Exam 10 Flashcards
1
Q
What are the components of a basic OB/Gyne history?
A
- CC
- Present illness
- Menstrual history
- Obstetric history
- Other (contraceptive, gynecologic, endocrine, family, social, sexual)
2
Q
Define polymenorrhea.
A
Cycle being more frequent than every 21 days
3
Q
Define oligomenorrhea
A
Cycle greater than 35 days
4
Q
What are the aspects of the menstrual history?
A
- Menarche/menopause/cycle length
- Menorrhagia
- Post-coital bleeding
- Dysmenorrhea/PMS
5
Q
What are the aspects of the obstetric history?
A
- Infertility
- Spontaneous/elective abortions
- Vaginal deliveries/C sections/pregnancy complications
6
Q
Explain the GP system.
A
G (gravita) - number of pregnancies
P (para) - number of full-term pregnancies, number of pre-term pregnancies, number of abortions, number of living children
7
Q
All pelvic and breast exams should be ___.
A
Chaperoned
8
Q
What should be done prior to the basic pelvic exam?
A
- Have the patient empty their bladder
- Defer if menstruating
- Assume lithotomy position
- Drape patient with sheet
9
Q
What is the exam for pelvic relaxation?
A
Ask the patient to strain and/or cough. Observe for signs of stress incontinence and/or abnormal bulging of walls of vagina
10
Q
What are the 4 types of speculum?
A
- Graves
- Pederson
- Pediatric
- Oncology
11
Q
What is the shape of the Graves speculum and which populations is it used for?
A
Duckbill; sexually active and multiparous women
12
Q
What is the shape of the Pederson speculum and which populations is it used for?
A
Stilleto; virginal, nulliparous, elderly women
13
Q
The pediatric speculum is a miniature ___.
A
Peerson
14
Q
The oncology speculum is used in patients who have had a ___.
A
Vulvectomy
15
Q
What should be done prior to the speculum exam?
A
- Warm speculum with water
- Touch inner thigh with patient for temperature
- Ask patient to lower knees laterally and to relax perineal musculature
- Press fingers on perineal body and assess relaxation
- Make sure blades are closed and thumbscrew loosened (if metal)
16
Q
Insert the speculum at ___ (angle).
A
45 degrees
17
Q
What are the symptoms of bacterial vaginosis?
A
Often no symptoms; some have malodorous homogenous discharge
18
Q
What are the components of the Ansel criteria?
A
- pH>4.5
- Clue cells (20%)
- Whiff test
- Adherent milky white discharge
(3/4)
19
Q
What are the symptoms of trichomonoiasis?
A
Frothy gray/green discharge, pruritis, may be asymptomatic; strawberry cervix
20
Q
What are the symptoms of vulvovaginal candidiasi?
A
Pruritis, dyspareunia, burning, discharge
21
Q
What are the USPSTF recommendations regarding screening for cervical cancer?
A
F, age 21-65 - pap smear every 3 years OR F, age 30-65, pap smear + HPV screening every 5 years
22
Q
How is the pap smear performed?
A
Use the cytobrush (broom), rotate 5 times, put into liquid medium, send to lab; avoid cytobrush in pregnancy
23
Q
When should a woman be referred for colposcopy?
A
- All women with clearly recognizable dysplasia
- Atypical squamous cells of undetermined significance + any risk factor for cervical neoplasia
- 2 sequential pap smears with ASC-US (repeated within 1 year) and no risks
24
Q
What are risk factors for cervical neoplasia?
A
- Multiple sexual partners
- History of STDs
- High risk HPV infection
- Previous malignant or pre-malignant lower genital tract condition
25
What are the recommendations regarding chlamydia and gonorrhea testing in women?
1. All sexually active women 24 y/o or younger, including adolescents OR
2. High risk - history of STDs, new or multiple partners, inconsistent condom use if not in mutually monogamous relationship, exchanging sex for money/drugs, incarceration, military recruits, patients receiving care at STI clinics
26
What is examined in the bimanual exam?
Vagina, cervix, uterus, adnexa
27
What is the normal shape and size of ovaries?
