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Health Assessment > Test 3 part 2 > Flashcards

Test 3 part 2 Flashcards

1
Q

framework for musculoskeletal diagnosis first question

A

Is it musculoskeletal, secondary to systemic disease or secondary to visceral disease?

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2
Q

framework for musculoskeletal diagnosis

musculoskeletal structure breakdown

A

is it
Nonspecific (mechanical) back pain

Specific musculoskeletal back pain: clear relationship between anatomic abnormalities and symptoms

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3
Q

framework for musculoskeletal diagnosis

musculoskeletal structure breakdown

Specific musculoskeletal back pain
what falls here?

A

Lumbar radiculopathy due to herniated disk, osteophyte, facet hypertrophy, or neuroforaminal narrowing

Spinal stenosis

Cauda equina syndrome

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4
Q

framework for musculoskeletal diagnosis
under back pain due to systemic disease affecting the spine

falls into 2 big categories

A

Serious and emergent (requires specific and rapid treatment)

Serious but nonemergent (requires specific treatment but not urgently

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5
Q

framework for musculoskeletal diagnosis
under back pain due to systemic disease affecting the spine

Serious and emergent (requires specific and rapid treatment)

A

Neoplasia

Plasma cell myeloma (formerly multiple myeloma), metastatic carcinoma, lymphoma, leukemia

Spinal cord tumors, primary vertebral tumors

Infection

Osteomyelitis

Septic diskitis

Paraspinal abscess

Epidural abscess

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6
Q

framework for musculoskeletal diagnosis
under back pain due to systemic disease affecting the spine

Serious but nonemergent (requires specific treatment but not urgently)

A

Osteoporotic compression fracture

Inflammatory arthritis

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7
Q

framework for musculoskeletal diagnosis

under back pain due to Back pain due to visceral disease (serious, requires specific and rapid diagnosis and treatment)

A

Retroperitoneal

Aortic aneurysm

Retroperitoneal adenopathy or mass

Pelvic

Prostatitis

Endometriosis

Pelvic inflammatory disease

Renal

Nephrolithiasis

Pyelonephritis

Perinephric abscess

Gastrointestinal (GI)

Pancreatitis

Cholecystitis

Penetrating ulcer

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8
Q

Framework Big categories for arthritis

A

Monoarticular

polyarticular

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9
Q

Under Framework Big categories for arthritis

monoarticular

A

Inflammatory

Noninflammatory

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10
Q

Under Framework Big categories for arthritis

monoarticular
Inflammatory

A

Infectious

Crystalline

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11
Q

Under Framework Big categories for arthritis

monoarticular
Inflammatory
infectious

A

Nongonococcal septic arthritis

Gonococcal arthritis

Lyme disease

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12
Q

Under Framework Big categories for arthritis

monoarticular
Inflammatory
Crystalline

A

Monosodium urate (gout)

Calcium pyrophosphate dihydrate deposition disease (CPPD or pseudogout)

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13
Q

Under Framework Big categories for arthritis

monoarticular
NonInflammatory

A

Osteoarthritis (OA)

Traumatic

Avascular necrosis

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14
Q

Under Framework Big categories for arthritis

Polyarticular arthritis
Inflammatory

A

Rheumatologic

Infectious

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15
Q

Under Framework Big categories for arthritis

Polyarticular arthritis
Inflammatory
Rheumatologic

A

Rheumatoid arthritis (RA)

Systemic lupus erythematosus (SLE)

Psoriatic arthritis

Other rheumatic diseases

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16
Q

Under Framework Big categories for arthritis

Polyarticular arthritis
Inflammatory
infectious

A

Bacterial
viral
Postinfectious

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17
Q

Under Framework Big categories for arthritis

Polyarticular arthritis
Inflammatory
infectious
Bacterial

A

Bacterial endocarditis

Lyme disease

Gonococcal arthritis

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18
Q

Under Framework Big categories for arthritis

Polyarticular arthritis
Inflammatory
infectious
Viral

A

Rubella

Hepatitis B

HIV

Parvovirus

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19
Q

Under Framework Big categories for arthritis

Polyarticular arthritis
Inflammatory
infectious
Postinfectious

A

Enteric

Urogenital

Rheumatic fever

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20
Q

Under Framework Big categories for arthritis

Polyarticular arthritis
nonInflammatory

A

OA

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21
Q

tinel test

A

Carpal tunnel

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22
Q

painful arc test

A

rotator cuff

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23
Q

In young children, failure to spontaneously move an arm or leg can be a sign of

A

pseudoparalysis

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24
Q

Report of night pain by an adolescent is a

A

red flag for intraosseous pain of a bone tumor

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25
Q

Severe hip pain that develops over 1-4 days is typical of

A

osteomyelitis or septic arthritis in children and is an emergency condition

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26
Q

Neonates may not have a fever, but will refuse to feed

A

septic hip

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27
Q

Common in adolescent males
Painful swelling of the anterior aspect of the tibial tubercle
Caused by strenuous activity, esp. Of the quadriceps

