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Flashcards in Female Pelvic Exam Deck (26)
1

What is the equipment involved? 5

1. Drapes
2. Speculum (plastic versus metal)
3. Gloves
4. Water soluble lubricant
5. Lamp (standing lamp versus local lighting)

2

Specimen collection equipment such as what?
7

1. Sterile cotton swabs
2. Glass slides
3. Wooden or plastic spatula
4. Cervical brush devices
5. Cytologic fixative
6. Culture plates or media
7. DNA probe kits for chlamydia and gonorrhea,
if needed

3

How can we minimize pt apprehension?

Talk before touch
Tell the woman what you are doing with each part of the exam

4

Preparing for the Pelvic Exam
3

1. Empty bladder (Have your medical assistant remind the patient ahead of time. Consider offering patient another opportunity)

2. Warm speculum (but not too warm)

3. Appropriate position
The more abducted the hips, the easier the examination… NEVER force the legs apart!!

5

What is the position the pt should be in for the exam called?

Lithotomy Position
(hip flexion and abduction)

6

What structures are we looking at for the external examination in the pelvic exam?
8



Always orient the patient to your hand on a location separate from what?

1. Labia majora
2. Labia minora
3. Clitoris
4. Urethral meatus
5. Vaginal introitus
6. Perineum
7. Anus
8. Skene and Bartholin glands


the genitalia initially!

7

What are we looking for when examing the labia majora?
6

1. Symmetry
2. Redness or swelling
3. Excoriation, rashes, ulcers or other lesions
4. Discoloration or thinned white appearance
5. Varicosities or angiomas
6. Trauma

8

What are we looking for when examing the labia minora?
8

1. Symmetry
2. Moisture
3. Color
4. Inflammation
5. Excoriation
6. Discharge
7. Ulcers
8. Verrucous changes

9

What are we looking for with the clitoris? 3

Urethral meatus? 3

Clitoris
1. Size
2. Atrophy/hypertrophy
3. Adhesions or inflammation of prepuce/hood

Urethral meatus
1. Discharge
2. Polyps, carbuncles, or fistulas
3. Irritation or inflammation

10

What are we looking for when examing the vaginal introitus?
5

1. Moisture
2. Swelling
3. Discoloration
4. Discharge
5. Lesions, fistulas, or fissures

11

What are we looking for when examing the Perineum? 3

Anus? 4

Perineum
1. Scarring
2. Inflammation
3. Fistulas, lesions, or growths

Anus
1. Color
2. Scarring or skin tags
3. Excoriation
4. Fissures or lesions

12

What are we looking for when examing the Skene and Bartholin glands?
5

1. Discharge
2. Tenderness
3. Swelling
4. Masses
5. Temperature

13

Three critical items with placing the speculum?

1) Retract the labia minora laterally
2) Avoid the urethra by downward pressure on posterior vaginal introitus
3) Angle the speculum about 30-45° downward towards sacral promontory. (to “scoop” the cervix)

14

What structures are we looking at for the internal examination in the pelvic exam?
2

1. Cervix
2. Cervical os

15

What are we looking for when examing the cervix? 5

What are we looking for when examing the cervical os?

Cervix
1. Color
2. Position
3. Size
4. Surface characteristics (location of SCJ, presence of nabothian cysts)
5. Discharge

1. Size
2. Shape

16

Pelvic Exam: Specimen Collection Types?
4

1. Pap smear
2. Gonorrhea and chlamydia swab
3. Herpes swab and media
4. Wet mount

17

Bimanual Examination looks at what structures? 4

1. Cervix palpation
2. Uterus palpation
3. Ovaries palpation
4. Adnexa

18

What are we assessing in cervical palpation in the bimanual exam?
7

1. Size, length, and shape
2. Position
3. Consistency
4. Movement
5. Nodules
6. Hardness
7. Tenderness

19

What are we assessing in uterus palpation in the bimanual exam?
6

1. Location
2. Position *
3. Size and shape (symmetry)
4. Contour
5. Mobility
6. Tenderness

20

What does version refer to in uterus palpation?

Flexion?

Version: position of entire uterus relative to axis of vagina

Flexion: position of fundus relative to axis of cervix

21

What are we assessing in ovaries palpation in the bimanual exam?
6

Adnexa? 2

1. Size *
2. Shape
3. Location
4. Consistency
5. Tenderness
6. Nodularity

1. Masses
2. Tenderness

22

What size is the normal reproductive ovary?

2x3cm

23

Rectovaginal Exam
Change glove after bimanual exam before doing rectal to avoid what?

transmission of HPV or other infections

24

What structures are we looking at with the Ractovaginal Exam?
5

1. Anal sphincter
2. Rectal walls
3. Rectovaginal septum
4. Uterus or Adnexal Mass
5. Stool

25

What are we looking for with the following structures in the retrovaginal exam:
1. Anal sphincter? 1
2. Rectal walls? 3
3. Rectovaginal septum? 2

1. Anal sphincter
Tone

2. Rectal walls
-Masses, polyps, nodules, strictures or induration
-Irregularities
-Tenderness

3. Rectovaginal septum
-Tone and thickness
-Nodules (Uterosacral nodularity)

26

What are we looking for with the following structures in the retrovaginal exam:
1. Uterus or Adnexal Mass? 4
2. Stool? 2

Uterus or Adnexal Mass
1. Location and position
2. Size, shape, and contour
3. Consistency
4. Tenderness

Stool
1. Color
2. Blood (Guaiac)