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1

who gets pelvic exam

all women 21+, unless you have an OB or GYN problem-specific complaint

<21 years old, inspect lesions but do not perform internal

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2
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3

what does the pelvic exam look at

size, position of vagina, cervix, uterus, and ovaries

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4

when do you get a pelvic exam

  • annually over 21 (regardless of sexual activity)

  • during pregnancy

  • suspect infection

  • women with pain in her pelvic or low back area

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5

why do you do a pelvic exam

diagnosis pathology such as pregnancy, infection or cancer

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6

Mons pubis

fat pad over pubic symphysis

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7

Labia majora

rounded folds of adipose tissue

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8

labia minora

thinnner, pinkish red folds that extend anteriorly to form prepuce

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9

vestibule

boat-shaped fossa btw labia minora

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10

introitus

vaginal opening

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11

perineum

tissue btw introitus and anus

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12

urethral meatus

open into vestibule btw clitoris and vagina

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13

paraurethral (skenes) glans

posterior to the urethral meatus on either side

  • lubrication during sexual activity

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14

Bartholins glands

located posteriorly on either side of vaginal opening

  • normal secretion for lubrication

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15

vagina

musculomembranous tube extending upward and posteriorly btw urethra and rectum

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16

uterus

flattened fibromuscular structure shaped like inverted pear

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17

cervix

lower part of the uterus (extend into vagina)

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18

Adnexa

refer to ovaries, fallopian tubes and supporting tissues

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19

where is the clitoris found

between the prepuce

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20

size of ovaries

3.5 cm

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21

when are ovaries palpable

only in childbearing age

shrink after menopause due to increase in hormones→ if felt may indicate cancer

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22

ectoervix

outer surface, squamous epithelium surround the os

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23

transformation zone

squamocolumbar junction migrates toward os as patient ages

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24

where is cervix located

top of vaginal canal

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25

where is pap smear sampled from

transformation zone

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26

describe cervix during puberty

broad band of deep red columnar epithelium around os is replaced by squamous epithelium

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27

why do you look at cervical os when doing an exam

slit like indicate pregnancy

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28

average age of menarche

12.5

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29

normal cycle length

21-35 days

average 28 days

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30

why is menarche before average age concerning

increased exposure to hormones = increased risk for endometrial or breast cancer

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31

typical length of menses

3-7 days

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32

why is long menses (7+ days) of concern?

risk of anemia (same with heavy flow)

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33

dyspareunia

pain with intercourse

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34

how to classify heavy, light, moderate flow?

number of tampons per hour

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35

amenorrhea

absence of menses

no menarche by 15 yo (primary) or >3 missed menstrual periods (secondary)

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36

PMS

emotion, behavioral and physical sx occurring 5 days before menses for 3 consecutive days

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37

menopause

12 mo without menses

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38

premenopausal

intermittent menses

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39

premature ovarian failure

menopause < 40 yo

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40

post menopausal bleeding

bleeding >6 mo or more after cessation of menses

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41

polymenorrhea

cycle last <21 days

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42

oligomenorrhea

infrequent bleeding

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43

menorrhagia

abnormally heavy menstrual bleeding

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44

metrorrhagia

uterine bleeding at irregular intervals

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45

postcoital bleeding

bleeding after intercourse

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46

Gravida

total # of pregnancies

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47

Para

outcome of pregnancies

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48

GP (FPAL)

full term

premature

abortions

living children

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49

what is considered premature

under 37 weeks but over 20

20-36 weeks

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50

what is considered a full term pregnancy

37 weeks

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51

what is considered abortion

under 20 weeks

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52

acute pelvic pain is considered? chronic

< 6 mo

at least 6 mo

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53

DES exposure if likely if pt born before

1971

may be at risk for vaginal or cervical cancer due to exposure

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54

myomectomy

removal of fibroids (benign)

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55

common surgeries

  • hysterectomy

    • partial or complete

  • Ovarian cystectomy

  • C section

  • Myomectomy

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56

A 34 yo female present today for her first pre-natal visit. She tells you that she has 1 living child that was preemie. She had 2 elective abortions when she was 17, 1 miscarriage, 1 full term child that passed away at 6 mo due to SID. What are her G and P

G6 P(F1 P1 A2 L1)

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57

patients should have nothing in the vagina for …. hours prior to a pelvic exam

48 hours

no sexual activity, tampons, douching

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58

T/F you should no void prior to exam

F- you should void

pressing on bladder can be uncomfortable

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59

position of pelvic exam

dorsal lithotomy

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60

bimanual exam palpation

used to check a woman's internal pelvic organs

  • inserts two fingers into the vagina and then places pressure with the other hand to the lower part of the belly

