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PD Exam 2: Male, Female, Rectum, Prostate
-see separate abdominal quizlet! -minimal info from female exam.
Terms in this set (60)
T/F: The Bartholin glands are located in the labia majora.
the actual GLANDS are located in the labia majora, the openings to the bartholin ducts are in the labia MINORA (posterior fourchette area)
Female patient presents complaining of painful intercourse. On inspection, you note an abnormal appearance of the hymen. Which 2 common abnormal hymens can present with painful intercourse?
-Cribriform (looks like pinholes)
-Septate (not fully separated)
A 12y/o female presents to the clinical complaining of pelvic pain x 3 days. She has not had her first period yet. She describes this pain as severe but intermittent, it only comes on once a month and lasts for a week. What should you be sure to inspect during your exam of this patient?
-pelvic pain in 11-12y/o girls who haven't had a period yet.....check for IMPERFORATE HYMEN!!
What is the name of the septum that separates the vagina from the bladder?
What is considered the normal position of the uterus?
tipped forward at about a 45 degree angle
Which variation in uterine position describes a uterus that is tipped backward (posteriorly)?
T/F: The cervical os is considered part of the corpus of the uterus.
False! (this was in the book.)
-the cervix technically is not part of the uterus.
What is the name of the portion of the fallopian tube that opens into the uterine cavity?
T/F: It is normally easy to palpate the fallopian tubes during the bimanual exam.
they're super hard to feel.
if you can feel a fallopian tube: think ectopic pregnancy!
What is another name for the retrouterine cul-de-sac?
Pouch of Douglas
What vessels provide the main blood supply to the uterus?
Uterine artery/ vein
(located in cardinal ligament)
What is the Broad Ligament?
a fold of peritoneum that connects the uterus, fallopian tubes, and ovaries to the pelvis
What 2 pelvic joints widen and soften during pregnancy?
Which part of the pelvis is measured to determine if a woman can give birth vaginally or not?
What is the name of the speculum commonly used in an normal office or OR setting?
(the other one is Pederson- used on elderly/prepubescent- its smaller)
What is the best position for performing the female genitalia exam?
T/F: It is important that female patients have a full bladder in order to properly perform the internal examination.
we want them to have an EMPTY bladder!
What is the name of the position similar to dorsal lithotomy but without the use of the stirrups?
(some midwives prefer this one bc its not as uncomfortable)
Upon inspection/palpation of your female patient, you note that the labia majora feel warm and appear red and swollen. What condition might this indicate?
(bc the bartholin's GLANDS are located in the labia majora)
T/F: When palpating for Bartholin cysts, you should palpate the labia minora at the 5 and 7:00 positions.
False!!! tricky tricky!
you want to palpate the labia MAJORAAAAAA!
everything else was true
You note discharge upon milking of the Skene glands. What organism is commonly the cause of this infection?
(fun fact: skene glands are responsible for female ejaculation)
Explain the difference between an abscess and a cyst of the Bartholin glands.
-Abscess: draining nasty discharge, pt prolly feeling symptoms
-Cyst: you feel something but its not draining, no symptoms, not doing anything
What is it called when you see a portion of bladder falling into the vaginal canal while performing the female genital exam?
(these are seen alot in elderly)
What is a rectocele?
a piece of weakened rectum protruding into the vaginal pouch.
How do you tell the difference between a rectocele and a cystocele?
(also: cystoceles more commonly protrude thru the anterior vaginal wall, rectoceles protrude thru the posterior vaginal wall)
What causes uterine prolapse?
-uterine prolapse= uterus is falling into the vagina (varying degrees)
-all the ligaments that hold the uterus in place become lax with old age and let the uterus fall
You are seeing a 78 year old female patient for routine GYN exam. She tells you she constantly feels like she has to pee and when she does pee, it sounds like nothing really comes out. She also says she always feels like she hasn't finished pooping when she has bowel movements. She also says that it was very painful The last time she had intercourse (she is a silver fox apparently). During the speculum exam, you notice a decent amount of pink tissue protruding into the vaginal canal. What is the most likely diagnosis?
What is Goodell's Sign?
soft cervix- associated with pregnancy!
