Seidel 18 Female Genitalia

Front 1

The symphysis pubis is covered by a pad of adipose tissue called the ___ or ____

Back 1

mons pubis or mons veneris

Front 2

Extending downward and backward from the mons pubis are the ____, two folds of adipose tissue covered by skin

Back 2

labia majora

Front 3

Lying inside and usually hidden by the labia majora are the ____, two hairless, flat, reddish folds

Back 3

labia minora

Front 4

Posteriorly, the labia minora meet as two ridges that fuse to form the ___

Back 4

fourchette.

Front 5

Tucked between the frenulum and the prepuce is the ___, a small bud of erectile tissue, the homolog of the penis and a primary center of sexual excitement.

Back 5

clitoris

Front 6

_____ drain a group of urethral glands and open onto the vestibule on each side of the urethra.

Back 6

Skene ducts

Front 7

____, located posteriorly on each side of the vaginal orifice, open onto the sides of the vestibule in the groove between the labia minora and the hymen

Back 7

Bartholin glands

Front 8

During sexual excitement, ____ secrete mucus into the introitus for lubrication.

Back 8

Bartholin glands

Front 9

The vagina inclines posteriorly at an angle of approximately ___degrees with the vertical plane of the body

Back 9

45 degrees

Front 10

The anterior wall of the vagina is separated from the bladder and urethra by connective tissue called the ____

Back 10

vesicovaginal septum

Front 11

The posterior vaginal wall is separated from the rectum by the _____

Back 11

rectovaginal septum

Front 12

The __________ is a deep recess formed by the peritoneum as it covers the lower posterior wall of the uterus and upper portion of the vagina, separating it from the rectum

Back 12

rectouterine cul-de-sac (pouch of Douglas)

Front 13

In nulliparous women the uterus size is approximately ___cm long, ___cm wide, and ___ cm thick

Back 13

5.5 to 8 cm, 3.5 to 4 cm, 2 to 2.5 cm

Front 14

The nonpregnant uterus weighs approximately ___ g

Back 14

60 to 90

Front 15

The ____ of the uterus comprise the fallopian tubes and ovaries.

Back 15

adnexa

Front 16

Each fallopian tube ranges from___ cm long and is supported by a fold of the broad ligament called the ____

Back 16

8 to 14cm, mesosalpinx

Front 17

The ovaries are approximately ___ long, ___wide, ___thick in the adult woman during the reproductive years

Back 17

3 cm long, 2 cm wide, and 1 cm thick

Front 18

The internal genitalia are supported by four pairs of ligaments:___, ___, ___, ___

Back 18

the cardinal, uterosacral, round, and broad ligament

Front 19

Protrusion of the abdomen as the uterus grows causes the pelvis to tilt ___, placing additional strain on the back and sacroiliac joints.

Back 19

forward,

Front 20

The shallow upper section is considered the ___ pelvis, which consists mainly of the flared-out iliac bones

Back 20

FALSE

Front 21

The ___ pelvis is the lower curved bony canal, including the inlet, cavity, and outlet; through these the fetus must pass during birth

Back 21

TRUE

Front 22

The upper border of the pelvis outlet is at the level of the___, which project into the pelvic cavity and serve as important landmarks during labor.

Back 22

ischial spines

Front 23

The lower border of the pelvis outlet is bounded by the___ and ___

Back 23

pubic arch and the ischial tuberosities

Front 24

In infants/children, The uterus is approximately ___ long, with the cervix constituting about two thirds of the entire length of the organ.

Back 24

35 mm

Front 25

During childhood, the genitalia, except for the ___, grow incrementally at varying rates. Anatomic and functional development accelerates with the onset of puberty and the accompanying hormonal changes.

Back 25

clitoris

Front 26

In adolescents, If the hymen is intact, the vaginal opening is about ___

Back 26

1 cm

Front 27

onset of menstruation (menarche), which on the average, occurs between ____ years of age in the United States

Back 27

11 and 14

Front 28

The high levels of _______that are necessary to support pregnancy are responsible for uterine enlargement during the first trimester.

Back 28

estrogen and progesterone

Front 29

After the third month, uterine enlargement is primarily the result of __________

Back 29

mechanical pressure of the growing fetus

Front 30

During pregnancy, when does the uterus enter the abdominal cavity?

Back 30

12 weeks of gestation

Front 31

Hormonal activity (___ and ___) is responsible for the softening of the pelvic cartilage and strengthening of the pelvic ligaments.

Back 31

relaxin and progesterone

Front 32

Pregnancy, The symphysis pubis relaxes and increases in width, and there is marked mobility of the pelvis at term with resolution of changes occurring within _______ postpartum

Back 32

3 to 5 months

Front 33

During pregnancy, an increase in ___ and ___ causes pelvic congestion and edema

Back 33

uterine blood flow and lymph

Front 34

During pregnan y, The glands near the external os proliferate with eversion of the _____, which tend to be friable.

