Week 1 pt 2 Flashcards
1) What does the greater pelvis do?
2) What does the lesser pelvis contain?
1) Greater pelvis (also known as the false pelvis) supports the pregnant uterus at term.
2) Lesser pelvis (also known as the true pelvis) contains the pelvic viscera (uterus, vagina, bladder, fallopian tubes, ovaries, & distal rectum and anus).
They are separated by the linea terminalis.
What are the most and least common Caldwell-Moloy pelvic types?
1) Gynecoid most common (40-50%)
2) Platypelloid least common (2-5%)
Vagina:
1) What types of cells?
2) What is the shape? What can weaken it?
3) What is the major blood supply?
1) Stratified squamous epithelium surrounded by 3 smooth muscular layers
2) “H”-shaped
Walls supported by pelvic fascia
Weakened by age & childbirth
3) Major blood supply via vaginal artery
branch of hypogastric artery
List parts of the uterus
Cervix (2-3cm long)
Isthmus
Body (corpus)
1) Why would you assess the size of the pelvis?
2) What is pelvimetry?
3) How is pelvis size estimated?
4) What is the most narrow part? What size does it need to be?
1) Adequate for vaginal birth?
2) Measurement of pelvic outlet, pelvic inlet, & mid-pelvis
3) Bimanual exam, x-ray, or CT scan
4) Obstetric conjugate; needs to be > 11 cm
-Unable to directly measure clinically
Where are the ureters near the uterus?
Broad ligament
True or false: a patient who is postmenopausal should not have palpable ovaries
True
What is the primary support of the uterus?
Utero-sacral ligament
What are the 3 uterine wall layers?
Endometrium
Myometrium
Serosa
What are 3 positions of the uterus?
Anteverted
Midposition
Retroverted
What will you see in female pts with Turner syndrome?
(45XO) - streaks of abnormal ovarian tissue in pelvis
1) What is Mullerian agenesis assoc. with? (besides absence of uterus)
2) What are 2 uterine changes that can occur?
1) Vaginal anomalies
2) Double uterus, bicornuate uterus
What is the most common cause of congenital adrenal hyperplasia (CAH)?
21-hydroxylase deficiency
Mesonephric ducts normally degenerate during development; Remnants of the ducts can persist and manifest as __________ cysts located in vaginal wall or broad ligament
Gartner
Describe how to build a patient-provider partnership
1) Verify the patient’s identity and how she prefers to be addressed
2) Empathic communication: characterized by provider communicating with empathy & sympathy
3) Motivational interviewing: “reflective listening” replaces “advice giving”
Patient talks and provider actively listens
5) Steps of patient-centered partnership women’s healthcare visit
List the parts of gynecological Hx
days between periods
1) Menstrual history begins with menarche
2) Last menstrual period (LMP) (even “light” but on-time bleeding)
3) Length of periods (number of days of bleeding)
4) Any recent change in periods
5) Estimation of amount of flow (clots)
6) Irregular bleeding
7) Intermenstrual bleeding
8) Postcoital bleeding
Give examples of premenstrual Sx
Anxiety
Fluid retention
Nervousness
Mood fluctuations
Food cravings
Variations in sexual feelings
Difficulty sleeping
Menstrual cramps & discomfort: how do you tell if normal vs abnormal?
If NSAIDs don’t help & if interfering with ADLs
1) Define menopause
2) Define perimenopause
1) Cessation of menses for > 1 year
2) Transition from menstrual to non-menstrual life when ovarian function begins to wane (often lasts 1-2 years)
List Sx of perimenopause
Begins with increasing menstrual irregularity
Varying or decreased flow
Hot flashes, nervousness, mood changes
Decreased vaginal lubrication with sexual activity
Altered libido
List 3 parts of gynecologic Hx
Illnesses & treatments
Surgeries
Sexual
List 4 questions of sexual Hx
“Are you currently or have you ever been sexually active?”
“Please tell me about your sexual partner or partners.”
Sexual & behavioral risks (STI screening)
Contraceptive history (current & past; desire for conception)
1) Define gravidity (G)
2) Define parity (P)
1) Gravidity (G) - number of pregnancies (current or previous)
2) Parity (P) - number of births carried to viability (>20 weeks)
What are 2 ways to document gravidity and parity?
G#PTPAL (ie G2P1001) (or GxPxAx (ie G2P1A0))
1) Define gravida
2) Define primigravida
3) Define multigravida
4) Define nulligravida
5) Define primipara
6) Define multipara
7) Define nullipara
1) Is or has been pregnant
2) Has experienced/ is experiencing first pregnancy
3) Has experienced/ is experiencing multiple pregnancies
4) Never been and is not pregnant
5) Pregnant for the first time or only has given birth once
6) Given birth 2+ times
7) Never given birth or never had pregnancy progress past gestational age of abortion
1) What are 4 live birth details?
2) List 5 pregnancy complications
1) Birthweight, sex, # weeks at delivery, & type of delivery (vaginal vs C-section)
2) DM, HTN, preeclampsia, depression, or anxiety
True or false: Previous breastfeeding history (if applicable) is a part of obstetric Hx
True
You are helping out in the OB clinic and are seeing a 30-year-old patient who has been pregnant 5 times but only has two kids. She had an abortion at age 16 years (9wks) and an ectopic at age 17 years. She later had a baby at 32 weeks that passed away and twins at 36 weeks who are doing well.
