QTR 2 Complete DO Exam 1: Abdominal and Female GU

Question 1

What is the appropriate order of inspection, palpation etc in the abdominal exam?

Answer 1

History, Inspect, Ascultate, Percussion, Palpation

Question 2

Define dyschezia.

Answer 2

Difficult or Painful Defecation

Question 3

Define Melena. What would this condition indicate?

Answer 3

Black, tarry stools, indicative of an upper GI bleed.

Question 4

Define hematochezia. What would this condition indicate?

Answer 4

red blood in the stool or rectum, indicative of a lower GI bleed.

Question 5

Describe what normal bowel sounds would sound like.

Answer 5

Usually gurgles and clicks, or boborygmi that indicates peristalsis. Absence of bowel sounds would indicate a problem. Also listen to the abdominal aorta for bruits

Question 6

A palpable spleen could indicate what?

Answer 6

Spleen is not usually palpable, so this would indicate splenomegaly, perhaps due to infection, autoimmune or immunodeficiency disease.

Question 7

What would a positive Lloyd’s Sign indicate?

Answer 7

remember this is essentially percussion over the kidney, as could indicate a kidney stone or nephritis of some type.

Question 8

Which screening technique should ALWAYS be included as part of the abdominal exam?

Answer 8

Digital Rectal Exam

Question 9

Where should you percuss to assess the size of the spleen?

Answer 9

At the anterior axillary line, somewhere around ribs 9-11. Normally you would not be able to percuss the spleen here, but in situations of splenomegaly you would potentially see a positive percussion test.

Question 10

Describe the Rovsing’s sign.

Answer 10

Palpation in the LLQ of a patient with appendicitis would elicit pain in the RLQ, due to a shift in abdominal visceral towards the parietal peritoneum on the Right.

Question 11

What would a positive test at McBurney’s Point indicate? Where is this palpation site?

Answer 11

It would indicate appendicitis, and is located 2/3 from the umbilicus to the ASIS. Note, this would only be positive in a more progressed appendicitis, once the peritoneum has become inflammed.

Question 12

What is the two question test?

Answer 12

Asking the patient with diffuse abdominal pain two questions: Where did you have pain when it first started, and where does it hurt now? A positive test will result in pain that was described as diffuse epigastric or periumbilical pain ( or around the T10 dermatome) that progresses to point tenderness in the RLQ (at about McBurney’s Point)

Question 13

A patient with somatic dysfunction in the T7-T9 paravertebral area, along with a positive Murphy’s Sign, is likely experiencing what?

Answer 13

Cholecystitis

Question 14

What are some useful GYN specific questions to include in history taking?

Answer 14

Menstrual History , FDLMP, Associated Sx such as pain with intercourse, lumps/masses in the breast, nipple discharge, STDs, Family Hx, Pap smears, sexual hx, parity (and # of live births)

Question 15

What is the mnemonic for assessing parity?

Answer 15

GTPAL (# of pregnancies, # term of pregnancies, number of preterm pregnancies, # of abortions/miscarriages, # of living children

Question 16

How do you calculate expected date of confinement?

Answer 16

aka a newborns due date = FDLMP + 1 year - 3months + 7 days

Question 17

The female breast lies between what landmarks?

Answer 17

The 2nd and 6th ribs and the sternal border and midaxillary line ( breast extends into the axilla)

Question 18

Small elevations surrounding the areola are formed by _____.

Answer 18

Glands of Montgomery (sebaceous glands)

Question 19

Normally with aging, what anatomical changes occur in the female breast?

Answer 19

decreased size, replacement of glandular tissue by fat, flabbier and may hang lower on the chest

Question 20

What is the normal pathway for lymphatic drainage from the breast?

Answer 20

from breast tissue to the pectoral nodes, axillary nodes, and then infraclavicular and supraclavicular nodes.

Question 21

What are some risk factors for BRCA in females?

Answer 21

age, hx of cancer in opposite breast or with 1st degree relative, early menarche, late parity or nulliparous, estrogen replacement therapy

Question 22

What physical findings would be red flags for BRCA?

Answer 22

Unilateral erythemamatous rash/ peau d’orange, irregular masses, unilateral nonmilky discharge from the nipple

Question 23

What are some considerations to address prior to a PAP exam?