Back 34

columnar endocervical glands

Front 35

The softness and compressibility of the isthmus result in exaggerated uterine ____ during the first 3 months of pregnancy, causing the fundus to press on the urinary bladder.

Back 35

anteflexion

Front 36

During pregnancy, The vaginal changes are similar to the cervical changes and result in the characteristic ___ color

Back 36

violet

Front 37

During pregnancy, The papillae of the mucosa have a ___ appearance

Back 37

hobnailed

Front 38

During pregnancy, The vaginal secretions increase and have an acidic pH due to an increase in ___ production by the vaginal epithelium.

Back 38

lactic acid

Front 39

___ is conventionally defined as 1 year with no menses.

Back 39

Menopause

Front 40

avergae age of Menopause

Back 40

between 40 and 55 year

Front 41

After menopause, The vagina narrows, shortens, and loses its rugation; and the mucosa becomes thin, pale, and dry, which may result in ___

Back 41

dyspareunia

Front 42

Menopause has systemic effects, which include an increase in___ and ___.

Back 42

body fat and intraabdominal deposition of body fat (tendency toward male pattern of body fat distribution)

Front 43

After Menopause, Levels of total and low-density lipoprotein cholesterol ___

Back 43

increase

Front 44

After menopause, women experience an increased risk of ___ disease

Back 44

cardiovascular

Front 45

shortened interval between periods

Back 45

less than 19 to 21 days

Front 46

lengthened interval between periods

Back 46

more than 37 days

Front 47

High risk HPV

Back 47

HPV 16, 18, 31, 33, 45

Front 48

sexual intercourse before ___ of age is a risk factor for cervical cancer

Back 48

16 years

Front 49

Cervical cancer Cigarette smoking: ___ the risk; tobacco by-products have been found in the cervical mucus of women who smoke.

Back 49

doubles

Front 50

women whose mothers took _____ during pregnancy are at risk for cervical cancer

Back 50

diethylstilbestrol (DES)

Front 51

Race: invasive cervical cancer rates are higher in ___, ___, ___.

Back 51

blacks, Hispanics, and Native Americans/American Indians

Front 52

Some evidence indicates that long-term use (___) of OC may slightly increase the risk of cervical cancer

Back 52

more than 5 years

Front 53

Most ovarian cancers develop after menopause; half are found in women older than ___ of age.

Back 53

63 years

Front 54

Reproductive history risk factor for Ovian cancer; early menarche (before ___), infertility, nulliparity, or first child after ___, menopause after ___

Back 54

early menarche (before age 12), or first child after age 30, menopause after age 50

Front 55

Which Inherited genetic mutation is a risk factor for Ovarian cancer

Back 55

BRCA1 or BRCA2 gene.

Front 56

Ovarian cancer occurs 50% more frequently in __ women than __ women.

Back 56

white > black

Front 57

use of cosmetic __ in feminine hygiene sprays or in sanitary napkins has been suggested as a risk factor for ovarian caner

Back 57

talc (Talcum powder)

Front 58

What about reproductive years are a increase risk factor for endometrial cancer

Back 58

Early menarche: before 12 years of age; Late menopause: after 50 years of age; increases the number of years during which the endometrium is exposed to estrogen.

Front 59

Women with increased bleeding during perimenopause have an increased risk (___greater) of endometrial cancer

Back 59

4 times

Front 60

Having many pregnancies __ endometrial cancer risk, and women who have not been pregnant have a___.

Back 60

reduces, higher risk

Front 61

Obesity increases a woman's risk of endometrial cancer by ___.

Back 61

2 to 5 times

Front 62

What antiestrogen drug is a risk factor for Endometrial Cancer

Back 62

Tamoxifen

Front 63

endometrial cancer more common in women with what endocrine disease.

Back 63

both type I and type II diabetes

Front 64

What genetic mutation is a risk factor for endometrial cancer

Back 64

BRCA1 or BRCA2

Front 65

Position used to for Female GU examination

Back 65

lithotomy

Front 66

Labial swelling, redness, or tenderness, particularly if unilateral, may be indicative of a _____

Back 66

Bartholin gland abscess

Front 67

Labia minora, Look for inflammation, irritation, excoriation, or caking of discharge in the tissue folds, which suggests __ or ___

Back 67

vaginal infection or poor hygiene

Front 68

Labia minora, Discoloration or tenderness may be the result of ___

Back 68

traumatic bruising

Front 69

Labia minora, Ulcers or vesicles may be signs of a___

Back 69

sexually transmitted infection

Front 70

Generally the clitoris is about __ cm or less in length and __ cm in diameter.

