300 Exam 3 breast/genitalia

The breasts are ---- mammary glands on the anterior chest wall, superficial to the ---- ---- and serratus anterior muscles
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Suspensory ligaments, ----, extend through connective tissue layer through breast and attach to underlying muscle fasciacooper'sVascular supply is mostly through branches of internal ---- artery and lateral --- artery, in the deeper tissues of breastmammary, thoracicIntercostal arteries supply --- tissuessuperficialBulk is composed of retro mammary and subcutaneous tissue that surrounds --- tissueglandularThe nipple is surrounded by ---- ----pigmented areolaNipple is composed of ---- infiltrated with circular and longitudinal ---- muscle fibersepithelium, smooth----, ----, and ---- stimuli causes nipple to become erect and lactiferous ducts emptytactile, sensory, automatic---- glands (montgomery tubercles) may be seen on areolasebaceous---- follicles surround the areolahair----- nipples or breast tissue are present along mammary ridgessupernumeraryBreast support is provided by- suspensory ligaments - chest muscles - inframammary ridge--- drains breast radially and deeplylymph--- ---- and brachial arteries drain toward the axillary nodessuperficial scapularMedial internal mammary chain of lymph nodes drain toward ---- breast and ----opposite, abdomenthe ----, ----, and ----- nodes drain through the areola and nipplemidaxillary, subclavicular, supreclavicular---- node drains posterior chest wall and portion of armsubscapular---- node drains anterior chess wellpectoral----- node drains upper arm, also called lateral axillary nodesbrachial---- nodes (rotter) drains retro areolar areainterpectoralchildhood and adolescence is --- stage of breast developmentlatent----- is early sign of puberty in girlsthelarche (onset of female breast development)onset of breast developmentthelarcheIn older adults before menopause, glandular tissue begins to ----atrophyAfter menopause, glandular tissue continues to atrophy replaced by ---- tissuefatty---- ligaments relax, ---- --- thickens, and the breasts hang more looselysuspensory, mammary ridgeHistory of present illness....- breast discomfort - breast mass - nipple dischargePast medical history......- previous breast disease - surgeries - menstrual history (menarche, menopause) - pregnancy/history - lactation/history - past use of hormones, ics, hormones after menopauseFamily history...- breast cancer - other breast disease, male and femalePersonal and social....- age - change in breast characteristics - changes in breast w/ menstrual cycle - 1st day of LMP - menopause - breast support w/ exercise - caffeine intake - BSE - breast cancer risk factors - benign heart disease/risk factors - mammography history - meds OTC, prescriptions, hormones - etoh usePersonal history of breast problems increases a women's risk of breast cancertruesebaceous glands on the nipple are also called:montgomery tubercleis an extension of the tissue of the breast that extends into the axilla.tail of spenceWhen examining, divide the breast into --- quadrants (at nipple) and the tail of spence4T/F: during inspection it is important to look for unilateral differencestruehigher level amount of malignancy is often seen at thetail of spenceDuring inspection with arm ROM.....- sitting arms at side - sitting arms over head - sitting pushing heels of hands together - sitting leaning forward if large breasted - good lighting - good exposure to assess breast symmetryWhile inspecting the breast....- size (not usually symmetrical) - contour - symmetry - skin color (look for unilateral skin changes) - texture - venous pattern (bilateral) - lesions - vary in shape (convex, pendulous or conical) - texture should be smooth, contour uninterrupted - LOOK FOR DIMPLINGtorturous, dilated vein in one breast because malignancy in breast is sayingfeed me, causing more blood to flowfull on topconvexbreasts that do not have an upright and/or round appearance, and are, instead, longer and more cylindrical shaped.pendulouscone shapedconicalwhen inspecting men, there is no need to change --- ----arm positionare common minor congenital malformations that consist of nipples and/or related tissue in addition to the nipples normally appearingsupernumerary nipplewhen orange like peel appearance of nipple occurs because ofedema in the hair folliclesT/F:healthy nipples should point in the same directiontrueNipples should point --- and ---down, laterallyNipple and areola inspection.....