1) Gyno Flashcards
Gynecology deals w/
Obstetrics focuses on:
= health & diseases of women’s sex organs.
= care of women throughout pregnancy.
What internal organs are part of the female reproductive system?
Ovaries, fallopian tubes, uterus, & vagina.
What is the role of external female genitalia:
What are the parts of the external genitalia:
= protect body openings & play a role in sexual function.
= vulva, mons pubis, labia majora/minora, & glands (Skene’s & Bartholin’s).
Why are women more prone to UTIs than men:
= Shorter urethra allows bacteria to travel more easily to the bladder. Infection can progress to kidneys, causing pyelonephritis
Menstrual Phase:
Proliferative Phase:
Secretory Phase:
= Endometrium sheds (~50 mLs) Lasts 3-5 days
= Endometrium thickens w/ estrogen; ovulation occurs at Day 14.
= Progesterone from corpus luteum prepares endometrium for implantation.
What are the hormones involved in ovulation:
= FSH (follicle-stimulating hormone) triggers egg maturation, & LH (luteinizing hormone) signals ovulation.
function of the cervix during pregnancy:
= Forms a mucus plug to block pathogens from reaching the fetus & supports the uterus during gestation
External genitalia fn & aka:
= Protect, pleasure, propriate & Vulva/Pundium
Dysmenorrhea:
Painful menstruation due to uterine contractions or conditions like endometriosis.
Dyspareunia:
Painful intercourse often caused by ovarian cysts or infections.
What happens during menopause:
S/S:
= marks cessation of ovarian Fn, estrogen production, & menstrual cycles, ~occurring 45-55Yrs
= hot flashes, mood swings, & vaginal dryness, osteoporosis
Ectopic pregnancy:
Why is it dangerous:
= fertilized egg implants outside uterus (most commonly in the fallopian tube)
= can rupture by ~8 Wks, causing severe bleeding & leading cause of maternal death in 1st trimester
PID (Pelvic Inflammatory Disease):
Organs commonly involved:
More prone to:
= infection of sex organ/s, often caused by untreated STDs (EX: gonorrhea, chlamydia)
= uterus, fallopian tubes, ovaries.
= It leads to inflammation, scarring, & can increase the risk of ectopic pregnancy.
How does fundal height relate to pregnancy:
Soonest to use reliably:
= Top of Uterus down to Top of Pubic bone w/ cloth measuring tape; each cm = 1Wk (top of uterus when feeling dip down STOP)
= After 20 weeks, it corresponds roughly to gestational age in weeks (EX: 25 cm ≈ 25 weeks).
What is the function of the prostate gland in males:
The prostate gland produces a fluid that nourishes sperm & aids in its motility during ejaculation.
Menorrhagia:
= Excessive menstrual bleeding; more than their average
Amenorrhea:
Primary Amenorrhea:
2ndary Amenorrhea :
= Absence of menstruation
= Never started periods.
= Periods stopped after being regular.
How do hormonal changes affect PMS:
How do hormonal changes affect PMDD:
= physical & emotional symptoms like bloating, fatigue, & irritability before a period
= severe form of PMS w/ extreme mood swings/ depression
What are common forms of contraception?
= Condoms, IUDs, birth control pills, diaphragms, spermicides, & rhythm/withdrawal methods (“pull-out game”).
What is the function of the corpus luteum?
After ovulation, the corpus luteum forms at the site of the released egg & secretes progesterone & estrogen to maintain the uterine lining.
What is cystitis:
If untreated, can progess to:
bladder infection
= kidneys infected (pyelonephritis), kidney damage, sepsis, dialysis
Significance of Braxton Hicks contractions:
= irregular uterine contractions during pregnancy that help the uterus prepare for labor. They don’t cause cervical dilation.
endometriosis:
Cavital-pneumial pneumothorax:
= abnormal growth of endometrial cells make tissue outside the uterus, often causing pelvic pain, heavy periods, & infertility.
