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DU PA GYN anat/phys

Duke PA Gynecologic Anatomy and Physiology

list the structures that form the true pelvis between the pelvic inlet and the pelvic outlet, bounded by the pelvic surfaces of the hip bones, sacrum, and coccyx
assessment of sexual maturity, as classified by Tanner, depends on __ the growth of pubic hair and the development of breasts
the area of the cervix most at risk for dysplasia transformation zone (squamocolumnar junction)
lymph from the vulva and vagina drains into the __ nodes inguinal
lymph from the internal genitalia, including the upper vagina, flows into the __ nodes (which are not palpable) pelvic, and abdominal
bleeding that occurs after 6 months without periods and warrants further investigation postmenopausal bleeding
the abscence of periods amenorrhea
failure to initiate periods primary amenorrhea
cessation of periods after they have been established secondary amenorrhea
physiologic forms of secondary amenorrhea pregnancy, lactation, menopause
infrequent/irregular periods oligomenorrhea
oligomenorrhea can occur for as long as __ after menarche 2 years
pain with menstruation and is usually felt as a bearing down, aching, or cramping sensation in the lower abdomen and pelvis dysmenorrhea
a complex of symptoms occuring 4-10 days before a period. premenstrual syndrome
PMS symptoms include tension, nervousness, irritabilitiy, depression, mood swings, weight gain, abdominal bloating, edema, tenderness of the breasts, and headaches
abnormally frequent periods polymenorrhea
increased amount or increased duration of flow associated with a period menorrhagia
bleeding occuring between periods metrorrhagia, intermenstrual bleeding
bleeding after intercourse postcoital bleeding
in the gravida-para system the G stands for total number of pregnancies
in the gravida-para system the P stands for outcomes of pregnancies (children born)
in the gravida-para system what are the notations you may see after the P and what do they stand for F-full term, P-premature, A-abortion, L-living child
postcoital bleeding suggests __ cervical disease or in an older woman atrophic vaginitis
at how many weeks can the mother usually feel the baby moving 20
what are the common early signs of pregnancy tenderness/tingling/enlargement of breasts, N/V, easy fatigability, feeling the baby move
most common vulvovaginal symptoms vaginal discharge and local itching
discomfort or pain during intercourse dyspareunia
involuntary spasm of the muscles surrounding the vaginal orifice that makes penetration during intercourse painful or impossible vaginismus
widespread screening by __ has contributed to a significant decline in the incidence and mortality of cervical cancer Papanicolaou (Pap) smear
80%-90% of cervical cancers are __ squamous cell carcinomas
10%-20% of cervical cancers are __ adenocarcinomas in glandular cells
the most important risk factor for cervical cancer is __ present in 95%-100% of squamous cell cancers infection with the high-risk strains of the human papillomavirus (HPV)
risk factors for development of cervical cancer early sexual activity, multiple sexual partners, history of STD
what makes up the bony pelvis sacrum posteriorly, hip bones anteriorly/laterally (ilium, ischium, pubis)
what are the joints of the bony pelvis symphysis pubis, 2 sacroiliac joints
the true pelvis lies below the __ linea terminalus
top margin of the true pelvis sacral promontory, top of the pubic bone
bottom of the true pelvis outlet of the pelvis
measure of the pelvic inlet, approximated by the diagonal conjugate, from sacral promontory to back of symphysis >10cm obstetric conjugate
distance between the ischial spines >10cm, landmark for station of the fetal head inter-spinous diameter
50% of women have what type of pelvis gynecoid
what are the four pelvic types gynecoid (straight walls), anthropoid (deeper), android (converging sidewalls), platyllepoid (flat)
hair overlying the mons pubis escutcheon
fat pad overlying pubic symphysis mons pubis
folds of adipose tissue, covered in hair (male homologue scrotum) labia majora
no hair, extend anteriorly to form prepuce and clitoris, no hair labia minora
in a female the homologue to the penis clitoris
area within the labia minora vestibule
is in the anterior vestibule urethra
is in the posterior vestibule vagina
area between the vagina and anus, often injured during child birth perineum
1st degree perineum tear involves __ vaginal epithelium/perineal skin
2nd degree perineum tear involves __ perineal body (fascia and muscle)
3rd degree perineum tear involves __ perineal body and external anal sphincter
4th degree perineum tear involves __ perineal body, external anal sphincter, and rectal mucosa
periurethral glands at 10 and 2 o'clock in the vestibule Skene's glands
glands at 4 and 8 o'clock in the vestibule, prone to abscess Bartholin's glands
upper 1/4 of vagina is separated from the rectum by the __ cul-de-sac of Douglas (recto-uterine pouch)
when doing speculum exam of vagina focus in what direction posteriorly
