Well Woman Exam LECT [Slides 50-105]

Question 1

What are some high risk factors for ALL AGES that require earlier bone mineral density (BMD) screening?

Answer 1

• Hx. of fractures
• Body weight less than 127 lbs
• Current smoker, alcoholic or RA

Question 2

When would you screen your patients that are younger than 40 w/ mamography?

Answer 2

• Hx of breast cancer in family
• (+) for BRCA1 or BRCA2 mutations
• Hx of high risk biopsy results

Question 3

What are high risk factors for all ages that require earlier screening for lipid profiles?

Answer 3

BMI > 30

Personal or family h/o DM, PVD

Family h/o familial hyperlipidemia

Family h/o of premature cardiovascular disease

Question 4

What are the high risk factors for ALL ages that require earlier screening for colorectal related illnesses?

Answer 4

FAMILY HISTORY

Family h/o colorectal cancer

Family h/o familial adenomatous polyposis

Hx of colorectal cancer, polyps, IBD

Question 5

What population of patients would you consider giving a menigococcal vaccination?

Answer 5

Close quarter living patients (college students in dorms, military recruits)

Patients traveling to hyperendemic areas

Adults w/ asplenia

Question 6

How do you perform a breast exam?

Answer 6

Either in sitting or supine position

Palpate all quadrants of the breast systematically

Compare size, symmetry, contour, venous pattern, skin and or nipple abnormalities

Question 7

What should you do for a patient’s first pelvic exam?

Answer 7

Show her the instruments

Inform her of importance of testing

Question 8

How do you perform a pelvic exam?

Answer 8

Set the head at 30 degrees

Inform patient of position, bottom barely off the end of the table

Warm up the speculum

Adjust light

Put on gloves

Question 9

What are the major parts of a speculum?

Answer 9

Upper & lower blades

Thumb screw

Thumb hinge

Handle screw

Handle

Question 10

What are the three types of speculums?

Answer 10

A) Pediatric speculum

B) Pederson speculum

C) Graves speculum

Question 11

How do you properly insert the speculum?

Answer 11

Make sure bottom is off the end of the table

Warm speculum w/ warm water

Hold speculum w/ dominant hand, take opposite hand and separate labia minora and majora

Direct the speculum at a 45 degree angle

Question 12

What is super important to remember with insertion of speculums?

Answer 12

Insert the speculum as far as it will go, THEN open the speculum in a smooth and well controlled fashion

Question 13

If the cervix is not in view after speculum insertion…what do you do? what do you NOT do?

Answer 13

Angle speculum superior or inferior.

DO NOT PULL SPECULUM OUT INITIALLY

If still can’t find cervix after reajustment, remove speculum and perform a bimanual exam.

Review her surgical history and ask if she has had any “female” surgeries

Question 14

When performing a speculum exam w/ cervical cytology (PAP), what is used first and second?

Answer 14

1st = Spatula to scrape the ectocervix

2nd = Cytobrush obtains endocervical cells

Question 15

What are the added benefits of using liquid-based prep OVER conventional slide cervical cytology?

Answer 15

Liquid based prep has the added benefits of:

Single specimen can be used to perform

• Cytology
• HPV testing
• Evaluate ASCUS cytology
• Test for Gonorrhea and chlamydia

Question 16

How do you perform a internal bimanual exam (IBE)?

Answer 16

Insert lubrigated gloved finers into vagina and press downward, waiting for muscles to relax, place other hand on suprapubic region

Palpate vaginal walls

Be careful where you place your thumb during the bimanual exam

Be mindful of language you use (use terms like “healthy”, “normal”)

Question 17

What are the positions of the following uteri?

Answer 17

A= Anteverted positon

B= Anteflexed position

C= Retroverted position

D= Retroflexed positon

E= Midposition position

Question 18

How do you palpate the ovaries?

Answer 18

Place fingers of abdominal hand on right lower quadrant

Intravaginal hand place both fingers in the right lateral fornix

Question 19

What can a rectovaginal exam be particularly helpful in differentiating between?

Answer 19

Rectocele vs Enterocele