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2 other medical terms for external female genitalia
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mons pubis is ...
pad of adipose tissue covering the symphysis pubis
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labia majora are ...
outside folds of adipose tissue
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labia minora are
smaller, hairless fold of skin inside the labia majora
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labia minora are joined anteriorly at the ___ & posteriorly at the ___
clitoris, fourchette
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prepuce is
hood of skin over the clitoris
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clitoris is made of ___ tissue
erectile
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vestibule is
portion between the inner labia of the external female genitalia containing the openings to the structures and glands
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urethral meatus is sometimes within
the vagina
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paraurethral glands are also called
Skene's glands
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Are Skene's glands visible
not usually
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urethral ducts on each side of urethra that secrete fluid and drain into the urethra
Skene's glands
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introitus is another name for
the vaginal orifice
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Fold of tissue at vaginal opening
Hymen
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Bartholin's glands are located
at 4 and 8 o'clock at the posterior vaginal opening
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What do Bartholin's glands do
Secrete a clear lubricating mucus during sexual excitement phase
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Perineum is the
tissue between fourchette & anus
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rugae are
folds along the walls of the vagina during reproductive years
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after menopause, the walls of the vagina become
smooth and slick (loss of rugae)
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the cervix is part of the
uterus
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the cervix protrudes how far into the vagina
1-3 cm unless there is uterine prolapse
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uterus muscle is lined on the inside with the
endometrium
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adnexa refers to
the ovaries and fallopian tubes
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what hormone stimulates growth of the female secondary sexual characteristics
estrogen
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female puberty begins between the ages of __ and __ and lasts ___ years
8.5, 13, 3
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first sign of female puberty is
breast and pubic hair development
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menarch occurs between the ages of __ and ___
10 and 14
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precocious puberty refers to sexual development before the age of
8
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for precocious puberty or late puberty (what age?), refer patient to
late puberty is past 13.5 years with lack of initial development. Refer to endocrinologist
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the menstrual cycle during puberty is regular or irregular
irregular
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menopause is defined as
12 consecutive months without a menstrual cycle
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at what average age range does menopause occur
48-55 yrs, single number average is 51
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if a patient should go < 12 mos (for example, 10 mos) and then menstruate, this phase is called
peri-menopausal
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for peri-menopausal women, advise to continue with
birth control
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changes with the older adult female reproductive system after menopause
Pubic hair thins & grays
Atrophy of labia, clitoris, vagina, ovaries & uterus
Ligaments relax & uterus may slightly prolapse
- decreased elasticity and lubrication of the vagina
- Increased vaginal pH (alkaline)
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atrophic vaginitis is
atrophy of the vagina: decrease elasticity and lubrication
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dyspareunia is
painful sexual intercourse
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increased vaginal pH is significant because
the patient is more prone to infection
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age of menarch is important because
increases lifetime exposure to estrogen which increases risk of breast cancer
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birth control pills do what to the regularity of the menstrual cycle
they control it and thus regularize the cycle
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dysmenorrhea is
painful menstruation
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why do very thin females have amenorrhea
Amenorrhea = absence of menses. Very thin people don’t have enough fat tissue to store hormones
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Hypomenorrhea is
very light menstrual bleeding
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Menorrhagia is associated with
Menorrhagia is heavy bleeding during periods (associated with dysmenorrheal – as cramping helps get rid of the blood)
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Metrorrhagia is caused by
Metrorrhagia – bleeding at irregular intervals (e.g., hormonal imbalance, uterine cancer)
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Dysfunctional uterine bleeding diagnosis is made after what is ruled out
diagnosis made after tumor, inflammation, pregnancy, trauma or hormonal imbalance ruled out
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why is postmenopausal bleeding considered serious
menstrual bleeding 6 months after menopause … {usually serious and a sign of endometrial cancer}
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classic menopause symptoms
hot flashes, insomnia, mood changes, vaginal dryness are the classic signs
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patient with what will go through menopause immediately
bilateral salpingo-oophorectomy
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patients undergoing bilateral salpingo-oophorectomy almost usually get what other procedure
hysterectomy
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oophorectomy is
removal of an ovary
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A patient with a hysterectomy without BSO (bilateral salpingo-oophorectomy) will no longer have what
bleeding during menstrual period
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salpingo-oophorectomy is
removal of fallopian tube and ovary
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If uterus is present, the patient is given progesterone with estrogen hormone replacement therapy ... why?
must give both estrogen and progesterone because progesterone prevents uterine cancer
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estrogen increases the risk of ___ but decreases what other common age related (mostly female) problem
breast cancer, osteoporosis
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gravida is
# of pregnancies
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cervical cancer is an STI from
HPV
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increase risk of abnormal PAP smear
- multiple sex partners
- partners that have / had multiple sex partners
- early sexual activity (increases # of partners)
- oral contraceptives (less likely to use condoms)
- STIs (prior infections)
- smoking (increases risk of all cancers)
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Why no PAP smear before age 21
the female body clears the virus
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Guidlines for PAP: females in 20s, 30+
- 20s: every 2 years if prior PAP is normal
- 30s: every 3 years if prior 3 consecutive PAPs are normal
- annually otherwise or more frequently if indicated
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No need to get a PAP smear unless the __ is present
cervix
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colposcopy is
an instrument to see the cervix used when obtaining a biopsy
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what is Loop Electrocautery Excision Procedure and what is it for?
