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PA II > FIanl > Flashcards

FIanl Flashcards

1
Q

Serous discharge from nipple

  • If UNILAT. = ?
  • If BILAT. = ?
A
  • Yellow watery stain on clothes
  • Unilat: Assoc w. Intraductal papilloma
  • Bilat: BCP’s , usually BENIGN
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2
Q

Bloody discharge from nipple

A
  • Think cancer 1st
  • May be Benign intraductal papilloma
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3
Q

MILKY discharge from nipple

A
  • Lactating Woman
  • Or Galactorrhea = Pituitary Tumor in Males/Females
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4
Q

Purulent discharge from nipple

A
  • Breast abscess
  • REFER OUT
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5
Q

Multicolored Sticky discharge from nipple

A
  • Mammary Duct Ectasia
  • Burn & itch around nipple
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6
Q

RISK FACTORS of FEMALE BREAST CANCER [3]

A
  • Early Menarch/Puberty (<12)
  • Late Menopause (>55)
  • Exposure to Estrogen
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7
Q

RISK FACTORS for MALE BREAST CANCER

A
  • Infertility
  • Late Puberty
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8
Q

INSPECTION findings of Breasts

  • If BILAT: ?
  • If UNILAT: ?
A
  • Increased Venous Patterns
  • BILAT: Normal (Preggo / Obesity)
  • UNILAT: Malignancy
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9
Q

If BREAST is DIMPLING or BULGING…

  • Recent INVERSION of the NIPPLE
A
  • Sign of cancer
  • Sign of Malignancy
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10
Q

Presentation of Fibroadenoma

A
  • (15 - 30 yo)
  • Round & Lobular
  • Usually SINGLE
  • Non-Tender
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11
Q

Presentation of Benign Fibrocystic Breast

A
  • ( 30 - 55 yo)
  • Lumpy bumpy breast
  • Tender @ Menses
  • Usually MULTIPLE
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12
Q

Ductal Carcinoma in Situ (DCIS)

A
  • “Pre-Cancer”
  • NOT SPREAD thru Duct Walls
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13
Q

Invasive ductal carcinoma (IDC)

  • MC…
A
  • Begins in duct & breaks thru wall into FATTY TISSUE
  • MC breast cancer
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14
Q

Invasive lobular carcinoma

  • ____ TO DETECT on ____
A
  • Starts in milk producing glands & METS.
  • Hard ; Mammograms
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15
Q

Inflammatory Breast cancer

  • MISTAKEN as….
A
  • Uncommon
  • No TUMOR
  • UNILAT Breast red + warm+ itchy
  • Mistaken: Mastitis
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16
Q

Pagets disease of the NIPPLE

  • ASSOC with…
A
  • Starts in breast ducts & spreads to nipple Areola
  • Crusty + Red ozing skin
  • Assoc: DCIS + IDC
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17
Q

Reasons for LOW Sperm count

A

Environment: Heat , Radiation , Chemicals

  • Life Style: Drugs , ETOH , Tobacco
  • Cryptochordism Hx
  • Mumps Hx
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18
Q

Phimosis

A
  • FIXED foreskin
  • WON’T retract
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19
Q

Paraphimosis

A
  • Foreskin RETRACTED & FIXED
  • Swells the Penis
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20
Q

Balantitis

A
  • Inflammed penis w. Bacterial or Fungi infection
  • Due to Poor Hygiene or Diabetes
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21
Q

Hypospadias

A
  • Urethra exits the VENTRAL side of penis (bottom)
  • Congenital Defect
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22
Q

Epispadias

A
  • Urethra exits on the DORSAL side of penis (top)
  • Congenital Defect
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23
Q

Peyronie Dz

A
  • Fibrous band in the Corpus Cavernosum
  • PAINFUL ERECTION
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24
Q

Priapism

A
  • Prolonged PAINFUL ERECTION
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25
Q

Characteristics of Penile Cancer

A
  • Non-tender
  • Indurated nodule/ulcer
  • Assoc with poor hygiene
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26
Q

MALES notice STD signs and symptoms _____

A
  • MORE THAN females bc its symptomatic
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27
Q

1° Syphilis [4]

A
  • PAINLESS chancre
  • Non-Tender enlarged inguinal lymph nodes
  • Red erosion around ulcer
  • Goes away in 3-6 wks
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28
Q

