Quiz 3

Question 1

Specificity and Sensitivity

Answer 1

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?

Question 2

What kind of cells are obtained for adequate Pap Smear

Answer 2

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.

Question 3

Most common vaginitis— Bacterial vaginosis (BV)

Know the vaginitis

Answer 3

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.

Question 4

Pap criteria

Answer 4

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.

Question 5

What is smoking associated with?

Answer 5

Cervical Cancer

Question 6

21 year old non smoker got all 3 Gardasil shots, PAP show ASCUS, What do you do?

Answer 6

Recheck in one year

Question 7

ASCUS

Answer 7

Least problematic

Question 8

Which vaginitis has characteristic findings when introduced to KOH and saline

Answer 8

Candida with the spaghetti and meatballs. Scan potassium hydroxide (KOH) preparation for branching Hyphae of Candida.

Question 9

What are the findings for Trichomonas

Answer 9

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

Question 10

Bacterial Vaginosis finding on Microscopy

Answer 10

Clue cells.

Fishy odor after applying KOH(“whiff test”); vaginal secretions with pH> 4.5

Question 11

What is the primary purpose of the PAP

Answer 11

The pap smear is designed to detect cancer cells in the cervix and vagina.

Question 12

ASCUS
LSIL
HSIL

Answer 12

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.

Question 13

Endometrial CA sign

Answer 13

Post Menopausal bleeding. This is a red flag and an endometrial biopsy is warranted. Refer pt to GYN.

Question 14

Cervical CA risk

Answer 14

HPV, multiple sexual partners, smoking, early sexual debut, family Hx. (Being immunosuppressed also increases the risk of getting cervical CA)

Question 15

Testicular CA risk factor

Answer 15

Cryptorchidism (undescended testes), in late teens and young adults, family history

Question 16

First sign of syphilis

Answer 16

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

Question 17

Older men with dysuria

Answer 17

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.

Question 18

Risk of prostate CA

Answer 18

> 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.

Question 19

How do you obtain a GC/CL on a woman

Answer 19

Via swab of vaginal secretions

Question 20

Female with right lower quadrant pain

Answer 20

??? 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..

Question 21

Evaluating an inguinal hernia

Answer 21

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.

Question 22

Main causes of musculoskeletal issues

Answer 22

Injury

Question 23

Test for scoliosis

Answer 23

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.

Question 24

What type of injury is most frequently caused by inversion

Answer 24

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.

Question 25

Ottawa ankle rules

Answer 25

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 %

Question 26

Costochondritis

Answer 26

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.

Question 27

Phalen and Tinel tests are not positive tests for Carpal tunnel

Answer 27

Tinel and phalen signs do not reliably predict positive electrodiagnosis of carpal tunnel disease.

Question 28

Heberden and Bouchard’s nodes

Answer 28

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.

Question 29

Anterior cruciate ligament (ACL) tear

Answer 29

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.

Question 30

L3-L4 slipped disc findings

Answer 30

leads to decreased patella reflex

Question 31

Risk for osteoporosis

Answer 31

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

Question 32

What will help to decrease the symptoms of RA

Answer 32

Heat and decrease exercise???

Opt for low impact exercises such as yoga, biking and swimming which lets you work out without painful pounding.

Question 33

Intra-rater reliability

Answer 33

The same person gets the same results in a given test

Question 34

PSA

Answer 34

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

Question 35

Melanoma lesions that are suspicious

Answer 35

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

Question 36

Basal cell CA

Answer 36

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.

Question 37

Papule

Answer 37

<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

Question 38

Scabies

Answer 38

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.

Question 39

Seborrheic keratosis

Answer 39

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.

Question 40

Shingles

Answer 40

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.

Question 41

Varicocele,

Answer 41

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.

Question 42

Ballotment test

Answer 42

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.

Question 43

hydrocele

Answer 43

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.

Question 44

undescended testicles

Answer 44

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.

Question 45

epididymitis

Answer 45

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.

Question 46

Mc Murray test

Answer 46

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.

Question 47

Lachman test

Answer 47

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.

Question 48

Macule

Answer 48

<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

Question 49

vesicle

Answer 49

<1cm, superficially raised, filled with serous fluid
examples:
herpes simplex, herpes zoster, erythema multiforme, impetigo

Question 50

patch

Answer 50

> 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

Question 51

positive predictive value

Answer 51

the proportion of positive test results that are true positives (such as correct diagnoses)