This document provides guidance on performing a thorough clinical examination for gynecological patients. It discusses the prerequisites for examination including ensuring privacy and consent. It describes examining each body system starting with general physical exam assessing height, weight, skin, nails, lymph nodes, and secondary sex characteristics. Breast, abdominal, pelvic exams and speculum exams are covered in detail including positioning, inspection, palpation, and identifying common findings. The importance of a systematic approach and correlating exam findings with history and tests for accurate diagnosis is emphasized.
Female Genital Cosmetic Surgery (FGCS) ‘enhancement’ or ‘mutilation’? Michelle Fynes
Decisions to alter genitalia may be based on misguided assumptions of normal dimensions. Recent report dimensions of female genitals (50 premenopausal women).
Female Genital Cosmetic Surgery (FGCS) ‘enhancement’ or ‘mutilation’? Michelle Fynes
Decisions to alter genitalia may be based on misguided assumptions of normal dimensions. Recent report dimensions of female genitals (50 premenopausal women).
Adenomyosis is a benign disease of the uterus characterized by ectopic endometrial glands and stroma within the myometrium.
It is associated with myometrial hypertrophy and may be either diffuse or focal.
Adenomyosis is a benign disease of the uterus characterized by ectopic endometrial glands and stroma within the myometrium.
It is associated with myometrial hypertrophy and may be either diffuse or focal.
4 cases of pelvic mass are discussed .Adnexal mass invilves masses arisinf from ovary,fallopian tube,uterus,bowel and some miscellenious masses.USG is used to detect its size and the origin.Histopathological findings are diagnostic.
21 08-16 anatomy of reprod system and appliedMini Sood
This is a presentation of the male and female reproductive system with methods of examination to detect common ailments. An easy to understand and remember for the 3rd or 4th year student in Women's health
USMLE ENDOCRINE 04 Mammary glands breast ANATOMY MEDICAL .pdfAHMED ASHOUR
Surgery plays a crucial role in the management of various breast conditions, including both benign and malignant disorders. Understanding the surgical options for breast conditions is essential for breast surgeons, oncologists, and other healthcare professionals involved in breast care.
The choice of surgery depends on the specific diagnosis, patient preferences, and the overall treatment plan.
Surgical interventions aim to address the underlying condition, restore aesthetics when relevant, and contribute to the overall well-being of individuals with breast-related health concerns.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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2 Case Reports of Gastric Ultrasound
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Clinical approach to gynaecological patient(part 2
1. CLINICAL APPROACH TO
GYNAECOLOGICAL PATIENT(PART-2)
Prof. M.C.Bansal.
MBBS, MS. FICOG, MICOG
NIMS medical College ,Jaipur.
Founder Principal & Controller ;
Jhalawar Medical CollegeAnd Hospital , Jhalawar.
Ex. Principal & controller;
MahatmaGandhi Medical CollegeAnd Hospital ,
Sitapur, Jaipur .
2. Pre requisites for clinical
examinations
Thorough clinical examination is essential and
integral part of clinical approach to any patient ; to
reach the provisional diagnosis one should co relate
and analyse the positive as well as negative points
noted in history taking and findings of clinical
examination.
On the basis of probable cause; necessary and
relevant investigations should be ordered . , their
interpretations must be done in the light of above
findings and analysis done ___ final diagnosis so
derived is more likely to be exact and true.
Reaching to diagnosis by short history / few clinical
finding is always deceiving.
3. Pre requisites for clinical
examinations--- Ensure adequate Privacy .
Good and sufficient light (As good as natural color).
Take consent of parent/ guardian if patient is minor / patient herself
when major.
A female nurse/ her relative should also stand near by when female
patient is examined., so that intensions of gynaecologist are not
misunderstood.
