PD Male and Female Reproduction systems

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What are the Tanner Stages for?: Breast development

Female gential development

Male genital development
What is the frequency for breast self-examination?: Monthly
At what point should BSE begin?: When breast tissue begins to develop.
For menstruating females, at what time during the menstral cycle should the breast self exam be preformed.: 2-3 days after menses.
Where are most breast carcinomas located?: UOQ (upper outer quadrant)
Why are breast carcinomas located in the UOQ?: That is where the greatest grandular tissue lies.
What are some normal variations that can be observed in the breast exam?: Bilateral venous pattern
Bilat long standing nipple inversion. Asymmetry in breast size.
What abnormality in the breast exam can indicate breast carcinoma?: Retraction, dippling, nipple inversion, bloody discharge, mass or palpable lymph nodes.
If nipple discharge is discovered on exam, what do you do with it?: Place on slide and fix with fixative for cytological exam.
What are 2 types of speculums?: Graves and Pederson
What is the graves speculum used for?: Multiparous (woman has given birth) and larger women.
What are the Pederson speculums used for?: Nulliparous (non child bearing woman) Not sexually active women.
What governs out standby policy in the Navy (Instruction Number): BUMEDINST 6320.83
Why is a stand by necessary?: Medical legal reasons.
What are the 3 positions for breast exam?: 1. Arms overhead.
2. Hands at hips.
3. Leaning forward.
Which breast exam position is useful for large breasts?: Leaning forward.
What is the proper position for lymph node exam?: Seated with arms flexed at sides for the supraclavicular and infraclavicular.
Seated with arms flexed for axillary nodes.
What axillary nodes are located posterior to the anterior axillary fold and drains breast and chest?: Anterior axillary lymph nodes.
What lymph nodes drain the posterior chest wall and arms?: Posterior subscapular lymph nodes.
What lymph nodes drain the nipple and areola?: Mid axillary (central) node and the supraclavicular and infraclavicular nodes.
What lymph nodes are along the medial proximal humerus and drain the arm?: Lateral brachial lymph nodes.
Describe the incline of the vaginal canal.: It has a posterior incline of 45 degrees.
What would explain a slit like appearance of the os in a nulliparous?: Cervical dialation from a pregnancy termination (abortion)
What are the 3 components of the cervix?: 1. Internal os (uterine opening)
2. Endocervical canal.
3. External os (vaginal opening)
What is the adnexa?: The ovaries and fallopian tubes.
What is the vaginal fornix?: Innermost recess of the vagina surrounding the cervix.
Inguninal lymphandenopathy in a female can represent a disease in what structure?: The vulva or inferior vagina.
Where are the Bartholin's glands located?: at 4 and 8 O'clock positions of the intriotus.
Where are the Skene's glands located?: Paraurethral.
Define menapause.: 1 continuous year without menses.
Define surgical menopause.: Surgical removal of the ovaries causing amenorrhea.
Describe the proper procedure for inserting a vaginal speculum.: 1. Insert 1 finger into the vaginal introitus and gently press down.
2. Use the other fingers to seperate labia.
3. insert speculum obliquely and downward at a 45 degree angle.
What is the order of obtaining a specimen during a pap smear?: 1. Wooden spatula.
2. Cervical brush.
3. Dacron swab.
4. CTA (cotton tip applicator)
How do you collect a GC culture?: Use dacron swab, swab cervical os, rotating for 30 seconds, place swab in provided test tube.
Describe how to perform a wet mount.: Swab fornix of vagina, paint surface of glass slide, drop of Saline, apply cover slip, view under microscope.
Describe how to perform a KOH.: Use a 2nd swab from fornix, paint glass slide, add a drop of KOH, apply cover slip, heat fix, whiff test for fishy odor, view under microscope.
What is the normal position for the uterus?: Midline abdomen.
What is a normal mobility of the cervix?: 1-2 cm in each direction.
What disease in due to endometrial tissue implanting outside of the uterus causing severe dysmenorrhea?: Endometriosis.
