CHAPTER 23: THE GYNECOLOGIC
EXAMINATION AND PRENATAL CARE
What is the purpose of performing the bimanual pelvic examination? - Answer-The
purpose of performing the bimanual pelvic examination is to allow the physician to
palpate the uterus and ovaries for size, shape, position, and detection of tenderness or
lumps.
What is the purpose of the rectal-vaginal examination? - Answer-The purpose of the
rectal-vaginal examination is to provide a view of the tone and alignment of the pelvic
organs and adnexal region, and note the presence of hemorrhoids, fistulas, and fissures
for early detection of colorectal cancer.
Describe the laboratory procedure that can be used to identify Trichomonas vaginalis in
the medical office. - Answer-Trichomonas may be identified in the medical office by a
wet preparation, which involves using a sterile swab to place a small amount of the
discharge on a microscope slide, adding a drop of isotonic saline to it, and placing a
coverslip over the mixture to protect it. The slide is examined under the microscope and
observed for presence of the lashing movements of the flagella and motility of the
organism.
Describe the laboratory procedure that can be used to identify Candida albicans in the
medical office. - Answer-Candida may be identified microscopically in the medical office
by placing a specimen of the vaginal discharge on a slide using a sterile swab and
adding a drop of a 10% solution of potassium hydroxide (KOH).
What are the symptoms of PID? What complications can occur from PID? - Answer-The
symptoms of PID include lower abdominal pain, fever, nausea, and vomiting,
dyspareunia, vaginal discharge, and bleeding between periods. Complications of PID
are serious and include chronic pelvic pain, scarring of the fallopian tubes, ectopic
pregnancy, and infertility.
How are chlamydial and gonorrheal infections usually diagnosed? - Answer-Chlamydia
and gonorrheal infections are usually diagnosed by using a nucleic acid amplification
test (NAAT) or a DNA probe test.
List the symptoms of each of the following sexually transmitted diseases:
a. Trichomoniasis in the female:
b. Candidiasis in the female:
c. Chlamydia
Female:
, Male:
d. Gonorrhea
Female:
Male: - Answer-a. Trichomoniasis in the female: Symptoms include a profuse, frothy
vaginal discharge that is usually yellowish green and has an unpleasant odor; itching
and irritation of the vulva and vagina; dyspareunia; and dysuria. The cervix may exhibit
small red spots, a condition known as "strawberry cervix".
b. Candidiasis in the female: Symptoms include white patches on the mucous
membrane of the vagina; a thick, odorless, cottage cheese-like discharge; vulval
irritation; and dysuria. The discharge is extremely irritating and usually results in burning
and intense itching.
c. Chlamydia
Female: Most women with chlamydia have no symptoms, if symptoms do occur, they
may include dysuria, itching and irritation of the genital area, and a yellowish, odorless
vaginal discharge.
Male: Symptoms include mild dysuria and a thin, watery discharge from the penis.
d. Gonorrhea
Female: May have no symptoms or may exhibit dysuria and a yellow vaginal discharge.
Male: Symptoms include dysuria and a whitish discharge from the penis, which may
progress to a thick and creamy discharge. The burning and pain experienced during
urination are often severe.
What is the purpose of prenatal care? - Answer-The purpose of prenatal care is to
promote the health of the mother and fetus through prevention of disease and early
detection, diagnosis, and treatment of problems common to pregnancy.
List the three categories of medical office visits for provision of prenatal and postnatal
care to the pregnant woman. - Answer-The three categories of prenatal and postnatal
office visits are the first prenatal visit, return prenatal visits, and the 6 weeks postpartum
visit.
List the four components of the first prenatal visit. - Answer-The four components of the
first prenatal visit are usually the completion of a prenatal record form, an initial prenatal
examination, consisting of a complete physical examination, prenatal patient education,
and laboratory tests.
What is the purpose of the prenatal record? - Answer-The purpose of the prenatal
record is to provide information regarding the past and present health of the patient and
serves as a database and flow sheet for subsequent prenatal visits and is essential for
helping identify high-risk patients.
