1
Q
Puberty for females
A
10-14 years old
breast development
menarche 2-3 years after beginning puberty
2
Q
Puberty for males
A
11-16 years old
penile growth and pubic hair development
3
Q
Tanner Stages: boys
A
1) prepubertal
2) enlargement of testes and scrotum
3) enlargement of penis
4) increased size of penis and growth of glands
5) adult genitalia
4
Q
Tanner Stages: girls
A
1) prepubertal
2) breast bud stage with elevation of breast and papilla
3) further enlargement of breast and areola
4) areola and papilla form a secondary mound above level of breast
5) mature stage
5
Q
Tanner stages: boys and girls pubic hair
A
1) pre
2) sparse
3) darker, coarser
4) covering smaller area than adult
5) adult in type
6
Q
When does menarche start in terms of breast stages?
A
stage 3 or 4
7
Q
What age does breast development and pubic hair occur?
A
8-13
8
Q
When does pubic hair and size of male genitalia begin?
A
9 to 13.5
9
Q
Menstrual History
A
- age of menarche
- last menstrual period
10
Q
Gyn History
A
- breast history
- last mammogram
- previous GYN surgery
- history of infertility
- last pap smear
11
Q
OB History
A
-gravida = # pregnancies T- term deliveries (>37 wks) P- preterm (20-37 wks) A- abortion (<20 wks) L- live delivery regardless of gestational age -mode of delivery with indication for operative delivery -gestational age at delivery -maternal complications -fetal complications -delivery complication
12
Q
Contraceptive/Sexual History
A
- contraception method
- currently sexual active
- # partners in last 3 months
- condom use
- history sexual abuse
13
Q
Well Woman Exam
A
- pap smear for women over 21 to 65
- yearly for women with abnormal pap
- every 3 years for women with consecutively normal pap smears
- every 5 years with women normal pap smear with negative HPV testing
- mammogram at 50 years or earlier for women who are at high risk
14
Q
Pap Smear
A
- help screen for cervical cancer
- 99% cervical cancer is due to high risk HPV strains
- not hereditary
- sample taken of cervix (ectocervix) and the cervical canal (endocervix) during speculum
15
Q
Pap Smear Technique
A
- sample from ecto, endo, transitional zone, and squamocolumnar junction
- transformation zone = area between original SCJ and new SCJ
- transformation zone is important bc most common area of precancerous lesion and cancers
16
Q
Indications for Pap Smear
A
- every 3 years if normal pap
- co testing with HPV every 5 years
- if abnormal then every year or less with additional intervention
- no further pap is hysterectomy for noncancerous reason
17
Q
Pelvic Exam
A
- examines internal and external genitalia
- visual inspection
- bimanual exam
- insert middle finger into vagina lifting upward and using other hand to push downward to examine the vagina, uterus, and ovary
- performed on both left and right side
- check for cervical tenderness
- obtain swabs for STIs
18
Q
Broad DDX: GU
A
UTI
STI
Pelvic Inflammatory Disease
Hernia
19
Q
Broad DDX: GYN
A
ectopic pregnancy ovarian torsion ruptured ovarian cyst spontaneous abortions tubo-ovarian abscess uterine fibroid
20
Q
Broad DDX: GI
A
appendicitis
constipation
IBS
21
Q
Ectopic Pregnancy
A
-abdominal or pelvic pain with vaginal bleeding
-may have other pregnancy related symptoms
-hemorrhage or death = complication
-workup includes urine pregnancy test, speculum exam, transvaginal ultrasonography
-surgical removal
ALWAYS DO PREGNANCY TEST
22
Q
UTI
A
- dysuria, urinary frequency, urinary urgency, suprapubic pain
- e coli = main cause
- perform abdominal exam, check for costovertebral angle tenderness (lloyd’s punch)
- workup includes urinalysis
- antibiotic treatment
23
Q
Well Male Exam
A
- prostate exam and testicular exam not recommended routinely
- prostate specific antigen (PSA) not recommended routinely
- PSA may be indicated for patient with family history of prostate cancer
- if indicated based on history: inspection, palpation, retract foreskin if present, palpate for hernias, examine prostate by palpation on digital rectal exam (DRE)
24
Q
Prostate Exam
A
- palpate prostate gland
- palpate the prostate lobes and median sulcus
25
Inguinal Hernia
- pain with increased intra-abdominal pressure
- may have palpable bulge on affected side
- physical exam shows invaginating scrotal skin with index finger into the inguinal canal and have patient cough or perform valsalva
- workup includes imaging
- if mild hernia, watchful waiting
- if moderate to severe hernia, surgery to repair
26
5 P's in Sexual History
1) Partners
2) Practices
3) Prevention of pregnancy
4) Protection from STIs and HIV
5) Past history of STI
27
STI risk factors
- new sex parter in past 60 days
- multiple sex partners
- sex with partners recently treated for STI
- no or inconsistent condom use outside a mutually monogamous sexual partnership
- trading sex for money or drugs
28
Which conditions are considered STI?
