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Describe anatomy and physiology of the breast:

• Between 2nd and 6th ribs
• Composed of glandular tissue, fibrous tissue including suspensory ligaments, adipose tissue
o Suspensory ligaments, or Cooper’s ligaments, are fibrous bands extending vertically from surface to attach on chest wall muscles
o Lobes are embedded in adipose tissue
o Breast may be divided into four quadrants by imaginary


Where is the “tail of Spence” and why is it important?

• Breast tissue that projects up and laterally into axilla – close to axillary lymph nodes. The upper outer quadrant is the site of most breast tumors.


What are normal changes in the breast throughout the month?

• Each month, women experience fluctuations in hormones that make up the normal menstrual cycle. Estrogen, which is produced by the ovaries in the first half of the menstrual cycle, stimulates the growth of milk ducts in the breasts. The increasing level of estrogen leads to ovulation halfway through the cycle, and then the hormone progesterone takes over in the second half of the cycle, stimulating the formation of the milk glands. These hormones are believed to be responsible for the cyclical changes such as the swelling, pain, and tenderness that many women experience in their breasts just before menstruation. During menstruation, many women also experience changes in breast texture, with breasts feeling particularly lumpy. These are the glands in the breast enlarging to prepare for a possible pregnancy. If pregnancy does not occur, the breasts return to normal size. Once menstruation begins, the cycle begins again


What are some changes in the male breast and recommendations for those?

• During adolescence, it is common for the breast tissue to temporarily enlarge, producing gynecomastia. This condition is usually temporary, but reassurance is necessary for the adolescent male, whose attention is riveted on his body image. May reappear in aging male and may be due to testosterone deficiency.


What should you tell a pt that has breast pain?

• Ask about where it is, when it began, is it localized or all over, is the painful spot sore to touch, do they feel burning or pulling sensation, is the pain cyclic or related to the menstrual cycle, is it brought on by strenuous activity, especially involving one arm? You can also tell a pt they can try pain relief medicines, decrease estrogen (after talking to doctor), wear a well fitted support or sports bra, and consider making changes in diet to eliminate caffeine and start a low fat, high complex carbohydrate diet.


How do you check for nipple and skin retraction?

• Have pt lift her arms slowly over head, both breasts should move up symmetrically. Then have her push her hands onto hips and to push her two palms together to contract the pectoralis major. A slight lifting of both breasts will occur. Then ask the woman with large pendulous breasts to lean forward and you should note the symmetric free-forward movement of both breasts.


When should we tell pts to examine breasts?

• The best time to conduct BSE is right after the menstrual period, or the 4th – 7th day of the menstrual cycle, when the breasts are the smallest and least congested.


When should menopausal women examine breasts?

• Advise the pregnant or menopausal woman who is not having menstrual periods to select a familiar date to examine her breasts each month.


What do we see with a speculum inserted into the vagina?

• A full view of the cervix, in which we should be able to see the color (usually pink and even), position (midline, projects 1-3 cm into vagina), size (diameter 2.5 cm), and os (small and round if she has never had children, horizontal and irregular slit if she has had children)


What are some changes that occur with menopause?

• Includes the preceding 1-2 years of decline in ovarian function, shown by irregular menses that gradually become farther apart and produce a lighter flow. Ovaries stop producing progesterone and estrogen. Uterus shrinks in size and drops. Ovaries atrophy to 1-2 cm and are not palpable after menopause. Cervix shrinks and looks paler with thick, glistening epithelium. Vagina becomes shorter, narrower, and less elastic because of increased connective tissue. Vaginal epithelium atrophies and becomes thinner, drier, and itchy. Decreased vaginal secretions leave the vagina dry.


What are some “safe subjects” to use when starting a gynecological exam?

• Discuss menstrual history because it is non-threatening


How do you bring up sex in an interview?

• Begin with open-ended questions and communicate that you accept the individual’s sexual activity and believe it is important and show that you’re comfortable.


What are the differences between stress and urge incontinence?

• Stress incontinence is urinary incontinence that occurs when involuntary pressure is put on the bladder by coughing or laughing or sneezing or lifting or straining. Urge incontinence is urinary incontinence that is generally attributable to involuntary contractions of the bladder muscle resulting in an urgent need to urinate accompanied by a sudden loss of urine; most common in people over 60 years of age.


What should you know before starting oral contraceptives?

• The client should not smoke, because that can increase vascular problems.


How to assess a pt for risk of STI?

• Ask if they have had any sexual contact with a partner that has an STI, when, how it was treated, were there any complications? Any precautions to reduce risk for STIs? Do they use condoms at each episode of sexual intercourse? Ask about number of sexual partners.


What are some things we should tell a pt before a pap smear?

• Nothing should go in the vagina within 24 hours before the examination.


What does a normal scrotum look like?

• Darker than rest of skin


What are some things that are normal for the testes?

• Normally feel oval, firm, rubbery. Slightly tender to moderate touch.


What does the cremaster muscle do?

• Controls the size of the scrotum by responding to ambient temperature


Where is sperm made?

• Testes.


Where do inguinal hernias occur and what do they feel like?

• Occur in horizontal chain along the groin inferior to the inguinal ligament and the vertical chain along the upper inner thigh. They feel like round, sometimes painful swelling.


What should you do if someone has an erection during an exam?

• Do not stop the exam or leave the room. Reassure the male that this is only a normal physiologic response to touch, just as when the pupil constricts in response to bright light.


What are specific parts of the male genitourinary system that you should see and assess?

• Penis, scrotum, inguinal area


What should you do if there is urethral damage?

• Stay active and drink a lot of water


How to perform a testicular self exam?

• Do it once a month, in the shower where the warm water relaxes the scrotal sac, examine and palpate, check for changes, and report changes immediately


What is the nature of the anal canal?

• It is the outlet of the GI tract and is about 3.8 cm long in the adult.


What does the Cowper’s gland do? What does it secrete?

• Two bulbourethral glands are each the size of a pea and are located inferior to the prostate on either side of the urethra. They secrete a clear, viscid mucus.


What does the prostate gland do? What does it secrete?

• The prostate gland surrounds the bladder neck and the urethra and has 15-30 ducts that open into the urethra. It secretes a thin, milky alkaline fluid that helps sperm viability.


What is the difference between prostatic hypertrophy and cancer of the prostate?

• Hypertrophy resent in 1/10 males at the age of forty and grows larger with age. It is thought to be caused by hormonal imbalance that leads to the proliferation of benign adenomas, that gradually impede urine output because they obstruct the urethra. Cancer of the prostate is usually slow growing and is more common in North America and northwestern Europe. It can cause pain, difficulty in urinating, problems during sexual intercourse, or erectile dysfunction. Other symptoms can potentially develop during later stages of the disease


What do hemorrhoids feel like for a pt?

• Flabby papules due to varicose vein in rectum that may be painful, burning, itchy, sometimes can bleed