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38 Cards in this Set
- Front
- Back
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What position of patient called in pelvic exam?
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dorsal lithotomy position- hips on the edge of the table with feet in stirrups
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What is Chandeler sign?
What does this sign possibly indicate |
when checking for cervical motion tenderness (CMT), the patient has extreme pain (jumps for the chandelier)
- associated with PID |
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For Menstrual history what questions are important?
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• FDLMP
• menarche • Cycle length • Menstruation length • Pain or problems with menstruation? • If menopausal…time of menopause and subsequent treatment |
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With obstetrics how do you label the patient?
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GFP&L
G- grevada or times pregnant F= full term deliveries P= pre term deliveries A= abortions elective and non elective L= #living children |
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What are the prenatal vitamins?
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extra folic acid to prevent neural tube defects
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What are the CAGE questions again?
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• Have you ever tried to cut down
• Have you ever been annoyed with your drinking • Have you ever felt guilty about your drinking • Do you have an “eye opener” drink in the morning |
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At patient visit what is BMI you should address?
What are the preventative medicine? |
<18 or >25
• Calcium and Vitamin D intake • Regular daily exercise • Screening Mammogram • HPV vaccination (9-26) • Prevention of STD • Screening Colonoscopy • DEXA |
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What are the questions you need to ask about the breast?
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– Pain
– Discharge- • Bloody, milky, green – Masses – Nipple inversion (new) – Rash- sometimes inflammatory breast cancer presents like this |
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What are the ROS questions for GU for women?
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– Discharge
– Dysparunia- painful sex• Dryness – Menses - (• Regularity, Heaviness, • Pain • Menarche – Menopause) – Urinary incontinence |
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What is the amount of testing needed for mammography?
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(q1-2 yrs ages 40-50, every year 50+)
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What should the HPV vaccine be given?
What vaccination is given if pt in contact with infant<12 mo or prior to becoming pregnant? |
19-26
- Tdap |
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What are the periodic assessment sexuality questions?
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• Development
• High-risk behaviors • Preventing unwanted/unintended pregnancies (postponing sexual involvement, contraceptive options) • Sexually Transmitted diseases (partner selection, barrier protection) • Prevention of Date Rape • Reproductive Health Plan/preconceptual counseling (all ages over 18) • Sexual function |
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Questions to ask about Fitness/Nutrition/Psychosocial?
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• Discussion of exercise program
• Dietary/nutrition assessment (eating disorders) • Folic Acid Supplementation • Calcium Intake • Suicide/Depression symptoms • Interpersonal/family relationships • Sexual Orientation and Gender identity • Personal Goal Development/Work/Retirement enjoyment |
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Once you get the patient up and ready what is the order?
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1. external genitalia exam- not abnormalities
2. palpate inguinal lymph nodes, spread mons pubis for moles, do Tanner staging 3. Examine labia majora and minora 4. With your gloved index finger, tell your patient that you are going to insert a finger – place the tip of your index finger at the introitus of the vagina. Place slight posterior pressure to the perineum and the posterior forchette and ask your patient to try to relax that muscle. |
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How do you insert the speculum?
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If right handed
1. With your right hand, start to insert the closed speculum over the tip of your left index finger. Remove your left finger as the speculum advances. 2. Continue to advance the speculum with your right hand, as your left hand moves the labia minora on the superior side of the introitus and the speculum out of the way. 3. Aim the speculum to the posterior cul de sac at the top of the vagina -->posterior and down |
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If doing slide for Pap what do you do order wise and instruction wise?
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1. spatula first and place it in the cervical os (endocervical and turn 360 degrees)
2. two way to create a pap "smear" - slide- on about half of the top of the slide, wipe one side of the spatula, and then wipe the other (spatula first and cytobrush second) - thin prep- may swish or actually drop part of the swab into media |
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Describe the internal- bimanual exam...
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Put lubricant on hand and tell patient that you are going to check her female parts on the inside
- when you insert the fingers into the vagina your left hand site on the suprapubic area (feel ovaries and fundus of ovary)? |
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How do you feel for the ovaries?
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Let go of the cervix and move your two fingers to the patient’s right posterior cul de sac. Gently push up intravaginally (superior and anterior) with your right hand while gently pushing down (inferior and posterior) with your left suprapubic hand. You are trying to feel the right ovary. Estimate the size of the right ovary.
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Ovaries should feel like what?
