Flashcards in Female Deck (58):
- Date of last pelvic exam
-Date of last PAP smear and results
-Date of last breast exam
- Date of last mammogram and results
- Date of DEXA and results?
DEXA is testing for
is testing for shingles
Female GU ROS
Urinary first: frequency, polyuria, nocturia, hematuria, hesitancy, urgency, buring or pain whith urinating, incontinence, reduced caliber of stream, renal stones?
Menses: Age at menarche? regularity? Frequency and duration of menses? amount of bleeding? bleeding between periods or after intercourse? LMP? dysmenorrhea? premenstrual tension?
Menopause: age at menopause, menopausal symptoms, postmenopausal bleeding
vaginal discharge, itching, lesion, lumps, STI and HIV exposure, txt, precaustion against
sexual interest, orientation, function and satisfaction. problems including dypareunia.
Number or pregnancices? number and type of delieveries? number of abortions (spontaneous and induced), complication of pregnancy, methods of contraception.
What is dypareunia
Dys (pain): painful sex
# of pregnancies
# of Deliveries
# of abortions (spontaneous or induced). anything less than 20 weeks.
a spontaneous abortion is commonly called?
one who has not borne offspring
given birth to one or more offspring
last menstrual period
estimated date of confinement= due date
EDD- estimated date of delivery
Naegle's rule =
to calculate EDC
LMP + 7 days - 3 months + 1 year (try a few examples of these for the exam)
or can use pregnancy wheel
Gynecologic hx consists of :
Menarche (age, cycle length (regularity), length of time between (frequency), duration (commonly 3-7 days)
* count first day to first day of menses
first day of menstrual cycle
The character of flow:
light, medium, heavy (presence of clots)
Ask frequency, duration, relief.
Amount, duration, frequency, timing
Premenstrual tension consists of:
headaches, weight gain, breast tenderness, mood changes, relief measures
questions to ask about Menopause:
-menopausal symptoms (hot flashes, night sweats, vaginal dryness, dry/thin skin, dry/brittle hair, estrogen therapy, psychological changes, mood swings, loss of concentration or memory, anxiety, irritability, decreased libido
-post menopausal bleeding
If a patient has vaginal discharge ask about
itching, lesions, lummps, STI's and their treatments, exposure to HIV, precaustion against STI's and HIV. Date of last pelvic exam, PAP smear, history of abnormal pap smears and their treatments, hx of cervical, endometrial, ovarian neoplasm, fibroids, endometriosis, polyps, cysts, DES.
Urinary habit changes: frequency, urgency
Osteric hx we ask about:
- # of pregnancies
-# of deliveries (year each child was delievered, gender and weight of babies, method of delivery (NSVD, CS, vacuum/forceps assist). note if it was an external or internal incision as they differ.
- # of abortions
-complication of pregnancy & delivery
-current method (satisfaction, consistent use, side effect)
-previous methods (duration, side effects, reason for discontinuation)
Why do female pt feel concerned during pelvic examinations?
- previous experience was unpleasent or demeaning
- fear of findings such as STIs or CA
- previously raped or abused
-First exam or virginal pt
*** understand pts apprehension, acknowledge embarrassment or self conciousnes, inquire about tampon use, show pt instrumentation, reassure "nothing sharp," the discomfort is only pressure not pain
What is the position for pelvic exams?
dorsal lithotomy with stirrups
Before a pelvic exam the patient's responsibility is to:
- avoid intercourse 24-48 hours before exam
-empty bladder before exam
- try to relax abdominal and vaginal muscles
-****no lubricant, vaginal inserts, docuhing before exam.
The providers responsibilities include:
-explain each step of exam first
-drape pt accordingly (mid abdomen to knees)
- offer a pt a mirror?
- always state what you are about to do before you touch your pt
- avoid unexpected or sudden movements
-monitor comfort of exam (watch patients face)
-be gentle when inserting speculum * warm first
Female pelvic exam instrumentation requirements
- good lighting
-vaginal speculums (plastic vs metal)
- pediatric vs adult sizes
-water soluble lubricant (KY jelly)
-glass sides or ethy alcohol solution (thin prep PAP)
-cytobrushes (ouch)/ spatulas
What is the difference between plastic and metal speculums?
plastic speculums have removable light source in the handle
Use a small speculum for:
children, elderly, females who have not had intercourse
Use a wider, larger speculum for:
those who are obese, multiparous, and sexually active
- inform the patient you are going to touch her inner thigh (at the knee)
- Communicate to her that you are going to start the exam, in a reassuring, soothing tone.