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61

tanner stage 1 (typically prior to age 11)

elevation of nipple only

no pubic hair, only fine hair

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62

tanner stage 2 (typically age 11-12)

breast bud stage. Elevation of breast and nipple as small bud

sparse pubic hair, mostly along labia

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63

tanner stage 3 (typically age 12-13)

further elevation of breast and areola with no separation of their contour

pubic hair become darker, coarser, curlier

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64

tanner stage 4 (typically 13-14)

projection of areola and nipple to form a secondary moud

almost adult like, but pubic hair does not cover medial thigh

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65

tanner stage 5 (14-15)

mature breast, projection of nipple, but areola receded to general contour

adult quality and quantity of hair, extending to thigh

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66

inspect external genitalia

  1. mons pubis

  2. vulva

  3. vaginal introitus

  4. clitoris / urethral meatus

  5. perineum

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67

T/F hymnal ring break with pregnancy, intercourse, tampons

F- stretches, it doesnt break

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68

risk factors of vulvar carcinoma

HPV and DES exposure

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69

anatomic variation of normal hymen

knowt flashcard image
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70

vulvar carcinoma

cancer of labia and genital skin

<p>cancer of labia and genital skin </p>
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71

Bartholin cyst

usually 4 and 8 oclock

need drainage

<p>usually 4 and 8 oclock </p><p>need drainage </p>
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72

Condyloma Accuminata (HPV)

genital region and anus

difficult to treat

M and F

<p>genital region and anus </p><p>difficult to treat </p><p>M and F</p>
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73

Syphilitic chancre

1st sign of syphilis

NOT painful

indurated red base

same in M and F

<p>1st sign of syphilis </p><p>NOT painful</p><p>indurated red base </p><p>same in M and F</p>
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74

Genital herpes

itchy, burning and tingling (may occur before lesion even appear)

2 types

I- cold sores

II- genital

  • only distinguish with culture

<p>itchy, burning and tingling (may occur before lesion even appear)</p><p>2 types </p><p>I- cold sores</p><p>II- genital </p><ul><li><p>only distinguish with culture </p></li></ul>
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75

Pubic lice

knowt flashcard image
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76

Different speculums

  • Pederson or Graves

  • Metal or plastic

  • Small, medium and large

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77

what you need for internal pelvic exam

  1. speculum

  2. culture supplies

  3. pap smear: scrap, brush, broom

  4. water based lubricant / gloves

  5. good lighting

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78

regular culture screening should be done on individuals who are…

under 25 and sexually active → over 25+ dont need culture unless abnormality

screen for chlamydia

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79

pederson or graves

pederson: long and skinner

Graves: shorter and wider

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80

what angle do you hold speculum at when youre inserting for a pelvic exam

45 degree downward slope

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81

yellow-green d/c indicative of

STI

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82

red d/c indicative of

menstruation, cervical infection, cervical polyps, endometrial or cervical cancer

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83

pink d/c indicative of

cervical bleeding, vaginal irritation, implantation bleeding

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84

grey d/c indicative of

BV

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85

clear d/c indicative of

healthy, pregnancy, ovulation, hormonal imbalance

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86

white d/c indicative of

healthy, yeast infection

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87

candidal vaginitis

white, curdy, thick and not malodorous

“cottage cheese”

may see yeast bugs on culture (not always, diagnose by sx)

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88

BV

gray or white, thin, milky, malodorous

associated with fish odor

CLUE CELLS on wet mount

can do whiff test

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89

whiff test

test for BV

mix sample with KOH solution

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90

Trichomonal vaginitis

yellowish green and gray, frothy, malodorous

not fishy

mobile parasites on culture (distinguish BV) present in 75% pt

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91

cervical scrape during pap smear

press turn and scrape clockwise

  • full circle

  • extocervix

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92

endocervical brush

roll it btw thumb and index finger, clockwise and counter clock wise

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93

what two fingers do you use to perform bimanual exam

index and middle finger

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94

normal position of uterus

ante-verted (AV) at mid position (M)

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95

when to do a recto vaginal exam

  • recto-vaginal wall

  • recto- vaginal pouch

  • retroverted uterus

  • rectal masses

  • anal sphincter tone

  • pelvic structure and pathology when vaginal exam is not possible

  • screen for colorectal cancer

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96

hemoccult examines

blood in stool not visible to naked eye

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97

what does the inguinal nodes drain

vulvar and lower vagina

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98

pelvic and abdominal lymph nodes drain

internal genitalia and upper vagina

non palpable

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99

cervical cancer screening: pap smear according to ACOG/ACS/ USPSTF

begin at age 21

age 21-29: PAP q3 years

30-65: PAP q3 years

<30 yo: do not offer HPV co-testing

age 30-65: can opt for HPV cotesting q 5 years (preferred)

can d/c if pt has a total hysterectomy or >65 years with adequate screening hx and are not otherwise at high risk for cervical cancer (no recent abnormal PAP)

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100

HPV

most common sexually acquired infection in the words

can be passed even when infected person has no signs or sx; sx can develop years after exposure

most HPV infections are self-limiting; persistent infection with oncogenic HPV type cause cervical cancer

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