WGU D117 Female Exam/Updated A+ Score Solution
1. Discuss the female gynecologic exam techniques and the order
in which they should be performed.
2. Explain the anatomy that should be assessed with each
technique in each exam section.
The first part of the exam should be the history and physical
questions while the patient is fully clothed. This allows the patient to
remain comfortable. After, instruct the patient to remove clothes
from the waist down and provide them with a gown or sheet to
cover. To continue the exam, consent should be given, and a
chaperone should be present. The provider should wash hands and
wear gloves during the entire procedure.
You begin with the Breasts and axillae exam, this is done to
look for any lumps, redness, tenderness, or swelling on the
breasts or adjacent lymph nodes.
o It is recommended by the American College of
Obstetricians and Gynecologists that clinical breast
examination starts at the age of 25, with mammograms
at the age of 40.
o To begin the breast examination, the patient should be
seated facing you so you can visually examine the breast
for size, shape, texture, color, and symmetry. This should
be done in a few different positions: seated normally,
having the patient put their hands behind their neck,
then move their elbows forward slowly, and then put
their hands on their hips and roll their shoulders forward.
(Inspecting the Breasts in Different Positions, n.d).
o For Palpation of the breast tissue, have the patient lay
supine on the bed and place their hand behind their head
for the side you are examining. It is recommended to use
a pattern so as not to miss any tissue. For the concentric
circle pattern, you begin at the outer edge of the breast
tissue and go clockwise, circling inward as you get back to
the “12” position. There is also the wedge pattern and
, vertical strip pattern. (Following Patterns for Breast
Palpation, n.d).
o Next, the axillae lymph nodes should be examined. Have
the patient sit facing you on the table, have the patient
bend their right elbow, and place their arm in yours. Use
the finger pads of your left hand to examine the right
axillae by pressing firmly into the first rib and gently
rolling your fingers downward. Be sure to examine all
areas of the axillae, then down the arm to the elbow, and
finally down the midline to the bra line. Repeat this
procedure on the left side. Then, have the patient slightly
tip their head forward to examine the supraclavicular and
infraclavicular lymph nodes. These nodes should not be
palpable in adults. (Palpating Lymph Nodes Near the
Breats, n.d).
o Finally, the supraclavicular and infraclavicular also need
to be examined. These are found above and below the
collarbone. Palpate the area to check for tenderness or
swelling.
• Next, you should examine the Female genitalia, this is done
to access the vulva and perineum.
o At this point in the exam, have the patient lay back on the
bed and position their feet in the stirrups in the modified
lithotomy position.
o A systemic approach is suggested for evaluation,
beginning with visually inspecting the mons pubis for any
lesions, warts, or blisters. Next, inspect the inguinal area
for rash, redness, and enlarged lymph nodes. Next,
thoroughly examine the vulva and labia majora. Assess
for lesions, redness, itching, and thickening of the skin.
Next, assess the labia minora for white plaques, “lacelike”
striae, and any fusion of normally separated skin areas.
Assess the vestibule, skene's glands, and vestibular
glands for redness or inflammation. Lastly, assess the
perineal area for pigment changes, rashes, fissures,
1. Discuss the female gynecologic exam techniques and the order
in which they should be performed.
2. Explain the anatomy that should be assessed with each
technique in each exam section.
The first part of the exam should be the history and physical
questions while the patient is fully clothed. This allows the patient to
remain comfortable. After, instruct the patient to remove clothes
from the waist down and provide them with a gown or sheet to
cover. To continue the exam, consent should be given, and a
chaperone should be present. The provider should wash hands and
wear gloves during the entire procedure.
You begin with the Breasts and axillae exam, this is done to
look for any lumps, redness, tenderness, or swelling on the
breasts or adjacent lymph nodes.
o It is recommended by the American College of
Obstetricians and Gynecologists that clinical breast
examination starts at the age of 25, with mammograms
at the age of 40.
o To begin the breast examination, the patient should be
seated facing you so you can visually examine the breast
for size, shape, texture, color, and symmetry. This should
be done in a few different positions: seated normally,
having the patient put their hands behind their neck,
then move their elbows forward slowly, and then put
their hands on their hips and roll their shoulders forward.
(Inspecting the Breasts in Different Positions, n.d).
o For Palpation of the breast tissue, have the patient lay
supine on the bed and place their hand behind their head
for the side you are examining. It is recommended to use
a pattern so as not to miss any tissue. For the concentric
circle pattern, you begin at the outer edge of the breast
tissue and go clockwise, circling inward as you get back to
the “12” position. There is also the wedge pattern and
, vertical strip pattern. (Following Patterns for Breast
Palpation, n.d).
o Next, the axillae lymph nodes should be examined. Have
the patient sit facing you on the table, have the patient
bend their right elbow, and place their arm in yours. Use
the finger pads of your left hand to examine the right
axillae by pressing firmly into the first rib and gently
rolling your fingers downward. Be sure to examine all
areas of the axillae, then down the arm to the elbow, and
finally down the midline to the bra line. Repeat this
procedure on the left side. Then, have the patient slightly
tip their head forward to examine the supraclavicular and
infraclavicular lymph nodes. These nodes should not be
palpable in adults. (Palpating Lymph Nodes Near the
Breats, n.d).
o Finally, the supraclavicular and infraclavicular also need
to be examined. These are found above and below the
collarbone. Palpate the area to check for tenderness or
swelling.
• Next, you should examine the Female genitalia, this is done
to access the vulva and perineum.
o At this point in the exam, have the patient lay back on the
bed and position their feet in the stirrups in the modified
lithotomy position.
o A systemic approach is suggested for evaluation,
beginning with visually inspecting the mons pubis for any
lesions, warts, or blisters. Next, inspect the inguinal area
for rash, redness, and enlarged lymph nodes. Next,
thoroughly examine the vulva and labia majora. Assess
for lesions, redness, itching, and thickening of the skin.
Next, assess the labia minora for white plaques, “lacelike”
striae, and any fusion of normally separated skin areas.
Assess the vestibule, skene's glands, and vestibular
glands for redness or inflammation. Lastly, assess the
perineal area for pigment changes, rashes, fissures,
