FOCUS NOTES — REPRODUCTIVE,
ENDOCRINE, GI & NEURO
REPRODUCTIVE
Puberty
● Precocious: <8 girls, <9 boys; central = ↑GnRH, peripheral = sex hormones
independent of GnRH.
● Delayed: no secondary sex characteristics by 13 girls/14 boys.
● Workup: Tanner staging, bone age, FSH/LH, estradiol/testosterone.
Menstrual Disorders
● Menorrhagia: heavy/prolonged bleeding, usually >7 days.
● Metrorrhagia: bleeding between cycles.
● Oligomenorrhea: cycles >35 days.
● Primary amenorrhea: no menses by 15.
● Secondary amenorrhea: no menses ≥3 months if previously regular.
Reproductive Labs
● Estradiol: ovarian estrogen; ↓ menopause/ovarian failure, ↑ tumors/exogenous
estrogen.
● Progesterone: ovulation marker; low = anovulation.
● FSH: ↑ = ovarian failure/menopause.
● LH: ovulation; ↑ menopause/PCOS.
● CA-125: ovarian cancer marker; also ↑ with endometriosis/menstruation.
Prostate/DRE
● BPH: enlarged, smooth, symmetric.
● Cancer: hard, irregular/nodular.
● Prostatitis: tender, boggy.
● Avoid DRE in acute prostatitis → bacteremia/sepsis risk.
● Labs: PSA, UA, urine culture.
Male GU Disorders
, ● Varicocele: dilated veins, usually left; “bag of worms,” worse standing/Valsalva; infertility
risk.
● Epididymitis: gradual pain/swelling; STI or urinary pathogens; UA/NAAT/culture.
● Balanitis: glans inflammation; diabetes/poor hygiene; erythema/discharge.
● Orchitis: painful swollen testicle; often viral/mumps.
● Torsion: sudden severe pain, high-riding testis, absent cremasteric reflex →
emergency; Doppler US.
● Hydrocele: painless fluid-filled scrotal swelling; transilluminates.
● Testicular cancer: painless mass; cryptorchidism risk; US + AFP, β-hCG, LDH.
STIs/Vaginal Infections
● HPV: warts/cervical dysplasia → cancer; Pap/HPV testing.
● HSV: painful grouped vesicles/ulcers; PCR.
● BV: thin gray discharge, fishy odor, pH >4.5, positive whiff.
● Candida: thick white discharge + itching; KOH yeast/hyphae; normal pH.
● Syphilis: painless chancre; RPR/VDRL + treponemal confirmation.
● Gonorrhea: purulent discharge/cervicitis; NAAT.
● Chlamydia: often asymptomatic; NAAT; PID/infertility risk.
● Trichomonas: frothy yellow-green discharge/strawberry cervix; NAAT/wet mount.
ENDOCRINE
Diabetes Diagnostic Values
Test Normal Prediabete Diabete
s s
A1C <5.7% 5.7–6.4% ≥6.5%
Fasting <100 100–125 ≥126
glucose
2-hr OGTT <140 140–199 ≥200
Endocrine Disorders
● Diabetes mellitus: ↓effective insulin → hyperglycemia, polyuria, polydipsia, polyphagia.
● Diabetes insipidus: ↓ADH/action → polyuria, polydipsia, dilute urine.
● Addison: ↓cortisol/aldosterone → fatigue, hypotension, hyperpigmentation,
hyperkalemia.
ENDOCRINE, GI & NEURO
REPRODUCTIVE
Puberty
● Precocious: <8 girls, <9 boys; central = ↑GnRH, peripheral = sex hormones
independent of GnRH.
● Delayed: no secondary sex characteristics by 13 girls/14 boys.
● Workup: Tanner staging, bone age, FSH/LH, estradiol/testosterone.
Menstrual Disorders
● Menorrhagia: heavy/prolonged bleeding, usually >7 days.
● Metrorrhagia: bleeding between cycles.
● Oligomenorrhea: cycles >35 days.
● Primary amenorrhea: no menses by 15.
● Secondary amenorrhea: no menses ≥3 months if previously regular.
Reproductive Labs
● Estradiol: ovarian estrogen; ↓ menopause/ovarian failure, ↑ tumors/exogenous
estrogen.
● Progesterone: ovulation marker; low = anovulation.
● FSH: ↑ = ovarian failure/menopause.
● LH: ovulation; ↑ menopause/PCOS.
● CA-125: ovarian cancer marker; also ↑ with endometriosis/menstruation.
Prostate/DRE
● BPH: enlarged, smooth, symmetric.
● Cancer: hard, irregular/nodular.
● Prostatitis: tender, boggy.
● Avoid DRE in acute prostatitis → bacteremia/sepsis risk.
● Labs: PSA, UA, urine culture.
Male GU Disorders
, ● Varicocele: dilated veins, usually left; “bag of worms,” worse standing/Valsalva; infertility
risk.
● Epididymitis: gradual pain/swelling; STI or urinary pathogens; UA/NAAT/culture.
● Balanitis: glans inflammation; diabetes/poor hygiene; erythema/discharge.
● Orchitis: painful swollen testicle; often viral/mumps.
● Torsion: sudden severe pain, high-riding testis, absent cremasteric reflex →
emergency; Doppler US.
● Hydrocele: painless fluid-filled scrotal swelling; transilluminates.
● Testicular cancer: painless mass; cryptorchidism risk; US + AFP, β-hCG, LDH.
STIs/Vaginal Infections
● HPV: warts/cervical dysplasia → cancer; Pap/HPV testing.
● HSV: painful grouped vesicles/ulcers; PCR.
● BV: thin gray discharge, fishy odor, pH >4.5, positive whiff.
● Candida: thick white discharge + itching; KOH yeast/hyphae; normal pH.
● Syphilis: painless chancre; RPR/VDRL + treponemal confirmation.
● Gonorrhea: purulent discharge/cervicitis; NAAT.
● Chlamydia: often asymptomatic; NAAT; PID/infertility risk.
● Trichomonas: frothy yellow-green discharge/strawberry cervix; NAAT/wet mount.
ENDOCRINE
Diabetes Diagnostic Values
Test Normal Prediabete Diabete
s s
A1C <5.7% 5.7–6.4% ≥6.5%
Fasting <100 100–125 ≥126
glucose
2-hr OGTT <140 140–199 ≥200
Endocrine Disorders
● Diabetes mellitus: ↓effective insulin → hyperglycemia, polyuria, polydipsia, polyphagia.
● Diabetes insipidus: ↓ADH/action → polyuria, polydipsia, dilute urine.
● Addison: ↓cortisol/aldosterone → fatigue, hypotension, hyperpigmentation,
hyperkalemia.
