Ch 6 Physical Exam of the Female Genitalia Flashcards
Amenorrhea
Absent menstrual cycle
The Vulva, External female genital organs include:
Mons pubis
Labia majora
Labia minora
Clitoris
Vaginal Vestibule
Vaginal Orifice
Urethral opening
Primary center of sexual excitement
Clitoris
In the labia minor is a vestibule containing the:
Urethra
Vagina
Skene glands
Bartholin glands
Bartholin glands, located posteriorly on each side of the vaginal orifice, open onto the sides of the vestibule in the groove between the:
Labia minora and the hymen
During sexual excitement, what glands secrete mucus into the introitus for lubrication?
Bartholin glands
The vagina inclines:
Posteriorly
Musculomembranous tube that is transversely rugated
Vagina
Anterior wall of the vagina is separated from the bladder and urethra by the ________ septum
Vesicovaginal septum
The posterior wall of the vagina is separated from the rectum by the ______ septum
Rectovaginal
Pelvic organs may be palpated through pockets around the cervix called:
Fornices
The nonpregnant uterus is usually positioned anteroposteriorly and weighs:
60-90 g
The uterus is divided anatomically into the:
Corpus and cervix
The uterine corpus consists of the:
Fundus
Body
Isthmus
Convex upper portion between the fallopian tubes
Fundus
Main portion of the uterine corpus
Body
Constricted lower portion adjacent to the cervix
Isthmus
The cervix extends from the _____ into the vagina
Isthmus
The adnexa of the uterus are composed of the:
Fallopian tubes
Ovaries
Pair of oval organs resting in a slight depression on the lateral pelvic wall at the anterosuperior iliac spine
Ovaries
What controls the menstrual cycle and supports pregnancy?
Ovaries
The internal genitalia are supported by what ligaments?
Cardinal
Uterosacral
Round
Broad
Prolonged menses is defined as greater than how many days?
> 7 days
The pelvis is formed by what four bones?
2 Innominate
Sacrum
Coccyx
What are the four pelvic joints?
2 Sacroiliac joints
Symphysis pubis
Sacrococcygeal
What contributes to the strengthening and elasticity of pelvic ligaments and softening cartilage?
Increased levels of the circulating hormones Estrogen and Relaxin
Later in pregnancy the symphysis pubis _______
Separates
Shallow upper section of the pelvis
False pelvis
Lower curved bony canal of the pelvis
True pelvis
Term pregnancy is longer than ___ weeks
37 weeks
Infant/Child
The cervix is ______ of the entire length of the uterus
Two-thirds
Infant/Child
Thin covering inside the introitus, giving the vaginal opening a crescent-shaped appearance
Hymen
During childhood, what part of the genitalia does not grow incrementally at varying rates?
Clitoris
Adolescents
If the hymen is intact, the vaginal opening is __ cm
1 cm
Average age of menarche
11-14
Pregnant women
Muscular walls become more elastic, and the uterus rises out of pelvis into the abdominal cavity by __ weeks of gestation
12 weeks
Pregnant women
Uterine weight at term, excluding the fetus and placenta
1000 g
Pelvic congestion and edema during pregnancy occur from:
Increases in blood volume
The cervix becomes bluish during:
Pregnancy
“Waddle gait” is due to:
Pelvic joint separation
Pregnant women
The papillae of the mucosa have a ______ appearance
Hobnailed
Ovarian function diminishes around age ___
40
Menopause occurs between:
40 and 55 years of age
Ovulation ceases about how long prior to menopause
1-2 years
Menopause is conventionally defined as:
1 year with no menses
After menopause, women experience an increased risk of:
Cardiovascular disease
Prescribed to reduce the impact of menopausal symptoms and sequalae
Hormone replacement (estrogen with or without progestin)
Examination:
Patient expresses what before an examination may be a sign that something is not quite right
Marked anxiety
Patient should have an empty ______ during exam
Bladder
Examination position.
