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N507 Exam 2 > (14) Female Genitalia > Flashcards

(14) Female Genitalia Flashcards

1
Q

mons pubis

A

hair covered fat pad overlying the symphysis pubis

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2
Q

labia majora

A

rounded folds of adipose tissue forming the outer lips of the vagina

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3
Q

labia minora

A

thinner pinkish-red folds or inner lips that extend anteriorly to form the prepuce

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4
Q

vestibule

A

boat-shaped fossa between th elbaia minora

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5
Q

introitus

A

vaginal opening (may be hidden by hymen in virgins)

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6
Q

perineum

A

tissue between the Introits and anus

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7
Q

urethral meatus

A

opens into vestibule between clitorus and vagina

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8
Q

paraurethral (Skene) glands

A

lie just posterior and adjacent to the meatus on either side of the openings

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9
Q

Bartholin glands

A

located posteriorly on both sides of the vaginal opening but not usually visible

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10
Q

vagina

A

musculomembranous tube extending upward and posteriorly between the urinary bladder and urethra and rectum

  • its upper 3rd lies at a horizontal plane and terminates in the cup-shaped fornix
  • vaginal mucosa lies in transverse folds or rugae
  • lies at almost right angle to uterus
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11
Q

uterus

A

thick-walled fibromuscular structure shaped like an inverted pear

  • convex upper surface is the uterine fundus
  • body of uterus (corpus) and cylindrical cervix are joined inferiorly at the isthmus
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12
Q

3 layers of uterine wall

A

perimetric - serial coating from perineum

myometrium - distensible smooth muscle

endometrium - adherent inner coating

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13
Q

cervix

A

protrudes into vagina, diving the upper vagina into 3 recesses (anterior, posterior, lateral fornices)

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14
Q

ectocervix

A

vaginal surface of cervix

  • seen easily w/ the help of a speculum
  • at its center is round, oval, or slit-like depression(the external os of the cervix) which marks the opening into the endocervical canal
  • covered by plushy red columnar epithelium that surrounds the os and lines the endocervical cancel, and by shiny pink squamous epithelium continuous with the vaginal lining
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15
Q

cervical puberty changes

A
  • broad band of columnar epithelium encircling os (ectropion) is gradually replaced by squamous epithelium
  • squamocolumnar junction migrates toward the os creating the transformation zone: this is the area at risk for dysplasia and tested by pap smear
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16
Q

Fallopian tube

A

has a fanlike tip (fimbria)

  • extended from ovary to each side of the uterus and conducts oocyte from the periovarian peritoneal cavity to the uterine cavity
  • normally not palpable
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17
Q

ovaries

A

almond shaped glands that vary considerably in size but aver approx 3.5x2x1.5cm from adulthood to menopause
-palpable on pelvic exam in 1/2 of women during reproductive years

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18
Q

adnexa

A

ovaries
tubes
supporting tissues

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19
Q

2 primary functions of ovaries

A
  1. production of oocytes

2. secretion of hormones (estrogen, progesterone, testosterone)

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20
Q

increased ovarian hormonal secretion at puberty causes:

A

growth of uterus and its endometrial lining
enlargement of vagina
thickening of epithelium
development of secondary sex characteristics (breasts, pubic hair)

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21
Q

parietal perineum

A

extends downward behind uterus into a cul-de-sac called rectouterine pouch (pouch of Douglas)
- can just reach on rectovaginal exam

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22
Q

greater pelvis

A
  • protected by bony wings of ilia

- contains lower abdominal viscera, narrows inferiorly at lesser pelvis which surrounds the pelvic cavity and perineum

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23
Q

pelvic floor

A

supports pelvic organs

a long of tissue composed of muscle, ligaments, and end-pelvic fascia

helps support the pelvic organs above the outlet of the lesser pelvis

aid in sexual function (orgasm), urinary and fecal continence, stabilizing of connecting joints

consists of pelvic diaphragm and perineal membrane

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24
Q

pelvis diaphragm

A

separates the pelvic cavity from the perineum

consists of elevator ani and coccygeal muscles which attach to the inner surface of the lesser pelvis