Answer 23

empty the bladder, proper positioning and draping, explain the entire process, warm hands and speculum, and GET A CHAPERONE

Question 24

What tissues should you sample during a PAP smear?

Answer 24

endocervical and ectocervical tissue

Question 25

What test would you use to detect blood in the stool?

Answer 25

a Hemoccult Test

Question 26

Thinning/Atrophied external genitalia presenting with severe itching and resorption of the labia and clitoris would indicate what?

Answer 26

Lichen Sclerosis

Question 27

Patient presents with a hard palpable ulcer of the labia, with a positive HX of syphilis infection…what is your diagnosis?

Answer 27

Chancre

Question 28

Patient presents with intense pruritus (itching), erythmatous and edematous vagina and vulva, and a thick whitish discharge resembling cottage cheese. What is your diagnosis?

Answer 28

Candidiasis (Yeast Infection)

Question 29

Infection by this protozoan will cause pruritus along with a frothy, malodorous discharge. Also may present with strawberry cervix.

Answer 29

Trichomoniasis Infection : light microscopy will reveal small flagellated cells

Question 30

A patient comes to your clinic complaining of profuse vaginal discharge which has a foul, rotten fish odor ( ew.) . Light microscopy shows clue cells. What is your diagnosis?

Answer 30

Bacterial Vaginosis

Question 31

Patient presents for a regular yearly PAP smear, and also mentions she has had some post coital bleeding and problems urinating. During the PAP, you notice an unusually friable ectocervix with some bleeding. There is a small amount yellow-green mucopurulent discharge. During your bimanual exam, the patient lurches toward the ceiling reacting to pain produced by the exam (Chandelier Sign). What might be the dx?

Answer 31

Likely Chlamydia, with some pelvic inflammation… although Chlamydia can at times mimic Gonorrhea and may be completely asymptomatic .

Question 32

This is the most common STD in the US.

Answer 32

Chlamydia

Question 33

During a routine PAP examination you notice an unusual white, wart like growth near the external cervical os. You examine a bit further by spraying the area with an acetic acid (vinegar) wash, which results in a marked white condyloma. What is your dx?

Answer 33

Likely infection by the human papilloma virus with concomitant cervical condyloma - suggest HPV4 vaccination and regular screening

Question 34

99% of cervical polyps are _________.

Answer 34

Benign

Question 35

Pelvic Inflammatory disease usually follows what untreated infections?

Answer 35

Chlamydia and Gonorrhea

Question 36

A 61 y/o female visits your clinic for a wellness exam. She is post menopausal as of age 58, but notes some bloody vaginal discharge recently. What might you be concerned about?

Answer 36

Endometrial Cancer…. any postmenopausal female presenting with uterine/vaginal bleeding should be suspect of cancer until proven otherwise.

Question 37

A 28 year old sexually active female visits your clinic with pelvic pain. FDLMP was approximately 45 days ago. You note a unilateral palpable mass in the LLQ. What tests might you order, and what might be your dx?

Answer 37

Order an HCG…suspect ectopic pregnancy. Any female of childbearing age presenting with abdominal/ pelvic pain or menstrual changes should be screened for pregnancy

Question 38

A 48 year old female presents to your clinic for a usual wellness exam. During your bimanual exam you notice a solid, palpable mass in the RLQ just lateral to the uterus. Do you suggest further workup? what might you order, and what might the dx be?

Answer 38

Absoutely- female is not menopausal and presents with a solid ovarian mass (not soft like a cyst). Ultrasound would be a good screening, followed by potentially an ovarian biopsy. You should be concerned about ovarian cyst, or more likely cancer at this point.

Question 39

A 49 y/o Female visits your clinic noting acute epigastric pain which began rather suddenly 1 day ago. The patient has a BMI of 36, and is very sedentary. Her diet consists of mainly McDonald’s happy meals and butterscotch candies. What are your differentials? What futher screening might you do?

Answer 39

Probably thinking cholecystitis/ cholelithiasis ( she is Fat, Female, Over Forty, Fertile etc)… or perhaps GERD. Could check Murphy’s Sign and McBurney’s Point, history would also help R/O appendicitis. Also do hemoccult test to r/o GI bleeds etc. Maybe an endoscopy ?