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Physical Assessment 2 > GI: Female + Male GU > Flashcards

GI: Female + Male GU Flashcards

1
Q

the axillary tail of breast tissue extends into which fold?

A

anterior axillary fold

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2
Q

most vessels from breast drain into which lymph node

A

axillary LN

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3
Q

which LNs are most likely to be palpable

A

central nodes

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4
Q

which nodes drain into central nodes? (3)

A

pectoral
subscapular
lateral nodes

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5
Q

Mastalgia

MC presenting sympt for?

A

breast pain

MC presenting symp for BCA

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6
Q

Galactorrhea

*what increases the risk of it being pathogenic?

A

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

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7
Q

what four positions do you need to inspect female PT

A

arms at sides
arms over head
arms on hips
leaning forward

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8
Q

how do you determine the origin of nipple discharge

what to note with discharge

A

compressing areola with index finger

  • color
  • consistency
  • quanity
  • exact location
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9
Q

what is better, a painful or painless nodule>

A

Painful

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10
Q

Peau d’orange

  • describe it
  • cause?
  • sign of?
A 
SIGNS OF BCA 
skin color
thickening 
prominent pores 
cased by edema of skin produced by lympahtic blockage
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11
Q

peau d’orange
skin dimpling, flattening, changes in contour
nippel inverrsion
paget disease of nipple

A

signs of BCA

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12
Q

smooth, rubbery, round, mobile, nontender, describes what kind of mass

A

fibroadenoma

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13
Q

usually soft to firm, round, mobile, often tender

A

cysts

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14
Q

nodular, ropelike

A

fibrocystic changes

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15
Q

irregular, firm, may be mobile or fixed to surrounding tissue

A

CA until proven otherwise

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16
Q

preferable to do axilla exam with the patient in what position

A

sitting (not supine)

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17
Q

enlarged nodes can be from?

A
  • immunizations

- infection

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18
Q

nodes >1 cm
+firm or hard
+matted together or fixed (immobile)
suggests?>

A

malignancy

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19
Q

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?

A

possible BCA

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20
Q

describe how inguinal hernias can form

A

when loops of bowel force their way through weak areas of the inguinal canal

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21
Q

locations for hernias

A

inguinal

femoral

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22
Q

yellow penile discharge ?

A

GC***/ chlamydia

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23
Q

swelling in groin may indicate ?

A

mumps orchitis
scrotal edema
testicular CA

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24
Q

testicular painless nodule

A

consider testicular CA

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25
Q

age group testicular CA is MC diagnosed in

A

20-34YO

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26
Q

you can feel the hernia touch fingertip after asking PT to cough— direct or indirect?

A

indirect hernia

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27
Q

hernia bulges anteriorly and pushes the side of finger forward after PT coughs–indirect or direct

A

direct

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28
Q

which is MC? Indirect or direct

A

Indirect

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29
Q

who is most likely to get femoral hernias?

A

women

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30
Q

hernia is below the inguinal ligament, appears more lateral

  • can be hard to differentiate from lymph nodes
  • *what kind of hernia?
A

Femoral hernia

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31
Q

do femoral hernias go into the scrotum?

A

no

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32
Q

above inguinal ligament, close to the pubic tubercle (near the external inguinal ring)
*what hernia is this

A

direct

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33
Q

do direct hernias go into the scrotum?

A

rarely

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34
Q

hernia is above inguinal ligament, near its midpoint (the internal inguinal ring) *what kind of hernia

A

indirect

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35
Q

Does indirect hernia go into the scrotum

A

often

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36
Q

phimosis

A

inability to retract the foreskin

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37
Q

paraphimosis

A

tight prepuce that once retracted.. but cannot be returned

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38
Q

which is worse: phimosis or paraphimosis?

A

paraphimosis–

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39
Q

single red PAINLESS ulcer/ chancre

A

syphillus

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40
Q

HPV genital warts also called

A

condyloma acuminata

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41
Q

veins of spermatic cord are twisted

“bag of worms”

A

varicocele

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42
Q

non-tender fluid filled mass under scrotum

A

hydrocele

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43
Q

can the fingers palpate above the mass for a hydrocele?

A

YES

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44
Q

can the fingers palpate above the mass for a scrotal hernia?

A

no

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45
Q

what is epididymitis

MCC for kids and MCC adults

A

inflammation of epididymis
MMC Kids: N. gonorrhea & C. trachomatis
MMC Adults: E. coli and pseudomonas

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46
Q

testicular torsion

  • MC PT population?
  • define
A

younger
Life threatening and sudden onset
testicle twists around on its spermatic cord, obstructs blood flow to kidney***

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47
Q

TOC for testicular torsion

A

US

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48
Q

ABSENT cremasteric reflex indicates?