What are her G’s and P’s?
G5P0222
List parts of Preconception counseling & care
1) Family planning & pregnancy spacing
2) Immunization status
3) Genetic history (maternal & paternal)
4) Teratogens (environmental & occupational exposures)
5) Assessment of socioeconomic, educational, & cultural context
6) History of infertility
Why should you ask abt family history of illnesses in 1st degree relatives?
Genetic predisposition
Tests or interventions for patient or family members
What should ROS include?
Previous or current symptoms
Pertinent positives & negatives (general and/or focused)
What are important parts of PE?
Detect abnormalities (suggested & unsuspected)
Chaperone
Extent directed by CC, managed conditions, & medically indicated by history
How is a breast exam documented?
Description (can use clock descriptions), diagram, or both
Describe how to visually inspect breasts
1) Patient standing or seated.
2) Lean forward for large and/or pendulous breasts
3) With arms at side then overhead
4) Any marked differences b/t the 2 breasts? Recent changes?
-Some asymmetry is common
Describe how to palpate breasts
1) While arms raised overhead
2) Up & down with wave-like motion with finger pads
3) Do not squeeze nipple.
List some abnormal breast findings
1) Discolorations or ulcerations
2) Leathery, puckered appearance (aka peau d’orange) caused by edema of lymphatics
3) Clear of milky discharge (galactorrhea)
4) Bloody discharge (usually unilateral)
5) Pus
Describe breast self-awareness counseling & what’s not recommended
1) Awareness of normal appearance & feel
2) Routine breast self-examination (BSE) not recommended (but considered for some)
Describe an abdominal exam
1) Not done in every evaluation
2) Inspection:
Contour (flat, scaphoid, protuberant)
Presence & distribution of hair
Striae, operative scars, masses
3) Percussion: if areas of distention (tympany & dullness)
4) Auscultate: four quadrants
5) Palpation:
Tenderness (start in non-painful area)
Rebound tenderness, muscle guarding, rigidity
-Masses: size, cystic or solid, smooth or nodular, fixed or mobile, if associated with ascites
Describe an annual pelvic exam
1) Empty bladder to ensure comfort & assist your exam
“Clean catch” urine specimen from mid-stream if needed
2) Muscle relaxation needed
3) *Explain every part of exam before performing
“Talk before you touch”
Avoid being abrupt or stern
Rehearse what you will say and how you will say it.
4) Draping sheet over patient’s lap & knees
5) Assist patient to assume lithotomy position
Head of bed up 30 degrees
6) Examiner position: seated at foot of table
7) Gloves
Pelvic exam:
1) List parts of the external genitalia
2) List things you should palpate and what you may need to do depending on CC
1) External genitalia:
mons pubis, labia majora, labia minora, perineum, & perianal area
2) Clitoral hood, introitus, outer vagina, urethral meatus, areas of urethra & Skene glands
-Depending on CC/RFE, may…
a) milk urethra (culture discharge)
b) Bartholin glands
What should you do with a metal speculum?
Warm with water, hands, or warming tray/drawer
What are 2 types of speculums?
1) Graves
2) Pederson (nulliparous, postmenopausal)
Describe proper speculum insertion
1) Hold speculum in dominant hand with blades closed
2) Open introitus (2 fingers on perineum)
3) Insert horizontally/obliquely (45 degrees) with slight downward pressure
4) Avoid superior pressure
5) Open in smooth & deliberate fashion
6) May tilt speculum down to view cervix
7) Lock in open position
What should you look for when visualizing the cervix?
1) Nulliparous vs multiparous
2) Normal vaginal discharge?
3) Ectropion, Nabothian cysts, small polyps (benign)
4) Inflammation, masses, dysplasia (require further eval)
Describe how to remove a speculum
1) Inform patient
2) Keep blades open slightly first (avoids pinching cervix)
3) Withdraw ~ 1 inch before slowly releasing thumb hinge
4) Withdraw slowly to inspect vaginal walls
Bimanual Exam: Describe how to perform this
1) “Vaginal” hand (index and middle fingers) & “abdominal” hand (use finger pads not fingertips) to entrap & palpate pelvic organs
*Make sure you use lubricant on your vaginal hand glove
2) Palpate the cervix, cervical position, uterus, uterine position, adnexa, ovaries
3) Rectovaginal exam if indicated
What aspects of the uterus should you note during a bimanual exam?
1) Uterine position:
Mid-position (normal)
2) Version: tilted along long axis
Anteverted
Retroverted
3) Flexion: tilted on shorter axis
Anteflexed
Retroflexed
Not on quiz!!
1) Avg amount of blood lost in a menstrual period = __________ mL.
2) What type of menstrual pad can hold ~5 mL?
3) Fully soaked overnight pad can hold ~________mL.
4) Light tampon holds ____ mL (fully soaked).
5) Fully soaked ________ tampon can hold ~12 mL.
1) ~20-60
2) Daytime
3) 10-15
4) ~3mL
5) super
