Clinical/Comm Skills - Week 1 - Gynaecological examination (bimanual palpation, swabs and smears)

Question 1

Gynaelogical examination of a patient include pelvic swab and smear test Prior to a vaginal examiantion, what consent is required from a patient?

Answer 1

Verbal consent is sufficient in a conscious patient

Question 2

Who else should be involved in a vaginal examination? and why?

Answer 2

Chaperone should be in attendance - makes patient feel more at ease and for safety of both doctor and patient

Question 3

What equipment should be at hand in the gynaecological examination?

Answer 3

Swabs, speculum, lubricating gel and light

Question 4

What position should the patient be in for the vaginal examination?

Answer 4

Patient should be supine, knees bent, heels together and knees apart

Question 5

What is looked for on inspection in a gynaecological examiantion?

Answer 5

Inspect external genitalia -hair distribution, vulval skin, pubis, labia minora and majora, clitoris, external urethral meatus, perineum and perianal region

Question 6

What is the final step of inspection? What is the introitus) This step is to see if women has stress incontinence/prolapse

Answer 6

Gently part the labia to visualise introitus (Vaginal canal) and ask women to cough to demonstrate stress incontinence/prolapse

Question 7

What fingers are lubricated for the bimanual palpation of the vagina? What fingers part the labia and what fingers are inserted?

Answer 7

Part the labia with the index and middle finger of the left hand (non-dominant hand) Lubricate index and middle finger of dominant hand and insert into the vagina

Question 8

The cervix is palpated using the two inserted fingers WHere is the non dominant hand now placed? What is cervical excitation upon tocuhing the cervix?

Answer 8

The non dominant hand is placed suprapubically Cervical excitation is where there is extreme cervical pain on palpation (very tender)

Question 9

The dominant hand is then moved into the posterior fornix of the vagina (diagram just shows anterior and posterior fornix) How is the position of the uterus assesed now that the fingers lie in the posterior fornix?

Answer 9

https://s3.amazonaws.com/classconnection/403/flashcards/11907403/png/pjpgpngjpgpngjpg_-16013DFF62961986583.png

Question 10

When palpating the uterus, what are you palpating for?

Answer 10

Mobility, size, position (and regularity) Also size, position, mobility of any adenexal masses

Question 11

Bilaterally palpate for adnexal masses by moving dominant hand to vaginal fornix and non-dominant hand to coinciding iliac fossa What are the adenxae? (uterine appendages)

Answer 11

These are the fallopian tubes and ovaries - can be felt on bimanual palpation in a thin person

Question 12

Palpate the Pouch of Douglas via the posterior fornix for any pelvic mass What is the pouch of douglas?

Answer 12

This is the rectouterine pouch

Question 13

https://s3.amazonaws.com/classconnection/403/flashcards/11907403/png/pjpgpngjpg-16013E8B71605B472F7.png

Answer 13

A - size, shape, mobility, position and cervical motion tenderness are all felt for on bimanual palpation in a gynaeocological examination (size, mobility and position are all uterus/adenexal masses (shape may also be uterus) Tenderness is the cervix

Question 14

Speculum part Lubricate speculum (if smear use minimal gel on blades or use water so as not to contaminate smear test) How is the labia parted?

Answer 14

Labia is parted using dominant finger and thumb

Question 15

How is the speculum inserted into the vagina?

Answer 15

Inserted into the vagina in the 3oclock position and rotated into the 12 oclock positon (the handle part of the speculum is what is in the 3 oclock psotiion and rotated to 12 oclock) Insert speculum fully in a 45 degree angle towards the coccyx

Question 16

The speculum once inside is opened to visualise the cervix What is inspected for here?

Answer 16

Inspect for vaginal discharge, vaginal wall mucosa , cervix and prolapse

Question 17

What swabs are taken once the speculum is in?

Answer 17

High vaginal swab (HVS) and an endocervical swab is taken Label specimens and complete microbiology request form

Question 18

When the speculum is inserted, a smear can also be done to exam the cervical tissue The cervical os is visualised and the tip of the brush is rested in the cervical os How is the smear and how is the smear sample put into the pot?

Answer 18

Smear is taken by rotating the smear 10 times clockwise in the cervical os The smear is then dunked and rotated 10 times anti-clockwise in the medium (of the pot) Pot lid is replaced, jar is labelled and sent for cytology