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Physical Diagnosis > PD Female Genitalia > Flashcards

PD Female Genitalia Flashcards

1
Q

History questions

A 
Menarche
Usual cycle length
Usual flow length
Gravida/para
Sexual history
STDs
Preventative care
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2
Q

Common complaints

A 
Abnormal bleeding
Pain
Vaginal discharge
Menopausal sx
Infertility
Sexual dysfunction
Urinary complaints
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3
Q

Amenorrhea

Primary, secondary

A

Primary - never menstruated

Secondary - previous menstruation, but none in last 6 months

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4
Q

Oligomenorrhea

A

Reduction of frequency of menstruation with interval greater than 40 days and less than 6 months

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5
Q

Hypomenorrhea

A

Reduction in number of days or amount of flow

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6
Q

Menorrhagia

A

Excessive menstrual bleeding longer in duration than usia (and amount greater than 80 mL blood loss)

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7
Q

Metrorrhagia

A

Menstrual bleeding at irregular intervals, but of expected amounts

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8
Q

Dysfunctional uterine bleeding

A

Irregular bleeding, unrelated to anatomic lesion of the uterus

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9
Q

Dysmenorrhea

A

Painful menstruation

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10
Q

Chronic pelvic pain

A

Pelvic discomfort not limited to menses for greater than 6 months

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11
Q

Dyspareunia

A

Pain associated with intercourse

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12
Q

Patient prep

A 
Empty bladder
Exam gown
Assistant/chaperone present
Ensure privacy
Instruments are already prepared
No surprises! Constantly communicate with the patient
Patient sits at edge of table
Head of bed at 30 degrees, relaxes abdominal muscles and allows you to maintain eye contact
Always maintain eye contact
Drape across legs and abdomen
Adequate lighting to shine onto perineum
Glove both hands
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13
Q

Why keep eye contact

A

Helps clinician observe patient response

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14
Q

External genitalia

A 
Mons pubis
Labia majora
Labia minora
Perineum
Perianal area
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15
Q

Tanner staging

A

P1 - 5

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16
Q

P1 pubic hair

A

Preadolescent

No growth of pubic hair

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17
Q

P2 pubic hair

A

Initial, scarcely pigmented straight hair, especially along medial border of labia

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18
Q

P3 pubic hair

A

Sparse, dark, visibly pigmented, curly pubic hair on labia

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19
Q

P4 pubic hair

A

Hair coarse and curly, abundant, but less than adult

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20
Q

P5 pubic hair

A

Lateral spreading, triangle shaped to medial thighs

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21
Q

P1 breast

A

Prepubertal

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22
Q

P2 breast

A

Breast and papilla are elevated as a small mound

Areolar diameter increases

23
Q

P3 breast

A

Further enlargement of the breast bud with loss of the contour separation between breast and areola

24
Q

P4 breast

A

Areola and papilla form a secondary mound

25
Q

P5 breast

A

Mature areola is part of the general breast contour

26
Q

Inspection/palpation

A

Spread labia - inspect introits and outer vain
Urethrea - inspect/milk for discharge, skene’s glands
Bartholin’s glands - rotate finger posteriorly, grasp with thumb

27
Q

Skene’s glands

A

Parauretheral glands, minor vestibular glands
Pair of glands situated on each side of urethral meatus
Its secretions help to lubricate the external genitalia during coitus

28
Q

Types of speculum

A

Pederson and Graves

29
Q

Pederson speculum

A

Flat, narrow blades with little curvature

For most nulliparous and postmenopausal women

30
Q

Graves speculum

A

Wide, higher blades with curved sides

For most parous women

31
Q

Speculum exam prep

A

Examine speculum
Clean, proper working order
Moisten and warm with warm water
Avoid lubricants, may interfere with cytologic and microbiologic specimens

