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PACS > Exam 3 (wks 8-12) > Flashcards

Exam 3 (wks 8-12) Flashcards

1
Q

Musculoskeletal System

ROM for TMJ

A
  • over/under bite
  • lateral crossbite
  • jaw opening/closing
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2
Q

Musculoskeletal System

ROM for c-spine

A
  • flexion
  • hyperextension
  • L&R rotation
  • lateral bending
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3
Q

Musculoskeletal System

ROM for T-spine

A
  • minor flexion
  • extension
  • L&R rotation
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4
Q

Musculoskeletal System

ROM for L-spine

A
  • flexion
  • hyperextension
  • lateral bending
  • L&R rotation
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5
Q

Musculoskeletal System

ROM for Shoulder

A
  • flexion
  • hyperextension
  • abduction
  • adduction
  • external rotation
  • internal rotation
  • protraction
  • retraction
  • shrug
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6
Q

Musculoskeletal System

ROM for elbow

A
  • flexion
  • hyperextension
  • pronation
  • supination
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7
Q

Musculoskeletal System

ROM for wrist

A
  • flexion
  • hyperextension
  • radial deviation
  • ulnar deviation
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8
Q

Musculoskeletal System

ROM for MCP/PIP/DIP in phalanges

A
  • MCP: flexion, hyperextension, abduction, adduction
  • PIP: flexion, extension
  • DIP: flexion, extension
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9
Q

Musculoskeletal System

ROM for thumb MCP

A
  • flexion
  • extension
  • abduction
  • adduction
  • thumb-finger opposition
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10
Q

Musculoskeletal System

ROM for hips

A
  • flexion
  • hyperextension
  • abduction
  • adduction
  • external rotation
  • internal rotation
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11
Q

Musculoskeletal System

ROM for knees

A
  • flexion
  • hyperextension
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12
Q

Musculoskeletal System

ROM for ankle

A
  • tibiotalar: dorsiflexion, plantar flexion
  • subtalar: inversion, eversion
  • transtarsal: stabilize heel, twist foot in both directions
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13
Q

Musculoskeletal System

ROM for toes

A
  • curls toes up/down
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14
Q

Musculoskeletal System

ROM in Hallex

A
  • flexion
  • extension
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15
Q

Musculoskeletal System

where is the tibiotalar joint?

A
  • consists of the articulation of the tibia, fibula, and talus. It is protected by ligaments on the medial and lateral surfaces.
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16
Q

Musculoskeletal System

what type of joint is the tibiotalar?

A

The tibiotalar joint is a hinge joint that permits flexion and extension (dorsiflexion and plantar flexion) in one plane

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17
Q

Musculoskeletal System

what does the subtalar joint permit?

A
  • pivot
  • rotate
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18
Q

Musculoskeletal System

subtalar AKA

A

talocalcaneal

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19
Q

Musculoskeletal System

describe the midfoot joints of the ankle/foot

A
  • Articulations of the foot between the tarsals and metatarsals, the metatarsals and proximal phalanges, and the middle and distal phalanges allow flexion and extension
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20
Q

Musculoskeletal System

when does bone growth finish? why?

A
  • bone growth is completed at about age 20 years,
  • when the last epiphysis closes and becomes firmly fused to the shaft.
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21
Q

Musculoskeletal System

when is peak bone mass achieved?

A

age 35

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22
Q

Musculoskeletal System

Changes to MSK in elderly pts

3

A
  1. Kyphosis (increased osteoclasts)
  2. bony prominences become more apparent w/ loss of SubQ fat
  3. cartilage around joints deteriorates
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23
Q

Musculoskeletal System

describe kyphosis

A

abnormally excessive convex curvature of the spine

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24
Q

Musculoskeletal System

potential cause of kyphosis

A

osteoporosis

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25
Q

Musculoskeletal System

describe osteoporosis

A

new bone creation (osteoblasts) doesn’t keep up with old bone destruction (osteoclasts)

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26
Q

Musculoskeletal System

which bones are most vulnerable to fractures?

2

A
  1. long bones
  2. vertebrae
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27
Q

Musculoskeletal System

describe MSK changes in menopausal women

A

decreased estrogen increases bone resorption and decreases calcium deposition, resulting in bone loss and decreased bone density.

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28
Q

Musculoskeletal System

what % of bone mass is lost by age 80?

A

30%

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29
Q

Musculoskeletal System

3 potential causes of muscle wasting (atrophy)

A
  1. injury
  2. disease of the muscle
  3. damage to the motor neuron
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30
Q

Musculoskeletal System

how does injury lead to atrophy?

A

pain & immobility –> muscle wasting

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31
Q

Musculoskeletal System

describe muscular distrophy & its sx

A
  • group of genetic disorders involving gradual degeneration of the muscle fibers
  • musle atrophy, muscle weakness, waddling gait
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32
Q

Musculoskeletal System

what occurs after damage to motor neurons in muscles?

