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Perform a focused physical examination on a reproductive-aged woman

Learner Task: Perform a focused physical examination on a reproductive-aged woman.
Educator Script: Provide the following details of focused physical examination as asked by the learner:

  • Vital Signs: 37.5°C, BP 122/68 mm Hg, BMI 33 kg/m2
  • HEENT: Examination shows pale mucous membranes. She has no exophthalmos and her thyroid is symmetric, slightly enlarged, non-tender.
  • Pelvic examination: No vulvar, vaginal or cervical lesions. You palpate an enlarged, midline pelvic mass, approximately 16 weeks in size. It is non-tender with irregular contour. You do not think there are any adnexal masses, but are unsure. There are no hemorrhoids present. 

Educator Checklist: Physical Examination

Mark the appropriate column to indicate whether the learner included each element in his or her response. When completed, tally the “Included” column to calculate the learner’s score.

Other Included =1 Not Included =0
Asks for at least 2 vital signs
Performs at least two components: mucous membranes and exopthalmos, palpates thyroid
General Approach and Communication Skills
Properly introduces himself or herself to the patient
Asks patient how she would like to be addressed
Clarifies purpose of visit
Washes hands or uses an antiseptic wash
Uses appropriate draping techniques for patient privacy
Maintains sterile technique
Performs the exam in a systematic fashion
Prefaces exam maneuvers with simple explanations
Establishes and maintains rapport with the patient
Makes the patient feel comfortable
Closes the exam in an appropriate manner
Gives explanations in clear language, avoids jargon
Invites questions/ checks for understanding
External Examination
Checks all equipment/supplies
Adjusts exam light prior to gloving and washing hands
Positions patient on back, hips to end of table and heels on foot rests
Examines external genitalia
Inspects mons pubis
Inspects labia majora
Inspects labia minora
Inspects clitoris without touching clitoris
Inspects urethral meatus
Inspects introitus
Inspects Bartholin’s gland
Inspects perineum
Inspects anus
Speculum Examination
Holds speculum at 45-degree angle
Inserts speculum properly
Rotates speculum at full insertion
Opens speculum slowly
Identifies cervix
Secures speculum in open position
Handles speculum appropriately
Removes speculum appropriately
Bimanual Pelvic Examination
Introduces correct two fingers into vagina with thumbs tucked
Palpates cervix and cervical os
Palpates uterine body, apex of fundus
Notes uterine size
Describes position of uterus
Palpates right adnexa/ovary
Palpates left adnexa/ovary
Instructs patient to return to sitting position at the conclusion of exam
Rectovaginal Examination*
Re-gloves for RV
Asks patient to bear down as finger is inserted
Inserts middle finger into rectum
Inserts index finger into vagina
Palpates uterus
Palpates right adnexa/ovary
Palpates left adnexa/ovary

*Often not performed – student only asked about technique.