you distinguish between a tubo-ovarian abscess and imperforate hymen?

A

Tubo-ovarian mass can present with intermittent abdominal pain (like imperforate hymen), but the mass isn’t usually palpable midline (imperforate hymen does have a midline abdominal mass)

129
Q

What is hydrometrocolpos?

A

Collection of fluid in the uterus (can be due to imperforate hymen and retained menstrual fluids)

130
Q

What is the next most appropriate step in evaluation of a patient with signs and symptoms consistent with imperforate hymen and/or hydrometrocolpos

A

PE of the external genitalia

131
Q

How does vulvovaginitis present?

A

Vaginal irritation, pain, and pruritus

Can also present as dysuria

132
Q

What are non-STD causes of vulvovaginitis?

A
  1. Enterobius vermicularis (pinworms)
  2. Group A beta hemolytic strep
  3. Staph
  4. Candida
133
Q

What are STD causes of vulvovaginitis?

A
  1. Gonorrhea
  2. Chlamydia
  3. Trichomonas Vaginalis
  4. Herpes Simplex
134
Q

What are some features that can lead to vulvovaginitis?

A

Poor hygiene, chemical irritants (bubble bath), tight clothing

*Could be sexual activity in teens or sexual abuse in kids, but above are more likely on boards

135
Q

What should you consider with vaginitis in a young girl?

A

May be due to a foreign body (like toilet paper)

*This could include discharge and a foul odor

136
Q

What could be a cause of vaginitis in a young girl with recent antibiotic use?

A

Candida infection

137
Q

What are 2 things you should think of with green vaginal discharge?

A
  1. Neisseria gonorrhea

2. Beta hemolytic strep infection

138
Q

Milk curd vaginal discharge that is itchy?

A

Candida vaginitis

139
Q

How do you treat candida vaginitis?

A

Topical clotrimazole

140
Q

What does condyloma acuminata look like?

A

Flat popular lesions which are often pedunculated in the genital and/or anal mucosa

141
Q

How does transmission of condyloma acuminate occur?

A

Almost always via sexual contact

142
Q

What virus causes veneral warts (condyloma acuminata)?

A

HPV (human papiilomavirus)

143
Q

Describe HPV lesions (veneral warts)?

A

Non-tender and bleed with minor trauma

144
Q

True or False: Anogenital warts due to HPV infection are often asymptomatic in males

A

True

145
Q

What are veneral wards due to HPV a risk factor for?

A

Development of cervical cancer

146
Q

True or False: Anogneital warts have a high spontaneous resolution rate

A

True

147
Q

What is a treatment option for anogenital warts?

A

Observe for 1-2 years before treatment (because anogenital warts have a high spontaneous resolution rate)

148
Q

What are the treatments for anogenital warts?

A
  1. Observation is initial management
  2. Medical treatment with chemical cauterization (use podophyllin or podofilox)
  3. Surgical excision
149
Q

True or False: Vaccination is still recommended even if a patient already has veneral (HPV) warts

A

True- the vaccine would protect against strains other than the one contracted by the patient

150
Q

Name 3 lesions that could be confused with condyloma acuminata

A
  1. Molluscum contagiosum
  2. Bartholin cysts
  3. Condyloma lata
151
Q

Describe genital molluscum contagiosum lesions

A

Smaller (compared to HPV warts), rarely genital, smooth, flesh colored, central umbilication

152
Q

What is a large and tender genital lesion that may present as a fluctuant mass on the vaginal wall?

A

Bartholin cyst

153
Q

When is condyloma lata seen?

A

Part of secondary syphillis

154
Q

Describe condyloma lata

A

Whitish-gray papules that have coalesced in the genital area (flatter than condyloma acuminate)

*This will also have systemic symptoms like fever

155
Q

What is the recommendation for a child with benign vulvitis (Mild perianal and vaginal pruritus and dysuria)?

A

Reassurance and sitz baths

*Make sure to rule out sexual abuse, trauma, or signs of pinworms

156
Q

Describe the primary lesion (initial infection) with HSV

A

Painful with tender inguinal nodes

157
Q

Describe subsequent lesions with HSV

A

Ulcerative

158
Q

What is the treatment of primary HSV infection?

