Obgyn Exam 3

Front 1

when should a girl have her first pelvic exam?

Back 1

when she becomes sexually active or between 18-20 yo

Front 2

what three scenarios are cause for concern with regards to delayed puberty?

Back 2

1. no menarche by 17yo
2. stages of puberty do not progress for 5 yo
3. if by 14 there are no secondary sexual characteristics

Front 3

what tanner stage: elevation of papilla only

Back 3

stage 1

Front 4

breast bud, areola enlarges, small mount of tissue elevates papilla

Back 4

2

Front 5

what tanner stage:
projection of areola and papilla to form a secondary mound of tissue above level of breast

Back 5

4

Front 6

what tanner stage?
darker coarser grwoth on pubis

Back 6

3

Front 7

what tanner stage?
sparse growth primarily along labia

Back 7

2

Front 8

what makes up the pediatric cocktail and when do we use it

Back 8

when we have to do vaginal exam on kids. made up of Promethazine, meperidine, chlorpromazine - provides analgesia and amnesia

Front 9

white papular lesions resembling leukoplakia, may cover vulva and perianal regions

Back 9

lichen sclerosus et atrophicus

Front 10

how do we handle a ped case if we suspect sexual abuse?

Back 10

needs immediate attention
1. complete PE
2. cervical and rectal smears
3. VDRL (syphillis)
4. psychological eval
5. record findings carefully

Front 11

adhesion of labia minora in midline usually result of irritaiton or skin dz. can result in retention of urine and infection

Back 11

labial agglutination

Front 12

how can we treat labia agglutination

Back 12

topical estrogen BID for 2-4 wks (wach for breast dev)
surgical seperation

Front 13

one of the MCCC of vaginal outflow tract obstructions, presents with bulging introitus

Back 13

imperforate hymen

Front 14

what is hematocolpos?

Back 14

bluish discoloration and blue dome seen in imperforate hymen

Front 15

red mass at vaginal orifice. occludes vagina and usually causes dysureia.

Back 15

prolpased urethra

Front 16

when do we see monilial vaginitis?

Back 16

common in diabetic children or after abx therapy

Front 17

failure of caudal mullerian duct development of urogenital sinus. ovarian development is normal but uterous is not usually functional

Back 17

vaginal atresia

Front 18

what is the MCC of vaginal cysts in infants?

Back 18

ectopic ureter with vaginal terminus

Front 19

presents as ureterocele, appears as cystic mass protruding from vagina. if ureter patent, constant irritation and vaginitis may be presenting signs

Back 19

ectopic ureter with vaginal terminus

Front 20

what two conditions may develop as a result of ectopic ureter with vaginal terminus?

Back 20

hydropnephrosis
hydrourtere

Front 21

imperforate anus associated with rectovagnal connection. only a skin dimple is found at norma and anal site

Back 21

vaginal ectopic anus

Front 22

are vaginal tumors common in peds?

Back 22

no, uncommon but if found usually malignant

Front 23

what are the two types of vaginal tumors we might find?

Back 23

1. vaginal adenosis (benign)
2. clear cell adenocarcinoma

Front 24

presens as a strawberry red area within vagina. benign condition. hx of maternal DES

Back 24

vaginal adenosis

Front 25

malignancy associated with DES. vaginal bleeding, discharge, and pain MC, but can be asymptomatic

Back 25

clear cell adenocarcinoma

Front 26

impairment of synthesis or cortisol and aldosterone. Defect in 21 hydroxylase leads to virilization of female

Back 26

congenital adrenal hyperplasia (pseudohermaphroditism)

Front 27

how do we dx CAH? pseudohermaphroditism? how do we tx?

Back 27

1.urinary pregnanetriol and 17 ketosteroids elevated
tx: hydrocortisone

Front 28

maternal ingestion of synthetic progestins can result in?

Back 28

masculinization of female

Front 29

masculinizaiton of external genitalia, enlarged clitoris, labial fusion, normal vagina, tubes an uterus. growth and dev. normal. progressive virilization does not occur.

Back 29

maternal ingestion of synthetic progestins

Front 30

46XY genotpy and female phenotype. vagina ends in blind ouch. testicles present in labia. are often reared as females

Back 30

testicular feminization. androgen insensitivity sydnrome

Front 31

46XX entopy. external genitali appear male, female, or ambitious. both male and female internal genetalia may be present.

Back 31

true hermaphroditism

Front 32

this may be secondary to obstructions and other anatomic causes. N.V and diarrhea common. 25% have severe sx

Back 32

dysmenorrhea

Front 33

is shown to have constant, noncyclic estrogen levels that stimulate growth and dev. of endometrium

Back 33

DUB

Front 34

Increase in PGF 2 alpha leads to what?

Back 34

myometrial ischemia (uterine angina) and uterine hypercontractility

Front 35

endometrial production and secretion of prostaglandins after ovulation is the proposed etiology of what?

Back 35

primary dysmenorrhea

Front 36

What is the MC sx associated with DUB?

Back 36

menometrorrhagia

Front 37

what is the etiology of adolescent DUB?

Back 37

immature hypothalamic-pituitary axis (abnormal hormonal stimulation of endometrium, pregnancy, blood dyscrasia, malignancy)

Front 38

amenorrhea and secondary sterility due to intrauterine adhesion and uterine synechiae. Most frequent cause of secondary amenorrhea of anatomic orgin.

Back 38

Asherman's syndrome

Front 39

Amenorrhea, eating disorders, premature osteoprorisia

Back 39

female athlete triad

Front 40

amenorrhea is associated with bone loss which bone affected more than the cortical bone?

Back 40

trabecular

Front 41

how do we define delayed puberty?

Back 41

failure of menarche by 16 and failure or thelarche by 13

Front 42

when is an evaluation for delayed pubery necessary?

Back 42

if no secondary sex characteristics appear by 14 or failure of menarche by 17

Front 43

early sexual maturation with secondary signs of sexual development, with men ache before what age?

Back 43

precocious puberty,
menarche before 8-9

Front 44

what is part of the full work up for precocious puberty?

Back 44

1. Full History and physical
2. bone age studies
3. US, CT, MRI to exclude ovarian or adrenal tumor

Front 45

what are the 5 potential causes of precocious puberty?

Back 45

MC idiopathic
1. CNS disorders (trauma to hypothalamus, meningitis)
2. Congenital anomalies (neurofibromaosis, hydrocephalus)
3. chronic ingestion of estrogens (OCPs)
4. adrenal estrogen secreting tumor - rare
5. estrogen producing ovarian cyst of neoplasm

Front 46

what is the tx for precocious puberty?

Back 46

GnRH agonsists. down regulate receptor function -- temporary reversible inhibito of HPO axis

Front 47

minors deemed mature can get evaluated/treatment w/o parental consent for:

Back 47

1. pregnancy
2. emancipation
3. STI
4. emergency care
5. mental health care
6. drug tx
7. contraception