Female Genitalia

Question 1

Things to avoid prior to exam

Answer 1

Intercourse

douching or suppositories 24 to 48 hours prior

Question 2

Prep for exam

Answer 2

-raise head and shoulder with pillow, bed
-empty bladder
-arms down or crossed
-warn the pt!!!
lithotomy position: with buttocks beyond edge of bed and hips flexed, abduted and externally rotated

Question 3

Tanner stages

Answer 3

1: no pubic hair
2. few dark hairs on labia (straight)
3. some pigmented hairs across pubes (curly)
4. has not spread to thighs
5. adult: spread to inner thighs

Question 4

Nulliparous vs. multiparous cervix

Answer 4

nuliparous external os is a small circular opening, multiparous is slit shaped because of previous childbirths

Question 5

Nabothian cyst location, prognosis

Answer 5

located on the cervix, normal variant

Question 6

Papsmear screening

Answer 6

1. within 3 years of first intercourse
2. annually until 30 yo
3. > 30 with 3 consecutive normal papsmear, do every 2-3 years
4. continue in hysterectomy patients

Question 7

What are you sampling in a papsmear?

Answer 7

Translocation junction or external os of cervix

Question 8

What cells are located in the translocation junction? Ectocervix and endocervix

Answer 8

Ectocervix: simple squamous
Endocervix: columnar cells

Question 9

What is the name of the system you retrieve results for PAPsmears

Answer 9

BETHESDA (CIN) system

Question 10

What does CIN stand for?

Answer 10

Cervical Intraepithelial neoplasia

Question 11

CIN 1

Answer 11

within normal limits
atypical squamous cells of undetermined significance (ASC-US)
mild dysplasia Low grade squamous intraepithelial lesion (LGSIL)

Question 12

CIN2

Answer 12

high grade squamous intraepithelial lesion (HGSIL)

Moderate dysplasia

Question 13

CIN 3

Answer 13

HGSIL with severe dysplasia or carcinoma in situ

Question 14

In what direction do you insert the speculum

Answer 14

Obliquely

Question 15

Which finger is placed in the anal canal for the rectovaginal exam

Answer 15

middle finger, feel wall for abnormal thickness in infection, fistula and malignancy

Question 16

What is palpated in the bimanual exam

Answer 16

fallopian tubes (adnexa)
pelvic side walls for nodularity of ovaries

Question 17

What is the purpose of the bimanual exam?

Answer 17

check the uterus for:
size
position
shape
contour
mobility

Question 18

Where can adenocarcinoma arise from?

Answer 18

endocervix endometrium and extrauterine sites

Question 19

AGC and treatment

Answer 19

atypical glandular cells

tx:colposcopy with our without biopsy

Question 20

HPV

Answer 20

human papillomavirus

Question 21

what does HPV infect

Answer 21

keratinocytes of skin and mucus membranes

Question 22

How is HPV transmitted

Answer 22

genital contact

Question 23

What is the leading cause of cervical cancer

Answer 23

HPV

Question 24

Who gets the HPV vaccine

Answer 24

before sexual activity begins

Question 25

What strains does the HPV vax cover

Answer 25

6, 11, 16, 18

Question 26

Anteverted uterus

Answer 26

normal position (anteriorly)

Question 27

retroverted uterus

Answer 27

body of the uterus and the cervix are tilted backwards

Question 28

Retroflexion of uterus

Answer 28

backward angulation of body of uterus in respect to cervix, cervix unmoved

Question 29

pH of bacterial vaginosis

Answer 29

>4.5 (basic)

Question 30

Cause of bacterial vaginosis

Answer 30

imbalance of bacterial flora, may or may not be STI

Question 31

d/c of bacterial vaginosis

Answer 31

grey/white

Question 32

Diagnosis of bacterial vaginosis

Answer 32

``` clue cells (bound to bacteria) positive whiff test ```

Question 33

pH of trichhomonal vaginitis

Answer 33

>4.5

Question 34

infections with pH <4.5

Answer 34

Yeast

Question 35

Infections with pH >4.5

Answer 35

Bact Vaginosis, trichomonas, gonorrhea

Question 36

Cause of Trichomonal vaginitis

Answer 36

STI | Trichomonas vaginalis

Question 37

Discharge of Trich

Answer 37

greenish/white

Question 38

signs of trich

Answer 38

strawberry cervix, protozoa

Question 39

pH of yeast infection

Answer 39

<4.5

Question 40

discharge of yeast infection

Answer 40

thick white with itching and burning

Question 41

Lab of yeast infection

Answer 41

hyphae in KOH

Question 42

Colposcopy

Answer 42

illuminate cervix to take punches (biopsy)

Question 43

pH of gonorrhea

Answer 43

>4.5

Question 44

Discharge of gonorrhea

Answer 44

green/yellow with pruritus

Question 45

PAP smear guidelines- NEW! 65 Hysterectomy HPV vaccinated

Answer 45

``` under 21, don't do 21-29: cytology every 3 yr 30-65: cytology every 3 years or co-testing (HPV and cytology every 5 yr) >65: don't do unless prior concerns Hysterectomy: don't do unless HGSIL HPV vax: continue to screen ```