Gynae Exam

Question 1

Speculum
- Introduction
- Consent

Answer 1

Speculum
- Introduction

1. Name & DoB
2. Pregnant possibility

• Consent
  1. Any idea what this involves?
  2. Inserting plastic speculum into vagina

3. Inspect walls and cervix
4. Sample of cells from neck of womb with small plastic brush
   - uncomfortable
5. Let me know if you need me to stop
6. Vaginal spotting afterwards
7. Chaperone
8. Any questions
9. Bladder

Question 2

Speculum exam
- Preparation

Answer 2

Speculum exam

• Preparation
  1. Gloves
  2. Speculum and lube
  3. Brush and sample pot

Question 3

Speculum exam
- Positioning

Answer 3

Speculum exam
- Positioning

1. Bend knees up as far as possible
2. Feet together
3. Relax knees out

Question 4

Speculum
- Cervix signs

Answer 4

Speculum
- Cervix signs

1. Ectropion
2. Ulcers
3. Masses
4. Discharge

Question 5

Speculum
- Cervical brushing

Answer 5

Speculum
- Cervical brushing

1. Rotate 5 times anticlockwise
2. Remove without touching speculum

Question 6

Speculum
- Finishing

Answer 6

Speculum
- Finishing

1. Allow patient to get dressed
2. Deposit brush into container

Question 7

Speculum
- Summary and completion

Answer 7

Speculum

• Summary
  1. Cervix
  2. Os
  3. Masses
  4. Discharge
• Completion
  1. Bi-manual pelvic exam

Question 8

Bimanual exam
- Introduction
- Consent

Answer 8

Bimanual exam

• Introduction
  1. Name & DoB
• Consent
  1. Internal vaginal examination

2. Two fingers into abdomen and hand onto abdomen
3. Assess vagina, uterus, ovaries
4. Uncomfortable not painful
   - Stop at any time
   - Chaperone if that is ok
5. Pregnant possible
6. Bladder
7. Step behind curtain
   - Remove clothing including underwear
   - Cover with blanket

Question 9

Bimanual exam
- Position

Answer 9

Bimanual exam

• Position

1. Flat
2. Bend knees
   - keeping heels together
   - relax knees outwards
3. Stop at any point

Question 10

Bimanual exam
- Examination

Answer 10

Bimanual exam
- Examination

1. Inspect vulva
   - Erythema, rashes
   - Masses, scars
   - Discharge
2. Cough
   - prolapse
3. Lube
4. Separate labia and insert fingers
   - cervical excitation (motion tenderness)
5. Palpate uterus and adnexa
6. Withdraw and inspect fingers

Question 11

Bimanual exam
- Finally
- Summary
- Completion

Answer 11

Bimanual exam

• Completion
  1. Get dressed
• Summary
  1. Vulva
  2. Cervix
• no excitation
  3. Uterus and adnexa

Complete
1. Urinalysis
2. Pregnancy test
3. Speculum
4. Swabs
5. Imaging