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GYNECOLOGY > Approach to Patient, Office Gynecology, & Breast Disorders > Flashcards

Approach to Patient, Office Gynecology, & Breast Disorders Flashcards

1
Q

What are the usual complaints in gynecology?

A

Pelvic masses
Abnormal bleeding
Difficulty urinating

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2
Q

LMP and PMP are included in which parts of the History taking?

A

History of Present Illness and OB/Gyne history

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3
Q

Where should caesarian section be included in the History Taking?

A

OB/Gyne history

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4
Q

Mean duration of the normal regular cycle?

A

28 ± 7 days or 21 to 35 days

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5
Q

Pertains to the number of pregnancies regardless of the pregnancy outcomes

A

Gravidity

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6
Q

Parity pertains to the number of pregnancies which reached the age of viability which is:

A

20 weeks

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7
Q

Age of Gestation of a preterm baby

A

<37 weeks

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8
Q

Criteria for abortion

A

<20 weeks
<500 g
<25 cm

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9
Q

T/F: Ectopic Pregnancy and Blighted ovum are part of the count for abortion

A

true

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10
Q

Gynecologic Physical Examination should begin with a general evaluation of the patient’s:

A

appearance and affect

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11
Q

T/F: HEENT is not usually performed in Gynecologic PE

A

True

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12
Q

What vital measurement is routinely done in PE of postmenopausal women to document evidence of osteoporosis?

A

height

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13
Q

When is the timing of BSE in menstruating women?

A

7-10 days following onset of menstruation

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14
Q

When is the timing of BSE in postmenopausal women?

A

Same calendar day of each month

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15
Q

What are the things to look for during BSE Inspection?

A

ConSROD
- Contour
- Swelling
- Retractions or Dimpling
- Orange Peeling (Inflammatory Breast CA)
- Direction of the nipple

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16
Q

What are the four steps to inspect the breast?

A

SOHL
- arms at SIDE
- arms OVERHEAD
- hands on HIPS pressing firmly to flex the muscle
- Leaning forward

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17
Q

Technique that increases tactile sensation during palpation on BSE

A

Wet technique

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18
Q

Which fingers are used during palpation on BSE?

A

flat pads of 2nd, 3rd, 4th fingers

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19
Q

What are the 3 methods of palpating in BSE?

A

Wedge method (Radial/Hands of the Clock)
Vertical Strip (Linear) method
Rotary (Spiral/Circular) Method

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20
Q

What is commonly implied by a hypoactive bowel sound?

A

ileus caused by peritoneal irritation

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21
Q

What is commonly implied by a hyperactive bowel sound?

A

Intrinsic irritation of the bowel or partial or complete bowel obstruction

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22
Q

What is commonly implied by a localized percussion tenderness of the abdomen?

A

peritoneal inflammation

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23
Q

Which part of the Gynecologic Exam checks for varicosities and edema?

A

Examination of Extremities

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24
Q

T/F: Annual screening of the pelvis for asymptomatic, non-pregnant adult women is found to be very beneficial

A

False: annual pelvic screening do not offer benefit and can cause harm

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25
Q

What is the position during pelvic examination?

A

Dorsal Lithotomy Position

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26
Q

What is the normal or common pattern of pubic hair for females (Female Escutcheon)?

A

Inverted triangle over the mons pubis

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27
Q

What is the escutcheon pattern that may indicate androgen activity or neoplastic growth in reproductive organs in female patient?

A

Diamond pattern or Male escutcheon pattern

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28
Q

What is the anatomical focal point of support for the perineum?

A

Perineal body

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29
Q

This pertains to the prolapse of the bladder into the vaginal wall

A

Vaginal cystocele

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30
Q

This pertains to a cystocele combined with distal prolapse of the urethra with or without associated urethral hypermobility

A

Cystourethrocele

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31
Q

T/F: bladder should be empty during Speculum Exam

A

True

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32
Q

When should one collect urine in relation to a speculum exam if there is suspected UTI

A

Prior to the exam

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33
Q

What is the technique used in performing a Pap Smear

A

3-cotton pledget technique

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34
Q

What is the manner of insertion of the speculum to avoid the urethra and rectum during examination?

A

diagonal

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35
Q

Choose between Nulliparous and Multiparous Cervix:
Soft Consistency

A

Multiparous Cervix

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36
Q

Choose between Nulliparous and Multiparous Cervix:
Opening is minimal or almost closed/round or oval

A

Nulliparous cervix

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37
Q

Choose between Nulliparous and Multiparous Cervix:
(+) Healed stellate lacerations

A

Multiparous cervix

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38
Q

Choose between Nulliparous and Multiparous Cervix:
Round external os

A

Nulliparous cervix

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39
Q

Choose between Nulliparous and Multiparous Cervix:
Somewhat hard

A

Nulliparous cervix

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40
Q

Choose between Nulliparous and Multiparous Cervix:
Opening is slit-like

A

Multiparous cervix

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41
Q

Choose between Nulliparous and Multiparous Cervix:
Pink and without lesions

A

Nulliparous cervix

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42
Q

T/F: The bimanual (internal) gynecologic exam is usually done in pregnant or non-pregnant women

A

True

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43
Q

Which fingers are placed within the vagina during bimanual gyne examination?

A

Index and middle fingers of the dominant hand

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44
Q

Palpation of which anatomical location during bimanual exam can help in determining the location of female reproductive organs?

A

fornix

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45
Q

The adnexa can be located during bimanual exam by palpating:

A

the posterior fornix

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46
Q

What is the normal ovary size

A

3 x 2 cm

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47
Q

Which structures are palpated for nodularity during Rectovaginal Exam?

A

Rectovaginal septum
Uterosacral ligaments

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48
Q

A patient should abstain from sexual intercourse within ___ hours after pap smear

A

24 hours

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49
Q

T/F: Pap Smear should not be conducted when the patient is on her menstrual period

A

True

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50
Q

T/F: Pap Smear is contraindicated during pregnancy

A

False

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51
Q

Which of the following is a low-risk indication for Pap Smear:
A. History of later coitus
B. Multiple Sexual Partners
C. Single sexual partner but partner has multiple sexual partners

A

A

52
Q

The initial screening for Pap Smear should begin at the age of ___ regardless of sexual activity

A

21

53
Q

Frequency of Pap Smear screening for a 25-year-old

A

every 3 years
(21-29 yo)

54
Q

Frequency of Pap Smear Screening for a 66 yo

A

No longer recommended
(after 65 years with normal adequate testing over the past 10 years, and has not been treated for high-grade dysplasia within the past 20 years)

55
Q

Frequency of Pap smear screening for a 68-year-old woman who is immunocompromised

A

annually
One of the exceptions to “no screening rule” in elderly:
- HIV seropositive
- Immunosuppression
- Exposed to DES in utero

56
Q

How often is Pap plus High-risk-HPV Co-testing done in 30–65-year-olds?

A

every 5 years

57
Q

Frequency of Pap Smear for a 70-year-old who underwent supracervical hysterectomy in her 50s?

A

every 3 years

58
Q

The goal of a Pap Smear is to collect cells from which part (zone) of the cervix?

A

Transformation zone

59
Q

Instrument used to collect cells in the endocervix during pap smear

A

cytobrush

60
Q

Instrument used to collect cells in the ectocervix during pap smear

A

Ayer’s spatula

61
Q

From which areas should we take specimens from when performing the 3-cotton pledget technique of Pap Smear

A

Endocervix
Ectocervix
Lateral Vaginal Wall

62
Q

3 ways to stain the Pap Smear specimen

A

Gram Stain
Wet or Saline smear
KOH smear

63
Q

Which staining is used to check for Trichomonas in Pap smear?

A

Wet or Saline smear

64
Q

Which staining demonstrates fungal infection in Pap smear specimens

A

KOH Smear

65
Q

T/F: A pap smear specimen coming from a genitalia with fishy odor would be best stained using which solution?

