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PD Year 1 > Exam 1 - Spring > Flashcards

Exam 1 - Spring Flashcards

1
Q

visceral pain is associated with…

A

hollow organs

  • distension
  • forceful contraction

solid organs

  • stretch of capsule
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2
Q

visceral pain is described as…

A

gnaw

burn

cramp

ache

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3
Q

parietal pain originates

A

inflam of peritoneum

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4
Q

pairetal pain is described as…

A

steady, aching

aggravated by mvmt/coughing

more severe & precise than visc

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5
Q

what type of pain is assocaited with rebound tenderness?

A

parietal

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6
Q

what position do pts with parietal pain usually like to be in?

A

lie still

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7
Q

rebound tenderness

A

pain with quick withdraw of pressure –> inflammation of peritoneal

“which hurts more, when I press or let go?”

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8
Q

what is blumberg’s sign

A

rebound tenderness

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9
Q

what are other ways to elicit rebound tenderness signs?

A

percussing pt’s ab lightly ad indirectly

better: “cough”

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10
Q

what is referred pain?

A

pain at a distance from organ: usually well localized

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11
Q

what parts of the body can refer pain to the abdomen?

A

chest

spine

pelvis

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12
Q

what is the color of bile vomitus?

A

yellowish green

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13
Q

what is the color of vomitus with blood?

A

“hematemesis”

brown/black = “coffee ground” –> blood altered by gastric acids

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14
Q

assessment of stool: diarrhea

A

increased h2o content

volume > 200g in 24 hours

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15
Q

melena

A

black, tarry stool

upper GI bleed

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16
Q

hematochezia

A

bright blood in stool

lower GI bleeding

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17
Q

hematochezia can be caused by

A

lower GI bleed

BRISK upper GI bleed

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18
Q

melena is usually from ____________ but can also be from….

A

upper GI

small bowel, right colon

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19
Q

jaundice

A

yellowish discoloration of skin and sclera

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20
Q

jaundice is due to…

A

increased lvls of bilirubin (from brkdown of Hb)

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21
Q

increased bilirubin is most suggestive of…

A

Hb (hemolysis)

problem within hepatobiliary sys

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22
Q

supra pubic pain can be caused by

A

bladdar/pelvis

bladder infection

urinary retention

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23
Q

order of physical exam for abdomen

A

inspection

ausculatation: must preceded percussion and palpation!

precussion

palpation

special tests

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24
Q

what is this and what is the disease?

A

abdominal straie

cushing’s syndrome

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25
Q
A

Sister Mary Joseph Nodule

metastatic disease

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26
Q
A

Caput Medusae

portal htn

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27
Q
A

cullen’s sign

periumbilical ecchymosis: bluish discoloration around umbilicus

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28
Q

cullen’s sign usually occurs due to

A

hemoperitoneum

hemorr panc

uterine tube rupture: ectopic pregnancy

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29
Q
A

grey turner’s sign: flank ecchymosis

  • need to “turn” them over to see
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30
Q

grey turner’s sign usually occurs during

A

retro-peritoneal bleeding

hemorr panc

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31
Q

why would you perform auscultation of abdomen before palpation anad precussion?

A

bowel motility

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32
Q

auscul bowel sounds with the _________ of your stethoscope

A

diaphragm

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33
Q

bowel sounds: normal

A

5-34/min

gurgling, clicking

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34
Q

borborygmi

A

loud, audible sounds

prolongeded gurgles of hyperperistalsis

NORMAL

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35
Q

high pitched bowel sounds

A

tinkling (raindrops on barrel)

signs of early intestinal obstruction

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36
Q

increased bowel sounds are indicative of

A

diarrhea

early intes obstruction

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37
Q

decreased bowel sounds are indicative of

what is the parameter?

A

none for a minute - decreased gut activity

ab sx

ab infection/peritonitis/injury

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38
Q

absent bowel sounds are indicative of

parameters?

A

no sounds ofr 2 minutes

caused by:

  • longer-lasting intestinal obstruction
  • intestinal perforation
    • intestinal ischemia/infarction
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39
Q

vascular abdominal sounds

A

pathology!

bruit: AAA, renal arteries, fem arteries

friction rubs: spleen, liver

venous hum: b/w xiphistenum & umbilicus

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40
Q

percussion of abdomen helps to assess (5)

A

amount & distribution of ab

solid or fluid masses

percussion tenderness

size of spleen and liver

ascites

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41
Q

percussion technique

A

light, then harder

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42
Q

ab percussion: tympany

A

gastric air bubble

gas filled portions of intestines

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43
Q

excessive tympany with abdominal percussion indicates

A

excess gas like in an obstruction

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44
Q

ab percussion: dullness

A

solid organs

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45
Q

unexpected dullness in percussion of ab =

A

megaly

full stomach

mass

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46
Q

how to proceed with palpation of abdomen?

