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EC Physical Examination > Female Genitalia > Flashcards

Female Genitalia Flashcards

1
Q

What structures make up the vulva? (8)

A 
mons pubis
labia majora
labia minora
clitoris
vestibular glands
vaginal vestibule
vaginal orifice
urethral opening
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2
Q

The clitoris is tucked between the ____ and the ____.

A

frenulum and the prepuce

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3
Q

Posteriorly the labia minor meet as two judges that fuse to form the _____.

A

fourchette

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4
Q

The labia minor enclose the area designated as the _____.

A

vestibule

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5
Q

What are the 6 openings of the vestibule?

A

urethra
vagina
2 ducts of Bartholin glands
2 ducts of Skene glands

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6
Q

Which ducts drain a group of urethral glands and open onto the vestibule on each side of the urethra?

A

Skene ducts

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7
Q

Which glands open onto the sides of the vestibule in the groove between the labia minor and the hymen?

A

Batholin glands

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8
Q

What is the connective tissue that separate the anterior wall of the vagina from the bladder and urethra?

A

vesicovaginal septum

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9
Q

What separates the posterior vaginal wall from the rectum?

A

rectovaginal septum

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10
Q

The pocket formed around the cervix is divided into what?

A

anterior, posterior and lateral fornices

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11
Q

What is the deep recess formed by the peritoneum as it covers the lower posterior wall of the uterus and the upper portion of the vagina separating it from the rectum

A

rectouterine cul de sac (pouch of Douglas)

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12
Q

The uterus is a flattened _____ and usually inclines forward at a ____ degree angle.

A

anteroposteriorly

45 degree

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13
Q

What is the size of the uterus in nulliparous patients?

A

5.5 to 8 cm long
3.5 to 4cm wide
2-2.5 cm thick
weighs: 40-50g

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14
Q

How does the uterus differ in a parous pt compared to a nulliparous patient?

A

parous patient may be larger by 2 to 3 cm in any dimension

weighs 20-30 MORE than nulliparous patient

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15
Q

The uterus is divided anatomically into the ___ and the ____.

A

corpus and cervix

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16
Q

What are the 2 parts of the corpus?

A

the funds and the isthmus

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17
Q

The ____ extends from the isthmus into the vagina.

A

cervix

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18
Q

The uterus opens into the vagina via the _____

A

external cervical os

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19
Q

What comprises the adnexa of the uterus?

A

Fallopian tubes and ovaries

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20
Q

Each Fallopian tubes ranges from ___ to ___ cm long and is supported by a fold of the broad ligament called the ______.

A

8 to 14 cm long

mesosalpinx

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21
Q

The isthmus end of the Fallopian tube opens into the _____

A

uterine cavity

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22
Q

What transports the ovum to the uterus?

A

rhythmic contractions of the tubal musculature

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23
Q

The ovaries are at the level of the ____ iliac spine.

A

anterosuperior

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24
Q

How big is an ovary during the reproductive years?

A

3cm x 2cm x 1cm

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25
Q

What happens during the menstrual phase days 1-4 at the ovary?

A

estrogen levels begin to rise, preparing follicle and egg for next cycle.

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26
Q

What happens during the menstrual phase days 1-4 in the uterus?

A

(decreased?) progesterone stimulates endometrial prostaglandins that cause vasoconstriction; upper layers of endometrium shed

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27
Q

What happens during the menstrual phase days 1-4 in the breast?

A

cellular activity in the alveoli decreases; breast ducts shrink

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28
Q

What happens during the menstrual phase days 1-4 with the CNS hormones?

A

FSH and LH decrease

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29
Q

What happens during the post menstrual, preovulatory phase (days 5-12) in the ovary?

A

ovary and maturing follicle produce estrogen; follicular phase (egg develops within follicle)

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30
Q

What happens during the post menstrual, preovulatory phase (days 5-12) in the uterus?

A

Proliferative phase-uterine lining thickens

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31
Q

What happens during the post menstrual, preovulatory phase (days 5-12) in the breast?

A

parenchymal and proliferation of breast ducts occurs

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32
Q

What happens during the post menstrual, preovulatory phase (days 5-12) with the CNS hormones?

