The Breast and Female GU
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. What would you like to do?
What are the axillary lymph nodes and how are they positioned?
When is the best time to do a clinical Breast exam?
5-7 days post menstruation
What are UPSTF and ACS position on BSE?
- UPSTF: Providers SHOULD NOT teach BSE
- ACS: women's choice
Mammogram screening ACS vs UPSTF?
- - 50 and > q 1-2 years
- -Against clinicians teaching women how to perform BSE
- After age 40
- - Annual CBE
- - Monthly BSE – optional
- - Women at high risk – MRI and mammogram every year
- - Women at moderate risk – Mammogram and possible MRI every year
- - Women at low risk – Mammogram every year
- -Ages 20 to 39
- CBE every 3 years
- Monthly BSE – optional
RF of BC?
- 50 or older
- Family hx - 1st degree relative = positive family hx
- early menarche, delayed menopause
- 1st live birth after 35 or no pregnancy at all.
What are the 4 views to examine the breast? ( esp dimplig and retraction)
- arms at side
- arms over head
- arms pressed against hips
- leaning forward
How is menopause define?
12 months without period - usually between the ages of 45-52
What does post-menopausal bleeding indicate?
- bleeding that occurs
- after 6 months w/o periods and warrants further investigation. (possible
- endometrial cancer)
What are some general considerations that the patient should keep in mine before doing the vaginal exam?
( vaginal interactions, bladder? gowning/drapping, gloves, etc )
avoid intercourse, douching or use of vaginal suppositories for 24-48 hrs before examination.
- -The patient must have an empty bladder.
- -The patient must be appropriately gowned
- and draped.
- - Use non-sterile gloves on both hands. You may want to double-glove your dominant hand
- -Properly dispose of soiled equipment and
- -Both male and female examiners should be
- chaperoned by a female assistant.
- - Always tell the patient what you are
- about to do before you do it.
What are the 2 most basic shapes of speculum and how are they different from eachother?
- Medium Pedersen: usually most comfortable for sexually active women
- Narrow bladed Pedersen: best
- for pts w/ small introitus, such as a virgin or an elderly woman.
- Graves: for parous women with vaginal prolapse
How do you perform a vaginal exam when the vaginal orifice is smaller?
- When vaginal orifice is even smaller, a fairly good bimanual exam can be performed
- by placing 1 finger in the rectum rather than in the vagina.
Sign and Symptoms of PID
pain with adnexal tenderness, and mvt of cervix
In what type of women is it expected to not feel or difficult to palpate ovaries?
- - post menopausal women
- - obese women
- - women difficult to relax
- ovaries are palpable in ½ women in
- reproductive years.
- Fallopian tubes cannot be felt.
How do you perform a vaginal exam with hands or with speculum?
see notes for elaborate answer
What are some RF for cervical cancer?
- HPV infection ( RF to that: Immunosuppresion,
- High parity, Cigarette smoking, Long-term use of oral contraceptives, Nutritional
- women who begin to have sex early
- multiple sexual partners
SS of cervical cancer?
- - Abnormal vaginal bleeding
- Between menses.
- After sexual intercourse, douching, or a pelvic exam.
- Menstrual bleeding may last longer and be heavier than usual.
- Bleeding after menopause
- Increased vaginal discharge
How to prevent CC?
What is the difference between the 2 types of HPV vaccines?
When can boys and girls get them?
- Monogamy, Condoms
- HPV Vaccine
- - Gardasil
- * Prevents 4 HPV types (6, ll, 16, 18)
- * Shown to also protect against cancers of the anus, vagina, and vulva.
- *Licensed to use in males
- Prevents 2 HPV types (16, 18)
- Both vaccines are administered as a 3-dose series
Routinely recommended for 11 and 12 year old girls (can be started as early as age 9)
Also recommended for ages13-26 in females
, and 13 through 21 in males
Explain the physiology of the cervix?
- Columnar --> endocervix
- Squamous --> ectocervix
- - Original- border where original squamous cells meet columnar cells - Present- innermost border where maturing squamous cells meet native columnar cells.
What is the transformation zone?
- Area of actively maturing epithelium between present SCJ and original SCJ -->
- 90% of neoplasias occur in this area
- sample area for papsmear
Pap smear - when to start?
Even of pregnant?
When to stop?
- Pregnant and < 21 = NO!
- Stop: > 65, after total hyterectomy
Population not appropriate for a pap?
-HIV positive women
- Women who are immunosuppressed
- -Women who were exposed to
- diethylstillbestrol (DES) in utero
- - Women previously treated for CIN2, CIN 3
- or cancer ( These women remain at risk for persistent or recurrent disease for
- 20 years after treatment)
Guidelines for obtaining speciment to test for pap smear?
- - Obtain one specimen from the endocervix
- and another from the ectocervix, OR
- a combination specimen using the cervical brush
- Cervical scrape/ Endocervical brush
--> Place longer end of scraper in cervical os, press, turn and scrape in a full circle ( 360 degrees) making sure to include the transformation zone and SJC --> Smear the specimen on a glass slide. Set slide on safe spot that is easy to reach
- For pregnant women:
- cotton tip applicator, moistened with saline is best instead of the endocervical brush.
- Cervical Broom
--> plastic brush tipped with a broomlike fringe for collection of a single specimen containing both squamous and columnar epithelial cells.
- - Yellowing d/c on cervical swab =
- mucoprurulent cervicitis ( caused by Chlamidia, gonorrhea, herpes simplex)
How are Pap smear reported?
- The Bethesda System of
- Reporting Pap smear results
What would you like to do?
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