A

fasciculation (muscle twitching)

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33
Q

Musculoskeletal System

describe crepitus

A
  • grating sound/sensation
  • can be felt when 2 irregular bony surfaces are rubbing together as a joint moves or when 2 rough edges of a broken bone rub together.
  • if tenosynovitis is present then it could be the tendon rubbing the tendon sheath
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34
Q

Musculoskeletal System

differentiate AROM and PROM

A
  • PROM: ask the pt to relax and let you passively move the joints to the end of the ROM, do not force the joint, muscle tone can be assessed
  • AROM: pt moves their joints individually

PROM should be greater than AROM by ~5deg but should be equal bilaterally

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35
Q

Musculoskeletal System

what would suggest problems with the joint, their muscle groups, or the nerve supply?

6

A
  1. pain
  2. limited ROM
  3. spasms
  4. joint instability
  5. deformity
  6. contracture
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36
Q

Musculoskeletal System

what is a goniometer

A

tool used to precisely measure the angle when a joint appears to have an increase or limitation in its range of motion

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37
Q

Musculoskeletal System

describe how to grade muscle strength

A
  • 0: no evidence of movement
  • 1: trace of movement
  • 2: full ROM, but not against gravity
  • 3: full ROM against gravity but not resistance
  • 4: full ROM against gravity and weak with resistance
  • 5: full ROM against gravity and full resistance
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38
Q

Musculoskeletal System

Describe Lordosis

A
  • exaggerated inward curve of the spine
  • typically affects lower back/lumbar spine
  • common in pregnant women
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39
Q

Musculoskeletal System

describe kyphosis

A
  • “hunchback”, exaggerated rounding of the back
  • typically affects the upper back/thoracic spine
  • common in aging adults
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40
Q

Musculoskeletal System

describe gibbus

A
  • extreme kyphosis, lookslike individual in folded over
  • associated w/ collapsed vertebra from osteoporosis
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41
Q

Musculoskeletal System

describe dislocation of the shoulder

A

when the shoulder contour is asymmetric and one shoulder has hallows in the rounding contour

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42
Q

Musculoskeletal System

what is winging of the scapula associated with?

A

anterior serratus muscle nerve damage

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43
Q

Musculoskeletal System

describe a winged scapula

A

observe for a winged scapula, an outward prominence of the scapula, indicating injury to the nerve of the anterior serratus muscle.

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44
Q

Musculoskeletal System

what should be elbow carrying angle be?

A

5 to 15 deg laterally- the angle between the humerus and radius while the arm is passively extended, palm forward

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45
Q

Musculoskeletal System

describe cubitus valgus

A

a lateral angle extending 15 deg

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46
Q

Musculoskeletal System

describe cubitus varus

A

a medial carrying angle- less than 5 deg

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47
Q

Musculoskeletal System

what is the significance of subQ nodules on the extensor surface of the forearm near the elbow?

A

may indicate a rheumatoid nodule or gouty tophi

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48
Q

Musculoskeletal System

describe heberden nodes

A
  • hard bony overgrowths along the DIPs
  • associated with osteoarthritis
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49
Q

Musculoskeletal System

describe Bouchard nodes

A
  • hard bony overgrowths along the PIPs
  • associated w/ osteoarthritis
  • can cause spindle shape fingers which are associated w/ acute stages of RA
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50
Q

Musculoskeletal System

describe swan neck deformities

A
  • bending in (flexion) of the base of the finger, a straightening out (extension) of the middle joint, and a bending in (flexion) of the outermost joint
  • indicates RA
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51
Q

Musculoskeletal System

expected range between the tibia and femur

A

less than 15 deg

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52
Q

Musculoskeletal System

describe genu valgum vs varum

A
  • valgum: knees stuck together (knock kneed)
  • varum: knees don’t go together (bow legged)
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53
Q

Musculoskeletal System

differentiate pes varus, valgus, heel pronation

A
  • varus: toed in
  • valgus: toed out
  • pronation: outer edge of heel hits the group first, then foot rolls inward to the arch
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54
Q

Musculoskeletal System

describe:
* normal foot arch
* pes planus
* pes cavus

A
  • normal: arch in the sagittal plane formed by the calcaneus and the metatarsals; may flatten w/ weight bearing
  • planus: foot remains flat even when not bearing wt
  • cavus: foot w/ high instep
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55
Q

Musculoskeletal System

how is leg length measured

A
  • from the ASIS to the medial malleolus of the ankle, crossing the knee on the medial side
  • from the umbilicus to the medial malleolus if you cannot find the ASIS
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56
Q

Musculoskeletal System

how is arm length measured

A
  • from the acromion process through the olecranon process to the distal ulnar prominence
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57
Q

Musculoskeletal System

how is the circumfrence of the extremities measured?

A

measured in centimeters at the same distance on each limb from a major landmark

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58
Q

Musculoskeletal System

what might the discrepancy be between limbs?

A

no more than 1 cm bilaterally

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59
Q

Musculoskeletal System

describe fibrous joints

A
  • non-flexable
  • made of connective tissue (collagen)
  • ex: sutures, homphoses, syndesmoses
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60
Q

Musculoskeletal System

what are cartilaginous joints?

A
  • joints that are cushioned by a layer of cartilage that joins the bones together
  • ex: where ribs meet the sternum
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61
Q

Musculoskeletal System

6 types of synovial joints

A
  1. hinge joints: knee/elbow
  2. ball and socket: shoulder/hip
  3. condyloid: wrist/ankle
  4. planar: vertebrae
  5. saddle: thumb
  6. pivot: wrist to the forearm
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62
Q

Neuro Exam

describe MMSE and MoCA-B

A
  • MMSE: mini mental status exam, brief, measures orientation, registration, attention, calculation, recall, ability to follow commands, and language
  • MoCA-B: more broad, has higher sensitivity and specificity
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63
Q

Neuro Exam

describe components of assessing appearance and behavior

A
  • grooming: assess hygiene, grooming, appropriate
  • emotional status: should be cooperative and friendly
  • body language: note posture, eye contact, facial expression
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64
Q

Neuro Exam

what could poor hygiene, inappropriate dress, or lack of concern with appearance indicate in someone who previously was well dressed?

3

A
  1. depression
  2. psych disorder
  3. dementia
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65
Q

Neuro Exam

what might slumped posture and lack of facial expressions indicate?

A
  • Parkinson’s
  • depression
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66
Q

Neuro Exam

what might excessively energetic movements or constantly watchful eyes suggest?

5

A
  • tension
  • mania
  • anxiety
  • illicit/prescription drug effects
  • metabolic disorder
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67
Q

Neuro Exam

describe components of assessing cognitive abilities

A
  • state of consciousness: A&Ox4, GCS
  • memory: evaluate their responses to hx questions
  • response to analogies: ask pt to do simple analogies first then more complex
  • abstract reasoning: ask pt to tell you the meaning of a fable or metaphor
  • attention span: ask pt to follow short set of commands
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68
Q

Neuro Exam

what might these mean:
* person disorientation
* place disorientation
* time disorientation

A
  • Person disorientation results from cerebral trauma, seizures, or amnesia.
  • Place disorientation occurs with psychiatric disorders, delirium, and cognitive impairment.
  • Time disorientation is associated with anxiety, delirium, depression, and cognitive impairment.
69
Q

Neuro Exam

if a patient cannot describe simple analogies what might that indicate?

A
  • An inability to describe similarities or differences may indicate a lesion of the left or dominant cerebral hemisphere.
70
Q

Neuro Exam

What could a decreased attention span be indicative of?

A

This may be related to fatigue, depression, delirium, or toxic or metabolic causes that result in confusion.

71
Q

Neuro Exam

describe the arithmetric exam and what it might indicate?

A
  • Ask the patient to do simple arithmetic, without paper and pencil
  • The calculations should be completed with few errors and within 1 minute when the patient has average intelligence.
  • Impairment of arithmetic skills may be associated with depression, cognitive impairment, and diffuse brain disease.
72
Q

Neuro Exam

components of examining emotional stability

2

A
  • mood/feelings
  • thought processes
73
Q

Neuro Exam

components of evaluating sppech and language

A
  • voice quality
  • articulation
  • comprehension
  • coherence (pt’s intentions/perceptions)
  • aphasia (speech disorders)
74
Q

Neuro Exam

describe aphasia

A
  • speech disorder that can be repetitive (understand language) or expressive (speaking language)
  • Wernicke’s: can talk but don’t understand
  • Broca’s: the mouth is broca, can’t talk
  • Global: everything is gone
  • can result from facial muscle or tongue weakness
75
Q

Neuro Exam

describe tests to evaluate memory

A
  • immediate recall: repeat something right after it’s said
  • recent memory: 3-5 words then ask about them again in a few minutes
  • remote memory: ask about verifiable past events

inability to do any is indicative of dementia

76
Q

Neuro Exam

differentiate:
* confusion
* lethargy
* delirium
* stupor
* coma

A
  • Confusion: Inability to think or reason in a focused, clear manner.
  • Lethargy: falls asleep without repeated stimulation
  • Delirium: fluctuating acute confusion
  • Stupor: requires vigorous and/or painful physical stimulation to be awakene
  • Coma: not able to be aroused by any stimulus any sort and no response to the environment
77
Q

Neuro Exam

Describe GCS

A
  • max points = 15; min points= 3
  • evaluates eye opening response, verbal response, motor response
  • best response: 15 pts
  • comatose pt: 8 pts
  • totally unresponsive: 3 pts
78
Q

Neuro Exam

GCS- grading for eye opening response

A
  • spontaneously = 4
  • to speech = 3
  • to pain = 2
  • no response = 1
79
Q

Neuro Exam

-GCS- grading for verbal

A
  • A&Ox3 or 4: 5 pts
  • confused: 4 pts
  • inappropriate words: 3 pts
  • incoherent sounds: 2 pts
  • no response: 1 pt
80
Q

Neuro Exam

GCS- grading of motor responses

A
  • obeys commands: 6 pts
  • moves to localized pain: 5 pts
  • flexion withdrawal from pain: 4 pts
  • abnormal flexion (decorticate): 3 pts
  • abnormal extension (decerebrate): 2 pts
  • no response: 1
81
Q

