Female Genitalia - Ha

Front 1

When is the onset of puberty for females?

Back 1

8.5 - 13 years

Front 2

Pediculosis pubis

Back 2

Severe perineal itching.
Excoriations and erythematous areas.
May see little dark spots.
May see nits (eggs) attached to hair.
Usu. localized to pubic area.
Occasionally in eyebrows/lashes.

Front 3

HSV II

Back 3

Episodes of local pain, dysuria, fever.
Clusters of small, shallow vesicles
Surrounding erythema.
Erupts on genital areas/inner thigh.
Inguinal adenopathy/ Edema.
Labial ulcers in 1 - 3 days.
Virus goes dormant but can recur.

Front 4

Syphilitic Chancre

Back 4

Begins as small, solitary silvery papule.
Erodes to a red, round superficial ulcer w/yellow serous dischage.
Nontender, indurated base.
Can be lifted like a button.
Nontender lymphadenopathy.

Front 5

Contact dermatitis

Back 5

Allergen contact.
Red, swollen vesicles.
Lesions may weep, crust, scale, thicken skin.
Excoriations from scratching.

Front 6

HPV

Back 6

Painless, warty growths
Pink/soft, pointed, moist papules.
Can be cauliflower-like
Occur around vulva, introitus, anus, vagina, cervix.

Front 7

Bartholin's Gland Abscess

Back 7

Local pain, can be severe
Overlying skin red, shiny, hot.
Posterior part of labia swollen.
Palpable fluctuant mass and tenderness.
Mucosa shows red spot @ site of duct opening.
Requires incision/drainage/anti-Bs.

Front 8

Urethritis

Back 8

Dysuria, burning sensation.
Palpation of anterior vaginal wall shows erythema, tenderness.
Induration along urethra.
Purulent discharge from meatus.
Caused by Neisseria gonorrhoeae, chlamydia, or staph.

Front 9

Urethral Caruncle

Back 9

Tender, painful w/urination.
Urinary frequency, hematuria.
Dyspareunia or maybe asymptomatic.
Small, deep red mass protruding from meatus.
Usu. secondary to urethritis/skenitis.
May bleed on contact.

Front 10

Cystocele

Back 10

Feeling pressure in vagina.
Stress incontinence.
With straining, introitus widens and will see presence of a soft, round anterior bulge.
Bladder (covered by vaginal mucosa) prolapses into vagina.

Front 11

Rectocele

Back 11

Feeling of pressure in vagina, possibly constipation.
W/straining, introitus widens and will see presence of a soft, round posterior bulge.
Part of rectum, (covered by vaginal mucosa) prolapses into vagina.

Front 12

Uterine prolaps

Back 12

W/straining/standing, uterus protrudes into vagina.
Nontender, non-fluctuant, smooth hemisphere.
May cause a broad-based gait.
Graded.

Front 13

What are the grades of a prolapsed uterus?

Back 13

1st: Cervix appears @ introitus w/straining
2nd: Cervix bulges outside introitus w/straining
3rd: Cervix whole uterus protrudes even w/out straining (inside out)

Front 14

HPV (Condylomata)

Back 14

Virus can appear as abnormal white epithelium on cervix.

Front 15

Polyp (cervical)

Back 15

May have mucoid discharge/bleeding
Bright red, soft, pedunculated growth emerges from os.
Benign lesion (det. by biopsy).
May be lined w/squamous/columnar epithelium.

Front 16

DES Syndrome

Back 16

Prenatal exposure, causes cervical/vaginal abnormalities not apparent til adolescence.
Red, granular patches of columnar epthelium extend beyond normal squamocolumnar junction onto cervix and fonices (vag. adenosis).
Cervical abnormalities: Circular groove, transverse ridge, protuberant anterior lip, cockscomb formation.
Causes infertility, ectopic pregnancy, spontaneous abortion, preterm labor.

Front 17

Carcinoma

Back 17

Bleeding betw menstrual periods / after menopause.
Unusual vaginal discharge.
Chronic ulcer/induration -- early signs.
Dx by Pap smear/biopsy.

Front 18

Bluish cervix -- Cyanosis

Back 18

Occurs during pregnancy (normal).
Called "Chadwick's Sign"

Front 19

Erosion of cervix

Back 19

Lips inflamed/eroded.
Reddened granular surface is superficial inflammation.
No ulceration.
Usu. secondary to purulent/mucopurulent discharge.
Biopsy needed to disting. from carcinoma.

Front 20

Atrophic vaginitis

Back 20

Opportunistic infection r/t chronic estrogen deficiency.
Postmenopausal vaginal itching.
Dryness, burning sensation, dyspareunia, mucoid discharge flecked with blood.
Pale mucosa w/abraded areas that bleed easily.

Front 21

Candidiasis

Back 21

Intense pruritus.
Thick whitish discharge.
Vauva/vagina erythematous/edematous.
Dx by microscopic exam.

Front 22

What are predisposing causes of candidiasis?

