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99 Cards in this Set

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What are the four important health topics for promotion & counseling?
Pap smear screening
Options for family planning
STD’s and HIV
Changes in menopause
According to guidelines, when should a woman for her first screening & how often she should go after that time through her twenties?
-First screen: 3 years after first sexual intercourse or by age 21, whichever comes first

-Women up to age 30: Annual screening
If a woman has had a hysterectomy, how often she should she go to see her OB-GYN?
Women with hysterectomy: Discontinue routine screening if cervix was removed for benign reasons &no hx of abnormal or cancerous cell growth. If woman has this hx--> screen annually, & discontinue screening if 3 consecutive vaginal cytology tests are negative.
How often should a woman > 30y/o get be screened by her OB-GYN?
>30: Screen every 2-3 yrs if 3 consecutive annual cervical cytology results are (-) or if combined cervical cytology testing & high-risk HPV testing are (-)

Screen more frequently in pts w/ (+) Pap or high-risk HPV test; HIV infection; immunosuppression; DES exposure in utero; prior hx of cervical CA
What is primary amenorrhea?
Failure to begin menses
What is secondary amenorrhea?
Cessation of established periods – low body weight, malnutrition, anorexia nervosa, chronic illness hormonal dysfunction
What is Polymenorrhea?
frequent periods
What is Menorrhagia?
Increased amount or duration of flow
What is Oligomenorrhea & when is this normal?
–Infrequent periods, also be irregular
- Pattern 2 yrs after Menarche
- Before Menopause
What is Menorrhagia?
Increased amount or duration of flow
What is metrorrhagia?
Inter menstrual bleeding
What is post-coital bleeding suggestive of?
Cervical Disease.
What are other symptoms associated w/ Amenorrhea of Pregnancy & when should one be considered w/ abortion?
Breast changes, urinary frequency, nausea and vomiting. If followed by heavy bleeding--> suspect threatened abortion or dysfunctional uterine bleeding.
What is the definition of menopause & what is the avg age it occurs?
-Absence of menses for 12 consecutive months
-Between ages 45 thru 55
What are sx's associated w/ menopause?
- vasomotor changes (Hot Flashes)
- sweating
- sleep disturbances
- accelerated bone loss
- increase in total LDL cholesterol
- vulvo-vaginal atrophy leading to vaginal drying,dysuria, dyspareunia
Which areas should be examined on external female genitalia & what are the associated symtpoms of those areas?
-Mons pubis (pubic hair-->nl to delayed sexual maturity), labia majora & minora (inflammation), urethral meatus (urethral caruncle, discharge, lesions, Polyps,
Fistulas) & clitorus (enlarged in masculinization), vaginal introitus (imperforate hymen), perineum, Bartholin's gland (tender, inflamed in infection)
Which areas should be examined in internal female genitalia?
-Vagina, vagina walls, cervix, uterus, ovaries, pelvic muscles, rectovaginal wall.
What 2 things is it impt for the patient to do/be aware of prior to beginning the pelvic exam?
1. Avoid intercourse, douching, or use of vaginal suppositories for 24-48 hrs prior to exam.
2. Empty bladder before exam.
In what position should the patient be in for pelvic exam?
Supine w/ head & shoulders slightly elevated, arms @ sides or folded across chest to reduce tightening of abdominal muscles.
What things are important for the examiner to do during the exam?
-Explain each step in advance to pt.
-Drape pts from mid-abdomen to knees, depress drape b/w knees so you have eye contact w/ patient.
-Avoid unexpected/sudden mvmts.
-Warm speculum w/ tap water.
-Watch pt's face for comfort leve.
-Use excellent/gentle technique when inserting speculum.
-Wear gloves.
Should a male doc be assisted by a female assistant in the room?
Yes.
What does genital herpes look like on physical exam?
flat, gray papules.
When you assess the support of the vaginal outlet by asking the patient to strain down, what are three possible things for you to see?
Cystocele, Cystourethrocele, Rectocele.
What specimens should be obtained during the Pap?
-Obtain 1 specimen from endocervix &another from ectocervix.
Determine Cervical Size, Shape, slit-like, lesions, polyp, drainage.
What brush should be used during the Pap smear? For pregnant women?
-Endocervical Brush Note that for pregnant women use cotton-tip applicator, moistened in saline.
-Cervical Broom
What is Mittelschmertz?
lower abdominal pain associated with ovulation, may be accompanied by a degree of tenderness on the side in which ovulation took place that month and even by similarly unilateral and usually quite mild adnexal tenderness. Onset usually sudden, remission is spontaneous. If a pelvic examination is done, you may discover a bit of adnexal tenderness but it will otherwise be reassuringly negative.
