pelvic exam Flashcards
(23 cards)
inspection
look at hair distribution and surface characteristics of mons pubis, labia majora–skin should be smooth and clean
palpation
separate labia majora and inspect labia minora, clitoris, urethral orifice, perineum; palpate Skene and Bartholin glands
speculum exam
observe the cervix for color, position, size, surface characteristics, discharge and size/shape of os; obtain specimens for pap smear, HPV testing, culture or other lab analysis
bimanual exam
put on fresh gloves and lubricate index and middle fingers of dominant hand (watch the thumb!)-palpate cervix, place opposite hand on abdomen and palpate for uterus, palpate adnexa and ovaries
rectovaginal exam
insert index finger of dominant hand into vagina, place middle finger on anus and have patient bear down then insert finger in rectum; palpate rectal walls and rectovaginal septum; inspect for stool as you withdraw your fingers and note presence of blood
nullparious os
cervix of woman without children will be small, round or oval
parous/multiparous os
cervix of a woman with children/multiple children is usually a horizontal slit or may be irregular and stellate (star shaped)
para/parity
total number of DELIVERIES, regardless of method of delivery (after 20 weeks)–remember twins/triplets etc count as ONE delivery
gravida/gravidity
total number of PREGNANCIES, regardless of type, location and time/method of termination
Skene gland palpation
insert index finger (palm up) as far as second joint and with upward pressure, milk Skene glands by moving finger outwards–do this on both sides of urethra and directly on urethra; discharge usually indicates infection
Bartholin gland palpation
with index finger inserted to second joint, palpate tissue between thumb and index finger laterally anteriorly to posteriorly (on both sides) and note any tenderness or discharge
types of speculum
Graves - blades are curved with a space between the closed blades
Pederson - blades are as long as Graves, but are narrower or flatter (used in women with small vaginal openings)
pediatric/virginal - smaller in all dimensions with short, narrow, flat blades
uterus is divided into corpus and cervix
corpus: consists of fundus (convex upper portion of uterus between points of insertion of fallopian tubes)
cervix: extends from isthmus (lower portion of body of uterus) into vagina
adnexa
fallopian tubes and ovaries
cervical motion tenderness
Pain elicited when uterine cervix is manipulated during pelvic examination (can=pelvic inflammatory disease (PID) or ruptured ectopic pregnancy)
abnormal vaginal bleeding
Characterized by any unexpected bleeding; many possible causes: PID, polyps, cervical cancer, trauma, hormones, contraceptive pills
uterine prolapse
herniation of the uterus into or beyond the vagina; results from weakening of supportive structures
friable cervix
easily irritated and inflamed cervical tissue; could mean infection, carcinoma, inflammation of cervix
ectropion/entropion
ectropion: columnar cells extend from endocervix to visible opening of cervix (creating a circular, raised erythematous appearance)
entropion: opposite of ectropion (no visible transformation zone)
vaginal discharge
Usual discharge is odorless, may be creamy or clear, thick or thin
cystocele, rectocele, urethrocele
cystocele - hernial protrusion of the urinary bladder through ant. wall of vagina
rectocele - hernial protrusion of part of rectum through posterior vaginal wall
urethrocele - prolapse of the female urethra into the vagina
cervical stenosis
opening in the cervix is more narrow than is typical
cyanotic cervix
normally seen in pregnancy, 8-12 weeks of gestation
