What is the correct patient position for a screening exam with no complaints?Patient supine with hand behind head with a shoulder on pillow. Check both breast and axilla.Type of breast cancer screening that takes images of the breast, usually done in later age.MammogramPercent of women born in the US who will develop breast cancer at some point in their lives.12.4%Name 3 Breast Cancer risk factors1) Family History
2) Over 50
3) Late sexual maturity
(There may be more)What are the 5 D's related to nipples for observation of cancer.1) Discharge
2) Depression (Inversion)
3) Discoloration
4) Dermatologic changes
5) DeviationShortening or drawing back of the breast skin, suggesting attachment to the lower tissues.Retraction (Dimpling)True or False : Females with bilateral and life long nipple retraction are usually seen as normalTrue, unilateral recent retraction is sign of cancer.Dimpling of skin that resembles an orange skin, develops because of blocked lymphatic drainage.Peau D'orangeDilated superficial veins can be visible for 3 different causes, what are they?Cancer, pregnancy, lactationWhat are characteristics of a malignancy in the breast? (name 4)1) Hard
2) Fixed to surrounding skin
3) Immobile
4) Poorly defined/irregular marginsIntraductal carcinomas of the breast that metastasizes through the milk ducts to the nipple and areola can be indicative of what disease?Pagets DiseaseWhat are signs/symptoms of Pagets disease of the breast? (Name 3)Nipple itching, tingling, or redness. There may be scaling or thickened skin around the nipple.Very painful bacterial infection of the fatty tissues of the breast by Staph.MastitisSymptoms of mastitis (name 3)Unilateral breast enlargement, swelling with redness and warmth, feverDisease characterized by the formation of cysts and intraductal hyperplasia. Common in women in third/fourth/fifth decades. May be related to menstruation.Fibrocystic DiseaseDifferentiate between cancer and fibrocystic disease.Fibrocystic disease usually have large non-fixed and multiple cysts around time of menstruation while cancer is always present and fixed.Your patient has a lump in her breast, upon palpation the lump is painless, firm, smooth, and rubbery. It is also mobile. When describing it you say it feels like a marble. Diagnosis?Fibroadenoma of the breastAbnormally large mammary glands in the male.GynecomastiaMedical term for a pregnant womanGravidaTerm for onset of menstruation in adolescence of young adulthood. Average is 12.6 years of age in USA.MenarcheWhat does Para I or primipara mean?A woman who has given birth for the first timeAnatomical term for the vaginal orificeIntroitusTerm for the absence of menstruation. It can be primary (fail to start) or secondary.AmenorrheaTrue or False : Primary amenorrhea can be diagnosed for a female who has failure of menses to occur by 16 years in the presence of normal growth and secondary sexual characteristics.TrueName 3 reasons a female may have primary amenorrhea1) Congenital / genetic defect
2) Hormonal imbalance
3) Poor nutrition / anorexiaDiagnosis of a female who demonstrated menses at puberty but has subsequently ceased.Secondary amenorrheaDiagnosis of abnormal pain associated with the menstrual cycle. Usually only diagnosed if it affects ADLsDysmenorrheaTrue or False : Primary dysmenorrhea is usually due to smooth muscle contracting too much.TrueWhite vaginal discharge that could be normal with pregnancy or birth control, or abnormal with infection.LeukorrheaDiagnosis characterized by an abnormally heavy or extended menstrual period, where the female is bleeding longer than 7 days or needing to wake up at night to change sanitary protection. Passing of blood clots can also occur.MenorrhagiaDiagnosis of any uterine bleeding that is not related to menstruation. Can be caused by endometriosis, fibroids, or cancer.MetrorrhagiaMenstruation that is abnormally light or infrequent, usually in this case the female only has 4-9 a year.OligomenorrheaPain associated with sexual intercourse, need to consider abuse.DyspareuniaNatural biological process leading to the permanent cessation of the menses. Usually 12 months must pass from your last cycle.MenopauseTerm to describe the months leading up to true menopause, characterized by irregular menses, hot flashes, night sweats, etc.PerimenopauseAbdominal pain at the time of ovulation, results from irritation of the peritoneum by bleeding from ovulation siteMittelschmerzBleeding after intercourse, while sometimes normal in early encounters, can be signs of what in more experienced individuals.Cervicitis, or cervical cancer.True or False : Fungal infections lead to a thin vaginal discharge with a fishy odor.False - fungal is a thick, white, curd-like discharge. A thin discharge with a fishy odor is considered bacterial.What should you ALWAYS do at the start of a standard pelvic examination to signal it is about to begin.Touch the female's thighThese