Back 70

2cm, 0.5cm

Front 71

Clitoris Enlargement may be a sign of a __ condition

Back 71

masculinizing

Front 72

Urethral orifice, Signs of irritation, inflammation, or dilation suggest repeated ___ or ___

Back 72

urinary tract infections or insertion of foreign objects

Front 73

hymenal remnants (___)

Back 73

myrtiform caruncles

Front 74

Discharge from the Skene glands or urethra usually indicates an infection, most commonly, but not necessarily, ___

Back 74

gonococcal

Front 75

Swelling that is painful, hot to the touch, and fluctuant is indicative of an __ of the Bartholin gland

Back 75

abscess

Front 76

The abscess of Bartholin gland is usually ___ or ___ in origin and is pus filled.

Back 76

gonococcal or staphylococcal

Front 77

A nontender mass on the Bartholin gland is indicative of a ___, which is the result of chronic inflammation of the gland.

Back 77

Bartholin cyst

Front 78

Bulging of the anterior wall and urinary incontinence indicate the presence of a ___

Back 78

cystocele

Front 79

Bulging of the posterior wall indicates a ____

Back 79

rectocele

Front 80

___ is marked by protrusion of the cervix or uterus on straining.

Back 80

Uterine prolapse

Front 81

The perineal surface should be smooth; ___ scarring may be evident in women who have borne children

Back 81

episiotomy

Front 82

A bluish color cervix indicates _________.

Back 82

increased vascularity, which may be a sign of pregnancy

Front 83

Symmetric, circumscribed erythema around the os is an ___ that indicates exposed columnar epithelium from the cervical canal.

Back 83

expected finding

Front 84

A pale cervix is associated with ___

Back 84

anemia.

Front 85

cervix that is pointing anteriorly indicates a ___ uterus; one pointing posteriorly indicates an ___ uterus.

Back 85

retroverted, anteverted

Front 86

A cervix in the horizontal position indicates a uterus in ___

Back 86

midposition

Front 87

Cervix Deviation to the right or left may indicate a___, __, __.

Back 87

pelvic mass, uterine adhesions, or pregnancy

Front 88

Cervix Projection greater than 3 cm may indicate a ____.

Back 88

pelvic or uterine mass

Front 89

The cervix of a woman of childbearing age is usually 2 to 3 cm in diameter. An enlarged cervix is generally indicative of a ____.

Back 89

cervical infection

Front 90

____ may be observed as small, white or yellow, raised, round areas on the cervix

Back 90

Nabothian cysts

Front 91

An ____ becomes swollen with fluid and distorts the shape of the cervix, giving it an irregular appearance.

Back 91

infected nabothian cyst

Front 92

Look for friable tissue, red patchy areas, granular areas, and white patches that could indicate ____, ___, ___.

Back 92

cervicitis, infection, or carcinoma

Front 93

The os of a ___ woman is usually a horizontal slit or may be irregular and stellate.

Back 93

multiparous

Front 94

In pap swear, The cylindric-type brush collects___ cells only.

Back 94

endocervical

Front 95

The ____ device is used for collecting both ectocervical and endocervical cells at the same time

Back 95

broom-type

Front 96

DNA Probe for Chlamydia and Gonorrhea, Use a ___ (with plastic or wire shaft) when collecting your specimen, because wooden cotton-tipped applicators may interfere with the test results

Back 96

Dacron swab

Front 97

In a woman with vaginal discharge, these microscope examinations can demonstrate the presence of Trichomonas vaginalis, bacterial vaginosis, or candidiasis.

Back 97

Wet Mount and Potassium Hydroxide (KOH) Procedures

Front 98

The presence of trichomonads indicates ___.

Back 98

T. vaginalis

Front 99

The presence of bacteria-filled epithelial cells (clue cells) indicates ____

Back 99

bacterial vaginosis (Gardnerella vaginalis)

Front 100

he presence of fishy odor (the "whiff test") suggests___.

Back 100

bacterial vaginosis

Front 101

The KOH dissolves epithelial cells and debris and facilitates visualization of the ____

Back 101

mycelia of a fungus

Front 102

Cervix, Reddened patches, lesions, or pallor indicates a __ or __

Back 102

local or systemic pathologic condition

Front 103

Painful cervical movement suggests a pelvic inflammatory process such as ___ or ___.

Back 103

acute pelvic inflammatory disease or a ruptured tubal pregnancy

Front 104

uterus Deviation to the right or left is indicative of ___, ___, ___.

Back 104

possible adhesions, pelvic masses, or pregnancy

Front 105

____ 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

Back 105

Mittelschmerz,

Front 106

Uterus should be pear shaped and ___cm long

Back 106

5.5 to 8cm

Front 107

A fixed uterus indicates __

Back 107

adhesions

Front 108

Uterus Tenderness on movement suggests a ____ or ___.