A

10% KOH solution to check for bacterial vaginosis (Gardnerella vaginalis)

66
Q

Which classification is used for the findings in Pap Smear

A

Bethesda Classification

67
Q

Note the Bethesda Classification:
The size, shape, and other characteristics of the cells suggest that if a precancerous lesion is present, it is likely to be years away from becoming a cancer

A

Low-Grade Squamous Intraepithelial Lesion (LGSIL)

68
Q

Note the Bethesda Classification:
Glandular cells may appear slightly abnormal, but malignancy is unclear

A

Atypical Glandular Cell Change of Undetermined Significance (AGCUS)

69
Q

Note the Bethesda Classification:
There is a greater chance that the lesion may develop into cancer sooner

A

High-Grade Squamous Intraepithelial Lesion (HGSIL)

70
Q

Note the Bethesda Classification:
Pap smear reveals slightly abnormal squamous cells, but it is unclear whether they are cancerous

A

Atypical Squamous Cell Change of Undetermined Significance (ASCUS)

71
Q

T/F: For small lesions, Vulvar Biopsy may excise and treat the entire lesion

A

True

72
Q

This is often the first step in evaluation of women with abnormal cytology

A

Colposcopy

73
Q

This procedure uses binocular microscope for direct visualization of the cervix

A

Colposcopy

74
Q

What agent is used to improve visualization in colposcopy?

A

3-5% Acetic acid

75
Q

When should you not perform colposcopy in a menstruating patient?

A

14-16 days after ovulation

76
Q

This is an attractive alternative to cytology-based screening in low-middle income countries

A

Visual Inspection with Acetic acid

77
Q

What is the positive result of VIA?

A

Acetowhite areas in the squamocolumnar junction or entire cervix, or a growth over the cervix

78
Q

The appearance of white patches with VIA is due to:

A

coagulation of cellular proteins and indicate an abnormal epithelium

79
Q

This is the standard test to confirm a chronic uterine infection

A

Endometrial Sampling

80
Q

A blind procedure indicated for DUB & AUB that make use of a Novak curette or a Pipelle cannula

A

Endometrial Sampling

81
Q

Which instrument is the first choice for endometrial sampling?

A

Pipelle curette

82
Q

This is an x-ray imaging technique in which the uterine cavity and the lumina of the fallopian tubes are visualized by injecting contrast material through the canal

A

Hysterosalpingography (HSG)

83
Q

An HSG uses _________, which provides more precise visualization and reduces radiation exposure

A

screen fluoroscopy

84
Q

Uterine synechiae may be diagnosed or lysed with which minimally invasive procedure?

A

Hysteroscopy

85
Q

Give 3 indications for HSG

A

Infertility (Primary or Secondary)
Tubal Patency
Congenital condition (e.g., abnormal uteri)

86
Q

What determines the end point of tubal patency during HSG?

A

Tubal filling with intraperitoneal spilling
and
Increasing pelvic pain secondary to uterine distention due to tubal obstruction

87
Q

This tests the patency of the fallopian tubes with the use of saline and ultrasound instead of a contrast media and x-ray

A

Saline Infusion Sonohysterography (SIS)

88
Q

A procedure that directly visualizes the endometrial cavity with an endoscope and uses a distending media for diagnosis or operations

A

Hysteroscopy

89
Q

Which of the following is an indication for hysteroscopy?
A. Removal of IUD
B. Resection of submucous myoma
C. Removal of endometrial polyps
D. All of the Above

A

D.

90
Q

Which of the following is not an absolute contraindication for Hysteroscopy?
A. Acute pelvic infection with herpes
B. Pregnancy
C. Leiomyomata (>50% intramyometrial)
D. Recent uterine perforations

A

C.

91
Q

Which of the following is not a complication of Hysteroscopy?
A. Anaphylaxis due to dextran
B. Pulmonary edema
C. Hypernatremia
D. Gas embolism with CO2

A

C.

