Pcs Obgyn Final

Front 1

What are the four important health topics for promotion & counseling?

Back 1

Pap smear screening
Options for family planning
STD’s and HIV
Changes in menopause

Front 2

According to guidelines, when should a woman for her first screening & how often she should go after that time through her twenties?

Back 2

-First screen: 3 years after first sexual intercourse or by age 21, whichever comes first

-Women up to age 30: Annual screening

Front 3

If a woman has had a hysterectomy, how often she should she go to see her OB-GYN?

Back 3

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.

Front 4

How often should a woman > 30y/o get be screened by her OB-GYN?

Back 4

>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

Front 5

What is primary amenorrhea?

Back 5

Failure to begin menses

Front 6

What is secondary amenorrhea?

Back 6

Cessation of established periods – low body weight, malnutrition, anorexia nervosa, chronic illness hormonal dysfunction

Front 7

What is Polymenorrhea?

Back 7

frequent periods

Front 8

What is Menorrhagia?

Back 8

Increased amount or duration of flow

Front 9

What is Oligomenorrhea & when is this normal?

Back 9

–Infrequent periods, also be irregular
- Pattern 2 yrs after Menarche
- Before Menopause

Front 10

What is Menorrhagia?

Back 10

Increased amount or duration of flow

Front 11

What is metrorrhagia?

Back 11

Inter menstrual bleeding

Front 12

What is post-coital bleeding suggestive of?

Back 12

Cervical Disease.

Front 13

What are other symptoms associated w/ Amenorrhea of Pregnancy & when should one be considered w/ abortion?

Back 13

Breast changes, urinary frequency, nausea and vomiting. If followed by heavy bleeding--> suspect threatened abortion or dysfunctional uterine bleeding.

Front 14

What is the definition of menopause & what is the avg age it occurs?

Back 14

-Absence of menses for 12 consecutive months
-Between ages 45 thru 55

Front 15

What are sx's associated w/ menopause?

Back 15

- vasomotor changes (Hot Flashes)
- sweating
- sleep disturbances
- accelerated bone loss
- increase in total LDL cholesterol
- vulvo-vaginal atrophy leading to vaginal drying,dysuria, dyspareunia

Front 16

Which areas should be examined on external female genitalia & what are the associated symtpoms of those areas?

Back 16

-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)

Front 17

Which areas should be examined in internal female genitalia?

Back 17

-Vagina, vagina walls, cervix, uterus, ovaries, pelvic muscles, rectovaginal wall.

Front 18

What 2 things is it impt for the patient to do/be aware of prior to beginning the pelvic exam?

Back 18

1. Avoid intercourse, douching, or use of vaginal suppositories for 24-48 hrs prior to exam.
2. Empty bladder before exam.

Front 19

In what position should the patient be in for pelvic exam?

Back 19

Supine w/ head & shoulders slightly elevated, arms @ sides or folded across chest to reduce tightening of abdominal muscles.

Front 20

What things are important for the examiner to do during the exam?

Back 20

-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.

Front 21

Should a male doc be assisted by a female assistant in the room?

Back 21

Yes.

Front 22

What does genital herpes look like on physical exam?

Back 22

flat, gray papules.

Front 23

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?

Back 23

Cystocele, Cystourethrocele, Rectocele.

Front 24

What specimens should be obtained during the Pap?

Back 24

-Obtain 1 specimen from endocervix &another from ectocervix.
Determine Cervical Size, Shape, slit-like, lesions, polyp, drainage.

Front 25

What brush should be used during the Pap smear? For pregnant women?

Back 25

-Endocervical Brush Note that for pregnant women use cotton-tip applicator, moistened in saline.
-Cervical Broom

Front 26

What is Mittelschmertz?

Back 26

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.

Front 27

Should you be concerned about clitoromegaly in infants?

Back 27

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

Front 28

What is the difference in endometriosis presentation in adolescents & older women?

Back 28

-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.

Front 29

Should you smell the discharge?

Back 29

If sexual abuse is suspected, its helpful to be aware of characteristic odor of semen.

Front 30

What are the sx's of ectopic pregnancy?

Back 30

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.

Front 31

For a gonococcal, trichomonas vaginalis, and Bacterial Vaginosis or Candida Vulvovaginitis cultures, what would you use to collect specimen?

Back 31

sterile cotton swab

Front 32

For a gonococcal culture, where would you collect the sample?

