Peds GYN Flashcards
1
Q
Puberty: Definition
A
The onset of sexual development
2
Q
Puberty: Males
A
- Testes begin to produce sperm
- Male puberty complete with the first ejaculation that contains mature sperm
3
Q
Puberty: Females
A
- Ovaries begin to release mature ova
- Female puberty complete at first ovulatory menstrual period
- Can take up to 1-2yr after menarche
- Puberty complete when reproduction possible
4
Q
Androgens in Puberty
A
- Responsible for skeletal growth spurt and pubic and axillary hair growth, and acne and sebaceous glands
5
Q
Prepubertal Exam of genitals
A
- Presence of pubic/body hair
- Skin lesions
- Hygiene
- Anus for cleanliness, excoriation, erythema
- Tanner stage
- Clitoris (size)
- Labia minora
- any sign of estrgenization (vaginal mucosa should be moist, thin, and red, NOT dull pink)
- Hymen: Cresent shaped, annular or redundant, may have tags or notches
6
Q
Adolescent Genital/Puberty Exam
A
- Acne
- Tanner stage of breasts and external genitalia
- Thyroid
- Hair distribution on face, chest, back, arms, legs, and abdomen
- External vaginal exam (ONLY internal if PID or pregnancy suspected)
7
Q
Puberty: Diagnostics
A
- None routinely
- wet mount of vaginal secretions
- Saline: WBC, clue cells, trichomonads, bacteria
- KOH: yeast/hyphae
- Urine-based nucleic acid amplification test, cultures, and/or serologic testing for STI (Urine VERY accurate for trich, chlamydia, and gonorrhea)
- Ultrasound
- HCG
- NO PAP <21yr
8
Q
OCs: Monophasic
A
- Contain same amount of estrogen and progestin in all of the active pills
- Alesse, Loestrin, Ortho-Cyclen, Seasonale, Yaz, Beyaz
9
Q
OCs: BiPhasic
A
- Changes the amount of hormones estrogen and progestin once during the menstrual cycle
- Kariva, Mircette, Ortho-Novum 10/11
10
Q
OCs: Triphasic
A
- Contains three different levels of hormones in active pills
- Levels change every seven days during forst three weeks
- Cyclessa, Ortho TriCyclen, Nortel, Enpresse, Ortho-Novum
11
Q
OCs: quadraphasic
A
- hormones change 4 times per cycle
- Natazia is only one
12
Q
OCs: Only ones approved by Medicaid
A
- Mircette (desogestrel/ethinyl estradiol tablets)
- Sprintec (Norgestimate and ethinyl estradiol tablets)
13
Q
Labial Adhesions (Fusion)
A
- Fusion of the labia minora, usually benign
- From irritation and lack of estrogen
- Usually 3mo-6yr
- May have difficulty voiding and UTI’s
- Tx: Vaseline w/q-tip and gentle pressure q diaper change; Premarin 1% cream for 3wk with gentle pressure
14
Q
Vulvovaginitis: Basics
A
- Inflammation, often w/discharge from infection or irritation
- Often w/pruritus
- Usually from poor hygiene, bubble baths
- Must consider: foreign body, bacteria, candida, pinworms, chemical, mechanical, child abuse
15
Q
Vulvovaginitis: Hx
A
- Genital irritation, burning, itching, pain
- Vaginal dicharge
- Nighttime perianal itching
- Urinary complaints
- Recent ABX use
- Underlying illness
- Bubble baths/harsh soaps
- Tight clothing
- Super absorbent diapers
16
Q
Vulvovaginitis: PE
A
- Erythema
- Discharge
- Bacterial culture of secretions
- Wet mount, KOH
- Other testing if abuse suspected
17
Q
Vulvovaginitis: Tx
A
- ABX if bacterial
- Anti-fungal creams
- Albendazole (Ignore book, mebendazole no longer available)
- Handwashing
- Hygiene
- Treat STIs
18
Q
Mittelschmerz
A
- Pelvic pain that occurs during the time of ovulation
- Dull, achy pain in lower abdomen lasting a few minutes to several hours
- If very painful, OCs may be used, otherwise oral analgesics (Naproxen, IBU, prostaglandin inhibitors)
19
Q