A

FSH stimulates ovarian follicular growth

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33
Q

What happens during ovulation (day 13 or 14) in the ovary?

A

egg is expelled from follicle into abdominal cavity and drawn into the fallopian tine by fimbriae and cilia. follicle closes and begins to form corpus lute; fertilization of egg may occur in outer third of tube if sperm are unimpeded

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34
Q

What happens during ovulation (day 13 or 14) in the uterus?

A

end of proliferative phase; progesterone causes further thinking of the uterine wall

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35
Q

What happens during ovulation (day 13 or 14) with the CNS hormones?

A

LH and estrogen levels increase rapidly; LH surge stimulates release of egg

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36
Q

What are the symptoms during ovulation (day 13 or 14) ?

A

Mittelschmerz may occur with ovulation; cervical mucus is increased and is stringy and elastic (spinnbarkeit)

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37
Q

What happens during the secretory phase (days 15-20) in the ovary?

A

egg (ovum) is moved by cilia into the uterus

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38
Q

What happens during the secretory phase (days 15-20) in the uterus?

A

after the egg is released, the follicle becomes a corpus luteum; secretion of progesterone increases and predominates

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39
Q

What happens during the secretory phase (days 15-20) with the CNS hormones?

A

LH and FSH decrease

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40
Q

What happens during the premenstrual, luteal phase (days 21-28) in the ovary?

A

if implantation does not occur, the corpus lute degenerates; progesterone production decreases and estrogen production drops and then begins to rise as a new follicle develops

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41
Q

What happens during the premenstrual, luteal phase (days 21-28) in the uterus?

A

menstruation starts around day 28, which begins day 1 of the menstrual cycle

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42
Q

What happens during the premenstrual, luteal phase (days 21-28) in the breast?

A

alveolar breast cells differentiate into secretory cells

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43
Q

What happens during the premenstrual, luteal phase (days 21-28) with the CNS hormones?

A

increases levels of GnRH cause increased secretion of FSH

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44
Q

What are the symptoms during the premenstrual, luteal phase (days 21-28)?

A

vascular engorgement and water retention may occur

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45
Q

What are the 4 ligaments that support the internal genitalia?

A

cardinal
uterosacral
round
broad ligaments

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46
Q

What is necessary to support the pregnancy for uterine enlargement during the first trimester?

A

high levels of estrogen and progesterone

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47
Q

After the third month what is the primary cause of uterine enlargement?

A

mechanical pressure of the growing fetus

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48
Q

At term the uterus will have increased more than ____ fold and the capacity increases ____ to ___ times that go the non pregnant uterus.

A

10

500-1000x

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49
Q

What level is the uterus at 20 weeks?

A

level of the umbilicus

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50
Q

When does the uterus reach into the abdominal cavity?

A

12 weeks

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51
Q

Immediately after delivery the uterus is the size of what?

A

20 week pregnancy (umbilicus level)

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52
Q

How big is the uterus 1 week after delivery?

A

12 week pregnancy and palpable at the symphysis pubis

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53
Q

What is responsible for the softening of the pelvic cartilage and the strengthening of the pelvic ligaments?

A

relaxin and progesterone

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54
Q

What is the result of the pelvic joints separating from relaxin and progesterone?

A

waddle gait

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55
Q

When does the symphysis pubs return to the prepregnancy state postpartum?

A

within 2-5 months

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56
Q

during pregnancy what is the result of increased uterine blood flow and lymph?

A

pelvic congestion and edema

the uterus, cervix, and isthmus soften and the cervix takes on a bluish color

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57
Q

What is it called when the isthmus softens during pregnancy?

A

Goodell sign

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58
Q

What is it called when the cervix takes on a blue color in pregnancy?

A

Chadwick sign

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59
Q

The cervical canal is obstructed by ____ ___ soon after conception, protecting the infant from infection.

A

thick mucus

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60
Q

When the thick mucus plug dislodges at the beginning of labor what is that sign called?

A

bloody show

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61
Q

What causes the increased length of vaginal walls so that at times they can be seen protruding from the vulvar opening?

