Unit 4: Chapter 45

Question 1

Disorders of the External Genitalia and Vagina

Answer 1

Most skin cysts, nevi, and malignant neoplasms can occur on all hair-bearing skin.
The vulva (mons pubis, labia majora and minora, clitoris, and vestibule) is prone to skin infections because it is constantly exposed to secretions and moisture.

Question 2

Bartholin Gland

Answer 2

cyst is a fluid-filled sac that results from occlusion of the duct system in the Bartholin gland.
If the cyst becomes infected, an abscess may develop in the gland and is commonly caused by staphylococcal, chlamydial, and anaerobic infections.

Question 3

Bartholin Gland and Abscess Manifestation

Answer 3

Acute symptoms include infection, pain, tenderness, and dyspareunia (pain with intercourse).
Treatment of symptomatic cysts consists of appropriate antibiotics, local application of moist heat, and incision and drainage. A Word catheter may be used to drain the cyst for a few weeks. Reoccurring cysts may require surgical intervention.

Question 4

Bartholin Gland and Menopause

Answer 4

Bartholin glands shrink during menopause, so a growth postmenopause should be evaluated for malignancy.

Question 5

Vulvodynia

Answer 5

is a multifactorial chronic vulvar pain disorder of at least 3 months’ duration.

characterized by vulvar pain in the absence of relevant visible findings or a clinically identifiable disorder.
Either: primary or secondary.
Classified as localized or generalized, and as to whether it is provoked, unprovoked, or of mixed origin.

Question 6

Generalized Vulvodynia

Answer 6

involves severe, constant, widespread unprovoked pain or burning that interferes with daily activities.
No abnormalities are found on examination, but there is diffuse and variable hypersensitivity and altered sensation to light touch.

Question 7

Localized Vulvodynia

Answer 7

characterized by often stinging, burning, or cutting pain at onset of intercourse (i.e., insertional dyspareunia), localized point tenderness near the vaginal opening, and sensitivity to tampon placement.
Pain can be primary (present from first contact) or secondary (developing after a period of comfortable sexual relations).

Question 8

Vulvodynia Treatment

Answer 8

aims for symptom relief, is long term and multidimensional.
Regimens include long-term vaginal or oral antifungal therapy, avoidance of irritants, sitz baths with baking soda, emollients (vitamin E or vegetable oil for lubrication), anesthetic or steroid ointments, capsaicin cream, physical therapy, and surgery.
Oral medications, including tricyclic antidepressants, other antidepressants, or gabapentin, are often used to treat neuropathic pain.

Question 9

Vaginitis

Answer 9

inflammation of the vagina characterized by discharge and burning, itching, redness, and swelling of vaginal tissues.
Pain often occurs with urination and sexual intercourse.

Question 10

Atrophic Vaginitis

Answer 10

Most common in post menopausal.

is an inflammation of the vagina that occurs after menopause or removal of ovaries (causing estrogen deficiency).
Estrogen deficiency results in a lack of regenerative growth of the vaginal epithelium, rendering these tissues more susceptible to infection and irritation.
S&S: itching,m burning, painful intercourse.

Question 11

Cervix

Answer 11

omposed of two types of tissue”
1. The exocervix, the visible portion, has stratified squamous epithelium, which also lines the vagina.
2. The endocervix, the canal that leads to the endometrial cavity, is lined with columnar epithelium that has large, branched mucus-secreting glands.

Question 12

Transformation Zone

Answer 12

Critical area in the development of cervical cancer.
Samples with a Pap smear
If sample abnormal, this zone is examined during colposcopy with a colposcope.

Question 13

Cervicitis

Answer 13

Acute cervicitis may result from direct infection of the cervix or may be secondary to a vaginal or uterine infection.
It may be caused by infective agents

cervix becomes reddened and edematous. Irritation from infection results in mucopurulent drainage and leukorrhea.
Treated with antibiotic therapy.

Question 14

Cancer of the Cervix

Answer 14

Most easily cured reproductive cancers

Risk factors include early age at first intercourse, multiple sexual partners, smoking, and a history of sexually transmitted infections (STIs).

Question 15

Cancer of the Cervix Pathogenesis

Answer 15

Pap smear cytological screening allows precancerous lesions to be detected and treated before cancer develops.
Atypical cells may display changes in the nuclear and cytoplasmic parts of the cell and variation in cell size and shape (i.e., dysplasia). These precancerous changes represent a continuum of changes with indistinct boundaries that may gradually progress to cancer in situ and then to invasive cancer or may spontaneously regress.

Question 16

Cancer of the Cervix Grading of Histopathologic Findings

Answer 16

findings of dysplastic changes of cancer precursors uses the term cervical intraepithelial neoplasia (CIN),which describes premalignant changes in the epithelial tissue: CIN I is defined as dysplasia or atypical changes in the cervical epithelium
CIN II is moderate dysplasia
CIN III is severe dysplasia.