A

Oral acyclovir

Could also use famciclovir or valacyclovir

159
Q

History of unprotected sexual intercourse several weeks ago, now with vesicular lesions on the penis… best diagnostic test to do initially?

A

Viral culture for herpes simplex

160
Q

Why is the tzanck test not the best diagnostic test to initially do when you suspect herpes?

A
  • Tzanck test has a sensitivity less than 50%

- Doesn’t differentiate herpes from varicella

161
Q

What does a Tzanck test detect?

A

Multinucleated giant cells (will pick up herpes and varicella)

162
Q

What is the medical term for genital crabs?

A

Pediculosis pubis

163
Q

How do patients with pediculosis pubis present?

A

Red, crusted suprapubic macules

164
Q

What should you consider if someone has blue-gray dots in their pubic area?

A

Maculae cerulea- Pediculosis pubis (crabs)

165
Q

How is crabs (pediculosis pubis) spread?

A

Primarily by close contact (especially sexual contact)

166
Q

Why does pediculosis pubis require close contact for spread?

A

They are slow moving and sluggish

167
Q

How long do peduiculosis pubis last without a meal?

A

1-2 days (the meal is blood)

168
Q

Where can pediculosis pubis be found?

A

Pubic area
Anal hairs
Facial hair
Eyelashes

169
Q

What should you be suspicious of in any child with pubic lice?

A

Sexual abuse

170
Q

What are the treatment options for pediculosis pubis?

A
  1. Permethrin 1% or 5%
  2. Pyrethrin with piperonyl butoxide
  3. Malathion
171
Q

What can be done for pediculosis pubis in the eyelashes?

A

Apply petroleum jelly several times per day for 10 days

172
Q

What is the drug that you can use as second line treatment for pedulosis pubis and which populations can you not use this in?

A

Lindane

Cannot use in neonates or pregnant women

173
Q

What is bacterial vaginosis due to?

A

Gardnerella vaginalis

174
Q

What is bacterial vaginosis associated with?

A

The use of anything that disrupts the normal balance of the vaginal flora (antibiotics, IUDs, ect.)

175
Q

True or False: Bacterial vaginosis is not necessarily an STD

A

True- Gardnerella vaginalis is a part of normal vaginal flora, but more common in those who are sexually active

176
Q

How is bacterial vaginosis diagnosed?

A
  1. Whiff test- Tests for presence of amines after addition of KOH (malodorous fishy/amine odor)
  2. Clue cells
177
Q

What is the triad of bacterial vaginosis?

A
  1. Copious grey-white vaginal discharge
  2. Vaginal pH >4.5
  3. Clue cells under microscopy
178
Q

What is estimated to be the most prevalent nonviral STD in US teens?

A

Trichomoniasis

179
Q

True or False: Trichomonas is a reportable STD

A

False- “True” numbers for prevalence aren’t known

180
Q

What are the symptoms of trichomoniasis in males?

A

None- they are asymptomatic

181
Q

What are the symptoms of trichomoniasis in females?

A

Burning, itching, abnormal vaginal odor, dyspareunia

182
Q

Flagellated organisms on wet mount
Frothy yellow discharge
Strawberry cervix/Petechia (due to friable mucosa)

A

Trichomonas vaginalis

183
Q

What is the treatment for trichomonas?

A

Metronidzole (Flagyl)

184
Q

What is important to remember for trichomonas treatment?

A

Partners need to be treated

185
Q

True or False: Gonorrhea is most commonly asymptomatic

A

True

186
Q

What do you need to consider for any adolescent with arthritis?

A

Gonorrhea

187
Q

What STD may present with sore throat, fever, and cervical adenopathy?

A

GC pharngitis

188
Q

What is the most common reportable STD?

A

Chlamydia

189
Q

What is the second most common reportable STD?

A

Gonorrhea

190
Q

How does gonorrhea present in males?

A

Dysuria and discharge

191
Q

If gonorrhea progresses to epididymitis, what is the presentation?

A

Unilateral pain and swelling of the scrotum

192
Q

How does gonorrhea present in females?

A

Urethritis, cervicitis, dysuria, malodorous discharge

193
Q

True or False: Gonorrhea infection can ascend to any part of the female reproductive tract

A

True

194
Q

What are 2 locations gonorrhea infection can spread outside of the reproductive tract?

A
  1. Peritoneum causing peitonitis

2. Liver capsule causing peri-hepatitis (Fitz-Hugh-Curtis syndrome)

195
Q

True or False: LFTs will be elevated in Fitz-Hugh-Curtis symdrome

A

False- This is peri-hepatitis (not hepatitis) and LFTs will be normal

196
Q

What % of cases does disseminated GC infection occur?

A

1-2%

197
Q

True or False: Local symptoms of gonorrhea are not usually present once dissemination becomes apparent

A

True

198
Q

What are potential symptoms of disseminated gonorrhea?

A

Fever, arthritis, rash, meningitis, endocarditis

199
Q

How is diagnosis of disseminated gonorrhea usually made?

A

Gram stain with intracellular gram-negative diplococci

200
Q

What is the gold standard for diagnosis of disseminated gonorrhea?

A

Culture

*But empiric treatment if often indicated prior to culture results

201
Q

What do you need to remember when counseling patients with gonorrhea?

A

Partners need to be treated

202
Q

What else do patients who are being treated for gonorrhea need to be treated for?

A

Chlamydia

203
Q

What are minimal criteria for diagnosis of PID?

A

Lower abdominal or pelvic pain along with uterine, adnexal, or cervical motion tenderness

204
Q

Besides the minimal criteria for PID name 5 additional criteria that aid in the diagnosis

A
  1. WBC in vaginal secretions
  2. Temp >38.3C
  3. Elevated ESR or CRP
  4. Lab evidence of GC or chlamydia
  5. Abnormal cervical or vaginal mucopurulent discharge
205
Q

Adolescent with lower abdominal pain, shuffling gait, denies sexual activity?

A

Consider PID

206
Q

What are findings on the pelvic exam in PID?

A

Extremely painful cervical motion tenderness (chandelier sign)

207
Q

What specimens/testing do you need to obtain during a pelvic exam for PID?

A
  1. Chlamydia/GC cultures
  2. Trichomoniasis
  3. Bacterial vaginosis
208
Q

Besides GC and chlamydia, what else can PID be caused by?

A
  1. Anaerobes

2. Gram-negative rods

209
Q

Besides GC/Chlamydia, Trichomoniasis, and Bacterial Vaginosis, what 2 other things do patients with PID need testing for?

A
  1. Syphilis

2. HIV

210
Q

What 2 things is PID a risk factor for?

A
  1. Ectopic pregnancy

2. Infertility

211
Q

What vaccine should you counsel patients with PID on?

A

HPV vaccine (also need to look for evidence of HPV)

212
Q

Asymptomatic sexually active female…most appropriate STD screen?

A

Urine PCR for chlamydia or gonorrhea

along with appropriate blood tests for HIV and syphilis

213
Q

When do you treat for suspected PID?

A

Empirical treatment for all sexually active females at risk for STIs who present with lower abdominal/pelvic pain and meet criteria

214
Q

Outpatient treatment for PID?

A
  1. Parenteral cephalosporin (Cefoxitin IV/Cefotetan IV/Ceftriaxon 250mg IM)
  2. Doxycycline 100mg BID x14 days
  3. +/- Metronidazole 500mg BID x14 days
215
Q

In what timeframe do patients with PID need to be re-checked?

A

Within 72 hours of starting antibiotics

216
Q

What do you need to counsel patients with PID on regarding their partner?

A
  • Notify partner so they can be treated

- No sex until both are treated

217
Q

Name indications for inpatient treatment of PID?

A
  1. If follow-up isn’t assured
  2. Symptoms don’t improve in 48 hours
  3. Can’t tolerate outpatient management
  4. Severely ill
  5. Pregnant
218
Q

What needs to be done if pain persists after treatment for PID?

A

Abdominal US (to evaluate for a tubo-ovarian abscess)

219
Q

What 2 bugs can cause Fitz Hugh Curtis?

A
  1. Chlamydia

2. Gonorrhea

220
Q

Female teenage with RUQ pain, nausea, vomiting. Only medication is OCPs. Best initial step to make correct diagnosis?

A

Cervical cultures

221
Q

What is Fitz Hugh Curtis syndrome?

A

Perihepatitis

*Manifestation of gonococcal and chlamydial infections

222
Q

What is treatment for Fitz Hugh Curtis?

