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53 Cards in this Set
- Front
- Back
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What are four reasons to perform a pelvic exam?
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1. Annual physical
2. Abdominal complaint 3. Pregnancy 4. GU complaint |
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What are things in the GU HPI that would bring about a pelvic exam?
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Dysuria
Discharge (leukorrhea) Frequency Urgency Pruritis Odor Incontinence |
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What things to you look for in the GU history before doing a pelvic exam?
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Infertility
Gynecological history Sexual history Menopausal symptoms Cancer risk factors Family history (cancer, menopause) |
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Exposure to this can cause problems for women.
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Diethylstibestrol - prescribed between 1938-1971, Used to prevent miscarriage and other complications.
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What is the major side of effect of DES?
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Adenocarcinoma of vagina and cervix in daughters of recipients.
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DES exposure in utero causes?
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1. Increased infertility rate
2. Poor pregnancy outcomes (miscarriage, ectopic, preterm delivery |
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What do you look for in the extremities of a patient who is presenting for a physical exam that also includes a pelvic exam?
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Signs of bruises/signs of abuse.
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What equipment is required for the pelvic exam?
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Drapes
Speculum Gloves Lubricant Cotton Swabs Glass slides Spatula Cervical brush Fixative Culture plates/tubes |
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What are two things to never do with a patient during the pelvic exam?
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Never touch the patient prior to telling her you are going to do so.
Never touch the patient with your bare hands - wear gloves (double glove) |
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What is the sequence of the pelvic exam?
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1. Give anticipatory directions
2. Inspect and palpate external genitalia 3. Inspect vagina and cervix using speculum 4. Obtain vaginal smears and cultures 5. Perform bimanual examination |
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What do you inspect during the external female genitalia examination?
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Hair distribution
Skin Labia majora Labia minora Clitoris Urethral meatus Introitus Bartholin's glands Perineum Anus |
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When locating the cervix it might be necessary to?
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It may be necessary to slightly withdraw
speculum and reposition Insert index finger into introitus and locate the cervix Back finger out a bit and press down on vaginal floor |
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What is involved with inspecting the cervix and the os?
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Inspect the Cervix
Position Color Inspect the OS Parity Lesions Discharge |
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What are three things used to do a PAP smear?
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Spatula
Cytobrush Cervical Broom |
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Performed from a standing position
Lubricate index finger and middle fingers Tell the patient you are about to touch her again Touch the patients thigh with your gloved hand Insert tips of fingers into the introitus and press downward Continue to insert fingers to their full length |
The Bimanual Examination
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When performing the bimanual examination and you are palpating the cervix what four things do you look for?
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Position
Shape Mobility Tenderness - In setting of PID and STD this can mean a progression |
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When performing the bimanual examination and you are palpating the vaginal walls and the uterus what do you look for?
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Palpate the Vaginal walls
Morphology Tenderness Palpate the Uterus Size Shape Position Tenderness Masses |
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When you are palpating the ovaries during the bimanual examination what are you looking for?
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Cysts, tenderness etc.
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What do you do with the rectovaginal exam?
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Withdraw fingers from vagina and re-lubricate
Inform woman of touching again Tell her what you are going to do She may feel urgency of a bowel movement Insert index finger in vagina Insert middle finger into rectum as the patient bears down |
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What do you look for in the rectovaginal examination?
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Observe rectal muscle tone
Palpate rectal walls Masses Nodules Tenderness Palpate posterior wall of uterus Collect stool for fecal occult blood |
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What are some abnormalities that may be found on the female pelvic exam?
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Abnormal bleeding
Premenopausal and postmenopausal Dysmenorrhea Bartholin cyst abscess Dysplasia of the cervix Cervical polpy Leiomyoma of the uterus (fibroids) Infections Sexually Transmitted Diseases |
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Dysfunctional uterine is caused by overgrowth of
endomentrium (unopposed estrogen) and is seen in what patients? |
Teenagers
Late 30s to late 40s Obese women Polycystic ovarian syndrome |
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Normal menstrual bleeding averages ? days (range?) with mean blood loss of ?
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Normal menstrual bleeding averages 4 days
(range 2-7 days) with mean blood loss of 40mL |
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MENORRHAGIA EVALUATION - What is involved?
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Cervical smears
Pregnancy test CBC, sed rate, glucose levels TSH, PT/PTT Cervical biopsy Endomentrial Cuettage Hyterscopy |
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Vaginal bleeding occurring 6 months (or more)
after cessation of menstrual flow warrants investigation Hyperplasia (endometrial overgrowth) Endometrial cancer Cervical cancer Atrophic vaginitis Trauma Endomentrial polyps |
POSTMENOPAUSAL MENORRHAGIA
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Exam the vulva and vagina for bleeding, ulcer, or
neoplasm Cytology smear Ultrasound of endometrium If endometrial thickness > 5mm = D&C |
EVALUATION of POSTMENOPAUSAL MENORRHAGIA
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Menstrual pain
Begins 1-2 years after menarche May become more severe with time Frequency can increase up to age 20, then subside 50-70% of women affected at some point in time 5-6% have incapacitating pain |
Primary dysmenorrhea
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What is the TX of primary dysmenorrhea?
