Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Examinations > Intimate Examinations > Flashcards

Intimate Examinations Flashcards

1
Q

What are the stages involved in preparing a patient for an intimate examination?

A
  • introduce yourself and explain the procedure to the patient
  • give the patient privacy to undress
  • documentation
  • offer a chaperone
  • explain what you are doing as you go along
  • identify patient, wash hands and obtain and record consent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What 7 reasons might a rectal examination be performed for?

A
  • acute abdomen
  • genitourinary problems
  • change in bowel habit
  • blood or mucus present in the stool
  • anal / rectal irritation or pain
  • to assess consistency of faeces
  • to assess sphincter control
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is meant by acute abdomen as a reason for performing a rectal examination?

A

this is any presentation with acute abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What type of anal/rectal irritation or pain is often present and indicates the need for a rectal examination?

A

tenesmus

this is persistent ineffectual spasm of the rectum accompanied by the desire to empty the bowel

this is common in IBS / IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 6 special considerations for a rectal examination?

A
  • rectal surgery or trauma
  • obvious bleeding
  • recent pelvic radiotherapy
  • patients with spinal injuries
  • bowel inflammation
  • history of sexual abuse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What signs might be present on rectal examination if someone has had recent pelvic radiotherapy?

A
  • sore fragile skin
  • diarrhoea
  • fragile blood vessels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why should special consideration be taken when performing a rectal exam on a patient with a spinal injury?

A
  • spinal injury (above T6) can lead to autonomic dysreflexia that causes a sudden onset of high BP
  • when an irritating stimulus is introduced below the level of injury (e.g. over-full bladder / rectal examination), impulses sent to the spinal cord will travel until they are blocked by the lesion at the level of injury
  • the impulse cannot reach the brain, so it activates a reflex increasing sympathetic activity
  • this leads to spasm and narrowing of the blood vessels and an abrupt rise in BP
  • patient may experience cardiac arrhythmia, severe headache and nausea & vomiting and this is life threatening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which part of the rectum is examined during a rectal examination?

What does should it look / feel like?

A

the rectum is in 3 sections - lower, middle and upper, with a total length of 15 cm

only the lower part of the rectum is examined

a normal rectum should be smooth and pliable and the examination should not be painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why is a rectal assessment done?

What else might be able to be felt?

A

a rectum assessment is done for lymph nodes, abscesses and polyps

you may also be able to palpate faeces, fistulas, rectal tumours, vaginal tumours (females) and enlarged prostate (males)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What else might be able to be palpated when performing a rectal examination on a male?

What might happen to the patient?

A

when performing a rectal examination you may also be able to palpate the prostate gland

the patient may experience an urge to urinate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What should a normal prostate feel like?

What structures are felt for?

A
  • a normal prostate is 3.5cm side to side
  • it is smooth and rubbery
  • checking is done for two lobes and a medial sulcus
  • it should be non-tender
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is benign prostatic hypertrophy?

What might the prostate feel like in this condition?

A
  • this is common in men aged 60 and over
  • there is smooth and symmetrical enlargement of the prostate
  • the median sulcus may be indistinct
  • the prostate protrudes more than 1cm into the rectum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What might be felt on prostate examination if there is cancer of the prostate?

A
  • prostate feels asymmetrical
  • there is a stony hard consistency
  • discrete nodules may be palpable
  • the median sulcus is obliterated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What signs are looked for when externally inspecting the rectum?

A
  • hygiene
  • pressure sores
  • skin rashes
  • haemorrhoids
  • fistula / sinus
  • discharge
  • polyps / skin tags
  • carcinoma
  • warts
  • worms
  • prolapse
  • foreign bodies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is actually involved in the digital rectal examination?

A

this is a physical examination during which you insert a gloved finger into the patient’s rectum to feel for abnormalities

privacy and dignity must be maintained at all times and this procedure must always be chaperoned

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What equipment is needed for the digital rectal exam?

A
  • lubricant (for internal use only)
  • non-sterile gloves
  • apron
  • gauze
  • disposable continence pad
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What needs to be done before starting the digital rectal examination?

A
  • check consent
  • answer any patient questions
  • close the door / curtains to maintain privacy
  • introduce the chaperone
  • position the patient on left lateral side with knees drawn up to the chest
  • put on gloves and apron
  • uncover the patient’s buttocks to maintain dignity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Following visual inspection, what are the reasons why you should NOT proceed with digital rectal examination?