A

mucosa of the vaginal walls and the connective tissue thicken and smooth muscle cells hypertrophy

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62
Q

In pregnant females the papillae of the mucosa have what appearance?

A

hobnailed appearance

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63
Q

What causes an increase in vaginal pH during pregnancy?

A

an increase in lactic acid production by the vaginal epithelium to keep bacteria from multiplying but may cause Candida infection

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64
Q

What is the median age of menopause in the US?

A

51 years

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65
Q

What is menopause defined as?

A

1 year with no menses (amenorrhea)

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66
Q

What is the result of a decrease in estrogen levels in menopause?

A

the labia and cliotris become smaller

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67
Q

What might account for the decrease in libido and in muscle mass in menopause?

A

both adrenal androgens and ovarian testosterone markedly decrease after menopause

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68
Q

What happens to the vagina after menopause?

A

the vaginal Introits gradually constricts. The vagina narrows, shortens and loses its rugae and the mucosa becomes thin, pale and dry which can result in dyspareunia (pain with intercourse)

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69
Q

What happens to the cervix after menopause?

A

smaller and paler

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70
Q

What happens to the uterus after menopause?

A

it decreases in size and the endometrium thins

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71
Q

What happens to the ovaries after menopause?

A

they decrease in size to 1-2 cm, follicles gradually disappear and the surface od the ovary convolutes

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72
Q

What are the systemic effects of menopause?

A

increase in body far and intraabdominal deposition of body fat
levels of total and LDL cholesterol increase
thermoregulation is altered producing hot flashes

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73
Q

What is the absence of menstruation?

A

amenorrhea

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74
Q

shortened interval between periods-less than 19-21 days?

A

polymenorrhea

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75
Q

lengthened internal between periods- more than 35 days?

A

oligomenorrhea

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76
Q

excessive flow during normal duration of regular periods?

A

hypermenorrhea

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77
Q

decreased flow during normal duration of regular periods?

A

hypomenorrhea

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78
Q

regular and normal interval between periods, excessive flow and duration?

A

menorrhagia

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79
Q

irregular intervals between periods, prolonged duration with expected amounts

A

metrorrhagia

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80
Q

irregular or excessive bleeding during periods and between periods?

A

menometrorrhagia

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81
Q

What are the risk factors for cervical cancer? (12)

A 
HPV Infection (16,18,31,33,45)
No HPV Vaccination 
Lack of pap smear
three or more full term pregnancies
patients younger than 17
cigarette smoking
HIV infection
Chlamydia infection
Overweight (less fruits and veggies)
DES exposure
Long term OCP use
Low socioeconomic status
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82
Q

What are the risk factors for ovarian cancer? (10)

A 
increased age
BRCA1 BRCA2 or PTEn gene
family history
obesity
nulliparity or parity after 35
use of fertility drugs
increased with h/o breast, endometrial or colon cancers
hormone replacement therapy
50% reduction with OCPs
High fat diet
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83
Q

What are the risk factors of endometrial cancer? (11)

A 
# of menstrual cycles
nulliparity
obesity
tamoxifen
estrogen replacement therapy 
Ovarian diseases (polycystic ovaries, granulosas)
high animal fat diet
increased age
FMH of endometrial, breast or ovarian, or colorectal cancers
BRCA1 or BRCA2 gene
prior pelvic radiation therapy
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84
Q

What is the size of the clitoris?

A

2cm or less and 0.5cm in diameter

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85
Q

What is a bright red polypoid growth that protrudes from the urethral meatus; and usually cause no symptoms

A

caruncle

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86
Q

Discharge from the scene glands or the urethra usually indicate what?

A

an infection-most commonly gonococcal

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87
Q

What indicates a Bartholin cysts?

A

a nontender mass

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88
Q

What indicates a Bartholin infection?

A

painful, hot to the touch and fluctuant that is usually filled with pus (gonococcal or staphylococcal)

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89
Q

What is a pale cervix associated with?

A

anemia

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90
Q

What is a blue cervic associated with?

