Genitalia/EKG Flashcards
The pelvic organs are supported by a sling of tissues composed of
muscle, ligaments and fascia, through which the urethra, vagina and rectum all pass
in the United States the range of age of menarche is between
9 and 16
Normal menses is
Every 24 to 32 days
Menopause is defined as no menses for 12 months, and the average age of menopause is
no menses for 12 months; 45 to 52 years
Although thought of as primarily a male problem, women can also have ___ in the groin
hernias
The SA node initiates the ___
normal rhythmic electrical impulse.
depolarization of the atria inscribes the ___ wave on the EKG
P
The SA node rhythmically depolarizes and this wave of depolarization spreads through the atria causing them to
contract
Because the SA node is very small, you do not see
its electrical activity on the EKG
When the atrial depolarization stimulus reaches the AV node, depolarization slows, producing a brief pause, and allowing
the atrial blood to enter the ventricles
Once the depolarization reaches the ventricular conduction system, it conducts very rapidly through the ___ and the ___
Bundle of His (junctional bundle) and the left and right bundle branches and their subdivisions.
The terminal filaments of the Purkinje fibers distribute the depolarization stimulus to the
ventricular myocardial cells
P wave represents the
depolarization of the atria
The cells of the ventricles have the ___ firing rate, which is ___
slowest; 20-40 per minute
Depolarization of the ventricular myocardium produces the
QRS complex on the EKG
Following the QRS complex, there is a segment of the horizontal baseline knows as the ____ which represents the plateau phase of repolarization
ST segment
The T wave represents
the final phase of ventricular depolarization (becomes negatively charged)
Ventricular contraction (systole) begins with the ___ and lasts until the end of the ___
QRS; T wave
A long QT interval often warns that the patient is vulnerable to
irregular rhythms
PR interval normally lasts
QRS complex normally lasts
QT interval normally lasts
The cardiac cycle is represented by
the P wave, the QRS complex, the T wave and the baseline that follows until another P wave appears
Physiologically, the cardiac cycle represents
atrial systole or atrial kick – ventricular systole – then the resting stage that follows until another cycle begins again
The limb leads record
activity in the coronal or frontal plane of the body
Electrical activity moving from right arm to left arm in lead I (negative to positive electrode) is recorded as a
positive deflection of the ECG tracing of lead I
The chest leads record activity in the
axial (horizontal) plane of the body
VI and V2 chest leads are located at
the 4th ICS either side of sternum
V4 chest lead is located at
5th ICS MCL
V3 chest lead is located
between V2 and V4
V6 is located at the
5th ICS mitral area
V5 is located at the
5th ICS between V4 and V6
Electrical activity moving towards the positive electrode from the negative electrode will be viewed as
upright complexes on the monitor
When Lead II is used, both the flow of negative to positive impulses of the ECG machine and that of the heart are traveling in
the same direction
Mons pubis
a hair-covered fat pad overlying the symphysis pubis
labia majora
rounded folds of adipose tissue
labia minora
thinner folds that extend anterior to form the prepuce and clitoris should be dark pink, moist, symmetric
vestibule
boat shaped fossa between the labia minora
introitus
Posterior portion of the vestibule that is the vaginal opening (introitus) which may be covered by the hymen in virgins
perineum
the tissue between the introitus and anus
Urethral meatus
opens in to the vestibule between the clitoris and the vagina
The openings of the Bartholin’s glands are located
posteriorly on either side of the vaginal opening, but are not usually visible.- secrete mucus to lubricate the vagina
Vagina is a hollow tube extending upward and posteriorly between the
urethra and rectum. It terminates in the cup-shaped fornix.
The uterus is a
flattened fibromuscular structure shaped like an inverted pear.
2 parts of the uterus
the body and the cervix, which are joined together by the isthmus. The upper surface of the body is called the fundus. The cervix protrudes into the vagina.
Fallopian tubes extend from each side of the uterus toward the
ovary
The two ovaries are almond-shaped structures that vary in size but average
3.5 x 2 x 1.5 cm. The ovaries are palpable during reproductive years but fallopian tubes are normally not felt.
The term adnexa refers to
the ovaries, tubes and supporting tissues.
vulvovaginal symptoms include
burning, itching, and the quantity and quality of discharge (including texture, amount, color, and smell)
When asking about sexual history, be
professional and matter of fact
If you suspect urethritis or inflammation of paraurethral glands, how should you inspect?
insert your index finger into the vagina and milk the urethra gently from inside outward; culture any discharge that has been “milked out”
Delayed puberty is often
familial or related to chronic illness Can also be due to abnormalities in the hypothalamus, anterior pituitary gland or ovaries
Cystocele
bulge of the anterior vaginal wall, together with the bladder above it, that results from weakened supporting tissues. The upper two thirds of the vaginal wall are involved.
Rectocele is the
bulging of the posterior wall of the vagina, together with the rectal wall behind it. Weakened supporting structure are the cause.
