Test 4 Review Flashcards
Organs in the RUQ
Liver Gallbladder Head of Pancreas Right Kidney Hepatic flexure of Colon
Organs in RLQ
Cecum Appendix Ascending Colon Small Intestine Right Ovary and tube
Organs in LUQ
Left Lobe of LIVER Spleen Stomach Left Kidney Splenic flexure of colon Pancreas (body and tail)
Organs in LLQ
Sigmoid Colon
Descending Colon
Small Intestine
Left Ovary and tube
Bright Red Vomitus
Fresh Blood
Coffee Grounds Vomitus
Old Blood that has had time to mix with digestive juices
Vomitus and Bile
-Color
Dark brown or black
Order for Assessment of the Abdomen
- Inspection
- Auscultation
- Percussion
- Palpation
Abdominal Inspection Contour
Normal:
-Straight horizontal line from costal margin to symphysis pubis
Abnormal:
- Rounded
- Scaphoid - inverted
- Protuberant - pregnant
Caput Medusae
Engorged dilated vein at umbilicus
Vena cava obstruction
Cullen’s Sign
Light blue tint at umbilicus
-free blood in peritoneal cavity
This can occur either following rupture of a Fallopian tube secondary to an ectopic pregnancy or w/ ACUTE HEMORRHAGIC PANCREATITIS
Von Recklinghausen’s Disease
Cafe au lait spots may be attributed to Von Recklinghousen’s disease
-formation of neurofibromas
Normal Bowel Sounds
Intermittent high pitched gurgling sounds
-5-30 times per minute
Normal hyperactive bowel sounds (borborgymi)
Absent bowel sounds are abnormal
Borborygmi
Normal Hyperactive bowel sounds. Loud, audible stomach growling sounds )
Murphy’s Sign
Assessing for Cholecystitis
- With Pt Supine, stand at Pt’s right side
- Palpate below the liver margin at the lateral border of the rectus muscle
- Have Pt take a deep breath
- NORMAL RESPONSE IS ‘NO PAIN IS ELICITED’
Murphy’s sign is positive in inflammatory processes of the gallbladder, such as cholecystitis
Rovsing’s Sign
Differential technique to elicit referred pain, reflective of peritoneal inflammation secondary to appendicitis
- Press deeply and evenly in the LLQ for 5 seconds
- No pain should be elicited
- Abdominal pain felt in the RLQ is abnormal and is a positive Rovsing’s sign
Rebound Tenderness
- Several seconds of firm pressure to abdomen
- Hand 90 Degree angle perpendicular
- QUickly release pressure
- SHOULD NOT HAVE PAIN
-Peritoneal irritation
-Pain in RLQ = Appendicitis
Area in the RLQ is known as MCBURNEY’S POINT
Obturator Muscle Test
Test for appendicitis:
- Flex knee to hip
- Rotate leg inward
- Observe for pain
- SHOULD NOT HAVE PAIN
Pain indicates irritation of obturator muscle and can be caused by a ruptured appendix or pelvic abscess.
Iliopsoas Muscle Test
An inflamed or perforated APPENDIX may be distinguished by irritation of the lateral ilipsoas muscle:
- Hand on Rt thigh. Push down as pt raises leg
- Observe for pain in RLQ as described by pt
- SHOULD NOT BE PAIN
Inflammation of ilipsoas muscle in groin caused by inflamed appendix
Prostate Gland
Prostate lies just below the bladder and encircles the urethra like a doughnut
-Size and shape of a chestnut
Prostatic secretions are thin, milky, and alkaline
- Provide transport medium for spermatozoa
- fluid composes 15-20% of ejaculate
Primarily for reproduction, also provides protection against UTI
Prostate Structure and Exam
Prostate has 5 Lobes:
-Anterior, Posterior, Median, and 2 lateral
The right and left lateral lobes are accessible to examination
Rectal Prolapse
Associated with:
- Poor tone of the pelvic musculature
- Chronic straining at stool
- fecal incontinence
- neurological disease or traumatic damage to the pelvis
Complete rectal prolapse involves entire bowel wall
Rectal Prolapse Assessment
A small, symmetrical projection of 2 to 4 cm long indicates a rectal prolapse
The rectal prolapse is best assessed w/ the Pt in a SQUATTING POSITION
Kyphosis
Excessive Convexity of the thoracic spine
Pt w/ kyphosis presents w/ chin tilted downward onto the chest and abdominal protrusion.
