GI: Female + Male GU Flashcards
the axillary tail of breast tissue extends into which fold?
anterior axillary fold
most vessels from breast drain into which lymph node
axillary LN
which LNs are most likely to be palpable
central nodes
which nodes drain into central nodes? (3)
pectoral
subscapular
lateral nodes
Mastalgia
MC presenting sympt for?
breast pain
MC presenting symp for BCA
Galactorrhea
*what increases the risk of it being pathogenic?
discharge of milk containing fluid unrelated to pregnancy
*risk of it being pathogenic increases if its bloody, unilateral, spontaneous, women >40 or with a mass
what four positions do you need to inspect female PT
arms at sides
arms over head
arms on hips
leaning forward
how do you determine the origin of nipple discharge
what to note with discharge
compressing areola with index finger
- color
- consistency
- quanity
- exact location
what is better, a painful or painless nodule>
Painful
Peau d’orange
- describe it
- cause?
- sign of?
SIGNS OF BCA skin color thickening prominent pores cased by edema of skin produced by lympahtic blockage
peau d’orange
skin dimpling, flattening, changes in contour
nippel inverrsion
paget disease of nipple
signs of BCA
smooth, rubbery, round, mobile, nontender, describes what kind of mass
fibroadenoma
usually soft to firm, round, mobile, often tender
cysts
nodular, ropelike
fibrocystic changes
irregular, firm, may be mobile or fixed to surrounding tissue
CA until proven otherwise
preferable to do axilla exam with the patient in what position
sitting (not supine)
enlarged nodes can be from?
- immunizations
- infection
nodes >1 cm
+firm or hard
+matted together or fixed (immobile)
suggests?>
malignancy
Breasts pendulous with diffuse fibrocystic changes. Single firm 1 x 1 cm mass, mobile and nontender, with overlying peau d’orange appearance in right breast, upper outer quadrant at 11 o’clock.” SUGGESTIVE OF?
possible BCA
describe how inguinal hernias can form
when loops of bowel force their way through weak areas of the inguinal canal
locations for hernias
inguinal
femoral
yellow penile discharge ?
GC***/ chlamydia
swelling in groin may indicate ?
mumps orchitis
scrotal edema
testicular CA
testicular painless nodule
consider testicular CA
age group testicular CA is MC diagnosed in
20-34YO
you can feel the hernia touch fingertip after asking PT to cough— direct or indirect?
indirect hernia
hernia bulges anteriorly and pushes the side of finger forward after PT coughs–indirect or direct
direct
which is MC? Indirect or direct
Indirect
who is most likely to get femoral hernias?
women
hernia is below the inguinal ligament, appears more lateral
- can be hard to differentiate from lymph nodes
- *what kind of hernia?
Femoral hernia
do femoral hernias go into the scrotum?
no
above inguinal ligament, close to the pubic tubercle (near the external inguinal ring)
*what hernia is this
direct
do direct hernias go into the scrotum?
rarely
hernia is above inguinal ligament, near its midpoint (the internal inguinal ring) *what kind of hernia
indirect
Does indirect hernia go into the scrotum
often
phimosis
inability to retract the foreskin
paraphimosis
tight prepuce that once retracted.. but cannot be returned
which is worse: phimosis or paraphimosis?
paraphimosis–
single red PAINLESS ulcer/ chancre
syphillus
HPV genital warts also called
condyloma acuminata
veins of spermatic cord are twisted
“bag of worms”
varicocele
non-tender fluid filled mass under scrotum
hydrocele
can the fingers palpate above the mass for a hydrocele?
YES
can the fingers palpate above the mass for a scrotal hernia?
no
what is epididymitis
MCC for kids and MCC adults
inflammation of epididymis
MMC Kids: N. gonorrhea & C. trachomatis
MMC Adults: E. coli and pseudomonas
testicular torsion
- MC PT population?