A

ask pt if they have pain then palp that place last

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47
Q

palpation technique

A

encourage relaxtion & palp during exhalation - mouth breath

light: pads
deep: with both hands

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48
Q

what decreases with ab palpation while pt is breathing with mouth open and jaw dropped?

A

voluntary guarding

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49
Q

You ask your patient to tell you “ which hurts more when I press or let go” and then you proceed to firmly press your fingers down into her abdomen and then withdraw your hand quickly. By doing this technique you have assessed for the presence of:

a) voluntary guarding
b) Blumberg’s sign
c) rigidity
d) Cullen’s sign

A

Blumberg’s sign

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50
Q

direct assessment of liver is difficult due to…

A

liver!

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51
Q

percussion - liver span

A

measure vertical span of liver, mid-clav

  • umb –> lower border
  • nipple line –> upper border
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52
Q

liver span

A

mid sternal: 4-8cm

mid clav: 6-12 cm

larger is men & taller people

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53
Q

liver palpation technique

A
  1. L (posterior hand) - move liver anterior
  2. ask pt to take a deep breath
    * inhale = liver moves “down” - 3 cm below costal margin
  3. palp “down and up”
  4. liver should feel: soft, sharply defined, regular (mild tenderness = normal)
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54
Q

what is an alternative way for palp the liver?

A

hooking technique

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55
Q

spleen percussion

A

two techniques

  • L lower naterior border from cardiac dullness @ 6th rib –> anterior ax line –> costal margin –> Traube’s space
  • L anterior ax line = tympanic: ask pt to take a deep breath = still tympanic
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56
Q

spleen palpation

A

pt supine

  1. L (posterior hand) to bring spleen anterior
  2. “take a deep breath”
  3. spleen will move “down”
  4. repeat with R lateral fetal (knees partially flexed)
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57
Q

spleen can be palpated in what percent of adults?

A

5%

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58
Q

kidney palpation

A

pt supine

  1. L (posterior) hand to push kidney “fwd”
  2. “take a deep breath” - will move kidney “down”
  3. press down with R hand
  • R kid = sometimes palp
  • L kid = rarely palp
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59
Q

CVA tenderness

A
  1. fingertip palpation first
  2. fist percussion
    * use fish to pound on hand - painful jar/thud
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60
Q

bladder can be palpated if…

A

distended above pubic symphysis: round/smooth dome

usually cannot be palp

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61
Q

palpation of aorta

A
  1. press firm and deep on upper ab slightly L of midline, one hand on each side of aorta
  2. feel for pulsations
  3. assess width: >3cm = AAA
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62
Q

ascites

A

protuberant ab with bulging flanks

flud = sinks with gravity while bowel (filled with air) will rise

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63
Q

ascites occurs with (8)

A

MOCCHIN’

malnutrition

ovarian ca

cirrhosis

constrictive percarditis

heart failure

IVC/hepatic vein obstruction

nephrotic syndrome

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64
Q

how to test for ascites?

A

shifting dullness when pt turns onto one side

fluid wave

  • tap one side –> should feel on other side
  • false positive: sometimes not until it is too late or in people without ascite
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65
Q

the presence of what makes the dx of ascites highly likely

A

positive fluid wave

shifting dullness

peripheral edema

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66
Q

appendicitis symptoms

A

fever, nausea, vomiting

periumb (vague) –> migration of pain to RLQ

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67
Q

McBurney’s point

A

2in from ASIS

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68
Q

rovsing’s sign

A

RLQ pain during palp of LLQ –> referred rebound tenderness

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69
Q

psoas sign

A

pain with resisted flexion on R side

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70
Q

obturator sign

A

appendicities

pain on passive internal rotation of flexed thigh

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71
Q

tests for appendicities

A
  1. Mcburney’s
  2. rovsings
  3. psoas
  4. obturator
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72
Q

