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PCM IV Exam I > Female GU exam (King 15 questions) > Flashcards

Female GU exam (King 15 questions) Flashcards

1
Q

normal clitoris size

A

2 cm or less in length

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2
Q

shallow ulcers on red bases

painful

A

herpes

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3
Q

painless

cauliflower appearance

A

HPV

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4
Q

SINGLE chancroid like lesion on labia

A

primary syphilis

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5
Q

multiple slightly raised round or oval, flat topped papules covered by a gray exudate

A

secondary syphilis

this is contagious

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6
Q

ulcerated lesion on vulva

PAINLESS

A

vulvar carcinoma

often look like HSV BUT they are completely painless

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7
Q

bartholin gland abscess

A

usually required incision and drainage

word catheter for 4-6 weeks and oral antibiotics

if recurrent, consider marsupialization

commonly caused chlamydia and gonococcal infections

abscess is usually preceded by a cyst

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8
Q

skene’s glands?

A

peri-urethral

secrete lubrication

may have infection/abscess caused by chlamydia and gonoccocus

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9
Q

what is a cystourethrocele

A

when the entire vaginal wall, together with the bladder and urethra is involved in a bulge

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10
Q

cystocele

A

bulge of the upper two thirds of the anterior vaginal wall

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11
Q

rectocele

A

herniation of the rectum into the posterior wall of the vagina

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12
Q

what is reccomended for use in lubricating the speculum

A

warm water

lubricants can interfere wit the ability to read the pap smear and STD cultures

don’t lubricate until the bimanual

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13
Q

what is the proper technique for insertion of the speculum

A

separate labia minora with one hand

direct the speculum downward at 45 degrees towards the sacrum

pressure should be on the posterior wall NOT anterior wall (more sensitive)

do not open the speculum until it is fully inserted into the vagina

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14
Q

what are nabothian cysts

A

inclusion cyst of the endocervical glands

benign

may resemble cervical pathology but these are a normal variant

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15
Q

what types of epithelium make up the transformation zone and what influence does estrogen have on this area?

A

squamous and columnar epithelium

under the influence of estrogen the columnar epithelium will convert into squamous epithelium (metaplasia)

this is where cellular abnormalities occur and cervical cancer can arise

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16
Q

what are some infectious causes of cervicitis

A

chlamydia
neisseria gonorrhea

trichomonas vaginalis

HSV

HPV

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17
Q

what does cervicitis look like

A

eroded, hemorrhagic

not smooth

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18
Q

what is version of the uterus

A

relationship b/w the fundus of the uterus and the vagina

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19
Q

what is flexion of the uterus

A

relationship b/w the fundus of the uterus and the cervix

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20
Q

anterverted uterus

A

usually easier to palpate the uterus

hand inside is just trying to push up on the cervix

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21
Q

anteflexed

A

the uterus itself is flexed

this is the most common position

22
Q

what is the rectovaginal exam useful for?

A 
assessing:
posterior wall of vagina
rectovaginal pouch (Pouch of douglas)
retroflexed/retroverted uterus
rectum
23
Q

what is the lactiferous sinus and what lines it

A

Deep to the nipple-areola complex, each major duct has a
dilated portion (lactiferous sinus), which is lined with stratified
squamous epithelium

24
Q

what lines major ducts of the breast

A

lined by two layers of cuboidal cells

minor ducts are lined by single layer of columnar or cuboidal

25
Q

where does the breast extend to and from on the body

A

extends from the level of the second or third rib to the infra-mammary fold at the six or seventh rib

extends transversely from the lateral border of the sternum to the anterior axillary line

26
Q

what lies under the deep posterior surface of the breast

A

fascia of pectoralis major
serratous anterior and external abdominal oblique muscles

upper extent of the rectus sheath

27
Q

what is unique about the upper outer quadrant of the breast>

A

contains a greater volume of tissue than do the other quadrants

breast cancer incidence is higher in this area so do NOT miss this on exam

28
Q

where is the prinicipal blood supply to the breast from?

