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Clinical Med > Test 5 > Flashcards

Test 5 Flashcards

1
Q

menopause defeinition

A

without period for 12 months 45-55yrs of age

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2
Q

for females of reproductive age always ask:

A

the first day of their last period

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3
Q

bigest pelvic acute concern?

A

ectopic pregnancy

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4
Q

ACOG Guidelines for PAPS

A
  • Begins at age 21 (regardless of behavior, risk factors, and age of first sex
  • 21-29 yr olds - cytology every 3 years no HPV testing
  • 30-65 yr old- cytology and HPV testing every 5 years; cytology alone every 3 years; HPV alone not recommended
  • After 65 yrs - depends on previous resuts; previous negative; 3 consecutive neg or 2 consecutive co-test= no further testing; continue screening if CIN2, CIN3 or adenocarcinoma; hysterectomy = no further testing if cervix removed and no history of CIN2 or higher; screening continues every 3 years for next 20 years
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5
Q

ACOG guidelines do not apply if:

A
  • HIV infection
  • Immunosuppression
  • Exposure to diethylstilbestrol (DES) in utero
  • History of cervical cancer
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6
Q

HPV vaccine guidelines:

A
  • Targets HPV-16 and HPV-18
  • 2 most common cancer causing HPV types
  • Vaccine does not protect against 30% of cervical cancer caused by HPV types other than 16 and 18
  • Nearly 100% protection if women are not exposed to the virus and get the vaccine
  • Less level of protection if a woman was already exposed to HPV 16 or 18
  • May not see impact of vaccine for 15-20 years, thus still need to screen regularly
  • Now given to both sexes
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7
Q

Stage 1 Tanner of Penis

A
  • 9-13yrs
  • trace pubic hair
  • small amount of lengthening of the penis and testicles
  • infrequent erections
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8
Q

Stage 2 Tanner of Penis

A
  • 11-13 yrs
  • height 3in per year
  • hair thickens and darkens
  • testicles lengthen
  • sac thins and reddened
  • body lean
  • more infrequent erections
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9
Q

Stage 3 Tanner of Penis

A
  • 14yrs
  • penis continues to grow in length
  • testicle sac grows
  • hair very prominent
  • nipples sensitive
  • voice changes/breaks
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10
Q

Stage 4 Tanner of Penis

A
  • 15 yrs
  • height of 4in per year
  • testicles lengthens
  • penis considerably thickens
  • armpit hair begins
  • pubic hair fully covered
  • acne begins
  • voice deepens
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11
Q

Stage 5 Tanner of Penis

A
  • 16-18yrs
  • adolescence complete
  • penis and testicle full size
  • body growth slowly stops
  • pubic hair to inner thighs
  • hair chin and cheeks
  • muscle development
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12
Q

direct hernia

A
  • less common
  • men>40yr
  • rare women
  • above inguinal ligament, close to pubic tubercle
  • rarely into scrotum
  • bulges anteriorly and pushes the side of examiners finger forward
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13
Q

Indirect hernia

A
  • most common
  • both sexes
  • often children, maybe adults
  • above inguinal ligament near midpoint
  • often into scrotum
  • comes down inguinal canal and touches fingertip
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14
Q

femoral hernia

A
  • least common
  • more common in women than men
  • below inguinal ligament
  • more lateral than inguinal hernia
  • hard to differentiate from lymph node
  • never scrotum
  • inguinal canal is empty
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15
Q

scrotum drains its lymph into the

A

inguinal nodes

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16
Q

penis drains its lymph into the

A

inguinal nodes

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17
Q

testes drain its lymph into the

A

abdomen

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18
Q

melena color of stool

A

black tarry sticky stool
usually higher GI
GERD, peptic ulcer, gastritis

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19
Q

black color of stool

A

non-sticky

iron, licorice, bismuth salts

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20
Q

hematochezia color of stool

A

red blood
usually in colon, rectum, or anus
colon cancer, polyps, diverticula, hemorrhoids, anal fissue, inflammatory conditions of the colon and rectum

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21
Q

reddish, nonbloody cold of stool=

A

ingestion of certain foods

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22
Q

Prostate cancer screening

A
  • start age 50
  • start at 45 if African American , father or brother with prostate cancer before 65
  • if tested: PSA with or without rectal; frequency of testing depends on level
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23
Q

PSA Test

A 
Biomarker for early detection
Limitations
Elevated in benign conditions
False positives
False negatives
Unnecessary testing
Biopsy
Level interpretation 
Common cutpoint for biopsy is 4.0 ng/ml
Over diagnosis
Side effects with treatment
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24
Q

Digital Rectal Exam

A

Low sensitivity: 59%
Specificity: 94%
Detects tumors on the posterior and lateral aspects
Misses 25-35% of tumors arising in other areas
Abnormal findings need to be investigated