Palpating the perineum should normally feel
thick, smooth and muscular in the nulliparous woman, and thin and more rigid in the multiparous woman
prolapsed urethral mucosa is a
swollen red ring around the urethral meatus. Usually occurs before menarche or after menopause.
The shaft of the penis is formed by three columns of
vascular erectile tissue
three columns of vascular erectile tissue that compose the shaft of the penis are:
The corpus spongiosum, containing the urethra The two corpora cavernosa
The corpus spongiosum forms the
bulb of the penis, ending in the cone-shaped glans with its expanded base, or corona
In uncircumcised men, the glans is covered by a loose, hood-like fold of skin called the
prepuce, or foreskin, where smegma, or secretions of the glans, may collect
The urethra opens into the vertical, slit-like
urethral meatus
The scrotum is a
loose, wrinkled pouch divided into two compartments, each containing a testis
On the posterolateral surface of each testis is the softer comma-shaped
epididymis
The testes are ovoid, somewhat rubbery structures approximately ___ cm long
4.5
The left testis usually lies somewhat ___ than the right
lower
The vas deferens begins at the
tail of the epididymis
The basic landmarks of the groin are the
anterior superior iliac spine, the pubic tubercle, and the inguinal ligament
The inguinal canal, which lies ___, forms a tunnel for the vas deferens
above and parallel to the inguinal ligament
When loops of bowel force their way through weak areas of the inguinal canal, they produce
inguinal hernias
21-year-old male presents complaining of a “nodule” on the back of his left testicle found during testicular self-examination. On examination, you find both testicles to be of normal size, shape, and consistency. On the back of the left testicle in the area of the “nodule,” you find a soft, nodular, tubelike structure with no areas of abnormal tenderness. Your most likely diagnosis is: A. Acute epididymitis B. Cyst of the epididymis C. Normal epididymis D. Carcinoma of the epididymis
C
Which of the following statements about hernias is true? A. Indirect inguinal hernias are the most common form of hernia B. Femoral hernias are the least common form and are more common in women C. Direct inguinal hernias are more common in men over age 40 D. Indirect inguinal hernias originate above the inguinal ligament near its midpoint E. All of the above
E
An indirect inguinal hernia produces a bulge over the
midpoint of the inguinal ligament
60 % of all hernias are
indirect inguinal hernia More common in infants and males 16-20 years
Direct inguinal hernia herniates directly behind and through the
external inguinal ring above the inguinal ligament; rarely enters scrotum
Direct inguinal hernias are usually
painless; round swelling close to the pubis in area of internal inguinal ring; easily reduced when supine
Direct inguinal hernias are less common, usually found in men ages ___ and a result of ___
over 40 Acquired weakness; heavy lifting, obesity, ascites.
Testicular CA is the most common cancer of
young men age 15-34 Males with undescended testicles are at greatest risk, and whites are 4 times more likely to get testicular CS than non-whites
Testicular Self Examination (TSE)
T= timing; once a month S= shower; warm water relaxes scrotal sac E= examine; check for changes, report changes immediately
Hernias are
protrusions of a part of the abdominal cavity within the peritoneal sac that goes through a weakened part in the abdominal wall.
If the content of a hernia sac can be easily replaced the hernia is said to be
reducible. If not, the hernia is irreducible or incarcerated.
When the blood supply of the incarcerated contents is interrupted the hernia is strangulated and __ may occur
gangrene
Female Hernias
Much less common. To feel an indirect inguinal hernia palpate in the labia majora and upward to just lateral to the pubic tubercles. Most common is indirect inguinal hernia then femoral
Femoral hernias
herniated through femoral ring and canal, below inguinal ligament more often on right side pain may be severe, may become strangulated least common ; more common in women Acquired weakness; heavy lifting, obesity, ascites.
Prostate gland lies
in front of the anterior wall of the rectum and 2cm behind the symphysis pubis It is bi-lobed structure with a round or heart shape. It measures 2.5 cm long and 4 cm in diameter. The two lateral lobes are separated by a shallow groove called the median sulcus. The two seminal vesicles project like rabbit ears above the prostate.
prostate gland has ___ ducts that open into the urethra and secretes ____
15-30 a thin, milky alkaline fluid that helps sperm viability
Anal canal is about ___ long in adults
3.8cm
two types of anal canal muscle sphincters
Internal- involuntary control by autonomic nervous system. External-surround the internal, under voluntary control
There are anal columns, which are folds of mucosa that extend vertically down from rectum and end in anorectal junction. Each column has artery and vein. Sometimes veins enlarge and form a ____
hemorrhoid
Flabby skin sac in the perianal area is a sign of
hemorrhoid
Shiny blue skin sac in the perianal area is a sign of
thrombosed hemorrhoid
Small round opening in anal area is indicative of a
fistula
Inflammation or tenderness, swelling, tuft of hair or dimple at tip coccyx may indicate
pilonidal cysts.
Circular red doughnut of tissue in the perianal area is a sign of
rectal prolapse
Note that a false positive stool culture may occur if patient has
eaten significant amounts of red meat or beets within 3 days of the test
mass in the anus: Carcinoma
asymptomatic An early lesion may be a single firm nodule with rolled edges. As lesion grow, it has an irregular cauliflower shape and is fixed and stonehard.
