Chapter 27: Female Genitourinary System
Exam 2022-2023
External Genitalia - Answer- -(vulva) mons pubis, clitoris, external urinary meatus,
urethra,
... [Show More] bartholin's glands, vagina, labia minora, labia majora, hymen
What is the mons pubis? - Answer- -round, firm pad of adipose tissue covering the
symphysis pubis
Vestibular Glands (Bartholin) - Answer- -secrete clear lubricating fluid
Internal Genitalia - Answer- -ovaries, uterus, vagina, rugae, cervix, Fallopian tubes
What is the uterus? - Answer- -pear shaped, thick walled muscular organ
The Aging Woman - Answer- -menopause cessation of the menses, occurs around
48-50
-the preceding is 1-2 years of decline in ovarian function shows irregular menses that
gradually become farther apart and produce lighter flow
-ovaries stop producing estrogen and progesterone
More Aging Woman - Answer- -uterus shrinks
-ovaries atrophy to 1-2 cm not palpable after menopause
-sacral ligaments relax, and pelvic musculature weakens; thus uterus drops
-cervix shrinks and looks paler with a thick, glistening epithelium
-vaginal epithelium atrophies —> thinner, drier, itchy —> fragile mucosal surface at
risk for bleeding and vaginitis
HPV vaccine - Answer- -linked to steep decline in the presence of the virus in
teenage girl and young women
-recommended for boys and girls age 11 and 12
-HPV causes almost all cervical cancers as well as vulvar, vaginal, anal, and
oropharyngeal cancers in female
Female Genital Mutilation - Answer- -is a ice coercive procedure performed on girls
before puberty
-social custom, illegal in US
-involves the removal of partial or total of clitoris, believed to inhibit sexual pleasure
-can case, severe bleeding, death, sterility, infection, psychological trauma, and
severe consequences during childbirth
Subjective Data - Answer- -menstrual history
-obstetric history
menopause
-patient centered care
-acute pelvic pain
-urinary symptoms
-vaginal discharge
-past history
-sexual activity
-contraceptives use
-STI contact
Menstrual History - Answer- -usually nonthreatening, good place to start
What is LMP? - Answer- -last menstrual period
What is menarche? - Answer- -first period
-usually 12-13 yo, delayed onset suggests endocrine or underweight problem
Period Cycle - Answer- -normally every 28 days; varies from 18-45 days
Amenorrhea - Answer- -absent period
Duration of Period - Answer- -average 3-7 days
Menorrhagia - Answer- -heavy period
What is dysmenorrhea? - Answer- -painful period, responds to ibuprofen because it
works on uterine smoothie muscles
Menopause - Answer- -when they have actually stopped getting period for over a
year
Premenopausal - Answer- -ranges from 40-55 and has hormone shifts resulting in
vasomotor instability
PAP tests - Answer- -dont start until 21
-once every 3 years for women 21-30
-HPV and pap "co-testing" every 3 years for women 30-65
Delaying PAP test - Answer- -delaying until 21 allows HPV infections to regress
spontaneously in adolescents, avoiding overtreatment
Acute Pelvic Pain - Answer- -less than 3 months
-consider urgent conditions: pelvic inflammatory disease (PID), appendicitis, ruptured
ovarian cyst, ovarian torsion
Urinary Symptosm - Answer- -urgency dysuria, nocturia, hematuria (blood in urine,
occurs with UTI and kidney disease), bile in urine or UTI
Vaginal Discharge - Answer- -normal is small, clear, or cloudy, always nonirritating
Postmenapausal Bleeding - Answer- -warrants pelvic exam, transvaginal
ultrasonography
Position for Inspecting Vagina - Answer- -lithotomy position
-have her empty bladder, ask if she wants family member, elevate head, place legs
in stirrups (but dont abduct too far), communicate
Palpation - Answer- -assess Bartholin glands, palpate posterior part of labia majora
with index finger in vagina and thumb outside at 5 and 7 o'clock positions
Speculum Examination - Answer- -instruct woman to "bear down", turn speculum