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25
Q

Colorectal Cancer Screening

A

—-Average risk
Starting at 50 years both male and female
Annual Fecal occult blood
Multiple stool take home kit
Positive result-colonoscopy
Sigmoidoscopy every 5 years with fecal occult blood every 3 years
Screening colonoscopy every 10 years
Another option: double contrast barium enema or computed tomography colonography every 5 years
—-Increased risk
Inflammatory bowel disease or family history of an inherited polyposis syndrome
Colonoscopy every 3-5 years

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26
Q

Prostatitis Acute

A 
Presents fever, UTI and low back pain
Gland 	
Tender, swollen, “boggy” & warm
E coli
Under 35 STI
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27
Q

Prostatitis chronic

A 
Recurrent UTI
Asymptomatic of dysuria, mild back pain
Gland
Normal 
E coli
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28
Q

Benign Prostatic Hyperplasia

A 
Nonmalignant
50% of 50 year olds
Urgency, frequency, nocturia, decrease stream, incomplete emptying
 Gland
Normal or symmetrically enlarged
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29
Q

Prostate Cancer

A

Gland
Hardness
Irregular
Obscured median sulcus

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30
Q

Anal fissure

A

Painful
Location
Most are midline posteriorly
Swollen sentinel skin tag

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31
Q

Polyps

A

Fairly common
Variable size and number
Pedunculated or sessile
Soft and difficult to feel

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32
Q

Anorectal Fistula

A

Inflammatory tract
Opens into rectum or anus and skin or viscus
Usually caused by abscess

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33
Q

Hemorrhoids internal prolapsed

A 
Enlargement of vascular cushions
Above pectinate line
Not palpable
Bright red bleeding
Prolapse
Reddish moist
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34
Q

Hemorrhoids external thrombosed

A

Dilated veins
Below pectinate line
Usually asymptomatic unless thrombosed
Tender, blue, swollen and ovoid

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35
Q

Apendages of the skin

A 
Hair
Nails
Sebaceous glands
Eccrine sweat glands
Apocrine sweat glands
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36
Q

hair types:

A
  • Vellus – short, fine, inconspicuous and relatively unpigmented
  • Terminal hair - coarser, thicker, more conspicuous, and usually pigmented examples would be scalp hair and eyebrows
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37
Q

nails:

A
  • p33 in lab manual
  • Nail plate
  • Nail bed
  • Cuticle
  • Nail root
  • Nail plate
  • Lunula
  • Proximal nail fold
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38
Q

Sebaceous glands

A
  • Secrete sebum – a lipid rich substance that keeps the skin and hair from drying out
  • Largest sebaceous glands are found on the face and upper back
  • Absent from soles and palms
  • Production of sebum is dependent on gland size , which is directly influenced by androgen secretion
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39
Q

Eccrine sweat glands

A
  • Open directly on the surface of the skin
  • Help to regulate body temperature through water secretion
  • Located mainly in the axillae, forehead, palms and soles
  • Absent in the nail beds and some mucosal surfaces i.e. lip margins
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40
Q

Apocrine glands

A
  • Larger and deeper than eccrine glands
  • Specialized structures – axillae, nipples, areolae, anogenital area, eyelids, and external ears
  • Reach maturity only at puberty
  • Secretion can increase in times of stress
  • Odorless
  • Bacterial decomposition of apocrine sweat produces body odor
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41
Q

‘ABCDEs’ Early recognition of possible Melanoma

A

A – for Asymmetry of one side compared to the other
B – irregular Borders, ragged, notched, or blurred
C – variation in color – esp. blue and black mixed
D – for Diameter > 6 mm
E – for Evolution or change in size, symptoms, or morphology

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42
Q

‘HARMM’ Melanoma Risk Model

A
  • History of previous melanoma
  • Age over 50
  • Regular dermatologist absent
  • Mole changing
  • Male gender
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43
Q

Risk factors for Basal & Squamous Cancer

A
  • Age - > 50
  • Chronic exposure to sunlight, UVA & UVB
  • Fair, freckled, ruddy complexion
  • Light colored hair and eyes
  • Sunburn easily
  • Childhood blistering burns
  • Geographic – equator or high altitudes
  • Repeated trauma or irritation
  • Exposure to harmful chemicals
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44
Q

Normal mole*

A
  • Uniformly tan or brown
  • All look alike
  • Round or oval
  • Clear defined borders
  • Flat or smooth
  • Less than 6 mm
  • Typical adult 10-40
  • Waist, scalp, breast, sun exposed areas
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45
Q

Dysplastic mole*

A
  • Varied appearance
  • Irregular borders, notches
  • Fades in surrounding skin
  • Smooth, scaly, rough, irregular
  • Greater than 6 mm
  • Anywhere often on back, below waist, scalp, breast, buttocks
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46
Q

Schamroth’s Sign

A
  • clubbing – nail base angle < 180

- Associated with Cardiovascular, respiratory diseases as well as inflammatory bowel disease, cirrhosis

47
Q

common causes of bounding pulses (with lower extremities?)?