Supine with knees bent, legs spread apart, and feet placed in metal stirrups at the foot of the exam table
Lithotomy
Woman lies on her back with her knees bent so that both legs are spread flat and her heels meet at the foot of the table
Diamond-shaped position
Obstetric stirrups support the legs under the:
Knee
Woman lies on her back, knees bent and apart, feet resting on the exam table close to her buttocks
Does not require the use of stirrups
M-Shaped Position
The woman lies on her back with her straightened legs spread out wide to either side
V-position
Which variable position allows the women to place one foot in the stirrup and one leg straightened?
V-Shaped position
Women with sensory impairment may do what during exam?
Elevate the head to see the clinician
Length of the clitoris
<2 cm
Glands that are milked during exam to look for discharge and note any tenderness
Skene glands
Glands that are palpated to look for discharge, swelling that is painful, hot to touch indicates an abscess
Bartholin glands
Bartholin gland abscess are usually what in origin?
Gonococcal
Staphylococcal
Bulging of the anterior wall and urinary incontinence indicate the presence of a:
Cystocele
Bulging of the posterior wall indicates a:
Rectocele
Marked by protrusion of the cervix or uterus on straining
Uterine prolapsed
Use ______ to inspect cervix and vaginal walls
Speculum
Lubricate the speculum with:
Water or water-soluble lubricant
Used to warm a cold speculum
Water
Slowly insert the speculum along the path of _________
Least resistance
often slightly downward
Inspect the cervix for:
Position
Size
Surface characteristics
Discharge
Size and shape of the Os
A cervix pointing anteriorly indicates a:
Retroverted uterus
A cervix pointing posteriorly indicates an:
Anteverted uterus
Deviation of the cervix to the right or left may indicate a:
Pelvic mass
Uterine adhesions
Pregnancy
Vaginal smears and cultures from a pelvic exam
PAP smears
Gonococcal
Chlamydia and Gonorrhea DNA Probe
Wet Prep
KOH
The ovaries if palpable should feel:
Firm, smooth, ovoid
Rectovaginal exam allows the provider to reach ____ higher into the pelvis
2.5cm (1 inch)
After hymen tears, ______ may be visible
Hymen tags
Uterus is usually flattened and anteroposterior at a __-degree angle
45-degree angle
The perineum is ________ in multiparous women
Thinner and more rigid
Perineum is more thick and smooth in ______ women
Nulliparous women
Pale cervix suggests:
Anemia
Os of nulliparous women may be_____
Small, round, oval
Os found in ______ women may be more horizontal, irregular, or stellate
Multiparous
External labia swelling, pain, warmth, and redness may mean:
Bartholin gland abscess
In newborns, labia majora are separate and clitoris is prominent up to ___ weeks of gestation
36 weeks
Newborn
Hymen often protrudes and central opening is about __cm
0.5 cm
Newborns
Genitalia may be swollen and bruised for many days from:
Breech delivery
Mucoid whitish vaginal discharge may be seen from birth to 1 month of age as a result of:
Hormonal transfer in utero
Internal vaginal exam is performed on a young child only when there is a specific problem such as:
Bleeding, discharge, trauma, or sexual abuse
Infants
Vaginal discharge problems should be assessed for possible relationship to use of:
Diapers, powders, or lotions
Infants/Children
Swelling of vulvar tissues with bruising suggests:
Sexual abuse
Enlarged clitoris in newborn suggests:
Adrenal hyperplasia
In children a foul odor is more likely indicative of a:
Foreign body
All ______ teenagers should have an annual pelvic exam, pap smear, and STI evaluation
Sexually active
Young women who are not sexually active should have their first exam by age:
21
Vaginal secretions ______ before menarche
Increase
By menarche, vaginal opening should be at least __ cm wide
1 cm
Menstrual cycle characteristics may include:
Dysmenorrhea (painful periods)
Breast tenderness
Headaches
Vaginal discharge (yellow, green, or gray) with odor suggests:
Infection
Ulcers or vesicles may be from:
STI
Urethral inflammation or dilation suggests:
Repeated UTIs
Discharge from ____ glands suggests infection
Skene
Regar sign
Softening of the isthmus
Chadwick sign
Bluish cervix
Cervical softening
Goodell sign
The relationship of the presenting part of the ischial spines
Station
The uterus may be more anteflexed (pressing more on the bladder) during:
First 3 months
The uterus deviates at ____ weeks of gestation (Piskacek sign)
8-10 weeks
Enlarged uterus suggests:
Pregnancy
Tumor
With older adults, the cervix becomes:
Smaller, paler, and less mobile
Premenstrual Syndrome (PMS) usually begins at what age?