Forward downward hunching of the head, neck, shoulders, and upper back
Lordosis
Excessive concavity of the lumbar spine
Scoliosis
Lateral curvature of the spine (the thoracic or lumbar vertebrae). The curvature becomes accentuated on forward flexion of the waist
List
A leaning of the spine. If an imaginary line is drawn straight down from T1, the gluteal cleft is lateral to it..
** Look up slide 36 or pg 674
Scissors Gait
The gait of a Pt w/ multiple Sclerosis MS:
- Adduction at the knee level produces short, slow steps
- Gain is uncoordinated, stiff, and jerky;
- Foot is dragged across the floor in a semicircle
Spastic Hemiplegia Gait
Gait of Cerebral Palsy:
- extension of one lower extremity w/ plantar flexion and foot inversion
- arm is flexed at elbow, wrist, and fingers
- arm does not swing w/ gait
Pt walk by swinging affected leg in a semicircle
Foot is not lifted off the floor
Festinating Gait
Gait of Parkinson’s disease:
- Pt has decreased step height and length
- Increased step speed, resulting in shuffling
- posture is stooped
- hesitation to begin walking and to terminate walking
Antalgic Gait
Degenerative joint disease of the hip:
-Limited weight bearing on affected leg in an attempt to limit discomfort
Normal Gait
Walking is initiated in one smooth, rhythmic fashion
-foot is lifted 2.5 to 5 cm (1 to 2 inches) off the floor and propelled 12 to 18 inches forward in a straight path
Read pg 633
Tinel’s Sign
A tingling or pricking sensation that occurs in the hand, thumb, index, and middle fingers when the median nerve is tapped is indicative of median nerve compression (carpal tunnel syndrome)
Tingling in hand, thumb, index or middle finger abnormal = POSITIVE TINEL’S
Phalen’s Sign
- Ask the Pt to maintain the wrist flexion of 90 degrees for at least one minute
- Ask the Pt to describe the sensations that occur in the hands and fingers
Normal:
-There will be no change in the sensation of the hands and fingers
Trendelenburg Test
- Ask Pt to stand on one foot, w/ the knee of the non-weight bearing leg flexed to raise the foot off the floor.
- Assess the symmetry of the iliac crests while the Pt is standing on one leg
Normal:
-The iliac crest on the side opposite the weight-bearing leg elevates slightly
Limb Measurement
- Place Pt. in a supine position on the exam table w/ the legs extended
- Measure the leg from the anterior superior iliac spine to the medial malleolus
Normal:
-Limb length measurements should be w/in 1 to 3 cm of each other.
Cervical Spine ROM
- Chin to chest (flexion) 45 degrees
- Look up at ceiling (hyperextension) 55 degrees
- Move ear to shoulder w/out elevating shoulder (lateral bending) 40 degrees
- Turn head to each side to look at shoulder - 70 degrees
Shoulders ROM
- Forward Flexion – 180 degrees
- Hyperextension – 50 degrees
Abduction – 180 degrees
Adduction – 50 degrees
Internal Rotation – 90 degrees
External Rotation – 90 degrees
Elbow ROM
Flexion – 160 degrees
Extension – 0 degrees
Supination – 90 degrees
Pronation – 90 degrees
Wrist ROM
Flexion – 90 degrees
Hyperextension – 70 degrees
Fingers ROM
Flexion – 90 degrees
Hyperextension – 30 degrees
Wrist Deviation
Radial deviation – 20 degrees
Ulnar deviation – 55 degrees
Assessing Distal Limbs and Digits
Ask the Pt to perform specific movements of the distal limb on command:
Assessing Median Nerve:
- Ask pt to perform opposition of the thumb to the little finger
- Normal = complete motor function of the distal limb and digits, and the pt will not experience any numbness or tingling.
