All starred slides Flashcards
1
Q
A
2
Q
List the 5 stages of development
A
1) Newborn/Neonate (first 28 days after birth)
2) Infancy (0-12 months)
3) Early childhood (1-4 years)
4) Middle childhood (5-10 years)
5) Adolescence (11-20 years)
-Early, middle, late
3
Q
Expectation of milestones is adjusted for ______________.
A
prematurity
4
Q
What temp is most accurate for infants?
A
Rectal
5
Q
1) What is avg HR at birth?
2) What abt at 1-6 months?
3) 6-12 months?
A
1) 140
2) 130
3) 115
6
Q
Any fever lasting more than _______ days needs complete workup
A
5
7
Q
List 3 potential causes of acute limp in kids
A
1) Trauma
2) Injury
3) Slipped Capital Femoral Epiphysis (SCFE)
8
Q
Slipped Capital Femoral Epiphysis (SCFE) is most common in what group of children? What does this cause?
A
Obese; growth plate damaged, femoral head slips
9
Q
List and define 5 potential causes of chronic limp
A
1) Blount disease: Growth disease of the tibia
2) Avascular necrosis of the hip: Blood flow to the bone is interrupted
3) Leg length discrepancy
4) Spinal disorder: Scoliosis
5) Leukemia: Build up of cells in the bone and joints of the legs and hip.
10
Q
1) Define inspiratory stridor
2) What can it be caused by?
3) Give examples
A
1) Audible breath sound; high-pitched, inspiratory noise
2) Serious conditions
3) Laryngotracheobronchitis (croup), Epiglottitis, Foreign body
-Not as important to know: Bacterial tracheitis, hemangioma (subglottic), vascular ring, tracheomalacia
11
Q
Give the Coarctation of the aorta brief definition
A
Congenital narrowing of a section of the aorta
12
Q
1) What is the Ortolani test for?
2) Is the hip abducted or adducted?
A
1) The presence of a posteriorly dislocated hip that is reducible
2) Abducted
13
Q
The combination of what two maneuvers has a high specificity for DDH in infants <3 months?
A
Barlow and Ortolani
14
Q
1) What happens w a Barlow test when the hip is dislocatable? What abt if its subluxatable?
2) What does a positive Barlow test indicate?
A
1) If hip is dislocatable, posterior movement and palpable clunk may be detected as femoral head exits acetabulum (“jerk of exit”)
2) If the hip is subluxatable, there is subtle sliding movement or feeling of looseness (“tennis ball moving in a soup bowl”)
-A reduced hip that is subluxatable or dislocatable
15
Q
1) What does Barlow test test for?
2) What is done?
A
1) Ability to sublux or dislocate an intact but unstable hip
2) Hip is gently adducted with pronation of examiner’s hand (downward pressure no longer recommended)
16
Q
Describe the positive Ortolani Sign for DDH
A
1) “Clunk” felt as the femoral head, which lies posterior to the acetabulum, enters the acetabulum (reduced to normal position).
2) Palpable movement of the femoral head back into place
17
Q
1) How is an ortolani test done?
2) What should you avoid?
A
1) From an adducted position and hip flexed to 90°, the hip is gently abducted with supination of the examiner’s hand while lifting the greater trochanter anteriorly
Avoid extreme abduction
18
Q
1) Define hip dysplasia. Does it need to be Dxd early?
2) What is the Ortolani Test for?
A
1) Instability or dislocation of the hip in a newborn or infant.
Needs to be detected early to intervene
2) Test for the presence of a posteriorly dislocated hip that is reducible
19
Q
Give 4 examples of benign heart murmurs pre-school aged children
A
1) Still’s murmurs
2) Pulmonary flow murmur
3) Systemic flow murmurs / Supraclavicular systemic bruits
4) Venous hum
20
Q
Absence of red reflex in young children should lead to a high level of suspicion for __________________
A
retinoblastoma
21
Q
1) At what age should a baby respond to sounds?
2) At what age should a baby coo and gain head control?
A
1) Newborn
2) 2 months
22
Q
1) At what age should a baby roll over?
2) At what age should they babble?
3) At what age should they sit?
A
1) 3 months
2) 6 months
3) 5 months
23
Q
1) At what age begins “mama and dada specific”?
2) What age should a baby pull to stand, crawl, and actively manipulate reachable objects?
3) At what age may an infant recognize strangers?
A
1) 8 months
2) 9 months
3) 9 months
24
Q
At what age should an infant be able to walk and use a spoon?
A
11 months
25
Physical/ motor development:
1) At what age should a child be able to pedal a tricycle, jump in place, and feed themselves with utensils?
2) At what age should a child be able to cut with scissors, hop, and balance on 1 foot?
1) 3 years
2) 4 years
26
Physical/ motor development:
1) At what age should a child be able to pedal a tricycle, jump in place, and feed themselves with utensils?
2) At what age should a child be able to cut with scissors, hop, and balance on 1 foot?
1) 3 years
2) 4 years
27
Cognitive/ language:
1) At what age should a child be able to say 1-3 single words?
2) What abt 2-3 word phrases?
3) What abt having 100% understandable speech and talking in paragraphs?
1) 1 years
2) 2 years
3) 4 years
28
**Cognitive/ language development:**
1) What age should a child be able to know sentences, colors, and ask "why?"?
2) What age should a child be able to say ABCs, copy figures, and define words?
**Social emotional development:**
1) What age should a child know themself in a mirror?
2) What age should a child display imagination?
1) 3 years
2) 5 years
Social emotional:
1) 3 years
2) 4 years
29
1) When does the height spurt peak in males? What is the age range?
2) What about the age range of growth spurts of the penis?
3) What abt testicular growth spurts?
4) What abt pubic hair development?
1) 14; 10.5-16 and 13.5-17.5
2) 10.5-14.4 or 12.5-16.5
3) 9-13.5 or 13.5-17
4) 10.7-14.5 for PH3
30
1) When does the height spurt peak in females? What is the age range?
2) What is the age range of menarche?
3) What abt of breast development?
4) What abt of pubic hair?
1) 11.5; 9.5-14.5
2) 11-14.1
3) 8.2-21.1 for B2
4) 9.3-13.9 for PH3
31
1) Define hepatomegaly
2) How far does a normal liver edge extend?
3) Liver disease can lead to what?
1) liver extends >3 cm below the right costal margin
2) Normal liver edge extends 1-3 cm.
3) Decreased protein production and other complications
32
List 4 potential causes of hepatomegaly
1) Heart failure
2) Hepatitis
3) Epstein Barr Virus (EBV) infection
4) Biliary congestion
33
1) Define splenomegaly
2) Describe a normal spleen
1) Spleen extends >2 cm below the left costal margin
2) Moveable; rarely extends >1-2 cm.
34
List 5 potential causes of splenomegaly
1) **Mononucleosis (e.g., EBV)**
2) Hemolytic anemia
3) Leukemia
4) Autoimmune or inflammatory diseases
5) Portal hypertension
35
1) Define pyloric stenosis
2) What causes it?
