GYN History and Physical Flashcards
Gravida definition
of pregnancies
Parity definition
of births
Parity FPAL
F = full term 37+ weeks P = pre term 20 - <37 weeks A = abortion L = living
G4P1122 meaning
G = 4 meaning 4 pregnancies P1122 = 1 full term baby, 1 pre term baby, 2 aborted, 2 living
Shorthand for menstrual history
Age at menarch (onset of menses) x cycle length x # of days of bleeding (Eg, 13x28x5)
Normal vaginal discharge
- 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
When is uterine bleeding abnormal
- when it is assoc. w/ a change in the woman’s normal menstrual pattern or it occurs after menopause
Avg menstrual cycle duration and amount
- avg menstrual cycle lasts up to 7 days and is 35-40mL per cycle, but the range is wide
Menorrhagia definition
- blood loss >80mL (applied variably to ovulatory or anovulatory uterine bleeding)
Menopause definition
- 12 months of amenorrhea after the final menstrual period - occurs in ~40s
Pelvic organ prolapse presentation
- Complaints of vaginal bulge, vaginal pressure, or the need to place a finger in the vagina to void or defecate
Infertility definition
- 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
Infertility history focus
- Ovulation - Tubal and uterine problems - Male factors
Age at initial pelvic exam
- 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
ACOG recommendations regarding pelvic exam in adolescents and women in early 20’s
- 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
ACOG pelvic exam recommendation
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
True or False? Annual pelvic exams reduce mortality from ovarian cancer
- False
True or False? Pelvic exam under anesthesia have been shown to have limited sensitivity at detecting adnexal masses
- True
Pelvic exam consent parameters
- 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
Components of pelvic exam
- 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
Bartholin glands
- 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
Periurethral glands
- 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
Steps if abnormal discharge is identified
- 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)
Several normal variations of uterine position
- 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
