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PCM > Physical Exam of Abd/ Motivational Interviewing/Male GU Exam > Flashcards

Physical Exam of Abd/ Motivational Interviewing/Male GU Exam Flashcards

1
Q

Dysphagia

A

Trouble swallowing

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2
Q

Hematemesis

A

Vomiting blood

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3
Q

Melana

A

Black stool

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4
Q

Visceral Pain

A

Colic pain - hollow organ caused by distention or stretching, crescendo/decrescendo pattern, not well localized

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5
Q

Parietal Pain

A

Caused by inflammation of the peritoneum, steady aching pain that is usually well localized

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6
Q

Referred Pain

A 
From a distant site:
Gallbladder: Right Shoulder 
Spleen: Left Shoulder 
Pancreas or Aorta: Back 
Kidney: Loin to groin
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7
Q

Components and order of the abdominal exam

A

Inspection, auscultation, percussion, palpation, rectal exam, special techniques

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8
Q

How far should you expose in the abd exam?

A

Form xiphoid to pubis

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9
Q

Where is the best place to auscultate the abd?

A

RLQ - best place to listen to cecum

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10
Q

What are normal bowel sounds?

A

High pitched tinkle

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11
Q

When do you report absent bowel sounds?

A

After no sounds for 2 min

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12
Q

Borborygmi

A

Increased hyperactive bowel sounds, low pitched rumbling, hyperperistalisis

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13
Q

Abdominal bruits and locations

A 
Soft sound made by disrupted arterial flow through a narrowed artery "hissing sound"
Aortic: btw umbilicus and xiphoid
Renal a.: Lateral to aorta 
Iliac: lateral to umbilicus 
Femoral a.: along inguinal ligament
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14
Q

Percussion evaluates the presence of

A

Gaseous distention, fluid, solid masses, size and location of liver and spleen

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15
Q

Tympany

A

Most common, indicates presence of gas in the stomach and small bowel

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16
Q

Liver Percussion

A

Right mid clavicular line - resonant (lungs) to dull (liver) to tympanic (intestine)

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17
Q

Normal/Abnormal Liver Size

A

Normal 10cm

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18
Q

Fluid wave and shifting dullness indicates

A

ascites

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19
Q

Describe fluid wave

A

Assistants hands placed midline - tap on one flank while palpating the other, easily palpable impulse suggests ascites

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20
Q

Describe shifting dullness

A

Percuss pt abd on their back and then on their side - note where the sound changes form tympany to dull and the shift of the sound when the pt turns on their side (organs move to top and fluid shifts to bottom)

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21
Q

Light palpation

A

Looks for tenderness and areas of muscular spasm or rigidity - use finger tips with gentle motion

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22
Q

Deep palpation

A

Evaluates organ size, abnormal masses, aorta, deep pain - one hand on the other

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23
Q

Rebound tenderness

A

Evaluates for peritoneal tenderness and inflammation - slowly gently and deeply palpate, if there is pain test is +, includes rovings sign

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24
Q

Roving’s sign

A

Referred rebound tenderness, press on the LLQ and release, positive if pain in the RLQ

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25
Q

Is the spleen palpated under normal conditions?

A

No

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26
Q

Palpation of Aorta - Normal Size

A

Normal aorta 2.5-3 cm wide

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27
Q

Aortic aneurysm

A

Pathologic dilation, can be associated with bruit, assessed with ultrasound and CT

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28
Q

Percussion of kidney - Lloyds Sign

A

At level TV12 - gently hit over costovertebral angle on either side of the spine - pain over the kidney indicates inflammatory or infectious process

29
Q

What if a pt FOBT is +?

A

Requires thorough evaluation for colorectal cancer (CRC). Preferable colonoscopy but sigmoidoscopy and air contrast barium enema are also acceptable

30
Q

Obturator sign

A

Place right leg in figure 4 - press the right knee while holding down the left hip

31
Q

What signs will be positive in appendicitis?

A

Rovings, Psoas, and Obturator

32
Q

What imaging test is most sensitive to appendicitis?

A

CT scan - 90-98% sensitive

33
Q

If you expect appendicitis in a female pt what MUST you do?

A

Perform a pregnancy test

34
Q

Acute cholecystitis

A

Obstruction of the cystic duct usually by a gallstone, sometimes a neoplasm

35
Q

What symptoms are indicative of acute cholecystitis? What sign is +?

A

Biliary colic pain, pain radiation to right shoulder
Fat, female, fertile, fair flatulent
Murphys sign

36
Q

What is the diagnostic triad for acute cholecystisis?