= pneumothorax from endometriosis growth on lungs
Most common & hypothesized every women had at least once sexual pathology:
Common problem w/ fertilization:
= PID Pelvic Inflammatory Diseases
= Inflammation of endometrium thus swelling cutting of fallopian tube & semun gets stuck
Uterus 3 main jobs:
= Fucked, Fucking, Bleeding (Ovarys DONT connect to fallopian tubes)
Menarche:
of eggs @ Birth:
of eggs @ Menarche:
immature follicles/ova “eggs” are called:
= 1st menstruation, needs 16% body fat, ages 10-14 but now days 8-12
= 3 mil
= 30K
= Primordial Follicle
Primordial Menstrual Site:
What is LH & its job:
It comes from where:
= Ovarian follicles that house immature eggs.
= luteinizing hormone triggers the follicle to release its egg & stimulate fimbriae activity to guide the egg into the fallopian tube.
= Anterior portion of the Pituitary Gland
Full-term pregnancy:
Premature (preterm):
Postmature:
Hermaphrodites:
= 38-42 Weeks (40 average)
= Any birth before 37 weeks.
= Any birth after 43 weeks.
= Born w/ both sex organs; PC “Intersex”
Period of time from ovulation to menstruation (LFH egg burst) always 14 days
= Mensuration
Menstrual Phase) average blood vol & duration
What is the bleeding from:
Egg is implanted @
= ~50mLs & lasts ~ 3-5 days
= endometrium lining shedding
= Corpus lutium
Secretory phase)
vascularity increases in anticipation of implantation of fertilized
PMS:
Physical S/S prior to period:
= premenstral syndrome caused by hormones
= Breast tenderness or engorgement, Weight gain or bloating, Excessive fatigue, Cravings for specific food, Migraine headaches, Emotional responses
How many Wks to auscultate Fetal heart tones:
How to find for heart tones:
= 20 weeks
= gently palpate, find firm head & butt
Dysmenorrhea:
= Pain/”Severe discomfort” during menstruation & commonly goes w/ PMS
GPA Gravia:
GPA Para:
GPA Abortion:
GPAL:
= # of times gotten preg
= # of times delievered
= # of babys that died before delivering; NREMT “ any preg ends before 20wks of gestation regardless of cause”
= # of delivered children currently still LIVING
Use of more than 2 sanity pads per hour =
significant bleeding & If passed tissue bring it
Cystitis
= UTI) Urinary Tract Infection
DUB:
= Dysfunctional Uterine bleeding
“secretory phase” of the menstrual cycle?
vascularity increases during this phase in anticipation of implanting a fertilized egg.
Following ovulation, the site from where the egg was ejected out into the ABDMN cavity turns into:
Corpus Luteum
A very common infection of the female reproductive tract that is caused by either a virus, bacterium, or fungus is known as:
Pelvic Inflammatory Disease
The letter “L” in the GPAL acronym refers to:
The number of children that a patient has living
“proliferative phase” of the menstrual cycle?
The endometrium thickens and becomes engorged with blood
Ovulation occurs due to the release of what in the body?
A surge of Luteinizing Hormone
What is considered the most common cause of maternal death during the first trimester?
Ectopic pregnancies
PT complains of dyspareunia. You quickly recognize this as:
pain during intercourse
layers of the uterus in order from the most interior to the outer layer:
Endometrium, Myometrium, Perimetrium
“Tilt Test” is considered positive when:
= PT’s SBP Drops 20 mmHg or more
On average, most females will start menstruating how many days following ovulation?
14 days
vulva, or pudendum refers to:
Diamond-shaped, area of muscular tissues separating vagina & anus:
= The female external genitalia
= perineum
The perineum Fn:
2 common causes for it tearing:
An episiotomy & indications:
= form slinglike structure supports internal pelvic organs & is able to stretch during childbirth.
= This area is sometimes torn as a result of sexual assault or during childbirth.
= incision of perineum facilitates birth & to prevent spontaneous tearing
The mons pubis:
Primary fn:
= fatty tissue over pubic symphysis, the junction of pubic bones
= cushion for pubic symphysis during intercourse
The uterus has two major parts:
The upper two-thirds of the uterus:
The lower third of the uterus:
Rounded uppermost body portion of the uterus:
= the body (corpus) & the cervix (or neck)
= forms body; consists of smooth muscle layers
= is the cervix
= is the fundus, which lies above the point at which the fallopian tubes attach.
