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
What is the innervation of the peritoneum?
- The visceral peritoneum is innervated by the autonomic nervous system
- The parietal peritoneum is somatic innervation
When is free air better seen on an abdominal x-ray?
- Upright or decubitus position
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
What is the string of pearls sign?
- Air trapped between dilated plicae circularis
- Indicates small bowel obstruction
What do loops of bowel below the pelvis indicate?
- Inguinal Hernia
What is an appendicolith?
- Calcification of the appendix
- Indicates appendicitis
What is the most common cause of an UGI bleed?
- Peptic ulcer disease
What is AIM-65?
- Albumin (< 3.0)
- INR (> 1.5)
- SBP (< 90)
- Age (> 65)
What is the difference between acute and chronic diarrhea?
- Acute: > 3 watery stools per day, lasting < 14 days
- Chronic: lasting > 14 days
What is the stool osmotic gap formula?
- 290 - [(Na + K) x 2]
What is the most common cause of acute-onset secretory diarrhea?
- Bacterial infection
What is a thick yellow discharge from the penis indicative of?
- Gonorrhea
What is a reducible hernia?
- Hernia sac contents are easily replaced in the abdominal cavity
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)
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
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
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
What is a “pantaloon” hernia?
- When a patient has a simultaneous direct and indirect hernia on the same side
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
What is a Richter’s hernia?
- Incarceration or strangulation without obstruction
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
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
What is testicular hydrocele?
- Fluid filled sac in scrotum
- Transilluminates
What is spermatocele/epididymal cysts?
- Firm round mass, usually a couple of centimeters in diameter within scrotum, but distinct from testes
- Will transilluminate
What are varicoceles?
- Varicose veins of spermatic cord
- “Bag of worms”
- Associated with infertility
What is a sliding hernia?
- Organ is part of the hernia (e.g. colon)
What is the definition of oliguria?
- Urine output < 300-500 mL/day
What is the definition of anuria?
- Urine output < 50-100 mL/day
How can you tell if it is a respiratory disturbance?
- Change in PCO2
- Increased PCO2 = Respiratory Acidosis
- Decreased PCO2 = Respiratory Alkalosis
How can you tell if it’s a metabolic disturbance?
- Change in HCO3
- Increased HCO3 = Metabolic Alkalosis
- Decreased HCO3 = Metabolic Acidosis
What causes pre-renal AKI?
- Inadequate renal perfusion
- Most common cause is hypovolemia
- Most common cause of AKI
- Potentially reversible
What causes Intrarenal AKI?
- Direct renal parenchymal damage or disease
- Glomerulonephritis
- Acute Tubular Necrosis
- Most common cause of intrarenal AKI
- Acute Interstitial Nephritis
- Vasculitis
What does complete anuria suggest?
- Renal tract obstruction (post-renal AKI)
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%
What is Winter’s formula?
- PCO2 = [1.5 x (HCO3)] + 8 (+ 2)
- Used to measure respiratory compensation for a metabolic acidosis
What are the clinical manifestations of hypoglycemia?
- < 40-65 mg/dl
- Tachycardia
- Paresthesias
- Nausea
- Confusion
- Impaired judgement
- Sweating
- Pallor
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
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
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
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.
What is Fournier’s Gangrene?
- Necrotizing fasciitis located in the genital areas of males
