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.