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Clin Skills > female GU > Flashcards

female GU Flashcards

1
Q

lymph nodes: where do the vulva and lower vaginal drain?

what about internal genitalia? which are palpable?

A
  • Vulva and lower vagina drain to inguinal nodes

- Internal genitalia, including the upper vagina, flow into the pelvic and abdominal nodes WHICH ARE NOT PALPABLE

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2
Q

what is the ectocervix?

A

Ectocervix- vaginal end of cervix (ecto = outer, on the outside)

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3
Q

external canal of os?

A

External canal of os— endocervical canal (endo = prefix indicating within, inner)

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4
Q

external canal of os: At puberty the ectropion (columnar cells encircling the os) is replaced by ________ _______

A

At puberty the ectropion (columnar cells encircling the os) is replaced by squamous epithelium

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5
Q

Squamocolumnar Junction:
_____ ________ lines canal
_______ ________lines the vagina

A

Squamocolumnar Junction
Columnar epithelium lines canal
Squamous epithelium lines the vagina

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6
Q

what area is tested for a pap smear?

A

squamocolumnar junction

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7
Q

during puberty these is an increase hormone production leading to what changes in the female sex organs?

A

increased size of uterus and its endometrial lining, vagina and its vaginal epithelium

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8
Q

how big is the ovary?

A

Ovary- usually 3.5 x 2x 1.5 cm from adulthood through menopause

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9
Q

what two pelvic slings support the pelvic organs? what does each support?

A
  1. Pelvic diaphragm: Deep support

2. Urogenital diaphragm: Support the distal urethra. vagina and uterus And the anal sphincter for support of gut

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10
Q

“the goal of cytology screening is to find the cells BEFORE they are _________”

A

dysplastic

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11
Q

Cervical cancer screening: Pap smear and HPV infection
Risk factors are ____ and ______.
_____ and _______ found in virtually all of cervical cancers

A

Cervical cancer screening: Pap smear and HPV infection
Risk factors are viral and behavioral (failure to undergo screening and multiple sex partners)
HPV 16 and 18 found in virtually all of cervical cancers

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12
Q

HPV vaccine- Gardasil targets which HPV strains?

when do girls get it? when do boys get it?

A

HPV vaccine- Gardasil targets HPV 16, 18 , 6 and 11
Girls ~11-12 but before sexually active ideally
Boys ~ 9-26 – for prevention of genital warts

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13
Q

____ - _____% are squamous cell carcinoma and ____ % adenocarcinoma

A

80-90 % are squamous cell carcinoma and 20 % adenocarcinoma

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14
Q

Pap smear:
First screen - age ____
Up to 30 yo – screen every ___ years with _____
30 - 65 yo – every ___yrs with _______ if __ consecutive annual cervical cytology results are neg or every 5 yrs if combined cytology and high-risk HPV testing results are neg

(likely weeds)

A

First screen - age 21
Up to 30 yo – screen every 3 years with cytology
30 - 65 yo – every 3 yrs with cytology if 3 consecutive annual cervical cytology results are neg or every 5 yrs if combined cytology and high-risk HPV testing results are neg

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15
Q

is there screening for ovarian cancer?

A

none that are effective - can do gene studies for BRCA but most ovarian are not linked to genetics

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16
Q

dysmenorrhea (abnormal periods): primary vs secondary cause

A
  1. usually from prostaglandins

2. includes endometriosis, adenomyosis, pelvic inflammatory disease, and endometrial polyps

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17
Q

amenorrhea (absence of periods): primary vs secondary cause

A 
Primary amenorrhea:  (NOT abnormal)
Secondary amenorrhea: 
Pregnancy
Low body weight
Chronic illness
Hypothalamic-pituitary-ovarian dysfunction
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18
Q

dysmenorrhea vs amenorrhea

A

dys: abnormal periods
a: no periods

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19
Q

what is polymenorrhea?

A

less then 21 days between cycles

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20
Q

oligomenorrhea vs menorrhaghia vs metrorrhagia

A

Oligomenorrhea- infrequent bleeding
Menorrhagia- excessive flow
Metrorrhagia- intermenstrual bleeding

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21
Q

Dx of PMS is based on what? (weeds)

A

Signs and symptoms 5 days prior to menses for at least three consecutive cycles
Cessation of symptoms within 4 days after onset of menses
Interference with daily activities

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22
Q

Gravida/Para Notation “Gs and Ps”
G= ? P= ?
TPAL?