Neuro Exam

differentiate decorticate, decerbrate, and hemiplegia

A
  • decorticate: associated w/ injury above brainstem to corticospinal tracts
  • decerebrate: associated w/ injury to the brainstem
  • hemiplegia: associated to damage to ICA, MCA, or ACA
82
Q

Neuro Exam

Distinguish between the following disorders of altered mental status: delirium, dementia, and depression

A
  • Delirium: impaired cognition, arousal, consciousness, mood, and behavioral dysfx of acute onset
  • Dementia: A chronic, slowly progressive disorder of failing memory, cognitive impairment, behavioral abnormalities, and personality changes that often begins after age 60 years
  • Depression: Feelings of sadness, loss, anger, or frustration that interfere with everyday life for an extended period
83
Q

Neuro Exam

describe how to obtain, document, and interpret normal and abnormal mental status findings in a Physical Examination.

4 components

A
  1. Observe physical appearance and behavior
  2. Investigate cognitive abilities
  3. Observe speech and language for voice quality, articulation, coherence, and comprehension.
  4. Evaluate emotional stability for signs of depression, anxiety, thought content disturbance, and hallucinations.
84
Q

Neuro Exam

describe MMSE scoring

A
  • score < 20 may be associated with dementia
  • score > 26 not associated with dementia.
  • higher education associated with higher MMSE scores, even when dementia present
85
Q

Neuro Exam

CN I testing

A

● Odor Recognition: check patency of nares first; eyes closed; test one nostril at a time using soap, tobacco, vanilla, PB, orange extract, or coffee)

86
Q

Neuro Exam

how to test CN II

A
  • Visual acuity using Snellen chart and Rosenbaum pocket chart
  • Visual Fields by confrontation if 6 cardinal fields of gaze
  • Fundoscopic Exam
87
Q

Neuro Exam

how to test CN III

A
  • Inspect for unilateral eyelid ptosis
  • Direct and consensual pupillary response to light
  • Pupillary near-far accommodation
88
Q

Neuro Exam

how to test CN III, IV, VI

A
  • Extraocular Muscles (EOMs)
  • Corneal Light Reflex, bilaterally
89
Q

Neuro Exam

how to test CN V

A
  • sensory: corneal touch reflex and sharp/dull and soft touch intactness
  • motor: temporalis and masseter muscle tone
90
Q

Neuro Exam

how to test CN VII

A
  • sensory: labial speech sounds, salty/sweet taste on anterior 2/3 of tongue
  • motor: facial expression
91
Q

Neuro Exam

how to test CN VIII

A
  • cochlear division: whisper, rinne, weber test
  • vestibular divison: test of balance
92
Q

Neuro Exam

how to test CN IX

A
  • touch sensation
  • sour/bitter on posterior 1/3 of tongue
93
Q

Neuro Exam

how to test CN IX and X

A
  • gag reflex
  • “ahhhhh”
  • swallowing
94
Q

Neuro Exam

how to test CN XI

A
  • traps, sternocleidomastoid muscle strength
95
Q

Neuro Exam

how to test CN XII

A

tongue is midline, ROM, strength

96
Q

Neuro Exam

differentiate between 128 Hz tuning fork and 512 Hz tuning fork

A
  • 128: for vibratory sense testing proprioception in posterior column
  • 512: for cochlear testing
97
Q

Neuro Exam

What dermatomes are:
* C3
* C6
* C7
* C8
* T4
* T10
* T12
* L4
* L5
* S1

A
  • C3: proximal neck
  • C6: thumb, index finger
  • C7: middle finger
  • C8: ring and pinky finger
  • T4: Nipple level
  • T10: umbilicus
  • T12: inguinal
  • L4: medial foot
  • L5: mid dorsum foot
  • S1: lateral foot
98
Q

Neuro Exam

if you do stereognosis and they don’t know what you put in their hand, what is it called and what does it suggest

A
  • tactile agnosia
  • parietal lobe lesion
99
Q

Neuro Exam

explain use of and findings of pronator drift test

A
  • arms held out with palms up and with eyes closed
  • positive if an arm falls down, associated with corticospinal tract dysfunction
100
Q

Neuro Exam

List tests to assess posterior column function

6

A
  • Vibratory sense
  • Deep Pressure sensation (only is superficial not intact)
  • Positional sense
  • Stereognosis
  • Point Location
  • 2 Point discrimination
101
Q

Neuro Exam

list tests to assess cerebellar function

5

A
  1. observe gait
  2. heel toe walking
  3. point to point
  4. heel knee shin test
  5. RAM (UE and LE)
102
Q

Neuro Exam

describe tests to assess lateral spinothalamic tract function

2

A
  • superficial pain
  • temperature sensation
103
Q

Neuro Exam

describe tests to assess anterior spinothalamic tract function

A
  • superficial touch
  • deep pressure
104
Q

Neuro Exam

list tests to assess cerebral cortex sensory function

A
  • stereognosis
  • 2-point discrimination
  • extinctation phenomenon
  • graphesthesia (DISTAL ASPECT = TOP OF PAPER)
105
Q

Neuro Exam

describe romberg exam

A

Evaluates balance. Ask patient to close their eyes and stand feet together with arms at the sides. Positive sign indicated cerebellar ataxia, vestibular dysfunction, or sensory loss

106
Q

List the commonly tested deep tendon reflexes (DTRs), list the spinal nerves tested with each.