A 
F - Fever
A- Aortic insufficiency
C - Complete heart block
T - Thyrotoxicosis
S - Systolic hypertension
48
Q

bounding pulses caused by and associated with?

A

associated with wide pulse pressure where the difference bw diastolic and systolic pressure is greater than 60mmHg

49
Q

delay associated with pulses of capillary refill of toes… 2 potentials?

A

vasospasm or structural changes to the large vessels

50
Q

pitting edemas caused by:

A

heart failure (protein rich edema)press firmly for 5sec and if indent remains for 5sec its piting edema

51
Q

non-pitting edema caused by

A

lack of protein in exudate - kidney or liver problem

52
Q

pitting edema grading:

A

1+ 2mm
2+ 4mm
3+ 6mm
4+ 8mm

53
Q

macule definition

A

primary lesion non palpable skin change <.5cm

54
Q

patch definition

A

primary lesion non palpable skin change >.5cm

55
Q

papule definition

A

primary lesion palpable solid <.5cm

56
Q

nodule definition

A

primary lesion palpable solid .5-1cm

57
Q

tumor definition

A

primary lesion palpable solid >1cm

58
Q

plaque definition

A

primary lesion palpable solid >.5cm flat, elevated surface formed by coalescence of papules

59
Q

vesicle definition

A

primary lesion clear fluid filled <.5cm

60
Q

bulla definition

A

primary lesion clear fluid filled >.5cm

61
Q

pustule definition

A

primary lesion cloudy pus filled <.5cm

62
Q

abscess definition

A

primary lesion cloudy pus filled >.5cm

63
Q

secondary lesion:

A
  • either the result of progressive changes in the primary lesion or are caused by external causes
  • Type: Erosion, crust, scale, fissure, ulcer, lichenification, atrophy, excoriation, scar, keloid
64
Q

verruca

A

secondary skin lesion
red and black dots in white lesion
-wipe alchol on it and it will vasodialate

65
Q

in-grown toe nail

A

pustule or abcess

66
Q

thickened nails are not always…

A

FUNGAL! Sometimes just thick toe nails

67
Q

distinguish thick toe nails:

A 
(TOE CLYPT)
T: trauma
O: onychmycosis
E: eczema
C: circulatory problems
L: lichen planus
Y: yellow nail syndrome
P: psoriasis
T: tumor
68
Q

dry skin due to:

A
  • Insufficient number of sweat glands or autonomic dysfunction (diabetes)
  • Tinea pedis
  • Psoriasis
  • Eczema
69
Q

ulceration due to

A
  • break down and loss of dermis and epidermis
  • due to vascular disease and or anesthetic neuropathy
  • poor blood supply or completely numb
  • if the ulcer is red itll probably heal as long as you take the pressure up
70
Q

charcot foot

A

usually in diabetics where bones in foot loose shape

71
Q

Spinothalamic tract

A
  • small fibers
  • sharp and dull pain (nociceptive)
  • temperature
  • crude touch - complaint of burning or cramping
72
Q

posterior colum

A
  • large fibers
  • position
  • vibration
  • fine touch - complaint of pins and needles or electric shock
73
Q

Touch simuli: testing

A
  • Represents a measure of low threshold mechanoreception
  • abnormality indicates small fiber disease
  • Using a 5.07 Semmes-Weinstein monofilament (10 gms of pressure), apply pressure to the 1st, 3rd, & 5th, metatarsal heads, the 1st, 3rd, & 5th toes, the plantar arch, the plantar heel, beneath the 5th metabase and the dorsal midfoot
  • Normal is detecting filament in at least 7/10 areas. The inability to detect the pressure in more than 3 areas suggests the potential for neurotrophic ulceration
74
Q

Vibration testing:

A
  • use a 128 cycles/sec tuning fork over the IPJ of the hallux
  • ask the patient to tell you when it stops vibrating
  • –>if vibration sense decreased, proceed more proximally until vibration felt
  • loss of vibration in < 10 seconds is abnormal at any age
  • indicates large fiber disease
  • done over IP joint just behind nail
75
Q

Sharp stimuli testing

A
  • Ask the patient to close his eyes. Break a Q-tip in half and use each end to touch the skin
  • Ask a three-part question: “Which is sharper, the first touch, the second touch, or are both the same?”
  • Inability to detect sharp from dull supports the diagnosis of a small fiber disease
76
Q

temperature testing

A
  • Omit if pain sensation is normal
  • Touch the skin with hot and cold water test tubes
  • Lack of temperature sensation suggests small fiber disease
77
Q

Position sense (proprioception): testing

A
  • Passively move the great toe up and down by grasping along the sides of the interphalangeal joint only a few mms. and ask patient which direction you are moving the toe (PT EYES CLOSED)
  • Reduced perception (including falsely perceived motion) indicates large-fiber disease
78
Q

Small fiber disease list

A
  • Semmes-Weinstein monofilament
  • Sharp-dull
  • Temperature
79
Q

Large fiber disease

A
  • Vibration

- Proprioception

80
Q

tendon reflex tests the

A

SENSORY REFLEX

81
Q

stroke patients have what kind of tendow relfex test?

