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IPAP JUNIOR SEM. > PE Block I > Flashcards

PE Block I Flashcards

1
Q

What is the muscle that controls the scrotum

A

Cremaster muscle

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2
Q

What is a dupuytren contracture of the penis

A

Curvature of the penis while erect from fibrous tissue (peyronie Dz)
( 90 degree angle)

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3
Q

What medications can cause ejaculation D/o

A

Alpha blockers, antidepressants

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4
Q

What is the best approach to a penile/ genitalia exam

A

Neutral supportive approach

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5
Q

What should be noted upon examination of the glands penis

A

Color, smegma, urethral meatus, D/c, or lesions

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6
Q

A mass that is reproducable but does not transilluminate in the scrotum is most likely..

A

A hernia

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7
Q

A solid mass that is not reproducible and does not transilluminate is most concering for..

A

Testicular cancer, or incarcerated hernia

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8
Q

What are the two common etiologies of urethrits is a man

A

Men <35 STI (Chlamydia, Gonorrhea)

Men >35 Coliform bacteria (E. Coli)

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9
Q

What is the most common type of hernia in men and women

A

Indirect inguinal hernia

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10
Q

What is Balanitis

A

Inflammation of the glands penis

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11
Q

What is balanoposthitis

A

Inflamation of the glands and prepuce of the penis

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12
Q

What is the gen term for condyloma acuminata

A

HPV, genital warts

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13
Q

What is lymphogranuloam venerum caused by

A

Chlamydia trach

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14
Q

Penile cancer is associted with which HPVs

A

16 and 18

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15
Q

A painless ulceration that fails to heal on the penis is a sign of

A

Penile cancer

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16
Q

A smooth spherical non tender mass at the epididymis., superior and posterior to the testis .

A

Spermatocele

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17
Q

Pt presents with scrotal pain and heaviness, usually asymptomatic with “bag of worms” sensation ..

A

Varicocele

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18
Q

How are varicoceles graded

A

Small = palpated during Valsalva maneuver.

Moderate = easily palpated without Valsalva

Large = causing visible building of the scrotum.

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19
Q

Orchitis is usually a result of what prior infx

A

Mumps

Or if older pt, a bacterial migration from a prostate infx

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20
Q

How does epididymitis present in a male pt

A

usually with a UTI

Most commonly with an STI

Painful scrotum, with D.c and dysuria

+prehns sign: elecvation fo the scrtoum improves pain

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21
Q

A pt presents with:

Irregular, nontender mass fixed on the testis.
Does not transilluminate
May have a reactive hydrocele (transilluminates)
Inguinal lymphadenopathy.

Think..

A

Cancer

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22
Q

What is the most common genital tumor in males 15-30 yrs old

A

Germ cell tumor

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23
Q

Fluid accumulation in the tunica vaginalis is what…

A

Hydrocele

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24
Q

A nontender, smooth, firm mass, superior and anterior to the testes thinkl..

A

Hydrocele

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25
Q

Hydrocele is most common at what stage of life

A

Infancy

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26
Q

When is a prostate massage contraindicated

A

Acute prostatitis

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27
Q

A pt presents with acute rectal/ deep pelvic pain, urination problems, and sexual dysfunction ( male)

Think

A

Acute prostatits

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28
Q

A prostate that is very tender, boggy, with bacteria in the urine.. think

A

Acute prostatitis

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29
Q

How many drops of prostate fluid should be collected from prostate massage

A

At least 4

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30
Q

A pt presents with a decreased stream, dribbling, incomplete emptying of the bladder with increased frequency and urgency, + nocturia

Think

A

BPH

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31
Q

What does the prostate feel like with BPH

A

Smooth or rubbery, symmetrical enlarged

Median sulcus may be abscent

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32
Q

On DRE you find a hard, irregualr nodule, with an asymetric prostate enlargment
Think

A

Prostate cancer

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33
Q

What is the differnce between a perianal abscess and a perirectal abcess

A

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

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34
Q

How do thrombosed hemmrhoids present

A

As blue shiny masses near the anus

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35
Q

A pigmented of verrucous lesion on the anus

Think

A

Anal cancer

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36
Q

What is the most common colorectal cancer

A

Adenocarcinoma

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37
Q

G4T1P0A3L0 means

A 
G4= 4 total pregnancies 
T1= 1 full term birth 
P0= 0 preterm births 
A3= 3 abortions 
L0= no living children
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38
Q

When does menopaurse typically occur

A

Between 48-55

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39
Q

Define polymenorrrhea

A

Less than 21 days between cycles

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40
Q

define oligomenorrhea

A

Infrequent bleeding/ menses

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41
Q

Befine menorrhagia

A

Excessive flow

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42
Q

Define metrorhagia

A

Intermenstrual bleeding

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43
Q

Poscoital bleeding is an indication of

A

Cervical polyps or cancer in an older woman with atrophic vaginitis

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44
Q

What is the position for a female wellness exam

A

Lithotomy position

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45
Q

What is the staging that assess sexual maturity

A

Tanner staging

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46
Q

How does the perineum present in nulliparius vs periparius pts

A

Nulli: smooth and thick
Peri: Thinner, rigid

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47
Q

A small firm round cystic nodule in the labia suggests..

