#1: Anatomy

Question 1

Function of the pudendal nerve: (3)

Answer 1

1- sensory innervation to the external genitalia
2- innervates the striatal urethra and anal sphincters
3- innervates deep and superficial perineal structures

Question 2

Where pudendal nerve block administered

Answer 2

ischial spine

Question 3

main arterial supply of the perineum and lower 1/3rd of the vagina

Answer 3

Internal pudendal artery

Question 4

artery that supplies upper 2/3rds of the vagina

Answer 4

Vaginal artery

Question 5

main arterial supply of the uterus

Answer 5

Uterine artery

Question 6

main supply to the ovary

Answer 6

Ovarian artery

Question 7

Right ovarian vein returns to the:

Answer 7

IVC

Question 8

Left ovarian vein returns to the:

Answer 8

Left renal vein

Question 9

Drainage of the ovaries:

Answer 9

travels with the ovarian vessels to the para-aortic lymph nodes

Question 10

Drainage of the uterus and the upper two-thirds of the vagina:

Answer 10

flows through the obturator and internal and external iliac lymph nodes, ultimately draining into the common iliac nodes

Question 11

Drainage of distal one-third of the vagina, urethra, and vulva:

Answer 11

drains to the inguinal lymph nodes

Question 12

Two synovial joints of the bony pelvis:

Answer 12

sacroiliac joints and lumbosacral joints

–unflexible

Question 13

Two cartilaginous joints of the bony pelvis:

Answer 13

sacrococcygeal and symphysis pubis joint

–flexible and react to relaxin

Question 14

pelvimetry is used to assess for

Answer 14

cephalopelvic disproportion

Question 15

heavy or prolonged flow

Answer 15

menorrhagia

Question 16

development of breasts

Answer 16

thelarche

Question 17

bleeding at irregular intervals between periods

Answer 17

metorrhagia

Question 18

pain with menses

Answer 18

dysmenorrhea

Question 19

age at first menstruation

Answer 19

menarche

Question 20

Ligaments suspending the uterus: 3

Answer 20

round ligament
cardinal ligament
uterosacral ligament

Question 21

MOST reliable indicator of ovulation:

Answer 21

LH surge

Question 22

What Tanner Stage and age it occurs:

No breast budding, no pubic hair growth

Answer 22

Tanner Stage 1

<10 yo

Question 23

What Tanner Stage and age it occurs:

Small breast buds; fine, delicate, fuzzy pubic hair growth

Answer 23

Tanner Stage 2

9-13 yo

Question 24

What Tanner Stage and age it occurs:
Enlarging breast buds ; increased pubic hair, mainly in the center and not extending out to thighs or upward; dark and coarser

Answer 24

Tanner Stage 3

12-14 yo

Question 25

What Tanner Stage and age it occurs:
Noticeable triangular growth of pubic hair and axillary hair growth visible
Breasts form mounds with a secondary mound making up the areola and nipple
Menarche

Answer 25

Tanner Stage 4

12-15 yo

Question 26

What Tanner Stage and age it occurs:
Breasts are fully formed, the areola recesses
Pubic hair is adult in quantity and forms an upside-down triangle

Answer 26

Tanner Stage 5

14-18 yo

Question 27

Heterosexual precocious puberty occurs due to excessive androgens from: 3

Answer 27

1- Virilizing neoplasms: androgens are secreted by an ovarian or adrenal tumor
2- Congenital adrenal hyperplasia: an enzyme defect causes excessive adrenal androgen production
3-Exogenous androgen exposure

Question 28

Most girls in the US begin puberty by age:

Answer 28

13

Question 29

Primary amenorrhea (failure of menarche) is a cause for concern at age ________ if other secondary sex characteristics have developed

Answer 29

15-16

Question 30

Primary amenorrhea (failure of menarche) is a cause for concern at age ________ if secondary sex characteristics have NOT developed

Answer 30

13-14

Question 31

cervical ca is highly associated with this:

Answer 31

sustained HPV infection, particularly subtypes 16 and 18 in the US
–1/2 females develop HPV infx within 36 mos of initial intercourse, but the vast majority will clear in 2 yrs

Question 32

Why have updated guidelines been issued regarding the frequency of pap smears? (4)

Answer 32

1- Increased ability to detect HPV
2- Improved understanding of the patho of cervical CA, which requires sustained HPV infection and which is a slow-growing and very treatable CA.
3- Consideration for the possible AEs of surgical procedures performed for cervical dysplasia and future pregnancy.
4- Cost; both financial and emotional

Question 33

Pap Smear Screening: <21 yo

Answer 33

pap recommended only for women with HIV infection and women with SLE or organ transplants who are receiving long-term immunosuppression.

Question 34

Pap Smear Screening: 21- 29 yo

Answer 34

cytology testing every 2-3 years

Question 35

Pap Smear Screening: 30-65 yo

Answer 35

cytology +/- HPV testing every 3-5 yrs, more frequently if immuno-suppressed, HIV infection or prior cervical dysplasia

Question 36

Pap Smear Screening: >65 yo

Answer 36

D/C paps if prior 2 paps have been normal in the last 10 years
—If never screened, begin screening as if < 65 years

Question 37

Pap Smear Screening: hysterectomy at any age

Answer 37

D/C pap smear screening

Question 38

Pap Smear Screening: Hx of CIN 2, CIN 3, or adenocarcinoma of the cervix

Answer 38

continue screening for 20 years even if > 65 years

Question 39

Mammogram screening recommendations:

Answer 39

all women annually from age 50-74

Question 40

STI testing recommended

Answer 40

• -routine screening of women <26 yrs and sexually active teens for chlamydia and gonorrhea
• ->26 yrs if high risk behavior
• -HIV annually for all sexually active women