Female GU Exam + Breast (king-10) Flashcards
menarche
age at onset of menses
menopause
absence of menses for 12 consecutive months
usually 48-55 yrs old
post-menopausal bleeding
bleeding occuring 6 months or more after cessation of bleeding
amenorrhea
absence 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 sexual intercourse
sexual history as part of GYN visit
current sexual status
number of partners
gender of partners
any STDs
gravida
number of pregnancies
para
outcome of pregnancies usually four numbers 1. term >37 wks 2. premature 3. aborted <20wks 4. living
urologic hx as part of GYN visit
frequency burning incontinence (stress, urge, overflow) urgency nocturia hematuria
common CC
amenorrhea dysmenorrhea metrorrhagia vaginal d/c or itching abd/pelvic pain dyspareunia infertility PMS or PMDD change in urinary pattern
dyspareunia
pain with intercourse
PMDD
pre-menstrual dysphoric disorder
materials for exam
gloves spec lgiht cotton tipped swabs lube Pap materials (brush/spatula) slide and fixative pH paper, culture, slides, KOH/saline
inspect external genitalia
labia majora labia minora mons pubis urethral opening clitoris with prepuce vaginal entrance/introitus vestibule (surrounds vaginal opening)
inspection of glands
Skene’s
Bartholin’s (more important)
cystocele
prolapsed bladder through vaginal wall
rectocele
prolapsed rectum through vaginal wall
inspection of internal genitalia
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
cervical exam
look for: cervical color, position, suurface appearance, d/c, size and shape of os
test: Pap smear
Pap smear
examines cervix
samples vaginal secretions for wet mount
checks for STDs with GEN probe
os of cervix
inspect: shape polyps pus cancer cysts TZ
cervical lacerations from delivery
bilateral transverse
stellate
unilateral transverse
cervical os shapes
nulliparous: oval
gravid: slit
transformation zone
where premalignant changes and neoplasia occur
encompass immature and mature squamous metaplasia
true squamocolumnar junction
proximal limit of squamous metaplasia
usually not seen b/c its within endocervical canal, 3 cm from observed SCJ
Nabothian cysts
mucus filled cyst on cervix
cause: sq epith of ectocervix grows on col epith of endocervix
palpation: bimanual exam
lube index and middle fingers and insert:
- palpate cervix
- palpate uterus
- palpate both ovaries
- strength of pelvic floor
palpating cervix
for position, shape, consistency, regularitty, mobility, tenderness
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
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
version
relatioship between fundus of uterus and vagina
flexion
relationship between fundus of uterus and cervix
rectovaginal exam
3 purposes:
- palpated retroverted/flexed uterus and uterosacral ligaments
- screen for CRC in women >50
- assess pelvic path in post rectovaginal pouch (of Douglas)
female breast extends from?
- 2nd rib to 6th rib (inframammary fold)
- sternum to MAL
posterior breast rests on?
fascia of pec major, serratus anterior, ext abd oblique mm, upper extent of rectus sheath
axillary tail of Spence
extends laterally
crosses anterior axillary fold
contains greatest volume of breast tissue at attachment site (upper outer quadrant)
breast anatomy
15-20 lobes
CT bands insert perpendiculary to dermis and provide support
CT bands of breast called?
suspensory ligaments of Cooper
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
arterial supply of breast (3)
- internal mammary (perf branches)
- post. intercostals (lat branches)
- axillary a (esp: highest thoracic, lat thoracic, pec branch of thoracoacromial a)
medial mammary arteries
free, repeating branches from 2, 3, 4, anterior intercostal aa
lateral mammary branches
from lateral thoracic a
axillary tail drains into?
subscapular group (of axillary LN)
upper breast drains into?
infraclavicular LN
medial breast drainage
submamaary plexus of OPP breast
lymph along int thor a
then to mediastinal LN
inferior breast drainage
lymphatics of abd wall to extraperiotneal lymphatic plexus
subareolar and submammary plexuses drain to?
anterior or pectoral group of axillary LN
best time to examine breasts?
5-7 d post LMP
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
observe breast for (6)
development size/symmetry contour retractions/dimpling of skin skin color/texture venous engorgement
inspect nipple for (5)
retraction u/l or b/l d/c darkening ras/crusting/ulcerations supernumerary nipples
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
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
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
