Pelvic

Question 1

First cervical cancer screening

Answer 1

start at 21 years old- regardless of sexual activity

Question 2

How often should 21-29 pt. be screened for cervical cancer?

Answer 2

every 3 years with cytology

no HPV testing

Question 3

How often should 30-65 pt. be screened for cervical cancer?

Answer 3

every 5 years

with combo cytology and HPV testing

Question 4

How often should pt. 65+ be screened for cervical cancer?

Answer 4

stop screening, if consecutive normal testing for prior 10 years

Question 5

HPV vaccines

Answer 5

3 types

1. Gardasil 9- girls only up to age 26
2. Gardasil- girls and boys up to age 26
3. Cervarix- girls only up to age 25

Question 6

What is indicated with Skene’s gland discharge?

Answer 6

Milk it- putting pressure on the Skene’s gland, will cause discharge
- inflamed when infected with gonorrhea or chlamydia

Question 7

What types of epithelia cover the cervix

Answer 7

(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

Question 8

What should the cervical os look like?

Answer 8

Oval- nulliparous
Slit-like- parous
Unilateral transverse, bilateral transverse and stellate are also normal findings

Question 9

What three things do you want to feel on the bilmanual exam?

Answer 9

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

Question 10

What is the purpose of the rectovaginal palpation?

Answer 10

• 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

Question 11

What can cause a prolapsed uterus?

Answer 11

Prolapse of the uterus results from weakness of the supporting structures of the pelvic floor and is often associated with a cystocele and rectocele.

Question 12

How are the progressive stages of the uterus prolapse defined?

Answer 12

• 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.

Question 13

Nabothian cysts

Answer 13

• 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

Question 14

Cervical Polyp

Answer 14

• Benign lesions
• May cause irregular menstrual bleeding
• Tx: removal

Question 15

Cervical Cancer

Answer 15

• Cauliflower like growth

- Highly friable, bleed from cervix

Question 16

Cystocele

Answer 16

Anterior wall of the vagina protrudes into the vaginal cavity
Due to weakened pelvic floor muscles
Allows bladder to bulge into the vagina

Question 17

Rectocele

Answer 17

Rectum protrudes into vaginal cavity

Prolapse of wall between rectum and vagina

Question 18

Fibroids

Answer 18

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)

Question 19

Adnexal Masses

Answer 19

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

Question 20

Vaginal Candida Infection

Answer 20

• 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

Question 21

Bacterial Vaginosis Infection

Answer 21

• 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

Question 22

Trichomonas Vaginitis Infection

Answer 22

• 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

Question 23

Gonorrhea

Answer 23

• Neisseria Gonorrhea
• Must treat both patient and partner
• Found in adolescent young adults
• Exam: strawberry spots on cervix, milky white discharge

Question 24

Chlamydia

Answer 24

Chlamydia trachomatis
Most common bacterial STD
Can be asymptomatic
Exam: Red cervix with discharge

Question 25

What is the incubation period for gonorrhea?

Answer 25

1-14 days

Question 26

What can gonorrhea cause in men and women?

Answer 26

• Can cause cervicitis, urethritis in women, also PID

- Can cause urethritis, epididymitis, proctitis in men

Question 27

How is gonorrhea tested? Who should be screened?

Answer 27

Test: Obtain dirty urine, first 10-20cc of the stream
Who: all individuals under the age of 30

Question 28

What is the incubation period for chlamydia?

Answer 28

7-14 days

Question 29

Who should be screened for chlamydia?

Answer 29

Screen for CT in all individuals under the age of 30

Question 30

What can chlamydia cause in men and women?

Answer 30

Women- cervicitis, urethritis, PID

Men- urethritis, proctitis, epididymitis

Question 31

Syphilis

Answer 31

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

Question 32

What is the RPR test?

Answer 32

Test for latent syphilis in body

Question 33

Condyloma Acuminata Lesion

Answer 33

Rised, skin colored lesion on labia or vaginal opening

Question 34

Pediculosis pubis

Answer 34

pubic lice, lives in the hair,

becoming less of a problem with shaving/waxing

Question 35

Genital herpes

Answer 35

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.