Term
| What are the cases in which you can release information from a pt has given you? |
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Definition
abuse
pt is threatening to hurt someone
communicable diseases (to health dept) |
|
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Term
| one in __ pts will have same-sex, bisexual, or transgender partner preference |
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Definition
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Term
| Tanner stages for boys are based on what 3 characteristics? |
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Definition
| pubic hair, penis, testes/scrotum |
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Term
Which Tanner stage?
no pubic hair
penis is same size as in childhood
testes and scrotum same size as in childhood |
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Definition
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|
Term
Which tanner stage?
sparse gorwth or long, straight pubic hair at the base of the penis
slight or no penis enlargement
testes and scrotum larger, somewhat reddened and altered in texture |
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Definition
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|
Term
which tanner stage?
darker, coarser, curlier hair spreading sparsely over pubis symphysis
penis is larger, especially in length
testes and scrotum are further enlarged |
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Definition
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|
Term
which tanner stage?
coarse and curly pubic hair over greater area but not as seen in adult reaching thighs
penis is larger in length and width and the glans is developed
testes and scrotum further enlarged and scrotal skin is darkened |
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Definition
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|
Term
Which tanner stage?
hair is quantity and quality of adult, spread to thighs but not up over abdomen
penis is adult size and shape
testes and scrotum are adult size and shape |
|
Definition
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Term
| describe the male genital exam |
|
Definition
· Begin with introduction, instruct patient to the proper stance, wash hands while allowing patient to remove undergarments so as to provide some privacy
· Inspection: inspect the distribution of hair while noting the presence of any abnormalities or skin lesions. Inspect the penis and scrotum for any obvious abnormalities.
· Palpate the base of the penis for signs of inflammation and the shaft of the penis at positions along the top and sides noting the presence of any nodules or tenderness.
· Palpate the testes in methodical motion noting the presence of any nodules, noting the size shape and consistency of the testes. Locate the epididymis on the posterior testis noting its quality
o Remember the left lies somewhat lower than the right
· Palpate the spermatic cord bilaterally
· Bilaterally palpate along the spermatic cord laterally about 45 degrees to the external inguinal ring and ask the patient to turn head and cough in order to highlight the presence of a hernia
o Can always ausculate for bowel sounds for confirmation or transilluminate. |
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Term
| Describe the rectal and prostate exam |
|
Definition
RECTAL:
- Instruct the patient to the proper stance with forearms resting on the table
- Inspection: inspect the area for any lesions, fissures, inflammation, rashes, etc.
- Ask the patient to bear down while inserting examining finger to the PIP joint. Rotate 360 noting sphincter tone and the presence of internal fissures, lesions, tenderness, etc.
- Insert examining finger completely to examine more rectal surface for abnormalities
- Ask the patient to again bear down or clench in order to note the muscle tone of the external anal sphincter
PROSTATE:
- Progress finger into the rectum in order to palpate the prostate gland noting its lateral lobes and median sulcus between. Note the size, shape, consistency of the prostate and identify any nodules, enlargement, or tenderness. Normal prostate is rubbery and nontender. |
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Term
| A nontender, fluid-filled mass within the tunica vaginalis. it transilluminates and the examining fingers are able to get above the mass within the scrotum |
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Definition
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Term
| painless, moveable cystic mass just above the testis. |
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Definition
| spermatocele or epididymal cyst |
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Term
| the testis is acutely inflamed, painful, tender, and swollen. it may be difficult to distinguish from the epididymis. the scrotum may also be reddened. condition seen in mumps and other viral infections, usually occurs unilaterally. |
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Definition
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|
Term
| "bag of worms" - refers to varicose veins of the spermatic cord, usually found on the left. it feels like a soft bag of worms separate from the testis, and slowly collapses when the scrotum is elevated in the supine pt. may be associated wtih infertility |
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Definition
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|
Term
| acutely inflamed epididymis that may be difficult to distinguish from the testis. the epididymis is tender and swollen, the scrotum may be reddened and the van deferens inflamed. occurs chiefly in adults. coexisting UTIs or prostatitis suppoorts the diagnosis. |
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Definition
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Term
| risk factors for testicular cacner |
|
Definition
undescended testis
mumps orchitis
inguinal hernia
childhood hydrocele
age 15-35 |
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Term
| How can you tell the diff between a scrotal mass and a hernia? |
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Definition
| if it's a hernia, it will disappear when the pt lies down |
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Term
| when the contents of a hernia cannot be returned to the abdominal cavity |
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Definition
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|
Term
when the blood supply to the entrapped contents of a hernia is compromised
suspect strangulation in the presence of tenderness, nausea and vomiting, consider surgical intervention |
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Definition
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|
Term
What kind of hernia?