3) When does it usually present?
1) Narrowing due to thickening at the opening (pylorus muscle) from the stomach into the small intestine
2) Cause unknown
3) ~3-5 weeks of age.
36
What are two PE findings that require follow up for suspected pyloric stenosis?
1) Firm 2 cm “olive-like” mass of the RUQ or midline of the abdomen
2) Parent may report visible peristaltic waves across the abdomen and projectile vomiting (usually nonbilious) immediately after feeding, while infant remains hungry.
37
What are two PE findings that require follow up for suspected pyloric stenosis?
1) Firm 2 cm “olive-like” mass of the RUQ or midline of the abdomen
2) Parent may report visible peristaltic waves across the abdomen and projectile vomiting (usually nonbilious) immediately after feeding, while infant remains hungry.
38
1) A Firm 2 cm “olive-like” mass of the RUQ or midline of the abdomen is suspicious for what?
2) What condition is described?: "Parent may report visible peristaltic waves across the abdomen and projectile vomiting (usually nonbilious) immediately after feeding, while infant remains hungry"
1) Pyloric stenosis
2) Pyloric stenosis
39
1) What is the most common heart murmur?
2) Where is it? What is it related to and can it move?
3) What are the common ages?
1) Still's murmur
2) Left lower sternal border; related to flow, can change with position/Valsalva
3) 3 years to adolescence
40
1) What murmur is prominent in high-flow situations? (anemia, fever)
2) Where is this murmur?
3) What demographic is it seen in?
1) Pulmonary flow murmur
2) Upper left sternal border
3) Older children, adolescence and older.
41
1) Are systemic flow murmurs / Supraclavicular systemic bruits true "carotid bruits"?
2) What causes them?
1) Heard over carotids, but no, they're not.
2) Normal blood flow into aorta and head/neck vessels
42
1) What causes venous hum?
2) What is it sensitive to?
1) Blood returning from great veins to heart
2) Posture and head/neck position
43
1) What should you inspect about the head in an infancy PE?
2) Should you observe or palpate the two fontanelles? What are these and when does each close?
1) Inspect for symmetry
2) Palpate:
Anterior fontanelle: closes between 4 - 26 months of age
Posterior fontanelle: closes by 2 months of age
44
True or false: you should test for red light reflex in infants
True
45
Infancy male genital PE: what should you inspect and palpate for?
Inspect and palpate for descent of testes into scrotal sac
46
Infancy female genital PE; what should you do? (very general q)
Inspect genitals
47
1) At what age should a baby respond to sounds?
2) At what age should a baby coo and gain head control?
1) Newborn
2) 2 months
48
1) At what age should a baby roll over?
2) At what age should they babble?
3) At what age should they sit?
1) 3 months
2) 6 months
3) 5 months
49
1) At what age begins "mama and dada specific"?
2) What age should a baby pull to stand, crawl, and actively manipulate reachable objects?
3) At what age may an infant recognize strangers?
1) 8 months
2) 9 months
3) 9 months
50
At what age should an infant be able to walk and use a spoon?
11 months
51
Physical/ motor development:
1) At what age should a child be able to pedal a tricycle, jump in place, and feed themselves with utensils?
2) At what age should a child be able to cut with scissors, hop, and balance on 1 foot?
1) 3 years
2) 4 years
52
Cognitive/ language:
1) At what age should a child be able to say 1-3 single words?
2) What abt 2-3 word phrases?
3) What abt having 100% understandable speech and talking in paragraphs?
1) 1 years
2) 2 years
3) 4 years
53
**Cognitive/ language development:**
1) What age should a child be able to know sentences, colors, and ask "why?"?
2) What age should a child be able to say ABCs, copy figures, and define words?
**Social emotional development:**
1) What age should a child know themself in a mirror?
2) What age should a child display imagination?
1) 3 years
2) 5 years
Social emotional:
1) 3 years
2) 4 years
54
1) When does the height spurt peak in males? What is the age range?
2) What about the age range of growth spurts of the penis?
3) What abt testicular growth spurts?
4) What abt pubic hair development?
1) 14; 10.5-16 and 13.5-17.5
2) 10.5-14.4 or 12.5-16.5
3) 9-13.5 or 13.5-17
4) 10.7-14.5 for PH3
55
1) When does the height spurt peak in females? What is the age range?
2) What is the age range of menarche?
3) What abt of breast development?
4) What abt of pubic hair?
1) 11.5; 9.5-14.5
2) 11-14.1
3) 8.2-21.1 for B2
4) 9.3-13.9 for PH3
56
List 3 potential pediatric PE findings of the throat
1) Streptococcal pharyngitis
2) Peritonsillar abscess
3) Retropharyngeal abscess
57
1) Define Streptococcal pharyngitis
2) What does it cause do to the tongue?
3) How doe it affect the tonsils/ post pharynx?
4) How doe it affect the uvula and palate?
1) Bacterial infection of the pharynx (aka “strep”)
2) “Strawberry” tongue
3) White or yellow exudates on the tonsils or posterior pharynx.
4) Beefy red uvula
5) Palatal petechiae
58
What are 3 symptoms of peritonsillar abscess?
1) Erythema of one tonsil
2) Asymmetric enlargement of one tonsil
3) Lateral displacement of uvula
59
1) What are the symptoms of retropharyngeal abscesses?
2) What swelling may occur?
1) Fever, stiff neck, pain with neck extension, dysphagia, etc.
2) Midline or unilateral of posterior pharyngeal wall (visualization may not be possible and should not be attempted if significant airway compromise)
60
Koplik spots are pathognomonic for what? Describe these spots
Measles; bluish white dots about 1 mm in diameter surrounded by a rose-red areola
61
1) What severity does asthma present with?
2) What does it do to the inspiratory: expiratory ratio? Define this ratio as well
1) Varying severity
2) Prolonged expiratory phase; proportion of time spent on inspiration versus expiration
62
What are 3 childhood resp diseases?
1) Asthma
2) Pneumonia
3) Respiratory foreign body
63
What are 3 symptoms of pneumonia?
1) Fever
2) Tachypnea
3) Dyspnea
64
List 2 symptoms of respiratory foreign body
1) Inspiratory stridor
2) Prolonged inspiratory phase
65
1) Do benign heart murmurs come w associated findings? (breathing difficulties, color changes, growth/activity restriction, feeding difficulty, CP/SOB/palpitations, etc.)
2) True or false: Most, if not all children, will have one or more functional or benign murmurs before reaching adulthood.
1) As a rule of thumb, usually no
2) True
66
Should you identify murmurs by their quality or intensity? Give examples
By their quality, not intensity
-Ex: Systolic vs. diastolic, crescendo vs. decrescendo, high or low pitch, etc.
67
What 8 vital signs should you get during development? At what ages should you measure each?