A

testicular torsion

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49
Q

“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.”

A

normal exam findings

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50
Q

“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.”

A

suspicious of testicular CA

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51
Q

define adnexa

A

ovaries and fallopian tubes

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52
Q

normal range for cycle

A

24-32 days

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53
Q

normal range for menses

A

3-7 days

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54
Q

what do we want to r/o if PT has postmenopausal bleeding

A

want to be concerned about endometrial CA

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55
Q

amenorrhea

A

absence of menses

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56
Q

dysmenorrhea

A

pain with menses–often with bearing down, aching or cramping sensation at the lower abdomen or pelvis

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57
Q

polymenorrhea

A

menstrual cycle that is shorter than 21 days

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58
Q

menorrhagia

A

heavy or prolonged menstrual bleeding

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59
Q

metrorrhagia

A

bleeding b/w periods

abnormal bleeding

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60
Q

causes of secondary dysmenorrhea

A 
endometriosis 
adenomyosis (endometriosis in muscular layer of uterus) 
PID 
endometrial polyps
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61
Q

secondary causes of amenorrhea

A 
pregnancy 
lactation 
menopause 
low body wt 
hypothalamic-pituitary-ovarian-dsyfunction
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62
Q

post coital bleeding suggests

A

cervical polyps
CA
or in older women: atrophic vaginitis

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63
Q

Para?

break down the specifics

A 
outcome of pregnancies 
F P A L 
*full term 
*premature 
*abortion (spontaneous or therapeutic) 
*Living Child
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64
Q

Gravida?

A

total number of pregnancies

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65
Q

woman has two living children and only two pregnanies.. write the G/P

A

G2 P2002

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66
Q

define dyspareunia

A

discomfort during intercourse

*can be a sign of sexual dysfunction

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67
Q

list the vulvovaginal symptoms

A

vaginal discharge

dysuria

68
Q

list the proper sequence for a pelvic exam

A
  1. examine external genitalia
  2. perform speculum exam
  3. perform bimanual exam
  4. perform rectovaginal exam (if indicated)
69
Q

describe the Pedersen speculum

A

smaller and more narrow

70
Q

what is the bimanual exam?

A

index and middle finger inserted into vagina

*thumb is abducted and ring and little ringer flexed into palm

71
Q

Cervical motion tenderness

suggests?

A

pain with moving the cervix

suggests PID

72
Q

list two things that make lesions on the vulva

A

HPV

Herpes

73
Q

name three DZs causing vaginal discharge

A

yeast infection
BV
Trichomonas

74
Q

list three different bulges and swellings of the vulva/vagina/urethra

A

Cystocele (bladder protruding out….cysto- means bladdr)
Rectocele
Bartholin (labial swelling)

75
Q

yellow drainage from cervical OS can suggest?

-can lead to?

A 
GC Chlamydia (cervicitis) 
can lead to PID
76
Q

when is carcinoma of the cervix usually visible?

A

later stages of dz

77
Q

list some abornamlities of the uterus

A

prolapse
bleeding
myomas (fibroids)
endometrial CA

78
Q

list some Adnexa issues

A

Ovarian cysts
Ovarian CA
Ruptured tubal pregnancy (ectopic pregnancy)
PID

79
Q

Ectoptic Pregnancy

MC occur where?

A

90% occur in fallopian tube
may not be able to feel adnexal mass
LIFE THREATENING IF RUPTURE

80
Q

PID

MC cause?

A

85% caused by STD

+CMT

81
Q

what is the MCC of acute pelvic pain
2nd mC?
3rd mc?

A

1st: PID
2: ruptured ovarian cyst
3. appendicitis

82
Q

which is the MC CA in US?

A

prostate

83
Q

1 in ___ men will be diagnosed with prostate CA

A

1 in 8

84
Q

RF for prostate CA

A
  1. Age: rises rapidly >50
  2. Race/ethnicity: MC in AA men
  3. FAm hx
  4. gene changes: inherited mutations of BRCA 1 BRCA 2
  5. diet
  6. chemical exposures (firefighters have incr risk)
  7. prostatitis (inflammation of PG)
85
Q

information about screening tests for prostate CA

A

not very accurate

grade D rating

86
Q

who should NOT get screened for prostate CA

A

asymptomatic men regardless of age, race or fam hx

harms of screening outweigh benefits

87
Q

CONS to prostate screening

A
  1. high rate of false positive
  2. over diagnosis and over tx
  3. tx complications–ED and incontinence
    4.
88
Q

what does USPSTF say about men 70YO + about prostate CA screening

A

against the PSA-based screening

89
Q

what is the PSA screening test

A

prostate specific antigen test

90
Q

PSA

A

antigen produced naturally by prostate cells

91
Q

if PT agrees, how often is PSA screening done

A

every 1-2 years

92
Q

when should providers stop offering PSA screening

A

when PT reaches 70 YO
OR
whenever their life expectancy drops below 10

93
Q

is there a PSA level that garuntees a PT has or does not have prostate CA?

A

no… but higher than usual level is found can INDICATE prostate CA..

94
Q

what is the diagnostic gold standard for prostate screening

A

Prostate biopsy

95
Q

how can you lower risk of Prostate CA

A 
healthy weight 
physical activity 
healthy diet 
vit E 
ASA daily
96
Q

what is the 3rd most frequently diagnosed CA in both men and women

A

colorectcal CA

97
Q

what is the 3rd leading cause of death in US

A

colorectcal CA

98
Q

RFs for colorectal CA

A
  • increasing age
  • hx
  • adenomatous polyps
  • IBD
  • fam hx
  • male
  • AA
  • tobac use
  • read meat consumption
  • ETOH
  • obesity
99
Q

screening tests for Colorectcal CA (4)

A
  1. stool tests that detect occult fecal blood
  2. colonoscopy
  3. flexible sigmoidoscopy
  4. imaging tests–double contrast barium enema
100
Q

USPSTF guidelines for colorectcal CA screening:

  1. 50-70
  2. 76-85
  3. 85+
A
  1. high sensitivity FOBT annually, sigmoidoscopy every 5 years, colonoscopy every 10 years
  2. Screening not advised because benefits small in comparison to risks
  3. do not screen
101
Q

what does primary dysmenorrhea resut from

A

increased prostaglandin prod during the luteal phase of the menstrual cycle—when estrogen and progesterone levels decline

102
Q

how many days does it take to call it Polymenorrhea

A

less than 21 day intervals b/w menses

103
Q

define oligomenorrhea

A

infrequent bleeding

104
Q

what age range does menopause usually occur

A

48-55 (median 51)

105
Q

cessation of menses for 12 months, progresing through several stages of erratic cyclical bleeding
+hot flashes
+flushing
+sweating

A

PERImenopause

106
Q

what three general symptoms are linked to menopause

A

sleeping issues
vaginal symps
vasomotor symps

107
Q

name three causes of postmenopasual bleeding

A

endometrial CA
hormone replacement tx
uterine and cervical polyps

108
Q

amenorrhea followed by heavy bleeding suggests?

A

abortion
or
dysfunctional uterine bleeding related to lack of ovulation

109
Q

superficial vaginal pain may suggest?

A

local inflammation
atrophic vainitis
inadequarte lubrication

110
Q

deeper vaingal pain may suggest?

A

pelvic disorders

pressure on a normal ovary

111
Q

vainismus

A

invol spasm of muscles surrounding the vaginal orifice that makes penetration during intercourse painful r impossible

112
Q

what are two red flags for PID

A

recent IUD insertion

STIs

113
Q

mild unilateral pain lasting for a few hours to a few days arising at midcycle

  • what is this called
  • what can cause it
A

Mittelschmerz “ovulation pain”

  • ruptured ovarian cyst
  • tubo-ovarian abscess
  • ovulation
114
Q

chronic pelvic pain is a red flag for?

A

sexual abuse

115
Q

what is another cause of chronic pelvic pain

A

pelvic floor spasms from myofasicla pain

116
Q

at what age to start screening for cervical CA

A

21

117
Q

when to start vaccinating HPV

A

11-12
or
beofre their first sexual encounter
can start as early as 9

118
Q

what are the strains of HPV that the vaccine cover

*which causes genital warts

A

6 and 11—- cause 90% of gential warts

16 and 18

119
Q

do condoms eliminate the risk of cervical HPV?

A

no

120
Q

chlamydial infection is a cause of ?

A 
urethritis 
cervicitis 
PID 
ectopic pregnancy 
infertility 
chronic pelvic pain
121
Q

RFs for chlyamida

A

<26
multiple partners
prior hx of STIs

122
Q

in liquid based cytology, what can be filtered out

A

blood cells

123
Q

what can delay menarche

A

an imperforate hymen

124
Q

delayed puberty is often ?

