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Patient Assessment > Female Genitalia > Flashcards

Female Genitalia Flashcards

1
Q

what are risk factors of pelvic floor weakness

A
  • aging
  • Prior surgery or trauma
  • childbirth
  • obesity, DM, MS, parkinsons
  • meds
  • chronically increased abdominal exam
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2
Q

what are the fornix’

A

the corners of the cervix

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3
Q

what can weakness of the pelvic floor muscles cause?

A
  1. pain
  2. urinary or fecal incontinence
  3. Prolapse of the pelvic organs
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4
Q

what are important questions to ask in history?

A
  • contraception type
  • cervical cytology
  • history of gynecological findings
  • history of gynecological/abdominal procedures
  • screening for intimate partner violence
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5
Q

what is the average age of menarche

A

9-16 yo in the US

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6
Q

LMP

A

last menstual period

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7
Q

PMP

A

prior menstrual period

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8
Q

How to calculate cycle

A

first day of period to first day of period

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9
Q

what is pain with menses

A

Dysmenorrhea

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10
Q

what f/u questions should be asked if experiencing dysmenorrhea

A
  • pain
  • length
  • does it impact ADL
  • associated symptoms
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11
Q

what causes primary dysmenorrhea

A
  • no specific organic cause
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12
Q

what hormone increase can attribute to Primary dysmenorrhea

A

increased prostoglandin production

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13
Q

what causes secondary dysmenorrhea

A

ORGANIC cause
* endometriosis
* adenmyosis
* PID
* Endometrial polyps

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14
Q

what is emotional and behavioral symptoms such as sleep disturbances, poor concentration, social withdrawl etc in menstruating women?

in regards to period

A

Premenstrual syndrome (PMS)

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15
Q

what are the 3 criterias for diagnosis of PMS

A
  1. occur in the 5 days before menses for 3 cycles
  2. resolves within 4 days after menses onsest
  3. interferes with daily activities
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16
Q

what is amenorrhea

A

absense of periods

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17
Q

what is polymenorrhea

A

less than 21 days between menses

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18
Q

oligomenorrhea

A

infrequent bleeding

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19
Q

menorrhagia

A

excessive flow

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20
Q

metrorrhagia

A

intermenstrual bleeding

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21
Q

postcoital bleeding

A

post sex bleeding

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22
Q

PALM COEIN

A

structural: Polyp, Adenomyosis, Leiomyoma, Malignancy

Non-Structural: Coagulopathy, Ovulatory, Endometrial, Iatrogenic, Not classified

causes of abornmal bleeding

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23
Q

cessation of menses for ___ months is

A

menopause

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24
Q

what age does menopause occur

A

between 48-55

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25
Q

hot flashes, flushing sweating, are what type of symptoms of menopause

A

vasomotor symptoms

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26
Q

what is erratic cyclical bleeding and vasomotor symptoms before menses cease

A

perimenopause

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27
Q

what is bleeding post menopause concerning for

A

early sign of cancer

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28
Q

full term delivery is after what week

A

37 weeks

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29
Q

preterm labor is between what weeks

A

20-36 weeks and 6 days

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30
Q

what is an abortion classified as

A

loss of pregnancy before 20 weeks

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31
Q

what color is healthy discharge

A

white

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32
Q

what can pink vaginal discharge be from

A
  • cervical bleeding
  • vaginal irritation
  • implantation
    *
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33
Q

what can cause gray vaginal discharge

A

bacterial vaginosis or trichomoniasis

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34
Q

what causes yellow/green discharge

A

sexually transmitted infection (gonorrhea, chlamydia, trichomoniasis)

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35
Q

what caues red vaginal discharge

A
  • menstruation
  • cervical infection
  • cervical polp
  • endometrial or cervical cancer
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36
Q

what is the most common type of acute pain?

A

Pelvic inflammatory disease

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37
Q

History of STIs and recent IUD insertion are red flags for what?

A

PID

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38
Q

what are the three most common causes of acute pelvic pain

A
  • PID
  • ruptured ovarian cyst
  • appendicitis
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39
Q

what is a mild, one sided pelvic pain that lasts longer than a few hours midcycle (from ovulation)

A

Mittelshmerz

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40
Q

what differential diagnoses should always be included for acute pelvic pain

A
  • ectopic pregnancy
  • ovarian torsion
  • appendicitis
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41
Q

what should ALWAYS be ruled out in pts of reproductive age with abdominal pain?

A

ectopic pregnancy; use HcG levels or TVUS

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42
Q

what is pelvic pain that lasts longer than 6 months and doesn’t respond to treatment

A

Chronic pelvic pain

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43
Q

what are the DDx of chronic pelvic pain>

A
  • endometriosis
  • adenomyosis
  • myomas (fibroids)
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44
Q

what are some cervical cancer risk factors?