A

Same as PID

  1. Parenteral cephalosporin (Cefoxitin IV/Cefotetan IV/Ceftriaxon 250mg IM)
  2. Doxycycline 100mg BID x14 days
  3. +/- Metronidazole 500mg BID x14 days
223
Q

When should the RUQ pain (perihepatitis) resolve in Fitz Hugh Curtis?

A

Within 2 days after treatment

224
Q

Name 2 causes of pelvic pain that aren’t due to PID

A
  1. Ovarian cyst

2. Ovarian Torsion

225
Q

Teenage with unilateral abdominal discomfort occurring mid-cycle…

A

Ovarian cyst

226
Q

What is the US finding you will likely see with an ovarian cyst?

A

Fluid-filled cyst on the ovary

227
Q

What is management of an ovarian cyst based on?

A

Size

228
Q

What is the size cut-off for an ovarian cyst requiring follow-up US v. laparoscopic cyst aspiration?

A

6cm
<6cm- Follow-up US
>6cm/significant symptoms beyond discomfort- Laparoscopic cyst aspiration

229
Q

Sudden lower abdominal pain which radiates to the back, side, or groin/leg on the same side, nausea, vomiting?

A

Ovarian torsion

230
Q

How is an ovarian torsion diagnosed?

A

Doppler US

*This shouldn’t delay surgical consultation if US access isn’t immediately available

231
Q

Who is usually the perpetrator in sexual abuse?

A

Someone close to or known by the family

232
Q

What behavior is a red flag for sexual abuse in a child?

A

Child who acts out by describing explicit adult sexual behavior

*Kid may have observed or experienced inappropriate sexual behaviors

233
Q

True or False: Size of the hymen is not a good way to assess sexual abuse or molestation in the absence of supporting history and other physical findings

A

True- Hymen can be damaged in other ways like riding a bike

234
Q

What is a common variant in hymen findings?

A

Lacks tissue about 3/9 position

*This finding is nonspecific and doesn’t confirm sexual abuse

235
Q

True or False: Labial adhesions and some abrasions can be normal findings in certain injuries

A

True (bicycle seat injury)

236
Q

Name 6 findings that are normal variants in girls who have not been abused

A
  1. Gaping hymenal orifice
  2. Vaginal discharge
  3. Labial adhesions
  4. Friability of the posterior fourchette
  5. Linea vestibularis
  6. Vestibule pallor
237
Q

What is an example of when vaginal bleeding in young girls may not represent abuse?

A

Urethral prolapse

238
Q

African American girls, 3-8 years old, hyperemic doughnut-shaped mass in the vaginal region?

A

Urethral prolapse

239
Q

What is the management for urethral prolapse?

A

Warm sitz baths

Follow-up with urology

240
Q

Child with a foul odor from vagina?

A

Consider a foreign body (toilet paper)

*Look out for clues indicating suspicion of abuse

241
Q

What should you think with vaginal discharge in a child on antibiotics?

A

Yeast infection

242
Q

What is something that should be on your differential for white vaginal discharge?

A

Physiological leukorrhea

243
Q

What causes physiological leukorrhea?

A

Due to desquamation of epithelial cells under influence of estrogen

244
Q

What age group do you see physiological leucorrhea in?

A

11 (just prior to menarche)

245
Q

True or False: Neisseria gonorrhea infection on genital, rectal, and pharyngeal secretions cultures should be strongly considered a result of sexual abuse

A

True

246
Q

What are 2 ways chlamydia can be transmitted?

A
  1. Sexually

2. Vertically during birth process (and persist in positive cultures for months)

247
Q

What is the age after which rectal and vaginal chlamydia infection transmitted at birth no longer persist?

A

18 months

248
Q

True or False: Sexual abuse should be considered in any prepubertal child beyond infancy who presents with vaginal, urtheral, or rectal chlamydia infection

A

True

*Remember chlamydia has vertical transmission too

249
Q

True or False: Anogenital warts (congenital condyloma acuminata) can be transmitted through a contaminated birth canal

A

True

250
Q

If anogenital warts are transmitted through the birth canal, by what age do they usually manifest?

A

1 (some say up to 3)

251
Q

After what age would new onset of condyloma genital warts be likely due to child abuse?

A

3

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