Female And Male Exam Flashcards
The breast overlies the _________ and, at its inferior margin, the __________.
The breast overlies the pectoralis major and, at its inferior margin, the serratus anterior
The adult breast may be soft, but frequently feels granular, nodular or lumpy this uneven texture is normal and known as:
Physiologic nodularity
Most of the breast lymphatics drain toward the ______.
axilla
Not all breast lymphatics drain into the axilla—malignant cells from breast cancer may spread directly to_______or into the_____________ of lymph nodes
infraclavicular nodes or
into the internal mammary
chain of lymph nodes
What are five findings that are consistent with breast malignancy ?
- Hard consistency
- Irregular shape
- Dimpling of overlying skin
- Associated retraction of nipple
- Non-tender
Inspect the breasts with the patient in ______ position.
Sitting
If the patient is going to perform BSE, or should you desire to advocate for same on behalf of your patient, be sure you explain this to your patient.
Perform it :
- Monthly after age 20
- 5-7 days after onset of menses
- In the shower is best
- Arm should be raised when doing BSE
What pattern should be used when palpating the female breast?
• Place the patient in the supine position, with one arm above head—shoulder raised on towel/sheet, one breast undraped
Use the VERTICAL STRIP PATTERN (best validated technique)
Examine breast tissue for? (3)
- Consistency of tissues
- Tenderness
- Nodules
pattern used for BSE:
• Up-and-down or “strip” pattern utilized for BSE
If you are a male examining the female patient, you MUST have what.
- you must have a female assistant/chaperone -does not have to be a nurse
- should not be someone who came with the patient
You should also have an assistant if you are examining who ?
Examining a child or a patient who is mentally or physically handicapped
How does having an assistant with you help with the exam ? (3)
- protect you against allegations of inappropriate conduct
- expedite exam
- make patients feel more comfortable
What is the name of the position the patient is in for the pelvic exam?
Lithotomy position
What is included in the EGBUS findings of the female external genitalia ?
ext. genitalia, Bartholin’s, urethra and Skene’s
The bartholins glands are checked by?
by inserting the index finger into the vagina and placing the thumb at the posterior labia; palpate between finger and thumb
How to do an internal exam with the speculum
- Place the index finger of your non-dominant hand on the posterior portion of the introitus and push down gently
- With the speculum in your dominant hand, turn it to the entry angle (approximately 45 degrees) and gently insert into the introitus; continue inserting the length of the speculum
- Rotate the speculum horizontally and gently open it, catching the cervix in between the blades; it is common to have to close the speculum and reposition the blades to locate the cervix
A nullip os appears how?
small and perfectly round
The speculum exam should be performed before or after the bimanual exam?
Before
Where should specimens be collected from and with what tool.
Endocervix and ectocervix with “cervical brush”
If indicated, place two fingers inside the labia and ask the patient to bear down in order to see if the vaginal walls bulge or if any part of the rectum protrudes from the anus. This could possibly indicate what ?
(possibly indicating a cystocele or rectocele)
Three purposes for a rectovaginal exam.
- Palpate a retroverted uterus, the uterosacral ligaments, cul-de-sac, and adnexa
- Screen for colorectal cancer
- Assess pelvic pathology
The shaft of the penis is formed by three columns of vascular erectile tissue:
o The corpus spongiosum, containing the urethra
o The two corpora cavernosa
The corpus spongiosum forms the bulb of the penis, ending in the cone-shaped _______with its expanded base, or _______
Glans
Corona
The testes are ovoid, somewhat rubbery
structures approximately how long?
4.5 cm
T/F : The left testis usually lies somewhat lower than the right
True
A carefully performed exam of the male g.u./groin region will frequently yield (or exclude) the etiology regarding what type of pain in the abdomen?
Referred pain
What type of hernia are least common in general and more common in women than in men; hint :point of origin below the inguinal ligament
Femoral
Most common hernia
Indirect
What hernia is usually in men older than 40; rare in women. Point of origin: also above inguinal ligament, close to the pubic tubercle. Rarely into the scrotum; hernia bulges anteriorly and pushes side of finger forward
Direct
any palpable masses or any enlarged scrotum should be what
Transilluminated
A mass that does not transilluminate could be what four things ?
1- Inguinal Hernia: Usually, it causes pain and may be a bulge when standing upright, movement, or bearing down are present.
2- Varicocele: is a dilatation of the veins within the scrotum. Varicoceles are commonly seen on the left side.
3- Testicular tumor usually affects only one testicle. It rarely present with pain or discomfort in a testicle or the scrotum. Typically, testicular cancer produces a painless swelling of one testicle.
4- Hematoma (blood
A 21-year-old male presents complaining of a “nodule” on the back of his left testicle found during self-examination of his testes. On examination, you find both testes to be of normal size, shape, and consistency. On the back of the left testis in the area of the “nodule,” you find a soft, nodular, tube-like structure with no areas of abnormal tenderness. Your most likely diagnosis is:
a. Acute epididymitis
b. Cyst of the epididymis
c. Normal epididymis
d. Carcinoma of the epididymis
c. Normal epididymis
• The epididymis is located on the superior, posterior surface of each testis. It feels nodular, soft and cordlike and should not be confused with an abnormal lump
Techniques for inspecting hernias and lymphatic:
- Sit comfortably in front of the standing patient
- Note any areas of bulging or asymmetry
- Ask the patient to strain and bear down, making it easier to detect any hernias
If a large scrotal mass is found, ask the patient to lie down. If the mass disappears, it is a _______.