Fecal impaction
hard feces often resulting from decreased bowel motility or retained barium after gi x-ray exam. The person may complain of constipation or of diarrhea as a fecal stream passes around impaction.
Polyp in the anus:
A soft slightly movable mass – protruding growth from rectal mucosa. It ma be pedunculated (on a stalk) or sessile (a mound on the surface). Must have biopsy after proctoscopy.
Main characteristics of the EKG graph paper
- rolls out at 25 mm or 1 in/sec - each small box represents 0.04 seconds - each large box represents 0.2 seconds
method of rate calculation:
count the RR interval and large boxes 300-150-100-75-60-50
regular vs. regularly irregular vs. irregularly irregular heart patterns
regular: all RR of equal length regularly irregular: RR intervals of different lengths but overall pattern is present irregularly irregular: no overall pattern
When do the coronary arteries fill?
diastole
Normal Sinus Rhythm is when the SA nodes generate ___. On the EKG it looks like:
a regular sinus rhythm that paces the heart (60-100) on the EKG: consistent distance between the QRS complexes with a normal regular cardiac rhythm Regular rate and rhythm
Atrial flutter originates in
an atrial automaticity focus
In an atrial flutter, a single, strong ectopic focus in an atria start to beat fast at ____ BPM
250-350
The AV node acts as the gatekeeper, blocking some of the impulses to the
ventricles
Atrial fibrillation is caused by
many irritable atrial foci firing at rapid rates producing an rapid, erratic atrial rhythm
Atrial fibrillation on the EKG is
a wavy baseline without P waves. The QRS response is not regular and may be fast or slow.
Paroxysmal Supraventricular tachycardia is a term that encompasses both
paroxysmal atrial tachycardia and paroxysmal junctional tachycardia because they both originate above the ventricles
In supraventricular tachycardia, the heart rate is ___ BPM
150-250
supraventricular tachycardia occurs when there is a fast, strong stimulus above the ventricles but below the SA node, and the heart conducts
every beat
A ventricular focus can be made irritable by what two things?
low O2 (airway obstruction, absence of air, low O2 content, reduced cardiac output, poor to absent coronary blood supply due to infarction or insufficiency) and low K (hypokalemia)
A premature ventricular beat is called a ___. How does it originate?
premature ventricular contraction (PVC). It originates suddenly in an irritable automaticity focus in a ventricle and produces a giant ventricular complex on the EKG.
There is usually a pause after the PVC called a compensatory pause while
the ventricles finish repolarizing to make the receptive again to the next SA node generated cycle
Six or more PVC’s per minute is considered
pathological
A run of three or more PVC’s in rapid succession is called a run of
Ventricular tachycardia (Vtach)
Ventricular flutter or V-Tach is produced by
a single ventricular automaticity focus firing at an exceptionally rapid rate of 250-350 per minute. It has a smooth wave. It almost always deteriorates into ventricular fibrillation
Also try to measure QRS width: less than ___ second with SVT; greater than ___ second in V-Tac
.14
Ventricular fibrillation is a type of cardiac arrest caused by
rapid-rate discharges from many irritable ventricular foci, producing an erratic, rapid twitching of the ventricles.
If patient is having ventricular fibrillation, they need
CPR and defibrillation
What does ventricular fibrillation look like on the EKG?
There is a totally erratic appearance and lack of identifiable waves on the EKG.
4 conduction abnormalities
- first-degree AV block 2. second-degree AV block type I 3. Second-degree AV block type II 4. Third-degree AV block
Heart blocks can occur in what three places?
- the SA node - the AV node - the larger division of the ventricular conduction system
1 degree AV block occurs when the the impulse within the AV node is delayed, causing
a longer-than-normal pause before ventricular stimulation
the delay of first degree block prolongs the PR interval more than ___ on the EKG
one large square (.2 second) measured from the beginning of the P wave to beginning of QRS complex
Wenckebach phenomenon
2nd degree block in which the PR intervals become progressively longer from cycle to cycle until the AV node will no longer conduct a stimulus from above originates in AV node
Mobitz II
2nd degree block where you have consistently normal PR interval but then a normal, punctual P wave with no QRS response originates below AV node in His bundles or bundle branches
3rd degree Av block is also known as
complete Heart Block
In 3rd degree AV block, there is ___ between the P waves and QRS complexes
no relationship
In the sympathetic component of the autonomic nervous system, norepinephrine is secreted to B1 adrenergic receptors in the heart to elicit an excitatory response. This response has what 3 components?
- increases SA node pacing 2. increases force of myocardial contraction 3. Constricts arteries which increases blood pressure
In the parasympathetic component of the autonomic nervous system, acetylcholine activate cholingeric receptors to product an inhibitory effect. This effect has what 3 components?
- Decreases SA node pacing 2. Decreases force of contraction 3. Dilates arteries which decreases blood pressure