What penile tissue surrounds the urethra?: Corpora spongiosum.
What penile tissue is on the dorsum and sides of penis?: Corpora cavernosa
How is the urethral meatus examined in males?: Glands is pressed between finger and thumb to open.
How is the exam of an uncircumsized man different that that of a circumsized man?: You must retract foreskin, and smegma is expected.
If a mass is found on the testicular exam, what is the next step to evaluate the mass?: Transillumination
What are the three hernia types that are evaluated in the male genital exam?: 1.Indirect inguinal
2.Direct inguinal
3.Femoral
Describe the charactaristic of a Indirect inguinal hernia.: A hernia that passes through internal inguinal ring, into inguinal canal, pain with straining.
Describe characteristics of a Direct inguinal hernia.: A hernia that passes directly through abdominal wall defect into inguinal canal, usually painless.
Describe the characteristics of a Femoral hernia.: A hernia which passes through the femoral ring, canal and fossa, below inguinal ligament, pain may be severe.
What is the most common hernia seen on male genital exam?: Indirect inguinal hernia.
Define Hydrocele.: Fluid filled mass in the scrotum (tunica vaginalis)
Define spermatocele.: Sperm filled mass on the epididymis.
Define varicocele.: Varicosities of the pampiniform plexux(bag of worms)
What is DX of a 50 YO male with breast enlargement?: Gynecomastica
What is the DX of a 28 YO feamle with breast tenderness a small breast lump after a MVA.: Fat necrosis.
What is the DX of a 44 YO female with anterior vaginal bulging on pelvic exam and urinary incontinence?: Cystocele.
What is the DX of a 23 YO male presents with rash on end of penis, lesions are pearly and unbilicated with descrete margins.: Mulluscum Contagiosum
What is the DX of a 24 YO female presents with tender breast lump that she can feel during her period, on exam you find a small round well delineated mobile 2 cm mass in the OUQ of her left breast?: Fibrocystic disease.
What is the DX: 21 YO male presents with prolonged painful erection after taking 2 Viagras on a dare?: Priapism.
What is the DX: 55 YO female has been amenorrihic for 13 months with some vaginal dryness and itching and hot flashes?: Menopause.
What is the DX: 23 YO female complaining of foul smell, watery discharge for 7 days. On exam you find clue cells.: Bacterial vaginosis.
What is the DX: 25 YO male with painless chancre on shaft of penis?: Syphillis (SCC)
What is DX: 21 YO female presents with painfull lesions on her labia, lesions where first pruritic, on exam vesicles on a erythemic base are noted.: Herpes
WHat is the Dx: 50 YO female with posterior wall bulging on pelvic exam.: Rectocele.
What is the DX: 19 YO male presents with multiple cauliflower like lesions over penis and anus.: Genital warts (condyloma Acuminate)
What is the DX: 32 YO female presents with severe vaginal puritis with thick white curdle like discharge, hyphae are seen on KOH.: Candidida infection (yeast infection)
What is the DX: 23 YO female with unilateral labial swelling and inflammation.: Bartholin gland abcess.
What is the DX: 18 YO male with sudden onset of severe right testicular pain that is not relieved with manual elavation of the testicle?: Testicular torsion.
What is the DX: 24 YO female with yellow green discharge seen while milking the Skenes gland?: Usually GC.
What is the DX: 22 YO female with left sided pelvic pain and abnormal bleeding times 2 weeks and absence menses, small mass felt on left adnexal exam. Pos HCG.: Ectopic pregnancy.
What is the DX: 18 YO male with inability to retract his foreskin?: Phimosis.
What is not factored in Tanner Stage evaluation?: Chronological age.
At which Tanners age should breast exams begin?: Tanner Stage 5.
25% of menarchy begins at what Tanners stage?: Tanners stage 3.
What percentage of females begin a regular menstrual cycle in stanner stage 4?: 75%
What are the 3 components that make up the breasts?: 1. Glandular tissue.
2. Supporting tissue.
3. Fat
What are the 5 segments of the breasts?: 4 quandrants and the tail of spence.
What is the % of breast lumps found on BSE?: 90%
What does GAP stand for?: Gravida = # of pregnancies

Abortions= # of pregnancies not carried to term.

