Female Exam

Question 1

Who should get a pelvic exam and how often?

Answer 1

First exam - women at age 21 , every 3 years after.

Unless other health concerns.

Question 2

Important issues related to the pelvic exam.

Answer 2

Cultural issues
Patient modesty
Anxiety about the exam
History of rape or abuse
Office environment

Question 3

Pelvic exam: Office environment concerns

Answer 3

have an additional person in the exam room while assessing reproductive organs, explain what you are doing, ensure comfort and modesty.

Question 4

Pelvic exam: patient comfort/modesty

Answer 4

gowns and sterile drapes, foot of table does not face the door, door marked to avoid interuption, allow patient to wear socks, bra or sweater.

Question 5

3 parts of the pelvic exam

Answer 5

Speculum exam
Bimanual exam
Recto-vaginal exam

Question 6

3 parts prior to beginning gloved examination

Answer 6

History
Inspect
-pubic hair
-lymph nodes
-urethral meatus
-orifices
Palpate
-labia
-milk skene's and bartholin's glands
-perineum

Question 7

Speculum exam

Answer 7

1st exam.

performed without lubricant, speculum warmed and closed when inserted at 45 degree angle posteriorly

Question 8

Visual observation of cervix

Answer 8

position
color
surface characteristics
discharge
shape/size of os

Question 9

The Papanicolaou [pap] exam

Answer 9

minimum 2 samples taken

• cervical cells
• vaginalsecretion

-STD tests possible

Question 10

3 most common STDs among women

Answer 10

HPV, Herpes, Chlamydia

• QC (2nd highest in IA
• in women often no symptoms

Question 11

Goal of pap smear

Answer 11

Screen for cervical cancer, assessing the transition zone of cervix

Question 12

Accuracy of pap smear

Answer 12

• Decreased cervical CA death rate by 75%
• False-positives (10-40%)
• False-negatives (1-15%)

Question 13

vulvovaginitis

Answer 13

due to bacteria, viruses, fungi, protozoans.

symptomatic discharge

itching, burning, color change, texture or odor of discharge

Question 14

Bimanual exam

Answer 14

2nd exam

• evaluate cervix, uterus, adenexal regions
• PID, endometriosis
• important for even those who are not sexually active

Question 15

Recto-vaginal exam

Answer 15

3rd exam

allows exam of rectal walls, evaluates the posterios aspect of uterus

Question 16

Uterine fibroids

Answer 16

risk factors

• nulliparity
• african american (2-3x)
• older age

benign
40% OF WOMEN OVER 40
-MC pelvic tumor
-MC reason for hysterectomy

x-rays - cauliflower-like

Question 17

Symptoms/treatment of Uterine Fibroids (leiomyoma)

Answer 17

heavy menstrual bleeding
abdominal distortion
pelvic pressure
low back pain
dyspareunia
infertility
frequent urination
constipation
miscarriage or premature labor

wait and see
hysterectomy
drug therapy

Question 18

Endometriosis

Answer 18

“condition of inner layer”

normal endometrium found in abnormal places

risk factors
-25-44 years (10-15%)

Signs and symptoms

• PAIN, PAIN, PAIN
• pelvic mass
• alterations of menses
• dysmenorrhea
• infertility
• dyspareunia
• pain with defecation,urination

early onset of menses
short cycle (<27days)
severe menstrual cramps
prolonged flow (>1 week)