Packet 2 (Probably shouldn't look at in public)

Name all external genitalia

Clitoris, labia majora, labia minor, vagina, urethra, perineum, and anus

Name all internal pelvic structures

Uterus, cervix, fallopian tubes, and ovaries

1

Labia majora

2

Labia minora

3

Clitoris

4

Urethra

5

Vagina

6

Perineum

7

Anus

1

Fallopian tube

2

Uterus

3

Ovary

4

Cervix

What is the uterus used for?

Growing the embryo

What is the cervix?

Lower portion of uterus

What is the inner lining of uterus?

Endometrium

How are the ovaries located?

Floats freely and attached by fallopian ligaments

What is the definition of a menstrual cycle?

Recurrent cycle of physiological changes that reoccur in reproductive age women

What are ovarian follicles?

Cysts that contain an egg

What does FSH stand for?

Follicle-stimulating hormone

What does GnRH stand for?

Gonadotropin-releasing hormone

What does LH stand for?

Luteinizing hormone

What are hormones?

Biochemical substances produced in one area of the body and carried via the blood to send signals that trigger responses in another part of the body

What produces GnRH?

Hypothalamus

What does GnRH do?

Stimulates anterior pituitary to release FSH

What does FSH do?

Stimulate the development of follicles in the ovary, one becomes dominant

What do developing follicles produce?

Estrogen

What does the estrogen production from the dominant follicle cause?

The endometrium to thicken in preparation for potential implantation of an egg

When does estrogen production peak?

1-2 days prior to ovulation

What produces the sharp rise of estrogen 1-2 prior to ovulation?

Dominant follicle

What causes the release of LH?

Surge of estrogen

Where is LH produced?

Anterior pituitary

What causes the menstrual cycle?

Hormones

How does LH travel?

Blood

Where does LH travel to?

Ovary

What does LH due to the dominant follicle (prior to ovulation)

Makes a hole that releases an egg

What drop dramatically after ovulation?

Estrogen

What hormone is most found during the follicular phase?

Estrogen

What hormone is most found during the luteal phase?

Progesterone

What does the dominant follicle become after ovulation?

Corpus luteum

What does the corpus luteum produce?

Progesterone and some estrogen

What is progesterone do?

Develops endometrium for a potential fertilized egg

What does HcG stand for?

Human chorionic gonadotropin

If fertilization of the egg occurs what happens?

Corpus luteum’s life is extended by presence of HcG and continues to produce hormones

What hormone extends the life of the corpus luteum?

HcG

As pregnancy progresses what happen?

Hormone production is taken over by placenta

What happens if no pregnancy occurs?

The corpus luteum dies, progesterone levels fall, and a new cycle begins with the onset of menses

What is the physiology of a menstrual cycle?

Driven by hormones, hypothalamus produces GnRH which stimulates anterior pituitary to produce FSH, FSH stimulates the development of follicles in the ovary where one will become dominant, the developing follicles begin to produce estrogen, the estrogen produced by the dominant follicle causes the endometrium to thicken in preparation for potential implantation of an egg, the dominant follicle produces a sharp rise in estrogen which peaks 1-2 days prior to ovulation, this estrogen surge signals the release of LH from the anterior pituitary, LH travels via the blood to the ovary causing an enzyme release that make a hole in the dominant follicle releasing an egg (ovulation), estrogen drops dramatically after ovulation, the dominant follicle transformed by LH becomes the corpus luteum, the corpus luteum continues to produce some estrogen and now also progesterone which is needed to develop the endometrium so a potential fertilized egg can implant, if fertilization occurs the corpus luteum’s life is extended by the presence of HcG and continuing to produce progesterone and some estrogen, as pregnancy progresses hormone production is taken over by the placenta, and if no pregnancy occurs the corpus luteum dies, progesterone levels fall, and new cycle begins with the onset of menses

What signals day 1 of a menstrual cycle?

Day 1 of period

When is ovulation?

14 days before period starts

What signals the last day of a menstrual cycle?

Day 1 of period

What is the first part of the menstrual cycle?

Follicular phase

What is the second part of the menstrual cycle?