Keep all necessary equipments before patient ‘s examination is
started; weighing machine, measuring tap, height measuring scale
stand ,Bp. Instrument, torch, Pair of gloves, appropriate size and
variety of vaginal speculum, swabs ( dry, soaked with
antiseptic), swab sticks for collection of discharge for office
procedure for wet film- microscopic examination / culture , glass slide
and cover slips, Ayres spatula ,carrying /preservative media and
cervical brush for pap smear , acetic acid 1-5% , Lugols iodine, saline
for colposcopy or simple naked eye inspection of cervical lesion.
This will make the examination quicker, complete and comfortable to
both patient as well as patient.
4. General physical examination
Height , weight –calculate BMI.
Nails , palms --- for pallor , pigmentation, palmer
arrhythmia, clubbing, platynaechia ,fungal infection of
nails.
Carrying angle of elbow in turners .
Axilla –hair growth, lymph nodes .
Neck –Webbing of neck , thyroid goiter, lymph nodes
tubercular chain / healed sinus scar/ wircow’gland in left
supra clavicular region – metastasis in ca cervix / ovary.
Eyes– conjunctiva—pallor, sclera--- jaundice.
Face– hair growth--- hirsutism(use Ferriman-Gallway
score ) / familial hypertrichosis , achne – PCOD / steroid
or OCs therapy.
13. 7 & ½ years old Girl with well developed
Thalarche, puvarche and regular menses (
Homlogous precocious puberty)
14. Testicular faminizing
syndrome—Breast
developed, tall girl , primary
amenorrhoea. , no pubic hair
inguinal hernia may be there
containing testicle absence of
testicular receptors at end organs
prevent in development of wolfian
duct, but neutral development
makes one to look like female ; as
mullerian system development
enzymes are also not secreted by
testicles the mullerin duct
development is also not fully
supressed . It remains under
developed as estrogen is not
produced . Brest development is
under adrenal androgens
15. 16 years old girl with 46xx , dysplasia
, no secondary sex characters yet
developed , reporting as a case of
delayed menarche
16.
17. General Physical Examination
cont-- Scalp—hair loss –secondary to
chemotherapy, receding hair line in
musculinizing conditions .
Note --- BP, Pulse
, respiration, temperature,Gait, edema, vericos
e veins .
Other group of lymph nodes --- inguinal.
Development of secondary sex characters ---
> Breast development.
> Axillary Hair.
> Pubic Hair.
21. Examination Of Breast
One should never forget to examine the breast
Adolescent girls presenting w2ith
amenorrhea(primary)—may have under /
undeveloped breast for the age and breast
development should be assessed according to
tanner’s staging .
Women with secondary amenorrhea may have
galactorrhoea---Post Pill, prolactin secreting
pituitary tumor, hypothyroidism, drug induced .
Woman. Should be taught to-do self breast
examination.
22. Method of breast examination
Clinical examination of breast should be carried out
with the pads of 3 middle fingers of both hands
, with the patient(raised arms above her head and
arms by side of her chest ) while she is sitting on
stool / in supine position lying down on examination
coach.
Each breast should be examined systematically for
lumps if present –size location mobility
, consistency and nipple discharge if present should
be collected on glass slide for microscopy.
Compare both the breast in each aspect .
23. Systematic Breast Examination
Position –sitting with arms raised.
Extent ---lateral boarder of sternum to posterior
maxillary line and from clavicle to costal margin.
Inspection ---col0r of skin, pigmentation , engorged
subcutaneous blood vessels, edema , dimpling , puddie
–orange skin. Nipple retraction , nipple eczema.Any
visible swelling, ulcer, accessory nipple.
Palpation --- nipple discharge , palpable mass / cyst---its
size location, boundaries , mobility , consistency
, adherent to skin / underlying pectoral
muscle, tenderness, local rise in temperature and
surrounding tissue thickening.
Regional lymph nodes --- axillary group and
supraclavicular.
25. Stepwise Self Examination of
Brest Stand in front of mirror and look at your breast well expose as in previous slide-
Step 1-- to look at breast while standing with arms hanging next to the body .
Step2– Look at breasts when arms are behind your head.
Step 3– look at breasts while arms are by the side with hands resting at hip
bones.