You are concerned that your patient has acute appendicitis. You press on her left lower quadrant and she states she feels pain in her right lower quadrant. You have just determined that the patient has a positive:

a) Obturator sign
b) Rovsing’s sign
c) Turner’s sign
d) Murphy’s Point Tenderness
e) Psoas Sign

A

Rovsing’s sign

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73
Q

cholecystitis

A

inflammed gallbladder

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74
Q

murphey’s sign

A

cholescystitis

  1. place hand firmly @ RUQ
  2. “inhale deeply”
  3. pain/catch breathe –> inflammed!
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75
Q

ventral hernia

A

hernias of ab wall exclusive of groin hernias

  • protrustion intestines thru ab wall

can be seen better if pt raises head and shoulders off table

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76
Q

how tell a hernia from an intra-ab mass?

A

ask pt to raise head and shoulders off table

“strain down”

hernia = palp

mass = obscured by ab M

  • but can feel ab mass in ab wall!!
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77
Q

peritonitis assessment

A

ask pt to cough and ID the pain

palp with 1 finger, then hand

check for rigid, rebound, percussion, tenderness

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78
Q

peritonitis usually signals

A

acute abdomen

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79
Q

modifiable breast ca risk (6)

A

postmenopause

obesity

breast feeding

contraceptives

HRT

ETOH

physical inactivity

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80
Q

breast ca risks: non-modifiable (4)

A

age:

  • > 50
  • 1st full-term preg
  • menarche: <12
  • menopause: >55

breast

  • previous ca
  • atyp hyperplasia
  • density

previous chest wall radiation

probable: hxn no

t breastfeeding

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81
Q

selective risk factors for breast ca

A

fam hx breast/ovarian ca on both sides

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82
Q

order of breast exam

A
  1. inspection
  • arms @ sides
  • arms over head
  • hands on hips
  • leading fwd
  1. palpation
  • ax: seated
  • breast: supine
  • nipple
  1. if mass felt –> recheck nodes
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83
Q

axilla exam

A

seated

  1. “relax with L arm down”
  2. support pt’s wrist/hand
  3. cup fingers of R hand –> reach apex
  4. feel for nodes
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84
Q

nodes of the breast

location and final drainage

A

pec: anterior ax fold (pec major)
subscapular: post ax fold (lateral border of scapula)
lateral: upper humerus

—-> central —-> supra/infra-clav

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85
Q

pec nodes of breast will drain

A

anterior chest, most of breast

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86
Q

subscapular nodes of breast

A

posterior chest, part of arm

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87
Q

lateral breast nodes

A

most of arm

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88
Q

fibroadenoma

A

FIBROADENOMA: firm, round/rubbery, nontender, mobile

15-25 y/o

no retraction

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89
Q

breast self exam timing:

A

5-7 days after onset of menses

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90
Q

BSE for R breast

A
  1. lie down, pillow under R shoulder with R arm behind head
  2. palp with L 3 middle fingers: vertical stripe pattern
  3. L breast
  4. soapy shower, 1 arm behind head: repeat steps 2 & 3
  5. inspect in mirror: arms @ sides, hands on hips
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91
Q

must of a chaperone present for what exams?

A

breast

rectal

pelvic

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92
Q

auchincloss maneuver

A

hands on hips, shoulder roll lateral and medial

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93
Q

inspection of breast should happen in what order

A

pt sitting

  1. arms at sides
  2. arms over head
  3. hands on hips, shoulder roll
  4. leaning fwd
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94
Q

draping for breast exams

A

full exposure for exam

drape 1 while palp other

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95
Q

clinical breast exam

A

pt supine - vertical strip

  • circ motion with pads of 3 middle fingers: light –> medium –> deep
  • from tail of breast: axilla –> medial: clav to boob fold

pads of 3 fingers

change positions for lateral and medial breast

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96
Q

clinical breast exam: lateral breast

A
  1. pt roll to opposite hip
  2. “put hand you’re not laying on on head”
  3. palp ax –> nipple
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97
Q

clinical breast exam: medial breast

A
  1. “lay supine with shoulders flat”
  2. “put hand on neck”
  3. lift elbow to lvl of shoulder
  4. palp nipple –> midsternum: under boob –> clavicle
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98
Q