Condylomata lata

  • Characteristics?
  • Sites?
A
  • Lesion of 2° Syphilis
  • Flat, Moist growth after chancre RESOLVES
  • Glans , Perianal region
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29
Q

Condylomata Acuminata

A
  • Genital warts due to HPV
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30
Q

Genital Herpes

A
  • Small Vesicles
  • PAINFUL ULCERS
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31
Q

Hydrocele

A
  • Non-tender fluid mass
  • Remains in scrotum [DOES NOT ENTER INGUINAL CANAL]
  • Transilluminates on exposure
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32
Q

What of the testicle Transilluminates ?

  • What DOES NOT?
A
  • DO: Hydrocele , Spermatocele
  • DON’T: Tumor , Vascular structure , Blood , Hernia (Indirect) , Normal Teste
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33
Q

Direct hernia

A
  • Wall of the Ab. Muscles becomes WEAK
  • “External Ring Feel” on Finger pad
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34
Q

Indirect hernia

A
  • Failure of Inguinal ring to fully develop
  • Inguinal Canal feel on Fingertip
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35
Q

Femoral Inguinal Hernia

A
  • Below Inguinal Lig.
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36
Q

Technique used to BRING OUT Hernias

A
  • Valsalva technique w. bearing down
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37
Q

NORMAL Prostate Exam findings

A
  • Presence of median sulcus
  • No pain/tenderness/nodules
  • Symmetrical + “rubbery” feel
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38
Q

Prostatitis

A
  • Acute febrile condition caused by STD
  • Swollen & warm prostate
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39
Q

Benign Prostatic Hypertrophy (BPH)

A
  • Symmetrical enlarged prostate
  • “Boggy” feel
  • Urinary Symptoms
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40
Q

Prostate Cancer signs

  • Gold Standard Detection?
A
  • Altered contour
  • Hard w. Irregular Nodules
  • Digital Rectal Exam (DRE)
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41
Q

Amenorrhea

A
  • Absence of menses for at least 3 months
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42
Q

Oligomenorrhea

  • Normal Menarche range?
A
  • Menstrual interval exceeds 37 days between periods
  • (19 - 37) days
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43
Q

Polymenorrhea

A
  • Interval less than 19 days
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44
Q

Menorrhagia

  • Normal flow duration?
A
  • Menstrual Flow lasts > 7days
  • (2-7) days
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45
Q

Hypermenorrhea

A
  • Heavy flow (change pads every 2 hrs)
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46
Q

Metrorrhagia

A
  • Bleeding between periods
  • A.K.A : “Spotting”
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47
Q

Dysmenorrhea

  • Make note if…
A
  • Painful menstruation + Pelvic Pain
  • Starts BEFORE , at ONSET or DURING Menses
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48
Q

Menopause

  • Ask PT about…
A
  • Cessation of menses for 12 months
  • Age onset , Hot Flashes , Mood change
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49
Q

Perimenopause S & Sx

A
  • Irregular menses
  • Vaginal dryness
  • Vaginal Atrophy
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50
Q

Pediculosis pubis

A
  • “Crabs”
  • Dark Spots adhere to Pubic Hairs
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51
Q

Contact Dermatitis

  • Causes?
A
  • Swollen vesicles that “weep” & crust over (“scaly”)
  • Zealous hygiene , feminine products
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52
Q

Herpes vaginalis

  • Etiology?
A
  • PAINFUL vesicle & progress to ulcers
  • HSV Type 2
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53
Q

Syphilitic Chancre

A
  • Painless Lesion w. Inguinal Lymphadenopathy
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54
Q

Condylomata Lata

A
  • 2° syphilis
  • Looks like genital warts
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55
Q

Condylomata accuminata (HPV)

A
  • Pink colored
  • Moist papules appearing like cauliflower
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56
Q

Cystocele

  • Due to…
A
  • Bladder herniation into the ANT. Vaginal wall
  • Due to weak pelvic muscle
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57
Q

Rectocele

  • Due to…
A
  • Rectum herniation into POST. Vaginal wall
  • Weak pelvic muscle
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58
Q

Uterine prolapse

  • Due to…
A
  • Protrusion of Uterus -> vagina
  • Weak Pelvic Muscles
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59
Q

DISCHARGE of Trichomonas Vaginitis [3]

