Female Pelvis

Question 1

Clinical history protocol of imaging the female pelvis

Answer 1

• symptoms
• LMP (1st day of reproductive age)
• gravida/parity (if beyond puberty)
• surgeries (on UT or OV)
• previous imaging

Question 2

If the patient is 50-65 years old, what should you ask when it comes to LMP?

Answer 2

Ask if they still get periods

Question 3

If the patient is 17+ years old, what should you ask when it comes to gravida/parity?

Answer 3

ask if they have ever been told they are pregnant (b/c miscarriages count)

Question 4

How should you ask the patient about past pregnancies?

Answer 4

“Counting this pregnancy, how many times have you been told you are pregnant and how many times have you delivered?”

Question 5

What effects uterine size?

Answer 5

age & parity

Question 6

Other than the date, what else do we need to know about LMP?

Answer 6

if they are normal

Question 7

menarche

Answer 7

• first menstrual period
• pre-/post-

Question 8

menopause

Answer 8

• end of menstrual periods
• peri-/post-

Question 9

amennorhea

Answer 9

• w/o periods
• primary = never had a period
• secondary = had periods & they stopped (ex. pregnancy)

Question 10

dysmennorhea

Answer 10

• difficult period
• pain, duration, bleeding

Question 11

menorrhagia

Answer 11

heavy/excessive periods

Question 12

menometrorrhagia

Answer 12

• heavy bleeding w/ & w/o period
• bleeding in btwn. periods

Question 13

oligomenorrhea

Answer 13

• too few of periods
• longer cycles

Question 14

Gravida

Answer 14

• G = actual pregnancies
• twins = 1 pregnancy

Question 15

Parity

Answer 15

• P = actual deliveries beyond 20 weeks
• twins = 2 deliveries

Question 16

G_TPAL

Answer 16

• Gravida, term, preterm, abortus, living children
• ex. G3 P1112

Question 17

Parity types

Answer 17

• T = term deliveries (>36 weeks)
• P = preterm deliveries (<36 weeks)
• A abortions (spontaneous/elective/ectopic)
• L = living children (twins reflected)

Question 18

Key terms for G & P

Answer 18

• multi-/Nulli-/Primiparous-Gravid
• nulli = none
• primi = 1

Question 19

Patient pain

Answer 19

• acute vs. chronic
• pattern

Question 20

Patient bleeding

Answer 20

cyclic vs. intermittent

Question 21

Other reasons for exam

Answer 21

• F/U
• new symptoms
• MD concern
• labs
• medications (hormones, OCP’s)

Question 22

Other pertinent clinical history

Answer 22

• possibly pregnant? (ask before scan only)
• previous conditions (esp. before surgeries)
• degree or severity of pain/bleeding
• did pt fill bladder before exam?

Question 23

Patient education do’s

Answer 23

• ask questions carefully
• maintain pt modesty
• ask for permission to perform TV exam
• have a sonographer present for TV exam

Question 24

Patient education don’ts

Answer 24

• making suggestions may create pt’s condition
• ask about pregnancy after starting exam
• refer to ‘probe’ when discussing TV exam

Question 25

Lab values for female pelvis

Answer 25

- Gonadotropic hormones - estrogen & progesterone - non-gravid uterus

Question 26

Gonadotropic hormones

Answer 26

- FSH/LH - hCG (Human Chorionic Gonadotropin)

Question 27

FSH/LH lab values

Answer 27

- controlled by GnRH (releasing hormone from the hypothalamus) - levels may be monitored in suspected cases of infertility

Question 28

hCG (Human Chorionic Gonadotropin) lab values

Answer 28

- qualitative = is pt pregnant? - quantitative = how pregnant is the pt? - values double every 48-72 hours

Question 29

How can quantitative hCG be determined?

Answer 29

- rise proportionately in first 8 weeks of pregnancy - correlate w/ sonographic appearance of UT/gestational sac - only determined through blood sample

Question 30

What could be happening if hCG values are not increasing enough, staying the same, or decreasing?

Answer 30

pregnancy may not be viable

Question 31

Estrogen & progesterone lab values

Answer 31

may be monitored for infertility purposes

Question 32

Non-gravid uterus lab values

Answer 32

- WBC (white blood cell count) - increases w/ infection (PID - pelvic inflammatory disease) - vaginal/cervical/endometrial (ex. smears, biopsies, cultures, malignancies, STD's)

Question 33

Correlation

Answer 33

the process of establishing a relationship or connection btwn. 2 or more measures

Question 34

Assessing the patient's age/LMP/G/P

Answer 34

- look at size of UT - appearance of UT/OV

Question 35

When considering the type of pain the patient is experiencing, what should we be prepared to see?

Answer 35

pathology

Question 36

If the patient is asymptomatic for an abnormality detected by the physician, do we still need to focus on it during the exam?

Answer 36

yes

Question 37

What is the goal of hormonal medications?

Answer 37

- return a postmenopausal patient to near normal appearance - OCP's suppress normal cycle

Question 38

Labs correlation

Answer 38

- detect infectious processes (in any pelvic structure) - detect pregnancy

Question 39

Why is it important for us to ask the patient about previous surgeries on UT/OV?

Answer 39

we don't want to look for something that isn't there

Question 40

If the pelvic ultrasound is normal, what else could cause the symptoms?

Answer 40

- GI - GU - Vascular - Musculoskeletal