assessment of nipple discharge

A

compress circumfrentially on areola

note # ducts discharge is from

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99
Q

lithotomy position

A

stirrups

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100
Q

obtain urine specimen _________ GYN exam

A

before

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101
Q

GYN exam order

A
  1. external inspection, palp: genitalia, pubis, bartholin glands
  2. speculum: cervix - obtain specimen: pap smear then cultures
  3. internal spection: vag walls, M tone
  4. bimanual: cervix, uterus, adnexa
  5. rectovag
  6. rectal: guaiac/hemoccult
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102
Q

ectocervix

A

visible portion of cervix

red columnar epith around os, pinik shiny squamous continuous with vag lining

round or slit-like

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103
Q

endocervical canal

A

lined with columnar

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104
Q

squamocolumnar jxn

A

@ pub: columnar encircling ox replaced by squamous

later risk of dysplasia

PAP SMEAR

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105
Q

lymphatics of gyn

A

ingunal nodes: vulva, lower vagina

  • only ones accessible to exam

pelvic/ab nodes: upper vag, internal organs

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106
Q

for the best results with cervical ca screening

A

not on period

nothing in vag for 48 hours: sex, douches, tampons, contraceptive foams/creams, vag suppository

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107
Q

most important risk factor for cervical ca

A

HPV 16, 18

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108
Q

basic risk factors for cerv ca (8)

A

early sex

multiple partners

STIs

age

no

PAP

nutrition

smoking

immune status

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109
Q

drape in lithotomy pos

A

mid-ab –> knees, depress in middle for eye contact

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110
Q

first contact for max comfort in litho pos

A

inner thigh

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111
Q

lithotomy pos: pos of pt anatomically

A

thighs flexed & abducted

hips ext rot

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112
Q

examiner ____ for speculum exam and _____ for bimanual exam

A

sits

stands

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113
Q

gloves for gyn exam

A

dbl glove dominant hand

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114
Q

bartholin glands palpation

A

only if hx/inspection suggest problem

“pinch vag @ 4 and 8 o’clock”

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115
Q

speculum insertion steps

A
  1. lub speculum
  2. enter @ 45 angle, closed, over other index finger (in vag)
  3. direct down and posterior
  4. remove finger
  5. rotate speculum to horizontal pos
  6. open blades: warn of click!
  7. look into vag
  8. pos ends of speculum cupping cervix and lock
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116
Q

if cervical discharge is mucopurulent, culture for…

A

chlamydia

gonorrhea

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117
Q

pap smear

A

plastic:

  1. place longer end into os
  2. press, turn, scrape in full clockwise circle
  3. smear on glass slide

endocervical brush:

  1. cone shaped brush into os
  2. roll in circle b/w thunb and index
  3. smear onto glass with rolling motion

preg = cottom tip & saline

spray slide with fixative

118
Q

liquid base test

A

pap smear

benefits

  • less false negatives
  • no slides
  • no fixatives

use broom –> obtain specimen –> put into container

119
Q

withdrawl of speculum steps

A
  1. warn pt of click with closign the speculum
  2. release speculum and slowly close while pulling out: inspect vag walls
  3. rotate speculum @ same 45 degrees with insertion
120
Q

bimanual exam intro steps

A

lub index and middle finger of dom hand (has 2 gloves)

insert fingers: palm up, thumb abducted

121
Q

pain with mvmt of cervix =

A

chandelier’s sign

CMT: cerv mvmt tenderness

122
Q

what signs are suggestive of PID?

A

positive chandellier’s

CMT

adnexal tenderness

123
Q

what is a blueish hue to cervix or vag walls

A

Chadwick’s sign of early preg

124
Q

bimanual exam of uterus

A

palp hand pressing down & inward b/w pubic symphysis and umbilicus

slide into anterior cervix and sandwich cervix:

  • pelvic hand = anterior uterus
  • ab hand = posterior uterus
125
Q

bimanual exam: ovaries

A
  1. put ab hand on RLQ
  2. put pelvic hand in R lateral fornix
  3. sandwich ovaries: press in and down with outside hand and up with inside hand
  4. repeat for L side
126
Q

ovaries should not be palpable in….

A

postmenopausal women

127
Q

assessing pelvic M strength

A
  1. withdraw fingers so not touching cervix
  2. spread fingers in vag wall
  3. “please squeeze my fingers”
  • compress snugly and move inwards/upward
  • last over 3 sec
128
Q

rectovag exam

A
  1. inform pt
  2. reglove! remove glove from dominant hand
  3. lub fingers 2-3
  4. place index in vag and 3rd in anus
  5. “strain down” (will relax sphincter during insertion)
129
Q

urethral exam

A

perform if urethritis or inflammation of paraurethral glands suspected

insert index into vag and milk outwards

observe for discharge

130
Q

benign breast mass characteristics

A

skin changes

smooth, soft

firm, mobile

well-defined

131
Q

malignant breast mass characteristics

A

hard, immobile

fixed to skin/soft tissue

irreg margins

skin changes

132
Q

pre-preg, when to test for rubella?

