Female GU Exam

Question 1

Menarche

Answer 1

Onset of menses

Question 2

Menopause

Answer 2

Absence of menses for 12 consecutive months (48-55 y/o)

Question 3

Post menopausal bleeding

Answer 3

Bleeding occurring 6 months or more after cessation of bleeding

Question 4

Amenorrhea

Answer 4

Absence of menses

Question 5

Dysmenorrhea

Answer 5

Pain of menses

Question 6

Polymenorrhea

Answer 6

Menses at abnormally frequent intervals

Question 7

Oligomenorrhea

Answer 7

Abnormally scant or infrequent menses

Question 8

Menorrhagia

Answer 8

Excessive bleeding

Question 9

Metrorrhagia

Answer 9

Bleeding between periods

Question 10

Post coital bleeding

Answer 10

Bleeding after sexual intercourse

Question 11

Nine important points of gynecologic history

Answer 11

Last menstrual period
Regularity of periods
Usual time btw periods
Number of days of flow 
Amt of flow 
Pain btw periods 
Bleeding btw periods 
Age of menarche 
Sexual history

Question 12

Gravida-Para Notation

Answer 12

G: number of pregnancies 
P: outcome of pregnancies 
Term (T) >37 weeks gestation 
Premature (P)
Abortion (A) <20 weeks (induced or spontaneous)
Living (L)

Question 13

Explain G5P2032 in GP notation

Answer 13

G5P2032 5 pregnancies, 2 term deliveries, 3 abortions, 2 living

Question 14

Dysparenunia

Answer 14

Painful intercourse

Question 15

Location of Skene’s Glands and Bartholin’s Glands

Answer 15

Skene’s 10 and 2 o’clock

Bartholin’s 4 and 8 o’clock

Question 16

List the steps of the gynecological exam

Answer 16

Inspection of External Genitalia
Palpation of External Genitalia
Examination of Internal Genitalia

Question 17

Key points to insertion of the speculum

Answer 17

• 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.

Question 18

Rectocele

Answer 18

Floor of pelvis weak and rectum bulges into the vagina – can differntiate because it’s the posterior wall of the vagina that’s bulging out – asymptomatic – seen in women who have delivered multiple children and as women age

Question 19

Cystocele

Answer 19

Weak floor of pelvis, bladder distends and moves downwards into the vagina – can be visible bulging outwards or felt on examination
Can cause urinary incontinence due to the loss of the angle btw the urethra and the bladder

Question 20

Os of the cervix

Answer 20

Flattened in women who have vaginally delivered and round and tight in women who haven’t
May be starred shaped after difficult delivery

Question 21

Transformation zone (TZ)

Answer 21

Area where the cervix squamous cells and uterine columnar cells meet - cells tend to get dysplastic in this area - must get cells from here in a Pap smear
Where premalignant changes and neoplasia occur
Encompasses immature and mature squamous metaplasia
May appear as red epithelium towards center of Os

Question 22

True Squamocolumnar Junction (SCJ)

Answer 22

Proximal limit of squamous metaplasia
Usually not visualized
Within endocervical canal
Approximately 3 cm from observed SCJ

Question 23

How does the cervical os change with fertile/nonfertile phases?

Answer 23

Fertile - os is open, soft with fertile mucus

Infertile- os is closed, hard without mucus

Question 24

Describe a cervical polyp

Answer 24

Overgrowth of columnar epithelium typically benign - nice smooth regular epithelium but very red

Question 25

Describe a Nabothian Cyst

Answer 25

Normal variant - glands of cervix have gotten clogged up and bulge outward

Question 26

Describe the Pap Smear technique with the broom

Answer 26

Broom placed in os and other part is on transformation zone – twirl around 4 or 5 times and place in solution for slides

Question 27

Describe the steps of the bimanual exam

Answer 27

Lubricate the index and middle fingers of one of your gloved hands Palpate the cervix - position, shape, consistency, regularity, mobility, and tenderness Palpate the uterus - elevate the cervix and uterus with your pelvic hand, press your abdominal hand in and down, trying to grasp the uterus between your two hands. Note its size, shape, consistency, and mobility, and identify any tenderness or masses. Palpate each ovary - Place your abdominal hand on the right lower quadrant, your pelvic hand in the right lateral fornix. Press your abdominal hand in and down, trying to push the adnexal structures toward your pelvic hand. Ovaries are most often not palpable Strength of pelvis floor - looking for rectocele and cystocele that you can't see - ask pt to bear down