1) Height: every visit
2) Weight: every visit
3) BMI (body mass index): at every visit
4) Head circumference: birth to 36 months
5) BP: start measuring at age 2
6) Pulse: higher in infancy; slows down with aging
7) RR: higher in infancy; slows down with aging
8) Temp: <2 months of age: rectal temp
≥2 months of age: tympanic temp
68
What vital signs should be measured at every visit throughout development?
Height, weight, BMI, BP (at age 2+)
69
What vital signs are higher in infancy and slow down with aging?
Pulse and RR
70
What does an APGAR score consist of?
Appearance (skin color)
Pulse
Grimace (reflex irritability)
Activity (muscle tone)
Respiration
71
1) Define acrocyanosis (a 1 on the color pt of APGAR)
2) Describe the scale APGAR is measured on
1) Pink trunk, blue extremities
2) 7 to 10 is reassuring
-4 to 6 is moderately abnormal
-0 to 3 is low
72
1) Is HR >100 a good thing on APGAR?
2) Is "grimace" or "cry or active withdrawal" a more positive expression of reflex irritability on APGAR?
1) Yes
3) Cry or active withdrawal is more positive
73
1) What should you inspect about the head in an infancy PE?
2) Should you observe or palpate the two fontanelles? What are these and when does each close?
1) Inspect for symmetry
2) Palpate:
Anterior fontanelle: closes between 4 - 26 months of age
Posterior fontanelle: closes by 2 months of age
74
Infancy PE:
1) What should you inspect abt eyes?
2) What abt ears?
3) What reflex should you test w the ears?
4) What should you inspect abt the neck
1) Sclerae, pupils, irises, extraocular movements, and presence of **red reflex**
2) Position, shape, landmarks, patency of ear canal
3) Acoustic blink reflex
4) For masses
75
1) Do infants breathe through the nose or mouth?
2) What sinuses are present at birth?
3) What should you inspect abt the nose in an infancy PE?
1) Obligate nasal breathers for first the 2 months of life
2) Only ethmoid sinuses
3) Position of nasal septum
76
Infancy oral PE:
1) What should you inspect abt the mouth?
2) What should you palpate?
3) How do you know how many teeth a child should have?
4) Which teeth erupt first?
1) Mucosa, tongue, gums, palate, tonsils, and posterior pharynx
2) Gums and teeth
3) 6-26 months of age, 1 tooth per month
4) Central + lat. incisors first, molars last
77
Infancy neck PE:
1) What should you inspect for on the neck?
2) What should you palpate for?
3) What should you assess for?
1) Masses
2) Presence of adenopathy: unusual in infancy
3) Mobility of neck
78
Absence of red reflex in young children should lead to a high level of suspicion for __________________
retinoblastoma
79
1) Why should you inspect an infant's breasts?
2) What should you palpate for?
1) Enlarged in newborns secondary to maternal estrogen
2) Masses
80
Infancy male genital PE: what should you inspect and palpate for?
Inspect and palpate for descent of testes into scrotal sac
81
Infancy female genital PE; what should you do?
Inspect genitals
82
Infant abd. PE:
1) What should you inspect abt the abdomen/ what should be gone by 2 weeks old?
2) What should you auscultate?
1) Umbilical cord remnant is gone by 2 weeks of age
2) Bowel sounds
83
Infancy abd PE:
1) What should you palpate?
2) Are infant rectal exams generally done
1) Liver edge 1-2 cm below costal margin is normal; palpable spleen tip is normal
2) Generally not done
84
1) Testes undescended in scrotal sac by age _____ is abnormal and need to refer
2) From 18 months to 4 years of age what is seen in the knees?
3) Inspect spine for scoliosis in what children?
1) 1 year old
2) Knock-knees
3) Any child who can stand
85
1) What are Tanner stages?
2) While the age of puberty is highly variable, generally starts around age _________.
3) What age does puberty typically start in females? And in males?
1) Sexual maturity rating, to determine stage of puberty based on primary and secondary sex characteristics
2) 10-11
3) Females ~age 11; males ~age 12
86
1) What determine stage of puberty in both males and females?
2) What are stage 1 and stage 5 in both males and females?
1) Tanner stages
2) Stage 1: “Pre-puberty”; Stage 5: Full development
87
What is the first sign of puberty in females?
Breast budding
88
89
List 6 barriers to good geriatric care
1) Communication
2) Underreporting symptoms.
3) Multiple complaints that may interact; “somatization” of emotions
4) Lack of time- be patient; probe relatives or other caregivers, screening tools
5) Measure function, be alert to change, esp. rapid change
6) Track data, treat diagnoses instead of sxs, have pt. familiarity, multiple visits instead of few marathons
90
[barriers to good geriatric care]:
1) What type of change should you be particularly alert for?
2) What tools are important?
3) What may pts do to emotions?
1) Rapid change
2) Screening tools
3) somatization
91
1) How often is breast cancer screening with Mammography recommended for 40-75 y/o?
2) What abt over 75?
1) Screen yearly or biennially
2) Shared decision-making process about whether to continue screening (dependent on health/life expectancy)
92
1) What age range should be screened for cervical cancer?
2) What age range should be screened every 3 years with cervical cytology alone?
3) What age range should you screen every 3 years with cervical cytology alone, every 5 years with high-risk HPV testing alone, or every 5 years with both tests together (cotesting)?
1) Women aged 21-65 years
2) 21-29 yo
3) 30-65 yo
93
How often should cervical cancer screening be done >65y/o?
If adequate recent screening with normal Pap smears, and not otherwise at high risk for cervical cancer, routine screening is *not recommended*
94
1) What age should screening for colorectal cancer and premalignant polyps/lesions (USPSTF) for all adults of average risk? (both males and females).
2) When should this screening occur selectively?
3) What is the preferred test option and how often?
1) 45 y/o
2) In pts 76-85 years
3) Colonoscopy every 10 years (other testing options exist if pt is not amenable to colonoscopy)
95
What condition relevant to older adults has screening recommendations that vary depending on source (American Urological Association, American Cancer Society, USPSTF, etc.) and are controversial?
Prostate cancer
96
1) Screening for what condition may offer a small potential benefit, but have risks of harm (false positives, etc.)? What should you engage in bc of this?
2) When should discussion of screening for this condition begin for avg risk men? What abt higher risk?
1) Prostate cancer; shared decision making
2) 50 years; as early as age 40
97
1) What is the prostate cancer screening method?
2) How often and up to what age? What do these vary depending on?
1) Prostate-specific Antigen (PSA) testing
2) Every 1-2 years up to age 69-75 depending on the source (UpToDate recommendations are given above)
-USPSTF: men aged 55-69, individual decision of whether to screen with PSA
98
Who should be screened for lung cancer (USPSTF)?
Adults age 50-80 yo with:
1) 20 pack-year smoking history AND
2) Currently smoke or have quit within the past 15 years
99
1) What is the lung cancer screening (USPSTF) recommendation for those who need them?
