PD - Breast/GU/Pelvic Exams Flashcards
positions to examine breasts
- Arms at sides
- Arms overhead
- Hands pressed against hips
- Torso leaning forward
inspection of breasts
- appearance of skin– note discolorations or lesions
- size and symmetry of the breasts– a small degree of asymmetry is normal
- breast contour– should be symmetrical
- nipple examination– size, color, lesions, discharge
most accurate breast palpation technique
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.
Which structures (besides the breasts) should be palpated during breast exam?
axillae for lymphadenopathy
Male GU can be performed both standing and lying positions (T or F?)
true
most of inspection should be done both supine and and standing
Male GU inspection
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.
Male GU palpation
- 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
prostate palpation normal findings
lies anteriorly
bilobed, symmetric, rubbery w/ midline groove (“median sulcus”)
cremasteric reflex
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
test to help determine etiology of mass in scrotum
scrotal transillumination
fluid filled masses (hydrocele, spermatocele) –> transilluminate
solid masses (tumors, clots, hernias) –> no transillumination
positions for rectal exam
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
rectal exam inspection/palpation
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
important sx for GU and pelvic exam
- 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
testicular pain may be referred from…
Renal colic or appendicitis, or from any disease of the testis or epididymis (torsion, infection, tumor)
flank pain may result from…
hydronephrosis of the kidney, distention of the bladder or ureter or may be referred pain from testicle or labia
low pelvic pain
salpingo-oophoritis, cystitis, complication of pregnancy, hernia, ovarian torsion, tubo-ovarian abscess
groin or scrotum mass
inguinal hernia, hydrocele, varicocele, abscess
labial mass
syphilis, Bartholin’s gland abscess, herpes, condylomata, tumor
vaginal mass
cystocele, rectocele, uterine prolapse
common causes of vaginal pruritus
- Candida infection
- Glycosuria
- Contact dermatitis
A complete ______ exam should always be performed with the genitourinary exam.
A complete ABDOMINAL exam should always be performed with the genitourinary exam.
Speculum Exam
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.
Normally, the cervix is mobile. T or F?
TRUE
if painful –> abnormal (cervical motion tenderness)
During female exam, palpate the posterior fornix, which is immediately adjacent to the…
pouch of Douglas
Any stool on the rectal finger should be tested for ______.
Any stool on the rectal finger should be tested for OCCULT BLOOD.
Any evaluation of a patient greater than 12 weeks pregnant should include an evaluation for…
FETAL HEART TONES
use doppler stethoscope
palpation of adnexa
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.