most common, all ages, both sexes. often children, may be in adults.
point of origin is above the inguinal ligament, near its midpoint (internal inguinal ring)
the course is often into the scrotum
upon exam, the hernia comes down to the inguinal canal and touches the fingertip |
|
Definition
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|
Term
less common hernia, usually men older than 40.. rare in women
point of origin is above the inguinal ligmanet, close to the pubic tubercle, near the external inguinal ring
rarely has a course into the scrotum
upon exam, the hernia bulges anteriorly and pushes the side fo the finger |
|
Definition
|
|
Term
the least common type of hernia, more common in women
point of origin is below the inguinal ligmanet, it appears more lateral than an inguinal hernia. can be hard to differentiate from a lymph node
this type of hernia never courses into the scrotum
upon exam, you'll find the inguinal canal empty |
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Definition
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|
Term
| The 5 P's of sexual history taking |
|
Definition
partners
sexual practices
past STDs
prevention of STDs
Pregnancy history and plans |
|
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Term
| what is the lithotomy position? |
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Definition
| the position a pt should be in during a pelvic exam |
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Term
| pediculosis pubis: excoriations or itchy, small, red, maculopapules. What is the layman's term for this? |
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Definition
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Term
| inflammation, ulceration, discharge, swelling, or nodules in the vaginal mucosa could be what? |
|
Definition
herpes simplex
behcet's disease
syphilitic canchres
epidermoid cysts |
|
|
Term
| On the pelvic exam, what are you looking for when you ask the pt to cough? What about when you ask them to bear down? |
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Definition
cough: cystocele
bear down: rectocele |
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Term
| vaginal exams: generally use ___ speculum on most patients. for small vaginas or virgins use ____. if vagina is still too small, do a ___ exam. |
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Definition
grave's
pederson's
rectum |
|
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Term
| yellowish discharge from the cervix suggests... |
|
Definition
mucopurulent cervicitis:
chlamydia trachomatis
neisseria gonorrhea
herpes simplex |
|
|
Term
| Raised, friable, or lobed wartlike lesions on the cervix suggest ... |
|
Definition
condylomata
cervical cancer |
|
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Term
| For sexually active females 25 y/o and under, routinely screen for ___ associated with urethritis, cervicitis, PID, ectopic pregnancy, and infertility |
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Definition
|
|
Term
| vaginitis wtih discharge may suggest... |
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Definition
candida
trichomonal vaginalis
bacterial vaginosis |
|
|
Term
| pain on palpation of cervix and adnexal tenderness suggests... |
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Definition
|
|
Term
| differentials if the uterus is enlarged on bimanual exam |
|
Definition
pregnancy
uterine myomas (fibroids)
malignancy |
|
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Term
| what might it mean if ovaries are palpable in a post-menopausal woman? |
|
Definition
ovarian cyst
ovarian cancer (would have associated pain, bloating, increased abdominal size, UT symptoms)
tubo-ovarian abscess
salpingitis
inflammation of fallopian tube from pid or ectopic preg |
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Term
| What are some reasons that a woman may have decreased pelvic muscle strength |
|
Definition
age
vaginal deliveries
neurological deficit
urinary stress incontinence |
|
|
Term
| three purposes of the rectovaginal exam |
|
Definition
palpate a retroverted uterus, uterosacral ligaments, cul-de-sac, and adnexa
screen for colorectal cancer in women 50+
assess pelvic pathology |
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|
Term
Which tanner stage?
