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Clin Skills > Female Genitalia > Flashcards

Female Genitalia Flashcards

1
Q

What are Bartholin’s glands?

A

located posteriorly on either side of vaginal opening, not visible

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2
Q

What’s the vaginal surface of the cervix, covered by stratified columnar epithelium ?

A

ectocervix

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3
Q

What’s the external opening of the cervix?

A

external cervical os

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4
Q

What happens during puberty in the crvix?

A

broad band of SCE that surrounds the os is slowly replaced by stratified squamous epithelium

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5
Q

What’s the transformation zone?

A

squamocolumnar junction

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6
Q

What’s the adnexa?

A

ovaries, tubes, supporting tissues

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7
Q

What are the two primary functions of ovaries?

A

production of ova and secretion of hormones (incl estrogen, progesterone & testosterone, stimulate 2ndary sex characteristics)

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8
Q

How do you assess the maturity in girls?

A

utilize the Tanner scale

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9
Q

Where does lymph drain into from vulva and lower vagina?

A

inguinal nodes

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10
Q

Where does lymph from internal genitalia including upper vagina flow?

A

pelvic and abdominal lymph nodes

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11
Q

This is a reminder

A

to review stages of development

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12
Q

What’s stage 1 in development?

A

no breast tissue, no pubic hair

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13
Q

What’s stage 2 in development?

A

breast buds, sparse, long pigmented hair along labia majora

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14
Q

What’s stage 3 in development?

A

enlargement of breast and areola w/o separation, with darkening, coarsing, curling of hair which extends up and laterally

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15
Q

What’s stage 4 in development?

A

areola & nipple form a mound atop breast tissue, hair of adult consistency limited to mons

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16
Q

What’s stage 5 in development?

A

adult configuration w areola & breast having smooth contour, hair spreads to medial aspect of thighs

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17
Q

What’s uterine cancer until proven otherwise?

A

postmenopausal bleeding – 6 months or more after cessation of bleeding

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18
Q

What’s a primary dysmenorrhea cause?

A

result from increased prostaglandin production during luteal phase of menstrual cycle, when estrogen and progesterone levels decline

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19
Q

What’s a secondary dysmenorrhea cause?

A

endometriosis, adenomyosis, PID, endometrial polyps

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20
Q

What’s the criteria for diagnosis of PMS?

A

symptoms and signs in 5 days prior to menses for at least 3 consecutive cycles; cessation of symptoms & signs within 4 days after onset of menses and interference with ADLs

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21
Q

What’s primary amenorrhea?

A

abscence of periods including menarche

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22
Q

What’s secondary amenorrhea?

A

abscence of periods after menarche (pregnancy, lactation, menopause, low body weight, dysfunction)

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23
Q

What’s polymenorrhea?

A

less than 21 days between menses

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24
Q

What’s oligomenorrhea?

A

infrequent bleeding

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25
Q

What’s menorrhagia?

A

excessive flow

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26
Q

What’s metrorrhagia?

A

intermenstrual bleeding

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27
Q

What does postcoital bleeding?

A

cervical polyps, cancer in older women, atrophic vaginitis

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28
Q

What does postmenopausal bleeding indicate?

A

endometrial cancer, HR, uterine & cervical polyps

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29
Q

When do girls usually get their period?

A

9-16 years, often take a year to become regular

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30
Q

When does menopause typically occur?

A

48-55

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31
Q

What’s menopause?

A

accelerated bone loss, increase in total cholesterol and LDL, vulvovaginal atrophy, vasomotor symptoms, cessation for 12 months

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32
Q

What can help menopause but can increase health hazards?

A

hormone replacement therapy – do not use for chronic conditions, and for the low dose and for the shortest duration

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33
Q

What’s gravida?

A

number of times pregnant

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34
Q

What’s para?

A

number of pregnancies reaching a viable gestational age (live and stillbirths)

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35
Q

What’s abortus?

A

lost pregnancies, with stillbirths NOT counted

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36
Q

What’s T1/P1/A1/ L3 or 1113?