A

3 months prior

133
Q

folic acid

134
Q

horm changes in preg

A

increase estrogen, progesterone, placental hormones (HCG)

135
Q

estrogen and preg

A

endometrial growth –> supports early embryo

136
Q

progesterone and preg

A

lowers esop sphincter tone –> results in gastroesophageal reflux

relax ureter and bladder tone –> hydronephrosis, incr risk of bacteriuria

137
Q

coag and preg

A

hypercoag state

138
Q

Cv changes in preg

A

increase:

  • RBC mass
  • plasma vol
  • CO

decrease:

  • vasc resistance
  • BP
139
Q

musc-skel changes in preg occur due to…

A

wt gain

relaxin (horm)

140
Q

musc-skel changes in preg

A

lumbar lordosis

lig laxity in SI joints & pub symp

141
Q

breast changes in preg

A

stim by horm: increases:

  • vasc
  • glandular tissue (hyperplasia)
  • sens

more nodular by 3rd month

142
Q

breast changes mid-to-late preg

A

colostrum expressed

areolae darken

more pronounced montgomery glands

increasingly vis venous pattern

143
Q

uteral changes during preg

A

rotates R to accom rectosigmoid struct on L

enlarge –> results in:

  • freq voiding
  • round lig pain
  • R side hydronephrosis
144
Q

the uterus is most easily palpable above pubic bone @

A

12-13 weeks of preg

145
Q

vag secretions during preg

A

thick, white, more profuse

146
Q

vag walls during preg

A

thickens, deeply rugated

147
Q

cervical changes during preg

A

chadwicks: increased vasc and edema

increased secr

hegar’s sign

mucous plug

148
Q

hegar’s sign

A

palp softening of cer isthmus (portions of uterus that narrows into cervix)

149
Q

mucous plug fx

A

protects uterine environ from outside pathogens

150
Q

scehduled screenings during pregnancy include: (3)

A
  1. aneuploidy testing: 1st and 2nd trimester
  2. oral glucose tol test: 24028 weeks
  3. rectovag swab for group B strep: 35-37 weeks
151
Q

preg and constipation

A

slow GI transit

  • horm changes
  • dehydration
  • iron (prenatal vitamins)
152
Q

hemorrhoids during preg

A

constipation

decreased venous return

compression by fetus

changes in activity lvl

153
Q

when does the center of gravity shift during preg?

A

3rd trimester

154
Q

exercise during pregnancy assists: (7)

A

preeclampsia

preterm birth

decrease length of labor and complications during delivery

DM-G

DVT

varicose veings

wt gain

155
Q

tobacco and pregnancy

A

low birth wt

placenta previa/abruption

preterm labor

fetal digit anomalies

spont abortion/fetal death

156
Q

alcohol and preg

A

fetal alcohol syndrome

157
Q

what is the leading cause of preventable mental retardation in the US?

A

fetal alcohol syndrome

158
Q

foods to avoid during preg

A

unpasteurized, raw, undercooked

159
Q

preg recommends 2 servings of _________ per week

A

selected fish and shellfish

160
Q

Gravida

A

total # times preg

161
Q

para

A

babies delivered during viable period

162
Q

TPAL

A

term deliveries - preterm deliveries - abortions - living children

163
Q

G7P5 (4-1-1-5)

A

7 preg, 5 living children (4 term preg - 1 preterm deliver - 1 abortion - 5 live children)

164
Q

establishing the expected date of delivery (EDD)

A

Naegele’s rule:

  • first date LMP
  • subtract 3 months
  • add 7 days
165
Q

how to establish EDD when actual date of conception is known

A

conception age which is 2 weeks less than menstrual age can be used

166
Q

how to verify EDD

A
  1. doppler fetal HR: positive @ 10-12 weeks
  2. ultrasound: 1st trimester
  3. fetoscope: heard at 18 weeks
  4. fetal mvmt: quickening @ 18-24 weeks
167
Q

vital sign changes during preg

A

BP: falls in middle months –> return to normal in 3rd trimester

HR: increased resting

RR: gen unchanged

168
Q

chronic versus gestational htn

A

SBP > 140, DBP > 90 @ 20 wks gestation

chronic: BEFORE
gestational: AFTER

169
Q

preeclampsia

A

after 20wks gestation:

  • elev BP
  • SBP > 140, DBP > 90
  • proteinuria
170
Q

recommended wt gain during preg: low BMI

A

< 18.5

28-40

171
Q

Recommended Weight Gain in Pregnancy: normal BMI

A

18,5-24.9

25-35

172
Q

Recommended Weight Gain during pregancy: high BMI

A

25-29.9

15-25

173
Q

recommended wt gain during pregnancy: obese GMI

A

> 30

11-20

174
Q

what is the mask of pregnancy?

A

chloasma-hypermelanosis of sun-exposed areas DURING preg: 50-70% affected

175
Q

hair and pregnancy

A

dry and thinning

176
Q

mouth and preg

A

periodontal disease common

177
Q

nose and preg

A

congestion and nose bleeds more common

178
Q

eyes and preg

A

can be pallor –> anemia

examine retina is BP elevated

179
Q

lungs/thorax and preg

A

may complain of SOB but no change in RR

180
Q

heart and pregnancy

A

venous murmur common in adv preg

apical pulse be rotated up and L

181
Q

striae gravidarum

A

stretch marks

stretch of skin and tear of collagen in dermis

182
Q

fundal height

A

pub symp –> top of fundus

183
Q

auscultate fetal HR with _____ @ 10 weeks and _______ @ 18 weeks

A

doptone

fetoscope

184
Q

change in fetal HR from 1st weeks to term

A

150-160: 1st weeks

120-160: term

185
Q

during pregnancy, the uterus is in the pelvis until…

A

12-14 weeks

186
Q

leopolds maneuver

A

detms: fetal pos beginning 2nd trimester

greatest accuracy after 36 wks

helps detm readiness for vag delivery

187
Q

leopolds maneuver helps detm readiness for vag delivery by assessing: (5)

A

which side fetus back is facing

what part is @ pelvic inlet

upper and lower fetal poles

fetal desc into maternal pelvis

est size and wt

188
Q

cervical dilation

2, 4, 6, 8, 10 cm

A

2 = penny

4 = oreo

6 = soda can

8 = donut

10 = roll of cheap TP

189
Q

freq of prenatal visits

A

usually individualized but typ

  • 0-28 wks: 1/month
  • 28-36: every 2 weeks
  • 36-deliver: weekly
190
Q

anorectal jxn

A

pectinate/dentate line - serrated: sep anal canal from rectum

boundary b/w somatic and visceral N supplies

191
Q

columns of morgagni

A

anal columns

  • each contain an A and a V –> hemorrhoid!

folds of mucosa from rectum to anorectal jxn

193
Q

prostate gland location

A

in front of anterior wall of rectum

surround bladder neck and urethra - 15 to 30 ducts into urethra

194
Q

fx of prostate

A

thin, milky, alkaline fluid –> helps sperm viability

195
Q

prostate structure

A

bilobed: round/heart shape
2. 5cm long

196
Q

average length of examining finger of uterus

197
Q

peritoneum and rectum

A

covers superior 2/3s

–> rectovesical pouch: males

–> rectouterine pouch: females

198
Q

valves of houston

A

3 semilunar txverse valves

lowest one is palpable –> do not mistake for intrarectal mass

199
Q

technique for rectal exam

A

left lateral decubitus

200
Q

pilonidal cyst/sinus

A

congenital - sinus tract opening with slight drainage

generally symptomatic

201
Q

anal fistula

A

inflam tract/tube

openings @ skin, anus, rectum

202
Q

anal hemorrhoids

A

chronic increased venous pressure

203
Q

difference b/w internal and external hemorrhoids?

A

internal - above dentate line with painless bleeding

external - below dentate line with painful swelling

204
Q
A

Pruritus Ani

usually due to pinworms: esp younger pts

205
Q
A

Enterobius vermicularis: pinworm

egg deposit on perianal folds

most common symptom = perianal itching

common reinfections -> can affect entire household

206
Q

anal fissure

A

oval ulveration - sentinel tag

risk due to anal sex –> easy to transmit HIV, STI’s

207
Q

anal fissure is usually associated with

A

prior abscess

proctitis

crohn’s disease

208
Q
A

Condyloma Acuminata: HPV - warts

209
Q
A

Condyloma lata - secondary syphillis

flat and velvety“moist”

210
Q

rectal prolapse is a…

A

projection of pink mucosa seen when pt bears down

211
Q

what happens to the anal sphincter with pressure?