What to look for ?
Look for any change or difference in color, size shape, dimpling , any visible
prominent swelling in any part of either breast. Look for any in drawing /
retraction of nipple.
Step 4– feeling of( palpation ) whole surface and consistency of either breast
with flat of all the fingers pressed firmly against breast( right hand for left and
left hand for right breast ) in a circular fashion ; starting from areola to its
margins e.g from chest bone to the fold of arm pit and from collar bone to lower
limits of rib boarder. Brest is even and any abnormality can be appreciated easily
in the form of nodule/ swelling . . Feel the arm pit for ant nodule / swelling in the
tail of the breast / lymph nodes.
Step 5--- Nipple is picked in thumb and index finger, lit it out , sqeez for any
discharge --- milk, watery/ blood stained.
Step 6--- Feel for breast and nipple in the same manner as in step 4&5 , but
34. Systemic Examination
CVS– heart sounds, any murmur , parasternal heave , Epigastric
pulsation, prominent jugular veins. Compare all the peripheral
pulses in cases of turnner’s syndrome as coarctation of aorta
may co –exist.
Respiratory system--- Rate, breath odour, cynosis , clubbing
, breathlessness at rest / exertion/ bilateral lung examination---
air entery, chest movements, percussion (any dullness or hyper
resonance) , breath sounds and adventitious sounds(
crepitation , ronchi, plural rub etc).
Spine-- scoliosis, lordosis. Kyphosis, fracture spine / tenderness
over any spinal vertebra especially in menopausal women .
Mental function – orientation to place, time . Pituitary dwarf
are intelligent and have poor sex development while thyroid
dwarfs are having low IQ.
CNS--- when intra cranial lesion is suspected.
35. Abdominal Examination
Inspection---color of skin, pigmentation , caput
medusa, prominent veins and direction of blood
flow in them, protrusion of umbilicus/ its
displacement. Umbilical slitting –transverse or
vertical, thoraces-abdominal respiration , shape(
saphead / distension may be due to fat , as
cites, fetus , mass. Distended bladder, flatus and
faeces).Hernia sites ,striae gravidorum , linea
nigrans and albicans, bruises ., visible pulsations ---
intestinal / aneurism of abdominal aorta.cunter
irritation marks/ scar of previous surgery.
45. Abdominal Palpation
Palpation should be started from the are which has no pain .
Palpate for liver , spleen and kidney enlargement if any present
and describe it well in terms of size, shape margin ,consistency
surface, margin and tenderness ?
If mass is present – its localization and extension in abdominal
quadrant quadrants; is it arising from pelvis (lower pole can not
be reached as it is below symphysis pubis joint) ,is it arising in
abdomen and growing down?.
feel for its shape, margins all round, consistency(soft, solid . Firm.
Hard, variable , mobility—(up --down , side to side or tangential
to line of attachment of mesentery, does the abdominal wall
moves over it with respiration), nodularity , oblation.
Any tenderness ,muscle guarding / rigidity. Rebound tenderness.
49. Abdominal percussion
For generalized dull note --- ascites ,fluid thrill and
shifting dullness can be noted.
Abdominal mass maybe dull with in its boundary ( if
cystic fluid thrill may be present) rest abdomen will
be resonant as in cases of large ovarian cyst /
hydronephrosis.
Solid tumors will be dull.
Hyper resonant abdomen present in cases of
intestinal obstruction due to distended bowel loops
with gases.
Liver dullness is obliterated in intestinal perforation /
or after pneumoperitoneum create in laparoscopy.
52. Abdominal Auscultation
Very useful to auscult intestinal sounds --- if
absent, paralytic ileus –high pitched
exaggerated sounds in intestinal obstruction ;
rarely a bruit may be heard on hyper vascular
fibroid .
Pulsatile tumor may be aortic aneurism / solid
tumor sitting over normal aorta may also
conduct sound .
Bruit in renal angle present in cases of renal
artery aneurism ---- secondary Hypertension
54. Examination of Female Genital
Tract Positions --- dorsal, left lateral ( sim’s ), Knee elbow .
