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Year 2 RE SCP > Principles of Pelvic Examination > Flashcards

Principles of Pelvic Examination Flashcards

1
Q

When performing a pelvic examination, what are the 3 Cs?

A

1 - consent
2 - chaperone
3 - communication

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2
Q

Prior to performing a vaginal examination we ask the patient to lie flat with their legs straight to perform what examination?

A
  • abdominal examination
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3
Q

Prior to any physical examination what is it always important to ask the patient prior to actively touching or moving them?

A
  • do you have any pain
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4
Q

Prior to the pelvic examination we need to perform the abdominal examination. What are the 4 basic things we should do using IPA?

A
  • I = inspection (scars, obvious signs of pregnancy)
  • P = palpation (pain, masses, pregnancy)
  • P =percussion
  • A = auscultation
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5
Q

Label the image below using the labels below:

clitoris
pubic hair
prepuce
external urethral orifice
frenulum of clitoris
vaginal orifice
labium minor
hymen
labium major
posterior commissure
anus
fourchette
perineum
A

Label the image below using the labels below:

1 = clitoris
2 = frenulum of clitoris
3 = labium major
4 = labium minor
5 = fourchette
6 = perineum
7 = pubic hair
8 = prepuce
9 = external urethral orifice
10 = vaginal orifice
11 = hymen
12 = posterior commissure
13 = anus
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6
Q

What is the vulva?

A
  • outer part of female genitals
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7
Q

Once the woman is exposed and in position for a vaginal examination, before we actively touch anything we need to first look at the what?

A
  • whole vulva
  • look for redness (erythema, ulcers)
  • skin changes (bartholians cysts)
  • discharge
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8
Q

What and Bartholin’s glands?

A
  • glands located on each side of the vaginal opening

- glands that secrete fluid to help lubricate the vagina

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9
Q

Bartholin’s glands are located on each side of the vaginal opening. They are glands that secrete fluid to help lubricate the vagina. What is a What and Bartholin’s cyst?

A
  • blockage of Bartholin’s
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10
Q

Once the woman is exposed and in position for a vaginal examination and we have inspected the patient visually, we should ask the patient to do something for us. What is this and why?

A
  • ask patient to cough

- inspect for prolapse or incontinence

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11
Q

What tool is used to examine the inside of the vagina and attempt to see the cervix?

A
  • speculum

- more commonly use the cuscoe

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12
Q

When inserting the speculum we generally us the left hand to part the labia and then insert the speculum with the handle at aprox 90 degrees. Once the speculum is in, we then need to do what?

A
  • rotate 90 degree so handle is anterior

- blades should now be horizontal

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13
Q

When inserting the speculum we generally us the left hand to part the labia and then insert the speculum with the handle at aprox 90 degrees. Once the speculum is in, we then need to rotate 90 degree so that the handle is anterior and the blades should now be horizontal. We should be able to see the cervix as we open up the speculum, but if not what can we do to help see the cervix?

A
  • remove the speculum

- reinsert at a more downward angle behind the posterior blade

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14
Q

What part of the female reproductive tract are we looking at in the image below?

A
  • cervix
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15
Q

In the image below, which cervix is healthy and which has a potential ulcer?

A
  • left is normal

- right is potentially an ulcer

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16
Q

When looking down the speculum we should be looking to see if everything is normal on the vaginal walls. What are the 3 most common things to look for?

A

1 - erythema
2 - atrophy
3 - growths/malignancies

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17
Q

When looking down the speculum we should be looking to see if everything is normal with the cervix. What are the most common things to look for?

A
  • size of cervical opening (pin hole of nulliparous (never given borth) v. open slit for multiparous (multiple births))
  • cervical ectropian (cells of cervix grow on outside of cervix)
  • cervical lesions/Nabothian (mucus-filled cyst) follicles
  • cervical polyps, malignancies
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18
Q

In the image below we can see 2 different views of the cervix. Which is associated with nulliparous (no pregnancies) and which is multiparous (multiple pregnancies)?

A
  • left = nulliparous

- right = multiparous

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19
Q

Once the speculum is in and we have examined the vagina and cervix we should then palpate where?

A
  • pelvic area
  • feel for size, position of the uterus
  • assess if any tenderness
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20
Q

At the upper end of the vagina it surrounds the cervix, creating what?

A
  • two domes (fornices or vaults)

- anterior and posterior (holds semen following ejaculation) fornix

21
Q

At the upper end of the vagina it surrounds the cervix, creating two domes (fornices or vaults), the anterior and posterior (holds semen following ejaculation) fornix. When performing the pelvic examination what would we do during a manual bimanual examination?

A
  • lubricate and place right index and middle finger into vagina, feel for the cervix
  • feel for position of uterus
  • assessed both the anterior and posterior fornix
22
Q

The uterus is generally anteverted and will therefore feel firmer toward the anterior part of the cervix. What is the position of the fundus if the uterus is:

  • anteverted
  • retroverted
A
  • anteverted = fundus tilts towards the bladder

- retroverted = fundus tilts backwards towards the rectum

23
Q

Which image shows a retroverted and anteverted uterus?

A
  • anteverted = left

- retroverted = right

24
Q

Following a pelvic examination what 2 things must you discuss with the patient?

A

1 - what you have found

2 - follow up plan

25
Q

Label the pathological conditions that can occur in the male testes using the labels below

hydrocoele
normal
varicocoele
tumour of testes
epidydimal cyst
epididymitis
A 
1 = normal
2 = hydrocele
3 = epididymal cyst
4 = epididymitis
5 = varicocele
6 = tumour of testes
26
Q

What is the inguinal canal?

A
  • pathway by which structures can pass from the abdominal wall to the external genitalia
27
Q

The inguinal canal is a pathway by which structures can pass from the abdominal wall to the external genitalia. How is this canal formed?

