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Physical Exam 2 Didactic Midterm > Male and Female Exams > Flashcards

Male and Female Exams Flashcards

1
Q

H&P findinds concerning for Breast Cancer

A

Hard consistency

irregular shape

skin dimpling

nipple retraction

non-tender

nipple discharge

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2
Q

Anatomical Landmarks of the Breast

A

•Lies against the anterior thoracic wall-

  • pectoralis major and
  • the inferior margin of the serratus anterior

Extends from the clavicle and 2nd rib -> 6th rib

and extends from the sternum -> midaxillary line

•Surface area generally rectangular - quadrants cross perpindicular to the nipple

axillary tai_l of breast tissue extend into a_nterior axillary fold

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3
Q

Describe Insepction of the breast

A

•patient in sitting position and disrobed to the waist

Look for skin changes -color, thickening, and unusually prominent pores)

size and symmetry, contour, characteristics of the nipples (size, shape, direction in which they point, rashes, ulceration, and discharge)

•Assess four views:

arms at sides,

arms over head,

arms pressed against hips

leaning forward

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4
Q

what 4 views should the patient assume in a breast exam

A

•arms at sides

arms over head,

arms pressed against hips

leaning forward

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5
Q

when perfroming a breast exam:

Ask the patient to raise her arms above her head or press them against the hips as this can bring out __________ or_______

A

dimpling or retraction

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6
Q

during a breast exam what positions should the patient be in during:

inspection

palpation

A

inspection - sitting upright

palpation - supine, with one arm above head—shoulder raised on towel/sheet, one breast undraped

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7
Q

describe th technique of palpation of breast

A

Use finger pads

vertical strip pattern (best validated technique)

Palpate in small, concentric circles (light, medium, deep pressure)

Examine the entire breast, including periphery, tail, and axilla

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8
Q

best validated technique for breast palpation

A

vertical strip pattern

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9
Q

during palpation of breast tissue we are examining for?

A
  • Consistency of tissues
  • Tenderness
  • Nodules
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10
Q

if a nodule is noted on the breast exam what should you alose note?

A
  • Location—by quadrant or clock, with centimeters from nipple
  • Size—in centimeters
  • Shape
  • Consistency—soft, firm or hard
  • Delimitation—well circumscribed or not
  • Tenderness
  • Mobility—in relation to the skin, pectoral fascia and chest wall. Gently move the breast near the mass and watch for dimpling.
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11
Q

the breast exam conists of ?

A
  • Inspection
  • Palpation - Breast & Nipple
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12
Q

standardized approach to breast exam is?

A
  • Use a systematic and thorough search pattern
  • Use finger pads
  • Vary palpation pressures
  • Use a circular motion
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13
Q

when examining the nipple what should you note

A

Palpate each nipple

Note elasticity

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14
Q

define physiologic nodularity

A

•The adult breast may be soft, but frequently feels granular, nodular or lumpy ->

This uneven texture = physiologic nodularity

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15
Q

Most of the breast lymphatics drain toward the____

A

axilla

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16
Q

lymph drains from ??

_____ –> ______& _____-> _____

A

central axillary nodes -> infra and supraclavicular nodes -> axillary

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17
Q

malignant cells from breast cancer may spread directly to ??

A

infraclavicular nodes or into the internal mammary chain of lymph nodes

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18
Q

Patient eduction for SBE

A
  • Monthly after age 20
  • 5-7 days after onset of menses
  • In the shower is best - otherwise patient lying supine using “up and down” or “strip” pattern
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19
Q

BSE instructions for - Lyning Supine

A
  1. lie down w/ pillow under right shoulder and raise arm above head
  2. use pads of fingers making overlapping dime-sized circular motions
  3. apply 3 levels of pressure (light, medium, firm) - firm ridge on lower curve of each breast is normal
  4. examine in up and down or “strip” pattern - start in an imaginary straigh line down from armpit moving up and down accross breast until you hit sternum
  5. repeat on other side
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20
Q

BSE instructions for - standing

A
  1. stand in front of mirror w/ hands pressed firmly on hips look at breasts for changes in size, shape, contour, dimpling, etc

pressing down on hips contracts the chest wall muscles and enhances breast changes

