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39 Cards in this Set

  • Front
  • Back
Gynelogical history:

Ask about the age of menarche (when the first menses started); in the United States the age range is between the ages of ... and ....

Ask about menstruation patterns
-How often does the patient have menses?
(every ...-... days is normal)
-How long are the menses?
(... to ... days is normal)
-How heavy are the menses?
(this is a subjective measurement but it helps to quantify the number of pads or tampons used)

If applicable, what age did menopause occur? Menopause is defined as no menses for ... months. Average age of the
menopause is ... to ... years.
9 and 16
24-32
3 to 7
12
45 to 52
... is defined as the absence of menses.

... refers to the failure of menses to be initiated (causes: chromosomal abnormalities, malnutrition, hypothalamic-pituitary-ovarian dysfunction)

... refers to a cessation of periods after they have previously existed (physiologic causes: *pregnancy, breast feeding, menopause; pathologic causes: pituitary tumor, *hypothyroidism, *anorexia nervosa, *female athletes)
Amenorrhea
Primary amenorrhea
Secondary amenorrhea
...: Painful periods with cramping or aching in the lower pelvis and lower back
Dysmenorrhea
... means having too frequent of periods
Polymenorrhea
... refers to an increased amount of bleeding or duration of flow
Menorrhagia
... is bleeding that occurs between periods
Metrorrhagia
... is discomfort during intercourse
Dyspareunia
... refers to spasms of the muscles surrounding the vagina making penetration painful and difficult
Vaginismus
Physical exam of the female genitalia:

If patient is a child or adolescent, assess their sexual maturity (using the Tanner scale) by checking the ... pattern along the perineum and abdomen

Inspect the patient’s external genitalia
-Labia minora, Clitoris, Urethral meatus, Introitus

Note any inflammation, discharge, swelling or nodules; palpate any lesions

Check the ... by inserting the index finger into the vagina and placing the thumb at the posterior labia
(slide 9)
pubic hair
Bartholin’s glands
Internal Exam by speculum:

Select a speculum of appropriate size and shape and wet it under warm water.

Take the index finger of your non-dominant hand and place it on the posterior portion of the ... and push it gently down.

Take the speculum in your dominant hand and turn it to the entry angle (approximately ... degrees) and gently put it into the .... Continue inserting it the length of the speculum.

Now rotate the speculum horizontally and gently open the speculum, catching the ... in between the blades; it is common to have to close the speculum and reposition the blades to locate the cervix.
introitus
45
introitus
cervix
Cervix Inspection:

-Once the cervix is visualized, inspect the cervix and the ... (opening in middle of cervix); note the color, position and characteristics of the cervix
-Look for discharge or bleeding from the os
-Note any ulcerations, masses or nodules on the cervix
-Scrape with a broom, spatula, or brush the cervix and os to send for a ... smear
-Take ... for Chlamydia, gonorrhea or herpes
-Take a ... (saline slide of the vaginal and cervical secretions)
os
Papanicolaou
cultures
wet prep
anatomy of female genitalia:

slide 13-15
ok
Bimanual exam:

-Stand up at the end of the table between the patient’s legs
-Lubricate the index and middle finger of the dominant hand and carefully place them inside the ...; in small women, adolescents, or virgins you may just use the ... finger if needed
-Make sure the fourth and fifth digits are flexed against your palm and that your thumb is abducted (away from the patient’s body)
-Palpate the ..., feeling for any irregularities (remember the vaginal walls have rugae and will feel “bumpy”)
-Palpate the ... noting its position (anterior, posterior, deviated to the left or right), shape, consistency (firm or soft), mobility, and tenderness.
introitus
index
vaginal walls
cervix
Bimanual exam:

-Palpate the ... in the midline; take your non-dominant hand and place it over the suprapubic area just superior to the ... bone
-While you elevate the cervix with your dominant hand you press your non-dominant hand over the bladder, catching the ... between your hands, feeling for its size, shape, consistency, mobility and tenderness (easier in thin patients)
-If you cannot feel the uterus, slide the fingers in the pelvis into the ... and see if you can feel the uterus butting against the fingers; if so, the uterus is tipped posterior (...)
uterus
pubic
uterus
posterior fornix
retroflexed
Bimanual exam:

-Palpate the left ovary by placing your dominant hand in the left lateral ... and your non-dominant hand just ... of the midline superior to the pubic bone
-Palpate the right ovary by placing the dominant hand in the right lateral ... and the non-dominant hand just ... to the midline
-Identify the size, shape, consistency, mobility and tenderness of each adnexal area
-Before removing your hand, have the patient ... on your fingers to assess strength of the ... muscles
fornix
left
fornix
right
bear down
pelvic
bimanual exam:

pictures from slides 34-36
ok
... of the Uterus: refers to a tilting backwards of the entire uterus, including body and cervix. Common variant occurring in ~...% of women.