A

first reflex tighten and then relax with con’t pressure

212
Q

anal angle

A

towards the umbilicus

213
Q

palpation of anus with severe tenderness

A

do not force –> ask pt to bear down

maybe use lidocaine jelly

214
Q

rectal polyps

A

common

may be pedunculated (on stalk) or sessile (flat)

215
Q

rectal ca

A

irregular border - firm, nodular, rolled edge

central ulceration

216
Q

rectal shelf

A

peritoneal metastasis to peritoneal reflection anterior to rectum

can be felt with tip of examining finger: firm or hard

217
Q

occult blood in stool can indicate:

A

bleed in GI

colon ca/polyps

single negative stool sample does not rule out ca

218
Q

how can you get a false-positive occult blood test?

A

ingestion of red meat w/in 3 days of test

219
Q

grade for colorectal ca screening guidelines

A

A: 50-75 y/o: sigmoioscopy/colonoscopy

C: 76-85

D: > 85: no screening

I: insuff evid for CT colonography and DNA testing as screening modality

220
Q

colorectal screening test intervals

A

annual high-sens fecal occult blood test

or

sigmoidoscopy every 5 yrs with occult every 3

or

colonoscopy every 10 years

221
Q

DRE and colorectal ca screening

A

not recommended as stand-alone test

reach is limited

checking stool from DRE will miss >90% color abnorm

222
Q

DIPSS

A

discharge from penis

infection

pain in scrotum

swelling in scrotum

sores/growths on penis

223
Q

phimosis

A

inability to retract foreskin over glans

224
Q

tx for phimosis

A

circular or dorsal slit

225
Q

paraphimosis

A

retracted foreskin cannot be returned to regular position

226
Q

how does one usually get paraphimosis

A

usu by healthcare personal

227
Q

hypospadias

A

displace urethral meatus to underside

228
Q

balanitis

A

inflammed glans

229
Q

balanosposthitis

A

inflammed glans and foreskin

230
Q

how to inspect penis for discharge?

A

compress glans with pinching technique

if no discharge, ask pt to milk

231
Q

what do you ask the pt to replace before the scrotal exam?

A

replace foreskin

232
Q

what is the most ocmmon viral STI in the US?

it can occasionally form…

A

HPV: warts

large exophytic masses: interfere with poo and sex

233
Q

tx for anogenital warts

A

immune therapy

sx

234
Q

difference in HPV locations in men

A

circumcised: shaft
uncircumcised: glans

235
Q

what do anogenital warts look like?

A

pink or colored lesions

smooth, flat papules –> verrucous papilliform

236
Q

genital herpes

A

HSV1/2 - small vesicles –> painful ulcers on red base

237
Q

uniqueness about herpes

A

latent state

average incubation after exposure = 4 days (2-12 days range)

238
Q

syphilis incubation period

A

2-3 weeks: papule –> ulcer (chancre)

239
Q

chancre

A

syphilis ulcer: 1-2cm with raised, indurated margin

240
Q

syphilis tx

A

long acting pcn

241
Q

chancre healing

A

heal spont w/in 3-6 weeks even in absence of tx

242
Q

chancre base

A

usually non-exudative

243
Q
A

Syphilis Chancre

244
Q

peyronie’s disease

A

fibrotic tunical albuginea –> crooked erection

palp non-tender palques beneath skin of dorsum of penis

245
Q

penile fx

A

rupture of tunical albugnea of corpus cavernosum

246
Q

penile ca

A

undurated, nontender nodule/ulcer

247
Q

increased risk of penile ca with

A

HPV

HIV

smoking

PUVA exposure (tanning beds)

AA (african american)

248
Q
A

pearly penile papules: normal varient seen in Af-Am. and circumcised men

asymptomatic acral angiofibromas: corona and sulcus of glans

most freq after puberty

249
Q

transillumination of the scrotum

A

if scrotum is swollen, light it up

red glow = serous, hydrocele

dark = blood, testis, tumor, most hernias

250
Q

hydrocele

A

non-tender: fl-filled in tunica vaginalis

fingers can get above mass within scrotum

251
Q

scrotal edema

A

pitting, taut skin

252
Q

scrotal edema may be seen in

A

CHF

nephrotic syndrome

253
Q

epidermoid cysts

A

firm, yellowish, nontender skin nodules on scrotum

254
Q

cryptorchidism

A

hidden testicle: absent or undescended

  • usually desc spont by 6 months: if not –> sx!

