Female Physcial/breast Exam Flashcards
Clinical breast exam
1) observe patient while sitting upright
- look asymmetry or obvious lesions, brushes, masses
2) have patient lie supine and examine one breast at a time
- move in a circular pattern and Dont neglect move inward to the areola and nipple
- apply firm but not painful pressure (ask patient to inform if they feel any discomfort)
3) palpate the breast tail regions and axilla
Pelvic examination
1) have patient lie in the lithotomy position (laying down with knees/hips flexed and feet elevated)
2) report ion the stirrups as needed for patient comfort (also make sure they aren’t facing the door if possible and/or provide curtains to keep autonomy)
3) ensure patient is positioned at edge of the table and talk to patient as you perform each step in the exam
4) examine the entire external genitalia including areas between labia majora and minora and urethral meatus
Pap smear (cervix samples) and speculum use
1) move labia apart with gentile pressure to avoid internal traction from speculum
2) aim the tip of the speculum at a angle to make more narrow when inserting
3) apply downward pressure with the speculum insertion and slowly apply pressure on the notched locking tab until the cervic comes into full view
4) obtain endocervical and ectocervical samples
- ectocervix = outer part of the cervix distal to the uterine external os. Composed of stratified squamous epithelium
- endocervical = inner part of the cervix proximal to the uterine external os. Composed of simple columnar epithelium
5) release the notched locking tab and fully close the speculum prior to removal from vagina
Tools used in Pap smears
Speculum = used to open the cervix
Cervical broom
- samples both the endocervix and ectocervix
Cytobrush
- samples the endocervix only
Spatula
- SMA pole the ectocervix only
Testing materials based on Pap smear done
Biannual exam
Use single-use sterile lubricant and insert two fingers into the vagina while applying posterior pressure to the suprapubic region
Purpose = palpate the size and position of the uterus. Examine for any abnormalities such as adnexal masses or cervical motion tenderness (chandelier sign = PID)
if you have to do a Pap smear, do the Pap smear first then the manual exam to prevent contamination with sterile jelly if using it
USPSTF grades
A = recommend the service and there is high certainty that the net benefit is substantial
B = recommend the service and there is moderate certainty that the net benefit is substantial
C = recommend selectively offering or providing the service under professional judgement. Moderate certainty that the net benefit is small
D and I = discourage use and I = there is direct harm
What grade is breast exams by the USPSTF classification
If not symptoms = C/D
- there is no clinical evidence demonstrating patient self breast exam and physician breast exams are beneficial in screening for breast cancer
- only recommend the patient to understand their baseline breast appearance and to see a doctor if this changes
If breast symptoms are present = need to do a physician breast exam
Mammogram USPSTF grading
Women’s aged 50-74 yrs
- B grade
Women aged 40-49
- C grade
- needs family history or symptoms to do to prevent over diagnosis of benign conditions
Women aged under 40
- D grade
- need to be high grade. Otherwise = DONT do
- *high risk patients**
- 2 first or 2nd degree relatives with a history of breast cancer before age 50
- 3 first degree or 2nd degree relatives with a history of breast cancer at any point
- possesses genetic diseases associated with higher rates of breast cancer
Pelvic exam grade recommendations
Asymptomatic non pregnant women with no genetic disorders
- grade = I = DONT DO
Symptomatic, pregnant and or have genetic disorders that promote gynecological condtions
- grade = A/B = DO IT
Cervical cancer screening/pap smear grade recommendations
Women aged 21-65 yrs
- grade A
- every 3 years with cytology (as long as last one is negative)
- every 5 years for HPV testing
Women under age 21
- grade I
Women over age 65
- grade I
Women who have hysterectomy
- grade I
- becomes grade C if history over cervical dysplasia in past pap smears
STD/STI screening grade recommendations
Sexually active non-pregnant women aged 15-65
- grade B
Pregnant patient
- grade A
Colorectal cancer screening grade recommendations
Adults aged 45-75 yrs
- Grade A
Adults under the age of 45
- grade I
Adults aged 76-85
- grade C
- only screen if never had a colorectal screening before or if you know the patient would be up to treatment if something is found and they have no comorbidities that reduce life expectancy
start screening at age 45 or 10 yrs prior to the youngest age of a family member who was diagnosed with colorectal carcinoma (which ever is younger)
- *common screens**
- colonoscopy = every 10 years as long as its negative
- sigmoidoscopy every 5 years
- CT colongraphy every 5 years
- *if they refuse colonoscopy or contraindications present**
- fecal immunochemical tests(FIT)
- stool DNA test
- fecal occult guaiac every year
Osteoporosis screening grade recommendations
Women over the age of 65 and 65:
- grade B
Postmenopausal women under age 65 with increased risk of osteoporosis
- grade B
Premenopausal women
- grade D
- need extensive risk factors to screen
Risk factors:
- smoking
- history of osteoporosis
- low BMO
- chronic steroid use
- history of multiple fractures
- late menarche/early menopause
- hypocalcemia
- even more
Screening vs diagnostic testing
If a abnormality is detected or pertinent medical history findings leads to suspicion of underlying disease the screening test is usually converted to a diagnostic test
