Female GU Exam + Breast (king-10) Flashcards
1
Q
menarche
A
age at onset of menses
2
Q
menopause
A
absence of menses for 12 consecutive months
usually 48-55 yrs old
3
Q
post-menopausal bleeding
A
bleeding occuring 6 months or more after cessation of bleeding
4
Q
amenorrhea
A
absence of menses
5
Q
dysmenorrhea
A
pain with menses
6
Q
polymenorrhea
A
menses at abnormally frequent intervals
7
Q
oligomenorrhea
A
abnormally scant or infrequent menses
8
Q
menorrhagia
A
excessive bleeding
9
Q
metrorrhagia
A
bleeding between periods
10
Q
post-coital bleeding
A
bleeding after sexual intercourse
11
Q
sexual history as part of GYN visit
A
current sexual status
number of partners
gender of partners
any STDs
12
Q
gravida
A
number of pregnancies
13
Q
para
A
outcome of pregnancies usually four numbers 1. term >37 wks 2. premature 3. aborted <20wks 4. living
14
Q
urologic hx as part of GYN visit
A
frequency burning incontinence (stress, urge, overflow) urgency nocturia hematuria
15
Q
common CC
A
amenorrhea dysmenorrhea metrorrhagia vaginal d/c or itching abd/pelvic pain dyspareunia infertility PMS or PMDD change in urinary pattern
16
Q
dyspareunia
A
pain with intercourse
17
Q
PMDD
A
pre-menstrual dysphoric disorder
18
Q
materials for exam
A
gloves spec lgiht cotton tipped swabs lube Pap materials (brush/spatula) slide and fixative pH paper, culture, slides, KOH/saline
19
Q
inspect external genitalia
A
labia majora labia minora mons pubis urethral opening clitoris with prepuce vaginal entrance/introitus vestibule (surrounds vaginal opening)
20
Q
inspection of glands
A
Skene’s
Bartholin’s (more important)
21
Q
cystocele
A
prolapsed bladder through vaginal wall
22
Q
rectocele
A
prolapsed rectum through vaginal wall
23
Q
inspection of internal genitalia
A
warm and lube correctly sized spec hold at 45 angle pointing down gentle pressure on posterior introtus once in, straighten and advance open to see cervix
24
Q
cervical exam
A
look for: cervical color, position, suurface appearance, d/c, size and shape of os
test: Pap smear
25
Pap smear
examines cervix
samples vaginal secretions for wet mount
checks for STDs with GEN probe
26
os of cervix
```
inspect:
shape
polyps
pus
cancer
cysts
TZ
```
27
cervical lacerations from delivery
bilateral transverse
stellate
unilateral transverse
28
cervical os shapes
nulliparous: oval
gravid: slit
29
transformation zone
where premalignant changes and neoplasia occur
| encompass immature and mature squamous metaplasia
30
true squamocolumnar junction
proximal limit of squamous metaplasia
| usually not seen b/c its within endocervical canal, 3 cm from observed SCJ
31
Nabothian cysts
mucus filled cyst on cervix
| cause: sq epith of ectocervix grows on col epith of endocervix
32
palpation: bimanual exam
lube index and middle fingers and insert:
1. palpate cervix
2. palpate uterus
3. palpate both ovaries
4. strength of pelvic floor
33
palpating cervix
for position, shape, consistency, regularitty, mobility, tenderness
34
palpating uterus
elevate cervix and uterus with pelvic hand
press abdominal hand down to grasp uterus b/w both hands
palpate for size, shape, consistency, mobility, tenderness, masses/fibroids
35
palpating ovaries b/l
abdominal hand on RLQ
pelvic hand in R lat fornix
press abdominal hand down to push contents to pelvic hand
OFTEN NOT PALPATED
36
version
relatioship between fundus of uterus and vagina
37
flexion
relationship between fundus of uterus and cervix
38
rectovaginal exam
3 purposes:
1. palpated retroverted/flexed uterus and uterosacral ligaments
2. screen for CRC in women >50
3. assess pelvic path in post rectovaginal pouch (of Douglas)
39
female breast extends from?
- 2nd rib to 6th rib (inframammary fold)
| - sternum to MAL
40
posterior breast rests on?
fascia of pec major, serratus anterior, ext abd oblique mm, upper extent of rectus sheath
41
axillary tail of Spence
extends laterally
crosses anterior axillary fold
contains greatest volume of breast tissue at attachment site (upper outer quadrant)
42
breast anatomy
15-20 lobes
| CT bands insert perpendiculary to dermis and provide support
43
CT bands of breast called?
suspensory ligaments of Cooper
44
breast anatomy: lobes
each terminate into major lact duct opening into constricted orifice into ampulla of nipple
each duct has lact sinus lined w/ st sq epith
major ducts lined with 2 layers of cuboidal cells
minor ducts lined with 1 layer col/cub cell
45
arterial supply of breast (3)
1. internal mammary (perf branches)
2. post. intercostals (lat branches)
3. axillary a (esp: highest thoracic, lat thoracic, pec branch of thoracoacromial a)
46
medial mammary arteries
free, repeating branches from 2, 3, 4, anterior intercostal aa
47
lateral mammary branches
from lateral thoracic a
48
axillary tail drains into?
subscapular group (of axillary LN)
49
upper breast drains into?
infraclavicular LN
50
medial breast drainage
submamaary plexus of OPP breast
lymph along int thor a
then to mediastinal LN
51
inferior breast drainage
lymphatics of abd wall to extraperiotneal lymphatic plexus
52
subareolar and submammary plexuses drain to?
anterior or pectoral group of axillary LN
53
best time to examine breasts?
5-7 d post LMP
54
inspection of breast (4)
inspect w/ arms at side
inspect w/ arms overhead
inspect w/ palms pressed together
inspect w/ arms extended and bent forward at waist
55
observe breast for (6)
```
development
size/symmetry
contour
retractions/dimpling of skin
skin color/texture
venous engorgement
```
56
inspect nipple for (5)
```
retraction u/l or b/l
d/c
darkening
ras/crusting/ulcerations
supernumerary nipples
```
57
breast palpation technique
- pt supine, ipsilat arm above head
- finger pads, not tips
- in circles or strips
- flatten tissue against chest wall
- keep motion continous
- palpate breast by quadrant and tail of spence
58
breast palpation pressure
```
3 levels:
light to feel close to skin
med to feel deeper
firm to feel chest/ribs
Do all 3 pressures at one spot, then move on
```
59
movement of breast during palpation
up and down at imaginary line from axilla to sternum
| check entire breast going down until ribs and up to neck/clavicle
