Abdominal Assessment 3

Question 1

male and female reproductive assessment must be done by

Answer 1

advanced care provider

Question 2

breast and female genitalia structures

Answer 2

Quadrants, Tail of Spence, Areola, Nipple, Montgomery’s glands, Lymph Nodes

Question 3

focused breast history

Answer 3

Lump or thickening; Skin changes—red, dimpled, puckered, scaly, or inflamed; Nipple changes—inversion, eversion, discharge; Breast changes—size, shape, contour; Surgery or treatments involving breast; Children, breast feeding; Medications—HRT, BCP; Family—first-line relatives with breast cancer, genetic studies; Psychosocial—Mammogram, BSE; Review of Systems

Question 4

lumps or masses in breast can be normal if r/t

Answer 4

period, but do monthly self breast examine to make sure they don’t enlarge

Question 5

Gynecomastia

Answer 5

breast development in males, caused by certain cancers that alter hormones

Question 6

test braca gene 1 and 2 for

Answer 6

risk of breast cancer, 85 - 95% chance of developing breast cancer

Question 7

Risk factors of breast cancer - Family history

Answer 7

Premenopausal vs postmenopausal; Early menarch; Prolonged menstrual cycle >50; First child after 30 or never pregnant; Caucasian > Oriental; Genetic mutation in BRACA1 or BRACA2

Question 8

breast self exam

Answer 8

Timing (when estrogen is lowest); One week after start of menstrual cycle; 3-5 days after period stops; same day each month when breast are less tender: after hysterectomy, oophorectomy, or menopausal; Technique is important—observe patient performing BSE

Question 9

inspection positions of breast

Answer 9

5 Positions—arms at side, over head, hands on hips, leaning forward, supine with pillow under shoulder

Question 10

Inspect breast for

Answer 10

Size, shape, symmetry; Skin condition, color variation, venous pattern; Nipple direction, discharge

Question 11

lumps or masses

Answer 11

Smooth, round, movable, nontender usually normal; Irregular, poorly defined borders, nontender, immovable may be suspicious for malignancy; Warm, hard, painful–mastitis

Question 12

breast palpation techniques

Answer 12

Vertical strip—up & down across area; Pie wedge—from nipple out; Circle—concentric circles from out to in

Question 13

breast palpation

Answer 13

Feel for lumps or masses; Small circles with middle three finger pads; Examine breast from midaxillary line to sternal notch; nipple

Question 14

axillae and lymph nodes palpation

Answer 14

Tail of Spence; Axillary nodes; Clavicular nodes; Epitrochlear nodes - around upper arm

Question 15

recommendations to look for breast cancer

Answer 15

Self breast exam every month; Clinical breast exam 20-39 years of age; Mammogram every year after 40

Question 16

inspection and palpation of female

Answer 16

Lithotomy position; External genitalia - Labia, Urethral meatus, Perineum & anus, Glands - Skene’s, Bartholin’s; Internal genitalia - Speculum, Vaginal wall, Cervix, Specimens

Question 17

Bimanual exam:

Answer 17

Uterus and Adnexal exam (ovaries)

Question 18

Rectovaginal exam:

Answer 18

occult blood

Question 19

inspection and palpation of male

Answer 19

Hair distribution; Shaft of Penis—uncircumcised, retract foreskin; Scrotum; Urinary meatus

Question 20

palpation of male

Answer 20

Use thumbs and index/middle finger; Usually thumb on top with finger underneath testes; Roll testes between fingers and thumb both horizontal and vertical; Check for hernias and lymph nodes at groin

Question 21

testicular exam

Answer 21

Timing—after warm shower every month; Testicles - shape, size, color (left lower than right), smooth, oval, sensitive to pressure; Epididymis—create bulge on upper back, soft, spongy, not as smooth as testicles; Spermatic cord (vas deferens) - extends into pelvis

Question 22

Testicular Cancer risk factors

Answer 22

Age 20-40 (in young adults); Undescended testicles (cryptorchidism); Family history; Mumps; DES exposure

Question 23

Signs & Symptoms of testicular cancer

Answer 23

Hard, fixed, nontender mass; Scrotal swelling, scrotal heaviness

Question 24

digital rectal exam

Answer 24

Position—stand and bend over exam table; Symptoms—urinary, back pain; Prostate - Benign prostatic hyperplasia/hypertrophy, Cancer; Recommendations - Monthly TSE, DRE (check occult blood) & PSA over age 50

Question 25

factors affection sexuality

Answer 25

Chronic pain; Diabetes; CV disease; Myocardial Infarction; Joints/Mobility; Surgery—body image; Spinal Cord Injury; Mental Illness; STD; Medications

Question 26

inspection

Answer 26

contour symmetry, umbilicus, skin, pulsation or movement, demeanor

Question 27

ausculation

Answer 27

bowel sounds (diaphragm) start RLQ 5-30 min

Question 28

hyperactive bowel sounds

Answer 28

loud, high pitched, rushing sounds increase motility

Question 29

hypoactive or absent bowel sounds

Answer 29

occurs throughout surgery w/ inflammation of the peritoneum

Question 30

vascular sounds

Answer 30

(bell) arota, renal, iliac, and femora