Female Genitalia / Pap Flashcards
(59 cards)
1
Q
Female anatomy image
A
2
Q
Types of specula
A
A. Pediatric Pederson speculum. This may be selected for child, adolescent, or virginal adult examination.
B. Graves speculum. This may be selected for examination of parous women with relaxed and collapsing vaginal walls. (long as Pederson, but wider)
C. Pederson speculum. This may be selected for sexually active women with adequate vaginal wall tone. (regular size)
- There are larger ones. Why use them – obesity. Vaginal walls collapse.*
- Also some better for virginal adults – like Pederson but skinnier*
3
Q
Speculum procedure
A
- Labia separated gently
- Insert below urethral meatus
- 45o angle
- Downward pressure
- Rotate blades, open
- Visualize cx
- Inspect (tighten blade)
Wet prep before cervical specimen
4
Q
Ectropion
A
endocervical cells protrude out through os into vaginal portion. Normal in pregnancy, on OCPs, in teens.
5
Q
Os after vaginal birth
A
Smiling/slit
6
Q
Where to collect cervical specimen
A
specimen at os. Squamocolumnar junction & transformation zone
7
Q
Nabothian cyst
A
Benign. Glandular secretion – mucous secreting columnar cells covered by squamous epithelium
8
Q
Bimanual exam procedure
A
- Insert gloved index & middle finger
- Lubricant vaginal hand
- Palm up, watch thumb (clit)
- Palpate vagina for masses
- Cervical motion tenderness
- Cervix – size, shape, consistency, mobility, position, dilatation
- Palpate uterus with fingers
- Abdominal hand pressing down
- Position
- Size, consistency, mobility, contour
- Fibroids? Pregnant?
- Ovaries – often not palpable
- Pelvic tone (squeeze fingers – w/pelvic muscles)
- Rectocele, cystocele (bear down)
9
Q
palpating uterine position
A
- Sweep index finger up along anterior length
- Anteverted – isthmus sweeps upward.
- Retroverted, may feel flatter, may feel it going backward (harder to feel for when retroverted).
- Obese – you may not feel – document this.
10
Q
HPV common types
A
- Types 6,11: 90% genital warts
- Types 16,18: 70% cx CA
11
Q
Risk Factors Cervical CA
A
- Onset intercourse ≤18
- Multiple sexual partners
- Partner with multiple partners
- Smoking (2-3 x ↑ risk cx CA)
- Immunosuppression (HIV, meds)
- OCPs
- Less barrier use, ↑ risk STIs, HPV
12
Q
pap <21
A
not recommended
13
Q
Pap recommendatations 21-65
A
q 3 years cytology
14
Q
HPV cotest recommendations
A
- <30 not recommended
- 30-65 q 5 years preferred
15
Q
HPV testing alone
A
not recommended
16
Q
Pap >65yo
A
not indicated unless hx CIN2/3/AIS
17
Q
pap post-hysterectomy
A
Cx removed – stop screening unless cervical CA
Cx present – continue per guidelines
18
Q
Normal vaginal secretions, characteristics, pH
A
- Leukhorrea
- Changes – hormonal
- Normal secretions
- PH 3.8-4.5
- No itching or irritation
- Heterogeneous suspension
- Clear or white
- Consistency depends on cycle
19
Q
Equipment for wet prep
A
- Microscope
- Slides, cover slips
- Cotton-tipped applicator
- 10% KOH solution
- Saline
- PH paper 3.0-5.5 range
20
Q
Normal wet prep organisms
A
- Lactobacilli – predominate normal d/c
- Epithelial cells
- WBCs
- WBC: Epithelial ≤ 1:1
- RBCs
21
Q
Wet prep: abnormal pathogens
A
Candida & trich: not seen 40% time
BV: often seen asymptomatic women
22
Q
BV: discharge
A
- Thin, homogenous milky white, gray or yellowish
- Adherent, often increased
- Odor (d/t amines)
23
Q
BV pH
A
>4.5
24
Q
BV dx
A
- pH >4.5
- whiff test
- Wet prep
- No ↑ WBCs
- No candida
- Clue cells
25
BV bacteria
gardnerella vaginalis, bacteriodes, microplasma, reduced lactobacilli
26
Vaginitis: Trichomonas Vaginalis
What to expect on exam
* D/C yellow-green frothy, adherent
* Dysuria may be present
* Pruritis may be present
* Dyspareunia may be present
* Strawberry spots cx
27
Vaginitis: Trichomonas Vaginalis
What to expect on wet prep
* pH \> 4.5 often \> 5.5
* +/- “Whiff”
* ↑ WBCs
* Motile trichomonads
*Can present similarly to BV, discharge different*
28
Candidal Vulvovaginitis
what to expect on exam
* Intense burning, itching