32
Q

Speculum insertion

A

Dominant hand
Blades completely closed
First 2 fingers on opposite hand placed lateral and just below the introits
Apply downward and inward pressure, introits open slowly
Insert speculum at 45 degree angle, usually as far as it will go
Rotate speculum down
Open speculum smoothly and deliberately
Visualize cervix and manipulate angle if necessary
Tighten screw

33
Q

Speculum exam

A

Inspect cervix
Deep vaginal vault
Lateral walls of vagina

34
Q

Samples to be taken

A

Pap smear
Wet prep
Cultures

35
Q

Risk factors for cervical cancer

A 
Increases in late teens to 30s
Average age of newly diagnosed is 50-55
Personal hx of cervical cancer
Personal hx of infection with HPV or HSV2
Early age at first sexual intercourse
Multiple lifetime partners
HIV
Smoking
Long term use of OCP (under investigation)
36
Q

Rectocele

A

Fascia separating rectum from vagina becomes weakened allowing the front wall of the rectum to bulge into the vagina
Usually after menopause
Usually not painful
Large rectoceles may protrude the vaginal opening

37
Q

Cystocele

Causes

A

Wall between bladder and vagina weakens, allow bladder to prolapse into the vagina
May occur from excessive straining (childbirth), chronic constipation, heavy lifting

38
Q

Uterine prolapse

A

Uterus descends from its normal position in the pelvis into the vagina
Occurs when pelvic floor muscles/ligaments stretch and weaken

39
Q

Bimanual exam

A

Use both hands to entrap pelvic organs for palpation

Vaginal hand and abdominal hand

40
Q

Palpate uterus

A 
Size
Shape
Consistency
Mobility
Masses
Tenderness
Position
41
Q

Palpate cervix

A 
Circumferential exam
Size
Shape
Position
Mobility
Masses
Tenderness
42
Q

Palpate adnexae

A

Ovaries (1/2 are palpable in young women)
Tubes
Support structures

43
Q

Rectovaginal exam

A 
Not always done routinely
Evaluates posterior pelvic structures
Allows better palpation of ovaries
Change glove of vaginal hand
Use lubricant
Middle finger inserted into rectum
Index finger into vagina until reaches posterior fornix
Palpate uterosacral ligamants
Evaluate rectal canal
Remove fingers steadily and rapidly
44
Q

Uterosacral ligaments

A

Should be smooth, symmetric, nontender

45
Q

Rectal canal

A

Masses
Sphincter tone
Stool guiac test for blood

46
Q

Ovarian cancer risk factors

A 
Age between 40-60
Taking fertility drugs
Early menarche (before 12)
Late menopause (after 50)
Infertility, nulliparity, or first child after 30
Hx of breast CA or inherited gene mutations (BRCA1 or 2)
FHx of breast or ovarian CA
Hormone replacement therapy 
Exposure to talc or asbestos
47
Q

Bacterial vaginosis

Wet mount

A

Most common vaginal infection of childbearing age
Normal vaginal flora disrupted and overgrowth of certain bacteria occurs
May be accompanied by odor, pain, discharge, itching, burning

Wet mount shows clue cells

48
Q

Candida vaginitis

A

Yeast infection
Cottage cheese like discharge
Common while on antibiotics, steroids

49
Q

Trichomonas vaginitis

Tx

A

Caused by protozoal parasite Trichomonas vaginalis
Most curable STD in young women
Sx occur 5-28 days after exposure
Frothy, yellow green vaginal discharge with strong odor
Usually treated with a single dose of metronidazole

50
Q

Syphilis incubation

A

10-60 days

51
Q

Genital warts term

A

Condyloma accuminata

52
Q

Secondary syphilis term

A

Condyloma lata

53
Q

Tissues that are estrogen dependent

A

Vaginal mucosa, cervix, endometrium, and myometrium are estrogen dependent tissues

54
Q

Atrophic vaginitis

Sx

A 
When estrogen production decreases, these tissues atrophy
Dryness
Itching
Burning
Dyspareunia
Urinary symptoms

Physical Diagnosis (10 decks)

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