H&P Final Exam: Female and Male Genitalia and Breast Flashcards
Define menarche.
Onset of menses, aka what age did you first have a period.
What is LMP short for?
Last menstrual period
What is menorhhagia, and how do I measure it?
Menorrhagia = excessive flow
Measured by # of pads/tampons per day
What is the criteria for menopause?
Absence of menses for 12 consecutive months.
Occurs commonly between 48-55.
What is postcoital bleeding?
Bleeding after intercourse.
What are common causes of postcoital bleeding?
Cervical polyps or cancer
Atrophic vaginitis in post menopausal women.
What is polymenorrhea?
Fewer than 21 days between menses.
What is metrorrhagia?
Bleeding between periods.
What are nulligravida and nullipara?
Nulligravida = never preggo
Nullipara = never given birth PAST 20 weeks
How do I record pregnancy?
GPTPAL
Gravida
Para
Term
Preterm
Abortion
Living
If I have a woman with 3 confirmed pregnancies, 1 of which was born at 35 weeks, 38 weeks, and twins at 40 weeks, what is her GPTPAL? She has 4 children.
Gravida = 3
Para = 3
Term = 2
Preterm = 1
Abortion = 0
Living = 4.
G3P3T2P1A0L4
What counts as a term delivery?
> 37 weeks of gestation
What counts as a para?
Any birth that was done past 20 weeks.
What do TPAL all fall under?
Para
What is dyspareunia?
Pain during intercourse
If vaginal discharge is thick and friable, what is the most likely cause?
Yeast infection
What should you always have with you during a vaginal/pelvic exam?
A chaperone!!!!
What position do females need to be in for a pelvic exam?
Lithotomy position, aka feet in stirrups and butt just barely hanging off the edge.
What are the two types of speculums?
Pederson
Graves
What is a Pederson speculum used for?
Flat and narrow.
Medium Pedersons are used for sexually active women.
Narrow Pedersons are used for small introitus and elderly women with atrophic vaginitis.
What is a Graves speculum used for?
Wide with curved sides
Obese, and or parous women with vaginal prolapse.
What kind of speculum should I not use in obese women?
Plastic
How do I insert a speculum?
Make sure the speculum is warm.
Press downward with a finger on the vaginal introitus to relax it.
Insert obliquely.
What are the 3 types of cervical lacerations from delivery?
Bilateral transverse (straight line across)
Stellate (scrunched in the center)
Unilateral transverse (straight line across but not fully)
What is mucopurulent cervicitis?
Purulent yellow-green discharge from cervical os.
What are common causes of mucopurulent cervicitis?
STIs such as chlamydia, trachomatis, N. gonorrhoeae, or herpes simplex.
Where does the epithelium meet/transition on the cervix?
Squamocolumnar junction/transformation zone
Which epithelium is more central in the cervix?
Columnar
Deep, plushy, red.
What are the risk factors for cervical cancer?
Infection with HPV MC
Multiple Partners
Smoking
HIV
Using OCP >= 5 years (oral contraceptives)
Giving birth >= 3 children
What are the two types of cervical cancer?
Squamous cell carcinoma
Adenocarcinoma
Which cervical cancer is most common?
Squamous cell carcinomas, which account for 80-90%.
What is CIN?
Precursor to cervical cancer, it stands for cervical intraepithelial neoplasia.
It is a progressive cauliflower-like growth that spreads.
What does pap actually stand for?
Papanicolaou
What does cytologic screening sample?
The transformation zone of the cervix.
What are the 3 tools used in pap smears?
Spatula
Brush
Broom
What do each of the 3 tools in a pap smear collect?
Spatulas collect squamous and squamocolumnar cells.
Brushes collect columnar cells.
Brooms collect both squamous and columnar ells.
When do you start screening for cervical cancer and how often?
21 years of age.
every 3 years between 21-29
every 5 years for 30-65
What do HPV 16 and 18 most commonly cause?
70% of all clinical cancers.
What do HPV 6 and 11 most commonly cause?
90% of genital warts
About how many people contract HPV in a lifetime?
> 50% of all sexually active people.
What is the main concern with persisting HPV infections?
Induction of precancerous and cancerous lesions.
What does Gardasil vaccinate against?
HPV 16, 18, 6, and 11.
What cancers does Gardasil prevent?
Cervical, anal, and rectal cancers.
When is Gardasil best given?
11-12 years of age
Prior to any sexual activity.
What is Chandelier’s sign?
Pain upon moving the cervix + Adnexal tenderness.
AKA pelvic inflammatory disease
What kind of people are ovaries most palpable?
Slender and relaxed women.
When do ovaries become atrophic?
3-5 years after menopause.
What are the 3 primary goals of a rectovaginal exam?
