Female GU Exam Flashcards
Menarche
Onset of menses
Menopause
Absence of menses for 12 consecutive months (48-55 y/o)
Post menopausal bleeding
Bleeding occurring 6 months or more after cessation of bleeding
Amenorrhea
Absence of menses
Dysmenorrhea
Pain of 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
Nine important points of gynecologic history
Last menstrual period Regularity of periods Usual time btw periods Number of days of flow Amt of flow Pain btw periods Bleeding btw periods Age of menarche Sexual history
Gravida-Para Notation
G: number of pregnancies P: outcome of pregnancies Term (T) >37 weeks gestation Premature (P) Abortion (A) <20 weeks (induced or spontaneous) Living (L)
Explain G5P2032 in GP notation
G5P2032 5 pregnancies, 2 term deliveries, 3 abortions, 2 living
Dysparenunia
Painful intercourse
Location of Skene’s Glands and Bartholin’s Glands
Skene’s 10 and 2 o’clock
Bartholin’s 4 and 8 o’clock
List the steps of the gynecological exam
Inspection of External Genitalia
Palpation of External Genitalia
Examination of Internal Genitalia
Key points to insertion of the speculum
- Select appropriate size speculum.
- Warm and lubricate with warm water.
- Hold at 45 degree angle and point downward or posterior.
- Put gentle downward pressure on the posterior introitus.
- Once in the vagina, straighten the speculum and gently advance, maintaining posterior pressure.
- Slowly open the speculum to visualize the cervix.
Rectocele
Floor of pelvis weak and rectum bulges into the vagina – can differntiate because it’s the posterior wall of the vagina that’s bulging out – asymptomatic – seen in women who have delivered multiple children and as women age
Cystocele
Weak floor of pelvis, bladder distends and moves downwards into the vagina – can be visible bulging outwards or felt on examination
Can cause urinary incontinence due to the loss of the angle btw the urethra and the bladder
Os of the cervix
Flattened in women who have vaginally delivered and round and tight in women who haven’t
May be starred shaped after difficult delivery
Transformation zone (TZ)
Area where the cervix squamous cells and uterine columnar cells meet - cells tend to get dysplastic in this area - must get cells from here in a Pap smear
Where premalignant changes and neoplasia occur
Encompasses immature and mature squamous metaplasia
May appear as red epithelium towards center of Os
True Squamocolumnar Junction (SCJ)
Proximal limit of squamous metaplasia
Usually not visualized
Within endocervical canal
Approximately 3 cm from observed SCJ
How does the cervical os change with fertile/nonfertile phases?
Fertile - os is open, soft with fertile mucus
Infertile- os is closed, hard without mucus
Describe a cervical polyp
Overgrowth of columnar epithelium typically benign - nice smooth regular epithelium but very red
Describe a Nabothian Cyst
Normal variant - glands of cervix have gotten clogged up and bulge outward
Describe the Pap Smear technique with the broom
Broom placed in os and other part is on transformation zone – twirl around 4 or 5 times and place in solution for slides
Describe the steps of the bimanual exam
Lubricate the index and middle fingers of one of your gloved hands
Palpate the cervix - position, shape, consistency, regularity, mobility, and tenderness
Palpate the uterus - elevate the cervix and uterus with your pelvic hand, press your abdominal hand in and down, trying to grasp the uterus between your two hands. Note its size, shape, consistency, and mobility, and identify any tenderness or masses.
Palpate each ovary - Place your abdominal hand on the right lower quadrant, your pelvic hand in the right lateral fornix. Press your abdominal hand in and down, trying to push the adnexal structures toward your pelvic hand. Ovaries are most often not palpable
Strength of pelvis floor - looking for rectocele and cystocele that you can’t see - ask pt to bear down
Version
relationship between the fundus of the uterus and the vagina
Flexion
relationship between the fundus of the uterus and the cervix
Anteverted Uterus
Fundus <180 in relation to the vagina
Retroverted Uterus
Fundus >180 in relation to the vagina
Anteflexed/Retroflexed refers to the position of the ?
Uterus in relation to the cervix
Rectovaginal Exam indications
To palpate a retroverted and retroflexed uterus and the uterosacral ligaments
To screen for colorectal cancer in women 50 years or older
To assess pelvic pathology in the posterior rectovaginal pouch (Pouch of Douglas)
Describe the anatomy of the breast
Extends from 2nd rib - inframmary fold of 6th rib
Extends transversely from lateral border of sternum to mid axillary line
Deep rests on fascia of pec major, serratus ant and ext abd oblique and upper rectus sheath
Axillary tail of Spence extends laterally across ant axillary fold
Upper outer quadrant of breast contains greater volume of tissue than other quadrants
15-20 libes compose each lobule
Firbous bands of CT insert perpendicularly into dermis and provide structural support
Lobe - lactiferous duct - constricted orifice - ampulla
Dilated lactiferous sinus lined with stratified squamous epithelium
What is the difference between major and minor lactiferous ducts?
Major - two layers of cuboidal cells
Minor - single layer of cuboidal cells
What are the 3 sources of principal blood supply to the 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.
What forms the medial mammary arteries?
The second, third, and fourth anterior intercostal perforators and branches of the internal mammary artery arborize in the breast
What gives rise to the lateral mammary branches?
The lateral thoracic a.
Where does upper portion of breast drain?
Infraclavicular nodes
Where does medial portion of breast drain?
Sub mammary plexus of the opposite
breast and also to 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 to the extra peritoneal lymphatic plexus
Where does the axillary tail drain to?
Subscapular group of axillary nodes
Where does the lymph of the subareolar and submammary plexus drain?
Anterior or pectoral group of axillary nodes
When is the optimal time to examine the breast?
5-7 days after last menstrural period - least estrogen and least glandular tissue to prevent confusing with mass in breast
How do you describe locations on the breast?
Quadrants - upper inner, upper outer, lower outer, lower inner - most breast cancer in upper outer bc there is the most tissue here
Examine the breasts in what 4 positions?
Arms over head
Hands against hips
Palms pressed together
Arms extended and bent forward at waist
Tips for palpation of the breast
Patient supine - ipsilateral arm above the head
FINGER PADS not fingertips
Palpation is usually done in vertical strips or concentrically
Flatten the breast tissue against the chest wall
Motion should be continuous-Do not lift your hand off the breast
Methodically palpate the entire breast by quadrant and the Tail of Spunk
What pattern does the ACS say is most effective for covering entire breast?
The vertical pattern
What are the three different levels of pressure and what do they feel?
Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs.
Use each pressure level to feel the breast tissue before moving on to the next spot.
How should your movement be in palpating the breast?
Move around the breast in an up and down pattern starting at an imaginary line drawn straight down from the axilla and moving across the breast to the middle of the sternum.
Be sure to check the entire breast area going down until you feel only ribs and up to the neck or clavicle.
