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48 Cards in this Set

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Put the following pubertal milestones in order and give the mean age for each on. (Growth spurt, adrenarche, menarche, thelarche)
• 9.8 years thelarche (but as early as 9.5 in African American girls)

• 10.5 adrenarche

• 12 growth spurt

• 12.8 menarche
1. Thelarche can start as early as______, with an age range of ________.

2. At what age is the lack of thelarche considered delayed?

3. At what age is the start of puberty considered precocious?
1. Thelarche can start as early as 7-8… with an age range of 8-14

2. At what age is the lack of thelarche considered delayed? 12 (no breast buds by 12)


3. At what age is the start of puberty in GIRLS considered precocious? BEFORE 8
Give the 5 SMR (Tanner) ratings for breast development:
(see the chart above)
What is the mean age for Menarche?
What is the mean age for Menarche? 12.8 y/o
1. Which SMR, 2-3, 3-4 or -5 is the onset of menarche (related to the peak in weight velocity)?

2. For girls, at what age and SMR is the PHV?

3. With respect to breast budding and PHV, when (in years) does menarche begin?
1. Which SMR, 2-3, 3-4 or -5 is related to the peak in weight velocity? SMR 3-4

2. For girls, at what age and SMR is the PHV? 12 y... SMR 2-3

3. With respect to breast budding and PHV, when (in years) does menarche begin? 2-years after breast budding, and 1 year after PHV
In terms of time after breast bud formation and time after peak height velocity, when does Menarche occur?
Menarche begins 2 years after breast bud formation and 1 year after peak height velocity.
T/F ovulatory cycles many not be established for 2-3 years after onset.
True: ovulatory cycles many not be established for 2-3 years after onset.
What can cause retrograde menstration and what is the sequelae from this?
What can cause retrograde menstration and what is the sequelae from this? Obstructive Müllerian Anomalies
Name 5 different "obstructive Müllerian Anomalies.
Imperforate hymen, Transverse Vaginal septum, Lognitudinal vaginal septum, bicornate uterus, Uterine and vaginal agenesis (Myer-rokitansky-Kuster-Hauser syndrome)
What are the number one and number two causes of amenorrhea?
Amenorrhea causes: #1: gonadal agenesis… #2: uterine/vaginal agenesis (Myer-rokitansky-Kuster-Hauser syndrome)
What is the average age of dx of Müllerian agenesis?
What is the average age of dx of Müllerian agenesis? 16 y/o
What is the karyotype and sex hormone levels in Müllerian agenesis (no vagina)?
What is the karyotype and sex hormone levels in Müllerian agenesis (no vagina)? Both normal
Which two somatic abnormalities are seen with Myer-rokitansky-Kuster-Hauser syndrome (Müllerian agenesis)? How do you diagnose Müllerian agenesis?
Which two somatic abnormalities are seen with Myer-rokitansky-Kuster-Hauser syndrome (Müllerian agenesis)? Renal and skeletal abnormalities… How do you diagnose Müllerian agenesis? MRI
What 3 things happen to middle adolescent girls (age 14-17)?
What 3 things happen to middle adolescent girls (age 14-17)? Maturation of menstrual cycle, completion of linear growth, and Weight gain
Which hormones are most influencial in sexual behaviorin adolescents?
Which hormones are most influencial in sexual behaviorin adolescents? Androgens
Name 3 risk factors for adolescent childbearing.
Name 3 risk factors for adolescent childbearing. Low educational aspirations and achievement… involvement in problem behaviors… poverty
T/F adolescents are less likely to have 2nd trimester abortions.
FALSE: adolescents are MORE likely to have 2nd trimester abortions.
T/F mortality due abortion increases with gestational age, but it's still less risky than childbirth.
TRUE: mortality due abortion increases with gestational age, but it's still less risky than childbirth.
Adolescent girls have the highest incidence of STIs, what are the ramifcation of this?
highest rate of STIs --> Clamydia is often asymptomatic --> PID is a sequelae of chlamydia --> screening and Rx of cervicitis reduced the chances of PID, but adolescents are less likely to get GYN care.
What are 3 biological risk factors for adolescents making them more likely to be diagnosed with an STI?
Adolescent girls have the highest incidence of STIs, why? (1) larger zones of cervical ectopy… (2) lower prevalence of protective abs… (3) greater penetrability of cervical mucus
What are 3 behavioral risk factors for adolescents making them more likely to be diagnosed with an STI?
What are 3 behavioral risk factors for adolescents making them more likely to be diagnosed with an STI? Short duration of sexual relationships, increased sexual partners, they don't use contraceptives, poor judgement in partner choices
Which of these is not one of the 4 inflammatory disorders of the upper genital tract that define PID: urethritis, endometritis, salpingitis, endometriosis, tubo-ovarian abscess, pelvic peritonitis, yeast infection
Name 4 inflammatory disorders of the upper genital tract that define PID: endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis
Which of the following are part of the PID etiology: Polymicrobial infection, toxic shock, sexually transmnitted pathogens most often initiate inflammatory process, idopathic, anaerobic and facultative organisms also involved, Infections ascends from the cervix to the uterus, and fallopean tubes.
