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O'Neils Pointers Flashcards

1
Q

PAP SMEAR: Age specific guidelines

A

*Pediatrics
- Screening under 21 not recommended

*Geriatrics
-With adequate hx of screening and no CIN II in last 20 years - should not be screened
——Negative results
——3 Neg ctyology
——2 neg HPV + cytology(1 in last 5 years)

*Pregnancy
-Squamous lesions may progress during but regress after
- colposcopy ONLY to exclusive invasive cancer in high risk women
- unless cancer is ID’d, treatment of CIN is contraindicated

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2
Q

Risk factors for endometrial cancer

A
  • nulliparity
    -diabetes (due to anovulation from higher insulin)
    -taking unopposed estrogen
  • tamoxifen use
    -rapid weight gain and weight gain in general
    ——20-50 lb = 3X
    ——>50 lb: 10X
  • obesity
    -hypothyroidism
    -hypertension
    -hx of breast or colon cancer
    -early menarche(before 11)
    -late menopause(after 52)
    -estrogen secreting neoplasms
  • menstrual cycle irregularities and anovulation
    -age 35+
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3
Q

Differentials Vaginal Bleeding

A
  • ectopic pregnancy
    -pregnancy termination
    -placental abruption
    -placenta previa
    -uterine rupture
    -postpartum hemorrhage
    -menses
    -genitourinary trauma
  • ovarian torsion or cyst rupture
    -endometrial carcinoma/cancers
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4
Q

Antibiotic Treatment: Nongonococcal Urethritis

A

*Chlamydia trachomatis, ureaplasma and mycoplasma
- Doxy is preferred 100mg BID x 7 days
-Azithromycin 1G one time dose
OR
-Levofloxacin 500mg PO x 7days

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5
Q

Antibiotic Treatment: Gonorrhea

A

-High dose IM Ceftriaxone 500mg PO x7 days one time + 100 mg Doxy PO BID x7 days

-Gentamicin 240 mg IM once + azithromycin 2G PO one time

-800 mg Cefixime PO one time dose

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6
Q

Antibiotic Treatment: Trichomonas

A

-Metronidazole 500 mg PO BID x 7 days in females OR Metronidazole 2G PO one time in males
-Tinidazole 2g PO one time dose (No alcohol w/in 24hours)

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7
Q

Antibiotic Treatment: Genital Herpes

A

-Acyclovir dose dependent

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8
Q

Herpes suppressive therapy

A
  • Valacyclovir 500mg or 1000mg Daily
    -Acyclovir 400 mg BID
    -Famciclovir 250mg BID
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9
Q

Fragile X Males

A

-Large testicles
-large body habitus
-learning and behavioral issues
- large forehead and ears
-prominent jaw
-avoids eye contact
-hyperreflexivity of joints
-Mutation of FMR1 gene on X chromosome

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10
Q

Fragile X Females

A

-less common
-fewer prominent findings
-most common cause of autism in either gender
-Mutation of FMR1 gene on X chromosome

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11
Q

Fragile X Treatment

A
  • Medications for anxiety, ADHD and aggression
    -Therapy for social skills, communication and cognitive development
    -educational support
    -physical therapy for joint hyperlaxity
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12
Q

Vaccines and Pregnancy

A
  • NO LIVE VACCINES
    -Tdap with EVERY pregnancy
    -Flu shot recommended
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13
Q

Klinefelter Syndrome XXY

A

-infertility
-hypogonadism
-Phenotypic manifestations
*learning disabilities
*Low testicular Volume
*Hip and Breast Enlargement
*Abnormal body proportions
*Personality impairment

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14
Q

ACA Mammogram

A
  • 40 - 45 optional or high risk
  • 45 -55 annual
    -55 til estimated within 10 years of life - annual or biannual
  • high risk
  • MRI in addition to mammogram
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15
Q

Antibiotics for Asymptomatic bacteriuria and cystitis in pregnancy: Amoxicillin

A

Dose:
500 mg PO q8h or 875mg PO q12H

Duration:
5 to 7 days

Notes:
Resistance may limit its utility among gram negative pathogens

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16
Q

Antibiotics for asymptomatic bacteriuria and cystitis in pregnancy: Augmentin

A

Augmentin - Amoxicillin-clavulanate

Dose
500mg PO Q8H
OR
875mg PO Q12H

Duration
5-7 days

17
Q

Antibiotics for asymptomatic bacteriuria and cystitis in pregnancy: Cefpodoxime

A

Dose
100mg PO Q12H

Duration
5 to 7 days

18
Q

Antibiotics for asymptomatic bacteriuria and cystitis in pregnancy: Cephalexin

A

Dose
250mg to 500 mg PO Q6H

Duration
5 to 7 days

19
Q

Antibiotics for asymptomatic bacteriuria and cystitis in pregnancy: Fosfomycin

A

Dose
3g PO as single dose

Notes:
Doesn’t achieve therapeutic levels in the kidneys so should not be used if pyelonephritis is suspected

20
Q

Antibiotics for asymptomatic bacteriuria and cystitis in pregnancy: Nitrofrurantoin

A

Dose
100mg PO Q12H

Duration
5 to 7 days

Notes
-Doesn’t achieve therapeutic levels in kidneys, should not be used if pyelonephritis is suspected
-Typically avoided during 1st trimester and at term; however is appropriate alternative during these periods when other options cannot be used.

21
Q

Antibiotics for asymptomatic bacteriuria and cystitis for pregnancy: Pivmecillinam

A

Dose
185mg pivmecillinam base PO TID (dose approved in US)

Duration
3- 7 days

Dose
400mg pivmecillinam HCL PO TID (dose recommended in some European countries)

Duration
3 to 5 days

NOTES
-Don’t use if pyelonephritis is suspected
-Use in preg may result in false-positive test for isovaleric acidemia for newborn screening

22
Q

Antibiotics for asymptomatic bacteriuria or cystitis in pregnancy: Bactrim

A

Bactrim; Trimethoprim-sulfamethoxazole

Dose
800/160 mg (1 double strength tablet) Q12H

Duration
3 days

Notes:
-Typically avoided during 1st trimester and at term; however its an appropriate alternative during these periods wehn other options cannot be used.

23
Q

Parenteral regimens for empiric treatment of pyelonephritis in pregnancy: Mild to moderate Pyelonephritis

A

*Ceftriaxone
1g q24H

*Cefepime
1g Q12H

Aztreonam
1g Q8H

*Ampicillin
1-2g Q6H
PLUS
*Gentamicin
1.5mg/kg Q8H

24
Q

Parenteral regimens for empiric treatment of pyelonephritis in pregnancy: Severe Pyelonephritis w/ impaired immune system
and/or incomplete urinary drainage

A

*Zosyn: Piperacillin-Tazobactam
3.375g Q6H

*Meropenem
1g Q8H

*Ertapenem
1g Q24H

*Doripenem
500mg Q8H

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Tanner Staging Male: Stage 1
*Age of Onset of Male Sexual Maturity -9 years and younger *Linear growth -5-6 cm/year *Testis(gonadarche) -<4 mL or <2.5 cm *Penis -Same size as early childhood *Pubic Hair (pubarche) -None Present *Puberty -Mean age of pubertal onset: 11.5 years -Range: 9-14 years *spermarche -11-15 -avg: shortly after attainment of peak height velocity *Race modifications -White Pt: Stage 2 may begin 1 year earlier Black Pt: Stage 2 may begin 2 years earlier
26
Tanner Staging Male: Stage 2
*Age of onset male sexual maturity -9-11 years *Linear Growth -5-6 cm/year *Testis (gonadarche) -4 mL or 2.5 - 3.5 cm; scrotum becomes red and textured *Penis -Not yet enlarged *Pubic Hair (pubarche) -Sparse, lightly pigmented, straight along base of penis 12 (9.9-14.0) years *Puberty -Ages 11-15 -avg: shortly after attainment of peak height velocity *Race Modifications - White: Stage 2 may begin 1 year earlier -Black: Stage 2 may begin 2 years earlier
27
Tanner Staging Male: Stage 3
*Age of Onset Male sexual maturity -11-12.5 years *Linear Growth - 6-7 cm/year *Testis(gonadarche) - 12mL or 3.6 cm *Penis -Enlargement and lengthening *Pubic Hair (pubarche) - On pubis; more pigmented, coarse, curled, abundant 13.1(11.2-15.0)years *Puberty -Precocious onset: prior to 9 years (testicular develpment) -late onset: 13-14 years *Spermarche -Ages 11-15 -avg: shortly after attainment of peak height velocity *Race Modifications -White: stage 2 may begin 1 year earlier -Black: stage 2 may begin 2 years earlier
28
Tanner Staging Male: Stage 4
*Age of onset male sexual maturity -12.5 - 14 years *Linear growth -10 cm/year -peak height velocity 13.5 yr *Testis(gonadarche) -4.1-5 cm *Penis -increased size and breadth *Pubic Hair(pubarche) - Adult-like and abundant over smaller area than fully mature adult 13.9(12-15.8)years *Puberty -Precocious onset: prior to 9 years (testicular development) -late onset: 13-14 years *Spermarche - ages 11-15 -avg: shortly after attainment of peak height velocity *Race Modifications - white: stage 2 may begin 1 year earlier -Black: stage 2 may begin 2 years earlier
29
Tanner Staging Male: Stage 5
*Age of onset male sexual maturity -14 years and older *linear growth -ceases after age 17 *Testis(gonadarche) -fully matured in shape > 4.5 cm *Penis -fully matured in size and length: 16.5 years *pubic hair(pubarche) -adult in type and quality, with horizontal distributio; extends to thighs *puberty -Precocious onset prior to 9 years (testicular development) -Late onset: 13-14 years *Spermache -Ages 11-15 -avg shortly after attainment of peak height velocity *Race Modifications -White: stage 2 may begin 1 year earlier -Black: stage 2 may begin 2 years earlier
30
Tanner Staging Female: Stage 1
*Age of Onset Female Sexual Maturity -10 yrs and younger *Linear Growth -5-6cm/year *Breasts(thelarche) -Prepubertal; papilia elevated above chest wall *Pubic Hair(pubarche) -none present *Puberty -Mean age of pubteral onset: 10.5 years -Range: 8-12 years *Menarche -12.7 years (10.8-14.5 years) after breast, pubic and underarm hair begin to grow -Avg: 2.6 years after onset of puberty and 0.5 years after peak height velocity *Race modifications - White: Stage 2 may begin 1 year earlier -Black: stage 2 may begin 2 years earlier
31
Tanner Staging Female: Stage 2
*Age of onset female sexual maturity - 10.9 ( 10.2-11.3) years *Linear Growth - 7-8 cm/year *Breasts(thelarche) -Breast and papilia form small mound; areola increases in diameter; marks start of puberty; precedes menarche by 24 months *sparse, lightly pigmented; straight along boarder of labia (9-13.4 years) *Puberty -mean age of puberty onset 10.5 years -Range: 8-12 years *Menarche - 12.7 years( 10.8-14.5 years) after breast pubic and underarm hair begin to grow Avg: 2.6 years after onset of puberty and 0.5 years after peak height velocity *Race modifications - White: stage 2 may begin 1 year earlier -Black: Stage 2 may begin 2 years earlier
32
Tanner Staging Female: Stage 3
*Age of onset female sexual maturity -11.9 (9.9-13.9)years *Linear Growth -8 cm/year *Breasts(thelarche) -Breast and areola enlarge;no separation in contours *Pubic Hair(pubarche) -On mons pubis: more pigmented, coarse, curled, abundant (9.6-14.1 years) *puberty -Precocious onset: prior to 8 years (breast development) -Lane onset: 12-13 *Menarche -12.7 years (10.8-14.5 years)after breast, pubic and underarm hair begin to grow -Avg 2.6 years after onset of puberty and 0.5 years after peak height velocity *Race modifications -white: stage 2 may begin 1 year earlier -black: stage 2 may begin 2 years earlier
33
Tanner Staging Female: Stage 4
*Age onset female sexual maturity -12.9(10.5-15.3)years *Linear Growth -7 cm/year *Breast(thelarche) -Secondary mound formed by areola and papilla, about level of breast *Pubic Hair(pubarche) -Adult like and abundant over smaller area than in fully mature adult (10.4-14.8 years) *Puberty -Precocious onset: prior to 8 years(breast development) -late onset: 12-13 years *Menarche -12.7 years (10.8-14.5 years) after breast pubic and underarm hair begin to grow -avg: 2.6 years after onset of puberty and 0.5 years after peak height velocity *Race Mod -white: stage 2 may begin 1 year earlier -black: stage 2 may begin 2 years earlier
34
Tanner Staging Female: Stage 5
*age of onset female sexual maturity -15 years and older *Linear growth -ceases 2-2.5 years after menarche *Breasts(thelarche) -Adult breast: nipple projects; areola becomes part of contour of breast *pubic hair(pubarche) -Adult in type and quantity with horizontal distribution as inverse triangle; extends to thighs *Puberty -Precocious onset: prior to 8 years(breast development) -Late onset: 12-13 years * Menarche -12.7 years(10.8-14.5 years) after breast pubic and underarm hair begins to grow -avg: 2.6 years after onset of puberty and 0.5 years after peak height velocity *race mod -white: stage 2 may begin 1 year earlier -black: stage 2 may begin 2 years earlier
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