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90 Cards in this Set
- Front
- Back
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The _ is a hair-covered fat pad overlying the symphysis pubis.
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Mons pubis
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What is the introitus?
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The external vaginal opening
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Where are the Skene's glands?
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-aka Paraurethral glands
- posterior to the urethral meatus on either side |
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Where are the openings to the Bartholin's glands?
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- posterior on either side of the vaginal opening
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The two parts of the uterus are the ___ and the ___ and join at the ___
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1. corpus (body)
2. cervix 3. Isthmus |
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__ is the age of first menses
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menarche
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___ is the absence of menses for 12 months
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Menopause
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Postmenopausal bleeding occurs ____ or more months after cessation of menses.
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6
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___ is the absence of menses.
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Amenorrhea
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What is dysmenorrhea?
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pain with menses, often with bearing down, aching, or cramping sensation in lower abd or pelvis
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What is PMS
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- premenstrual syndrome
- cluster of emotional, behavioral, and physical symptoms occuring 5 days before menses for 3 consecutive cycles |
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___ can be imporant in signaling a possible pregnancy or menstrual irregularities.
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Dates of previous periods
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What causes primary dysmenorrhea?
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- increased prostaglandin production during luteal phase of the menstrual cycle, when estrogen and progesterone levels decline.
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What causes secondary dysmenorrhea?
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endometriosis, adenomyosis (endometriosis in muscular layers of uterus), pelvic inflammatory disease, and endometrial polyps
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What is the difference between primary and secondary amenorrhea?
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- primary: failure of periods to initiate at all
- secondary: cessation of periods after they've started |
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Pregnancy, lactation, menopause, anorexia, malnutrition, etc can all cause ___
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secondary amenorrhea.
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Describe the pattenrs encomapssd by the term "abnormal uterine bleeding"
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1. polymenorrhea - <21day intervals
2. oligomenorrhea - infrequent 3. menorrhagia: excessive flow 4. metorrhagia - intermenstrual bleeding 5. postcoital bleeding |
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What does postcoital bleeding suggest?
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cervical polyps or cancer,
in an older woman suggests atropic vaginitis |
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Menopause usually occurs between what ages?
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48-55 years
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Concerns regarding estrogen replacement for perimenopausal women includes:
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1. relieves symptoms of menopause,
2. increases risk of thrombosis |
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A pregnant pt is
G4P2A1P1L2 What does this mean? |
G3= 4 total pregnancies (including current)
P2 = 2 live births A1= 1 aborted (spontaneous or elective) P1 = 1 premature L2= 2 living |
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What are the most common vulvovaginal symptoms?
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vaginal discharge and local itching
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What is dyspareunia?
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Pain during sex
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Superficial dyspareunia suggests?
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- inflammation, atrophic vaginitis, or inadequate lubrication
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Deeper dyspareunia suggests?
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- Pelvic disorders, pressure on a normal ovary
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What is vaginismus?
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Involuntary spasm of the muscles surrounding vaginal orifice that makes penetration painful (may be physical or psychological)
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What is the "most important risk factor for cervical cancer"?
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infection with high-risk strains of HPV
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What is the most common STD in the US?
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Genital infection with HPV
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When should females receive their first screening for cervical cancer?
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- approx 3 years after first sex, or by 21 years whichever comes first
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How often should women be screened for cervical ca?
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1. up to age 30: annually with regular test or q2 years with liquid-based cytology
2. 30+: q2-3 yrs if 3+ annual results are negative and no risk factors, HIV infection 3. hysterectomy: only if cervix spared or hx cervical neoplasia or dysplasia 4. Older women: controversial |
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Describe the levels of scoring for the bethesda scale?
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- Neg
- Atypical squamous cells - Atypical squamous cells or glandular cells (of unknown source) - Low grade squamous intraepithelial cells - High grade squamous interepithelial cells - Glandular cells |
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What does the Bethesda system measure?
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Categorizes abnormal pap spmears into groups according to severity
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Prior to the pelvic exam, a patient should:
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- avoid sex, douching, or vaginal suppositories for 24-48 hours
- empty bladder - lie supine with head and shoulders elevated |
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What are causes of delayed puberty?
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- familial
- chronic illness - hypothalamus problems - ant. pituitary gland probs - ovarian probs |
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Excoriations or itchy, small red maculopapules suggest ___
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Pediculosis pubis (lice or "crabs")
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Yellowish discharge on the endocervical swab during a pelvic suggests ___
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Mucupurulent cervicitis (chlamydia trachomatis, gonorrhoeae, or herpes)
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Raised, friable, lobed lesions occur in ___
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condylomata or cervical cancer
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Pain on movement of the cervix along wiht adnexal tenderness suggest ___
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pelvic inflammatory disease
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Uterine enlargement suggests ____
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pregnancy, uterine myoma (fibroid), or malignancy
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Weakness of the pelvic muscles may be associated wiht ____
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urinary stress incontinence
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The most common hernia in the female groin is a ___ followed by the next most frequent, a ___ hernia
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1. indirect inguinal hernia
2. femoral hernia |
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A pt presents with a small, firm, round cystic nodule in the labia. It may be yellowish in color and has a dark punctum in the center.
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1. epidermoid cyst
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A pt presents with warty lesions on the labia and within the vestibule.
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Condyloma acuminatum
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A firm, painless ulcer suggests __
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primary syphilis
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Slightly raised, round or oval, flat-topped papules covered by gray exudate suggest ____
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Condylomata lata (secondary syphilis)
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Pt presents with shallow, small, painful ulcers on red bases.
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Herpes
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A 70 year-old female presents with an ulcerated or red-raised vulvar lesion. This suggests.
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Vulvar carcinoma
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What is a cystocele?
