PD - Breast/GU/Pelvic Exams Flashcards

1
Q

positions to examine breasts

A
  1. Arms at sides
  2. Arms overhead
  3. Hands pressed against hips
  4. Torso leaning forward
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2
Q

inspection of breasts

A
  1. appearance of skin– note discolorations or lesions
  2. size and symmetry of the breasts– a small degree of asymmetry is normal
  3. breast contour– should be symmetrical
  4. nipple examination– size, color, lesions, discharge
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3
Q

most accurate breast palpation technique

A

vertical strip method

Using the finger pads of the second, third, and fourth digits, palpate in small concentric circles. Begin in the axilla, moving in a vertical pattern up and down the breast until you have reached the midline.

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4
Q

Which structures (besides the breasts) should be palpated during breast exam?

A

axillae for lymphadenopathy

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5
Q

Male GU can be performed both standing and lying positions (T or F?)

A

true

most of inspection should be done both supine and and standing

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6
Q

Male GU inspection

A

Inspect the skin and hair for any signs of infestation (lice), masses, rashes or fungal disease. Inspect the penis for circumcision, phimosis (inability to retract the foreskin), masses, lesions, ulcers.

Retract the foreskin and inspect the glans, looking for fungal infection or mass, warts, nodules or inflammation.

Also inspect the urethral opening and scrotum.

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7
Q

Male GU palpation

A
  • Inguinal region- look for lymph nodes and hernias
  • Penis- palpate the corpus cavernosum, the corpus spongiosum, and the glans. Feel for scar tissue, nodules, masses.
  • Testes- feel for mass, size, tenderness, consistency. Check each separately
  • Epididymis- located on the POSTERIOR aspect of the testes, feel for tenderness, size, nodularity
  • Vas Deferens-can be palpated as part of the spermatic cord.
  • Spermatic Cord- can be palpated by inserting a finger up to the external inguinal ring. Hernias may also be palpated here.
  • Scrotum- palpate the scrotum itself for any additional masses.
  • Prostate- perform a prostate examination
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8
Q

prostate palpation normal findings

A

lies anteriorly

bilobed, symmetric, rubbery w/ midline groove (“median sulcus”)

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9
Q

cremasteric reflex

A

Gently stoking the inner thigh will cause the testicle to rise on the ipsilateral side due to contraction of the cremasteric muscle

can evaluate for testicular torsion, but nonspecific reflex overall

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10
Q

test to help determine etiology of mass in scrotum

A

scrotal transillumination

fluid filled masses (hydrocele, spermatocele) –> transilluminate

solid masses (tumors, clots, hernias) –> no transillumination

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11
Q

positions for rectal exam

A

pt supine, laying on side (left or right lateral decubitus positions)

females: lithotomy position
males: bend at waist w/ feet spread
children: supine or decubitus

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12
Q

rectal exam inspection/palpation

A

inspect for external hemorrhoids, lesions, masses, fissures, etc.

palpate: asking pt to bear down may help relax sphincter

palpate walls of rectum in orderly fashion noting any nodules, fluctuance, areas of tenderness, or stool

Character of the stool can also be assessed (such as rock hard stool in a patient who is impacted, etc.)

Males: PROSTATE.
-note symmetry of lobes, nodules, consistency, tenderness

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13
Q

important sx for GU and pelvic exam

A
  • Pain
  • Dysuria
  • Changes in urine flow or pattern
  • Red urine or hematuria
  • Penile discharge
  • Penile lesions
  • Scrotal enlargment
  • Groin mass or swelling
  • Impotence
  • Infertility
  • Abnormal vaginal bleeding
  • Dysmenorrhea- pain with menstruation
  • Vulvar masses or lesions
  • Vaginal discharge
  • Vaginal itching
  • Dyspareunia- pain during sexual intercourse
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14
Q

testicular pain may be referred from…

A

Renal colic or appendicitis, or from any disease of the testis or epididymis (torsion, infection, tumor)

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15
Q

flank pain may result from…

A

hydronephrosis of the kidney, distention of the bladder or ureter or may be referred pain from testicle or labia

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16
Q

low pelvic pain

A

salpingo-oophoritis, cystitis, complication of pregnancy, hernia, ovarian torsion, tubo-ovarian abscess

17
Q

groin or scrotum mass

A

inguinal hernia, hydrocele, varicocele, abscess

18
Q

labial mass

A

syphilis, Bartholin’s gland abscess, herpes, condylomata, tumor

19
Q

vaginal mass

A

cystocele, rectocele, uterine prolapse

20
Q

common causes of vaginal pruritus

A
  • Candida infection
  • Glycosuria
  • Contact dermatitis
21
Q

A complete ______ exam should always be performed with the genitourinary exam.

A

A complete ABDOMINAL exam should always be performed with the genitourinary exam.

22
Q

Speculum Exam

A

Separate the labia manually so they do not become caught in the speculum.

Gently insert the speculum vertically away from the urethra into the vaginal canal.

Turn the speculum horizontally and open it slowly, allowing inspection of the vagina and cervix.

The cervix is examined for size, shape, discharge, presence of lesions. At this point cultures, smears or biopsies may be taken.

23
Q

Normally, the cervix is mobile. T or F?

A

TRUE

if painful –> abnormal (cervical motion tenderness)

24
Q

During female exam, palpate the posterior fornix, which is immediately adjacent to the…

A

pouch of Douglas

25
Q

Any stool on the rectal finger should be tested for ______.

A

Any stool on the rectal finger should be tested for OCCULT BLOOD.

26
Q

Any evaluation of a patient greater than 12 weeks pregnant should include an evaluation for…

A

FETAL HEART TONES

use doppler stethoscope

27
Q

palpation of adnexa

A

Moving both the inner and outer hands to one side and then the other, the fallopian tubes, ovaries, masses and any areas of tenderness are palpated. It is not always possible to palpate the ovaries and fallopian tubes.