Breast Pelvic Exam Flashcards
(37 cards)
Primary lymph drainage of the breasts
Axillae
Secondary lymph drainage of breasts
internal mammary nodes
Where else can breast lymph drain
supraclavicular and infraclavicular
Where most cancers are found
upper outer quadrant; Tail of spence
Quadrants of the breast
Upper outer upper inner lower outer lower inner tail of spence
Concerning sx
breast lump/mass
discomfort/pain
nipple d/c
How to inspect breasts?
- arms overhead with palms together
- hands on hips and press down
- shrug shoulder
- lean forward
Skin dimpling
sign of cancer pulling on the breast tissue
Nipple inspection
inspect for eversion or inversion; recent onset of unilateral nipple inversion is suggestive of underlying malignancy
Concentric search pattern
begin w/ tail of spence and move in concentric circular fashion progressing from outer breast, ending up near the nipple; palpate areola, then region beneath nipple; assess for loss of nipple elasticity
Nipple d/c
Light milky discharge may be normal
Serous or bloody discharge typically abnormal
Examination of axillary nodes
1st: anterior axillary region, under pectoralis
2nd- mid axillary high into apex
3- posterior axillary beneath tere minor
4. down medial aspect of upper arm
Skene’s gland
paraurethral gland near urethral opening
Bartholian’s glands
to the left and right of vaginal opening; secrete mucous to lubricate vagina
Patient hx for pelvic exam
Date of menarch LMP Menses Last PAP/any abnormals? Sexually active? # partners Have you been pregnant (G, P) Hx of STI;s menopause sexual assault, abuse Do you feel safe? Contraceptive use?
Gravity
number of times pregnant
Parity
outcome of each pregnancy (term, preterm, living, abortion)
True/False; chaperone should be present for pelvic exam
True
Positioning for pelvic exam
drape, lay supine in lithotomy position, elevated HOB 30 degrees; ask patient to move down until she feels her buttocks extend slightly beyond the edge of the table
External examination
Check inguinal nodes
inspect pubic region (hair, redness, lesions)
inspect clitoris, urethral meatus, labial folds
Introitus (atrophy in menopausal women)
Perineum (use back of hands)
Pt. complains of labial swelling
SPECIALIZED EXAM: examine bartholin glands; r/o cyst, abscess, etc; milk the urethra if concern about infection, urethritis, STI (gonorrhea)
Milking the urethra
gently spread labia to visualize urethral meatus; insert finger into vagina and apply pressure to anterior vaginal wall as you slide your finger toward you; note presence of d/c and culture
Patient education for internal exam
Show speculum and how it works
you may hear clicking
may feel some pressure
it should NOT be painful
Parous cervix
Cervix that has birthed a child; external os is a large, transfers, stellate slit