A

Osgood Schlater Disease

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28
Q

causes of emergent lower extremity pain

A

compartment syndrome

cauda equina syndrome

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29
Q

_____ weakness causes difficulty in climbing stairs

A

Quadriceps

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30
Q

Pain and limping in children

A

may be incorrectly attributed to trauma instead of a more serious problem such as neoplastic tumors or bone infections

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31
Q

ducklike gait that reflects unilateral weakness of the gluteus medius muscle

A

Trendelenburg gait

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32
Q

an acute one sided limp because the pt takes quick soft steps to shorten the period of weight bearing on the involved extremity.

A

antalgic gait

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33
Q

circular outward swing of the leg and external rotation of the foot that requires less ankle movement. seen with pathology of the foot or ankle

A

circumduction gait

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34
Q

Certain antibiotics can cause _____ in children which produces joint pain and fever

A

Certain antibiotics can cause serum sickness in children which produces joint pain and fever

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35
Q

if a child walks without difficulty with shoes off, what is the problem

A

shoes are the problem. Inadequate shoe width is a common source of foot pain in children

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36
Q

lies with the thigh in a position of flexion, abduction or external rotation and cries when lower limb is moved

A

septic hip

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37
Q

Vague, nebulous discomfort in the front of the thighs, calves and behind the knees located outside of the joints in a child may indicate

A

growing pains

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38
Q

Pain in children __-__ may appear in rapid growth

A

Pain in children 6-12 may appear in rapid growth

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39
Q

In children, ligaments and joint capsules are 2-5x stronger than the epiphysis, _______ are more common than sprains

A

growth plate injuries

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40
Q

Asymmetric gluteal folds may indicate a

A

congenital dislocated hip

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41
Q

dysuria framework big categories

A

Skin: rash causing irritation with urination

Urethra

Male genital structures

female genital structures

bladder

kidney

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42
Q

dysuria framework big categories

skin

A

Herpes simplex

Irritant contact dermatitis

Syphilitic chancre

Erosive lichen planus

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43
Q

dysuria framework big categories

Urethra (urethritis from STI)

A

Gonorrhea

Chlamydia

Trichomoniasis

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44
Q

dysuria framework big categories

Male genital structures

A

1) Epididymis: epididymitis
2) Testes: orchitis
3) Prostate

A) BPH

B) Acute prostatitis

C) Chronic prostatitis

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45
Q

dysuria framework big categories

female genital structures

A

1)Vagina

A) Trichomoniasis

B) Bacterial vaginosis

C) Candidal infections

D) Atrophic vaginitis

2) Uterine/bladder prolapse
3) Cervix

A) Neisseria gonorrhoeae infection

B) Chlamydia trachomatis infection

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46
Q

dysuria framework big categories

Bladder

A

1) Acute cystitis

A) Uncomplicated (healthy women with no urinary tract abnormality)

B) Complicated (patients with any of the following: urinary obstruction; pregnancy; neurogenic bladder; concurrent kidney stone; immunosuppression; indwelling urinary catheter; male sex; systemic infection, such as bacteremia or sepsis)

2) Interstitial cystitis
3) Bladder cancer (with hematuria)

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47
Q

dysuria framework big categories

Kidney

A

Pyelonephritis

Renal cancer (with hematuria)

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48
Q

Dysuria or suprapubic pain or both with or without hematuria, frequency, urgency

A

Uncomplicated cystitis

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49
Q

Dysuria with vaginal irritation and discharge

A

Vaginitis

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50
Q

Fever, chills, nausea or vomiting, flank pain, CVA tenderness

A

Pyelonephritis

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51
Q

test for uncomplicated cystitis

A

Urine dipstick or urinalysis

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52
Q

test for Vaginitis

A

Pelvic exam with discharge examination by saline wet mount, whiff test, and KOH wet mount

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53
Q

test for Pyelonephritis

A

Urine dipstick or urinalysis

Urine culture

CT scan or ultrasound (if concern for obstruction or lack of clinical response)

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54
Q

Dysuria, urinary frequency, pain radiating to the low back, rectum or perineum

Malaise, fevers, chills, hesitancy

A

Acute prostatitis

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55
Q

Dysuria without radiation or flank pain

A

Complicated cystitis

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56
Q

Dysuria, penile discharge, pain with intercourse, testicular pain

A

Urethritis from STI

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57
Q

Signs of cystitis accompanied with hypotension, fever, lethargy, confusion, orthostasis, and SIRS