  1. examine each underarm while sitting up or standing and w/ your arms ponly slightly raised

raising your arm straight up tightens tissue in this area making it harder to examine

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21
Q

Peliv exam Sequencing & Position

A

lithotomy position

  • Examine external genitalia
  • Perform speculum examination
  • Perform bimanual examination
  • Perform rectovaginal examination
  • Perform rectal examination
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22
Q

explain the technique for speculum exam

A
  1. Place the index finger of your non-dominant hand push down on the posterior portion of the introitus
  2. Insert speculum (approximately 45 degrees) and gently insert into the introitus; continue inserting the length of the speculum
  3. Rotate the speculum horizontally and gently open it, catching the cervix in between the blades
  4. assess walls of vagina when withdrawing speculum
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23
Q

contrast Multip os vs nulip os

A

Multip op - bit dilated, due to the fact you have had a baby before

•nullip os - appears small and perfectly round

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24
Q

describe a scrotal exam

A

patient standing & examiner sitting

gown covers patient chest & abdomen

gloves worn at all times

Inspection

  • Skin – lift the scrotum to view its posterior surface
  • Scrotal contours – note swelling, lumps, veins

Palpation

  • Each testis and epididymis – note size, shape, consistency, and tenderness; feel for any nodules
  • Epididymis is a soft, nodular, cordlike structure at the back of the testicle
  • Each spermatic cord – note nodules or swelling

Transilumination

Transilluminate any palpable masses or any enlarged scrotum

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25
Q

A mass in the scrotum that does not transilluminate could be?

A

1- Inguinal Hernia: pain and may be a bulge when standing upright, movement, or bearing down are present.

2- Varicocele: is a dilatation of the veins within the scrotum. (left side more common)

3- Testicular tumor testicular cancer produces a painless swelling of one testicle.

4- Hematoma (blood)

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26
Q

if scrotal mass dissapears when the pt bears down it is likely a ???

A

hernia

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27
Q

define Varicocele

what side is more common?

A

is a dilatation of the veins within the scrotum.

Varicoceles are commonly seen on the left side

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28
Q

what is the presentation of a Testicular tumor

A

usually affects only one testicle.

It rarely presents with pain or discomfort in a testicle or the scrotum.

testicular cancer -> painless swelling of one testicle.

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29
Q

define locaion and consistency of he epididymis

A

superior, posterior surface of each testis.

  • nodular
  • soft
  • cordlike

should not be confused with an abnormal lump.

30
Q

name the 3 types of hernias

A

Femoral

Indirect

Direct Inguinal

31
Q

hernia more common in women than in men

A

femoral

32
Q

Most common hernia

A

indirect

33
Q

hernia usually in men older than 40

A

direct

34
Q

Point of origin for the hernias

femoral

Indirect

direct

A

femoral - below the inguinal ligament.

Indirect -

  • above the inguinal ligament
  • Lateral to inferior epigastric artery

direct - close to the pubic tubercle

  • above inguinal ligament,
  • medial to inferior epigastric artery
35
Q

path of indirect hernia

A

deep inguinal ring -> superficial inguinal ring -> scrotum

36
Q

name the hernia:

often into scrotum; the hernia comes down into the inguinal canal and touches the fingertip

exam technique?

A

Indirect

examining finger in inguinal canal during straining…’cough’, bear down’).

37
Q

name the hernia:

Rarely into the scrotum; hernia bulges anteriorly and pushes side of finger forward.

A

direct

38
Q

path of direct hernia

A

passes through superficial ring -> herniating into inguinal canal

39
Q

abnornal Physical exam findings of scrotum:

scrotal edema

crytorchidism

Klinefelter synd

A

scrotal edema - taut scrotal skin

crytorchidism - no palpable testes, unfilled scrotal sac

Klinefelter synd - small testes (<2cm)

40
Q

Abnormal PE findings of scrotum

acute orititis

testicular tumor

A

acute orititis - testicular pain, inflamn & swelling

testicular tumor - painless nodule, unilateral

41
Q

(+) transillumination scrotal finding usually indicates a??

A

hydrocele

42
Q

most common lesion of penis

si/sx

A

HSV 2

painful superficial lesion

43
Q

painless chancre of penis:

dx? pathogen?

