Breast and Pelvic

Question 1

What are the 4 components of the breast exam?

Answer 1

introduction

breast inspection

lymph node palpation

breast palpation

Question 2

How should you inspect the breasts?

Answer 2

inspect both breasts with pt sitting arms at side, pt sitting with arms above head, pt sitting with hands pressed to hips, pt leaning forward

Question 3

What are you looking for on the breasts?

Answer 3

size, symmetry, shape, contour, skin, scars

Question 4

Why is nipple inversion concerning?

Answer 4

can be suggestive of underlying malignancy, especially if unilateral

Question 5

How do you palpate the lymph nodes?

Answer 5

palpate supraclavicular lymph nodes, axillary lymph nodes in 3 sweeps and then lateral chain

Question 6

How should you palpate the breast?

Answer 6

examine all areas completely

inform pt before each maneuver

keep drape over areas not being examined

ask pt if pressure is comfortable

Question 7

What are the 5 segments of the breast?

Answer 7

upper outer quadrant, upper inner quadrant, lower inner quadrant, lower outer quadrant, tail of spence

Question 8

What are the various tissue types of the breast?

Answer 8

adipose, glandular, ductal tissue

Question 9

What are the different patterns for breast palpation?

Answer 9

vertical strip

concentric circles

radial spoke

utilize dime-sized circles and use pads of fingers

Question 10

What should you take note of during breast palpation?

Answer 10

nodules, indurations, masses, tenderness, nipple discharge

Question 11

Recommended time for breast exam for bra size B?

Answer 11

3 minutes/breast

6 minutes total

usually <2min total

Question 12

How can you check for nipple discharge?

Answer 12

place 2 fingers from each hand at edge of areola press down and inward toward nipple and then up and back down

light milk dc can be norm

serous/bloody dc- abnormal

Question 13

How can you document large breasts?

Answer 13

pendulous

Question 14

When is nipple discharge considered more normal?

Answer 14

if changing with menstrual cycle

Question 15

What are the 4 parts of the pelvic exam?

Answer 15

vulva and introitus (inspection-external)

speculum exam (inspection: internal exam)

bimanual exam (palpation)

rectal/rectovaginal exam

Question 16

How do you inspect vulva/introitus

Answer 16

look for skin changes, inspect labia majora and minor, perineal body/perineum and anus

use the back of hands to lift up and out to retract buttock

Question 17

What do you inspect on external pelvic exam? What do you palpate?

Answer 17

clitoris, urethral meatus, introitus and hymen, paraurethral gland

mons pubis, labia majora/minora, prepuce, bartholin’s duct

Question 18

epidermal inclusion cyst

Answer 18

type of vulvar lesion, can be normal-common to see on exam

Question 19

Cystocele, cystourethrocele, urethral caruncle and prolapse of urethra mucosa are all…

Answer 19

bulges/swelling of vulva, vagina and urethra

Question 20

Describe speculum insertion

Answer 20

separate labia, keep labia apart

keep blades closed until fully inserted, insert blade at 45deg angle

use posterior pressure

open speculum 1 or 2 clicks, depending on what is needed for full visualization

lock speculum in place

Question 21

Parous cervix

Answer 21

normal cervix of a women who has had a child

Question 22

squamo-columnar junction

Answer 22

junction of pink cervical skin/red endocervical canal, inherently unstable

key portion of the cervix to sample, most likely site of dysplasia

Question 23

What are some variations of normal cervical os?

Answer 23

lacs from delivery: unilateral transverse, bilateral transverse, stellate

Question 24

strawberry cervix is usually indicative of…

Answer 24

STD

Question 25

Nabothian cyst

Answer 25

appear as translucent nodules of the cervical surface, no pathologic significance..pt will be asymptomatic

Question 26

cervical polyp

Answer 26

bright red, soft and fragile

benign but may bleed

Question 27

How do you perform a pap smear?

Answer 27

insert spatula/endocervical brush into cervical os, rotate 360 deg

rinse by swirling in solution at least 10x

Question 28

How do you remove the speculum?

Answer 28

open speculum one more click, tip the front of the speculum down and gently pull back

when blades of speculum are free from cervix close speculum and remove

Question 29

How do you prepare for a bimanual exam?

Answer 29

lubricate internal fingers

place non-dominant hand on abd

dominant hand internal

Question 30

How do you palpate the cervix?

Answer 30

palpate the circumference of the cervix

gently rock the cervix from side to side

palpate cervix for firmness

Question 31

How do you palpate the uterine fundus?

Answer 31

place internal fingers on posterior side of cervix and outer hand on lower abd

gently palpate each side of uterus

expected findings: pear shaped, rounded, firm and smooth

Question 32

How do you palpate the ovaries?

Answer 32

move internal and external fingers lateral to uterus and use 3 sweeps moving from distal point toward pubic hair line

expected findings: smooth & ovoid, mild ttp

may not be palpable

Question 33

What are some variations in uterine position?

Answer 33

anteverted (most common)

anteflexed

retroverted

retroflexed

Question 34

Why would you perform a rectovaginal exam?

Answer 34

to palpate a retroverted or retroflexed uterus, palpate uterosacral ligaments, palpate cul-du-sac and adnexa, screen for colorectal cancer, assess pelvic pathology

Question 35

How do you perform a rectovaginal exam?

Answer 35

insert index finger into vagina and middle finger into rectum

apply pressure with fingers to anterior/lateral walls while hand on abd applies downward pressure