Breast and Pelvic Flashcards
What are the 4 components of the breast exam?
introduction
breast inspection
lymph node palpation
breast palpation
How should you inspect the breasts?
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
What are you looking for on the breasts?
size, symmetry, shape, contour, skin, scars
Why is nipple inversion concerning?
can be suggestive of underlying malignancy, especially if unilateral
How do you palpate the lymph nodes?
palpate supraclavicular lymph nodes, axillary lymph nodes in 3 sweeps and then lateral chain
How should you palpate the breast?
examine all areas completely
inform pt before each maneuver
keep drape over areas not being examined
ask pt if pressure is comfortable
What are the 5 segments of the breast?
upper outer quadrant, upper inner quadrant, lower inner quadrant, lower outer quadrant, tail of spence
What are the various tissue types of the breast?
adipose, glandular, ductal tissue
What are the different patterns for breast palpation?
vertical strip
concentric circles
radial spoke
utilize dime-sized circles and use pads of fingers
What should you take note of during breast palpation?
nodules, indurations, masses, tenderness, nipple discharge
Recommended time for breast exam for bra size B?
3 minutes/breast
6 minutes total
usually <2min total
How can you check for nipple discharge?
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
How can you document large breasts?
pendulous
When is nipple discharge considered more normal?
if changing with menstrual cycle
What are the 4 parts of the pelvic exam?
vulva and introitus (inspection-external)
speculum exam (inspection: internal exam)
bimanual exam (palpation)
rectal/rectovaginal exam
How do you inspect vulva/introitus
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
What do you inspect on external pelvic exam? What do you palpate?
clitoris, urethral meatus, introitus and hymen, paraurethral gland
mons pubis, labia majora/minora, prepuce, bartholin’s duct
epidermal inclusion cyst
type of vulvar lesion, can be normal-common to see on exam
Cystocele, cystourethrocele, urethral caruncle and prolapse of urethra mucosa are all…
bulges/swelling of vulva, vagina and urethra
Describe speculum insertion
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
Parous cervix
normal cervix of a women who has had a child
squamo-columnar junction
junction of pink cervical skin/red endocervical canal, inherently unstable
key portion of the cervix to sample, most likely site of dysplasia
What are some variations of normal cervical os?
lacs from delivery: unilateral transverse, bilateral transverse, stellate
strawberry cervix is usually indicative of…
STD
Nabothian cyst
appear as translucent nodules of the cervical surface, no pathologic significance..pt will be asymptomatic
cervical polyp
bright red, soft and fragile
benign but may bleed
How do you perform a pap smear?
insert spatula/endocervical brush into cervical os, rotate 360 deg
rinse by swirling in solution at least 10x
How do you remove the speculum?
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
How do you prepare for a bimanual exam?
lubricate internal fingers
place non-dominant hand on abd
dominant hand internal
How do you palpate the cervix?
palpate the circumference of the cervix
gently rock the cervix from side to side
palpate cervix for firmness
How do you palpate the uterine fundus?
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
How do you palpate the ovaries?
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
What are some variations in uterine position?
anteverted (most common)
anteflexed
retroverted
retroflexed
Why would you perform a rectovaginal exam?
to palpate a retroverted or retroflexed uterus, palpate uterosacral ligaments, palpate cul-du-sac and adnexa, screen for colorectal cancer, assess pelvic pathology
How do you perform a rectovaginal exam?
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
