Female GU and Breast Exam Flashcards
perineum
area between vagina and anus
may see scarring here - during baby delivery
adnexa
ovary and fallopian tube
menarche
age at onset of menses
menopause
absence of menses for 12 consecutive months
ages 48-55 usually
post-menopausal bleeding
occuring 6 month or more after cessation of bleeding
amenorrhea
absences 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 sex
gynecologic history
last period regularity of periods time between periods number of days of flow amount of flow pain with periods bleeding between periods age of menarche
sex history
current status
number of partners
gender of partners
any STDs
gravida-para notation
G - number of pregnancies
P - para-outcome of pregnancies
T = term P = premature A = abortion < 20 weeks (induced or spontaneous) L = living
G3 P3003
3 pregnancies
3 term deliveries all living
G4 P2305
4 pregnancies
2 term, 3 preterm (premature), 5 living
urological history
frequency burning incontinence urgency nocturia hematuria
dyspareunia
painful intercourse
PMDD
premenstrual dysphoric disorder
bartholins glands
in labia majora
- secrete lubrication
- duct opening to labia minora
- duct can get blocked and infected - abscess
4 and 8 oclock
skenes glands
paraurethral glands
- adjacent to urethral opening
- can get swelling/tenderness
10 and 2 oclock
cystocele
bladder descends and bulges out of vagina
rectocele
rectum bulges into vagina
exam of internal genitalia - speculum insertion
warm and lube correct speculum
- 45 degree angle and point down
- gentle downward pressure on introitus
- open slowly after advancing gently
exam of internal genitalia
cervix - color, position, surface, discharge, size, shape
procedures - PAP smear, sample of vaginal secretions, GEN probe
os
opening of cervix
-shape, polyps, pus, cancer, cysts
transformation zone
columnar cells of uterus to squamous cells of cervix
important area to collect cells for paps
cervical os
may have lacerations during delivery of child
pap smear
right at os - transformation zone
transformation zone
premalignant changes and neoplasia occur here
encompasses immature and mature squamous metaplasia
true squamocolumnar junction
proximal limit of squamous metaplasia
- usually not visualized
- within endocervical canal
- 3cm from observed SCJ
fertile phase
os is open with fertile mucus
nabothian cyst
cervix secretes a mucus
-they get plugged and can form cysts
can be confused with cancer
bimanual exam
index and middle finger
palpate cervix, uterus, and each ovary
version
relationship between fundus of uterus and vagina
flexion
relationship between fundus of uterus and cervix
anteverted
uterus less than 180 degrees from uterus
retroverted opposite
anteflexed
uterus fundus less than 180 degress from cervix
retroflexed is opposite
rectovaginal exam
3 purposes:
- screen colorectal cancer for women > 50 yo
- assess pelvic pathology in posterior rectovaginal pouch (pouch of douglas)
- palpate a retroverted and retroflexed uterus and uterosacral ligaments
female breast anatomy
level of 2nd rib to inframammary fold at 6th rib
transversely from lateral border of sternum to mid-axillary line
deep surface of breast rests on fascia of pectoralis major, serratus anterior and external obliqus, and upper extent of rectus sheath
axillary tail of spence - extends laterally across anterior axillary fold - upper outer quadrant of breast contains greater volume of tissue than other quadrants
most volume in breast?
upper outer quadrants
breast functional anatomy
15-20 lobes composed of lobules
fibrous bands of CT - suspensory ligaments of cooper - provide structural support
breast ducts
each lobe terminates in major lactiferous duct - opens through orifice to ampulla of nipple
deep to nipple - major duct has dilated portion - lactiferous sinus - lined with stratified squamous
major ducts - two layers cuboidal
minor ducts -single layer columnar or cuboidal
arterial supply of breast
perforating branch of internal mammary artery
lateral branches of posterior intercostal arteries
branches of axillary artery
2,3,4 anterior intercostal perforators of internal mammary - medial mammary arteries
lateral thoracic artery gives rise to lateral mammary branches
lymph of breast**
axillary tail - subscapular group of axillary nodes
upper - infra clavicular nodes
medial - sub mammary plexus of opposite breast and lymph glands along internal thoracic artery and to mediastinal nodes
inferior - lymph of abdominal wall and extra peritoneal lymphatic plexus
most of lymph from subareolar and submammary plexus to anterior or pectoral group of axillary nodes
axillary tail drainage
subscapular group of axillary nodes
upper lymph drainage
infra clavicular nodes
medial lymph drainage
sub mammary plexus of opposite breast and lymph glands along internal thoracic artery and to mediastinal nodes
inferior lymph drainage
lymph of abdominal wall and extra peritoneal lymphatic plexus
subareolar and submammary plexus drainage
anterior and pectoral group of axillary nodes
best time for breast exam
5-7 days following last period
4 quadrants of breast
upper outer - most cancers (most tissue)
upper inner
lower outer
lower inner
breast inspection
arms at side arms over head hands against hops palms pressed together arms extended and bent forward at waist
palpation of breast
patient supine with sheet under shoulders
use pads of fingers
-palpate by quadrant and tail of spence
vertical or rotary pattern palpation
tail of spence can be palpated along axillary fold
tail of spence
axillary tail of breast
palpation of axilla
common site of cancer
reading
Bates’ Guide to Physical Examination, 10th Edition, pages 389-411 & 521-544
