Approach to Patient, Office Gynecology, & Breast Disorders Flashcards
(126 cards)
1
Q
What are the usual complaints in gynecology?
A
Pelvic masses
Abnormal bleeding
Difficulty urinating
2
Q
LMP and PMP are included in which parts of the History taking?
A
History of Present Illness and OB/Gyne history
3
Q
Where should caesarian section be included in the History Taking?
A
OB/Gyne history
4
Q
Mean duration of the normal regular cycle?
A
28 ± 7 days or 21 to 35 days
5
Q
Pertains to the number of pregnancies regardless of the pregnancy outcomes
A
Gravidity
6
Q
Parity pertains to the number of pregnancies which reached the age of viability which is:
A
20 weeks
7
Q
Age of Gestation of a preterm baby
A
<37 weeks
8
Q
Criteria for abortion
A
<20 weeks
<500 g
<25 cm
9
Q
T/F: Ectopic Pregnancy and Blighted ovum are part of the count for abortion
A
true
10
Q
Gynecologic Physical Examination should begin with a general evaluation of the patient’s:
A
appearance and affect
11
Q
T/F: HEENT is not usually performed in Gynecologic PE
A
True
12
Q
What vital measurement is routinely done in PE of postmenopausal women to document evidence of osteoporosis?
A
height
13
Q
When is the timing of BSE in menstruating women?
A
7-10 days following onset of menstruation
14
Q
When is the timing of BSE in postmenopausal women?
A
Same calendar day of each month
15
Q
What are the things to look for during BSE Inspection?
A
ConSROD
- Contour
- Swelling
- Retractions or Dimpling
- Orange Peeling (Inflammatory Breast CA)
- Direction of the nipple
16
Q
What are the four steps to inspect the breast?
A
SOHL
- arms at SIDE
- arms OVERHEAD
- hands on HIPS pressing firmly to flex the muscle
- Leaning forward
17
Q
Technique that increases tactile sensation during palpation on BSE
A
Wet technique
18
Q
Which fingers are used during palpation on BSE?
A
flat pads of 2nd, 3rd, 4th fingers
19
Q
What are the 3 methods of palpating in BSE?
A
Wedge method (Radial/Hands of the Clock)
Vertical Strip (Linear) method
Rotary (Spiral/Circular) Method
20
Q
What is commonly implied by a hypoactive bowel sound?
A
ileus caused by peritoneal irritation
21
Q
What is commonly implied by a hyperactive bowel sound?
A
Intrinsic irritation of the bowel or partial or complete bowel obstruction
22
Q
What is commonly implied by a localized percussion tenderness of the abdomen?
A
peritoneal inflammation
23
Q
Which part of the Gynecologic Exam checks for varicosities and edema?
A
Examination of Extremities
24
Q
T/F: Annual screening of the pelvis for asymptomatic, non-pregnant adult women is found to be very beneficial
A
False: annual pelvic screening do not offer benefit and can cause harm
25
What is the position during pelvic examination?
Dorsal Lithotomy Position
26
What is the normal or common pattern of pubic hair for females (Female Escutcheon)?
Inverted triangle over the mons pubis
27
What is the escutcheon pattern that may indicate androgen activity or neoplastic growth in reproductive organs in female patient?
Diamond pattern or Male escutcheon pattern
28
What is the anatomical focal point of support for the perineum?
Perineal body
29
This pertains to the prolapse of the bladder into the vaginal wall
Vaginal cystocele
30
This pertains to a cystocele combined with distal prolapse of the urethra with or without associated urethral hypermobility
Cystourethrocele
31
T/F: bladder should be empty during Speculum Exam
True
32
When should one collect urine in relation to a speculum exam if there is suspected UTI
Prior to the exam
33
What is the technique used in performing a Pap Smear
3-cotton pledget technique
34
What is the manner of insertion of the speculum to avoid the urethra and rectum during examination?
diagonal
35
Choose between Nulliparous and Multiparous Cervix:
Soft Consistency
Multiparous Cervix
36
Choose between Nulliparous and Multiparous Cervix:
Opening is minimal or almost closed/round or oval
Nulliparous cervix
37
Choose between Nulliparous and Multiparous Cervix:
(+) Healed stellate lacerations
Multiparous cervix
38
Choose between Nulliparous and Multiparous Cervix:
Round external os
Nulliparous cervix
39
Choose between Nulliparous and Multiparous Cervix:
Somewhat hard
Nulliparous cervix
40
Choose between Nulliparous and Multiparous Cervix:
Opening is slit-like
Multiparous cervix
41
Choose between Nulliparous and Multiparous Cervix:
Pink and without lesions
Nulliparous cervix
42
T/F: The bimanual (internal) gynecologic exam is usually done in pregnant or non-pregnant women
True
43
Which fingers are placed within the vagina during bimanual gyne examination?
