Female GU, MSK, and Cultural Flashcards
1
Q
Purpose of female GU exam
A
ID pathology Cervical cancer STI Family Planning Counseling - preconception, menopause
2
Q
Whats part of Reproductive health visit?
A
History General / Vital Signs Breast Thyroid Cardiac Pulmonary Abdomen Pelvic exam
3
Q
Possible problem visits
A
Vulvovaginal S/s AUB Abnormal Uterine Bleeding Pelvic pain Pregnancy management Contraception complaint
4
Q
Menarch usually (age)
A
9-13 years old
5
Q
How often have menses
A
every 21-35 days
6
Q
how long are menses
A
4-7 days
7
Q
Menstrual Hx Documentation
A
Age of first x cycle frequency x duration
11 x 28 x 5
8
Q
Menorrhagia
A
excessive amount
>1 week
>80 mL
9
Q
Oligomenorrhea
A
Less frequency
>35 days
PCOS, Menopause
10
Q
Polymenorrhea
A
More frequency
<21 days
11
Q
Metrorrhagia
A
irregular interval
normal flow
12
Q
Menometrorrhagia
A
irregular interval
excessive flow
Meno + Metro
13
Q
Amenorrhea
A
absence of menses
14
Q
Primary amenorrhea
A
failure to ever start
Chromosomal, malnutrition, hypothalamic/pituitary
15
Q
Secondary amenorrhea
A
stopped after started
pregnancy, breast feeding, menopause, hypothyroid, pituitary tumor, anorexia
16
Q
Dysmenorrhea
A
Painful periods w/ back/pelvis cramping
17
Q
PMS when?
A
4 to 5 days before
18
Q
Pregnancy history Documentation
A
G# P (TPAL)
abortion = therapeutic, or surgical/abortion pill
19
Q
ROS focus
A
breast, gyn, GU, GI
20
Q
Dyspareunia
A
pain w/ sex
21
Q
Perimenopause
A
3-5 years before cessation (menopause)
22
Q
Average age of menopause
A
51 y/o
23
Q
S/S from oral contraception
A
ACHES Abdominal pain Chest Pain Headaches Eye problems Sudden leg/calf pain
24
Q
STI risk assesment - 5 Ps
A
Partners Prevention of pregnancy Protection from STIs Practices Past STI history
25
Proper sequence of female genital exam
1. Inspect external
2. Speculum exam
3. Bimanual exam
4. Rectovaginal exam
OPTIONAL 5. Rectal exam
26
Prepuce
clit hood
27
Skene's glands
around urethra, female orgasm
index finger in vagina, pressure anterior
milk for discharge = infection (gonorrhea)
28
Bartholin's glands
around vaginal opening - 4 & 8 oclock
| non-palpable unless cyst
29
Introitus
vaginal opening
30
HPV warts
condyloma acuminatum
31
Speculum exam requirements
Nothing in 1-2 days
empty bladder
lithotomy position
Relaxed patient
32
Spec exam draping
ab to knees
33
Ectocervix/ Endocervix cell type
Ectocervix - squamous epithelium
| Endocervix - columnar epithelium
34
Cervix blood supply
uterine artery
35
uterus layers
perimetrium, myometrium, endometrium
36
site of most ectopic pregs
ampulla - egg hangs out longest
37
Order of fallopian tube from uterus
isthmus, uterine tube, ampulla, infundibulum, fimbriae
38
External os - nulliparous/parous
Nulliparous - small oval
| Parous - linear, irregular
39
bubbly vag discharge
trichomonas
40
Where is nabothian cyst?
cervix
41
Bleeding after sex, common cause?
Cervical polyp
42
Cervical swab - must include cells from
transformation zone - endocervix (cancer)
| + ecto = rotate brush 360 degrees
43
when remove speculum, make sure
blades are closed
44
cystocele
bladder wall weakening (2 fingers in labia and patient pushes)
45
Bimanual exam - which hand in
Dom hand, other pressing abdomen
46
Bimanual exam - palpate
```
Vag walls
Cervix (consistency, position, movement (CMT/chandelier))
Uterus (position?)
Ovaries
Pelvic muscles
```
47
Uterus positions
retro/antiflexed, retro/anteverted
48
Enlarged uterus could be
pregnancy, fibroids
49
Adnexal mass could be
ectopic preg
50
Ovarian mass could be
cyst
51
tenderness could be
PID, Endometriosis, Cystitis
52
Cervical cancer cell type
80% squamous cell carcinoma (transformation zone)
53
HPV screen - no screen
less than 21 y/o, more than 65 y/o
54
HPV screen - just PAP no HPV
21-30 y/o, every 3 years
55
HPV screen - PAP w/ HPV (or not)
30-65 y/o every 3 years, w/ HPV every 5 years
56
3 components to MSK exam
Movement, Neuro, Vascular
57
TMJ range of motion assesment
palpate - crepitus, clicking
| 3 finger insert
58
Bouchard's nodes
osteoarthritis, PIP, painless (never MIP)
59
Heberden's nodes
osteoarthritis, DIP, painless (never MIP)
60
Tophi
gout, painful, MIP yes
61
Mallet finger
bent DIP on straight finger
| jammed then disrupted extensor tendon
62
Trigger finger
pops when straighten finger
| nodule at base of MIP, flexor tendon
63
Boutonniere deformity
Flex PIP, Hyperextend DIP
64
Swan-neck deformity
Hyperextend PIP, Flex DIP
65
Chronic rheumatoid arthritis deformity
in MIP (so NOT osteoarthritis), squeeze test hurts
66
Olecranon bursitis
NO pain, plumbers
67
Silver fork deformity, collee's fracture
distal radius fracture
68
joint effusion
fell - blood
longstanding rheumatoid arthritis flair - synovial
Gout - crystals/fluid
69
joint crepitus
cartilage loss
70
genu valGUM
knock knees
71
genu valRUM
bow-legged
72
mongolian spot
blue/black discoloration to back
73
FICA
F: What is your faith or belief?
Do you consider yourself spiritual or religious?
What things do you believe in that give meaning to your life?
I: Is it important in your life?
What influence does it have on how you take care of yourself?
How have your beliefs influenced your behavior during this illness?
What role do your beliefs play in regaining your health?
C: Are you part of a spiritual or religious community?
Is this of support to you and how?
Is there a person or group of people you really love or who are really important to you?
A: How would you like me, your healthcare provider, to address these issues in your healthcare?
74
Patient Explanatory Model
[1] What do you think has caused your problem?
[2] Why do you think it started when it did?
[3] What do you think your sickness does to you? How does it work?
[4] How severe is your sickness? Will it have a short or long course?
[5] What kind of treatment do you think you should receive?
[6] What are the most important results you hope to receive from this treatment?
[7] What are the chief problems your sickness has caused for you?
[8] What do you fear most about your sickness?