A
  • Biceps - C5 and C6
  • Brachioradialis - C5 and C6
  • Triceps - C6, C7 and C8
  • Patellar - L2, L3, and L4
  • Achilles - S1 and S2
107
Q

Neuro Exam

what might absent reflexes mean? hyperactive reflexes?

A
  • Absent reflexes may indicate neuropathy or LMN
  • Hyperactive reflexes indicate UMN
108
Q

Neuro Exam

Explain grading of DTRs

A
  • 0 - No response
  • 1+ Sluggish or diminished
  • 2+ Active or expected
  • 3+ More brisk than expected, slightly hyperactive
  • 4+ Brisk, hyperactive, with intermittent or transient clonus
109
Q

Neuro Exam

Which superficial reflexes are used?

A
  • abdominal: slight movement expected (diminished in obese, pregnant women, absent on side of corticospinal tract lesion)
  • cremasteric: should rise
  • plantar: babinski indicates pyramidal UMN lesion
110
Q

Neuro Exam

describe brudzinksi and kernig reflex

A
  • Brudzinski - Flex neck and observe for involuntary flexion of hips and knees
  • Kernig - Flex the leg at the knee & hip when the patient is supine, and then attempt to straighten the leg
  • Positive Signs - Indicate meningeal irritation
111
Q

Neuro Exam

discuss the significance of testing for point localization and extinction

A

evaluates posterior column of ascending tract and evaluates for LMN disorders

112
Q

Neuro Exam

Differentiate pos Tinel’s and Phalen’s signs

A
  • Tinel’s - Tapping nerve causes tingling sensation to radiate through that area → shows signs of damage to the median nerve, present in carpal tunnel
  • Phalen’s - Positive when flexing wrist to 90 degrees for 1 minute causes symptoms in the median nerve section and suggests carpal tunnel
113
Q

Female Repro

List changes that occur in the uterus, cervix, and vagina during pregnancy.

5

A
  • Uterus receives increased blood flow
  • uterus and cervix soften
  • cervix takes on bluish color.
  • Vaginal wall thickens which increases length.
  • Vaginal secretions increase and have an acidic pH to prevent bacteria from multiplying.
114
Q

Female Repro

List changes that occur in the external and internal female genitalia in older adult women.

8

A
  • Estrogen levels decrease which cause labia and clitoris to become smaller.
  • Labia Majora becomes flatter and body fat is lost.
  • Decrease in muscle mass and strength.
  • Vaginal introitus constricts and the vagina narrows/shortens.
  • The mucosa becomes thin, pale, and dry.
  • Cervix becomes smaller and paler.
  • Uterus decreases in size and endometrium thins out.
  • Ovaries decrease and follicles gradually disappear.
115
Q

Female Repro

Describe methods to help minimize a woman’s apprehension and discomfort during a pelvic examination.

7

A
  • Try to find the source of apprehension/discomfort.
  • Table can be set up with slight elevation of HOB.
  • Pt arms to side or under SI joints/upper buttocks.
  • Explain what you are going to do, elicit permission for exam, let Pt know can say “no”, explain next steps as doing, maintain eye contact, show and explain equipment.
  • Use “neutral touch” on inner thighs to signal you are starting exam/touching (this touch decreases startle for next maneuvers).
  • Tell them to let you know about discomfort.
  • Plan ahead for speculum size choices based upon sexual/reproductive history and external female GU exam and prior documentation (if available).
116
Q

Female Repro

describe proper patient positioning and draping procedure for pelvic examination

A
  • lithotomy position: stabilize feet in stirrups and slide butt to edge of table
  • dent drape in between pt’s knees to see their face
117
Q

Female Repro

describe expected appearance of labia majora

A

Gaping or close, dry or moist. Symmetric and either shriveled or full. Tissue should feel soft and homogenous. No swelling, excoriation, rashes, or lesions should be noted.

118
Q

Female Repro

describe expected appearance of labia minora

A

May appear symmetric or asymmetric, and the inner surface should be moist and dark pink. The tissue should feel soft, homogeneous, and without tenderness. Look for inflammation, irritation, excoriation, or caking of discharge in the tissue folds, which suggests vaginal infection or poor hygiene. Discoloration or tenderness may be the result of traumatic bruising. Ulcers or vesicles may be signs of an STI. Palpate for irregularities or nodules.

119
Q

female repro

describe expected apperance of clitoris

A

Inspect the clitoris for size. Generally, the clitoris is about 2 cm or less in length and 0.5 cm in diameter. Enlargement may be a sign of a masculinizing condition. Observe also for atrophy, inflammation, or adhesions.

