Female Flashcards
Menarche=age of onset is usually
9-13
How often does the patient have menses?
21 to 35 days is normal
How long are the menses?
4 to 7 days is normal
To document menstrual history:
Age x Cycle frequency x duration.
Example: age 11, every 28 days, 5 day duration= 11 x 28 x 5
increased frequency of menses
polymenhorrhea
excessive amount of menses
menorrhagia
decrease frequency of menses
oligomenorrhea
interval between menses irregular
metrorrhagia
combination: irregular interval, excessive amount of menses
menometrorrhagia
absent menses
amenhorrhea
failure of menses to be initiated
Primary amenhorrhea
cessation of menses have it had previously existed
Secondary amenhorrhea
painful periods with cramping or aching in the lower pelvis/lower back
dysmenorrhea
Complex of symptoms occuring 4 to 5 days before onset. Psychological and physical (tension, irritability, depression, mood swings, weight gain, bloating, edema, headaches, breast tenderness)
Premenstrual syndrome (PMS)
Pregnancy history documentation
G#P(TPAL) G#=total # pregnancies P=# deliveries T=full term deliveries >37 wks P=premature deliveries <20-37 weeks A=abortion/miscarriage L=living children
Total number of pregnancies
gravity
Number of deliveries
parity
full term deliveries
> 37 wks
premature deliveries
<20-37 weeks
Document:
- 5 living children
- 4 children delivered full term
- emergency surgery at 8 months
- 2 abortions
G_P_ _ _ _
G7 P4125
pain with sex
dyspareunia
what causes menopause?
decline in ovarian production of estrogen
Average age of menopause
51 years
Women on contraception. Ask about?
ACHES Abdominal pain Chest pain Headaches Eye problems Sudden leg or calf pain
abdominal pain-from IUD
dyspareunia
IUD came out
expulsion
5 P’s model of sexual history
Partners Prevention of pregnancy Protection from STIs Practices Past history of STIs
Sequence of female exam
1) Inspect
2) Speculum
3) bimanual
4) rectovaginal
5) rectal
Blood supply for female genitalia
internal iliac artery
all structures visible externally from pubis to perineum
vulva
fat pad located over pubic bone
mons pubis
hair-covered folds of tissue that protect inner genitalia
labia majora
protects opening of vagina and urethra
labia minora
erectile tissue to provide sexual pleasure
clitoris
thin membrane that partially surrounds the opening of the vagina
hymen
clitoral hood, provides protection
prepuce
location of bartholin glands
4 and 8 o’clock
Skene’s glands
function debatable; apply pressure on anterior vaginal wall
Before speculum exam… instructions for patient
NOTHING for 1 to 2 days (48-72 hours)
empty bladder before exam
What position is the speculum exam performed in?
lithotomy
Speculum is a _____ procedure, not a _____ procedure
clean, not sterile
Speculum insertion steps
1) insert index finger
2) locate the cervix
3) insert speculum at slight angle downward, slowly remove finger
4) apply posterior pressure to open/patient should inhale
5) slowly open, catch cervix in between blades and lock in place
elastic muscular tube extending upward; connects cervix to vulva
vagina
8-10 cm in length
consists of fibrous tissue and small amount of smooth muscle; makes up lower 1/3 of uterus
cervix
ectocervix
squamous epithelium
endocervical canal
columnar epithelium
blood supply of cervix
uterine artery
3 and 9 oclock
Cervical contains and external orifice and internal orifice. what is visible on exam?
external os
folds lining the vagina; allows expansion during sex and childbirth
rugae
small, oval cervix
nulliparous
linear, irregular cervix
parous
Mucus trapping
nabothian cyst
soft, friable mass protruding from cervix external os; most common benign cervical lesion
polyps
Specimen collection of PAP
1) obtain from endocervix AND ectocervix
2) place broom in, rotate 360 degrees
3) MUST INCLUDE CELLS FROM ENDOCERVIX (common site for cancer)
If pregnant, use cotton tipped
Abnormal secretion
wet prep of saline and KOH
Removing the speculum
make sure blades are closed to avoid lacerations
bladder wall weakening
cystocele
rectal tear or defect cause bulging
rectocele
pelvic floor muscles and ligaments stretch and weaken causing uterus to descend into vagina
uterine prolapse
place two fingers inside labia and ask patient to bear down to see if vaginal walls bulge
check for prolapse
place 2 fingers against walls of vagina and have patient squeeze fingers
assess vaginal tone
Pain elecited during bimanual exam
chandelier sign
enlarged uterus causes
pregnancy, fibroids
adexal mass causes
ectopic pregnancy
ovarian mass causes
cysts
tenderness with bimanual exam causes
pelvic inflammatory disease (PID)
Endometriosis
Cystitis
Cervical cancer is primarily
> 80% squamous cell carcinoma
>95% due to HPV
HPV types-cancer
16 and 18
HPV types-genital warts
6 and 11
Given to mothers to prevent miscarriage
diethylstilbestrol hormone (DES)
Cervical screening for women ages
21-65
Cytology guidelines
21-30 y
Cytology+HPV dna guidelines
30-65 y
Patient is <21: guideline?
do not screen
Patient is 21-30: guideline?
cytology every 3 years; no HPV
patient is 30-65: guideline?
cytology every 3 years OR cytology with HPV every 5 years
patient is >65 y: guideline?
do not screen
recommended vaccine for prevention of cervical, vulvar, vaginal, and anal, throat and penile cancers
Ages 9-26
Guardasil 9
recommended vaccine for prevention of precancerous lesions due to HPV
Ages 9-26
Guardasil HPV Quadrivalent
Speculum is ____ the bimanual exam
before
