Female GU, MSK, and Cultural Flashcards Preview

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Flashcards in Female GU, MSK, and Cultural Deck (74):
1

Purpose of female GU exam

ID pathology
Cervical cancer
STI
Family Planning
Counseling - preconception, menopause

2

Whats part of Reproductive health visit?

History
General / Vital Signs
Breast
Thyroid
Cardiac
Pulmonary
Abdomen
Pelvic exam

3

Possible problem visits

Vulvovaginal S/s
AUB Abnormal Uterine Bleeding
Pelvic pain
Pregnancy management
Contraception complaint

4

Menarch usually (age)

9-13 years old

5

How often have menses

every 21-35 days

6

how long are menses

4-7 days

7

Menstrual Hx Documentation

Age of first x cycle frequency x duration
11 x 28 x 5

8

Menorrhagia

excessive amount
>1 week
>80 mL

9

Oligomenorrhea

Less frequency
>35 days
PCOS, Menopause

10

Polymenorrhea

More frequency
<21 days

11

Metrorrhagia

irregular interval
normal flow

12

Menometrorrhagia

irregular interval
excessive flow
Meno + Metro

13

Amenorrhea

absence of menses

14

Primary amenorrhea

failure to ever start
Chromosomal, malnutrition, hypothalamic/pituitary

15

Secondary amenorrhea

stopped after started
pregnancy, breast feeding, menopause, hypothyroid, pituitary tumor, anorexia

16

Dysmenorrhea

Painful periods w/ back/pelvis cramping

17

PMS when?

4 to 5 days before

18

Pregnancy history Documentation

G# P (TPAL)
abortion = therapeutic, or surgical/abortion pill

19

ROS focus

breast, gyn, GU, GI

20

Dyspareunia

pain w/ sex

21

Perimenopause

3-5 years before cessation (menopause)

22

Average age of menopause

51 y/o

23

S/S from oral contraception

ACHES
Abdominal pain
Chest Pain
Headaches
Eye problems
Sudden leg/calf pain

24

STI risk assesment - 5 Ps

Partners
Prevention of pregnancy
Protection from STIs
Practices
Past STI history

25

Proper sequence of female genital exam

1. Inspect external
2. Speculum exam
3. Bimanual exam
4. Rectovaginal exam
OPTIONAL 5. Rectal exam

26

Prepuce

clit hood

27

Skene's glands

around urethra, female orgasm
index finger in vagina, pressure anterior
milk for discharge = infection (gonorrhea)

28

Bartholin's glands

around vaginal opening - 4 & 8 oclock
non-palpable unless cyst

29

Introitus

vaginal opening

30

HPV warts

condyloma acuminatum

31

Speculum exam requirements

Nothing in 1-2 days
empty bladder
lithotomy position
Relaxed patient

32

Spec exam draping

ab to knees

33

Ectocervix/ Endocervix cell type

Ectocervix - squamous epithelium
Endocervix - columnar epithelium

34

Cervix blood supply

uterine artery

35

uterus layers

perimetrium, myometrium, endometrium

36

site of most ectopic pregs

ampulla - egg hangs out longest

37

Order of fallopian tube from uterus

isthmus, uterine tube, ampulla, infundibulum, fimbriae

38

External os - nulliparous/parous

Nulliparous - small oval
Parous - linear, irregular

39

bubbly vag discharge

trichomonas

40

Where is nabothian cyst?

cervix

41

Bleeding after sex, common cause?

Cervical polyp

42

Cervical swab - must include cells from

transformation zone - endocervix (cancer)
+ ecto = rotate brush 360 degrees

43

when remove speculum, make sure

blades are closed

44

cystocele

bladder wall weakening (2 fingers in labia and patient pushes)

45

Bimanual exam - which hand in

Dom hand, other pressing abdomen

46

Bimanual exam - palpate

Vag walls
Cervix (consistency, position, movement (CMT/chandelier))
Uterus (position?)
Ovaries
Pelvic muscles

47

Uterus positions

retro/antiflexed, retro/anteverted

48

Enlarged uterus could be

pregnancy, fibroids

49

Adnexal mass could be

ectopic preg

50

Ovarian mass could be

cyst

51

tenderness could be

PID, Endometriosis, Cystitis

52

Cervical cancer cell type

80% squamous cell carcinoma (transformation zone)

53

HPV screen - no screen

less than 21 y/o, more than 65 y/o

54

HPV screen - just PAP no HPV

21-30 y/o, every 3 years

55

HPV screen - PAP w/ HPV (or not)

30-65 y/o every 3 years, w/ HPV every 5 years

56

3 components to MSK exam

Movement, Neuro, Vascular

57

TMJ range of motion assesment

palpate - crepitus, clicking
3 finger insert

58

Bouchard's nodes

osteoarthritis, PIP, painless (never MIP)

59

Heberden's nodes

osteoarthritis, DIP, painless (never MIP)

60

Tophi

gout, painful, MIP yes

61

Mallet finger

bent DIP on straight finger
jammed then disrupted extensor tendon

62

Trigger finger

pops when straighten finger
nodule at base of MIP, flexor tendon

63

Boutonniere deformity

Flex PIP, Hyperextend DIP

64

Swan-neck deformity

Hyperextend PIP, Flex DIP

65

Chronic rheumatoid arthritis deformity

in MIP (so NOT osteoarthritis), squeeze test hurts

66

Olecranon bursitis

NO pain, plumbers

67

Silver fork deformity, collee's fracture

distal radius fracture

68

joint effusion

fell - blood
longstanding rheumatoid arthritis flair - synovial
Gout - crystals/fluid

69

joint crepitus

cartilage loss

70

genu valGUM

knock knees

71

genu valRUM

bow-legged

72

mongolian spot

blue/black discoloration to back

73

FICA

F: What is your faith or belief?
Do you consider yourself spiritual or religious?
What things do you believe in that give meaning to your life?
I: Is it important in your life?
What influence does it have on how you take care of yourself?
How have your beliefs influenced your behavior during this illness?
What role do your beliefs play in regaining your health?
C: Are you part of a spiritual or religious community?
Is this of support to you and how?
Is there a person or group of people you really love or who are really important to you?
A: How would you like me, your healthcare provider, to address these issues in your healthcare?

74

Patient Explanatory Model

[1] What do you think has caused your problem?
[2] Why do you think it started when it did?
[3] What do you think your sickness does to you? How does it work?
[4] How severe is your sickness? Will it have a short or long course?
[5] What kind of treatment do you think you should receive?
[6] What are the most important results you hope to receive from this treatment?
[7] What are the chief problems your sickness has caused for you?
[8] What do you fear most about your sickness?