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Module 8: Mali: GU > CA random facts from lecture > Flashcards

CA random facts from lecture Flashcards

1
Q

Palpable Mass in 12-25 year old….what could it be?

A

fibroadenoma

nontender

MOBILE

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2
Q

palpable mass in a 25-50 year old…what could it be? 3

A

breast cyst (well circumscribed, sometimes tender)

fibrocystic changes

cancer ( FIXED MASS)

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3
Q

if there is a palpable mass in over 50 year old….what could it be?

A

cancer until proven otherwise!

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4
Q

what is the lifetime risk for breast cancer?

A

1 in 8

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5
Q

what is the most important RF for breast cancer?

A

AGE!!!!

suspect BRCA1 or 2 if before 50!!

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6
Q

what is the screening test of choice for breast cancer?

A

MAMMOGRAPHY

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7
Q

screening for breast cancer should be….

A

individualized!

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8
Q

when should you start screening for breast cancer?

A

40-50s depending on reccomendations

40 is the earliest you would screen

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9
Q

when should you stop screening mammograms for breast cancer?

A

if life expectancy is less than 10 years!

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10
Q

when should you suspect BRCA1 or 2 gene mutations?

3

A
  1. 1st degree relative w/breast cancer before 50

  1. greater than two individuals in same lineage with breast cancer
  2. 1st degree relative with ovarian cancer
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11
Q

clinical breast exam

when do they start?

how often should they be done?

A

start at 20

20-40: every 2-3 years

40+: annually

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12
Q

what are the four positions you have the pt put their arms in for clinical breast exam?

A
  1. arms at side
  2. arms overhead
  3. hands on hips
  4. leaning forward
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13
Q

how should you palpate the breast?

A

supine position, one breast at a time

vertical strip pattern with concentric circles

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14
Q

what are the quandrants of the breast? how do you describe the location of a lump/bump?

A

upper outer quadrant

upper inner quadrant

lower outer quadrant

lower inner quadrant

describe with clock numbers THEN cm from nipple

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15
Q

male breast cancer accounts for what percent of all breast cancer?

A

1%

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16
Q

if you see a nipple with what looks like eczema on it or dry skin, what should you always suspect?

A

pagets disease

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17
Q

what are the names of the lymph nodes in the axillary region? 4

two others to consider? 2

A
  1. lateral
  2. central
  3. subscapular
  4. pectoral

two others:

  1. infraclavicular
  2. supraclavicular
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18
Q

what are 5 tests you can do to dx breast cancer?

A
  1. breast bx
  2. US
  3. mammogram
  4. contrast enhanced MRI
  5. cytology of nipple discharge
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19
Q

what are 4 common/concerning male genital sxs?

A
  1. sexual response
  2. penile discharge/lesions
  3. scrotal pain, swelling, lesions
  4. STIs
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20
Q

what is the most important thing to remember about STIS?

A

PREVENTION!!

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21
Q

what are 3 ways to prevent STIs?

A
  1. condoms
  2. HPV vaccine
  3. universal testing
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22
Q

when preforming male and female exams, what must you always have?

A

a chaparone!

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23
Q

how should you inspect the penis?

A

standing or supine

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24
Q

what 2 fingers do you use to palpate the scrotom?

A

first two

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25
Q

what position is the patient in to inspect for hernias? what must you ask the patient to do?

A

standing

ask them to bear down

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26
Q

what percent of women with CA have not family hx or reproductive RF?

A

50%

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27
Q

where are indirect hernias?

A

near internal ring, often enter the scrotum

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28
Q

where are direct hernias? what are they associated with?

A

near external inguinal ring

associated with lifting or straining

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29
Q

where does femoral hernial occur? what is it associated with?

A

below femoral ligament

more associated with bowel incarceration/strangulation

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30
Q

what finge should you use to examine the right inguinal canal for hernia?

A

right hand

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31
Q

testicular torsion

3 defining characteristics!

A

cremasteric reflex absent

1 high riding testes with bell clapper deformity and profound swelling

EMERGENCY!!!!

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32
Q

epididymitis

2 defining characterstics

A
  1. cremaster reflex present
  2. epididymis tenderness and induration
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33
Q

what are 7 test you could do if you found abnormal findings on a male during a genital exam?

A
  1. scrotal US
  2. UA/UC
  3. gram stain of urethral discharge
  4. STI testing
  5. semen analysis
  6. aspiration
  7. tumor markers for alpha fetoprotein/HCG
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34
Q

testicular torsion is an…

A

EMERGENCY

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35
Q

who do you refer someone with a testicular mass to?

