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Ashly Benson: CPD > CPD Lab: Female genitalia, CBE, PVE > Flashcards

CPD Lab: Female genitalia, CBE, PVE Flashcards

1
Q

Location of Bartholin’s glands

A

5-7 o’clock of vaginal introitus. Palpate using thumb and index finger (if indicated)

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2
Q

Ddx of swelling of Barthloin’s glands

A

Bartholin’s gland cyst, abscess, adenocarcinoma

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3
Q

When is vaginal discharge heaviest and stringy?

A

Ovulation

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4
Q

Wet prep: location of sample

A

Posterior fornix

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5
Q

Order of sample taking

A
  1. Wet prep (check pH)
  2. Cervical culture
  3. Pap smear (a: V shaped brush 5x 360 rotations at squamocolumnar junction b: cytobrush into the os the depth of the brush, rotate once)
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6
Q

What do wet preps test for?

A

Candida albican, trichomonas, bacterial vaginosis (sample must be warm)

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7
Q

What do cervical cultures test for?

A

Uterine infection (streptococcus, gonorrhea, chlamydia)

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8
Q

Where is a cervical culture sample taken from?

A

Sterile swab inserted into the os one rotation holding swab in os up to level of the cotton for 30 seconds.

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9
Q

During the bi-manual exam, the internal hand _______ while the abdominal hand _________ __________.

A

Internal hand: palpates

Abdominal hand: maneuvers organs

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10
Q

Where should abdominal hand be placed during uterine palpation?

A

Midway between the umbilicus and the symphysis pubis

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11
Q

Where should the abdominal hand be placed during adnexal palpation?

A

Just medial to the iliac crest

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12
Q

What parameters should you assess if a mass is noted?

A 
Bilateral/unilateral
Cystic/solid
Smooth/irregular
Fixed/movable
Tender/non-tender
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13
Q

When is a recto-vaginal exam indicated?

A

1) Retrovertoed or retroflexed uteri
2) Suspected masses in rectovaginal septum (endometriosis)
3) Women over age 40: screen for colorectal CA

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14
Q 
Tanner Stages of sexual maturation rating (SMR)
Stage 1 (breast)
A

Preadolescent: elevation of nipple only

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15
Q

SMR Stage 2 (breast)

A

Breast bud stage: elevation of breast and nipple as a small mound; enlargement of areolar diameter

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16
Q

SMR Stage 3 (breast)

A

Further enlargement of elevation of breast and areola with no separation of their contours

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17
Q

SMR Stage 4 (breast)

A

Projection of areola and nipple to form a secondary mound above the level of the breast

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18
Q

SMR Stage 5 (breast)

A

Mature stage: projection of nipple only. Areola has receded to general contour of breast

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19
Q

SMR Stage 1 (pubic hair)

A

Preadolescent: no pubic hair except for fine body hair (vellus hair) similar to that of abdomen

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20
Q

SMR Stage 2 (pubic hair)

A

Sparse growth of long, slightly pigmented downy hair, straight or only slightly curly, chiefly along the labia

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21
Q

SMR Stage 3 (pubic hair)

A

Darker, coarser, curlier hair, spreading sparsely over the pubic symphysis

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22
Q

SMR Stage 4 (pubic hair)

A

Coarse and curly hair as in adults; area covered greater than in stage 3 but not as great as in the adult and not yet including the thighs

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23
Q

SMR Stage 5 (pubic hair)

A

Hair adult in quantity and quality, spread on the medial surfaces of the thighs but not up over the abdomen

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24
Q

Skene’s glands location

A

Posterior to the urethral meatus bilaterally

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25
Q

Condyloma Acuminata from HPV

A

Epidermal manifestation of HPV [commonly HPV 6 or 11 (genital warts)]

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26
Q

HPV and cervical dysplasia

A

HPV strains 16 and 18 cause 70% of cervical dysplasia

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27
Q

Pederson vs Graves and indications for each

A

Pederson: flat and narrow (younger, virginal, nulliparious women, menopausal/post menopausal women)
Graves: wider blade with curved sides (parous women)

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28
Q

What is it termed when the squamocolumnar junction is visible as a darker pink circle around the os?

A

Ectropion

29
Q

What does CMT indicate?

A

Infection, endometriosis, PID, ovarian cysts, adhesions, adnexal torsion

30
Q

Normal size, shape and configuration of the uterus?

A

Anteverted (most common position), anteflexed, retroflexed, retroverted
Normal size: 6cm x 4cm
Mobile, smooth and NT

31
Q

Difference between retroversion and retroflexion and how are they best palpated?

A

Retroversion: uterus is slightly tipped posteriorly

Retroflexion: the fundus is pointing backwards, anterior of uterus is convex

Palpate by rectovaginal examination

32
Q

What is a leiomyoma and what does it feel like on bimanual palpation?

A

A uterine fibroid, uterus feels enlarged and irregular, mobility of cervix may be restricted with inflammation.

33
Q

What is the normal size of an ovary? What does it feel like on bimanual palpation?

A

2-4 cm in menstruating women. Should feel like a little almond shape

34
Q

What is the purpose of the bimanual exam?

A

To assess vaginal walls, CMT uterus size shape, assess adnexa

35
Q

In the United States 1 in___ women could develop breast cancer?

A

1 in 9 women

36
Q

CBE can detect tumors as small as ___

A

3 mm

37
Q

What are the two most common locations of breast cancer?

