Test 4 Flashcards
What are the levels of the axillary lymph nodes?
- Level I: inferior to the pectoralis major insertion
- Level 2: posterior to the pectoralis major insertion
- Level 3: superior to the pectoralis major insertion
What are some common characteristics of breast carcinomas?
- Most are commonly:
- Non-tender
- Very hard consistency
- Fixation to the skin
- Irregular
- Age: usually > 50 y/o
What is the most common cause of bloody discharge in the nipple?
- Intraductal Papilloma
How often should someone recieve a clinical breast exam/mammography?
- Yearly after age 40
What are characteristics of a breast Fibroadenoma?
- Age: < 30 y/o
- Smooth, soft/firm, non-tender, freely movable
What are some characteristics of a breast cyst?
- Age: 30-50 y/o
- Smooth, firm/soft, tender/non-tender, freely movable
What are some characteristics of a fibrocystic breast?
- Age: 30-50 y/o
- Multiple, firm, tender
What is gravid?
- Number of times the patient has been pregnant
- Multiple gestations count as one pregnancy
What is parity?
- 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)
- 4 numbers
What is included in the menstrual history?
- Age at menarche
- Cycle length (average is 28-29 days)
- Duration of flow (average is 4-7 days)
- Quantity of blood loss
What is an ectopic pregnancy?
- The embryo implants outside of the uterus
What are the benign cervical lesions?
- Ectropian: glandular cells expand to external cervix
- Polyps
- Nabothian Cyst: benign glandular cyst
What is Chandelier sign?
- Cervical motion tenderness on palpation
- Suggests presence of pelvic infection (PID, pelvic inflammatory disease)
- Symptoms: fever, vaginal discharge, abdominal pain
What is endometriosis?
- Glandular cells from the uterine lining (endometrium) grow outside the uterine cavity
- Symptoms
- Dysmenorrhea (painful periods), Dyspareunia (painful sex), Dyschezia (painful defecation)
What is the most common cause of an adnexal mass?
- Ovarian cyst
What are common findings of women with endocrine disorders (esp. HPO axis)?
- Irregular menses
- Hypomenorrhea (infrequent menses) or Amenorrhea
What is jaundice?
- Yellowish staining of the conjunctiva, skin, and mucus membranes by bilirubin
When is juandice detectable on physical examination?
- When total bilirubin is > 3.0 mg/dl
What are the steps in the metabolism of bilirubin?
- RBCs destruction; breakdown of heme to bilirubin
- Unconjugated bilirubin transported (complexed with albumin) through blood to liver
- Uptake by hepatocytes
- Conjugated via glucuronosyl transferase
- Transported through biliary ducts to common bile duct to duodenum
- Reduced by bacterial enzymes to urobilinogens
- 80% excreted in feces, 20% reabsorbed (excreted in urine)
What are common causes of unconjugated hyperbilirubinemia?
- Hemolysis
- Gilbert Syndrome
- Heart failure
- Sepsis
What findings are predictive of hepatocellular jaundice?
- 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)
What findings are pedictive of obstructive jaundice?
-
Courvoisier’s Sign
- Palpable, non-tender gallbladder
What lab findings can differentiate hepatocellular jaundice from cholestatic jaundice?
- Transaminases > Alkaline Phosphatase = Hepatocellular Jaundice
- Alkaline Phosphatase > Transaminases = Cholestatic Jaundice
What does dark, “tea-colored” urine and light, “clay-colored” stool indicate?
- Conjugated/Direct Hyperbilirubinemia
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
What are peritoneal signs?
- Signs that indicate an acute abdomen and peritoneal involvement
- Include:
- Involuntary guarding
- Abdominal rigidity
- Rebound
What is the embryological origin of the appendix?
- Midgut