- shape (round/oval) - color (pink-black nipple and areola congruent) - size should be = - inversion (in) or eversion (out) - free of crusting - check for supernumerary nipplesSupernummary nipples are located along the ---- ---- ----, may have some glandular tissue but often noneembryonic mammary ridgeDuring palpating, have patient sitting and ---- move arm out if possiblesupineSystemic cover from mid axillary or back further to mid sternal ---- to ----th rib or belowsupraclavicular, 7thUse --- and --- methodfingerpads, stripUse three different levels-light mid deepTrace the size of a ---, don't lift hand, while including tail of spencedime---- ---- --- under breast is thick fibrous supporting ridgeinfra mammary ridgeTo palpate the nipple, palpate as above then compressing in two directions for ----dischargeNote characteristics of discharge if present....- color - consistence - odor - amountIn males, there is a thin layer of --- tissue, and can have glandular tissuefattyFemales have --- ---- and ---- tissuedense, firm, elastic---- feel of glandular tissuelobularHormonal changes may result in ---- and ----nodularity, tendernessWhen palpating lymph nodes, the process includes...- central axilla - down chest wall - subscapular - pectoral - lateral - brachial - epitrochlearSupraclavicular nodes, also called herald nodes, "---" the claviclehookWhen documenting mass location include....- quadrant - distance from nipple - draw pictureWhen documenting size of mass...- measure in cms - length - width - thicknessWhen documenting shape of mass...- round - discoid (disc shaped) - lobular - stellate (star like) - regular/irregularWhen documenting consistency of mass....- hard - soft - cyclicWhen documenting tenderness....- how muchWhen documenting mobility....- moveable and what direction - fixed? to skin or underlying or adjacent tissueWe want nodes to bemoveableWhen documenting borders....- discrete - poorly definedBorders of nodes should be well ---definedWhen documenting retraction....- dimpling? - altered contourAll --- ---- or --- ---- need further diagnosissolitary nodules (one nodule), dominant massesIf patient has had a mastectomy, you must examine the ---- ---- as well as the mastectomy siteunaffected breastPay special attention to the --- and the rest of the ----, also the ----scar, chest, axillaPalpate in small ---- with finger ---circles, padsTeach the patient....BSEMale and female breasts may be --- at birth, squeeze gently may express clear or white fluid called "---- ----"enlarged, writches milkIn infants, you can palpate --- to --- cm diameter enlargement, which will disappear in --- to --- weeks but may last up to 3 months1-1.5 1-2In adolescent females, asymmetry is ----normalPalpation on adolescent females should revealhomogenous, dense, firm, and elastic tissueIt is important at this age to teachbreast self examIn male adolescents, they may have transient unilateral or bilateral breast ---- which is usually benignenlargementMale adolescent breast enlargement should disappear withina year----- may also develop, which is noticeable and tender, usually resolves spontaneously. Occasionally may need surgical correction for cosmetic reasonsgynecomastiaIn older women, breasts hang --- on the chest, the lobular feel of glandular tissue is replaced by --- ---lower, granular tissuein older women, breast --- become much more significant. BSE!!!lumpsAs women age, they have decreased ---- hair, the ----- ridge thickens and is felt more easily, and the ---- become smaller and flattenaxillary, inframmary, nipplesMale genitalia includes....- penis - scrotum - testicles - epididymides - prostate gland - seminal vesiclesThe function of the penis is toexcrete end products of renal metabolism and to ejaculate sperm into the vaginaThe penis has two ---- ----, which are on the dorsum and sidescorpus cavernosaThe --- ---- is where the urethra is embodiedcorpus spongiosumThe distal end of the corpus spongiosum is the ---- ----glans penisThe urethra orifice is a slit like opening that is about --- mm ventral to the tip of the glans2Skin of the penis is thin and somewhat loose to permit ----erectionThe skin of the penis is free of --- ----, and is usually more darkly pigmented than the body skinsubcutaneous fatThe --- covers the glands unless the male is circumcisedprepuce---- is a cheesy white material that forms from epithelial cells from the prepuce and sebaceous material from the glandssmegmasmegma collects on the glans and formic of the ----foreskin---- tends to be more darkly pigmented than body skin and is divided into two pendulous sacs by a septumscrotumEach pendulous sac contains....