Gynecological Exam and Reproductive Health Lecture Review

Flashcards covering PAP technique, uterine positions, menstrual cycle hormones, endometrial cycle phases, breast and pubic hair Tanner stages, cervical cell types, and Pap smear interpretation using SIL, CIN, and the Bethesda system.

What is the first step in a PAP technique for sampling?

Position patient in lithotomy position.

In what position should the patient be for a PAP technique?

Lithotomy position.

After inserting the speculum, what area of the cervix should be visualized?

The transformation zone (squamo-columnar junction).

What is another name for the squamo-columnar junction?

SCJ.

Why is the squamo-columnar junction important for cell collection?

It has the greatest amount of cell turnover.

When should a bimanual exam be performed relative to a Pap smear?

After the Pap smear.

Should lubricant be used during a Pap smear?

No lubricant should be used.

What two tools are primarily used for collecting cervical samples?

Broom OR Cyto brush and spatula.

What type of sample does a broom collect?

Both echocervical and endocervical samples.

How should a broom be rotated when collecting samples?

360°.

What type of samples does a Cyto brush collect?

Endocervical samples.

How far should a Cyto brush be inserted into the canal?

2 cm until fully inside.

How many degrees should a Cyto brush be rotated?

Only 180° to avoid bleeding.

What type of samples does a spatula collect?

Echocervical samples.

How many degrees should a spatula be rotated?

360 degrees.

When should proper labeling of the specimen occur?

Prior to bimanual and prior to collecting cervical cultures.

What method of preparing cells for examination allows for HPV typing?

Liquid based medium (thin prep).

At what age should Pap testing typically start in the USA?

21 years old.

How often should women aged 21-29 have a Pap alone?

Every 3 years.

When is an HPV test reflexively done for women aged 21-29?

Only if ASC-US is present.

For women aged 30-65, how often is co-testing (Pap + HPV) done?

Every 5 years.

For women aged 30-65, how often can a Pap alone be done?

Every 3 years.

At what age can Pap testing usually stop?

65 years old.

What are the criteria for stopping Pap testing at 65?

Adequate negative prior screening and no high-risk history.

What is the most common uterine position?

Anteverted (80%).

Describe an anteverted uterus.

The uterus tips forward.

Describe a retroverted uterus.

The uterus tips backward.

Describe an anteflexed uterus.

The fundus tilts forward.

Describe a retroflexed uterus.

The fundus tilts backward.

During a bimanual exam, where is the cervix positioned with an anteverted uterus?

Anteriorly.

During a bimanual exam, where is the cervix positioned with a retroverted uterus?

More posteriorly.

What hormone triggers ovulation?

LH (luteinizing hormone) surge.

Where does the menstrual cycle cascade initiate in the brain?

Hypothalamus.

What hormone does the hypothalamus release in a pulsatile manner?

GnRH (Gonadotropin-releasing hormone).

What does GnRH stimulate?

The anterior pituitary.

What hormones does the anterior pituitary release?

FSH (follicle-stimulating hormone) & LH (luteinizing hormone).

What does FSH stimulate in the ovaries?

Follicle growth.

What do growing follicles in the ovary secrete?

Estrogen.

After ovulation, what does LH support?

The corpus luteum.

What hormones does the corpus luteum secrete?

Progesterone and estrogen.

How does low/moderate estrogen affect the hypothalamus/pituitary?

Negative feedback, suppressing FSH/LH.

What causes the LH surge that triggers ovulation?

Sustained high estrogen (mid-cycle).

How does progesterone (luteal phase) affect ovulation?

Negative feedback, inhibiting further ovulation.

What is the primary role of GnRH?

Starts the cascade of hormone release.

What are the key actions of FSH?

Follicle development and estrogen production.

What are the key actions of LH?

Triggers ovulation and maintains corpus luteum.

What are the key actions of estrogen?

Builds proliferative endometrium, thins cervical mucus, causes LH surge.

What are the key actions of progesterone?

Stabilizes endometrium, thickens cervical mucus, increases basal body temp.

If fertilization does not occur, what happens to the corpus luteum?

It degenerates within ~14 days and becomes a corpus albicans.

What happens to hormone levels when the corpus luteum degenerates?

Decrease in progesterone and estrogen.

What does the decrease in progesterone and estrogen trigger?

Endometrial breakdown and menstruation.

If fertilization occurs, what hormone does the trophoblast/early embryo secrete?

hCG (human chorionic gonadotropin).