Question 17

Cervical Cancer Diagnosis

Answer 17

abnormal Pap smear results will return as: atypical squamous cells of undetermined origin (ASC-US)
atypical squamous cells of undetermined origin that cannot exclude high-grade squamous intraepithelial lesion (ASC-H)
low-grade squamous intraepithelial lesion (LGSIL); high-grade squamous intraepithelial lesion (HGSIL);
or squamous cell cancer.

Question 18

Preventing Cervical Cancer: HPV

Answer 18

screening include HPV testing and cytology in females over 30 years of age.
Results dictate the next steps in disease management.
Cytology (Pap smear) alone is recommended beginning at 21 years of age and then every 3 years until age 29.
For females over 30, a Pap smear alone should be performed every 3 years or cotesting every 5 years.

Question 19

Endometriosis

Answer 19

functional endometrial tissue is found in ectopic sites outside the uterus.
estrogen dependent.
unclear whether it is an inflammatory disease or an immune disorder.
Implants of endometriosis are functional and can lead to scarring, adhesions, and ovarian cysts (endometriomas).

Question 20

Endometriosis Sites

Answer 20

Sites may include ovaries, posterior broad ligaments, uterosacral ligaments, pouch of Douglas, pelvis, vagina, vulva, perineum, or intestines

Question 21

Endometriosis Diagnosis

Answer 21

difficult to diagnose: its symptoms mimic other pelvic disorders, and the symptoms do not always reflect the extent of the disease. Imaging, including ultrasonography and magnetic resonance imaging (MRI), is useful in evaluating endometriomas and deep endometriosis.

Question 22

Endometriosis Treatment

Answer 22

Treatment may be initiated on the basis of clinical presentation because definitive diagnosis can be accomplished only through laparoscopy and confirmed with histology.
This minimally invasive surgery allows visualization of pelvic organs to determine presence and extent of endometrial lesions.

Treatments are pain relief, endometrial suppression and surgery

Question 23

Endometrial Cancer

Answer 23

Most common cancer in pelvis.
Most are adenoicarcinomas, < 1% sarcomas.

Two general groups:
1. develops on a background of prolonged estrogen stimulation and endometrial hyperplasia
2. is less commonly associated with hyperestrogenism and endometrial hyperplasia.

Question 24

Endometrial Cancer Diagnosis

Answer 24

Endometrial biopsy (tissue sample obtained by direct aspiration of the endometrial cavity), more accurate than a Pap smear.
Dilation and curettage (D&C), which consists of dilating the cervix and scraping the uterine cavity, is the definitive procedure for diagnosis because it provides a more thorough evaluation.

Question 25

Endometrial Treatment

Answer 25

Total abdominal hysterectomy with bilateral salpingo-oophorectomy plus sampling of regional lymph nodes and peritoneal washings for cytologic evaluation of occult disease is the treatment of choice when possible.

Question 26

Pelvic Inflammatory Disease

Answer 26

PID is a polymicrobial infection of the upper reproductive tract (uterus, fallopian tubes, ovaries) associated with sexually transmitted organisms such as N. gonorrhoeae or C. trachomatis and endogenous organisms including anaerobes such as Haemophilus influenzae, enteric gram-negative rods, and streptococci. Organisms ascend through the endocervical canal to the endometrial cavity, and then to the tubes and ovaries.

Question 27

Pelvic Inflammatory Disease Manifestations

Answer 27

include lower abdominal pain, dyspareunia, back pain, purulent cervical discharge, adnexal tenderness, and painful cervix on bimanual pelvic examination. Fever (>101°F), increased erythrocyte sedimentation rate, multiple leukocytes on wet-mount vaginal microscopy, and coinfection with chlamydia and/or gonorrhea further support diagnosis of PID.

Question 28

Ectopic Pregnancy

Answer 28

represents a true gynecologic emergency and should be considered when a female of reproductive age presents with pelvic pain. It occurs when a fertilized ovum implants outside the uterine cavity, commonly in the fallopian tube. Leading cause of death in first trimester.

Question 29

Ectopic Pregnancy Risk Factors

Answer 29

include tubal surgery, tubal ligation or reversal, previous ectopic pregnancy, and a tubal lesion or abnormality. Smoking, current IUD, history of PID or therapeutic abortion, and use of fertility drugs to induce ovulation have also associated.