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NSAIDS
Oral contraceptive Depot-medroxyprogesterone (Depo) Levonogestral IUD |
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Cause of pain usually exists
Endometriosis Pelvic inflammatory disease |
Secondary Dysmenorrhea
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What is involved with the evaluation and treatment of secondary dysmenorrhea?
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Evaluation
Exam Laparoscopy Treatment NSAIDS Oral contraceptives Surgical laparoscopy |
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May be cause by trauma or infection
Drainage of secretion is prevented causing swelling and pain Treatment Warm soaks I&D with placement of word catheter Antibiotics are not recommended |
BARTHOLINS CYST ABSCESS
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Presumptive diagnosis made by Pap smear
Benign Benign with inflammation Mild dysplagia Moderate dysplagia Severe dysplagia Carinoma in-situ Invasive carinoma Colposcopy Punch biopsy Prevention: HPV vaccine (Gardisil) ages 11-26 |
DYSPLAGIA OF THE CERVIX
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Cauterization or cryosurgery
Laser Loop excision Conization of cervix (removal of tranfomation zone) |
TREATMENT FOR DYSPLAGIA
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Abnormal uterine bleeding or vaginal discharge
Cervical lesion may be visible on exam Carcinoma in situ (stage 0) Hysterectomy Women wanting to retain uterus: conization or ablation with Pap q 3 months x 1 year Invasive Carcinoma Hysterectomy Radiation Chemotherapy |
CARCINOMA OF THE CERVIX
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Irregular enlargement of uterus
Heavy or irregular bleeding Dysmenorrhea Acute and recurrent pelvic pain Symptoms due to pressure on neighboring organs Classified by anatomical location Intramural Submucous Subserious Intraligamentous Parasitic (blood supply from organ it is attached) Cervical |
FIBROID TUMOR
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Vaginal irritation
Pruitus Pain Unsual discharge |
Vaginitis
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What are some of the clinical findings with a vaginitis?
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External and internal exam
Sample cervix for gonococcus or chlaymdia Wet prep : clue cells, trichomonads KOH: candiasis Vaginal pH (normal is 4.5) Bimanual exam for CMT (cervical motion tenderness) |
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Recent antibiotic use
Pregnancy, diabetes Heat, moisture, occlusive clothing Exam findings Vulvovaginal erythema White curd-like discharge |
Vulvovaginal candidiasis
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Sexually transmitted
Malordorous frothy, yellow-green discharge Vaginal erythema Red macular lesions on cervix |
Trichomonas vaginalis
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Not sexually tranmitted
Overgrowth of gardnerella Grayish Fishy odor pH 5.0-5.5 Wet prep: clue cells |
Bacterial vaginosis
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Sexually transmitted
Human papilloma virus (HPV) Vulvar lesions may be obvious Diagnosis by 4% acetic acid (vinegar) and colposcopy |
Genital Warts
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Sexually transmitted
Herpes Simplex 1 or 2 Diagnosed by herpes serology |
Genital herpes
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Women born in the US have a ? lifetime risk of developing breast cancer?
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13%
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This is the second leading cause of cancer death in women?
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Breast cancer
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Highest mortality rates of breast cancer are in women ? years of age and ? years of age.
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<35 years of age and >75 years of age.
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What are the demographic risk factors for breast cancer?
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Age - 75% occur in women older than 50 years of age
Education and income - Risk is greater in women with higher education and of higher socioeconomic status Location - Risk is greater in urban areas Ethnicity - Rates higher in caucasian women then African Americans, Latinos and Asian Americans. |
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What are the two previous history of breast conditions and disease that lead to a risk of breast cancer?
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Atypical hyperplasia 4.4%
Lobular Carcinoma in Situ 6.9-12% |
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What are the menstrual history and pregnancy history factors that can lead to increase risk of breast cancer?
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Breast tissue exposure to unopposed estrogen - Early menarche age < 12 = 1.3%
Delayed menopause - >55 =1.5-2% First live brith >35 years of age = 2-3% Nulliparity = 3% |
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What is recommended by the American Cancer Society concerning breast cancer screening?
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Monthly self breast exam - starting at 20 years of age
Clinical breast examination - To be performed by health professional every 3 years for women between 20-39 years of age then annually after age 40 Mammography - Annually beginning at age 40 |
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What does the American Geriatrics Society recommend as far as breast cancer screening?
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Mammography every 1 to 3 years after the age of 75 for women with a life expectancy of four or more years.
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This lies along the chest wall midway between anterior and posterior axillary folds. The pectoral, subscapular and lateral nodes drain into the central nodes.
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Central Axillary Nodes
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This is palpated along the anterior axillary fold at the lower border of the pectoralis major. It drains the anterior chest wall.
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Anterior Axillary (Pectoral) Nodes
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This is palpated along the posterior axillary fold at the lateral border of the scapula. Drain the posterior chest wall and a portion of the arm.
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Posterior axillary (subscapular) - axillary nodes.
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