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When should a examination of female genitalia performed?
- When there is an specific complaint.
- All newborn.
- Sexual assault or abuse.
- Well women exam.
why is Fornix important?
Important landmarks? why?
- F: usually where to collect samples (STDs, etc)
- C: pain upon palpation may mean pulbic imflammatory disease.
- L: hold everything up, and prevents prolapse (vaginal, urine).
- F: helps determine the stage of pregnancy, since it grows as the baby grows.
- Bartholin's gland: sometimes it gets infected and inflamed causing a painful lump. around 5 or 7. (GC and staph).
- Skene glands: around 11 oe 12 o'clock.
Differences in infants and children?
- external genitalia engorged (due to mother's hormones)
- Estrogen stimulates growth (puberty)
- Brick dust spots: caused by urates and are innocuous. (salmon color spots in the diaper, usually parents say blood in the diaper).
- Pseudomenstruation: blood in the diaper of the female due to withdrawal of blood from mother. (little is not abnomal, large and constant amts is)
differences in adolescents?
- Puberty: functional maturation of reproductive organs, not necessarily social maturation.
- Acidic vaginal secreation (which are good, avoid infections) (lot of dutching is bad bc of the removal of good bacteria)
- Menses: are irregular at first.
- Precocious puberty: less than 8.
- Average age of menses is abt 12-13, but is decreasing.
- Elavated BMI causes early menarches.
Differences in pregnant women?
- increased estrogen and progesterone. (until birth)
- soften pelvic cartilage (relaxation so that they can deliver).
- Strengthened of pelvic ligaments. (hold the baby in place).
- Vagina becomes thicken and more acidic.
- by 20 to 24 weeks, uterus is all the way to the live.
- Mucous plug develops in cervical canal.
older adults? what is menopause? approx age? what hormones decreased? results of the decreased?
- Menopause: 1 full yr w/o a period -- usually 40 to 55 yrs.
- Decreased strogen, adrenal androgens and ovarian testosterone, lubrication, and elasticity.
- internal genitalia decreases in size, ovaries get smaller (not palpable).
Review of systems? what should u ask?
- Ask: abnormal bleeding, pain, infertility, discharge, itching, discomfort, PMS complaints, manopausal complaints (bleeding is very concerning). Urinary symptoms. (stress incontinences, etc).
What should be ask in past medical and family history?
- age of menses.
- Obstretrical hx. (# of babies, abortion, miscarriages, vaginal or c-section)
- Post meno hx.
- Gyno hx. (HPV, surgeries, PID, infections, diabetes, cancer).
- DES mother's that receive this -- 1971.
- Congenital anomalies.
What is the name a pt should be for a pap smear (delivery babies)?
When should pap smear should be done, stopped?
- Lithotomy position:
- No pap until 21 yrs of age, and even every 3 yrs. -- after 65 yrs, no pap or HPV needed if they have been negative.
What is normal pH? What is the role of lactobacillus acidophilus? what is wet mount? how to do it?
- pH: 3.8 - 4.2.
- LA: may help maintain pH, n reduce the risk of infections (yeast). (Imprengnent in the panty line).
- WM: dicharges that can be analyzed at the office under a microscope (GC, CH should be sent to the lab -- trichomonas moves in the slide) -- bacterial vaginosis (fishy smell) -- candidiasis (like yeast).
- WM procedure: obtain sample from the fornix w 2 swabs -- 1st slide, sample w saline, then cover it to look at WBCs, Trich, clue cells, yeast/budding. -- 2nd slide, sample w KOH, then cover it, bacteria get killed and leaves yeast.
Bimanual examination purpuse?
- To palpate cervix, uterus, and ovaries.
- Extreme pain when touching the cervix could mean PID.
- Cervix should be somewhat movable
what is this?
HPV genital warts.
- S: palpula red a round lesion.
- H: ulcer vesicle-like.
When are examination of male genitalia done?
- when there r complaints.
- Part of the new born examination.
- overall well child or well person examination.
Male Infants and children differentiation?
- sexual differentiation occurs 12 weeks gestation.
- Foreskin fully retractable after 3-4.
Male pediatric differences? what is cryptochidism?
- Cryptochidism: undescended testes.
- They have higher risks of testicular cancer.
- Develop pubic hair.
- Decreased sexual activity.
- Orgasm less intense.
- Slower erections.
- all the others.
Past medical history?
- Hypospadias and epispadias (when the urethra meitus is not at the tip of the penis).
- Hydrocele (leakage of liquids) and varicocele (feels like a bag of warms).
- Orcatis: inflammation of the testes, very painful.
- Epididomitis: infection of the epidimious, usually caused from an STI or UTI.
- Chronic illness.
what kind of hernias are there?
- Indirect hernia: inguinal channel into the scrotum.
- Direct:Not in the inguinal channel. abdominal wall weakness. See it in the abdominal area.
- Femoral: below the inguinal channel.
What do u examine in the rectal exam?
- Rectal wall: should be even and firm, should be able to go in abt 10 cms.
- Prostate: normal size is abt 2-4 cms, smooth, movable, nontender.
- If ruberry feeling BPH (Benign hypertrophy)
- Hard, rocky, irregular and nodular: cancer.
- Tender: abscess or infection.