Endometrium is stimulated to build/prep by:
If fertilization does not occur, the lining:
myometrial fibers contract for:
= Estrogen & Progesterone
= degenerates & sloughs off (menses) ‘period’
= helps control post-birth bleeding & to maximize the sloughing of the endometrium
The fallopian tubes & AKA also called:
Fallopian tubes’ Fn:
Fertilization usually happens where:
= “uterine tubes” thin flexible tubes laterally from uterus & curve up & over each ovary
= conduct the egg from space around the ovaries into uterine cavity via peristalsis (wavelike contractions)
= in the distal third of the fallopian tube
Roughly, how many days does the hormone cycle for preparing the uterus to receive a fertilized egg
generally every 28 days
pregnant diabetics are more prone to:
Fetal Effects of Maternal Diabetes:
= postmature preg/s (past due date)
= baby becomes accustomed & don’t have enough somatostatin to reg/ alpha & beta cells & can lead to severe neonatal hypoglycemia, (fatal within hours if untreated)
Estrogen & progesterone role:
= from ovaries, make endo engorge & +blood vessels (stop secretions when menstruations start)
Secretory phase:
If fertilization does not occur:
= Uterine vascularity increases during this phase in anticipation of implantation of a fertilized egg
= Ischemic Phase) estrogen and progesterone levels fall. Vascular changes cause the endometrium to become pale and small blood vessels to rupture.
Dyspareunia:
Pain is commonly from:
= Painful intercourse
= Ovarion cysts most common cause, glands could undersecrete
Menopause:
= estrogen secretion & Ovarian Fn ends (45-55Yrs)
(end of reproductive life AKA “climacteric” derived from Greek meaning “critical time of life”)
Per NREMT GPA Abortion:
= pregnancy that ended before 20 weeks’ gestation
problem with children reporting SAs:
Many children wait to report or never report sexual abuse. (estimates vary across studies
about 1 in 4 girls and 1 in 13 boys experience child sexual abuse at some point in childhood.
Of these, 91 percent of child sexual abuse is perpetrated by someone the child or child’s family knows.
= Many children wait to report or never report sexual abuse. (estimates vary across studies
about 1/4 girls and 1/13 boys experience child sexual abuse at some point in childhood.
Of these, 91 percent of child sexual abuse is perpetrated by someone the child or child’s family knows.
Acquaintance rape is particularly common among adolescent victims.
To legally protect yourself w/ vaginal exams always:
= have “Vagina chaperone” & explain to PT what you’re planning to do & talk to her throughout the exam
With vaginal discharges, document what:
NEVER EVER EVER PERFORM:
Document the color and character of the discharge as well as the amount and the presence or absence of clots.
= internal vaginal exam in the field (WE AINT DOCs)
Dysuria:
Hesitancy:
= pain during urination
= trouble starting & stopping pee stream
Endometritis:
Complications of endometritis include:
Commonly reported S/Ss:
= Uterine lining infection often mimics PID & can be quite serious if not quickly treated w/ appropriate antibiotics.
= sterility, sepsis, or even death. Can occasional complication of miscarriage, childbirth, or gynecologic procedures such as D&Cs.
= mild to severe lower ABDMN pain; a bloody, foul-smelling discharge; fever (101-104°F)
onset of symptoms is usually 48-72HRs after the gynecologic procedure or miscarriage.
If > 30-60 days since PT’s LMP, you should assume:
Spontaneous Abortion
Straddle injury:
common form of blunt trauma) to genitals commonly from a bike seat
Ovaries secrete which hormones?
Estrogen & progesterone
how many women are sexually assaulted annually:
Estimated % of SAs never reported to authorities:
How many males rep/ of reported SAs:
how often SA victims know their assailants:
= 450,000 women are sexually assaulted annually
= estimated that > 60 %
= Male victims represent 5% of reported Sas.
= Most know their assailants (Friends & family & acquittances commit 80% of SAs against women)
Immediately after ovulation, the site from which the egg was released becomes the:
corpus luteum
The ovaries secrete what hormones:
Where do most eggs get fertilized at?
