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Test 4 Flashcards

1
Q

What are the levels of the axillary lymph nodes?

A
  • Level I: inferior to the pectoralis major insertion
  • Level 2: posterior to the pectoralis major insertion
  • Level 3: superior to the pectoralis major insertion
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2
Q

What are some common characteristics of breast carcinomas?

A
  • Most are commonly:
    • Non-tender
    • Very hard consistency
    • Fixation to the skin
    • Irregular
  • Age: usually > 50 y/o
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3
Q

What is the most common cause of bloody discharge in the nipple?

A
  • Intraductal Papilloma
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4
Q

How often should someone recieve a clinical breast exam/mammography?

A
  • Yearly after age 40
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5
Q

What are characteristics of a breast Fibroadenoma?

A
  • Age: < 30 y/o
  • Smooth, soft/firm, non-tender, freely movable
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6
Q

What are some characteristics of a breast cyst?

A
  • Age: 30-50 y/o
  • Smooth, firm/soft, tender/non-tender, freely movable
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7
Q

What are some characteristics of a fibrocystic breast?

A
  • Age: 30-50 y/o
  • Multiple, firm, tender
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8
Q

What is gravid?

A
  • Number of times the patient has been pregnant
  • Multiple gestations count as one pregnancy
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9
Q

What is parity?

A
  • What happened with each of those pregnancies
    • 4 numbers
      • Term deliveries (> 37 weeks from 1st day of LMP)
      • Preterm deliveries (20-36 weeks)
      • Abortions (< 20 weeks; elective or spontaneous)
      • Living (# of living children)
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10
Q

What is included in the menstrual history?

A
  • Age at menarche
  • Cycle length (average is 28-29 days)
  • Duration of flow (average is 4-7 days)
  • Quantity of blood loss
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11
Q

What is an ectopic pregnancy?

A
  • The embryo implants outside of the uterus
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12
Q

What are the benign cervical lesions?

A
  • Ectropian: glandular cells expand to external cervix
  • Polyps
  • Nabothian Cyst: benign glandular cyst
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13
Q

What is Chandelier sign?

A
  • Cervical motion tenderness on palpation
  • Suggests presence of pelvic infection (PID, pelvic inflammatory disease)
    • Symptoms: fever, vaginal discharge, abdominal pain
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14
Q

What is endometriosis?

A
  • Glandular cells from the uterine lining (endometrium) grow outside the uterine cavity
  • Symptoms
    • Dysmenorrhea (painful periods), Dyspareunia (painful sex), Dyschezia (painful defecation)
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15
Q

What is the most common cause of an adnexal mass?

A
  • Ovarian cyst
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16
Q

What are common findings of women with endocrine disorders (esp. HPO axis)?

A
  • Irregular menses
    • Hypomenorrhea (infrequent menses) or Amenorrhea
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17
Q

What is jaundice?

A
  • Yellowish staining of the conjunctiva, skin, and mucus membranes by bilirubin
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18
Q

When is juandice detectable on physical examination?

A
  • When total bilirubin is > 3.0 mg/dl
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19
Q

What are the steps in the metabolism of bilirubin?

A
  1. RBCs destruction; breakdown of heme to bilirubin
  2. Unconjugated bilirubin transported (complexed with albumin) through blood to liver
  3. Uptake by hepatocytes
  4. Conjugated via glucuronosyl transferase
  5. Transported through biliary ducts to common bile duct to duodenum
  6. Reduced by bacterial enzymes to urobilinogens
  7. 80% excreted in feces, 20% reabsorbed (excreted in urine)
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20
Q

What are common causes of unconjugated hyperbilirubinemia?

A
  • Hemolysis
  • Gilbert Syndrome
  • Heart failure
  • Sepsis
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21
Q

What findings are predictive of hepatocellular jaundice?