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25
Q

perineal membrane

A

triangular sheet of fribromuscular tissue that contains the bulbocavernosus and ischiocarvernous muscles, the superficial transverse perineal body, and the external anal sphincter

spans the anterior triangle. that anchors the urethra, vagina, and perineal body to ischiopubic rami

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26
Q

urogenital (levator) hiatus

A

key-like opening in the center of the pelvic diaphragm where the urethra, vagina, and anorectic pass through

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27
Q

deep urogenital diaphragm

A

inferior to the pelvic diaphragm

includes the external urethral sphincter, urethra, supporting deep transverse perineal muscles (which runs from inferior ischium to the midline)

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28
Q

pelvic structures of posterior triangle

A

external and sphincter muscles that encircles the rectum and internal sphincter

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29
Q

pelvic diaphragm is innervated by ?

A

sacral nerve roots S3 to S5

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30
Q

perineal membrane and urogenital diaphragm are innervated by ?

A

pudendal nerve

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31
Q

weakness of pelvic floor muscles may cause:

A

pain
urinary incontinence
fecal incontinence
prolapse of pelvic organs that can produce a cystocele, rectocele, enterocoele

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32
Q

risk factors for pelvic floor weakness

A

advancing age
prior pelvic surgery or trauma
parity and childbirth
clinical: obesity, diabetes, MS, parkinsons
meds: anticholinergics, alpha-adrenergic blockers
chronically increased intra-abdominal pressure from COPD
chronic constipation

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33
Q

loss of urethral support contributes to ?

A

stress incontinence

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34
Q

weakness of the perineal body d/t childbirth predisposes to ?

A

rectoceles and enteroceles

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35
Q

pubic hair

A

spreads downward in triangular position, pointing toward vagina

  • may form an inverted triangle pointing toward umbilicus (10%)
  • growth not complete until mid 20s
  • growth + breast development are main components of sexual maturity assessment in girls
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36
Q

leukorrhea

A

vaginal secretions

  • increase just before menarche
  • coincide with ovulation
  • accompany sexual arousal
  • must differentiate from cervical/vaginal infection discharge
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37
Q

lymph from vuvla and lower vagina drains into ?

lymph from internal genitalia (upper vagina) flows into ?

A

inguinal nodes

pelvic and abdominal lymph nodes (not palpable)

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38
Q

female genitalia: common/concerning symptoms

A
  • menarche, menstruation, menopause, postmenopausal bleeding
  • pregnancy
  • vulvovaginal symptoms
  • sexual health
  • pelvic pain (acute/chronic)
  • STIs
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39
Q

menarche

A

age at onset of menses

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40
Q

dysmenorrhea

A

pain w/ menses, often w bearing down, aching, or cramping sensation in lower abdomen or pelvis

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41
Q

premenstrual syndrome (PMS)

A

cluster of emotional, behavioral, and physical symptoms occurring 5 days before menses for 3 consecutive cycles

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42
Q

amenorrhea

A

absence of menses

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43
Q

abnormal uterine bleeding

A

bleeding between menses

includes infrequent, excessive, prolonged, or postmenopausal bleeding

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44
Q

menopause

A

absence of menses for 12 consecutive months, usually occurring between 48-55

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45
Q

postmenopausal bleeding

A

bleeding occurring 6 months or more after cessation of menses

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46
Q

onset of menstruation

A

9-16 y/o

  • takes about 1 year to settle into regular pattern
  • depends on genetics, socioeconomic status, nutrition
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47
Q

normal vs excessive menstrual blood

A

normal: dark red
excessive: bright red w/ “clots: (not true fibrin clots)

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48
Q

primary dysmenorrhea results from ?

A

increased prostaglandin production during luteal phase of menstrual cycle when estrogen and progesterone levels decline

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49
Q

causes of secondary dysmenorrhea?

