Wk 8: Women's health (5% of final) Flashcards
Describe the anatomy of the female breast
1) The female breast lies against the anterior thoracic wall, extending from the clavicle and second rib down to the sixth rib, and from the sternum across to the midaxillary line.
2) The breast overlies the pectoralis major and, at its inferior and lateral margins, the serratus anterior
How should you describe clinical findings?
1) Can divide breast into 4 quadrants
-A fifth area, the axillary tail of breast (aka “tail of Spence”) extends laterally across the anterior axillary fold
2) Alternatively, findings can be localized as the time on the face of a clock (e.g., 3 o’clock) and the distance from the nipple (in cm).
What are a few good general rules for the female exam?
1) Always interview the patient with her dressed (if possible), especially if this is your first time meeting her
2) Respect her privacy/modesty
3) Maintain your patient’s privacy (this includes where and how loudly you speak… many exam rooms have thin walls)
Your patients will be evaluating you as they are deciding what to share with you; what 4 things are they looking for?
1) Interest: do you appear to really care?
2) Judgmental: can they safely share?
3) Rapport: have you “connected”?
4) Have you helped them understand why honesty is so important?
Patient-provider partnership:
1) Define empathetic communication
2) Define motivational interviewing
1) Characterized by provider communicating with empathy & sympathy
2) “Reflective listening” replaces “advice giving”
What nonverbal communication should you have during the female exam? (5 things)
1) Make eye contact when the patient is talking
2) Talk in layman’s terms
3) Make them feel like they have all the time they need to share with you… if you don’t have the time, schedule an appointment with them when you will have the time
4) Don’t DO other things while they are talking
5) Control your facial expressions
What is the important past history for the female exam? (4 things)
- GYN-menstrual, sexual
- OB
- Medical
- Family
- Social
What are 4 important HPI questions to ask when pertinent to the CC?
1) Issues with menstrual/uterine bleeding? When did it start, how much, how long, clots?
2) Issues with pain? What hurts, when? what makes it better/worse. (Dyspareunia = pain with intercourse)
3) Issues with vaginal discharge? When did it start? Any odor? Itching? Different color/texture? Pain with intercourse?
4) STI concerns? Get details related to exposure, past hx of STIs and any current symptoms
1) Menstrual history begins when?
2) Average amount of blood from a menstrual period is how many mL?
3) A daytime menstrual pad can hold how much blood?
4) A fully soaked overnight pad can hold how much blood?
5) A light tampon holds how many mL?
6) Fully soaked super tampon can hold how many mL?
1) Age of menarche
2) ~20-60 mL.
3) ~5 mL.
4) ~10-15 mL.
5) ~3 mL (fully soaked).
6) ~12 mL
What are the 8 elements of menstrual history?
1) 1st day of Last menstrual period (LMP)
2) Length of periods (# of days of bleeding)
3) # of days between periods
4) Any recent change in periods
5) Estimation of amount of flow (including clots)
6) Irregular bleeding
7) Intermenstrual bleeding
8) Postcoital bleeding
1) Define irregular bleeding
2) When does intermenstrual bleeding occur?
3) When does postcoital bleeding occur?
1) No set pattern or duration
2) Between menses
3) Immediate after coitus
List 7 premenstrual symptoms
1) Anxiety
2) Fluid retention
3) Nervousness
4) Mood fluctuations
5) Food cravings
6) Variations in sexual feelings
7) Difficulty sleeping
Are menstrual cramps & discomfort always abnormal? Explain
Can be normal or abnormal; dysmenorrhea is abnormally painful menstrual periods
1) Define menopause
2) Define perimenopause. How long does it often last?
3) List the symptoms of perimenopause
1) Cessation of menses for >1 year
2) Transition from menstrual to non-menstrual life when ovarian function begins to wane (often 1-2 years)
3) Increasing menstrual irregularity; varying or decreased flow; hot flashes, nervousness, mood changes; decreased vaginal lubrication with sexual activity; altered libido
List the gynecologic histories you should take (PMH) (3)
1) Illnesses & treatments
2) Surgeries (what, why, when, who)
3) Sexual hx
What 5 sexual history questions do you need to ask?
1) “Have you ever been sexually active?”
2) “Please tell me about your sexual partner or partners.”
3) “Who are you sexually attracted to? Males, females, or both?”
4) Sexual & behavioral risks (STI screening)
5) Contraceptive history (current & past; desire for conception)
What are the 5 Ps of sexual Hx? Explain each.
1) Partners (Number: ever/last 2 months, men/women/both?)
2) Practices (Oral, vaginal, anal)
3) Protection from STIs (How do you protect yourself; what % of the time)
4) Past history of STIs (Ever been tested/diagnosed? What, when, treated, current concerns?)
5) Pregnancy intention (and Contraception hx): current & past contraception; desire for contraception/pregnancy
1) Define gravidity
2) Define parity
1) # of pregnancies, current and past, regardless of outcome (multiple gestation only counts once)
2) # of times a woman has given birth to an infant ≥20 weeks of gestation regardless of outcome
multiple gestation only counts once (except for living children)
How do you document OB history?
GTPAL (ex, G2P1001): gravidity, term, preterm, abortion/(miscarriage), living
1) Define term
2) Define preterm
3) Define abortion
4) Define living
1) Number of times a woman has given birth to an infant ≥37 weeks gestation
2) Number of times a woman has given birth to an infant between 20-36 6/7 weeks gestation
3) Number of losses before 20 weeks
4) Number of living children
1) Define gravida
2) Define primigravida and multigravida
3) Define nulligravida
1) Is or has been pregnant
2) Is in or has had one pregnancy; has been pregnant more than once
3) Has never been pregnant
1) Define primipara
2) Define multipara
3) Define nullipara
1) Has only birthed one child or is pregnant for the 1st time
2) Has given birth 2+ times
3) Has never given birth or had pregnancy go past gestational abortion age
What does GTPAL stand for?
G = total pregnancies
T = # born ≥37 weeks (= term)
P = preterm
A = miscarriages/abortions
L = living children
Pregnancy ends with one of what two things?
Birth (live or still) or abortion (spontaneous [miscarriage] or induced)
