Seidel Ch 19 Female Genitalia

Mrs. Davis is a 46-year-old patient who presents to your office with a complaint of a thin vaginal discharge with a fishy odor. She is not experiencing any itching. What condition do these symptoms indicate? A. Bacterial vaginosis B. Candida vulvovaginitis C. Trichomoniasis D. Physiologic vaginitis

A. Bacterial vaginosis The presence of fishy odor (the "whiff test") suggests bacterial vaginosis.

Which instrument is used to collect both ectocervical and endocervical cells? A. Cytobroom B. Cervix brush C. Wet mount with NaCl D. Wet mount with KOH

A. Cytobroom The broom-type device is used for collecting both ectocervical and endocervical cells at the same time.

The patient lies on the back with the knees bent so that the legs are spread flat and the heels meet at the end of the table. This is what position? A. Diamond shape B. Obstetric stirrups C. Knee-chest D. V shape

A. Diamond shape In the diamond-shaped position, the woman lies on her back with her knees bent so that both legs are spread flat and her heels meet at the foot of the table.

Mrs. Jones is a 68-year-old patient who presents to your office with a complaint of abdominal pain. Her husband died 1 year ago and she reports that she is not sexually active. Which finding would be of concern? A. Palpable ovaries B. Small and pale cervix C. Constriction of the vaginal introitus D. Absence of vaginal rugation

A. Palpable ovaries With aging, the uterus diminishes in size and may not be palpable, and the ovaries are rarely palpable because of atrophy. Ovaries that are palpable should be considered suspicious for tumor, and additional workup to exclude cancer is required.

The vagina, uterus, fallopian tubes, and ovaries are supported by four ligaments. Which of the following is a normal examination finding that evaluates this support? A. The uterus can be moved back and forward with manipulation. B. The patient is able to tolerate a wide-blade speculum during examination. C. The uterus and ovaries are easily assessed with bimanual palpation. D. The vagina and uterus are fixed and do not move with manipulation

A. The uterus can be moved back and forward with manipulation. The uterus should be mobile in the anteroposterior plane. A fixed uterus indicates adhesions.

When is frog position used as part of a patient assessment? A. To examine the external genitalia of a neonate B. To examine a child for an imperforate hymen C. To facilitate insertion of the speculum in an obese patient D. To evaluate degree of uterine prolapse

A. To examine the external genitalia of a neonate The appearance of the external genitalia can help in the assessment of gestational age in the newborn. Examination is conducted with the infant's legs held in a frog position.

Mrs. Wolf is a 29-year-old patient who presents for a routine examination. Which finding on examination leads you to suspect a sexually transmitted infection? A. Ulcers and vesicles on the vulva B. Atrophy of labia minora C. Dilation of the urethral orifice D. Bluish color to the cervix

A. Ulcers and vesicles on the vulva Ulcers or vesicles may be signs of a sexually transmitted infection.

You are completing a pelvic examination on a 38-year-old patient and note the presence of small, white and yellow, raised, round areas on the cervix. You determine these are: Nabothian cysts Herpes virus Squamocolumnar epithelium Cervical polyps

ANS: A Rationale: Nabothian cysts are mucinous retention cysts of the endocervical glands and are considered an expected finding and may be observed as small, white or yellow, raised round areas on the cervix.

During a pelvic examination for a postmenopausal woman, you would expect to assess: A wider and longer vaginal vault Absence of vaginal wall rugation A nonpalpable cervical os A more mobile cervix

ANS: B Rationale: Expected findings in the pelvic examination for an older woman include a narrower and shorter vagina, absence of rugation, less mobile cervix, and a palpable cervical os. The ovaries are rarely palpable because of atrophy.

An irregular interval between menstrual periods with excessive flow and duration is called: Polymenorrhea Menorrhagia Metrorrhagia Menometrorrhagia

ANS: C Rationale: A regular interval between periods with excessive flow is metrorrhagia.

The female patient should ideally be in which position for the pelvic examination? Fowler Prone Lateral-supine Lithotomy

ANS: D Rationale: Ideally, position the woman in a lithotomy position for a pelvic examination.

