Quiz 3 Flashcards
Specificity and Sensitivity
Sensitivity —- Test is the proportion of people that are know to have the disease and test positive for it
Specificity —- Relates to the tests ability to identify the negative results.
50:50 likelihood ratio is the same as 1?
What kind of cells are obtained for adequate Pap Smear
Endocervical and ectocervical
In addition to obtaining pap smear samples, cervical samples for gonorrhea and chlamydia should be obtained first. Then samples from the endocervix, cervix and vaginal pool. If the pt had a hysterectomy the samples from the vaginal cuff should be obtained.
Most common vaginitis— Bacterial vaginosis (BV)
Know the vaginitis
Most common types of vaginitis are: BV which results in overgrowth of one of several organism probably from anaerobic bacteria; might be transmitted sexually. Gray or white, thin homogeneous, malodorous, unpleasant fishy or musty genital odor.
Candidal Vaginitis: Yeast (normal overgrowth of vaginal flora) many factors predispose, including antibiotic therapy. White and curdy; may be thin but typically thick, not malodorous.
Trichomoniasis: a protozoan, often but not always acquired sexually. Yellowish green or gray; possibly frothy; often profuse and pooled in the vaginal fornix; may be malodorous.
Pap criteria
Paps should be done every 3 years beginning at age 21??. Although previous guidelines recommended that women have their first pap test 3 years after they started having sexual intercourse, waiting until 21 is now recommended because adolescents have a very low risk of cervical CA and a high likelihood that the cervical cell abnormalities will go away on their own.
What is smoking associated with?
Cervical Cancer
21 year old non smoker got all 3 Gardasil shots, PAP show ASCUS, What do you do?
Recheck in one year
ASCUS
Least problematic
Which vaginitis has characteristic findings when introduced to KOH and saline
Candida with the spaghetti and meatballs. Scan potassium hydroxide (KOH) preparation for branching Hyphae of Candida.
What are the findings for Trichomonas
Strawberry cervix, Dysuria, greenish-yellow discharge, possibly frothy; often profuse and pooled in the vaginal fornix; may be malodorous.
Male partners are usually asymptomatic but harbor organisms and they must be treated along with pt; intercourse should be avoided or condoms used until treatment is completed.
Other symptoms: Pruritus; pain on urination; dyspareunia
Bacterial Vaginosis finding on Microscopy
Clue cells.
Fishy odor after applying KOH(“whiff test”); vaginal secretions with pH> 4.5
What is the primary purpose of the PAP
The pap smear is designed to detect cancer cells in the cervix and vagina.
ASCUS
LSIL
HSIL
Atypical squamous cells of undetermined significance (ASCUS). A common cause of ASCUS pap smears are minor infections and cervical inflammation, it can cause cervical cells to appear abnormal but eventually return to normal appearance. There is no immediate cervical cancer risk with ASCUS
Low grade squamous intraepithelial lesion (LSIL). Mild or moderate dysplasia. It almost always indicates that an HPV infection is present, but may also indicate pre-cancer changes. LSIL is very common and usually goes away on it’s own without treatment.
High grade squamous intraepithelial lesion (HSIL) moderate to severe dysplasia, either CIN 3 or carcinoma in situ.
Endometrial CA sign
Post Menopausal bleeding. This is a red flag and an endometrial biopsy is warranted. Refer pt to GYN.
Cervical CA risk
HPV, multiple sexual partners, smoking, early sexual debut, family Hx. (Being immunosuppressed also increases the risk of getting cervical CA)
Testicular CA risk factor
Cryptorchidism (undescended testes), in late teens and young adults, family history
First sign of syphilis
Syphilis is commonly called the great imitator because the associated skin lesions can have a variety of presentations and appearances.
It is starts of as a painless ulcer/lesion Chancre.
The primary chancre lesion occurs anywhere from 10 to 90 days after exposure. It appears as a firm, indurated painless papule that erodes into an ulcer with raised or reddened borders. If primary infection is not treated, secondary syphilis develops. DX studies: Serum for VDRL
Older men with dysuria
Suspect Prostatitis
Prostatitis is an acute or chronic infection of the prostate gland.
S & Sx: commonly include fever, low back and perineal pain, urinary urgency and frequency, nocturia, dysuria and muscle and joint aches.
Risk of prostate CA
> age 50, family history, high fat diet.
Prostate CA is largely asymptomatic and is found as a result of screening for prostate cancer by digital rectal exam (DRE) and PSA.
How do you obtain a GC/CL on a woman
Via swab of vaginal secretions
Female with right lower quadrant pain
??? Ectopic pregnancy
Sx of an ectopic preganancy…..Vaginal bleeding, N/V lower abdominal pain, sharp abdominal cramps, pain on one side of the body, dizziness or weakness..
