Female GU and Breast Exam Flashcards
Menarche
age at onset of menses
menopause
absence of menses for 12 consecutive months (usually 48-55 y/o)
post-menopausal bleding
bleeding occurring 6 mos. or more after cessation of bleeding
amenorrhea
absence of menses
dysmenorrhea
pain with menses
Polymenorrhea
menses at abrnomally frequent intervals
oligomenorrhea
abnormally scant or infrequent menses
menorrhagia
excessive bleeding
metrorrhagia
bleeding between periods
post-coital bleeding
bleeding after sexual intercourse
Gravida/Para
Gravida: number of pregnancies
Para: outcome of pregnancies
T = term P = premature A = abortion <20 weeks L = living children
Dyspareunia
painful intercourse
Bartholin’s glands
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
Skene’s glands
also produce lubrication, called periurethra, they are adjacent to urethra
10 and 2 o clock
cystocele
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.
rectocele
rectum bulges into the vagina
- typically occurs after pregnancy
Cervical Os
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
Cervical polyp
overgrowth of columnar epithelium - benign
- can tell that it is smooth and redenned
nabothian cysts
glands secreting mucous form cysts when plugged up - difficult to tell between this and a carcinoma
bimanual hand exam
insert finger, lift cervix, use your hand on her abdomen to feel her uterus and ovaries
version
relationship between the fundus of the uterus and the vagina
flexion
the relationship between the fundus of the uterus and cervix
anteverted
fundus is less that 180 degrees, bends anteriorly from the vagina
retroverted
fundus is more than 180 degrees
- cervical os is pointed straight, more posteriorly
anteflexed
the fundus of the uterus is pointing anteriorly in a flexed position
retroflexed
fundus of uterus is pointed posteriorly
three blood supplies of breast
(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.
where does breast extend?
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.
what is breast composed of?
- 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.
** lymphatic drainage **
- breast cancer spreads most through lymphatic drainage
where does lymph from subareolar/submammary plexus drain?
to the anterior or pectoral group of nodes
where does axillary tail drain?
to subscapular group of axillary nodes
where does upper portion of breast drain?
to infra clavicular nodes
where does medial part of breast drain?
submammary plexus of the opposite breast and also the lymph glands along the internal thoracic artery and then to the mediastinal nodes
where does inferior portion of breast drain?
lymphatics of abdominal wall and the extra peritoneal lymphatic plexus
when is best time to examine breast
5-7 days following end of LMP…. after least amount of glandular tissue due to estrogen
Four quadrants of breast
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
Breast examination
arms over head brings underportion
hands on hips, can see the upper portion
leaning forward: shows lateral portion
lithotomy position
most common position for genital exams, with head of exam table elevated and heels in stirrups
ectocervix
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
endocervix
insert a cervical brush gently into the cervical os and rotate back and forth. transfer the specimen onto a slide or intoa specimen jar
Wet Mount or “hanging drop”
using cotton tipped swab, obtain a small sample of mucus from posterior fornix of vagina