A

epidermoid cyst.

These are yellowish in color.

Look for the dark punctum marking the blocked opening of the gland.

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48
Q

What is the most common cause of cancer to the vulva

A

Squamous cell carcinoma

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49
Q

A mole./ ulcer greater than 1 month on the vulva that changes in appearance
Think

A

Vulvar melanoma

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50
Q

An ulcerated or raised red vulvar lesion in an elderly woman may be a…

A

Vulvar carcinoma

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51
Q

A tense, hot, very tender abcess near the vaginal canal..

think

A

Skenes duct or bartholin cycts

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52
Q

What is a cystocele in a woman

A

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.

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53
Q

What is a cystourethrocele

A

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.

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54
Q

What is a rectocele

A

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.

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55
Q

What are the three type of vaginal speculums

A

Pederson ( metal )
Graves ( plastic)
Lighted

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56
Q

A cervix that is deviated to the left or right

Think

A

Pelvic mass, uterine adhesions, or pregnancy

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57
Q

Describe cervix with ectopy

A

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

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58
Q

What is a nabothian cyst

A

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

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59
Q

How do cervical polpys present

A

bright red, soft, and fragile.

They usually arise from the endocervical canal

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60
Q

What is the appraoch to BV Dx

A

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

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61
Q

Yellowish green or gray, possibly frothy; often profuse and pooled in the vaginal fornix; may be malodorous

Think

A

Trichomoniasis ( casues by protozoan found on a saline wet mount)

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62
Q

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

A

Atrophic Vaginitis

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63
Q

What is the cause of atrophic vaginitis

A

Caused of lack of estrogen during perimenopause and menopause

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64
Q

What is the most common cause of cervicitis

A

GC/ Chlamydia

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65
Q

A pt presents with Erythematous , friable cervix
Cervical tenderness
Mucopurulent/purulent discharge
“Strawberry cervix”

Think

A

Cervicitis, MC from GC/ Chlamydia

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66
Q

How do you use the spatula and cytobrush during a pap smear

A

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.

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67
Q

How many rotations must you do with a cytobroom

A

3-5 times

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68
Q

What is the primary risk fx for cervical cancer

A

HPV

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69
Q

Where is the fundal hieght at 12, 16, 20 wks of pregnancy

A

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

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70
Q

What is naegels rule to calc estimated delivery date

A

Add 1 yr to 1st day of last normal menstrual period, subtract 3 months and add 7 days

71
Q

What is the adnexa

A

“Adnexa”= space occupied by uterus, ovaries, fallopian tubes

“adnexa of uterus” = ovaries, f-tubes

72
Q

A pt presents with pelvic pain , dysmenorrhea, heavy or prolonged menes, +/- infertility

PE shows tender palpable nodules along the uterosacral ligaments

Think

A

Endometriosis

73
Q

Where is the most common cause of ectopic pregnancy

A

Fallopian tubes

74
Q

Pelvic or cervical tenderness with HOTN

Think!!?

A

Ectopic pregnancy

75
Q

Enlarged uterus with irregular, firm nodules in the contour of the uterus on bimanual exam

Think

A

Tumor

76
Q

An ovary that is palbable post menopause

Think

A

Ovarian cancer

77
Q

Pt presents with vague GI s/s ( Gas, indegestion, pressure, bloating) with an enlarged ovary

Older than 40,

Suspect

A

Ovarian cancer

78
Q

What is the most common cause of PID

A

GC/ Chlamydia

79
Q 
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

A

PID

80
Q

What age group always gets a DRE

A

Older than 50

81
Q

Where does the female breast start and extend to

A

From the 2nd rib to the 6th rib

From the sterum to the mid axiallary line

82
Q

What three things are contained in the nipple

A

Sebaceous glands.
Smooth muscle.
An occasional hair.

83
Q

Symettry of the nipple should be within…

A

Less than 3mm difference

84
Q

Recent inversion of a nipple is a sign of

A

Malignancy

85
Q

Where do the breasts primarily drain into

A

To the anterior and central axiallary nodules

86
Q

What is tanner staging 1-5 for breast tissue

A

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.

87
Q

What is thelarche

A

represents breast development and is the first sign of puberty in girls, which is indicated by Tanner Stage 2.

88
Q

When is the best time to conduct a blinical breast exam

A

5-7 days after the onset of menstration

89
Q

Unilateral venous patterns in the breast is a sign of..

A

Increased blood flow to a malignancy

90
Q

Hard, irregualr, poorly cirumscribed nodules, fixed to the skin strongly suggests what in the breast

A

Cancer

91
Q

Unilateraly bloody D/c from the breasts indicates

A 
Intraductal papilloma
Or 
Ductal carcinoma in situ
Or
Paget’s disease of the breast
92
Q

Describe peau d’ orange

A

Edema of the skin is produced by lymphatic blockade. It appears as thickened skin with enlarged pores.

93
Q

What is the most common cause of mastitis

A

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

94
Q

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

A

Mastitis from s. Aurues

95
Q

Describe pagets dz

A

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

96
Q

Does pagets dz respong well to steroids

A

No

97
Q

What are 4 complications of augmented breasts

A

Capsular contractures
Deflation or rupture
Post implant removal
Scars

98
Q

Describe fat necrosis of the breast

A

Benign

Assoc with truama

Painless Lump

Firm, irregular shap mass with area of discoloration

99
Q

Describe a intraductal palilloma

A

benign tumors of subareolar ducts that produce serous or bloody D/c

2-3 Cm in diameter

Mass may or may not be present

100
Q

Describe Duct ectasia

A

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

101
Q

What is the size criteria for male breast exam red flags

A

Any mass greater than 2 Cm

DDX;
Pseudogynecomastia – Softy fatty enlargement of obesity
Gynecomastia – Benign firm disc of glandular enlargement….tissue may be tender

102
Q

What is the total cardiac outoput recieved by the brain

A

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

103
Q

What sensations does the spinothalamic tract carry

A

Ascending tract that carries sensation for light touch, crude touch, pressure, temp and pain

104
Q

What sensations does dorsal columns carry in the spinal tract

A

Carries fibers for the sensations of fine touch, 2point discrimination and proprioception

105
Q

What does the corticospinal tract do

A

Permits skilled, delicate and purposeful movements

106
Q

What does the vestibulospinal tract do

A

Causes extensor muscles of the body to suddenly contract when an individual starts to fall

107
Q

What does the corticobulbar tract do

A

Arises from brain stem and innervates the motor functions of the cranial nerves

108
Q

What are three superifical reflexes

A

Plantar, Abdominal, cremastic

109
Q

What are 4 DTRs

A

Biceps, triceps, Patellar, Achilles

110
Q

Vomitting, coughing, and sneezing are what type of reflex

A

Visceral

111
Q

What type of reflex is babinskis

A

Pathological

112
Q

What are the 6 steps in a reflex

A 
Receptors
Afferent Neuron
Integrating center
Efferent neuron 
Effector  
Response
113
Q

What are the five areas of focus for a mental status exam

A 
Apperance/ behaviour 
Speech/ Language 
Mood 
Toughts, preceptions 
Congnitive
114
Q

How do you rate strength

A

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

115
Q

What is the cranial nerve assoc with medial upper arm

A

T1

116
Q

What 4 systems work together for coordination

A

Motor
Cerebellar
Vestibular
Sensory

117
Q

When conducting a Rapid alternating movement test, what is a postive finding

A

In cerebellar disease
One movement cannot be followed quickly by its opposite movement
Slow, irregular or clumsy movements

118
Q

What is a postive romberg test

A

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
119
Q

What is the grading scale for reflexes

A 
0- absent 
1- Hypoactive 
2- Normal 
3- Hyperactive without clonus 
4- Hyperactive with clonus
120
Q

Biceps tendon correlates to whta cranial nerve

A

C5 and C6

121
Q

Triceps tenden reflex is what CN

A

C6, C7

122
Q

Knee/ patellar reflexes are what Cercival Nerve

A

L2-4

123
Q

Babinski is what nerve

A

L5- S1

124
Q

What is the glasgow coma scale

A

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

125
Q

A pt presents with fatigue, blurred vission, dysuria, vision changes, sex dysfunction, with optic neurtitic, hyperactive DTRS, AMS

Is a woman,..
think

A

MS

126
Q

A pt presents with FVR, N/V/D
URI hx, SZR, AMS, +nuchal rigidity,

Think

A

Meningitis or encephalitis

127
Q

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…

A

Pseudotumor cerebri

Can present wtih abnml fundoscopis exam, inferior nasal vision defect, decreased visual acuity

Is a sign on ICP

128
Q

A pt presents with sudden onset of unilat weakness, AMS, aphasia, visual changes, Severe HA with unknown cause..

Think

A

Stroke

129
Q

A pt presents with gradual onset of numbness, tingling, night pain in one or both feet, Hx of DM or ETOH use

Think

A

Peripheral Neuropathy

130
Q

A pt presetns with suddne onset of facial wekaness, ptosis, hyperacusis, loss of taste of the anterior 2/3 of tonuge

Think

A

Bells palsy (CN VII)

131
Q

A pt presents with unilat facial pain that is OOPT exam

Think

A

Trigeminal neuralgia

132
Q

A pt presents wtih Diploplia, ptosis, dysphagia, dysarthria, dyspnea, worse with exercise, Sxs worse late in the day,

Think

A

Myasthenia Gravis ( CNII)

133
Q

Flexion plus external roation of the hip is what kind of hip dislocation

A

Anterior dislocation/ Fracture

134
Q

Flexion with internal rotation is what kind of hip dislocation

A

Posterior Dislocation

135
Q

What is trendelenburg sign

A

A hip drop, a sign of hip abductor weakness

136
Q

What does Ober test evaluate

A

It band syndrome
(Greater trochanter bursitis)

Positive finding: IT band tighness

137
Q

What does the FABER test evaluate

A

Anterior labrum tear

Positve test is pain at the SI joint

138
Q

What does the piriformis test evalualte

A

Piriformis syndrome/ sciatic nerve iritiation

Positive finding is pain in the glutes

139
Q

What is a trendelenberg test

A

Assesses abductor weakness
Congential hip dislocation
Rheumatoid Arthritis
OA

Postive finding is Drop of the NWB hip

140
Q

What is a Ortolani/ barlow test

A

Assess hip dysplasia in an infant

141
Q

A bulbous knee is a sign of

A

Knee bursitis

142
Q

Loss of the medial contour of the gastrocnemius is a sign of

A

A Tear in the calf

143
Q

The medial meniscuc is best palpated in what position

A

With the tibia internally rotated

144
Q

What does a pattelar apprehension test evaluate

A

Patellar subluxation or Dislocation

A postive test is apprehension

145
Q

What does the quad patellar grind test evaluate

A

Chrondomalacia of the patella

Positive tesst is crepitus

146
Q

What does lachmans test evaluate

A

ACL tear (first rule out a PCL tear)

Positve finding is laxity

147
Q

What does the anterior drawer test evaluate

A

ACL tear

Postive: laxity

148
Q

What does the posterior drawer test evaluate

A

PCL tear

Positive: laxity

149
Q

What does Sag sign of the knee indicate

A

PCL tear

150
Q

What does Quad active drawer test indicate

A

PCL tear

Postive: laxity

151
Q

What does a varus test of the knree evaluate

A

The LCL

152
Q

What does a valgus stress of the knee evaluate

A

An MCL tear

153
Q

What does the mcmurrays test evaluate

A

Meniscus tear

Postive: clicking, locking or pain

154
Q

What is apleys (grind) test used to evaluate

A

Meniscus tear

155
Q

What does thessalys (standing grind test) evaluate

A

Meniscus tear

156
Q

Tophi is a sign of

A

Gout

157
Q

What is pes cavus

A

High arch in the foot

158
Q

Mucsle atrophy of the posterior shoulder is a sign of..

A

RTC tear

159
Q

What does Roos test evaluate

A

Thoracic outlet ssyndrome

Postive: color change in the hands

160
Q

What does neer test evaluate

A

Supraspinatus impingment

Positve: pain at the lateral shoulder

161
Q

What does Hawkins/ kennedy test evaluate

A

Supraspinatus impingement

Positive: pain at lateral shoulder

162
Q

What does Jobes test evaluate

A

RTC tear (supraspinatus)

163
Q

What does the drop arm test evaluate

A

RTC tear ( supraspinatus)

Postive: uncotrolled drop

164
Q

What does the lift off test evaluate

A

RTC tear
(Subscapularis)

Postive: weakness or pain

165
Q

What does obriens test evaluate

A

SLAP tear

Positve: deep pain

166
Q

What does spurlings test evaluate

A

Cervical radiculopathy, or OA

167
Q

Faber test can evaluate what in the hip and spin e

A

Ankylosis spondylosis
Sacrolilitis
Iliopsoas strain

168
Q

What should you do a rectal exam as part of a well woman examination

A

If rextal S/s or if older than 50

169
Q

Where is the uterus if the cervix is anterior pointing

A

Retroverted

170
Q

Where is the uterus if the cervix is posterior pointing

A

Anterverted

171
Q

How should specimen retrival of a well woman exam be conducted if the pt is pregnant

A

If pregnant, use CTA moistened with saline, in place of endocervical brush and should be sterile!

172
Q

What is the most common cell type of cervical cancer

A

SCC> adenocarcinoma

173
Q

A hard granualr appearnace of the Os is a sigh of..

A

Cervical cancer

174
Q

WHat is the “adnexa”

A

Space occupied by the uterus, ovaries, and fallopian tubes

IPAP JUNIOR SEM. (43 decks)

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