A

increased vascularity and may be a sign of pregnancy

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91
Q

A cervix that is pointing anteriorly indicates a ____ uterus.

A

retroverted uterus

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92
Q

A cervix that is pointing posterior indicates an ____uterus

A

anteverted uterus

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93
Q

If the cervix is not midline and deviates to the left or right, what might that indicate?

A

a pelvic mass
uterine adhesions
pregnancy

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94
Q

If the cervix projects greater than ____ it may indicate a pelvic or uterine mass.

A

3 cm

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95
Q

What is the size of the cervix at child bearing age?

A

2-3 cm in diameter

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96
Q

What is the transformation zone of the cervix?

A

the junction of squamous and columnar epithelium

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97
Q

When does cervical ectropion occur?

A

when eversion of the endocervix exposes columnar epithelium

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98
Q

When is ectropion of the cervix most commonly seen?

A

adolescents, pregnant patients or those taking estrogen containing contraceptives

99
Q

What might be observed as small, white or yellow raised, round areas on the cervix that are mutinous retention cysts of the endocervical glands that are considered an expected finding?

A

Nabothian cysts

100
Q

How do nabothian cysts occur?

A

during the process of metaplasia at the transformation zone when endocervival columnar cells continue to secrete but are covered by squamous epithelium

101
Q

What should you look for on the cervix that could indicate cervicitis, infection or carcinoma?

A

friable tissue
red patchy areas
granular areas
white patches

102
Q

What type of discharge might indicate a bacterial or fungal infection compared to normal discharge?

A

will more likely have an odor and will vary in color from white to yellow, green or gray

103
Q

What is a hernial protrusion of the urinary bladder through the anterior wall of the vagina, sometimes exiting the introitus?

A

cystocele

104
Q

What is a hernial protrusion of part of the rectum through the posterior vaginal wall?

A

rectocele (proctocele)

105
Q

What is the size of the uterus?

A

pear shaped and 5.5 to 8cm

106
Q

What does a fixed uterus indicate?

A

adhesions

107
Q

What does tenderness on movement of the uterus with bimanual exam indicate?

A

pelvic inflammatory process or ruptured tubal pregnancy

108
Q

Are Fallopian tubes usually palpable?

A

NO

109
Q

What is the Naegele rule used to calculate EDD?

A

add 1 year to the first day of the last normal menstrual period, subtract 3 months, and add 7 days

110
Q

What is the average duration of pregnancy?

A

280 days or 40 weeks

111
Q

What is Piskacek sign?

A

uterine irregularity that occurs around weeks 8 to 10 as initial uterine enlargement may deviate to one side and an irregularity in its contour at the site of implantation

112
Q

How can you estimate the size of the uterus?

A

with tape measure measure from the upper part of the pubic symphysis to the superior uterine fundus in centimeters

113
Q

When is uterine measurement the most accurate?

A

between 20 and 32 weeks of gestation when the fundal height in centimeters correlates well with the gestational age in weeks (+ or - 2cm)

114
Q

What is an expected pattern of fundal height?

A

a 1 cm increase per week is expected

115
Q

What should you consider if the uterine size is smaller than expected?

A

consider the possibility of intrauterine growth restriction

116
Q

What factors can affect the accuracy of fundal height measurement?

A 
obestiy
amount of amniotic fluid
myxomata
multiple gestation
fetal size
position the uterus
117
Q

What is the uterus within the pelvis?

A

weeks 10-12

118
Q

When is the uterus palpable just above symphysis pubis?

A

week 12

119
Q

When is the uterus palpable halfway between the symphysis and umbilicus; balloteement of fetus is possible by abdominal and vaginal exam

A

week 16

120
Q

When is the uterine fungus at the lower border of the umbilicus?

A

week 20

121
Q

When does the uterus change from globular to ovoid shape; fetus palpable?

A

weeks 24-26

122
Q

When is the uterus approximately halfway between umbilicus and xiphoid?

A

week 28

123
Q

When is the uterine fungus just below xiphoid?

A

week 34

124
Q

When does the fundal height drop as the fetus begins to engage in pelvis?

A

week 40

125
Q

What is Goodell sign? When is it seen?

