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Physical Diagnosis I > GU (Female AND Male) > Flashcards

GU (Female AND Male) Flashcards

1
Q

Which segment of the breast is most common for breast CA?

A

Upper outer quadrant is most common for breast CA

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2
Q

What four characteristics of a lump/mass are more concerning for breast CA?

A
  • Irregular
  • Fixed
  • Hard
  • Non-tender
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3
Q

What four motions will you have a patient perform while inspecting the breasts?

A
  • Arms overhead with palms together
  • Hands on hips and press down
  • Shrug shoulders
  • Lean forward
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4
Q

What four skin changes of the breast should be evaluated for?

A
  • Dimpling
  • P’eau d’orange
  • Nipple inversion
  • Supernumerary nipple/extra nipple
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5
Q

What is p’eau d’orange?

A

Thickened, red/dusky skin concerning for inflammatory BCA

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6
Q

What presentation of nipple inversion is more concerning for breast CA?

A

Recent onset of inversion that is unilateral = concerning for malignancy

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7
Q

What type of nipple discharge is more concerning?

A

Bloody or serous, only 1 duct

- Light milky is normal

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8
Q

How do you perform an axillary nodes examination on a female? 4 steps

A
  • 1st hand sweep: anterior axillary region, including Pectoralis muscle
  • 2nd hand sweep: mid-axillary HIGH into apex
  • 3rd hand sweep: posterior axillary region beneath Teres Minor muscle
  • 4th hand sweep: down medial aspect of upper arm
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9
Q

What are the six steps for the female external pelvic examination?

A
  1. Palpate inguinal nodes
  2. Inspect pubic region
  3. Inspect clitoris, urethral meatus – use one finger of each hand to lift up/out on clitoral hood)
  4. Inspect labial folds by separating labia minor and labia majora
  5. Inspect introitus (entrance into vaginal canal); look for atrophy
  6. Inspect perineum – using back of hands, lift up/out to spread cheeks of buttocks
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10
Q

What are two normal presentations of a cervix?

A

Parous and nonparous

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11
Q

What does a parous cervix look like?

A

External os is smooth, circular

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12
Q

What does a nonparous cervix look like? What does this indicate?

A

External os is large, transverse (indicates history of vaginal delivery)

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13
Q

When using the Spatula/Cytobrush cervical sampling device, what is the protocol for inserting/rotating each part (spatula, brush)?

A
  1. Insert spatula into cervical os and rotate 360 degrees

2. Insert endocervical brush (Cytobrush) into cervical os and rotate ½ turn in one direction

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14
Q

When using the Broom cervical sampling device, what is the protocol for inserting/rotating the broom?

A

Insert central bristles into endocervical canal with shorter bristles contacting ectocervix, and rotate clockwise 5 times

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15
Q

For both the Spatula/Cytobrush cervical sampling device and Broom cervical sampling device, how many times should the device by swirled in solution before discarding?

A

Swirl in solution at least 10 times

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16
Q

What are three advantages to using the ThinPrep and SurePath pap smears?

A
  • Decreased artifact/ unwanted blood or mucous
  • Increased disease detection
  • Can test for HPV, STIs simultaneously
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17
Q

What is very important to remember when performing the bimanual exam on a female?

A

TUCK THE THUMB!

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18
Q

What are the four different types of uterus positions? Which is most common?

A
  • Anteverted (most common): tilted forward slightly
  • Anteflexed: flexed/tilted forward
  • Retroverted: tilted backward slightly
  • Retroflexed: flexed/tilted backward
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19
Q

Which two uterine positions would warrant a rectovaginal examination?

A
  • Retroverted

- Retroflexed

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20
Q

Where are the Bartholin’s glands located and why would you check them (specialized test)?

A

Bartholin’s glands are at the 5 and 7 o’clock positions of the introitus (entrance to vaginal canal)
- Check for cyst or abscess

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21
Q

Why might you perform Milk the Urethra (specialized exam)?

A

Complaints of discharge

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22
Q

What two characteristics of a lymph node might indicate cancer?

A

Hard or immobile nodes suggest cancer

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23
Q

What three structures are you checking for when examining the scrotal contents?

A

Testes, epididymis, spermatic cord

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24
Q

What should a normal testicle feel like on palpation?

A

Regular-shaped eraser, or hard-boiled egg-like

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25
Q

After performing the testicular exam, what should you recommend to your patient?

A

Advise monthly exam during/after shower (testicular CA has highest incidence in 15-35 years)

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26
Q

What should a normal epididymis feel like on palpation? Where are these located?

A

“Wad of noodles”

- Located superiorly and posterolateral on testicle

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27
Q

What should a normal spermatic cord feel like on palpation?

A

“Inside of a BIC pen”

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28
Q

What STI is caused by HPV?

A

Condyloma acuminata

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29
Q

What is the most common STI worldwide?

A

Condyloma acuminata

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30
Q

What STI is caused by HSV type 2?

A

Genital herpes

31
Q

What condition begins as painful vesicles on an erythematous base → vesicles ulcerate?

A

Genital herpes

32
Q

What STI involves painless papules that erode into painless ulcers? What is the primary concern with these ulcers?

A

Syphilitic chancre

- Ulcers can become infected

33
Q

What is the typical course/treatment of syphilitic chancre?

