Female GU Flashcards
Menarche
age at onset of menses
menopause
absence of menses for 12 consecutive months
(usually 48-55 years old)
post-menopausal bleeding
bleeding occuring 6 months or more after cessation of bleeding
amenorrhea
absence of menses
dysmenorrhea
pain with menses
polymenorrhea
menses at abnormally frequent intervals
oligomenorrhea
abnormally scant or infrequent menses
menorrhagia
excessive bleeding
metrorrhagia
bleeding between periods
post-coital bleeding
bleeding after sexual intercourse
Questions to ask in a GYN Hx (9)
- Last mentrual period
- regularity of periods
- ususal time between periods
- number of days of flow
- amount of flow (number of pads/tampons per day)
- pain with periods
- bleeding between periods
- age of menarche
- Sexual Hx
Questions in Sexual Hx (4)
- Current sexual status (active and with whom: M/F)
- number of partners (increased number = increased risk of infections)
- gender of partners
- STDs?
OB Hx: Gravida-Para Notation
G= number of pregnancies
P= outcome of pregnancies
- T = term >37 weeks
- P = Premature
- A = abortion <20 weeks (induced or spontaneous)
- L = Living
Urologic Hx (6)
- frequency
- burning
- incontinence (stress, urge, overflow)
- urency
- nocturia
- hematuria
Common Chief Complaints (9)
- amenorrhea
- dysmenorrhea
- metrorrhagia
- vaginal discharge/itching
- abdominal/pelvic pain
- dysparunia
- infertility
- pre-menstrual syndrome (premenstrual dysphoric disorder)
- changes in urinary patterns
dyspareunia
painful intercourse
Skene’s (Paraurethral) glands
- Position: 10 and 2 o’clock
- Function: Lubrication
Bartholin’s Glands
- Position: 4 and 8 o’clock
- Function: Lubrication
Inspection of Cervix (6)
- color
- position
- surface characteristics
- discharge
- os
- transformation zone
Palpation of Genitalia
- glands
- run finger along urethra on anterior wall of vagina
Cystocele
bladder falls onto anterior vaginal wall
can be seen externally
Rectocele
rectum pushes on posterior wall of vagina
can be seen
may have problems with bowel movements because distorts path of sigmoid colon
Inspection of External Genitalia
- warn patient first
- spread labia
- look at vaginal introitus
- Glands
Insertion of Speculum (6 Steps)
- select appropriate size speculum
- warm and lubricate with warm water
- hold at 45 degree anglean d point downward or posterior
- gentle downward pressure on posterior introitus
- once in vagina, straighten the speculum and gently advance maintaining posterior pressure
- slowly open the speculum to visualize the cervix
Procedures done during Internal genitalia exam (3)
- PAP smear
- Sample of vaginal secretions for wet mount
- GEN probe (nucleic acid amplification-espescially used for chlamydia)
Inspection of cervical os (7)
- shape
- size
- polyps
- pus
- cancer
- cysts
- transformation zone
Cervical Os shapes
- nulliparous-oval
- multiparous-slit-like
- Lacerations from birth (bilateral transverse, stellate, unilateral transverse)
Squamocolumnar Junction
- junction of columnar and squamous epithelium
- varies with age and hormonal status
true squamocolumnar junction
- proximal limit of squamous metaplasia
- usually not visualized (within endocervical canal)
transformation zone
- where premalignant changes and neoplasia occur
- encompasses immature and mature squamous metaplasia
Nabothian cysts
glandular duct blocked and produces a small cyst
[normally: cervix full of glandular tissue that secretes mucus]
Characteristics of cervix in fertile phase
- os open
- soft
- fertile mucus
characteristics of cervix in infertile phase
- os closed
- hard
- no mucus
PAP smear technique
option 1:
- -spatula (long end in os)-rotate 360
- -place brush in os and swirl 360
option 2: use “broom”-rotate 360
Bimanual Exam (instructions)
- middle and index finger of nondominate hand placed in vagina with fingertips on cervix (to lift up uterus)
- press dominate/abdominal hand in and down trying to grasp the uterus between your two hands
- slide abdominal hand on RLQ/LLQ to palpate uterine tubes and try for ovaries (most not palpable-if you can, might be abnormal)
Bimanual Exam (what you feel for) (4)
- cervix: tenderness, size, position, mobility
- uterus: size, shape, consistency, mobility, position, fibroids/nodules
- ovaries: size, shape, mobility, tenderness; remember to do bilaterally
- strength of pelvic floor
Version
relationship between fundus of uterus and the vagina
Flexion
relationship between the fundus of the uterus and the cervix
Anteverted
fundus pointed forward toward anterior body wall
Anteflexion
fundus of uterus flexed anteriorly and inferiorly toward cervix
Retroverted
fundus of uterus >90-100 degrees from anterior wall of vagina
Retroflexed
Fundus of uterus flexed posteriorly and inferiorly toward cervix
Rectovaginal Exam (3 purposes)
- palpate a retroverted and retroflexed uterus and the utersacral ligaments
- screen for colorectal cancer in women 50+ years
- assess pelvic pathology in posterior recvaginal pouch (Pouch of Douglas)
Anatomy mature female breast
- 2nd to 6th ribs
- lateral border of sternum to MAL
- axillary tail of Spence extends laterally across the anterior axillary fold
- 15-20 lobes composed of several lobules each
- suspensory ligaments of Cooper inserted perpendicularly into dermis to provide structural support
Lymph drainage of breast
- axillary tail: subscapular group of axillary l.n.
- upper: infraclavicular l.n.
- medial: submammary plexus of opposite breast, l.n. along internal thoracic artery –> mediastinal l.n.
- inferior: lymphatics of abdominal wall and to extraperitoneal lymphatic plexus
- subareolar and submammary: anterior or pectoral group of axillary l.n.
Optimal time to do breast exam
5-7 days after LMP
Breast Inspection (6)
- development
- size and symmetry
- contour-look for tumors
- retraction/dimpling of skin/tissue
- skin color and texture
- venous engorgement
Breast Inspection Positions (5)
- Seated, arms down
- armsm over head
- hands on hips
- palms pressed together in front of abdomen
- arms extended and ebnt forward at waist
Breast Palpation
- Patient supine, ipsilateral arm above the head
- use fingerpads
- pattern: vertical strips or concentrically
- motion continuous-do not lift hands
- palpate by quadrant, then tail of Spence
- 3 levels of pressure-light, medium, firm (superficial to deep-each level before moving to new area)
- extend palpation upward until feel only clavicle and downward until feel only ribs
- Patient sitting, palpate axilla
