PD Female Genitalia Flashcards Preview

Physical Diagnosis > PD Female Genitalia > Flashcards

Flashcards in PD Female Genitalia Deck (54):
1

History questions

Menarche
Usual cycle length
Usual flow length
Gravida/para
Sexual history
STDs
Preventative care

2

Common complaints

Abnormal bleeding
Pain
Vaginal discharge
Menopausal sx
Infertility
Sexual dysfunction
Urinary complaints

3

Amenorrhea
Primary, secondary

Primary - never menstruated
Secondary - previous menstruation, but none in last 6 months

4

Oligomenorrhea

Reduction of frequency of menstruation with interval greater than 40 days and less than 6 months

5

Hypomenorrhea

Reduction in number of days or amount of flow

6

Menorrhagia

Excessive menstrual bleeding longer in duration than usia (and amount greater than 80 mL blood loss)

7

Metrorrhagia

Menstrual bleeding at irregular intervals, but of expected amounts

8

Dysfunctional uterine bleeding

Irregular bleeding, unrelated to anatomic lesion of the uterus

9

Dysmenorrhea

Painful menstruation

10

Chronic pelvic pain

Pelvic discomfort not limited to menses for greater than 6 months

11

Dyspareunia

Pain associated with intercourse

12

Patient prep

Empty bladder
Exam gown
Assistant/chaperone present
Ensure privacy
Instruments are already prepared
No surprises! Constantly communicate with the patient
Patient sits at edge of table
Head of bed at 30 degrees, relaxes abdominal muscles and allows you to maintain eye contact
Always maintain eye contact
Drape across legs and abdomen
Adequate lighting to shine onto perineum
Glove both hands

13

Why keep eye contact

Helps clinician observe patient response

14

External genitalia

Mons pubis
Labia majora
Labia minora
Perineum
Perianal area

15

Tanner staging

P1 - 5

16

P1 pubic hair

Preadolescent
No growth of pubic hair

17

P2 pubic hair

Initial, scarcely pigmented straight hair, especially along medial border of labia

18

P3 pubic hair

Sparse, dark, visibly pigmented, curly pubic hair on labia

19

P4 pubic hair

Hair coarse and curly, abundant, but less than adult

20

P5 pubic hair

Lateral spreading, triangle shaped to medial thighs

21

P1 breast

Prepubertal

22

P2 breast

Breast and papilla are elevated as a small mound
Areolar diameter increases

23

P3 breast

Further enlargement of the breast bud with loss of the contour separation between breast and areola

24

P4 breast

Areola and papilla form a secondary mound

25

P5 breast

Mature areola is part of the general breast contour

26

Inspection/palpation

Spread labia - inspect introits and outer vain
Urethrea - inspect/milk for discharge, skene's glands
Bartholin's glands - rotate finger posteriorly, grasp with thumb

27

Skene's glands

Parauretheral glands, minor vestibular glands
Pair of glands situated on each side of urethral meatus
Its secretions help to lubricate the external genitalia during coitus

28

Types of speculum

Pederson and Graves

29

Pederson speculum

Flat, narrow blades with little curvature
For most nulliparous and postmenopausal women

30

Graves speculum

Wide, higher blades with curved sides
For most parous women

31

Speculum exam prep

Examine speculum
Clean, proper working order
Moisten and warm with warm water
Avoid lubricants, may interfere with cytologic and microbiologic specimens

32

Speculum insertion

Dominant hand
Blades completely closed
First 2 fingers on opposite hand placed lateral and just below the introits
Apply downward and inward pressure, introits open slowly
Insert speculum at 45 degree angle, usually as far as it will go
Rotate speculum down
Open speculum smoothly and deliberately
Visualize cervix and manipulate angle if necessary
Tighten screw

33

Speculum exam

Inspect cervix
Deep vaginal vault
Lateral walls of vagina

34

Samples to be taken

Pap smear
Wet prep
Cultures

35

Risk factors for cervical cancer

Increases in late teens to 30s
Average age of newly diagnosed is 50-55
Personal hx of cervical cancer
Personal hx of infection with HPV or HSV2
Early age at first sexual intercourse
Multiple lifetime partners
HIV
Smoking
Long term use of OCP (under investigation)

36

Rectocele

Fascia separating rectum from vagina becomes weakened allowing the front wall of the rectum to bulge into the vagina
Usually after menopause
Usually not painful
Large rectoceles may protrude the vaginal opening

37

Cystocele
Causes

Wall between bladder and vagina weakens, allow bladder to prolapse into the vagina
May occur from excessive straining (childbirth), chronic constipation, heavy lifting

38

Uterine prolapse

Uterus descends from its normal position in the pelvis into the vagina
Occurs when pelvic floor muscles/ligaments stretch and weaken

39

Bimanual exam

Use both hands to entrap pelvic organs for palpation
Vaginal hand and abdominal hand

40

Palpate uterus

Size
Shape
Consistency
Mobility
Masses
Tenderness
Position

41

Palpate cervix

Circumferential exam
Size
Shape
Position
Mobility
Masses
Tenderness

42

Palpate adnexae

Ovaries (1/2 are palpable in young women)
Tubes
Support structures

43

Rectovaginal exam

Not always done routinely
Evaluates posterior pelvic structures
Allows better palpation of ovaries
Change glove of vaginal hand
Use lubricant
Middle finger inserted into rectum
Index finger into vagina until reaches posterior fornix
Palpate uterosacral ligamants
Evaluate rectal canal
Remove fingers steadily and rapidly

44

Uterosacral ligaments

Should be smooth, symmetric, nontender

45

Rectal canal

Masses
Sphincter tone
Stool guiac test for blood

46

Ovarian cancer risk factors

Age between 40-60
Taking fertility drugs
Early menarche (before 12)
Late menopause (after 50)
Infertility, nulliparity, or first child after 30
Hx of breast CA or inherited gene mutations (BRCA1 or 2)
FHx of breast or ovarian CA
Hormone replacement therapy
Exposure to talc or asbestos

47

Bacterial vaginosis
Wet mount

Most common vaginal infection of childbearing age
Normal vaginal flora disrupted and overgrowth of certain bacteria occurs
May be accompanied by odor, pain, discharge, itching, burning

Wet mount shows clue cells

48

Candida vaginitis

Yeast infection
Cottage cheese like discharge
Common while on antibiotics, steroids

49

Trichomonas vaginitis
Tx

Caused by protozoal parasite Trichomonas vaginalis
Most curable STD in young women
Sx occur 5-28 days after exposure
Frothy, yellow green vaginal discharge with strong odor
Usually treated with a single dose of metronidazole

50

Syphilis incubation

10-60 days

51

Genital warts term

Condyloma accuminata

52

Secondary syphilis term

Condyloma lata

53

Tissues that are estrogen dependent

Vaginal mucosa, cervix, endometrium, and myometrium are estrogen dependent tissues

54

Atrophic vaginitis
Sx

When estrogen production decreases, these tissues atrophy
Dryness
Itching
Burning
Dyspareunia
Urinary symptoms