A
  • Green/Grey profusion
  • Malodorous (smells bad)
  • Assoc. w. pruritus (itching)
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60
Q

DISCHARGE of Candida Vaginitis [4]

A
  • White
  • Thick & Curdy
  • Non-malodorous (no smell)
  • Assoc. w. Pruritis
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61
Q

DISCHARGE of Bacterial Vaginitis [4]

A
  • Grey/white
  • Minimal discharge
  • Malodorous (fishy)
  • No pruritis
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62
Q

DISCHARGE of Atrophic Vaginitis [3]

A
  • Post menopausal (Dec Estrogen)
  • Color variable , CAN BE BLOODY
  • Assoc. w . pruritis
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63
Q

Bimanual Palpation of Uterus [4]

A
  • Cervix freely mobile
  • W/o Tenderness
  • Smooth
  • Firm
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64
Q

Pregnant uterus palpation [3]

A
  • Soft & Symmetrically enlarged
  • Amenorrhea Hx
  • Chadwicks sign: Blue cervix seen 6-8 weeks
65
Q

Uterine myomas (fibroids)

A
  • ENLARGED uterus
  • Soft & Mobile
  • PAINLESSLY nodular
66
Q

CANCER of Endometrium

A
  • Uterus ENLARGED
  • Hard & FIXED
  • PAINFUL Nodular
67
Q

Endometriosis

  • MC site?
  • Typical Hx?
A
  • Endometrial tissue OUTSIDE the lining of uterine cavity
  • Ovaries [Pelvic Area]
  • Hx: LBP , Pelvic Pain , Hypermenorrhea
68
Q

Polycystic Ovarian Syndrome (PCOS)

  • Due to…
  • How are the Follicles?
A
  • Multiple Bilat. cysts
  • Complex Endocrine abnormalities
  • Incompletely developed follicles
69
Q

S/Sx of PCOS [4]

A
  • Amenorrhea
  • Irregular menses
  • Obesity
  • Hirsutism
70
Q

Ovarian cancer S/Sx [4]

A
  • Obesity
  • Bloated
  • Pelvic Pain
  • Change in Bowel or Bladder Habits
71
Q

Palpation of Ovarian Cancer [3]

  • Best Imaging ?
A
  • Solid
  • Fixed
  • Poor Margin Mass

Imaging: Ultrasound , CT

72
Q

Pelvic inflammatory Dz

A
  • Adnexal Mass
  • ↑ Temp
  • (+) Chandelier’s Sign: Intense Pain moving Cervix
73
Q

MC causes of a Symmetric/Asymmetric ROUNDED AB. [4 F’s]

A
  • Female
  • Fatty
  • Flatus (gas)
  • Fluid
74
Q

Order of examination of the Ab

A
  • Inspection
  • Auscultation
  • Percussion
  • Palpation
75
Q

The MC cause of ROUNDED AB.

A
  • Fat
76
Q

Findings of FATTY Ab. [3]

A
  • NORMAL percussion
  • “Fatty apron” can be lifted for stuff
  • Sunken Umbilicus
77
Q

Findings of GAS Ab. [3]

A
  • ↑ Tympany
  • Distention marked in LARGE
  • Universal / Local
78
Q

Findings of FLUID (Ascites) Ab. [2]

A
  • ALWAYS ABNORMAL
  • Due to ↓ Albumin
79
Q

Ascites Procedure: Most to Least sensitive [4]

A
  • Auscultatory percussion
  • Puddle sign
  • Shifting dullness
  • Fluid wave

** Prognosis finding w. PERCUSSION ***

80
Q

Findings of the Ab. due to PREGNANCY [2]

A
  • Fetal heart sounds
  • Umbilical Dullness + Flank Tympany
81
Q

Findings of the Ab. due to TUMOR [3]

A
  • Displaced air filled bowel SUPERIORLY
  • NOT UNIFORM
  • Due to Pelvic Tumors (Ovary / Uterus Mass)
82
Q

PURPLE Striae of Ab is assoc. w ____

  • Vs Silver Striae?
A
  • Cushings
  • Silver: OLD stretch marks
83
Q

Caput medusa

A
  • Periumbilical Venous Dilation -> Portal HTN due Hepatic Cirrhosis (Late Liver Dz)
84
Q

