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53 Cards in this Set
- Front
- Back
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Name the parts of the external female genitalia. |
Mons pubis Clitorial head and clitoris Labia majora and minora Urethral opening Vaginal entrance(introitus) Perineum (??) Anus |
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How much does the vagina expand during birth? What are the dimensions of the uterus? Where is the cervix located? |
Up to 10 cm 2.5 cm x 5 cm x 8 cm Between vagina and uterus |
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Where are the Fallopian tubes? How long are they? What is their purpose? |
Connect uterus to ovaries 10 - 14 cm Passage of egg from ovary to uterus |
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Ovary functions? Dimensions? How many oocytes does one contain? What keeps it in place |
Egg and female hormone (estrogen and progesterone) 1 x 2 x 3 cm 0.5 million Pelvic suspensory ligament and utero-ovarian ligament |
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What is the position of the vagina? What is its function? |
Posterior to urethra, urinary bladder, anterior to rectum |
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What is the position of the uterus? What is the endometrium? Myometrium? Perimetrium? |
Posterior to bladder/SI, anterior to sigmoideum Uterus lining Uterine smooth muscle Outer layer of uterus |
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What are the roles of estrogen, progesterone, and prolactin? |
Genitalia development, menstrual cycle regulation Menstrual cycle regulation, pregnancy maintenance Milk production stimulation |
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What is the hypothalamic-pituitary-gonadal axis? What hormones does each organ release? |
Gonotropin releasing hormone Lutenizing hormone, follicle stimulating hormone, and prolactin Estrogen and progesterone (negative feedback on GnRH at low levels?) |
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What is the purpose of the menstrual cycle? When does it start? What are the steps in a cycle? What/when is menopause? |
Reproduction 1st period around 13 yo (10-15) 1st day of bleeding marks beginning, 2-7 days of bleeding, controlled by endocrine system, total length 28 days The end of the reproductive phase, at 51 yo +/- 4 |
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How long does it take an oocyte to become an egg? What are the different stages of follicles? |
3 months Primary follicle, secondary follicle, ovulation (egg release), corpus luteum (degenerates in 11-13 days if no pregnancy) |
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What is the follicular phase? How long does it last? What happens at day 6-7? What does this follicle do? What happens as a result? |
Development of the follicle 14 days The most developed follicle is selected It releases estrogen, which initiates new layer of endometrium and LH and FSH production Ovulation |
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How long does the luteal phase last? What happens first? What happens if there is no pregnancy? |
14 days Progestrone is released, preparing the endometrium for implantation (also suppress LH and FSH) Corpus luteum degenerates and hormone production stops -> Endometrium is rejected (menstrual bleeding) |
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How does the egg enter the fallopian tube? What happens if it is not fertilized? |
It is swept in by fimbria It disintegrates |
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What are the three main gynecological clinical symptoms? |
Abnormal vaginal bleeding Lower abdomen pain Vaginal discharge |
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What are the different types of abnormal bleeding, and what can they indicate? |
No bleeding -> Pregnancy, menopause, hormone change Bleeding during intercourse -> Sensitive cervix, infection, cancer Bleeding during menopause -> Cancer Bleeding during early pregnancy -> nothing, miscarriage, ectopic pregnancy |
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What can lower abdomen pain indicate? Discharge? |
Infection, cancer, endometriosis (intrauterine issue outside it), fibroids (benign uterine tumors), early pregnancy complications Infection, cancer (older women) |
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What should you ask about in histories? |
Prior pregnancies Sexual activity Contraception Family history Allergies Prior disease/surgery |
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What organs should you perform the normal palpation, auscultation, etc on? What are the three parts of the pelvic exam? |
Abdomen, lungs, heart Inspection, bimanual examination, ultrasound |
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What are the three steps of the inspection? |
