Female Genitourinaryand Breast Examination Flashcards
(68 cards)
1
Q
What is menarche?
A
Age at onset of menses
2
Q
What is menopause?
A
•absence of menses for 12 consecutive months.(usually 48 – 55 years old)
3
Q
Describe post-menopausal bleeding.
A
•bleeding occurring 6 months or more after cessation of bleeding
4
Q
What is amenorrhea?
A
absence of menses
5
Q
What is dysmenorrhea?
A
pain with menses
6
Q
What is polymenorrhea?
A
menses at abnormally frequent intervals
7
Q
What is oligomenorrhea?
A
abnormally scant of infrequent menses
8
Q
What is menorrhagia?
A
Excessive bleeding
9
Q
What is metrorrhagia?
A
Bleeding between periods
10
Q
Describe post-coital bleeding
A
bleeding after sexual intercourse
11
Q
What are the eight items you must hit in the gynecologic history?
A
- •Last menstrual period
- •Regularity of periods
- •Usual time between periods
- •Number of days of flow
- •Amount of flow
- •Pain with periods
- •Bleeding between periods
- •Age of menarche
12
Q
What are G and P in the gravida-para notation?
A
G – gravida-number of pregnancies
P – para-outcome of pregnancies
13
Q
What are the subtypes of the Para notation?
A
- T = term > 37 weeks gestation
- P = premature
- A = abortion < 20 weeks (induced or spontaneous)
- L = living
(T’Pal - mnemonic… see attached image of T’Pal from Star Trek: Enterprise)
14
Q
Identify the indicated structures
A
15
Q
Identify the indicated structures
A
16
Q
What does G3P3003 indicate?
A
•3 pregnancies, 3 term deliveries and all living
17
Q
G5P2032 indicates what?
A
•5 pregnancies, 2 term deliveries, 3 abortions, 2 living
18
Q
What does G4P3105 mean?
A
•4 pregnancies, 3 term deliveries, 1 preterm deliveries, 5 living
19
Q
What does G3P3002 mean?
A
•3 pregnancies, 3 term deliveries, 2 living
20
Q
What are six components of the urologic history to touch on?
A
- –Frequency
- –Burning
- –Incontinence (stress , urge, overflow)
- –Urgency
- –Nocturia
- –Hematuria
21
Q
What is PMDD?
A
Premenstrual dysphoric disorder
22
Q
This exam is best performed with an…?
A
Empty bladder (patient comfort and easier exam)
23
Q
What are the necessary materials for the exam?
A
–Gloves
–Speculum(metal or plastic) – appropriate size
–Light sources
–Cotton-tipped swabs
–Lubricant
–Pap materials (brush/spatula/broom)
–Slide and fixative or liquid media
–pH paper, culture, slides, KOH/saline
24
Q
Identify the indicated structures
A
25
Identify the indicated structures
26
At what "time" on an imaginary clock face will you find Skene's glands?
10 and 2
27
At what "time" on an imaginary clock face will you find Barthonlin's glands?
4 and 8
28
What is this?
Cystocele
29
What is this?
Rectocele
30
Describe the procedure for the examination of the internal genitalia
Insertion of the Speculum
- Select appropriate size speculum.
- Warm and lubricate with warm water.
- Hold at 45 degree angle and point downward or posterior.
- Put gentle downward pressure on the posterior introitus.
- Once in the vagina, straighten the speculum and gently advance, maintaining posterior pressure.
- Slowly open the speculum to visualize the cervix.
31
What should you note regarding the cervix?
1. Color
2. -Position
3. -Surface Characteristics
4. -Discharge
5. -Size and shape of the os
32
What procedures are involved in the internal exam?
- PAP smear
- Sample of vaginal secretions for wet mount
- GEN probe
33
What is a cystocele?
Bladder falls into vagina
34
What is a rectocele?
The rectum protrudes into the vagina
35
What is a GEN probe for?
Nucleic Acid Amplification test, for Chlamyida
36
What should you note about the Os?
–Shape
–Polyps
–Pus
–Cancer
–Cysts
37
38
What epithelium types are the red and pink areas?
Red: Columnar
Pink: Squamous
39
What are the two transitional landmarks of the cervical Os?
Transformation zone
True squamocolumnar zone
40
Why is the transformation zone important?
