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Health Assessment > Female Genitalia / Pap > Flashcards

Female Genitalia / Pap Flashcards

1
Q

Female anatomy image

A
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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*
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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

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4
Q

Ectropion

A

endocervical cells protrude out through os into vaginal portion. Normal in pregnancy, on OCPs, in teens.

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5
Q

Os after vaginal birth

A

Smiling/slit

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6
Q

Where to collect cervical specimen

A

specimen at os. Squamocolumnar junction & transformation zone

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7
Q

Nabothian cyst

A

Benign. Glandular secretion – mucous secreting columnar cells covered by squamous epithelium

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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)
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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.
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10
Q

HPV common types

A
  • Types 6,11: 90% genital warts
  • Types 16,18: 70% cx CA
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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
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12
Q

pap <21

A

not recommended

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13
Q

Pap recommendatations 21-65

A

q 3 years cytology

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14
Q

HPV cotest recommendations

A
  • <30 not recommended
  • 30-65 q 5 years preferred
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15
Q

HPV testing alone

A

not recommended

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16
Q

Pap >65yo

A

not indicated unless hx CIN2/3/AIS

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17
Q

pap post-hysterectomy

A

Cx removed – stop screening unless cervical CA
Cx present – continue per guidelines

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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
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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
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20
Q

Normal wet prep organisms

A
  • Lactobacilli – predominate normal d/c
  • Epithelial cells
  • WBCs
    • WBC: Epithelial ≤ 1:1
  • RBCs
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21
Q

Wet prep: abnormal pathogens

A

Candida & trich: not seen 40% time
BV: often seen asymptomatic women

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22
Q

BV: discharge

A
  • Thin, homogenous milky white, gray or yellowish
  • Adherent, often increased
  • Odor (d/t amines)
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23
Q

BV pH

A

>4.5

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24
Q

BV dx

A
  • pH >4.5
    • whiff test
  • Wet prep
    • No ↑ WBCs
    • No candida
      • Clue cells
25
Q

BV bacteria

A

gardnerella vaginalis, bacteriodes, microplasma, reduced lactobacilli

26
Q

Vaginitis: Trichomonas Vaginalis

What to expect on exam

A
  • D/C yellow-green frothy, adherent
  • Dysuria may be present
  • Pruritis may be present
  • Dyspareunia may be present
  • Strawberry spots cx
27
Q

Vaginitis: Trichomonas Vaginalis

What to expect on wet prep

A
  • pH > 4.5 often > 5.5
  • +/- “Whiff”
  • ↑ WBCs
  • Motile trichomonads

Can present similarly to BV, discharge different

28
Q

Candidal Vulvovaginitis

what to expect on exam

A
  • 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
Q

Candidal Vulvovaginitis

What to expect on wet prep

A
  • pH usually < 4.5
  • No amine odor
  • KOH (wet prep): Hyphae, spores

may see lots or very little on wet prep, not correspond to symptoms

30
Q

Condylomata Acuminata

A
  • Genital warts
  • They are bumps, st cauliflower like
  • Can be all over, to perianal
  • NO test
  • Treat w/acid, creams, laser, etc
31
Q

Herpes Simplex Virus

A
  • 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
Q

primary dysmenorrhea, causes

A

d/t increased PG production during luteal phase of menstrual cycle, when estrogen adn progesterone levels decline

33
Q

secondary dysmenorrhea, causes

A

e.g., endometriosis, adenomyosis (endometeriosis in the muscular layers of uterus), PID, endometrial polyps

34
Q

Primary amenorrhea

A

period never starts

35
Q

secondary amenorrhea

A

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
Q

postcoital bleeding

A

cervical polyps or cancer, or, in older women, atrophic vaginitis

37
Q

causes of postmenopausal bleeding

A

endometrial cancer, hormone replacement therapy, uterine & cervical polyps

38
Q

amenorrhea followed by heavy bleeding suggests

A

threatened abortion or dysfunctional uterine bleeding related to lack of ovulation

39
Q

gravida para notation

A

, outcome, Full term, Premature, Abortion, LIving

GPFPAL

40
Q

dyspareunia suggests

A

Superficial: local inflammation, atrophic vaginitis, inadequate lubrication

Deep pain: pelvic d/os or pressure on a normal ovary

41
Q

Most common causes of acute pelvic pain

A
  1. PID
  2. Ruptured ovarian cyst
  3. appendicitis

always r/o ectopic 1st w/UPT, and consider mittelschmerz, tubo-ovarian abscess

42
Q

mittelschmerz

A

pain from ovulation at midcycle

43
Q

Endometriosis

A

causes chronic pelvic pain

from retrograde menstrual flow and extension of uterine lining outside uterus (50-60% of women w/pelvic pain)

44
Q

Chronic pelvic pain, consider

A

endometriosis, adenosis, fibroids, red flag for hx sexual abuse

also consider pelvic floor spasm from myofscial pain w/trigger points on exam

45
Q

reasons for delayed puberty

A

familial or r/t chronic illness

abnormal function of hypothalamus, anterior pituitary gland, ovaries

46
Q

pediculosis pubis

A

lice/crabs

on exam: excoriations or itchy, small, red maculopapules. Nits or lice at bases of pubic hairs

47
Q

why enlarged clitoris

A

in masculinizing conditions

48
Q

menarche unduly late in relation to development of breasts, pubic hair, check for…

A

imperforate hymen

49
Q

lateral displacement of cervix suggests

A

endometriosis involving uterosacral ligaments

50
Q

yellowish discharge on endocervical swab suggests

A

mucopurulent cervicitis d/t chlamydia trachomatis, neisseria gonorrhoeae, or herpes simplex

51
Q

Raised wartlike lesions occur in…

A

condylomata or cervical cancer

52
Q

vaginitis w/discharge can result from…

A

candida, trichomonas vaginalis, bacterial vaginosis

53
Q

rectovaginal mass could be…

A

stool or malignancy

Stool: can usually be dented by digital pressure. Do rectovaginal exam

54
Q

cervical motion tenderness suggests

A

PID, ectopic pregnancy, appendicitis

55
Q

ovaries 3-5 y after menopause

A

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
Q

most common hernia in women

A

indirect inguinal. Femoral is 2nd

57
Q

lab eval trich

A

saline wet mount for trichomonads

58
Q

lab eval candidal vaginitis

A

Potassium hydroxide (KOH) prep for branching hyphae of Candida

59
Q

lab eval BV

A
  • 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

Health Assessment (14 decks)

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