A

RUQ pain, fever and leukocytosis

37
Q

What is Murphys sign?

A

RUQ pain, sudden arrest of inspiration during palpation of the liver and GB

38
Q

What will lab tests of an acute cholecystisis pt reveal?

A

Leukocytosis with left shift, serum bilirubin may be mildly elevated, AST/ALT can be elevated, Ultrasound detects stones, thickening of GB wall, dilated bile duct and fluid, HIDA scan (radionuclide biliary scan)

39
Q

Role of Expert

A

Provide information in a manner pt can hear without feeling offensive, validates all perspectives, costs and benefits, then allows pt to make decision for themselves

40
Q

Why do people change behavior?

A

Because they decide it is what they want to do - benefits outweigh the costs

41
Q

What are the six stages of change?

A

Precotemplation, contemplation, preparation, action, maintenance, relapse

42
Q

Describe precontemplation

A

Pt not thinking about change, may be resigned to behavior, may have tried to change in the past but failed so gives up, denial, believes the consequences aren’t serious

43
Q

Describe contemplation

A

Pt weighing cost/benefits, ambivalence about change, giving up something enjoyable makes them feel a loss, barriers and benefits, I know I need to but

44
Q

Describe preparation

A

Experimenting with small change, prepare to make specific change, small dietary changes, brand of cigarettes, decrease in drinking

45
Q

Describe action

A

Taking definitive action, much praise necessary to maintain

46
Q

Describe maintenance

A

Maintaining over time, ongoing support and encouragement, continued appreciation of gains

47
Q

Describe relapse

A

Normal part of the process of change, pt usually feels demoralized, not starting back at zero, recognized continued attempts to try not focus on the sense of failure

48
Q

Define motivational interviewing

A

Directive, client centered counseling style for eliciting behavior change by helping clients explore and resolve ambivalence

49
Q

General principles of motivational interviewing

A

Express empathy - pt feels heard and validated, less defensive
Support self-efficacy - pt is in control of their lives
Roll with resistance
Develop discrepancy - change occurs when a pt wants to be someplace other than where they are

50
Q

Name 5 behaviors inclusive in motivational interviewing

A

Seeking to understand the persons frame of reference
Expressing affirmation and acceptance Exploring without prejudice pt options
Monitoring the pt readiness to change
Affirming the clients freedom of choice and self direction

51
Q

Is direct persuasion an effective method for resolving ambivalence?

A

No

52
Q

T/F Readiness to change is not a patient trait but a fluctuating product of interpersonal interaction

A

True

53
Q

Name and describe the 3 columns of vascular erectile tissue

A

Corpus spongiosum - contains the urethra

Corpora cavernoas - two bilateral

54
Q

tunica vaginalis

A

serous membrane covering the testes

55
Q

vas deferens

A

cordlike tube, transports sperm from epididymis to urethra

56
Q

Spermatic cord

A

Contains vas deferens, blood vessels, nerves, and muscle fibers

57
Q

Prostate lobe has how many lobes and where is prostate cancer most common?

A

5 lobes - anterior, posterior, middle and two later

Most common in posterior lobe

58
Q

Indirect hernia

A

Most common in men and women
Above the inguinal ligament
Often into the scrotum

59
Q

Direct hernia

A

Less common, usually in men, rare in women
Above the inguinal ligament
Rarely into the scrotum

60
Q

Femoral hernia

A

Least common but more common in men than women
Below inguinal ligament
Never into scrotum

61
Q

Components of the Male GU Exam

A

Penis, scrotum, hernias, prostate and special techniques

62
Q

Inspection of Penis involves

A

Skin, hair, foreskin, glans (tip) and meatus - compression of glans to check for discharge

63
Q

Describe the prostate gland

A

Bi-lobed, heart shaped, constancy of your nose, about the size of a walnut, inferior aspect of the posterior lobe is best palpated on a DRE

64
Q

Hypospadias

A

Congenital displacement of the urethral meatus on the inferior surface of the penis along the urethral groove - important in new born exam - also associate with congenital renal abnormalities

65
Q

Phimosis

A

Foreskin can’t retract over the penis, very painful in erection, hygiene issues - circumcise

66
Q

Paraphimosis

A

Foreskin cannot be retracted back over the glans - circumcise

67
Q

Hydrocele

A

Fluid filled mass within the tunica vaginalis - transilluminates with light

68
Q

Cryptorchidism

A

Undescended testicle, usually atrophies, increased risk for cancer

PCM (4 decks)

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