PHYSICAL EXAMINATION Flashcards
IN REGARDS TO THE FEMALE PHYSICAL EXAM OF THE GENITALIA,
- ABNORMAL BLEEDING
- PAIN
- VAGINAL DISCHARGE
- PREMENSTRUAL SYMPTOMS
- MENOPAUSAL SYMPTOMS
- INFERTILITY
- URINARY SYMPTOMS
ALL OF THESE ARE THINGS THE PATIENT WILL REPORT WHEN DURING THE ASSESSMENT?
HISTORY OF PRESENT ILLNESS.
HISTORY OF DIABETES, CANCERS, INFERTILITY IN SIBLINGS, MOTHER TAKING DIETHYLSTILBESTEROL (DES), MULTIPLE BIRTHS IN FAMILY,
THIS IS ALL WHAT ASPECT OF THE PHYSICAL ASSESSMENT.
FAMILY HISTORY
WHAT IS THE MAIN POSITION A WOMAN SHOULD BE IN FOR A PELVIC EXAM?
TRADITIONAL LITHOTOMY POSITION
IN REGARDS TO THE FEMALE GENITOURINARY EXAM.
- MENSTRUAL
- MENOPAUSAL
- OBSTETRIC
- GYNECOLOGICAL
THESE HISTORIES ARE ALL APART OF WHICH AREA OF THE PHYSICAL ASSESSMENT FOR THE PROVIDER/
PAST MEDICAL HISTORY
WHEN ASSESSING A FEMALE’S OBSTERIC HISTORY, WHAT IS THE ACRONYM WE USE TO ASK ABOUT PREGANCIES AND HOW IS IT DEFINED?
G- GRAVIDITY: EVERY TIME PREGNANT
P- PRETERM: BIRTH TOOK PLACE BEFORE 37 WEEKS
A- ABORTION: SPONTANEOUS OR INTENTIONAL EXODUS OF A FETUS
L- LIVING: HOW MANY KIDS CURRENTLY ALIVE
WHAT ARE SOME OTHER POSITIONS A FEMALE PATIENT GOING THROUGH A PELVIC EXAM CAN BE IN?
DIAMOND
OBSTRETRIC STIRRUPS
M SHAPED
V SHAPED
- NOTING HAIR DISTRIBUTION
- INSPECTION OF THE LABIA MAJORA & MINORA
- INSPECTION OF THE CLITORIS
- INSPECTION OF THE URETHRAL ORIFICE
- INSPECTION OF THE HYMEN
- PALPATION OF THE SKENE AND BARTHOLIN GLANDS
- TESTING MUSCLE TONE OF THE VAGINA
- PALPATE AND INSPECT THE PERINEUM
EXTERNAL INSPECTION AND PALPATION OF THE FEMALE GENITALIA
WHAT TOOL IS USED FOR INTERNAL INSPECTION OF THE VAGINA?
VAGINAL SPECULUM
WHEN INSPECTING THE INTERNAL GENITALIA OF THE VAGINA, WHAT ARE WE INSPECTING ON THE CERVIX?
COLOR POSITION SIZE SURFACE CHARACTERISTICS DISCHARGE SIZE AND SHAPE OF THE OS PINK IN COLOR AND EVENLY DISTRIBUTED
DURING EXAMINATION OF THE INTERNAL VAGINAL WALL, THE WALL SHOULD BE ——— AND FEELING FOR———-
PALPATING VAGINAL WALLS FOR ANY MASSES, NODULES, CYSTS AND GROWTHS. SHOULD BE SMMOTH HOMOGENOUS AND NON TENDER.
THIS PORTION OF THE EXAM IF INDICATED WOULD ALLOW THE PROVIDER TO REACH ABOUT 2.5CM HIGHER INTO THE PELVIS
RECTOVAGINAL EXAM
WHEN IS IT APPROPRIATE TO DO AN INTERNAL VAGINAL EXAM ON INFANTS OR CHILDREN?
ONLY WHEN THERE IS SPECIFIC PROBLEMS SUCH AS BLEEDING, DISCHARGE, TRAUMA, OR SUSPECTED SEXUAL ABUSE.
ALL SEXUALLY ACTIVE FEMALES IN THEIR ADOLESCENT TEEN YEARS SHOULD HAVE A PELVIC EXAM, PAP AND STI SCREEN AT WHAT PERIODICITY?