A

familial or related to chronic illness or reflect disorders of hypothalamus, AP gland or ovaries

125
Q

excoriation or itchy small red maculopapules suggest?

A

pediculosis pubis –found at the base of pubic hairs

126
Q

enlarged clitoris is seen with?

A

masculinizing endocrine disorders

127
Q

lateral displacement of the cervix is seen with?

A

endometriosis

128
Q

RFs for vaginal CA

A

diethylstilbestrol (DES) exposure in utero

HPV infection

129
Q

stool in the rectum may simulate a?

A

rectovaginal mass– but the stool can be dented by digital pressure

130
Q

uterine enlargement suggests?

A

preg
uterine myomas
malignancy

131
Q

how many years after menopause do the ovaries become atrophic

A

3-5

132
Q

is it a good or bad sign to palpate an ovary in a postmenopausal woman

A

not good– they should not be palpable since they atrophy post menop

133
Q

common findings for ovarian CA

A

pelvic pain
bloating
incr abdominal sie
UT s/s

134
Q

MC type of hernias in women

A

indirect

135
Q

vaginal mucosa and cervix coated with thin white homogenoous discahrge with fishy odor

A

BV

136
Q

bulge of upper two thirds of the anterior vaginal wall, together with the bladder above it
-what is it

A

cystocele

137
Q

small red benign tumor visible at the posterior urethral meatus
MC in postmenop women and usually causes no symps

A

Urethral caruncle

138
Q

labial swelling— feels tense, hot, very tender abscess

+/- pus emerging from the duct or erythema around the duct opening

A

Bartholin gland infection

139
Q

swollen red ring around the urethral meatus

A

prolapsed ureathal mucosa

140
Q

entire anterior vaginal wall together with the bladder and urerthra produces a bulge

A

cystourethrocele

141
Q

white-yellowish in color… small firm round cystic nodule in the labia suggests?
+dark punctum marking the blocked opening

A

epidermoid cyst

142
Q

warty lesions on the labia and within the vestibule

A

condyloma acuminata from HPV

143
Q

painless ulcer

A

syphilis

144
Q

large raise round or oval flat topped gray or white lesions
and
rash and mucous membrane sores in the mouth, vagina or anus

A

condylomata lata

145
Q

shallow ulcers on red base

A

herpes

146
Q

ulcerated or raised red vulvar lesion

A

vulvar carcinoma

147
Q

discharge: yellowish green or gray possibly frothy, often profuse and pooled in the vaginal fonix–may be malodorous
+pruritis
+pain on urination

A

trichomonal vaginitis

148
Q

discharge: white and curdy, may be thi but typically thick, not as profuse, not malodours

A

candidal vaginitis

149
Q

discharge: gray or white, thin, homogenous, malodorous, coasts the vaginal walls, usually not profuse, may be minimal
+fishy odor

A

BV

150
Q

describe a cyst vs a tumor

A

cyst–smooth and compressible

tumor–solid and nodular

151
Q

size of a small cyst is under?

A

6 cm diameter

152
Q

RF for ectopic preg

A 
tubal damage from PID 
hx 
prior tubal surgery 
>35 YO 
IUD 
subfertility 
assisted reproductive techniques
153
Q

adnexal, cervical and uterine compression tenderness hallmark of?

A

PID

154
Q

anal fissures are seen in?

A

CD

procitits

155
Q

swollen, thickened fissured perianal skin with excoriations?

A

Pruritus ani

156
Q

tender purulent reddened mass with fever or chills suggests?

A

anal abscess

157
Q

induration caused by?

A

inflammation
scarring
malignancy

158
Q

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)

A

Pilonidal cyst

159
Q

external or internal hemorrhoids are below the pectinate line

A

External

160
Q

external or internal hemorrhoids are above the pectinate line

A

internal

161
Q

painful oval ulceration of the anal canal MC in the midline posteriorly

A

anal fissue

162
Q

what is an ano-rectal fistual

A

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

163
Q

sessile vs pedunculated polyps

A

sessile–lie on mucosal surface

pedunc–stalk

164
Q

prostate gland feels: tender, swollen, boggy and warm

A

acute bacterial prostatitis

165
Q

spontaneous unilateral bloody discharge from one or two breast ducts

A

intraductal papilloma
ductal carcinoma in situa
paget disease

166
Q 
clear
serour 
green 
black 
or nonbloody 
discharges all sugest?
A

BENING findings

167
Q

causes for nonpurerperal galactorhhea

A

hyperT
pituitary prolactinoma
dopamine antagonists (psychotropics and phenothiazines)

Physical Assessment 2 (6 decks)

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