Index and middle fingers of the dominant hand
44
Palpation of which anatomical location during bimanual exam can help in determining the location of female reproductive organs?
fornix
45
The adnexa can be located during bimanual exam by palpating:
the posterior fornix
46
What is the normal ovary size
3 x 2 cm
47
Which structures are palpated for nodularity during Rectovaginal Exam?
Rectovaginal septum
Uterosacral ligaments
48
A patient should abstain from sexual intercourse within ___ hours after pap smear
24 hours
49
T/F: Pap Smear should not be conducted when the patient is on her menstrual period
True
50
T/F: Pap Smear is contraindicated during pregnancy
False
51
Which of the following is a low-risk indication for Pap Smear:
A. History of later coitus
B. Multiple Sexual Partners
C. Single sexual partner but partner has multiple sexual partners
A
52
The initial screening for Pap Smear should begin at the age of ___ regardless of sexual activity
21
53
Frequency of Pap Smear screening for a 25-year-old
every 3 years
(21-29 yo)
54
Frequency of Pap Smear Screening for a 66 yo
No longer recommended
(after 65 years with normal adequate testing over the past 10 years, and has not been treated for high-grade dysplasia within the past 20 years)
55
Frequency of Pap smear screening for a 68-year-old woman who is immunocompromised
annually
One of the exceptions to "no screening rule" in elderly:
- HIV seropositive
- Immunosuppression
- Exposed to DES in utero
56
How often is Pap plus High-risk-HPV Co-testing done in 30–65-year-olds?
every 5 years
57
Frequency of Pap Smear for a 70-year-old who underwent supracervical hysterectomy in her 50s?
every 3 years
58
The goal of a Pap Smear is to collect cells from which part (zone) of the cervix?
Transformation zone
59
Instrument used to collect cells in the endocervix during pap smear
cytobrush
60
Instrument used to collect cells in the ectocervix during pap smear
Ayer's spatula
61
From which areas should we take specimens from when performing the 3-cotton pledget technique of Pap Smear
Endocervix
Ectocervix
Lateral Vaginal Wall
62
3 ways to stain the Pap Smear specimen
Gram Stain
Wet or Saline smear
KOH smear
63
Which staining is used to check for Trichomonas in Pap smear?
Wet or Saline smear
64
Which staining demonstrates fungal infection in Pap smear specimens
KOH Smear
65
T/F: A pap smear specimen coming from a genitalia with fishy odor would be best stained using which solution?
10% KOH solution to check for bacterial vaginosis (Gardnerella vaginalis)
66
Which classification is used for the findings in Pap Smear
Bethesda Classification
67
Note the Bethesda Classification:
The size, shape, and other characteristics of the cells suggest that if a precancerous lesion is present, it is likely to be years away from becoming a cancer
Low-Grade Squamous Intraepithelial Lesion (LGSIL)
68
Note the Bethesda Classification:
Glandular cells may appear slightly abnormal, but malignancy is unclear
Atypical Glandular Cell Change of Undetermined Significance (AGCUS)
69
Note the Bethesda Classification:
There is a greater chance that the lesion may develop into cancer sooner
High-Grade Squamous Intraepithelial Lesion (HGSIL)
70
Note the Bethesda Classification:
Pap smear reveals slightly abnormal squamous cells, but it is unclear whether they are cancerous
Atypical Squamous Cell Change of Undetermined Significance (ASCUS)
71
T/F: For small lesions, Vulvar Biopsy may excise and treat the entire lesion
True
72
This is often the first step in evaluation of women with abnormal cytology
Colposcopy
73
This procedure uses binocular microscope for direct visualization of the cervix
Colposcopy
74
What agent is used to improve visualization in colposcopy?
3-5% Acetic acid
75
When should you not perform colposcopy in a menstruating patient?
14-16 days after ovulation
76
This is an attractive alternative to cytology-based screening in low-middle income countries
Visual Inspection with Acetic acid
77
What is the positive result of VIA?
Acetowhite areas in the squamocolumnar junction or entire cervix, or a growth over the cervix
78
The appearance of white patches with VIA is due to:
coagulation of cellular proteins and indicate an abnormal epithelium
79
This is the standard test to confirm a chronic uterine infection
Endometrial Sampling
80
A blind procedure indicated for DUB & AUB that make use of a Novak curette or a Pipelle cannula
Endometrial Sampling
81
Which instrument is the first choice for endometrial sampling?
Pipelle curette
82
This is an x-ray imaging technique in which the uterine cavity and the lumina of the fallopian tubes are visualized by injecting contrast material through the canal
Hysterosalpingography (HSG)
83
An HSG uses _________, which provides more precise visualization and reduces radiation exposure
screen fluoroscopy
84
Uterine synechiae may be diagnosed or lysed with which minimally invasive procedure?