Should you be concerned about clitoromegaly in infants?
All really premature female infants give impression of apparent clitoromegaly. Don't jump to conclusions. 1/5000 babies will have an endocrine problem. Look for other virilizing signs & don't hesitate to ask for confirming opinion
What is the difference in endometriosis presentation in adolescents & older women?
-Adolescents: pelvic pain either cyclic and noncyclic.
-Older women: pain most often cyclic. Don't let noncyclic pelvic pain in an adolescent rule out possibility of endometriosis.
Should you smell the discharge?
If sexual abuse is suspected, its helpful to be aware of characteristic odor of semen.
What are the sx's of ectopic pregnancy?
often not dx'ed before rupture b/c sx's mild. Big clue: sudden, dramatic change from mild, even vague abdominal pain thats there but not particularly distressing to a sudden onset of severe abdominal tenderness in hypogastric area, particularly on involved side. Rigidity and rebound may come on early or late. Main point: If woman presents w/ vague abdominal complaints, check out sexual contact & menstrual history, do pelvic exam, & don't disregard mild tenderness that might be evoked. Try, at least, to anticipate emergency of rupture.
For a gonococcal, trichomonas vaginalis, and Bacterial Vaginosis or Candida Vulvovaginitis cultures, what would you use to collect specimen?
sterile cotton swab
For a gonococcal culture, where would you collect the sample?
Cervical os.
What is the gonococcal specimen collection time& what would you do w/ specimen after its collected?
Hold in place for 10-30 secs. Use “Z” technique and smear the specimen on the culture plate
For trichomonas vaginalis culture where would you collect the sample?
Vaginal discharge.
Trichomonas vaginalis: what is the specimen collection time & what would you do w/ specimen once it's collected?
No specified time. Place it on a glass slide and add a drop of normal saline
Bacterial Vaginosis or Candida Vulvovaginitis: Where would you collect specimen? What is the specimen collection time? What would you do w/ specimen after its collected?
Vaginal discharge, no specified time, After its collected-->Place it on a glass slide and add a drop of normal saline
DNA Probe for Gonorrhea & Chlamydia: what would you use to collect specimen?
Dacron swab.
Chlamydia/Gonorrhea: Where would you collect specimen? What is the collection time? What would you do w/ specimen once its collected?
Cervical os; Rotate in place for 30 seconds. Place it in a special tube containing specimen reagent
Is the breast exam usually done before or after pelvic exam?
BEFORE
How should you insert speculum during vaginal exam?
@ 45 degree angle avoiding anterior structures-->once past introitus, rotate speculum horizontally-->open bills 2-3cm apart-->should see cervix-->secure speculum by clicking ratchett.
What should you be feeling during palpation of cervix?
Palpate cervix: note size, shape, and consistency.
-Gently move cervix side to side between your fingers and note mobility & tenderness.
-Gently lift the cervix forward and note mobility and tenderness
What is the Pouch of Douglas?
rectouterine pouch--extension of parietal peritoneum
What types of cells does the vagina have that are on the outer pt of the ectocervix?
Squamous cells.
What is the ectropion?
broad band of columnar epithelium encircling the os.
Where does lymph from the vulva & lower vagina drain? Lymph from the internal genitalia?
-Lymph from vulva & lower vagina drain into inguinal lymph nodes;
-Lymph from internal genitalia incl upper vagina drain into pelvic & abdominal lymph nodes (not palpable)
What is leukorrhea?
Inc vaginal secretions--coincide w/ ovulation
What happens w/ aging?
pubic hair->sparse & gray; estrogen dec-->clitoris & labia get smaller; vagina narrows, shortens & mucosa gets thin, pale, dry; uterus & ovaries dec in size. Can't palpate ovaries post menopause.
What is menarche?
Age of 1st period; usually 9-16, takes a yr to get normal; age varies depending on genetics, socioeconomic status, nutrition.
Postmenopausal bleeding (bleeding after 6 months of not having period) is suggestive of what?
Endometrial CA.
What is the difference b/w primary & secondary amenorrhea?
Primary--failure to initiate periods;
Secondary: cessation of periods after they've been established.
What are the most common vulvovaginal symptoms?
Vaginal discharge (find out amt, color, consistency, odor) & itching. Ask about sores or lumps
what are some reasons for a woman being unable to reach orgasm?