- testis - epididymis - spermatic cord - muscle layerThe muscle contracts or relaxes the scrotum therefore helping to control the ---- of the ----temperature, testesTestes produce --- and ----spermatazoa, testosteroneThe adult testes measure ---x---x--- cms and is ---- in shape4x3x2 ovoid (egg)The ---- is a soft comma shaped structure located on the posterior lateral upper aspect of testes in 90% of males, rest are anterior lateral placedepididymisThe epididymis stores --- for maturation and also ---- spermsperm, transports---- ---- begins at the tail of the epididymis and travels up the spermatic cord through the inguinal canal to the seminal vesicle to form ejaculatory ductvas deferens--- gland is about the size of a testis, and surrounds the urethra at the bladder neckprostateThe posterior surface of the prostate gland lies in close contact with the --- --- wallanterior rectalThe prostate gland is --- and is divided by a shallow median sulcus into right and left lateral lobesconvexThe median lobe of the prostate gland is not accessible topalpationThe ---- vesicles extend outward from the prostate glandseminalThe prostate gland produces the major part of the ---- fluid which contains ----, which liquifies coagulated semenejaculatory, fibrinolysinSexual physiology is under control of the --- ---- systemautomatic nervous20-50 ml of blood engorge the ---- ----, caused by increased arterial blood supply and decreased venous outflowcorpus cavernosa---- is a neurovascular reflex induced by psychogenic and local reflex mechanismerectionThe local reflex mechanism involves a ---- ---- --- and tactile stimulispinal reflex arcPsychogenic stimuli can be any type such as....auditory visual imaginationIn infants and children, the external genitalia are identical for males and female until --- weeks gestation8During the 8-9th week gestation, any fetal insult may result in major --- ----genital anomaliesAny injury after that period may result in ---- morphological anomaliesminorDuring the --- trimester, the testes descend into the inguinal canal3rdSometimes at birth the testes have not descended and may do so during the ---- periodpostnatalSeparation of the prepuce from the glans penis is often ---- at birth, and may remain so until -- to --- years of ageincomplete, 3-4In adolescents, with the onset of puberty, ---- ---- begins at the base of the penisdowny hairThe scrotal skin ---, ----, and becomes increasingly ----reddens, thins, pendulousDuring puberty, the --- and ---- begin enlargingtestes, penisAs maturation continues, the --- --- darkens and extendspubic hairThe --- gland enlargesprostateBy the end of puberty, the pubic hair is ---, ----, and ----, and forms a diamond shape from the umbilicus to the anuscurly, dense, coarseThe growth of the testes and scrotum are complete, and the penis is ---- in length and breadthincreasedIn older adults, pubic hair becomes more --- and --- with agingsparse, fineThere is no change in the production of mature ---- with agingspermatozoaThe variability of sperm probably --- with agingdecreasesThe ---- ---- probably decreases due to frequency of intercourseejaculatory volumeThe scrotum becomes more --- with agingpendulouserection may develop more ---- and the --- may be less intenseslowly, orgasmHistory of present illness.....- Difficulty achieving or maintaining an erection - Pain-- prolonged painful erection - Constant or intermittent with one or more partners - Associated with ETOH or other drug ingestion - Curvature of penis in any direction - Meds that may influence performance RX or OTCs - difficulty with ejaculationIf having difficulty with ejaculation......Painful or premature, efforts to treat Ejaculate color, consistency, odor, amt. MedsMeds that may influence performance RX or OTCs include....Antihypertensives, diuretics, sedatives, tranquilizer, estrogens, inhibitors of androgen synthesis.If there is discharge or lesion on the penis....- Character- lumps, sores, rash - Discharge- color, odor, consistency, tendency to stain underwear - Symptoms- itching, burning, stinging - Exposure to STDs - Number of sexual partners, do partners have symptomsIf there is infertility...- Life style factors, clothing, hot baths, staying in hot env - Length of time trying to impregnate, - sexual activity pattern, - knowledge of women=s reproductive pattern - Hx of undescended testicles - Diagnostic eval to date - MedsIf there is enlargement in the inguinal area....- Intermittent or constant- associated with straining or lifting - Change in size or character of mass. - Pain in groin- Character of pain, tearing, sudden searing, cutting. Assoc activity, use of truss - Testicular pain or mass- change in size of testicle, events surrounding onset, (when noted) irregular lumps, soreness, or heaviness of testes.PMH should include.....