PD II Female GU Pt 1 (A&P, Hx, S&S)

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119 Terms

1

what are the glands of the vestibule?

Skene’s and Bartholin’s (greater vestibular)

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2

where are the Skene’s glands?

paraurethral

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3

where are the Bartholin’s glands?

posterolateral to the vaginal orifice

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4

what is the vagina?

passage connecting uterus and introitus

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5

what is the introitus?

opening of vagina

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6

what are the borders of the vagina?

  • anterior = urethra

  • posterior = rectum

  • inferior = vulva

  • superior = cervix

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7

what are rugae?

transverse folds where vaginal mucosa lies

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8

what is the function of the vagina?

intercourse and birthing canal

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9

what are the forcines of the vagina?

  • anterior

  • posterior

  • lateral (2)

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10

where is the anterior fornix?

near vesico-uterine pouch

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11

where is the posterior fornix?

betw posterior vagina and cervix near rectovaginal pouch

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12

what can be palpated from the lateral fornices?

ovaries and fallopian tubes

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13

what is the arterial supply of the vagina?

internal iliac a.

  • uterine a.

  • vaginal a.

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14

where does the upper 1/3 of the vagina drain into?

inguinal nodes

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15

where does the lower 2/3 of the vagina drain into?

pelvic, sacral, and abdominal nodes

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16

what is the arterial supply of the uterus?

uterine and ovarian a.

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17

where does the uterus drain into?

lumbar nodes

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18

what is the ectocervix?

covering cervical face

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19

what is the endocervix?

in cervical canal (AKA os)

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20

what are the squamous cervical epithelium?

shiny, pink (outer)

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21

what are the columnar cervical epithelium?

deep, red, plushy (inner)

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22

where do the squamous and columnar cervical epithelium meet?

squamocolumnar junction

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23

what is the transformation (transitional) zone?

AKA squamocolumnar junction, where pap smears are obtained

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24

what occurs at the squamocolumnar junction?

area of constant cellular activity

  • highly sensitive to irritants, mutagens, and viral agents (HPV)

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25

what is an anteverted/anteversion uterus?

NORMAL POSITION

  • forward facing

  • right angle to vagina

  • posterosuperior to bladder

  • anterior to rectum

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26

what is a retroverted/retroversion uterus?

BACKWARD TILTED

  • tipped back aiming towards rectum INSTEAD of toward abdomen

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27

what is a retroflexed uterus?

uterus is bent backwards towards rectum

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28

what are the components of the adnexa?

  • ovaries

  • fallopian/uterine tubes

  • supporting ligaments (broad, round, ovarian)

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29

what conditions are related to the adnexa?

masses or tenderness

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30

what are the primary functions of the ovaries?

  • production of ova (eggs)

  • secretion of hormones

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31

what hormones are secreted from the ovaries?

  • estrogen

  • progesterone

  • testosterone

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32

what hormone is secreted by the hypothalamus?

GnRH

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33

what hormones are secreted from the pituitary?

FSH and LH

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34

what hormone is secreted from the follicle?

estrogen

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35

what is menarche?

1st period

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36

what are the aspects of the menstrual cycle?

  • days between day 1 and day 1

  • days of bleeding

  • regularity

  • associated moliminal sxs

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37

what is menopause?

cessation of menses x 1 yr

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38

what does G stand for in the GPA system?

gravida, total number of pregnancies

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39

what does P stand for in the GPA system?

parity, pregnancies > 20 wks

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40

what does A stand for in the GPA system?

abortions (spontaneous or induced termination)

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41

what is a normal menstrual frequency?

> 24 and < 38 days

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42

what is a normal menstrual duration?

< 8 days

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43

what is dysmenorrhea?

painful menses

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44

what is primary dysmenorrhea?

begins shortly after menarche and occurs with every menses

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45

what causes primary dysmenorrhea?

increased endometrial prostaglandin synthesis —> increased tone

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46

how is primary dysmenorrhea treated?

decrease prostaglandins (NSAIDs)

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47

what is secondary dysmenorrhea?

acquired disorder as a result of endometriosis, IUDs, polyps, fibroids, obstruction of flow, etc

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48

how is secondary dysmenorrhea treated?

treat primary cause

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49

what is an imperforate hymen?

blockage of normal vaginal opening

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50

what results from an imperforate hymen?

amenorrhea as a result of a vaginal outlet obstruction

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51

what s/sxs are associated with amenorrhea?

lower abdominal pain, dysuria, bowel movement changes

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52

how is an imperforate hymen treated?

perforation

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53

what causes a painless vaginal chancre?

syphilis

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54

what causes painful vaginal vesicles?

HSV

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55

what causes painful vulva masses?

abscess of Bartholin gland

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56

what causes vaginal venereal warts?

HPV

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57

what is the normal vaginal pH?

