Well Woman Exam 1

Question 1

it is recommended that women between 20-39 should get breast exams how frequently?

40 and older?

Answer 1

20-39: every 1 to 3 years

40 and older: mammogram every year

Question 2

a well women physcial exam should contain

Answer 2

vitals, general, cardiovascular, respiratory, breast, abdomen (looking for scars), pelvic exam, extremities, neuro

Question 3

when should pelvic exams begin?

Answer 3

they should begin at age 21

Question 4

breast examination:

Answer 4

sit upright: palpate all 4 quadrants, push toward chest wall

inspect breast and compare size contours, nipple skin, tissue (dense/firm/elastic)

supine position with hand behind head and repeat exam, allows for tissue to dissipate and have deeper palpation

palpate the nipple: compress the nipple between thumb and index finger

review them with how to conduct a self breast exam and importance of it

Question 5

if in a breast examination a mass or a lump is identifies it should be characterized by?

Answer 5

by location, size, shape, mobility, and retraction

Question 6

patients first pelvic exam: show her the instruments and inform her of the importance of testing

• set head of bed up to _ degrees
• position:
• speculum/supplies:

adjust _

put on _

inspect _ and _ and examine _ genitalia thoroughly

Answer 6

30 degrees

dorsal lithotomy position

warm up supplies (can drape patient while getting supplies and until you’re ready for exam

adjust light

put on gloves

vulva and perineum
external genitalia thoroughly

Question 7

pediatric speculum

Answer 7

narrow blades; for children

Question 8

pederson speculum

Answer 8

narrower blade for nulliparous females (first pap)

Question 9

graves speculum

Answer 9

wider blades; multiprous females

Question 10

parts of the speculum

Answer 10

upper and lower blades

thumb screw

thumb hinge

handle screw

handle

Question 11

how do you insert a speculum

Answer 11

make sure bottom is barely off the end of table

warm speculum with warm water

hold speculum in dominant hand (place on her inner thigh so you can assess temperature)

take other hand and separate labia minora and majora exposing the introtus

direct speculum at a 45 degree angle into the vaginal vault

insert all the way in (normal vagina is 10cm)

open speculum in a smooth controlled fashion

Question 12

you may have to adjust angle of speculum depending on if the patient has _

Answer 12

prolapse

Question 13

if the cervix is not in view

Answer 13

angle the superior or inferior becuase it may be int he anterior or posterior fornix region

DO NOT PULL SPECULUM OUT IF YOU CANT SEE IT

Question 14

if you still cannot find the cervix after readjustmnt you should?

Answer 14

remove speculum and preform bimanual exam and review surgical history (has she had a hysterectomy)

Question 15

nulliparous cervix

multiparous cervix

Answer 15

nulliparous- conical

multiparous- transverse

Question 16

pregnant cervix

Answer 16

chadwicks sign (blueish hue)

Question 17

trichomonas cervix

Answer 17

yellowish green discharge, punctuate hemorrhages on ectocervix

Question 18

BV cervix

yeast vagnitis cervix

Answer 18

BV cervix: foul smelling, thin gray homogeneous discharge; amine odor

yeast vagnitis cervix: adherent white discharge

Question 19

always screen cervical discharge: chlamydia and gonorrhea testing

Answer 19

swab inserted into cervical os for 45 seconds

Question 20

_ is used to gently scrape the ectocervix

Answer 20

spatula

Question 21

_ is used after the spatula to obtain endocervical cells

Answer 21

cytobrush

Question 22

cervical cytology: slide

Answer 22

1/2 slide wipe with spatula

1/2 slide with cytobrush

***gives cytology only

Question 23

cytology: thin prep

Answer 23

remove tip of swab and place in media

***used for cytology, HPV testing, ASCUS. Gonorrhea and chlamydia

Question 24

one specimens are obtained from a pap smear unlock or remove the speculum being sure to not pinch the labia or the cervix, dont forget to look at the vaginal _ during your exam as you retract the speculum. Place disposable speculum in?

place metal speculums in?

Answer 24

ruggae

hazardous red bag

in designated area

Question 25

internal bimanual exam you place your fingers into the vagina and press _ and wait for the muscles to relax then you will place your other hand on the _ region

Answer 25

downward

suprapubic region

you can use 1 or 2 fingers

Question 26

what are you looking for in a internal bimanual exam

in an IBE locate the cervix with _ surface of the finger and examine around the _

move the cervix gently side to side and observe patient expresion or discomfort; cervical motion tenderness can suggest _

check cervical _ ; no pregnant feel firm while pregnant feels softer

palpate the uterus by placing your left hand above the patients _ _ and the right intravaginal fingers in the _ _ behind the cervix

with the abdominal hand press down firmly and with the vaginal hand lift the uterus up thus entrapping the uterus; asses the uterus for size, _ , countour, and mobility

in pregnancy the uterine consistency becomes softer and you make be able to palpate between the cervix and fundus; this is known as ?

Answer 26

palpate vaginal valls looking for any masses, be careful where you place your thumb.

palmar

fornices

PID (chandelier sign)

consistency

pubic symphysis

posterior fornix

shape

hegars sign

Question 27

in an IBE how do you palpate the ovaries

Answer 27

you place fingers of the abdominal hand on the right lower quadrant with the intravaginal hands in the right lateral fornix and then press them upward toward the abdominal hand

your abdominal hand should press inwardly and obliquely

Question 28

rectovaginal exam is preformed with _ finger in the vagina and _ finger in the rectum

a rectovaginal exam is used to assess _ _ , __ and for _ _ nodularity

Answer 28

index

middle

anal sphincter, rectal walls, and uterosacral nodularity

Question 29

tight anal sphincter:

lax anasphincter:

absent sphincter:

Answer 29

tight: scarring, fissurs, inflammation

lax: neurologic defecit

absent: improper repair from a 3rd/4thh degree laceration in childbirth

Question 30

the rectal walls should feel _

when feeling the anal walls you should have the patient ?

check rectal wall for?

Answer 30

smooth

bear down

masses, polyps, strictures

Question 31

conclusion of the well exam

Answer 31

cover patient
get out of lithotomy position
extend a hand and help her sit up
hand her some tissues or wipes, inform where the trashcan is
have her get dressed while you step out of the room and inform her to open the xam door when she is redy for you to come back in

then go back it to review: talk about the exam, prescription, mammograms, immunizations, future appointments, verablize understanding and get all questions answered.