Fcm - Obgyn Physical Exam Of Female Gu And Breast

Front 1

What is the mons pubis? What is the normal distribution of hair?

Back 1

The mons pubis is the hair covered area of skin over the symphysis pubis.

The normal distribution of hair is an ipsilateral, equilateral triangle with the base parallel to the pubic bone and the apex at the labia majora.

Front 2

Hirsutism

Back 2

An increase in the quanitity or increased distribution of pubic hair, specifically on the mons pubis.

Front 3

Virilism

Back 3

The presence of male secondary sexual characteristics in a female. Includes abnormal hair distribution, amenorrhea, deepening of voice, and clitoromegaly.

Can be due to polycystic ovarian syndrome, Cushing's syndrome, or performance enhancing drugs.

Front 4

Describe the dorsal lithotomy position

Back 4

Supine position; hips forward flexed to 45 degrees, abducted to 45 degrees; knees flexed to 90 degrees

Front 5

Vulvar dystrophy

Back 5

Includes lichen sclerosis, squamous cell hyperplasia, and mix dystrophy. Symptoms include bloody discharge, vulvar pain, and dyspareunia (painful sexual intercourse).

These are not uncommon in post-menopausal women.

Front 6

Lichen sclerosis

Back 6

Atrophic, loss of skin appendages; can lead to fibrosis

Front 7

Squamous cell hyperplasia

Back 7

Whitish papules; thickening of keratin

Front 8

Mixed dystrophy

Back 8

A mixture of lichen sclerosis and squamous dyperplasia; increased chances of developing squamous cell carcinoma

Front 9

Seborrheic dermatitis

Back 9

Manifests with one or more red patches or plaques adjacent to or in the hair of the mons and labia majora with greasy scales. The distribution on the labia majora and mons is quite symmetric. There are often concurrent patches and plaques in other hair bearing areas including the scalp and eyebrows.

Front 10

Tinea cruris

Back 10

Manifests with erythematous macerated, pruritic patches in the inguinal folds, on the labia majora. This is due to infection of the skin with candida. It can include candida vulvovaginitis and candidal infections in other areas including the feet and axilla. This may be associated with diabetes mellitus and use or elevated levels of glucocorticoids.

Front 11

Candidal vulvovaginitis

Back 11

Manifests with moderate vulvar and vaginal pruritis, and white, curdle-milk type vaginal discharge. The vulva itself is red, pruritic, and with areas of maceration. There is a thick, white, curdled-milk-like discharge from the introitus.

Front 12

Bartholin cyst

Back 12

Tender nodule located on posterior 2/3rds of labia majora. This is due to acute obstruction of the Bartholin's gland duct.

Front 13

Inclusion cyst

Back 13

Non-tender nodule located on the lateral aspects of the labia majora. The nodules often have a yellow hue to them.

Front 14

Condyloma acuminatum

Back 14

Flesh colored, exophytic lesions; these are due to infection with HPV

Front 15

Malignant melanoma

Back 15

Presents with pigmented lesions that have dysplastic features. It is rare and accounts for < 2% of all vulvar neoplastic lesions.

Front 16

Herpes simplex virus

Back 16

Causes painful clusters of lesions that develop into ulcers.

Front 17

Primary Lues-chancre

Back 17

Manifests with solitary ulcer that is painless. Chancre is a primary infection with Treponema pallidum. Usually present on the mucous membrane surfaces of the patient.

Front 18

Squamous cell carcinoma

Back 18

Manifests with an ulcer that is solitary, erythematous, often painless, with discrete margins and a relatively clean base. This ulcer slowly grows in size. Company it keeps includes enlarged ipsilateral inguinal lymph nodes.

Front 19

Bartholin glands

Back 19

These glands lie in the labia majora but the orifice is in the cleft between the labia minora and the introitus. They secrete mucus to lubricate the vagina and are homologous to bulbourethral glands in males.

Front 20

Skenes glands (paraurethral glands)

Back 20

Lie on the sides of the urethral meatus. They secrete mucus emptying into the urethra.

Homologous to the prostate.

Front 21

Bacterial vaginitis

Back 21

Manifests with patient complaining of a malodorous, whitish-grey, thin, homogenous liquid discharge that coats the surface of the vagina and vulva. The vaginal walls are diffusely red. On the wet mount, there are clumps of pigment on the vaginal cells, the clumps being bacteria (called Clue cells). The KOH prep will result in a fishy, amine odor to the wet mount solution.

This is typically due to an overgrowth of Gardenerella bacteria in the vagina and a loss of the lactobacilli, which results in lysis and destruction of vaginal epithelial cells.

Front 22

Candida vaginitis

Back 22

Manifests with a thick, white, akin to curdled milk appearing discharge throughout the vulva and vagina. The discharge is often adherent to the vaginal wall and has associated erythema of the vaginal wall and the vulva. The diagnosis is usually made on inspection alone but can be confirmed by a KOH that demostrates yeast present. This is due to Candida infection of the mucosa itself.

Front 23

Gartner's cyst

Back 23

Yellowish thin walled nodule antereolateral wall of the vagina. It is due to failure of the Wolfian duct to degenerate, which leaves vestigial rests of tissue in the vaginal wall. This rarely causes any problems for the patient.

Front 24

Cystocele

Back 24

Occurs when the tough fibrous wall between a woman's bladder and her vagina is torn by childbirth, allowing the bladder to herniate into the vagina. It manifests with a soft, bulging mass in the wall of the anterior vagina. The bulge increases with Valsalva and in severe cases protrudes beyond the introitus.

Front 25

Chandelier sign

Back 25

In pelvic inflammatory disease, it is cervical motion tenderness found during bimanual examination of the cervix.

Front 26

Prolapsed uterus

Back 26

Manifests with the cervix abnormally displaced inferiorly into the vagina. 2nd degree has the tip of the cervix prolapsed past the introitus. 3rd degree has protrusion of the cervix and uterus outside the introitus.

Front 27

Prolapsed rectum

Back 27

Manifests with abnormal protrusion of the anus and rectum, such that the mucosa is everted and exposed past the anus. Valsalva will increase the size of the prolapse. This is distinct from but may be concurrent to a rectocele.