Health Assessment Exam 2 Flashcards
What are the organ systems contained within the Right Upper Quadrant (RUQ) of the abdomen?
Digestive System:
* Liver (right lobe)
* Gallbladder
* Duodenum
* Head of pancreas
* Hepatic flexure of the colon
* Ascending colon (part)
* Transverse colon (part)
Urinary System:
* Right kidney (upper pole)
* Right adrenal gland
What are the organ systems contained within the Left Upper Quadrant (LUQ) of the abdomen?
Digestive System:
* Stomach
* Spleen
* Left lobe of liver
* Body and tail of pancreas
* Splenic flexure of the colon
* Transverse colon (part)
* Descending colon (part)
Urinary System:
* Left kidney (upper pole)
* Left adrenal gland
What are the organ systems contained within the Right Lower Quadrant (RLQ) of the abdomen?
Digestive System:
* Cecum
* Appendix
* Ascending colon (part)
Urinary System:
* Right ureter
Reproductive System:
* Right ovary and fallopian tube (female)
* Right spermatic cord (male)
What are the organ systems contained within the Left Lower Quadrant (LLQ) of the abdomen?
Digestive System:
* Descending colon (part)
* Sigmoid colon
Urinary System:
* Left ureter
Reproductive System:
* Left ovary and fallopian tube (female)
* Left spermatic cord (male)
What are the key alarm symptoms (Red Box Findings) that require immediate medical attention?
General Abdominal Red Flags:
* Sudden onset severe pain
* Severe, persistent pain lasting >6 hours
* Unintentional weight loss
* GI bleeding (hematemesis, melena, or hematochezia)
* Recurrent vomiting
* Pain associated with mental status changes
* Cardiovascular compromise (hypotension, tachycardia)
* Rapid deterioration of patient condition
What is Murphy’s Sign and what does it indicate?
Murphy’s Sign: Pain upon palpation of the gallbladder
Indication: Suggestive of cholecystitis
What is McBurney’s Point Tenderness and what does it suggest?
McBurney’s Point Tenderness: Pain at McBurney’s point
Indication: Suggestive of appendicitis
What does a positive Blumberg Sign (Rebound Tenderness) indicate?
Indication: Suggests peritoneal irritation
What is the significance of Cullen’s Sign?
Cullen’s Sign: Periumbilical bruising
Indication: Suggestive of retroperitoneal hemorrhage or pancreatitis
What does Kehr’s Sign indicate?
Kehr’s Sign: Left shoulder pain when lying down
Indication: Suggestive of splenic rupture
What are common GI symptoms associated with abdominal pain?
Common GI Symptoms:
* Nausea and Vomiting
* Dysphagia
* Odynophagia
* Early Satiety
* Anorexia
* Unintentional Weight Loss
* Bloating
* Distension
* Heartburn
* Acid Reflux
* Diarrhea
* Constipation
* Hematochezia
* Melena
* Jaundice
* Abdominal Mass or Distension
What is the current recommendation for colorectal cancer screening for average-risk individuals?
Start screening at age 45 and continue until age 75 if life expectancy permits
What is the gold standard for colorectal cancer screening?
Colonoscopy every 10 years for those at average risk
What are the locations of hernias?
Common Hernia Locations:
* Inguinal Hernia (Direct and Indirect)
* Femoral Hernia
* Umbilical Hernia
* Epigastric Hernia
* Incisional Hernia
* Spigelian Hernia
* Obturator Hernia
* Hiatal Hernia
What are the red flag signs of impending incarcerated hernia?
Red Flag Signs:
* Pain and Tenderness
* Skin Changes Over the Hernia
* Nausea and Vomiting
* Abdominal Distension
* Fever and Tachycardia
* Irreducibility
* Absence of Bowel Sounds Over the Hernia
What is the Rovsing Sign?
Description: Pressure in the LLQ elicits pain in the RLQ
Indication: Suggestive of appendicitis due to referred pain
What is the Psoas Sign?
