Introduction to Gynecology Flashcards
1
Q
Approach to the female patient
A
- Communication is the key to women – use language your patient can understand but remain professional
- Gynecologists are often the primary care providers for women
- Context of general health, psychological, social and emotional status of the patient
- Open relationship between patient and provider; nonjudgmental attitude and trust
- Initial contact with the patient while she is fully clothed and comfortable
- Good eye contact, active listening
- Invite the patient to participate in the examination process, ask questions and give feedback
- Explain everything you are about to do before you do it
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2
Q
Types of pelvis
A
- Gynecoid: female – round, wide, spacious; 40-50% of women
- Android: male – narrow, flat, wedge shaped; 30% of women
- Anthropoid: narrow, long oval; 20% of women
- Platypelloid: wide, short oval; 2% of women
- Mixed types occur in some patients
3
Q
Axis of pelvis, pelvic inlet, pelvic outlet
A
- Axis of pelvis: curve of sacrum and coccyx
- Pelvic inlet: plane from top of pubis to sacral promontory
- Pelvic outlet: plane from bottom of pubis to top of coccyx
4
Q
Contents of the pelvic cavity
A
- Bladder
- ureters and urethra
- uterus
- fallopian tubes and ovaries
- vagina
5
Q
Pudendum
A
- External genitalia
- vulva
- mons pubis
- labia majora, labia minora
- clitoris (female penis)
- urethra
- vestibule with skene’s glands, hymen, bartholin’s glands, vaginal entroitus
- perineum
- anus
6
Q
vagina
A
- Muscular tube from the vestibule to the uterus
- 7.5cm in length, long axis parallel with lower sacrum
- Covered by the hymen in children
- Surrounded by 2 bulbocavernosus muscles which act as a sphincter at the opening
- Vaginal wall consists of mucous membrane and 3 external smooth muscle layers to make the vagina very distensible
- Lumen lined by stratified squamous epithelium, submucosal layer of connective tissue
- Submucosal rugae produce vaginal folds in the lumen
- Normally colonized with aerobic bacteria and lactobacilli
- Low acidic pH between 3.5 – 4.0
- Estrogen effect makes vaginal epithelium thick with large amount of glycogen, normal vaginal secretions and cervical mucous
- Hostile to infection and semen
- Meets the uterus at the cervix at a 45-90 degree angle
- Circular area around the cervix is called the fornix: anterior fornix, 2 lateral fornices, and posterior fornix that forms the pouch of Douglas
- Pouch of Douglas allows access to the peritoneal cavity from the vagina during culdocentesis
7
Q
Cervix
A
- Distal part of the uterus, connected via the uterine isthmus to the uterine body
- External cervical os opening to the vagina
- Round in nulliparous women
- Transverse slit after childbirth
- Cavity of the cervix is barrel shaped with longitudinal folds that extend through the canal
- Covered with stratified squamous epithelium at the external os, which changes to simple columnar epithelium in the transformation (transition) zone
- Transformation zone is at the level of the external cervical os, but is higher up in the endocervical canal in postmenopausal women; may be more superficial with ectropion (everted cervix)
- Transformation zone important in Pap smear, dysplasia and cervical cancers
8
Q
Uterus
A
- (uterine corpus or body)
- Pear shaped muscular organ between the base of the bladder and the rectum
- Covered on each side by the broad ligament
- Connects with the Fallopian tubes at the cornu, at the superior-lateral angles
- Area above and between the cornu is the fundus; area of greatest breadth
- 7-8cm long and 4-5cm wide in the nulliparous adult female
- Position of the uterus is determined by the angle of the long axis of the corpus with the cervix
- Normal position is anteversion (anteflexion); may also be in retroversion, lateral version, or military position – these may all be normal variations
9
Q
Adnexa
A
uterine tubes and ovaries
10
Q
Fallopian tubes (oviducts)
A
- Convey the ova to the uterus
- Run along the superior border of the broad ligament from the superior-lateral aspect of the uterine body to the ovaries on each side
- 7-14cm in length and has 3 portions:
- Isthmus
- Ampulla
- Infundibulum
- Isthmus is narrow and straight, adjoining the uterus
- Ampulla is wider part of the tube that opens in a funnel-like dilatation that is the infandibulum
- Infandibulum is fringed by finger-like processes called fimbriae that surround the ovary and help collect the oocyte at ovulation
- Lining of the tubes is ciliated columnar epithelium, assisting oocyte transport to the uterus body
11
Q
Ovaries
A
- 2 paired organs measuring 3-5cm long, 2-3cm wide, 1-3cm thick
- Decrease in size after menopause when follicular development ceases
- Attached to the uterus by the ovarian ligament
- Covered by a low columnar epithelium
- Consist of a cortex and medulla
- Medulla: connective tissue fibers, smooth muscle cells, and supporting tissues
- Cortex: areolar stroma, vessels, scattered follicles of epithelial cells which house the oocytes in various stages of maturity
- Follicles enlarge as they mature until they burst, releasing the ovum and becoming transformed into a corpus luteum
12
Q
Lymphatics
A
- Complicated! Usually follow venous distribution
- External genitalia generally drain to the superficial inguinal nodes or superficial femoral nodes
- Uterus and cervix drain via several chains of lymph nodes into para-aortic chains
- Oviducts and ovaries have retroperitoneal drainage into para-aortic chains
13
Q
Breast anatomy
A
- Secondary reproductive glands of ectodermal modified sweat gland origin
- Organs of lactation; contain the mammary glands
- Tissue protrudes anterior to the pectoralis major muscle and includes the axillary tail of Spence
- Breast lymphatics drain to the axilla; less into supraclavicular nodes
- The areola is a circular pigmented zone at the tip of the breast
- Glands of Montgomery in the skin of the areola are sebaceous glands responsible for lubrication of the nipple
- Circular and longitudinal smooth muscle bands at the nipple encircle the lactiferous ducts where milk is expelled during breastfeeding
14
Q
Tanner Stages
A
- Stage 1 – Prepubertal
- Stage 2 – Breast buds
- Stage 3 – Further breast enlargement
- Stage 4 – Areola forms distinct mound on breast
- Stage 5 – Breast fills out, areola forms single contour with breast
Pubic hair:
- Stage 1 – No hair
- Stage 2 – Wisps of hair on labia
- Stage 3 – Hair on mons pubis in midline
- Stage 4 – Hair spreads outward
- Stage 5 – Hair froms inverse triangle, reaching inner thighs
15
Q
Well woman exam - history
A
- Age
- 1st day of last normal menstrual period (LMP)
- Gravidity and Parity (GxPtpal)
- X=pregancies
- T=term pregnancies
- P=premature deliveries
- A=abortions (spontaneous and elective)
- L=living children
- Example: G4P2113 – 4 pregnancies, 2 full term deliveries, 1 premature delivery, 1 abortion, and 3 living children
- Chief complaint, HPI with pertinent ROS
- PMH
- Contraception method
- Medications and habits
- Medical history
- Surgical history
- Allergies
- Bleeding disorders (personal or family)
- Social history (especially domestic violence)
- Family history (especially genetic disorders)