Back 22

Oral contrcaptives
AntiBs
More alkaline vaginal pH (as w/menstruation, postpartum, meopause)
Pregnancy (incr. glycogen/diabetes).

Front 23

Trichomoniasis

Back 23

Pruritus, water and stinky discharge.
Urinary frequency, terminal dysuria.
Worse during menstruation.
Vulva erythematous.
Vagina diffusely red, granular, occasionally w/red, raised papules.
Petechiae.
Frothy, yellow-green, foul-smelling.
Microscopic exam.

Front 24

Bacterial vaginosis

Back 24

Profuse discharge, constant wetness, fishy odor.
Thin, creamy gray-white, malodorous discharge.
No inflammation on vag wall/cervix
Surface parasite
Vag pH > 4.5
Microscopic exam

Front 25

Chlamydia

Back 25

Minimal/no symptoms
May have Urinary freq., Dysruria, vag discharge, postcoital bleeding.
May have yellow/gree mucopurulent discharge.
Friable cervix.
Cervical motion tenderness
Easily confused with Gonorrhea.
Wrong tx can cause chlam to ascend to cause PID.
Most common STD

Front 26

Gonorrhea

Back 26

Vagianal discharge, dysuria, abnormal uterine bleeding, abscess in Bartholin's or Skene's glands.
Often asymptomatic.
Dx by positive culture.

Front 27

Myomas (Uterine fibroids)

Back 27

Varies, depending on size/location.
Often asymptomatic.
Vague discomfort, bloating, heaviness, pelvic pressure, dyspareunia, urinary freq, backagche, hypermenorrhea.
Uterus irregularly enlarged, firm, mobile, nodular w/hard, painless nodules in uterine wall.
Heavy bleeding produces anemia.
Usu benign.
Highest incidence between age 30-45 years, in Blacks.
Estrogen dependent.
Usu regress post-menopause.
Surgery may be indicated.

Front 28

Carcinoma of endometrium

Back 28

Abnormal and intermenstrual bleeding before menopause.
Postmenopausal bleeding or mucosanguinous discharge.
Pain/weight loss occur -- late signs.
Uterus may be enlarged.
Dx w/endometrial tissue sample.

Front 29

What are risk factors for endometrial carcinoma?

Back 29

Early menarch, late menopause, history in infertility, failure to ovulate, tamoxifen, unopposed estrogen therapy, obesity

Front 30

Endometriosis

Back 30

Cyclic/chronic pelvic pain.
Irregular uterine bleed or hypermenorrhea.
May be asymptomatic
Uterus fixed, tender to movement.
Small, firm nodular masses tender to palpation on posterior aspect of fundus, uterosacral ligaments, ovaries, sigmoid colon.
Often ovaries are enlarged.

Front 31

What is the cause of endometriosis

Back 31

Aberrant growths of endometrial tissue scattered throughout pelvis, probably as a result of transplantation of tissue by retrograde menstruation.Extopic tissue responds to hormone stimulation, builds up between periods, sloughs during menstruation.
May cause infertility from pelvic adhesions, tubal obstruction, decr ovarian function.

Front 32

Acute Salpingitis (PID)

Back 32

Fever >38C or 100.4F
Suprapubic pain/tenderness
Acute: Rigid, boardlike lower adb musculature. May have purulent discharge fr cervix. Intense pain in lateral fonices/adnexa.
Chronic: Bilateral, tender, fixed adnexal masses.

Front 33

What are the complications of PID?

Back 33

Ectopic pregnancy
Infertility
Reinfections
Usu caused by Neisseria gonoohoeae and Chlamydia trachomatis

Front 34

Ectopic pregnancy

Back 34

Amenorrhea/irregular vaginal bleeding, pelvic pain.
Softened cervix/fundus.
Moveent of cervix/uterus causes pain.
Palpable tender pelvic mass.
Mass is solid, mobile, unilateral.
Potential for serious sequelae (rupture, peritonitis)

Front 35

Ovarian cyst

Back 35

Usu. asymptomatic
Smooth, round, fluctuant, mobile, nontender mass on ovary.
Some resolve spontaneously w/in 60 days.
Follow closely. Can rupture.

Front 36

Ovarian cancer

Back 36

May have abdominal pain, pelvic pain, increased abd size, bloating, nonspecific GI symptoms.
May be asymptomatic.
May palapte solid tumor on ovary.
Heavy, solid, fixed, poorly defined mass suggests malignancy.
Benign mass may feel mobile/solid.
Biopsy to distinguish.

Front 37

Pseudohermaphroditism

Back 37

Ambiguous genitalia.
Congenital, resulting from hyperplasia of adrenal glands (too much androgen).
Masculinized external genitalia.

Front 38

What can bulging of the vaginal wall indicate?

Back 38

Cystocele, rectocele, or uterine prolapse

Front 39

The cervix may appear nulliparous/parous after childbirth.

Back 39

Parous (slit, slightly open)