Duke PA Gynecologic Anatomy and Physiology
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| 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
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| assessment of sexual maturity, as classified by Tanner, depends on __ | the growth of pubic hair and the development of breasts
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| the area of the cervix most at risk for dysplasia | transformation zone (squamocolumnar junction)
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| lymph from the vulva and vagina drains into the __ nodes | inguinal
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| lymph from the internal genitalia, including the upper vagina, flows into the __ nodes (which are not palpable) | pelvic, and abdominal
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| bleeding that occurs after 6 months without periods and warrants further investigation | postmenopausal bleeding
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| the abscence of periods | amenorrhea
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| failure to initiate periods | primary amenorrhea
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| cessation of periods after they have been established | secondary amenorrhea
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| physiologic forms of secondary amenorrhea | pregnancy, lactation, menopause
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| infrequent/irregular periods | oligomenorrhea
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| oligomenorrhea can occur for as long as __ after menarche | 2 years
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| pain with menstruation and is usually felt as a bearing down, aching, or cramping sensation in the lower abdomen and pelvis | dysmenorrhea
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| a complex of symptoms occuring 4-10 days before a period. | premenstrual syndrome
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| PMS symptoms include | tension, nervousness, irritabilitiy, depression, mood swings, weight gain, abdominal bloating, edema, tenderness of the breasts, and headaches
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| abnormally frequent periods | polymenorrhea
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| increased amount or increased duration of flow associated with a period | menorrhagia
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| bleeding occuring between periods | metrorrhagia, intermenstrual bleeding
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| bleeding after intercourse | postcoital bleeding
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| in the gravida-para system the G stands for | total number of pregnancies
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| in the gravida-para system the P stands for | outcomes of pregnancies (children born)
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| 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
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| postcoital bleeding suggests __ | cervical disease or in an older woman atrophic vaginitis
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| at how many weeks can the mother usually feel the baby moving | 20
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| what are the common early signs of pregnancy | tenderness/tingling/enlargement of breasts, N/V, easy fatigability, feeling the baby move
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| most common vulvovaginal symptoms | vaginal discharge and local itching
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| discomfort or pain during intercourse | dyspareunia
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| involuntary spasm of the muscles surrounding the vaginal orifice that makes penetration during intercourse painful or impossible | vaginismus
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| widespread screening by __ has contributed to a significant decline in the incidence and mortality of cervical cancer | Papanicolaou (Pap) smear
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| 80%-90% of cervical cancers are __ | squamous cell carcinomas
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| 10%-20% of cervical cancers are __ | adenocarcinomas in glandular cells
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| 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)
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| risk factors for development of cervical cancer | early sexual activity, multiple sexual partners, history of STD
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| what makes up the bony pelvis | sacrum posteriorly, hip bones anteriorly/laterally (ilium, ischium, pubis)
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| what are the joints of the bony pelvis | symphysis pubis, 2 sacroiliac joints
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| the true pelvis lies below the __ | linea terminalus
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| top margin of the true pelvis | sacral promontory, top of the pubic bone
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| bottom of the true pelvis | outlet of the pelvis
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| measure of the pelvic inlet, approximated by the diagonal conjugate, from sacral promontory to back of symphysis >10cm | obstetric conjugate
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| distance between the ischial spines >10cm, landmark for station of the fetal head | inter-spinous diameter
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| 50% of women have what type of pelvis | gynecoid
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| what are the four pelvic types | gynecoid (straight walls), anthropoid (deeper), android (converging sidewalls), platyllepoid (flat)
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| hair overlying the mons pubis | escutcheon
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| fat pad overlying pubic symphysis | mons pubis
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| folds of adipose tissue, covered in hair (male homologue scrotum) | labia majora
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| no hair, extend anteriorly to form prepuce and clitoris, no hair | labia minora
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| in a female the homologue to the penis | clitoris
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| area within the labia minora | vestibule
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| is in the anterior vestibule | urethra
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| is in the posterior vestibule | vagina
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| area between the vagina and anus, often injured during child birth | perineum
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| 1st degree perineum tear involves __ | vaginal epithelium/perineal skin
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| 2nd degree perineum tear involves __ | perineal body (fascia and muscle)
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| 3rd degree perineum tear involves __ | perineal body and external anal sphincter
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| 4th degree perineum tear involves __ | perineal body, external anal sphincter, and rectal mucosa
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| periurethral glands at 10 and 2 o'clock in the vestibule | Skene's glands
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| glands at 4 and 8 o'clock in the vestibule, prone to abscess | Bartholin's glands
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| upper 1/4 of vagina is separated from the rectum by the __ | cul-de-sac of Douglas (recto-uterine pouch)
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| when doing speculum exam of vagina focus in what direction | posteriorly
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| muscles that make up the pelvic diaphragm | levator ani muscles, coccygeal muscles
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| bladder hernia through vagina | cystocele
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| rectal hernia through vagina | rectocele
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| small intestine hernia through posterior vagina | enterocele
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| most dangerous place to have an ectopic pregnancy | interstitial (cornual) portion of the oviducts
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| where is tubal ligation done | isthmus of oviducts
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| where does labor pain come from | 11th and 12th thoracic nerve roots, sacral roots 2/3/4, pudendal nerve
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| on average how long after the onset of puberty will menarche occur | 2.5 years
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| 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
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| beginning of breast development usually age 8 or beyond | thelarche
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| cyclical changes in hormones from hypothalamus, anterior pituitary and ovaries, produces one fully mature oocyte which is ovulated mid cycle | menstrual cycle
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| what are the phases in the menstrual cycle | menses (day 1), follicular/proliferative phase (estrogen levels rise), luteal phase=progesterone (after ovulation)
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| __ is released by the hypothalamus in pulses, it initiates release of both LH and FSH by the anterior pituitary | gonadotropin releasing hormone
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| __ 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)
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| secreted by the anterior pituitary, surge induces ovulation of the dominant follicle, iduces androgen synthesis by the follicular theca cells | lutenizing hormone (LH)
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| 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
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| progesterone level over 4 at day 21 of cycle is indicative of what | that ovulation occurred
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| endometrium-follicular phase | proliferation, straight glands, no glycogen
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| endometrium luteal phase | secrete glycogen/mucous, glands become tortuous, length constant at 14 days
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| menstrual endometrium | spiral arteries rupture, functional endometrium is shed
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| how long does menses usually last | 2-8 days
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| about how much blood is lost during menses | 25-60 cc
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| cervical mucous is __ in proliferative phase | thinner
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| cervical mucous is __ in luteal phase | thicker
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| 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
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| average age of perimenopause | 47.5
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| what is widely used to detect menopause | FSH >35 (no negative estrogen feedback to pituitary)
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| first symptoms of menopause | menstrual irregularities
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| bone density is lost at a rate of __% per year after menopause | 1-2
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| 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
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| symptoms of vulvovaginal changes post menopause | itching, burning, dyspareunia
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| 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
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| the transverse folds of the vagina | rugae
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| two parts of the uterus | body (corpus), and the cervix
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| vaginal surface of the cervix | ectocervix
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| at the center of the ectocervix is a round, oval, or slitlike depression call the | external os of the cervix
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| when should the first pap smear take place | 3 years after first sexual intercourse or by age 21 whichever comes first
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| how often should women up to the age of 30 get screened with the pap smear | annually
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| 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
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| 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
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| 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
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| 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
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| which speculum is usually most comfortable for sexually active women | medium pederson
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| which speculum is usually most comfortable for the patient with a relatively small introitus (virgin or elderly women) | narrow bladed pederson
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| what speculum is best used for parous women with vaginal prolapse | graves
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