Pelvic Flashcards
First cervical cancer screening
start at 21 years old- regardless of sexual activity
How often should 21-29 pt. be screened for cervical cancer?
every 3 years with cytology
no HPV testing
How often should 30-65 pt. be screened for cervical cancer?
every 5 years
with combo cytology and HPV testing
How often should pt. 65+ be screened for cervical cancer?
stop screening, if consecutive normal testing for prior 10 years
HPV vaccines
3 types
- Gardasil 9- girls only up to age 26
- Gardasil- girls and boys up to age 26
- Cervarix- girls only up to age 25
What is indicated with Skene’s gland discharge?
Milk it- putting pressure on the Skene’s gland, will cause discharge
- inflamed when infected with gonorrhea or chlamydia
What types of epithelia cover the cervix
(1) shiny pink squamous epithelium, which resembles the vaginal epithelium.
(2) deep red, plushy columnar epithelium, which is continuous with the endocervical lining.
- These meet at the squamocolumnar
junction.
- Red could mean infection or cancer
- Pale could mean menopause
- discharge, mass, lesions, nodules are bad
What should the cervical os look like?
Oval- nulliparous
Slit-like- parous
Unilateral transverse, bilateral transverse and stellate are also normal findings
What three things do you want to feel on the bilmanual exam?
Palpate the cervix- Assess for cervical motion tenderness, if present = PID
Palpate the uterus- Note shape, size, consistency, mobility and identify any masses or tenderness. Should be soft, oval with no masses
Palpate the ovary or adnexa- If possible, note, size shape consistency, mobility and tenderness. Non-palpable in larger women
What is the purpose of the rectovaginal palpation?
- To palpate a retroverted uterus the cul-de-sac, adenexa, uterosacral ligament
- Screen for colon cancer in women 50+ yrs (guac positive = colon cancer)
- Assess pelvic rectal pain
What can cause a prolapsed uterus?
Prolapse of the uterus results from weakness of the supporting structures of the pelvic floor and is often associated with a cystocele and rectocele.
How are the progressive stages of the uterus prolapse defined?
- First-degree prolapse, the cervix is still well within the vagina.
- Second-degree prolapse, it is at the introitus.
- Third-degree prolapse (procidentia), the cervix and vagina are outside the introitus.
Nabothian cysts
- Metaplasia turns columnar epithelium is transformed into squamous epithelium.
- Occurs during adolescence, when estrogen is high
- May block the secretions of columnar epithelium and cause retention cysts, called nabothian cysts.
- They appear translucent nodules on cervical surface.
- No pathological significance
Cervical Polyp
- Benign lesions
- May cause irregular menstrual bleeding
- Tx: removal
Cervical Cancer
- Cauliflower like growth
- Highly friable, bleed from cervix
Cystocele
Anterior wall of the vagina protrudes into the vaginal cavity
Due to weakened pelvic floor muscles
Allows bladder to bulge into the vagina
Rectocele
Rectum protrudes into vaginal cavity
Prolapse of wall between rectum and vagina
Fibroids
Benign uterine tumors
Single or multiple
Feel firm, irregular nodules
Prevents uterus from contracting, which increases bleeding and thus is associated with IDA (iron deficiency anemia)
Adnexal Masses
Ovarian Cyst- smooth, compressible, non-tender
Ovarian Cancer- palpable mass, non-tender, pelvic pain, bloating, UTI symptoms
PID- acute, bilateral adenexal tenderness, cervical motion tenderness
Vaginal Candida Infection
- White and curdy, typically thick, not malodorous
- Pruritus (itchy), vaginal soreness, pain on urination and with intercourse
- Scan potassium hydroxide (KOH) prep for hyphae (visualize under microscope)
- Vaginal Ph
Bacterial Vaginosis Infection
- Gray or white, thin malodorous discharge (fishy or musty)
- Scan wet mount for clue cells (epithelial cells with stippled borders); visualize under microscope
- Sniff for fishy odor after applying KOH (whiff test)
- Vaginal ph >5.0
Trichomonas Vaginitis Infection
- A protozoa
- Yellowish green or gray frothy discharge, may be malodorous
- Pruritus (itchy), pain on urination and dyspareunia
- Do saline wet mount for trichomonads
- Treat both patient and partner
Gonorrhea
- Neisseria Gonorrhea
- Must treat both patient and partner
- Found in adolescent young adults
- Exam: strawberry spots on cervix, milky white discharge
Chlamydia
Chlamydia trachomatis
Most common bacterial STD
Can be asymptomatic
Exam: Red cervix with discharge
What is the incubation period for gonorrhea?
1-14 days
What can gonorrhea cause in men and women?
- Can cause cervicitis, urethritis in women, also PID
- Can cause urethritis, epididymitis, proctitis in men
How is gonorrhea tested? Who should be screened?
Test: Obtain dirty urine, first 10-20cc of the stream
Who: all individuals under the age of 30
What is the incubation period for chlamydia?
7-14 days
Who should be screened for chlamydia?
Screen for CT in all individuals under the age of 30
What can chlamydia cause in men and women?
Women- cervicitis, urethritis, PID
Men- urethritis, proctitis, epididymitis
Syphilis
A firm, painless ulcer = chancre of primary syphilis.
Most develop internally and go undetected.
May see slightly raised, flat , round or oval papules covered by gray exudate on labia suggestive of secondary syphilis
What is the RPR test?
Test for latent syphilis in body
Condyloma Acuminata Lesion
Rised, skin colored lesion on labia or vaginal opening
Pediculosis pubis
pubic lice, lives in the hair,
becoming less of a problem with shaving/waxing
Genital herpes
Shallow, small, painful ulcers on red bases suggest a herpes infection.
Initial infection-may be extensive.
Recurrent infections- usually confined to a small local patch.