A

softening of the cervix

4-6 weeks

126
Q

What is Hegar sign? When is it seen?

A

softening of the uterine isthmus

6-8 weeks

127
Q

What is McDonald sign?

A

Fundus flexes easily on the cervix

7-8 weeks

128
Q

What is Brain von Fernwalk sign?

A

fullness and softening of the fundus near the site of implantation
7-8 weeks

129
Q

What is Piskacek sign?

A

palpable lateral bulge or soft prominence of one uterine Cornu
7-8

130
Q

What is Chadwick sign?

A

bluish color od the cervix, vagina, and vulva

8-12

131
Q

What is the thinning of the cervix that results when myocetrial activity pulls the cervix upward, slowing the cervix to become part of the lower uterine segment during prelabor or early labor?

A

effacement

132
Q

What is the result of effacement?

A

cervix is reduced in length

133
Q

What is the length of the cervix at the end of the third trimester?

A

3-4cm

134
Q

If there is shortening of the cervix (less than 29mm) noted on vaginal US in mid pregnancy, what does that indicate?

A

risk for preterm delivery

135
Q

When does effacement precede cervical dilation?

A

effacement precedes cervical dilation in the primipara and often occurs with dilation in the multipara

136
Q

What involves opening of the cervical canal to allow to the passage of the fetus?

A

dilation

137
Q

Shortening of the cervic (less than 29mm) noted on vaginal US indicates the risk of what?

A

preterm delivery

138
Q

what is detected by doppler by 11 to 12 weeks of gestations and heard by fetoscope at 19-20 weeks gestation

A

fetal heart rate (FHR)

139
Q

When is fetal movement (FM) appreciated by pregnant patients?

A

between 16 and 20 weeks gestation

140
Q

What is the Cardiff count to 10 method?

A

a patient sounds 10 movements, noting the length of time for them o occur.

141
Q

Are there universally accepted FM count criteria?

A

No but the standard ranges from 12 times in 1 hour to 10 times in 12 hours

142
Q

If there is no FM technique used when should the patient notify the healthcare professional?

A

the occurrence of 3 or fewer FMs in 2 hours for 2 consecutive days while the patient is at rest in left lateral position

143
Q

If there are risks involved whens would FM be monitored?

A

start as early as 28 weeks

144
Q

What are the Leopold maneuvers used for?

A

in the latter half of the 3rd trimester, assessment of fetal position can be performed using the four steps of Leopold maneuvers

145
Q

How are you supposed to stand for the Leopold maneuver?

A

After positioning the patient supine with the head slightly elevated and knees slightly flexed, place a small towel under the right hip. If you are right-handed, stand at the right side facing the patient and perform the first three steps, then turn and face the feet for the last step

146
Q

When do you use step 4 of the Leopold maneuver?

A

if the present part is not engaged

147
Q

What is step 1 of the Leopold maneuver?

A

place hang over the fundus and identify
head-feels round firmed freely moveable
buttocks- feels softer and less mobile

148
Q

What is step 2 of the Leopold maneuver?

A

use palmar surface to locate the back of the fetus. back will feel convex and small parts will feel irregular

149
Q

What is step 3 of the Leopold maneuver?

A

with the right hand using thumb and third finger grasp the presenting part over the symphysis pubis.

150
Q

How will the head feel if its not engaged in step 3?

A

it will be firm and moveable from side to side and easily displaced upward

151
Q

What is step 4 of the Leopold maneuver?

A

turn and face the patients feet and use two hands to outline the fetal head.

152
Q

What suggests that the head is flexed and the vertex is present on palpation? (opitmal position)

A

palpation of the cephalic prominence on the same side as the small parts

153
Q

What suggests on palpation that the the presenting part is extended?

A

palpation of the cephalic prominence on the same side as the back

154
Q

What should be recorded from abdominal palpation?

A

presenting part- vertex (head) or breach (buttocks)
The lie- longitudinal, transverse(perpendicular), or oblique
altitude (flexed or extended)

155
Q

How can FHR be used to estimate the position of the fetus?

