Breast Pelvic Exam Flashcards
Breast tissue components
- Adipose
- Glandular
- Ductal
Palpation patterns
- Vertical strip/ lawnmower/ ladder
- Concentric circles
- Radial spoke
Duration of palpation for someone w/ a bra size B
- 3 mins each breast
- 6 mins total
Mastectomy breast exam
- Examine scar & axilla
- Lymphedema
4 parts of pelvic exam
- Vulva & introitus (external)
- Speculum
- Bimanual
- Rectal/Rectovaginal
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
Palpate cervix
- Palpate the circumference of the cervix
- Gently rock the cervix from side to side
- Palpate cervix for firmness
Palpate uterine fundus
- Place internal fingers on posterior side of cervix & outer hand on lower abdomen
- Gently palpate each side of the uterus
Uterine fundus: Expected findings
Pear shaped, rounded, firm, & smooth
Palpate ovaries
- Move internal & external fingers lateral to uterus & use 3 sweeps moving from distal point toward pubic hair line, attempting to palpate the ovaries
Ovaries: Expected findings
- Smooth & ovoid
- Mildly tender to palpation
- Similar to an almond
- May not be palpable
Rectovaginal exam technique
- Index finger inserted into vagina while middle finger inserted into rectum
- Straining can help relax anal sphincter
- Apply pressure w/ fingers to anterior & lateral walls while hand on abdomen applies downward pressure
Rectovaginal exam purpose
- Palpate a retroverted or retroflexed uterus
- Palpate uterosacral ligaments
- Palpate the cul-de-sac & adnexa
- Screen for colorectal cancer
- Assess pelvic pathology
What are the borders of the breast?
- Upper = clavicle
- Lower = 6th rib
- Medial = sternum
- Lateral = mid-axillary
4 components of breast exam
- Intro
- Breast inspection
- Lymph node palpation
- Breast palpation
What does recent onset of unilateral nipple inversion suggest?
Malignancy
Vulvar lesions
- Aphthous ulcers
- Genital herpes
- Epidermal inclusion cyst
- Warts
- Vulvar neoplasia
Bulges/swelling of vulva, vagina, & urethra
- Cystocele
- Urethrocele
- Urethral caruncle
- Prolapse of urethral mucosa
Cervical lacerations from delivery
- Unilateral transverse
- Bilateral transverse
- Stellate
Abnormal findings of the cervix
- Cervicitis
- Strawberry cervix = STI
- Yeast infection
- Polyp
- Carcinoma
- Nabothian cyst
Pap smear supplies
- Broom
- Cytobrush/spatula
How many times should you swirl the sample in a pap smear?
10 times
Spatula technique
- Insert into cervical os
- Rotate 360˚
Endocervical brush technique
- Insert into cervical os
- Rotate 1/2 turn in 1 direction
Bimanual technique
- Dominant hand internal
- Non-dominant hand external
Variations in uterine position
- Anteverted (most common)
- Anteflexed
- Retroverted
- Retroflexed
Pregnancy complications
- Diabetes
- HTN
- Preeclampsia
- Hx of depression before or after a pregnancy
