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HMS PDR > Basic Breast and Pelvic Exams > Flashcards

Basic Breast and Pelvic Exams Flashcards

1
Q

Basic surface anatomy of female genitalia

A
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2
Q

Location of Bartholin’s glands

A

Note that these are not normally visible unless enlarged or inflammed

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3
Q

Preparation for female pelvic examination

A
  1. Explain purpose of exam and ask for permission
  2. Request that the patient empty her bladder
  3. Ensure that examination equipment is within reach: light source, vaginal speculum of appropriate size in warm water, materials for Pappanikalou smear, bacteriologic cultures, or other requried instruments, water soluble lubricant, cotton suaves, examining gloves, tissues
  4. Assistance of third party (nurse) usually indicated
  5. Be aware at all times that the patient may be apprehensive and do whatever necessary to make patient feel comfortable
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4
Q

Anatomy of cervix as viewed from inside the vagina

A
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5
Q

Why can you not use a gel lubricant for vaginal exams?

A

Because it will interfere with bacterial culture and proper Pap smear sampling, which are usually the indications for vaginal exam in the first place.

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6
Q

What should you do if the cervix does not come into view upon inserting the speculum?

A

Withdraw the speculum slightly and reposition it with a different slope.

This is a common occurence, as the anatomy of the cervical-vaginal junction often differs between patients.

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7
Q

Indications for taking a sample upon cervical exam

A
  • Malodorous
  • Colored discharge (clear discharge of varying thickness is normal, yellowish suggests mucopurulent cerivicitis)
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8
Q

What are the likely causes of there is mucopurulent discharge coming from the cervix?

A
  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
  • HSV 1 or 2
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9
Q

What are the likely causes of there is mucopurulent discharge coming from the vaginal wall?

A
  • Candida species
  • Bacterial vaginosis
  • Trichomonas vaginalis
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10
Q

How should one move the cervical broom in order to take a proper Pap smear sample?

A
  • 360o clockwise rotation with the tip inserted into the cercal os such that the squamo-columnar epithelial junction is sampled, enabling observation of both the squamous vaginal epithelium and the columnar uterine epithelium
  • When brushing the slide, both sides of the broom should be brushed to ensure a complete sample
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11
Q

What Pap smear sampling tool should be used in pregnant women?

A

A cotton-tipped applicator moistened with warm saline

Do NOT use a cervical broom or brush

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12
Q

Positioning for a uterine exam

A
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13
Q

Adnexal

A

Basically means para-uterine. Used to describe the fallopian tubes, ovaries, and connective tissue supporting the uterus.

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14
Q

“Full strength” pelvic floor muscles

A

Contraction of fingers that moves them upward and inward and lasts for at least 3 seconds

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15
Q

What is the advantage of having a male patient stand for a genital exam?

A

Varices and hernias are better visualized

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16
Q

The depicted lesions are seen on a male patient’s routine genital exam. What are they?

A

Epidermoid cysts. Benign and common, no need for treatment or concern.

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17
Q

Where should the epididymis be palpable on scrotal exam?

A

Superiorly and posteriorly.

Should feel cord-like, but not have any lumps

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18
Q

One effective way to determine whether a femoral or inguinal lesion is a hernia is to . . .

A

. . . listen for bowel sounds with a stethoscope

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19
Q

What to do if you find a hernia on physical exam

A

Attempt to return it to the abdomen by applying mild pressure, but do not continue if the patient reports pain, nausea, or gag reflex

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20
Q

When is testicular self-examination best performed?

A

After a warm bath or shower

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21
Q

Breast surface anatomy

A
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22
Q

Systematic breast exam

A

There is evidence that the linear method is more effective than others, so this should be employed