- chlamydia (bacteria)
- gonorrhea (bacterial)
- herpes simplex 2 (viral)
- HPV (viral)
- syphilis (bacterial)
- trichomoniasis (protozoa)
- hep B and C (viral)
- HIV/AIDS (viral)
29
Complications of untreated STIs
- pelvic inflammatory disease
- upper genital tract infections
- infertility
- chronic pelvic pain
- cervical cancer
- chronic infection with herpes viruses, hepatitis viruses, and HIV
30
Key to Treatment of STIs
- antibiotics and antivirals
| - behavioral counseling
31
Gonorrhea (bacteria)
- gram neg intracellular diplococci
- penile discharge and dysuria
- pelvic pain or vaginal discharge
- can cause pelvic inflammatory discharge if untreated
- scarring of fallopian tube may occur if not treated
- workup includes nucleic acid amplification tests on endocervical, urethral, vaginal, pharyngeal, rectal, or urine samples
- treatment includes antibiotics, counseling
32
Chlamydia (bacteria)
- gram neg chlamydia trachomatis
- most cases = asymptomatic
- penile charge, pruritus, dysuria
- vaginal discharge, vaginal bleeding, pain during intercourse, dysuria
- can cause infection of urogenital, norectal, conjunctival or pharyngeal infections
- complication includes PID or fertility issues if left untreated
- workup includes nucleic acid amplification tests
- treatment includes antibiotics, counseling
33
Syphilis (bacteria)
- spirochete, treponema pallidum
- primary = chancre
- secondary = joint pains, fatigue, lymphadenopathy, mucopapular rash
- latent phase = may be asymptomatic
- tertiary = neurosyphilis
- complication may be progression to neurosyphilis
- workup includes serologic testing, antibody detection testing, microscopy
- treat with antibiotics (penicillin)
34
Genital Herpes (HIV)
- herpes simplex virus 2
- single or clusters of vesicles on the genitalia
- may have burning, tingling and pain prior to a vesicle appearance
- viral DNA travels by axon to the spinal cord sensory ganglion and persists for life
- complications include meningitis, PID, hepatitis, increase risk in HIV infection
- workup includes serologic test, PCR of sample from lesion
- treatment includes antiviral (acyclovir)
35
Trichomonasis (protozoa)
- protozoa with flagella
- can be asymptomatic
- most men are asymptomatic, but some have penile discharge
- female may have foul smelling thin or purulent vaginal discharge, vaginal pruritus, dysuria
- workup includes a wet mount or NAATs
- treatment includes antiprotozoal medication (metronidazole)
36
HPV (virus)
- human papillomavirus, a group of >100 viruses
- genital warts
- most lesions are self limited
- high risk strains can lead to cancer or the oropharyngeal region or lower genital tract
- workup includes routine pap smear, intervene if any cervical changes, may test for HPV during routine pap smear
- treatment includes vaccinating with gardasil vaccine, routine pap smear, and genital wart removal
