Female GU and Breast Exam

Question 1

Menarche

Answer 1

age at onset of menses

Question 2

menopause

Answer 2

absence of menses for 12 consecutive months (usually 48-55 y/o)

Question 3

post-menopausal bleding

Answer 3

bleeding occurring 6 mos. or more after cessation of bleeding

Question 4

amenorrhea

Answer 4

absence of menses

Question 5

dysmenorrhea

Answer 5

pain with menses

Question 6

Polymenorrhea

Answer 6

menses at abrnomally frequent intervals

Question 7

oligomenorrhea

Answer 7

abnormally scant or infrequent menses

Question 8

menorrhagia

Answer 8

excessive bleeding

Question 9

metrorrhagia

Answer 9

bleeding between periods

Question 10

post-coital bleeding

Answer 10

bleeding after sexual intercourse

Question 11

Gravida/Para

Answer 11

Gravida: number of pregnancies
Para: outcome of pregnancies

T = term
P = premature
A = abortion <20 weeks
L = living children

Question 12

Dyspareunia

Answer 12

painful intercourse

Question 13

Bartholin’s glands

Answer 13

glands in labia majora, secrete lubrication, small duct opens right in labia minora. if duct becomes plugged, gland continues to secrete

4 and 8 o’clock

Question 14

Skene’s glands

Answer 14

also produce lubrication, called periurethra, they are adjacent to urethra

10 and 2 o clock

Question 15

cystocele

Answer 15

a medical condition that occurs when the tough fibrous wall between a woman’s bladder and her vagina (the pubocervical fascia) is torn by childbirth, allowing the bladder to herniate into the vagina.

Question 16

rectocele

Answer 16

rectum bulges into the vagina

- typically occurs after pregnancy

Question 17

Cervical Os

Answer 17

Cervix is squamous, Cervical Os is columnar (reddeend): area where the two meet is transformation zone (this is the best place to collect cells from)

Cervical Os is the opening between cervix and vagina

Question 18

Cervical polyp

Answer 18

overgrowth of columnar epithelium - benign

- can tell that it is smooth and redenned

Question 19

nabothian cysts

Answer 19

glands secreting mucous form cysts when plugged up - difficult to tell between this and a carcinoma

Question 20

bimanual hand exam

Answer 20

insert finger, lift cervix, use your hand on her abdomen to feel her uterus and ovaries

Question 21

version

Answer 21

relationship between the fundus of the uterus and the vagina

Question 22

flexion

Answer 22

the relationship between the fundus of the uterus and cervix

Question 23

anteverted

Answer 23

fundus is less that 180 degrees, bends anteriorly from the vagina

Question 24

retroverted

Answer 24

fundus is more than 180 degrees

- cervical os is pointed straight, more posteriorly

Question 25

anteflexed

Answer 25

the fundus of the uterus is pointing anteriorly in a flexed position

Question 26

retroflexed

Answer 26

fundus of uterus is pointed posteriorly

Question 27

three blood supplies of breast

Answer 27

(1) perforating branches of the internal mammary artery
(2) lateral branches of the posterior intercostal arteries
(3) branches from the axillary artery, including the highest thoracic, lateral thoracic, and pectoral branches of the thoracoacromial artery

The second, third, and fourth anterior intercostal perforators and branches of the internal mammary artery arborize in the breast as the medial mammary arteries.
The lateral thoracic artery gives rise to lateral mammary branches.

Question 28

where does breast extend?

Answer 28

The mature female breast extends from the level of the second rib to the inframammary fold at the sixth rib.
It extends transversely from the lateral border of the sternum to the mid axillary line.
The deep or posterior surface of the breast rests on the fascia of the pectoralis major, serratus anterior, and external oblique abdominal muscles, and the upper extent of the rectus sheath.
The axillary tail of Spence extends laterally across the anterior axillary fold. The upper outer quadrant of the breast contains a greater volume of tissue than do the other quadrants.

Question 29

what is breast composed of?

Answer 29

• The breast is composed of 15 to 20 lobes which are each composed of several lobules.
• Fibrous bands of connective tissue travel through the breast (suspensory ligaments of Cooper), insert perpendicularly into the dermis, and provide structural support.
• Each lobe of the breast terminates in a major (lactiferous) duct (2 to 4 mm in diameter), which opens through a constricted orifice (0.4 to 0.7 mm in diameter) into the ampulla of the nipple.
• Deep to the nipple-areola complex, each major duct has a dilated portion (lactiferous sinus), which is lined with stratified squamous epithelium.
• Major ducts are lined with two layers of cuboidal cells, while minor ducts are lined with a single layer of columnar or cuboidal cells.

Question 30

** lymphatic drainage **

Answer 30

• breast cancer spreads most through lymphatic drainage

Question 31

where does lymph from subareolar/submammary plexus drain?

Answer 31

to the anterior or pectoral group of nodes

Question 32

where does axillary tail drain?

Answer 32

to subscapular group of axillary nodes

Question 33

where does upper portion of breast drain?

Answer 33

to infra clavicular nodes

Question 34

where does medial part of breast drain?

Answer 34

submammary plexus of the opposite breast and also the lymph glands along the internal thoracic artery and then to the mediastinal nodes

Question 35

where does inferior portion of breast drain?

Answer 35

lymphatics of abdominal wall and the extra peritoneal lymphatic plexus

Question 36

when is best time to examine breast

Answer 36

5-7 days following end of LMP…. after least amount of glandular tissue due to estrogen

Question 37

Four quadrants of breast

Answer 37

Upper outer, Upper inner, lower inner and lower outer quadrant.
* most breast cancers are in the upper outer quadrant because have the most breast tissue there

Question 38

Breast examination

Answer 38

arms over head brings underportion
hands on hips, can see the upper portion
leaning forward: shows lateral portion

Question 39

lithotomy position

Answer 39

most common position for genital exams, with head of exam table elevated and heels in stirrups

Question 40

ectocervix

Answer 40

cervical scrape. rotate a wooden or plastic cervical scraper 360 degrees around the cervical os and transfer the specimen onto a slide or into a specimen jar

Question 41

endocervix

Answer 41

insert a cervical brush gently into the cervical os and rotate back and forth. transfer the specimen onto a slide or intoa specimen jar

Question 42

Wet Mount or “hanging drop”

Answer 42

using cotton tipped swab, obtain a small sample of mucus from posterior fornix of vagina