Ovulation occurs due to the surge of what:
= Estrogen & progesterone
= distal third of the fallopian tube
= Luteinizing Hormone
A patient complains of lower abdominal pain that occurs during sexual intercourse. You recognize this patient is complaining of:
Dyspareunia
Pain that occurs in the patient’s lower abdomen during ovulation is termed:
Mittelschmerz
Menorrhagia:
excessive menstrual bleeding “More than usual”
Labias &t heir function:
2 distinct sets of labia:
What can cause injury to the labia:
= Structures that protect the vagina & urethra
= Labia majora (lateral) & labia minora (medial)
= Trauma to vulvar area EX: SA, childbirth, or bicycle riding.
What is the function of the labia majora:
Structure & Fn of the labia minora:
= Protect the inner structures of the vulva
= Pleasure; engorge in blood & lubricate via sebaceous glands (Skene & Bartholin)
What is the vestibule, and what does it contain?
= The area protected by the labia minora; it contains the urethral opening, vaginal orifice (introitus), & the hymen.
Corpus albican)
“Scar” b/c not fertilized) has fluid in it Common spot for ovarian cysts
What is the hymen, and where is it located?
A thin fold of mucous membrane forming the external border of the vagina, partly closing it.
What are the 2 primary functions of the ovaries?
- Secrete estrogen & progesterone in response to FSH & LH from the anterior pituitary.
- Dev/ & release eggs (ova) for reproduction.
openings of the fallopian tubes fn:
Two openings: a fimbriated (fringed) end opening into ABDMN cavity near the ovaries & a minute opening into the uterus.
1) What occurs during proliferative phase:
2) What triggers ovulation, & when does it occur?
3) How does a follicle mature and rupture during the menstrual cycle?
4) Corpus luteum, and how does it form?
1= 1st 2 weeks, dominated by estrogen, thickens uterine lining & engorges it w/ blood
2= surge of LH @ ~day 14 triggers ovulation (release of an egg)
3= In response to FSH & increased estrogen, a follicle matures & ruptures once per cycle, discharging its egg into the fallopian tube.
4= yellowish body of cells formed from ruptured follicle under LH influence; it produces progesterone during the 2nd half of the menstrual cycle.
Ruptured Ovarian Cyst:
= Cysts are fluid-filled pockets. When they develop in the ovary, they can rupture & be source of pain
The monthly development of small corpus luteum cysts rupture
a small amount of blood is spilled into the abdomen. Because blood irritates the peritoneum, it can cause abdominal pain and rebound tenderness.
Tubo-ovarian abscess (TOA):
Rupture of the abscess can lead to:
= pocket of pus that forms b/c an infection in a fallopian tube & ovary (adnexa) ~result of PID
= sepsis & other complications including frank peritonitis. Rqs prompt eval/ & Rx of parenteral antibiotics &, in certain situations, surgical drainage.
ovarian torsion (adnexal torsion):
When an ovary becomes twisted around the tissues (stalk) that support it, similar in nature to a testicular torsion in a male.
leiomyomas or myomas, uterine fibroids:
benign (not cancerous) growths/“tumors” that develop from the muscle layer of the uterus.
Several surgical treatments uterine fibroids are:
Hysterectomy:
Myomectomy:
Scleroses:
= removing uterus, various fibroids, & radiation
= complete surgical removal of the uterus
= surgical removal of the various fibroids
= interventional radiology procedure that blocks the blood supply to a particular fibroid, causing it to die and slough off.
Corpus lutium
on the ovary where the egg was implanted & keep secreting estrogen & progesterone to keep secreting
Pregnancy’s effect on) Respiratory:
Blood Volume:
Cardiac Output & HR:
BP: Decreases in 2nd trimester, returns to baseline.
GI: Slower motility → constipation.
Urinary: ↑ frequency due to bladder compression.
Musculoskeletal: Loosened ligaments → joint pain
= Increased rate, decreased lung capacity.
= ↑ 45% (at risk for anemia)
= CO↑ 30-50% & HR↑ 10-15 BPM.
BP: Decreases in 2nd trimester, returns to baseline.
GI: Slower motility → constipation.
Urinary: ↑ frequency due to bladder compression.
Musculoskeletal: Loosened ligaments → joint pain.
Pregnancy’s effect on) GI:
Urinary:
Musculoskeletal:
= Slower motility (peristalsis) → constipation hemorrhoids
= ↑ frequency due to bladder compression.
= Loosened ligaments → joint pain possiple Lordosis