A 
endometriosis
adenomyosis (endometriosis in muscular layers of uterus)
PID
endometrial polyps
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50
Q

criteria for PMS diagnosis

A
  • signs and symptoms in the 5 days prior to menses for at least 3 consecutive cycles
  • cessation of S/S within 4 days after onset of menses
  • interference with daily activities
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51
Q

PMS symptoms & signs

A 
emotional and behavioral symptoms:
depress
angry outbursts
irritability
anxiety
confusion
crying spells
sleep disturbance
poor concentration
social withdrawal

bloating
weight gain
swelling of hands/feet
generalized aches/pains

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52
Q

primary amenorrhea

A

absence of ever having periods

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53
Q

secondary amenorrhea

& causes

A

cessation of periods after they have been established

  • pregnancy
  • lactation
  • menopause
  • low body weight (malnutrition, anorexia)
  • stress
  • chronic illness
  • hypothalamic-pituitary-ovarian dysfunction
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54
Q

patterns of abnormal bleeding

A
  • polymenorrhea (<21 days between menses)
  • ogliomenorrhea (infrequent bleeding)
  • menorrhagia (excessive flow)
  • menorrhagia (intermenstrual bleeding)
  • postcoital bleeding
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55
Q

postcoital bleeding suggests ?

A

cervical polyps of cancer

in older women: atrophic vaginitis

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56
Q

perimenopause symptoms

A

vasomotor symptoms: hot flashes, flushing, sweating

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57
Q

menopause changes

A
  • ovaries stop producing estradiol or progesterone

- pituitary secretion of luteinizing hormonal and follicle-stimulating hormone gradually becomes markedly elevated

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58
Q

causes of postmenopausal bleeding

A

endometrial cancer
hormone replacement therapy
uterine/cervical polyps

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59
Q

Gravida

A

total number of pregnancies

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60
Q

Para

A

outcomes of pregnancies

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61
Q

amenorrhea followed by heavy bleeding suggests

A

threatened abortion

dysfunctional uterine bleeding r/t lack of ovulation

62
Q

most common vulvovaginal symptoms

A

vaginal discharge

itching

63
Q

sexual dysfunction

A

classified by the phase of sexual response

  • lack desire
  • fail to become aroused and attain adequate lubrication
  • unable to reach orgasm
64
Q

causes of sexual dysfunction (females)

A 
lack of estrogen
clinical illness
trauma/abuse
surgery
pelvic anatomy
psych conditions
65
Q

dyspareunia

A

pain with intercourse

66
Q

vaginismus

A

involuntary spasm of the muscles surrounding the vaginal orifice that makes penetration during intercourse painful to impossible
-causes may be physical or psychological

67
Q

superficial vaginal pain suggests ?

A

local inflammation
strophic vaginitis
inadequate lubrication

68
Q

deeper vaginal pain suggests ?

A

pelvic disorders

pressure on normal ovary

69
Q

sexual problems are commonly related to ?

A

situational and psychosocial factors

70
Q

Acute pelvic pain suggests ?

A 
*warrants immediate attention*
ectopic pregnancy
ovarian torsion
appendicitis
PID
ruptured ovarian cyst
Mittelschmerz (mild unilateral pain last a few hours-days at mid cycle from ovulation)
tubo-ovarian abscess
71
Q

red flags for PID (causes)

A

new IUD insertion

STIs

72
Q

chronic pelvic pain suggests ?

A

(lasts >6 months and doesn’t respond to tx)

endometriosis (from retrograde menstrual flow and extension of uterine lining outside of uterus)
PID
adenosis
fibroids
sexual abuse
pelvic floor spasm
73
Q

Female Genitalia: health promotion

A 
cervical cancer screenings
ovarian cancer: risk factors and screening
STIs
options for family planning
menopause and HRT
74
Q

most important risk factor for cervical cancer

A

persistent infection w. high risk HPV subtypes (16&18)

75
Q

2 notable risk factors for cervical cancer

A
  • failure to undergo screening
  • multiple sexual partners

(also smoking, immunosuppression, long term OCP, chlamydia, parity, prior cervical CA)

76
Q

3 symptoms of ovarian cancer

A

abdominal distention
abdominal bloating
urinary frequency

77
Q

ovarian cancer risks

A 
BRCA1/2
family hx breast/ovarian CA
obesity
nulliparity
use of postmenopausal HRT
78
Q

ovarian cancer risk decreased by

A

OCP
multiple pregnancies
breastfeeding
tubal ligation

79
Q

Chlamydia is cause of ?

