Female

Question 1

Borders of breast

Answer 1

Lower: 6th rib
Upper: clavicle
Medial: sternal
Lateral: Midaxillary

Question 2

components of breast exam

Answer 2

Introduction
Breast inspection
Lymph node palpation
Breast palpation

Question 3

Inspection positions

Answer 3

Patient sitting, arms at sides
Patient sitting, arms above head
Patient sitting, hands pressed to hips
Patient leaning forward, supporting them

Question 4

Peau D Orange

Answer 4

Dimpling of skin

Question 5

Skin changes

Answer 5

Dimpling
Nipple Eversion or inversion
-recent onset of nipple inversion is suggestive of malignancy

Question 6

Lymph node palpation

Answer 6

Thoracica Interna
Apicales
Deltopectoral
Centrales
Laterales
Posteriores
Anteriores
Interpectorales

Question 7

Lymph node drainage

Answer 7

drain primarily to axillae second to internal mammary

can also drain to supraclavicular and jugular nodes

Question 8

Five segments of breast

Answer 8

Upper outer quadrant
Upper inner quadrant
Lower inner quadrant
Lower outer quadrant
Tail of Spence(into armpit)

Question 9

Take note of:

Answer 9

Nodules
Indurations
Masses
Tenderness 
Nipple discharge

Question 10

Duration of palpation recommended vs actual

Answer 10

Bra size B:
3 minutes per breast
6 minutes total time
Average time physicians spent in one study- 1.8 minutes to examine both breasts

Question 11

Nipple discharge

Answer 11

Check for nipple discharge by placing two fingers from each hand at edge of areola:
Press down, inward toward nipple, then up & back down
Repeat at 90 degrees to first position
Light milky discharge may be normal
Serous or bloody discharge typically abnormal

Question 12

Special exam masectomy or breast augmentation

Answer 12

Examine scar and axilla

Lymphedema

Question 13

Four parts of pelvic exam

Answer 13

Vulva and introitus  (inspection: external exam)
Speculum exam (inspection: internal exam)
Obtaining samples (pap, HPV test, cultures, biopsy)
Bimanual exam (palpation)
Rectal/Rectovaginal exam

Question 14

Inspect during pelvic exam

Answer 14

Clitoris
Urethral meatus
Introitus and hymen
Paraurethral (Skene’s) gland

Question 15

Palpate during pelvic exam

Answer 15

Mons pubis
Labia majora & minora
Prepuce
Bartholin’s duct

Question 16

Bartholins glands

Answer 16

on lower portion of vaginal opening

Question 17

Vulvar Lesions

Answer 17

Aphthous ulcer
Genital herpes
Epidermal inclusion cyst: normal finding
Warts
Vulvar neoplasia

Question 18

Bulges/swelling of vulva vagina and urethra

Answer 18

Cystocele
Cystourethorcele
Urethral Caruncle
Prolapse of urethral mucosa

Question 19

angle of speculum insertion

Answer 19

45 degrees to avoid injury to urethra. Use downward pressure!

Question 20

Normal cervix variations

Answer 20

Parous and nonparous

Question 21

Squamo-columnar Junction

Answer 21

Junction of pink cervical skin and red endocervical canal
Inherently unstable
Key portion of the cervix to sample
Most likely site of dysplasia

Question 22

Cervical Os normal variants

Answer 22

Unilateral transverse
bilateral transverse
stellate(star)

Question 23

Cervix: Abnormal (look at images)

Answer 23

Cervicitis
Strawberry cervix from STI
Polyp
Carcinoma
Nabothian cyst

Question 24

PAP SMEAR supplies

Answer 24

Broom or cytobrush/spatula

Question 25

Bimanual exam

Answer 25

``` nondominant on abdomen dominant inside vagina Palpate the circumference of the cervix Gently rock the cervix from side to side Palpate the cervix for firmness ```

Question 26

Uterine fundus palpation

Answer 26

Place internal fingers on posterior side of cervix and outer hand on lower abdomen Gently palpate each side of the uterus Expected findings: Pear-shaped, rounded, firm & smooth

Question 27

Palpate the ovaries:

Answer 27

Move internal and external fingers lateral to uterus and use 3 sweeps moving from distal point toward pubic hair line, attempting to palpate the ovaries. Expected findings: Smooth & ovoid, mildly tender to palpation, similar to an almond May not be palpable

Question 28

Variations of Uterine Position

Answer 28

Anteverted(most common) Anteflexed Retroverted Retroflexed

Question 29

Rectovaginal exam purpose

Answer 29

``` Palpate a retroverted or retroflexed uterus Palpate uterosacral ligaments Palpate the cul-de-sac and adnexa Screen for colorectal cancer Assess pelvic pathology ```

Question 30

Rectovaginal exam technique

Answer 30

Index finger inserted into vagina while middle finger inserted into rectum Straining can help relax anal sphincter Apply pressure with fingers to anterior and lateral walls while hand on abdomen applies downward pressure

Question 31

Complications of pregnancy

Answer 31

Diabetes Hypertension Preeclampsia History of depression before or after a pregnancy