A
  • Spider Angiomata (spider telangiectasia)
  • Palmar Erythema
  • Dilated abdominal veins (“caput medusae”)
  • Ascites
  • Palpable spleen
  • Asterixis (inability to maintain fixed position)
  • Fector Hepaticus (characteristic breath of severe parenchymal liver disease)
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22
Q

What findings are pedictive of obstructive jaundice?

A
  • Courvoisier’s Sign
    • Palpable, non-tender gallbladder
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23
Q

What lab findings can differentiate hepatocellular jaundice from cholestatic jaundice?

A
  • Transaminases > Alkaline Phosphatase = Hepatocellular Jaundice
  • Alkaline Phosphatase > Transaminases = Cholestatic Jaundice
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24
Q

What does dark, “tea-colored” urine and light, “clay-colored” stool indicate?

A
  • Conjugated/Direct Hyperbilirubinemia
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25
What is Reynold's Pentad?
* Fever, Jaundice, RUQ pain, confusion, shock * Indicative of _Ascending Cholangitis_ * **Charcot's Triad** * Fever, Jaundice, RUQ pain * Most common cause is common bile duct stone
26
What are peritoneal signs?
* Signs that indicate an _acute abdomen_ and peritoneal involvement * Include: * Involuntary guarding * Abdominal rigidity * Rebound
27
What is the embryological origin of the appendix?
* Midgut
28
What is the innervation of the peritoneum?
* The _visceral_ peritoneum is innervated by the autonomic nervous system * The _parietal_ peritoneum is somatic innervation
29
When is free air better seen on an abdominal x-ray?
* Upright or decubitus position
30
How can you differentiate the small bowel from the large bowel on x-ray?
* Small bowel has _plique circularis_, which goes **360** around the bowel * Large bowel has _haustra_, do NOT go completely around
31
What is the string of pearls sign?
* Air trapped between dilated plicae circularis * Indicates small bowel obstruction
32
What do loops of bowel below the pelvis indicate?
* Inguinal Hernia
33
What is an appendicolith?
* Calcification of the appendix * Indicates appendicitis
34
What is the most common cause of an UGI bleed?
* Peptic ulcer disease
35
What is AIM-65?
* Albumin (\< 3.0) * INR (\> 1.5) * SBP (\< 90) * Age (\> 65)
36
What is the difference between acute and chronic diarrhea?
* Acute: _\>_ 3 watery stools per day, lasting \< 14 days * Chronic: lasting \> 14 days
37
What is the stool osmotic gap formula?
* 290 - [(Na + K) x 2]
38
What is the most common cause of acute-onset secretory diarrhea?
* Bacterial infection
39
What is a thick yellow discharge from the penis indicative of?
* Gonorrhea
40
What is a reducible hernia?
* Hernia sac contents are easily replaced in the abdominal cavity
41
What is an incarcerated hernia?
* Hernia sac is caught within defect and the hernia sac remains in same position * On physical examination, the hernia is palpable, non-tender, and the hernia cannot be reduced (irreducible)
42
What is a strangulated hernia?
* The hernia is not only incarcerated, but a block in the vascular supply to contents of sac produces ischemia and eventually infarction of the contents of the sac * Patients are usually febrile * The hernia sac is tender and irreducible * The overlying skin may be erythematous
43
What is an indirect inguinal hernia?
* Results from the failure of embryonic closure of the processus vaginalis after the testicle has passed through it * Protrudes through the inguinal ring * It is the **most common cause of groin hernia**
44
What is a direct inguinal hernia?
* Protrudes through a weakened area in the transversalis fascia near the medial inguinal fossa within an anatomic region known as the medial or **Hesselbach's triangle** * **​**Area defined by the edge of the rectus abdominis muscle, the inguinal ligament and the inferior epigastric artery