A

Gravida/Para Notation “Gs and Ps”
G= gravida, or total number of pregnancies
P= para, or outcomes of pregnancies or the number that were carried to a viable gestational age (twins still only count as 1 “P”)
T=full term birth >37 weeks
P=premature < 37 weeks
A=abortion includes therapeutic and elective
L=living child total number of living children

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23
Q

when asking about STDs what do you want to be “wary” of ?

A

Partner in room, parents in room, “cheating” partners

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24
Q 
techniques of exam:
Always interview the patient with....
Encourage patients to wear \_\_\_\_\_
Encourage patients to bring \_\_\_\_\_\_\_\_
Watch the patient’s \_\_\_\_
Warn the patient ....
Touch \_\_\_\_ \_\_\_\_\_ \_\_\_\_ first
Once you have touched her ...
\_\_\_\_the speculum!
\_\_\_\_the stirrups
Don’t talk about “\_\_\_\_\_”
A 
Always interview the patient with her clothes on!
Encourage patients to wear socks
Encourage patients to bring a companion
Watch the patient’s face
Warn the patient before you touch her
Touch the upper thigh first
Once you have touched her, don’t lose contact
Warm the speculum!
Pad the stirrups
Don’t talk about “blades”
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25
Q

what two types of speculum do you use?

A

Pederson, Graves

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26
Q

positioning the pt :
Put your hand at the end of the table over the sheet and have the patient move down until what?
Drape the sheet around the legs and arrange so that you can see the patient and only the ______ is visible.

A

until she feels your hand.

only the perineum is visible.

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27
Q

what are you inspecting when you inspect the external genitalia?

A 
assess tanner stage then... 
mons pubis
labia majora
perineum
labia minora
clitoris
urethral meatus
vaginal opening (introitus)
Anything patient is concerned about
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28
Q

external exam:Palpate any _____

If any swelling or historical indications, check _______ _____

A

lesions, bartholin’s glands

29
Q

external exam: If any historical indications, milk ______ _____
culture: ______

A

milk: Skene’s (paraurethral) glands

culture: any discharge

30
Q

are bartholin’s or skenes glands usually palpable?

A

normally nonpalpable; swelling and tenderness indicate abnormality (e.g., abscess).

31
Q

how would you test for relaxation of supporting structures? (what are you palpating and how are you doing this?

A

Palpate perineal tone.

–> Tell patient to hold breath and strain (Valsalva Maneuver).

32
Q

3 parts of internal exam

A

Assess support of vaginal walls
Speculum examination
Bimanual Examination

33
Q

how do you assess the support of vaginal walls? what would warrant further investigation?

A

Separate labia with two fingers ask patient to strain. – bulging of the vaginal walls

34
Q

when yo u are testing the relaxation of supporting structures, what would inidicate abnormality? what would you maybe inquire about after?

A

Involuntary loss of urine, or descent of vaginal wall or cervix to the introitus indicates abnormality. Inquire about loss of urine with cough or sneeze.

35
Q

3 characteristics you assess the vagina and cervix for?

A

Color
Discharge
Lesions

36
Q

Nulliparous vs Multiparous Os?

A

Nulliparous (circular os)

Multiparous (slit like os)

37
Q

what characteristics of the cervix do you need to note? (5)

A

Determine color, size, shape, consistency, and mobility

38
Q

what doesa normal cervix look like? (size, color, type of epithelium)

A

Normal: 2-3 cm
Pink, smooth epithelium
Squamocolumnar junction

39
Q

abnormal cervix will show what 4 possible things?

A

ulcer
growth
Eversion of cervix
Endocervical epithelium may grow out into vaginal portion of cervix

40
Q

Nabothian (retention) cysts on the cervix, are these worrisome?

A

Nabothian (retention) cysts are of little clinical importance

41
Q

inspect the vaginal wall while ….

A

removing the speculum

42
Q

what should you take note of about the mucosa of the vaginal wall? (5)

A
  1. Color of mucosa- pink, rugated, pliable
  2. Inflammation
  3. Discharge-Thin, clear fluid (from cervical secretions)
  4. Ulcers
  5. Masses
43
Q

what is bulging of the anterior vaginal wall? what avout posterior?

A

Bulging of anterior wall (cystocele); posterior wall (rectocele)

44
Q

what must you note about any abnormal fluid in/near the vaginal wall? (4)

A

fluid characteristics (odor, color, consistency, quantity)

45
Q

Be sure the speculum is ____ before removal!

A

closed

46
Q

how do you warm the speculum?