Para = # of living children.
What are the risk factors for breast cancer?: Greater than age 50
Family HX or Past Medical HX
Previous Biopsy of breast DZ.
Breast cancer gene BRCA1 & BRCA2.
Longer estrogen exposure.
BSE should be preformed how many days after menstraul cycle?: 2 - 3 days
Women that do not menstrate should do what in regards to BSE.: Choose a day to preform Breast Self Exam
Describe Peau D' Orange in regards to etiology, characteristics.: Thickening, orange peel texture skin with prominent pores caused by obstruction of lymph discharge 2nd to underlying and advanced CA
Where would supernumerary nipples be located if present?: Along mammary lines Axilla to inguinal area.
What are the risk factors for cervical cancer?: Age

PHx of cervical dysplasia, infection of Human Papilloma Virus, Herpes Simplex Virus

Early age of 1st sexual intercourse.

Multiple sex partners

HIV Pos.

Smoking

Long term use of oral contraceptives.
Describe findings of a normal cervix.: The cervix should be pink, with color evenly distributed, located midline, have a smooth surface, with no discharge. The size and shape depends on if the woman has given birth or not.
What is examined on the external genital exam? (10): Labia Majora, Labia Minora, Clitoris, Urethral Orifice, Vaginal Introitus, Skene and Bartholin Glands, Muscle tone, Perineum, Anus
What is inspected on internal exam of a woman, and what are you looking for?: You inspect the cervix for, color, position, size, surface characteristics, discharge, and size and shape of the os
Name 3 physcilogical changes in Tanner stage 4: Increased fat deposits

Projection of areola and nipple in a secondary mound

75% of females are mmenstruating and beginning regular cycle.
State 3 physiological changes in Tanner stage 5: Only nipple projects

Areola usually part of general breast contour and pigmented

10% of females do not reach menarche until this stage
How many Tanner stages are there in the evaluation of the female pubic hair growth?: 6
What are the 4 horomones involved with a females menstrual cycle.: LH, FSH, Progesterone, Estrogen
What 2 examination techniques are omitted when preforming a breast exam?: Precussion and ascultation
Is long standing bilat nipple retraction normal?: Yes
What is the Pt. position while palpating lymphnodes: Sitting with arms at their side, examiner supports the arm they are inspecting.
How often is TSE preformed?: monthly
Does having multiple sex partners increase the risk of cervical cancer?: yes
What is the proper technique to examine the Bartholin and Skene glands?: Palm facing up, index finger in vagina to the depth of the 2nd joint, using upward pressure move the finger outward.
What is Chadwicks sign?: Bluish coloring of the cervix,vagina, and vulva after approx. 8-12 weeks of gestation.
What direction does the vaginal rugae present.: Transvers down the vaginal canal.
Is the internal os visible on a pelvic exam?: No, only the external is visible.
What is the swab of choice for a GC specimen.: DNA probe or Dacron swab
If a specimen from a pap smear is found to contain a Gram Negative Diplococci what could be the possible DX?: Neisseria gonorrhoeae
What is a DX that needs to be ruled out in a Pt. with lymphadenopathy.: Cancer
When should males be taught how to preform TSE: ages 15-30
Whats is a diagnostic procedure in the male exam to distinguish between hernia and Hydrocele?: Transillumination
What part of a males penis produces and maintains an erection: Corpora Cavernosa
Testicular cancer is most common in males of what age range?: 15 - 30 y/o
What is Prehn's sign assist in diagnosing?: Testiculr torsion, it is positive when pain is not relieved in affect testicle while elevating it.
What is a complication of a pt. with a hernia.: That it could become strangulated or incarcerated. This would cu off the blood supply and lead to necrosis of the tissue.
Describe a normal testicle?: It is smooth, rubbery, nontender and free of nodules
What muscle is capable of moving the scrotum and regulating scrotal temp.: Cremaster muscle
What is the #1 cancer in males age 15-30: Testicular cancer.

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