- Surgery of genitourinary tract- along with prostate, hernia repair are surg for varicocele, hypospadias, epispadias, undescended testicle, sterilization - STDs, organism, effectiveness of treatment, residual problems, multiple partners, - Chronic illness- cancer, diabetes, vascular problems, ETOH abuse, arthritis, cardiac or respiratory diseases.Family history includes....- infertility in sibs - hernia repair - cancer in genitourinary systemPersonal and social history....- Employment- risk of trauma, exposure to toxins, radiation - Exercise- protective device - Concerns about genitalia- size, shape, surface characteristics, texture - TSE - Concerns about sexual practices, single or multiple partners, heterosexual, homosexual, or bisexual - Reproductive function, method of contraception, number of children - Street drugs, ETOH useDuring the exam, hair distribution narrowing midline pattern from the ---- will go back to the ---, will be scant on the scrotum, and not present on the penisumbilicus, anusHair is ---- and more coarse than scalp fair, look for infestations.terminalObserve the penis skin for --- and ----color, consistencyUsually the penis is --- than body skin color, smooth and wrinkleddarkerprepuce meansforeskinIf there is prepuce, you need to ---- it, and the skin should be darker in color than glansretractIt is essential to detect --- or ---- of the penischancres, carcinomaa painless ulcer that is particularly seen in the genitaliachancreIf chancre or carcinoma, you will see ----- or ----smegma, phimosisa sebaceous secretion in the folds on the skin, especially under a man's foreskinsmegmacongenital narrowing of the opening of the foreskin so that it cannot be retractedphimosisThe glans should be smooth, pink, or lighter than the ---- and -----shaft, bulbousThe glans should be --- if circumciseddryThe location of the urinary meatus should be ----, slit, mms from tip of glansmidlinea congenital condition in males in which the opening of the urethra is on the underside of the penishypospadiasis a rare type of malformation of the penis in which the urethra ends in an opening on the upper aspect (the dorsum) of the penis.epispadiasCompress the glans to open the -----, check for discharge, there should be noneurethraThe opening of the urethra should appearpink and glisteningShaft of the penis should be ----, smooth, and semi firm consistencynontenderMilk the penis from the base down, if any discharge appears it can indicateSTIThe ---- should be more deeply pigmented than body skin, surface may be coarse and rugousscrotumScrotum are usually ---- due to lower hanging testicle on the ---- because of longer spermatic cordasymmetric, leftSebaceous cysts on the scrotum will be seen aslumpsIf there is ----, it would be due to chronic diseaseedemaInspect the contour for lumps and swelling, lifting up the --- to note posterior surfacescrotumPalpate the ---- with the thumb and first two fingers. It should feel smooth, rubbery, and nonnondular , will be sensitive to pressuretestesThe ---- is comma shapred toward the head of testis, usually posterolateral. It becomes slightly larger at superior portion of the testisepididymisPalpate the --- ---- from the tail of epididymis up to the inguinal canal. Will be associated with arteries and veins and often cannot differentiate. Should not be variscosities or nodules.vas deferensInspect the --- and --- for signs of hernia (swelling)groin, scrotumAsk the patient to bear down as if they have having a --- ---bowel movementInspect the inguinal canal and --- ---, asking the patient to relaxfossa ovalisInsert the finger in the lower --- and move upward in the middlescrotumMove to the --- --- and ask the patient to coughoval ringIf suddenly you feel ---- within the ring, it is an indirect hernia.viscusIf --- to the ring, it is direct herniamedialIf you find a hernia, examine other side carefully because hernias are oftenbilateralPalpate the groin for --- ----femoral herniaIn the newborn, examine for anomalies, ----- genitalia, and incomplete developmentambiguousExamine the newborn penis for ---- of the ----placement, urethraIn infants, you will often see- hypospadius - cordee tendoneedownward bowing of the peniscordee tendoneethe significance of a hypospadius is....a possible corded tendon, or downward bowing of the penisIf the infant is not circumcised, check the stream of urine, it should arc over the ---- ----, do not retract the foreskinsymphysis pubisWith circumcised infants, look for signs of ---- or ----infection, ulcerationWith the newborn scrotum check the....size shape rugae presence of testesPremature infants may have ---- scrotum, the full term will have a loose pendulous scrotum with rugae and a midline raphesmootherPalpate over the internal ---- --- with flat part of the fingers, you should feel smooth spermatic cordinguinal canalIf the smoothness disappears, an --- --- may be visibleinguinal canalVisible inguinal bulging indicatesherniaIn children, well formed --- indicate testes have descended during infancyrugaeIn children, a painless mass may indicatetumorSpermatogenesis requires maintenance of temp lower than37 Cproduction of spermspermatogenesisHPI should include female/male....