Pelvic Exam

Question 1

How do you minimize the pt’s apprehension?

Answer 1

• keep woman involved in exam: ask if there is anything i can help you be more comfortable?
  Try to relax as best you can, let me know if I’m hurting you
• talk b/f touch - tell woman what you are doing with each part of the exam

Question 2

Preparation b/f pelvic exam?

Answer 2

• physical comfort: temp of room, head of bed elevated as needed for pt comfort and eye contact with you
• stirrups padded and in comfortable position
• privacy:
  room setup
  chaperone
• have pt empty bladder
• warm speculum
• appropriate position - more abducted the hips the easier the exam - don’t force legs apart though

Question 3

External exam of the vagina - labia majora?

Answer 3

• labia majora:
  symmetry
  rednes or swelling
  excoriation, rashes, ulcers or other lesions
• discoloration or thinned white appearance
• varicosities or angiomas
• trauma
  ** always orient the pt to your hand on location separate from genitalia initially

Question 4

External exam of the vagina - labia minora?

Answer 4

• symmetry
• moisture
• color
• inflammation
• excoriation
• d/c
• uclers
• verrucous changes
• have to spread apart labia majora to get good look of labia minora

Question 5

External exam - clitoris and urethral meatus?

Answer 5

- clitoris:
size
atrophy/hypertrophy
adhesions or inflammation of prepuce/hood
- urethral meatus:
d/c
polyps, carbuncles, fistulas
irritation or inflammation

Question 6

External exam - vaginal introitus?

Answer 6

• moisture
• swelling
• discoloration
• d/c
• lesions, fistulas, or fissures

Question 7

External exam - perineum and anus?

Answer 7

• perineum: scarring, inflammation, fistulas, lesions or growths
• anus:
  color, scarring or skin tags, excoriation, fissures or lesions

Question 8

External exam - palpating the skene and bartholin glands?

Answer 8

• d/c
• tenderness
• swelling
• masses
• temp

Question 9

Critical items with placing the speculum?

Answer 9

• 1) retract labia minora laterally
• 2) avoid urethra by downward pressure on posterior vaginal introitus
• 3) angle speculum about 30-45 degrees downward towards the sacral promontory

Question 10

Internal inspection includes?

Answer 10

- cervix:
color, position, size, surface characteristics (location of SCJ, presence of nabothian cysts)
 d/c
- cervical os:
size and shape

Question 11

Specimen collection includes?

Answer 11

• pap smear
• gonorrhea and chlamydia swab
• herpes swab and media
• wet mount

Question 12

Bimanual exam - cervix palpation?

Answer 12

• size, length and shape
• position
• consistency
• movement
• nodules
• hardness
• tenderness

Question 13

bimanual exam - uterus palpation?

Answer 13

• location
• position
• size and shape (sym.)
• contour
• mobility
• tenderness

Question 14

How do we feel an ovary on PE?

Answer 14

• with downward pressure with hand on abdomen

Question 15

How can uterus be palpated if it is retroverted or retroflexed?

Answer 15

• through rectal exam

Question 16

Ovaries palpation and adnexa - on bimanual exam?

Answer 16

Ovaries:

• size**
• shape
• location
• consistency
• tenderness
• nodularity

adnexa:

• masses
• tenderness

Question 17

What is involved in the rectovaginal exam?

Answer 17

• anal sphincter: tone
• rectal walls: masses, polyps, nodules, strictures, or induration, irregularities, tenderness
• rectovaginal septum: tone and thickness, nodules
• uterus or adnexal mass: location, position, size, shape and contour, consistency, tenderness
• stool: color, blood - guaiac

Question 18

What might compromise a pelvic exam?

Answer 18

• full bladder

Question 19

Classic position of the uterus?

Answer 19

• anteverted