Back 108

pelvic inflammatory process or ruptured tubal pregnancy

Front 109

The ovaries, if palpable, should feel firm, smooth, ovoid, and approximately __ by__ by__ cm in size.

Back 109

3 by 2 by 1 cm

Front 110

An extremely tight anal sphincter may be the result of anxiety about the examination; may be caused by scarring; or may indicate spasticity caused by __, __, __.

Back 110

fissures, lesions, or inflammation

Front 111

A lax anal sphincter suggests ____, whereas an absent sphincter may result from improper repair of ___ after childbirth or trauma.

Back 111

neurologic deficit, third-degree perineal laceration

Front 112

For infants, Examination is conducted with the infant's legs held in a ___

Back 112

frog position

Front 113

enlarged clitoris must always suggest ____ when seen in the newborn.

Back 113

adrenal hyperplasia

Front 114

In infants, An imperforate hymen is rare but can cause difficulty later, including __ in the child and ___ in the adolescent.

Back 114

hydrocolpos, hematocolpos

Front 115

If the baby was a ___ delivery, her genitalia may be swollen and bruised for many days after delivery.

Back 115

breech

Front 116

A mucoid, whitish vaginal discharge is commonly seen during the newborn period and sometimes as late as ___after birth.

Back 116

4 weeks , expected finding

Front 117

Vaginal discharges in infants and young children may occur as the result of irritation from the __ or __. These discharges are usually mucoid.

Back 117

diaper or powder

Front 118

___ vaginitis is common in young girls and does not require an internal examination.

Back 118

Bubble bath

Front 119

A previously obscured hymenal opening almost always becomes visible with this technique, as does the interior of the vagina, nearly to the cervix. Most foreign bodies are visible with this method.

Back 119

anterior labial traction

Front 120

In teens, Bartholin and Skene glands are usually not palpable; if they are, enlargement exists. This indicates infection, which is most often (but not always) ___.

Back 120

gonococcal

Front 121

Ask the girl to cough and as she does so, observe the hymen. An imperforate hymen will __

Back 121

bulge

Front 122

A foul odor is more likely indicative of a ___ (particularly in preschool children)

Back 122

foreign body

Front 123

Vaginal discharge may also result from__, __, __ infection

Back 123

trichomonal, gonococcal, or monilial

Front 124

Swelling of vulvar tissues, particularly if accompanied by bruising or foul-smelling discharge, should alert you to the possibility of ___

Back 124

sexual abuse

Front 125

The injuries resulting from sexual molestation are generally more __- and ___ grossly.

Back 125

posterior and may involve the perineum

Front 126

Young women who are not sexually active should have their first examination by age ____.

Back 126

21 years

Front 127

In the ___ month of pregnancy the cervix, vagina, and vulva acquire their bluish color from increased vascularity.

Back 127

second

Front 128

Races have a similar percentage of the gynecoid type, but ___ women more often have the android type, and ___ women more often have the anthropoid type.

Back 128

white, black

Front 129

What sign and what weeks gestation: Softening of the cervix

Back 129

Goodell, 4 to 6

Front 130

What sign and what weeks gestation:Softening of the uterine isthmus

Back 130

Hegar, 6-8 weeks

Front 131

What sign and what weeks gestation:Fundus flexes easily on the cervix

Back 131

McDonald, 7-8 weeks

Front 132

What sign and what weeks gestation:Fullness and softening of the fundus near the site of implantation

Back 132

Braun von Fernwald, 7-8 weeks

Front 133

What sign and what weeks gestation:Palpable lateral bulge or soft prominence of one uterine cornu

Back 133

Piskacek, 7-8 weeks

Front 134

What sign and what weeks gestation:Bluish color of the cervix, vagina, and vulva

Back 134

Chadwick, 8-12 weeks

Front 135

Round shape pelvis

Back 135

Gynecoid (50% of Women)

Front 136

Heart shape pelvis

Back 136

Android (23% of Women)

Front 137

Oval shape pelvis

Back 137

Anthropoid (24% of Women)

Front 138

Flat shape pelvis

Back 138

Platypelloid (3% of Women)

Front 139

Which pelvis type has Usual mode of delivery C-section?

Back 139

Android (23% of Women)

Front 140

the most important clinical measurement for estimating the AP diameter of the pelvic inlet

Back 140

Diagonal conjugate

Front 141

The AP diameter of the pelvic inlet obtained only by x-ray techniques or estimated from the diagonal conjugate (there may be a discrepancy)

Back 141

Obstetric conjugate

Front 142

provides information on the adequacy of the pelvic outlet; two techniques can be used

Back 142

Biischial diameter, intertuberous diameter, or transverse diameter of the outlet

Front 143

Which way of measuring the pelvis can only be estimated

Back 143

Transverse diameter or interspinous diameter:

Front 144

From the symphysis pubis (inferior border) to the sacral promontory

Back 144

Diagonal conjugate

Front 145

From the symphysis pubis (posterior border) to the sacral promontory

Back 145

Obstetric conjugate

Front 146

The narrowest transverse diameter in the midplane between the interspinous processes

Back 146

Transverse diameter or interspinous diameter

Front 147

From the interior border of one ischial tuberosity to the other

Back 147

Biischial diameter, intertuberous diameter, or transverse diameter of outlet

Front 148

___ refers to the thinning of the cervix that results when myometrial activity pulls the cervix upward, allowing the cervix to become part of the lower uterine segment during prelabor or early labor.

Back 148

Effacement

Front 149

Shortening of the cervix (<29 mm) noted on vaginal ultrasound in midpregnancy indicates risk for ____

Back 149

preterm delivery

Front 150

___ is the relationship of the presenting part to the ischial spines of the mother's pelvis.

Back 150

Station

Front 151

The uterus may become more ___ during the first 3 months from softening of the isthmus.

Back 151

anteflexed

Front 152

Early uterine enlargement may not be symmetric, and you may feel deviation of the uterus to one side and an irregularity in its contour at the site of implantation. This uterine irregularity occurs around week 8 to 10 ___sign.

Back 152

Piskacek sign

Front 153

In the ___, the woman lies on her side with both knees bent, with her top leg brought closer to her chest

Back 153

knee-chest position

Front 154

In the___ position the woman lies on her back with her knees bent so that both legs are spread flat and her heels meet at the foot of the table

Back 154

diamond-shaped

Front 155

In the ____ position the woman lies on her back near the foot of the table with her legs supported under the knee by obstetric stirrups

Back 155

obstetric stirrups

Front 156

In the ___ position the woman lies on her back, knees bent and apart, feet resting on the examination table close to her buttocks. entire body supported by the table

Back 156

M-shaped

Front 157

In the ___ position the woman lies on her back with her straightened legs spread out wide to either side of the table. If a woman is able to put one foot in the stirrup, a variation of this position would allow the woman to hold one leg out straight and keep one foot in a stirrup.

Back 157

V-shaped

Front 158

A woman with visual or hearing impairment will probably want to assume a____ position for the pelvic examination

Back 158

foot-stirrup

Front 159

______ usually begins in a woman's late 20s and increases in incidence and severity as menopause approaches. It is characterized by edema, headache, weight gain, and behavioral disturbances such as irritability, nervousness, dysphoria, and lack of coordination. Symptoms occur 5 to 7 days before menses and subside with onset of menses.

Back 159

Premenstrual syndrome (PMS)

Front 160

____ can be caused by insufficient, nonmotile, or immature sperm, ductal obstruction of sperm, and transport-related factors

Back 160

Male infertility

Front 161

inability to conceive over a period of 1 year of unprotected regular intercourse has many causes, including both male and female conditions.

Back 161

INFERTILITY

Front 162

The presence and growth of endometrial tissue outside the uterus causes pelvic pain, dysmenorrhea, and heavy or prolonged menstrual flow. On bimanual examination, tender nodules may be palpable along the uterosacral ligaments. Diagnosis is confirmed by laparoscopy

Back 162

ENDOMETRIOSIS

Front 163

How do Adolescents present with Endometriosis?

Back 163

pelvic pain that is cyclic and noncyclic

Front 164

How do older women present with Endometriosis?

Back 164

The pain in older women is most often cyclic

Front 165

Warty lesions on the labia, within the vestibule, or in the perianal region are the result of human papillomavirus (HPV) infection. Venereal warts are sexually transmitted. They are generally flesh-colored, whitish pink to reddish brown, discrete, soft growths. They may occur singly or in clusters and may enlarge to form cauliflower-like masses

Back 165

CONDYLOMA ACUMINATUM (GENITAL WARTS)

Front 166

Caused by a poxvirus

Back 166

MOLLUSCUM CONTAGIOSUM

Front 167

The lesions are white or flesh-colored, dome-shaped papules that are round or oval. The surface has a characteristic central umbilication from which a thick creamy core can be expressed. The lesions may last from several months to several years. Diagnosis is usually based on the clinical appearance of the lesions.

Back 167

MOLLUSCUM CONTAGIOSUM

Front 168

Lesions of secondary syphilis appear about 6 to 12 weeks after infection. They are flat, round, or oval papules covered by a gray exudate

Back 168

CONDYLOMA LATUM

Front 169

A _____ is a firm, painless ulcer. Most chancres in women develop internally and often go undetected

Back 169

SYPHILITIC CHANCRE (PRIMARY SYPHILIS)

Front 170

_____ is a sexually transmitted infection that produces small red vesicles. The lesions may itch and are usually painful. Initial infection is often extensive, whereas recurrent infection is usually confined to a small localized patch on the vulva, perineum, vagina, or cervix

Back 170

Genital herpes

Front 171

_____ are commonly, but not always, caused by gonococcal infection. It may be acute or chronic. Acute inflammation produces a hot, red, tender, fluctuant swelling that may drain pus. Chronic inflammation results in a nontender cyst on the labium

Back 171

Inflamed Bartholin glands

Front 172

A ___ is a hernial protrusion of the urinary bladder through the anterior wall of the vagina, sometimes even exiting the introitus. The bulging can be seen and felt as the woman bears down. More severe degrees are accompanied by urinary stress incontinence

Back 172

cystocele

Front 173

Hernial protrusion of part of the rectum through the posterior wall of the vagina is called _______. Bulging can be observed and felt as the woman bears down

Back 173

rectocele or proctocele

Front 174

____ in young women may be related to in utero DES exposure. Findings include vaginal discharge, lesions, and masses; and there may be a history of spotting, pain, and change in urinary habits. Cancer of the vulva appears as an ulcerated or raised red lesion on the vulva

Back 174

Vaginal cancer

Front 175

A bright red polypoid growth that protrudes from the urethral meatus, most ___ cause no symptoms

Back 175

urethral caruncles

Front 176

(+)KOH "whiff" test; wet mount: + clue cells

Back 176

Bacterial vaginosis (Gardnerella vaginalis)

Front 177

Pruritic discharge; itching of labia; itching may extend to thighs

Back 177

Candida vulvovaginitis (Candida albicans)

Front 178

White, curdy discharge; pH 4.0 to 5.0; cervix may be red; may have erythema of perineum and thighs

Back 178

Candida vulvovaginitis (Candida albicans)

Front 179

KOH prep: mycelia, budding, branching yeast, pseudohypha

Back 179

Candida vulvovaginitis (Candida albicans)

Front 180

Watery discharge; foul odor; dysuria and dyspareunia with severe infection

Back 180

Trichomoniasis (Trichomonas vaginalis)

Front 181

Profuse, frothy, greenish discharge; pH 5.0 to 6.6; red friable cervix with petechiae ("strawberry" cervix)

Back 181

Trichomoniasis (Trichomonas vaginalis)

Front 182

Wet mount: round or pear-shaped protozoa; motile "gyrating" flagella

Back 182

Trichomoniasis (Trichomonas vaginalis)

Front 183

Purulent discharge from cervix; Skene/Bartholin inflammation; cervix and vulva may be inflamed. Culture/Gram Strain

Back 183

Gonorrhea (Neisseria gonorrhoeae)

Front 184

Partner with nongonococcal urethritis; often asymptomatic; may complain of spotting after intercourse or urethritis ± purulent discharge; cervix may or may not be red or friable DNA probe

Back 184

Chlamydia (Chlamydia trachomatis)

Front 185

Dyspareunia; vaginal dryness; perimenopausal or post-menopausal Pale, thin vaginal mucosa; pH < 4.5 Wet mount: folded, clumped epithelial cells

Back 185

Atrophic vaginitis

Front 186

New bubble bath, soap, douche, or other hygiene products Foul smell; erythema; pH < 4.5 Wet mount:WBCs

Back 186

Allergic vaginitis

Front 187

Red and swollen vulva; vaginal discharge; history of use of tampon, condom, or diaphragm Bloody or foul-smelling discharge Wet mount:WBCs

Back 187

Foreign body

Front 188

Enlarged fluid-filled retention cysts often distort the shape of the cervix. ____ vary in size and may occur singly or in multiples.

Back 188

Infected nabothian cysts

Front 189

___ are bright red, soft, and fragile. They usually arise from the endocervical canal

Back 189

Cervical polyps

Front 190

____ produces a hard granular surface at or near the cervical os. The lesion can evolve to form an extensive irregular cauliflower growth that bleeds easily. Early lesions are indistinguishable from ectropion

Back 190

Cervical cancer

Front 191

Columnar epithelium from the cervical canal appears as shiny red tissue around the os that may bleed easily. ___ is not an abnormality, but because it is indistinguishable from early cervical carcinoma, further diagnostic studies (e.g., Pap smear, biopsy) must be performed for differential diagnosis.