A
  • HPV infection
  • failure to screen
  • smoking
  • multiple partners
  • immunosuppression
  • long term contraception use
  • chlamydia trachomatis coinfection
  • parity
  • prior cervical cancer
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45
Q

when do you start screening and what is the interval

A

21 years
cyctology q3 years or
21-29yo: cytology q3 years and 30-64 yo: cytology + HPV q5 years

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46
Q

when do you stop screening for cervical cancer

A

age 65 + 3 consecutive negative cytology

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47
Q

pap smear stands for

A

papanicolaou test

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48
Q

what is a procecure where a brush is used to remove cells from the cervix to be check for atypia

A

pap smear

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49
Q

what is a procedure that takes a samples of cervical cells to check for HPV 16 and 18

A

hrHPV

50
Q

what is the 5th leading cause of cancer death in women?

A

ovarian cancer

51
Q

what cancer has no effective screen tests

A

ovarian cancer

52
Q

what can CA-125 indicated

A

it can be elevated in women with ovarian cancer but also breast cancer (prostate ect)

53
Q

what 3 symptoms indicate concern for ovarian cancer in women >50

A
  • abdominal distention
  • abdominal bloating
  • urinary frequency
54
Q

what are the risk factors of ovarian cancer

A
  • family history of breast or ovarian
  • BRCA1 or BRCA 2
  • obesity
  • nulliparity
  • post menopausal hormone replacement therapy
55
Q

what is the most common reported STI in the us right now

A

chlamydia trachomatis

56
Q

what is the mc way to test for STI

A

dirty urine sample (doesn’t test for gonorrhea)

57
Q

what population should have screening of chlamydia, syphilis, hep b, and HIV

A

pregnant women (add gonorrhea for at risk women)

58
Q

for chlamydia, gonorrhea,

when should you test for STIs in women

A

sexually active <25 yo and retest 3 months post treatment

59
Q

when should you screen for syphilis

A

asymptomatic adults at increased risk (incarceration or transactional work)

60
Q

when should you screen for trichomonas

A

women receiving care in high prevelance setting (STI clinics, correctional facility)

61
Q

what are the screening recs for HIV?

A

all women 13-64 at least 1x

62
Q

what are the recommendations for screening for HPV and cervical cancer?

A

women 21-29yo q3 years
women 3-65 yo q3 years or q5 year combo with cytology and HPV testing

63
Q

what are the screening recommendations for HepB

A

women at increased risk (more than 2 partners in 6 months)

64
Q

what are the screening guildelines for Hep C

A

all adults over 18 yo

65
Q

what are the two most common hernias in females

A
  1. indirect
  2. direct
  3. femoral
66
Q

what is tanner stage 1

A

prepubertal, no pubic hair

67
Q

tanner stage 2

A

sparse hair growth with minimally pigmented hair, mainly on the labia

68
Q

what is tanner stage 3

A

considerably darker and coarser hair spreading over the mons pubis

69
Q

what is tanner stage 4

A

thick adult-type hair that does not spread to the medial surface of the thighs

70
Q

what is tanner stage 5

A

adult type hair that is distributed on classical inverse triangle

71
Q

what is the lithotomy position

A
  • heels in footrest
  • but exrtending slightly beyond the table
  • thighs flexed, abducted, externally rotated at the hips
  • head supported by a pillow
  • hands on the side or folded on her chest
72
Q

2 shapes of a speculum

A
  1. graves (wider-vaginal prolapse)
  2. Pedersen (for everything else)
73
Q

what angle should the speculum be at?

A

30-45 degree

74
Q

what should flagellated, motile trichomonads

A

Trichomonas on a wet prep

75
Q

what shows clue cells?

A

bacterial vaginosis

76
Q

what is the name of the vaginal pH testing paper

A

litmus paper

77
Q

what is the normal vaginal pH

A

<4.5

78
Q

what does a pH greater than 4.5 indicated?

A

bacterial vaginosis, trichomonas

79
Q

what method of herpes culture sample is more likely to be a false positive

A

swabbing the residual erosions

80
Q

chandelier sign is a hallmark of

A

PID (cervical motion tenderness)

81
Q

what may cause the uterus to not be palpable

A

retroversion or retroflexion of the uterus

82
Q

what is the average size of a ovary

A

3.5cm x 2cm x 1.5cm

83
Q

when are ovaries not palpable

A

within 3-5 years of menopause onset

84
Q

what can cause adnexal masses?