What is the role of hCG if fertilization occurs?

It "rescues" the corpus luteum, maintaining progesterone and estrogen production.

How long does hCG maintain the endometrium until the placenta takes over hormone production?

Approximately 10-12 weeks.

What phase of the endometrial cycle is characterized by shedding of the endometrium and bleeding?

Menstrual Phase (Day 1-5).

What triggers the menstrual phase?

Decreased progesterone and estrogen.

What stimulates the proliferative phase (Day 6-14)?

Estrogen from the developing follicle.

What happens to the endometrium during the proliferative phase?

It thickens and spiral arteries develop.

What happens to cervical mucus during the proliferative phase?

It becomes thin and watery, favorable to sperm.

What stimulates the secretory phase (Day 15-28)?

Progesterone from the corpus luteum.

What happens to the endometrium during the secretory phase?

It becomes edematous, vascular, and nutrient-rich, ready for implantation.

What happens to cervical mucus during the secretory phase?

It thickens, blocking sperm and protecting pregnancy.

What is "Thelarche"?

Breast development.

How long after the growth spurt does thelarche typically initiate?

1 year.

What is "Pubarche"?

Pubic hair growth.

When does axillary hair typically appear relative to pubarche?

2 years after the first appearance of pubic hair.

What is "Menarche"?

The first menstrual period.

When does menarche typically occur relative to thelarche?

1-3 years after thelarche.

What is Tanner Stage 1 for breast development?

No puberty changes.

What is Tanner Stage 2 for breast development?

Slight elevation, breast bud forms, tender, asymmetrical.

What is Tanner Stage 3 for breast development?

Breast forms a mound above the chest, nipple still remains flat.

What is Tanner Stage 4 for breast development?

Areola and nipple separate.

What is Tanner Stage 5 for breast development?

Full-size breast development.

What is Tanner Stage 1 for pubic hair development?

Nothing in the area (none).

What is Tanner Stage 2 for pubic hair development?

Sparse, lightly pigmented hair growth, minimal labia curl.

What is Tanner Stage 3 for pubic hair development?

Coarse, dark, curly hair.

What is Tanner Stage 4 for pubic hair development?

More coarse hair across the pubic area.

What is Tanner Stage 5 for pubic hair development?

Same quality of hair but extends to medial surface of thighs, full development.

What are the two types of cervical cells?

Squamous epithelial cells and Columnar epithelial cells.

Describe squamous epithelial cells on the cervix.

Flat tissue, pink and shiny, covering the knob or surface of the cervix.

Describe columnar epithelial cells in the cervix.

Deep red, found in the interior of the canal (endocervical canal), "column-like cells" with height 4x their width.

What is the transformation zone?

Where columnar epithelium transforms to squamous epithelial cells (metaplasia) at the squamocolumnar junction (SCJ).

What is Cytology the study of?

The microscopic appearance of cells (e.g., Pap results or SILs).

What is Histology the study of?

The microscopic appearance of tissues (e.g., Biopsy or CINs).

What does SIL stand for?

Squamous Intraepithelial Lesion.

When is SIL used to describe changes in the cervix?

To describe Pap test screening results.

What does LSIL stand for?

Low Grade Squamous Intraepithelial Lesion.

What does HSIL stand for?

High Grade Squamous Intraepithelial Lesion.

Is SIL a diagnosis of pre-cancer or cancer?

No, it's NOT a diagnosis of pre-cancer or cancer.

What does CIN stand for?

Cervical Intraepithelial Lesion.

When is CIN used to describe changes in the cervix?

To report cervical biopsy results.

How is CIN graded?

1, 2, or 3.

What does CIN 1 represent?

Mild dysplasia, usually resolves on its own.

What do CIN 2 and CIN 3 represent?

Moderate and severe dysplasia, high grade, treatment required.

What percentage of untreated CIN 3 can progress to cancer?

30-50%.

What system is used for reporting Pap smear results?

The Bethesda System of cytologic classification.

What does NILM stand for in the Bethesda system?

Negative for intraepithelial lesion or malignancy.

What does ASC-US stand for?

Atypical squamous cells of undetermined significance.

What does AGC stand for in the Bethesda system?

Abnormal (Atypical) glandular cells.

If endometrial cells are present in a Pap smear comment for a woman >40 years, what should be evaluated?

Whether the patient is menopausal; if so, shedding endometrial cells would be abnormal.