Question 30

Polycystic Ovary Syndrome

Answer 30

PCOS is a common endocrine disorder affecting 6% to 15% of females of reproductive age and is a frequent source of chronic anovulation

Question 31

Polycystic Ovary Syndrome Treatment

Answer 31

Most effect: lifestyle modifications (weight loss) Other: depends on the most bothersome manifestations and the individual’s goals. Combined oral contraceptive agents ameliorate menstrual irregularities and improve hirsutism and acne. Metformin, an insulin-sensitizing drug, is an important component. For Fertility: clopiphene citrate or injectable gonadoptropins

Question 32

Ovarian Cancer

Answer 32

Often lethal as difficult to diagnose because symptoms mimic other benign health issues. Because of this, the disease often spreads before the time of discovery.

Question 33

Ovarian Cancer Risk Factors

Answer 33

most significant: ovulatory age; the length of time during a female’s life when her ovarian cycle is not suppressed by pregnancy, lactation, or oral contraceptive use. The incidence is much lower in parous versus nulliparous women. Other: Family history,

Question 34

Uterus and Pelvis Ligaments

Answer 34

structures are maintained in position by the uterosacral ligaments, round ligaments, broad ligaments, and cardinal ligaments. The two cardinal ligaments maintain the cervix in position.

Question 35

Cystocele

Answer 35

a herniation of the bladder into the vagina. It occurs when muscle support for the bladder is weakened, and the bladder sags below the uterus. This causes the anterior vaginal wall to stretch and bulge downward, allowing the bladder to herniate into the vagina due to gravity and pressures from coughing, lifting, or straining

Question 36

Rectocele

Answer 36

herniation of the rectum into the vagina. It occurs when the posterior vaginal wall and underlying rectum bulge forward, protruding through the introitus because the pelvic floor and perineal muscles are weakened. Symptoms: discomfort because of the protrusion of the rectum and difficulty in defecation

Question 37

Enterocele

Answer 37

Defect, hernial sac in which the small bowel protrudes when standing. The area between the uterosacral ligaments posterior to the cervix may weaken for the sac. May extend into the rectovaginal septum. Congenital or acquired. Symptoms: asymptomatic or dull dragging sensation with low backache.

Question 38

Dysmenorrhea

Answer 38

is pain or discomfort with menstruation that causes some degree of monthly disability for a significant number of individuals.

Question 39

Primary Dysmenorrhea

Answer 39

is menstrual pain not associated with physical abnormality or pathology.64 It occurs with ovulatory menstruation beginning 6 months to 2 years after menarche. Symptoms begin 1 to 2 days before menses, peak on the first day of flow, and subside within several hours to days.

Question 40

Primary Dysmenorrhea Manifestations

Answer 40

systemic symptoms such as headache, nausea, vomiting, diarrhea, fatigue, irritability, dizziness, and syncope. pain is dull, lower abdominal aching or cramping, spasmodic or colicky in nature, often radiating to the lower back, labia majora, or upper thighs.

Question 41

Secondary Dysmenorrhea

Answer 41

Is menstrual pain caused by specific organic conditions, such as endometriosis, uterine fibroids, adenomyosis, pelvic adhesions, IUDs, or PID. Laparoscopy often is required for diagnosis if medication for primary dysmenorrhea is ineffective.

Question 42

Dysmenorrhea Treatment

Answer 42

Aims for symptom control Ovulation suppression and symptomatic relief of dysmenorrhea can be used simultaneously with oral contraceptives. Relief of secondary dysmenorrhea depends on the cause, and medical or surgical intervention may be needed

Question 43

Breast Cancer Detection

Answer 43

Most common and skin cancer manifest as a mass, a puckering, nipple retraction, or unusual discharge. The variety of symptoms and potential for self-discovery stress the need for females to know their normal breast appearance and texture. Other: Mammography

Question 44

Breast Cancer Treatment

Answer 44

include surgery, chemotherapy, radiation, and hormonal manipulation. Radical mastectomy (i.e., removal of the entire breast, underlying muscles, and all axillary nodes) is rarely the primary surgical therapy unless cancer is advanced. Preferred: Modified surgical techniques (mastectomy plus axillary dissection or lumpectomy for breast conservation) plus chemotherapy or radiation therapy.

Question 45

Infertility

Answer 45

Inability to conceive a child after 1 year of unprotected intercourse.

Question 46

Infertility Male Factors

Answer 46

Sufficient Quantity of Sperm Causes include varicocele, ejaculatory dysfunction, hyperprolactinemia, hypogonadotropic hypogonadism, infection, immunologic problems, obstruction, and congenital anomalies. Risk factors include a history of mumps orchitis, cryptorchidism, testicular torsion, hypospadias, previous urologic surgery, and history of STIs.

Question 47

Infertility Female Factors

Answer 47

pregnancy require production and release of a mature ovum capable of being fertilized, cervical mucus for sperm transport and sperm viability in the female reproductive tract, patent fallopian tubes with the motility to pick up and transfer the ovum to the uterine cavity, an endometrium suitable for implantation and nourishment of a fertilized ovum, and a uterine cavity that allows for growth and development of a fetus.