A

with warm water

47
Q 
how do you insert the speculum: 
Apply \_\_\_\_\_\_\_ pressure at ......
Slide speculum ....
Do NOT put pressure on the \_\_\_\_\_\_\_!!!
Angle the speculum \_\_\_\_\_\_
Push along the \_\_\_\_\_ \_\_\_\_\_\_\_of the vagina
Once inserted into the vagina....
A

Apply downward pressure at the lower margin of the introitus
Slide speculum at an angle in a slightly downward slope
Do NOT put pressure on the urethra!!!
Angle the speculum vertically
Push along the back wall of the vagina
Once inserted into the vagina, open speculum and find the cervix

48
Q

how to remove the speculum:
First,…..
Disengage the speculum from the ______, then slide the speculum out slowly while ….
Let the _______ close the speculum and you rotate …. This ensures you do NOT …..

A

First, unscrew the thumb screw- KEEPING pressure on the handle to keep speculum open
Disengage the speculum from the cervix, then slide the speculum out slowly while you inspect the vaginal walls.
Let the pressure from the vagina close the speculum and you rotate the same way you did to put it in. This ensures you do NOT pinch the labia.

49
Q

which speculum for sexually active women? virgins/elderly? parous women with vaginal prolapse?

A

The medium Pederson is usually comfortable for sexually active women.
The Narrow Pederson for virgins or elderly women
Graves speculum are suited for parous women with vaginal prolapse

50
Q

bimanual exam.. what fingers do you use? what are you palpating? (4)

A 
LUBRICATE! (water vs. jelly). Use index and middle finger
Palpation: 
Cervix
Uterus (and it's fornices (arches)) 
Ovaries
Vaginal wall
51
Q

when you palpate the vaginal wall on bimanual exam, what are you noting?

A

(Note nodularity or tenderness of vaginal wall)

52
Q

what are you looking for when you palpate and move the cervix?

A

Chandelier’s sign (PID)

53
Q

when you palpate the cervix, what are you noting? (6)

A 
Position
Shape 
Consistency
Regularity
Mobility 
Tenderness
54
Q

how do you palpate the uterus? (long explanation)

A

place exterior hand midway between umbilicus and symphysis pubis. Elevate the cervix and uterus with your pelvic hand and capture uterus between the two hands. Then move your pelvic hand to the anterior fornix to evaluate the anterior uterus; abdominal hand can now evaluate the posterior uterus

55
Q

what are you noting when you palpate the uterus? (5)

A 
Size
Shape
Consistency
Mobility 
Tenderness and or masses
56
Q

how do you palpate the ovary ?

A

abdominal hand in right lower quadrant. Pelvic hand in right lateral fornix. Try to capture the ovary between the two hands.

57
Q

how do you palpate the vaginal wall? (what are you checking for?)

A

Check for strength of pelvic muscles
Spread fingers to touch the vaginal walls. Ask patient to squeeze her muscles around them and hold for as long as she can. Normal is compresses fingers snugly, pulls them upward and inward and held for at least 3 seconds.

58
Q

what can you feel with the rectovaginal exam?

A

the posterior cervix and uterus and evaluating a retroverted uterus.

59
Q

instead of “blades” of the speculum, call them what?

A

bills - like a birds

60
Q

what would you do if you suspect gonorrhea or chlamydia? what is the process for this?

A

culture

Must use Dacron Q-tip and turn in os and leave in os at least 20 seconds.

61
Q

for wet mount, use saline for what? KOH or what?

A

saline: trichomonas
KOH: BV and yeast

62
Q

what do you used to determine vaginal pH? what is normal?

A

Determine pH with Nitrazine or pH paper (normal is 4.5 and below)

63
Q

what is the “whiff” test for?

A

for amine odor characteristic of bacterial vaginosis

64
Q

cervical scrape pap smear

A

Longer end of scraper in cervical os, press and turn in full circle including transformation zone in sample. Smear on glass slide; may cause some bleeding

65
Q

endocervical brush pap smear

A

Place brush in os and roll between thumb and index finger clockwise and counterclockwise; Smear slide with brush gently

66
Q

for pap smear, spray slide with ______

A

Spray slide with fixative

67
Q

what do you use in place of endocervical brush in pregnant women?

A

Cotton-tipped applicator with saline in place of endocervical brush in pregnant women

68
Q

cervical broom pap smear: what specimen do you do this for? how do you do it?

A

– Single specimen with both squamous and columnar epithelial cells. Rotate tip of brush in os in full clockwise direction then stroke each side of brush on glass slide. Promptly place slide in solution or spray with fixative or place sample directly into preservative (liquid-based cytology)

Clin Skills (25 decks)

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