2) When should screening be discontinued?
1) Annual screening with low dose computed tomography (LDCT) of the chest.
2) Once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery
100
What is the recommendation for skin cancer screening (USPSTF) for asymptom. adolescents and adults (do not have signs/ symptoms of skin cancer)?
“The current evidence is insufficient to assess the balance of benefits and harms of visual skin examination [whole-body screening skin exam] by a clinician to screen for skin cancer.”
101
1) Osteoporosis screening to prevent osteoporotic fractures (USPSTF) is recommended in women >______.
2) How should you screen them? What does frequency of screening depend on?
3) Screening may begin earlier if woman is _______________ and at increased risk of osteoporosis
1) 65
2) Screen with bone measurement testing (e.g., DEXA scan to measure bone mineral density [BMD]); a number of factors
3) postmenopausal
102
What is the current recommendation for osteoporosis screening to prevent osteoporotic fractures (USPSTF) in **men**?
"Insufficient evidence to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men.”
103
Define dementia
An acquired condition that is characterized by a decline in at least two cognitive domains:
1) Loss of memory
2) Attention
3) Language
4) Visuospatial
5) Executive functioning
104
1) List types of dementia diagnoses
2) Which is most common?
starred
1) Alzheimer disease (AD), vascular dementia, dementia with Lewy bodies, and Parkinson disease with dementia, and dementia of mixed etiology.
2) AD
105
Define delirium
Serious disturbance in mental abilities that results in confused thinking and reduced awareness of surroundings
106
What are 4 non-underlying disease related causes for delirium?
1) Intoxication
2) Sleep deprivation
3) Medications
4) Illegal drugs
107
Elder abuse:
1) What should screening include looking for?
2) What is the prevalence of elder abuse? What group is it higher in?
3) Why may abuse not be detected?
1) Screening should include looking for abuse, neglect, exploitation, and abandonment.
2) Prevalence ranges from 5-10%
Higher in elders with dementia and depression
3) Elders less likely to report, therefore abuse may not be detected
108
Why are elders less likely to report, therefore abuse may not be detected? (4 reasons)
1) Fear of retaliation
2) Physical or cognitive inability to report.
3) Unwillingness to expose the abuser
4) 90% are family members
109
1) The great heterogeneity in older pts health contributes to the difficulty in distinguishing between __________ aging verses ____________ conditions.
2) This makes it harder to answer what question?
1) intrinsic; pathologic
2) "When to treat?"
110
1) If undecided on whether to treat, then evaluate what abt a pt's function?
2) What should determine your decision after that?
1) Whether function is sufficiently impaired
2) If so, then treat; if not very impaired, then watch, wait, reevaluate
111
List 6 ADLs (activities of daily living)
Bathing
Dressing
Toileting
Transferring
Continence
Feeding
112
1) What main thing should you ask abt ADLs?
2) In general, what are ADLs?
3) What 3 questions should you ask to help answer the main question?
1) Ask how well the patient performs the ADLs
2) Basic self-care abilities
3) -Can the patient perform these activities independently?
-Does the patient need help?
-Is the patient completely dependent on others for ADLs?
113
1) What main thing should you ask abt Instrumental Activities of Daily Living (IADLs)?
2) In general, what are IADLs?
3) What 3 questions should you ask to help answer the main question?
1) Ask how well the patient performs the IADLs
2) Activities which are higher level functions
3) -Can the patient perform these activities independently?
-Does the patient need help?
-Is the patient completely dependent on others for IADLs?
114
Blood pressure:
1) With aging, ______ and __________________ increase, whereas __________ decreases (widening pulse pressure)
2) Isolated systolic hypertension (SBP ≥140 mmHg with DBP <90 mmHg) after age 50 and widened pulse pressure >60 increases risk for what 3 things?
1) SBP and peripheral vascular resistance; DBP
2) Stroke, renal failure, and heart disease
115
1) Define orthostatic hypotension
2) What % of older adults does it occur in?
3) List 4 symptoms
1) Drop in SBP of >20 mmHg or DBP of >10 mm Hg, increase of HR of 20 BPM, or dizziness within 3 minutes of standing
2) 20%
3) Lightheadedness, weakness, unsteadiness, and visual blurring
116
Heart rate and rhythm:
1) Resting HR is unchanged, but ___________________ declines, affecting response to exercise and physiologic stress.
2) Why?
3) What abt heart rhythm can change w age?
1) maximal heart rate
-Due to slowing of pacemaker cells in SA node and blunted β-adrenergic response (Beta blockers may also do this)
3) More likely to have abnormal heart rhythms
117
1) Does RR change w age?
2) What do age-related changes in temp. regulation lead to?
1) No; respiratory rate unchanged
2) Susceptibility to hypothermia
118
What is the "5th vital sign" in older adults?
Functional Status
119
1) Assessment of older adults places special emphasis on maintaining what 2 things?
2) Maintaining what is the primary focus?
1) Independence and optimal level of function
2) Functional status
120
1) A number of performance-based assessment instruments for functional status are available, such as what? What does this screening assess?
2) Patients should also undergo risk factor assessment for _______
1) 10-Minute Geriatric Screen; physical, cognitive, and psychosocial factors
2) falls
121
List the 2 types of macular degeneration.
Which is more common and less severe? Which is neovascular?
Two types:
1) Dry atrophic: more common, less severe
2) Wet exudative: neovascular
122
List 2 symptoms of macular degeneration
1) Poor central vision
2) Blindness
123
What is the leading cause of visual impairment?
Cataracts
124
List some of the multiple risk factors for cataracts
1) Cigarette smoking
2) High alcohol intake
3) Diabetes mellitus (DM)
4) Medications (e.g., steroids)
5) Trauma
125
1) Define glaucoma
2) What does it lead to?
1) Increased intraocular pressure
2) Optic nerve damage
126
In older adults:
1) Systolic bruits heard in middle or upper portions of carotid arteries suggest what? From what?
2) What does having an S3 strongly suggest after age 40?
1) Partial arterial obstruction; atherosclerosis
2) Heart failure and dilatation of the left ventricle from CHF
127
1) S4 can be heard in healthy older people, but often suggests decreased ____________ and impaired _______________.
2) What may occur as a result?
1) ventricular compliance and impaired ventricular filling
2) LVH (left ventricular hypertrophy)
128
1) Menstrual periods typically cease between what ages? What is the median?
2) Women often experience hot flashes for up to how many years? What are 3 other symptoms they may have?
3) Within how long are the ovaries usually no longer palpable?
1) 48-55; median 51 years
2) Five year; vaginal dryness, urge incontinence, or dyspareunia
3) 10 years
129
1) Proliferation of prostate epithelial and stromal tissue (aka benign prostatic hyperplasia (BPH)) begins in what decade?
2) What decade does it continue to and what happens then?
3) How many men w BPH have symptoms?