A

Urosepsis

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58
Q

Fever, chills, nausea or vomiting, flank pain, CVA tenderness

A

Pyelonephritis

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59
Q

test for Acute prostatitis

A

Digital rectal exam with gentle prostate exam

Urinalysis

Urine culture

Urine GC PCR

Basic metabolic panel

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60
Q

test for Urethritis from STI

A

Examination for penile discharge

Urine GC PCR

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61
Q

test for urosepsis

A

Complete blood count

Urinalysis

Urine culture

SIRS criteria

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62
Q

presents with dysuria, low back pain, perineal pain or ejaculatory pain with fever, chills, and myalgias. Patients often have associated urinary symptoms including frequency, urgency, or obstruction.

A

Acute prostatitis

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63
Q

an infection of the prostate gland that occurs from an ascending urethral infection or through reflux of infected urine into the prostate through the ejaculatory or prostatic ducts.

A

Acute prostatitis

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64
Q

Acute prostatitis Frequent pathogens include

A

gram-negative coliform bacteria, E coli, Klebsiella, Proteus, enterococci, and Pseudomonas.

Sexually transmitted bacteria, such as Gonorrhea and Chlamydia, may also be the cause

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65
Q

low back pain, dysuria, and perineal pain, the disease may also present with nonspecific symptoms such as myalgias, malaise, or nausea and vomiting. Patients may also present with obstructive symptoms, such as, hesitancy, incomplete voiding, and weak stream.

A

Acute prostatitis

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66
Q

On physical exam, the prostate gland may be tender, warm, swollen, or firm.

A

Acute prostatitis

No rectal exam or prostate exam- can worsen infection

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67
Q

in acute prostatitis Urinalysis will show

A

consistent with cystitis (eg, leukocyte esterase, nitrites, or white blood cells)

May also be normal

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68
Q

presents with dysuria or suprapubic pain or both. Often, there is associated urinary frequency, urgency, or hematuria. There is usually no penile or vaginal discharge, CVA tenderness, nausea, vomiting, or fever.

A

Cystitis

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69
Q

cystitis

Most common bacterial pathogens include

A

Gram negatives: Escherichia coli (75–95%), Klebsiella pneumoniae, and Proteus mirabilis

Gram positives: Staphylococcus saprophyticus, Enterococcus faecalis, and group B streptococcus

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70
Q

Risk factors for cystitis

A

Sexual intercourse

Use of spermicides

Previous UTI

A new sexual partner in the past year

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71
Q

Cystitis in the elderly

A

Delirium, functional decline, or acute confusion may be the presenting symptoms of cystitis in elderly patients.

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72
Q

urinalysis findings suggestive of cystitis

A

Leukocyte esterase is an enzyme released by leukocytes and signifies pyuria. LR+ 12.3–48

The presence of nitrites indicates the presence of bacteria that convert urinary nitrates to nitrites.

White blood cells on urine microscopy (> 5 per high powered field)

Hematuria demonstrated by positive blood on dipstick or red blood cells (RBCs) on microscopy

Table 16-2 shows the sensitivity, specificity, and likelihood ratios of urinalysis and microscopy findings.

The negative likelihood ratio of leukocyte esterase and urine nitrite is only 0.3; the absence of these findings does not rule out cystitis.

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73
Q

Symptomatic premenopausal women should be or should not be treated despite negative midstream urine cultures.

A

should be

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74
Q

The diagnosis of cystitis should or should not be ruled out by a urinalysis that is negative for both leukocyte esterase and nitrites in the presence of a convincing clinical presentation.

A

should not be

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75
Q

typically presents with dysuria and flank or back pain, fever, chills, malaise, nausea and vomiting.

A

Pyelonephritis

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76
Q

an infection affecting the parenchyma of the kidney.

A

Pyelonephritis

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77
Q

Complicated pyelonephritis is present if the patient is

A

Male

Pregnant

Immunosuppressed

Has urinary obstruction, nephrolithiasis, foreign-body/catheters, or kidney dysfunction

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78
Q

CVA tenderness on physical exam suggests

A

pyelonephritis but is actually nondiagnostic

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79
Q

pyelonephritis

indications for admission

A

Unstable vital signs

Inability to tolerate oral medications

Concern for nonadherence

Pregnancy

Immunocompromised state

Concern for urinary tract obstruction or nephrolithiasis

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80
Q

presents with dysuria, urethral pruritus, and penile discharge. Patients may also have dyspareunia, abdominal pain, or testicular pain

A

Urethritis

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81
Q

cervicitis typically have cervical discharge, dysuria, and dyspareunia. They may also have spontaneous or postcoital vaginal bleeding.