120
Q

Female Repro

describe expected appearance of urethral orifice

A

Appears as an irregular opening or slit. It may be close to or slightly within the vaginal introitus and is usually in the midline. Inspect for discharge, polyps, caruncles, and fistulas. A caruncle is a bright red polypoid growth that protrudes from the urethral meatus; most urethral caruncles cause no symptoms. Signs of irritation, inflammation, or dilation suggest repeated urinary tract infections or insertion of foreign objects.

121
Q

Female Repro

describe expected appearance of vaginal introitus

A

Can be a thin vertical slit or a large orifice with irregular edges from hymenal remnants (myrtiform caruncles). The tissue should be moist. Look for swelling, discoloration, discharge, lesions, fistulas, or fissures.

122
Q

Female Repro

describe expected appearance of skene and bartholin glands

A

If a discharge occurs, note its color, consistency, and odor, and obtain a culture. Discharge from the Skene glands or urethra usually indicates an infection—most commonly, but not necessarily, gonococcal. Note any swelling, tenderness, masses, heat, or fluctuation. Swelling that is painful, hot to the touch, and fluctuant is indicative of infection of the Bartholin gland. The infection is usually gonococcal or staphylococcal in origin and is filled with pus. A nontender mass is indicative of a Bartholin cyst, which is the result of chronic inflammation of the gland.

123
Q

Female Repro

describe expected appearance of perineum

A

Should be smooth; episiotomy scarring may be evident in patients who have borne children. The tissue will feel thick and smooth in the nulliparous patient. It will be thinner and rigid in multiparous patients. In either case, it should not be tender. Look for inflammation, fistulas, lesions, or growths.

124
Q

Female Repro

describe normal appearance of anus

A

More darkly pigmented, and the skin may appear coarse. It should be free of scarring, lesions, inflammation, fissures, lumps, skin tags, or excoriation.

125
Q

Female Repro

what should be used to lubricate vaginal speculum when collecting pap sample? why?

A
  • warm water (NOT GEL)
  • gel can obscure cellular element and interfere w/ specimen analysis and interpretation
126
Q

Female Repro

clinical significance of cervial deviation

5 components

A
  • The cervix should be located in the midline.
  • Deviation to the right or left may indicate a pelvic mass, uterine adhesions, or pregnancy.
  • The cervix may protrude 1 to 3 cm into the vagina.
  • Projection greater than 3 cm may indicate a pelvic or uterine mass.
  • The cervix of a patient of childbearing age is usually 2 to 3 cm in diameter.
127
Q

Female Repro

differentiate between nulliparous and parous cervicals

A
  • nulliparous: size is 5.5 to 8cm long, 3.5 to 4 cm wide, 2 to 2.5 cm thick; approx 40 to 50 g
  • parous: larger by 2 to 3 cm in any dimension.
128
Q

Female Repro

describe proper technique for performing pap smear

A
  • Collect specimens as indicated for Pap smear, HPV testing, sexually transmitted infection screening, and wet mount.
  • Be sure to follow Standard Precautions for the safe collection of human secretions.
  • Label the specimen with the patient’s name, date, and a description of the specimen (e.g., cervical smear, vaginal smear, culture). (LMP)
129
Q

Female Repro

describe proper technique for performing KOH prep

9 components

A
  • Obtain a specimen of vaginal discharge using a swab.
  • Smear the sample on a glass slide and add a drop of normal saline.
  • Place a coverslip on the slide, and view under the microscope.
  • The presence of trichomonads indicates T. vaginalis.
  • The presence of bacteria-filled epithelial cells (clue cells) indicates bacterial vaginosis.
  • On a separate glass slide, place a specimen of vaginal discharge, apply a drop of aqueous 10% KOH, and put a coverslip in place.
  • The presence of a fishy odor (the “whiff test”) suggests bacterial vaginosis.
  • The KOH dissolves epithelial cells and debris and facilitates visualization of the mycelia of a fungus.
  • View under the microscope for the presence of mycelial fragments, hyphae, and budding yeast cells, which indicate candidiasis.
130
Q

Female Repro

Describe proper procedure for gonococcal exam

A
  • Immediately after the Pap smear is obtained, introduce a sterile cotton swab into the vagina and insert it into the cervix
  • Hold it in place for 10 to 30 seconds.
  • Withdraw the swab and spread the specimen in a large Z pattern over the culture medium, rotating the swab at the same time.
  • Label the tube or plate, and follow agency routine for transporting and maintaining appropriate temperature of the specimen of the specimen.
131
Q

Female Repro

describe proper technique for chalmydia testing

4 components

A
  • Use a Dacron swab (with plastic or wire shaft) when collecting your specimen, as wooden cotton-tipped applicators may interfere with the test results.
  • Insert the swab into the cervical os and rotate the swab in the endocervical canal for 30 seconds to ensure adequate sampling and absorption by the swab.
  • Avoid contact with the vaginal mucous membranes, which would contaminate the specimen.
  • Remove the swab and place it in the tube containing the specimen reagent.
132
Q

Female Repro

what position are most uteruses in?