Hysteroscopy
85
Give 3 indications for HSG
Infertility (Primary or Secondary)
Tubal Patency
Congenital condition (e.g., abnormal uteri)
86
What determines the end point of tubal patency during HSG?
Tubal filling with intraperitoneal spilling
and
Increasing pelvic pain secondary to uterine distention due to tubal obstruction
87
This tests the patency of the fallopian tubes with the use of saline and ultrasound instead of a contrast media and x-ray
Saline Infusion Sonohysterography (SIS)
88
A procedure that directly visualizes the endometrial cavity with an endoscope and uses a distending media for diagnosis or operations
Hysteroscopy
89
Which of the following is an indication for hysteroscopy?
A. Removal of IUD
B. Resection of submucous myoma
C. Removal of endometrial polyps
D. All of the Above
D.
90
Which of the following is not an absolute contraindication for Hysteroscopy?
A. Acute pelvic infection with herpes
B. Pregnancy
C. Leiomyomata (>50% intramyometrial)
D. Recent uterine perforations
C.
91
Which of the following is not a complication of Hysteroscopy?
A. Anaphylaxis due to dextran
B. Pulmonary edema
C. Hypernatremia
D. Gas embolism with CO2
C.
- should be hyponatremia
92
This procedure provides a window to directly visualize pelvic anatomy and may be diagnostic and therapeutic
Laparoscopy
93
What is the most common indication for diagnostic laparoscopy?
Pelvic Pain evaluation (previously female sterilization)
94
Which of the following is an absolute contraindication for laparoscopy?
A. Inflammatory bowel disease
B. Advanced malignancy
C. Tuberculous peritonitis
D. Large hiatal hernia
C.
95
Mature breasts are ___% glandular tissue and ___% fat and connective tissue
20% glandular tissue and 80% fat and connective tissue
96
Cyclic breast tenderness and fullness occurs during which phase of menstruation?
Luteal phase
97
The lymphatics of the breast converge in the:
subareolar plexus of Sappy
98
Approximately 75% of the lymphatics, particularly the outer quadrants, of the breast drain to which nodes?
axillary regional nodes
99
Which anatomic level of the axillary nodes includes infraclavicular nodes medial to the pectoralis minor?
Level III
100
The lateral group of axillary nodes is designated as Level:
I
101
The 25% of lymphatics from the breast drains to which nodes?
internal mammary or parasternal nodes
102
The inferior phrenic nodes, which also drains the breasts, can provide a route for metastatic disease to which organs?
Liver, Ovaries and Peritoneum
103
Pertains to supernumerary nipples
Polythelia
104
Pertains to accessory breasts
Polymastia
105
Pertains to the absence of nipple or areola (an AD trait)
Athelia
106
Pertains to massive hypertrophy of the breast during puberty
Virginal hypertrophy
107
Benign Breast Disorders can be classified to ANDI, which means:
Aberrations of normal development and involution
108
Palpating a firm, rubbery, freely mobile breast mass that does not change in size with menstrual cycle could indicate which BBD?
Fibroadenoma
109
T/F: 20% of fibroadenoma recurs after surgical removal
True
110
This BBD has dominating stromal elements that will invade ducts in a leafy projection
Phyllodes tumor
111
This is most common of all BBD
Fibrocystic Change
112
What is the 2nd most common BBD?
Fibroadenoma
113
A palpable mass of excessive nodularity similar to a "plateful of peas" may indicate which BBD?
Fibrocystic change
114
What is the classic symptom of Fibrocystic change?
Cyclic Bilateral breast pain
115
What is the frequent location pain due to fibrocystic changes?
Upper outer quadrant
116
Mastitis and Inflammatory disease of the breast may be lactational occurring during:
First 6 weeks of breastfeeding
117
A non-lactational mastitis can be associated with:
breast cyst or cyst rupture
118
This BBD is frequently diagnosed when biopsy demonstrates sterile granulomas after excluding other causes of granulomatous mastitis such as tuberculosis
Idiopathic Granulomatous Mastitis
119
What are the two most common causes of spontaneous non-milky discharge?
Intraductal Papilloma
Fibrocystic change
120
This imaging can aid in diagnosing the cause of an abnormal nipple discharge
Ductography (galactogram)
121
What is the classic symptom of Intraductal Papilloma?
Intermittent but spontaneous bloody discharge from one nipple involving 1 or 2 ducts
122
What is the management for Intraductal Papilloma?
Excisional biopsy of involved duct and small amount of surrounding tissue
123
This is a benign nonsuppurative inflammatory process of the breast adipose tissue
Fat necrosis
124
Fat necrosis of the breast is commonly caused by
trauma
125
Which of the following is associated with Fat necrosis of the breast?
A. Warfarin use
B. Radiotherapy
C. Breast biopsy
D. All
D.
126