Evaluating an inguinal hernia
Have pt lay down. To examine for an inguinal hernia you need to follow the spermatic cord upward to the inguinal ligament. Find the triangular slitlike opening of the external inguinal ring. If you have difficulty locating the hernia, you should have the pt lie down.
Main causes of musculoskeletal issues
Injury
Test for scoliosis
Make sure the child bends forward with the knees straight (Adams’ bend test). If scoliosis is detected a scoliometer is used to test for the degree of scoliosis. This mostly seen in girls and is usually detected in early adolescence.
What type of injury is most frequently caused by inversion
Ankle sprain.
Sprains are the most common of all ankle injuries. Most ankle sprains involve the lateral ligament complex and are caused by forceful inversion and plantar flexion.
Ottawa ankle rules
Order film if on of the following is met:
Inability to bear wt for four steps (both immediately and in emergency department)
Bone tenderness at posterior edge or tip of either malleolus
Sensitivity = 100%
Specificity = 79 %
Costochondritis
Pain at the costosternal cartilage site. It can follow trauma to the chest wall but the cause is often not identifiable. The symptoms may follow a period of coughing or exercising.
S & Sx: Pt may report pleuritic pain that is affected by breathing or chest motion. The site of tenderness is limited and the pain is reproducible with firm pressure to the site.
No diagnostic studies are warranted.
EXAMINE THE RIBS AND STERNUM.
Phalen and Tinel tests are not positive tests for Carpal tunnel
Tinel and phalen signs do not reliably predict positive electrodiagnosis of carpal tunnel disease.
Heberden and Bouchard’s nodes
Heberden’s nodes are had or bony swellings that can develop in the distal interphalangeal joints (DIP), the joints closest to the end of the fingers and toes, they are a sign of osteoarthritis.
Bouchard’s nodes are hard bony outgrowths on the proximal interphalangeal joints (PIP) seen in osteoarthritis.
Palpation of the medial and lateral aspects of the joints checking for swelling, bogginess, bony enlargement or tenderness.
Anterior cruciate ligament (ACL) tear
ACL injury is identified through a positive drawer test. ACL is typically injury occurs deceleration combined with sudden turning or pivoting. Often pts recall hearing or feeling a “pop” at the time of injury.
L3-L4 slipped disc findings
leads to decreased patella reflex
Risk for osteoporosis
Decreased estrogen, small stature, immobility.
Osteoporosis is a major threat to the U.S public health. It can occur at any age. It is a skeletal disorder characterized by compromised by bone strength predisposing a person to an increased risk of fracture.
Risk factors include: Postmenopausal status in white women, age older than 50 yrs, weight les than 70 Kg, family hx of fx in a first degree relative,, hx of fx, higher intakes of alcohol, women with delayed menarche or early menopause, current smokers, low levels of vit D, use of corticosteroids for more than 2 months, inflammatory disorders of the musculosketal, pulmonary or GI system
What will help to decrease the symptoms of RA
Heat and decrease exercise???
Opt for low impact exercises such as yoga, biking and swimming which lets you work out without painful pounding.
Intra-rater reliability
The same person gets the same results in a given test
PSA
Controversial. Doing a PSA does not identify aggressive CA.
For men with symptoms of prostate disorders, the clinicians role is more straightforward. Review the symptoms of prostate disorder—incomplete emptying of the bladder, urinary frequency, weak or intermittent stream or straining to initiate flow, hematuria, nocturia or even bony pains in the pelvis
Melanoma lesions that are suspicious
Irregular borders, change in size, asymmetry, variation in color.
Risk factors for melanoma: History of previous melanoma, Age over 50, Regular dermatologist absent, mole changing, male gender.
ABCD of examining moles;
A: asymmetry of one side of mole compared to the other
B: irregular borders, especially ragged, notched, or blurred
C:Variation or change in color, especially blue or black
D: diameter greater 6mm or different from others, especially if changing or itching or bleeding
Basal cell CA
Raised, dimpled (indented), fleshy, shinny.
Basal cell CA, arising in the lowest or basal level of the epidermis, accounts for approx. 80% of skin cancers. They arise from sun-exposed areas usually on the head and neck. They are pearly white, translucent, tend to grow slowly, though malignant, rarely metastasize. It can however become quite destructive and invasive if not diagnosed and treated in a timely fashion.
Papule
<1cm in diameter, raised, palpable, firm
Examples:
flesh, white, or yellow: flat wart, milium, sebaceious hyperplasia, skin tag
blue: venous lake, llichen planus, melanoma
brown: seborrheic keratosis, melanoma, dermatofibroma, nevie
red: acne, cherry angioma, early folliculitis
Scabies
Scabies is highly contagious the mite sarcoptes scabiei is responsible for this condition. After the mite mates on the skin surface, the female burrow beneath the skin and the infected person develops a delayed sensitivity reaction to the mite, larvae and fecal material.
