Examination of gynecological patient. ten teachers summary. i hope it's helpful!

1. Examination of gynecological patient
1. General examination:
a. Hands andmucous membranes:anemia.
b. SupraclavicularLNs:virchow’snode onleftside  troissier’ssign
2. Thyroidgland
3. Chestand breasts:
a. mainlyif there’sasuspecionof ovariantumor(krukenberg)
b. Pleural effusion asaconsequence of ascites
4. Neurological exam
5. Abdominal exam:
a. Patientshouldemptyherbladderbefore examination  ddx pelvicmass
b. Semi-sittingposition
c. Start by inspectionformasses,dilatedveins,scars(pfannenstielscar),and
hernia/divercationof recti.
d. Palpation forabdominal andpelvicmasses; organomegaly,andperitoneal signs.
Palpate forhernial orificiesandLNs. N.B.:youcan’tget below pelvicmasses.
e. Percussionforshiftingdullness,andfluidthrill.
f. Ascultationof bowel soundstoR/Obowel obstruction.
6. Pelvicexam:
a. If the C/Oisn’tincontinence;askthe patienttoemptybladder.
b. If a UTI issuspected,askthe patienttogive a urine sample.
c. Inspectionof genetaliaandsurroundingskininlithotomyorleftlateral position.
d. Askpatienttostrain andto cough  view prolapse orurinanryincontinence.
e. Use speculumtovisualise the vaginaandcervix  use wateraslubricantif to
take a sample.
f. Bimaual examtopalpate the cervix forirregularity,hardness,andtenderness.
g. Palpate the fundusviaabdomenforshape,size,position,mobility,consistency,
and tenderness.
h. Palpate the adenexae viathe lateral fornicesforswellingandtenderness.
i. Palpate the uterosacral ligamentforscarringor tendernessinendometriosis.
7. Rectal exam:
a. Can be done inchildrenoradultswhoneverhad intercouse.
b. Usedto ddx rectocele fromenteroceleviapouchof douglas.
c. Rectovaginal examtoidentifyalesioninthe rectovaginal septum.