  • should be hyponatremia
92
Q

This procedure provides a window to directly visualize pelvic anatomy and may be diagnostic and therapeutic

A

Laparoscopy

93
Q

What is the most common indication for diagnostic laparoscopy?

A

Pelvic Pain evaluation (previously female sterilization)

94
Q

Which of the following is an absolute contraindication for laparoscopy?
A. Inflammatory bowel disease
B. Advanced malignancy
C. Tuberculous peritonitis
D. Large hiatal hernia

A

C.

95
Q

Mature breasts are ___% glandular tissue and ___% fat and connective tissue

A

20% glandular tissue and 80% fat and connective tissue

96
Q

Cyclic breast tenderness and fullness occurs during which phase of menstruation?

A

Luteal phase

97
Q

The lymphatics of the breast converge in the:

A

subareolar plexus of Sappy

98
Q

Approximately 75% of the lymphatics, particularly the outer quadrants, of the breast drain to which nodes?

A

axillary regional nodes

99
Q

Which anatomic level of the axillary nodes includes infraclavicular nodes medial to the pectoralis minor?

A

Level III

100
Q

The lateral group of axillary nodes is designated as Level:

A

I

101
Q

The 25% of lymphatics from the breast drains to which nodes?

A

internal mammary or parasternal nodes

102
Q

The inferior phrenic nodes, which also drains the breasts, can provide a route for metastatic disease to which organs?

A

Liver, Ovaries and Peritoneum

103
Q

Pertains to supernumerary nipples

A

Polythelia

104
Q

Pertains to accessory breasts

A

Polymastia

105
Q

Pertains to the absence of nipple or areola (an AD trait)

A

Athelia

106
Q

Pertains to massive hypertrophy of the breast during puberty

A

Virginal hypertrophy

107
Q

Benign Breast Disorders can be classified to ANDI, which means:

A

Aberrations of normal development and involution

108
Q

Palpating a firm, rubbery, freely mobile breast mass that does not change in size with menstrual cycle could indicate which BBD?

A

Fibroadenoma

109
Q

T/F: 20% of fibroadenoma recurs after surgical removal

A

True

110
Q

This BBD has dominating stromal elements that will invade ducts in a leafy projection

A

Phyllodes tumor

111
Q

This is most common of all BBD

A

Fibrocystic Change

112
Q

What is the 2nd most common BBD?

A

Fibroadenoma

113
Q

A palpable mass of excessive nodularity similar to a “plateful of peas” may indicate which BBD?

A

Fibrocystic change

114
Q

What is the classic symptom of Fibrocystic change?

A

Cyclic Bilateral breast pain

115
Q

What is the frequent location pain due to fibrocystic changes?

A

Upper outer quadrant

116
Q

Mastitis and Inflammatory disease of the breast may be lactational occurring during:

A

First 6 weeks of breastfeeding

117
Q

A non-lactational mastitis can be associated with:

A

breast cyst or cyst rupture

118
Q

This BBD is frequently diagnosed when biopsy demonstrates sterile granulomas after excluding other causes of granulomatous mastitis such as tuberculosis

A

Idiopathic Granulomatous Mastitis

119
Q

What are the two most common causes of spontaneous non-milky discharge?

A

Intraductal Papilloma
Fibrocystic change

120
Q

This imaging can aid in diagnosing the cause of an abnormal nipple discharge

A

Ductography (galactogram)

121
Q

What is the classic symptom of Intraductal Papilloma?

A

Intermittent but spontaneous bloody discharge from one nipple involving 1 or 2 ducts

122
Q

What is the management for Intraductal Papilloma?

A

Excisional biopsy of involved duct and small amount of surrounding tissue

123
Q

This is a benign nonsuppurative inflammatory process of the breast adipose tissue

A

Fat necrosis

124
Q

Fat necrosis of the breast is commonly caused by

A

trauma

125
Q

Which of the following is associated with Fat necrosis of the breast?
A. Warfarin use
B. Radiotherapy
C. Breast biopsy
D. All

A

D.

126
Q
A

GYNECOLOGY (1 decks)

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