A

urology

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36
Q

who do you refer somone with a hernia to?

A

general surgery

incarcerated/strangulated is an EMERGENCY!!

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37
Q

post menopausal bleeding is a red flag because you need to rule out?

A

endometrial cancer

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38
Q

gravida para notation

explain this notation

A

G=total # of pregnancies

Para=# of successful pregnancies

then TPAL

term

preterm

abortion

living children

EX: G4P2113

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39
Q

when does cervical cancer screening start and stop?

A

start: 21
stop: 65

40
Q

how often do you screen for cervical cancer for women 21-29?

A

every 3 years!

41
Q

how often to you screen for cervical cancer in women 30-65? what do you screen with?

A

every 5 years, PAP+ HPV cotest!

42
Q

what position is a women in to have a pap done? what to make sure you do?

A

lithotomy position

keep downward pressure

43
Q

what two fingers do you insert to do a bimanual exam?

A

index and middle

44
Q

what are the 5 things you are palpating for on bimanual exam?

A
  1. cervix
  2. uterus
  3. ovaries
  4. access pelvic floor muscles
  5. rectovaginal exam
45
Q

what is pathonewmonic for trichomoniasis?

A

strawberry cervix

46
Q

is urine HCG qual or quant?

A

qual

47
Q

is serume HCG quant or qual?

A

BOTH

48
Q

what are the 3 things you could look for on a wet prep?

A

clue cells

yeast

trichomonas

49
Q
A

clue cells bacterial vaginosis

50
Q
A

HYPHAE

YEAST INFECTION

51
Q
A

trich

flagella present!

52
Q

how much does HcG rise by every 48 hours?

A

increases by 50%

53
Q

what is indicated by:

  1. HCG rising too fast
  2. HCG rising too slow
A

RISES TOO FAST:

1. multiple gestations

RISES TOO SLOW:

1. nonviable IUP

2. ectopic pregnancy

54
Q

polycystic ovarian syndrome

what is this?

3 things your at increased risk for?

4 PE findings

A

OVULATORY DYSFUNCTION and HYPERANDROGENISM

puts at risk for:

1. metabolic syndrome

2. T2DM

3. CVD

4. endometrial cancer

PE FINDINGS:

acne

hirsuitism

menstrual irregularities

obesity

DX VIA transvaginal US and testosterone

55
Q

what are 3 RF for prostate cancer?

A
  1. age
  2. african
  3. family hx
56
Q

what age do you start prostate screening? remember?

A

50 years old

BUT INDIVIDUALIZED

57
Q

what lab can you check if suspected prostate cancer?

A

PSA every 2-4 years

58
Q

what is important to know about digital rectal exams and prostate cancer?

A

early detection has not been show to reduce mortality and may leave for over dx and over tx

59
Q

what finger should you use for digital rectal exam?

A

index finger

60
Q

what are 5 tests you could do for followup to an abnormal digital rectal exam?

A
  1. PSA
  2. guiac
  3. transrectal US guided prostate bx
  4. post-prostatic massage urine culture
  5. colonoscopy
61
Q

what percent of pregnancies are unitended?

A

50%

62
Q

when is the best time to take a home pregnancy test?

A

1 week after missed period

63
Q

what are the urine requirements for HCG for a positive test?

A

20-50 units

64
Q

what are the unit requirements of HCG for a serum test to be positive?

A

5-10 units

65
Q

what is the scheduling for OBGYN visits once a woman finds out she is pregnant?

4 rules

A

1. 1st vist: 8 weeks after gestation

2. every 4 weeks until 28 weeks pregancy (1/month)

3. every 2 weeks until 36 weeks gestation

4. weekly 36-42 weeks

66
Q

what is your biggester concern from 36 weeks to delivery that makes for weekly visits?

A

preclampsia

67
Q

what is the best way to gage estimated due date? and then confirmatory?

A

last menstrual period

confirm with US where they measure from crown to rump to determine due date

68
Q

what are the 3 most common sxs of pregnancy?

A
  1. morning sickness
  2. breast tenderness and fullness
  3. urninary frequency and fatigue
69
Q

first prenatal visit key points:

3

3 others

A

1. beasts: fuller due to increased vascularity and glandular hyperplasia

2. pelvic:

1. chadwicks sign: blueish discoloration of the cervix due to increased blood flow

2. uterus soft

  1. venous hum
  2. lower extremity edema and varicose veins
  3. hemmorids
70
Q

explain the size of the uterus during these phases:

  1. 6-8 weeks
  2. 8-10 weeks
  3. 10-12 weeks
A
  1. 6-8 weeks=plum

  1. 8-10 weeks=orange
  2. 10-12 weeks=grapefruit
71
Q

explain how the pts weight might influence how much weight they will gain in the pregnancy?