ANNUALLY IF ACTIVE
BY 21 IF NON-ACTIVE
SOFTENING OF THE ISTHMUS DURING PREGNANCY
REGAR SIGN
BLUISH COLORED CERVIX DURING PREGNANCY
CHADWICK SIGN
COMMON ABNORMALITIES:
CAN BEGIN IN THE LATE 20’S FOR FEMALES
- INCREASES IN INCIDENCE AND SEVERITY AS MENOPAUSE APPROACHES
- SHOWS EDEMA, HEADACHE, WEIGHT GAIN, AND BEHAVIORAL DISTURBANCES
- LASTS 5-7 DAYS
PREMENSTRUAL SYNDROME
SOFTENING OF THE CERVIX DURING PREGNANCY
GOODELL SIGN
DEFINED AS UNABLE TO CONCEIVE AFTER 1 YEAR OF TRYING
INFERTILITY
PRESENCE AND GROWTH OF ENDOMETRIAL TISSUE OUTSIDE THE UTERUS CAUSES PELVIC PAIN, DYSMENORRHEA, AND HEAVY OR PROLONGED MENSTRUAL FLOW
ENDOMETRIOSIS
WARTY LESIONS ON THE LABIA, WITHIN THE VESTIBULE OR IN THE PERIANAL REGION AS A RESULT OF HPV. THESE ARE SEXUALLY TRANSMITTED AND ARE FLESH COLORED, WHITISH PINK OR RED . THEY ARE ALSO DISCRETE, SOFT GROWTHS THAT FORM CAULIFLOWER LIKE MASSES
CONDYLOMA ACUMINATUM
BENIGN SKIN INFECTION CAUSED BY POXVIRUS
- INCUBATION TAKES ABOUT 2-7 WEEKS
- LESIONS ARE NORMALLY WHITE OR FLESH COLORED
- DOME SHAPED
- CENTRAL UMBILICATION WITH A CREAMY CORE
MOLLOSCUM CONTAGIOSUM
LESIONS OF SECONDARY SYPHILLIS THAT APPEAR ABOUT 6 TO 12 WEEKS AFTER INFECTION.
-THEY ARE FLAT, ROUND, PAPULES COVERED BY GRAY EXUDATE.
CONDYLOMA LATUM
A FIRM, PAINLESS ULCER DEVELOPED INTERNALLY IN WOMEN
SYPHILLITIC CHANCRE
LESIONS THAT ITCH AND ARE PAINFUL AND USUALLY CONFINED TO A SMALL LOCALIZED PATCH ON THE VULVA
HERPES LESION
THIS GLAND CAN BE INFLAMED BY A GONOCOCCAL INFECTION THAT PRODUCES A RED, HOT, TENDER AND FLUCTUANT SWELLING THAT MAY DRAIN PUS.
BARTHOLIN GLAND INFLAMMATION
A HERNIAL PROTRUSION OF PART OF THE RECTU THROUGH THE POSTERIOR WALL OF THE VAGINA.
RECTOCELE
A HERNIAL PROTRUSION THROUGH THE ANTERIOR WALL OF THE VAGINA. SEEN WHEN BEARING DOWN
CYSTOCELE
CANCER OF THE VULVA, THAT WILL SHOW VAGINAL DISCHARGE , LESIONS, AND MASSES . CAN APPEARR ULCERATED OR RAISED ON THE VULVA
CARCINOMA
A BRIGHT RED POLPOID GROWTH THAT PROTRUDES FRO THE URETHRAL MEATUS
URETHRAL CARBUNCLE
WATERY DISCHARGE, USUALLY NOT FOUL SMELLING, DYSURIA, PROFUSE FROTHY, GREENISH DISCHARE
TRICHOMONIASIS
PURULENT DISCHARGE FROM THE CERVIX, WITH GLANDULAR INFLAMMATION OF THE SKENES AND BARTHOLIN
GHONORRHEA
HOMOGENOUS,THIN, WHITE OR GRAY DISCHARGE WITH POSITIVE KOH
BACTERIAL VAGINOSIS
COMMON AND BENIGN TUMORS THAT APPEAR FIRM IRREGULAR NODULES IN THE CONTOUR OF THE UTERUS
MYOMA
GROWTHS IN THE OVARIES THAT ARE EITHER UNILATERAL OR BILATERAL, AND SMOOTH
OVARION CYSTS
MARKED PELVIC TENDERNESS WITH TENDERNESS AND RIGIDITY OF THE LOWER ABDOMEN. THERE IS A TENDER ADNEXAL MASS AND IS INDICITIVE OF A SURGICAL EMERGENCY
RUPTURED TUBAL PREGNANCY
THIS INFLAMMATORY DISEASE IS NORMALLY CAUSED BY GONOCOCCAL AND CHLAMYDIAL INFECTION THAT MAY BE ACUTE OR CHRONIC.
