Exam 2 - Gynecological Observation

what is a UTI

infection that occurs in any part of urinary system including the kidneys, ureters, bladder, and urethra

what are some symptoms seen on physical examination of a UTI

suprapubic tenderness on palpation

red or swollen urethral meatus

absence of systemic signs like fever

true or false:

fever is never possible with UTIs

false it is possible with upper UTIs

what are common types of UTIs

cystitis: infection of bladder

urethritis: infection of urethra

pyelonephritis: infection of kidney

what are risk factors for UTI

female (short urethra)

sexual activity (urinate after intercourse)

chronic use of spermicides

menopause

chronic health conditions

what are treatment options for UTI

antibiotic therapy

pain management

hydration

cranberry juice

what are normal findings of the Skene's gland

no visible swelling or redness of urethra

no expressed discharge while milking

mild pressure may feel strange but not painful

what are normal findings of bartholin glands

not distinctly palpable

no visible swelling, redness, or asymmetry

no tenderness when compressed

what are findings for Bartholin Cyst

painless or mildly tender

soft, fluctuant mass at 4 or 8 o'clock near vaginal opening

overlying skin appears normal or slightly stretched

patient may notice "lump when I sit or walk"

findings for bartholin abscess

very tender, warm, red swelling

unilateral

painful to walk, sit, have intercourse

possible fever or systemic symptoms

what are normal Labia findings

mild asymmetry, color variation, and hyperpigmentation

small sebaceous cysts, healed scars

occasional ingrown hairs or follicles on labia majora

what is a condition of the labia which produces thin, white crinkled plaques

lichen sclerosis

what do the vaginal walls of a reproductive-age female look like

pink, moist, rugae/wrinkled walls

no focal erythema, ulcers, or plaques

thin layer of clear/white discharge

what do the vaginal walls of a postpartum/late-cylce female look like

mucosa may appear more congested or slightly bulish

discharge consistency can change with cycle phase

what are typical rugae findings

good estrogen support if they are present

smooth, pale, thin walls suggest atrophy or low estrogen state

what is this describing?

pale, thin, smooth walls with loss of rugae

petechiae, easy bleeding with contact

dryness, burning, dyspareunia

due to low estrogen

atrophic vaginitis

what does physiologic/normal discharge look like

clear to white, non-clumpy

mild or no odor

describe bacterial vaginosis

thin, gray-white discharge

often coats vaginal walls

fishy odor

describe candida

thick, white, cottage-cheese discharge

clumpy and adherent

intense itching and burning

describe trichomonas

frothy, yellow-green discharge

may see strawberry cervix

often strong odor

what is a normal color of the cervix during pregnancy

blueish hue

what are signs of pregnancy on examination

goodell

chadwick

hegar

mcdonald

braun von fernwald

what is goodell sign

softening of cervix

what is chadwick sign

bluish/purplish color of cervix, vagina, and vulva

what is hegar sign

softening of the uterine isthmus due to hormones of pregnancy

what is mcdonald sign

fundus flexes easily on the cervix

what is braun von fernwald sign

fullness/softening of fundus at site of implantation

what is chandelier sign

tenderness upon palpation of cervix

who more commonly has uterine prolapse

postmenopausal women, especially those who have had multiple vaginal deliveries

what is a typical presentation of uterine prolapse

history of multiple vaginal births

symptoms worsen with prolonged standing or physical activity

history of chronic cough or constipation

vaginal bulge or feeling of something falling out

pelvic pressure, especially end of day

incontinence, urgency, or difficulty emptying bladder

difficult bowel movements

what is a cystocele

bladder prolapse

what is a rectocele

rectal prolapse

what is the best standard for diagnosis of uterine prolapse

physical exam

what are risk factors of uterine prolapse

childbirth

older age

menopause

obesity

chronic conditions

what are some treatment options for uterine prolapse that are least invasive

pelvic floor exercise

pessary devices (hold uterus in place)

what are some treatment options for uterine prolapse that are moderately invasive

hormonal therapy

what is the most invasive treatment option for uterine prolapse

surgical repair

what is the most common type of cervical cancer

squamous cell carcinoma (outer part of cervix)

what cervical cancer develops in the glandular cells that line the cervical canal

adenocarcinoma

cervical cancer is the ___ leading cause of cancer deaths in females

fourth

what is typical patient presentation of cervical cancer

persistent infection with high-risk HPV strains

dyspareunia

pelvic pain and discomfort

abnormal vaginal bleeding

unusual vaginal dishcarge

unexplained weight loss and fatigue

what are the high-risk strains of HPV? what do these put you at risk for???

HPV 16 and 18

CERVICAL CANCER

what are risk factors for cervical cancer

HPV infection

multiple sex partners

smoking

oral contraceptives

what is the screening tool for cervical cancer? what is the gold standard for cervical cancer diagnosis?

pap smear

cervical biopsy

what is the least invasive cervical cancer treatment option

watchful waiting

cryotherapy

LEEP

what is the moderately invasive cervical cancer treatment

conization (removal of cone-shaped section of abnormal tissue)

what is the most invasive treatment option for cervical cancer

radiation

chemotherapy

hysterectomy

pelvic exenteration (remove pelvic organs)

what is the most common type of vulvar cancer

squamous cell carcinoma

what is typical patient presentation of vulvar cancer

Persistent itching, burning, or pain in the vulva

Skin changes, such as color changes or thickening

History of HPV infection, particularly with high-risk strains

Immunosuppression (e.g., HIV infection)

Pain or tenderness in the vulvar area

A visible lump, ulcer, or wart-like growth, especially one that is not healing

Bleeding or discharge not related to the menstrual cycle

what are risk factors for vulvar cancer

HPV

women over 50

chronic vulvar conditions

smoking

immunosuppression

history of cervical precancer or cancer

what is the gold standard for vulvar cancer diagnosis

biopsy

what are treatments for vulvar cancer in order from least to most invasive

topical tx for skin lesions

surgical excision, radiation therapy

radical vulvectomy, chemotherapy

what is the most common vaginal cancer

squamous cell carcinoma

what is typical patient presentation for vaginal cancer

abnormal vaginal bleeding especially postmenopausal or postcoital

watery or bloody vaginal discharge

pelvic pain or pressure

dyspareunia

presence of a mass or lump in vagina

what are risk factors for Vaginal Cancer

HPV

women over 60

history of cervical cancer

smoking

what three cancers have HPV as a risk factor

cervical, vaginal, and vulvar

what is the gold standard for diagnosis vaginal cancer

biopsy

what are treatment options for vaginal cancer from least to most invasive

topical tx

surgical excision, radiation

vaginectomy, pelvic exenteration, chemo