Week 1 pt 2

Question 1

1) What does the greater pelvis do?
2) What does the lesser pelvis contain?

Answer 1

1) Greater pelvis (also known as the false pelvis) supports the pregnant uterus at term.
2) Lesser pelvis (also known as the true pelvis) contains the pelvic viscera (uterus, vagina, bladder, fallopian tubes, ovaries, & distal rectum and anus).
They are separated by the linea terminalis.

Question 2

What are the most and least common Caldwell-Moloy pelvic types?

Answer 2

1) Gynecoid most common (40-50%)
2) Platypelloid least common (2-5%)

Question 3

Vagina:
1) What types of cells?
2) What is the shape? What can weaken it?
3) What is the major blood supply?

Answer 3

1) Stratified squamous epithelium surrounded by 3 smooth muscular layers
2) “H”-shaped
Walls supported by pelvic fascia
Weakened by age & childbirth
3) Major blood supply via vaginal artery
branch of hypogastric artery

Question 4

List parts of the uterus

Answer 4

Cervix (2-3cm long)
Isthmus
Body (corpus)

Question 5

1) Why would you assess the size of the pelvis?
2) What is pelvimetry?
3) How is pelvis size estimated?
4) What is the most narrow part? What size does it need to be?

Answer 5

1) Adequate for vaginal birth?
2) Measurement of pelvic outlet, pelvic inlet, & mid-pelvis
3) Bimanual exam, x-ray, or CT scan
4) Obstetric conjugate; needs to be > 11 cm
-Unable to directly measure clinically

Question 6

Where are the ureters near the uterus?

Answer 6

Broad ligament

Question 7

True or false: a patient who is postmenopausal should not have palpable ovaries

Answer 7

True

Question 8

What is the primary support of the uterus?

Answer 8

Utero-sacral ligament

Question 9

What are the 3 uterine wall layers?

Answer 9

Endometrium
Myometrium
Serosa

Question 10

What are 3 positions of the uterus?

Answer 10

Anteverted
Midposition
Retroverted

Question 11

What will you see in female pts with Turner syndrome?

Answer 11

(45XO) - streaks of abnormal ovarian tissue in pelvis

Question 12

1) What is Mullerian agenesis assoc. with? (besides absence of uterus)
2) What are 2 uterine changes that can occur?

Answer 12

1) Vaginal anomalies
2) Double uterus, bicornuate uterus

Question 13

What is the most common cause of congenital adrenal hyperplasia (CAH)?

Answer 13

21-hydroxylase deficiency

Question 14

Mesonephric ducts normally degenerate during development; Remnants of the ducts can persist and manifest as __________ cysts located in vaginal wall or broad ligament

Answer 14

Gartner

Question 15

Describe how to build a patient-provider partnership

Answer 15

1) Verify the patient’s identity and how she prefers to be addressed
2) Empathic communication: characterized by provider communicating with empathy & sympathy
3) Motivational interviewing: “reflective listening” replaces “advice giving”
Patient talks and provider actively listens
5) Steps of patient-centered partnership women’s healthcare visit

Question 16

List the parts of gynecological Hx

Answer 16

days between periods

1) Menstrual history begins with menarche
2) Last menstrual period (LMP) (even “light” but on-time bleeding)
3) Length of periods (number of days of bleeding)
4) Any recent change in periods
5) Estimation of amount of flow (clots)
6) Irregular bleeding
7) Intermenstrual bleeding
8) Postcoital bleeding

Question 17

Give examples of premenstrual Sx

Answer 17

Anxiety
Fluid retention
Nervousness
Mood fluctuations
Food cravings
Variations in sexual feelings
Difficulty sleeping

Question 18

Menstrual cramps & discomfort: how do you tell if normal vs abnormal?