Which of the following are part of the PID etiology: TRUE: Polymicrobial infection, sexually transmnitted pathogens most often initiate inflammatory process, anaerobic and facultative organisms also involved, Infections ascends from the cervix to the uterus, and fallopean tubes. FALSE: toxic shock, idopathic
Which two bacteria are implicated in PID?
Which two bacteria infections are implicated in PID? Chlamydia > gonorrhea
What is the time frame for the use of plan-B contraception?
What is the time frame for the use of plan-B contraception? 72 hrs after unprotected sex… best if used before 24 hrs
What is plan-B?
What is plan-G? large bolus of progesterin (Lenoorgestrel)
Which is more effective, Plan-B or combined OCP? Which has fewer SE?
Which is more effective, Plan-B or combined OCP? Plan-B Which has fewer SE? Plan-B (less nausea and vomiting)
What is Yasmin, and what are the contraindications, why?
What is Yasmin: OCP… what are the contraindications? Kidney, liver or adrenal dz… why? Yasmin has antimineralocorticoids --> ↑ Ca
What is Seasonale?
What is Seasonale? Long term OCP (levonorgestrel) menses 4x/year… SE: ↑ breakthrough bleeding
What is Mirena? How long does it last?
What is Mirena? Progesterin IUS (levonorgestrel) How long does it last? 5 years… Advantage: ↓ bleeding
What follows a 3 consecutive 7 days of patches? What do patches contain?
What follows a 3 consecutive 7 day patches? One patch free week… What do patches contain? Progestin and a small dose of estrogen
What is in the combined cratraceptive vaginal ring? What are the 3 advantages of the ring? What is the dose?
What is in the combined cratraceptive vaginal ring? P and E… What are the 3 advantages of the ring? Highly effective/fewer SE/rapid return of fertility… 3 weeks in… one week out
After onset of menarche, what is the time it takes for maturity of ovulation? What is the median cycle length in during the maturing process?
After onset of menarche, what is the time it takes for maturity of ovulation? 2 years… What is the median cycle length in during the maturing process? 31 days
What are 4 cause of irregular periods in adolescents?
What are 4 cause of irregular periods in adolescents? Weight changes, smoking, stress, intense exercise
What are 4 consequences of functional ovarian hyperandrogenism (PCOS)?
What are 4 consequences of functional ovarian hyperandrogenism (PCOS)? Acne, oligomenorrhea, dysfunctional uterine bleeding, obesity
What are the cardinal features of PCOS?
What are the cardinal features of PCOS? Hyperandrogenism and insulin resistance… most teens present with menstrual irregularities… with variable obesity, hirsutism, acne, acanthosis nigricans
What things are needed for a PCOS dx?
What is needed for a PCOS dx? Oligomenorrhea, eleveated free testosterone/or androstenedione, LH/FSH ratio >3:1, 17-OH-Progesterone is normal
What is the Rx for PCOS?
What is the Rx for PCOS? Weight loss, suppression of androgens with OCP
What are the long term complications of PCOS?
What are the long term complications of PCOS? DM, CAD
Name 3 other endocrine disorders that can cause menstrual disorders in adolescents.
Name 3 other endocrine disorders that can cause menstrual disorders in adolescents. Thyroid dysfx, hyperprolactinemia, Cushing's syndrome
What is the definition of dyfunctional uterine bleeding (DUB)?
DUB: irregular, painless bleeding of endometrial origin that is prolonged, excessive and unpatterned
T/F DUB is associated with ovulatory cycles.
FALSE DUB is associated with ANOVULATORY cycles… NOT ovulatory cycles.
What is the basis for Rx of DUB?
What is the basis for Rx of DUB? The degree of anemia
T/F: for DUB, the first line treatment is curettage, with hormonal follow up.
FALSE: for DUB, the first line treatment is hormones, which almost always work… with curettage rarely needed
Which of these are the 4 goals of DUB management? Correct hemodynamic imbalance, restore ovulation, prevent uncontrolled blood loss, correct anemia, replenish iron stores, reduce the risk of endometrial cancer.
Which of these are the 4 goals of DUB management? Correct hemodynamic imbalance, prevent uncontrolled blood loss, correct anemia, replenish iron stores
T/F DUB is always Rx with progestin (to make the endometrium more stable), regardless of the eitology.
TRUE: DUB is always Rx with progestin (to make the endometrium more stable), regardless of the eitology.
Which of the following is true of Primary Dysmenorrhea: onset at menarche, spontaneous, pain starts on first day of blood flow, accompanied by loose stools, normal pelvic exams
Which of the following is true of Primary Dysmenorrhea: TRUE: pain starts on first day of blood flow, accompanied by loose stools, normal pelvic exams FALSE:onset at 4-18 months after menarche NOT at start of menarche, FAMILY HX NOT spontaneous,
What is the pathophysiology of Primary Dysmenorrhea?
What is the pathophysiology of Primary Dysmenorrhea? ↓ progesterone at end of ovulatory cycle triggers lysosomal breakdown; enzymes released act on phospholipids --> ↑ synthesis of PG in the endometrium and menstrual fluid; PG --> ↑ myometrial tone and uterine contractions --> uterine ischemia and pain