Bates-FemaleGenitalia Flashcards
The _ is a hair-covered fat pad overlying the symphysis pubis.
Mons pubis
What is the introitus?
The external vaginal opening
Where are the Skene’s glands?
-aka Paraurethral glands
Where are the openings to the Bartholin’s glands?
- posterior on either side of the vaginal opening
The two parts of the uterus are the ___ and the ___ and join at the ___
- corpus (body)
__ is the age of first menses
menarche
___ is the absence of menses for 12 months
Menopause
Postmenopausal bleeding occurs ____ or more months after cessation of menses.
6
___ is the absence of menses.
Amenorrhea
What is dysmenorrhea?
pain with menses, often with bearing down, aching, or cramping sensation in lower abd or pelvis
What is PMS
- premenstrual syndrome
___ can be imporant in signaling a possible pregnancy or menstrual irregularities.
Dates of previous periods
What causes primary dysmenorrhea?
- increased prostaglandin production during luteal phase of the menstrual cycle, when estrogen and progesterone levels decline.
What causes secondary dysmenorrhea?
endometriosis, adenomyosis (endometriosis in muscular layers of uterus), pelvic inflammatory disease, and endometrial polyps
What is the difference between primary and secondary amenorrhea?
- primary: failure of periods to initiate at all
Pregnancy, lactation, menopause, anorexia, malnutrition, etc can all cause ___
secondary amenorrhea.
Describe the pattenrs encomapssd by the term “abnormal uterine bleeding”
- polymenorrhea - <21day intervals
What does postcoital bleeding suggest?
cervical polyps or cancer,
Menopause usually occurs between what ages?
48-55 years
Concerns regarding estrogen replacement for perimenopausal women includes:
- relieves symptoms of menopause,
What does this mean?
G3= 4 total pregnancies (including current)
What are the most common vulvovaginal symptoms?
vaginal discharge and local itching
What is dyspareunia?
Pain during sex
Superficial dyspareunia suggests?
- inflammation, atrophic vaginitis, or inadequate lubrication
Deeper dyspareunia suggests?
- Pelvic disorders, pressure on a normal ovary
What is vaginismus?
Involuntary spasm of the muscles surrounding vaginal orifice that makes penetration painful (may be physical or psychological)
What is the “most important risk factor for cervical cancer”?
infection with high-risk strains of HPV
What is the most common STD in the US?
Genital infection with HPV
When should females receive their first screening for cervical cancer?
- approx 3 years after first sex, or by 21 years whichever comes first
How often should women be screened for cervical ca?
- up to age 30: annually with regular test or q2 years with liquid-based cytology
Describe the levels of scoring for the bethesda scale?
- Neg
What does the Bethesda system measure?
Categorizes abnormal pap spmears into groups according to severity
Prior to the pelvic exam, a patient should:
- avoid sex, douching, or vaginal suppositories for 24-48 hours
What are causes of delayed puberty?
- familial
Excoriations or itchy, small red maculopapules suggest ___
Pediculosis pubis (lice or “crabs”)
Yellowish discharge on the endocervical swab during a pelvic suggests ___
Mucupurulent cervicitis (chlamydia trachomatis, gonorrhoeae, or herpes)
Raised, friable, lobed lesions occur in ___
condylomata or cervical cancer
Pain on movement of the cervix along wiht adnexal tenderness suggest ___
pelvic inflammatory disease
Uterine enlargement suggests ____
pregnancy, uterine myoma (fibroid), or malignancy
Weakness of the pelvic muscles may be associated wiht ____
urinary stress incontinence
The most common hernia in the female groin is a ___ followed by the next most frequent, a ___ hernia
- indirect inguinal hernia
A pt presents with a small, firm, round cystic nodule in the labia. It may be yellowish in color and has a dark punctum in the center.
- epidermoid cyst
A pt presents with warty lesions on the labia and within the vestibule.
Condyloma acuminatum
A firm, painless ulcer suggests __
primary syphilis
Slightly raised, round or oval, flat-topped papules covered by gray exudate suggest ____
Condylomata lata (secondary syphilis)
Pt presents with shallow, small, painful ulcers on red bases.
Herpes
A 70 year-old female presents with an ulcerated or red-raised vulvar lesion. This suggests.
Vulvar carcinoma
What is a cystocele?
a bulge of upper two thirds of anterior vaginal wall and bladder above it resulting from weakneed supporting tissues
A ___ is a bulging of the entire anterior vaginal wall, bladder, and urethra, is a ____
- cystourethroceleL
What is a urethral caruncle?