Luteal phase

During pregnancy where do sperm and egg meet?

Fallopian tubes

What is the position of the patient in a pelvic examination called?

Lithotomy position

What is this position called?

Lithotomy position

What is a speculum examination?

Speculum inserted intravaginally and opened inside to visualize cervix,

What is a speculum examination good at showing?

Cervical opening

What tissue do you retrieve at the cervical opening?

Squamocolumnar junction

Why do we need to retrieve tissue samples from squamocolumnar junction?

Cancer starts there

How do you do a bimanual pelvic examination?

Use both hands, palpation of inner vaginal organs (uterus, cervix, ovaries), with two digits while pushing up with intervaginal hand

What is this?

Speculum examination

What is this?

Bimanual pelvic examination

What is the first thing you ask about a patients history when discussing women health?

Problem visit or routine

If problem visit what should you ask?

Onset, last time they had intercourse, 7 factors, any previous problems, obstetrical history, GTPAL (gravida, term, preterm, abortion/miscarriage, and living children), birth control and what kind, family history, last normal menstrual period (from day 1 of bleeding), and sexual history and how many

Name 3 types of speculums

Graves, pedersen, and virginal

What speculum do you use for the young?

Pederson

What speculum do you use for a normal adult (non-virgin)?

Graves

What does GTPAL stand for?

Gravida, term, preterm, abortion/miscarriage, and living children

What is gravida?

Amount of pregnancies

What is preterm?

Delivered before 37 weeks

What is term?

Delivered at 37 weeks or after

What should be asked for patient history for a pelvic exam?

Routine or problem visit, 7 factors, onset of problem, duration and relation to cycle, any previous pelvic problems, obstetrical history, GTPAL, any birth control and what kinds, family history, last normal menstrual cycle, and sexual history

What are the 7 factors?

Setting, chronology, location, quality, quantity, aggravating/alleviating factors, and associated manifestations

Physical exams of pelvic anatomy

Visual inspection of external genitalia, speculum exam, bimanual exam, and rectal exam

What does normal vaginal fluid appear as?

Clear to white

Ph of vaginal fluid

3.8-4.5

Vaginal fluid is acidic, neutral, or basic?

Acidic

What bacteria are in vaginal fluid?

Lactobacillus acidophilus, staph epidermidis, and beta-hemolytic strep

What do you see in a microscope slide of vaginal fluid?

Long rods, epithelial cells, and few or no white blood cells

Common vaginal symptoms

Vaginal discharge, swelling or itching, odor, erythema, and edema

What 3 laboratory tests do they do for vaginal infections?

pH Assessment, Amine test (Whiff test), and wet-mount microscopic exam

What is pH assessment good for?

Finding what kind of infection is present

How does a pH assessment go?

Applying a drop of vaginal discharge to pH paper, which should be acidic

If pH is decreased then what kind of infection is likely present?

Yeast infection

If pH is increased what kind of infections are likely present?

Bacterial vaginosis and trichomonas

How does an amine test (whiff test) go?

Small amount of vaginal discharge on a slide with 10% KOH

What results from a positive amine test (whiff test) and what does it indicate?

A release of aromatic amines (fishy odor), which indicates increased presence of anaerobes, which is associated with bacterial vaginosis

What has increased presence in an amine test (whiff test)?

Anaerobes

What does an increased amount of anaerobes mean with in an amine test (Whiff test)?

Bacterial vaginosis

How does a wet-mount microscopic exam go?

Sample of vaginal discharge on a slide mixed with saline solution with a cover slip under a microscope

What are you looking for in a wet-mount microscopic exam?

Bacteria, yeast cells, trichomonads, white blood cells, and clue cells

If you have yeast cells what is it indicative of on a wet-mount microscopic exam?

Yeast infection

If you have trichomonads what is it indicative of on a wet-mount microscopic exam?

Trichomonas

If you have excessive white blood cells what is it indicative of on a wet-mount microscopic exam?

Infection

If you have Clue cells what is it indicative of on a wet-mount microscopic exam?

Bacterial vaginosis

What does a positive Amine test (Whiff test) smell like?

Fishy