A

anteverted (straight up toward belly) or anteflexed (curved up toward belly)

133
Q

Female Repro

describe retroverted, retroflexed, midposition

A
  • retroverted: straight down
  • retroflex: curved toward anus
  • midposition: straight back
134
Q

Female Repro

discuss normal findings when palpating ovaries and adnexal areas

A
  • ovaries: firm, smooth, ovoid, 3x2x1 cm in size; moderately tender on palpation
  • adnexal: hard to palpate (location, position, fat tissue)
135
Q

Female Repro

Discuss the pelvic structures being assessed during a bimanual palpation and describe normal and abnormal findings.

A
  • Structures Assessed - Vaginal walls, cervix, uterus, ovaries and adnexal areas
  • Normal findings - Cervix smooth, firm, mobile. No cervical motion tenderness. Uterus midline, anteverted, firm, smooth, and nontender; not enlarged. Ovaries not palpable. No adnexal tenderness.
  • Abnormal - Tenderness, nodules, irregularities, enlargements, motion tenderness
136
Q

Female Repro

discuss red flags for sexual abuse in children or adolescents

A
  • medical concerns: evidence of abuse/neglect, trauma in sensitive regions, unusual skin color in sensitive areas, STI, itching/bleeding/pain, rashes/sores.
  • behavior concerns: problems with school, weight changes, depression, anxiety, sleep problems increased aggression
  • sexual behaviors: provocative mannerisms, inappropriate sexual knowledge
137
Q

Female Repro

differentiate the following terms:
* hydrocolpos
* vulvovaginitis
* atrophic vaginitis

A
  • Hydrocolpos - Distention of the vagina caused by accumulation of fluid due to congenital vaginal obstruction
  • Vulvovaginitis - Inflammation of vulvar and vaginal tissues
  • Atrophic vaginitis - Inflammation of the vagina due to the thinning and shrinking of the tissues, as well as decreased lubrication
138
Q

Male Repro

Define and distinguish between each of the following terms: phimosis, paraphimosis, epispadias, hypospadias, balanitis, balanoposthitis, and smegma.

A
  • Phimosis: the foreskin is tight and cannot be retracted
  • Paraphimosis: the inability to replace the foreskin to its usual position after it has been retracted behind the glans
  • Epispadias: rare birth defect at the opening of the urethra where the urethra does not develop into a full tub, and the urine exits the body from an abnormal location. Causes are unknown.
  • Hypospadias: congenital defect in which the urethral meatus is located on the ventral surface of the glans penile shaft or the base of the penis
  • Balanitis: inflammation of the glans (head) of the penis; occurs most often in uncircumcised males
  • Balanoposthitis: inflammation that affects both the glans penis and prepuce.
  • Smegma: thick, white, cheesy substances that collects under the foreskin of the penis
139
Q

Male Repro

Explain when complete separation of the prepuce from the glans normally occurs, and explain what harm can come to a young boy if the foreskin is forcibly retracted.

A

Separation of the prepuce from the glans normally occurs around ages 3 to 4 years in uncircumcised children. If the foreskin is forcibly retracted, it can get permanently stuck behind the glands.

140
Q

Male Repro

why is the scrotum usually asymmetric? which testicle is lower?

A
  • The scrotum usually appears asymmetric because one testes tends to develop faster than the other.
  • The right seems to develop more quickly than on the left and the one on the left hangs lower
141
Q

Male Repro

distinguish between incarcerated and strangulated hernias

A
  • Incarcerated Hernia: a mass that neither changes in size nor transilluminates and trapped in the intestine or abdominal tissue
  • Strangulated Hernia: the blood supply to the protruded tissue is compromised; nonreducible → prompt surgical intervention
142
Q

Male Repro

describe indirect inguinal hernia

A
  • most common
  • pts usually young males
  • hernia in the internal inguinal ring
  • may pass into the scrotum
  • expect soft swelling in area of internal ring, touches fingertip on examination
143
Q

Male Repro

describe direct inguinal hernias

A
  • males > females; 40 y/o
  • through external inguinal ring, located in Hesselbach’s triangle (rarely enters scrotum)
  • bulge in area of Hesselbach’s triangle, usually painless, easily reduced, bulges anteriorly, pushes against side of finger on examination
144
Q

Male Repro

describe femoral hernias

A
  • least common
  • females
  • through femoral ring, femoral canal, fossa ovalis
  • R sided presentation more common L; pain is severe; inguinal canal empty on exam
145
Q

Male Repro

how should epididymis feel?

