female rectal exam

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Physical exam on 11 February 2007, 7:45 pm
ID: Ms. Betty Boop, an ageless Caucasian woman, cartoon / entertainer, single, no

Relevant history:
Ms. Boop is G0. LMP was in 1952. Does not currently use any form of birth control.
No history of any STDs. No dyspareunia or vaginal bleeding after coitus. No
gynecologic surgeries. No incontinence, burning on urination, discharge, or known
vaginal prolapse.

Vital signs
Temp:       72 °F                     Pulse:     24 frames / second
Resp:       not measured              BP:        couldn’t find a 2-d cuff
Pulse-ox:     21% (on room air)       Pain:        0
Height:       5’ 3” (by pt. report)   Weight:      102# (by pt. report)

General & MSE
    Ms. Boop is here today for her semi-centennial check-up. She is alert and oriented x
1 (person), she is unaware of her location or the current century. She is dressed rather
formally and very well groomed. Eye contact is fleeting and she appears quite agitated as
she dances around the examining room. Her mood is elevated and her affect is quite
labile. Her speech is pressured and actually comes out more sing-songy, very high-
pitched and rapid. Thought process is circumstantial with loose associations, bordering
on flight-of-ideas. Content is grandiose with notions of being every man’s heartthrob.
No suicidality or homicidality. Responding with singing and dancing to “the background
music” that only she can hear. Insight and judgment are poor. Recent memory and
higher cognitive functions are impaired.

Breast & Axilla
Inspection: Breasts are symmetric with no skin lesions, dimpling, or retractions. Nipples
are everted with no apparent discharge. Pigmentation is normal, no dermatitis.
Palpation: No tenderness, masses, or enlarged lymph nodes are palpated in breast or
axilla. No nipple discharge is expressed. Breasts are fibrocystic in consistency.

Inspection: Hair in normal distribution, Tanner stage 5. No lesions on vulva, labia,
urethral meatus, or introitus. Mucosa is atrophic. No discharge.
Palpation: No tenderness or lymphadenopathy in inguinal or femoral nodes. No femoral
or inguinal hernias. No swelling, tenderness, or discharge from Bartholin’s glands. No
cervical motion tenderness. Uterus small, anteverted. No adnexal tenderness or masses
palpated on bimanual exam.
Pap smear: Cervix visualized well, os nulliparous, cervical epithelium normal with no
discharge or polyps. Sample obtained with broom, looks sufficient, sent for
cytopathology in liquid. No bleeding visualized afterward.
                                 (draw as appropriate)

No hemorrhoids or perianal lesions. Sphincter tone is normal. No rectovaginal fistula.
No stool is felt in the rectal vault. No nodules or polyps appreciated in the rectum.

Fecal occult blood testing was completed with an adequate sample, negative with
appropriate controls.

                                                                     Dorian Gray, MS-2
                                                                          p: PIC-TURE