Clin Assess Flashcards
What is the dx: 18yo female wiyh breast lump. It is a round mass that is well-delineated and very mobile and non tender.
fibroadenoma
What is the dx: A 40yo female presents with a beast lump. It is soft and elastic and mobile. It is slightly tender.
breast cyst
What is the dx: Patient presents with breast lump. The mass is irregular and fixed and not clearly delineated.
Breast Cancer
What are common signs of breast cancer (7)
- retraction signs
- skin dimpliing
- nipple retraction, deviation
- edema of the skin (orange peel appearing)
- Paget’s disease
- breast pain/discomfort
- nipple discharge (galacorhhea)
What is a female patients lifetime risk of developing breast CA?
12% (1 in 8)
What are high risks for breast CA?
- female
- 65+
- BRCA1/BRCA2
- high breast tissue denisty
- biopsy-confirmed atypical hyperlplsia
What are medium risks for breast CA?
- 1+ first-degree relative with breast CA
- high-dose radiation to chest
- high bone density (post menopausal)
What are lower risks for breast CA?
- late age first pregnancy (>30)
- early menarche (55yp_
- no full-term pregnancies
- never breast fed
- recent OCP use
- recent long-term use of HRT
- obesity (postmenopausal)
What are some breast cancer risk assessment tools? (3 models)
- Gail model: best for infividuas over 50yo who have no family hx
- Claus model: best used for indivuduals with no more than 2 first-degree relatives
- BRCAPRO model: used for high risk womrn
Mammogram screening recommendations
- 40-50yo: “individual decision”
- 50-74yo: biennial
- 75yo+: controversial
How often/when to do breast self-exams?
monthly, 5-7 days after onset of menses
Who should get a breast MRI?
young women at high risk for breast CA
What age do people generally get indirect hernias?
young people (but can be seen at any age)
What are clinical features of indirect hernias?
- internal inguinal ring
- often in scrotum (can hear bowel sounds)
- cannot get finger above mass
Patient presents with hernia after lifting/straining. What is the most likely type of hernia?
Direct hernia
What are clinical features of direct hernias?
- external inguinal ring
2. bulges anteriorly and pushes side of finger forward
What type of hernia is more associated with bowel movements?
femoral hernias
Male patient presents with YELLOW penile discharge. What is the most likely dx?
Gonorrhea
What color penile discharge is associated with chlamydia?
WHITE discharge
Male patient presents with palpable, nontender, hard plaques are found just beneath the skin. The patient complains of a crooked painful erection. What is the most likely?
Peyronie’s disease
Male patient presents with indurated nodule or ulcer that is nontender?
carcinoma of the penis
Who is most at risk for developing penile CA?
UNCIRCUMCISED MEN!
Patient presents with scrotal swelling. The scrotum has pitting edema and the scrotal skin is taut (pulled tight)
scrotal edema
Patient presents with nontender, fluid-filled testicular mass. The scrotum transilluminates and you are able to palpate above the mass
Hydrocele
What is cryptochidism?
No palpable testies, unfilled scortum due to atrophied testis.
What are people with cryptochidim at high risk for?
testicular CA
A non-immunized male presents with an acutely inflamed, painful, tender swollen testicle. What is the most likely dx?
orchitis from UMPS!
Patient presents with a painless, movable cytic mass just above the testis. It transilluminates. What are the most likely dx?
Spermatocele and cyst of epididymis
Patient presents with tender, swollen testicle that is difficult to distinguish from the testis.
Acute epididymitis
What is the most common cause of epididmytiis?
chlamydia!
Patient presents with scrotum that feels like a “bag of worms”
varicocele
What side is varicoele usually found on?
left side
When is a self-testicular exam best performed?
after a warm bath or shower
What are causes of primary dysmenorrhea?
Increased prostaglandin production during luteal phase
What are secondary causes of dysmenorrhea?
- endometriosis
- adenomyosis
- PID
- endometrial polyps
How do you define polymenorrhea?
less than 21-day intercal between menses
What labs should you order to determine the cause of amenorrhea?
- hcg
- prolactin/FSH/LH
- TSH
What does the G stand for (in gravida para)?
total number of pregnancies
What does the P stand for?
number of delivered pregnancies
What does the F stand for?
number of full-term pregnancies
What does the P stand for?
premature deliveries
What does the A stand for?
abortions
What does the L stand for?
number of living children
What are the 3 signs of ovarian CA?
- abdominal distention
- abdominal bloating
- urinary frequency
What are risk factors for ovarian CA?
- family history
2. BRCA1/2
Elderly woman with ulcerated or raised red vulvular lesion
vulvular CA
Patient with yellow/green FROTHY vaginal discharge
trichomoniasis
What presents as a cauliflower like growth on cervix?
cervical CA
On exam you feel a firm, irregular nodule in continuity with uterine surface
uterine fibroid
What frequency should prenatal visits be?
- 1st visit at 8 weeks
- 8-28 weeks: every 4 weeks
- 28-36 weeks: every 2 weeks
- 36wks-delivery: weekly
When can the FHR first be heard?
10 weeks
What is chadwicks sign?
bluish discoloration of cervix due to increased blood flow
What labs should be ordered at first prenatal visit?
- STI (gonorrhea, chlamydia, HIV, syphilis, Hep B)
- PAP (only if indicated)
- genetic screening
- CBC
- blood type, Rh
- Rubella, varicella immunity
- UC
- TSH
- TRANSVAGINAL US
What labs do you do at second trimester prenatal visit?
- 1hr glucose (24-28 weeks)
- CBC (hbg, platelets)
- Rhogam if Rh negative
- US (check anatomy
What labs do you want to order during the third trimester?
- group B strep (36 weeks)
2. Hbg (36 weeks)
When should you start feeling fetal movement?
- quickening 18-22 weeks
2. external palpation: 24 weeks
How do you estimate a womens due date?
- crown to rump via transvaginal US
2. count back 3 months from LMP and add 7 days
What are the 4 cervical changes?
- dilation
- effacement
- position
- consistency
