01. GYN Overview

Question 1

Lateral fornices

Answer 1

Pouches lateral to the cervix that contain the broad ligaments; the ovaries and fallopian tubes may be palpated here

Question 2

Layers of the Uterus

Answer 2

Endometrium (innermost); Mymetrium (muscular); Perimetrium (peritoneal covering)

Question 3

Isthmus

Answer 3

Nonmobile, medial portion of fallopian tube that has a narrow lumen

Question 4

Ampulla

Answer 4

Most common site for ectopic pregnancies

Question 5

Fimbrae

Answer 5

Direct egg into fallopian tube

Question 6

Lymphatic drainage of vulva and lower vagina

Answer 6

Inguinofemoral lymph nodes, then external iiac chains

Question 7

Lymphatic drainage of cervix

Answer 7

Parametria (cardinal ligaments) to pelvic nodes (hypogastric, obturator, external iliac groups)

Question 8

Lymphatic drainage of endometrium

Answer 8

Thru broad ligament and infundibulopelvic ligament to the pelvic and para-aortic chains

Question 9

Lymphatic drainage of ovaries

Answer 9

Via the infundibulopelvic ligaments to the pelvic and para-aortic chains

Question 10

Adrenarche

Answer 10

Change in adrenal gland a/w production of androgen (~ age 8)

Question 11

Tanner Stage I (females)

Answer 11

0-15 yrs; Pre-adolescent breasts; No pubic hair

Question 12

Tanner Stage II (females)

Answer 12

8-15 yrs; Breast budding (thelarche); areolar hyperplasia w/ small breast tissue; Long downy pubic hair near labia; Peak growth velocity often occurs soon after stage II

Question 13

Tanner Stage III (females)

Answer 13

10-15 yrs; Further breast tissue enlargement; no separation of areola contours; Increase in amount and pigmentation of pubic hair; Menarche in late stage III (2% of girls)

Question 14

Tanner Stage IV (females)

Answer 14

10-17 yrs; Separation of contours; areola and nipple form secondary mound above breast tissue; Pubic hair adult in type but not distribution; Menarche occures in most girls in stage IV, 1-3 yrs after thelarche

Question 15

Tanner Stage V (females)

Answer 15

12.5-18; Large breast with single contour; Pubic hair has adult distribution; Menarche occurs in 10% of girls in stage V.

Question 16

Metrorrhagia

Answer 16

Uterine bleeding at irregular intervals

Question 17

Polymenorrhea

Answer 17

Menstrual cycles with intervals of 21 days or fewer

Question 18

Mittelschmerz

Answer 18

One-sided, lower abdominal pain associated with ovulation

Question 19

Leiomyoma

Answer 19

Benign tumor derived from muscle, most often of the uterus (AKA fibroid)

Question 20

Hypothalamic reproductive cyle hormone

Answer 20

GnRH (gonadotropin releasing hormone)

Question 21

Pituitary reproductive cyle hormones

Answer 21

FSH; LH

Question 22

Ovarian sex steroid reproductive cyle hormones

Answer 22

Estrogens (17B-estradiol; estrone; estriol); progesterone

Question 23

Function of FSH

Answer 23

Stimulates graafian follicles of ovary; assist follicular maturation and secretion of estradiol

Question 24

Function of LH

Answer 24

Stimulates final RIPENING OF FOLLICLES and the SECRETION OF PROGESTERONE their rupture to RELEASE THE EGG; and CONVERSION of RUPTURED FOLLICLE into CORPUS LUTEUM

Question 25

Function of estrogens

Answer 25

Control course of the menstrual cycle

Question 26

Function of progesterone

Answer 26

Antiestrogenic steroid; ACTIVE PRINCIPLE OF THE CORPUS LUTEUM; synthetic form is used to CORRECT MENSES ABNORMALITIS, contraceptive, and control recurring abortions