A

Urethritis

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82
Q

Urethritis and cervicitis are usually due to

A

STI
usually
N gonorrhoeae and C trachomatis.

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83
Q

STIs that can cause Urethritis and cervicitis

A

N gonorrhoeae and C trachomatis.
Mycoplasma genitalium

Trichomonas

Herpes simplex virus (may also cause cervicitis)

Adenovirus

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84
Q

In a man with dysuria,_____ is often warranted.

A

In a man with dysuria, STI testing is often warranted.

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85
Q

Cervicitis can be diagnosed by

A

identifying mucopurulent endocervical discharge on pelvic exam. Sustained cervical bleeding caused by gentle passage of a swab in the cervical os may also be seen.

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86
Q

presents with fever, chills, hypotension, and lethargy or altered mental status. Symptoms of the underlying infection, such as dysuria or flank pain, are often present.

A

Urosepsis

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87
Q

presents with abnormal vaginal discharge, odor, irritation, itching, dysuria, or dyspareunia.

A

Vaginitis

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88
Q

Common infectious causes of vaginitis are

A

bacterial vaginosis, trichomoniasis, and candidiasis.

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89
Q

Bacterial vaginosis occurs when the normal flora of the vagina is replaced with

A

anaerobic bacteria most commonly, Gardnerella vaginalis.

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90
Q

Trichomoniasis is an STI caused by the

A

flagellated protozoan, Trichomonas vaginalis. It can also infect men, causing urethritis or silent infection.

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91
Q

Often occurs with changes in the vaginal environment such as high estrogen states (menses, pregnancy), antibiotic use, immunosuppression, or poorly controlled diabetes.

A

Vaginitis category

Vulvovaginal candidiasis

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92
Q

Caused by estrogen deficiency (most often postmenopausal) and results in thin, dry vaginal mucosa

A

Atrophic vaginitis

93
Q

pH > 4.5

A

Bacterial vaginosis

94
Q

Clue cells > 20% on wet mount

A

bacterial vaginosis

95
Q

Leukocytes >epithelial cells

A

Trichomonas

96
Q

Point of care DNA hybridization probe

A

Bacterial vaginosis

trichomonas

Candidiasis

97
Q

At least 3 of 4 amsel criteria

A

Bacterial vaginosis

98
Q

NAAT

A

Trichomonas

99
Q

rapid POC antigen vaginal test

A

trichomonas

100
Q

Male- testes, scrotum, and penis are the same size and shape as in a young child. No growth in pubic hair
Female- only the nipple is raised above the level of the breast, as in the child. No growth of a pubic hair.

A

Tanner 1

101
Q

Male-enlargement of the penis, especially in length, further enlargement of testes; descent of scrotum. Dark, definitely pigmented, curly pubic hair around the base of penis.
Female- budding stage; bud-shaped elevation of the areola; areola increased in diameter and surrounding area slightly elevated. Initial, scarcely pigmented straight hair, especially along the medial border of the labia.

A

tanner 2

102
Q

Male- enlargement of the penis, especially in length, further enlargement of testes; descent of scrotum. Dark, definitely pigmented, curly pubic hair around the base of penis.
Female- breast and areola enlarged. No contour separation. Sparse, dark, visibly pigmented, curly pubic hair on labia.

A

tanner 3

103
Q

Male- continued enlargement of penis and sculpturing of the glans, increased pigmentation of scrotum. “Not quite adult” Pubic hair definitely adult in type but not in extent (no further than inguinal fold)
Female- Increasing fat deposits. The areola forms a secondary elevation above that of the breast. This secondary mound occurs in app. Half of all girls and some cases, persist into adulthood. Hair coarse and curly, abundant but less than adult.

A

tanner 4

104
Q

Male- Scrotum ample, penis reaching nearly to bottom of scrotum. Hair spread to medial surface of thighs but not upward
Female- the areola is usually part of general breast contour and is strongly pigmented. Nipple projects. Lateral spreading; type and triangle spread of adult hair to medial surface of thighs.

