Examination

Question 1

Preparation:

What should be offered?

How should you ask the patient to undress themselves?

4 P’s to check before beginning?

Answer 1

Chaperone

(1) Go behind curtain
(2) Take off trousers/skirt and underwear and get on the bed
(3) The blanket should be there to cover lower half

Pain
Pee - do they need to?
Period - LMP
Pregnancy - are they?

Question 2

Inspection:

What no note generally?

What do you note on the abdomen?

Answer 2

Wellness
Weight 
Pallor - anaemia 
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Pfannenstiel scar (bikini line) of C-section, ectopic, or hysterectomy 

Scars of abdominal surgery which might suggest adhesions

Question 3

Abdo palpation:

What would tenderness suggest?

What else might you see on palpation?

Answer 3

Peritonism from ectopic or PID

Masses

Question 4

Positioning:

How should the patient position themselves?

Answer 4

Flat with one pillow

Bend up knees and drop apart, so that ankles are together but knees apart

Question 5

Vulva and vaginal inspection:

What do you look for?

What gland may be swollen?

Why do you ask the patient to cough or strain down?

Answer 5

Inspect labia

• Discharge
• Inflammation
• Ulceration
• Atrophy

Bartholin’s gland - can become a cyst or abscess

Prolapse
Stress incontinence

Question 6

Speculum examination:

If it is metal, how can it be warmed?

What do you do with your left hand?

What do you look at on the cervix?

Answer 6

Run under hot tap

Part labia

Openness of cervix 
Polyps 
Malignancy (vascular, irregular lesions) 
Ectropion 
Bleeding or discharge

Question 7

Speculum examination:

What is an HVS?

What is an endocervical swab?

Should a swab be taken before or after a smear?

Answer 7

High vaginal swab - wipe around the cervix and vaginal walls

Swabbing the cervical os

Swab > smear

Question 8

Speculum examination:

How do you take a smear?

Answer 8

Take the plastic broom into cervical os
Rotate 360 degrees
5 times

Withdraw
Put in the specimen container
Swirl 5 times

Question 9

Bimanual examination:

What fingers do you use to examine?

What do you note as you insert fingers?

Vaginismus - what is it?

What should you note when feeling the cervix?

What is cervical excitation?

Answer 9

Index and middle

Soreness
Lesions on the vaginal wall

Contraction of vaginal wall

Firmness, size and position

Moving cervix side to side causing excitation

Question 10

Bimanual examination:

You then put fingers below the cervix and push up. What does this do?

How can you test for enlarged or tender ovaries or fallopian tubes?

Answer 10

Moves uterus up against left hand on the abdomen - note the uterus’ size, position, tenderness and mobility

Fingers in lateral fornix in turn, and push up towards the left hand