* May have dysuria (esp if scratching, adds to dysuria)
* Often worst immediately preceding menses
* Often have dyspareunia
* Discharge white, cottage cheese-like
29
Candidal Vulvovaginitis
What to expect on wet prep
* pH usually \< 4.5
* No amine odor
* KOH (wet prep): Hyphae, spores
## Footnote
*may see lots or very little on wet prep, not correspond to symptoms*
30
Condylomata Acuminata
* Genital warts
* They are bumps, st cauliflower like
* Can be all over, to perianal
* NO test
* Treat w/acid, creams, laser, etc
31
Herpes Simplex Virus
* Mucocutaneous lesions
* Herpes has many stages – this stage is easiest to do swab, get positive culture result
* Earlier stages can show bumps/vesicles
* Severe dysuria, pain
* Can treat pain
32
primary dysmenorrhea, causes
d/t increased PG production during luteal phase of menstrual cycle, when estrogen adn progesterone levels decline
33
secondary dysmenorrhea, causes
e.g., endometriosis, adenomyosis (endometeriosis in the muscular layers of uterus), PID, endometrial polyps
34
Primary amenorrhea
period never starts
35
secondary amenorrhea
cessation of periods - e.g., d/t pregnancy, lactation, menopause
low body weight (d/t malnutrition, anorexia, stress, chronic illness, hypothalamic pituitary ovarian dysfunction)
36
postcoital bleeding
cervical polyps or cancer, or, in older women, atrophic vaginitis
37
causes of postmenopausal bleeding
endometrial cancer, hormone replacement therapy, uterine & cervical polyps
38
amenorrhea followed by heavy bleeding suggests
threatened abortion or dysfunctional uterine bleeding related to lack of ovulation
39
gravida para notation
GPFPAL
#, outcome, Full term, Premature, Abortion, LIving
40
dyspareunia suggests
Superficial: local inflammation, atrophic vaginitis, inadequate lubrication
Deep pain: pelvic d/os or pressure on a normal ovary
41
Most common causes of acute pelvic pain
1. PID
2. Ruptured ovarian cyst
3. appendicitis
## Footnote
*always r/o ectopic 1st w/UPT, and consider mittelschmerz, tubo-ovarian abscess*
42
mittelschmerz
pain from ovulation at midcycle
43
Endometriosis
causes chronic pelvic pain
from retrograde menstrual flow and extension of uterine lining outside uterus (50-60% of women w/pelvic pain)
44
Chronic pelvic pain, consider
endometriosis, adenosis, fibroids, red flag for hx sexual abuse
also consider pelvic floor spasm from myofscial pain w/trigger points on exam
45
reasons for delayed puberty
familial or r/t chronic illness
abnormal function of hypothalamus, anterior pituitary gland, ovaries
46
pediculosis pubis
lice/crabs
on exam: excoriations or itchy, small, red maculopapules. Nits or lice at bases of pubic hairs
47
why enlarged clitoris
in masculinizing conditions
48
menarche unduly late in relation to development of breasts, pubic hair, check for...
imperforate hymen
49
lateral displacement of cervix suggests
endometriosis involving uterosacral ligaments
50
yellowish discharge on endocervical swab suggests
mucopurulent cervicitis d/t chlamydia trachomatis, neisseria gonorrhoeae, or herpes simplex
51
Raised wartlike lesions occur in...
condylomata or cervical cancer
52
vaginitis w/discharge can result from...
candida, trichomonas vaginalis, bacterial vaginosis
53
rectovaginal mass could be...
stool or malignancy
Stool: can usually be dented by digital pressure. Do rectovaginal exam
54
cervical motion tenderness suggests
PID, ectopic pregnancy, appendicitis
55
ovaries 3-5 y after menopause
usually atrophic and nonpalpable. If palpable, investigate for ovarian cyst or cancer.
If pelvic pain bloating, increased abdominal size, urinary tract sx, more common in women w/ovarian cancer
56
most common hernia in women
indirect inguinal. Femoral is 2nd
57
lab eval trich
saline wet mount for trichomonads
58
lab eval candidal vaginitis
Potassium hydroxide (KOH) prep for branching hyphae of *Candida*
59
lab eval BV
* saline wet mount for clue cells (epithelial cells w/stippled borders);
* sniff for fishy odor after applying KOH (whiff test)
* vaginal secretions pH \>4.5
