Medicine Study Set: Pelvic Exam & Family Planning Terms

who should have a pelvic (gyno) exam

every 3 years, all women once they become sexually active (baseline at 21)

3 parts to the pelvic exam

speculum, bimanual, recto-vaginal

during a pelvic exam, inspect the urethral meatus for...

incontinence

during a pelvic exam, you need to palpate...

labia, milk the scenes glands, then labial, then palpate bartholin's glands and perineum

is the speculum exam performed with or without lubricant jelly?

without

visual observation of the cervix

-position

-color

-surface characteristic

-size and shape of "os"

the Os is circle-shaped in who?

nulliparous women

what is the goal of a pap smear?

screen for cervical cancer

Pap smear has decreased the death rate due to cervical cancer by ______%

75%

"bacterial" vaginosis aka vulvovaginitis may be due to...

bacteria, viruses, fungi or protozoans

2nd part of the pelvic exam

bimanual

the bimanual exam is necessary to evaluate...

cervix, uterus, and adnexal regions (ovaries, fallopian tubes, surrounding areas)

with the bimanual exam, you need to move the cervix to assess for...

PID, endometriosis

3rd and final part of the pelvic exam

recto-vaginal exam (DRE)

what does the recto-vaginal exam help evaluate?

posterior aspect of uterus, rectal walls

MC tumor of the pelvis

-very common (40% of women >40)

-MC reason for hysterectomy

-benign

uterine fibroid (myoma, leiomyoma, fibroma)

risk factors for developing uterine fibroids

-older (40+)

-nulliparity or delay childbearing

-African American women (2-3x)

uterine fibroids symptoms

-abdominal distention

-LBP

-heavy menstrual bleeding

-pelvic pressure

-infertility

cauliflower-like radio-opaque mass seen in pelvic cavity, in area of uterus

uterine fibroids

what type of drug therapy is used to treat uterine fibroids?

GnRH agonist

endometrial tissue located outside the uterus

-ectopic tissue responds to hormone levels

endometriosis

endometriosis risk factors

-young age

-family hx

-nuliparity or delayed childbearing

-asians and caucasians

s/s of endometriosis

-pain (LBP/pelvic)

-pelvic mass

-alteration of menses

-dysmenorrhea

-infertility

-dyspareunia

-pain with defecation, urination

-long periods (short time between them)

adhesions caused by inflammation around site of endometriosis, cause uterus and cervix to be "fixed" and cervix is very painful upon movement

peritoneal adhesions

peritoneal adhesions definitive dx

direct visualization of lesions

inability to conceive for over a period of 1 year

infertility

Inflammation of Bartholin gland is commonly caused by...

gonorrhea

(may be staph, e.coli, gonorrhea or chlamydia)

main risk factor for cervical cancer

exposure to HPV

fluid-filled sac in an ovary

ovarian cyst

what type of ovarian cyst is common, single, small and often resolves on its own?

follicular

what type of ovarian cyst is common, large, mucus can spread through abdominal cavity?

mucinous

what type of ovarian cyst is acutely painful, amennorhea

corpus luteum

what type of ovarian cyst may contain teeth or hair, is a heavy cyst, and is prone to torsion and pain?

dermatoid/teratoma

suspect ovarian cancer in a woman >40 years with:

pain, gas, indigestion, pressure, swelling, bloating, cramps, feeling of fullness even after light meal (GI symptoms)

MC site of ectopic pregnancy

fallopian tubes

causes of ectopic pregnancies (what blocks/slows movement)?

-PID (can be from chlamydia)

-scarring

-past ectopic pregnancy

-past infxn

-surgery

symptoms of ectopic pregnancy

LBP, mild cramping on one side of pelvis

ectopic pregnancy exam findings

-pelvic tenderness, tenderness and rigidity of lower abdomen

-cervical motion tenderness (chandelier sign)

-rupture

inflammation and infection of organs in the pelvic region

-complication of STI, MC chlamydia

pelvic inflammatory disease

with _______, during the bimanual exam the patient guards and usually cannot take the examination

acute PID

cervical motion tenderness

-PID

chandelier sign

do STI's in women stay inside or outside the vaginal canal?

inside (can't wash it out ; douches increase risk)

systemic effects of chlamydial infection

-arthritis

-eye infnx

-skin lesions

-infect baby at birth

-reiter's syndrome and PID

with chlamydia, you'll have a ___ increased risk of HIV and other viruses

5X

50% of PID is from ______

chlamydia

how many million women/year get PID?

1 million

how many women/year will become infertile d/t PID?

>100,000 (1 in 8-10 cases)

complications with bacterial vaginosis

-increased susceptibility to AIDS, herpes

-increased risk of PID

-increased risk of pregnancy complications

-infertility

-1/4 women have this (not all will develop lesions but can spread it)

-lesions may be internal, unseen by partner

herpes

what type of HPV causes 50% of all cervical cancer?

HPV 16&18

what % of sexually active men and women acquire genital HPV at some point?