A

the area of maximal intensity of the fetal heart rate

156
Q

Presentation is breech is FHR is heard _____ umbilicus and presentation is vertex if FHR is heard ______ umbilicus.

A

above; below

157
Q

What is the relationship of the presenting part to the ischial spines of the pregnancy patients pelvis?

A

station

158
Q

How is station measured?

A

determined by cm above and below the ischial spines and it recorded by a plus(below spine) or minus sign (above spine). (0=at the spines)

159
Q

What are the routine cervical exam findings?

A

dilation, cervical length and station

160
Q

What are Braxton-Hicks contractions?

A

uterine contractions as early as the third month of gestation

161
Q

When can Braxton-Hicks become more painful?

A

as the pregnancy progresses and with increased gravidity

162
Q

When do contractions require evaluation?

A

the regular occurrence of more than four to six uterine contractions per hour before 27 weeks gestation

163
Q

How can uterine contractions be assessed accurately?

A

either indirectly through the abdominal wall or directly with the placement of an intrauterine pressure catheter

164
Q

If palpating uterine contraction what is a mild classification?

A

slightly tense finds that is easy to indent with the fingertips.

165
Q

If palpating uterine contraction what is a moderate classification?

A

firm fundus that is difficult to indent with the fingertips

166
Q

If palpating uterine contraction what is a strong classification?

A

rigid or hand, birdlike fundus or one that does not indent with fingertips

167
Q

How is contraction duration measured?

A

measures in seconds from the beginning until relaxation occurs

168
Q

How is contraction frequency measured?

A

from the beginning of one contraction to the beginning of the next

169
Q

What are the intervals of frequency of contractions used to asses regularity?

A

regular
irregular
sporadic

170
Q

The uterus may become more ____ during the first 3 months from softening of the isthmus.

A

anteflexed

171
Q

What is the result of the uterus becoming more anteflexed?

A

the fundus may press on the urinary bladder causing the patient to experience urinary frequency

172
Q

In older adults what should be considered if the ovaries are palpable?

A

suspicious for tumor

173
Q

What are the alternate position for pelvic examination in patients with mobility impairments?

A 
knee chest position
diamond shape position
obstetric stirrups position
M-shaped position
V shaped position
174
Q

What is a collection of physical, psychological and mood symptoms related to a patients menstrual cycle?

A

Premenstrual syndrome (PMS)

175
Q

What are the symptoms of PMS?

A 
breast swelling and tenderness
acne
bloating and weight gain
headache or joint pain
food cravings
irritability
difficulty concentrating
mood swings
crying spells 
depression
176
Q

What do PMS symptoms occur?

A

5-7 days before menses (luteal phase)

177
Q

What is the presence and growth of endometrial tissue outside the uterus?

A

endometriosis

178
Q

What are the symptoms of endometriosis?

A

pelvic pain
dysmenorrhea
heavy or prolonged menstrual flow

179
Q

What is it called when HPV invades the basal layer of the epidermis; virus through skin and causes mucosal microabrasions. Painless

A

Condyloma acuminatum (genital warts)

180
Q

What is a viral infection of the skin and mucous membranes considered an STD infection in adults. in contrast to the non sexually transmitted infection occurring in young children?

A

Molluscum Contagiosum

181
Q

What is caused by the poxvirus, the virus enters the skin through small breaks of hair follicles and spreads person to person. painless

A

Molluscum Contagiosum

182
Q

What are the white or flesh colored, dome shaped papules that are round and oval with central umbilication from which thick creamy core can be expressed

A

Molluscum Contagiosum

183
Q

What are the skin lesions associated with primary syphillis?

A

Syphilictic Chancre

184
Q

What is the bacteria, STI that causes Syphilictic Chancre?

A

Treponema pallidum

185
Q

When do Syphilictic Chancre occur and how are they treated?

A

generally 2 weeks after exposure

last 2-6 weeks and heals without treatment

186
Q

What is a painless solitary lesion that is firm, small, round and ulcerated with indurated borders and a clear base?

A

Syphilictic Chancre

187
Q

What are the lesions of secondary syphilis?

