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88 Cards in this Set
- Front
- Back
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mons pubis
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Hair-covered fat pad that cushions the symphysis pubis (i.e., pubic bone)
- protective of bone |
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vestibule
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Boat-shaped fossa between the labia minora
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introitus
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Vaginal opening
In some virgins, it may be hidden by the hymen |
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perineum
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Tissue between the introitus and anus
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labia majora
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Rounded folds of adipose tissue
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labia minora
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Folds interior to the labia majora that extend anteriorly to form the prepuce
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structure of the uterus?
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uterus = flattened, fiber-muscular structure, shaped like inverted pear
2 parts: body and cervix --> fundus = upper part of body --> cervix protrudes into uterus body and extends into vagina --> fallopian tubes extend from each side of uterus towards ovaries |
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What internal structure extends into the vagina?
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Cervix
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What is the vagina's position in the body?
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Extends upward and posteriorly between the urethra and the rectum
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What is the name of the area of the cervix where cancer commonly occurs? What is it?
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Transformation zone - where pap smears are taken.
transformation zone = junction of the 2 types of epithelium tissue (columnar and squamous) in the cervix |
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Which area of the cervix resembles the uterine tissue?
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Columnar epithelium surrounding the external os
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How does vaginal childbirth affect the cervix?
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It changes the shape of the external os
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What is the squamous epithelium of the cervix continuous with?
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Vaginal tissue
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What is the normal age range for menarche in the U.S.?
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between 9 to 16 years old
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What is the normal duration for menses?
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3 to 7 days
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What is a normal time frame between menses?
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24 to 32 days
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How can you quantify the heaviness of the menses?
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Number of pads or tampons used
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What is the definition of menopause?
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No menses for 12 consecutive months
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What is the average age of menopause?
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45 to 52 years old (we tend to follow the pattern of our mother)
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What does "gravida" in the obstetrical history mean?
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Number of pregnancies
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What does "para" in the obstetrical history mean?
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Number of children from pregnancy
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What does "ab" in the obstestrical history mean?
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Miscarriages or induced abortions
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What vulvovaginal symptoms should you inquire about?
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1. Burning
2. Itching 3. Quantity and quality of discharge (including texture, amount, color, and smell) |
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What open-ended questions should you ask regarding a patient's sexual history?
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1. Are you sexually active?
2. Have you been sexually active within past 2 months or have you ever been sexually active? 3. With men, women, or both? 4. How many sexual partners have you had? More than 5? 5. Do you desire to become pregnant? 6. What contraceptive measures do you use? 7. Have you ever had any STIs? |
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Why is 5 significant for number of sexual partners?
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More than 5 partners puts women at increased risk for cervical problems
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What should you have patient do before genital exam?
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Have patient empty the bladder
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What external parts of the genitalia should you inspect?
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1. Mons pubis
2. Labia majora and minora (pink, symmetric and moist) 3. Clitoris 4. Urethral meatus 5. Introitus (should have no bulges) 6. Perineum |
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What should you note when viewing the female external genitalia?
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Any inflammation, discharge, swelling, or nodules
Palpate any lesions |
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Signs of prolapsed urethra? When does prolapse of the urethral meatus most commonly occur?
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a) swollen, red ring surrounding urethra
b) before menarche or after menopause |
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What is cystocele?
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Protrusion (prolapse) of the bladder into the vagina (pushing anterior vaginal wall down)
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What is urethrocele?
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Protrusion (prolapse) of the urethra into the vagina
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What is rectocele?
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Protrusion (prolapse) of the rectum into the vagina (pushing posterior vaginal wall down)
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In what position should you examine a woman for hernias? Most common type of hernia in women?
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a) Woman should be standing (need pressure of abdominal contents)
b) femoral hernia |
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Where should you palpate for hernias in women?
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Palpate the labia majora just upward and lateral to the pubic tubercles
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What is urethritis?
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inflammation of the urethra
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What should you do if you suspect urethritis or inflammation of the paraurethral glands?
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Insert your index finger into the vagina and milk the urethra gently from inside outward. Culture any discharge that has been "milked out."