1) Third decade
2) Until the seventh, then plateaus
3) Only half
130
True or false: Signs and symptoms of alcohol abuse/ use disorder may be subtler in older adults
True
131
True or false: Signs and symptoms of alcohol abuse/ use disorder may be more obvious in older adults
False; may be more subtle
132
List the 4 CAGE questions
1) Have you ever felt you should Cut down on your drinking?
2) Have people Annoyed you by criticizing your drinking?
3) Have you ever felt bad or Guilty about your drinking?
4) Have you ever taken a drink first thing in the morning (Eye-opener) to steady your nerves or get rid of a hangover?
133
1) What test is preferred over CAGE?
2) What does this test identify?
3) How many questions and what's the scoring?
1) Alcohol Use Disorders Identification Test-Concise (AUDIT-C)
2) Not just harmful drinkers detected by CAGE, but also hazardous drinkers who have not yet reached that level of harm (early intervention to reduce consumption)
3) 3 Questions, scored from 0-12
134
What are the 3 questions for the Alcohol Use Disorders Identification Test-Concise (AUDIT-C)?
1) How often did you have a drink containing alcohol in the past year?
2) How many drinks did you have on a typical day when you were drinking in the past year?
3) How often did you have 6 or more drinks on one occasion in the past year?
135
136
1) Define gravidity
2) Define parity
1) # of pregnancies, current and past, regardless of outcome (multiple gestation only counts once)
2) # of times a woman has given birth to an infant ≥20 weeks of gestation regardless of outcome
multiple gestation only counts once (except for living children)
137
How do you document OB history?
GTPAL (ex, G2P1001): gravidity, term, preterm, abortion/(miscarriage), living
138
1) Define term
2) Define preterm
3) Define abortion
4) Define living
1) Number of times a woman has given birth to an infant ≥37 weeks gestation
2) Number of times a woman has given birth to an infant between 20-36 6/7 weeks gestation
3) Number of losses before 20 weeks
4) Number of living children
139
1) Define gravida
2) Define primigravida and multigravida
3) Define nulligravida
1) Is or has been pregnant
2) Is in or has had one pregnancy; has been pregnant more than once
3) Has never been pregnant
140
1) Define primipara
2) Define multipara
3) Define nullipara
1) Has only birthed one child or is pregnant for the 1st time
2) Has given birth 2+ times
3) Has never given birth or had pregnancy go past gestational abortion age
141
What does GTPAL stand for?
G = total pregnancies
T = # born ≥37 weeks (= term)
P = preterm
A = miscarriages/abortions
L = living children
142
1) Define "breast self-examination"
2) Is it generally currently recommended for average-risk women? Why or why not?
1) Self-inspection in a systematic way on a regular, repetitive basis (e.g., monthly) for detection of breast cancer.
2) No longer recommended for average-risk women, lack of evidence for benefits (beyond mammography) and potential harm from false-positives.
143
Pt education on “Breast Self-Awareness” is recommended; what does this include?
1) Being aware of normal appearance and feel of one’s breasts
2) Be educated on signs/symptoms of breast cancer and notify health care provider if any changes (pain, mass, new nipple discharge, redness).
144
1) True or false: Breast cancers are not frequently self-detected
2) True or false: Breast cancer is the most common female malignancy
1) False; they are frequently self-detected
2) True
145
When should clinical breast exams (CBE) be recommended to each of the two age groups?
1) 25-39 yo: may be offered every 1-3 yrs based on shared decision-making*
2) ≥40 yo: may be offered annually based on shared decision-making*
*Uncertainty if CBE offers additional benefits beyond screening mammography, and there is possibility of false positives/harm.
146
When should mammography be recommended to each of the two age groups?
1) 40-75 years old: screen every 1-2 yrs
2) Older than 75 years: shared decision-making process about whether to continue screening (dependent on health/life expectancy)
147
1) What should you do first in a breast exam?
2) Is asymmetry of breasts common?
3) What should you further evaluate for?
4) What should you describe about any masses?
5) What is normal for large breasts?
1) Visual inspection first; have pt lean forward for large and/or pendulous breasts
2) Yes, some asymmetry is common
3) Marked differences or recent changes
4) Size, shape, consistency, position, & mobility
5) Normal firm transverse inframammary ridge with large breasts
148
1) When should you palpate the breast?
2) In what 2 positions should you inspect?
3) In what positions should you palpate? How should you palpate?
1) After visual inspection
2) With pt seated with arms at sides, then with pt supine and ipsilateral arm above head*
Palpation with pt supine, ipsilateral arm above head; use pads of fingers for palpation (not tips/no nails)
149
1) What should you thoroughly palpate during a breast exam?
2) What technique is best validated?
3) What should you squeeze?
1) Rectangular area extending from clavicle to inframammary fold and from midsternal line to posterior axillary line and well into axilla (tail of breast)
2) Vertical strip
3) Not nipple, but rather tissue surrounding
150
What are 8 symptoms concerning for malignancy?
1) Rapid change in the appearance of one breast
2) Thickness, heaviness or visible enlargement of one breast
3) Discoloration, giving the breast a red, purple, pink or bruised appearance
4) Unusual warmth of the affected breast
5) Dimpling or ridges on the skin of the affected breast, similar to an orange peel
6) Itching
7) Enlarged lymph nodes under the arm, above the collarbone or below the collarbone
8) Flattening or nipple inversion
151
1) What does redness of the breast suggest?
2) What is it often due to?
3) In women who have not recently nursed a baby it is worrisome for what?
1) Infection or inflammation
2) Mastitis in postpartum patient.
3) Inflammatory breast cancer (IBC)
152
1) What is dimpling often a sign of?
2) In what positions should you assess it?
1) A tumor beneath.
2) With pt supine, sitting, and standing
153
1) Is it suspicious if there's asymmetry of the breast?
2) What is nipple retraction a sign of if new?
1) Yes
2) A tumor beneath. Carefully palpate around and under the nipple
154
List 5 abnormal nipple findings
1) Discoloration or ulceration
2) Clear or milky discharge (galactorrhea)
3) Nipple discharge may be sent for culture & sensitivity and cytopathology
4) Bloody discharge (usually unilateral)
5) Pus/purulent discharge
155
1) What is galactorrhea and what may it be due to? Bilateral or unilateral usually?
2) Is bloody discharge of the nipple usually bilateral or unilateral? What is it associated with?
3) What does pus usually indicate?
1) Clear or milky discharge may be due to stimulation (normal) or elevated prolactin levels (abnormal).
-Bilateral (usually)
2) Usually unilateral, associated w. inflammation (usually intraductal papilloma).
-Evaluation to rule out malignancy is required.
3) Infection but may be due to underlying tumor.
156
1) Is nipple discharge usually cancer? Explain.
2) What can be a sign of ductal ectasia or fibrocystic changes?
