SCP 2 RE Flashcards
In a diabetic foot exam, you notice that one of the patient’s feet is a reddish/purple colour, and the other is their normal skin colour. What could this indicate?
Unilateral discolouration is a sign of acute iscaemia
Name some factors that contribute to the development of foot ulcers:
Sustained hyperglycaemia Angiopathy (peripheral vascular disease) Abnormal immunity Neuropathy and loss of sensation Foot deformity Skin atrophy- dryness/cracks in the skin Friction/footwear/calluses Trauma- mechanical, chemical, or thermal
“A break in the skin which is failing to heal”
ulcer
What does the acronym “SINBAD” stand for?
Site Ischaemia Neuropathy Bacterial infection Area Depth
Most common site of foot ulcers?
the forefoot
___________ is necrosis secondary to inadequate perfusion (can be wet or dry)
Gangrene
Erythema of the foot could be due to infection or acute ________
ischaemia
It’s important to remove dead tissue in foot ulcers in order to prevent _______
sepsis
One sign of chronic lack of blood perfusion in the lower extremities is _____ loss.
hair
Sudden onset unilateral warmth, redness and oedema over the foot/ankle, usually with a history of minor trauma
Charcot arthropathy
NB: 30% can present without pain or discomfort
__________ sounds should heard in a Doppler ultrasound of the lower extremity . As the disease progresses, only _________ sounds are heard.
Triphasic, monophasic
The ________ _______ pulse is palpable on the dorsum of the foot in the first intermetatarsal space just lateral to the extensor tendon of the great toe
dorsalis pedis
Where would you palpate the posterior tibialis pulse?
Behind the medial malleolus
Impaired sense of vibration and proprioception indicate an impairment in which area of the CNS?
the dorsal columns
What are the sites on the foot at highest risk of peripheral neuropathy?
Toes and heads of the metatarsals
What type of tool is used to test for peripheral neuropathy in the feet?
10g monofilament
Where should you place a tuning fork to test a patient’s sense of vibration?
Start by placing the tuning fork on the patient’s sternum to test whether they can feel it, then move it to the interphalangeal joint of the 1st hallux. Move to proximal bony prominences if they cannot feel vibration distally.
Which nerve root is associated with the “ankle jerk” reflex?
S1
What is one of the first nerve roots affected in diabetic neuropathy (due to its long length?)
S1
If someone has a “moderate” diabetic foot risk score, how often should they be screened, and by whom?
Annual screening by a podiatrist
If someone has a “high” diabetic foot risk score, how often should they be screened, and by whom?
Annual screening by a specialist podiatrist
What are the four components of a diabetic foot exam?
Inspection
Palpation
Sensation
Gait assessment
Difficulty rising from a chair could potentially be a sign of what endocrine condition?
hypothyroidism (proximal muscle weakness)
What is a major (lifestyle) risk factor for eye disease in Grave’s patients?
smoking
A rare complication of autoimmune thyroid disease that presents with digital clubbing and swelling of digits and toes is known as
thyroid acropachy
Oncholysis can be a sign of what endocrine condition?
Hyperthyroidism
How might a patient’s pulse be affected in underactive and overactive thyroid conditions?
Hypothyroid- bradycardia
Hyperthyroid- tachycardia and/or AF
Medical term for protrusion specific to the eyes
Exopthalmos
Name eye signs that could be seen in hyperthyroid (Graves disease) patients
Exopthalmos/proptosis Chemosis (conjunctival injection) Corneal inflammation Lid retraction Lid lag (with downward eye movement) Pain with eye movements Double vision
Inflammation of orbital tissue, retrobulbar pain, diplopia, lid-lag, chemosis, and proptosis/exopthalmos are signs of?
Thyroid eye disease.
NB: The higher the TSH receptor antibody levels, the more likely it is that the eyes are going to be affected
What are NOSPECS classification or EUGOGO activity scores used to determine?
How quickly a patient with signs of thyroid eye disease should be referred to an opthalmologist
What abnormality presents as a painless, firm, midline neck mass that elevates with swallowing and tongue protrusion?
A thyroglossal duct cyst
How would you differentiate a thyroglossal duct cyst from a thyroid nodule on physical exam?
While both thyroglossal duct cysts and thyroid nodules move up with swallowing, only the thyroglossal cyst moves up with tongue protrusion
“Retrosternal extension,” or dullness to percussion over the sternum, can be a sign of a
goitre
infiltrative skin condition caused by circulating Ab. (Can be caused by either TPO Ab or TSH receptor Ab)
Pre-tibial myxedema
What is the gold standard imaging technique used for assessing thyroid nodules?
Ultrasound +/- fine needle aspiration
Peau d’orange is a RED FLAG sign of?
Breast cancer
Name 6 important characteristics to note/document when palpating a breast lump
Location Size Shape Consistency Whether it is mobile Overlying skin (puckering, etc)
Which lymph nodes do breast cancers spread to first?
