Prepared by: ROSELYN SENAS PACARDO, MAN, MM,RN, RM

I ANATOMY AND PHYSIOLOGY (EXTERNAL AND INTERNAL FEMALE GENITALIA)

EXTERNAL GENITALIA (CD)

INTERNAL FEMALE GENITALIA

SITUATION A. A group of young couples attended a seminar on reproductive health. 1. Which glands are located on either side of the female urethra and secrete mucus to keep the opening moist and lubricated for urination? A.Cowper s gland B.Bartholin s glands C.Skene s glands D.Prostate gland

ANSWER AND RATIONALE A.Cowper s gland (Bulbourethral glands) secrete an alkaline fluid that helps counteract the acid secretion of the urethra; comprises 5% of semen B. Bartholin s glands (vulvovaginal glands/paravaginal) located lateral to the vaginal openings; lubricates distal vagina C. Skene s glands ( para or periurethral glands) located just lateral to the urinary meatus; ducts open into the urethra and provides lubrication D. Prostate gland secretes a thin, alkaline fluid that makes up 60% of the semen * 30% of semen from seminal vesicles; epididymis 5% Pillitteri pp. 73 - 74

2. In the woman, the area of the skin, connective tissue, and the muscle between the vulva and anus that flattens and stretches to accommodate the birth of the baby is the:

A.Perineum B.Prepuce C.Hymen D.Mons Veneris

ANSWER AND RATIONALEA.Perineum located posterior to the fourchette B.Prepuce hood that covers the clitoris C.Hymen tough but elastic semicircle of tissue that covers the opening to the vagina in childhood D.Mons Veneris (Mons pubis or Mt. of Venus) located over the symphisis pubis; protect the junction of the pubic bone from trauma Pillitteri pp. 73 - 74

1.

Glans of Clitoris 2. Labium Majora 3. Hymen 4. Posterior labial commissure 5. Prepuce of clitoris 6. Labium minora 7. External orifice of urethra 8. Vaginal orifice

9. Perineum

3. Which of the following types of

smooth muscle fibers of the myometrium contain the living ligatures which will compress the blood vessels after birth to limit blood loss? A. Longitudinal fibers B. Interlacing fibers C. Circular fibers D. Transverse fibers

ANSWER AND RATIONALE

A. Longitudinal fibers (outer layer) - found mostly in the fundus and are designed to expel the fetus efficiently toward the pelvic outlet during birth B. Interlacing fibers (middle layer) fibers are arranged in figures of 8 C. Circular fibers form constrictions where the fallopian tubes enter the uterus and surround the internal cervical os. Circular fibers prevent reflux of menstrual blood and tissue into the fallopian tubes, promote normal implantation of the fertilized ovum by controlling its entry into the uterus, and retain the fetus until the appropriate time of birth D. Transverse fibers - no such fibers Source: McKinney vol 1 2nd ed. 2007 p. 222

4. The site of fertilization is in the: A. Second division of the fallopian tube B. Outer third of the fallopian tube C. At the fundic area of the uterus D. At the junction between the fundus and the fallopian tube

ANSWER AND RATI NALE A. Second division o the allopian tube Isthmus; Not the site o ertilization; cut during bilateral tubal ligation . uter third o the allopian tube - (Ampulla) . At the undic area o the uterus Not the site o ertilization D. At the unction bet een the undus and the allopian tube Interstitial; Not the site o ertilization Source: Pilliterri vol. 1 5th ed. 2007 p. 76; 183

5. During the reproductive health session one of the participants asked the nurse, How many oocytes are still left in my ovary since I had my menarche at the age of 12 and I am now 18 years old? What would be your expected response from the nurse? A. B. C. D. You will have approximately 226 You will have approximately 227 You will have approximately 228 You will have approximately 229 426 oocytes. 427 oocytes. 428 oocytes. 429 occytes.

ANSWER AND RATIONALE

A. You will have approximately 226 426 oocytes. B. You will have approximately 227 427 oocytes. C. You will have approximately 228 428 oocytes. (18 yrs 12 yrs= 6 yrs x 12 eggs released per year = 72; 300 to 500 eggs during the reproductive years 72 = 228 428) D. You will have approximately 229 429 occytes.