Examination is usually performed in dorsal position with hip
and knee flexed and feet resting on the examination couch .
Her buttocks are brought down to the edge of tail end of the
couch.
Lithotomy position with legs in strips is to combersom to
patient for examination in OPD. It is used in MOT while doing
short office procedure with / with out sedation.
Gynaecologist stands on her right side nearer to her foot end.
Head of patient can be with pillow raised to relax the
abdominal muscles.
Examination is conducted in the same order as described in
next slide
110. Female child 46 XX with congenital adrenal hyperplasia -----clitoral enlargement
, fusion of poorly developed labia with narrow vestibule --- urethral and vaginal
openings
122. Vaginal Per Speculum
ExaminationVagina Cervix
Color
Dryness / discharge
Mucosal Lesions
Cysts
Growth
Bleeding from vaginal
Mucosa.
Structural anomalies
Color
External OS
Tears lacerations
Ectropion
Erosion
ulcer
Sqamo columnar Junction
Transitional Zone .
Discharge.
Nebothian Follicle / cyst
Polyp / growth/ protruding IUCD thread
Bleeding on touch
Bleeding through os
Examination after application of acetic acid
and Lugol’s iodine with naked eye if needed
---Colposcopy as office procedure
140. Abdomino- pelvic Bimanual Examination
Gloved, lubricated index and middle fingers are insert in vagina
after cleaning vulva and vestibule with antiseptic lotion and
separating both labia with the finger and thumb of left hand.
Once internal finger reach the cervix the palmer surface of all
fingers of left hand are placed parallel to S.P. over supra pubic
lower abdomen.
Direction of cervix is decide – forte ward ( if external is facing to
and anterior lip is near to S.P. / Backward when external os is
facing posterior fornix and anterior lip is facing posterior
vaginal wall. Feel for its consistency(soft in pregnancy / firm –
normal / hard in malignancy . tender Cx on movement ---
ectopic/ acute inflammation. Ulcer / protruding growth /polyp /
valvety erosion and IUCD thread may also be felt ; protruding
down in / through cervical canal , slippery shaft , smooth
mucous polyp may some time be present.
141.
142. Abdomino- pelvic Bimanual
Examination Now put your both fingers in posterior fornix
, uterus is pushed upward and anteriorly towards
the abdominal hand and uterus is palpated
between two hands --- its size , shape , surface
, consistancy and tenderness.
If uterine fundus and its posterior surface can be
palpated ---uterus is ante flexed (AF) ante verted
(AV) , if uterus can not be lifted and its fundus is
posterior in POD ---it is retro flexed (RF) and
retro verted ( RV )
143. Abdomino- pelvic Bimanual Examination
The normal uterus is anteverted, anteflexd , pear
shaped firm,6-7 cm long and 4cm wide at its
fundus. mobile regular and non tender.
Normal adnexa is not palpable , all fornices are
free / empty, non tender .
Ovaries are about3x2 cm in size and usually not
palpable unless enlarged.
Palpable ovary in menopausal women should be
viewed with suspicion.
145. Abdomino- pelvic Bimanual Examination
Vaginal fingers are now to lateral (right and left )
fornices respactvely to palpate ; while abdominal
hand is placed just medial to ipsilateral
anteriosperior iliac spine well above the poupart’s
ligament and adnexa is palpated in between two
hands.
Some time to palpate thickening / induratin /
infiltration in recto vaginal fascia one has to
per0form bimanual rectal and vaginal examination
at the same time ---index Finger in vagina and
middle finger in rectum with their pulp facing
anteriorly; left hand is put on abdomen as usual for
performing bimanaual palpation.
146. Bimanual Pelvic Examination – PV and PR simultaneously; to palpate the involvement of
anterior Rectal and posteriorVaginal wall By malignancy / Endometriosis
147. Bimanual examination – findings to be
noted-----1. Uterus
Anteverted / anteflxed / midposition / shifted to
right or left side of mid line/ retroverted /
retoflaxed.