Answer 18

If NSAIDs don’t help & if interfering with ADLs

Question 19

1) Define menopause
2) Define perimenopause

Answer 19

1) Cessation of menses for > 1 year
2) Transition from menstrual to non-menstrual life when ovarian function begins to wane (often lasts 1-2 years)

Question 20

List Sx of perimenopause

Answer 20

Begins with increasing menstrual irregularity
Varying or decreased flow
Hot flashes, nervousness, mood changes
Decreased vaginal lubrication with sexual activity
Altered libido

Question 21

List 3 parts of gynecologic Hx

Answer 21

Illnesses & treatments
Surgeries
Sexual

Question 22

List 4 questions of sexual Hx

Answer 22

“Are you currently or have you ever been sexually active?”
“Please tell me about your sexual partner or partners.”
Sexual & behavioral risks (STI screening)
Contraceptive history (current & past; desire for conception)

Question 23

1) Define gravidity (G)
2) Define parity (P)

Answer 23

1) Gravidity (G) - number of pregnancies (current or previous)
2) Parity (P) - number of births carried to viability (>20 weeks)

Question 24

What are 2 ways to document gravidity and parity?

Answer 24

G#PTPAL (ie G2P1001) (or GxPxAx (ie G2P1A0))

Question 25

1) Define gravida 2) Define primigravida 3) Define multigravida 4) Define nulligravida 5) Define primipara 6) Define multipara 7) Define nullipara

Answer 25

1) Is or has been pregnant 2) Has experienced/ is experiencing first pregnancy 3) Has experienced/ is experiencing multiple pregnancies 4) Never been and is not pregnant 5) Pregnant for the first time or only has given birth once 6) Given birth 2+ times 7) Never given birth or never had pregnancy progress past gestational age of abortion

Question 26

1) What are 4 live birth details? 2) List 5 pregnancy complications

Answer 26

1) Birthweight, sex, # weeks at delivery, & type of delivery (vaginal vs C-section) 2) DM, HTN, preeclampsia, depression, or anxiety

Question 27

True or false: Previous breastfeeding history (if applicable) is a part of obstetric Hx

Answer 27

True

Question 28

You are helping out in the OB clinic and are seeing a 30-year-old patient who has been pregnant 5 times but only has two kids. She had an abortion at age 16 years (9wks) and an ectopic at age 17 years. She later had a baby at 32 weeks that passed away and twins at 36 weeks who are doing well. What are her G’s and P’s?

Answer 28

G5P0222

Question 29

List parts of Preconception counseling & care

Answer 29

1) Family planning & pregnancy spacing 2) Immunization status 3) Genetic history (maternal & paternal) 4) Teratogens (environmental & occupational exposures) 5) Assessment of socioeconomic, educational, & cultural context 6) History of infertility

Question 30

Why should you ask abt family history of illnesses in 1st degree relatives?

Answer 30

Genetic predisposition Tests or interventions for patient or family members

Question 31

What should ROS include?

Answer 31

Previous or current symptoms Pertinent positives & negatives (general and/or focused)

Question 32

What are important parts of PE?

Answer 32

Detect abnormalities (suggested & unsuspected) Chaperone Extent directed by CC, managed conditions, & medically indicated by history

Question 33

How is a breast exam documented?

Answer 33

Description (can use clock descriptions), diagram, or both

Question 34

Describe how to visually inspect breasts

Answer 34

1) Patient standing or seated. 2) Lean forward for large and/or pendulous breasts 3) With arms at side then overhead 4) Any marked differences b/t the 2 breasts? Recent changes? -Some asymmetry is common

Question 35

Describe how to palpate breasts

Answer 35

1) While arms raised overhead 2) Up & down with wave-like motion with finger pads 3) Do not squeeze nipple.