Late 20s
Characterized by edema, headache, weight gain and behavioral disturbances such as irritability, nervousness, dysphoria, and lack of coordination
Symptoms lasts 5-7 days
Premenstrual Syndrome
Infertility is defined as:
Inability to conceive over a period of 1 year of unprotected regular intercourse
Factors that cause infertility other than anatomical
Stress
Nutrition
Chemical substances
Certain Diseases/Sexual/Immunological responses
Presence of growth of endometrial tissue outside the uterus causes pelvic pain, dysmenorrhea, and heavy or prolonged menstrual flow
Endometriosis
Warty lesions on the labia from HPV.
Flesh-colored, whitish pink to reddish brown, discrete, soft growths and may form cauliflower-like masses
Condyloma Acuminatum
Benign skin infection caused by poxvirus
Incubation period is 2-7 weeks
Dome shaped papules
Molluscum Contagiosum
Lesions secondary syphilis appear about 6-12 weeks after infection
Flat, round, or oval papules covered by gray exudates
Condyloma latum
A firm, painless ulcer
In women develop internally
Syphilitic chancre
Small red vesicles
Lesions may itch and are painful and usually confined to a small localized patch on the vulva, perineum, vagina or cervix
Herpes
Caused by gonococcal infection
Hot, red, tender, fluctuant swelling that may drain pus
Chronic inflammation results in a nontender cyst on the labium
Inflammation of Bartholin gland
A hernial protrusion of the urinary bladder through the anterior wall of the vagina
Bulging can be seen as the women bears down
Cystocele
Hernial protrusion, part of the rectum through the posterior wall of the vagina
Rectocele
Findings include vaginal discharge, lesions, and masses
Vulva appears as ulcerated or raised red lesions on the vulva
Carcinoma
A bright red polypoid growth that protrudes from the urethral meatus
Urethral carbuncle
Watery discharge usually not foul smelling; dysuria, profuse frothy, greenish discharge
Trichomoniasis
Purulent discharge from the cervix; skene/Bartholin inflammation
Gonorrhea
Homogenous thin, white or gray discharge
Positive KOH with clue cells
Bacterial vaginosis
Enlarged fluid-filled retention cysts that vary in size
Infected Nabothian cysts
Bright red, soft and fragile arise from the endocervical canal
Cervical polyps
Appear as shiny red tissue around the Os that may bleed easily
Columnar epithelium
Result of weakening of the supporting structures of the pelvic floor, often occurring with a cystocele or rectocele
Uterine prolapsed
In second-degree prolapse, the cervix is at the:
Introitus (opening)
In third-degree prolapsed the cervix is:
Outside the introitus
Are common, benign, uterine tumors that appear as firm, irregular nodules in the contour of the uterus
Myomas
Growths that can occur unilaterally or bilaterally
Smooth in nature
Ovarian cysts
Causes marked pelvic tenderness, with tenderness and rigidity of the lower abdomen
A tender, unilateral adnexal mass may indicate the site of pregnancy
Surgical emergency
Ruptured tubal pregnancy
Pelvic inflammatory disease is often caused by:
Gonococcal or Chlamydial infection
Inflammation or infection of the fallopian tube and associated with Pelvic inflammatory disease
Salpingitis
Vaginal secretions that collect behind an imperforate hymen and manifested by small midline lower abdominal mass or small cyst between the labia
Hydrocolpos
Vaginal discharge accompanied by warm, erythematous, and swollen vulvar tissue
Vulvovaginitis
A loop of cord may advance with the presenting part
Usually occurs with rupture of the membranes
Prolapse of the umbilical cord
Common during pregnancy and may involve both the vulva and rectal area. Pressure from the pregnant uterus contribute to the formation.
Vulvar varicosities
Caused by lack of estrogen. Vaginal mucosa is dry and pale.
The accompanying vaginal discharge may be white, gray, yellow, green or blood-tinged.
Atrophic vaginitis