Inspect labia minora, majora, look for bleeding and discharge Insert speculum Isolate cervix and inspect for bleeding, discharge, abnormal surface |
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What do you do in the bimanual examination |
One hand on abdomen, one hand in cervix Isolate cervix, test for cervical motion tenderness Determine uterus size Palpable masses |
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What to look for on an ultrasound? What do the colors mean? |
Uterus, ovaries, free fluid, masses Black -> mass, grey -> tissue, white -> bone |
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Name the eight types of contraception, with percent efficacies: |
Condom (97%) Diaphragm (96%) Intrauterine device, copper or hormone (99%) Combined pill(99%) Progesterone-only pill(98%) Contraceptive implant(100%) Vaginal ring(99%) The morning after pill (97%) |
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What women group are IUDs best for? What are the two types, and how do they work, with what side effects? |
At least one prior pregnancy Copper: Spermacide, preventing fertilization -> heavier menstrual periods Hormonal: Levonogestrel (form of progesterone) Changes intrauterine environment, preventing fertilization and ovulation -> reduced menstrual periods and infection risk, but with headaches, mood swings, and irregular periods |
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What is in the combined pill? How does it work? How often do you take it? What other health effects are involved? |
Estrogen and progesterone Inhibits FSH, LH release -> inhibits follicle growth and ovulation 21 days in a row, same time of day (withdrawal bleeding after 21 days) Reduces heavy bleeding, acne, risk of ovarian cancer, but increases risk of blood clots |
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What does the progesterone only pill do? What other effects does it have? When should you use it? |
Changes intrauterine environment and sperm activity (progestrogen) Normal menstrual period, but risk of bleeding between periods When combined pill is contraindicated |
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What options are there for emergency contraception? |
Morning after pill: Levonogestrel (progesterone) best before 12 hrs (max 72), inhibits ovulation and implantation, but can cause nausea and vomiting (mechanism unknown) Copper IUD: Before day 5, 99% effective |
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Up to what points is abortion not regulated? What accompanies the process? |
12 weeks Information on options and risks, signed consent, offered supporting talk |
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What considerations can allow for abortion after 12 weeks? |
Maternal health severely at risk (no special permission needed) Pregnancy, birth, care for child a health risk for mother Result of rape or abuse Risk of fetus being severely ill (Downs) Mother too immature, ill to take care of baby Pregnancy, birth, or care for child could cause serious burden for mother (e.g. 5 other kids) |
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What are the two types of abortion? What are the pros and cons of each? |
Medical - Low risk of infection, no anesthesia, at home or hospital, but higher risk of incomplete abortion, and longer period of bleeding (before week 8, after week 12) Surgical - Quick, low risk of incomplete abortion, shorter period of bleeding, but high risk of infection/perforation, has to be done at hospital (weeks 8 - 12) |
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What drugs are used in a medical abortion? What are the risks of complications? |
Mifepristone day 1, softens and dilates cervix Misoprostol day 2, causes cervical contractions 5% will need an evacuation, 0.5% will need to be hospitalized for heavy bleeding |
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What are the steps of a surgical abortion? |
Misprostol before surgery General anesthesia Cervical dilation Suction |
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What is a female sterilization? When is special permission needed? How many women regret it? How effective is it? |
Permanent contraception by closure of fallopian tubes If the woman is 18 - 25 yo and not in immediate danger 20% of 25 - 29 women regret it 1% become pregnant anyways |
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Two types of sterilization? |
Laparoscopy: Applying clips or resecting tuba Hysteroscopy: Fallopian implants |
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When and how many free IVF treatments can a couple get? What are the three types of infertility treatments |
If couple fails to conceive after 12 months, and the woman is under 40 yo, she can get up to three free IVF attempts (up to 46 yo in private clinics) Insemination/In vitro fertilization/Intracytoplasmic sperm injection |