3.5 x 2 x 1.5 cm
| Almond shape
28
The name of the warts caused by HPV is called ___.
Condyloma accuminatum
29
The name of the warts caused by secondary syphilis is called ___.
Condyloma lata
30
What are signs of pelvic relaxation seen with aging?
1. Cystocele
| 2. Urinary incontinence
31
What are the components of the male GU exam?
1. Abdominal (kidney, ureter, bladder)
2. External genitalia (penis, scrotum/testes, epididymis, vas deferens, spermatic cord)
3. Hernia exam
4. Inguinal node exam
5. Upright exam
6. Digital rectal exam (prostate, seminal vesicles)
32
What are the steps of the abdominal exam?
1. Inspection
2. Light palpation
3. Deep palpation
4. Bladder
5. Flank
6. Kidney
33
When is the kidney palpable?
Children, lean adults, abnormality
34
What are causes of kidney enlargement?
1. Hydronephrosis
2. Mass
3. Polycystic kidney disease
4. Compensatory hypertrophy
5. Perinephric pathology (adrenals, retroperitoneum)
35
What are causes of renal pain (CVA tenderness)?
1. Pyelonephritis
| 2. Urolithiasis
36
How do patients with polycystic kidney disease present?
30-50 y/o, flank pain, hematuria, proteinuria, renal failure, HTN; can progress to ESRD
37
The bladder is a ___(peritoneal) organ.
Extraperitoneal
38
Where and when is the bladder palpable?
Above pubic symphysis in the midline; not palpable if empty
39
The bladder is ___ to percussion when full.
Dull
40
What are causes of bladder pain with palpation?
1. Cystitis
2. Stone
3. Mass
4. Interstitial cystitis/bladder pain syndrome
41
What are causes of bladder distention?
Urinary retention due to BPH, urethral stricture, bladder stone, MS, spinal cord injury
42
What are causes of bladder masses?
Invasive bladder tumors (superficial bladder tumors are typically not palpable)
43
True or false - the ureter is not palpable.
True (except when massively dilated in the pediatric population)
44
How should the ureter be examined?
Radiologically
45
What are the effects of a ureteropelvic junction obstruction and how is it treated?
Hydronephrosis and obstruction; treat with pyeloplasty
46
How should the penis be examined?
1. Note circumcised or uncircumcised (retract foreskin if present)
2. Hold by plans to check for skin lesions
3. Open meatus gently (masses, stenosis, discharges, condyloma)
4. Palpate shaft for masses in corporal bodies
47
What are some causes of skin lesions of the penis?
Herpes, condyloma, syphilis, chancroid, penile SqCC
48
What are some lesions of the foreskin?
Phimosis, paraphimosis, penile cancer, lichen sclerosis
49
What are some meatal abnormalities?
Hypospadias, meatal stenosis, condyloma, penile cancer
50
What are causes of corporal body masses?
Peyronie's disease, penile fracture, penile or urethral cancer
51
What are some scrotal skin lesions?
Sebaceous cysts, condyloma
52
What are some causes of scrotal or testicular enlargement?
Hydrocele, hernia, mass
53
True or false - a mass in the testis is cancer until proved otherwise.
True
54
What are some causes of epididymal masses?
Cysts, spermatocele, adenomatoid tumor
55
What component of the male genitalia feels like linguini upon palpation?
Vas deferens
56
Blunt injury to the scrotum can cause...
...testicular rupture, hematoma, dislocation of testis, or testicular torsion
57
How is the hernia exam performed?
1. Place the examining finger underneath the peripubic fat pad at the external ring
2. Direct the patient to perform a Valsalva maneuver
3. Repeat in standing position
58
What is an indirect hernia?
Follows the same pathway as the testicle through the internal ring and into the scrotum
59
What is a direct hernia?
Directly through the inguinal canal floor made of transversalis fascia medial to the epigastric vessels
60
How is the inguinal node exam performed?
1. Identify ASIS (top of inguinal ligament)
| 2. Palpate in gentle, circular motion
61
What is the purpose of the upright hernia exam?