Assessing Ulnar nerve:
-ask pt to perform abduction of the fingers
Assessing Radial Nerve:
-ask Pt to perform hyperextension of the thumb or wrist
Assessing the Median Nerve
Ask Pt to perform opposition of the thumb to the little finger of the same hand.
Normal finding is that there will be complete motor function of the distal limb and digits, and the Pt will not experience any numbness or tingling
Assessing the Ulnar Nerve
Ask Pt to perform abduction of the fingers
Assessing the Radial Nerve
Ask Pt to perform hyperextension of the thumb or wrist
Herniated Intervertebral Disc
- Pt is placed in a supine position w/ both legs fully extended
- Ask Pt to raise both legs at least 2 inches off table while maintaining the legs in extension for at least 30 seconds
Inability to do this is suggestive of pressure on the spinal nerves and is indicative of a herniated intervertebral disc
Ovarian Cycle
Consists of 2 phases:
- Follicular phase
- Luteal phase
During Follicular phase:
-Actions of FSH and LH from anterior pituitary gland stimulate ripening of 1 ovarian follicle called graffian follicle. Remaining follicles are suppressed by LH
Ovulation occurs when high levels of LH cause the release of the ovum from the Graafian follicle
DUring Luteal phase, LH stimulates development of the corpus luteum
Follicular Phase
During the follicular phase, actions of FSH and LH from the anterior pituitary gland stimulate the ripening of one ovarian follicle called the Graafian follicle. The remaining follicles are suppressed by LH
FSH
Follicle stimulating Hormone
-FSH and LH from pituitary gland stimulate one ovarian follicle called Graafian follicle
FSH is engaged in ripening of one ovarian follicle
LH
Luteinizing Hormone
- stimulates development of corpus luteum
- suppresses all other follicles
HCG
Human Chorionic Gonadotropin
- secreted by the implanting blastocyst
- maintains Corpus Luteum
- HCG is tested in pregnancy tests
Ovulation
Ovulation occurs when high levels of luteinizing hormone LH cause the release of the ovum from the Graafian follicle
- Endometrial lining begins to regenerate under the influence of estrogen
- Cervical mucus becomes clearer, thinner, and threadlike
- Basal body temp rises
Allergies (Vagina)
- Numerous feminine hygiene products can cause allergic reactions or increase the incidence of CANDIDA VAGINOSIS
- Be aware of any latex allergies; condom and diaphragms are usually made of latex.
- Spermicide nonoxynol 9 can also cause allergic reactions
Menarche
The onset of menstruation, which occurs between 9 and 16 years of age, and ends at menopause, which occurs between 45 and 55 years of age
Menopause
Cessation of menstruation
Associated Symptoms Include:
-hot flashes, palpitations, numbness, tingling, drenching sweats, mood swings, vaginal dryness, itching
Treatment of symptoms includes
-Estrogen replacement therapy
Pap Smear (Preparation)
Instruct the Pt not to use vaginal sprays, douche, or have coitus 24 to 48 hours before the scheduled physical assessment and a Pap smear
Pap Smear (procedure)
Collection of specimens from the ENDOCERVIX and the CERVIX
-In Pt w/ hysterectomy, specimen is obtained from vaginal cuff.
Purpose of Pap smear is to evaluate cervicovaginal cells for pathology that may indicate carcinoma
HSV
Herpes Simplex Virus
Small, swollen, red vesicles that fuse together to form a large, burning ulcer that can be painful and itch are indicative of herpes simplex virus HSV
HPV
Human Papillomavirus
White, dry, cauliflower-like growths that have narrow bases are suggestive of condyloma acuminatum (HPV
Sexual abuse Signs
- Bruising of the mons pubis, labia, or perineum, and vaginal or rectal tears
- Emotional signs such as lack of eye contact, extreme anxiety or guarding. Refusal to assume certain positions can indicate abuse
- Presence of STD in the Very Young or Very Old PT is strongest evidence of sexual abuse
Strongest Evidence of Sexual Abuse
Presence of an STD in the VERY YOUNG or the VERY OLD Pt is the strongest evidence of sexual abuse.