Axillary lymph nodes
What further imaging is recommended for women after finding a breast lump? Younger/older women?
Ultrasound for younger women
Mammogram for older women
List some of the circumstances in which patient data can be shared without their consent
- If there is concern about the safety of someone <18, or a vulnerable adult
- A contact is at risk of serious harm, where the patient has not informed them, and can’t be persuaded to do so
- An order is received from a judge or a court to disclose information
How are GUM clinic services different from general medical services?
Anonymous Self-referral Direct access Free Confidential
List some clinical features of female GU disease
Vaginal discharge Abnormal bleeding Abdominal pain/dyspareunia Dysuria Itching/soreness Ulceration (can be painful or painless) Lumps Systemic symptoms Can be asymptomatic
List some clinical features of male GU disease
Urethral discharge Testicular pain Dysuria Itching/soreness Ulceration (can be painful or painless) Lumps Systemic symptoms Can be asymptomatic
What are the “Three C’s” of an intimate examination?
Consent
Communication
Chaperone
Sexual symptom that can be experienced by men with diabetes or heart disease
erectile dysfunction, low libido
Cyst that can form within the vulva, which can become infected and swollen
Bartholin’s cyst
What is the most common type of speculum used for a female pelvic exam?
Cuscoe (bivalve) speculum
Mucous-filled cervical cyst
Nabothian cyst
red appearance to the centre part of the central cervix externally- often d/t hormonal changes, but it can happen when the glandular cells from inside the cervix come down onto the external part of the cervix
Ectropion
What would be the concern if a cervix appeared “macerated” and irregular when visualised during the speculum exam?
Cervical cancer
When would it be most appropriate to use a Sims speculum?
To assess for prolapse
What is another name for a prolapsed bladder?
Cystocele
In about 15% of women, the position of the uterus is
retroverted
How can adnexal masses be palpated in a bimanual examination?
With fingers pressed into the lateral fornices of the vagina, with other hand pressing on top of the lower abdomen
Describe the correct procedure for inserting a bivalve/Cuscoe speculum
Ensure correct size is used +/- lubricant/water
Gently part labia with left hand
Insert bivalve speculum, with blads vertical
Rotate 90 degrees so handles point anteriorly and blades are now horizontal
Slowly open blades to see cervix between them
If cervix cannot be seen, reinsert speculum at a more downward angle as cervix may be behind the posterior blade
Protrusions of bowel or fat through the musculature of the abdomen
hernias
Collection of fluid within the tunica vaginalis of the testicle
hydrocele
Dilation of the testicular veins within the spermatic cord
varicocele
What are the two attachment sites of the inguinal ligament?
the ASIS and pubic tubercles
Site of origin of an indirect inguinal hernia
Deep inguinal ring
This type of hernia does not pierce the posterior wall. The abdominal contents pass through the deep inguinal ring, passing through the inguinal canal and exiting via the superficial ring.
Indirect inguinal hernia
This type of hernia is caused by a weakness in the posterior wall of the inguinal canal. The abdominal contents (usually just fatty tissue, sometimes with bowel) are forced through this defect and enter the inguinal canal. This means that the contents emerge in the canal medial to the deep ring
Direct inguinal hernia
Bladder enlargement can be felt above the
symphysis pubis
Congenital hernia that can form if the two folds of tunica vaginalis fail to fuse
Patent process vaginalis (congenital hernia seen in children)
Which type of hernia is due to muscle weakness, and therefore occurs more commonly in older men?
Direct inguinal hernia
External spermatic fascia is derived from
external oblique muscles
Cremaster muscle is derived from
Internal oblique
Internal spermatic fascia is derived from
Transversalis fascia
Where does lymph from the testicles drain to?
The common iliac and para-aortic lymph nodes
Where does lymph from the penis, the scrotum, and lower limb drain into?
Superficial inguinal lymph nodes
What are three important landmarks to identify towards the beginning of a male pelvic exam?
ASIS’s
Pubic tubercles
Pubic symphysis
How can you differentiate between a solid testicular lump and a cystic testicular lump on physical examination?
cystic lumps will transilluminate
Scarring in the tunica albinguinea of the corpus cavernosum can indicate?
Peyronie’s disease
Varicoceles become more obvious to spot when patients are in what position?
standing
If the fingers can “get above” a testicular mass, this indicates
A scrotal swelling
If the fingers CANNOT “get above” a testicular mass, this indicates
Hernia
If a swelling feels separate from the testicle, the lesion is likely in the
Epidiymus
3 key questions for differentiating common scrotal pathologies:
Can you get above it?
Is it separate from the testicle?
Does it transilluminate (cystic or solid?)
Abrupt haemorrhage or infarction of the pituitary gland
Pituitary apoplexy (Sheehan’s syndrome)
complete loss of outer (peripheral) visual fields
bi-temporal hemianopia
Associated with lesions of the optic chiasm, such as tumours of the pituitary gland