* 90% of neoplasia occurs here
* Where premalignant changes and neoplasia occur
* Encompasses immature and mature squamous metaplasia
(Zone between original and current squamocolumnar junction)
41
What is important to know about the true Squamocolumnar Junction (SCJ)?
•Proximal limit of squamous metaplasia
•Usually not visualized
–Within endocervical canal
–Approximately 3 cm from observed SCJ
42
Identify indicated structures
43
Describe the cervix in the fertile phase
OS is open, soft, with fertile mucus
44
Describe the cervix in the infertile phase
Os is closed, hard, with no mucus
45
What is this most likely?
Cervical polyp
46
What is this? Should you get alarmed?
Nabothian Cysts - typically will resolve on its own, not cause for alarm.
47
What do you palpate in the bimanual exam?
Cervix
Uterus
Both ovaries
Pelvic Floor
48
What should you note regarding the cervix on palpation?
–Tenderness, size, position, mobility
49
What should you note regarding the uterus on palpation?
–Size, shape, consistency, mobility
–Position
–Fibroids (nodules)
50
What should you note regarding the ovaries on palpation?
–Size, shape, mobility, tenderness
–Remember to palpate bilaterally
51
What is version?
The relationship between the fundus of the uterus and the vagina
52
What is flexion?
The relationship between the fundus of the uterus and the cervix
53
What is the term for this?
Retroverted
54
What is this called?
Anteflexed
55
What is this called?
Anteverted
56
What is this called?
Retroflexed
57
What are the three purposes of a rectovaginal exam?
1. To palpate a retroverted and retroflexed uterus and the uterosacral ligaments
2. To screen for colorectal cancer in women 50 years or older
3. To assess pelvic pathology in the posterior rectovaginal pouch (Pouch of Douglas)
58
Where does the mature female breast extend from/to?
* The mature female breast extends from the level of the second rib to the inframammary fold at the sixth rib.
* It extends transversely from the lateral border of the sternum to the mid axillary line.
59
Describe lymphatic drainage of the breast.
Most of the lymph from subareolar and submammary plexus is drained to the
anterior or pectoral group of axillary nodes
Axillary tail drains to subscapular group of axillary nodes
Upper portion drains into infraclavicular group
The inferior part of the breast is drained by the lymphatics of abdominal wall and to the extra peritoneal lymphatic plexus.
Medial part of the breast is drained by sub mammary plexus of the opposite
breast and also to the lymph glands along the internal thoracic artery and then to the mediastinal nodes
60
What is the optimal time to examine the breast?
5-7 days following the end of the LMP.
| (secretory tissue is the smallest)
61
What are the positions you inspect the breasts in?
1. Seated with arms at sides
2. Arms over head
3. Hands against hips
4. Palms pressed together
5. Arms extended and bent forward at the waist
62
What are you looking for on breast inspection?
–Development
–Size and symmetry
–Contour (tumor will change contour of breast)
–Retractions or dimpling of skin
–Skin color and texture
–Venous engorgement
63
What should we be inspecting the nipple for?
–Retraction unilateral or bilateral
–Discharge
–Darkening
–Rash, crusting or ulcerations
–Supernumerary nipples
64
What are some tips for palpation of the breast?
* Perform the examination with the patient supine and the ipsilateral arm above the head
* Use your finger pads not fingertips
* Palpation is usually done in vertical strips or concentrically
* Flatten the breast tissue against the chest wall
* Motion should be continuous-Do not lift your hand off the breast
* Methodically palpate the entire breast by quadrant and the Tail of Spence
65
Why should you include the axilla in palpation of the breast exam?
Can have metastasis here only potentially.
66
What are some documentation items for breasts?
* Perform the examination with the patient supine and the ipsilateral arm above the head
* Use your finger pads not fingertips
* Palpation is usually done in vertical strips or concentrically
* Flatten the breast tissue against the chest wall
* Motion should be continuous-Do not lift your hand off the breast
* Methodically palpate the entire breast by quadrant and the Tail of Spence
67
What are the items you should document for the pelvic exam?
–Female hair pattern. No vulvar lesions noted. Urethra and bladder non-tender. Vagina is without discharge or lesions. Cervix smooth, no lesions, no discharge or cervical motion tenderness. Uterus not enlarged and symmetrical. Non-tender. . Pelvic support adequate. No masses or tenderness in adnexa. Ovaries nonpalpable
68
What are items to document regarding the rectal exam?
–Sphincter tone adequate. No hemorrhoids or perianal lesions noted. No rectal masses noted.