Palpate retroverted uterus, uterosacral ligaments, cul-de-sac, and adnexa.
Screen for colorectal cancer > 50 years of age
Assess pelvic pathology
What are the risk factors for breast cancer?
Aging
BRCA1 and BRCA2
Menstrual history (Onset before 12 and menopause after 55)
Dense breast tissue
Personal/Family Hx of breast cancer
History of radiation exposure
In utero exposure to DES (diethylstilbestrol) from 1940-1971.
What is breast tissue sensitive to?
Hormones
What surrounds the nipple?
Glandular tissue, which forms 15-20 septated lobes.
What can I find within a breast lobe?
Lobules that drain into milk-producing ducts
What kind of tissue forms the structural support for the breast?
Fibrous CT
Suspensory ligaments
What kind of tissue surrounds the breast?
Adipose tissue.
What kind of disease will fluctuate with hormones?
Fibrous breast disease.
Cancer will stay the same.
What are the 4 positions for a breast exam when standing?
Arms at side
Arms overhead
Hand pressed against hip
Leaning forward
What does an orange peel sign suggest?
Aggressive breast cancer
What position does the patient need to be in to examine the lateral breast?
Supine with slightly rolling onto opposite hip.
Hand over forehead, but shoulder touching the bed.
How do I palpate the lateral breast?
Start at axilla, using fingers 2-4.
Make small, concentric circles and go in a snake to the nipple. (Vertical strip)
What position does the patient need to be in to examine the medial breast?
Hand at the shoulder now, so the elbow is bent to like 15 deg. (see slide 12 if unclear)
What is physiologic nodularity?
The uneveness of adult breast tissue.
It is normal and often felt bilaterally.
How do I tell if what a mass in the breast is affixed to?
A mobile mass that becomes fixed when the arm relaxes is attached to the ribs and intercostal muscles.
If fixed when hand is pressed against hip, it is attached to the pectoral fascia.
How do I describe the location of a mass on the breast?
Time on a clock + distance from nipple.
What kind of glands do I find on the surface of the areola?
Small, rounded elevations made of:
Sebaceous glands
Sweat glands
Accessory areolar glands
How do the areola and nipple play a function in breastfeeding?
They have smooth muscle that contracts to express milk from the ductal system.
Sensory innervation from an infant sucking will cause milk letdown.
What are supernumerary nipples?
Extra nipples along the milk line.
No pathologic significance.
What lymph nodes are most commonly implicated in breast cancer?
Central lymph nodes.
The ones deep in the axilla.
Are self-breast exams recommended?
No.
What are chancres?
Painless ulcers.
Indicative of syphilis
What is the difference between a circumcised and uncircumcised penis?
Foreskin covers the glans (head) in an UNcircumcised penis.
Circumcised has nothing covering the glans.
What do hair distribution excoriations suggest on a male?
Pubic lice (crabs)
or scabies
What can I palpate the testicle between on a PE?
Thumb and first two fingers.
What is crytoporchidism?
Undescended testis (aka hidden testes)
When does a testes normally descend by?
9 months.
If it takes 1+ year, consider surgery.
What is the cremaster reflex?
Immediate contraction of the cremaster, which pulls up the testis ONLY ON the AFFECTED SIDE.
Done by lightly stroking upper inner thigh.
Is a monthly testicular exam recommended?
Yes.
What is a cystic structure in the spermatic cord suggestive of?
Hydrocele
What does a chronically infected vas deferens feel like?
Thickened or beady
Where is the internal and external inguinal ring?
Internal inguinal ring is ~1cm above midpoint of inguinal canal.
External inguinal ring is just above and lateral to pubic tubercle.
What important structure relative to this class passes through the inguinal canal?
Vas deferens
Where does a direct inguinal hernia present?
Medial to inguinal canal. Heading inferiorly to the external inguinal ring.
Where does an indirect inguinal hernia present?
Going down from the internal inguinal ring to the lateral scrotum.
Where does a femoral hernia present?
Going down from the internal inguinal ring just medial to the femoral vessels on the upper medial thigh.
Note:
Originates the same area as an indirect, but is more lateral.
Which hernia most commonly descends into the scrotum?
Indirect inguinal hernia
What is the most common hernia?
Indirect inguinal hernia
Most common in children also.
What hernia is more common in men?
Direct if the man is > 40.
What hernia is more common in women?
Femoral hernia
What do you need a patient to do when checking for hernias?
Bear down by coughing and turning their head.
What are the two types of masses/hernias?
Incarcerated (cannot return contents to abdomen)
Strangulated (blood supply is compromised)
How do you differentiate between a mass and a hernia?
Bowel sounds. Hernias are protrusions of abdominal organs, so they have BS.
How do you differentiate between an incarcerated and strangulated mass?
A strangulated mass will be very tender and cause N/V.