--> if pus is seen when pressing against skene's glands: could indicate gonnorrhea or chlamydia |
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What are the three columns of vascular erectile tissue in the shaft of the penis?
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1. Corpus spongiosum (contains the urethra)
2. Two (2) corpora cavernosa |
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What part of the penis does the corpus spongiosum form?
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Bulb of the penis, which ends with the cone-shaped glans and its expanded base (corona)
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What is another name for foreskin?
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Prepuce
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What may accumulate between the glans and foreskin?
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Smegma, a cheesy, whitish material
(normal finding) |
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What is the scrotum?
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A loose, wrinkled pouch divided into two compartments, each containing a testis
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What is the structure of the testes?
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- Ovoid
- somewhat rubbery - approximately 4.5 cm long - left testis usually lies somewhat lower than the right - epididymis can be felt on posterior part (long/tubular) |
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What are the basic landmarks of the groin in men?
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1. Anterior superior iliac spine
2. Pubic tubercle 3. Inguinal ligament |
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What is the purpose of the inguinal canal? Pathway of the vas deferens?
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Forms a tunnel for the vas deferens
Vas deferens begins at tail of epididymis --> passes through scrotal sac --> passes through inguinal canal on its way up to abdomen |
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What causes the formation of inguinal hernias?
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Loops of bowel force their way through weak areas of the inguinal canal
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Besides the inguinal canal, where is another common place for hernias?
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Femoral canal
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What questions should you ask men during the genital health history?
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1. Frequency, urgency, and nocturia
2. Dysuria (painful urination) 3. Hesitancy and straining --> could be due to prostate enlargement 4. Urine color 5. Past GU history 6. Penis - pain, lesions, discharge 7. Scrotum, self-care behaviors, any lumps 8. Sexual activity and contraceptive use 9. STI contact and risk reduction |
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What position should a male patient be in for genital examination?
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Standing or supine
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What position should the patient be in for hernia assessment?
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Patient should stand & put weight in opposite leg so muscles of the leg you're inspecting are relaxed
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What should you check for on the skin surrounding the penis?
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1. Excoriations
2. Inflammation |
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What should you look for when examining the glans?
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1. Ulcers
2. Scars 3. Nodules 4. Inflammation Sebaceous cysts on penis can be normal |
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How should you inspect the male urethra?
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Compress the glans gently between your index finger above and thumb below to open the urethral meatus.
Inspect for discharge. Normally there is none. |
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What should you look for when examining the scrotum?
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Lift the scrotum to view the posterior skin
Note any swelling, lumps, or torturous veins |
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What should you inspect the spermatic cord for?
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Nodules or swelling
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What might smaller testes indicate?
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1. Pituitary malfunction
or 2. Cirrhosis of the liver |
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What are some risks for testicular cancer?
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1. Age --> greater risk between 18 and 35 years old
2. Undescended testicles at birth |
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How do you palpate for a hernia? How can the patient assist in helping you identify hernias?
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a) invaginate finger (right finger on right side) & push up until you hit the external inguinal ring (triangular)
b) Pt assists you by coughing or bearing down (val salva maneuver) c) if you feel something tap your finger --> intestinal contents pushing through inguinal canal (this is a DIRECT INGUINAL HERNIA) |
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What should you do if you suspect a scrotal hernia?
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1. Ask the patient to lie down. If the scrotal mass disappears, it is a hernia.
2. If the mass remains, listen to the mass with a stethoscope. If bowel sounds are heard, it is a hernia. |
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What is a direct hernia?
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Protrusion of the bowel into the external inguinal ring
- no pain - common later in life (>40 yo) - obesity could be a factor - caused by ascites, fat, heavy lifting |
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What is an indirect hernia?
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Protrusion of the bowel into the internal inguinal ring
- pain on straining - most common hernia - may be congenital or acquired - can occur at any age in women or men (most often in infants or 16-20 yo for men) |
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Which hernia can move into the scrotum?
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Indirect hernia
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What is a femoral hernia?