most common location: just outside external inguinal ring

255
Q

not corrected cryptorchidism is an increased risk for

A

testicular ca

infert

torsion

inguinal hernia

256
Q

acute orchitis

A

inflamed painful, tender, swollen testicle: hard to distinguish from epididymis

possible RED scrotum, usually unilateral

due to: mumps (viral)

257
Q

testicular length is usualy…

A

less than/equal to 3.5cm

258
Q

Klinefelter’s syndrome

A

less than/equal to 2cm small firm testes

259
Q

small, soft testes can suggest: (5)

A
  1. atrophy in cirrhosis
  2. myotonic dystrophy
  3. estrogen use
  4. hypo-pituitary
  5. follows orchitis
260
Q

risk factors for testicular tumors

A

cryptorchidism

ca of contrallat testicle

mumps orchitis

childhood hydrocele

261
Q

testicular tumor markers

262
Q

what is the most common neoplasm in men ages _________

A

15-35: test ca

263
Q

dev of testicular ca

A

early = painless nodule –> late = replaces testicle (feels heavier than usual)

264
Q

epididymitis

A

inflammed vas deferens

usually alongside acute prostatitis

may have red scotum, inflammed vas deferens

265
Q

varicocele

A

“bag of worms”

varicose veins of spermatic cord: usually L

266
Q

why is standing the best pos for locating varicocele?

A

varicocele collapses when scrotum is elevated

267
Q

TB of epididymis

A

chromic inflammation –> firm enlargement of epididymis

thickening/beading of vas deferens

268
Q

spermatocele v epididymal cysts

A

s = > 2cm

e = < 2 cm

269
Q

epididymal cyst

A

painless, movable mass above testis

transilluminates

270
Q

testicular torsion

A

twist testicle on spermatic cord –> necrosis

painful, tender, swollen and retracted UP

cannot elicite cremasteric reflex

271
Q

inguinal hernia palpation

A

invag scrotal skin –> travel up inguianl canal –> ask pt to cough/strain down –> hernia will touch fingertip

272
Q

what is the most common groin hernia in men and women?

A

indirect inguinal

273
Q

indirect inguinal hernia

A

goes through inguinal canal to touch fingertip

defective obliteration of fetal processus vaginalis –> mostly congenital

274
Q

indirect inguinal hernia are more freq on _______ b/c…..

A

right, descends last

275
Q

direct inguinal hernia

A

usually in men > 40: hesselbach’s triangle (weak inguinal canal floor)

bulge near external inguinal ring - RARELY enters scrotum

276
Q

femoral hernia

A

below inguinal lig: women > men

usually more lateral than inguinal hernias

277
Q

most common methods for screening for prostate ca is….

278
Q

PSA

A

glycoprotein released by prostate epith cells: biomarker for prostate ca

279
Q

shortcomings of DRE for prostate ca screening

A

DRE only reaches posterior and lateral surf of prostate

many false positives

280
Q

when does prostatic hyperplasia usually begin?

A

5th decade

281
Q

during what exam will the pt feel the urge to urinate?

A

prostate exam: rotation of finger anterior to palp prostate

282
Q

BPH

A

symm enlarged, smooth, firm, elastic

protrudes into rectal lumen

median sulcus may be obliterated

283
Q

prostate ca

A

area of hardness (nodule) –> usually distinct

can be irregular if prostate enlarged

284
Q

symptoms of BPH

A

irritative: urgency, freq, nocturia
obstructive: decreased stream, incomplete emptying with straining

285
Q

what in men can cause urinary obstruction and chronic UTI?

286
Q

what should always raise suspicion for prostate gland pathology

A

new onset ED

287
Q

only ____ cases of prostate ca palp on rectal exam

288
Q

prostatitis

A

80% = gram negative bacteria

suspect STI in men under 35 y/o

elevated PSA

289
Q

PSA for ca screening sould be done _________ after prostatitis episode

A

1 month

both due to elev PSA

290
Q

prostatitis may cause:

A

urethral discharge

lower urinary tract obstruction

PD Year 1 (6 decks)

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