- change in bowel function (character, frequency, consistency, onset, accompanying symptoms) - anal discomfort (pain, stinging, burning) - rectal bleeding (color, relation to defacation, amount, accompanying changes, associated symptoms, meds) - changes in urinary function (M)- hx of enlarged prostate or prostatitisPMH should include....- hemorrhoids - spinal cord injury - males prostatic hypertrophy or carcinoma - females - episotomy or 4th degree laceration during deliveryFH.....- rectal polyps - travel history - diet - risk factors for colorectal and prostate cancer - EOTHTanner staging in adolescents is done to evaluate the....maturation of the sexual organsDuring the adult exam, the patient should be in theleft lateral recumbent positionThe left lateral recumbent position allows us to view- sacrococcyxgeal (pilonidal area) - perianal areaThe skin in these areas should be intact, no rashes, lesions, dimpling, tufts of hair or ---scarssexual activity in older men is related totheir health and how sexually active they have been in their livesPalpate for ---- and ----tenderness, inflammationIf there is tenderness/inflammation, this may indicate..... (3)- rectal abcess - anorectal fissure/fistula - pilonidal cystIf tenderness is found, adults with ---- are more likely to have a fungus infection and children are more likely to have ----diabetes, pinwormsInspect the anus by gently spreading thebuttocksThe anus skin should be....coarse, darker pigmentedLook in the anus for lesions, tags, warts, fistulas, orhemorrhoidsUse the clock method to describe findings, 12 o'clock = -----, 6 o'clock = -----12 anterior midline, 6 posterior midlineAsk patient to bear down to ---- external sphincterrelaxLubricate the finger and place against the anus to wait for relaxation. Gently insert into rectum directing toward the -----, ask to the patient to tighten the anal sphincter, noting the muscular anal ringumbilicusInsert the finger further into the rectum and note thelater and posterior rectal wallsLater and posterior rectal walls should besmooth, even and uninterruptedRotate the finger to the --- --- --- to examine the posterior surface of the prostateanterior rectal wallSize of the posterior surface of the prostate should be....1 cmProtrusion is about4cm in diameterContour is ----convexThere should be slightmobilityConsistency of the posterior surface of the prostate should feel like apencil eraserIt should be nontender, and you should be able to feel thesulcusSulcus enlargement can range from grade 1 ---- cms, up to grade 4, ---- cms1-2, >4The prostate should never be nodular because this can indicatecancer---- consistency indicates hypertrophyboggy---- softness indicates abscessfluctuantDuring the female exam, you can palpate a ---- or ---- uterus and often the cervix, be careful not to mistake tumors for the cervixretroflexed retrovertedAfter the male prostate and female uterine exam, ask the patient to bear down and reach in another few cms, may be able to note....- peritoneal inflammation - nodular shelf lesions of peritoneal metastasisThe female external genitalia includes....- mons pubis - labia majora - labia minora - clitorus - vestibular glands - vaginal vestibule - vaginal orifice - urethra---- ---- is a pad of adipose tissue covering the symphysis pubis, terminal hair covers it and extends down the labia major in the post pubescence femalemons pubis---- ---- lies inside the labia major, and is hairless, flat, and reddish.labia minoraAnteriorly, the labia minor meet at the --- ---- and divide and form the ---- of the clitoris, and the prepuce of the clitorisanterior vulva, frenulumThe ---- sit between the frenulum and prepuceclitorisThere are 6 openings in the ----, two skenes glands on either side of the urethra, 2 bartholins glands posteriorly on either side of the vaginavestibuleThe --- lies between the clitoris and vaginaurethraThe --- lies in the posterior vestibulevaginaThe vagina is varied in size and shape, ---- connective tissue