A

term/premature/abortions/living

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37
Q

What are term births?

A

after 37 weeks

38
Q

If a fetus is aborted after ___ weeks then it is counted as a premature birth

A

20

39
Q

What do you need to ask about regarding a patient’s sexual history?

A

relationship status, preferences WITHOUT judgement, concerns about sex life, satisfaction in sex life

40
Q

What is dyspareunia?

A

pain during sex – should be evaluated with respect to localization, timing, and other characteristics of pain

41
Q

What should you consider with dyspareunia?

A

lack of estrogen, medical illness, and psychiatric conditions

42
Q

What is vaginismus?

A

involuntary spasm of the muscles surrounding vaginal orifice, making penetration painful or impossible – physical or physiological

43
Q

What should you consider with sexual dysfunction?

A

general health, medications, alcohol, partners knowledge, attitudes, values, fears, communication, settings

44
Q

Acute pelvic pain in menstruating girls and women warrant ___ attention

A

immediate

45
Q

What could acute pelvic pain in menstruating girls and women be?

A

ectopic pregnancy, ovarian torsion, appendicitis – consider recent instrumentation, IUD placement, STDs, GI, urinary sources

46
Q

What’s chronic pelvic pain?

A

pain lasting more than 6 months and does not respond to treatment. Ask pt to keep a pain journal

47
Q

What occurs due to retrograde mensural flow and extension of uterine lining outside the uterus?

A

endometriosis

48
Q

What are tumors in the uterine wall, submucosal or subserosal surfaces and a red flag for history of sexual abuse?

A

adenosis and fibroids

49
Q

What’s the most important risk for cervical CA?

A

persistent infection w/ high risk HPV 16 or 18

50
Q

What are two notable risk factors of cervical cancer?

A

failure to undergo screening and multiple sexual partners

51
Q

How long does it take for an HPV lesion to progress to cervical cancer?

A

10 years

52
Q

What HPVs are associated with genital warts?

A

6 and 11

53
Q

what are other risk factors for cervical cancer?

A

smoking, immunosuppression, long-term use of oral contraception, coinfection w/ chlamydia, parity, prior cervical CA, genetic polymorphisms affecting entry of HPV DNA, diethylstilbestrol estrogen

54
Q

What’s an average risk woman?

A

no history of high-grade, precancerous cervical lesion, not immunocompromised, no in utero exposure to DES

55
Q

When should you start being screened for cervical cancer?

A

21

56
Q

How often should you be screened after 21?

A

21-65 every 3 years or 21-29 every 3 years and 30-65 AND HPV testing for high risk

57
Q

When do you end cervical screening?

A

age >65 years, assuming 3 consecutive negative results or 2 and HPV testing w/n 10 years, with the most recent being within 5 years

58
Q

What are the ways you can classify pap smear cytology?

A

1) negative for intraepithelial lesion or malignancy
2) epithelial cell abnormalities (precancerous and cancer lesions such as squamous cells or glandular cells)
3) other malignant neoplasms, such as sarcomas or lymphomas

59
Q

What are squamous cells to note on a pap smear?

A

ASC of undetermined significance (US)
low grade squamous intraepithelial lesions (LSIL) including mild dysplasia
high-grade squamous epithelial lesions (HSIL), including moderate and severe dysplasia w/ features of suspicious for invasion
invasive squamous cell carcinoma

60
Q

What are glandular cells to note on a pap smear?

A

atypical endocervical cells specified or not, or favor neoplasia
atypical endometrial cells specififed or NOS
atypical glandular cells favoring neoplasia
endocervical adenocarcinoma in situ
adenocarcinoma

61
Q

When is HPV vaccine recommended?

A

Routine for girls 11 & 12, 3 dose series over 6 months, recommended for both boys and girls before the age 9

62
Q

What’s the catch-up vaccination?

A

recommended 13-26 who have not had prior vaccination

63
Q

How prevalent is ovarian cancer?