Source: Pilliterri vol. 1 5th ed. 2007 p. 183

ANATOMY AND PHYSIOLOGY (PELVIS AND MENSTRUAL CYCLE)

PARTS OF THE PELVIS (CD)

TYPES OF PELVIS

MENSTRUAL CYCLEOn the third day of the menstrual cycle Estrogen level

hypothalamus GnRH

APG FSH Maturation of immature oocyte inside a primordial follicle (ovum) ovaryProduces

Estrogen

Primordial follicle becomes Graafian follicle ; continues to secrete high level of estrogen Endometrium thickens 13th day of menstrual cycle Low level of progesterone

HypothalamusGnRH

APG Luteinizing Hormone Ovary Progesterone

Increased estrogen and progesterone pushes the ovum to the surface of ovary LH surge and release of prostaglandins Graafian follicle ruptures then matured ovum released - OVULATION GF becomes corpus luteum; contains high amount of progesterone

Causes

Glands of endometrium corkscrew, twisted, highly vascular, velvety soft,and spongy No fertilization (until 24th day of MC) CL becomes corpus albicans Decrease estrogen and progesterone Thickened lining of uterus degenerates, sloughs off, capillaries rupture - MENSES

FACTS TO REMEMBERCHARACTERISTIC

MENARCHE INTERVAL DURATION AMOUNT COLOR ODOR

DESCRIPTION Average Onset: 11 13 years Average Range: 9 17 years Average: 28 days Range: 15 to 45 days Average: 2 to 7 days Range: 1 to 9 days 20 to 80 mL per flow Dark Red Marigold

TERMS TO REMEMBERAMENORRHEA OLIGOMENORRHEA MENORRHAGIA Temporary cessation of mensesMarkedly diminished menstrual flow

Excessive bleeding during menses

METRORRHAGIA Bleeding at irregular intervals POLYMENORRHEA Frequent menses occurring at less than 3 weeks interval

MITTELSCHMERZ Middle pain during ovulation ARBORIZATION TEST

Fern-like pattern of cervical mucus during ovulation as seen under the slide Cervical mucus can be stretched into long strands

S INNBARKEIT TEST

SITUATION B: A nurse is conducting a health teaching class, reviewing the functions of the pelvis and the importance of the menstrual cycle.

6. Three of the bones below unite to form the innominate bone. Which of the following bones is not included? A.Pubis B.Ilium C.Coccyx D.Ischium

ANSWER AND RATIONALE

A.Pubis anterior portion of the innominate bone B.Ilium forms the upper and lateral part of the hip bone C.Coccyx just below the sacrum, composed of five very small bones fused together D.Ischium inferior portion of the hip bonePillitteri p. 82

7. One of the participants asks, What is a gynecoid pelvis? . The nurse replies that this type of pelvis: A.Has an inlet that is oval, smoothly curved, but the anteroposterior diameter is shallow. B.Has a narrow pubic arch. C.Has a narrow transverse diameter and the anteposterior diameter of the inlet is larger than normal. D.Has an inlet that is well-rounded forward and backward and the pubic arch is wide

ANSWER AND RATIONALE A.Has an inlet that is oval, smoothly curved, but the anteroposterior diameter is shallow. (Platypelloid; flat pelvis) B. Has a narrow pubic arch. (Android; heart-shaped; male pelvis) C.Has a narrow transverse diameter and the anteposterior diameter of the inlet is larger than normal. (Anthropoid; ape-like pelvis; oblong) D.Has an inlet that is well-rounded forward and backward and the pubic arch is widePillitteri p. 264

8. A couple trying to conceive asks the nurse, When does ovulation occur? . The woman reports a 28-day cycle. Which of the following response of the nurse is correct? A. On the 14th day prior to the next menstrual cycle. B. On the 15th day prior to the next menstrual cycle. C. On the 16th day prior to the next menstrual cycle. D. On the 17th day prior to the next menstrual cycle.

ANSWER AND RATIONALE

A. On the 14th day prior to the next menstrual cycle. Deduct 14 days from the given menstrual cycle B. On the 15th day prior to the next menstrual cycle. C. On the 16th day prior to the next menstrual cycle. D. On the 17th day prior to the next menstrual cycle.Pillitteri p. 84

14th day

9. A lady asks the nurse to describe the follicle stimulating hormone (FSH) and the luteinizing hormone (LH). The nurse accurately responds by stating that? A.FSH and LH are released by the anterior pituitary gland. B.FSH and LH are secreted by the corpus luteum of the ovary. C.FSH and LH are secreted by the adrenal glands. D.FSH and LH stimulate the formation of milk during pregnancy.

ANSWER AND RATIONALE

9. A lady asks the nurse to describe the follicle stimulating hormone (FSH) and the luteinizing hormone (LH). The nurse accurately responds by stating that? A.FSH and LH are released by the anterior pituitary gland. B.FSH and LH are secreted by the corpus luteum of the ovary. (progesterone) C.FSH and LH are secreted by the adrenal glands. D.FSH and LH stimulate the formation of milk during pregnancy. Estrogen and progesterone stimulates APG to Pillitteri pp. 83 84; 632 produce prolactin

10. The hormone that is secreted by the corpus luteum and prepares the endometrium for implantation is: A.Estrogen B.Luteinizing hormone C.Progesterone D.Gonadotropin-releasing hormone

10. The hormone that is secreted by the corpus luteum and prepares the endometrium for implantation is: A.Estrogen from ovary B.Luteinizing hormone from APG C.Progesterone D.Gonadotropin-releasing hormone released by hypothalamusPillitteri pp. 83 - 84