1) Usually benign but may be an early sign of endocrine dysfunction or cancer
2) Non-bloody, bilateral discharge with nipple stimulation (“nonspontaneous”)
*spontaneous = occurring without nipple stimulation
157
1) When is milky discharge of the nipple common? What else is it associated with?
2) What is bloody unilateral nipple discharge concerning for?
What does it usually require?
1) Common during childbearing; associated with hyperprolactinemia or hypothyroidism, OCPs, tricyclic antidepressants
2) Invasive ductal carcinoma, intraductal papilloma, or intraductal carcinoma (e.g., be concerned for cancer)
-Ductography and ductal excision
158
1) If you clearly identify a discrete mass, consider it to be _________ until proven otherwise.
2) In general, determination of final diagnosis requires a what?
1) malignant
2) Biopsy
159
1) Should a dominant breast mass that does not have a corresponding abnormality on Mammogram still be considered malignant until proven otherwise?
2) Mammograms miss up to ____% of cancers
1) Yes
2) 30%
160
True or false: While uncommon, breast cancer can occur in men
True
(Thus, discrete masses should be appropriately evaluated).
161
1) Breast cancer can occur in young women (20s and 30s) so what should be appropriately evaluated?
2) What is more difficult about evaluating young patients for breast cancer?
1) Thus worrisome masses in this population should be appropriately evaluated.
2) Mammograms more likely to be false-negative
162
1) True or false: you should pay very careful attention to any mass that the patient brings to your attention.
2) True or false: Women who are very self-aware can often detect subtle/early changes concerning for malignancy that an examiner may have difficulty identifying.
1) True
2) True
163
1) Define mastalgia (breast pain)
2) What percent of women does it affect during lifetime?
1) Breast pain
2) 70% of women
164
1) What is the most common type of mastalgia? What is it associated with? Bilateral or unilateral?
2) What is noncyclical mastalgia not associated with? What is it associated with?
3) What is extramammary (non-breast, pain referred from other locations) mastalgia associated with?
1) Bilateral and benign, begins during luteal phase, resolves with menses
2) Not associated with menstrual cycle; assoc with duct ectasia, mastitis, large breast size, meds, pregnancy, etc.
3) Chest wall trauma, rib fxs, shingles (varicella-zoster virus), heart, gallbladder, etc.
165
1) What is required to determine the cause of mastalgia?
2) What should be done if there's concerning findings? Why? Give examples
1) Careful physical exam to determine cause.
2) Imaging to rule out malignancy/serious pathology (unilateral, noncyclical, localized pain, breast mass, skin changes, etc.)
166
1) Define fibrocystic breast changes
2) How common is it?
3) What are the symptoms?
1) Benign changes in breast epithelium producing a nodular, sensitive breast
2) Common; ½ of all women experience
3) Lumpiness, swelling, pain/tenderness; nodular, rope-like densities
167
What are the essentials of fibrocystic breast change diagnosis? What is the most common age?
1) Painful, often multiple, usually bilateral mobile masses in the breast.
2) Rapid fluctuation in size of masses is common. *Frequently worsens just before menses (increase in pain and size of cysts).
3) Affected by hormone levels
-Most common age is 30–50 years (premenopausal); occurrence is rare in postmenopausal women.
168
1) How are fibrocystic breast changes diagnosed
2) How are they treated?
1) Diagnosed with CBE and sx history; mammogram, ultrasound may be used. Aspirate palpable cysts
2) Observation (Decrease caffeine intake), vitamin E supplementation
169
1) Define mastitis
2) What are the symptoms?
1) Inflammation of breast tissue that may be accompanied by infection (e.g., bacteria):
2) Erythema, warmth, swelling, tenderness/pain; fatigue, malaise, fever
170
1) When does mastitis generally occur? What is it particularly associated with?
2) How is lactational mastitis treated?
1) I lactating or recently lactating women; incomplete emptying of the breast (engorgement) or plugged duct(s)
2) NSAIDs, cold compresses, ongoing breastfeeding and/or hand expression to help empty breast, antibiotics if associated infection
171
3 most common breast masses are what?
Fibroadenoma (benign tumor), cysts, and breast cancer
172
1) With fibroadenoma (benign tumor) what is the typical age?
2) How many are there usually?
3) Shape and size?
4) Consistency?
5) Delineation?
6) Mobility?
7) Tenderness?
8) Retraction signs?
1) 15-25 years, usually puberty and young adulthood, but up to 55
2) Usually single, may be multiple
3) Round, disc like, or lobular; typically small (1-2cm)
4) Usually firm (but may be soft)
5) Well delineated
6) Very mobile
7) Usually nontender
8) Absent
173
1) In cysts of the breast, what is the typical age?
2) How many are there usually?
3) Shape?
4) Consistency?
5) Delineation?
6) Mobility?
7) Tenderness?
8) Retraction signs?
1) 30-50 yrs, regress after menopause
2) Single or multiple
3) Round
4) Soft to firm, usually elastic
5) Well delineated
6) Mobile
7) Often tender
8) Absent
174
1) In breast cancer, what is the typical age?
2) How many are there usually?
3) Shape?
4) Consistency?
5) Delineation?
6) Mobility?
7) Tenderness?
8) Retraction signs?
1) 30-90, most common >50
2) Usually single, although may coexist w other nodules
3) Irregular or stellate
4) Firm or hard
5) Not clearly delineated
6) May be fixed to skin or underlying tissues
7) Usually nontender
8) May be present
175
1) What age is a pelvic exam recommended in?
2) Describe how to perform a pelvic exam
1) ACOG recommends annual pelvic exam in women 21 yrs & older
2) -Empty bladder to ensure comfort & assist your exam
-“Clean catch” urine specimen from mid-stream if needed
(A full bladder will push the uterus and cervix higher in the pelvis and make the exam more difficult and uncomfortable.)
-Muscle relaxation needed
-Explain every part of exam before performing (“Talk before you touch”)
-Avoid being abrupt or stern
-Rehearse what you will say and how you will say it.
176
What should you evaluate about the cervix?
1) Nulliparous vs multiparous
2) Normal vaginal discharge?
3) Ectropion (when inside of cervical canal everts), retention (Nabothian) cysts, small polyps (benign)
4) Inflammation, masses, dysplasia (further eval)
177
List the 5 early Sx of Adnexal Neoplasm. Specify which is most common
1) Abdominal bloating or distention- most common
2) Abdominal or pelvic pain
3) Decreased energy or lethargy
4) Early satiety
5) Urinary urgency
178
What should you physically examine for Adnexal Neoplasm?
1) Assess for any signs of infection or cancer
2) The breast examination is especially important because the ovary is a common site of metastatic breast carcinoma (abdomen, too)
3) Bimanual exam assessing each side and comparing sides
-keep in mind age-parameters for ovarian size
179
Give the vague symptomatology of ovarian cancer
Abdominal bloating or distention
Abdominal or pelvic pain
Decreased energy
Early satiety
Urinary urgency
Abnormal menstrual cycles
Unexplained back pain that worsens over time
Non-specific gastrointestinal symptoms
180
1) What are functional ovarian cysts?