Assess for varicoceles
62
What are varicoceles?
Dilated veins of the spermatic cord; feels like a bag of worms
63
What are normal prostate physical exam findings?
Smooth and rubbery
64
What are some causes of prostate enlargement?
BPH, prostatitis, cancer
65
What can cause nodularity of the prostate?
Cancer (prostate and rectal), BPH nodules, prostate calcifications
66
What can cause bogginess and tenderness of the prostate?
Infection, prostatitis
67
What can cause seminal vesicle pathology?
Tumor or ejaculatory duct obstruction
68
What is the most common non-cutaneous malignancy in US men?
Prostate cancer
69
The Emergency Medical Treatment and Active Labor Act requires hospitals with EDs to provide a ___ to any individual who comes to the ED and requests such an examination. It also prohibits hospitals with EDs from ___ to examine or treat individuals with an emergency medical condition.
Medical screening examination; Refusing
70
What is the Illinois Good Samaritan Act?
Grants good-faith immunity to individuals who provide emergency assistance without charging a fee
71
What is the Illinois Health Care Surrogate Act?
Enables family members, friends, or guardians to make medical treatment decisions for people who lack the ability to make and communicate decisions about medical care, and who do not have a Power of Attorney.
72
The Illinois Health Care Surrogate Act permits a surrogate decision maker to forgo life sustaining treatment only if what three conditions are met?
1. Patient has no valid Health Care Power of Attorney or Living Will Declaration in Place, or one is in place but it does not apply to the patient's condition or is invalid for some reason
2. Patient must lack decisional capacity
3. Patient must have a qualifying condition
73
What is the order of priority as described by the Illinois Health Care Surrogate Act?
1. Patient's guardian of the person
2. Patient's spouse
3. Any adult son or daughter of the patient
4. Either parent of the patient
5. Any adult brother or sister of the patient
6. Any adult grandchild of the patient
7. Close friend of the patient
8. Patient's guardian of the state
74
What provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information? At the same time, it is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes?
The HIPAA Privacy Rule of the health Insurance Portability and Accountability Act
75
What specifies a series of administrative, physical, and technical safeguards for covered entities to use to assure the confidentiality, integrity, and availability of electronic protected health information?
The Security Rule of HIPAA
76
What is HIPAA's Breach Notification Rule?
Requires hospitals to tell the government and the patient about situations that involve an impermissible use or disclosure of the patient's protected health information, except those in which the hospital demonstrates that there is a low probability that the protected health information is compromised
77
What prohibits a physician from making a referral for certain designated health services to an entity in which the physician (or an immediate member of his or her family) has an ownership/investment interest or with which he or she has a compensation arrangement, unless an exception applies?
Physician Self-Referral Law (Stark Law)
Note - also prohibits the entity from presenting or causing to be presented claims to Medicare for those referred services; establishes a number of exceptions and grants the Secretary the authority to create regulatory exceptions for financial relationships that do not pose a risk of program or patient abuse
78
What is the Excluded Provider Rule?
OIG has the authority to exclude individuals and entities from federally funded health care programs pursuant to section 1128 of the SSA and maintains a list of all currently excluded individuals and entities
79
The ___ makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a federal health care program.
Anti-kickback Statute
80
The ___ protects the government from being overcharged or sold substandard goods or services. It imposes civil liability on any person who knowingly submits, or causes to be submitted, a false or fraudulent claim to the Federal Government.
False Claims Act
81
A defensible case can be made indefensible by ___.
Poor documentation
82
True or false - the patient's medical record should not be used to place blame for a bad outcome.
True
83
When in doubt about a patient outcome, what should you do?
Contact risk management/patient safety department; do not document in the patient chart that you called risk management
84
What is upcoding?
Billing for a higher service than the one actually performed
85
What is phantom billing?
Billing for a service that was never performed
86
True or false - not billing for a service insulates a provider from liability.
False - it does not insulate a provider from liability
87
Who should make the decision regarding writing-off a bill?
Risk management or another department
88
Under the False Claims Act, every service provided to a ___ patient must be billed to CMS.
Medicare
