nsg 6430
Midterm Womens gynecological health
Menstrual Cycle Physiology (from Chapter 5)
Menstrual phase - endometrium becomes very thin d/t low estrogen levels
- Hypophysis secretes more FSH
- FSH stimulates secretion of estrogen and estrogen serves as proliferation signal to
the endometrial basal layer
- Follicular phase
- Follicles secrete as they mature, increasing amts of estrogen which thickens the
new functional layer of endometrium in uterus
-simulates crypts in cervix to produce fertile cervical mucus
-end of phase= ovulation
Menstrual Cycle Pain and Premenstrual Conditions
- Dysmenorrhea- originates from uterine cx during menstrual phase, triggers
prostaglandin production and release. This increases contraction of uterus, reduces
uterine blood flow, and causes ischemia/pain
Risk factors- age <30, smoking, bmi <20, early menarche, hx pelvic
surgery, depression
Primary- 6-12 months after menarche, continues 8-72 hours into cycle
Secondary- caused by pelvic pathology, pain increases over time, occurs
before, during, and after menses
Adenomysis, IBS, endometriosis, leiomyoma, interstitial cystitis
- #1 cause of secondary dysmenorrhea is endometriosis- it causes tissue to attach to
surrounding organs and breaks off and bleeds. Patients can also have constipation,
diarrhea, and bloating.
1. Which uterine positions is most associated with dysparenunia and dysmenorrhea
- Retroverted and retroflexed
2. Post coital bleeding
- Atrophic vaginitis
3. PMS occurs with greatest frequency and severity in
- Late luteal phase
4. Which layer of the ovaries contains lymphatics and blood vessels
- Central medulla
Normal and Abnormal Uterine Bleeding
- Structural
P- Polyps- deep bright red growths, bleed easily
A- Adenomyosis- occurs in multiparous, over age 40, occurs with
tamoxifen use
L- Leiomyoma- fibroids- leading indication for hysterectomy
M- Malignancy- hyperplasia
- Non-structural
C- Coagulopathy- von willebrands disease (easy bruising, bleeds heavy)
, O- Ovulatory dysfunction- anovulation (occurs with pregnancy, bmi<18,
lactation, excessive exercise, perimenopause, pcos, thyroid/pituitary
issues)
E- Endometrial- predictive, cyclic manner, can also be caused by
chlamydia/gonorrhea
I- Iatrogenic- example- mirena, skyla, SSRIs
N- Not yet classified
Women’s Health from a Feminist Perspective
- Characteristics of a feminist perspective include the use of critical analysis to
question assumptions about societal expectations and the value of various roles on
both sociopolitical and individual levels
Women’s Growth and Development Across the Lifespan
1. Lobar growth and alveolar budding of the breast is directly stimulated by
- Progesterone
Using Evidence to Support Clinical Practice
Health Promotion
- Primary
Prevention of disease
- Secondary
Early detection
- Tertiary
Limit disability and promote rehab
- Recommended topics for health promotion according to USPSTF
Alcohol use
Breastfeeding
Diet/exercise
STIs
Skin cancer
Tobacco use
Gynecologic Anatomy and Physiology
1. Procidentia describes uterine descent beyond the
- Vulva
2. In characterizing the degree of prolapse, a situation where the leading part of the
prolapse is more than 1cm beyond the hymen but less than or equal to the toal
vaginal length is defined as
- Stage 3
3. First sign of virilization is
- Enlargement of the clitoris
4. Which muscle is considered to be the most critical component of pelvic support
, - Levator ani muscle
5. The bartholins glands are located at
- 4 and 8 o clock
6. What is responsible for regulating gynecologic organ activities
- FSH AND LH
7. The proliferative, secretory and menstrual phases make up
- Endometrial cycle
Gynecologic History and Physical Examination
1. Which kind of speculum is often most suitable for examination of the nulliparous
patient?