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a bulge of upper two thirds of anterior vaginal wall and bladder above it resulting from weakneed supporting tissues
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A ___ is a bulging of the entire anterior vaginal wall, bladder, and urethra, is a ____
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- cystourethroceleL
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What is a urethral caruncle?
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Small, red, benign tumor visible at posterior part of urethral meatus.
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How can you differentiate between a urethral caruncle and urethral carcinoma?
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- palpate the urethra through the vagina for thickening, nodularity, or tenderness, and feel for inguinal lymphadenopathy
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____ forms a swollen red ring around the urethral meatus.
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Prolapse of urethral mucosa
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When does a urethral mucosa prolapse generally occur?
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Before menarche or after menopause
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What is the cause of a Bartholin's gland infection>
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Trauma, gonococci anaerobes, and chlamydia.
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A tense, hot, tender abscess posterior to the vaginal opening iwth purulent drainage suggests a ____
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Acute infection of a Bartholin's gland
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How would a chronic infection of the Bartholin's cyst present>
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- non-tender cyst posterior to the vaginal opening that may be large or small
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What is a rectocele?
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A herniation fo the rectum into the posterior wall of the vagina froma weakness or defect in the endopelvic fascia
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What two types of epithelia cover the cervix?
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1. shiny pink squamous epithelium
2. deep red, columnar epithelium (continuous with cervix) |
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What is the squamocolumnar junction?
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Where the type of epithelium changes between the vagina and the cervix
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Where do most dysplastic changes occur within the cervix?
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Squamocolumnar junction
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What are nabothian cysts?
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translucent nodules on the cervical surface that often develop during adolescence when pink squamous epithelium takes over the columnar epithelium... this is normal and has no pathologic significance
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Cervical polyps usually arise from ____, and appears as a ___.
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1. endocervical canal
2. bright red, soft, and fragile |
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Describe findings consistent with carcinoma of the cervix.
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- begins in area of metaplasia
- early stages it cannot be distinguished from normal - late stages, extensive, irregular, cauliflower-like growth develops |
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What factors increase risk for cervical cancer?
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- early, frequent intercourse
- multiple partners - smoking - infection with HPV |
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Cervical abnormalities in female infants of women who took DES may include:
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1. columnar epithelium that covers most or all of the cervix
2. vaginal adenosis (extension of epithelium to vaginal wall 3. circular collar or ridge of tissue of varying shapes between the cervix and vagina |
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Adnexal masses most commonly result from ___
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disorers of fallopian tubes or ovaries.
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A pt presents with a smooth, compressible mass on her R ovary. It is not tender. You should suspect ___
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Ovarian cysts
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A pt presents with a solid, nodular mass to her R ovary. You suspect.
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Ovarian tumor
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What are the diagnostic parameters of polycystic ovarian syndrome?
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- exclusion of several endocrine disorders
- 2 of the 3 following: absent or irregular menses, hyperandrogenism, and confirmation ofpolycystic ovaries on US |
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Symptoms of ovarian cancer include ___
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pelvic pain, bloating, increased abd. size, urinary tract symptoms
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A 23 year old female presents with severe abdominal pain, guarding, and tenderness. She has a small, palpable mass to the R adnexa. She appears pale, and nauseous with vomiting. Suspect -
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Ruptured tubal pregnancy
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Pelvic inflammatory diseasemost commonly is due to infection of the ___
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1 fallopian tubes (salpingitis)
2. tubes and ovaries (salpingo-oophoritis) |
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What is salpingitis?
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inflammation of the fallopian tubes
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What is oophoritis?
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INflammation of the ovaries
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PID is caused most commonly by:
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1. neisseria gonorrhoeae
2. chlamydia trachomatis, 3. and other organisms |
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A pt presents with severe abdominal pain, diffusely, with bilateral adnexal masses and spasming of the pelvic muscles. You should suspect __
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PID
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If PID is not treated, what can occur?
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tubo-ovarian abscess or infertility
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Describe uterine Myomas.
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- aka fibroids
- benign uterine tumors - may be singular or mutliple - firm, irregular, nodules in continuity with uterine surface. |
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__ resutls from weakness of supporting structures of hte pelvic floor and is associated with cystocele or rectocele.
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Prolapse of the uterus
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Describe the degrees of uterine prolapse:
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1. first deg - cervix still well within the vagina
2. 2nd deg - cerivx is at the introitus 3. 3rd deg - (procidentia) - cervix and vagina are outside introitus |
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What is retroversion of the uterus?
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- tilting backward of the entire uterus including body and cervix.
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A pt presents with a cervix facing forward and uterine body cannot be felt on manual exam. You should suspect ___
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retroversion of the uterus
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What is retroflexion of the uterus?
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- backward angulation of the body of the uterus in relation to the cervix. Body is often palpable through post fornix or rectum
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A female presents with a yellowish green (or grey) discharge that appears frothy and foul smelling. She also complains of itching and painful urination. ON exam you find her labias reddened. You suspect ___
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Trichomonas vaginalis
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A pt presents with white cheese-like discharge and severe vaginal itching. The discharge has no unique odor. She also complains of painon urination and painful sex. You suspect ___
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candidal vaginitis
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A pt presents with white discharge that is foul smelling. The discharge appears minima, however the pt reports a 'fishy' smell. You suspect _
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bacterial vaginosis
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How do you identify trichomonas in the lab?
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Look for trichomonads on wet mount.
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How do you look for candida inthe lab?
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- KOH prep for hypae
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How do you identify bacterial vaginitis in the lab?
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- clue cells on saline prep
- whiff test with KOH |
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Describe qualities of atrophic vaginitis.
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- +/- discharge
- atrophic vulva - atrophic vaginal mucosa - bleeds easily |