A

Upper outer quadrant (tail) 50%
Areola-nipple complex 18%

Upper inner quadrant 15%
Outer lower quadrant 11%
Inner lower quadrant 6%

38
Q

What is the main risk factor for developing breast cancer?

A

Being a woman

39
Q

What age group is most commonly diagnosed with Breast CA?

A

Women over 50 (77%)

40
Q

Women with what gene mutation have an 80% risk of developing breast cancer during their lifetime and at a younger age?

A

BRCA1 or BRCA2

41
Q

What are some other risk factors for developing breast CA?

A

1st degree relatives, early menarche, late menopause, later pregnancy, alcohol, obesity, high fat diets, HRT, ionizing radiation exposure

42
Q

What are protective factors?

A

Physical activity (risk reduction 18% w/2.5 hrs of brisk walking/week), lower menopausal BMI, breast feeding for 16 months

43
Q

When is the best time to do the SBE (self breast exam)?

A

Just after menstruation

44
Q 
Vertical Strip Search Pattern:
Palpating with which fingers?
How many levels of pressure?
How many seconds per circular motion?
Average time to examine both breasts?
A

3 middle finger pads moving in dime sized circular pattern
3 levels of pressure (light, medium, deep)
1 seconder per circular motion
6-8 minutes

45
Q

If you note a nodule or mass what should you chart?

A

location, size (in cm), shape, consistency, delimitation, mobility

46
Q

What is the breast perimiter?

A 
Superior: clavicle
Medially: lateral edge of sternum
Inferior: inframammary fold
Lateral: Latissimus dorsi muscle
Line from lateral edge of clavicle to edge of Lat Dorsi @ lower axilla
47
Q

What position should the patient be in when palpating the axillary, supraclavicular and infraclavicular lymph nodes?

A

Seated w/ gown on

48
Q

What are characteristics of a malignant tumor?

A

irregular shape, stony hard consistency, poorly delimited, fixed, NTTP, with skin retraction present

49
Q

What are the defining characteristics of cystic disease?

A

More than 1 mass, round, elastic and well delimited, mobile, tender

50
Q

What is a differential characteristic between cystic disease and a benign adenoma?

A

Cystic disease: 1 or more masses and tender

Benign Adenoma: 1 non-tender mass

51
Q

Allen’s test

A

Assesses latency of ulnar and radial arteries and arteries of the hands: pump hand open and closed inn cactus arm position, occlude both radial/ulnar arteries and then let one go. Upper limit for refill: 7-10 seconds

52
Q

Which parts of the arm do the epitrochlear lymph nodes drain?

A

Epitrochlear nodes: between grooves of the biceps and triceps, 3 cm proximal to the medial epicondyle

Ulnar aspect of arm drains to epitrochlear

53
Q

Which parts of the arm drain to the axilla?

A

Radial

54
Q

Which pulse may be congenitally absent?

A

Dorsal Pedis

55
Q

Where is the posterior tibial pulse palpated? Dorsal Pedis?

Popliteal?

A

Behind medial malleolus
Lateral to extensor hallicus longus
Behind pts flexed knee

56
Q

How is capillary refill assessed?

A

Hold pts hand at heart level and compress nail for 5 seconds.

Normal refill time: 2 sec (children and adult men) 3 sec (adult women) 4 sec (elderly)

57
Q

What test is used when coarctation of the aorta is suspected?

A

Ankle Brachial Index (BP in arms is higher than legs)

Normally BP in upper arms is lower than legs by 10-20 mmHg

58
Q

What makes one suspect coarctation of the aorta?

A

Diminished or delayed femoral pulses compared to brachial or radial pulses

59
Q

Edema rating

A 
Trace = 1+ (slight w/rapid response)
Mild = 2+ (0-0.6 cm 10-15 sec response)
Moderate = 3+ (0.6-1.3 cm 1-2 min response)
Severe = 4+ (1.3-2.5 cm 2-5 min response)
60
Q

What are the key physical exam findings for deep venous thrombosis?

A

Pain and tenderness along the course of major veins
Unilateral pitting edema
Swelling of the entire leg
Calf swelling greater than 3 cm compared to the uninvolved leg

61
Q

What are signs of arterial insufficiency?

A

Pallor, ulcers, loss of normal hair distribution, diminished pulses

62
Q

What is the characteristic of ulcers of arterial insufficiency?

A

Ulcers are found at pressure points

63
Q

What is claudication?

A

Pain while walking

64
Q

How do you perform Beurger’s test and what does it test for?

A

Arterial insufficiency: have pt raise legs to 60 degrees until maximal pallor develops (60 sec), return legs/have pt stand. Color should return in <10 seconds

65
Q

What is the Trendelenburg test?

A

Beurger’s w/tourniquet to assess superficial and deep veins of the legs.

66
Q

How do you interpret results of Trendelenburg’s test?

A

Elevate leg to drain leg, put tourniquet on and return leg to standing. Watch for rapid refilling. If vein fills w/tourniquet = deep vein (femoral) competency. Remove tourniquet and look for additional filling = superficial (saphenous) problem as well. If no filling until tourniquet is removed = saphenous problem only

67
Q

Using Well’s criteria, what is a high, moderate and low probability score?

A

High >/= 3
Moderate 1 or 2
Low 0

68
Q

What is the next step with a moderate or high probability?

A

Compression ultrasound

69
Q

What is the next step with a low probability?

A

Serum D-dimer

If negative, DVT is ruled out
If positive, compression ultrasound is indicated

Ashly Benson: CPD (3 decks)

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