骨盆 II: 窥镜考试成绩

A speculum is a bivalve instrument used to separate the vaginal canal walls, allowing visual inspection of the cervix and access for specimen collection. Two types exist: disposable plastic and reusable metal. Plastic specula are most commonly used in clinics for routine testing, while metal specula come in Graves and Pederson designs for different patient anatomies.

Hold the plastic speculum in your non-dominant hand with your index finger above the bills, middle finger below, and thumb on the back, avoiding the thumb lever. Insert it halfway into the vaginal canal at a 45-degree angle, then rotate it flat while clearing the labia. Angle the tip toward the floor and insert fully until flushed against the pelvis.

During cervical inspection, observe the exocervix, which is normally 2-3 centimeters in diameter, pink, and smooth; the external os, the opening of the endocervix into the vagina; and the four fornices, recesses between the cervix margin and vaginal wall. Note the cervix's tone, color, position, and any discharge, lesions, polyps, ulcerations, or masses.

Insert the spatula with its long end in the external os and short end against the squamocolumnar junction, then rotate 360 degrees while maintaining pressure. Remove and rinse vigorously in the liquid cytology canister. Next, insert the endocervical brush into the os until only bottom bristles show, rotate 180 degrees, remove, and rinse thoroughly by swirling and pressing against the canister sides.

The Pap test detects abnormal cells in the cervix, both cancerous and precancerous, enabling early intervention. Discovered in 1928 by Georgios Papanicolaou, this screening method has significantly reduced cervical cancer cases and deaths in the United States. Current screening guidelines are available through the U.S. Preventive Services Task Force website.

Use patient-friendly language, referring to speculum "bills" rather than "blades" to avoid anxiety. Show the speculum without pointing it directly at the patient and explain what to expect. Establish non-invasive contact first by placing your hand on their thigh, then teach relaxation techniques like bearing down to help the vaginal introitus open naturally.

Release the locking mechanism by pressing down the thumb lever and remove the speculum two to three inches to clear the cervix from the tip. Remove your thumb from the lever and place it on the handle. Rotate the speculum 45 degrees while smoothly removing it completely. Keep your hand underneath to catch any discharge, then discard if disposable.