Vaginal Speculum
Insert the Speculum at an OBLIQUE angle on a plane parallel to the exam table.
Gently rotate the speculum blades to a horizontal angle and advance the speculum at a 45 degree downward angle against posterior vaginal wall until it reaches end of vagina
Encourage the Pt to BEAR DOWN. This will help to relax the perineal muscles.
Cervix
Normal Cervix is a glistening pink
- It may be pale after menopause
- Blue (chadwick’s sign) during pregnancy
Carcinoma of the Cervix
Can manifest as a cauliflower-like overgrowth
Cervical Polyp
Observed as a bright red, soft protrusion through the cervical os.
Seminal Vesicles
Secrete fluid that helps provide a source of energy for sperm metabolism
Produce prostaglandins, which contribute to sperm motility and viability
Urethral Discharge
Associated w/
- dysuria
- painful ejaculation
- fever
- change in frequency of urination
- pruritus, conjunctivitis, arthritis, dermatological rash
- STD
Urethral Discharge
-further assessment
- a new sexual partner in the last 6 months
- multiple partners
- partner known to have other partners
- Unprotected intercourse
Hydrocele
Accumulation of fluid between the two layers of tunica vaginalis.
Spermatocele
Sperm-filled cysts at the top of the testis or in the epididymis
Blockage of the efferent ductules of the rete testis causes formation of sperm-filled cysts called spermatocele
Variocele
Dilated veins in the pampiniform lexus of the spermatic cord
Decreased sperm count
Inguinal Hernia
Ask Pt to turn head and cough
Note any masses felt
Pg 808
Epispadias
When the urethral meatus opens dorsally on the glans penis
Epispadias is a rare defect that is present at birth (congenital)
In this condition, the urethra does not develop into a full tube. The urine exits the body from the wrong place
Hypospadias
Condition in which the urethral meatus opens ventrally on the glans penis
Testicular Torsion
Surgical Emergency
Twisting or torsion of testis causes venous obstruction, secondary edema, eventual arterial obstruction
Cryptorchidism
Describes one or both testes that are undescended
Absent testes
Orchitis
Presents as an acute, painful onset of swelling to the testicle along w/ warm scotal skin, described as “heaviness in the scrotum.”
It is an infectious process, w/out sudden onset
Epididymitis
Palpation reveals induration swollen, tender epididymis
Pathogenic organisms from urethra to epididymis
Bacterial pathogens:
-Chlamydia trachomatis
-Neisseria gonorrhoeae
Epididymitis Symptoms
- Blood in semen
- Discharge from urethra
- Discomfort in lower abdomen or pelvis
- Fever
- Groin Pain
- Lump in testicle
- Pain during ejaculation or urination
- Painful scrotal swelling and testicle pain during bowel movement
Scrotal Edema
-Scrotal edema accompanies edema associated w/ the lower half of the body, such as CONGESTIVE HEART FAILURE, RENAL FAILURE, AND PORTAL VEIN OBSTRUCTION
Trauma is a major cause of acute scrotal swelling
Scrotal or testicular hematoma formation, as well as testicular rupture, may be present
Transillumination of the Scrotum
- Used to determine the etiology of a scrotal mass
- Normal = no red glow
- Normal testicle does not transilluminate
Transmission of a red glow indicates serous fluid w/in the scrotal sac (indicating either hydrocele or Spermatocele)
Breast Masses
Breast masses can occur anywhere in the breast or axilla
Usually found in the upper outer quadrant because it is the location of most of the glandular tissue
Masses can be unilateral or bilateral
Breast Masses
-characteristics
Masses that are soft, well defined, and tender indicate cysts
These are most common in women ages 30 to 50 yrs and will diminish after menopause.
Breast Inspection
- Arms at Side
- Arms over head
- Hands on hips
- Lean Forward
Reddened areas of the breasts, nipples, or axillae are abnormal findings and may indicate inflammation
-An infection such as mastitis, or inflammatory carcinoma.
Unilateral superficial vascular patterns are abnormal
-They occur as a result of an increased blood supply and may indicate tumor formation, which requires increased vascularization and an increased blood supply.
Breast Inspection
-Facing you-Arms at Side
- Areola nipples
- Color
- Vascularity
- Thickening
- Contour
- Dimples
- Lesions/masses
- Exudates
Breast Inspection
-Arms overhead
Repeat the inspection w/ the Pt’s arms raised over head. This will accentuate any retraction (tissue drawn back) if present.
Breast Inspection
-Hands on Hips
Repeat the inspection w/ the Pt pressing her hands into her hips
Will contract the pectoral muscles and accentuate any retractions if present
Breast Inspection
-Pt leaning forward
Have the Pt lean forward to allow the breasts to hang freely away from the chest wall and repeat the inspection
Look for retractions, dimples, and masses
Fibroadenoma
The MOST COMMON benign tumor of the breast in women under 30 years old.
Lumps may be:
- Mobile, easily moveable under the skin
- single lobular nodule
- non-tender, Painless
Peau d’ orange
Characterized as thickening or edema of the breast tissue or nipple and may present itself as enlarged skin pores that give the appearance of an orange rind.
May be indicative of obstructive lymphatic drainage resulting from a tumor, or inflammatory breast cancer
Diagnosed via core biopsy // 1% of cancers
Breasts of Pregnant Women
Colostrum:
-During pregnancy and up through the first week after birth, there may be a yellow discharge from the nipples known as colostrum
Breast Palpation
Pt supine includes the following:
- Peripheral breast tissue to the nipple, the tail of spence, and the areola
- The nipple is compressed to express any discharge
- Tail of Spence should be included in exam because this area and the upper outer quadrant are the areas where MOST BREAST MALIGNANCIES DEVELOP
- Area around areola should be palpated for masses
Palpating Nodes
- Infraclavicular Nodes
- Supraclavicular Nodes
- Axillary Nodes
Breast Cancer
Poorly defined, firm lump that is non-tender, fixed to the skin, and more than 1 cm in diameter should be reported as suspicious of breast cancer.
Risk Factors:
- females
- early menarche
- over age 50
- Personal or family history
Chadwick’s sign
Blue Color of the Cervix during Pregnancy
Late Menarche
Primary amenorrhea is defined as late onset of menarche among females aged 16 (or 14 if secondary sex characteristics are present).
Evaluate client for:
- Pregnancy
- Inadequate nutrition / eating disorders
- chronic diseases/ Crohn’s disease
- environmental stess/ intense athletic training
- Use of opiates or steroids
- autoimmune disease
Alcohol and GI
Altered nutrition, impaired gastric absorption, at risk for upper and lower GI bleeding, cirrhosis of liver
Mastitis
Inflammatory condition of the breast that occurs most frequently in lactating women.
Manifests as a local area that is swollen, painful, and erythematous and is usually caused by Staphylococcus aureus (S. aureus).
Fever is usually present
Colostrum
During pregnancy and up through the first week after birth, there may be a yellow discharge from the nipples known as colostrum.
Breast Palpation
- Wedge method
- Concentric circles
- Parallel lines
- Glandular Tissue
- Areola
- Compression of nipple
- Bimanual palpation
Indirect Inguinal Hernia
Palpated at the inguinal ring. An impulse may be felt on the fingertip when the Pt is asked to cough.
A larger indirect inguinal hernia may feel like a mass at the inguinal canal
Direct Inguinal Hernia
Oval swelling found at the pubis on inspection. Coughing causes enlargement on palpation of the mass.
Portions of the bowel or omentum protrude directly through the external inguinal ring.
