PD Female Genitalia

Question 1

History questions

Answer 1

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

Question 2

Common complaints

Answer 2

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

Question 3

Amenorrhea

Primary, secondary

Answer 3

Primary - never menstruated

Secondary - previous menstruation, but none in last 6 months

Question 4

Oligomenorrhea

Answer 4

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

Question 5

Hypomenorrhea

Answer 5

Reduction in number of days or amount of flow

Question 6

Menorrhagia

Answer 6

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

Question 7

Metrorrhagia

Answer 7

Menstrual bleeding at irregular intervals, but of expected amounts

Question 8

Dysfunctional uterine bleeding

Answer 8

Irregular bleeding, unrelated to anatomic lesion of the uterus

Question 9

Dysmenorrhea

Answer 9

Painful menstruation

Question 10

Chronic pelvic pain

Answer 10

Pelvic discomfort not limited to menses for greater than 6 months

Question 11

Dyspareunia

Answer 11

Pain associated with intercourse

Question 12

Patient prep

Answer 12

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

Question 13

Why keep eye contact

Answer 13

Helps clinician observe patient response

Question 14

External genitalia

Answer 14

Mons pubis
Labia majora
Labia minora
Perineum
Perianal area

Question 15

Tanner staging

Answer 15

P1 - 5

Question 16

P1 pubic hair

Answer 16

Preadolescent

No growth of pubic hair

Question 17

P2 pubic hair

Answer 17

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

Question 18

P3 pubic hair

Answer 18

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

Question 19

P4 pubic hair

Answer 19

Hair coarse and curly, abundant, but less than adult

Question 20

P5 pubic hair

Answer 20

Lateral spreading, triangle shaped to medial thighs

Question 21

P1 breast

Answer 21

Prepubertal

Question 22

P2 breast

Answer 22

Breast and papilla are elevated as a small mound

Areolar diameter increases

Question 23

P3 breast

Answer 23

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

Question 24

P4 breast

Answer 24

Areola and papilla form a secondary mound

Question 25

P5 breast

Answer 25

Mature areola is part of the general breast contour

Question 26

Inspection/palpation

Answer 26

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

Question 27

Skene's glands

Answer 27

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

Question 28

Types of speculum

Answer 28

Pederson and Graves

Question 29

Pederson speculum

Answer 29

Flat, narrow blades with little curvature | For most nulliparous and postmenopausal women

Question 30

Graves speculum

Answer 30

Wide, higher blades with curved sides | For most parous women

Question 31

Speculum exam prep

Answer 31

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

Question 32

Speculum insertion

Answer 32

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

Question 33

Speculum exam

Answer 33

Inspect cervix Deep vaginal vault Lateral walls of vagina

Question 34

Samples to be taken

Answer 34

Pap smear Wet prep Cultures

Question 35

Risk factors for cervical cancer

Answer 35

``` 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) ```

Question 36

Rectocele

Answer 36

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

Question 37

Cystocele | Causes

Answer 37

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

Question 38

Uterine prolapse

Answer 38

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

Question 39

Bimanual exam

Answer 39

Use both hands to entrap pelvic organs for palpation | Vaginal hand and abdominal hand

Question 40

Palpate uterus

Answer 40

``` Size Shape Consistency Mobility Masses Tenderness Position ```

Question 41

Palpate cervix

Answer 41

``` Circumferential exam Size Shape Position Mobility Masses Tenderness ```

Question 42

Palpate adnexae

Answer 42

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

Question 43

Rectovaginal exam

Answer 43

``` 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 ```

Question 44

Uterosacral ligaments

Answer 44

Should be smooth, symmetric, nontender

Question 45

Rectal canal

Answer 45

Masses Sphincter tone Stool guiac test for blood

Question 46

Ovarian cancer risk factors

Answer 46

``` 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 ```

Question 47

Bacterial vaginosis | Wet mount

Answer 47

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

Question 48

Candida vaginitis

Answer 48

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

Question 49

Trichomonas vaginitis | Tx

Answer 49

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

Question 50

Syphilis incubation

Answer 50

10-60 days

Question 51

Genital warts term

Answer 51

Condyloma accuminata

Question 52

Secondary syphilis term

Answer 52

Condyloma lata

Question 53

Tissues that are estrogen dependent

Answer 53

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

Question 54

Atrophic vaginitis | Sx

Answer 54

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