muscles that make up the pelvic diaphragm levator ani muscles, coccygeal muscles
bladder hernia through vagina cystocele
rectal hernia through vagina rectocele
small intestine hernia through posterior vagina enterocele
most dangerous place to have an ectopic pregnancy interstitial (cornual) portion of the oviducts
where is tubal ligation done isthmus of oviducts
where does labor pain come from 11th and 12th thoracic nerve roots, sacral roots 2/3/4, pudendal nerve
on average how long after the onset of puberty will menarche occur 2.5 years
maturational increase in adrenal androgen production, which begins at about 6 years of age in both girls and boys. causes hair growth, body odor, skin oiliness, acne adrenarche
beginning of breast development usually age 8 or beyond thelarche
cyclical changes in hormones from hypothalamus, anterior pituitary and ovaries, produces one fully mature oocyte which is ovulated mid cycle menstrual cycle
what are the phases in the menstrual cycle menses (day 1), follicular/proliferative phase (estrogen levels rise), luteal phase=progesterone (after ovulation)
__ is released by the hypothalamus in pulses, it initiates release of both LH and FSH by the anterior pituitary gonadotropin releasing hormone
__ is released by the anterior pituitary, essential for early ovarian follicle growth, induces proliferation of granulosa cells in the follicle that secrete estrogen, negative feedback on GnRH secretion follicle stimulating hormone (FSH)
secreted by the anterior pituitary, surge induces ovulation of the dominant follicle, iduces androgen synthesis by the follicular theca cells lutenizing hormone (LH)
steroid hormone made by the corpus luteum, slows endometrial proliferation induces secretion of glands in endometrium in preparation for implantation and early pregnancy maintenance progesterone
progesterone level over 4 at day 21 of cycle is indicative of what that ovulation occurred
endometrium-follicular phase proliferation, straight glands, no glycogen
endometrium luteal phase secrete glycogen/mucous, glands become tortuous, length constant at 14 days
menstrual endometrium spiral arteries rupture, functional endometrium is shed
how long does menses usually last 2-8 days
about how much blood is lost during menses 25-60 cc
cervical mucous is __ in proliferative phase thinner
cervical mucous is __ in luteal phase thicker
severe form of PMS, can have these symptoms sadness/despair/suicidal, tension/anxiety, panic attacks , irritability that affects others, mood swings /crying, disinterest in daily activities, binge eating/craving , physical sxs PMDD
average age of perimenopause 47.5
what is widely used to detect menopause FSH >35 (no negative estrogen feedback to pituitary)
first symptoms of menopause menstrual irregularities
bone density is lost at a rate of __% per year after menopause 1-2
vulvovaginal changes post menopause loss of collagen and adiposity in vulva, clitoris loss of protective covering, vaginal surface thinner/less elastic/more friable, vaginal dryness/genital tract atrophy, vaginal mucosa and endometrium become thin and dry
symptoms of vulvovaginal changes post menopause itching, burning, dyspareunia
signs of vulvovaginal changes post menopause pale/smooth/shiny vaginal epithelium, loss of elasticity or turgor of skin, sparsity of pubic hair, dryness of labia, fusion of labia minora, introital stenosis, friable/unrugated epithelium, pelvic organ prolapse, vulvar dermatoses/lesions, petechiae
the transverse folds of the vagina rugae
two parts of the uterus body (corpus), and the cervix
vaginal surface of the cervix ectocervix
at the center of the ectocervix is a round, oval, or slitlike depression call the external os of the cervix
when should the first pap smear take place 3 years after first sexual intercourse or by age 21 whichever comes first
how often should women up to the age of 30 get screened with the pap smear annually
how often should women 30 or older get screened with the pap smear, ir combined cervical cytology testing and high risk HPV testing are negative every 2-3 years
the american cancer society recommends discontinuing screening in women after age __ if three consecutive pap tests are negative an pap smears result in the prior 10 years have been negative 70
the american cancer society states that pap testing should continue regardless of age in the following conditions in healthy women hx of cervical cancer, DES exposure in utero, HIV infection, weakened immune system
indications for pelvic examination during adolescence amenorrhea, excessive bleeding, or dysmenorrhea, unexplained abdominal pain, vaginal discharge, prescription of contraceptives, bacteriologic and cytologic studies in a sexually active girl, patient desires to be examined
which speculum is usually most comfortable for sexually active women medium pederson
which speculum is usually most comfortable for the patient with a relatively small introitus (virgin or elderly women) narrow bladed pederson
what speculum is best used for parous women with vaginal prolapse graves
Created by: bwyche