breasts with just nipple elevation and no pubic hair growth |
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Definition
|
|
Term
which tanner stage?
very small amount of hair seen on labia + breast buds and enlargement of areolar diameter |
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Definition
|
|
Term
which tanner stage?
enlargement and elevation of breasts and areoli with no separation of their contours. further pubic hair growth |
|
Definition
|
|
Term
which tanner stage?
projection of the nipple to form a secondary mound above the level of the breast + continued pubic hair growth |
|
Definition
|
|
Term
Which tanner stage?
projection of nipple only. areola has receded to general contour of the breast + pubic hair growth over the labia, mons pubis, and medial surfaces of the thighs |
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Definition
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Term
| indications for pelvic exam in adolescents |
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Definition
| 3 years after first sexual intercourse or by 21 years of age |
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|
Term
What disease? how would you evaluate it?
Discharge: yellowish green or gray possibly frothy. often profuse amount, pooled in vernix, may have odor.
symptoms: pruritis, pain on urination and vaginal intercourse.
signs: labia may be reddened, vaginal mucosa diffusely reddened with petechiae in posterior fornix. |
|
Definition
trichomonas vaginalis
evaluate via saline wet mount for trich protozoans |
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|
Term
what disease? what test?
cause is yeast (normal overgrowth of vaginal flora
discharge: white and curdy, typically thick, no odor.
symptoms: itching, vaginal soreness, pain with urination, dypareunia (pain with intercourse).
signs: vulva and surrounding skin are inflamed and swollen. vaginal mucosa is red with white patches of discharge which can be scraped off. |
|
Definition
candida vaginitis
lab evaluation should include potassium hydroxide for preparation |
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|
Term
What disease? what labs?
bacterial overgrowth probably from anaerobic bacteria. may be an STD.
discharge: grey or white, thin, homogenous, malodorous; coats vaginal walls. usually not profuse. may be minimal. unpleasant or fish genital odor.
signs: normal vulva and vagina |
|
Definition
bacterial vaginosis
clue cells: epithelial cells iwth stippled borders
whiff tests: sniff for fishy odor after applying KOH
vaginal secretions with pH >4.5 |
|
|
Term
What disease?
inflammation of the vagina due to thinning tissue and decreased lubrication. related to reduced estrogen levles.
symptoms: burning on urination, light bleeding after intercourse, painful sexual intercourse causing a loss in sexual interest, slight vaginal discharge, vaginal soreness, itching or burning |
|
Definition
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|
Term
| a bulge of the upper two thirds of the vaginal wall, together with the bladder above it. it results from weakened supporting tissues |
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Definition
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|
Term
herniation of the urinary bladder and urethra.
bulge involves the anterior vaginal wall, together wiht the bladder and urethra |
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Definition
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Term
| a bulge in the posterior vaginal canal. it is defined as a herniation of the rectum into the posterior wall of the vagina. occur due to a weaking or defect in the endopelvic fascia |
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Definition
|
|
Term
| what are some causes of bartholin's gland infections? |
|
Definition
| trauma, gonococci anaerobes, chlaymdia trachomatis |
|
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Term
| small, red, benign tumor visible at the posterior part of the urethral meatus. mainly post-menopausal women and usually no symptoms. carcinoma of the urethral can be mistaken for this. |
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Definition
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|
Term
What uterine abnormality?
results from weakness of the pelvic floor
often associated wtih cystocele and rectocele
uterus first become retroverted and descends down vaginal canal
first degree: cervix is in vagina
second degree: at introitus
third degree: cervix and vag are outside of introitus |
|
Definition
|
|
Term
what uterine abnormality?
tilting back of entire uterus
happens in 20 % of women
early clue: cervix faces foreword, uterus cannot be felt
moderate: body not palpable with either hand
marked: body felt through fornix or rectum
usually mobile and asymptomatic |
|
Definition
|
|
Term
what uterine abnormality?
