module 16 women abnormalities 2

Question 1

gonorrhea

Answer 1

• subjective: partner with STI, no s/s or s/s of PID
• objective: purulent discharge from cervix; Skene/Bartholin gland inflammation; cervix and vulva may be inflamed
• Dx: gram stain, culture, DNA probe

Question 2

chlamydia

Answer 2

• subjective: often no s/s, spotting after intercourse or urethritis
• objective: purulent discharge; cervix may or may not be red or friable
• Dx: DNA probe

Question 3

atrophic vaginitis

Answer 3

• subjective: dysparenunia, vaginal dryness, peri/postmenopausal
• objective: pale, thin vaginal mucosa
• Dx: wet mount: folded, clumped epithelial cells

Question 4

allergic vaginitis

Answer 4

• subjective: new bubble bath, soap, douche, or other hygiene products
• objective: foul smell, erythema
• Dx: wet mount: WBC

Question 5

foreign body

Answer 5

• subjective: red and swollen vulva, vaginal discharge, hx of use of tampon, condom, diaphragm
• objective: bloody or foul-smelling discharge
• Dx: wet mount: WBC

Question 6

cervical cancer patho

Answer 6

classified according to the type of tissue from which the cancer arises

• squamous: dysplastic or premalignant lesion at active squamocolumnar junction
• adenocarcinoma:
• • usually caused by HPV

Question 7

cervical cancer subjective

Answer 7

usually no s/s

may report unexpected vaginal bleeding or spotting

Question 8

cervical cancer objective

Answer 8

• often no findings on physical exam
• hard granular surface at or near the cervical os
• lesion can evolve to form extensive irregular cauliflower growth that bleeds easily
• early lesions are indistinguishable from ectropion
• precancerous and early cancer changes detected by pap smear

Question 9

uterine prolapse patho

Answer 9

descent or herniation of the uterus into or beyond the vagina
- weakened supporting structures of the pelvic floor

Question 10

uterine prolapse subjective

Answer 10

sensation of pelvic heaviness and or uterus follow out
tissue protruding from vagina
urine leakage or urge incontinence
difficulty having a BM 
low back pain

Question 11

uterine prolapse objective

Answer 11

1st degree: cervix remains within the vagina
2nd degree: cervix is at the introitus
3rd degree: cervix and vagina drop outside the introitus

Question 12

uterine bleeding patho

Answer 12

abnormality in menstrual bleeding and inappropriate uterine bleeding are common gynecologic problems

Question 13

uterine bleeding subjective

Answer 13

shortened or lengthened interval between periods
absence of menstruation
normal intervals between periods, inc. or dec. flow, longer duration
irregular intervals between periods with excessive flow and duration
bleeding between periods

Question 14

uterine bleeding objective

Answer 14

dysfunctional: none
endocrinopathies:
- pelvic exam normal, physical findings consistent with endocrine disorder
Coagulopathies:
- findings consistent with specific coagulaopathy
Pregnancy related:
- consistent with stage of pregnancy

Question 15

myoma (leiomyomas, fibroids) patho

Answer 15

common, benign, uterine tumors

- arise from the overgrowth of smooth muscle and connective tissue in the uterus

Question 16

myoma subjective

Answer 16

related to the number of tumors as well as location and size, may include

• heavy menses
• abd. cramping usually felt during menstruation
• urinary freq., urgency, and/or incontinence from pressure on bladder
• constipation, difficult defecation ,or rectal pain from pressure on the colon
• generalized pelvic and or lower abd discomfort

Question 17

myomas objective

Answer 17

firm, irregular nodules in the contour of the uterus on bimanual exam
uterus may be enlarged

Question 18

endometrial cancer patho

Answer 18

most often in postmenopausal pt
cancers of the glandular cells in the lining of the uterus
- inc. risk: pt with uterus taking tamoxifen

Question 19

endometrial cancer subjective

Answer 19

postmenopausal vaginal bleeding

- red flag for endometrial cancer

Question 20

endometrial cancer objective

Answer 20

none

dx with endometrial biopsy

Question 21

ovarian cyst patho

Answer 21

fluid-filled sac in an ovary

• follicle undergoes varying rates of maturation and cysts can occur
• > hypothalmaic-pituitary dysfunction, native anatomic defects

Question 22

ovarian cyst subjective

Answer 22

usually no s/s
may report lower abd. pain: sharp, intermittent, sudden, and severe
sudden onset of abd. pain suggest cyst rupture

Question 23

ovarian cyst objective

Answer 23

pelvic mass may be palpated

cervical motion tenderness may be elicited

Question 24

ovarian cancer patho

Answer 24

• epithelial: arise from a layer of germinal epithelium on the outside of the ovary
• stromal: from connective tissue cells that help form the structure of the ovary and produce hormones
• germ cell: from germ cells (produce the egg)

Question 25

ovarian cancer subjective

Answer 25

no s/s at first pt > 40 with persistent and unexplained vague GI s/s - abd. discomfort, gas, indigestion, pressure, swelling, bloating, cramps, felling full even after a light meal

Question 26

ovarian cancer objective

Answer 26

no physical findings | bimanual exam: enlarged ovary in premenopausal pt or a palpable ovary in postmenopausal pt

Question 27

tubal/ectopic pregnancy patho

Answer 27

pregnancy occurring outside the uterus

Question 28

tubal pregnancy subjective

Answer 28

``` abnormal vaginal bleeding low back pain mild cramping on one side of the pelvis pain in lower abd. or pelvic area if pregnancy ruptures: s/s may worsen light-headed/syncope pain in shoulder area severe, sharp and sudden pain in lower abd. ```

Question 29

tubal pregnancy objective

Answer 29

- marked pelvic tenderness, with rigidity of the lower abdomen - cervical motion tenderness; tender, unilateral adnexal mass may indicate site of pregnancy - tachycardia, hypoTN: reflect hemorrhage of a ruptured pregnancy into the peritoneal cavity - - surgical emergency

Question 30

PID patho

Answer 30

infection of the uterus, fallopian tubes, and the other reproductive organs - common complication of STI

Question 31

PID subjective

Answer 31

``` s/s may be mild or absent vaginal discharge with foul odor painful intercourse painful urination irregular menstrual bleeding pain in the upper abdomen ```

Question 32

PID objective

Answer 32

acute PID - very tender, bilateral adnexal areas - pt guards and usually cannot tolerate bimanual exam Chronic PID - bilateral, tender, irregular, and fairly fixed adnexal areas

Question 33

salpingitis patho

Answer 33

inflammation or infection of the fallopian tubes | - often associated with PID

Question 34

salpingitis subjective

Answer 34

``` lower quadrant pain - dull, cramping, worse with motion or sex coexisting purulent vaginal discharge abnormal vaginal bleeding nausea, vomiting, fever ```

Question 35

salpingitis objective

Answer 35

cervical motion tenderness and/or adnexal tenderness on bimanual exam mucopurulent cervical discharge