Female Pelvic And Breast Exam

Front 1

What comprises the vulva?

Back 1

Mons pubis
Labia majora
Labia minora
Clitoris
Vaginal vestibule
Urethral orifice

Front 2

What is included in the internal female genitalia?

Back 2

Vagina
Uterus
- Corpus
- Cervix
Adnexa
- Fallopian tubes
- Ovaries

Front 3

What equipment is needed for a pelvic exam?

Back 3

Drape
Speculum
Gloves
Water-soluble lubricant
Specimen collection equipment
- Liquid-based Pap
- Wet prep
- GC/CT (chalmydia) swab
Light source

Front 4

Graves speculum

Back 4

Multiparous (have had multiple children)
Obese
Unable to visualize the cervix with the Pederson

Front 5

Pederson speculum

Back 5

Virginal
Nulliparous
Thin
Menopausal
Adolescent

Front 6

Lithotomy position

Back 6

Help place patient’s feet in the foot holders

Have her slide her buttocks down to the end of the table.
- Buttocks should be slightly hanging over the edge
- If the patient is not positioned correctly, the speculum exam will be difficult

Ensure the sheet covers her abdomen to her knees

Front 7

What position should the patient be in for a pelvic exam?

Back 7

Lithotomy position

Front 8

What is appropriate draping for a pelvic exam?

Back 8

Drape for minimal exposure

Cover knees and symphysis then depress the drape between her knees
Allows for eye contact between you and the patient
Keeps the thighs covered for entire exam

Arrange the exam light and equipment to be used.

Front 9

What is the proper gloving technique for a pelvic exam?

Back 9

Wash hands and put on gloves
- Once you have touched any of the patient’s genital skin, assume that your glove is “contaminated”
- Do not touch anything except the patient, the drape, and what your MA hands you after you put on gloves.

Front 10

What should the practitioner do when beginning a pelvic exam?

Back 10

It is your job to minimize the patient’s apprehension and discomfort.
Explain what you are doing before you do it.
Maintain eye contact and sit down.
Ask the woman to separate or relax her legs to the side.
Inform her that you are going to begin your exam
Start with a neutral touch - ex: on inside of leg

Front 11

What should be inspected on the external genitalia?

Back 11

Labia major
Labia minora
Clitoris
Urethral orifice
Vaginal introitus (opening)
Skene and Bartholin glands
Muscle tone
Perineum
Anus

Front 12

How to insert the speculum

Back 12

Insert at a downward angle so if you don't locate cervix, you can rotate it up.

Insert it vertically and then rotate after it is inserted.

Front 13

What should inspection of the cervix include?

Back 13

Color
Position
Size
Surface characteristics
Discharge
Size and shape of the os

Front 14

How will the os appear on women who have/have not had children?

Back 14

Multiparous women - has a line
Nulparous women - more circular

Front 15

Cervical cell types

Back 15

Columnar
Line cervical canal (endocervix)
One cell layer thick

Squamous
On portio of cervix (ectocervix)
8-16 layers thick

Squamocolumnar junction
Where columnar and squamous cells meet
Most likely area for dysplasia

Front 16

Cellular changes during aging

Back 16

Over time, columnar cells transform
into squamous cells (a normal process)

Front 17

Transformation Zone

Back 17

The area between where the SCJ used to be and where it currently is equals
the Transformation Zone.

This is where you want to take the Pap smear because this is where dysplasia is most likely to occur.

Front 18

Liquid-based Pap smear

Back 18

???

Front 19

Most common reasons for pelvic screenings.

Back 19

Chlamydia
Gonorrhea
Trichomonas
Bacterial vaginosis

Front 20

Withdrawal of speculum

Back 20

Unlock the speculum and remove it slowly and carefully

Inspect the vaginal walls
- Note color, surface characteristics, and secretions

The blades will tend to close themselves

Avoid pinching the cervix and vaginal walls

Maintain downward pressure of the speculum

AVOID THE ANTERIOR STRUCTURES
- Urethra and clitoris

Front 21

Who needs a rectovaginal exam?

Back 21

Age > 50 years
Pelvic pain
Pelvic mass

Front 22

Rectovaginal examination

Back 22

Reaches almost 2.5 cm higher into the pelvis
Examines the back side of the uterus
Checks tone and alignment of pelvic organs
Guaiac
Rectal growths and/or masses

Front 23

What should be examined during a rectovaginal exam?