45
What is a "pantaloon" hernia?
* When a patient has a simultaneous direct and indirect hernia on the same side
46
What is a femoral hernia?
* Rare relative to inguinal hernias * More common in women than in men * Hernia defect is just _medial_ to femoral vessels
47
What is a Richter's hernia?
* Incarceration or strangulation without obstruction
48
What are the characteristics of a testicular tumor?
* Usually painless, but may give patient a sense of mild, dull pain within scrotum * Nodule within testicle * Will not transilluminate * May have very hard consistency
49
What is testicular torsion?
* Twisting of the spermatic cord – stopping the blood flow * Sudden onset of pain * Testicle palpated high in the scrotum * **Blue dot sign**: ischemic appendix testes, indicating testicular torsion
50
What is testicular hydrocele?
* Fluid filled sac in scrotum * Transilluminates
51
What is spermatocele/epididymal cysts?
* Firm round mass, usually a couple of centimeters in diameter within scrotum, but distinct from testes * Will transilluminate
52
What are varicoceles?
* Varicose veins of spermatic cord * **“Bag of worms”** * Associated with infertility
53
What is a sliding hernia?
* Organ is part of the hernia (e.g. colon)
54
What is the definition of oliguria?
* Urine output \< 300-500 mL/day
55
What is the definition of anuria?
* Urine output \< 50-100 mL/day
56
How can you tell if it is a respiratory disturbance?
* Change in PCO2 * _Increased_ PCO2 = Respiratory **Acidosis** * _Decreased_ PCO2 = Respiratory **Alkalosis**
57
How can you tell if it's a metabolic disturbance?
* Change in HCO3 * _Increased_ HCO3 = Metabolic **Alkalosis** * _Decreased_ HCO3 = Metabolic **Acidosis**
58
What causes pre-renal AKI?
* Inadequate renal perfusion * **Most common** cause is hypovolemia * Most common cause of AKI * Potentially reversible
59
What causes Intrarenal AKI?
* Direct renal parenchymal damage or disease * Glomerulonephritis * Acute Tubular Necrosis * **Most common** cause of intrarenal AKI * Acute Interstitial Nephritis * Vasculitis
60
What does complete anuria suggest?
* Renal tract obstruction (post-renal AKI)
61
What is the fractional excretion of sodium (FENa)?
* FENa = (Urine Na/Plasma Na)/(Urine Cr/Plasma Cr) x 100% * Examples: * **Pre-renal AKI**: FENa = \< 1% * **Acute Tubular Necrosis**: FENa = \> 2%
62
What is Winter's formula?
* PCO2 = [1.5 x (HCO3)] + 8 (_+_ 2) * Used to measure respiratory compensation for a metabolic acidosis
63
What are the clinical manifestations of hypoglycemia?
* \< 40-65 mg/dl * Tachycardia * Paresthesias * Nausea * Confusion * Impaired judgement * Sweating * Pallor
64
How do you treat hypoglycemia?
* If conscious and able to eat/drink * 15-20g of carbohydrates * 3-4 oz juice or non-diet soda * If not able to drink/eat * 1 mg IM glucagon * 50% dextrose in water (D50) IV
65
What is Rhinocerebral Mucormycosis?
* Caused by Saprophytic fungi, particularly in patients with DKA * Clinical presentation: * Hemorrhagic or purulent nasal discharge * Swollen, closed eye with lid edema * Facial and ocular pain * Black eschar on palate, nasal mucosa
66
What is malignant otitis externa?
* Invasive infection of external auditory canal * May invade bone or perforate the TM * Clinical presentation: * Edema of ear canal * Purulent ear discharge * Ear pain * May have facial or other CN palsies * Etc. * **Most common** pathogen is _Pseudomonas Aeruginosa_
67
What is Necrotizing Fasciitis?
* Infection of SQ tissue which travels along fascial planes * Infection rapidly progresses over hours * Anesthesia along area involved * Bullous formation, dusky skin color, skin ulceration, etc.
68
What is Fournier's Gangrene?
* Necrotizing fasciitis located in the genital areas of males

ECR (2 decks)

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