A
  • located on posterolateral surface of the testis
  • should be smooth, discrete, larger cephalic, non-tender
146
Q

Male Repro

how should vas deferens feel

A
  • has accompanying arteries and veins, but cannot be precisely identified by palpation
  • smooth and discrete (if bumpy = DM)
147
Q

Male Repro

describe the cremasteric reflex

A
  • stroke inner thigh with a blunt instrument such as the handle of the reflex hammer or for a child, your finger.
  • the testicle and scrotum should rise on the stroked side
148
Q

Male Repro

describe a bifid (deep cleft) scrotum in a newborn

A

usually associated with other GU anomalies or ambiguous genitalia

149
Q

Male Repro

discuss management options for a newborn with undescended testicles

A
  • hormonal: can give hCG
  • surgery: orchidopexy (frees testicle from restrictive tissues) or testicular auto-transplant (indicated when testicle is located very high in the abdomen)
150
Q

Male Repro

discuss the techniques used to distinguish between a hydrocele and hernia

A
  • if a bright penlight transilluminates the mass and there is no change in size when reduction is attempted, it most likely contains fluid (hydrocele w/ a closed tunica vaginalis)
  • a mass that does not transilluminate but does change in size when reduction is attempted is probably a hernia
151
Q

Male Repro

describe the appearance of ambiguous genitalia

A

appearing neither clearly male or female

152
Q

Male Repro

how does testicular cancer occur?

A
  • seminomas and non-seminomas arise from germ cells
  • non-germ cell tumors arise from supportive and hormone-producing tissue
153
Q

Male Repro

describe etiology of penile cancers

A

associated with HPV 16 and 18

154
Q

Male Repro

describe prevention of prostate cancer

A
  • screening
  • prostate exams
  • colonoscopies
  • DRE
155
Q

Rectal Exam

discuss the role of internal and external sphincters in defecation and in fecal continence

A
  • The anal canal is normally kept securely closed by concentric rings of muscle, the internal and external sphincters.
  • The internal ring of smooth muscle is under involuntary autonomic control. The urge to defecate occurs when the rectum fills with feces, which causes reflexive stimulation that relaxes the internal sphincter.
  • Defecation is controlled by the striated external sphincter, which is under voluntary control.
  • The lower half of the canal is supplied with somatic sensory nerves, making it sensitive to painful stimuli, whereas (the upper half is under autonomic control and is relatively insensitive.)
  • Therefore conditions of the lower anus may cause pain, whereas those of the upper anus will usually not.
156
Q

Rectal Exam

describe normal size of prostate

A
  • large chestnut
  • 4x3x2 cm
  • diameter is 4cm
157
Q

Rectal Exam

4 positions used for rectal examination

A
  • knee chest
  • Lithotomy
  • L lateral w/ hips & knees flexed
  • standing w/ hips flexed and upper body supported by examining table
158
Q

Rectal Exam

Explain how to properly document the location of anal lesions by clock position and quadrant description.

A
  • Anal lesions can be documented as if looking at the face of a clock or by dividing the perianal area into (4) anatomic quadrants: right anterior, right posterior, left anterior, left posterior.
159
Q

Rectal Exam

Identify common abnormalities associated with rectal pain on a digital exam.

A

Rectal pain is almost always indicative of a local disease. Look for irritation, rock-hard constipation, rectal fissures, fluctuance from a perianal abscess, or thrombosed hemorrhoids. Always inquire about previous episodes of pain.

160
Q

Rectal Exam

Discuss the proper prostate size quantification on exam and documentation in the medical record.

A
  • classified by amout of protrustion into the rectum
  • Grade I: 1-2 cm
  • Grade II: 2-3 cm
  • Grade III: 3-4 cm
  • Grade IV: 4+ cm
161
Q

Rectal Exam

explain prostate findings with prostate cancer

A
  • hard, irregular nodule
  • asymmetric
  • median sulcus may be obliterated
162
Q

Rectal Exam

explain prostate findings with BPH

A
  • smooth, rubbery, symmetric, enlarged
  • +/- median sulcus
163
Q

Rectal Exam

explain prostate findings with prostatic hypertrophy

A

rubbery or boggy consistency

164
Q

Rectal Exam

explain prostate findings with prostatic infection

A
  • enlarged, acutely tender, asymmetric
  • abscess may develop and feels like a fluctuant mass
165
Q

Rectal Exam

discuss “shelf lesions” above the prostate in males or in the cul-de-sac of females

A

Hard, nodular lesions felt at the anterior rectal wall. Because the anterior rectal wall is in contact w/ the peritoneum, you may be able to detect the tenderness of peritoneal inflammation and nodularity of peritoneal metastases.

166
Q

Rectal Exam

what might these stool findings mean:
* light tan/gray
* black
* pencil like
* ribbon
* mucoid
* fatty

A
  • tan/gray: obstructive jaundice
  • black: upper intestinal bleed
  • pencil: spasmodic contraction in rectal area (intermittent); permantnet stenosis from scarring/pressure from malignancy (persistent)
  • ribbon: rectal cancer
  • mucoid: intestinal inflammation and mucous colitis; bloodstained mucus in liquid feces (amebiasis)
  • fatty: pancreatic disorders or malabsorption syndromes
167
Q

Rectal Exam

explain how to test for fecal occult blood

A

Rectal exam to obtain fecal sample on finger that can then be tested for occult blood using a chemical guaiac procedure.

168
Q

Rectal Exam

discuss the significance of an absent “anal wink” reflex

A

Lack of contraction may indicate a lower spinal cord lesion or chronic abuse.

PACS (5 decks)

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