Lack of estrogen, medical illness, psychiatric conditions.
What is vaginismus?
Involuntary spasm of muscles surrounding vaginal orifice that makes penetration during intercourse painful or impossible (may be physical or psychological)
What are the 4 topics important for health promotion & counseling in an OB-GYN exam?
1. Pap smear.
2. Options for family planning
3. STDs & HIV
4. Changes in menopause.
Excoriations or itchy, small, red maculopapules suggest what?
Pediculosis pubis (lice or 'crabs')
When the uterus is retroverted, the cervix points more _____ than normal.
Anterior
Pain on movement of the cervix, together w/ adnexal tenderness suggests what?
pelvic inflammatory disease.
Nodules on the uterine surface are suggestive of what?
Myomas
If you can feel an ovary in a postmenopausal woman, what should you consider?
Abnormality like a cyst or tumor b/c 3-5 yrs post menopause the ovaries have usually atrophied & are no longer palpable.
What are some examples of adnexal masses that one might palpate when trying to feel the ovaries?
Ovarian cysts, tumors, abscesses, swollen fallopian tubes of PID, and tubal pregnancy. Uterine myoma make simulate adnexal mass.
As you pull your hand out of the introitus, you should ask the patient to squeeze your fingers tightly for 3 seconds. What are some reasons for impaired strength in this area?
Age, vaginal deliveries, neuro deficits, urinary stress incontinence.
Where should you try to palpate to feel an indirect inguinal hernia?
Palpate labia majora & upward to just lateral to the pubic tubercles. Indirect inguinal hernia=most common hernia in female groin. Next most common is femoral hernia.
Chlaymdia trachomatis or Neisseria honorrhea can lead to what condition and what do you need to do on the physical exam?
Urethritis; Insert finger into vagina & milk urethra gently from inside outward.
What is the most common cause of CA in women worldwide?
Breast CA (risk inc w/ age; genetics can be a factor--mutations of BRCA1 & 2)
When do women get increased nodularity in the breasts?
Premenstrually
Which breast/axillary lymph nodes are palpated most frequently?
central nodes on chest wall, high in axially b/c anterior folds; Other three groups of lymph nodes drain to this particular area-->Pectoral nodes:anterior, subscapular nodes-posterior, lateral--along upper humerus. infraclavicular, supraclavicular.
When should one be concerned w/ milky breast discharge?
-Milky bilateral discharge--or galatorrhea: reflects pregnancy or prolactin or other hormones imbalance.
-Nonmilky unilateral discharge: local breast disease.
What are three important topics for health promotion and counseling on breasts?
-risk factors for breast cancer (previous breast CA, affected mom or sister, biopsy showing atypical hyperplasia, inc age, early menarche, late menopause, late or no pregnancies, & previous radiation to chest wall).
-breast cancer screening
-breast self-exam
At what age should a woman start doing a breast self-exam & how often should she get a clinical breast exam?
Monthly breast self exams starting @ 20, breast exam by doctor every 3 yrs for 20-39 y/o, and annually after 40. Yearly mammography for 40 and older.
When is the best time of the month to perform a breast self-exam?
5-7 days AFTER menstruation onset, since breasts swell & get more nodular before menses due to increased estrogen.
What types of changes of the breasts are suggestive of breast CA?
thickening of skin & unusually prominent pores (may accompany lymphatic obstruction), flattening of the normally convex breast, asymmetry of directions in which nipples point, rash or ulceration in Paget's dz of the breast, retracted nipple, asymmetry when leaning over.
What three position should you ask the patient to be in to better examine asymmetry in her breasts?
1. Arms over head
2. Hands pressed against hips
3. Leaning forward
How long does a thorough breast exam take for each breast?
3 minutes/each.
What are tender cords of the breast suggestive of?
Mammary duct ectasia--a benign but sometimes painful condition of dilated ducts w/ surround inflammation, sometimes associated w/ masses.
How would you describe a nodule thats strongly suggestive of cancer?
Hard, irregular, poorly circumscribed nodules, fixed to skin or underlying tissues.
Which characteristics of the nodule should you note?
Location--by quadrant or clock--cm from nipple;
Size-in cm
Shape-round or cystic, disclike, or irregular in contour;
Consistency-soft, firm, or hard.
Delimitation-well circumscribed or not
Tenderness
Mobility
How would the nipple change w/ cancer?
Nipple thickens & loss of elasticity.
What does deeply pigmented, velvety axillary skin suggest?
Acantosis nigricans--one form of which is assoc w/ internal malignancy.