A
  • formed by testes moving from abdomen into the scrotum
  • as the testes move down they take abdominal layers alongside it
  • the folds of the abdominal layers form a canal like opening
28
Q

What is the difference between a direct and indirect inguinal hernia?

A
  • direct = peritoneal sac protrudes directly through the abdominal wall, entering the inguinal canal though the posterior wall of the inguinal canal
  • indirect = peritoneal sac enters the inguinal canal through deep inguinal ring
29
Q

Which lymph nodes drain the penis and scrotum?

A
  • superficial inguinal lymph nodes

- can be enlarged and palpated below the inguinal ligament

30
Q

Label the penis below using the labels provided:

skin
superficial fascia
deep fascia
septum of penis
tunica albuginea
corpus spongiosum
spongy urethra
deep artery of the penis
corpora cavernosa
A 
1 = septum of penis
2 = skin
3 = superficial fascia
4 = deep fascia
5 = tunica albuginea
6 = deep artery of the penis
7 = corpora cavernosa
8 = spongy urethra
9 = corpus spongiosum
31
Q

In the penis, what 2 areas once filled with blood cause an erection?

1 - spongy urethra
2 - corpora cavernosa
3 - corpus spongiosum
4 - tunica albuginea

A

2 - corpora cavernosa

32
Q

When examining the testicles and epididymis using our index/ring finger and thumbs what are the key questions we want to ask about the testes?

A
  • testicles present
  • where they lie in scrotum
  • size
  • consistency
  • lumps
  • epididymis (behind testicle)
33
Q

In the male pelvic examination, do we just examine the patient on the bed?

A
  • no
  • standing and lying down
  • standing, lying on back and then a rectal examination (prostate)
34
Q

During the male pelvic examination, what 2 common problems might we see if a patient is standing?

A
  • hernia

- varicocele

35
Q

During the male pelvic examination, what 4 things are we looking at in a specific order?

A

1 - skin
2 - penis
3 - testicles
4 - perineum

36
Q

During a male pelvic examination how high and low on the body would we examine?

A
  • as high as the umbilicus

- as low as the knees

37
Q

Arrange these parts of the pelvic examination in the correct order:

palpate superficial inguinal ring and ask patient to cough
ask patient to cough looking for visible masses
identify landmarks (ASIS, pubic symphysis and tubercle)
palpate the abdomen

A 
1 = identify landmarks (ASIS, pubic symphysis and tubercle)
2 = ask patient to cough looking for visible masses
3 = palpate the abdomen
4 = palpate superficial inguinal ring and ask patient to cough
38
Q

Once we have examined the abdominal region, where would we generally move to next?

A
  • scrotum
39
Q

When assessing the scrotum, what is the order for assessment?

A 
1 = inspect the scrotum
2 = palpate the scrotum (testicles, epididymis and spermatic cord)
3 = transillumination 
4 = assess for enlarged lymph nodes (especially if cancerous)
40
Q

When assessing the scrotum, if we find a mass, we may choose to perform transillumination. What is this?

A
  • try shining a light through mass

- identifies if it is a mass or cyst containing fluid

41
Q

Following examination of the scrotum we would move to examine the penis. Arrange the order below on how to examine the penis:

tell the patient what you are going to do
replacement of foreskin
visually inspect the penis
retract the foreskin and inspect the gland penis and urethral meatus
palpate the penis

A

1 - tell the patient what you are going to do
2 - visually inspect the penis
3 - palpate the penis
4 - retract the foreskin and inspect the glan penis and urethral meatus
5 - replacement of foreskin

42
Q

During a penis examination we will retract the foreskin and then replace the foreskin. Why is this important?

A
  • assess for paraphimosis (inability of foreskin to return to normal position)
  • phimosis = greek for muzzle
  • osis = greek for process
43
Q

The glans is part of the penis, which part is it?

A
  • round head of the penis
44
Q

Following the scrotum examination, what would be the next part of the male pelvic examination?

A
  • ask patient to stand up and examine genitalia
45
Q

Once the scrotal examination is complete we will ask the patient to stand. Arrange the order of the examination below:

  • inspect the scrotum
  • inspect lower abdomen and examine genitalia
  • transillumination and auscultation
  • ask to cough and palpate for hernia
  • ask to cough and inspect for hernia
  • palpate scrotum (testes, epididymis, spermatic cord)
A
  • inspect lower abdomen and examine genitalia
  • ask to cough and inspect for hernia
  • ask to cough and palpate for hernia
  • inspect the scrotum
  • palpate scrotum (testes, epididymis, spermatic cord)
  • transillumination and auscultation
46
Q

When assessing scrotal swelling there are 3 questions we can ask ourselves which will help diagnose the patient. What are these 3 questions?

A

1 - can you get above it?
2 - is it separate from the testicle?
3 - is it solid or cystic (does it transilluminate)?

47
Q

When assessing scrotal swelling there are 3 questions we can ask ourselves which will help diagnose the patient:

1 - can you get above it?
2 - is it separate from the testicle?
3 - is it solid or cystic (does it transilluminate)?

If you can get above or cannot get above the swelling what is the likely diagnosis of each?

A
  • cannot get above swelling = likely to be hernia

- can get above swelling = scrotal in origin

48
Q

When assessing scrotal swelling there are 3 questions we can ask ourselves which will help diagnose the patient:

1 - can you get above it?
2 - is it separate from the testicle?
3 - is it solid or cystic (does it transilluminate)?

If you can or cannot separate the swelling from the testes, what is the likely diagnosis in each?

A
  • separate from testes = arising from epididymis or spermatic cord
  • not separate from testes = arising from testes directly

Year 2 RE SCP (8 decks)

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