covers some portion of the vaginahymenalWhen it is torn, it leaves hymenal ---tagsthe --- is a musculomembranous tube that is transversely rugged during reproductive yearsvaginaThe vagina lies at an angle of --- degrees with the vertical place of the body45The upper end of the vagina is a --- ---- which ends in the cervix, which protrudes into the vagina, and pockets of the posterior, anterior, and lateral fornicesblind vaultThe walls of the vagina are ---- and make it possible to examine organs through these wallsthinThe --- sits between the rectum and the bladderuterusThe uterus is ----, pear shaped and relatively mobileinvertedThe uterus is covered by the ---- and lined by ----, which is shed during menstruationperitoneum, endometrium---- --- --- --- (pouch of douglas) is a deep recess formed by the peritoneum which covers the lower posterior wall of the uterus and upper portion of the vaginaretrouterine cul de sacUterus usually inclines forward at a --- degree angle although may be anteverted, anti flexed, retroverted or retroflexed45The size of the uterus of a nulliparous (never given birth) woman is ....- 5.5-8 cms long - 3.5-4 wide - 2-2.5 cm thickThe uterus of a parous (has given birth) woman may be2-3 cms larger in any dimensionThe uterus is divided anatomically into the --- and ----corpus cervixThe corpus is divided in the (3)- fundus - body - isthmusThe fallopian tubes are inserted at the --- of the corpusfundusThe ---- of the uterus is comprised of the fallopian tubes and ovariesadnexaEach tube ranges from --- to --- cms8-14The --- rest in a depression of lateral pelvic wall at the anteriosuperior iliac crestovariesDuring the reproductive years, the ovaries are about --- cm long, --- cm wide, and -- cm thick3, 2, 1Testicular cancer is highest in age group --- to --- years19-40HPI of abnormal bleeding, less than -- to --- days or more than --- days between periods is concerning19-21, 37HPI for females should include....- nature of flow - temporal sequence - associated symptoms - meds - pain - vaginal discharge (character, occurrence, douching, clothing, discharge in partner, use of condoms, symptoms)Ask about menopausal symptoms, including....- age at menopause - symptoms - postmenopausal bleeding - self image - mothers experience - meds - contraceptionAsk about infertility, including....- how long trying to get pregnant - abnormal structures - diagnostic evals to dateAsk about urinary symptoms, including....- character - description of urine - associated symptoms - related to sexual activity - method of contraceptionAsk about menstrual history, including....- age of menarche - last period - # days in cycle - character of flow - duration - presence of clots - dysmenorrhea -intermenstrual bleeding or spotting - intermenstrual pain - pmsAsk about sexual history and current activity, including....- # of partners - sex of partners - method of contraception - satisfaction - protection from STDs - satisfaction with relationshipsObstetric history, including....- # of pregnancies - # to term pregnancies - # preterm pregnancies - # abortions - # living children - complicationsGynecologic history, including....- pap smears and results - any abnormal pap smears - gynec procedures or surgery - STDs - PID - vaginal infections - diabetes - cancerFamily history of....- diabetes - cancer of reproductive system - mother DES while pregnant with pt - multiple pregnancies - congenital anomaliesPersonal and social history.....- cleansing - contraceptive history - douching history - sexual history - last pelvic exam - last pap smear and results - street drugsWhen doing the female exam, make sure to first ---- the bladderemptyHave the patient in ---- positionlithotomyDrape covering the knees, to --- ---symphysis pubisInspect the inner ---- and palpatethighInspect ---- distribution, should have an inverted triangle but does varyhairThe skin of the inguinal and mons pubis should be --- and ----, with no rashessmooth, clearthe --- ---- will have darker pigmentation, shriveled or full, gaping or closed, usually symmetrical, skin surface smooth, and may be dry or moistlabia majoraSpread the labia to view inner labia major, labia ----, and surface of the ----minora, vestibuleIt should appear dark pink and moist, usually ----symmetricalLook for excoriation, usually means ----scratchingLook for caking of discharge, may meaninfection process or hygieneThe clitoris is usually --- cms in length and --- cm in diameter2, 0.5Look at the surface, medial aspect covered with prep use, look for.....