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Normal ovaries feel like fleshy, fibrous, gum. They are oval
shaped and “slide” between your two hands. It’s a little uncomfortable for the patient to put pressure on them. Usually very easy to palpate in thin women, but may be difficult to feel in larger ladies |
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What is menarche?
Which hormone is released in pulses and what does the speed of the pulse determine? |
onset of menstrual cycle, after onset of normal cycles GnRH is released in pulses
- rapid pulses- favors LH release and FSH is favored with slow pulsess |
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What is the term describes breast development?
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Thelarche- requires estrogen
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Describe the Tanner staging for five stages of breast development...
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1. only niple is raised above the level of the breast with child
2. Budding stage- bud-shaped elevation of the areola, increased diameter and surrounding area slightly elevated 3. Breast and areola enlarged 4. Increasing fat deposits 5. Adult stage areola is part of the general breast contour and strongly pigmented |
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Describe the 6 stages of Tanner staging for femal puberty vaginal development
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slide 10
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How do you define precocious puberty? MCC?
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Development of any sign of secondary sexual maturation at an age earlier than 2.5 SD less than expected age (8)
MCC- idiopathic |
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What is Heterosexual precocious puberty: (causes?)
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development of secondary sexual
characteristics opposite those of anticipated causes- virilizing neoplasms, congenital adrenal hyperplasia, or exposure to exogenous androgens |
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What is isosexual precocious puberty?
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premature sexual maturation that is appropriate for the phenotype of the affected individual
Causes: constitutional and organic brain disease (tumors, trauma |
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Define delayed puberty?
Causes? Tests? |
Failure to under thelarche by age 14
causes: hypogonadotropic hypogonadism (ex. Anorexia nervosa, Kallman syndrome) or hypergonadotropic hypogonadism (chromosomal or injury to ovaries by surgery, chemotherapy, radiation therapy) Tests: MRI of brain, FSH (to see if pituitary is doing job), karyotype, progesterone, prolactin |
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Amenorrhea define primary and secondary...
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primary- no spontaneous uterine bleeding by age of 16
secondary- patient with prior menses has abesent menses for 6 months or more |
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Slide 17 fucking high yield as balls
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cone sucks the balls
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Most common cause of hypogonadotropic hypogonadism (low FSH and LH levels) is?
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constitutional delay of growth and puberty
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Cllinical features of androgen insensitivity? (karyotype?
Who may have this? |
Apparently Jaime Lee Curtis
- Normal breasts but no sexual hair • Normal looking female external genitalia - Absent • uterus and upper vagina Karyotype 46, XY • Male range testosterone level • Treatment : gonadectomy after puberty + HRT |
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Vulvar/Vaginal Congenital Anomalies
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1. Transverse vaginal septum- wouldnt be able to get the speculum in, found at juntion of upper and middle thirds of the vagina someties with perforation
2. Atresia of vagina- lack of canalization at caudal or cranial ends of vaginal plate |
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Differential diagnosis of Secondary Amenorrhea
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1. Pregnant!
2. Thyroid disease 3. Hyperprolactinemia 4. Hypothalamic- pituitary dysfunction - (anorexia, breastfeeding, vigourous exercise, severe psychological stress, systemic disease) 5. Hypergondotropic hypogonadism- premature ovarian insufficiency (symptoms of hot flushes/dyspaurenia) 6. Asherman's Syndrome- intrauterine scarring causes lack of menstration: test with HSG |
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Tests for no period last six months...
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UCG (pregnancy), TSH, Prolactin, FSH
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if pt has normal prolactin and abnormal TSH and Mild hypothyroid what kind of menstrual problem is associated
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More often associated with hypermenorrhea or
oligomenorrhea (as opposed to amenorrhea) – Treatment should restore menses • May take several months |
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What is tested for ovarian neoplasms (sertoli-leydig tumor)
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total testosterone > 200ng/dl
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Describe the treatment for the following types of bleeding?
1. massive bleeding 2. moderate bleeding 3. uresponsive to conservative treatment |
1. Massive Bleeding - 25mg IV conjugated estrogens then hormonal treatment (combination hormonal therapy, Mirena)
2. • Moderate Bleeding - Combination hormonal treatment, Mirena, Lysteda (trenexamic acid) 3. • Unresponsive to conservative therapy : Endometrial ablation, hysterectomy |
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Define the following...
a. polymenorrhea b. menorrhagia c. metrorhagia |
a. abnormally frequent menses at interval at <24 days
b. excessive and/or prolonged menses (>80mL and > 7 days) occuring at normal intervals c. metrorrhagia: irregular episodes of uterine bleeding |