50%

is uterine/endometrial cancer, cervical cancer, or ovarian cancer most deadly?

ovarian

uterine/endometrial cancer risk factors

nuliparity, overweight, HRT/ERT, high animal fat, older age, diabetes, family hx

cervical cancer risk factors

HPV, age >50, smoking, family hx, diet low in fruits/veggies, oral contraceptives (?)

ovarian cancer risk factors

use of HRT, >65, nuliparity, family hx, fertility drugs, obesity, BRCA 1/2

how to prevent uterine/endometrial CA

no HRT< low fat, regular pelvic exams

how to prevent cervical CA

sexual abstinence/monogamy, condoms, no smoking, fruits/veggies, regular Pap tests

how to prevent ovarian cancer

avoid HRT and pill, parity, breast feeding, low fat, more fruits/veggies, regular pelvic exams

who is more likely to die from a heart attack and experience delays in emergency care - women or men?

women

what does a heart attack look like in women?

-may be silent

-anxious, stressed, uneasy

-shortness of breath

-general discomfort, chest tightness

-sweating

-may have unusual pattern

MC cancer in women

-1/3 cases of CA in women

-200,000 new cases last year

breast cancer

how dangerous is breast cancer?

86% survival rate 5 years after diagnosis

who is at greatest risk for breast cancer?

women, >50, family, no children/delayed child bearing, hx, overweight/sedentary

who may have 3 genetic coding errors that may predispose them to breast and ovarian cancer?

ashkenazi jews

-BRCA1 and 2

preventable risk factors of breast CA

-alc consumption >1 serving/day

-HRT/ERT

-delayed childbearing

-no children

-high animal fat

-sedentary lifestype

-obesity

breast cancer prevention methods

increase physical activity, limit alc consumption, limit animal fat, control weight, have children early and breastfeed

breast screening recommendations for ages 20-39

monthly/regular self exams, clinical exam every 3 years

breast screening recommendations for ages 50+

mammogram every 1-2 years, clinical exam every year, monthly/regular self exam

rare but deadly form of breast cancer which is characterized by swelling of breast, itching, skin changes, pink/red/orange colored area, nipple retraction, breast pain, warm breast

-MC younger women

-African Americans increase risk

interstitial great cancer (IBC)

___ out of ___ breast lumps are NOT cancer

8 out of 10

What subset of the female population has seen the greatest increase in the incidence of AIDS?

African American young women

How do most women get exposed to HIV?

heterosexual contact

Which part of the country has the highest incidence and prevalence of HIV in women?

southwest and northeast

(midwest = lowest)

average age of menopause

50 y/o

part of climacteric before menopause

-menstrual cycle irregular

perimenopause (5-8 years before menopause)

menopause clinical conditions

-atrophic vaginitis

-hot flushes

-osteoporosis

-sexual dysfunction

-coronary heart disease

-mood disorders

-cognitive decline

-skin and hair changes

after menopause, risk of CHD are _____ that of women same age before menopause

2-3x

natural and herbal management of menopause

-Soy products (isoflavones)

-Black cohosh

-Wild yam

-Clover

-Ginseng

-Licorice

-Dong quai

these are all examples of _______

-threats or intimidation

-restraint from freedom or activities

-physical violence

-rape or coercive sexual assault

-verbal or emotional abuse

-denying access to support, resources, money

partner violence

how many women report being physically or sexually abused over their lifetime?

1/4

intimate partner homicides accounted for ___% of murders of women and __% of men

30 % women ; 5% men

T/F: growing up in a violent family makes you more at risk to experience partner violence?

True

children who witness abuse:

-more often depressed

-higher rates of suicide

-increase psychological problems

-more likely to become violent/abusive

-law making it a crime to cross state lines to break a restraining order

-abusers cannot legally own a firearm

-federal crime

1994 violence against woman act

when do most serious acts of violence and homicides occur?

when abused women tries to leave

prevalence of infertility in women?

13%

what is the most important prognostic indicator in IVF?

age of female parter

(>43 years... live birth rate is 2.4%)

disadvantages to the "pill"

increased risk of blood clots, stroke, uterine and ovarian cancers, no protection against STD

Who is the pill not recommended for?

women 35+ who smoke

depo-proverb failures

1-7% (99% effective for most)

disadvantages of depo-provera

systemic side effects/risk of hormones, no protection against STDs

flexible plastic rod with progesterone inserted under the skin ; prevents ovulation

implanon

disadvantages of implanon

irregular bleeding, mood swings, HA, weight gain

IUD failure rate

1-3%

advantages of IUD

effective, reliable, does not interfere with spontaneity, no systemic effects

IUD disadvantages

may cause spotting, cramps, may be rejected, scarring effect locally in uterus

condoms failure rate

5-20%

advantages of condoms

inexpensive, available w/o prescription or dr visit, protect from STDs

diaphragm/cervical cup failure rate

6-20% / 10-40% (cervical cap higher failure rate)

natural family planning failure rate

10-20%