- atrophy - inflammation - adhesionsThe ---- is usually midline, look for discharge, polypls, caruncles, and fistulasurethraIf there is any irritation, dilation, or inflammation, it may indicatedUTIsThe vaginal ---- may be slit or gaping, should be moist, look for discharge, lesions, fistulas, fissures and abcessesintroitusIt should feelsmooth nonnondular nontenderWith the labia still separated, place the index finger in vagina palm upward, and milk --- glands on either sir of urethra and then on urethra - note the discharge and tendernessskenesIf there is discharge, get a culture and describe.....- odor - amount - consistency - colorPalpate sides of the vagina between thumb and forefinger, then move to the ---- portion of the vaginaposterolateralat the ---- gland area, note swelling or tenderness from the ductbartholinsIf there are any masses, pain, or hot swellings, it indicates an ---abcessCulture the discharge and note the amount, consistency and odor, it is usually --- or ---- in origingonococcal, staphlococcalA nontender cyst indicates...chronic irritation of glandAt the ----, the surface should be smooth, may see episotomy scarring. Look for lesions, rashes, irritation, fistulas, or growths. It should be nontender.perineumWhen doing a pelvic exam, lubricate with ---- ONLY, especially if collecting specimenswaterSupport the ---- with downward pressure of the fingersintroitusWait for relaxation, open the vagina wide, and insert the speculum in path of least resistance, ---- and toward the ----downward, rectumOpen blades slightly and sweep --- gently until the --- comes into viewup, cervixThen---- the blades and expose the cervix between the bladesopenWhen you see the cervix, make sure to note.....look at color, (pink and uniform), size, (small, round, oval), position, (related to position of uterus), surface characteristics (smooth) and discharge, (clear, or milky, thin, thick, stringy). Look where discharge is coming from, cervix or vagina.When doing a pap smear, the spatula does a 360 degree sweep, then brush inserted until bristles closest to handle are visible. --- to full turnrotateWhen taking a ---- culture, take a sterile cotton swab into the cervical os and leave in pale for 10-30 seconds, strike a Z pattern on a plategonococcalWith a Gen Probe, do a --- swab and leave in place for 30 secondsdacronWhen doing --- mounts, swab in place on slide, drop of NSS with glass over slip, one second slide use KOH and glass cover slipwetIf the slide is NSS trichmonads positive or epithelial cells are peppered with bacteria, this indicates....bacterial vaginosisWithdraw speculum, close blades slightly, and draw away from the cervix, as withdrawing, look at the --- ---- for color, lesions, discharge and tendernessvaginal wallsWhen doing a ---- exam, lubricate fingers, insert into the vagina, and apply downward pressure while waiting for relaxationbimanualWatch where the --- is, palpate the vagina as moving fingers to cervixthumbFind the cervix, run fingers around it, noting....- size - shape - firmness - tip of nose - mobilityWhen doing a bimanual exam on the uterus, one had with intravaginal fingers in the anterior formix, and the other hand should be midway between the --- and --- ---umbilicus, symphysis pubisBegin to slide top hand down, will feel the --- at pubis, should be --- and ----fundus, anteverted, anteflexedIntravaginal fingers in posterior formix, press on cervix, top hand at symphysis press down, should feel uterus between hands if ---- or ----, probably won't feel fundus with abdominal handretroverted, retroflexedThe midline uterus is more difficult, keep in contact with cervix, move one finger above and one finger below and press ----inConfirm your findings with a ---- examspeculumTo exam the ----, Intravaginal fingers in lateral fornices, abd hand on lower quadrant corresponding to side examining. Push intravaginal finger laterally and up while bringing abd hand obliquely down toward symphysis. May capture ovary. Will be mildly tender. Should be smooth, firm, ovoid. Not nodular or enlarged. Then exam opposite side.adnexaWhen doing a rectal vaginal exam, one finger should be in the vagina, one in the anus, and wait for ---- before proceedingrelaxationNote the ---- tone, and rectal ----, ask woman to bear down in order for you to reach further an extra cmsphincter, wallsInfants will have labia majora and prominent clitoris up to --- weeks36Full term labia majora completely covers the --- --- and ----labia minora, clitorisThe clitoris may appear ----, but is not significantlargeThe central opening in the hymen should be ---- cms0.5Whitish vaginal discharge may be seen as late as4 weeksAdhesions between labia minora may be seen but oftenspontaneously resolve