A

peforating branches of the internal mammary artery

lateral branches of the posterior intercostal arteries

branches from the axillary artery (highest thoracic, lateral thoracic, pectoral branches of the thoracoacromial)

29
Q

what makes up the medial mammary arteries

A

The second, third, and fourth anterior intercostal
perforators and branches of the internal mammary artery
arborize in the breast as the medial mammary arteries

30
Q

what branches does the lateral thoracic artery give off

A

branches to:

  • serratus anterior
  • pec major and minor
  • subscapularis
  • lateral mammary branches
31
Q

where does majority of lymph of the breast drain to?

A

axillary nodes

if you find a node, it will likely be in the axilla (lateral chest wall sometimes)

medial nodes, YOU CAN”T PALPATE bc they are b/w ribs and the sternum

if you have breast cancer on one side you better check the other breast

32
Q

when is the optimal time to examine the breast

A

5-7 days following LMP

b/c this is the time when there is the least amount of estrogen influence

when estrogen is high, glandular tissue is much more prominent and breasts are tender/engorged

33
Q

what causes erythema of the breast

A

mastitis

inflammatory carcinoma

34
Q

what causes masses of the breast

A

cysts
fibroadenoma
carcinoma

35
Q

nipple discharge can be from what?

A

bloody- papilloma, cancer
non-bloody – endocrine disorder

could also indicate pregnancy

36
Q

dermatitis of the nipple

scaly, eczemalike lesion

A

paget’s of nipple

37
Q

what 4 positions must you examine the breast in

A

arms over head
hands against hips
palms pressed together
leaning forward

38
Q

reticular inflammatory pattern

usually found in a woman who just have birth and is breastfeeding

the engorged glands get infected –> redness, swelling, tenderness

A

mastitis

39
Q

Peau d’orange

A

cancer that has invaded dermal lymphatics causing edema

fairly late changes in the course of the disease

40
Q

when palpating the breast, should you use finger pads or finger tips

A

finger pads

41
Q

how many levels of pressure should you use when examining the breast

A

3

dont’ ever lift hand

42
Q

what does the american cancer society suggest for palpation pattern

A

vertical

43
Q

age 15-20
puberty and young adult hood

usually single mass but may be multiple

round, disclike or lobular

soft or firm

well delineated

very mobile

nontender
no retraction

A

fibroadenoma

44
Q

30-50
regress after menopause except with estrogen therapy

single or multiple

round

soft to firm, usually elastic

well delineated

mobile

often tender

absent retraction

A

cysts of breast

45
Q

what are the risk factors for breast cancer

A

• Previous history of Breast Cancer
• Family history of Breast Cancer in first degree relative
– Family history extremely important (you better ask specifically)
– Also a very high correlation between breast and ovarian
• Age - Risk increases with age: 5% of cases present
before age 40 (2% before age 35)
• Nulliparous
• First child after age 30
• Early Menarche
• Estrogens and HRT
• Radiotherapy to chest
• Smoking

46
Q

what are some presentations of breast cancer? in decreasing order of frequency

A 
lump- most common
painful lump
nipple changes
nipple discharge 
skin contour changes

breast pain/mastaligia alone is very uncommon

47
Q

stage 1 breast cancer

A

no more than 2 cm in diameter

cancer hasn’t spread to lymph nodes

there is no distant mets

5 year survival is 98percent

48
Q

stage 2 breast cancer

A

b/w 2cm - 5 cm in diameter
-may or may not have spread to axillary lymph nodes

OR

cancer is more than 5 cm in diameter but hasn’t spread to the axillary lymph nodes

OR

the tumor is less than 2 cm in diam but has spread to less than 4 of the axillary lymph nodes

there is NO distant mets

mean 5 year survival is 76 percent to 88 percent

49
Q

stage 3 breast cancer

A

locally advanced

spread to the lymph nodes near the breast

may be larger than 5 cm with spread to axillary lymph nodes

OR

smaller than 5 cm but the cancer has spread to the axillary lymph nodes above the collarbone

5 year survival is 40-50 %

50
Q

inflammatory breast cancer is what stage ?

A

stage III

has spread to the breast skin, causing swelling and redness

5 year survival is 49-56 %

51
Q

stage IV breast cancer

A

distant mets
-liver, lung, bone

treatment may help shrink or control the cancer for a while, but it usually wont completely cure

symptom relief is a priority at this stage

PCM IV Exam I (5 decks)

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