A

tanner 5

105
Q

Male- hair spread along linea alba (occurs in 80% of men)

Further extension laterally, upward, or dispersed (occurs in 10% of women)

A

tanner 6

106
Q

microscopic hematuria with negative culture

check

A 
BP
BUN
Creatinine
Urine protein
Red cell casts
107
Q

normal GFR

A

> = 60

108
Q

Painless hematuria sometimes with blood clots

Smoking history

Male sex

Toxin exposure

Age over 40

A

Bladder cancer

109
Q

test for Bladder cancer

A

Cystoscopy

Urine cytology

CT urogram

110
Q

hematuria, bladder pain

flank/abdominal pain, renal colic

A

stone disease

111
Q

test for stones

A

Bladder : Noncontrast CT

Cystoscopy

Ureter or kidney: Non contrast CT

112
Q

Urgency frequency, nocturia, urge incontinence, stress incontinence, hesitancy, poor flow, straining, dysuria

A

Benign prostatic hypertrophy

113
Q

test for BPH

A

rectal exam

114
Q

Abdominal pain, recent/concurrent urinary tract infection, fever, chills, urinary retention, recent prostate biopsy

A

Prostatitis

115
Q

must not miss

hematuria

A

Prostate cancer

116
Q

test for prostate cancer

A

Rectal exam

Prostate-specific antigen

117
Q

must not miss
Hematuria

Flank pain

Abdominal mass

A

Renal cell carcinoma

118
Q

imaging for Renal cell carcinoma

A

CT scan

119
Q

Episodes of gross hematuria (tea-colored urine) that coincide with respiratory infections

A

IgA nephropathy

120
Q

test for IgA nephropathy

A

Urinalysis with microscopy

Serum creatinine

Renal biopsy

121
Q

Family history of hematuria without history of chronic kidney disease

A

Thin basement membrane nephropathy

122
Q

test for Thin basement membrane nephropathy

A

Urinalysis with microscopy

Serum creatinine

Renal biopsy

123
Q

Antecedent group

A streptococcal pharyngitis 1–3 weeks prior to episode of gross hematuria, often with high BP and edema

A

Infection-related glomerulonephritis

124
Q

test for Infection-related glomerulonephritis

A

Urinalysis with microscopy

Serum creatinine

Antibodies to streptococcal antigens

Serum complement levels

125
Q

Hematuria with strong family history of progressive renal disease and sensorineural hearing loss

A

Alport syndrome

126
Q

test for Alport syndrome

A

Urinalysis with microscopy

Serum creatinine

Family history

Renal biopsy

127
Q

presents as painless visible (gross) hematuria in an older male smoker. However, episodes of gross hematuria may be intermittent, and thus asymptomatic nonvisible (microscopic) hematuria may be the only sign for some patients. If present, symptoms may include dysuria or obstructive symptoms.

A

Bladder Cancer

128
Q

what gender and race is bladder cancer most prevalent

A

white male

129
Q

Occupations associated with a higher risk of ____ include miners, bus drivers, rubber workers, motor mechanics, leather workers, blacksmiths, machine setters, hairdressers, and mechanics.

A

Occupations associated with a higher risk of bladder cancer include miners, bus drivers, rubber workers, motor mechanics, leather workers, blacksmiths, machine setters, hairdressers, and mechanics.

130
Q

______ cancer is a must not miss diagnosis in patients with gross hematuria not due to an infection.

A

Urothelial

131
Q

useful for detecting carcinoma in situ.

A

Hexaminolevulinate fluorescence cystoscopy

132
Q

patients aged 40 years or older, or with visible urinary blood clots, require _____ even if the bleeding is glomerular.

A

cystoscopy

133
Q

what is the gold standard for diagnosing bladder cancer

A

white light flexible cystoscopy

134
Q

most commonly presents with visible hematuria within 12–72 hours of a mucosal (typically an upper respiratory) infection. It can also be discovered upon detection of asymptomatic, non-visible hematuria with or without proteinuria during routine medical screening.

A

IgA Nephropathy

135
Q

most common cause of primary glomerulonephritis worldwide.

A

IgA Nephropathy

136
Q

IgA Nephropathy Occurs with greatest frequency in

A

Asians and whites.

137
Q

IgA Nephropathy A definitive diagnosis can only be made by

A

renal biopsy with immunofluorescence or immunoperoxidase studies for IgA deposits.

138
Q

new onset of hematuria, proteinuria, and edema, often with hypertension and mild acute kidney injury, following or concurrent with an infection.

A

Infection-Related Glomerulonephritis (IRGN)

139
Q

the 2 most common sites of infection leading to IRGN,

A

URI and skin infections

140
Q

pathogens most commonly attributed to IRGN

A

group A streptococci, specifically Streptococcus pyogenes.

141
Q

Presents with hematuria, proteinuria, and edema, often accompanied by hypertension and mild acute kidney injury

Urinary output usually improves after 5–7 days, followed rapidly by resolution of edema and normalization of BP

A

Acute nephritic syndrome (

142
Q

Present in many patients with mild, self-limited streptococcal infections

Characterized by low-grade proteinuria (< 1 g/day), pyuria, and nonvisible (microscopic) hematuria; often goes undetected

A

Subclinical or asymptomatic GN

143
Q

presents with the triad of hematuria, flank pain, and a palpable abdominal mass but now is far more commonly detected incidentally as a renal mass seen on a radiographic examination done for other reasons.