Question 27

Ovulation cycle day of Menstruation Onset

Answer 27

Day 2-5

Question 28

Ovulation cycle day of Peak Estrogen

Answer 28

Day 12

Question 29

Ovulation cycle day of Peak LH

Answer 29

Day 14

Question 30

Ovulation cycle day of Peak FSH

Answer 30

Day 14

Question 31

Ovulation cycle day of Peak Progesterone

Answer 31

Day 22

Question 32

Ovulation cycle day of Ovulation

Answer 32

Day 14

Question 33

Ovulation cycle day of 2nd Estrogen Peak

Answer 33

Day 22

Question 34

Ovulation cycle day of 2nd FSH Peak

Answer 34

Day 3

Question 35

Average age of Menarche

Answer 35

Age 12-13

Question 36

Normal Cycle Length

Answer 36

21-35 day

Question 37

Average duration of menstrual cycle

Answer 37

5 days

Question 38

5 P's of Sexual History

Answer 38

Partners, Prevention, of pregnancy, Protection from STDs, Practices, Past history of STDs

Question 39

Gravidity

Answer 39

Total number of pregnancies

Question 40

Parity

Answer 40

Number of pregnancies a patient carried to viability

Question 41

GFPAL

Answer 41

Gravidity/Full-term/Premature/Abortion/Living

Question 42

Anteverted uterus

Answer 42

Straight uterus that is tilted toward the umbilicus

Question 43

Anteflexed uterus

Answer 43

Uterus that bends toward the umbilicus; makes uterus feel smaller

Question 44

Retroverted uterus

Answer 44

Straight uterus that tilts toward spine; common in 20% of women; may not be palpable except with rectal exam

Question 45

Retroflexed uterus

Answer 45

Uterus with backward angulation that bends toward the spine; palpable through posterior fornix or rectum

Question 46

Uterine Prolapse

Answer 46

Uterus drops into vaginal canal

Question 47

Causes of uterine prolapse

Answer 47

Excessive stretching of pelvic fascia/ligaments/muscles during pregnancy/labor/vaginal delivery

Question 48

Uterine Prolapse Grade 1

Answer 48

Descent within normal position & ischial spines (bubbled cervix)

Question 49

Uterine Prolapse Grade 2

Answer 49

Descent within ischial spines and hymen

Question 50

Uterine Prolapse Grade 3

Answer 50

Descent within hymen

Question 51

Uterine Prolapse Grade 4

Answer 51

Descent through hymen

Question 52

Complete Uterine Prolapse

Answer 52

Uterus falls enough that some tissue rests outside the vagina (Grade 4)

Question 53

Cause of Cystocele or Rectocele

Answer 53

Loss of normal tissue integrity or tissue disruption as result of trauma (childbirth, obstetric injury, surgery)

Question 54

Cystocele/Rectocele/Enterocelel Risk Factors

Answer 54

Multiparity; Obesity; Chronic Cough; Heavy lifting; Estrogen loss; Smoking

Question 55

Enterocele

Answer 55

Loss of support of the apex of vagina, through rupture or attenuation of the pubovesicocervical fascia, manifested by descent or prolapse of the vaginal wall and underlying peritoneum, most commonly AFTER ABDOMINAL OR VAGINAL HYSTERECTOMY

Question 56

Enterocele causes

Answer 56

Loss or rupture of normal support mechanisms in pouch of Douglas; True herniation of peritoneal cavity between the uterosacral ligaments and into the rectovaginal septum

Question 57

3 Categories of Dyspareunia

Answer 57

1) Vulvar pain; 2) Vaginal/deep pain; 3) Combination

Question 58

Vulvar vestibulitis

Answer 58

Most common type of premenopausal dyspareunia

Question 59

Vulvar vestibulitis characteristics

Answer 59

Highly localized "burning" or "cutting" pain; Severe with attempted penetration

Question 60

Vulvar or vaginal atrophy

Answer 60

Common cause of Dyspareunia in postmenopausal women

Question 61

Vulvar or vaginal atrophy characteristics

Answer 61

D/t estrogen deficiency; Pain is associated with penetration or with discomfort in the anterior portion of the vagina