Exam (elaborations)
Female Genitourinary System With complete solution 2024/25
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Female Genitourinary System With complete solution 2024/25
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Female Genitourinary System Withcomplete solution 2024/25
Abscess of Bartholin's gland - Correct Answers S - local pain can be severe
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O - overlying skin red, shiny and hot
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posterior part of labia is swollen ll ll ll ll ll
palpable fluctuant mass and tenderness ll ll ll ll
Mucosa shows red spot at site of duct opening ll ll ll ll ll ll ll ll
requires incision and drainage, antibiotic therapy ll ll ll ll ll
ll Acetic acid wash - Correct Answers acetic acid (white vinegar) screens for asymptomatic
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ll HPV, which causes genital warts
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Adolescent pap smear circumstances - Correct Answers Start periodic Pap smears
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when intercourse begins
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- Although techniques of examination are listed in adult
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section, you will need to provide additional time and ll ll ll ll ll ll ll ll
psychologic support for adolescent having her first ll ll ll ll ll ll
pelvic examination ll
Adolescent pelvic exam - Correct Answers First pelvic examination experience
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determines how
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adolescent will approach future care ll ll ll ll
- Your accepting attitude and gentle, unhurried approach are important; you have unique
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teaching opportunity here
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- Take time to teach, using girl's own body as illustration
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- Your frank discussion of anatomy and sexual behavior
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communicates that these topics are acceptable to discuss and not taboo with health care ll ll ll ll ll ll ll ll ll ll ll ll ll
providers
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- This affirms girl's self-concept
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- During bimanual examination, note that adnexa are not palpable in adolescent
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Adolescent pelvic exam circumstances - Correct Answers - When contraception is
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desired
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- When girl's sexual activity includes intercourse
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- At age 18 in virgins
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ll Aging Woman Clitoris - Correct Answers size also decreases after age 60 years
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Aging woman examination - Correct Answers To avoid painful examination, take care to
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lubricate
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instruments and examining hand adequately ll ll ll ll
,- Use Pedersen speculum, rather than Graves, because its narrower, flatter blades are
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more comfortable in women with vaginal stenosis or dryness
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- Menopause and resulting decrease in estrogen production cause numerous physical
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changes
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ll Aging woman examination pubic hair - Correct Answers gradually decreases, becoming
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ll thin and sparse in later years
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ll Aging woman examination skin - Correct Answers thinner and fat deposits decrease,
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ll leaving mons pubis smaller and labia flatter ll ll ll ll ll ll
Aging woman ruage of vaginal wall - Correct Answers Internally, rugae of vaginal walls
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decrease, and walls look
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pale pink because of thinned epithelium
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- Cervix shrinks and looks pale and glistening
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- May retract, appearing to be flush with vaginal wall
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- Sometimes hard to distinguish cervix from surrounding vaginal mucosa
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- Alternately, cervix may protrude into vagina, if uterus has prolapsed
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- With bimanual examination, you may need to insert only one gloved finger if vaginal
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stenosis exists
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- Uterus feels smaller and firmer, and ovaries are not palpable normally
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aging woman with arthritis - Correct Answers taking a mild analgesic or anti-inflammatory
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before appointment may ease joint pain in positioning
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- Allow extra time for positioning and "unpositioning"
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after examination; be careful to maintain dignity and
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privacy
- Schedule appointment times when joint pain or stiffness
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is at its least
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aging women changes - Correct Answers Female's hormonal milieu decreases rapidly in
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contrast with slow decline in aging male
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Menopause
Uterus shrinks in size because of decreased myometrium ll ll ll ll ll ll ll
- Ovaries atrophy to 1 to 2 cm and are not palpable after menopause
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- Ovulation still may occur sporadically after menopause
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- Uterus droops as sacral ligaments relax and pelvic musculature weakens
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- Sometimes it may protrude, or prolapse, into vagina
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- Cervix shrinks, looks paler, thick, glistening epithelium
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ll ambiguous genitalia - Correct Answers Female pseudohermaphroditism is a congenital ll ll ll ll ll ll ll ll ll ll ll ll
ll anomaly resulting from hyperplasia of the adrenal glands which exposes the female fetus
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ll to excess amounts of androgens
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ll Anal culture - Correct Answers insert sterile cotton swab into anal canal about 1 cm;
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ll rotate and move it side to side ll ll ll ll ll ll
, anterior fornix - Correct Answers continuous recess is present around the fornix in the
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front
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At birth - Correct Answers external genitalia are engorged because of
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presence of maternal estrogen ll ll ll
at puberty - Correct Answers estrogens stimulate growth of cells in the
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reproductive tract and development of secondary sex ll ll ll ll ll ll
characteristics
atrophic vaginitis - Correct Answers S - postmenopausal vaginal itching, dryness,
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burning sensation, dyspareunia mucoid discharfe
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O - Pale, dry mucosa with abraded areas that bleed easily, decreased rugae
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may have bloody discharge ll ll ll ll
decrease in unusual shiny vaginal secretions ll ll ll ll ll
Vagina may be shortened and narrowed ll ll ll ll ll
Cervix less protuberant ll ll
Estrogen causes tissues thick, moist, rugated and glycogen rich ll ll ll ll ll ll ll ll
Bacterial vaginosis - Correct Answers S - profuse discharge, "constant wetness" with
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"foul, fishy, rotten" odor
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O - thin, creamy, gray-white malodorous discharge
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No inflammation on vaginal wall or cervix because this is a surface parasite
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Vaginal pH > 4.5 ll ll ll
Bimanual Examination - Correct Answers Note of caution
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- Normal adnexal structures often are not palpable
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- Be careful not to mistake an abnormality for a normal
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structure
- To be safe, consider abnormal any mass that you
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cannot positively identify, and refer woman for further
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study
Bimanual Examination: Adnexa - Correct Answers Move both hands to right to explore
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adnexa
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- Place abdominal hand on lower quadrant inside anterior iliac
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spine and place intravaginal fingers in lateral fornix
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- Push abdominal hand in and try to capture ovary
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- Often you cannot feel ovary; normally feels smooth, firm, almond shaped, and movable,
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sliding through fingers
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- Fallopian tube is not palpable normally; no other mass or
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pulsation should be felt ll ll ll
- Move to left to palpate other side
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- Then, withdraw your hand and check secretions on fingers before discarding the glove
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- Normal secretions are clear or cloudy and odorless
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