What is Chadwick's Sign?
bluish discoloration of the cervix. also associated with pregnancy
What condition is associated with a pale appearance to the cervix?
What might cause the cervical os to appear stellate?
What does the cervical os commonly look like in a multiparous female?
T/F: A female patient who had a hysterectomy for a noncancerous reason should still get Pap screenings done.
if hysterectomy for non-cancer: no more Paps!
if Ca: pap from the vestibule
Female patient presents with bleeding after sex. You do a speculum exam and see something funky sticking out of her cervical os. What is it?
A. cancer. shitty.
B. uterine prolapse
C. cervical polyp
D. a chunk of endometrium
C. cervical polyp
(commonly presents w/ bleeding during intercourse)
T/F: A bimanual exam should be performed with the examiner seated.
you should do the bimanual STANDING UP!
(do the speculum exam sitting down tho)
T/F: It is normal for the cervix to be immobile on palpation during the bimanual exam.
it should move 1-2cm.
What is the normal size of the ovaries in a plain jane lady during her reproductive years?
Which uterine position is best felt during a rectovaginal exam?
Where do you hide money from a surgeon?
Tape it to his kids.
Which set of sphincter muscles are under our voluntary control?
STRIATED muscle sphincters!!!!*
(external anal sphincter)
Which portion of the anal canal is sensitive to pain?
the EXTERNAL portion! aka the distal portion (bc its innervated by somatosensory neurons)
What is the name of the 3 little folds found in the rectum?
they are completely normal
In what lobe(s) of the Prostate do almost all disease begin in?
POSTERIOR lobes! (convenient bc these are the ones that are palpable! wowie!)
Patient comes to the clinic complaining of "seeing blood when she wiped after taking a poop". She tells you that she often gets constipated and has to put a decent amount of effort into pooping. She also tells you that her anus is often itchy and hurts. She describes the blood that she saw as bright red. What is the most likely diagnosis?
(v common cause of itching anal pain, presents w rectal bleeding that is bright red colored)
What is the name of the position most commonly used to perform the rectal exam?
the Sims position!!!! i luv the sims omggg
What are the ABCs of anesthesiology?
Airway, Breakfast, Coffee
What is the name of the common finding seen on the sacrococcygeal area that is nothing more than an ingrown hair?
How far into the rectum should you insert your finger to palpate the posterior and lateral rectal walls?
What should you do if you palpate a Houston valve during the rectal exam?
not a damn thing. they're normal af.
What do a pizza delivery man and a gynecologist have in common?
They both can smell it but they can't eat it.
Why do you ask the patient to bear down when you are palpating high into the rectum (6-10 cm)?
-you become aroused when patients shit all over you
-lol jk, a mass might come down to touch your finger that would not have been felt otherwise!
How do we determine size of the prostate?
A. you can just tell by feeling it
B. by its protrusion into the rectum
D. who the hell cares
B. protrusion into the rectum!
(normal size- minimal protrusion aka <1cm)
Why do you NOT continue palpating an exquisitely tender and enlarged prostate?
this can be a sign of
and if you keep pushing around on the prostate, you can induce sepsis and kill ur patient. not a good look.
How do you perform Hemoccult testing for blood in stool?
slowly remove finger from anus, wipe any stool on finger on a slide, put developer on the slide.
-if it turns BLUE- there is occult blood in the patient's stool!!!!!
How do we grade the degree of prostate enlargement?
-by amount of protrusion into the rectal wall
Grade I: pushes in 1-2cm
Grade II: 2-3cm
Grade III: 3-4cm
Grade IV: 4+ cm
What changes in consistency of the prostate will you be able to feel in a patient with BPH?
prostate will be enlarged, rubbery (like a hard-boiled egg), boggy, non-tender
How do you describe the normal consistency of the prostate?
-firm (like a bouncy ball), smooth, symmetrical, nontender
T/F: A prostate that feels hard and tender during a rectal exam is likely indicative of prostate cancer.
prostate cancer- hard and NONtender!
How often should DRE be done in males to screen for prostate cancer?
Annually in all males!
(DRE= digital rectal exam)
What's the difference between God and a surgeon?
God knows he's not a surgeon.
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