backwarn angulation of the body in relation to the cervix
cervix maintains usual position
body of uterus is palpable through posterior fornix through the rectum |
|
Definition
|
|
Term
| how does bp compare in midpregnancy than in non-pregnant pts? |
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Definition
| it is lower in midpregnancy |
|
|
Term
____ is systolic bp >140 and diastolic >90, first occuring after week 20 and without proteinuria
___ is systolic >140 and diastolic >90 after week 20 and with proteinuria |
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Definition
gestational htn
preeclampsia |
|
|
Term
|
Definition
| irregular brownish patches aroudn the forehead and cheeks, across the nose or along the jaw -- during pregnancy |
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|
Term
the fetal examiner can usually feel fetal movements at ___ weeks.
The mother can usually feel them at ___ weeks |
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Definition
|
|
Term
doptone can detect fetal hr at ___ weeks
FHR is audible with fetoscope at ___ weeks |
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Definition
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|
Term
| FHR should be near ___ in early pregnancy and ___ in late pregnancy |
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Definition
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|
Term
| 28th week of pregnancy, start doing ____ to identify the fetal position of the fetus in relation to the woman's back and estimates the weight fot he fetus |
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Definition
|
|
Term
Which leopold maneuver?
the examiner stands looking at the pt and places their hands on the upper abdomen with the fingertips touching. then the examiner gently palpates the upper abdomen to figure out which end of the fetus is up. |
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Definition
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|
Term
which leopold maneuver?
still facing the pt, place hands on the lateral sides of the abdomen wtih the fingers pointing toward the woman's head. using one hand to steady the fetus and the other hand to palpate, feel for the position of the fetus' back. |
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Definition
| sides of the maternal abdomen |
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|
Term
Which leopold maneuver?
the examiner faces the woman's feet and places their fingers together in the lower pole of the abdomen. gently palpate, starting at the pubic symphysis, feeling for the fetus head which would be in the lower pole of the abdomen. |
|
Definition
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|
Term
which leopold position?
examiner faces the pts feet. wtih the dominant hand, grasp the part of the fetus in the lower pole and gasp the fetus in the upper pole with your non-dominant hand. this allow you to distinguish between the fetal head and buttocks. |
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Definition
| confirmation of the presenting part |
|
|
Term
___ is aka subareolar ductal carcinoma or CIS
it causes nipple erosion or superficial ulceration
accoutns for 1% of breast cancers |
|
Definition
| paget's disease of the breast |
|
|
Term
| three types of breast tissue: |
|
Definition
|
|
Term
| most breast cancer is located in which quadrant? |
|
Definition
|
|
Term
| when would you want to use knee crutches instead of stirrups in a gyn exam? |
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Definition
|
|
Term
| when would you do a wet mount exam? |
|
Definition
| if you suspect a yeast or bacterial infection |
|
|
Term
| The ___ is the place behind the cervix where the two uteral sacral ligaments pair and could be a hiding place for endometriosus |
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Definition
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|
Term
| suggestive symptoms of pregnancy |
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Definition
amenorrhea
breast tenderness
fatigue
syncope/vertigo/low bp
urinary frequency
nausea |
|
|
Term
___ is softening of the uterus isthmus due to increased vascularity
___ is softening of the anterior wall of the uterus due to increased vascularity
both are suggestive of pregnancy |
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Definition
hegar's sign
ladin's sign |
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|
Term
____ is blue discoloration of the cervix
___ is softening of the cervix
both are suggestive of pregnancy |
