Holistic Health Final Exam Questions
And Answers!!!
Structure-cervix - ANS § Nulliparous-no pregnancy
§ Multiparous-previous pregnancies
Subjective-Breast - ANS § Breast pain (mastalgia)- location, timing (menses), provocative
(exercise, intercourse, bra)
§ Swelling- with menses, pregnancy, breast feeding
§ Trauma
§ Lump- location, first noticed, related to menses, change to overlying skin
§ Nipple discharge-how long, colour (blood tinged), consistency, odour
Ø Galactorrhea milky- white discharge from breasts
§ Self-care
Ø Screening/exams??? Know their breasts (shower/supine)
Ø Mammogram
Subjective- Menstrual - ANS § date of last menstrual period (LMP)
§ age at the time of your first period (Menarche)
§ how often
§ how long
§ usual flow: light, medium, heavy? Pads/ tampons do you use each day or hour?
§ any clotting- indicates heavy flow/ vaginal pooling
§ Pain/cramps before or during/spotting between
Ø treat it? interfere with activities? Associated- bloating, breast tenderness, moodiness?
Subjective- Obstetrical - ANS G- gravida number of pregnancies (twins = once)
T- term deliveries at term
P- premature
A- abortions (not vile - before 20 weeks - non threatened)
L- living children (people with twins would have an L of 2)
Any complications during pregnancy/delivery
Subjective-Menopause/Urinary - ANS Menopause
§ change in periods
§ associated symptoms- next slide
§ Treatments for symptoms
§ Hormone replacement
,Urinary symptoms
§ Frequency, burning, nocturia, hematuria, cloudy, foul smelling, incontinence-stress
Subjective-Vaginal Discharge - ANS § Amount, how long
§ Character-colour (white, yellow-green, grey, "cottage cheese like"), odour, itching, rash, pain
during intercourse (dyspareunia)
§ Selfcare
Ø Douche (alters flora)
Ø Talcum powder (ovarian cancer)
Ø Panty hose/nylon underwear (local irritation)
Ø Last Papanicolaou (PAP) & results
Subjective-Sexual practices - ANS § Intercourse in last 6 months
§ Number of partners
§ Do you use contraceptives (intercourse/oral sex)
§ History of sexually transmitted infections (STI)
§ Lifestyle
Objective- Breast - ANS • normal slight asymmetry- left breast slightly larger
• upper outer quadrant is the site of most breast tumours
• nipples usually protrude, can be flat or inverted- note change/discharge
• supernumerary nipple normal and common
• Different positions-retraction (hands above head, on hips, palms together, lean forward (large
breasts)
Objective- lymph nodes - ANS • examine axillae- rash/infection
• palpate axilla-tenderness/lymph nodes Reach your fingers high into the axilla
• Palpate breast- supine, arm overhead, pad under side (flattens breast & displaces)
• Large breast can use bimanual
• If discharge reported- press nipple
Objective: Physical Exam - Preparation (female health) - ANS • Preparation
Ø Lithotomy position and draping
Ø Measures to enhance comfort during exam
Ø Mirror pelvic examination
Development-Breast - ANS • Full development average of 3 years-range is 1.5 to 6 years
• Breasts of nonpregnant women change with hormones during menses
Developmental-Pregnancy (female health) - ANS Breasts
• changes start during the second month
• expansion of the ductal system and fatty tissue
• development of true secretory alveoli
• breasts enlarge/ more nodular
, • Nipples-larger, darker, areolae become larger and darken- venous pattern is prominent
• fourth month- colostrum (protein/lactose no fat)
• Milk production (lactation)- 1 to 3 days postpartum
• missed menstrual period
• cervix softens (Goodell's sign)- 4 to 6 weeks
• vaginal mucosa and cervix look cyanotic (Chadwick's sign)- 6 to 8 weeks (vascularity)
• isthmus softens (Hegar's sign) - 6 to 8 weeks.
• uterus growth -bladder- urinary frequency
• 10 to 12 weeks - uterus globular
• 20 to 24 weeks- uterus oval shape-almost to liver
• mucous plug-cervical canal -protects fetus from infection- as does change in discharge PH)
during pregnancy (but can get yeast infections)
Developmental-Aging (female health) - ANS • Menopause- cessation of the menses- 48 to
51yrs can vary from 35 to 60 years
Ø preceding 1 to 2 years -decline in ovarian function- irregular menses -ovaries stop producing
progesterone and estrogen-reproductive tract estrogen dependent-physical changes
• uterus shrinks
• ovaries atrophy
• ovulation may occur sporadically
• sacral ligaments relax/pelvic musculature weakens
• uterus droops- may protrude or prolapse- into vagina
• cervix shrinks-paler
• Vagina-shorter, narrower, less elastic
• without sexual activity, vagina atrophies
• vaginal epithelium - thinner, drier, and itchy, PH changes, decreased lubrication
• after menopause- ovarian secretion of estrogen and progesterone decreases- (middle
age-marked 80 & 90s)
• decrease breast size & elasticity (may droop or sag)
• around the nipple, the lactiferous ducts are more palpable and feel firm and stringy because of
fibrosis and calcification
• axillary hair decreases.
Abnormal findings breast - ANS Breast Cancer
Modifiable risk factors
• Increased Estrogen
Ø Nulliparity or first child after age 30 years
Ø Hormonal contraceptive use
Ø Hormone replacement therapy
• Increases risk
• Alcohol intake of ≥1 drink daily (increased risk)
• Obesity (post menopause estrogen)
• High socioeconomic status (later children/fewer)