Dysmennorrhea: Basics
A
- Painful menstruation with cramping in lower ABD or pelvis
- Primary: Caused by exaggerated response to prostaglandins resulting in uterine contractions and vasoconstriction
- Secondary: Caused by endometriosis. ovarian cysts, infection, uterine abnormalities
20
Q
Dysmennorrhea: Hx
A
- Onset: usually 6-24mo after menarche
- Begins with menses and lasts 2-3 days
- Usually lower ABD and radiating to back and thighs
- Associated Sx: N/V, diarrhea, HA, fatigue, nervousness, dizziness, urinary frequency
- # of missed school days
- Sexual Hx: dyspareunia, menorrhagia, infections, discharge
- Family Hx: Endometriosis
21
Q
Dysmennorrhea: PE
A
- External genitalia
- rule out hymenal abdnomality (imperforate or transverse hymenal septum (suspect in pubertal female s menses))
22
Q
Dysmennorrhea: Tx
A
- NSAIDs
- OCs
- Thiamin
- VitE
- Mag
- Topical heat
- Reduce caffeine and salt intake
- Increase fiber and water
- Exercise
- Smoking cessation
- Refer if intervention not successful or if suspect secondary causes
23
Q
Adolescent Pregnancy
A
- Always ask about rape
- Ask about partner
- Referral for WIC, medicaid, country services
- Start prenatal vitamins ASAP
24
Q
Amenorrhea: Basics
A
- Lack of menses
- Primary: absence of menarche by 16yrs of age with normal pubertal development or absence of menarche by 14yr in absence of secondary sex characteristics
- Secondary: Absence of menses for 3 cycles of more than 6mo in females with established menses
25
Amenorrhea: Etiology
- Disorders of the outflow tract or uterine target organ: vaginal septum, imperforate hymen
- Disorders of the ovary: gonadal dysgenesis, PCOS
- Disorder of anterior pituitary
- Disorder of hypothalamus
- Pregnancy
26
Amenorrhea: Dx
- Hcg
- TSH
- FSH, LH
- Prolactin
- Karyotype
- Consider androgens
27
Amenorrhea: Management
- Provera 10mg q day x 7d
| - Menses should occur, then follow this with OCs to establish regular menses
28
Dysfunctional Uterine Bleeding: Basics
- Abnormal uterine bleeding that is excessive, prolonged, or unpatterned
- NL menses: q 21-45d, last 3-7d; 10-15 soaked pads/tampons per cycle
29
Dysfunctional Uterine Bleeding: etiology
- estrogen production continues without the balancing decrease in FSH which would suppress estrogen
- Endometrium thickens and sheds in a orderly fashion
- Anovulation is the most common cause in adolescents
30
Dysfunctional Uterine Bleeding: Dx
- Hcg
- CBC
- Retic
- ESR
- CRP
- Coags
- TSH
- FSBS
- Prolactin
- Free testosterone levels
- US of pelvis
31
Dysfunctional Uterine Bleeding: Tx (Mild)
- shortened cycle or menses longer that NL with slight increase in flow and Hgb >12
- Observe and keep calendar
- Fe supplement
- OCs for 3-4mo
- Use NSAIDs to reduce heavy bleeding
- Reassess in 3mo
32
Dysfunctional Uterine Bleeding: Tx (moderate)
- Shortened (1-3wk), irregular cycle with moderate-to-heavy bleeding and Hgb 10-12
- 35mcg monophasic OCs
- Use same day start if not bleeding
- If bleeding, start with one OC BID x3-4d until bleeding stops, then continue with q day until pack finished, skip placebo, and start next pack without withdrawal bleeding
- May go up to 4 pills per day
33
Dysfunctional Uterine Bleeding: Tx (Severe)
- irregular, prolonged, heavy bleeding and Hgb <10
- refer to GYN
- If not actively bleeding, may manage as moderate DUB
34
Endometriosis: Basics
- Proliferation of ectopic endometrial tissue outside of the pelvic cavity
- Manifested by dysmenorrhea that progressively worsens
- May have acyclic pain, pelvic pain, GI complaints, dyspareunia