A

2/3 of women affected over 55 yo

64
Q

When ovarian cancer has metastasized to the peritoneal cavity or other organs?

A

25%

65
Q

What are 3 IMPORTANT symptoms of ovarian cancer?

A

abdominal distention, abdominal bloating, urinary frequency

66
Q

What are risk factors of ovarian cancer?

A

history of breast cancer, or BRCA2 gene mutation, 1st degree relative w/ breast or ovarian CA

risk is DECREASED with oral contraceptives, pregnancy, hx of breastfeeding

67
Q

What is the most commonly reported STI?

A

chlamydia trachomatis

68
Q

Without treatment for chlamydia what happens?

A

PID

69
Q

What should you screen for in all pregnant women?

A

chlamydia, syphilis, Hep B, HIV

70
Q

What should you screen for at least once a year for sexually active LGB and MSM?

A

chlamydia, gonorrhea, syphilis

71
Q

T/F: HIV testing should happen at least once ages 13-64yo

A

true

72
Q

T/F: HIV testing once a year is not needed for unsafe sex practices, IV drug users

A

false

73
Q

What’s the failure rate of natural birth control?

A

18%

74
Q

What’s the failure rate of a condom?

A

18% (condom), 6-12% (diaphragm)

75
Q

What’s the failure rate of an implantable?

A

IUD and subdermal implant at lowest rate (.8%)

76
Q

What’s the failure rate of pharmacologic/hormonal?

A

spermicide, birth control pill, injections, patches, vaginal rings (6-12%)

77
Q

What does HRT of estrogen + progestin and estrogen alone put a patient at risk for?

A

decreased risk for fractures, BUT increased risk of stroke, thromboembolic events, gallbladder, and urinary incontinence

78
Q

What does HRT of estrogen + progestin put them at risk for?

A

risk for breast cancer and probable dementia

79
Q

What does HRT of estrogen alone put them at risk for?

A

decreased risk of breast cancer

80
Q

What are some techniques of examination?

A
  • avoid intercourse 24-48
  • empty bladder
  • lie supine w head and shoulders elevated
  • obtain consent
  • select chaperones
  • drapes from mid-abdomen to knees, depress the drapes between the knees
  • avoid unexpected or sudden movement (announce what you are going to do)
  • choose correct size speculum
  • warm speculum
  • watch for patient’s face
  • gentle technique
81
Q

What are the 3 different steps of examination?

A

external inspection, bimanual examination (if indicated: rectovaginal exam), cervical evaluation w/ pap smear

82
Q

What are you looking at in the external examination?

A

assess sexual maturity, warn patient before you touch: labia minora, clitorus, urethral meatus, introitus (note inflammation, ulcerations, discharge, swelling, palpate for lesions)

83
Q

If there’s swelling/inflammation on the external genitalia, examine and palpate Bartholin Glands?

A

bartholin glands inflammation

84
Q

When examining the cervix, apply _____ pressure at the introitus to slightly enlarge the vaginal opening

A

downward

85
Q

Insert the speculum while it is ______, past your fingers in a _____ slope

A

closed, downward

86
Q

Only open the speculum with inserted to its ____ _______

A

full length

87
Q

What should you note about the cervix?

A

color, position, surface characteristics, ulcerations, nodules, masses, bleeding, discharge

88
Q

What specimens do you need for examining the cervix?

A

one specimen from endocervix, one specimen from ectocervix

for sexually active 26 or younger, other asymptomatic women at risk of infection, culture routinely

89
Q

How should you examine bimanually?

A

lubricate index and middle fingers –> insert lubricated finger into vagina and note nodularities, tenderness, palpate the cervix, uterus, place your fingers in the anterior fornix and place hand on patient’s abdomen and palpate the body of uterus between hands, and palpate each ovary

90
Q

What are 4 indications for rectovaginal examination?

A

palpate retroverted uterus, palpate uterosacral ligament, cul-de-sac, and adnexa, screen for colonrectal cancer in women 50y/o older, and assess for pelvic pathology

Clin Skills (14 decks)

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