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DU PA GYN anat/phys
Duke PA Gynecologic Anatomy and Physiology
| Question | Answer |
|---|---|
| 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
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