Question 36

List some abnormal breast findings

Answer 36

1) Discolorations or ulcerations 2) Leathery, puckered appearance (aka peau d’orange) caused by edema of lymphatics 3) Clear of milky discharge (galactorrhea) 4) Bloody discharge (usually unilateral) 5) Pus

Question 37

Describe breast self-awareness counseling & what's not recommended

Answer 37

1) Awareness of normal appearance & feel 2) Routine breast self-examination (BSE) not recommended (but considered for some)

Question 38

Describe an abdominal exam

Answer 38

1) Not done in every evaluation 2) Inspection: Contour (flat, scaphoid, protuberant) Presence & distribution of hair Striae, operative scars, masses 3) Percussion: if areas of distention (tympany & dullness) 4) Auscultate: four quadrants 5) Palpation: Tenderness (start in non-painful area) Rebound tenderness, muscle guarding, rigidity -Masses: size, cystic or solid, smooth or nodular, fixed or mobile, if associated with ascites

Question 39

Describe an annual pelvic exam

Answer 39

1) Empty bladder to ensure comfort & assist your exam “Clean catch” urine specimen from mid-stream if needed 2) Muscle relaxation needed 3) *Explain every part of exam before performing “Talk before you touch” Avoid being abrupt or stern Rehearse what you will say and how you will say it. 4) Draping sheet over patient’s lap & knees 5) Assist patient to assume lithotomy position Head of bed up 30 degrees 6) Examiner position: seated at foot of table 7) Gloves

Question 40

Pelvic exam: 1) List parts of the external genitalia 2) List things you should palpate and what you may need to do depending on CC

Answer 40

1) External genitalia: mons pubis, labia majora, labia minora, perineum, & perianal area 2) Clitoral hood, introitus, outer vagina, urethral meatus, areas of urethra & Skene glands -Depending on CC/RFE, may… a) milk urethra (culture discharge) b) Bartholin glands

Question 41

What should you do with a metal speculum?

Answer 41

Warm with water, hands, or warming tray/drawer

Question 42

What are 2 types of speculums?

Answer 42

1) Graves 2) Pederson (nulliparous, postmenopausal)

Question 43

Describe proper speculum insertion

Answer 43

1) Hold speculum in dominant hand with blades closed 2) Open introitus (2 fingers on perineum) 3) Insert horizontally/obliquely (45 degrees) with slight downward pressure 4) Avoid superior pressure 5) Open in smooth & deliberate fashion 6) May tilt speculum down to view cervix 7) Lock in open position

Question 44

What should you look for when visualizing the cervix?

Answer 44

1) Nulliparous vs multiparous 2) Normal vaginal discharge? 3) Ectropion, Nabothian cysts, small polyps (benign) 4) Inflammation, masses, dysplasia (require further eval)

Question 45

Describe how to remove a speculum

Answer 45

1) Inform patient 2) Keep blades open slightly first (avoids pinching cervix) 3) Withdraw ~ 1 inch before slowly releasing thumb hinge 4) Withdraw slowly to inspect vaginal walls

Question 46

Bimanual Exam: Describe how to perform this

Answer 46

1) “Vaginal” hand (index and middle fingers) & “abdominal” hand (use finger pads not fingertips) to entrap & palpate pelvic organs *Make sure you use lubricant on your vaginal hand glove 2) Palpate the cervix, cervical position, uterus, uterine position, adnexa, ovaries 3) Rectovaginal exam if indicated

Question 47

What aspects of the uterus should you note during a bimanual exam?

Answer 47

1) Uterine position: Mid-position (normal) 2) Version: tilted along long axis Anteverted Retroverted 3) Flexion: tilted on shorter axis Anteflexed Retroflexed

Question 48

Not on quiz!! 1) Avg amount of blood lost in a menstrual period = __________ mL. 2) What type of menstrual pad can hold ~5 mL? 3) Fully soaked overnight pad can hold ~________mL. 4) Light tampon holds ____ mL (fully soaked). 5) Fully soaked ________ tampon can hold ~12 mL.

Answer 48

1) ~20-60 2) Daytime 3) 10-15 4) ~3mL 5) super