Diastsis Recti

A
  • SEPARATION of Rectus Ab. muscles
85
Q

Cullen’s sign

  • Ex
A
  • Periumbilical bruising w. Intra-ab. bleeding
  • Spleen Rupture / Ectopic Preggo / Acute Pancreatitis
86
Q

Grey Turner’s sign

A
  • Flank bruising seen w. Acute pancreatitis
87
Q

Bowl sounds: Ausculatory Center of Bowel

  • Normal Range?
A
  • Listen for 1 min (If none -> Listen for 3 min)
  • (5 - 34) sounds per minute
88
Q

Bowel sites for FRICTION RUBS

  • NORMAL percussion of Bowel?
A
  • Liver: Costal Edge (Mid-Costal Line)
  • Spleen: L. 7th ICS MAL (Mid-Axillary Line)
  • Tympany
89
Q

Normal LIVER size

  • Causes of ↑ size ?
A
  • MCL 6-12cm
  • MSL 4-8
  • Causes: Hepatitis , RSHF
90
Q

Spleen Size ESTIMATION

A
  • Percussed on L. 9th ICS @ AAL (Anterior Axillary Line)
  • Stays TYMPANIC
91
Q

Presentation of Appendicitis [3]

A
  • Umbilical -> RLQ pain (RLQ local if Peritoneum involved)
  • Fever , Constipation
92
Q

Presentation of Diverticulitis [4]

A
  • “L. sided appendicitis”
  • LLQ pain
  • Affects SIGMOID colon
  • > 50 yo
93
Q

Presentation of Hepatitis / Cholecystitis

A
  • RUQ Pain
  • (+) Murphy’s Sign
94
Q

Presentation of Pancreatitis

A
  • Acute Epigastric Ab. Pain -> Radiates to BACK
95
Q

Presentation of Renal Calculi

A
  • Flank/Inguinal pain [“loin to groin”]
  • Writhes to find comfort but NO IMPROVEMENT
96
Q

Presentation of AAA

A
  • Pain in Low Ab -> Radiates to BACK = RUPUTRE
97
Q

Presentation of Ectopic Pregnancy

A
  • Low Ab pain
  • Severe when ruptured vaginal bleeding
98
Q

23 yr old with sore throat of 3 days duration and mild fever

  • What finding of the abdomen would you expect
A
  • Spleen size increased
99
Q

Pulse Pressure (PP)

  • The wider the PP = ?
  • NORMAL PP?
A
  • Systolic pressure - Diastolic pressure
  • More Likely to get CVD
  • 30 - 50 mmhg
100
Q

Hypotension

  • When to be CONCERNED?
A
  • < 90/60
  • If S & Sx present
101
Q

Orthostatic Hypotension: Systolic & Diastolic

A
  • Systolic: ↓ > 15 mmhg upon standing
  • Diastolic: ↓ > 10 mmhg upon standing
102
Q

OLD vs NEW “Normal” of HTN

  • HTN Crisis (Emergency) value?
A
  • Old: 140/90
  • New: < 120/80
  • HTN Crisis: > 180 / 120
103
Q

Hypertensive Crisis: Symptoms

A
  • Chest Pain , Severe Headache , Distress
104
Q

2° causes of HTN [RAT HAPM]

A
  • Renal Dz [Renal A Stenosis , Polycyst. Kidney]
  • Adrenal Dz [Conn’s , Cushing , Phreochromocystoma]
  • Thyroid Dz [Hyper]
  • Hyperparathyroidism [Ca+ lvl]
  • Acromegaly
  • Preggo
  • Meds
105
Q

Vital findings of HTN?

  • [ __ - __ BP ↑] = ↑ Risk of Stroke or Death from CVD
A
  • ↑ BP > 10 mmHg difference in arms
  • [10 - 15] BP ↑
106
Q

Ophthalmoscopic exam (eye) findings of HTN [4]

A
  • AV nicking
  • Copper/Silver wire
  • Cotton Wool spots (soft exudate)
  • Papilledema (head trauma)
107
Q

INSPECTION findings of HTN [4]

A
  • AV nicking
  • Copper/Silver wire
  • Cotton Wool spots (soft exudate)
  • Papilledema (head trauma)
108
Q

INSPECTION findings of HTN [4]