are small, irregular, fleshy projection that are remnants of a ruptured hymen, completely normal.Hymenal CarunclesAn enlarged clitoris, can be congenital or acquired via severe hormonal imbalance.ClitoromegalyLocal pain, irritation, or increased urge to urinate with difficulty starting, most commonly caused by a bacterial infection.Urethral Inflammation (Urethritis)Benign, reddish, fleshy growth situated at the urethral meatusUrethral caruncleInvoluntary loss of urine with increased intra abdominal pressure, suggests damaged external sphincter or pelvic diaphragm.Stress IncontinenceMigration of the uterus to the vaginal opening with increased intra-abdominal pressureUterine ProlapseBulging of the anterior wall of vagina, caused by protrusion of the urinary bladder through relaxed or weakened musculature.Cystocele / CystourethroceleBulging of the posterior vaginal wall of vagina, caused by protrusion of the intestinal contents through relaxed or weakened pelvic musculature.RectoceleTrue or False : Warm water is used as a lubricant for insertion of the speculum.TrueDiscuss insertion of the speculumInsert vertically keeping pressure posterior away from urethra and clitoris. rotate speculum to horizontal position when inserted and spread until cervix is visible.Small white or purplish firm nodule that commonly appears on the cervix, caused by an occlusion and dilation of a mucous gland.Nabothian Cyst (Retention Cyst)Test for cervical cancer which takes a smear of exfoliated cells are taken from the cervix and stained/examined under a microscope.Papanicolaou Smear (PAP smear)What three areas are cells obtained from in a pap smear?Endocervical, Cervical scrape, vaginal poolCancer most commonly occurs in this area of the lower uterus at the squamocolumnar junction.CervixVaulted upper part of the vagina surrounding the uterine cervix. It is a ringed recess that forms around the cervix anterior, lateral, and posterior.FornixWhat color does the cervix and vagina turn in pregnancy?Bluish in colorThese glands are located deep in the labia majora, close to the perineum. Provides lubrication to the vaginal opening during sexual arousal.Bartholin's glands.True or False : In the bimanual exam, two fingers are inserted into the vagina, while the other hand palpates the abdomen starting at the umbilicis.TrueTrue or False : The normal size of the uterus upon bimanual examination is about 3 inches long, 2 inches wide, and an inch thick shaped like a pear.TrueThis is a nonmalignant growth/tumor protruding from the mucous lining of cervix.Endo-cervical polypInflammation of the uterine cervix, biggest concern is an STDCervicitisItching, redness, and a thin yellowish discharge. Superficial erosions may be present, and this is often associated with aging and diminished vaginal lubrication.Atrophic VaginitisA common infection by candida albicans that produces a white curdy discharge. Usually occurs after something throws off normal flora like antibiotics.Monilial Vaginitis (Yeast Infection)An infection that has a watery mucous in the vagina with a fishy smell, formally called gardnerella vaginitis.Bacterial VaginosisPatient's vagina emits a malodorous yellow, green, or grey discharge. Usually caused by sexual transmission of a protozoan.Trichomonas VaginitisThe most commonly reported notifiable disease in the United States.ChlamydiaWhy is Chlamydia linked to infertilization?Build up of scarring that can block the fallopian tubes.Soft warty papillomatous projection appearing on the labia and within the vaginal vestibule. Is viral (HPV) in origin, and increases chances of cervical cancer.Condyloma Acuminatum (Venereal Wart)Slighty raised, moist, flattened papules that appear on the labia or within the vestibule. A sign of secondary syphilis.Condyloma LatumAcute or Chronic inflammation of the pelvic cavity, can be caused by 100% cotton tampons.Pelvic Inflammatory Disease (PID)True or False : PID is most commonly caused by sexually transmitted diseases.TrueTrue or False : The highest rate or PID reported in woman is 30-40 years old.False, 20-29 yearsTrue or False : Scarring damage of PID may increase the risk of ectopic pregnancy.True, 1:16 chance with PID, 1:147 chance without.Presence of endometrial tissue in abnormal locations that does not shed but does react to hormones. Causes cyclic issues.EndometriosisCommon benign masses of myometrium found as incidental findings in lumbar or pelvic x-rays.Uterine Fibroids75% of women experience this syndrome which peak during a woman's 20s and 30s, and causes many symptoms ranging in severity during a woman's cycle.PMSTrue or False : 20% of US couples have infertility problemsFalse : 10-15%True or False : Infertility is defined as the inability to become pregnant after 6 months of having frequent, unprotected sex.True and False. For couples under 35 years, 12 months are given to become pregnant. For couples over the age of 35, it is only 6 months.
