Final Flashcards
GYN subjective/history data
menstrual history obstetric history - gravidity [pregnancies] and parity [births] amenorrhea [menopause] urinary symptoms vaginal discharge past GYN history past pap exam and results sexual activity contraceptive use STD's
breast exam abnormalities
dimpling edema nipple retraction fixation deviation in nipple pointing benign breast disease cancer fibroadenoma
female tanner stages
I [10-13 year old] - preadolescent pubic hair/breasts II - sparse, straight pubic hair - small mound-sized breasts III [12-14 year old] - dark curled pubic hair - bigger, separated breasts w/o contour IV - abundant coarse, curly pubic hair - areola forms on breasts V [14-17 year old] - triangle-shaped area of pubic hair reaching top thighs - nipple projection of breasts
male tanner stages
I [10.5-14 year old] - no pubic hair - pre-adolescent penis and testes II - scanty pubic hair - slight increase in penis and testes III [12.5-15 year old] - darker, curlier pubic hair - longer penis and larger testes IV - coarse, curly pubic hair - larger penis and darkened scrotum V [14-16 year old] - pubic hair reaches thighs - fully grown penis and testes
abnormalities in male genitalia
cryptorchidism [absent testes] testicular torsion spermatic cord varicele [varicose veins on the testes] testicular tumor hydrocele [fluid from the abdomen in the scrotal cavity] scrotal hernia orchitis [inflammation of the testes] benign prostatic hypertrophy prostatis [enlargement of the prostate] caarcinoma
types of cancer in males
testicular cancer
- most common cancer in young men between ages 20-39
- highest risk among white, Caucasian males
- risk factor: non-descended testes, family hx
prostate cancer
- common in men age 50 years or older
- highest risk among black males
- risk factors: diet high in fat, animal products, and calcium; diet low in fruits an vegetables; limited or low levels of physical activity
inguinal nodes cancer
- symptoms: hard, 1 cm or larger, discrete nodes
types of pain
acute pain - usually has a rapid onset - short-term, self-limiting - seen in nociceptive pain chronic pain - pain lasting more than 6 months - slow onset - types: malignant [i.e. tumor cells], non-malignant [i.e. musculoskeletal conditions]
sources of pain: nociceptive
nociceptive receptor are neurons that detect painful sensation from the periphery and transmit them to the CNS
designed to signal tissue damage or inflammation
located in the skin, connective tissue, muscle, and the thoracic, abdominal, pelvic viscera
may present wit somatic, cutaneous, or visceral pain
sources of pain: neuropathic
results from damage to the peripheral or central nervous system
often due to direct injury to the nerve fibers
constant irritation and inflammation causes the nerve cells to become altered/damaged
responses to pain
physiologic
- increased adrenaline level, blood glucose, blood pressure, heart rate, and respiratory rate, dilated pupils, muscle tension and rigidity, pallor
behavioral
- grimacing, moaning, crying, restlessness
affective
- exaggerated weeping, withdrawal, anxiety, depression, fear, anger, anorexia, fatigue
heart sounds
S1
- closure of the mitral and tricuspid valves
- beginning of systole
S2
- closure of the aortic and pulmonic valves
- beginning of diastole
heart failure
symptoms are often gradual in their development, as the body has great capacity to compensate for early changes in many diseases. often, pt.’s will wait until their breathing is severely impaired before seeking medical attention
there are two types: left-sided and right-sided
right-sided heart failure symptoms
jugular [neck vein] distention enlarged liver anorexia and nausea edema of hands, fingers, legs and sacrum distended abdomen nocturia
left-sided heart failure symptoms
fatigue weakness angina confusion hacking cough at night dyspnea crackles in lungs frothy, pink-tinged sputum tachypnea
heart conduction system
the SA node [anatomical pace-maker] starts the sequence by causing the atrial muscles to contract
the signal travels to the AV node, throguh the bundle of His, down the bundle branches, and through the purkinje fibers, causing the ventricles to contract
this signal creates the electrical current that can be seen as an EKG or ECG
anatomy of the lungs
the right lung has 3 lobes
the left lung has 2 lobes
posteriorly, only the upper and lower lobes of either lung can be auscultated
thorax palpation technique
symmetric chest expansion
crepitus
tenderness
tactile fremitus
normal breath sound: bronchial
heard over trachea and larynx
short inspiration and long expiration
sounds are rough
may only be auscultated anteriorly
normal breath sound: brochovesicular
heard over major bronchi between scapulae and upper sternum 1st and 2nd ICS
inspiration and expiration match the length
normal breath sound: vesicular
heard over periphery of lung
majority of lungs have vesicular sounds
long inspiration and short expiration
abnormal breath sound: fine crackles [rales]
discontinuous, short popping sound
usually heard during inspiration
caused by inhaled air colliding with previously deflated airways, sound occurs when airway pops open
not cleared by coughing
seen in: pneumonia [auscultated in the superior lung fields], heart failure, chronic bronchitis
abnormal breath sound: course crackles
discontinuous bubbling or gurgling sound
mostly hear on inspiration
caused by inhaled air colliding with secretions in the trachea or bronchi
cleared by coughing/suctioning but returns
abnormal breath sound: sibilant wheezes
high-pitched, musical sound
heard on inspiration and expiration
caused by air trying to squeeze through a passage narrowed by airway obstruction from collapse, or swelling
seen in: acute asthma, chronic bronchitis
abnormal breath sound: sonorous rhonchi
low-pitched rumbling
caused by passage of airflow obstruction by thick secretions
cleared by coughing but returns
seen in: bronchitis, obstruction from tumor, cystic fibrosis
abnormal breath sound: stridor
high-pitched crowing sound, often louder in the neck than over the chest wall
heard on inspiration
caused by upper airway obstruction, from swollen tissue or lodged foreign body
seen in: epiglottitis, foreign body
abnormal breath sound: pleural friction rub
grating or creaking sound heard on inspiration and expiration caused by rubbing together of inflamed or roughened pleurae heard best at anterolateral wall seen in: pleuritis
abnormal breath sound: absent
reduction in the intensity of breath sounds
commonly described as reduced air entry
seen in: bronchial occlusion, collapsed lung or lobe, pleural effusion, or pneumothorax [heard in the inferior lung field]
arterial disease symptoms
dependent rubbor or elevation pallor
thin, brittle skin
extremity hair loss
thickened, opaque toe nails
ulcers occur on toes or on a bony prominence
- are painful and have a punched-out appearance or regular margins
intermittent claudication [a condition caused by ischemia of the muscles; characterized by attacks of pain, brought on by mobility
venous disease symptoms
stasis dermatitis- brown, flaky pigmentation of skin
legs may have a bluish cast and dilated veins
chronic swelling
ulcers are found around the lower leg near the ankle due to trauma of the edematous skin
- has irregular margins and may be painless
grading pulses
0= absent \+1= weak, thready \+2= normal \+3= bounding
abdominal inspection technique
first step contour skin characteristics and color symmetry umbilicus
abdominal auscultation technqiue
second step
auscultate bowel sounds with diaphragm and vascular sounds, over the aorta, renal, ilian, and feemoral arteries, with bell
abdominal percussion technique
third step
note areas of tympany and dullness [over an organ or fat]
perform CVA tenderness exam
abdominal palpation technique
fourth step
light palpation
- assess for tenderness, masses, and muscular resistance
deep palpation
- assess for organ enlargement, masses, bulges, or swelling