A
  • ↑ Loudness of S2
  • Crackles in Lungs if LSHF
  • Bruits [Athero/Anuerysm]
  • Thyroid [Hyper]
109
Q

AB findings of HTN [3]

  • Extremity?
A
  • Cushing striae + Obesity
  • Bruits
  • Large Kidney
  • Extremity: Pit. Edema (Bilat) + Low Peri. Pulse
110
Q

MC Hx complaints Peri. Vascular Dz [4]

A
  • Pain in extremity + Swelling
  • Cold/Numb
  • Claudication (Intermit.)
  • Color change
111
Q

Peripheral pulse grading scale

A

0: none

1: diminished

2: expected

3: increased

4: bounding

112
Q

MC MISSING PULSE in humans

  • If ABSENT, use -> _____
A
  • Dorsalis Pedis
  • Post. Tibial
113
Q

Peripheral A. we have AUSCULATED [5]

A

Temporal

  • Cartoid
  • Subclavian
  • Aorta
  • Femoral
114
Q

Peripheral Atherosclerotic Occlusive Dz [PAOD]

  • How much Lumen size ↓ before CLAUDICATION?
A
  • Thick Arterial wall = ↓ in A. Lumen size
  • 60-80% ↓
115
Q

PAOD

MC Location: ?

Palpation: ?

Instrumentation (BP): ?

A
  • Superficial Femoral A.
  • ABSENT PULSE
  • BP > 10 mmhg difference from arm to arm
116
Q

PAOD:

CC : ?

Past Med. Hx: ?

Family Hx: ?

Lifestyle: ?

Review of Systems: ?

A
  • Claudication
  • ↑ Cholesterol or Diabetes
  • CV problems or ↑ Cholesterol
  • Poor Diet , Smoking
  • Poor Circulation , ↑ Appetite + Thirst & Urination of Diabetes
117
Q

Ankle Brachial Index (ABI)

  • When is it ABNORMAL?
A
  • BP in ankle/BP in arm
  • If ratio is less than 1.0
118
Q

Thoracic Aortic Aneurysm

  • MC caused by…
  • MC…
A
  • Dilated Aorta (In 40 - 70 yo)
  • Athero (From HTN)
  • Site of dissecting aneurysm
119
Q

60% of Thoracic Aortic Aneurysm is _____

  • If NOT -> ?
A
  • ASYMPTOMATIC
  • Sx: Boring Chest pain + SEVERE RIPPING PAIN
120
Q

60% of Abdominal Aortic Aneurysm (AAA) is _____

  • If NOT -> ?
A
  • ASYMPTOMATIC
  • Sx: Ab. Pain that refers to LOW BACK
121
Q

INSPECTION findings of AAA [3]

  • MC between…
A
  • Bruit
  • Lateralization
  • Pulsatile mass (Mid -> Upper Ab)
  • Renal & Infrarenal lvl
122
Q

AAA management

A
  • REFER -> Vascular surgeon
  • MODIFY techniques (No F&D , No Force)
123
Q

Beurgers Dz (Thromboangiitis obliterans)

A
  • Recurring inflammation in A. & V.
124
Q

Risk factors of Beurgers Dz

A
  • Smoker
  • MC in Jewish ppl
125
Q

CC of Buergers Dz

  • ↑ with…
A
  • Pain in extremity w. Parethesias
  • Emotion , Smoking , Cold Exposure
126
Q

Peripheral vascular findings of Buergers Dz

A
  • 0 (None) / 1 (Decreased) PULSE Grade
  • Spots in Extremities
127
Q

Raynaud’s Dz

  • Risk Factors?
  • If ASSOC. with Risk Factors / Unilateral = ?
A
  • Artery vasoconstriction [Paroxysmal Cold/Pain/Pallor/Ulcer]
  • SLE , RA , Scleroderma
  • Raynauds Phenomenon
128
Q

Hx Finding of Raynaud’s

  • Color Change: ?
A
  • BILATERAL throb & burn upon exposure to COLD
  • Color: White -> Blue -> Red
129
Q

DVT (Deep V. Thrombosis)

  • MC sites?
A
  • Clot formation in the wall of Veins
  • Iliofemoral , Popliteal & Small V. of Calf
130
Q

Risk factors of DVT [Virchow’s Triad]