Description: Tests for irritation of the iliopsoas muscle
Indication: Suggests retrocecal appendicitis
What is the Obturator Sign?
Description: Evaluates irritation of the obturator internus muscle
Indication: Suggestive of pelvic appendicitis
What are the abdominal organs located in the Right Upper Quadrant (RUQ)?
Abdominal Organs in RUQ:
* Liver
* Gallbladder
* Duodenum
* Head of pancreas
* Right kidney
* Right adrenal gland
* Hepatic flexure of colon
* Ascending and part of transverse colon
What are the abdominal organs located in the Left Upper Quadrant (LUQ)?
Abdominal Organs in LUQ:
* Stomach
* Spleen
* Left lobe of liver
* Body and tail of pancreas
* Left kidney
* Left adrenal gland
* Splenic flexure of colon
* Part of transverse and descending colon
What are the abdominal organs located in the Right Lower Quadrant (RLQ)?
Abdominal Organs in RLQ:
* Cecum
* Appendix
* Right ovary and fallopian tube
* Right ureter
* Right spermatic cord
What are the abdominal organs located in the Left Lower Quadrant (LLQ)?
Abdominal Organs in LLQ:
* Part of descending colon
* Sigmoid colon
* Left ovary and fallopian tube
* Left ureter
* Left spermatic cord
What are the abdominal organs located in the Epigastric Region?
Abdominal Organs in Epigastric Region:
* Aorta
* Pancreas
* Liver
* Stomach
What are the abdominal organs located in the Umbilical Region?
Abdominal Organs in Umbilical Region:
* Small intestines
* Appendix
What are the abdominal organs located in the Suprapubic (Hypogastric) Region?
Abdominal Organs in Suprapubic Region:
* Uterus
* Bladder
* Aorta
What are the structures located in the left lower quadrant (LLQ)?
Left ovary and fallopian tube, left ureter, left spermatic cord, part of descending colon, sigmoid colon
These structures are important for understanding abdominal anatomy during assessments.
What is the function of the liver?
Metabolism, detoxification, bile production, storage of vitamins and glycogen
The liver plays a crucial role in various metabolic processes.
What are the normal bowel sounds heard during auscultation?
High-pitched, gurgling sounds 5–34 times per minute
Abnormal findings include hyperactive or hypoactive sounds.
What does rebound tenderness indicate?
Peritoneal irritation
This is assessed through the Blumberg Sign during an abdominal exam.
What are the alarming symptoms referred to as ‘Red Box Findings’?
Severe, sudden onset abdominal pain, progressive worsening pain, rebound tenderness, involuntary guarding, jaundice with weight loss, palpable abdominal mass, severe vomiting
These findings require immediate clinical attention.
What is the basic function of the gallbladder?
Stores and releases bile to aid in fat digestion
Bile is essential for the emulsification of fats in the digestive process.
Fill in the blank: During a clinical breast exam, palpation should be systematic, applying ____ Light Pressure, ____ Medium Pressure, and ____ Deep Pressure.
Light Pressure, Medium Pressure, Deep Pressure
This technique ensures thorough examination of breast tissue.
What is Murphy’s Sign indicative of?
Cholecystitis
It is characterized by pain on inspiration during RUQ palpation.
List the 4 strongest risk factors for breast cancer in women.
- Female Sex
- Increasing Age
- Personal or Family History of Breast Cancer
- BRACA1 or BRACA2 Gene Mutations
These factors significantly increase the likelihood of developing breast cancer.
What is assessed during percussion of the abdomen?
Tympany and dullness
Tympany indicates air-filled structures while dullness suggests solid organs or masses.
What does Kehr’s Sign indicate?
Left shoulder pain from spleen rupture
This sign is associated with diaphragmatic irritation.
What are the three most common types of breast complaints?
- Breast lump
- Breast Pain
- Nipple Discharge
Each complaint requires specific questioning to gather relevant clinical information.