A

small red papule

syphillis

T. pallidium

44
Q

Genital warts (condyloma acuminata) are caused by what??

A

•HPV subtypes 6 and 11

45
Q

what abornmal PE finding in a male GU exam is associated w/

seen in mumps and other viral infections

A

Acute orchitis - unilateral

46
Q

describe a chancroid

cause?

A

Red papule or pustule initially, -> forms a painful deep ulcer

H. ducreyi

47
Q

painful deep lesions of the penis are caused by?

A

cancroid

H. ducreyi

48
Q

compare / contrast

Chanchre vs Cancroid

A

Chanchre - painless, syphillis, T. pallidium

Cancroid - painful deep lesion, H. ducreyi

49
Q

define phimosis vs paraphimosis

A

phimosis - tight prepauce that cannot be retracted

paraphimosis - tight prepauce that once retarced cannot be returned

50
Q

if you notice a scrotal hernia and place your stethoscope and hear bowel sounds…

it is a???

A

indirect inguinal hernia until proven otherwise

51
Q

Carcinoma of the penis usually affects what population?

A

•Uncircumcised male w/ hx of HPV

52
Q

benign indurated plaque on penis is??

A

Peyronie’s Disease

53
Q

define hypospadias

A

ventral displacement of the urethral meatus

54
Q

penile cancer presents as

A

non-tender, indurated nodule or ulcer

55
Q

how to differentiate b/w hydrocele and scrotal hernia

2 ways:

A

hyrocele -

+ transilumination, fingers CAN get above mass

scrotal hernia -

  • transilumination, fingers CANNOT get above mass
56
Q

Dx?

A

hydrocele

57
Q

dx?

A

scrotal hernia

58
Q

define location of

Indirect vs Direct hernias

A

indirect - superior to inguinal ligament, lateral to inferior epigastric artery

Direct - superior to inguinal ligament, medial to inferior epigastric artery

59
Q

hernia that is seen in scrotum

describe its path:

A

indirect

deep inguinal ring -> superficifal inguinal ring -> into scrotum

60
Q

hernia in inginal canal

desribe its path

A

Direct

passes through superficial ring -> herniating into inguinal canal

61
Q

describe location and normal exam findings of the prostate gland

A

lies against the anterior rectal wall

  • rounded & heart-shaped
  • rubbery
  • 2.5 cm long
  • lateral lobes and median sulcus are palpable
62
Q

list normal prostate findings

A

rubbery

nontender

heart-shaped, rounded

2.5cm long

palpable mediun sulcus

palpable lateral lobes

63
Q

prostate exam patient positions

A
  • The patient may stand, leaning forward with his upper body resting across the examining table and hips flexed
  • The patient may lie on his left side with his buttocks close to the edge of the exam table near you; flex the patients hips and knees, especially the top leg
64
Q

abnromal prostate findigns

A

BPH

Prostatitis

Prostate cancer

65
Q

benefits of a chaperone

A

protection against allegations of innappropriate conduct

expedite exam

patient feels more comfortable

66
Q

when should a chaperone ALWAYS be present

A

male examining a female

child or patient / mental pr physical diability

**should NOT be someone who came w/ patient - staff memeber

67
Q

Elements of scrotal exam

A

Inspection

  • Skin – lift the scrotum to view its posterior surface
  • Scrotal contours – note swelling, lumps, veins

Palpation

•Each testis and epididymis – note size, shape, consistency, and tenderness; feel for any nodules

•Epididymis is a soft, nodular, cordlike structure at the back of the testicle

•Each spermatic cord – note nodules or swelling

Transillumination

Transilluminate any palpable masses or any enlarged scrotum

68
Q

•characteristic breast mass findings that are least suggestive of malignancy

A

tenderness

69
Q

examining a femoral hernia (female):

positioning?

palpation?

A

•a woman should stand up to be examined

  • Palpate the labia majora just upward
  • and lateral to the pubic tubercles
70
Q

Of the axillary lymph nodes, the_____ nodes are palpable most frequently

A

central

71
Q

•If central nodes feel large, hard, or tender—or if there is suspicious lesion what other groups of LNs should you examin

A
  • Pectoral nodes
  • Lateral nodes
  • Subscapular nodes

Physical Exam 2 Didactic Midterm (4 decks)

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