Genitourinary/Peripheral Vascular/Neurological

Question 1

Hypospadias

Answer 1

A developmental anomaly in which the urethra opens below its usual placement at the tip of the penis. It may open anywhere on the undersurface (ventral aspect) of the penis or even on the perineum.

Question 2

Epispadias

Answer 2

The urethral opening is above its usual placement and anywhere along the upper surface (dorsal aspect) of the penis.

Question 3

Cryptorchidism

Answer 3

Undescended testicle

Question 4

Hydrocele

Answer 4

A nontender, fluid-filled mass that occupies the space within the tunica vaginalis. The mass will transilluminate.

Question 5

Varicocele

Answer 5

Refers to varicose veins of the spermatic cord. On examination, the mass feels like a “bag of worms” and is non-tender.

Question 6

Spermatocele

Answer 6

A non-tender, cystic scrotal mass which contains sperm and can be palpated above the tesits. It will transilluminate.

Question 7

Inguinal Hernia

Answer 7

A weakness in the abdominal wall in the inguinal region of the body in which the intestion bulges out or into the scrotum.

Question 8

Direct Inguinal Hernia

Answer 8

Emerges medial to the inferior epigastric artery.

Question 9

Indirect Inguinal Hernia

Answer 9

Passes through the inguinal canal and emerges lateral to the inferior epigastric artery.

Question 10

Flexion/Version of the Uterus

Answer 10

Orientation of the uterus in the pelvic cavity varies.

Flexion refers to whether the uterus is bent on itself (angulated)

The uterus may be flexed (bent) on itself either anteriorly (anteflexed) or posteriorly (retroflexed). The point of reference is the superior (top) aspect of the organ. That is, the upper part is bent forward or backward.

The entire uterus may also be tipped or tilted (as opposed to flexion) either anteriorly (anteversion) or posteriorly (retroversion). The point of reference is the superior (top) aspect of the organ. That is, the upper part is tilted forward or backward.

Question 11

Uterine Prolapse

Answer 11

Due to weakness of the supporting structures, the uterus descends to variable degrees in the vaginal canal. In its greatest severity, the entire uterus protrudes beyond the vaginal introitus.

Question 12

Cystocele

Answer 12

There is weakness of the supporting structures of the bladder, causing a bulging of the anterior vaginal wall and the bladder.

Question 13

Rectocele

Answer 13

There is weakness of the supporting structures of the rectum, causing a bulging of the posterior vagina and the rectal wall behind it.

Question 14

Myomas (Fibrosis)

Answer 14

Common benign uterine tumors. They may be single or multiple. They are firm nodules, may be very large and can cause marked enlargement and irregularity of the uterus.

Question 15

Ovarian Cysts and Other Tumors

Answer 15

There are a variety of benign ovarian cysts. Common ones include serous cystadenoma and mucus cystadenoma. They are smooth and usually somewhat compressible. Der-moids are common, benign tumors containing varying proportions of tissue from all three germ layers including hair, teeth, and bone.

Cancers can be cystic or solid. They may be nodular. Serous Cystadenocarcinomas and Mucus Cystadenocarcinoma can be huge and ascites is often associated.

Question 16

Edema

Answer 16

Fluid in intercellular tissue spaces

May be pitting - depression caused by pressure, or non-pitting

Many causes

Grading: typically 1-4+

(ex. Dependent edema with venous insufficiency; right heart failure)

Question 17

Lymphedema

Answer 17

Caused from lymphatic obstruction as for example when a lymph node dissection has been done or radiation for a malignancy. It is non-pitting.

(ex. lymphedema of the arm after surgery for breast cancer)

Question 18

Pulses

Answer 18

Generally described as normal, decreased, or absent

“Bounding” peripheral pulses with Patent Ductus Arteriosis

Question 19

Light/Simple/Gross Touch

Answer 19

Transmitted by fibers in the Anterior Spinal Thalamic Tract

Test by wisp of cotton

Question 20

Pain and Temperature

Answer 20

Transmitted by fibers in the Lateral Spinal Thalamic Tract

Pin prick traditionally used

Question 21

Proprioception

Answer 21

Fibers run in the dorsal (posterior columns) of the spinal cord.

Three components

1. Position Sense
2. Vibratory Sensation
3. Tactile Sense

Question 22

Tactile Sense = Tactile Discrimination

Answer 22

The ability to recognize size, shape, and texture of objects by feeling (also referred to as stereognosis)

The ability to recognize letters and figures drawn on the skin by touch (also referred to as stereognosis and graphesthesia)

Two point discrimination - The ability to recognize two separate points at which pressure is applied on the skin (also known as stereognosis)

Question 23

Stereognosis

Answer 23

Ability to recognize objects placed in hand - a proprioceptive function

(ex. finding a dime in your pocket or keys in your purse)

The inability to do so is called astereognosis

Question 24

Graphesthesia

Answer 24

Ability to recognize numerals or letters traced on the skin – proprioceptive function

Question 25

Two Point Discrimination

Answer 25

Ability to distinguish two points simultaneously applied to the skin distinct from one single point - a proprioceptive function.

Question 26

Romberg

Answer 26

A test of position sense – of the posterior columns - NOT the cerebellum

Question 27

Nystagmus

Answer 27

The rhythmic oscillation of the eyes - occurs with problem in inner ear and vestibular nuclei. Can be drug related.

(ex. Dilantin)

Question 28

Dysdiadochokinesis

Answer 28

Inability to stop one movement and follow it immediately by the directly opposite action. That is to perform rapid alternating movements smoothly and in coordinated fashion.

Question 29

Tremor

Answer 29

Involuntary oscillating movement or trembling in an extremity.

There are resting, postural, and intention tremors.

(ex. Resting tremor in Parkinson’s Disease)

Question 30

Strength

Answer 30

Tested in both upper and lower extremities

Tested both proximally and distally

Flexion, extension, etc.

Graded 0 to 5 (ex. 3/5)

Question 31

Hemiplegia

Answer 31

Paralysis of one side of the body

ex. Cerebrovascular accident

Question 32

Hemiparesis

Answer 32

Weakness on one side of the body

ex. Cerebrovascular accident

Question 33

Deep Tendon Reflexes

Answer 33

Stretch reflexes

Grading 0 to 4+

Clonus = sustained series rhythmic jerks = 4+

Question 34

Pathologic Reflexes

Answer 34

Babinski- Using a blunt object (ex. handle of reflex hammer, key) stroke the plantar surface of the outer border of the foot from the heel extending distally and then curving medially across the distal foot.

A normal response is a downgoing (plantar flexion) great toe.

An abnormal response is an upgoing (dorsiflexion) great toe with spreading of the toes.

Sign of upper motor neuron disease (ex. CVA).

Normal in infants.