A
  1. low BMI: 25-30 pounds
  2. obese: possibly none
72
Q

what should a prego woman take for supplement?

A

multivitamin with folic acid!

73
Q

what are five foods a prego lady should avoid?

A
  1. fish
  2. cheese (esp soft)
  3. raw milk
  4. large fish! or uncooked
  5. deli meat!!
74
Q

what do you need to remind a woman not to do when in 3rd trimester?

A

lay supine on back! don’t lay flat!!

75
Q

what do you need to screen for in a prego lady?

A

abuse! rates increase in this population!

76
Q

what are the 3 most important immunizations a prego lady can get?

A
  1. influenza (not nasal)
  2. Tdap (for whooping cough)
  3. RhoGAM (if Rhnegative!)
77
Q

what are the 5 most common genetic screening to test the a fetus for?

A
  1. down syndrome trisomy 21
  2. hemoglobinpaties
  3. cystic fibrosis
  4. fragile X
  5. ashkenazi jewish population
78
Q

explain the pattern of BP in a prego woman?

A

cardiac output increase, vascular resistance decreases

this means the BP dips in the middle of the pregnancy between weeks 16-24 so know this so can accuary analyze health

79
Q

what are 3 things you might wnat to check on a urine dip stick of a prego woman?

A
  1. protein
  2. glucose (nephrons get leakier so helps check for gestation diabetes)
  3. ketones (indicates hydration)
80
Q

when do you start to hear the fetal HR? rate? if abnormal?

A

10 weeks! !!

120-160

if abnormal hr do NST which alllows you to monitor the HR for longer time ~20 mins and monitor fetal contractions

81
Q

Rh postive babies in Rh negative mom are at risk for developing…

A

hemolytic anemia

82
Q

who and when do you give RhoGAM to?

A

Rh negative mothers

26-28 weeks gestation

83
Q

second trimester:

quickened growth starts___

external palpations start___

A

quickened growth (visible): 18-22 weeks

external palpations: 24 weeks

84
Q

second trimester key points:

5 milestones for H&P

A

monitor:

  1. uterine contractions
  2. fundal height starting at 20 weeks
  3. 1-hr GDM screen 24-28 weeks
  4. Rhogram if RH- @ 28 weeks
  5. US to check anatomy
85
Q

third trimester H&P:

6 milestones

2 labs

A
  1. fetal movement

a. can check baby size on the outside
b. check baby position via leopold maneuver can confirm with US
2. vaginal leaking
a. want to know if amniotic fluid since prevents against infection with the baby
3. preclampsia
4. fetal presentation
5. cervix exam
6. labs
a. check group B step at 36 weeks

b. HgB at 36 weeks

86
Q

what does fetal presentation refer to?

A

1. vertex position

2. complete breech

3. incomplete breech

4. frank breech

87
Q

what are the leopld maneuvers?

A

used to determine the position of the fetus in uterus and determine if baby is breeched and a cessarian section is needed

best accuarcy if after 36 weeks

88
Q

what are the 5 desciptions you use for the cervix during the 3rd trimester?

A
  1. dilation
  2. effacement
  3. fetal station
  4. consistency
  5. position of the cervix
89
Q

how much does cervix dilate?

A

0-10 cm

90
Q

how is effacement of the cervix measured?

A

thinning of the cervix

91
Q

fetal station scale

A

-3 to +2

92
Q

what is the consistency and position of the cervix described as in pregnancy?

A

CONSISTENCY

firm

medium

soft

POSTION OF CERVIX

posterior

middle

anterior

93
Q

just some fun random complaints in pregnancy?

A

heartburn

urinary frequency

vaginal discharge

constipation

hemorrhoids

backache

nausea

breast tenderness

fatigue

lower abdominal pain

abdominal striae

loss of mucous plug

edema

94
Q

post-natal visit occurs when?

A

6 weeks post partum

95
Q

what are some things you should offer at the postnatal visit?

A

menses resumes

family planning

screen for post partum depression

breastfeeding return to work

sexual activity

weight loss guide

stress management

96
Q
A

Module 8: Mali: GU (6 decks)

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