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Why do pelvic exams?
- routine health maintenance (pap)
- vulvar/vaginal complaints
- abdominal complaints
- STD exposure
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What are the components of the examination?
- breast exam
- external pelvic
- internal pelvic
- bimanual exam (BME)
- rectal (if sx's or >50 yrs)
- microscopy/lab
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How can parity (# of deliveries) be further denoted?
- 1) term
- 2) preterm deliveries (20-36 wks)
- 3) abortions (before 20 wks)
- 4) living children
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What are the abnormal vaginal bleeding patterns?
- polymenorrhea: <21 days between menses
- oligomenorrhea: infrequent bleeding
- menorrhagia: excessive flow
- metrorrhagia: intermenstrual bleeding
- postcoital bleeding
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What instructions can you give to pts for the best pap results?
- do not douche/have intercourse within 24 hours
- empty the bladder
- **not always possible!**
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What should you look at when examining the external structures during the pelvic exam?
- tanners if adolescent (maturity)
- mons, labia, perineum (lesions, swelling, redness)
- urethral meatus (irritation, inflammation, dilatation, discharge)
- introitus (tissue should be soft & moist, is hymen intact, look for prolapse, swelling, discoloration, discharge, lesions, fistulas, fissures)
- skene's ducts & bartholin's glands (swelling, discoloration, heat, tenderness; milk glands for discharge if they look abnl, culture any discharge)
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What are you looking for when examining the cervix?
- color, position, surface characteristics, lesions, nodules, masses
- discharge or bleeding
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What is the method to collect vaginal specimens?
- first: scrape with SPATULA (T-zone and SCJ)
- second: roll ENDOCERVICAL BRUSH in the os
- third: GC/CHLAMYDIA swab
- last: OTHER swabs for wet mount and/or KOH
- **can use cytobroom instead of spatula and cytobrush, if preggo use STERILE CTA moistened with saline instead of brush**
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How do you use the spatula?
insert long arm into os, turn 360 to collect cells from external os
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How do you use the cytobrush?
place brush into os, rotate 180 to collect endocervical cells
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What is the size of the uterus if a woman is 12, 16, 20 or >20 wks pregnant?
- 12 wks: palpable @ symphysis pubis
- 16 wks: midway between pubis & umbilicus
- 20 wks: at umbilicus
- >20 wks: 1cm for ever week of gestation
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When must you do a rectovaginal exam?
- if the uterus is not palpable (retroflexed)
- pt is >50 yrs
- pt has rectal complaints
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What are the physical changes related to menopause?
- pubic hair: sparse & grey
- labia: smaller, flatter, dryer
- introitus: gaping/constricted
- vagina: narrower, atrophic, less rugated
- uterus: smaller
- ovaries: non-palpable
- rectal tone: weaker
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What are the risk factors for developing cervical cancer?
- HPV
- early sexual activity
- multiple partners
- H/O STDs
- no pap smear
- age
- smoking
- poor health & nutritional status
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What strains of HPV cause 70% of cervical cancers? What strains cause 90% of genital warts?
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What strains of HPV does the vaccine target?
- HPV 6, 11, 16, 18
- almost 100% effective in preventing HPV 16 & 18 related CIN adenocarcinoma in situ, reduces risk of anogenital warts, intraepithelial neoplasia, invasive cancers
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What is the series of shots for HPV vaccination?
3 shots (0, 2 months, 6 months)
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Who should get the HPV vaccine?
- girls/women 9-26
- the earlier the better, sexual activity is reported in girls <13 yrs (8%)
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What is the most common STD reported in the US and is the most common in women?
chlamydia trachomatis (gonorrhea is similar)
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