Back 191

Ectropion

Front 192

The ____ as the result of weakening of the supporting structures of the pelvic floor, often occurring concurrently with a cystocele and rectocele. The uterus becomes progressively retroverted and descends into the vaginal canal

Back 192

uterus prolapses

Front 193

In ___ uterine prolapse, the cervix remains within the vagina

Back 193

first-degree

Front 194

In ___ uterine prolapse, the cervix is at the introitus;

Back 194

second-degree

Front 195

in ___ uterine prolapse, the cervix and vagina drop outside the introitus

Back 195

third-degree

Front 196

Types of Uterine Bleeding and Associated Causes: Midcycle estradiol fluctuation associated with ovulation

Back 196

Midcycle spotting

Front 197

Types of Uterine Bleeding and Associated Causes: Anovulation or threatened abortion with excessive bleeding

Back 197

Delayed menstruation

Front 198

Types of Uterine Bleeding and Associated Causes: Chronic PID, endometriosis, DUB, anovulation

Back 198

Frequent bleeding

Front 199

Types of Uterine Bleeding and Associated Causes: Endometrial polyps, DUB, adenomyosis, submucous bleeding leiomyomas, IUD

Back 199

Profuse menstrual

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Types of Uterine Bleeding and Associated Causes: Endometrial polyps, DUB, uterine or cervical cancer, oral contraceptives

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Intermenstrual or irregular bleeding

Front 201

Types of Uterine Bleeding and Associated Causes: Endometrial hyperplasia, estrogen therapy, endometrial cancer

Back 201

Postmenopausal bleeding

Front 202

___ are common, benign, uterine tumors that appear as firm, irregular nodules in the contour of the uterus. They may occur singly or in multiples and vary greatly in size. The uterus may become enlarged

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MYOMAS (LEIOMYOMAS, FIBROIDS)

Front 203

____ occurs most often in postmenopausal women. Nearly all ___ are of the glandular cells found in the lining of the uterus. Most known risk factors linked to the balance between estrogen and progesterone in the body. Women taking Tamoxifen are at increased risk. Postmenopausal vaginal bleeding is a red flag

Back 203

Endometrial cancer

Front 204

Difference between OVARIAN CYSTS AND TUMORS

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Cysts tend to be smooth and sometimes compressible, whereas tumors feel more solid and nodular; neither is usually tender

Front 205

woman older than 40 years of age with persistent and unexplained vague gastrointestinal symptoms such as generalized abdominal discomfort and/or pain, gas, indigestion, pressure, swelling, bloating, cramps or feeling of fullness even after a light meal.

Back 205

OVARIAN CARCINOMA

Front 206

A ____ causes marked pelvic tenderness, with tenderness and rigidity of the lower abdomen. Motion of the cervix produces pain. A tender, unilateral adnexal mass may indicate the site of the pregnancy. Tachycardia and shock reflect the hemorrhage into the peritoneal cavity and cardiovascular collapse. This is a surgical emergency

Back 206

ruptured tubal pregnancy

Front 207

A sudden, dramatic change from mild, even vague abdominal pain that is there but not particularly distressing to a sudden onset of severe abdominal tenderness in the hypogastric area, particularly on the involved side.

Back 207

Ectopic Pregnancy

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___ produces very tender, bilateral adnexal areas; the patient guards and usually cannot tolerate bimanual examination

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Acute PID

Front 209

The symptoms of ___ are bilateral, tender, irregular, and fairly fixed adnexal areas

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chronic PID

Front 210

Inflammation or infection of the fallopian tube is often associated with PID. ___ causes lower quadrant pain with tenderness on bimanual examination

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Salpingitis

Front 211

AMBIGUOUS GENITALIA , partially fused labia suggest the presence of a ___

Back 211

scrotum

Front 212

AMBIGUOUS GENITALIA , urinary meatus that is not located behind the clitoris may indicate the presence of a ___

Back 212

penis

Front 213

Vaginal secretions can collect behind an imperforate hymen. ___ may be manifested by a small midline lower abdominal mass or a small cystic mass between the labia. The condition may resolve spontaneously or may require surgical intervention.

Back 213

Hydrocolpos

Front 214

Vaginal discharge that is accompanied by warm, erythematous, and swollen vulvar tissues is termed ____. Possible causes include sexual abuse; trichomonal, monilial, or gonococcal infection; secondary infection from a foreign body; and nonspecific infection from bubble baths, diaper irritation, urethritis, and injury

Back 214

vulvovaginitis

Front 215

The cause of PROM is not known; however, certain conditions such as __ and ___ have been implicated

Back 215

infection and hydramnios

Front 216

Some health care professionals also consider the rupture of membranes before the onset of labor in a term pregnancy to be premature rupture if labor does not begin in ___

Back 216

12 hours

Front 217

Amniotic fluid placed on a slide and air-dried will have a ___ pattern.

Back 217

"fern"

Front 218

Amniotic fluid has a pH of 7.15 and will turn Nitrazine paper ___.

Back 218

blue-green

Front 219

When the presenting part of the fetus does not fill the pelvic inlet, a loop of cord may advance with the presenting part

Back 219

PROLAPSE OF THE UMBILICAL CORD

Front 220

Predisposing factors are premature labor, a fetus in breech presentation or transverse position, hydramnios, a high or floating presenting part (not engaged), and multiple pregnancy.