Back 32

Cervical os.

Front 33

What is the gonococcal specimen collection time& what would you do w/ specimen after its collected?

Back 33

Hold in place for 10-30 secs. Use “Z” technique and smear the specimen on the culture plate

Front 34

For trichomonas vaginalis culture where would you collect the sample?

Back 34

Vaginal discharge.

Front 35

Trichomonas vaginalis: what is the specimen collection time & what would you do w/ specimen once it's collected?

Back 35

No specified time. Place it on a glass slide and add a drop of normal saline

Front 36

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?

Back 36

Vaginal discharge, no specified time, After its collected-->Place it on a glass slide and add a drop of normal saline

Front 37

DNA Probe for Gonorrhea & Chlamydia: what would you use to collect specimen?

Back 37

Dacron swab.

Front 38

Chlamydia/Gonorrhea: Where would you collect specimen? What is the collection time? What would you do w/ specimen once its collected?

Back 38

Cervical os; Rotate in place for 30 seconds. Place it in a special tube containing specimen reagent

Front 39

Is the breast exam usually done before or after pelvic exam?

Back 39

BEFORE

Front 40

How should you insert speculum during vaginal exam?

Back 40

@ 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.

Front 41

What should you be feeling during palpation of cervix?

Back 41

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

Front 42

What is the Pouch of Douglas?

Back 42

rectouterine pouch--extension of parietal peritoneum

Front 43

What types of cells does the vagina have that are on the outer pt of the ectocervix?

Back 43

Squamous cells.

Front 44

What is the ectropion?

Back 44

broad band of columnar epithelium encircling the os.

Front 45

Where does lymph from the vulva & lower vagina drain? Lymph from the internal genitalia?

Back 45

-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)

Front 46

What is leukorrhea?

Back 46

Inc vaginal secretions--coincide w/ ovulation

Front 47

What happens w/ aging?

Back 47

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.

Front 48

What is menarche?

Back 48

Age of 1st period; usually 9-16, takes a yr to get normal; age varies depending on genetics, socioeconomic status, nutrition.

Front 49

Postmenopausal bleeding (bleeding after 6 months of not having period) is suggestive of what?

Back 49

Endometrial CA.

Front 50

What is the difference b/w primary & secondary amenorrhea?

Back 50

Primary--failure to initiate periods;
Secondary: cessation of periods after they've been established.

Front 51

What are the most common vulvovaginal symptoms?

Back 51

Vaginal discharge (find out amt, color, consistency, odor) & itching. Ask about sores or lumps

Front 52

what are some reasons for a woman being unable to reach orgasm?

Back 52

Lack of estrogen, medical illness, psychiatric conditions.

Front 53

What is vaginismus?

Back 53

Involuntary spasm of muscles surrounding vaginal orifice that makes penetration during intercourse painful or impossible (may be physical or psychological)

Front 54

What are the 4 topics important for health promotion & counseling in an OB-GYN exam?

Back 54

1. Pap smear.
2. Options for family planning
3. STDs & HIV
4. Changes in menopause.

Front 55

Excoriations or itchy, small, red maculopapules suggest what?

Back 55

Pediculosis pubis (lice or 'crabs')

Front 56

When the uterus is retroverted, the cervix points more _____ than normal.

Back 56

Anterior

Front 57

Pain on movement of the cervix, together w/ adnexal tenderness suggests what?

Back 57

pelvic inflammatory disease.

Front 58

Nodules on the uterine surface are suggestive of what?

Back 58

Myomas

Front 59

If you can feel an ovary in a postmenopausal woman, what should you consider?

Back 59

Abnormality like a cyst or tumor b/c 3-5 yrs post menopause the ovaries have usually atrophied & are no longer palpable.

Front 60

What are some examples of adnexal masses that one might palpate when trying to feel the ovaries?

Back 60

Ovarian cysts, tumors, abscesses, swollen fallopian tubes of PID, and tubal pregnancy. Uterine myoma make simulate adnexal mass.

Front 61

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?

Back 61

Age, vaginal deliveries, neuro deficits, urinary stress incontinence.

Front 62

Where should you try to palpate to feel an indirect inguinal hernia?

Back 62

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.

Front 63

Chlaymdia trachomatis or Neisseria honorrhea can lead to what condition and what do you need to do on the physical exam?

