#1: Anatomy Flashcards
Function of the pudendal nerve: (3)
1- sensory innervation to the external genitalia
2- innervates the striatal urethra and anal sphincters
3- innervates deep and superficial perineal structures
Where pudendal nerve block administered
ischial spine
main arterial supply of the perineum and lower 1/3rd of the vagina
Internal pudendal artery
artery that supplies upper 2/3rds of the vagina
Vaginal artery
main arterial supply of the uterus
Uterine artery
main supply to the ovary
Ovarian artery
Right ovarian vein returns to the:
IVC
Left ovarian vein returns to the:
Left renal vein
Drainage of the ovaries:
travels with the ovarian vessels to the para-aortic lymph nodes
Drainage of the uterus and the upper two-thirds of the vagina:
flows through the obturator and internal and external iliac lymph nodes, ultimately draining into the common iliac nodes
Drainage of distal one-third of the vagina, urethra, and vulva:
drains to the inguinal lymph nodes
Two synovial joints of the bony pelvis:
sacroiliac joints and lumbosacral joints
–unflexible
Two cartilaginous joints of the bony pelvis:
sacrococcygeal and symphysis pubis joint
–flexible and react to relaxin
pelvimetry is used to assess for
cephalopelvic disproportion
heavy or prolonged flow
menorrhagia
development of breasts
thelarche
bleeding at irregular intervals between periods
metorrhagia
pain with menses
dysmenorrhea
age at first menstruation
menarche
Ligaments suspending the uterus: 3
round ligament
cardinal ligament
uterosacral ligament
MOST reliable indicator of ovulation:
LH surge
What Tanner Stage and age it occurs:
No breast budding, no pubic hair growth
Tanner Stage 1
<10 yo
What Tanner Stage and age it occurs:
Small breast buds; fine, delicate, fuzzy pubic hair growth
Tanner Stage 2
9-13 yo
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
Tanner Stage 3
12-14 yo
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
Tanner Stage 4
12-15 yo
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
Tanner Stage 5
14-18 yo
Heterosexual precocious puberty occurs due to excessive androgens from: 3
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
Most girls in the US begin puberty by age:
13
Primary amenorrhea (failure of menarche) is a cause for concern at age ________ if other secondary sex characteristics have developed
15-16
Primary amenorrhea (failure of menarche) is a cause for concern at age ________ if secondary sex characteristics have NOT developed
13-14
cervical ca is highly associated with this:
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
Why have updated guidelines been issued regarding the frequency of pap smears? (4)
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
Pap Smear Screening: <21 yo
pap recommended only for women with HIV infection and women with SLE or organ transplants who are receiving long-term immunosuppression.
Pap Smear Screening: 21- 29 yo
cytology testing every 2-3 years
Pap Smear Screening: 30-65 yo
cytology +/- HPV testing every 3-5 yrs, more frequently if immuno-suppressed, HIV infection or prior cervical dysplasia
Pap Smear Screening: >65 yo
D/C paps if prior 2 paps have been normal in the last 10 years
—If never screened, begin screening as if < 65 years
Pap Smear Screening: hysterectomy at any age
D/C pap smear screening
Pap Smear Screening: Hx of CIN 2, CIN 3, or adenocarcinoma of the cervix
continue screening for 20 years even if > 65 years
Mammogram screening recommendations:
all women annually from age 50-74
STI testing recommended
- -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