A

Condyloma Latum

188
Q

What is the bacteria that causes Condyloma Latum?

A

Treponema pallidum

189
Q

When do Condyloma Latum appear?

A

about 6-12 weeks after infection

190
Q

What is the appearance of Condyloma Latum ?

A

flat, round or oval papules covered by a gray exudate

191
Q

What is a sexually transmitted viral infection of the skin and mucosa caused by herpes simplex virus?

A

genital herpes

192
Q

What are painful lesions in the genital area that may cause burning or pain with urination that are usually transmitted in the absence of symptoms

A

genital herpes

193
Q

What is the appearance of genital herpes?

A

superficial vesicles in the genital area; internal or external and may be eroded

194
Q

How does initial infection compare to recurrent infection of genital herpes?

A

initial infection is often extensive whereas recurrent is usually confined to small patch

195
Q

What is the common cause of inflammation of the Batholin gland?

A

Neisseria gonorrhea

196
Q

What are the types of vaginal carcinoma and where do they begin?

A

squamous cell carcinoma- epithelial lining
adenocarcinoma-glandular tissue
malignant melanoma- melanocytes
sarcomas- deep in the wall of the vagina

197
Q

How does squamous cell ca of the vagina begin?

A

IN the epithelial lining of the vagina; maybe caused by HPV develops over a period of many years from precancerous changes called vaginal intraepithelial neoplasia (VAIN)

198
Q

What is the subjective data of vaginal carcinoma?

A 
abnormal vaginal bleeding
difficult or painful urination
pain during sexual intercourse
pain in the pelvic area back or legs
edema in the legs
RISK: exposure to in utero DES
199
Q

What are the types of vulvar cancer?

A

squamous cell-epithelial cells (MC)
adenocarinoma- Bartholin glands
Melanoma
Basal cell ca

200
Q

What type of vaginal infection is associated with an increase in clear or mucous discharg?

A

Physiologic vaginitis

201
Q

What is the diagnostic test for physiologic vaginitis?

A

wet mount up to 3-5 WBCs and epithelial cells

202
Q

What is a type of vaginal infection with foul-smelling (fishy) discharge with homogenous thin, white or gray discharge. pH>4.5

A

Bacterial vaginosis (Gardnerella vaginalis)

203
Q

How is Bacterial vaginosis (Gardnerella vaginalis) diagnosed?

A

+KOH “whiff test”

wet mount + clue cells

204
Q

What type of vaginal infection has a pruritic discharge, itching of the labia that may extend into the thighs
white curdy discharge
pH 4.0-5.0

A

Candida vulvovaginitis

Candida albicans

205
Q

How is Candida vulvovaginitis

Candida albicans diagnosed?

A

KOH prep: budding, branching yeast, pseudohyphae

206
Q

What type of vaginal infection has a watery discharge with a foul odor, dysuria and dyspareunia with severe infection
profuse, frothy, greenish discharge
strawberry cervix
pH 5.0-6.6

A

Trichomoniasis (Trichomonas vaginalis)

207
Q

How is Trichomoniasis (Trichomonas vaginalis) diagnosed?

A

wet mount: round or pear shaped protozoa motile “gyrating” flagella

208
Q

What type of vaginal infection has a parter with an STI and may be asymptomatic or symptoms of PID
purulent discharge from cervix, skene/batholin gland inflammation
cefrvix and uvula may be inflamed

A

Gonorrhea (Neisseria gonorrheae)

209
Q

How is Gonorrhea (Neisseria gonorrheae) diagnosed?

A

gram stain
culture
DNA probe

210
Q

What vaginal infection is a parter with nongonococcal urethritis; often asymptomatic but may complain of spotting after intercourse or urethritis
may have purulent discharge, cervix may be red

A

Chlamydia

Chlamydia trachomatis

211
Q

How is Chlamydia

(Chlamydia trachomatis) diagnosed?

A

DNA probe

212
Q

What type of vaiginal infection involves dyspareunia, vaginal dryness, peri or post menopausal
pale, thin vaginal mucosa
pH >4.5

A

atrophic vaginitis

213
Q

How is atrophic vaginitis diagnosed?