picture on slide 38, compare to slide 39
Retroversion
20
...: body of uterus can be felt posteriorly, either through the posterior fornix, or through the rectum. Usually mobile and asymptomatic. (cervix faces forward)

picture on slide 40, compare to slide 41
Marked Retroversion
... of the Uterus: refers to a backward angulation of the body of the uterus in relation to the cervix. The cervix maintains its usual position

picture on slide 42, compare slide 43
Retroflexion
... of the Uterus: results from weakness of the supporting structures of the pelvic floor and is ofter associated with a cystocele and a rectocele.
-3rd degree often seen in women w/ multiple pregnancies, pts w/ pelvic floor surgeries, and older women).

picture on slide 44, compare slide 45
Prolapse
... exams are useful in younger patients or virgins when placing two fingers in the vagina would be painful

Place the index finger of the dominant hand inside the vagina as before but this time place the middle finger within the anus; ask the patient to ... so that the anal sphincter will relax

Repeat the maneuvers of the bimanual exam; this exam is especially useful in ... uteri

picture on slide 47
Rectovaginal
bear down
retroflexed
Hernias:

-Although thought of as primarily a male problem women can have hernias in the groin also
-Examination techniques are similar to men; a woman should ... to be examined
-Palpate the labia majora just upward and lateral to the ...
stand up
pubic tubercles
Urethritis:

-If you suspect a urethritis or inflammation of ... glands insert your index finger into the vagina and milk the urethra gently from inside outward; culture any discharge that has been milked out
paraurethral
... (...) of the Uterus: very common benign uterine tumors. May be single or multiple and vary greatly in size (see page 456).

picture on slide 51
Myomas (Fibroids)
...: a bulge of the upper two thirds of the vaginal wall, together with the bladder above it. It results from ... supporting tissues.

picture on slide 52
Cystocele
weakened
...: when the entire anterior vaginal wall, together with the bladder and the urethra is involved in the bulge.

picture on slide 53
Cystourethrocele
...: a herniation of the rectum into the posterior wall of the vagina, resulting from a weakness or defect in the ... fascia.

picture on slide 54
Rectocele
endopelvic
...: a small, red, benign tumor visible at the posterior part of the urethral meatus. Usually noted in postmenopausal women (55-60 y/o). Usually asymptomatic.

picture on slide 55
Urethral Caruncle
...: Forms a swollen red ring around the urethral meatus. Usually occurs before menarche or after menopause. Identify the ... at the center of the swelling to make the diagnosis.

picture on slide 56
Prolapsed urethral mucosa
urethral meatus
look at slides 57-59
ok
...: a small, round, firm nodule in the labia suggests this. Yellowish in color. Look for the dark punctum marking the blocked opening of the gland. Usually due to blocked sweat gland. Not really a big deal.

picture on slide 60
Epidermoid Cyst
...: human papillomavirus. Venereal wart.

picture on slide 61
Conyloma Acuminatum
...: shallow, small, painful ulcers on red bases suggest this type of infection. Initial infection may be extensive. Recurrences are usually confined to a small local patch.

picture on slide 62
Genital Herpes
...: a firm, painless ulcer. Because most of these in women develop ..., they often go undetected.

picture on slide 63
Syphilitic Chancre
internally
...: (...) slightly raised, round, or oval, flat-topped papules covered by a gray exudate suggest this. These constitute one manifestation of secondary syphilis and are ....

picture on slide 64
Secondary Syphilis
Condyloma Latum
contagious
...: an ulcerated or red vulvar lesion in an elderly woman may indicate this.

picture on slide 65
Carcinoma of the Vulva
... Infection: causes include trauma, gonococci, anaerobes, and Chlamydia trachomatis. Acutely, it is a hot, tense, very tender abscess. Chronically, a non-tender cyst is felt.
-more common in older women and women w/ ... in any age

picture on slide 66
Bartholin’s Gland
STD
..., a yeast (normal overgrowth of vaginal flora). Use KOH prep and look for branching hyphae.

picture on slide 67
Candida albicans
...: probably from anaerobic bacteria; may be transmitted sexually. Scan saline wet mount for “clue cells” (epithelial cells with stippled borders). May have fishy odor after application of KOH (“whiff test”).

picture on slide 68
Bacterial Vaginosis