Mrs. McKnight is a 58-year-old patient who presents with a complaint of pelvic pain. Which finding on examination would make you concerned about a pelvic mass? A. A cervix that is pale in color B. A cervix deviating to the right C. A cervix protruding 2.5 cm into the vagina D. A cervix that is pointing anteriorly

B. A cervix deviating to the right Deviation of the cervix to the right or left may indicate a pelvic mass, uterine adhesions, or pregnancy. Pale cervix - anemia Pointing anteriorly - retroverted Pointing posteriorly - anterverted Normal protrusion is 1-3 cm Cervical diameter of chilbearing age - 2-3 cm

Mrs. Smith is a 45-year-old patient who presents to your office with a complaint of a thick, white, and curdy vaginal discharge. The discharge has no odor, but she is experiencing vaginal itching. What could these symptoms indicate? A. Bacterial vaginalis B. Candidiasis C. Trichomonas vaginalis D. Gonorrhea

B. Candidiasis Candida vulvovaginitis (Candida albicans) is characterized by pruritic discharge; itching of labia; itching may extend to thighs; white, curdy discharge.

Which is an important guideline to be followed when collecting a specimen for a DNA test for Chlamydia trachomatis? A. Use a spatula to collect the specimen. B. Check the expiration date on the reagent. C. Obtain the specimen from the anterior fornix. D. Use a gel lubricant on the speculum.

B. Check the expiration date on the reagent. When collecting specimens for DNA tests for organisms, use a Dacron swab (with plastic or wire shaft) because wooden cotton-tipped applicators may interfere with the test results. Also be sure to check the expiration date so as not to use out-of-date materials.

Which instrument is commonly used to collect endocervical cells? A. Dacron swab B. Cytobrush C. Sterile cotton swab D. Wet mount with NaCl

B. Cytobrush Brushes and brooms are now being used in conjunction with, or instead of, the conventional spatula to improve the quality of cells obtained. The cylindric-type brush collects endocervical cells only.

Mrs. Mills is a 33-year-old patient who presents with a complaint of pelvic pain. On examination, you plan to do a DNA test for gonorrhea. Which instrument would you use for this purpose? A. Cytobrush B. Dacron swab C. Cervix brush D. Sterile cotton swab

B. Dacron swab DNA tests for organisms involve the construction of a nucleic acid sequence that will match to a sequence in the DNA or RNA of the target tissue. The results are rapid and sensitive. Use a Dacron swab (with plastic or wire shaft) when collecting your specimen, because wooden cotton-tipped applicators may interfere with the test results. Memory aid - evil std evil brush Dacron ~ Draco Malfoy

Mrs. Tucker is a 45-year-old patient who presents with a complaint of urinary incontinence when she is engaging in physical activity. Which associated finding might explain this problem? A. Hernial protrusion in the posterior wall of the vagina B. Hernial protrusion through the anterior wall of the vagina C. Symptoms associated with prementrual syndrome (PMS) D. Enlargement and protrusion of the cervix into the vaginal vault

B. Hernial protrusion through the anterior wall of the vagina A cystocele is a hernial protrusion of the urinary bladder through the anterior wall of the vagina, sometimes even exiting the introitus. The bulging can be seen and felt as the woman bears down. More severe degrees of cystocele are accompanied by urinary stress incontinence

Mrs. Black is a 47-year-old patient who presents for a complaint of pain. While you are palpating the introitus of the vagina, the patient jumps and complains of severe tenderness. A mass is palpated that is warm to touch. With which problem are these clinical findings consistent? A. Cancer of the cervix B. Inflammation of the Bartholin glands C. A cystocele D. Acute genital wart infection

B. Inflammation of the Bartholin glands Bartholin and Skene glands are usually not palpable; if they are, enlargement exists. Swelling that is painful, hot to the touch, and fluctuant is indicative of infection of the Bartholin gland, which is most often (but not always) gonococcal.

Mrs. McMahon is a 38-year-old patient who presents for a routine examination. The patient lies on her back near the foot of the table with the legs supported under the knees. What position is this? A. Diamond shape B. Obstetric stirrups C. Knee-chest D. V shape

B. Obstetric stirrups In the obstetric stirrups position, the woman lies on her back near the foot of the table with her legs supported under the knee by obstetric stirrups.

Which is a guideline to be followed when examing a woman who has had a hysterectomy? A. Omit bimanual and internal palpation maneuvers. B. Obtain a Pap smear from the suture line if needed. C. Avoid collecting vaginal cultures and specimens D. Palpate internal areas before inserting the speculum.

B. Obtain a Pap smear from the suture line if needed. If indicated, a Pap smear should be taken from this suture line with the blunt end of the spatula or blunt broom.

How are early cervical cancer changes detected? A. KOH "whiff" test B. Pap smear C. Visual inspection D. Bimanual examination

B. Pap smear Precancerous and early cervical cancer changes are detected by Pap smear, not by physical examination.

Ms. Exeter is a 26-year-old patient who presents for a routine yearly Pap smear. She is in a monogamous relationship and reports no problems currently. Which information would you give the patient after a Pap smear? A. "You may have heavier bleeding with your next menstrual period." B. "You may experience abdominal cramping for the next couple of days." C. "You will feel nauseated for the rest of the day." D. "You may experience mild bleeding or spotting over the next couple of hours."