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PROLAPSE OF THE UMBILICAL CORD

Front 221

The presence of variable decelerations in fetal heart rate is also associated with ___

Back 221

cord compression

Front 222

In early pregnancy, bleeding may be due to unknown causes of little consequence or to a potentially life-threatening condition such as an ___

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ectopic pregnancy

Front 223

Late in pregnancy, causes of bleeding may range from benign conditions such as cervical changes to a potentially life-threatening ___

Back 223

abruptio placentae

Front 224

However, women who are bleeding in labor or who have a suspected ___ should not be examined without preparation for emergency cesarean section.

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placenta previa

Front 225

____ occur commonly during pregnancy. The varicosities may involve both the vulva and the rectal area. Pressure from the pregnant uterus and possibly hereditary factors contribute to the formation of the varicosities.

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Vulvar varicosities

Front 226

___ is caused by lack of estrogen. The vaginal mucosa is dry and pale, although it may become reddened and develop petechiae and superficial erosions. The accompanying vaginal discharge may be white, gray, yellow, green, or blood-tinged. It can be thick or watery, and although it varies in amount, the discharge is rarely profuse

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ATROPHIC VAGINITIS

Front 227

Estrogen levels begin to rise, preparing follicle and egg for next cycle
Progesterone stimulates endometrial prostaglandins that cause vasoconstriction; upper layers of endometrium shed
Cellular activity in the alveoli decreases; breast ducts shrink
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels decrease
Menstrual bleeding may vary, depending on hormones and prostaglandins

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MENSTRUAL PHASE: DAYS 1 TO 4

Front 228

Ovary and maturing follicle produce estrogen; follicular phase-egg develops within follicle
Proliferative phase-uterine lining thickens
Parenchymal and proliferation (increased cellular activity) of breast ducts occurs
FSH stimulates ovarian follicular growth

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POSTMENSTRUAL, PREOVULATORY PHASE: DAYS 5 TO 12

Front 229

Egg is expelled from follicle into abdominal cavity and drawn into the uterine (fallopian) tube by fimbriae and cilia; follicle closes and begins to form corpus luteum; fertilization of egg may occur in outer one third of tube if sperm are unimpeded
End of proliferative phase; progesterone causes further thickening of the uterine wall
LH and estrogen levels increase rapidly; LH surge stimulates release of egg
Mittelschmerz may occur with ovulation; cervical mucus is increased and is stringy and elastic (spinnbarkeit)

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OVULATION: DAY 13 OR 14

Front 230

Egg (ovum) is moved by cilia into the uterus
After the egg is released, the follicle becomes a corpus luteum; secretion of progesterone increases and predominates
LH and FSH decrease

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SECRETORY PHASE: DAYS 15 TO 20

Front 231

If implantation does not occur, the corpus luteum degenerates; progesterone production decreases, and estrogen production drops and then begins to rise as a new follicle develops
Menstruation starts around day 28, which begins day 1 of the menstrual cycle
Alveolar breast cells differentiate into secretory cells
Increased levels of gonadotropin-releasing hormone (GnRH) cause increased secretion of FSH
Vascular engorgement and water retention may occur

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PREMENSTRUAL, LUTEAL PHASE: DAYS 21 TO 28

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* Evidence of general physical abuse or neglect
* Evidence of trauma and/or scarring in genital, anal, and perianal areas
* Unusual changes in skin color or pigmentation in genital or anal area
* Presence of sexually transmitted infection (oral, anal, genital)
* Anorectal problems such as itching, bleeding, pain, fecal incontinence, poor anal sphincter tone, bowel habit dysfunction
* Genitourinary problems such as rash or sores in genital area, vaginal odor, pain (including abdominal pain), itching, bleeding, discharge, dysuria, hematuria, urinary tract infections, enuresis

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Medical complaints and findings:
For sexual abuse

Front 233

* Problems with school
* Dramatic weight changes or eating disturbances
* Depression
* Sleep problems or nightmares
* Sudden change in personality or behavior
* Aggression or destructiveness
* Sudden avoidance of certain people or places

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Examples of nonspecific behavioral manifestations:
for sexual abuse

Front 234

* Use of sexually provocative mannerisms
* Excessive masturbation or sexual behavior that cannot be redirected
* Age-inappropriate sexual knowledge or experience
* Repeated object insertion into vagina and/or anus
* Child asking to be touched/kissed in genital area
* Sex play between children with 4 years or more age difference
* Sex play that involves the use of force, threats, or bribes

Back 234

Examples of sexual behaviors that are concerning: Sexual abuse

Front 235

No foul odor, itching or edema
Foul-smelling discharge; complains of "fishy odor"

Back 235

Bacterial vaginosis (Gardnerella vaginalis)