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What are the causes (with percents) of female infertility? |
Ovulation disorders (21%) F Tube disorders (14%) Abnormal sperm (24%) Endometriosis (6%) Sexual dysfunction (6%) Unknown (29%) |
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What is involved in a clinical exam for infertility? |
History (past infections, surgeries, sex, menstruation) Semen test Se-progesterone (1 week prior to menstruation) to test for corpus luteum function (ovulation) Se-FSh (day 2-5) -> 10IE/L is a sign of small follicle reserve HSG (Hysterosalpingography) uterine x-ray Genitalia ultrasound |
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Infertility treatments? |
Ovulation disorders -> synthetic estrogen Fallopian tube disorders -> operation/IVF Abnormal sperm -> insemination, IVF, ICSI |
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Symptoms of infection? |
Pain Discharge Pain during intercourse Bleeding Fever None |
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Infection examination? |
Normal abdominal exam Gynecological exam w/ swab test Urine test Blood test |
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List vaginal STIs. |
Herpes simplex (ulcerations, burning sensation, treat with aciclovir) HPV (genital warts, increased risk of cervcal cancer, treat with cream or laser) Syphilis (multistage) |
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List cervical STIs. |
Chlamydia (lives in cervical cells, discharge, swab, Azitromycine) Gonorrhea (discharge, swab, Ceftriaxone) HPV (again apparently) |
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Other vaginal infections? |
Bacterial vaginosis (floral imbalance, fish-smelling discharge, wet smear, metronidazole) Candidiasis (yeast infection) itching and burning, smear, Fluconazole) Trichonoma vaginalis (parasite): smelly green discharge, burning sensation, itching, wet smear, Metronidazole) |
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What can cause a uterine infection? What can happen if one occurs? |
Chlamydia, bacteria Serious infection including fever, sepsis Severe discharge Can cause infertility if spreads to fallopian tubes and ovaries |
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Symptoms, cause, examination, and treatment for endometriosis. |
Uterus tissue outside uterus (after retrograde menstruation) Pain during menstruation and intercourse, infertility Ultrasound or laparoscopy Hormonal treatment to stop ovulation or surgical removal |
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What are single ovarian cysts? What are the implications of having one? |
Ovarian follicle < 2 cm Can cause bleeding or pain 95% benign Surgery rarely needed |
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What is polycystic ovarian syndrome (symptoms, mechanisms, treatment)? |
At least 12 follicles No ovulation or menstrual bleeding, with obesity, infertility, acne, and hirsutism (hairiness), insulin resistance Increased LH -> increased estrogens and androgens, negative FSH feedback Weight loss, the pill, Metformin (T2D) |
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What are the three types of gynecological cancer? |
Cervical Ovarian Uterine |
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What is cervical dysplasia? Mild/severe? What causes it? In whom is it most common? How to detect it? |
Premalignant state Mild is 1% of way to cancer, severe is 12% 70-90% HPV Women in 30s Pap smear every 3 years from 23 yo (few symptoms) |
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What is the incidence of cervical cancer? Symptoms? Treatment? Staging/survival rate? |
0.011% (40-50 yo, 90% HPV) Bleeding during sex, discharge, pain Cervical conisation, hysterectomy, radiation Stage with biopsy: 5 yr survival - I: 97%, III: 30-40%, IV: 10% |
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Ovarian cancer incidence? What are risk factors? Treatment? |
0.014%, >50 yo Many ovulations, BRCA I and II, RMI >200, few other symptoms Hysterectomy, salpingo-oophorectomy debulking (staging) , chemotherapy 5 yr survival- 1: 85-90%, III: 15-20%, IV: 5% |
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Uterine cancer incidence? Risk factors/symptoms? Staging? Treatment? Survival? |
0.013, 50-60 yo High estrogen, HNPCC, postmenopausal bleeding Biopsy or aspiration Hysterectomy and salpingo-oophorectomy, radiation I: 75-90%, III: 40%, IV: 5-10% |
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What is a laparoscopy? What are the steps? |
Camera-surgery General anesthesia -> Insert ports -> Inflate w/ gas -> Insert camera and instruments |
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Seemingly arbitrary take home message? |
A gynecological exam always includes an ultrasound |
