Gender Specific Diagnostic Reasoning

Question 1

female breast considerations

Answer 1

screening recommendations
breast health promotion
concerning symptoms- lump, pain, discharge

Consider age and familial history for red flags

Question 2

boob concerning symptoms

Answer 2

lump or mass
pain or discomfort during exam
nipple discharge

Question 3

normal screening age for mammograms

Answer 3

40

Question 4

screening interval for women 40-74 for mammograms

Answer 4

annual or bi-ennial

Question 5

when do you stop mammograms

Answer 5

75 ehh its fine
depends on health status

Question 6

what test do you do for ladies with dense breasts (Joanna)

Answer 6

ultrasound

Question 7

breast feed maternal benefits immediate

Answer 7

reduction of hemorrhage risk, blood pressure, weight loss, stress reduction, delay in ovulation; infant bonding

Question 8

breast feeding benefits long term

Answer 8

reduction in risk for breast, ovarian, endometrial ca, HTN, and DM

Question 9

breatfeeding benefits child benefits

Answer 9

decreased risk of DM1, celiac, asthma, obesity, respiratory infections and related hospitalizations

Question 10

importance of self breast exam

Answer 10

how they can recognize a change
lump or mass
pain
nipple discharge

Question 11

common breast masses (3)

Answer 11

fibroadenoma
cyst
cancer

Question 12

Subjective breast exam

Answer 12

OLDCARTS- consider accompanying symptoms carefully to help guide the approach to diagnosis

Question 13

objective breast exam

Answer 13

shape
consistency
delineation
mobility
signs of retractions

Question 14

which masses are more common in younger ladies ages 15-25

Answer 14

fibroadenoma and cysts

Question 15

differences b/t fibroadenoma/cysts and cancer

Answer 15

cancer more common in later than 50s
usually single/firm

adenoma- more than 1, soft, not irregular

Question 16

fibroadenoma testing for younger ladies

Answer 16

no concurrent testing
usually related to menstrual cycle

Question 17

know age ranges for fibroadenoma, cancer, cyst

Answer 17

fibroadenoma- age 15-25
Cysts- 30-50 - regress after menopause except with estrogen therapy
Ca- 30-90 most common over 50

Question 18

pelvic pain, bleeding, menstural subjective assessment

Answer 18

OLDCARTS
abnormal menarche
abnormal bleeding
pelvic pain
STI
sexual dysfxn
discharge

Question 19

menstrual irregularities subjective info

theres a lot

Answer 19

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

Question 20

physical exam for menstrual irregularities

Answer 20

abd and pelvic exam
hematologic/coagulopathy
structural causes- polyps/ fibroid
preggo
endocrine? thyroid disease

Question 21

diagnostics for menstrual irregularities

Answer 21

exam
CBC, coags, HCG, pelvic ultrasound, endometrial biopsy
sometimes its a med

Question 22

ammenorrhea causes (7)

Answer 22

outflow
primary ovarian insufficiency
pituitary
hypothalamic
thyroid
PCOS tumor adrenal
physiologic- breastfeed, contraception, meno, preggo

Question 23

primary menarche dx

Answer 23

no period by age 16

Question 24

secondary menarche

Answer 24

amenorrhea for 3 months in a woman with past menses

Question 25

need to know amenorrhea

Answer 25

sexual practices birth control chronic/acute illness stress meds- changes in doses

Question 26

approach to amenorrhea: objective

Answer 26

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

Question 27

pregnancy nomenclature: G(ravida)

Answer 27

gravida- total pregnancies, include all live, deceased, spont ab, elective AB

Question 28

preggo nomenclature: P(arity)

Answer 28

number of Preggo surviving >20 weeks

Question 29

preggo nomenclature: T(erm)

Answer 29

of prego considered to be 37-40 weeks gestation

Question 30

preggo nomenclature: L(iving)

Answer 30

number of living children alive at data collection

Question 31

preggo nomenclature A

Answer 31

abortions, voluntarily or spontaneous before 20 weeks gestation

Question 32

preggo physical exam how does the fundus help you

Answer 32

THE FUNDAL HEIGHT- helps you know how many weeks they are

Question 33

how to calculate the Estimated Due Date

Answer 33

first day of last menstrual period (aug1) add 7 days (aug 8) - 3 months- may 8 add 1 year = May 8th of next year

Question 34

mens health concern

Answer 34

penile discharge/lesions (gross) scrotal or testicular pain, swelling, or lesions

Question 35

general approach to the dudes assessment about his peen

Answer 35

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

Question 36

testicular torsion

Answer 36

common in puberty acute onset of pain radiates to groin lower and+/- NV

Question 37

physcial exam : testicular torsion

Answer 37

asymmetrical scrotal swelling elevated testicle on affected side absent cremaster reflex severe pain with manipulation

Question 38

plan for testicular torsion

Answer 38

refer to uro byeeee

Question 39

hydrocele def, historical and subjective risk assessment

Answer 39

def- fluid filled scrotal sac risk- idopathic may develop after trauma subjective- painless unilateral swelling feeling of heaviness

Question 40

risk spermatocele and definition/subjective assessment

Answer 40

definition cystic mass in epididymis (ie the nut) only seen after puberty no identifiable risks subjective non tender mass

Question 41

varicocele definition and historical risk / subjective assessment

Answer 41

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

Question 42

Objective hydrocele assessment

Answer 42

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

Question 43

objective spermatocele

Answer 43

Large or small mass on the testicle depending on size Non-tender during palpation

Question 44

objective varicocele

Answer 44

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

Question 45

assessment/plan fibroadenoma

Answer 45

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

Question 46

assessment/plan cyst

Answer 46

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)

Question 47

assessment/plan breast Ca

Answer 47

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

Question 48

fundal heights for 12 weeks, 36-38 weeks, and 40 weeks

Answer 48

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

Question 49

general approach to scrotal pain/swelling

Answer 49

Obtain careful history: OLDCARTS! Potential causes: Testicular torsion Hydrocele Varicocele Spermatocele Inguinal hernia

Question 50

Lifetime risk for a dude to develop a groin hernia

Answer 50

25%