A

Self-limiting within 4-8 weeks

34
Q

What are the two possible etiologies of urethritis?

A
  • Gonococcal (N. gonorrhoeae)

- Non-gonococcal (Chlamydia, Trachomatis)

35
Q

What condition involves fibrosis of fibrous layer surrounding corpora cavernosa?

A

Peyronie’s Disease: idiopathic condition

36
Q

What are the symptoms for Peyronie’s Disease? What may be palpable on exam?

A

Symptoms: penile curvature, painful erections, ED

- On exam, firm plaques palpable

37
Q

What two characteristics are most common with penis carcinoma?

A

More common in uncircumcised males, and age 50 years

38
Q

What type of hernia goes into inguinal canal and into scrotum? Is this more or less common? Which population and age group is this most seen?

A

Indirect inguinal

  • Most common
  • Occurs in all ages, both sexes
39
Q

What type of hernia goes through abdominal wall and rarely into scrotum? Is this more or less common? Which population and age group is this most seen?

A

Direct inguinal

  • Less common than indirect
  • Occurs more in males age 40+
40
Q

What type of hernia goes inferolateral to inguinal ligament and never into scrotum? Which population is this most seen?

A

Femoral

  • Least common
  • Occurs more in females
41
Q

What condition feels like a “a bag of worms” on exam?

A

Varicocele

42
Q

What condition involves varicose veins of scrotal vessels that develop slowly? What is this condition associated with?

A

Varicocele

- Associated with infertility

43
Q

What condition involves soft, painless hemi-scrotal swelling?

A

Hydrocele

44
Q

Which two scrotal conditions exhibit transillumination on exam?

A
  • Hydrocele

- Spermatocele/Epididymal Cyst

45
Q

What condition involves painless, mobile mass just above testes?

A

Spermatocele/Epididymal Cyst

46
Q

Is a Hydrocele or Spermatocele/Epididymal Cyst larger?

A

Hydrocele

47
Q

What condition involves acute onset unilateral dull-severe scrotal pain radiating to flank?

A

Acute Epididymitis

48
Q

What condition involves hemi-scrotal swelling → fluctuant mass; with fever and chills?

A

Acute Epididymitis

49
Q

What condition will exhibit a positive Prehn’s sign on exam? What is this exam?

A

Acute Epididymitis

- Positive if elevation of scrotum provides relief

50
Q

What condition involves inflammation/infection of testis? What condition does this sometimes present similar to?

A

Acute Orchitis

- Presents similarly to Acute Epididymitis

51
Q

What is Acute Orchitis a complication of?

A

Complication of epididymitis and Mumps

52
Q

What scrotal/testicular condition is considered an emergency? What population is this most common in?

A

Testicular Torsion

- Most common in neonates and adolescent

53
Q

What condition presents with acute onset unilateral severe scrotal pain with hemi-scrotal swelling?

A

Testicular Torsion

54
Q

How can you differentiate between Acute Epididymitis and Testicular Torsion on exam?

A

Testicular Torsion will not have a positive Prehn’s sign (no relief with elevation of scrotum)

55
Q

What reflex will be absent with Testicular Torsion?

A

Absent cremasteric reflex

56
Q

What is the Bell-Clapper deformity and what condition is it associated with?

A

Bell-Clapper deformity: testicles fall forward to lie horizontally rather than vertical
- Associated with Testicular Torsion

57
Q

What is often the cause or onset of Testicular Torsion?

A

Often occurs hours after vigorous physical activity/trauma

58
Q

What condition involves painless, solid swelling or nodule with inguinal LAD?

A

Testicular Tumors

59
Q

What three other systems should be considered with Testicular Tumors?

A
  • Abdominal
  • Pulmonary
  • Neurologic
60
Q

What anal/rectal condition can cause bright red bleeding with defecation?

A

Internal Hemorrhoids

61
Q

What anal/rectal condition involves tender, swollen, fluid mass at anal margin?

A

External Hemorrhoids

62
Q

What condition involves severe pain with defecation/scant bleeding?

A

Anal Fissure

63
Q

What condition involves an infected anal crypt gland?

A

Anorectal Abscess

64
Q

What condition involves severe pain of anal/rectal area; fever, malaise?

A

Anorectal Abscess

65
Q

What is a complication of an Anorectal Abscess, and why is this concerning?

A

Anorectal fistula

- Possible spread of infection

66
Q

What diagnostic step is recommended for Rectal Polyps?

A

Biopsy to rule out malignancy/colon CA

67
Q

What anal/rectal condition involves firm, nodular, rolled edge?

A

Rectal Carcinoma

68
Q

What condition involves enlarged, tender prostate gland? What other symptoms may be present?

A

Acute Prostatitis

- Associated UTI symptoms (fever, chills)

69
Q

How should Acute Prostatitis be treated?

A

Antibiotics

70
Q

What condition presents with presents with recurrent UTIs?

A

Chronic Prostatitis

71
Q

How should Chronic Prostatitis be treated?

A

Antibiotics for longer

72
Q

What symptoms occur with Benign Prostatic Hypertrophy (BPH)? What will be felt on exam?

A

Slowed urine stream with difficulty starting stream

- On exam, symmetrical gland enlargement

73
Q

What condition involves slow-growing tumor with irregular contour and obscured median sulcus?

A

Prostate Carcinoma

Physical Diagnosis I (4 decks)

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