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23
Q

Distended bladder

A

Note that the swelling is below the level of the umbilicus

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24
Q

Tinea cruris vs candidal intertrigo

A
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25
Hidratenitis Suppuritiva
Often also in axilla if in pelvic area
26
HPV
moist vs dry
27
HSV
Tends to be in areas covered by the foreskin
28
Epidermal Inclusion cyst
Benign, but often removed for cosmetic reasons
29
Angiokeratoma
Found in older males, benign
30
Scrotal edema
31
For an uncircumsized male, . . .
. . . **you should always retract the foreskin to look at the head.** This may reveal phimosis or paraphimosis (the latter is a surgical emergency with obstructed venous outflow)
32
What is going on in this picture?
Paraphimosis This is a **surgical emergency**, there is a band constricting venous outflow
33
What is going on in this picture?
Phimosis
34
Balanitis
Inflammation of the glans penis
35
Hypospadias
When the urethral meatus is lower down the shaft of the penis Requires surgery to fix, but not life threatening. Generally repaired during infancy nowadays.
36
Meatal stenosis
Happens if children are circumsized in the neonatal period. Result of scarring of the head of the penis and subsequent blockage, due to rubbing against the head of a diaper. Prevent by applying prophylactic vassaline post-circumcision
37
What is going on in this picture?
Pearly penile papules Completely benign, normal anatomic variant, not indicative of any pathology.
38
Peyronie
Causes curving when the penis is erect, but only when erect, so not observable on physical exam. However, you may be able to palpate a fibrotic or calcified plaque on the side of the penis. Describe the size and location in report.
39
Erections during exam are almost always brought on by . . .
. . . **anxiety, NOT arousal.** If you note a developing erection during exam, start with penile exam and get it out of the way (it is so fast that it will be done before the penis is erect). You may then ask the patient to hold the penis to the abdomen so you may examine the scrotum. Let your patient know that this is a normal response triggered by anxiety if they are concerned, but no need to address if your patient doesn't bring it up.
40
Palpating epididymis
Will be on the posterior side if facing the patient. Palpate with thumb and third finger of non-dominant hand. Have patient show you where the pain is. Be able to gently recapitulate the pain to ensure you are in the right location. Then, palpate the anterior with dominant hand. Most of the time your patient will have discovered anterior masses before you. Posterior not necessarily.
41
Most testicular pain is due to \_\_\_.
Most testicular pain is due to **a problem with the epididymis, not the testicle itself**. Though patients may be unaware of this.
42
Varicocele grading
43
Hydroceles
* Caused by inflammation and may remain * There is poor lymphatic drainage in the testicle * May be small or very large and bothersome or non-bothersome. * If not bothersome, they are basically always benign * Can test for hydrocele vs mass by transillumination in kids, but this does not work in adults
44
Scrotal abscesses
* Emergent * Can develop into necrotizing fascitis * May develop post-ingrown follicle * Especially dangerous in diabetes mellitus patients and the elderly
45
Hernia exam
Always use the same hand as the side you are examining (patient's right inguinal area, your right hand)
46
The walls of the rectum change in size in response to. ..
**. . . SLOW pressure. So, when examining the rectum, always always always go slowly.** They pass bigger poop than your finger every day
47
Prostate cancer feels like. . .
. . . **a rock**. It is hard. If it is cancer, you will know it.
48
Why is having a full erection for more than 4 hours dangerous?
Because much of the venous blood is not draining during an erection, and thus ischemia may develop. This rarely happens on PDE5 inhibitors unless they are combined with other drugs known to increase the risk, some of which are illicit (including cocaine).
49
Menstrual history taking
Normal cycle length 21-42 days
50
Obstetrical history
**G = gravid** (# of pregnancies) **P = para** (full term deliveries, vaginal or C section) **x1-x2-x3-x4**: **full term deliveries**-**preterm deliveries**-**miscarriages**-**living children**
51
Differing recommendations for frequency of breast exam
52
Maneuvers in clinical breast exam
53
Five P's of the clinical breast exam
54
Positions for vertical strip breast exam
Circle around the areola and then continue for vertical strip method
55
Hand-form for palpation in breast exam
56
Levels of pressure for breast exam
57
Physical signs of breast cancer
Note that localized tenderness is the more concerning sign
58
Process of the external pelvic exam
59
Insertion of the speculum
Insert at a 45 degree angle, avoiding contact with the very anterior aspect of the vaginal canal, as this is the most sensitive region.
60
Variations on a normal cervix
For the picture on the right, there is no fungal plaque, the cervical columnar epithelium is just very pale. This is normal.
61
What region of the cervix has the highest risk of cancer?
The squamo-columnar junction, because of the high cell turnover.
62
Bimanual exam
Utilize dominant hand inside the vaginal canal
63
Cervical motion tenderness
Palpating the cervix and moving it slightly back and forth produces pain This is extremely painful for individuals with cervicitis, usually indicative of an STI such as neisseria gonorrheae.
64
Anteverted vs Midverted vs Retroverted uterus
Anteverted -\> uterus leans anteriorly Midverted -\> uterus projects straightly as it ascends into the abdomen Retroverted -\> uterus leans posteriorly
65
Rectovaginal exam
Not a standard part of the exam, only done when indicated by symptoms of fistula or cancer
66
Concluding the pelvic exam
If possible, speak to the patient when they are dressed and you are both seated at the same level. Review findings and plans for testing. Ask if the patient has any questions.
67
From a TIC approach, you should always try to do the entire pelvic exam . . .
. . . **while you are seated.** Both portions. This changes how you maneuver a bit, but it is worth it for the patient's comfort.
68
Nowadays, lubricant on the speculum. . .
. . . **is not a problem**. Only in some ill-equipped primary care clinics will you ever need to worry about this now. This is because most places nowadays use liquid medium rather than slide smear on the spot.
69
Digital rectal exam
* **Preparation:** * Lubrication and Gauze Sponge * Apply lubrication to sphincter * SLOW entry of finger, with pressure posteriorly * **Arc the finger across rectum:** * Sphincter Tone: lax, tight (anxiety) * Masses? * **Prostate Exam:** * Size (Normal is ~40 grams) * Hard masses * Nodularity (BPH) * **At end of exam:** * Provide Gauze Sponge, privacy, and access to sink * Wipe lubrication from rectum: “I have cleaned the area, so you should be OK to get dressed”

HMS PDR (30 decks)

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