A
  • if the patient has NOT given informed consent
  • if the patient has fistulae
  • if there is excessive rectal bleeding
  • if there is a history of 3rd degree heart block or autonomic dysreflexia
  • if the patient is a child or there is evidence of possible abuse or the presence of a foreign body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the stages involved in the digital rectal examination?

A
  • lubricate the index finger of the right/left hand
  • tell the patient you are going to insert your finger and to take deep breaths in and out
  • run gloved lubricated finger down the natal cleft to relax the sphincter
  • place finger into rectum to first joint of finger, asking patient to bear down if necessary to relax the sphincter
  • test sphincter tone
  • advise the patient that you will now advance the finger further into the rectum
  • perform 180o posterior sweep of rectum
  • turn arm to perform 180o sweep of anterior aspect of rectum
  • in a male patient, consider pliability of prostate, its location, tenderness, size and regularity of shape
  • slowly withdraw finger and examine for blood, mucus or pus
20
Q

What is involved in the clear up following digital rectal examination?

A
  • clean the patient using wipes and then cover the patient and give them time to redress
  • provide assistance if necessary and appropriate
  • remove apron and gloves and wash hands
  • discuss findings as appropriate and document same
21
Q

How should the findings of the rectal examination be documented?

A
  • document if anything was observed on external inspection
  • comment on the rectal wall
    • were faeces palpable?
    • was there any blood or mucus on inspection of finger?
  • describe what was felt on palpation of the prostate and what this might mean
    • benign prostatic hypertrophy or cancer of the prostate?
22
Q

What further examinations may be performed if a rectal mass or prostate mass is found on rectal examination?

A

Rectal mass:

  • imaging
  • tumour markers
    • CEA (non-specifc)
    • CA19-9
  • colonoscopy and biopsies

Prostate mass:

  • imaging
  • tumour markers
    • ​PSA
  • ​renal function
  • cystoscopy and biopsy
23
Q

What might be some reasons to perform a breast examination?

A
  • lump found on self examination
  • pain or mastalgia (breast pain)
  • nipple discharge
  • women just feel like their breast “looks different”
24
Q

What are the 4 stages involved in the general inspection of the breasts?

A

Stage 1:

  • position patient sitting on the edge of the bed, naked to the waist
  • observe for symmetry and size of both breasts

Stage 2:

  • ask patient to raise arms above their head
  • certain features may be present in some positions and not others
  • check for symmetry, tethering, changes to the contour of the breast

Stage 3:

  • Ask patient to place hands on their hips and press inwards
  • observe for evidence of symmetry, tethering, changes to contour of the breast

Stage 4:

  • ask patient to push their hands together to engage the pectoral muscles and observe for changes
25
Q

What changes / signs should be observed for when performing general inspection of the breasts?

A
  • symmetry of breast tissue
  • changes in breast size / shape
  • dimpling or flaking of the skin
  • venous pattern
  • nipple discharge
  • nipple retraction
  • rash on areola or nipple
  • peau d’orange
  • tethering
  • inflammation
  • ask if any pain or “tugging” sensation is experienced
26
Q

After performing the general inspection of the breasts, how should the patient be positioned?

What should be explained to them?

A
  • ask patient to lie in supine position with arms flat along their sides
  • explain that you will first examine the “normal” breast in order to determine breast tissue changes
  • ask the patient to tell you if they have any pain or discomfort
27
Q

What method should be used to examine the breast?

A
  • palpate with the middle three fingers and the hand flat
  • use rotary movements to compress the tissue gently against the chest wall
28
Q

Which areas need to be examined during the breast examination?

A
  • quadrants
  • areolar area
  • tail of Spence
  • axillae
  • supra-clavicular fossa

the other breast is then examined and findings are compared

29
Q
A
30
Q

What might need to be asked about the consistency of the breasts?

A

normal consistency of breasts changes with menstrual cycle

you may need to check with the patient if the texture of the breasts is what is normal for them at that point in the cycle

31
Q

What is involved in the clear up and discussion stage of breast examination?

A
  • following examination, allow patient time to dress in privacy before discussing findings
  • note any masses, position, size, consistency, relationship to skin and underlying tissue
  • note tenderness, skin discolouration & temperature around the region
  • document findings
32
Q

What 6 factors must be documented relating to a breast lump?

A
  • size
    • size in cm and shape (regular, irregular)
  • site
    • ​position (o’clock) and distance from the nipple
  • consistency
    • ​rubbery, stony, hard, fluctuant
  • mobility
    • ​attached to skin / underlying structures
  • regularity
  • tenderness
33
Q

What are the characteristics of benign breast lumps?