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Protrusion of the bowel into the femoral canal
- extremely painful - happens more often on R side - may become incarcerated (strangulated) --> loses blood supply & becomes gangrenous - most common in women AND the kind women get most often |
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What is an incarcerated hernia?
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A hernia whose contents cannot be returned to the abdominal cavity
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What is the location of the prostate?
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In front of the anterior wall of the anus
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When palpating the prostate, what should you feel for?
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The median sulcus. If you can't feel it --> prostate is enlarged
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What are the differences between the internal rectal sphincter and the external rectal sphincter?
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Internal sphincter: smooth muscle, under autonomic nervous system control (involuntary)
External sphincter: skeletal muscle, voluntary control |
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What questions should you ask the patient with respect to the rectum/anus?
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1. Usual bowel routine
2. Change in bowel habits 3. Rectal bleeding (hemorrhoids) vs. blood in the stool (also called occult blood; GI bleeding) 4. Medications (laxatives, stool softeners, iron) 5. Rectal conditions (pruritis, hemorrhoids, fissure, fistula) 6. Family history 7. Self-care behaviors (high-fiber diet, most recent examinations) |
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What should you inspect in the perianal area?
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1. Skin
2. Anal opening 3. Sacrococcygeal area 4. Watch person perform valsalva maneuver |
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What should you palpate for in the anus and rectum?
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1. Canal wall
2. Perianal tissue 3. Rectal wall 4. Prostate gland |
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What is anal winking?
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When you put your finger against the anus, the muscle contracts. (Absent anal winking would signal a neuro problem)
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What finding might make you suspect rectal cancer?
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A firm mass within the rectum that is raised with ulcerated edges
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If anything abnormal is found in the anus, what should you do?
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Biopsy the abnormal tissue
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What test assesses for occult blood?
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Hemoccult test
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describe the ovaries
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- 3.5 x 2 cm
- almond-shaped - palpable in 50% of childbearing women (bimanual palpation) |
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adnexa
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includes ovaries, fallopian tubes, and connecting fascia & blood vessels
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describe the cervix
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- 2 types of epithelial tissue:
a) columnar epithelium (inner layer; moves into uterus & isn't as visible in older women) b) squamous epithelium (outer layer) - os = the opening of the cervix (can change appearance after having a baby) |
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What is a prolapsed uterus?
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when the cervix comes down through the vagina - looks like head of a baby
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Most common STI?
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chlamydia
**anyone 26 & under should be tested regularly (especially women) --> in women, it's mostly asymptomatic - 40% of women who get chlamydia get PID - 20% of women who get chlamydia become infertile |
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Women make up what percentage of HIV patients?
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25% (mostly from heterosexual relationships)
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landmarks of inguinal canal
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1) external inguinal ring = palpable
2) internal inguinal ring = non-palpable inguinal canal i a tunnel for the vas deferens |
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What does the inguinal ligament do?
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it connects the iliac spine & pubic tubercle
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What might you feel in the genital examination of men with CHF?
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accumulation of fluid/edema in testicles --> could feel smooth to touch
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describe the anus
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- 3.5 - 4 inches long
- no hair or sebaceous glands - rectum merges w/ anus at anorectal junction - rectal ampulla = contains anal columns; each has 1 artery and 1 vein |
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What are hemorrhoids?
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when the veins of the rectal ampulla/anal columns become enlarged
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describe the rectum
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- about 12 inches long
- attaches to sigmoid colon - merges w/ anus at anorectal junction |
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describe the prostate
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- bi-lobed --> 2 lobes come together at median sulcus (palpable ridge)
- lies in front of the anterior wall of rectum & 2 cm behind pubic symphysis - protrudes 1 cm into rectum - feels rubbery, mobile - 2 seminal vesicles project like rabbit ears above it - secretes thin, milky, alkaline fluid that aids sperm viability (semen) into urethra |
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types of rectal bleeding and what they indicate
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a) black, tarry stool --> GI bleed
b) fresh/red blood on toilet paper --> hemorrhoids |
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What vitamin makes stool very dark?
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iron
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