A

wet mount: folded, clumped epithelial cells

214
Q

What type of vaginal infection involved new bubble bath, soap, douche
with fell smell and erythema
maybe altered pH

A

allergic vaginitis

215
Q

How is allergic vaginitis diagnosed?

A

wet mount :WBCs

216
Q

What originates from dysplastic or premalignant lesions present at the active squamocolumnar junction?

A

cervical cancer

217
Q

What is the most important causative agent in cervical cancer at the molecular level?

A

HPV

218
Q

What is the result of weakening of the supporting structures of the pelvic floor, often occurring with a cystocele and rectocele?

A

uterine prolapse

219
Q

What is first degree prolapse?

A

the cervix remains within the vagina

220
Q

What is second degree prolapse?

A

the cervix is at the Introitus

221
Q

What is third degree prolapse?

A

the cervix and vagina drop outside the introitus

222
Q

What is a common cause of mid cycle spotting?

A

midcycle estradiol fluctuation associated with ovulation

223
Q

What is a common cause of delayed menstruation?

A

anovulation or threatened abortion with excessive bleeding

224
Q

What is a common cause of frequent bleeding?

A

chronic PID, endometriosis, DUB, anovulation

225
Q

What is a common cause of profuse menstrual bleeding?

A

endometrial polyps, DUB, adenomyosis, sub mucous bleeding leiomyomas, IUD

226
Q

What is a common cause of intermenstrual or irregular bleeding?

A

endometrial polyps, DUB, uterine or cervical cancer, oral contraceptives

227
Q

What is a common cause of postmenopausal bleeding?

A

endometrial hyperplasia, estrogen therapy, endometrial cancer

228
Q

What is the main cause of dysfunctional uterine bleeding?

A

90% caused by anovulation

10% ovulatory in origin- can be caused by dysfunction of corpus lute or mid cycle bleeding

229
Q

What arises from the overgrowth of smooth muscle and connective tissue in the uterus?

A

myomas

leiomyomas, fibroids

230
Q

What type of cancers most often appears in postmenopausal patients?

A

endometrial cancer

231
Q

What is the most known risk factor for endometrial cancers?

A

imbalance between estrogen and progesterone in the body

232
Q

Follicle undergoes varying rates of maturation and cysts can occur as the result of the hypothalamic-pituitary dysfunction or because of native anatomic defects in the reproductive system

A

ovarian cysts

233
Q

When can ovarian cysts be present?

A

from neonatal period to menopause

most occur during infancy and adolescence

234
Q

What are the types of tumors associated with ovarian cancer?

A

epithelial ** MC
stromal (connective tissue)
germ cell (cells that produce the egg)

235
Q

When a pt is over 40 years old when should you suspect ovarian cancer?

A

with persistent and unexplained vague GI symptoms such as generalized abdominal discomfort, gas, pain, indigestion pressure, swelling, bloating, cramps and fullness even after a light meal

236
Q

What is inflammation of the uterus, Fallopian tubes and other reproductive organs. A common and serious complicated of some STIs

A

Pelvic inflammatory disease (PID)

237
Q

What are the two STIs that commonly cause PID?

A

gonorrhea and chlamydia

238
Q

What is inflammation or infection of the fallopian tubes often associated with PID, can be acute or chronic?

A

Salpingitis

239
Q

What is the first stage of salpingitis?

A

acquisition of a vaginal or cervical infection

240
Q

What is the second stage of salpingitis?

A

involves ascent of the infection to the upper genital tract

241
Q

What are the organisms most commonly associated with acute salpingitis?

A

Neisseria gonorrheae and Chlamydia trachomatis

same as PID

242
Q

What is the presentation of salpingitis?

A 
LQ pain- constant and dull or cramping
pain may be accentuated by motion of sexual activity. 
coexisting purulent vaginal discharge 
NV & Fever
abnormal  vaginal bleeding
243
Q

Inflammation of the vagina sue to the thinning and shrinking of the tissues as well as decreased lubrication from the lack of estrogen during perimenopause and menopause?

A

atrophic vaginitis

EC Physical Examination (9 decks)

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