- define
younger
Life threatening and sudden onset
testicle twists around on its spermatic cord, obstructs blood flow to kidney***
TOC for testicular torsion
US
ABSENT cremasteric reflex indicates?
testicular torsion
“Circumcised male. No penile discharge or lesions. No scrotal swelling or discoloration. Testes descended bilaterally, smooth, without masses. Epididymis is nontender. No inguinal or femoral hernias.”
normal exam findings
“Uncircumcised male; prepuce easily retractable. No penile discharge or lesions. No scrotal swelling or discoloration. Testes descended bilaterally; right testicle smooth; 1 × 1 cm firm nodule on left lateral testicle. It is fixed and nontender. Epididymis nontender. No inguinal or femoral hernias.”
suspicious of testicular CA
define adnexa
ovaries and fallopian tubes
normal range for cycle
24-32 days
normal range for menses
3-7 days
what do we want to r/o if PT has postmenopausal bleeding
want to be concerned about endometrial CA
amenorrhea
absence of menses
dysmenorrhea
pain with menses–often with bearing down, aching or cramping sensation at the lower abdomen or pelvis
polymenorrhea
menstrual cycle that is shorter than 21 days
menorrhagia
heavy or prolonged menstrual bleeding
metrorrhagia
bleeding b/w periods
abnormal bleeding
causes of secondary dysmenorrhea
endometriosis adenomyosis (endometriosis in muscular layer of uterus) PID endometrial polyps
secondary causes of amenorrhea
pregnancy lactation menopause low body wt hypothalamic-pituitary-ovarian-dsyfunction
post coital bleeding suggests
cervical polyps
CA
or in older women: atrophic vaginitis
Para?
break down the specifics
outcome of pregnancies F P A L *full term *premature *abortion (spontaneous or therapeutic) *Living Child
Gravida?
total number of pregnancies
woman has two living children and only two pregnanies.. write the G/P
G2 P2002
define dyspareunia
discomfort during intercourse
*can be a sign of sexual dysfunction
list the vulvovaginal symptoms
vaginal discharge
dysuria
list the proper sequence for a pelvic exam
- examine external genitalia
- perform speculum exam
- perform bimanual exam
- perform rectovaginal exam (if indicated)
describe the Pedersen speculum
smaller and more narrow
what is the bimanual exam?
index and middle finger inserted into vagina
*thumb is abducted and ring and little ringer flexed into palm
Cervical motion tenderness
suggests?
pain with moving the cervix
suggests PID
list two things that make lesions on the vulva
HPV
Herpes
name three DZs causing vaginal discharge
yeast infection
BV
Trichomonas
list three different bulges and swellings of the vulva/vagina/urethra
Cystocele (bladder protruding out….cysto- means bladdr)
Rectocele
Bartholin (labial swelling)
yellow drainage from cervical OS can suggest?
-can lead to?
GC Chlamydia (cervicitis) can lead to PID
when is carcinoma of the cervix usually visible?
later stages of dz
list some abornamlities of the uterus
prolapse
bleeding
myomas (fibroids)
endometrial CA
list some Adnexa issues
Ovarian cysts
Ovarian CA
Ruptured tubal pregnancy (ectopic pregnancy)
PID
Ectoptic Pregnancy
MC occur where?
90% occur in fallopian tube
may not be able to feel adnexal mass
LIFE THREATENING IF RUPTURE
PID
MC cause?
85% caused by STD
+CMT
what is the MCC of acute pelvic pain
2nd mC?
3rd mc?
1st: PID
2: ruptured ovarian cyst
3. appendicitis
which is the MC CA in US?
prostate
1 in ___ men will be diagnosed with prostate CA
1 in 8
RF for prostate CA
- Age: rises rapidly >50
- Race/ethnicity: MC in AA men
- FAm hx
- gene changes: inherited mutations of BRCA 1 BRCA 2
- diet
- chemical exposures (firefighters have incr risk)
- prostatitis (inflammation of PG)
information about screening tests for prostate CA
not very accurate
grade D rating
who should NOT get screened for prostate CA
asymptomatic men regardless of age, race or fam hx
harms of screening outweigh benefits
CONS to prostate screening
- high rate of false positive
- over diagnosis and over tx
- tx complications–ED and incontinence
4.
what does USPSTF say about men 70YO + about prostate CA screening
against the PSA-based screening
what is the PSA screening test
prostate specific antigen test
PSA
antigen produced naturally by prostate cells
if PT agrees, how often is PSA screening done
every 1-2 years
when should providers stop offering PSA screening
when PT reaches 70 YO
OR
whenever their life expectancy drops below 10
is there a PSA level that garuntees a PT has or does not have prostate CA?
no… but higher than usual level is found can INDICATE prostate CA..
what is the diagnostic gold standard for prostate screening
Prostate biopsy
how can you lower risk of Prostate CA
healthy weight physical activity healthy diet vit E ASA daily
what is the 3rd most frequently diagnosed CA in both men and women
colorectcal CA
what is the 3rd leading cause of death in US
colorectcal CA
RFs for colorectal CA
- increasing age
- hx
- adenomatous polyps
- IBD
- fam hx
- male
- AA
- tobac use
- read meat consumption
- ETOH
- obesity
screening tests for Colorectcal CA (4)
- stool tests that detect occult fecal blood
- colonoscopy
- flexible sigmoidoscopy
- imaging tests–double contrast barium enema
USPSTF guidelines for colorectcal CA screening:
- 50-70
- 76-85
- 85+
- high sensitivity FOBT annually, sigmoidoscopy every 5 years, colonoscopy every 10 years
- Screening not advised because benefits small in comparison to risks
- do not screen
what does primary dysmenorrhea resut from
increased prostaglandin prod during the luteal phase of the menstrual cycle—when estrogen and progesterone levels decline
how many days does it take to call it Polymenorrhea
less than 21 day intervals b/w menses
define oligomenorrhea
infrequent bleeding
what age range does menopause usually occur
48-55 (median 51)
cessation of menses for 12 months, progresing through several stages of erratic cyclical bleeding
+hot flashes
+flushing
+sweating
PERImenopause
what three general symptoms are linked to menopause
sleeping issues
vaginal symps
vasomotor symps
name three causes of postmenopasual bleeding
endometrial CA
hormone replacement tx
uterine and cervical polyps
amenorrhea followed by heavy bleeding suggests?
abortion
or
dysfunctional uterine bleeding related to lack of ovulation
superficial vaginal pain may suggest?
local inflammation
atrophic vainitis
inadequarte lubrication
deeper vaingal pain may suggest?
pelvic disorders
pressure on a normal ovary
vainismus
invol spasm of muscles surrounding the vaginal orifice that makes penetration during intercourse painful r impossible
what are two red flags for PID
recent IUD insertion
STIs
mild unilateral pain lasting for a few hours to a few days arising at midcycle
- what is this called
- what can cause it
Mittelschmerz “ovulation pain”
- ruptured ovarian cyst
- tubo-ovarian abscess
- ovulation
chronic pelvic pain is a red flag for?
sexual abuse
what is another cause of chronic pelvic pain
pelvic floor spasms from myofasicla pain
at what age to start screening for cervical CA
21
when to start vaccinating HPV
11-12
or
beofre their first sexual encounter
can start as early as 9
what are the strains of HPV that the vaccine cover
*which causes genital warts
6 and 11—- cause 90% of gential warts
16 and 18
do condoms eliminate the risk of cervical HPV?
no
chlamydial infection is a cause of ?
urethritis cervicitis PID ectopic pregnancy infertility chronic pelvic pain
RFs for chlyamida
<26
multiple partners
prior hx of STIs
in liquid based cytology, what can be filtered out
blood cells
what can delay menarche
an imperforate hymen
delayed puberty is often ?
familial or related to chronic illness or reflect disorders of hypothalamus, AP gland or ovaries
excoriation or itchy small red maculopapules suggest?
pediculosis pubis –found at the base of pubic hairs
enlarged clitoris is seen with?
masculinizing endocrine disorders
lateral displacement of the cervix is seen with?
endometriosis
RFs for vaginal CA
diethylstilbestrol (DES) exposure in utero
HPV infection
stool in the rectum may simulate a?
rectovaginal mass– but the stool can be dented by digital pressure
uterine enlargement suggests?
preg
uterine myomas
malignancy
how many years after menopause do the ovaries become atrophic
3-5
is it a good or bad sign to palpate an ovary in a postmenopausal woman
not good– they should not be palpable since they atrophy post menop
common findings for ovarian CA
pelvic pain
bloating
incr abdominal sie
UT s/s
MC type of hernias in women
indirect
vaginal mucosa and cervix coated with thin white homogenoous discahrge with fishy odor
BV
bulge of upper two thirds of the anterior vaginal wall, together with the bladder above it
-what is it
cystocele
small red benign tumor visible at the posterior urethral meatus
MC in postmenop women and usually causes no symps
Urethral caruncle
labial swelling— feels tense, hot, very tender abscess
+/- pus emerging from the duct or erythema around the duct opening
Bartholin gland infection
swollen red ring around the urethral meatus
prolapsed ureathal mucosa
entire anterior vaginal wall together with the bladder and urerthra produces a bulge
cystourethrocele
white-yellowish in color… small firm round cystic nodule in the labia suggests?
+dark punctum marking the blocked opening
epidermoid cyst
warty lesions on the labia and within the vestibule
condyloma acuminata from HPV
painless ulcer
syphilis
large raise round or oval flat topped gray or white lesions
and
rash and mucous membrane sores in the mouth, vagina or anus
condylomata lata
shallow ulcers on red base
herpes
ulcerated or raised red vulvar lesion
vulvar carcinoma
discharge: yellowish green or gray possibly frothy, often profuse and pooled in the vaginal fonix–may be malodorous
+pruritis
+pain on urination
trichomonal vaginitis
discharge: white and curdy, may be thi but typically thick, not as profuse, not malodours
candidal vaginitis
discharge: gray or white, thin, homogenous, malodorous, coasts the vaginal walls, usually not profuse, may be minimal
+fishy odor
BV
describe a cyst vs a tumor
cyst–smooth and compressible
tumor–solid and nodular
size of a small cyst is under?
6 cm diameter
RF for ectopic preg
tubal damage from PID hx prior tubal surgery >35 YO IUD subfertility assisted reproductive techniques
adnexal, cervical and uterine compression tenderness hallmark of?
PID
anal fissures are seen in?
CD
procitits
swollen, thickened fissured perianal skin with excoriations?
Pruritus ani
tender purulent reddened mass with fever or chills suggests?
anal abscess
induration caused by?
inflammation
scarring
malignancy
cyst located in the midline superficial to the coccyx or the lower sacrum
-see an opening of a sinus tract (sometimes with a small tuft of hair surrounded by a halo or erythema)
Pilonidal cyst
external or internal hemorrhoids are below the pectinate line
External
external or internal hemorrhoids are above the pectinate line
internal
painful oval ulceration of the anal canal MC in the midline posteriorly
anal fissue
what is an ano-rectal fistual
inflammatory tract or tube that opens at one end into the anus or rectum and at the other end onto the skin surface or into another viscus
sessile vs pedunculated polyps
sessile–lie on mucosal surface
pedunc–stalk
prostate gland feels: tender, swollen, boggy and warm
acute bacterial prostatitis
spontaneous unilateral bloody discharge from one or two breast ducts
intraductal papilloma
ductal carcinoma in situa
paget disease
clear serour green black or nonbloody discharges all sugest?
BENING findings
causes for nonpurerperal galactorhhea
hyperT
pituitary prolactinoma
dopamine antagonists (psychotropics and phenothiazines)
