GYN History and Physical

Question 1

Gravida definition

Answer 1

of pregnancies

Question 2

Parity definition

Answer 2

of births

Question 3

Parity FPAL

Answer 3

F = full term 37+ weeks P = pre term 20 - <37 weeks A = abortion L = living

Question 4

G4P1122 meaning

Answer 4

G = 4 meaning 4 pregnancies P1122 = 1 full term baby, 1 pre term baby, 2 aborted, 2 living

Question 5

Shorthand for menstrual history

Answer 5

Age at menarch (onset of menses) x cycle length x # of days of bleeding (Eg, 13x28x5)

Question 6

Normal vaginal discharge

Answer 6

• mucoid endocervical secretions in combination w/ desquamated vaginal wall epithelium & normal bacteria - physiologic discharge is typically clear, white or light yellow - volume varies considerably among women & timing in the menstrual cycle

Question 7

When is uterine bleeding abnormal

Answer 7

• when it is assoc. w/ a change in the woman’s normal menstrual pattern or it occurs after menopause

Question 8

Avg menstrual cycle duration and amount

Answer 8

• avg menstrual cycle lasts up to 7 days and is 35-40mL per cycle, but the range is wide

Question 9

Menorrhagia definition

Answer 9

• blood loss >80mL (applied variably to ovulatory or anovulatory uterine bleeding)

Question 10

Menopause definition

Answer 10

• 12 months of amenorrhea after the final menstrual period - occurs in ~40s

Question 11

Pelvic organ prolapse presentation

Answer 11

• Complaints of vaginal bulge, vaginal pressure, or the need to place a finger in the vagina to void or defecate

Question 12

Infertility definition

Answer 12

• Failure of a couple to conceive after 12 months of regular intercourse w/o use of contraception in women <35, and after 6 months of regular intercourse w/o use of contraception in women >35q11q1

Question 13

Infertility history focus

Answer 13

• Ovulation - Tubal and uterine problems - Male factors

Question 14

Age at initial pelvic exam

Answer 14

• ACOG recommends a first reproductive health visit b/w 13-15. A pelvic exam is not included unless indicated due to symptoms or for screening for a STI

Question 15

ACOG recommendations regarding pelvic exam in adolescents and women in early 20’s

Answer 15

• Annual screening for gonorrheal infection for all sexually active adolescents - Annual screening for chlamydial infection for all sexually active women age 25 or younger - Initiate cervical cancer screening at age 21

Question 16

ACOG pelvic exam recommendation

Answer 16

Annual pelvic exam for pts >21. However, the college recognizes that - This recommendation is based on expert opinion - Limitations of the internal pelvic exam screening should be recognized

Question 17

True or False? Annual pelvic exams reduce mortality from ovarian cancer

Answer 17

• False

Question 18

True or False? Pelvic exam under anesthesia have been shown to have limited sensitivity at detecting adnexal masses

Answer 18

• True

Question 19

Pelvic exam consent parameters

Answer 19

• Adolescents may undergo pelvic exam w/o their parents’ knowledge or permission if the exam is performed in the context of testing or treatment for STI’s - Parental consent is required for childhood exams, adolescent pelvic exams, and pelvic exams unrelated to sexual contact

Question 20

Components of pelvic exam

Answer 20

• pelvic exam traditionally includes the internal and external genitalia, and pelvic organs - comprehensive exam also includes urinary and GIT, including urethra, anus and rectum - a more comprehensive exam, involving the abdomen, breast, and other sites may be indicated to provide complete primary care or to evaluate gynecologic problems that involve other organ systems

Question 21

Bartholin glands

Answer 21

• The Bartholin gland openings are located at the 4 and 8 o’clock positions just outside the hymenal ring - The glands are not palpable when healthy

Question 22

Periurethral glands

Answer 22

• The largest of which are Skene’s glands, are adjacent to the distal urethra - If enlarged or tender, an attempt should be made to express exudate, which suggests infections

Question 23

Steps if abnormal discharge is identified

Answer 23

• Volume, color, consistency and odor should be noted and a sample taken w/ a cotton swab - Physiologic pH of vaginal discharge is <4.5; an elevated pH may be due to infection (eg, bacterial vaginosis) or exogenous substances (eg, semen)

Question 24

Several normal variations of uterine position

Answer 24

• Axial: the axis of the uterus is the same as the vaginal axis - Version: position of the entire uterus relative to the axis of the vagina; eg, anteverted, retroverted - Flexion: position of the uterine fundus relative to the axis of the cervix; eg, anteflexed, retroflexed