A
  • firm lumps
  • move freely
  • regular in shape
  • often painful
  • skin changes are not usually apparent
34
Q

What tends to be the characterisitcs of malignant breast lumps?

A
  • stony hard
  • tethered to underlying structures
  • irregular contour
  • usually painless
  • nipple discharge
  • peau d’orange
  • lymph nodes may be palpable
35
Q

What are the 3 stages involved in the triple assessment of breast lumps?

A
  • breast clinical examination
  • appropriate radiological imaging
    • targeted USS of lump in <35s
    • targeted USS of lump + bilateral mammogram in >35s
  • histopathology - core biopsy of palpable lump
36
Q

What are the only contraindications for performing a scrotal examination?

A

there are no real contraindications for performing a scrotal examination except for patient refusal or pain

37
Q

What are the reasons why a scrotal examination may be conducted?

A
  • pain
  • dragging sensation
  • trauma to scrotum or testicles
  • urethral discharge
  • inguinal, scrotal or testicular lumps / masses
  • scrotal asymmetry or swelling
  • routine preventative screening for testicular cancer
38
Q

What are you looking for on external inspection of the scrotum?

A
  • skin changes - rash / ulcer / cellulitis
  • scarring
  • swelling
    • unilateral or bilateral?
    • scrotal or inguinoscrotal?
  • bruising
  • necrotic looking tissue - fournier gangrene
  • inspection of the skin of the perineum
39
Q

What is involved in inspection of the penis?

A

retract the foreskin (if present) to check for any balanitis / discharge / evidence of STD

  • urethral discharge
  • gential warts
  • balanitis
  • chancre (syphilis)
40
Q

What components are involved in the testicular examination?

A

this involves inspection of the scrotum

and palpation of the testicles, epididymis and spermatic cord

41
Q

What is involved in the introduction prior to testicular examination?

A
  • introduce yourself (name and role) and check patient identity
  • explain the procedure and gain consent
  • get a chaperone and document name of chaperone in notes
  • gather equipment
    • non-sterile gloves
    • pen torch (cleaned before use)
    • plus any additional kit required e.g. swabs
  • wash hands and apply gloves
  • patient should be positioned supine and undressed from the waist down
    • ​patient can cover themselves with a sheet to ensure privacy and dignity is maintained
  • check that the patient is comfortable
42
Q

What are the stages involved in the testicular examination after inspection of the scrotum?

A
  • stand to the side of the patient and examine the “normal” testicle first
  • using a box technique, fix the testicle in place
  • palpate the testicle assessing size, shape, consistency and tenderness
  • palpate the epididymis assessing size, shape, consistency and tenderness
  • palpate the spermatic cord by rolling it between the thumb and index finger
  • repeat this process with the other testicle / epididymis / spermatic cord
  • ask patient to stand and repeat examination of scrotum, in particular looking for evidence of varicocele and hernia
  • assess for transillumination by shining light from pen torch through the scrotal sac - clear fluid will allow light to pass through it, solid masses will not
  • palpate for enlarged inguinal / supraclavicular lymph nodes
  • palpate for inguinal hernia
  • check for cremasteric reflex (stroke inside of thing and observe scrotal skin contractions)
  • check for Prehn’s sign (if there is testicular pain, this is relieved by elevating the testes)
  • cover the patient after examination
43
Q

Depending on clinical findings, what other tests might be done?

A
  • perform vital signs
  • take urethral swab
  • perform urinalysis
44
Q

What is hydrocele and what would it look like on examination?

A

the accumulation of fluids around a testicle, causing the scrotum to swell

  • this develops slowly
  • lax swelling or tense
  • dull ache
  • can “get above it”
  • can’t feel the testis separately
  • transilluminate
45
Q

What is epididymoorchitis?

How does it present on testicular examination?

A

inflammation of the epididymis and/or testicles

  • gradual onset of scrotal pain and swelling
  • dysuria, frequency or urgency
  • 25% have fever and chills
  • tender tail and head of epidiymus
  • erythema and mild scrotal cellulitis
  • normal cremasteric reflex
  • Prehn’s sign +ve
46
Q

What is epididymal cyst and how does it present on examination?

A

a fluid-filled cyst within the epididymus

  • common around the age of 40
  • usually patients present with a lump
  • can be multiple and bilateral
  • well defined, fluctuant and will transilluminate
  • treatment is not usually necessary, and reassurance is required
47
Q
A

Clinical Examinations (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions