Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med Exam 4 > 20 - Anus, Rectum and Prostate > Flashcards

20 - Anus, Rectum and Prostate Flashcards

1
Q

Common patient concerns

A
  • Changes in bowel habits
  • Blood in stool
  • Pain with defecation; rectal bleeding or tenderness
  • Anal warts or fissures
  • Weak urine stream
  • Burning with urination

(These make good screening questions, too.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Melena

A

Black, tarry stools

Can be caused from high protein, bleeding from a high source in the GI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Stools that are black, but not tarry

A

Iron

Bismuth salts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hematochezia

A 
Red blood in stool
Lower source (colon, rectum, or anus)

Hemorrhoids, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Reddish, nonbloody stool

A

Ingestion of red foods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the difference between screening and diagnosing/treating?

A

Screening is for people who don’t have symptoms

If someone has symptoms, you are diagnosing and treating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Do you screen for prostate cancer?

A

No, the USPSTF ranks this screen at a D, which indicates no screening

D = “don’t screen”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does “cancer” mean?

A

Social term referring to biological agent that will kill a person before their natural time of death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does “screening” mean?

A

When you are looking for disease or dysfunction when the person doesn’t have symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If a patient has symptoms, what are you doing when you try to find the problem?

A

Diagnose, NOT screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Prostate Cancer Stats

A
  • Leading male cancer diagnosis
  • Second leading cause of death
  • Risk increases after 50
  • African Americans higher risk - Caucasian (earlier age, more advanced)
  • Family history and diet are relevant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

According to the USPSTF, what does a D mean?

A

Recommends against the screening service. There is a moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.

The suggestion discourages the use of screening.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the two ways that we can screen for prostate cancer?

A 
PSA = prostate specific antigen
DRE = digital rectal examination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the appropriate plan of action for prostate cancer screening?

A
  • At 50 years, talk to patient, discuss pros and cons

- At 45 years with an at-risk male, begin screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What makes a male at-risk?

A

African American

Father or brother with prostate cancer before 65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What should you NOT test with these patients?

A

PSA: Prostate specific antigen

Not a good representation of risk or need for intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do we know about screening for prostate cancer based on screening studies?

A

They are commonly recommended and uncommonly useless

18
Q

What do we know about PSA?

A

Prostate specific antigen

  • Used to think it was a biomarker for early detection
  • Many limitations (elevated in benign conditions, false positives, false negatives, unnecessary testing such as biopsies)
  • “Over diagnosis”
  • Side effects with treatment are common
19
Q

What do we know about DRE?

A

Digital Rectal Examination

  • Low sensitivity: 59%
  • Specificity: 94%
  • Detects tumors on the posterior and lateral aspects
  • Misses 25-35% of tumors arising in other areas
  • Abnormal findings need to be investigated
  • Can combine prostate and colo-rectal exam
20
Q

Is colorectal cancer screening recommended?

A

Depends on the age…

  • 50-75 = grade A
  • 76-85 = grade C
  • Over 85 = grade D
21
Q

What do we know about colorectal cancer screening?

A
  • There is an average risk, so we screen for it
  • Starting at 50 years for both male and female
  • Need annual high-sensitivity fecal occult blood test (if positive, need a colonoscopy)
22
Q

What increases risk for colorectal cancer?

A
  • Inflammatory bowel disease
  • Family history of an inherited polyposis syndrome
  • At risk means you should have a colonoscopy every 3-5 years
23
Q

When do you do a female DRE?

A

During pelvic exam

Be careful because the cervix, a retroverted uterus or even a tampon can mimic a tumor

24
Q

DRE technique

A
  • Position and drape
  • Gloves
  • Inspect sacrococcygeal and perianal areas
  • Lubricate index finger
  • Explain to patient may feel sense of urge
  • Pad of finger on anus
  • Introduce finger with relaxation
  • After: Wipe or offer tissues
25
Q

Common abnormalities found during DRE exam

A

Prostate

  • Prostatitis
  • Benign Prostatic hyperplasia
  • Cancer

Rectum/anus

  • Anal fissure
  • Polyps
  • Cancer
  • Hemorrhoids
  • Prolapse
26
Q

Signs of bacterial prostatitis

A 
Dysuria
Frequency
Nocturia (new)
Hesitancy
Suprapubic pain
Painful ejaculation
“Flu-like” symptoms
27
Q

Classic symptoms of prostatitis

A

Calor (warmth)
Dolor (pain)
Rubor (swelling, redness, heat)
All of the above refer to inflammation

Tumor

28
Q

What test results will you see in prostatitis?

A

DRE controversial
Labs: elevated WBC and positive UA
PSA would be elevated, but we don’t screen

29
Q

What are the signs of benign prostatic hypertrophy?

A 
Urgency
Frequency
Nocturia (gradual)
Hesitancy
Weak stream
Hematuria (non-specific)
30
Q

What are the symptoms of benign prostatic hypertrophy?

A

Enlarged
Nontender
Hard
Symmetrical

31
Q

Is the PSA useful in benign prostatic hypertrophy?

A

NO

32
Q

Signs of prostate cancer

A

Same as BPH

33
Q

What are the symptoms of prostate cancer?

A 
Nodules
Nontender
Induration
Asymmetric
Lateral lobes
34
Q

Is the PSA useful in prostate cancer?

A

NO

35
Q

Anal fissure

A
  • Tear in skin at anus
  • Acute
  • Small amount blood
  • May appear large
  • Cause is straining or constipation
  • Treat conservatively
36
Q

Anal fistula

A
  • Infected anal gland
  • Above dentate line
  • Chronic draining abscess
  • Bypasses external sphincter
  • Surgical treatment (except in Crohn’s)
37
Q

Hemorrhoids (external)

A

Painful
Thrombose
Skin tag

38
Q

Hemorrhoids (internal)

A

Painless
Bleed
Protrude

39
Q

Prolapse

A
  • Protruding mass
  • Reducible initially
  • Associated with poor bowel habits, digital disimpaction, chronic constipation
40
Q

Polyps

A
  • Polyps
  • Intestinal growths
  • May be asymptomatic, bleed or obstruct
  • Found on DRE or colonoscopy
  • Biopsy mandatory
  • Classification big topic
41
Q

Rectum and anal cancer

A
  • Staged
  • Screening is effective
  • Risk based (symptoms, family hx)
  • Surveillance for (+)
  • USPSTF recommended
42
Q

Anal PAP

A

Anal screening cytology or DNA

Goal uncertain; USPSTF NO recommendations

  • Initial screening in high risk populations
  • Similar reporting as PAP

Technique

  • Water moistened polyester fiber
  • Left lateral position
  • Swab gently inserted to stop point
  • Remove swab with a spiral motion
  • Sample fixed with ethanol or liquid cytology

Clin Med Exam 4 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions