PE Block I Flashcards
What is the muscle that controls the scrotum
Cremaster muscle
What is a dupuytren contracture of the penis
Curvature of the penis while erect from fibrous tissue (peyronie Dz)
( 90 degree angle)
What medications can cause ejaculation D/o
Alpha blockers, antidepressants
What is the best approach to a penile/ genitalia exam
Neutral supportive approach
What should be noted upon examination of the glands penis
Color, smegma, urethral meatus, D/c, or lesions
A mass that is reproducable but does not transilluminate in the scrotum is most likely..
A hernia
A solid mass that is not reproducible and does not transilluminate is most concering for..
Testicular cancer, or incarcerated hernia
What are the two common etiologies of urethrits is a man
Men <35 STI (Chlamydia, Gonorrhea)
Men >35 Coliform bacteria (E. Coli)
What is the most common type of hernia in men and women
Indirect inguinal hernia
What is Balanitis
Inflammation of the glands penis
What is balanoposthitis
Inflamation of the glands and prepuce of the penis
What is the gen term for condyloma acuminata
HPV, genital warts
What is lymphogranuloam venerum caused by
Chlamydia trach
Penile cancer is associted with which HPVs
16 and 18
A painless ulceration that fails to heal on the penis is a sign of
Penile cancer
A smooth spherical non tender mass at the epididymis., superior and posterior to the testis .
Spermatocele
Pt presents with scrotal pain and heaviness, usually asymptomatic with “bag of worms” sensation ..
Varicocele
How are varicoceles graded
Small = palpated during Valsalva maneuver.
Moderate = easily palpated without Valsalva
Large = causing visible building of the scrotum.
Orchitis is usually a result of what prior infx
Mumps
Or if older pt, a bacterial migration from a prostate infx
How does epididymitis present in a male pt
usually with a UTI
Most commonly with an STI
Painful scrotum, with D.c and dysuria
+prehns sign: elecvation fo the scrtoum improves pain
A pt presents with:
Irregular, nontender mass fixed on the testis.
Does not transilluminate
May have a reactive hydrocele (transilluminates)
Inguinal lymphadenopathy.
Think..
Cancer
What is the most common genital tumor in males 15-30 yrs old
Germ cell tumor
Fluid accumulation in the tunica vaginalis is what…
Hydrocele
A nontender, smooth, firm mass, superior and anterior to the testes thinkl..
Hydrocele
Hydrocele is most common at what stage of life
Infancy
When is a prostate massage contraindicated
Acute prostatitis
A pt presents with acute rectal/ deep pelvic pain, urination problems, and sexual dysfunction ( male)
Think
Acute prostatits
A prostate that is very tender, boggy, with bacteria in the urine.. think
Acute prostatitis
How many drops of prostate fluid should be collected from prostate massage
At least 4
A pt presents with a decreased stream, dribbling, incomplete emptying of the bladder with increased frequency and urgency, + nocturia
Think
BPH
What does the prostate feel like with BPH
Smooth or rubbery, symmetrical enlarged
Median sulcus may be abscent
On DRE you find a hard, irregualr nodule, with an asymetric prostate enlargment
Think
Prostate cancer
What is the differnce between a perianal abscess and a perirectal abcess
Perianal abscess: infection of the soft tissues surrounding the anal canal, with formation of a discrete abscess cavity
Perirectal abscesses: infection of the mucus-secreting anal glands, which drain into the anal crypts; abscess formation occurs in the deeper tissues
How do thrombosed hemmrhoids present
As blue shiny masses near the anus
A pigmented of verrucous lesion on the anus
Think
Anal cancer
What is the most common colorectal cancer
Adenocarcinoma
G4T1P0A3L0 means
G4= 4 total pregnancies T1= 1 full term birth P0= 0 preterm births A3= 3 abortions L0= no living children
When does menopaurse typically occur
Between 48-55
Define polymenorrrhea
Less than 21 days between cycles
define oligomenorrhea
Infrequent bleeding/ menses
Befine menorrhagia
Excessive flow
Define metrorhagia
Intermenstrual bleeding
Poscoital bleeding is an indication of
Cervical polyps or cancer in an older woman with atrophic vaginitis
What is the position for a female wellness exam
Lithotomy position
What is the staging that assess sexual maturity
Tanner staging
How does the perineum present in nulliparius vs periparius pts
Nulli: smooth and thick
Peri: Thinner, rigid
A small firm round cystic nodule in the labia suggests..
epidermoid cyst.
These are yellowish in color.
Look for the dark punctum marking the blocked opening of the gland.
What is the most common cause of cancer to the vulva
Squamous cell carcinoma
A mole./ ulcer greater than 1 month on the vulva that changes in appearance
Think
Vulvar melanoma
An ulcerated or raised red vulvar lesion in an elderly woman may be a…
Vulvar carcinoma
A tense, hot, very tender abcess near the vaginal canal..
think
Skenes duct or bartholin cycts
What is a cystocele in a woman
A cystocele is a bulge of the upper two thirds of the anterior vaginal wall, together with the bladder above it. It results from weakened anterior supporting tissues.
What is a cystourethrocele
When the entire anterior vaginal wall, together with the bladder and urethra, produces the bulge, a cystourethrocele is present.
A groove sometimes defines the border between the urethrocele and cystocele, but is not always present.
What is a rectocele
A rectocele is a herniation of the rectum into the posterior wall of the vagina, resulting from a weakness or defect in the endopelvic fascia.
What are the three type of vaginal speculums
Pederson ( metal )
Graves ( plastic)
Lighted
A cervix that is deviated to the left or right
Think
Pelvic mass, uterine adhesions, or pregnancy
Describe cervix with ectopy
Cervical ectropion occurs when eversion of the endocervix exposes columnar epithelium.
The everted epithelium has a red, shiny appearance around the os and may bleed easily.
Ectropion is common in adolescents, pregnant patients, or those taking estrogencontaining contraceptives.
Ectropion is not an abnormality, but because it is indistinguishable from early cervical carcinoma, further diagnostic studies
What is a nabothian cyst
retention cysts,also callednabothian cysts.
These appear as translucent nodules or small, white or yellow, raised, round areas on the cervix.
These are mucinous retention cysts of the endocervical glands and are considered a normal finding
How do cervical polpys present
bright red, soft, and fragile.
They usually arise from the endocervical canal
What is the appraoch to BV Dx
Scan saline wet mount forclue cells(epithelial cells with stippled borders); sniff for fishy odor after applying KOH (“whiff test”); test the vaginal secretions for pH > 4.5
Yellowish green or gray, possibly frothy; often profuse and pooled in the vaginal fornix; may be malodorous
Think
Trichomoniasis ( casues by protozoan found on a saline wet mount)
A pt presents with :
Vaginal soreness Pruritus Post-coital bleeding Vaginal mucosa is dry and pale Vaginal discharge -White, gray, yellow, green or blood-tinge than can be thick or watery
Think
Atrophic Vaginitis
What is the cause of atrophic vaginitis
Caused of lack of estrogen during perimenopause and menopause
What is the most common cause of cervicitis
GC/ Chlamydia
A pt presents with Erythematous , friable cervix
Cervical tenderness
Mucopurulent/purulent discharge
“Strawberry cervix”
Think
Cervicitis, MC from GC/ Chlamydia
How do you use the spatula and cytobrush during a pap smear
Spatula – insert long arm into os, turn 360° to collect cells from the external os.
Cytobrush – Place brush into os and rotate 180° to collect endocervical cells.
How many rotations must you do with a cytobroom
3-5 times
What is the primary risk fx for cervical cancer
HPV
Where is the fundal hieght at 12, 16, 20 wks of pregnancy
12 wks - At symphysis pubis.
16 wks - midway between pubis and umbilicus
20 wks - at umbilicus
> 20 wks - 1 cm for every week of gestation
What is naegels rule to calc estimated delivery date
Add 1 yr to 1st day of last normal menstrual period, subtract 3 months and add 7 days
What is the adnexa
“Adnexa”= space occupied by uterus, ovaries, fallopian tubes
“adnexa of uterus” = ovaries, f-tubes
A pt presents with pelvic pain , dysmenorrhea, heavy or prolonged menes, +/- infertility
PE shows tender palpable nodules along the uterosacral ligaments
Think
Endometriosis
Where is the most common cause of ectopic pregnancy
Fallopian tubes
Pelvic or cervical tenderness with HOTN
Think!!?
Ectopic pregnancy
Enlarged uterus with irregular, firm nodules in the contour of the uterus on bimanual exam
Think
Tumor
An ovary that is palbable post menopause
Think
Ovarian cancer
Pt presents with vague GI s/s ( Gas, indegestion, pressure, bloating) with an enlarged ovary
Older than 40,
Suspect
Ovarian cancer
What is the most common cause of PID
GC/ Chlamydia
A pt presents with Vaginal discharge with foul odor Dyspareunia Dysuria Irregular menses Pain in lower abdomen
PE: exquisite tenderness to palpation of bilateral adnexa
Patient is guarding and cannot tolerate bimanual exam
Fever
Purulent endocervical discharge
Think
PID
What age group always gets a DRE
Older than 50
Where does the female breast start and extend to
From the 2nd rib to the 6th rib
From the sterum to the mid axiallary line
What three things are contained in the nipple
Sebaceous glands.
Smooth muscle.
An occasional hair.
Symettry of the nipple should be within…
Less than 3mm difference
Recent inversion of a nipple is a sign of
Malignancy
Where do the breasts primarily drain into
To the anterior and central axiallary nodules
What is tanner staging 1-5 for breast tissue
1: Preadolescent, nipple elevated off chest wall.
2: Breast bud.
3: Breast bud and areola elevate as a unit.
4: Areola and nipple form a secondary mound.
5: Adult breast shape.
What is thelarche
represents breast development and is the first sign of puberty in girls, which is indicated by Tanner Stage 2.
When is the best time to conduct a blinical breast exam
5-7 days after the onset of menstration
Unilateral venous patterns in the breast is a sign of..
Increased blood flow to a malignancy
Hard, irregualr, poorly cirumscribed nodules, fixed to the skin strongly suggests what in the breast
Cancer
Unilateraly bloody D/c from the breasts indicates
Intraductal papilloma Or Ductal carcinoma in situ Or Paget’s disease of the breast
Describe peau d’ orange
Edema of the skin is produced by lymphatic blockade. It appears as thickened skin with enlarged pores.
What is the most common cause of mastitis
MC: Staph aureus
MC in lactating women
Presents with sudden onset of erthyema, edema, fever and chills
TTP, hot to touch breast tissue, hard with areas of flucuation
Purulent D/c
A lactating mother presents with sudden onset erythema, edema, fevers and chills
TTP, Hot to touch, hard with areas of flucuation in the breasts
+/- purulent D/c
Think
Mastitis from s. Aurues
Describe pagets dz
Rare form of breast cancer that starts at the areola or nipple, often with eczematous appearance
Surface manifestation of underlying ductal carcinoma
Crusting of the nipple, areola and surrounding skin
Does pagets dz respong well to steroids
No
What are 4 complications of augmented breasts
Capsular contractures
Deflation or rupture
Post implant removal
Scars
Describe fat necrosis of the breast
Benign
Assoc with truama
Painless Lump
Firm, irregular shap mass with area of discoloration
Describe a intraductal palilloma
benign tumors of subareolar ducts that produce serous or bloody D/c
2-3 Cm in diameter
Mass may or may not be present
Describe Duct ectasia
Benign condition of subareolar ducts produce nipple discharge
Seen in menopausal women
Necrotic and desquamating epithelium cells produce a green, or brown sticky fluid
Unilat or bilat breasts
May not feel a mass and nipple retraction often present
What is the size criteria for male breast exam red flags
Any mass greater than 2 Cm
DDX;
Pseudogynecomastia – Softy fatty enlargement of obesity
Gynecomastia – Benign firm disc of glandular enlargement….tissue may be tender
What is the total cardiac outoput recieved by the brain
20%
Via 2 internal carotid and 2 internal vertebral arteries
Drains via the venus plexus and dural sinuses that empty into the internal jugular veins
What sensations does the spinothalamic tract carry
Ascending tract that carries sensation for light touch, crude touch, pressure, temp and pain
What sensations does dorsal columns carry in the spinal tract
Carries fibers for the sensations of fine touch, 2point discrimination and proprioception
What does the corticospinal tract do
Permits skilled, delicate and purposeful movements
What does the vestibulospinal tract do
Causes extensor muscles of the body to suddenly contract when an individual starts to fall
What does the corticobulbar tract do
Arises from brain stem and innervates the motor functions of the cranial nerves
What are three superifical reflexes
Plantar, Abdominal, cremastic
What are 4 DTRs
Biceps, triceps, Patellar, Achilles
Vomitting, coughing, and sneezing are what type of reflex
Visceral
What type of reflex is babinskis
Pathological
What are the 6 steps in a reflex
Receptors Afferent Neuron Integrating center Efferent neuron Effector Response
What are the five areas of focus for a mental status exam
Apperance/ behaviour Speech/ Language Mood Toughts, preceptions Congnitive
How do you rate strength
0- no muscle movement
1- Visible muscle movement without joint movement
2-movemtn at the joint, not against gravity
3- movement at joint, not against light resistance
4- movement against resistance, but less than normal
5- full strenght
What is the cranial nerve assoc with medial upper arm
T1
What 4 systems work together for coordination
Motor
Cerebellar
Vestibular
Sensory
When conducting a Rapid alternating movement test, what is a postive finding
In cerebellar disease
One movement cannot be followed quickly by its opposite movement
Slow, irregular or clumsy movements
What is a postive romberg test
Positive Romberg
- Good balance with eyes open, loss of balance with eyes closed (dorsal column disease)
- Cerebellar ataxia – difficulty standing with feet together with eyes open or closed
What is the grading scale for reflexes
0- absent 1- Hypoactive 2- Normal 3- Hyperactive without clonus 4- Hyperactive with clonus
Biceps tendon correlates to whta cranial nerve
C5 and C6
Triceps tenden reflex is what CN
C6, C7
Knee/ patellar reflexes are what Cercival Nerve
L2-4
Babinski is what nerve
L5- S1
What is the glasgow coma scale
Eye opening on 1-4
1: none
2: to pressure
3: to sound
4: spontaneous
Verbal 1–5
1: none
2: sounds
3: words
4: confused
5: AO
Motor 1-6
1: none
2: extension
3: Abnml flexision
4: normal flex
5: localising
6: obeys commands
A pt presents with fatigue, blurred vission, dysuria, vision changes, sex dysfunction, with optic neurtitic, hyperactive DTRS, AMS
Is a woman,..
think
MS
A pt presents with FVR, N/V/D
URI hx, SZR, AMS, +nuchal rigidity,
Think
Meningitis or encephalitis
A pt presents with Sever HA, awken from sleep, brief episodes of blurred vision, whoosing sound in ears,
Is an obese woman of child bearing age
Think…
Pseudotumor cerebri
Can present wtih abnml fundoscopis exam, inferior nasal vision defect, decreased visual acuity
Is a sign on ICP
A pt presents with sudden onset of unilat weakness, AMS, aphasia, visual changes, Severe HA with unknown cause..
Think
Stroke
A pt presents with gradual onset of numbness, tingling, night pain in one or both feet, Hx of DM or ETOH use
Think
Peripheral Neuropathy
A pt presetns with suddne onset of facial wekaness, ptosis, hyperacusis, loss of taste of the anterior 2/3 of tonuge
Think
Bells palsy (CN VII)
A pt presents with unilat facial pain that is OOPT exam
Think
Trigeminal neuralgia
A pt presents wtih Diploplia, ptosis, dysphagia, dysarthria, dyspnea, worse with exercise, Sxs worse late in the day,
Think
Myasthenia Gravis ( CNII)
Flexion plus external roation of the hip is what kind of hip dislocation
Anterior dislocation/ Fracture
Flexion with internal rotation is what kind of hip dislocation
Posterior Dislocation
What is trendelenburg sign
A hip drop, a sign of hip abductor weakness
What does Ober test evaluate
It band syndrome
(Greater trochanter bursitis)
Positive finding: IT band tighness
What does the FABER test evaluate
Anterior labrum tear
Positve test is pain at the SI joint
What does the piriformis test evalualte
Piriformis syndrome/ sciatic nerve iritiation
Positive finding is pain in the glutes
What is a trendelenberg test
Assesses abductor weakness
Congential hip dislocation
Rheumatoid Arthritis
OA
Postive finding is Drop of the NWB hip
What is a Ortolani/ barlow test
Assess hip dysplasia in an infant
A bulbous knee is a sign of
Knee bursitis
Loss of the medial contour of the gastrocnemius is a sign of
A Tear in the calf
The medial meniscuc is best palpated in what position
With the tibia internally rotated
What does a pattelar apprehension test evaluate
Patellar subluxation or Dislocation
A postive test is apprehension
What does the quad patellar grind test evaluate
Chrondomalacia of the patella
Positive tesst is crepitus
What does lachmans test evaluate
ACL tear (first rule out a PCL tear)
Positve finding is laxity
What does the anterior drawer test evaluate
ACL tear
Postive: laxity
What does the posterior drawer test evaluate
PCL tear
Positive: laxity
What does Sag sign of the knee indicate
PCL tear
What does Quad active drawer test indicate
PCL tear
Postive: laxity
What does a varus test of the knree evaluate
The LCL
What does a valgus stress of the knee evaluate
An MCL tear
What does the mcmurrays test evaluate
Meniscus tear
Postive: clicking, locking or pain
What is apleys (grind) test used to evaluate
Meniscus tear
What does thessalys (standing grind test) evaluate
Meniscus tear
Tophi is a sign of
Gout
What is pes cavus
High arch in the foot
Mucsle atrophy of the posterior shoulder is a sign of..
RTC tear
What does Roos test evaluate
Thoracic outlet ssyndrome
Postive: color change in the hands
What does neer test evaluate
Supraspinatus impingment
Positve: pain at the lateral shoulder
What does Hawkins/ kennedy test evaluate
Supraspinatus impingement
Positive: pain at lateral shoulder
What does Jobes test evaluate
RTC tear (supraspinatus)
What does the drop arm test evaluate
RTC tear ( supraspinatus)
Postive: uncotrolled drop
What does the lift off test evaluate
RTC tear
(Subscapularis)
Postive: weakness or pain
What does obriens test evaluate
SLAP tear
Positve: deep pain
What does spurlings test evaluate
Cervical radiculopathy, or OA
Faber test can evaluate what in the hip and spin e
Ankylosis spondylosis
Sacrolilitis
Iliopsoas strain
What should you do a rectal exam as part of a well woman examination
If rextal S/s or if older than 50
Where is the uterus if the cervix is anterior pointing
Retroverted
Where is the uterus if the cervix is posterior pointing
Anterverted
How should specimen retrival of a well woman exam be conducted if the pt is pregnant
If pregnant, use CTA moistened with saline, in place of endocervical brush and should be sterile!
What is the most common cell type of cervical cancer
SCC> adenocarcinoma
A hard granualr appearnace of the Os is a sigh of..
Cervical cancer
WHat is the “adnexa”
Space occupied by the uterus, ovaries, and fallopian tubes