< 4.5

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58

what is leukorrhea?

vaginal discharge

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59

what bacteria is predominant in a healthy vagina?

lactobacilli

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60

during what part of the menstrual cycle are vaginal secretions clear and elastic?

estrogen surge

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61

during what part of the menstrual cycle are vaginal secretions thicker and white?

Luteal phase

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62

what is the most common cause of candida vaginitis?

Candida albicans

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63

what risk factors are associated with candida vaginitis?

  • antibiotics/steroids

  • diabetes

  • OCP

  • immunosuppression

  • douching

  • tight clothing

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64

what s/sxs are associated with candida vaginitis?

  • white, curd-like “cottage cheese” discharge

  • no odor

  • pruritis

  • dysuria

  • dyspareunia

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65

how does candida vaginitis present on exam?

  • inflammed vulva/vagina mucosa

  • +/- friability with thick adherent white discharge

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66

how is candida vaginitis diagnosed?

KOH prep with branching/pseudohyphae

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67

how is candida vaginitis treated?

antifungal (oral, topical, intravaginal)

  • -AZOLE!!

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68

what is bacterial vaginosis?

elusive pathogenesis, polymicrobial anaerobic overgrowth

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69

what is the most common cause of bacterial vaginosis?

Gardnerella vaginalis

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70

what risk factors are associated with bacterial vaginosis?

  • multiple sex partners

  • frequent intercourse

  • after douching

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71

how is bacterial vaginosis diagnosed?

Gram stain and Amsel criteria (3/4)

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72

what are the Amsel criteria?

  • homogenous, non-clumping VD

  • amine (fishy) odor when potassium hydroxide solution is added to vaginal secretions

  • presence of clue cells (> 20%) on microscopy

  • vaginal pH > 4.5

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73

in what pathologies can the “whiff" test” be positive?

BV and trich

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74

what are clue cells?

stippled appearance due to adherent coccobilli and fuzzy, obscured borders

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75

how is BV treated?

  • metronidazole (Flagyl or Metrogel) (PO or topical/vaginal)

  • clindamycin (Cleocin or Clindesse) (PO or topical/vaginal)

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76

what risks are increased with BV?

  • pregnancy complications

  • STIs

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77

what is a common side effect of clindamycin?

C. diff infections

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78

what is a common side effect of metronidazole?

disulfuram rxn

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79

what are the signs/symptoms of trichomonas?

  • vulvovaginitis (dysuria, dyspareunia)

  • leukorrhea (yellow/gray/green, frothy, odor)

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80

how does trichomonas present on exam?

  • vaginal erythema

  • “strawberry cervix” (punctate erythema on cervical face)

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81

how is trichomonas diagnosed?

  • wet mount

  • culture

  • detected on pap smears

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82

what is seen on a positive trich wet mount?

motile trichomonads (single celled parasite with 2-5 plagellae)

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83

how does gonococcal cervicitis present?

  • green, yellow, no odor, adherent

  • pus from cervical os

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84

what is vulvitis?

external genital pruritus, burning, redness, rash

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85

what is vaginitis?

inflammation of the vagina

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86

what is vulvovaginitis?

vaginal irritation, pain, and pruritus

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87

what can cause vaginal itching?

  • candidiasis

  • glucosuria (DM, DM rx, renal tubule acidosis)

  • vulvar leukoplakia

  • external irritant

  • psychosomatic

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88

what treatment should be AVOIDED for vaginal itching?

talcum powder on vulva

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89

what can cause abdominal pain?

  • complication of pregnancy

  • acute inflammation

  • chronic inflammation

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90

what acute inflammation can cause abdominal pain?

  • infections

  • ovulatory (mittelschmerz)

  • IUD

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91

what chronic inflammation can cause abdominal pain?

  • structural/functional disorder

  • infections

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92

what is dyspareunia?

pain during or after intercourse

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93

what physiologic causes can cause dyspareunia?

  • infection

  • tumors (rectovaginal septum, uterus, ovaries)

  • atrophic vaginitis

  • inadequate lubrication

  • vaginismus

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94

what is vaginismus?

severe pelvic pain and spasm when labia is merely touched

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95

what psychogenic causes can cause dyspareunia?

  • fear of pregnancy

  • penetration anxiety

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96

what can cause general changes in hair distribution?

  • dermatologic alopecia

  • dieting, stress

  • infection

  • idiopathic, autoimmune

  • thyroid disease

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97

what is hirsutism?

excess hair on face, trunk, or limbs (male pattern)

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98

what condition is associated with hirsutism?

PCOS

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99

what s/sxs are associated with PCOS?

  • amenorrhea

  • oligomenorrhea

  • infertility

  • acne

  • obesity

  • aconthosis nigricans

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100

what is virilization?

excessive hirsutism with receding temporal hair, deep voice, or clitoral enlargement

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