PELVIC INFLAMMATORY DISEASE.
INFLAMMATION OF THE FALLOPIAN TUBE AND IS NORMALLY ASSOCIATED WITH PID
SALPINGITIS
WITH REGARD TO HORMONAL ABNORMALITIES IN INFANTS AND CHILDREN,
WHAT ARE VAGINAL SECRETIONS THAT COLLECT AN IMPERFORATE HYMEN AND MANIFESTED BY A LOWER ABD MASS OR SMALL CYST BETWEN THE LABIA.
HYDROCOLPOS
VAGINAL DISCHARGE ACCOMPANIED WITH WARM, ERYTHEMATOUS AND SWOLLEN VULVAR TISSUE
VULVOVAGINITIS
THIS COMMON ABNORMALITY IN PREGNANT WOMEN,
A LOOP OF CHORD MAY ADVANCE WITH THE PRESENTING PART AND USUALLY OCCURS DUE TO A RUPTURE OF THE MEMBRANES.
PROLAPSED UMBILICAL CHORD
COMMON ABNORMALITY IN OLDER ADULTS
-CAUSED BY LACK OF ESTROGEN. VAGINAL MUCOSA IS DRY AND PALE.. ACCOMPANYING DISCHARGE MAY BE WHITE,GREY, YELLOW,GREEN OR BLOOD TINGED
ATROPHIC VAGINITIS
WHAT ARE SOME NON-MODIFIABLE RISK FACTORS FOR BREAST CANCER IN WOMEN?
AGE, GENDER, PERSONAL OR FAMILY HX, EARLY MENARCHE, LATE MENOPAUSE, HEAVY BREASTS.
WHAT ARE SOME MODIFIABLE RISKE FACTORS FOR BREAST CANCER IN WOMEN?
ALCOHOL CONSUMPTION, HORMONE THERAPY, OBESITY, HAVING KIDS AFTER 30, LACK OF ACTIVITY AND HIGH FAT DIETS.
THE GREATEST AMOUNT OF GLANDULAR TISSUE IN THE BREAST IS LOCATED IN WHAT QUADRANT
UPPER OUTER
WHAT PART OF THE BREAST EXTENDS UP INTO THE AXILLA AND IS IN DIRECT CONTACT WITH THE AXILLARY LYMPH NODES?
TAIL OF SPENCE
WHAT ARE THE LYMPHATIC NETWORKS OF THE BREAST?
PECTORAL
SUBSCAPULAR
CENTRAL
BRACHIAL
WHAT ARE YOU INSPECTING DURING THE BREAST EXAMINATION?
(BREAST)
SIZE, SHAPE, CONTOUR, SYMMETRY, VENOUS PATTERNS OR ANY LESIONS.
(NIPPLES AND AREOLE)
SHAPE SHOULD BE ROUND AND BILATERALLY SYMMETRICAL
WHAT ARE THE 5 D’S IN REGARD TO THE EXAMINATION OF THE NIPPLES
DISCHARGE DEPRESSION DISCOLORATION DERMATOLOGIC CHANGES DEVIATION
YOU BEGIN THE BREAST EXAM WITH THE PATIENTS ARMS DOWN AT THE SIDE. WHAT ARE THE OTHER POSITIONS YOU HAVE THE PATIENT DO TO CHECK FOR MASSES IN THE BREAST?
ARMS EXTENDED OVERHEAD
ARMS AT HIPS WITH SHOULDERS ROLLED FORWARD
HAVE PATIENT LEAN FORWARD AT THE WAIST
ALL OF THESE ARE SEATED
WHAT IS APART OF THE PALPATION PORTION OF THE BREAST EXAM?
CHEST WALL SWEEP
BI-MANUAL PALPATION
LYMPH NODE PALPATION
SUPINE PALPATION OF THE MAMMARY GLANDS
WHAT ARE THE 3 AUTHORIZED WAYS TO DO THE MAMMARY GLAND CHECK FOR PALPATION OF THE BREAST?
LIGHT, MEDIUM AND DEEP PRESSURE IN EITHER A:
- SNAKE
- CIRCULAR
- WEDGE
WHAT AREAS ARE YOU CHECKING THE LYMPHNODES DURING PALPATION OF THE BREAST EXAM?
MID AXILLARY DOWN TO THE BRA LINE. THEN BACK UP THE ARM TO THE BRACHIAL AND DOWN THE ELBOW AND BACK TO THE AXILLA,
THEN ONCE AT THE AXILLA YOU WILL DO ANTERIOR AND POSTERIOR AXILLARY SPACES ALWAYS RETURNING TO THE AXILLARY.