|
Definition
chadwick's sign
goodell's sign |
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|
Term
| Uterus that is 4-6 weeks size... what does this mean? |
|
Definition
| not pregnant or very early pregnancy |
|
|
Term
| uterus that is 6-8 weeks size in a nulliparous woman |
|
Definition
|
|
Term
| at what stage in gestation can you palpate the uterus above the pubic symphysis? |
|
Definition
|
|
Term
| When might you order an early pregnancy ultrasoudn? |
|
Definition
if you're concerned about pregnancy location (ectopic)
or concerned about pregnancy viability (threatened miscarriage) |
|
|
Term
8 weeks since last period
pos pregnancy test
empty uterus |
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Definition
|
|
Term
| What is included in the initial OB visit? |
|
Definition
complete hx prenatal form
complete PE |
|
|
Term
___ : the number of pregnancies you've had, including current gestation
___ : the number of births |
|
Definition
|
|
Term
|
Definition
G2P1: two pregnancies, 1 birth. currently pregnant
G2P1011: two pregnancies, 1 term pregancies, 0 pre-term deliveries, 1 pre-term loss, 1 child alive |
|
|
Term
Average length of human pregnancy:
___ days after conception
___ days after 1st day of last period |
|
Definition
|
|
Term
| How is a due date calculated? |
|
Definition
Nagele's rule: EDD = LMP + 7 days - 3 mos
LMP = July 1, EDD = April 8
EDD = estimated date of delivery |
|
|
Term
| How are the trimesters divided? |
|
Definition
first: conception to 14 weeks
second: 15-27 weeks
third: 28-40 weeks |
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|
Term
| Wat is part of the prenatal vist? |
|
Definition
}Vital signs + urine exam (spilling protein)
}Pertinent recent history
}Abdominal exam
◦Measure uterus
◦Determine fetal position (lie)
◦Listen for fetal heart tones (FHT)
}Digital vaginal exam
◦Assess cervix 14-18 weeks in certain cases
◦Assess cervix weekly >35 weeks in almost all cases
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|
|
Term
Measureing the gravid uterus:
___ exam to weeks 10-12
___ exm >12 weeks |
|
Definition
bimanual
pubis to top of fundus |
|
|
Term
Uterine growth landmarks:
nulliparous = ?
12 weeks = ?
20 weeks = ?
36 weeks = ? |
|
Definition
0 = size of pts fist
12 weeks = palpable at pubic symphysis
20 weeks = palpable at umbilicus
36 weeks = palpable at xiphoid |
|
|
Term
| Gestation period and uterine size |
|
Definition
| 28 cm uterus = 28 weeks gestation |
|
|
Term
| Where is the best place to measure FHTs? |
|
Definition
|
|
Term
| What fetal position is head down (normal)? |
|
Definition
|
|
Term
| 3 possible fetal positions |
|
Definition
vertex (normal, head down)
breech (bottom down)
transverse (sideways - requires C section) |
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|
Term
| parts of cervical assessment in pregnancy |
|
Definition
cervical thickness = effacement
cervical dilation in cm
confirm presenting part of fetus
determine how far into pevlic the persenting part is (engagement) - 1 cm above cervix = minus 1, 1 cm below cervix = plus 1 |
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|
Term
Wht disease in men?
typically affects shaft and foreskin, not the glans |
|
Definition
|
|
Term
Single, painless ulcer on the penis
single, painful ulcer |
|
Definition
|
|
Term
| look like nodules under the skin on the base of the penis |
|
Definition
|
|
Term
foreskin is inflamed and pt cannot pull it back over glans
foreskin is inflamed and pt cannot pull it foreward over glans |
|
Definition
|
|
Term
| how do you tell the diff bewteen a scrotal hernia and a hydrocele? |
|
Definition
hydrocele - you can get fingers above mass in scrotum
hernia - cannot get fingers above mass |
|
|
Term
| very painful, enlarged teste |
|
Definition
|
|
Term
| enlarged, inflamed epidiymis |
|
Definition
|
|
Term
| enlarged veins in scrotum |
|
Definition
|
|
Term
| emergnecy situation in which the spermatic cord gets wrapped around itself. could cause ischemia to testicle |
|
Definition
|
|
Term
| inadequate enjoyment of sex or complete failure of enjoy any form of sexual intercourse |
|
Definition
|
|
Term
| form of severe anxiety related to a hx of sexual assault |
|
Definition
|
|
Term
| pt has thhe desire for sex but their genital area doesnt respond right |
|
Definition
|
|
Term
| Delayed or absent organsm |
|
Definition
|
|
Term
| ___ must accompany a sexual fxn disorder for a diagnosis |
|
Definition
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