- Peterson speculum
2. Which speculum is most appropriate for the exam of a parous menstrual woman
- Graves
3. Elevating the head of the examining table 30 degrees facilitates the
- Observation of the patients responses
4. In the cooperative model, creating an interaction where the patient feels that she
being heard and accepted is an illustration of the principle of
- Empathy
5. Which of the follow about breast exam is correct
- Inspection is done first
6. During bimanual exam of the adnexa in normal premenopausal women, the
ovaries are palpable
- About half of the time
7. Which uterine configuration is most difficult to assess for size, shape,
configuration, and mobility
- Retroverted
8. Inquiry concerning adult and child history of sexual abuse and assault should be
included in the sexual history
- Always even for a new patient
9. A transducer is placed in the vagina to measure intra abdominal pressure as part of
- Multichannel urodynamic testing
10. A cystocele may best be demonstrated clinically by
- Use of valvsalva maneuver
11. The use of Q tip test is used to evaluate the
- Amount of urethral mobility / associated with upward rotation of 30 degrees
12. The situation when the cervix descends below the vulva is termed
- Procidentia
13. Cystocele is best defined as
- Descent or prolapse of the bladder
14. Breast exams should be done during what phase of the menstrual cycle
- Follicular phase
15. Most acute cause of pelvic pain are prob
- Salpingo-oophoritis secondary to PID
Periodic Screening and Health Maintenance
, - Mammograms recommended every 1-2 years in women 40 and older
- Pap every 3 years for all women 21-65
- Pap with co testing of HPV every 5 years 30-65
- No pap for women over 65 and who have had a hysterectomy
- Clinical breast exam yearly age 20 and older
- Bone density for women age 65 and older
- Colorectal screening with colonoscopy every 10 and sigmoid every 5 age 50 and
older unless African American and they get screened at age 45 / don’t screen for
age 85 and older
- Fecal occult blood testing every year starting at age 50 -75
Contraception
- Progestin only is recommended for high risk patients
Smokers
Hypertension
History of dvts/family history stroke, clots
History of migraines with aura
1. Continuous administration of combo oral contraceptives is effective in treating
endometriosis because the treatment
- Induces a decidual reaction in the endometrial implants
2. Progesterone component of OCP does what
- Decrease LH
Breast Conditions
Types of mastalgia (breast pain)
Cyclic- occurs with menses, poorly localized, outer quadrants, soreness and aching
bilateral
Non cyclic- not occurring with menses, constant or intermittent, unilateral, localized,
sharp or burning
Chest wall- localized, increased with movement
Nipple discharge
-causes: OCPs, antipsychotics, reglan, methadone, verapamil, CCBs, amphetamines,
hypothyroidism, stress, stimulation, pregnancy, menstrual cycles, marijuana use,
intraductal papilloma, mammary duct ectasia, and pituitary tumors.
-pituitary tumors- cause changes in vision and headaches
-mammary duct ectasia- causes bilateral sticky green, brown or black discharge (occurs in
age >50).
- evaluation- order pregnancy test, f negative, order prolactin and tsh. If elevated order an
MRI to evaluate for pituitary tumors.
1. Peau d-organge change in the breast is associated with
- Edema of the lymphatics
2. A patient with an intraductal papilloma of the breast will most likely present with
- Unilateral bloody nipple discharge
3. A patient has an abnormal screening mammogram. The next step should be
Midterm Womens gynecological health
Menstrual Cycle Physiology (from Chapter 5)
Menstrual phase - endometrium becomes very thin d/t low estrogen levels
- Hypophysis secretes more FSH
- FSH stimulates secretion of estrogen and estrogen serves as proliferation signal to
the endometrial basal layer
- Follicular phase
- Follicles secrete as they mature, increasing amts of estrogen which thickens the
new functional layer of endometrium in uterus
-simulates crypts in cervix to produce fertile cervical mucus
-end of phase= ovulation
Menstrual Cycle Pain and Premenstrual Conditions
- Dysmenorrhea- originates from uterine cx during menstrual phase, triggers
prostaglandin production and release. This increases contraction of uterus, reduces
uterine blood flow, and causes ischemia/pain
Risk factors- age <30, smoking, bmi <20, early menarche, hx pelvic
surgery, depression
Primary- 6-12 months after menarche, continues 8-72 hours into cycle
Secondary- caused by pelvic pathology, pain increases over time, occurs
before, during, and after menses
Adenomysis, IBS, endometriosis, leiomyoma, interstitial cystitis
- #1 cause of secondary dysmenorrhea is endometriosis- it causes tissue to attach to
surrounding organs and breaks off and bleeds. Patients can also have constipation,
diarrhea, and bloating.
1. Which uterine positions is most associated with dysparenunia and dysmenorrhea
- Retroverted and retroflexed
2. Post coital bleeding
- Atrophic vaginitis
3. PMS occurs with greatest frequency and severity in
- Late luteal phase
4. Which layer of the ovaries contains lymphatics and blood vessels
- Central medulla
Normal and Abnormal Uterine Bleeding
- Structural
P- Polyps- deep bright red growths, bleed easily
A- Adenomyosis- occurs in multiparous, over age 40, occurs with
tamoxifen use
L- Leiomyoma- fibroids- leading indication for hysterectomy
M- Malignancy- hyperplasia
- Non-structural
C- Coagulopathy- von willebrands disease (easy bruising, bleeds heavy)
, O- Ovulatory dysfunction- anovulation (occurs with pregnancy, bmi<18,
lactation, excessive exercise, perimenopause, pcos, thyroid/pituitary
issues)
E- Endometrial- predictive, cyclic manner, can also be caused by
chlamydia/gonorrhea
I- Iatrogenic- example- mirena, skyla, SSRIs
N- Not yet classified
Women’s Health from a Feminist Perspective
- Characteristics of a feminist perspective include the use of critical analysis to
question assumptions about societal expectations and the value of various roles on
both sociopolitical and individual levels
Women’s Growth and Development Across the Lifespan
1. Lobar growth and alveolar budding of the breast is directly stimulated by
- Progesterone
Using Evidence to Support Clinical Practice
Health Promotion
- Primary
Prevention of disease
- Secondary
Early detection
- Tertiary
Limit disability and promote rehab
- Recommended topics for health promotion according to USPSTF
Alcohol use
Breastfeeding
Diet/exercise
STIs
Skin cancer
Tobacco use
Gynecologic Anatomy and Physiology
1. Procidentia describes uterine descent beyond the
- Vulva
2. In characterizing the degree of prolapse, a situation where the leading part of the
prolapse is more than 1cm beyond the hymen but less than or equal to the toal
vaginal length is defined as
- Stage 3
3. First sign of virilization is
- Enlargement of the clitoris
4. Which muscle is considered to be the most critical component of pelvic support
, - Levator ani muscle
5. The bartholins glands are located at
- 4 and 8 o clock
6. What is responsible for regulating gynecologic organ activities
- FSH AND LH
7. The proliferative, secretory and menstrual phases make up
- Endometrial cycle
Gynecologic History and Physical Examination
1. Which kind of speculum is often most suitable for examination of the nulliparous
patient?
- Peterson speculum
2. Which speculum is most appropriate for the exam of a parous menstrual woman
- Graves
3. Elevating the head of the examining table 30 degrees facilitates the
- Observation of the patients responses
4. In the cooperative model, creating an interaction where the patient feels that she
being heard and accepted is an illustration of the principle of
- Empathy
5. Which of the follow about breast exam is correct
- Inspection is done first
6. During bimanual exam of the adnexa in normal premenopausal women, the
ovaries are palpable
- About half of the time
7. Which uterine configuration is most difficult to assess for size, shape,
configuration, and mobility
- Retroverted
8. Inquiry concerning adult and child history of sexual abuse and assault should be
included in the sexual history
- Always even for a new patient
9. A transducer is placed in the vagina to measure intra abdominal pressure as part of
- Multichannel urodynamic testing
10. A cystocele may best be demonstrated clinically by
- Use of valvsalva maneuver
11. The use of Q tip test is used to evaluate the
- Amount of urethral mobility / associated with upward rotation of 30 degrees
12. The situation when the cervix descends below the vulva is termed
- Procidentia
13. Cystocele is best defined as
- Descent or prolapse of the bladder
14. Breast exams should be done during what phase of the menstrual cycle
- Follicular phase
15. Most acute cause of pelvic pain are prob
- Salpingo-oophoritis secondary to PID
Periodic Screening and Health Maintenance
, - Mammograms recommended every 1-2 years in women 40 and older
- Pap every 3 years for all women 21-65
- Pap with co testing of HPV every 5 years 30-65
- No pap for women over 65 and who have had a hysterectomy
- Clinical breast exam yearly age 20 and older
- Bone density for women age 65 and older
- Colorectal screening with colonoscopy every 10 and sigmoid every 5 age 50 and
older unless African American and they get screened at age 45 / don’t screen for
age 85 and older
- Fecal occult blood testing every year starting at age 50 -75
Contraception
- Progestin only is recommended for high risk patients
Smokers
Hypertension
History of dvts/family history stroke, clots
History of migraines with aura
1. Continuous administration of combo oral contraceptives is effective in treating
endometriosis because the treatment
- Induces a decidual reaction in the endometrial implants
2. Progesterone component of OCP does what
- Decrease LH
Breast Conditions
Types of mastalgia (breast pain)
Cyclic- occurs with menses, poorly localized, outer quadrants, soreness and aching
bilateral
Non cyclic- not occurring with menses, constant or intermittent, unilateral, localized,
sharp or burning
Chest wall- localized, increased with movement
Nipple discharge
-causes: OCPs, antipsychotics, reglan, methadone, verapamil, CCBs, amphetamines,
hypothyroidism, stress, stimulation, pregnancy, menstrual cycles, marijuana use,
intraductal papilloma, mammary duct ectasia, and pituitary tumors.
-pituitary tumors- cause changes in vision and headaches
-mammary duct ectasia- causes bilateral sticky green, brown or black discharge (occurs in
age >50).
- evaluation- order pregnancy test, f negative, order prolactin and tsh. If elevated order an
MRI to evaluate for pituitary tumors.
1. Peau d-organge change in the breast is associated with
- Edema of the lymphatics
2. A patient with an intraductal papilloma of the breast will most likely present with
- Unilateral bloody nipple discharge
3. A patient has an abnormal screening mammogram. The next step should be