SO YOU’VE FINISHED YOUR MANUAL PALPATION IN A CIRCULAR PATTERN OF THE MAMMARY GLANDS FEELING FOR MASSES. WHAT’S THE LAST STEP WHILE THE PATIENT IS LYING DOWN?
DEPRESS THE NIPPLES WITH TWO FINGERS. AND IF THERER IS ANY COMPLAINT OF DISCHARGE YOU WILL COMPRESS THE NIPPLE TO ILICIT DISCHARGE. NOTING IT’S CHARACTERICS.
BENIGN CYST FORMATIONS CAUSED BY DUCTAL ENLARGEMENT IS ASSOCIATED WITH A LONG FOLLICULAR OR LUTEAL PHASE. LESIONS ARE FILLED WITH FLUID AND USUALLY BILATERAL AND MULTIPLE
FIBROCYSTIC CHANGES
BENIGN TUMORS COMPOSED OFF STROMAL AND EPITHELIAL ELEMENTS THAT REPRESENT A HYPERPLASTIC AND PROLIFERATIVE PROCESS.
ACCOUNT FOR THE MAJORITY OF BREAST TUMORS IN YOUNG WOMEN.
FIBROADENOMA
PEAK INCIDENCE BETWEEN AGES 40 AND 75 AND NORMALLY OCCURING IN WOMEN OVER 50.
FINDINGS ARE MARKED ASYMMETRY, PROMINENT UNILATERAL VEINS, DISCOLORATION, FIXED INVERSION OF DEVIATION OF THE NIPPLE
MALIGNANT BREAST TUMORS
NECROSIS OF THIS AS A RESULT TO LOCAL INJURY.
A FIRM, IRREGULAR MASS, USUALLY APPEARING AS AN AREA OF DISCOLORATION
FAT NECROSIS
BENIGN TUMORS ABOUT 2 TO 3 CM IN THE SUBAREOLAR DUCTS. COMMON CAUSE OF BLOODY DISCHARGE FROM THE NIPPLES.
INTRADUCTAL PAPILLOMAS
SURFACE MANIFESTATION OF AN UNDERLYING DUCTAL CARCINOMA
SHOWS RED, SCALY CRUST PATCH FORMS ON THE NIPPLE, AREOLA, AND SURROUNDING SKIN. LESIONS ARE USUALLY UNILATERAL
PAGET DISEASE
SMOOTH, FIRM, MOBILE, TENDER DISK OF BREAST TISSUE LOCATED BEHIND THE AREOLA IN MALES.
GYNECOMASTIA
INFLAMMATION OF THE SEBACCOUS GLANDS IN THE AREOLA
RETENTION CYSTS
LACTATION OF THE BREASTS NOT ASSOCIATED WITH CHILD BIRTH AND MOST COMMONLY CAUSED BY PITUITARY TUMORS, CUSHING SYNDROME, AND HYPOGLYCEMIA
ALSO ASSOCIATED TO DRUGS SUCH AS PHENAZOTHIAZINES, TRICYCLIC, ANTI-DEPRESSENTS AND ESTROGEN.
GALACTORRHEA
INFECTION OR INFLAMMATION OF THE BREAST TISSUE WITH A SUDDEN ONSET OF SWELLING AND TENDERNESS AND IS THE RESULT USUALLY FROM A STAPH INFECTION AND FOUND TO BE MOSTLY FROM LACTATING WOMEN
MASTITIS
THIS COMMONLY OCCURS IN MENOPAUSAL WOMEN
SUBAREOLAR DUCTS BECOME BLOCKED WITH DESUAMATING EPITHELIUM, NECROTIC DEBRIS, AND CHRONIC INFLAMMATORY CELLS.
MAMMARY DUCT ECTASIA
A 32 Y/O FEMALE SAILOR REPORTS TO MEDICAL C/O DISCOMFORT IN HER L BREAST. UPON OBTAINING HPI SHE STATES THIS HAS BEEN HAPPENING BEFORE HER PERIOD STARTS. SHE DRINKS 1/2 A BOTTLE A NIGHT OF RED WINE AND NOTICES A MASS EVERY NOW AND AGAIN THAT FLUCTUATES IN SIZE, WHICH AGAIN IS NOTED DURING PRE MENSES.
BREAST MASS
IN REGARDS TO A PATIENT WITH BREAST MASS.
WHAT LABS OR IMAGING ARE WE GOING TO GET?
NO LABS REQUIRED
ULTRASOUND AND MAMMOGRAPHY
(US ONLY FOR PATIENTS UNDER 30Y/O)