A 
urethritis
cervicitis
PID
ectopic pregnancy
infertility
chronic pelvic pain
80
Q

female genitalia important areas of examination

A 
external:
mons pubis
labia major and minora
urethral meatus; clitoris
vaginal introitus
perineum
internal:
vaginal, vaginal walls
cervix
uterus; ovaries
pelvic muscles
rectovaginal wall
81
Q

Pap smear and menses

A

glass-slide technique: don’t conduct during menses b/c blood can interfere w/ interpretation

liquid-based cytology: blood cells can be filtered out

82
Q

tips for successful pelvic exam: patient

A
  • 24-48 hrs before no sex, douching, suppositories
  • empty bladder
  • lie supine w/ head/shoulders elevated, arms at side or across chest to enhance eye contact and reduce tightening of abd muscles
  • thighs flexed, abducted, externally rotate at hips
83
Q

delayed puberty suggests ?

A

often familiar or r/t chronic illness

- reflect disorders of hypothalamus, anterior pituitary gland, ovaries

84
Q

external female genitalia: excoriations or itchy small red maculopapules suggest ?

A 
pediculosis pubis (lice, crabs)
(often found at bases of pubic hairs)
85
Q

enlarged clitoris is seen in ?

A

masculinizing endocrine disorders

86
Q

speculum insertion: 2 steps

A
  1. when inserting speculum hold at angle then
  2. slide inward along posterior wall of vagina applying downward pressure to keep vaginal Introits relaxed

(then rotate into horizontal position maintaining posterior pressure to insert to full length - don’t open blade early)

87
Q

lateral displacement of cervix suggests ?

A

endometriosis involving the uterosacral ligaments

88
Q

yellowish discharge on endocervical swab suggests ?

A

mucropurulent cervicitis from C. trachoma’s, N. gonorrhoeae, herpes simplex

89
Q

raised, friable, or lobed warlike lesion on cervix suggests ?

A

condylomata

cervical cancer

90
Q

use of lower speculum blade as retractor during bearing down help expose?

upper blade?

A

anterior vaginal wall defects such as cystoceles

rectoceles

91
Q

stool vs rectovaginal mass

A

can dent stool w/ digital pressure

92
Q

cervical motion tenderness and/or adnexal tenderness are hallmarks of ?

A

PID
ectopic pregnancy
appendicitis

93
Q

uterine enlargement suggests ?

A

pregnancy
uterine myxomas (fibroids)
malignancy

94
Q

nodules on uterine surfaces suggest

A

myomas or fibroids

95
Q

how to palpate uterus

A

internal hand to elevate cervix and uterus + external hand on abdomen midway between umbilicus and symphysis pubis
- then slide pelvic hand fingers into anterior fornix and palpate body of uterus (pelvic hand feels anterior surface, abdominal hand feels posterior surface)

-if can’t feel uterus may be posterior tipped (retrodisplaced): slide pelvic fingers into posterior fornix and feel for uterus

obese of poorly relaxed abdominal wall can prohibit palpation

96
Q

involuntary voiding or lack of awareness suggests ?

A

cognitive or neurosensory deficits

97
Q

stress incontinence arises from

A

decreased intraurethral pressure

98
Q

pain from sudden bladder overdistention accompanied ?

A

acute urinary retention

99
Q

bladder disorders may cause ? pain

A

suprapubic

100
Q

bladder infection vs sudden over distention of bladder vs chronic bladder distention pain

A

infection: lower abdomen, dull and pressure like
sudden: agonizing
chronic: usually painless

101
Q

how to palpate ovaries

A

abdominal hand - lower quadrant

pelvic hand - lateral fornix

102
Q

ovaries 3-5 years after menopause

A

become atrophic and nonpalpable

investigate palpable ovary for ovarian cyst or breast cancer

103
Q

S/S ovarian cancer

A

pelvic pain
bloating
increased abdominal size
UTI symptoms

104
Q

Adnexal masses can arose from ?

