Week 1 pt 2 highlights

Question 1

What are the 2 conjugates of the pelvis?

Answer 1

Diagonal and obstetric

Question 2

What is the most common pelvic shape?

Answer 2

Gynecoid (round)

Question 3

Define:
1) Urogenital diaphragm
2) Bulbocavernosus muscles

Answer 3

1) The muscles, blood supply, and nerve supply = external portion of pelvic floor
2) Act as a sphincter

Question 4

1) What cell type makes up the vagina?
2) What shape is it?
3) What is the major blood supply?

Answer 4

1) Stratified squamous epithelium [surrounded by 3 smooth muscular layers]
2) “H”-shaped
3) Vaginal artery

Question 5

1) Define fornix
2) What makes up the ectocervix?
3) What makes up the endocervix?
4) What is the area where >90% cervical neoplasia arise?
5) What is a nabothian cyst? Is it common?

Answer 5

1) Area around cervix; divided into 4 regions (ant/two lat/post)
2) Stratified squamous epithelium
3) Columnar epithelium
4) Active SCJ
5) Non-pathologic blockage of columnar cells (that continue to produce mucus) under stratified squamous cells
-Common in menstruating women, usually asymptomatic

Question 6

What is the size of the uterus in nulliparous women?

Answer 6

7-8cm long, 4-5cm wide (at widest)

Question 7

What are 2 positions of the top of the uterus?

Answer 7

May also fold forward (anteflexed) or backward (retroflexed)

Question 8

There’s an increased risk of perforation in __________ and ___________ uteri with certain procedures

Answer 8

anteflexed & retroflexed

Question 9

1) Are uterine and vaginal anomalies frequent or infrequent?
2) When do they occur?
3) Are ovarian dysgenesis (congenital absence) in chromosomal abnormalities common or rare?

Answer 9

1) Infrequent
2) Embryonic development
3) Rare

Question 10

What is a more common uterine/ vaginal anomaly?

Answer 10

Müllerian abnormalities

Question 11

Müllerian abnormalities:
1) What is Mullerian agenesis?
2) Can external genitalia appear normal?

Answer 11

1) Absence of uterus
2) Yes

Question 12

Give an example of an external genitalia anomaly

Answer 12

Congenital adrenal hyperplasia (CAH) (causes masculinization)

Question 13

___________________ ducts normally degenerate during development

Answer 13

Mesonephric

Question 14

Gartner cysts are located in _________ wall or __________ ligament

Answer 14

vaginal; broad

Question 15

1) Define empathic communication
2) Define motivational interviewing

Answer 15

1) Characterized by provider communicating with empathy & sympathy
2) “Reflective listening” replaces “advice giving”
(i.e. patient talks and provider actively listens)

Question 16

What is a good rule in women’s health?

Answer 16

“Talk before you touch”

Question 17

1) Menstrual history begins with what?
2) What is one aspect of periods you should ask about?

Answer 17

1) Menarche
2) Any recent change in periods?

Question 18

What does perimenopause begin with?

Answer 18

increasing menstrual irregularity

Question 19

What should you break parity down further to? Define it

Answer 19

TPAL: Term (>37wks), premature (20-36 6/7wks), abortion/miscarriage (<20wks), living

Question 20

TPAL: Pregnancy ends with either:
1) _____ birth (>37wks)
2) ______ birth (< 37 weeks gestation)
3) miscarriage OR _________
# living children

Answer 20

1) term
2) premature
3) abortion

Question 21

You should ask abt family history of illnesses in _______ degree relatives

Answer 21

1st

Question 22

What are 3 exams of particular importance to OB/GYN care?

Answer 22

Breast
Pelvic
Abdomen

Question 23

What are the vitals important to women’s health?

Answer 23

Temperature, heart rate (pulse), blood pressure, height, weight, BMI

Question 24

Clinician breast exam + appropriately scheduled mammography is best means of wha

Answer 24

Early detection of breast cancer

Question 25

List the parts of a breast exam in order

Answer 25

1) Visual inspection 2) Palpation

Question 26

Breast palpation: 1) Up & down with wave-like motion with ___________. 2) Do not ___________ nipple.

Answer 26

1) finger pads 2) squeeze

Question 27

Leathery, puckered appearance (aka _____________) caused by edema of lymphatics is concerning for advanced BC

Answer 27

peau d’orange

Question 28

Clear/ milky discharge of nipples is called what?

Answer 28

Galactorrhea (normal, or high PRL)

Question 29

1) Is a firm transverse inframammary ridge with large breasts abnormal or normal? 2) What are 2 things nipple discharge can be sent for?

Answer 29

1) Normal 2) Culture & sensitivity and cytopathology

Question 30

Routine _________________________ not recommended (but considered for some)

Answer 30

breast self-examination (BSE)

Question 31

Is an abd. exam done in every evaluation?

Answer 31

Not done in every evaluation

Question 32

ACOG recommends annual pelvic exam in women ______ yrs & older

Answer 32

21

Question 33

1) You should get a “_________catch” urine specimen from mid-stream if needed 2) What are some rules of pelvic exam?

Answer 33

1) Clean 2) “Talk before you touch” Avoid being abrupt or stern Rehearse what you will say and how you will say it.

Question 34

In a women's health PE, you should assist patient to assume _____________ position

Answer 34

lithotomy

Question 35

Speculum insertion: 1) Insert horizontally/obliquely (45 degrees) with slight ___________pressure 2) Avoid ____________ pressure 3) Once inserted, you may tilt speculum _____ to view cervix

Answer 35

1) downward 2) superior 3) down

Question 36

Failure to find cervix most commonly due to what?

Answer 36

Not advancing speculum far enough

Question 37

What 3 aspects of the cervix require further eval?

Answer 37

Inflammation, masses, dysplasia

Question 38

The pap test feels like a “slight scraping sensation”, and specimens are collected from the ____________ zone & __________

Answer 38

transformation; endocervix

Question 39

When removing a speculum, why should you keep blades open slightly first?

Answer 39

Avoid pinching cervix

Question 40

Bimanual Exam: 1) “Vaginal” hand (_______ and ________ fingers) & “abdominal” hand (use __________ not fingertips) to entrap & palpate pelvic organs 2) Rectovaginal exam is done when?

Answer 40

1) index and middle 2) finger pads 3) If indicated