Back 63

Urethritis; Insert finger into vagina & milk urethra gently from inside outward.

Front 64

What is the most common cause of CA in women worldwide?

Back 64

Breast CA (risk inc w/ age; genetics can be a factor--mutations of BRCA1 & 2)

Front 65

When do women get increased nodularity in the breasts?

Back 65

Premenstrually

Front 66

Which breast/axillary lymph nodes are palpated most frequently?

Back 66

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.

Front 67

When should one be concerned w/ milky breast discharge?

Back 67

-Milky bilateral discharge--or galatorrhea: reflects pregnancy or prolactin or other hormones imbalance.
-Nonmilky unilateral discharge: local breast disease.

Front 68

What are three important topics for health promotion and counseling on breasts?

Back 68

-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

Front 69

At what age should a woman start doing a breast self-exam & how often should she get a clinical breast exam?

Back 69

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.

Front 70

When is the best time of the month to perform a breast self-exam?

Back 70

5-7 days AFTER menstruation onset, since breasts swell & get more nodular before menses due to increased estrogen.

Front 71

What types of changes of the breasts are suggestive of breast CA?

Back 71

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.

Front 72

What three position should you ask the patient to be in to better examine asymmetry in her breasts?

Back 72

1. Arms over head
2. Hands pressed against hips
3. Leaning forward

Front 73

How long does a thorough breast exam take for each breast?

Back 73

3 minutes/each.

Front 74

What are tender cords of the breast suggestive of?

Back 74

Mammary duct ectasia--a benign but sometimes painful condition of dilated ducts w/ surround inflammation, sometimes associated w/ masses.

Front 75

How would you describe a nodule thats strongly suggestive of cancer?

Back 75

Hard, irregular, poorly circumscribed nodules, fixed to skin or underlying tissues.

Front 76

Which characteristics of the nodule should you note?

Back 76

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

Front 77

How would the nipple change w/ cancer?

Back 77

Nipple thickens & loss of elasticity.

Front 78

What does deeply pigmented, velvety axillary skin suggest?

Back 78

Acantosis nigricans--one form of which is assoc w/ internal malignancy.

Front 79

What 2 muscles are behind the breast?

Back 79

Pec major & serratus anterior

Front 80

What is nonpuerperal galactorrhea?

Back 80

Milky discharge unrelated to prior pregnancy & lactation. Leading causes: hormonal, pharmacologic.

Front 81

How should you examine a mastectomy patient?

Back 81

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

Front 82

What are the 2 positions patient can use to do a self-breast exam?

Back 82

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.

Front 83

Describe the characteristics of a fibroadenomas in the breast.

Back 83

Age:15-25, up to 55. Usually single. Round, disclike, or lobular. Well delineated, VERY mobile, usually tender, no retraction signs

Front 84

Describe the characteristics of cysts in the breast.

Back 84

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.

Front 85

Describe the characteristics of CA in the breast.

Back 85

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.

Front 86

How does the breast get retraction signs?

Back 86

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.

Front 87

Describe the peau d' orange sign.

Back 87

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.

Front 88

What is Paget's disease of the nipple?

Back 88

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.

Front 89

What are the three most common kinds of breast masses?

Back 89

Fibroadenoma (benign tumor), cysts, & breast CA.

Front 90

When does one get retention cysts on the cervix?

Back 90

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.

Front 91

Describe a cystocele.

Back 91

Weakened supporting tissue-->Bulge of anterior vaginal wall w/ bladder above it. Involves upper 2/3 of vagina

Front 92

Describe a cystourethrovele

Back 92

Anterior vag wall + bladder & urethra involved in bulge.
-May have groove b/w urethrocele & cystocele.

Front 93

Describe a rectocele.

Back 93

Wkness/defect in endopelvic fascia-->Herniation of rectum into posterior wall of vagina

Front 94

Describe a Bartholin's gland infection and some organisms that can cause it.

Back 94

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.

Front 95

Describe a urethral caruncle.

Back 95

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.

Front 96

Describe a prolapse of urethral mucosa.

Back 96

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.

Front 97

Describe the characteristics of cervical cancer.

Back 97

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.

Front 98

Describe the characteristics of bacterial vaginosis.

Back 98

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')

Front 99

Define parity vs gravidity.

Back 99

-Parity=# of babies delivered (live births or still births)
-Gravidity: # of times a woman has conceived.