D. "You may experience mild bleeding or spotting over the next couple of hours." A cylindric broom-type device is used for collecting both ectocervical and endocervical cells at the same time. This broom uses flexible plastic bristles, which are reported to cause less blood spotting after the examination.

Which finding would you expect when doing a pelvic examination on a woman who is approximately 5 weeks pregnant? A. Bluish coloration of the vagina B. Softening of the uterine isthmus C. Easy flexing of the fundus on the cervix D. Cervical consistency similar to that of butter

D. Cervical consistency similar to that of butter The consistency of the cervix in a nonpregnant woman will be firm, like the tip of the nose; during pregnancy the cervix is softer.

Ms. Horter is a 27-year-old nulliparous woman who presents for a routine examination. On examination, you observe a slit-shaped cervical os. Which item in her history explains this finding? A. Early onset of menarche B. Multiple sex partners C. Infection with the human papillomavirus (HPV) D. Elective abortion

D. Elective abortion Trauma from induced abortion or difficult removal of an intrauterine device may also change the shape of the os to a slit.

Mrs. Symer brings in her newborn infant for a routine examination. On examination, you note a prominent labia minora. Which of the following explains this finding? A. Maternal infection B. Ambiguous genitalia C. Prematurity D. Expected finding

D. Expected finding The newborn's genitalia reflect the influence of maternal hormones. The labia majora and minora may be swollen, with the labia minora often more prominent.

Which is the maternal anatomic landmark that serves as the baseline for determination of fetal station? A. Coccyx B. Sacral promontory C. Symphysis pubis D. Ischial spines

D. Ischial spines Station is the relationship of the presenting part to the ischial spines of the mother's pelvis.

The patient lies on her back with knees bent apart and the feet resting on the examination table near the buttocks. What position is this? A. Obstetric stirrups B. V shape C. Diamond shape D. M shape

D. M shape In the M -shaped position, the woman lies on her back, knees bent and apart, feet resting on the examination table close to her buttocks.

Which is a defining symptom of endometrial cancer? A. Feeling of pelvic pressure B. Pain on intercourse C. Uterine retroflexion D. Postmenopausal bleeding

D. Postmenopausal bleeding Postmenopausal vaginal bleeding is a red flag for endometrial cancer.

Ms. Green is a 23-year-old patient who presents to your office with menses-related complaints. You suspect PMS. Symptoms associated with PMS are probably caused by: A. ovulation. B. thickening of the uterine lining. C. elevations in body temperature. D. fluctuations in hormone levels.

D. fluctuations in hormone levels. The etiology of PMS is unclear; likely causes include hormonal factors and responses to hormonal factors

cervical cancer risk factors

HPV Lack of regular screening - linked to low SE status 3+ full term pregnancies Younger than 17 yo with 1st pregnancy @ increased than those who had 1st child after 25 yo Smoking HIV + Chlamydia Diet - low in fruit/veg, Obesity DES exposure - 1940s-1960s Long term use of oral contraceptives (>5 years)

water based lubricants verses water on the speculum

Per the book, use water - these people are a-holes and there are studies that prove lubricants do not affect samples

Mrs. Jones presents to your office with complaints of pain after sexual intercourse, pain during urination, and irregular menstrual bleeding. What do you suspect is occurring in this patient? A. She has salpingitis. B. She has pelvic inflammatory disease. C. She has vulvovaginitis. D. She has atrophic vaginitis

B. She has pelvic inflammatory disease. Pelvic inflammatory disease (PID) symptoms include painful intercourse, painful urination, irregular menstrual bleeding, and pain in the right upper abdomen. Salpingitis - Lower quad pain, constant and dull or cramping that can be made worse by sex or motion; purulent vag discharge; abnormal bleeding; N/V/fever Vulvovainitis - Vag discharge; discomfort, pain, or itching; vulvuar irritation; burning with urination Artophic Vaginitis - Vaginal soreness or itching; discomfort or bleeding with sex

The patient lies on her back with the legs straightened out and spread wide to either side of the table. What position is this? A. M shape B. V shape C. Diamond shape D. Knee-chest

B. V shape In the V -shaped position, the woman lies on her back with her straightened legs separated widely to either side of the table.