A
  • Injury to V.
  • Hypercoagulability
  • Circulatory stasis
131
Q

DVT symptoms

  • If ASYMPTOMATIC -> ____ is 1st consequence!!
A
  • Redness & Swelling
  • Tenderness
  • Unilateral Ankle & Calf edema
  • Pulmonary Embolus
132
Q

MC complaints of CVD [6]

A
  • Chest pain
  • Palpitations
  • SOB/Dyspnea
  • LE edema
  • Fatigue
  • Dizziness / Syncope
133
Q

Chest pain can come from : [5]

A
  • Cardiac
  • GI
  • Pulmonary
  • Musculoskeletal
  • Physiologic
134
Q

Angina & AMI : Both experience _____ [2]

A
  • Diffuse Retrosternal Pressure
  • Levine’s Sign
135
Q

Levine’s sign

A
  • Clutching of the chest
136
Q

Presentation of Angina Pectoris

A
  • Preceded by activity
  • Relieved by rest
  • < 30 minutes duration
137
Q

Presentation of AMI

A
  • Pain w/o activity
  • Mildly relieved by rest
  • > 20 minute duration
138
Q

REFERRAL of Heart Attack pain

A
  • Down left arm
  • Middle of back
  • Neck tie like
  • Left shoulder
139
Q

Conditions that MIMICS Angina/AMI [4]

A
  • Esophageal spasm
  • Hiatal dernia
  • Gall bladder
  • Pancreatic disease
140
Q

Pancreatic disease pain

A
  • Epigastric pain that radiates to back
141
Q

MSK conditions that MIMICS Heart Attack

A
  • Costochondritis (Tietze’s)
  • Rib Fx
  • Intercostal Neuralgia

must be reproducible

142
Q

For a MSK condition to MIMIC a Heart Attack it must be ____

A
  • REPRODUCIBLE [Palpate , Motion]
143
Q

Scalene & SCM TrP referral

A
  • Lateral arm into hand
  • Chest
144
Q

L. sided Scoliosis would present with ____

A
  • Cardiac pain -> Mimicking ANGINA
145
Q

Hypokyphosis is associated w. ____

  • Best Heard @ ___
A
  • Split S1 sound (Heart)
  • Tricuspid Valve
146
Q

INSPECTION findings that suggest CVD , Athero / PAD (Peri. A. Dz

A
  • Xanthoma
  • Splinter Hemorrhage in Nail
  • Palatal Petechial Hemorrhage
  • Club fingers
147
Q

Xanthomas

  • If on HAND/ACHILLES = ?
A
  • Yellow plaque (Lipid/Cholsterol deposit) in PERIORBITAL
  • Tendon Xanthoma
148
Q

Splinter hemorrhages

  • Assoc. w. _____
A
  • Red-Brown lines on Nail + Spots on Palate
  • Subacute bacterial endocarditis
149
Q

Locations of Heart sounds [5]

A

Aortic: R. 2nd ICS sternal edge

Pulmonic: L. 2nd ICS sternal edge

Erbs Point: 3rd ICS L. sternal edge

Tricuspid: 5th ICS L. sternal edge

Mitral: 5th ICS L. MCL line

150
Q

Point of MAX INTENSITY & Apical pulse is located at ____

A
  • 5th ICS left MCL
151
Q

Split S1 sound

  • BEST at ____
A
  • Delay between closure of MV & TV
  • TV
152
Q

Split S2 sound

  • BEST at ____
A
  • Delay between closure of AV & PV
  • Base
153
Q

Split S1 sound is seen in people w ______

A
  • FLAT back ( Ex. Hypokyphosis )
154
Q

Midsystolic click is found in..

A
  • Mitral Valve Prolapse (MVP) patients
155
Q

Grading murmurs

A

1- Barely audible

2- Clearly audible

3- Moderately audible

4- Loud w. THRILL

5- Very loud w. THRILL

6- Can hear with steth. NOT touching chest wall

156
Q

THRILLS are palpable in which Graded Murmurs ?

A
  • Grade 4-6
157
Q

Innocent murmurs

A
  • Grade 1-2
  • Soft/musical
  • Short duration
  • Dec or ABSENT when seated
158
Q

Which MURMURS are INNOCENT ?

  • Which AREN’T ?
A
  • Systolic (Innocent)
  • Diastolic (Never innocent)

PA II (1 decks)

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