zapping the abnormal cervical cells
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surgery to inactivate / kill abnormal cervical cells by freezing is called
cryosurgery
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for an abnormal PAP smear w/ procedure to kill the bad cells, how frequently is next PAP smear done
every 3 months until shows no abnormality
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How long after a procedure to kill abnormal cervical cells should PAP smear show normal - or else procedures must be repeated
<= 1 year
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Under new guidelines, test for both __ and __ under age 26
chlamydia and gonorrhea
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immunizations are available for which 2 STIs
Hepatitis B virus (HBV) and Human papilloma virus (HPV)
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HBV can develop into
liver cirrhosis and liver cancer
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HBV schedule for immunization dosing
0,1,6 mos
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what are Gardisil and Cervarix
HPV vaccines
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Gardisil protects against
HPV subtypes 16, 18 which causes 70% of cervical cancer and HPV subtypes 6, 11 which causes 90% of genital warts. Also protects against precancers of vaginal and vulva.
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dosing schedule for Gardisil
0,2,6 mos
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recommended ages for immunizing males and females with Gardisil
girls: 11-12 yo (catch up 13-26 yo if not given previously)
boys/men: 9-26 yo
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Cervarix protects against what? Not recommended for ___.
HPV subtypes 16 and 18 only (cervical cancer). Does not protect against genital warts.
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Cervarix dosing schedule
0,1,6 mos
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condyloma is (are)
genital warts
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Why do patients with DM get more frequent yeast infections?
glucose in vagina
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why avoid douching?
raises vaginal pH increasing risk of infection, where normally it is acidic which prevents infection
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Clothing recommendation to avoid bacterial vaginosis
avoid tight clothing
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why ask patients to stay on same birth control for 3 mos if there are minor problems
it takes 3 mos for the body to adjust and the problems frequently moderate or disappear
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emergency contraception: where to find, how soon to take, what is it
found at pharmacies but not on the shelf
take as soon as possible < 72 hrs from event
is basically a megadose of contraceptive drugs
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important to have patient do what before pelvic exam
empty bladder
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what is the position for the female patient for the pelvic exam
lithotomy
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external genitalia drains to what lymph nodes
inguinal
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insert index & middle finger into vagina--ask pt to contract muscles... weakness may indicate
neurologic problems (for example multiple sclerosis)
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cystocele, rectocele, uterine prolapse
- cystocele = bladder lapsed into vaginal wall
- rectocele = rectum lapsed into vaginal wall
- uterine prolapse = uterus pushing into (in some cases through) the vagina
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nulliparous
has not given vaginal birth
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parous
has given vaginal birth
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graves speculum is used for
women with larger vagina -- usually those that have given birth ("graves for gravida")
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pederson speculum is used for
women with smaller vagina (smaller narrower blade on speculum): nulliparous and post-menopausal
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lubricate speculum with ___ only. Why?
tap water only. Does not disturb the resident bacteria which may be needed for specimen.
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what is the significance of the following vaginal discharges
clear w/o odor
white, curd-like
yellow, foamy
gray, malodorous
- normal
- yeast
- trichomonous
- bacterial vaginosis
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cervical opening shapes: (identify significance)
round
slit-like
- round = nulliparous (not had childbirth vaginally)
- slit-like = parous (had childbirth vaginally)
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significance: color of cervix
dark pink
pale
bluish-purple
- premenopausal
- menopausal
- pregnancy
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What is Chadwick's sign?
bluish-purple cervix which indicates pregnancy
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5 positions of the uterus in the patient's body
- anteverted uterus (tilted toward bladder - cervix posterior)
- retroverted uterus (tilted posteriorly - cervix anterior) cannot palpate from abd
- midposition uterus (horizontal cervix)
- anteflexed uterus (uterus curves anteriorly)
- retroflexed uterus (uterus curves posteriorly) cannot palpate from abd, examiner should attempt to palpate from the rectum
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if there are suspected abnormal cervical cells, squirt what on them? what happens?
- if suspected abn cells, squirt vinegar (same as
- acetic acid) on the cervix and the abn cells will turn white
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a wet mount is what?
preparation of a slide for microscopic evaluation of vaginal discharge
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must use fixative immediately after taking a sample of cervical cells ... why?
cells must be preserved for observation and will degrade almost immediately
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efor a thin prep collection (cervical cell sample for PAP smear), how many times should the spatula or broom be twirled in solution?
>= 10 times
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Where are the hands in Bimanual Abdominal-Vaginal Exam
insert index & middle finger in vagina/place other hand on ABD wall (and palpate uterus)
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ovary premenopausal and postmenopausal size. Can they be palpated?
- premenopausal 3x2x1 cm - palpable
- postmenopausal 1-2 cm - should not be palpable
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are fallopian tubes normally palpable
no
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classic sign of pelvic inflammatory disease is CMT (which stands for... ?). This is also called the ___ sign because ..
cervical motion tenderness, colloquially called the "Chandelier's sign" because it hurts so much the patient will jump off the table and grab the chandelier.
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