EXAMINATION AND PRENATAL CARE
What is the purpose of performing the bimanual pelvic examination? - Answer-The
purpose of performing the bimanual pelvic examination is to allow the physician to
palpate the uterus and ovaries for size, shape, position, and detection of tenderness or
lumps.
What is the purpose of the rectal-vaginal examination? - Answer-The purpose of the
rectal-vaginal examination is to provide a view of the tone and alignment of the pelvic
organs and adnexal region, and note the presence of hemorrhoids, fistulas, and fissures
for early detection of colorectal cancer.
Describe the laboratory procedure that can be used to identify Trichomonas vaginalis in
the medical office. - Answer-Trichomonas may be identified in the medical office by a
wet preparation, which involves using a sterile swab to place a small amount of the
discharge on a microscope slide, adding a drop of isotonic saline to it, and placing a
coverslip over the mixture to protect it. The slide is examined under the microscope and
observed for presence of the lashing movements of the flagella and motility of the
organism.
Describe the laboratory procedure that can be used to identify Candida albicans in the
medical office. - Answer-Candida may be identified microscopically in the medical office
by placing a specimen of the vaginal discharge on a slide using a sterile swab and
adding a drop of a 10% solution of potassium hydroxide (KOH).
What are the symptoms of PID? What complications can occur from PID? - Answer-The
symptoms of PID include lower abdominal pain, fever, nausea, and vomiting,
dyspareunia, vaginal discharge, and bleeding between periods. Complications of PID
are serious and include chronic pelvic pain, scarring of the fallopian tubes, ectopic
pregnancy, and infertility.
How are chlamydial and gonorrheal infections usually diagnosed? - Answer-Chlamydia
and gonorrheal infections are usually diagnosed by using a nucleic acid amplification
test (NAAT) or a DNA probe test.
List the symptoms of each of the following sexually transmitted diseases:
a. Trichomoniasis in the female:
b. Candidiasis in the female:
c. Chlamydia
Female:
, Male:
d. Gonorrhea
Female:
Male: - Answer-a. Trichomoniasis in the female: Symptoms include a profuse, frothy
vaginal discharge that is usually yellowish green and has an unpleasant odor; itching
and irritation of the vulva and vagina; dyspareunia; and dysuria. The cervix may exhibit
small red spots, a condition known as "strawberry cervix".
b. Candidiasis in the female: Symptoms include white patches on the mucous
membrane of the vagina; a thick, odorless, cottage cheese-like discharge; vulval
irritation; and dysuria. The discharge is extremely irritating and usually results in burning
and intense itching.
c. Chlamydia
Female: Most women with chlamydia have no symptoms, if symptoms do occur, they
may include dysuria, itching and irritation of the genital area, and a yellowish, odorless
vaginal discharge.
Male: Symptoms include mild dysuria and a thin, watery discharge from the penis.
d. Gonorrhea
Female: May have no symptoms or may exhibit dysuria and a yellow vaginal discharge.
Male: Symptoms include dysuria and a whitish discharge from the penis, which may
progress to a thick and creamy discharge. The burning and pain experienced during
urination are often severe.
What is the purpose of prenatal care? - Answer-The purpose of prenatal care is to
promote the health of the mother and fetus through prevention of disease and early
detection, diagnosis, and treatment of problems common to pregnancy.
List the three categories of medical office visits for provision of prenatal and postnatal
care to the pregnant woman. - Answer-The three categories of prenatal and postnatal
office visits are the first prenatal visit, return prenatal visits, and the 6 weeks postpartum
visit.
List the four components of the first prenatal visit. - Answer-The four components of the
first prenatal visit are usually the completion of a prenatal record form, an initial prenatal
examination, consisting of a complete physical examination, prenatal patient education,
and laboratory tests.
What is the purpose of the prenatal record? - Answer-The purpose of the prenatal
record is to provide information regarding the past and present health of the patient and
serves as a database and flow sheet for subsequent prenatal visits and is essential for
helping identify high-risk patients.