2) What type of cyst occurs when an ovarian follicle fails to rupture during follicular maturation and ovulation does not occur?
1) Not neoplasms, but anatomic variations that arise due to normal ovarian function
2) Follicular cyst
181
1) When does a follicular cyst become medically significant?
2) How are they diagnosed?
1) If large enough to cause pain or persists beyond one menstrual interval
2) Pelvic ultrasound (adjunct to PEx)
182
1) How do most follicular cysts resolve?
2) What if the presumed functional cyst persists?
1) Most spontaneously resolve within 6 weeks
2) Another type of cyst or neoplasm should be suspected and further evaluated
183
1) Placental growth is a cardiovascular change during pregnancy that involves what?
2) What two things does the body increase to compensate for these changes?
3) When does the placenta stop growing?
1) New vessels are added, increased blood flow to placenta
2) HR and cardiac output
3) At ~week 26
184
What does more fluid being present during pregnancy lead to? (2 things)
1) Daytime pedal edema
2) Nocturia/frequent nighttime urination (bc of daytime edema)
185
Why does nocturia/frequent nighttime urination occur in pregnancy?
Excess blood volume that was in her legs all day finally returns to more central circulation and acts like a fluid bolus
186
1) Define physiologic hypotension
2) IVC compression can happen in pregnancy; what are the symptoms and what process in the body causes each?
3) How can IVC compression be relieved?
1) Normal dip in the BP during pregnancy
2) Less venous return > cardiac output is decreased > blood pressure falls > dizziness, presyncope > syncope
3) If she’s on her back or right side, move to left lateral decubitus
187
1) What urinary change is common in pregnancy besides nocturia?
2) What are pregnant people at higher risk of?
1) Mild glucosuria
2) UTI
188
Why are pregnant ppl at a higher risk of UTI?
Dilation of urinary tract (secondary to increased blood volume) = greater risk of ascending infection
189
1) Define gestational diabetes
2) What factors put people at risk for this?
1) Elevated blood glucose that starts after 20 weeks gestation
2) Obesity, being Hispanic or Southeast Asian
190
How is gestational diabetes diagnosed?
All women are screened weeks 24-28 with oral glucose tolerance test (OGTT)
191
List 3 potential GI pregnancy side effects
1) Constipation
2) GERD
3) Gallbladder disease
192
What 2 things should you counsel a pregnant pt with constipation on?
1) Dietary fiber
2) Stool softener vs. motility agent
193
1) What causes GERD in pregnant people?
2) How is it treated? (2 things)
1) LES relaxation plus compression of stomach by gravid uterus = reflux
2) -Lifestyle changes: Avoid caffeine, spicy food, nicotine, mint, large meals, fatty meals
-TUMS (calcium carbonate) acceptable in pregnancy
194
What can accompany gallbladder disease in pregnancy?
1) Formation of new stones
2) Worsening of stones
3) Cholecystitis
195
What causes breast enlargement in pregnancy?
What are the 3 steps?
-Mammary glands
1) Proliferate in 1st trimester
2) Glands differentiate in 2nd trimester
3) Glands produce milk in 3rd trimester
196
When is 1st trimester?
2nd?
3rd?
1st trimester: conception to 12 weeks
2nd trimester: 13-27 weeks
3rd trimester: 28-40 weeks
197
What are 5 potential skin changes that can occur w pregnancy? Describe each
1) Hyperpigmentation: “mask of pregnancy” also called “melasma”
-Etiology unknown
2) Linea nigra: Darkening of skin over linea alba
3) Palmar erythema
4) Spider angiomata: telangiectasia
198
1) What should be the causes of weight gain in pregnancy?
2) How much weight gain is normal in each pt of pregnancy?
1) Amniotic fluid, placenta, fetus, maternal adipose stores
2)
1 lb/month first trimester
1lb/week thereafter
199
1) How does being underweight affect pregnancy weight gain recommendations?
2) What abt being overweight?
1) Gain more; build up adipose stores
2) Gain less: adipose stores are adequate, and weight gain should be due to fluid, placenta, fetus
200
1) What assesses (grossly) the growth of the fetus?
2) What is this measurement equal to?
1) Fundal height measurement
2) Fundal height (in cm) ≈ gestation age (in weeks) between 16-36 weeks gestation
201
A larger than expected fundal height measurement is concerning for what 4 things?
1) Molar pregnancy
2) Large for gestational age baby/Gestational diabetes
3) Polyhydramnios
4) Multiples
202
A smaller than expected fundal height measurement is concerning for what 3 things?
1) Small for gestational age baby or IUGR
2) Fetal Death
3) Oligohydramnios
203
1) What is the goal for kick counts/ # of movements?
2) Fetal movement decreases in response to fetal _______________.
3) If mom perceives decreased fetal movement, what should be instituted?
1) > 10 movements/2 hrs
2) hypoxemia
3) Further testing
204
1) Auscultation of heart tones can usually be done by fetoscope by the _____th week and with doppler by the _____th week (though typically not done until ______th week).
2) After how many can weeks fetal heart rate be assessed with external fetal monitor?
3) What 2 fetal HR questions should you ask yourself?
1) 12th; 8th; 10th
2) Sixteen (16)
3) -Is the heart rate within normal range? (110-160 bpm)
-Do you hear/see any abnormalities?
205
When should a pregnant woman go to the hospital? (4 reasons)
*important*
1) Contractions occur approximately every 5 minutes for at least 1 hour
2) A sudden gush of fluid or a constant leakage of vaginal fluid (suggesting rupture of membranes [ROM])
3) Any significant vaginal bleeding
4) Significant decrease in fetal movement
206
At 20 weeks, fundus should be where?
At the umbilicus (20 cm fundal height)
*important*
207
1) What is the most common cause of perinatal morbidity and mortality?
2) What is this defined as?
1) Preterm birth
2) Birth before 37 completed weeks of gestation
208
What are the two types of preterm birth?
Spontaneous vs medically indicated (induced)
209
List 4 maternal complications (medical or obstetric)
that may cause PTL
1) Activation of maternal/fetal HPA axis due to stress
2) Inflammation/infection (see next slide)
3) Hemorrhage (e.g., placental abruption)
4) Pathologic uterine distention (polyhydramnios, etc.)
-Preterm labor may be secondary to these pathogenic processes
210
What are 7 S/Sx of preterm labor?
1) Menstrual-like cramps
2) Low, dull backache
3) Abdominal pressure
4) Pelvic pressure
5) Abdominal cramping (with or without diarrhea)
6) Increase or change in vaginal discharge (mucous, watery, light bloody discharge)
7) Uterine contractions, often painless
211
1) Define post-term pregnancy
2) What two groups is it most common in?
3) What is the most common cause of it?