A

Renal Cell Carcinoma

144
Q

have isolated hematuria with normal kidney function, no or minimal proteinuria, and a uniformly thinned glomerular basement membrane (GBM) on electron microscopy analysis of biopsy specimen.

A

Thin Basement Membrane Nephropathy

145
Q

most common cause of persistent hematuria in children and adults

A

Thin Basement Membrane Nephropathy

146
Q

The only way to definitively diagnose TBMN is by

A

kidney biopsy and electron microscopy.

147
Q

Absence of menarche by age 16 years with normal pubertal growth and development.

A

Primary Amenorrhea

148
Q

The absence of menarche by age 14 years with lack of normal pubertal growth and development

A

Primary Amenorrhea

149
Q

Absence of menarche 2 years after sexual maturation is complete.

A

Primary Amenorrhea

150
Q

Absence of menstruation for at least three cycles in those with established normal menstruation or 9 months in those with previous oligomenorrhea (menstrual periods occuring at intervals of greater than 35 days, with only four to nine periods in a year
Common cause: due to pregnancy, lactation, and menopause

A

secondary amenorrhea

151
Q

If pregnant with bleeding… rule out

A

ectopic pregnancy

152
Q

onset of menstruation

A

9-17 yrs old

153
Q

median age of menstruation

A

12 years old, 2-3 years from thelarche (breast budding) to menarche

154
Q

If once had menses and stops it is

A

secondary amenorrhea

155
Q

Sudden amenorrhea

more likely

A

pregnancy or stress

156
Q

Gradual amenorrhea

A

indicates PCOS

Ovarian failure

157
Q

ovarian failure is considered premature younger than age

A

40

158
Q

Palpate the scrotum to assess for undescended testicles. Holding a finger in the inguinal canal prevents the testicles from slipping into the canal when palpating the scrotum. The left scrotal sac usually hangs lower than the right.

A

Dains-Scrotal pain

159
Q

(positive Prehn sign)

A

Elevation of an affected testicle may relieve discomfort

Dains-Scrotal pain
characteristic of epididymitis

160
Q

occurs from dilated veins in the scrotal sac and usually occurs on the left side. A varicocele is often more prominent when the patient is standing and regresses with the patient in the prone position.
It is classically described as a bag of worms

A

A Varicocele

161
Q

(a cystic swelling on the epididymis) is not as large as a hydrocele but does not transilluminate.

A

spermatocele

162
Q

a nontender collection of fluid in the scrotum. It will transilluminate but may make testicular palpation difficult.

A

hydrocele

163
Q

Sudden onset of testicular pain that radiates to groin, may have lower abdominal pain. Exquisitely tender testicle, testicle may ride high bc of shortened spermatic cord; cremasteric reflex absent; elevation of affected testicle does not relieve pain (negative Prehn sign)

A

Torsion-

164
Q

abrupt onset over several hours; febrile; pain in scrotum or testicles. Tender, swollen, epididymitis or testicles; elevation of affected testicle may lessen discomfort. Positive Prehn sign, may have fever.

A

Epididymitis

165
Q

occurs with menstrual cycles

A

Cyclic Breast Pain -

166
Q

40-50 years of age
Localized pain that is sharp, stabbing, burning and throbbing
Cysts, fibroadenomas, duct ectasia, mastitis, breast injury and breast abscesses are associated

A

Noncyclic Mastalgia

167
Q

Inflammation of the breast tissue with swelling, tenderness, chills, fever and increase pulse rate

A

Mastitis/ Abscess

168
Q

Subareolar ducts become blocked with desquamating secretory epithelium, necrotic debris and chronic inflammatory cells
Pain, tenderness, inflammation, nipple discharge and possibly nipple retraction

A

Mammary Duct Ectasia

169
Q

Area of erythema and pain can precede the development of grouped vesicles

A

Herpes Zoster

170
Q

Heaviness, burning, tenderness in the breast
Rapid increase in size
Inverted nipple
Peau d’orange physical exam

A

Inflammatory Breast Cancer

171
Q

XXY - in males
Gynecomastia and prepubertal testes
Breast pain is usually the first sign

A

Klinefelter Syndrome

172
Q

Naegele rule

A

the EDD can be estimated by taking the LMP, adding 7 days, subtracting 3 months, and adding 1 year

173
Q

Given during every pregnancy (27-36 weeks)

Caregivers in direct contact with the infant should also receive

A

TDAP

174
Q

how do you assess the fundal height

A

If gestational age is >20 weeks, when the fundus should reach the umbilicus. With a plastic or paper tape measure, locate the pubic symphysis and place the “zero” end of the tape measure where you can firmly feel that bone. Then extend the tape measure to the very top of the uterine fundus and note the number of centimeters measured. Through subject to error between 16 and 36 weeks, measurement in centimeters should roughly equal the number of weeks of gestation. (May under detect newborns who are small for gestational age).

