Gender Specific Diagnostic Reasoning Flashcards
don't fail the final
female breast considerations
screening recommendations
breast health promotion
concerning symptoms- lump, pain, discharge
Consider age and familial history for red flags
boob concerning symptoms
lump or mass
pain or discomfort during exam
nipple discharge
normal screening age for mammograms
40
screening interval for women 40-74 for mammograms
annual or bi-ennial
when do you stop mammograms
75 ehh its fine
depends on health status
what test do you do for ladies with dense breasts (Joanna)
ultrasound
breast feed maternal benefits immediate
reduction of hemorrhage risk, blood pressure, weight loss, stress reduction, delay in ovulation; infant bonding
breast feeding benefits long term
reduction in risk for breast, ovarian, endometrial ca, HTN, and DM
breatfeeding benefits child benefits
decreased risk of DM1, celiac, asthma, obesity, respiratory infections and related hospitalizations
importance of self breast exam
how they can recognize a change
lump or mass
pain
nipple discharge
common breast masses (3)
fibroadenoma
cyst
cancer
Subjective breast exam
OLDCARTS- consider accompanying symptoms carefully to help guide the approach to diagnosis
objective breast exam
shape
consistency
delineation
mobility
signs of retractions
which masses are more common in younger ladies ages 15-25
fibroadenoma and cysts
differences b/t fibroadenoma/cysts and cancer
cancer more common in later than 50s
usually single/firm
adenoma- more than 1, soft, not irregular
fibroadenoma testing for younger ladies
no concurrent testing
usually related to menstrual cycle
know age ranges for fibroadenoma, cancer, cyst
fibroadenoma- age 15-25
Cysts- 30-50 - regress after menopause except with estrogen therapy
Ca- 30-90 most common over 50
pelvic pain, bleeding, menstural subjective assessment
OLDCARTS
abnormal menarche
abnormal bleeding
pelvic pain
STI
sexual dysfxn
discharge
menstrual irregularities subjective info
theres a lot
age of menarche
date of last menstrual period
patterns
episode of previous bleeding or amenorrhea
pattern of bleed
amount and frequency- XXL?
color of blood-
recent infection, STD, trauma, pain, fever
birth control practices
sexual activity
physical exam for menstrual irregularities
abd and pelvic exam
hematologic/coagulopathy
structural causes- polyps/ fibroid
preggo
endocrine? thyroid disease
diagnostics for menstrual irregularities
exam
CBC, coags, HCG, pelvic ultrasound, endometrial biopsy
sometimes its a med
ammenorrhea causes (7)
outflow
primary ovarian insufficiency
pituitary
hypothalamic
thyroid
PCOS tumor adrenal
physiologic- breastfeed, contraception, meno, preggo
primary menarche dx
no period by age 16
secondary menarche
amenorrhea for 3 months in a woman with past menses
need to know amenorrhea
sexual practices
birth control
chronic/acute illness
stress
meds- changes in doses
approach to amenorrhea: objective
guided by suspicion based on hx
1- pelvic exam, HCG to r/o preggo
step 2- TSH , LH, FSH
step 3- prolactin, T3/4, testosterone
pregnancy nomenclature: G(ravida)
gravida- total pregnancies,
include all live, deceased, spont ab, elective AB
preggo nomenclature: P(arity)
number of Preggo surviving >20 weeks
preggo nomenclature: T(erm)
of prego considered to be 37-40 weeks gestation
preggo nomenclature: L(iving)
number of living children alive at data collection
preggo nomenclature A
abortions, voluntarily or spontaneous before 20 weeks gestation
preggo physical exam how does the fundus help you
THE FUNDAL HEIGHT- helps you know how many weeks they are
how to calculate the Estimated Due Date
first day of last menstrual period (aug1)
add 7 days (aug 8)
- 3 months- may 8
add 1 year = May 8th of next year
mens health concern
penile discharge/lesions (gross)
scrotal or testicular pain, swelling, or lesions
general approach to the dudes assessment about his peen
ask about peen discharge- consider an STI
OLDCARTS about lesions to narrow down causation
ex- painful red lesions- herp
painless chancroid lesion- syph
multiple clusters- HPV
ask about itchiness- scabies or pubic lice- gross, fungal infections less common in men
testicular torsion
common in puberty
acute onset of pain
radiates to groin lower and+/- NV
physcial exam : testicular torsion
asymmetrical scrotal swelling
elevated testicle on affected side
absent cremaster reflex
severe pain with manipulation
plan for testicular torsion
refer to uro byeeee
hydrocele def, historical and subjective risk assessment
def- fluid filled scrotal sac
risk- idopathic
may develop after trauma
subjective- painless
unilateral swelling
feeling of heaviness
risk spermatocele and definition/subjective assessment
definition cystic mass in epididymis (ie the nut)
only seen after puberty
no identifiable risks
subjective
non tender mass
varicocele definition and historical risk / subjective assessment
def- dilation of pampiniform venous complex……does that make them big??
risk- usually occurs during adolescence
Subjective findings
more common on L
may only be found during infertility
asymptomatic
occasional dull ache, fullness, non-radiating
pulling of the sc
Objective hydrocele assessment
Inability to feel the testicle
Possible excoriation and erythema of the scrotum
Able to extend fingers above the hydrocele during examination
Trans-illumination may be useful
*normal testes, solid masses, and hernias do NOT transilluminate
objective spermatocele
Large or small mass on the testicle depending on size
Non-tender during palpation
objective varicocele
Valsalva maneuver can increase feeling of varicocele during palpation
On inspection, has a “bag of worms” appearance
Unable to extend fingers above the varicocele during examination
assessment/plan fibroadenoma
firm, well delineated, very mobile and non-tender mass
Plan- no testing needed, consider surgical consult if mass increases in size or if it causes pain
assessment/plan cyst
round, firm, well delineated, mobile, and tender esp during period
plan- keep breast symptom calender
mammogram vs ultrasound (mammo for older ladies or if dx is less certain)
assessment/plan breast Ca
single, fixed, irregular in shape, NOT delineated, nontender +/- retraction/dimpling
plan- diagnostic mammo w/ reflex ultrasound
other diagnostics- MRI, CT, PET
consult breast surgery/oncology
fundal heights for 12 weeks, 36-38 weeks, and 40 weeks
12- just above pubic bone
36-38- right up under the sternum (can’t breathe)
40- she drops below the 38 week mark b/c she’s dropping and getting ready to GO
general approach to scrotal pain/swelling
Obtain careful history: OLDCARTS!
Potential causes:
Testicular torsion
Hydrocele
Varicocele
Spermatocele
Inguinal hernia
Lifetime risk for a dude to develop a groin hernia
25%