Mrs. Sandstrom brings in her 6-year-old daughter and expresses concern that her daughter seems to be experiencing vaginal bleeding. Which statement regarding vaginal bleeding in children is true? A. Vaginal bleeding in children is always a sign of sexual abuse. B. Vaginal bleeding in children is always clinically important. C. Vaginal bleeding in children is most commonly caused by carcinoma of the cervix. D. Occasional vaginal bleeding in the child is considered a benign finding.

B. Vaginal bleeding in children is always clinically important. Vaginal bleeding during childhood is always clinically important and requires further evaluation.

A patient complains of pain, dysmenorrhea, and heavy prolonged menstrual flow. Tender nodules are palpable along the uterosacral ligament. The symptoms and findings suggest: A. pelvic inflammatory disease. B. endometriosis. C. ectopic pregnancy. D. ovarian cancer.

B. endometriosis. Endometriosis involves pelvic pain, dysmenorrhea, and heavy or prolonged menstrual flow.

A 62-year-old woman went through menopause about 14 years ago. Which statement made by this patient indicates a need for further follow-up? A. "I have not been sexually active for about 4 years." B. "My pubic hair has become very thin." C. "I have small amounts of vaginal bleeding a couple of times a week." D. "I have been taking extra calcium since I reached menopause."

C. "I have small amounts of vaginal bleeding a couple of times a week." Postmenopausal vaginal bleeding is a red flag for endometrial cancer

Mrs. Kauffman is a 31-year-old patient who presents for a routine examination. On inspection, you note a cauliflower-like mass on the labia. What is the most likely cause? A. Primary syphilis B. Condyloma latum C. Condyloma acuminatum D. Venereal herpes

C. Condyloma acuminatum Condyloma acuminata (genital warts) are flesh-colored, whitish pink to reddish brown, discrete, soft growths on labia, vestibule, or perianal area. Lesions may occur singly or in clusters and may enlarge to form cauliflower-like masses. Memory aid - cumin taste good on cauliflower aCUMINatum

1. Which finding on examination of a 34-year-old woman is suggestive of pelvic inflammatory disease? A. Enlargement of the ovaries B. An everted cervix C. Pain resulting from movement of the cervix D. Unilateral labial swelling, redness, and tenderness

C. Pain resulting from movement of the cervix Painful cervical movement suggests a pelvic inflammatory process such as pelvic inflammatory disease or a ruptured tubal pregnancy.

A 27-year-old patient presents to your office saying that for the past 2½ months she has been getting a period every 16 or 17 days. Which term would you use to describe this problem? A. Hyperrmenorrhea B. Metrorrhagia C. Polymenorrhea D. Menorrhagia

C. Polymenorrhea Polymenorrhea is the term for a shortened interval between periods—less than 19 to 21 days.

When would you perform a nitrazine paper test? A. To diagnose genital herpes B. To evaluate infoertility C. To verify premature rupture of the membranes (PROM) D. To assess for allergic vaginitis

C. To verify premature rupture of the membranes (PROM) PROM should be verified with a sterile speculum examination to collect fluid for testing with nitrazine paper and microscopic examination.

An examiner plans to collect samples for cytologic studies during a vaginal examination. Which is the recommended method for lubricating the speculum? A. A water-soluble lubricant B. Topical anesthetizing ointment C. Warm water D. Vaginal secretions

C. Warm water The conventional wisdom has been that gel lubricants should not be used when collecting a Pap smear specimen because the gel could obscure cellular elements and interfere with specimen analysis and interpretation. Some studies (Gilson et al, 2006; Griffith et al, 2005; Harer et al, 2003) question this premise. An added advantage of using water as a lubricant is that a cold speculum can be warmed by rinsing in warm (but not hot) water.

Endometrial cancer risk factors

increased risk with more menstrual cycles in ones life infertility Obesity Tamoxifen ERT - in pts with a uterus Testosterone therapy - no eveidence this effects transmen Ovarian disease - cause increase in estrogen Diet high in animal fat DM 1 & 2 Risk increases with age - 95% in pts over 40 Family or personal hx involving breast, ovarian, endrometrial, or colorectal CA, BRCA1 & BRCA2 Pelvic radiation therapy

Ovarian Cancer risk factors

increases with age BRCA1 & BRCA2; PTEN; HNPCC; Peutz-Jeghers syndrom; MUTYH-associated polyposis 1st degree relative w/ ovarian or breast CA, strong family hx ovarian, breast, orcolon CA, Ashkenazi Jew Obesity Pregnancy after 35 Fertility drugs HRT - estrogen without progestrogen (post menopause women) Testosterone therapy - no eveidence this effects transmen High fat diet associated, but no proven link