Small, red, benign tumor visible at posterior part of urethral meatus.
How can you differentiate between a urethral caruncle and urethral carcinoma?
- palpate the urethra through the vagina for thickening, nodularity, or tenderness, and feel for inguinal lymphadenopathy
____ forms a swollen red ring around the urethral meatus.
Prolapse of urethral mucosa
When does a urethral mucosa prolapse generally occur?
Before menarche or after menopause
What is the cause of a Bartholin’s gland infection>
Trauma, gonococci anaerobes, and chlamydia.
A tense, hot, tender abscess posterior to the vaginal opening iwth purulent drainage suggests a ____
Acute infection of a Bartholin’s gland
How would a chronic infection of the Bartholin’s cyst present>
- non-tender cyst posterior to the vaginal opening that may be large or small
What is a rectocele?
A herniation fo the rectum into the posterior wall of the vagina froma weakness or defect in the endopelvic fascia
What two types of epithelia cover the cervix?
- shiny pink squamous epithelium
What is the squamocolumnar junction?
Where the type of epithelium changes between the vagina and the cervix
Where do most dysplastic changes occur within the cervix?
Squamocolumnar junction
What are nabothian cysts?
translucent nodules on the cervical surface that often develop during adolescence when pink squamous epithelium takes over the columnar epithelium… this is normal and has no pathologic significance
Cervical polyps usually arise from ____, and appears as a ___.
- endocervical canal
Describe findings consistent with carcinoma of the cervix.
- begins in area of metaplasia
What factors increase risk for cervical cancer?
- early, frequent intercourse
Cervical abnormalities in female infants of women who took DES may include:
- columnar epithelium that covers most or all of the cervix
Adnexal masses most commonly result from ___
disorers of fallopian tubes or ovaries.
A pt presents with a smooth, compressible mass on her R ovary. It is not tender. You should suspect ___
Ovarian cysts
A pt presents with a solid, nodular mass to her R ovary. You suspect.
Ovarian tumor
What are the diagnostic parameters of polycystic ovarian syndrome?
- exclusion of several endocrine disorders
Symptoms of ovarian cancer include ___
pelvic pain, bloating, increased abd. size, urinary tract symptoms
A 23 year old female presents with severe abdominal pain, guarding, and tenderness. She has a small, palpable mass to the R adnexa. She appears pale, and nauseous with vomiting. Suspect -
Ruptured tubal pregnancy
Pelvic inflammatory diseasemost commonly is due to infection of the ___
1 fallopian tubes (salpingitis)
What is salpingitis?
inflammation of the fallopian tubes
What is oophoritis?
INflammation of the ovaries
PID is caused most commonly by:
- neisseria gonorrhoeae
A pt presents with severe abdominal pain, diffusely, with bilateral adnexal masses and spasming of the pelvic muscles. You should suspect __
PID
If PID is not treated, what can occur?
tubo-ovarian abscess or infertility
Describe uterine Myomas.
- aka fibroids
__ resutls from weakness of supporting structures of hte pelvic floor and is associated with cystocele or rectocele.
Prolapse of the uterus
Describe the degrees of uterine prolapse:
- first deg - cervix still well within the vagina
What is retroversion of the uterus?
- tilting backward of the entire uterus including body and cervix.
A pt presents with a cervix facing forward and uterine body cannot be felt on manual exam. You should suspect ___
retroversion of the uterus
What is retroflexion of the uterus?
- backward angulation of the body of the uterus in relation to the cervix. Body is often palpable through post fornix or rectum
A female presents with a yellowish green (or grey) discharge that appears frothy and foul smelling. She also complains of itching and painful urination. ON exam you find her labias reddened. You suspect ___
Trichomonas vaginalis
A pt presents with white cheese-like discharge and severe vaginal itching. The discharge has no unique odor. She also complains of painon urination and painful sex. You suspect ___
candidal vaginitis
A pt presents with white discharge that is foul smelling. The discharge appears minima, however the pt reports a ‘fishy’ smell. You suspect _
bacterial vaginosis
How do you identify trichomonas in the lab?
Look for trichomonads on wet mount.
How do you look for candida inthe lab?
- KOH prep for hypae
How do you identify bacterial vaginitis in the lab?
- clue cells on saline prep
Describe qualities of atrophic vaginitis.
- +/- discharge
