1 - O+G - Hx + Ex - Gynae Ex Flashcards
7 parts of a FULL gynae exam
general Ex breast/axillary abdo vaginal cusco speculum rectal presentation
breast/axillary exam - can be used as? position of pt? then what? how to do axilla?
can be used as breast cancer screening tool
sit pt back, inspect for irregularities, palpate all four quadrants
axiall palpated w pts arms resting on examiners shoulders
Abdo exam - inspect? palpate? percuss? auscultate?
i - scars, (around PS + in umbilicus), striae, hernias, body hair distribution
p - ask about pain, masses/tenderness, specific palp above umb dow to PS - if mass, can you get below it at PS?
pe - bowel should be resonant, fluid filled + solid cavities dull - look for shifting dullness eg free fluid
aus - listen to bowel sounds`
Vaginal Ex - what to do before you start inspection?
ensure privacy, gain consent, explain simply
offer bathroom first
CHAPERONE
document in notes
warn of discomfort but shouldn’t be painful
get equipment - gloves, lube, speculum, swabs (3), tissues
Vaginal ex - inspection?
vulva and vaginal orifice for coloured areas, ulcers, lumps, prolapse, skin changes, discharge, scars
vaginal Ex - digital bimanual exam - purpose? explanation? which organs?
assess pelvic organs
“What the examination will involve is me using one hand to feel your tummy and the other hand to place two fingers into your vagina. This will allow me to assess the vagina, womb and ovaries. It shouldn’t be painful, but it will feel a little uncomfortable. Let me know at any point if you would like me to stop.”
uterus, cervix, adnexa, pouch of douglas
vaginal exam - digital bimanual ex - 4 organs assessed and what to feel for?
uterus - size/shape of small pear. size, consistency, regularity, mobility, ante/retroversion, tenderness
cervix - felt as an opening (like a toy car tyre) hard or irregular?
adnexa - lateral to uterus (tubes and ovaries) assess tenderness, size, consistency, masses - separate from uterus?
pouch of douglas - behind cervix, utero-sacral ligaments should be palpable - even? irreg? tender? mass?
Vaginal Ex - cusco speculum examination - purpose? how to pass speculum?
allows inspection of cervix and vaginal walls
close blades, parallel to labia, opening mechanism to pts right, insert
gently rotate 90 deg ant and insert as far as poss without discomfort
open slowly under direct vision, cervix comes into view`
Vaginal Ex - cusco speculum examination - look for? what else? how to take out speculum?
look for ulceration, spontaneous bleeding/irregularities
take cervical smear
now withdraw slightly and partly close
slowly withdraw with it just open - allows vaginal wall and introitus inspection
then close and remove, rotating again on way out
Rectal exam - when appropriate?
if posterior wall prolapse to distinguish between enterocoele and rectocoele, and assessing malignant cervical disease
also if cyclical rectal bleeding due to rectovaginal endometriosis
how to present
Mrs X is (general appearance), her BP, temp and HR are…., and abdo and pelvic examination reveals…. there is also …. (other relevant pos and neg findings)
