HAP 4 Flashcards
When can an “innocent murmur” be auscultated?
up to age 25
What is a normal jugular vein finding?
see-saw pulse
How do women present with an MI?
indigestion
How do diabetics present with an MI?
nausea and vomiting
What would cause rust/brown colored cough secretions?
TB
What would cause green-colored cough secretions?
bacterial infection
What would cause white/yellow colored cough secretions?
viral infection
BP _______ during pregnancy and CO ________.
BP decreases
CO increases by 30-40%
Increased BP during pregnancy is an abnormal sign related to ________.
preeclampsia - HR will increase as well and apical pulse will be higher and more lateral
Normal HR for babies is between ______
100-180
When kids have a heart rate under _____, we start compressions.
100bpm
What are signs of heart failure in babies?
poor weight gain
resting tachycardia
clubbing
CHF skin:
gray/cyanotic, cold, moist
CHF lungs:
dyspnea, orthopnea, wheezes/crackles
CHF pupils:
dilated
CHF blood pressure:
decreased
CHF patient demeanor
anxious, confused, fatigued
CHF GI:
ascites, N/V
CHF O2 Sat:
falling
Which abnormal heart sound does CHF present with?
S3
CHF spleen and liver:
enlarged
CHF urine output:
decreased
CHF leg presentation:
pitting edema
When do bone epiphyses close?
20
What are broken bones in a child indicative of?
abuse - children’s bones are very strong and not easily broken
When is scoliosis often diagnosed?
early in life
Pregnant women can develop which spinal irregularity?
lordosis
AND kyphosis
AND cervical flexion
AND waddling gait
Aging adults can develop which spinal irregularity?
kyphosis
Describe how we grade muscles:
0 - no muscle contraction 1 - slight muscle contraction 2 - full PROM 3 - full AROM against gravity 4 - full AROM against SOME resistance 5 - full AROM against FULL resistance (NORMAL)
From which joint do supination and pronation movement come from?
the elbow
Phalen’s test is for _______ and is done for how long?
carpal tunnel
1 minute
Tinel’s Sign is for _______
carpel tunnel
The bulge sign is for which joint?
knee
What is Lasegue’s Test for?
herniated disks - also called the straight leg raise test
What is Ortolani’s maneuver?
it checks for congenital hip dislocation in infants
What is Allis test?
it checks for hip dislocation
What is commonly dislocated in an infant during birth?
clavicle
What irregular spinal condition is normal in children?
lordosis with a pot belly
What irregular spinal condition is normal in adolescents
kyphosis due to poor posture
What test is done during adolescence to screen for scoliosis?
forward bend test
What is the Get Up and Go Test?
a test for aging adults where they get up from a chair, walk ten feet, walk back and sit down in ten seconds or less
Is rheumatoid arthritis or osteoarthritis inflammatory?
RHEUMATOID is INFLAMMATORY
Does rheumatoid arthritis or osteoarthritis feel better with joint movement throughout the day?
Rheumatoid
Does rheumatoid arthritis or osteoarthritis present with Heberden’s nodes and Bouchard’s nodes?
Osteoarthritis
Does rheumatoid arthritis or osteoarthritis cause ulnar deviation?
Rheumatoid
Does rheumatoid arthritis or osteoarthritis present with a fever?
Rheumatoid
Does rheumatoid arthritis or osteoarthritis feel worse with repetitive movement?
Osteoarthritis feels worse with repetitive movement
Symptoms from which arthritis hit the weight-bearing joints?
Osteoarthritis
Does rheumatoid arthritis or osteoarthritis present with degenerative changes?
Osteoarthritis
Where do Heberden’s nodes present?
Bouchard’s?
H - distal
B - proximal
What is the hallmark sign of Gout?
extreme big toe pain
What is a Tophi and when would you see one?
Tophi - round, pea-like deposits of URIC ACID in ear cartilage seen in GOUT
Where are the Montgomery glands located?
the areola
Where are the majority of breast masses found?
the tail of Spence
Where does 25% of lymphatic fluid go?
to the ipsilateral side
Lactation begins _____ days post-partum
1-3
What is witch’s milk?
a normal finding in infants - enlarged breasts that secrete witch’s milk due to estrogen crossing the placenta
Breast development usually begins between the ages of
8-10 (~2years before the onset of menses)
When should we start teaching a breast self-exam?
adolescence
What pattern is best to use to detect for breast cancer?
the vertical strip pattern
When should breast cancer screening begin?
annually beginning at age 45 at the latest
Who is at the highest risk of breast cancer?
those who have a 1st generation link (mother, sister, daughter)
What is retraction?
both breasts should move when the arms lift
Rank the 3 types of cancer for this exam in order of severity and give the age groups.