Hernia
If the mass remains you should do what ?
- Listen to the mass with a stethoscope. If bowel sounds are heard, it is a hernia.
- Shine a strong light from behind the scrotum through the mass (transillumination). If a red glow is observed, it is probably not a hernia
Which of the following statements about hernias is true?
a. Indirect inguinal hernias are the most common form of hernia
b. Femoral hernias are the least common form and are more common in women
c. Direct inguinal hernias are more common in men over age 40
d. Indirect inguinal hernias originate above the inguinal ligament near its midpoint
e. All of the above
e. All of the above
• Indirect inguinal hernias are the most common form of hernia
• Femoral hernias are the least common form and are more common in women
• Direct inguinal hernias are more common in men over age 40
• Indirect inguinal hernias originate above the inguinal ligament near its midpoint
Normal epididymis characteristics :
Epididymis is a soft, nodular, cordlike structure at the back of the testicle
What type of hernia causes pain and may be a bulge when standing upright, movement, or bearing down are present.
Indirect
What are vericoceles and where are they most commonly found ?
dilatation of the veins within the scrotum. Varicoceles are commonly seen on the left side.
Does a testicular tumor usually affect one or both testicles? Does it cause pain?
Testicular tumor usually affects only one testicle. It rarely present with pain or discomfort in a testicle or the scrotum.
Normally, the anal canal is held in a closed position by two muscles, the voluntary_____________ and involuntarily ____________
voluntary external anal sphincter and involuntary internal anal sphincter
The _____________ (often called the pectinate or dentate line) is the boundary between ________and _______ nerve supplies
The anorectal junction (often called the pectinate or dentate line) is the boundary between somatic and visceral nerve supplies
In the male, the prostate gland lies against the________
Anterior rectal wall
Normal shape and length of the prostate
It is rounded, heart-shaped, and normally
2.5 cm long
What part(s) of the prostate are normally palpable ?
Only the lateral lobes and median sulcus are palpable
Symptoms that are concerning regarding the prostate
- Change in bowel habits
- Blood in the stool
- Pain with defecation; rectal bleeding or tenderness
- Anal warts or fissures
- Weak stream of urine
- Burning upon urination
True or false : In asymptomatic adolescents, it is appropriate to defer the rectal exam
True
A 65-year-old male presents to clinic for a routine examination. The following is the documentation of his prostate examination. Which statement would be of concern?
a. Firm
b. Heart-shaped
c. 2.5 cm long
d. Median sulcus palpable
a. Firm
• The normal prostate is rubbery
any persistent penile sore is suspicious of what
Penile carcinoma
What is condyloma acuminata and what is the causative organism ?
Genital warts subtypes 6 and 11 of HPV
Genital Herpes Simplex. Causative organism? Usually; i.e., 90% HSV # _______?
2
A painless small red papule becomes a _______. Caused by ________. And has an incubation period of __________.
Chancre
Treponema Pallidium (syphilis)
9-90 days
Red papule or pustule initially, then forms a painful deep ulcer called a _________. Which is caused by the organism called___________. And has an incubation period of _________.
Chancroid
Haemophilus ducreyi
3-7 days
testis atrophied and an unfilled scrotum is called what
Cryptorchidism
What is seen in mumps and other viral infections and is usually unilateral?
Acute orchitis
Life scrotum to view what ?
Posterior surface / skin.
Look for scrotal ________ such as swelling, lumps, veins.
Contours
The female breast extends from where to where.
From clavicle/2nd rib down to 6th rib.
From sternum to midaxillary line
How many quadrants are in the breast exam ?
Four
If you hear bowel sounds on a mass it’s most likely a _______
Hernia
Hydrospadias
urethral opening in a different area than tip
When should clinical breast exams be done in women aged 20-39?
Every 3 years
Majority of breast masses are detected how ?
By the woman herself.
When draping the patient, you should always :
always cover what you aren’t looking at
Do NOT remove speculum when it is _______.
Open
How should the male patient be positioned during a rectal exam?
▪ Pt may stand leaning forward with upper body resting on table, hips flexed
▪ Or pt may lie on left side with buttocks close to edge of exam table, flex patients hips/knees, especially top leg
Most breast masses present in which quadrant ?
most breast masses present in upper outer quadrant
What is the tail of Spence ?
tail of breast (toward axilla)
Of the axillary lymph nodes, the ________ nodes are most palpable
Central
What type of hernia may bulge when standing upright, movement, or bearing down
Inguinal
What condition causes curved erections from scar tissue
Peyronie’s Disease
Point of origin for femoral hernia:
below inguinal ligament
Point of origin for indirect hernia
Above inguinal ligament
How to detect indirect hernia:
Can examine when patient bears down, hernia can come down and touch the fingertip in inguinal canal.
Point of origin in direct hernia:
above inguinal ligament, close to pubic tubercle