Question 28

Version

Answer 28

relationship between the fundus of the uterus and the vagina

Question 29

Flexion

Answer 29

relationship between the fundus of the uterus and the cervix

Question 30

Anteverted Uterus

Answer 30

Fundus <180 in relation to the vagina

Question 31

Retroverted Uterus

Answer 31

Fundus >180 in relation to the vagina

Question 32

Anteflexed/Retroflexed refers to the position of the ?

Answer 32

Uterus in relation to the cervix

Question 33

Rectovaginal Exam indications

Answer 33

To palpate a retroverted and retroflexed uterus and the uterosacral ligaments To screen for colorectal cancer in women 50 years or older To assess pelvic pathology in the posterior rectovaginal pouch (Pouch of Douglas)

Question 34

Describe the anatomy of the breast

Answer 34

Extends from 2nd rib - inframmary fold of 6th rib Extends transversely from lateral border of sternum to mid axillary line Deep rests on fascia of pec major, serratus ant and ext abd oblique and upper rectus sheath Axillary tail of Spence extends laterally across ant axillary fold Upper outer quadrant of breast contains greater volume of tissue than other quadrants 15-20 libes compose each lobule Firbous bands of CT insert perpendicularly into dermis and provide structural support Lobe - lactiferous duct - constricted orifice - ampulla Dilated lactiferous sinus lined with stratified squamous epithelium

Question 35

What is the difference between major and minor lactiferous ducts?

Answer 35

Major - two layers of cuboidal cells | Minor - single layer of cuboidal cells

Question 36

What are the 3 sources of principal blood supply to the breast?

Answer 36

(1) perforating branches of the internal mammary artery (2) lateral branches of the posterior intercostal arteries (3) branches from the axillary artery, including the highest thoracic, lateral thoracic, and pectoral branches of the thoracoacromial artery.

Question 37

What forms the medial mammary arteries?

Answer 37

The second, third, and fourth anterior intercostal perforators and branches of the internal mammary artery arborize in the breast

Question 38

What gives rise to the lateral mammary branches?

Answer 38

The lateral thoracic a.

Question 39

Where does upper portion of breast drain?

Answer 39

Infraclavicular nodes

Question 40

Where does medial portion of breast drain?

Answer 40

Sub mammary plexus of the opposite | breast and also to the lymph glands along the internal thoracic artery and then to the mediastinal nodes

Question 41

Where does inferior portion of breast drain?

Answer 41

Lymphatics of abdominal wall and to the extra peritoneal lymphatic plexus

Question 42

Where does the axillary tail drain to?

Answer 42

Subscapular group of axillary nodes

Question 43

Where does the lymph of the subareolar and submammary plexus drain?

Answer 43

Anterior or pectoral group of axillary nodes

Question 44

When is the optimal time to examine the breast?

Answer 44

5-7 days after last menstrural period - least estrogen and least glandular tissue to prevent confusing with mass in breast

Question 45

How do you describe locations on the breast?

Answer 45

Quadrants - upper inner, upper outer, lower outer, lower inner - most breast cancer in upper outer bc there is the most tissue here

Question 46

Examine the breasts in what 4 positions?

Answer 46

Arms over head Hands against hips Palms pressed together Arms extended and bent forward at waist

Question 47

Tips for palpation of the breast

Answer 47

Patient supine - ipsilateral arm above the head 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 Spunk

Question 48

What pattern does the ACS say is most effective for covering entire breast?

Answer 48

The vertical pattern

Question 49

What are the three different levels of pressure and what do they feel?

Answer 49

Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. Use each pressure level to feel the breast tissue before moving on to the next spot.

Question 50

How should your movement be in palpating the breast?

Answer 50

Move around the breast in an up and down pattern starting at an imaginary line drawn straight down from the axilla and moving across the breast to the middle of the sternum. Be sure to check the entire breast area going down until you feel only ribs and up to the neck or clavicle.