History and Examination Flashcards

Question

What are positive risk factors to look out for when assessing BBV risk?

Answer 1

Sexual contact with HIV positive partner Engaging in sexual activities with bisexual/homosexual men MSM Engaging in sexual activities with someone from an area of high HIV prevalence IV drug use Paying/being paid for sex Receiving blood transfusions/tattoos/piercings in environments when sterile equipment cannot be guaranteed

Answer 2

Pelvic examination of female genital organs Introduction, chaperone, consent Patient should have empty bladder Remove clothing from waist down and sanitary protection Any abdominal inspection and palpation performed before asking patient to lie on back with legs apart Abdominal inspection for scars, ascites Palpate for masses and tenderness, inguinal lymphadenopathy External examination for Deficiency - childbirth Abnormal hair distribution, cliteromegaly Skin abnormalities Discharge - colour, consistency Bleeding Swellings of vulva e.g. tumours, cysts Cough for any incontinence or prolapse Palpate labia majora Bimanual examination Complete examination, thank patient, summarise findings Further investigations; pelvic ultrasound, bloods depending on history and findings

Answer 3

Lubricate right index finger and middle finger Insert fingers into vagina, enter with palm facing sideways then rotate so palm is facing upwards Move along posterior wall of vagina and locate cervix Feel for smoothness, clots, mobility and firmness Place fingers in the posterior fornix, to lift the uterus whilst pushing fundus down by putting hand on symphysis pubis Assess uterus size (normal size of plum) Determine if anteverted or retroverted Note tenderness, mobility and shape Place fingers in lateral fornix, and then press lateral to umbilicus to feel for any adnexal tenderness or masses. Repeat on other side. Move cervix from side to side, check for cervical tenderness. Remove fingers gently, inspect for discharge or blood.

Answer 4

Introduce self etc. Measure patient's heigh and weight Ensure empty bladder Expose from xiphisternum to pubic symphysis Lie in supine position with head of bed raised to 15 degrees Will need measuring tape, pinnard stethoscope/doppler transducer, US gel General inspection Wellbeing Hands - radial pulse Head and neck - melasma, conjunctival pallor, jaundice, oedema Legs and calves - calf swelling, oedema, varicose veins ``` Abdominal inspection Distension compatible with pregnancy Fetal movement (>24) Surgical scars Skin changes in pregnancy - linea nigra, striae gravidarum (stretch marks) striae albicans (old silvery white striae) ``` Palpation Fundal height - medial edge of left hand press on xiphisternum to locate fundus Measure from here to PS in cm and inches, distance should be similar to gestational age Assess lie Place hands on either side of top of uterus, apply pressure Move hands and palpate down abdomen One side will feel fuller and firmer - back Presentation Palpate lower uterus Firm and round means cephalic, soft/non round is breech Breech can sometimes palpate head in upper uterus Ballot head pushing from one side to other Liquor volume Palpate and ballot Engagement If presenting part has entered bony pelvis - note how much of head is palpable; engagement measured in 1/5s Fetal auscultation Location back of fetus to listen for heart Place instrument towards where between fetal scapulae are Use of hand held doppler only after 16 weeks Feel mothers HR at same time Measure fetal HR for one min - should be 110-160bpm ``` Complete examination Palpate ankles Test for hyperreflexia (pre-eclampsia) Wash hands, summarise Perform BP and urine dipstick ```

Answer 5

Introduce self, explain, consent and chaperone Patient should have empty bladder, remove clothing Prepare gloves, lubricant, speculum, +/- smear, swabs, pipelle biopsy Abdominal examination Inspect for scars, ascites Palpate masses, tenderness Palpate groin for inguinal lymphadenopathy ``` External examination Inspect external genitalia Deficiency - childbirth Hair distribution, cliteromegaly Skin abnormalities - lesions, warts, erythema Discharge - colour, consistency Bleeding Swelling of vulva ``` Speculum Examination Part labia, insert with screw facing sideways, blades vertical, then rotate Slowly open, use light to inspect cervix ``` Look for abnormal discharge Erosions Ulcerations Growths Inflammation Bleeding Polyps Ectropion ``` Swabs taken if needed Remove speculum - unscrew, rotate back

History and Examination Flashcards

(29 cards)