pelvic exam

Question 1

inspection

Answer 1

look at hair distribution and surface characteristics of mons pubis, labia majora–skin should be smooth and clean

Question 2

palpation

Answer 2

separate labia majora and inspect labia minora, clitoris, urethral orifice, perineum; palpate Skene and Bartholin glands

Question 3

speculum exam

Answer 3

observe the cervix for color, position, size, surface characteristics, discharge and size/shape of os; obtain specimens for pap smear, HPV testing, culture or other lab analysis

Question 4

bimanual exam

Answer 4

put on fresh gloves and lubricate index and middle fingers of dominant hand (watch the thumb!)-palpate cervix, place opposite hand on abdomen and palpate for uterus, palpate adnexa and ovaries

Question 5

rectovaginal exam

Answer 5

insert index finger of dominant hand into vagina, place middle finger on anus and have patient bear down then insert finger in rectum; palpate rectal walls and rectovaginal septum; inspect for stool as you withdraw your fingers and note presence of blood

Question 6

nullparious os

Answer 6

cervix of woman without children will be small, round or oval

Question 7

parous/multiparous os

Answer 7

cervix of a woman with children/multiple children is usually a horizontal slit or may be irregular and stellate (star shaped)

Question 8

para/parity

Answer 8

total number of DELIVERIES, regardless of method of delivery (after 20 weeks)–remember twins/triplets etc count as ONE delivery

Question 9

gravida/gravidity

Answer 9

total number of PREGNANCIES, regardless of type, location and time/method of termination

Question 10

Skene gland palpation

Answer 10

insert index finger (palm up) as far as second joint and with upward pressure, milk Skene glands by moving finger outwards–do this on both sides of urethra and directly on urethra; discharge usually indicates infection

Question 11

Bartholin gland palpation

Answer 11

with index finger inserted to second joint, palpate tissue between thumb and index finger laterally anteriorly to posteriorly (on both sides) and note any tenderness or discharge

Question 12

types of speculum

Answer 12

Graves - blades are curved with a space between the closed blades
Pederson - blades are as long as Graves, but are narrower or flatter (used in women with small vaginal openings)
pediatric/virginal - smaller in all dimensions with short, narrow, flat blades

Question 13

uterus is divided into corpus and cervix

Answer 13

corpus: consists of fundus (convex upper portion of uterus between points of insertion of fallopian tubes)
cervix: extends from isthmus (lower portion of body of uterus) into vagina

Question 14

adnexa

Answer 14

fallopian tubes and ovaries

Question 15

cervical motion tenderness

Answer 15

Pain elicited when uterine cervix is manipulated during pelvic examination (can=pelvic inflammatory disease (PID) or ruptured ectopic pregnancy)

Question 16

abnormal vaginal bleeding

Answer 16

Characterized by any unexpected bleeding; many possible causes: PID, polyps, cervical cancer, trauma, hormones, contraceptive pills

Question 17

uterine prolapse

Answer 17

herniation of the uterus into or beyond the vagina; results from weakening of supportive structures

Question 18

friable cervix

Answer 18

easily irritated and inflamed cervical tissue; could mean infection, carcinoma, inflammation of cervix

Question 19

ectropion/entropion

Answer 19

ectropion: columnar cells extend from endocervix to visible opening of cervix (creating a circular, raised erythematous appearance)
entropion: opposite of ectropion (no visible transformation zone)

Question 20

vaginal discharge

Answer 20

Usual discharge is odorless, may be creamy or clear, thick or thin

Question 21

cystocele, rectocele, urethrocele

Answer 21

cystocele - hernial protrusion of the urinary bladder through ant. wall of vagina
rectocele - hernial protrusion of part of rectum through posterior vaginal wall
urethrocele - prolapse of the female urethra into the vagina

Question 22

cervical stenosis

Answer 22

opening in the cervix is more narrow than is typical

Question 23

cyanotic cervix

Answer 23

normally seen in pregnancy, 8-12 weeks of gestation