- cancer (30-80, up after 50)
- benign breast disease (30-55, down after menopause)
- fibroadenoma (15-30)
Which of the 3 types of cancer is irregular/ star-shaped?
cancer
What is the consistency of fibroadenoma?
firm/rubbery
What is the consistency of benign breast disease?
firm/rubbery
What is the consistency of cancer?
firm to stony hard
Which cancer has poorly defined margins?
cancer
Which of the three cancers usually appears in multiple places?
benign breast disease
Which cancer is fixed?
cancer
Which cancer is tender?
benign breast disease
Which cancer presents with retraction?
cancer
Which cancer grows cyclically?
benign breast disease
What are the 12 signs of breast cancer?
Growing vein Red and hot Invisible lump New fluid Dimpling
Pinching
Asymmetry
Nipple retraction
Hardening
Orange skin
Puckering
Erosion
Wet dreams are normal until what age?
12-13
Puberty manifests in what order for males?
1st testes enlargement
2nd hair
3rd penis size
Puberty manifests in what order for females?
1st breast enlargement
2nd pubic hair
3rd ovaries move into the pelvic cavity
4th period begins
Do female hormones decrease rapidly or gradually at menopause?
rapidly
To palpate for a hernia in males, we use what approach?
NAVEL
Nerve Artery Vein Empty space Lymph nodes
How should we teach Testicular Self Exam?
TSE
Timing - once a month
Shower - warm water relaxes the scrotum
Examine - check for and report changes immediately
What is Hypospadias?
opening of the urethra is on the underside of the penis instead of the tip
(hypo = less = under)
Whatis Epispadias?
opening of the urethra is on top of the penis instead of the tip
(Epi = uppy)
What is Priapism?
prolonged erection
What is Phimosis?
the foreskin of the penis can not be retracted
What is Paraphimosis?
the retracted foreskin of an uncircumcised male can not be returned back to its anatomical position
MEDICAL EMERGENCY
Which penis abnormality is a medical emergency?
paraphimosis
Where are the Skene and Bartholin glands located?
vagina
A PAP smear screens for which cancer?
cervical cancer
NOT for endometrial or ovarian
When should you NOT obtain a PAP smear?
during a woman’s period/heavy discharge
The cervical exam is ______
bimanual
The cervical opening should be either _____ or _____.
nulliparous - little hole
parous - little slit (after childbirth)
What are nabothian cysts?
benign growths that commonly appear on the cervix after childbirth
small, yellow retention cysts caused by cervical gland obstruction
How big is a normal cervix?
2.5 cm or 1 inch
Penile carcinoma presents as
warty growth with watery discharge
painless
on glans/inner lip of foreskin
STIs involving C. trachomatosa and gonorrhea often lead to ______
epididymitis
Testicular torsion is a surgical emergency whose hallmark sign is ________
sudden onset of severe pain and scrotal swelling
Chlamydia presents as
minimal or no S&S
yellow/green discharge
Left untreated, chlamydia can lead to:
PID
Gonorrhea presents as
minimal or no S&S
may have purulent discharge
Left untreated, gonorrhea can lead to:
PID
Syphilis often begins as
a small silvery papule that resolves spontaneously
secondary symptoms present as fever, rash, sore throat
Trichomoniasis presents as
malodorous discharge that worsens with period
the vagina has a strawberry appearance
Men have no S&S
Herpes presents as
pain, fever, and clusters of small blisters
infection lasts 7-10 days
virus remains dormant indefinitely
What is the most common STI?
HPV
How does HPV present subjectively?
painless warty growths that may go unnoticed
How does HPV present objectively?
cauliflower-like papules/patches
What is endometriosis?
benign growth of uterine tissue outside the uterus
causes pain and weird periods
What are ovarian cysts?
benign cysts in the ovaries that are asymptomatic
What causes cervical cancer?
HPV
What is the most common sign of cervical cancer?
abnormal bleeding between periods
What is the most common gynecological cancer?
endometrial cancer
Who usually gets endometrial cancer?
postmenopausal women, especially those taking estrogen
What is the hallmark sign of endometrial cancer?
abnormal bleeding, sometimes with watery discharge
Which gynecological cancer has the highest mortality rate?
ovarian cancer
What is the most common sign of ovarian cancer?
a feeling of fullness
by the time we can feel it, it’s usually too late
Describe 1st, 2nd, and 3rd-degree uterine prolapse
1st - prolapsed cervix remains in vagina
2nd - prolapsed cervix is introitus (at the vaginal opening)
3rd - cervix AND vagina drop outside introitus
The HPV vaccine covers what three conditions?
cervical cancer, anal cancer, and genital warts
What are the presumptive signs of pregnancy?
amenorrhea, breast tenderness, fatigue and increased urinary frequency
Who assesses the probable signs of pregnancy?
an examiner
What are two tests to determine positive pregnancy?
FHTs and cardiac activity on the ultrasound
When can a mother feel fetal movement?
between 18-20 weeks
called “quickening”