Size—normal / enlarged ( measured in terms of
enlargement as in gestational period )
Shape –regular/ irregular
Surface – smooth / bossed / uneven
consistency– firm / soft / heard / variable
Mobility– mobile / fixed / restricted.
Tenderness– absent / present
148. Bimanual examination – findings to be
noted-----
2.Adnexa-->
Palpable / not palpable
size –in approx Cm in all diameters—longitudinal / transverse / oblique.
Shape
Surface – regular smooth / nodular / lobulated.
Unilateral / bilateral
consistency--- soft/ cystic / firm / hard / variable.
Mobility --- mobile/ fixed / restricted .
Tenderness --- absent / present .
Induration .
Attachment to uterus --- does it move with uterus or cervcal movements /
while moving the adnexal mass uterus/ cervix also move .
3. Pouch Of Douglas
Any mass / thickening nodules fixed / fullness / tenderness / raised local
temperature / consistency of mass / fullness.
4.Per rectal Examination
thickening / indurations / adherent / ulcerated anterior rectal wall / sacral
ligament / recto vaginal fascia.
153. PV examintion in OvarianTumor __lump is separate from normal sized
Uterus
154. pelvic mass in left Fornix lateral and separate from Uterus , there is
free area ( cleavage in between Cervix and medial side of lower
pole of tumor
Cleavage/ free area
Cervix
tumor
155. Differentiating uterine from adnexal
mass
Criterias Uterus Adnexal mass
Location Central lateral
Size normal in size uterus / if
enlarged its size varies
Palpable if enlarged
adenexa
Groove between mass and
uterus
absent present
Transmitted mobility present Absent
156. Special situations
Children, adolescent and old women present special situation.
Children – local examination of vulva and vestibule should be
examined in presence of and with the help of her mother in
separating thighs and labia apart, speculum and pv
examination is not done if indicated ; it can be done under
general anaesthesia by using nasal speculum . Pr with little
finger will replace pv examination.
Adolescent Girls avoid speculum/ pv examination , pr can be
done, if pathology is highly suspected USG can help ; still some
vaginal examination / procedure is must the it should be done
after proper counselling , proper consent and under sedation /
anaesthesia.
Post menopausal women with narrow introitus due to estrogen
deficiency --- small size speculum with lubrication should be
used.
157. Screening / diagnostic procedures done
at the time of gynaecological
examination
Pap Smear .
Examination of vaginal / cervical/ nipple
discharge. A- saline preparation ; B- KOH
preparation ;C- Gram staining.
Endometrial sampling.
Culdoscentesis.
158. Current Recommendations For Pap
Smear.
Start at the age of 21 year --- if sexually active.
Once in 2 years till 30 years age .
Once in 3 years there after --- if HVP DNA
negative , low risk factors present for developing
Ca Cervix, last 3 samples are negative.
Annual Screening ---High risk for cancer / HVP
DNA positive.
Stop at 65 age if no positive smear in last 10
years.
159. Diagnosis of vaginitis by Examination Of
DischargeDiagnosis (Chief
complain)
Wet Film KOH Preparation Gram Stain
BacterialVaginosis (
Watery vaginal
discharge with bad
smell)
Clie Cells Fishy odour (Amine)
T.Vaginalis Vaginitis (
cream colored frothy
vag. Dis.With burning
at vulva)
FlagillatedOrganism
Candida Albicans (
thick curdy vag. Dis.
With itching at vulva)
Fungal Hyphae
, Spores
Gonococcal cervicitis
( dysurea, mailase
feverish ness
Gram Negative , intra
cellular diplococci.
160. Clue cells in Vagnalis vaginosis (Squamous
Epithelium Cells Loaded with Anerobes –
Gardenella Gondi
161. Large Motile Protozoa--- Trichmonas
Vaginalis.
Flagella
Nuclus
Undulant Membrane
Inclusion Bodies in
Cytoplasm