175
Q

fundal height If >4cm than expected:

A

consider multiple gestation, a large fetus, extra amniotic fluid, or uterine leiomyoma.

176
Q

fundal height if <4cm than expected:

A

low amniotic fluid, missed abortion, intrauterine growth retardation, or fetal anomaly.

177
Q

fetal HR is normally audible as early as

A

10-12 weeks gestation

178
Q

fetal HR location 10-18 weeks

A

located along the midline of the lower abdomen

179
Q

fetal HR >18 weeks

A

FHR is best heard over the back or chest and depends on fetal position. The leopold maneuvers can help identify the position.

180
Q

fetal HR normal

A

110-160

181
Q

Presents in adolescence with chronic, waxing and waning lesions.
inflammatory papules, pustules, comedones, and nodulocysts over the face, chest, and back

A

Acne Vulgaris

182
Q

Flesh- colored, translucent, or slightly red papule or nodule, with rolled border.
Most common head or neck of older adults
Friable, bleeding easily and developing crust (Telangiectasias)
Most common malignant tumor in humans
Asymptomatic and rarely causes pain
Highest risk- fair hair and eyes, easy freckling, and propensity for sunburn… less likely for people with darker skin

A

Basal Cell Carcinoma

183
Q

Cluster of tense blisters on exposed skin (>/=1cm) and surrounding skin is normal.
Caused by dermal hypersensitivity reactions to antigens from the saliva of insects (bedbugs, fleas, mosquitos, mites are typical)

A

Bullous Arthropod Bites

184
Q

Most common in infants & children
Presents as flaccid, transparent bullae in the intertriginous areas
Rupture easily leaving a rim of scale and shallow moist erosion
Causative agent staphylococcus aureus

A

Bullous Impetigo

185
Q

Elderly patients
1-2 cm tense blisters and bright red, urticarial plaques
Begin on lower extremities and progress upward
Autoimmune disease
Occur sporadically
Asymptomatic to intense pruritic

A

Bullous Pemphigoid

186
Q

Small, round or oval lesions on the back and trunk. Lesions often have somewhat silvery, adherent scales.
Small (0.5-1.5cm)
Upper trunk and proximal extremities
May involve face, ears, and scalp
May involve areas with minor skin trauma (koebner phenomenon)
Last 3-4 months
Seen in young adults preceded by a streptococcal throat infection
Increase risk for developing psoriasis vulgaris in 3-5 years
Increase incidence in families
NO PICTURE IN TEXT

A

Guttate Psoriasis

187
Q

Dark brown or black macule or papule in a middle aged person
Pigment variation throughout and irregular borders
Upper back in males
Leg in females
Whites are 26 times more likely to develop than blacks

A

Melanoma

188
Q

Extremely pruritic rash of numerous, round, crusted lesions on the lower extremities
Well demarcated coin shaped lesions composed of minute vesicles and papules on an erythematous base. Overlying crust, frequently with a weeping exudate.
Severely pruritic
Remitting and relapsing course

A

Nummular Dermatitis

189
Q

Multiple small, oval, scaly plaques with central trailing scale on the trunk and proximal extremities. A “herald patch”, the first to develop is often the largest.
May be pruritic
Two weeks after first patch smaller patches firm…”fir tree” pattern
Hx of prodrome of mild malaise, nausea, headache, and low-grade fever may be present.

A

Pityriasis Rosea

190
Q

Seen in patients with bleeding disorders or vascular damage
petechiae - capillary hemorrhages that present as non blanching, pinpoint, red spots over dependent body parts (lower extremities)
Purpura- larger hemorrhages into the skin
Nonpalpalbe hemorrhage- usually thrombocytopenia
Palpable purpura can be a sign of serious illness (e.g. rocky mountain spotted fever, acute meningococcemia, disseminated gonococcal infection).

A

Purpura/ Petechiae

191
Q

Adults with a facial rash
Gradual development of telangiectasias and persistent centrofacial erythema sometimes with inflammatory red papules and papulopustules. Comedones absent.
Often hx of easy flushing
May worsen with sun exposure, ingestion of spicy foods, thermally hot foods/ liquids, emotional stress, and exercise.
More common in women vs men
Peaks in middle age, usually after acne, but can overlap
Sun exposure can trigger
Ocular rosacea is common

A

Rosacea

192
Q

Oval macules… papules and plaques…copper/red to hyperpigmented in color
Present diffusely over the entire body then palms, soles and mucosal surfaces at a later stage.
Later stage thick scales may cover the plaques
Hx of transient, painless, genital ulcer in the preceding weeks can often be obtained
Nonpruritic

A

Secondary syphilis

193
Q

Firm but somewhat indistinct nodule or plaque may become ulcerated or bleed easily and become crusted
May come from actinic keratoses on the sun exposed skin of middle aged people
UV radiation is a major risk factor

A

Squamous cell carcinoma

194
Q

Patient with fever, malaise, headache, and myalgias who is taking a potentially causative medication.
After one week of symptoms a macular rash develops on the chest and face. Lesions then blister and rapidly erode. Skin is usually excruciatingly tender.

A

Stevens- Johnson Syndrome

195
Q

round , pink plaques with small peripheral papules and a rim of scales.
Centrifugal spread of the fungus from the initial site of infection
Neck and back most common location

A

Tinea Corporis

196
Q

Itchy rash with large or small, palpable, red areas over the entire body.
Can be acute (<6 weeks) or chronic (>6 weeks)
Rash and pruritis respond to antihistamines
Mucous membranes present as angioedema

A

Urticaria

197
Q

Usually a rash over a single unilateral dermatome
Closely grouped vesicles on an erythematous base
2-3 days become pustular and then crust over after 7-10 days.
Pain and paresthesias may occur along the involved dermatome often follow for a few days.
Caused by reactivation of VZV in a dorsal root ganglion
Most commonly in elderly population.

A

Varicella Zoster Virus [VZV]

198
Q

lesion without elevation or depression, < 1 cm

A

Macule:

199
Q

lesion without elevation or depression, > 1 cm

A

patch

200
Q

any solid, elevated “bump” < 1 cm

A

Papule:

201
Q

raised plateau-like lesion of variable size, often a confluence of papules

A

plaque

202
Q

solid lesion with palpable elevation, 1–5 cm

A

Nodule

203
Q

solid growth, > 5 cm

A

tumor

204
Q

encapsulated lesion, filled with soft material

A

cyst

205
Q

elevated, fluid-filled blister, < 1 cm

A

vesicle

206
Q

elevated, fluid-filled blister, > 1 cm

A

bulla

207
Q

elevated, pus-filled blister, any size

A

pustule

208
Q

inflamed papule or plaque formed by transient and superficial local edema

A

wheal

209
Q

a plug of keratinous material and skin oils retained in a follicle; open comedone has a black inclusion, closed comedone appears flesh-colored or pinkish

A

Comedone:

210
Q

Autoimmune blistering disorder

A

Bullous pemphigoid

Epidermolysis bullosa acquisita

Pemphigus vulgaris

211
Q

Blistering disorder

Hypersensitivity syndromes

A

Stevens-Johnson syndrome

Toxic epidermal necrolysis

212
Q

blistering disorder

infectious

A

Herpes simplex

Impetigo

Staphylococcal scalded skin

Varicella zoster

213
Q

Dermal reaction patterns

A

Erythema nodosum

Granuloma annulare

Sarcoidosis

Urticaria

214
Q

Folliculopapular eruptions (perifollicular papules)

A

Acne vulgaris

Folliculitis

Perioral dermatitis

Rosacea

215
Q

Prodromal pain symptoms

Localized lesions in a dermatomal distribution

A

Varicella zoster virus

216
Q

Acute onset, intertriginous location

Most common in children

A

Bullous impetigo

217
Q

Pruritus

Lack of constitutional symptoms

Exposure history

A

Bullous arthropod bites

218
Q

May present with early urticarial lesions and pruritus

Later intact blisters

A

Bullous pemphigoid

219
Q

Rapidly progressive rash with associated mucosal lesions

A

SJS

220
Q

Presents after acute pharyngitis

Discrete small red papules and plaques with adherent silvery scale

A

Guttate psoriasis

221
Q

Classically starts with a single “herald patch” 1–2 weeks prior to disseminated eruption

Primarily truncal distribution with “tree-like” appearance

A

Pityriasis rosea

222
Q

Solitary or few lesions

Annular lesions with a leading edge of scale

Pruritic

A

Tinea corporis

223
Q

Well-defined plaques with crust and papulovesicles

Pruritic

Symmetric distribution on extremities

A

Nummular dermatitis

224
Q

Palms and soles involved

Thinner plaques without adherent scale

A

Secondary syphilis

225
Q

postmenopausal women have an ____ risk of breast cancer

A

decreased

226
Q

decreased estrogen causes increased/decreased breast pain

A

increased

227
Q

fetal heart tones 20 weeks

A

umbilicus

228
Q

gram neg UTI

A

Proteus

229
Q

how do you tell basal from squamous

A

histology

Health Assessment (5 decks)

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