A
  1. tubo ovarian abscess
  2. salpingitis
  3. ectopic pregnancy
  4. PID
  5. malignancy
85
Q

what are the indicates for rectovaginal examination

A
  1. to palpate a retroverted uterus, uterosacral ligament, cul-de-sac
  2. colorectal cancer >45
  3. pelvic pathology
86
Q

what is a small, firm, round, cystic nodule in the labia

A

epidermoid cyst (benign)

87
Q

what color discharge is associated with epidermoid cyst

A

white or yellowish

88
Q

what is cauliflower-shaped or verrucous lesions

A

condyloma acuminatum

89
Q

what is hyperpigmented, smooth, broad based, flat topped papules?

A

condyloma latum

a manifestation of secondary syphilis

90
Q

what is a firm PAINLESS ulcer

A

syphilitic chancre from treponema pallidum

91
Q

what is localized vesicles followed by PAINFUL ulcer on an erythematous base?

A

genital herpes

92
Q

what is the most common cause of genital herpes

A

HSV-1 and HSV-2

93
Q

what is an ulcerated or raise red vulvar lesion

A

carcinoma of the vulva

94
Q

what is the most common type of carcinoma of the vulva

A

squamous cell carcinoma

95
Q

what is a bulge of the upper 2/3 of the anterior vaginal wall? what causes it?

A

cystocele
caused by: bladder prolapse/shifting

96
Q

what is a bulge of the entire anterior vaginal wall? waht causes it?

A

cystourethrocele
bladder and urethra

97
Q

what is a herniation of the rectum into the posterior wall of the vagina?

A

rectocele

98
Q

what is a small, red, benign tumor at posterior urethral meatus?

A

urethral caruncle

mostly in post menopausal women & aysmptomatic

99
Q

what is a tense, hot, tender gland that has purulent drainage from the ducts?

A

acute bartholin gland infection

100
Q

what is a red swollen RING around the urethral meatus

A

prolapse of the urethral mucosa

pre-menarche or post menopausal

101
Q

what is a nontender, cystic nodule at the edge of the labia

A

chronic bartholin gland infection

102
Q

what is the characteristics of trichomonal vaginitis?

A
  1. yellow/green/gray and malodorus discharge
  2. straberry cervix
  3. wet mount prep
  4. pH >4.5
103
Q

what are characteristics of candidal Vaginitis

A
  • white, curdy, thick discsharge
  • reddened vaginal mucosa with white patches of discharge
  • branching hyphae on KOH prep
  • pH <4.5
104
Q

what are characteristics of bacterial vaginosis

A
  1. gray or white, thin discharge
  2. malodorous discharge (fishy)
  3. normal appearance on exam
  4. saline wet mount for clue cells
  5. positive whiff test
  6. pH >4.5
105
Q

what is a nulliparous os look like

A

oval

106
Q

what does a parous os look like

A

slit-like

107
Q

what is a nabothian cyst

A

“retention cyst”
* translucent nodules with no pathologic significance

108
Q

what are charcteristics of cervical polyps

A

benign but may bleed
arises from the endocervical canal

109
Q

characterstics of mucopurulent cervicitis

A
  • purulent yellow discharge
  • from c. trachomatis, n. gonorrhoeae, herpes infections
110
Q

what can later stages of carcinoma of the cervix look like?

A

irregular cauliflower-like growth that may develop

111
Q

what are characteristics of fetal exposure of DES

A
  • columnar epithelium covere most or all of the cervix
  • there is a circular collar or ridge of tissue between the cervix and vagina
112
Q

what is the tilting backwards of the entire uterus so the cervix faces forward

A

retroversion of the uterus
* uterine body can not be felt with abdominal hand

113
Q

what is the backward angulation of the body of the uterus in relation to the cervix, and the cervix remains in its usual position>

A

retroflexion of the uterus and the uterine body can not be felt with abdominal hand

114
Q

what is first degree uterine prolapse

A

cervix falls into the upper part of the vagina

115
Q

what is 2nd degree uterine prolapse

A

cervix is at the vaginal introitus

116
Q

what is 3rd degree uterine prolapse

A

cervix and part of the uterus is outside of the vaginal introitus

117
Q

what is 4th degree uterine prolapse (procidentia)

A

the cervix and all of the uterus falls out of vagina

118
Q

what type of mass on the ovary is benign, smooth, and compressible

A

ovarian cyst

119
Q

what is a mass that is firm, and more nodular on the ovary?

A

ovarian cancer
experience symptoms of pelvic pain, bloating, abdominal size and uti symptoms

120
Q

what has a palpable adenexal mass in more the 1/2 of cases

A

ectopic pregnancy

121
Q

what are clinical features of ectopic pregnancy

A
  • abdominal pain
  • adnexal tenderness
  • abnormal uterine bleeding
122
Q

what may PID develop into

A

tubo-ovarian abscess

Patient Assessment (20 decks)

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