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.