Back 23

Reaches almost 2.5 cm higher into the pelvis
Examines the back side of the uterus
Checks tone and alignment of pelvic organs
Guaiac
- Rectal growths and/or masses

Front 24

Breast exam inspection

Back 24

Asymmetry
Dimpling
Retraction
Mass altering contour of breast
Skin color, edema
Nipple inversion, scaling, crusting

Front 25

Breast exam palpation

Back 25

Sitting and supine positions

Supraclavicular and infraclavicular regions, axilla, and breast

Systematic fashion

Pads of middle 3 fingers of both hands

Should take 3-5 minutes to complete

Front 26

Polymenorrhea

Back 26

Less than 21-day intervals between menses

Front 27

Oligomenorrhea

Back 27

Infrequent bleeding

Front 28

Menorrhagia

Back 28

Excessive flow

Front 29

Metrorrhagia

Back 29

Intermenstrual bleeding

Front 30

Menarche

Back 30

Age at onset of menses

Front 31

Menopause

Back 31

Absence of menses for 12 consecutive months, usually occurring between 48-55 years old

Front 32

Postmenopausal bleeding

Back 32

Bleeding occurring 6 months or more after cessation of menses

Front 33

Amenorrhea

Back 33

Absence of menses

Front 34

Dysmenorrhea

Back 34

Pain with menses, often with bearing down, aching or cramping sensation in lower abdomen or pelvis

Front 35

PMS

Back 35

Premenstrual syndrome
Cluster of emotional, behavioral and physical symptoms occurring 5 days before menses for three consecutive cycles.

Front 36

Abnormal uterine bleeding

Back 36

Bleeding between menses, including infrequent, excessive, prolonged or postmenopausal bleeding.

Front 37

Causes of primary dysmenorrhea

Back 37

Increased prostaglandin production during the luteal phase of the menstrual cycle, when estrogen and progesterone levels decline.

Front 38

Causes of secondary dysmenorrhea

Back 38

Endometriosis, adenomyosis, PID and endometrial polyps

Front 39

Causes of postcoital bleeding

Back 39

Cervical polyps, cancer or atrophic vaginitis

Front 40

Causes of postmenopausal bleeding

Back 40

Endometrial cancer, HRT, uterine and cervical polyps

Front 41

Dyspareunia

Back 41

Pain with intercourse

Front 42

Vaginismus

Back 42

Involuntary spasm of the muscles surrounding the vaginal orifice that makes penetration during intercourse painful or impossible.

Front 43

What is the most common cause of acute pelvic pain?

Back 43

PID, pelvic inflammatory disease

Front 44

Causes of pelvic pain

Back 44

PID
Ruptured ovarian cyst
Appendicitis
Mittelschmerz
Endometriosis
Fibroids
Pelvic floor spasm

Front 45

Epidermoid cyst

Back 45

Small, firm, round cystic nodule in labia
Yellowish in color
Dark punctum marking the blocked opening of the gland.

Front 46

Venereal wart

Back 46

Condyloma acuminatum
Warty lesions on labia and within the vestibule
Result from infection with HPV

Front 47

Chancre

Back 47

Firm, painless ulcer
Because most chancres in women develop internally, they often go undetected.

Front 48

Secondary syphilis

Back 48

Condyloma latum
Slightly raised, round or oval, flat-topped papules covered by a gray exudate, contagious

Front 49

Genital herpes

Back 49

Shallow, small, painful ulcers on erythematous bases
Initial infection may be extensive while recurrent infections are usually confined to a small local patch.

Front 50

Carcinoma of the vulva

Back 50

Ulcerated or raised red vulvar lesion in an elderly woman may indicate vulvar carcinoma.

Front 51

Trichomonal vaginitis

Back 51

Yellowish green or gray discharge, possibly frothy, Often profuse and pooled in vaginal fornix
Malodorous

Pruritus
Pain on urination
Vestibule and labia minora may be reddened

Saline wet mount

Front 52

Candidal vaginitis

Back 52

White and curdy discharge, typically thick, not profuse
Not malodorous

Pruritus
Vaginal soreness, pain on urination, dyspareunia

KOH

Front 53

Bacterial vaginosis

Back 53

Gray or white discharge
Thin, homogenous, coats the vaginal walls, not profuse
Malodorous - fishy or musty odor

Clue cells - epithelial cells with stippled borders

Front 54

Uterine prolapse

Back 54

1st degree - cervix still felt in vagina
2nd degree - cervix at introitus
3rd degree - cervix/vagina outside introitus

Front 55

Myomas

Back 55

Fibroids in uterus are common benign tumors
Firm, irregular nodules in continuity with uterine surface.

Front 56

Uterine retroversion

Back 56

Tilting backward of entire uterus, including body and cervix.
The body may not be palpable with either hand.

Front 57

Uterine retroflexion

Back 57

Backward angulation of body or uterus in relation to cervix.
Body of uterus is often palpable through the posterior fornix or through rectum.

Front 58

Cystocele

Back 58

Bulge of upper 2/3 of anterior vaginal wall, together with bladder above it.
Results from weakened supporting tissues.

Front 59

Cystourethrocele

Back 59

Entire vaginal wall, along with bladder and urethra is involved in the bulge

Front 60

Urethral caruncle

Back 60

Small, red, benign tumor visible at posterior part of urethral meatus.
Occurs mainly in postmenopausal women and usually causes no symptoms.
Inguinal lymphadenopathy may indicate carcinoma.

Front 61

Bartholin's glands infection

Back 61

Caused by trauma, infection, often Chlamydia
Pus, erythema, nontender cyst may be present.

Front 62

Prolapse of urethral mucosa

Back 62

Swollen red ring around urethral meatus
Usually occurs before menarche or after menopause

Front 63

Rectocele

Back 63

Herniation of rectum into posterior wall of vagina.
Results from a weakness or defect in the endopelvic fascia.