What 2 muscles are behind the breast?
Pec major & serratus anterior
What is nonpuerperal galactorrhea?
Milky discharge unrelated to prior pregnancy & lactation. Leading causes: hormonal, pharmacologic.
How should you examine a mastectomy patient?
Inspect mastectomy scar & axilla carefully for any masses or unusual nodularity. Note changes/signs fo inflammation. May have lymphedema post surgery. Masses, nodularity, change in color, or inflam, esp in incision line-->suggest recurrence of breast CA
What are the 2 positions patient can use to do a self-breast exam?
Supine or Standing (makes it easier to check upper outer quadrant, since this is where most CA is found). Arm behind head in both positions.
Describe the characteristics of a fibroadenomas in the breast.
Age:15-25, up to 55. Usually single. Round, disclike, or lobular. Well delineated, VERY mobile, usually tender, no retraction signs
Describe the characteristics of cysts in the breast.
Age: 30-50, regress after menopause except w/ estrogen therapy. Single or multiple. Round shape. Consistency: soft-firm, usually elastic, Well delineated, mobile. Often tender. No retraction signs.
Describe the characteristics of CA in the breast.
30-90 y/o. more common over 50. Usually single, but may coexist. Irregular or stellate shape. Firm/hard consistency, not clearly delineated from surrounding tissues. May be fixed to skin or underlying tissues. Usually nontender. May have retraction signs.
How does the breast get retraction signs?
Breast CA causes fibrosis-->shortening of fibrotic tissues produces retraction signs, incl dimpling, changes in contour, & retraction or deviation of nipple. Other causes: fat necrosis & mammary duct ectasia.
Describe the peau d' orange sign.
Often seen 1st in lower pt of breast or areola. Edema of skin is produced by lymphatic blockage. Appears as thickened skin w/ enlarged pores.
What is Paget's disease of the nipple?
Uncommon form of breast CA-->usually starts as scaly, eczemalike lesion. Skin may also weep, crust, or erode. Breast mass may be present. Suspect Paget's dz in any persisting dermatitis of nipple & areola.
What are the three most common kinds of breast masses?
Fibroadenoma (benign tumor), cysts, & breast CA.
When does one get retention cysts on the cervix?
w/ increasing estrogen stimulation during adolescence, all of pt of columnar epithelium is transformed into squamous epithelium by metaplasia. This change may block secretions of columnar epithelium and cause these cysts. Appear as 1 or more transluscent nodules on cervical surface, no pathologic significance.
Describe a cystocele.
Weakened supporting tissue-->Bulge of anterior vaginal wall w/ bladder above it. Involves upper 2/3 of vagina
Describe a cystourethrovele
Anterior vag wall + bladder & urethra involved in bulge.
-May have groove b/w urethrocele & cystocele.
Describe a rectocele.
Wkness/defect in endopelvic fascia-->Herniation of rectum into posterior wall of vagina
Describe a Bartholin's gland infection and some organisms that can cause it.
Causes: gonococci, Chlamydia trachomatis.
-Acutely, appears as tense, hot, very tender abscess. Can see pus coming out of duct or erythema around durct opening.
-Chronically-->can feel nontender cyst. Can be large or small.
Describe a urethral caruncle.
Small, red, benign tumor visible @ posterior pt of urethral meatus. Mainly in POSTmenopausal women, usually has no sx's. Occasionally, carcinoma of urethra is mistaken for caruncle. To check, palpate urethra thru vagina for thickening, nodularity, or tenderness, and feel for inguinal lymphadenopathy.
Describe a prolapse of urethral mucosa.
Prolapsed urethral mucosa forms swollen red ring around urethral meatus. Usually occurs before menarche or after menopause. ID urethral meatus @ center of swelling to make diagnosis.
Describe the characteristics of cervical cancer.
Begins in area of metaplasia. In earliest states, can't be distinguished from nl cervic. In late stage, extensive, irregular cailiflowerlike growth may develop.
-Risk factors: early frequent intercourse, multiple partners, smoking, & infection w/ HPV inc risk for cervical CA.
Describe the characteristics of bacterial vaginosis.
Discharge: gray or white, thin,homogenous, malodorous; coats vag wals; usually not profuse;
Unpleasant fishy or musty genital odor.
Lab: scan saline wet mount for clue cells (epithelial cells w/ stipled borders); sniff for fishy odor after applying KOH ('whiff test')
Define parity vs gravidity.
-Parity=# of babies delivered (live births or still births)
-Gravidity: # of times a woman has conceived.