1) Pregnancy that has gone beyond 42 completed weeks
2) Primiparous (first birth/pregnancy), and hx of post-term delivery
3) Incorrect estimation of gestational age
212
1) Who is a post-term pregnancy an increased risk to? What type of assessments must start if post-term?
2) Due to increased morbidity, most practices will not let pregnancy go beyond ___ wks
1) Incr. risk to baby; fetal assessment (kick counts, non-stress tests, ultrasound evaluation of amniotic fluid)
2) 42 wks
213
List 5 conditions assoc. with post-term pregnancy
1) Macrosomia
2) Shoulder dystocia
3) Meconium aspiration syndrome (MAS)
4) Dysmaturity syndrome
5) Oligohydramnios
214
1) Define macrosomia
2) Define shoulder dystocia
3) What can MAS cause?
1) Weigh of >4,500 g (~9.9 lbs)
2) Impaction of the anterior fetal shoulder behind the symphysis pubis during vaginal delivery causing a brachial plexus injury (emergency)
3) Severe respiratory distress/death
215
1) Define dysmaturity syndrome
2) Define oligohydramnios. When is this an indication for delivery?
1) Infants with characteristics resembling chronic growth restriction
2) Decreased amniotic fluid; if >36 weeks
216
217
Anatomical structures and their pathologies:
1) What is a pathology of the urethral meatus?
2) What is a pathology of the urethra?
3) What is a pathology of the glans?
4) What is a pathology of the corona/ prepuse?
1) Hypospadias
2) Cystitis
3) Balanitis
4) Paraphimosis
218
1) What is the significance of the corpus cavernosum?
2) What structure do vasectomies involve?
3) What pathology can occur at the epididymis/testicle?
4) What very common pathology can occur involving the Tunica Vaginalis?
1) Erection
2) Vas deferens
3) Epididymitis/orchitis
4) Testicular torsion
219
1) Hydroceles and varicoceles both involve what structure?
2) BPH can occur where?
1) Scrotum
2) Prostate
220
1) Define paraphimosis
2) Is it an emergency? Why or why not?
1) Retracted fοreѕkiո in an uncircumcised mаlе that cannot be returned to normal position
2) Emergency; can cause ischemia to the glans/penis
221
When loops of bowel force their way through weak areas of the inguinal canal, what type of groin hernia is this?
Inguinal
222
1) What type of hernias arise at internal inguinal ring?
2) What type of hernias arise more medially through floor of inguinal canal (Hesselbach’s triangle)?
1) Indirect inguinal
2) Direct inguinal
223
What are the boundaries of Hesselbach’s Triangle medially, laterally, and inferiorly?
1) Medially: Rectus abdominis m.
2) Laterally: Inferior epigastric vessels
3) Inferiorly: Inguinal ligament
224
1) What is the most common malignancy in adult males 15-35 years old?
2) Is it curable? Explain.
3) How does it often present as?
1) Testicular cancer
2) Highly curable if detected early; do not delay evaluation
3) Painless testicular mass
225
1) In any male with a solid, firm mass within the testis, __________________ must be the considered diagnosis until proven otherwise
2) How could it be proven otherwise?
1) testicular cancer
2) Scrotal ultrasound followed by other diagnostic work-up as necessary
226
1) Who are indirect inguinal hernias most common in?
2) What abt direct hernias?
3) What abt femoral hernias?
Of these, which hernia is most common?
1) All ages, both sexes. Often in children, may be in adults. Most common.
2) Usually in men >40 and rare in women. Less common.
3) Least common. More common in women.
-Indirect inguinal most common
227
What is the point of origin of:
1) Indirect inguinal hernias?
2) Direct inguinal hernias?
3) Femoral hernias?
-Of these, which can be hard to differentiate from lymph nodes?
1) Above inguinal ligament near midpoint (internal inguinal ring)
2) Above inguinal ligament close to pubic tubercle (near external inguinal ring)
3) Below inguinal ligament, more lateral than an inguinal hernia.
-Femoral hernias can be hard to differentiate from lymph nodes
228
How do
1) Indirect inguinal hernias
2) Direct inguinal hernias
3) Femoral hernias
relate to the scrotum, and to examining w. a finger in the inguinal canal?
1) Often into scrotum; the hernia comes down inguinal canal & touches the fingertip.
2) Rarely in the scrotum; hernia bulges anteriorly and pushes the side of the finger forward.
3) Never in the scrotum; inguinal canal is empty
slide 29
229
1) What demarcates the anal canal from the rectum?
2) What is the boundary between somatic (anal canal) and visceral (rectum) nerve supplies?
1) A serrated line
2) The anorectal junction (often called the pectinate or dentate line)
230
1) In the male, the prostate gland lies against what?
2) What does a normal prostate gland feel and look like? *important*
3) True or false: You can only palpate part of the prostate (right and left lateral lobes) on DRE.
1) The anterior rectal wall
2) Rounded, heart-shaped, 2.5 cm long, smooth, **rubbery, non-tender**, not fixed to surrounding tissues
3) True
231
What are 6 common or concerning Sx of the male anus, rectum, and prostate?
1) Change in bowel habits
2) Blood in the stool (hematochezia & melena)
3) Pain with defecation; rectal bleeding or tenderness
4) Anal warts or fissures
5) Weak stream of urine
6) Burning upon urination (dysuria)
232
What men's health Health Promotion and Counseling should be done? (3 things)
1) Discuss prostate cancer screening
2) Screen for colorectal cancer and premalignant polyps/lesions (USPSTF)
3) Provide counseling about sexually transmitted infections (STIs)
233
1) Prostate cancer is the leading cancer diagnosed in men in the United States, and the ________ leading cause of death
2) What are the primary risk factors? What else may be a risk factor?
3) Are screening recommendations universal?
1) third
2) Advanced age, ethnicity (black), and family history
-intake of dietary fat
3) Screening recommendations vary depending on source (American Urological Association, American Cancer Society, USPSTF, etc.) and are controversial
234
1) Why should you engage in shared decision making regarding prostate cancer screenings?
2) For average risk males, initiate discussion of screening at age ___ years (as early as age ____ for higher risk)
1) Screening may offer a small potential benefit, but there are risks of harm (false positives, etc.)
2) 50; 40
235
1) What prostate cancer screening method is recommended? How often and in what age group?
2) Frequency of ________ testing and age to initiate and stop screening varies depending on the source
1) Prostate-specific Antigen (PSA) testing every 1-2 years up to age 69-75
2) PSA
236
1) What type of GI cancer and polyps should you screen for in both males and females?
2) At what age should screening start for all adults of avg risk? (in both sexes)
3) What age group is there selective screening?
4) How often are colonoscopies done?
1) Colorectal cancer and premalignant polyps/lesions (USPSTF)
2) 45
3)76-85 years
4) Every 10 years (other testing options exist if pt is not amenable to colonoscopy)
237
When you provide counseling about sexually transmitted infections (STIs), what else should you suggest?
Partners to be tested