S & Sx: Pt complains of intense pruritus, often worst at night. Frequently a hx of similar symptoms in other family members or contacts. The lesions appear as small red papules, which often form vesicles, erode, and crust. The hands, finger webs, wrists, axillae and pubic areas are commonly involved.
Seborrheic keratosis
Common, benign, yellowish to brown raised lesions that feel slightly greasy and velvety or warty and have a “stuck on” appearance. Typically multiple and symmetrically distributed on the trunk of older people, but may also appear on the face and elsewhere such as in sun-exposed areas. In black people, often younger women may appear as small, deeply pigmented papules on the cheeks and temples. The cause is unknown.
Shingles
Pain before the rash occurs.
The skin lesions associated with herpes zoster are usually preceded by a period of regional neuralgia and discomfort as well as a period of malaise. Skin lesions appear as reddened macules, which later develop as clusters of vesicles and then ulcerate, crusting over. The distribution lies along a dermatome and is typically unilateral.
Diagnostic studies: Tzanck smear taken from the base of a vesicle is positive.
Varicocele,
a palpable or visible dilation of the vessels of the pampiniform plexus in the scrotum (varicose veins of the scrotum), retrograde reflux of blood in the internal spermatic vein dilates the pampiniform plexus. Most common on the left. Etiology remains unclear and there are no specific risk factors. Most are symptomatic but patient maycomplain of a dull ache, fullness, pain that does not radiate or pulling to the affected side. If large it may be visible on inspection, like a “bag of worms” which dissapates on elevation of the testicle. May cause infertility, can be surgically corrected.
Ballotment test
Patellar ballottement can be performed by compressing the patella posteriorly and releasing quickly, observing for rapid rebound indicating increased fluid pressure. Compressing the suprapatellar pouch can also help assess for increased knee effusion. If a click is heard during ballottment, a large effusion is present.
hydrocele
a collection of fluid between the layers of the tunica vaginalis which surrounds the testicle, or fluid along the spermatic cord (primarily water with some albumin). Often occurs unilaterally but can be bilateral, and it’s origin is idiopathic in adult males. Usually not painful, frequently present as a unilateral swelling of the scrotum that may extend into the inguinal canal. May be associated with heaviness or discomfort. A hydrocele can be confirmed with transillumination. May be surgically corrected.
undescended testicles
Cryptochordism, congenital condition, atrophied testis may lie in the inguinal canal or abdomen resulting in an unfilled scrotum. may descend by 6 months, surgically correct if not by one year. A risk factor for testicular cancer.
epididymitis
Inflammation of the epididymis cuased by spread of infection from the bladder or urethra. Uncircumcised men, indwelling catheters,BPH, recent GU instrumentation, or prostatic surgery are a risk factor. Gonorrhea and Chlamydia are often causative agents in young heterosexual men. Can progress to absess or chronic infection if untreated. usually 24-48 hr onset of painful swelling in the scrotum. Pain may descrease with elevation of scrotum (Prehn’s sign). May be associated urethral discharge, fever, urethritis, cystitis or prostatitis. pain may radiate to the inguinal canal and/or flank.
Mc Murray test
If a click is felt or heard at the joint line during flexion and extension of the knee, or if tenderness is noted along the joint line, further assiss the meniscus for a posterior tear. The medial meniscus is tested with the hip flexed and the knee externally rotated as the examiner moves the knee from full flexion to extension. To test the lateral mieiscus, the knee is internally rotated during the procedure. A snap heard heard or flet during this maneuver suggests a tear of the tested meniscus.
Lachman test
place the knee in 15 degrees flexion and external rotation. grasp the distal femur with one hand and the upper tibia with the other. With the thumb of the tibial hand on the joint line, simultaneously move the tibia forward and the femur back. Estimate the degree of forward excursion. Significant forward excursion indicates an ACL tear.
Macule
<1cm in diameter, flat, non palpable, circumcribed, discolored
Examples:
brown: freckle, junctional nevus, lentigo, melasma,
blue:mongolian spot, ochronosis
red: drug eruption, viral xanthema, 2nd syphilis
hypopigmented: vitiligo, idiopathic guttate hypomelanosis
vesicle
<1cm, superficially raised, filled with serous fluid
examples:
herpes simplex, herpes zoster, erythema multiforme, impetigo
patch
> 1cm in diameter, flat, non palpable, irregular shape, discolored
Examples:
Brown: large freckle, juntional nevus, lentigo, melasma
blue: mongolian spot, ochronosis
red: drug eruption, viral xanthema, 2nd syphilis
hyperogmented: vitiligo, idiopathic guttate hypomelasma
positive predictive value
the proportion of positive test results that are true positives (such as correct diagnoses)
