Female Pelvis/breast Cs1

Front 1

beginning of breast development
o 1 to 2 years before menarche
o Mean age 9.8 years
o May be asymmetric

Back 1

• Thelarche

Front 2

o Vascular engorgement
o Ducts increase in size and number

Back 2

pregnancy

Front 3

o Grandular tissue atrophies
o Fatty replacement of parenchyma

Back 3

• Post-menopausal

Front 4

inversion, flattening, fixation, secretion/discharge/galactorrhea, deviation, retraction

Back 4

• Nipple abnormalities

Front 5

may be due to infection, systemic disease, or breast cancer

Back 5

• Axillary lymphadenopathy

Front 6

breast enlargement in males (adolescent)

Back 6

• Gynecomastia

Front 7

infection that causes inflammation of breast tissue

Back 7

• Mastitis

Front 8

painless benign breast lump that occurs as an inflammatory response to local injury

Back 8

fat necrosis

Front 9

o Age (>40)
o Gender (female)
o Personal history of breast, ovarian, endometrial, cervical, or thyroid cancer
o Family history of breast cancer (only accounts for 10-20% of cases)
o Early menarche (before 12), late menopause (after 55), nulliparitiy, first child after 30 yo
 Think estrogen exposure
o Proliferative breast disease
o Hormone replacement therapy

Back 9

breast cancer risk factors

Front 10

o Inspection: retractions, dimpling, peau d’ orange, unilateral prominent venous network
 Positions- arms at side, arms over head, hands pushing on hips, leaning forward
o Palpation: include the nipple and tail of Spence
o Further investigation: observation, mammogram, ultrasound, biopsy

Back 10

breast cancer (inspection and palpation)

Front 11

• Inspection and Palpation are usually performed at the same time
• General Inspection:
o Symmetry
o Skin lesions
 Human Papillomavirus (HPV) (condyloma acuminatum-genital warts)
 Herpes Simplex Virus (HSV)
 Syphilis
 Lymphogranuloma venereum
 Others  dermatitis and malignancies
o Hair distribution
o Labia Majora: moisture, swelling, color, tenderness, Bartholin gland abcess/cyst, rash, lesions
o Labia Minora: Skene and Bartholin glands, clitoris, urethral orifice, perineum, vaginal introitus

Back 11

female pelvis physical exam

Front 12

• Use water for lubrication for cytologic studies or may use water soluble lubricant
• Use finger of opposite hand to assist and enter at a 45° angle
• Visualize/Inspect the cervix –color, ectropion (shiny red color to tissue around cervical os that bleeds easily), lesions, discharge, and position
o Cervical Os is small and round in nulliparous women; horozontal slit-like in a parous woman
o Position of the cervix corresponds with the position of the uterus
• Normal position is anteverted and anteflexed
o Cervix should be pink
• (FYI) If cervix is bluish in color it may indicate pregnancy (Chadwick’s Sign)

Back 12

internal pelvic exam

Front 13

• The PAP smear is the primary screening test for cervical cancer
• Cerivcal Os must be visualized so that endocervical cells are obtained
o If cervix is absent then sample from the vaginal cuff
• Use spatula around the ectocervix (rotate 360° degrees)  Ectocervical cells collected
• Use brush around endocervix (rotate ½ turn, ½ way in)  Endocervical cells collected
• (option) Cervical Broom collects both ectocervical and endocervical cells together
• During a PAP, both endocervical and ectocervical cells are collected
• PAPs may be obtained if an IUD or Nuvaring (intrauterine device) are in place

Back 13

obtaining the pap smear

Front 14

• Insert 2 fingers full length into the vagina
• Palpate cervix – assess size, shape, consistency, and mobility
o Should be mobile in all directions (anterior/posterior/lateral)
o There should NOT be tenderness on palpation of the cervix
• If there is pain then think PID
• Palpate fundus of the uterus – assess size, shape, and consistency
o Pear shaped and 5-8 cm in length
o Fundus usually located at the level of the pubis
• Post-menopausal women the uterus diminishes in size and may not be palpable
• Palpate Uterine Tubes and Ovaries (adenexa)
o Normally fallopian tubes and ovaries are non-palpable
o If palpable ovaries smooth, ovoid, and 3x2x1cm

Back 14

bimanual exam

Front 15

• Evaluate tone of anal sphincter and rectal walls
• Perform hemoccult

Back 15

rectal exam

Front 16

o Post Coital Bleeding
o Abnormal Uterine Bleeding
o All visible abnormal lesions should be BIOPSIED

Back 16

3 commonly associated symptoms with cervical cancer

Front 17

• Sexually Transmitted Disease (especially HPV, which is by far the most significant!)
• Early age of First Coitus (<15 years)
• Smoking
• Number of Partners (includes yours partners’ partners
• History of cervical dysplasia
• Obesity (BMI > 30)

Back 17

risk factors for cervical cancer

Front 18

• Nulliparity/Infertility
• Endometriosis
• Ovarian dysfunction
• Spontaneous abortion
• Exposure to talc or asbestos
• Irradiation of pelvic organs
• Anovulation
• Breast or endometrial cancer
• Family history of ovarian/breast cancer with BRCA1/BRCA2 genetic markers

Back 18

ovarian cancer risk factors

Front 19

FDLMP – First Day of Last Menstrual Period
EDC – Estimated Date of Confinement

Back 19

menstral history

Front 20

GP(FPAL)
G – Gravida (How many times pregnant)
P – Para (-ous) (How many live births)
P may be divided into the 4 following subcategories
• F – Full Term pregnancies
• P – Preterm pregnancies
• A – Abortions/Miscarriages
• L – Living children

Back 20

pregnancy history

Front 21

She had 3 pregnancies with 2 live births

Back 21

G3P2

Front 22

She had 3 pregnancies, 3 full term deliveries, but only 2 children are still living

Back 22

G3P(3002)

Front 23

She had 1 pregnancy, 2 pre-term deliveries, and 2 living children [twins]

Back 23

G1P(0202)

Front 24

She had 2 pregnancies, 1 full term delivery, 1 abortion/miscarriage, and 1 child living

Back 24

G2P(1011)

Front 25

• Interval between periods should be between 21-37 days
• Count FDLMP to first day of current period
• Length of period should be 3-7 days
• Spotting may occur 1-2 days after period

Back 25

Normal Uterine Bleeding: