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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
Condyloma Acuminata from HPV
Epidermal manifestation of HPV [commonly HPV 6 or 11 (genital warts)]
26
HPV and cervical dysplasia
HPV strains 16 and 18 cause 70% of cervical dysplasia
27
Pederson vs Graves and indications for each
Pederson: flat and narrow (younger, virginal, nulliparious women, menopausal/post menopausal women) Graves: wider blade with curved sides (parous women)
28
What is it termed when the squamocolumnar junction is visible as a darker pink circle around the os?
Ectropion
29
What does CMT indicate?
Infection, endometriosis, PID, ovarian cysts, adhesions, adnexal torsion
30
Normal size, shape and configuration of the uterus?
Anteverted (most common position), anteflexed, retroflexed, retroverted Normal size: 6cm x 4cm Mobile, smooth and NT
31
Difference between retroversion and retroflexion and how are they best palpated?
Retroversion: uterus is slightly tipped posteriorly Retroflexion: the fundus is pointing backwards, anterior of uterus is convex Palpate by rectovaginal examination
32
What is a leiomyoma and what does it feel like on bimanual palpation?
A uterine fibroid, uterus feels enlarged and irregular, mobility of cervix may be restricted with inflammation.
33
What is the normal size of an ovary? What does it feel like on bimanual palpation?
2-4 cm in menstruating women. Should feel like a little almond shape
34
What is the purpose of the bimanual exam?
To assess vaginal walls, CMT uterus size shape, assess adnexa
35
In the United States 1 in___ women could develop breast cancer?
1 in 9 women
36
CBE can detect tumors as small as ___
3 mm
37
What are the two most common locations of breast cancer?
Upper outer quadrant (tail) 50% Areola-nipple complex 18% Upper inner quadrant 15% Outer lower quadrant 11% Inner lower quadrant 6%
38
What is the main risk factor for developing breast cancer?
Being a woman
39
What age group is most commonly diagnosed with Breast CA?
Women over 50 (77%)
40
Women with what gene mutation have an 80% risk of developing breast cancer during their lifetime and at a younger age?
BRCA1 or BRCA2
41
What are some other risk factors for developing breast CA?
1st degree relatives, early menarche, late menopause, later pregnancy, alcohol, obesity, high fat diets, HRT, ionizing radiation exposure
42
What are protective factors?
Physical activity (risk reduction 18% w/2.5 hrs of brisk walking/week), lower menopausal BMI, breast feeding for 16 months
43
When is the best time to do the SBE (self breast exam)?
Just after menstruation
44
``` 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? ```
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
If you note a nodule or mass what should you chart?
location, size (in cm), shape, consistency, delimitation, mobility
46
What is the breast perimiter?
``` 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
What position should the patient be in when palpating the axillary, supraclavicular and infraclavicular lymph nodes?
Seated w/ gown on
48
What are characteristics of a malignant tumor?
irregular shape, stony hard consistency, poorly delimited, fixed, NTTP, with skin retraction present
49
What are the defining characteristics of cystic disease?
More than 1 mass, round, elastic and well delimited, mobile, tender
50
What is a differential characteristic between cystic disease and a benign adenoma?
Cystic disease: 1 or more masses and tender | Benign Adenoma: 1 non-tender mass
51
Allen's test
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
Which parts of the arm do the epitrochlear lymph nodes drain?
Epitrochlear nodes: between grooves of the biceps and triceps, 3 cm proximal to the medial epicondyle Ulnar aspect of arm drains to epitrochlear
53
Which parts of the arm drain to the axilla?
Radial
54
Which pulse may be congenitally absent?
Dorsal Pedis
55
Where is the posterior tibial pulse palpated? Dorsal Pedis? | Popliteal?
Behind medial malleolus Lateral to extensor hallicus longus Behind pts flexed knee
56
How is capillary refill assessed?
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
What test is used when coarctation of the aorta is suspected?
Ankle Brachial Index (BP in arms is higher than legs) Normally BP in upper arms is lower than legs by 10-20 mmHg
58
What makes one suspect coarctation of the aorta?
Diminished or delayed femoral pulses compared to brachial or radial pulses
59
Edema rating
``` 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
What are the key physical exam findings for deep venous thrombosis?
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
What are signs of arterial insufficiency?
Pallor, ulcers, loss of normal hair distribution, diminished pulses
62
What is the characteristic of ulcers of arterial insufficiency?
Ulcers are found at pressure points
63
What is claudication?
Pain while walking
64
How do you perform Beurger's test and what does it test for?
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
What is the Trendelenburg test?
Beurger's w/tourniquet to assess superficial and deep veins of the legs.
66
How do you interpret results of Trendelenburg's test?
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
Using Well's criteria, what is a high, moderate and low probability score?
High >/= 3 Moderate 1 or 2 Low 0
68
What is the next step with a moderate or high probability?
Compression ultrasound
69
What is the next step with a low probability?
Serum D-dimer If negative, DVT is ruled out If positive, compression ultrasound is indicated

Ashly Benson: CPD (3 decks)

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