-Spread the labia majora with your first two fingers so that you can see the labia majora, labia minora, the clitoris, and the urethra.
- Look for ulcers, lice, warts, and erythema
During the female external genitalia exam:
-assess the sexual maturity of an adolescent patient (tanner stages)
- the aging patient
(pubic hair: sparse grey, labia and clitoris smaller, vagina narrows and shortens)
-inspect external structures such as mons pubis, labia majora/minora, clitoris, urethral meatus, vaginal introitus, bartholian's and skene's glands, perineum, anus
-check for inflammation, lesion, ulcers, swelling, discharge
Hernia inspection occurs ____
the same way as in males
-make sure to palpate labia majora, go upward just lateral of pubic tubercules.
what is the most common hernia occurence in women?
Bartholian glands are:
responsible for lubrication
The bartholian gland are located:
Think of ear 5:00 or 7:00
when examing the bartholian glands:
-tell the pt you are going to insert on index finger into the vaginal vault
- use the external thumb of the same hand to lightly palpate at 5:00 and 7:00
- obstruction of these glands will lead to pain, enlargement, and possible discharge.
How do you insert the speculum?
-decrease pressure on the urethra by holding the speculum blades obliquely and inward along the posterior wall of the vagina.
- rotate speculum horizontally
-maintain pressure in the posterior direction
- insert speculum to its full length.
When speculum is inserted during the pelvic exam:
- open speculum carefully and cup the cervix
-rotate or adjust speculum until cervix is in full view
- if difficult finding cervix, withdraw speculum slightly and reposition it.
-inspect the cervical os (note color of cervix, position, ulceration, masses, bleeding, discharge).
If a uterus is retroverted it points _____
Nulliparous os are
a small hole
Transverse in apperance
The os migrates with aging T or F
True. Look at cervical variation slide 30
Precancerous cells derive from HPV and happen in the
endometrial cells within the os indicate:
PAP smear is know as the?
PAP smears check for?
abnormal cells (dysplasia) and or cancerous cells on the cervix and within the endocervical canal.
NOT A CHECK FOR UTERINE CA
- can use a cytobrush (ouch) or spatula
How do you perform a Pap smear?
-insert endocervical brush into the cervical os and gently twist (collects both squamous and columnar cells)
-remove the brush place into thin prep solution
- the spatula has a notched end that resembles a mitten
- insert the finger of the mitten into the cervical os and turn it 360 degrees
- remove the spatula and place into thin prep solution
-send sample to lab. results know within 48 hours
The PAP smear covers ____
the transformation zone and squamocolumnar junction
cervical ca is
not age related
When obtaining cultures
-Gonorrhea and Chlamydia cultures are taken from the cervix
-bacterial vaginosis, trich, canidal swabs are taken from vagina
-vaginal discharge should be inspected and have a pH, wet mount, and potassium hydroxide (KOH) analysis performed on it.
-repeat the process with a chlamydia swab, placing the swab in a special culture tube (gen probe).
-withdraw as you close speculum slowly and observe the vaginal mucosa.
- as speculum is withdrawn, keep it in slightly open position with your thumb.
-close speculum as it emerges from the introitus
-close the speculum and rotate it 90 degrees counterclockwise back to vertical
-put pressure on the posterior introitus as you slowly remove it.
-avoid pinching and excessive stretching
-inspect for color, inflammation, discharge, ulcerations or masses.
Bimanual exam allows
to palpate the adnexal organs and cervix "blindly"
you perform this exam standing up
Steps to the bimanual exam
-insert them in the vagina posterior introitus
(thumb abducted; ring and small finger flexed in palm)
-supinate your hand
(feel for nodules, tenderness of vaginal wall)
(palpate cervix: note position, consistency, mobility, tenderness)
Cervix can be moved without pain -normally
feel for the fornices of the cervix (ant/post)
Read slides for uterus, ovaries, fallopian tubes etc