A

tubo-ovarian abscess
salpingitis
inflammation of Fallopian tubes from PID
ectopic pregnancy

distinguish mass from uterine myoma

105
Q

pelvic muscle weakness arises from ?

contributes to ?

A

aging
vaginal deliveries
neurologic conditions

urine leakage of stress incontinence during increased abdominal pressure

106
Q

pelvic floor over recruitment w/ tightening, vaginal wall tenderness, and referred pain signal ?

A

pelvic pain from pelvic floor spasm, interstitial cystitis, vulvodynia, urethral spasm

107
Q

trigger point tenderness in external pelvic floor muscles accompanies ?

A

pelvic floor spasm and pelvic floor dysfunction from trauma, interstitial cystitis, fibromyalgia

108
Q

pelvic floor disorders include:

A

urinary/fecal incontinence
pelvic organ prolapse
other sensory and emptying abnormalities of lower urinary and GI tracts

109
Q

modularity and thickening of the uterosacral ligaments occur in ?

A

endometriosis

also pain w/ uterine movement

110
Q

retrovaginal exam: 3 primary purposes

A
  1. palpate retroverted uterus, uterosacral ligaments, cul-de-sac, adnexa
  2. screen for colorectal cancer in women >50
  3. assess pelvic pathology
111
Q

how to do retrovaginal exam

A

index - vagina
middle - rectum
-pt strain to relax anal sphincter & app pressure between fingers

112
Q

most common hernia in women

A
  1. indirect inguinal

2. femoral

113
Q

causes of urethritis

A

Gon. & Chlamydia

114
Q

how to palpate groin hernia in females

A

stand up

indirect inguinal - palpate in labia majora and upward to just lateral under pubic tubercles

115
Q

how to assess urethritis or inflammation of paraurethral glands

A

index finger - vagina

milk urethra gently outward from inside - note any discharge

116
Q

Epidermoid Cyst

A

small, firm round cystic nodule in labia

  • yellowish
  • look for dark puncture marking the blocked opening of a gland
117
Q

lesions of the vulva:

A
  1. epidermoid cysts
  2. venereal wart (condyloma acuminatum)
  3. syphilitic chancre
  4. secondary syphillis (condyloma latum)
  5. genital herpes
  6. carcinoma of vulva
118
Q

Venereal Wart

A

(condyloma acumination)
warty lesions on labia and within vestibule
-from human papillomavirus infection

119
Q

Syphilitic Chancre

A

firm, painless ulcer from primary syphilis

  • forms about 21 days after exposure to Treponema palladium
  • may remain hidden and undetected in the vagina and heals regardless of treatment in 3-6 weeks
120
Q

Secondary Syphilis

A

(condyloma latum)
large raised, round or oval, flat-topped gray or white lesions
-contagious and long w/ rash and mucous membrane sores in the mouth, vagina, or anus are manifestations of secondary syphilis

121
Q

Genital herpes

A

shallow small painful ulcers on red bases

  • Herpes Simplex 1 or 2
  • ulcers may take 2-4 weeks to heal
  • recurrent outbreaks of localized vesicles, then ulcers are common
122
Q

Carcinoma of the Vulva

A

ulcerated or raised red vulvar lesion (in elderly woman)

-usually squamous cell carcinoma arising on labia

123
Q

Bulges and Swelling of the Vulva, Vagina, and Urethra

A 
cystocele
urethral caruncle
bartholin gland infection
cystourethrocele
prolapse of the urethral mucosa
rectocele
124
Q

Cystocele

A

bulge of the upper 2/3 of the anterior vaginal wall, together with the bladder above it
-results from weakened anterior supporting tissues

125
Q

Urethral Caruncle

A

small red benign tumor visible at the posterior urethral meatus

  • occurs chiefly in postmenopausal women
  • usually asymptomatic
  • occasionally mistaken w/ carcinoma of the urethra
  • to check, palpate the urethra through the vagina for thickening, modularity, or tenderness, and palpate for inguinal lymphadenopathy
126
Q

Bartholin Gland Infection

A
  • causes: trauma, gonococci, anaerobes like bactericides and peptostreptococci, and C. trachoma’s
  • acute: gland appears as a tense, hot, very tender abscess
  • look for pus emerging from he duct or erythema around the duct opening
  • chronic: contender cuts is felt that may be large or small
127
Q

Cystourethrocele

A
  • entire anterior vaginal wall, together w/ bladder and urethra, produces a bulge
  • a groove sometimes define the border between the urethrocele and cystocele but isn’t always present
128
Q

Prolapse of the Urethral Mucosa

A

forms a swollen red sing around the urethral meatus

  • usually occurs before menarche or after menopause
  • identify the urethral meatus at the center of the swelling to make this diagnosis
129
Q

Rectocele

A

herniation of the rectum into the posterior wall of the vagina, resulting from a weakness or defect in the end-pelvic fascia

130
Q

physiologic discharge

A

clear or white
may contain clumps of epithelial cells
not malodorous

131
Q

Trichomonal Vaginitis:

cause
discharge
other symptoms
vulva/vaginal mucosa
lab eval
A

cause: Trichomonas vaginalis (protozoan), often but not always sexually transmitted
discharge: yellowish, green or gray; frothy; often profile and pooled in vaginal fornix; may be malodorous

other symptoms: pruritus (less severe than yeast); pain on urination; dyspareunia

vulva/vaginal mucosa: vestibule and labia minor may be erythematous; vaginal mucosa may be diffusely reddened, w/ small granular spots to petechiae in posterior fornix; in mild cases looks normal

lab eval: can saline wet mount of trichomonads

132
Q

Candidal Vaginitis:

cause
discharge
other symptoms
vulva/vaginal mucosa
lab eval
A

cause: Candida albicans - yeast; Abx and other factors predispose
discharge: white and curdy; may be thin but typically thick; not as profuse as rich; not malodorous

other symptoms: pruritus; vaginal soreness; pain on urination; dyspareunia

vulva/vaginal mucosa: vulva and even surrounding skin are often inflamed and sometimes swollen to a variable extent; vaginal mucosa is often reddened w/ white patches of discharge; mucosa may bleed when these patches are scraped off; in mild cases looks normal

lab eval: scan KOH preparation for the branding hyphae of Candida

133
Q

Bacterial Vaginosis:

cause
discharge
other symptoms
vulva/vaginal mucosa
lab eval
A

cause: bacterial overgrowth from anaerobic bacteria; often sexually transmitted
discharge: gray or white, thin, homogenous; malodorous; coats vaginal walls; usually not profuse, may be minimal

other symptoms: unpleasant fishy or musty genital odor; reported to occur after intercourse

vulva/vaginal mucosa: vulva and vingal mucosa usually appear normal

lab eval: scan saline wet mount of clue cells (epithelial cells q/ stippled borders); sniff for fishy odor after applying KOH (whiff test); test vaginal ph secretions for ph>4.5

134
Q

2 kind of epithelium cover cervix:

A
  1. shiny pink squamous epithelium which resembles the vaginal epithelium
  2. deep red, plushy columnar epithelium, which is continuous with the endocervical lining

(these meet at the squamocolumnar junction - when this junction is at or inside the cervical os only squamous epithelium is seen)
- ring of columnar epithelium is often visible to a varying extent around the os: result of normal process that accompanies fetal development, menarche, and first pregnancy

135
Q

Cervical retention cyst

A

(Nabothian cysts)

  • appear as translucent nodules on cervical surface and have no pathologic significance
  • estrogen stimulation increases during adolescence - all or part of columnar epithelium is transformed into squamous epithelium by metaplasia: this change may block secretions of columnar epithelium and cause these cysts
136
Q

Cervical Polyp

A

usually arises from endoervical canal becoming visible when it protrudes through cervical os

  • bright red, soft, fragile
  • when only tip is seen it cannot be differentiated clinically from a polyp originating in endometrium
  • polyps are benign but may bleed
137
Q

Mucopurulent Cervicitis

A

produces purulent yellow drainage from cervical os usually from chlamydia, Gon., herpes

138
Q

carcinoma of cervix

A
  • begins in area of metaplasia
  • in earliest stages cannot be distinguished from normal cervix
  • later stages, extensive, irregular, cauliflower like growth may develop
  • early frequent intercourse, multiple partners, smoking, HPV increase risk
139
Q

normal position variants of uterus

A

retroversion

retroflexion

140
Q

retroversion of uterus

A

tilting backward of entire uterus, including both body and cervix

  • cervix faces forward
  • uterine body cannot be felt by abdominal hand

moderate: body may not be palpable w/ either hand
marked: body can be felt posteriorly through posterior fornix of rectum

-usually mobile and asymptomatic

141
Q

fixed and immobile uterus suggests ?

A

endometriosis

PID

142
Q

retroflexion of uterus

A

backward angulation of body of uterus in relation to cervix

  • cervix maintains usually position
  • body of uterus often palpable through posterior fornix or through rectum
143
Q

myomas of uterus

A

(fibroids)

  • very common benign uterine tumors
  • may be single or multiple and vary greatly in size, ocassionally reaching large proportions
  • feel like firm irregular nodules that are continuous w/ uterine surface
  • may be confused w/ ovarian mass or retroflexed uterus
  • submucosal myomas may project towards the endometrial cavity and are not palpable although they may be suspected b/c enlarged uterus
144
Q

prolapse of uterus

A

results from weakness of the supporting structures of the pelvic floor

  • often associated w/ cystocele and rectocele
  • progressive stages the uterus becomes retroverted and descends down into vaginal canal to the outside:

1st degree: cervix still well w/in vagina
2nd degree: cervix at introitus
3rd degree: (providentia) cervix and vagina are outside introitus

145
Q

what may simulate an adnexal mass?

A

inflammatory disease of bowel (diverticulitis)
carcinoma of colon
pedunculate myoma of uterus

146
Q

ovarian cysts

A
  • smooth and compressible (tumors solid/nodular)
  • uncomplicated are usually nontender
  • small <6cm: mobile, cystic masses in young women usually benign and often disappear after next menstrual period
147
Q

polycystic ovarian syndrome

A
  • rests on exclusion of several endocrine disorders and 2 of 3 features: ovulatory dysfunction, androgen excess (hirsutism, acne, alopecia, elevated serum testosterone), and confirmation of polycystic ovaries on US
  • obese, metabolic syndrome, diabetes/impaired glucose tolerance are risk factors
148
Q

ovarian cancer

A

rare and usually persists at advanced age

  • symptoms: pelvic pain, bloating, increased abdominal size, urinary tract symptoms
  • often palpable ovarian mass
  • no screening tests but family hx ovarian/breast cancer is risk
149
Q

ectopic pregnancy risk factors

A 
tubal damage from PID
prior ectopic pregnancy
tubal surgery
>35
IUD
sub fertility
IVF
150
Q

Ectopic pregnancy

A

results from implantation of fertilized ovum outside endometrial cavity (Fallopian tube)

S/S: abd pain, adnexal tenderness, abnormal uterine bleeding
-palpable adnexal mass: large, fixed, ill defined w/ adherent momentum or small/large bowel

151
Q

PID

A

d/t spontaneous ascension of microbes from cervix or vagina to endometrium, Fallopian tubes, adjacent structures
- usually involve STDs (GC/Chlamydia) to bacterial vaginosis affecting fallopian rubes or ovaries

hallmark: adnexal, cervical, and uterine compression tenderness
- may lead to tube-ovarian abscess, infertility

N507 Exam 2 (6 decks)

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