What is the significance of Cullen’s Sign?
Periumbilical ecchymosis
This finding suggests retroperitoneal hemorrhage or pancreatitis.
What does the abdominal aorta bifurcate into?
Right and left common iliac arteries
This bifurcation occurs at approximately the level of L4.
What is the primary function of the kidneys?
Filter blood, regulate electrolytes, control blood pressure, produce erythropoietin
This highlights the kidneys’ role in maintaining homeostasis.
What is the common site for abdominal aortic aneurysms (AAA)?
Midline of the abdomen, near bifurcation of the aorta
AAA can lead to life-threatening conditions if ruptured.
What does Rovsing’s Sign indicate?
Appendicitis
Pain in the RLQ when the LLQ is palpated suggests irritation of the appendix.
What is the significance of Grey Turner’s Sign?
Flank bruising
This sign indicates retroperitoneal bleeding.
What question would you ask if a patient presents with a breast lump?
When did you first notice the lump? Has it changed in size?
What question would you ask regarding breast pain?
Is the pain related to your menstrual cycle?
What should you ask about nipple discharge?
What color is the discharge? Is it from one or both breasts?
During a clinical breast exam, what types of pressure should be applied during palpation?
Light Pressure, Medium pressure, Deep pressure
What has replaced the recommendation for monthly self-breast exams in average risk females?
Breast Self-Awareness
What are some concerning signs of breast cancer on physical exam?
- Skin dimpling
- Nipple retraction
- Bloody nipple discharge
- Peau d’orange appearance
- Palpable hard, immobile mass
What is the area of the cervix at greatest risk for dysplasia called?
squamocolumnar junction
How is menopause defined?
12 consecutive months without menstruation
What are common symptoms of menopause?
- Atrophic vaginal mucosa
- Decreased elasticity of the vaginal walls
- Thinning of pubic hair
What findings on physical history may indicate menopause?
- Atrophic vaginal mucosa
- Decreased elasticity of the vaginal walls
- Thinning of pubic hair
When would you use a Pederson speculum?
For nulliparous women or postmenopausal women
When would you use a Graves speculum?
For multiparous women
Mutations in BRCA1 or BRCA2 genes increase the risk for which cancers?
- Breast Cancer
- Ovarian Cancer
What are the cervical cancer screening recommendations?
- Pap smear every 3 years for women aged 21-29
- HPV and Pap co-testing every 5 years for women aged 30-65
- Discontinue screening if >65 and adequate prior negative screening
How is the cremasteric reflex assessed?
Stroke the inner thigh lightly, and observe ipsilateral testicle elevation
In a male with acute testicular pain, would the cremasteric reflex likely be present or absent?
Absent
What symptoms would a patient with Peyronie disease typically complain of?
- Penile Curvature
- Pain with erections
- Palpable fibrous plaque in the penis
What findings in a prostate exam may indicate prostate cancer?
- Hard, Irregular, Nodular Prostate
- Asymmetry
- Fixed Mass
List three common causes of gynecomastia.
- Hormonal imbalances (puberty, aging)
- Medications (Spironolactone, anti-androgens)
- Chronic Diseases (Liver disease, kidney failure)
What does the acronym OLDCARTS stand for in the context of history of present illness?
Onset, Location, Duration, Characteristics, Aggravating/Relieving Factors, Radiation, Timing, Severity
What components are included in the menstrual history?
- Age of menarche
- Last menstrual period (LMP)
- Cycle regularity, frequency, duration
- Amount and character of flow
- Associated symptoms
What does the GTPAL acronym stand for?
Gravida, Term, Preterm, Abortions, Living
What should be assessed during a gynecological history?
- Pap smears and results
- History of STIs
- History of gynecologic procedures or surgeries
- Contraceptive use
- Menopausal symptoms
What are the 5 P’s in sexual history?
- Partners
- Practices
- Protection
- Past STIs
- Pregnancy Prevention/Planning
What does the breast health history include?
- Self-breast exams
- Clinical breast exams
- Mammograms
- History of breast conditions
- Family history of breast cancer
What symptoms are associated with urinary health?
- Symptoms of UTIs
- Urinary incontinence
- Pelvic floor health
- History of kidney disease or stones
What endocrine and systemic health issues can affect gynecological health?
- Thyroid disorders
- Diabetes
- PCOS
- Weight and exercise history
What are the key components of a women’s gynecological physical exam?
- General considerations
- External genitalia exam
- Speculum exam
- Bimanual exam
- Rectovaginal exam
- Breast exam
- Documentation
What are the signs of breast cancer during a breast exam?
- Skin changes
- Nipple discharge
- Palpable masses
- Lymphadenopathy
- Asymmetry or contour abnormalities
- New inversion of nipple
- Ulceration or crusting on nipple
What are the Tanner stages for breast development?
- Tanner 1: No breast tissue
- Tanner 2: Breast buds appear
- Tanner 3: Contour elevates
- Tanner 4: Areola forms a secondary mound
- Tanner 5: Mature adult contour
What is the Tanner stage for male genital development when there is no pubic hair?
Tanner 1
What lifestyle modifications can reduce breast cancer risk?
- Maintain a healthy weight
- Limit alcohol
- Regular exercise
What are the cervical cancer screening recommendations according to ACOG?
- Pap smear starting at age 21
- HPV co-testing at age 30+
- Education on HPV vaccination
What are the symptoms of urinary incontinence?
- Stress
- Urge
- Mixed
At what age should a Pap smear start?
Age 21
What is the recommendation for HPV co-testing?
At age 30+ (or primary HPV testing)
What vaccine is recommended for HPV education up to age 45?
Gardasil 9
Name a lifestyle modification that can reduce cervical cancer risk.
Quit smoking
What are safe sexual practices to limit cervical cancer risk?
Limit partners, use barrier protection
What is the purpose of regular screenings?
Early detection prevents progression to cancer
What exercises can improve bladder control in pelvic health?
Pelvic floor exercises (Kegels)
How can weight management affect urinary incontinence?
Excess weight puts pressure on the bladder
What is one method for managing bladder symptoms?
Bladder training (timed voiding)
What weight loss percentage can improve symptoms of PCOS?
5-10%
What type of diet is recommended for managing PCOS?
Low-glycemic, high-fiber foods
What is an anti-inflammatory diet rich in for endometriosis management?
Omega-3s
What is a recommended exercise for endometriosis relief?
Regular exercise
True or False: Prostate cancer screening is recommended for all asymptomatic males.
False
What should be discussed regarding PSA testing?
Based on individual risk (especially if African American or family history)
What diet can reduce prostate cancer risk?
Heart-healthy diet (Mediterranean diet)
What should men be aware of regarding testicular health?
Self-exams for changes
What is a key component of a clinical breast examination?
Visual inspection and palpation
What should be observed during the visual inspection of breasts?
Symmetry, skin changes, nipple changes, visible masses
What palpation pattern is recommended for breast exams?
Vertical strip pattern
What are common findings in a normal breast exam?
Breasts symmetrical, smooth skin, no nipple inversion or discharge
What should be documented for abnormal breast findings?
Size, shape, consistency, mobility, tenderness, location
What is the screening recommendation for average-risk individuals?
Mammography
What are key components of a male GU physical exam?
History taking, inspection, palpation, digital rectal exam, special tests
What symptoms should be assessed in male GU history taking?
Pain, dysuria, erectile dysfunction, infertility
What should be inspected on the penis?
Lesions, ulcers, discharge, abnormal curvature
What does a digital rectal exam assess for?
Prostate size, shape, consistency, tenderness, nodules
What is Prehn’s Sign used to assess?
Relief of scrotal pain with elevation
Is routine screening for testicular cancer recommended?
No, but self-exam education is important
What is the most common type of inguinal hernia?
Indirect inguinal hernia