blade horizontal, insert at 45 degree angle downward, bringing cervix into view
Inspect Cervix and Os - Answer- -color: pink and even, during pregnancy its blue
(Chadick sign), after menopause its pale
-position: midline
-size
-os: small round
-surface: smooth
Nulliparous Cervix - Answer- -someone who never had baby, no dilation of cervix
-small and round
Porous Cervix - Answer- -after having babies
-slit like
What are nabothian cysts? - Answer- -benign growths that commonly appear on
cervix after childbirth
-small, smooth, yellow nodules that may be single or multiple
Cervical Secretions - Answer- -clear and thin, or thick, opaque, and stringy
-always odorless and nonirritating
-abnormal: foul-smelling, irritating, with yellow, green, white, or gray discharge
Vaginal Pool - Answer- -gently rub blunt end of an Ayre spatula over vaginal wall
under and lateral to cervix; wipe specimen on glass slide
Cervical Scrape - Answer- -Use a cytobrush or insert the bifid end of the Ayre
spatula into the vagina with the more pointed bump into the cervical os
-Rotate it 360 to 720 degrees, using firm pressure. The rounded cervix fits snugly
into the spatula's groove. The spatula scrapes the surface of the squamocolumnar
junction (SCJ) and cervix as you turn the instrument.
-Dip into a liquid vial or spread the specimen from both sides of the spatula onto a
glass slide. Use a single stroke to thin out the specimen, not a back-and-forth
motion. This specimen is important for the adolescent whose endocervical cells have
not yet migrated into the endocervical canal.
Endocervical Specimen - Answer- -insert cytobrush into the os to pull endocervical
cells from the SCF (squamocolumnar jxn)
Saline Mount, or "Wet Prep" - Answer- -spread sample of discharge onto a glass
slide and add one drop of normal saline solution and a coverslip
KOH Prep - Answer- -to a sample of the discharge on a glass slide, add one drop of
potassium hydroxide and a coverslip
Whiff Test - Answer- -fishy odor exudes after KOH on slide
Acetic Acid Wash - Answer- -screens for asymptomatic HPV, which causes genital
warts and cervical cancer
-abnormal findings: rapid acetowhitening or blanching especially with irregular
borders, suggests HPV
Vaginal Candidiases - Answer- -thick, white, and curd like discharge
Trichomoniasis - Answer- -profuse, watery, gray-green, and frothy
Cervix - Answer- -locate in midline, near anterior vaginal wall
-consistency: feels smooth and firm, as the consistency of the tip of the nose, it
softens and feels velvety at 5-6 weeks of pregnancy (Goodall Sign)
-contour: evenly rounded
Uterus - Answer- -determine position
Adnexa (Fallopian Tubes) - Answer- -pulsation or palpable Fallopian tube suggests
ectopic pregnancy
Rectovaginal Examination - Answer- -use this technique to assess the rectovaginal
septum, posterior uterine wall, cul-de sac and rectum.
-ask patient to bear down as you insert your index finger into the vagina and your
middle finger into the rectum
Order of Exams - Answer- -speculum
-bimannual
-rectovaginal
The Aging Adult - Answer- -natural lubrication is decreases
Total Historectomy - Answer- -took everything out (ovaries, uterus, Fallopian tubes)
Abscess of Bartholin Gland - Answer- S: local pain, can be severe
O: overlying skin red, shiny, hot, posterior part of labia swollen; palpable fluctuate
masa d tenderness, mucosa shows red sport at site of duct opening, requires
incision and drainage, antibiotic therapy
-I&D: incision & drainage
Uterine Prolapse - Answer- O: with straining or standing, uterus protrudes into vag,
no tender, no fluctuate, smooth hemisphere; may causes a broad-based gait,
prolapse is graded
Endometriosis - Answer- S: cyclic or chronic pain, occurring as dysmenorrhea or
dysparenuia, low backache, may have irregular uterine bleeding, hypermenorrhea,
or be asymptomatic... [Show Less]