A

Hpyerreflexive (4/4)

82
Q

polio patients have what kind of reflex?

A

hyporeflexive 0/4

83
Q

Deep reflexes

A
  • Deep reflexes: Often have to use reinforcement (Jendrassie maneuver) to facilitate observation of reflexes in the lower extremity
    • Knee reflex: innervated by L 2, 3, 4
    • Ankle reflex: innervated by S 1, 2
84
Q

Knee reflex indicates issue with

A

L2,3,4

85
Q

Jendrassie maneuver

A

having patient pull hands apart so that brain stops thinking about the reflex you are tryin to perform

86
Q

ANkle reflex indicates issue with

A

S1 and 2

87
Q

Superficial reflex or plantar response (L4, L5, S1, S2)

A
  • Elicited by stroking the lateral aspect of the sole from the heel to the ball of the foot, curving medially across the ball
  • Toes normally plantarflex
  • If there is dorsiflexion of the great toe and fanning of the other toes, it indicates upper motor neuron disease (Babinski response)
88
Q

All-in-one test

A
  • Hop-in-place with each foot
  • Ability to do this indicates:
  • intact motor system in the legs
  • normal cerebellar function
  • good position sense.
89
Q

peripheral neuropathy is suggested by:

A

patient is able to stand on tiptoes but not on heels

90
Q

spinal lesion is suggested by

A

patient is able to stand on heels but not on tiptoes

91
Q

how to check for disorders of the autonomous nervous system

A
  • Pulse rate changes with deep breathing: With normal vagal nerve input to the heart, the pulse rate at rest will increase with inspiration and decrease with expiration
  • Orthostatic dizziness and changes in blood pressure: A drop of > 30 mm Hg systolic and > 15 mm Hg diastolic recorded 60 to 90 seconds after standing following 5 minutes of supine rest
92
Q

premature infant range

A

27-36 weeks

93
Q

most accurate way to determine gestational age:

A

use last menstrual period

94
Q

tool used to estimate gentational age?

A

Ballard Score - done within first 24 hrs of life based on how the kid looks.

95
Q

baby head growth after birth?

A

1cm/mo for first year

96
Q

fontanel closure ant/post

A

posterior first at 6-9mo and ant bw 18 and 24 mo

97
Q

most reliable indicator of infants nutritional status?

A

weight

98
Q

Moro reflex

A
  • Abrupt removal of support of infant’s head in a supine position results in extension and abduction of the upper extremities only.
  • This reflex is lost at around 5 months
99
Q

Sucking reflex

A

-A fingertip introduced into an infant’s mouth will trigger simultaneous movement of the tongue and pharynx to allow for milk to be squeezed out of a nipple and propelled toward the esophagus.

100
Q

Grasp reflex

A
  • As pressure from a finger is made against the palm of a baby, the fingers curl around the other person’s finger
  • Disappearance by 4-6mo of age
101
Q

Rooting reflex

A
  • When the cheek is lightly touched, the infant turns his head toward the stimulus and purses his lips
  • Disappearance by 4-6mo of age
102
Q

Stepping or Placing reflex

A
  • When the newborn is supported vertically and the plantar surfaces of the feet are placed on a flat surface, the legs extended and partially support the infant.
  • If the infant is then lightly propelled, he makes walking movements with good coordination and relatively steady positioning of the feet in a “stepping movement”.
  • This reaction persists for about six weeks
103
Q

Tonic neck reflex

A
  • With the infant supine, turning of the head results in ipsilateral extension of the arm and leg in a “fencing” posture
  • Disappearance by 4-6mo of age
104
Q

Parachute reflex

A
  • With the infant sitting, tilting to either side results in extension of the ipsilateral arm in a protective fashion
  • Appears at 6-8 months of age
  • Persists throughout life
105
Q

The AP diameter to lateral diameter ratio during the first three years of life?

A

DECREASES

-RIB CAGE IS MORE CIRCULAR THAN ADULT

106
Q

birth RR:

A

40-60 per min

107
Q

1-6 mo RR

A

20-50 per min

108
Q

60mo to 2 yrs RR

A

20-40 per min

109
Q

3 years RR

A

20-30 per min

110
Q

6 year RR

A

16-22 per min

111
Q

adolescent RR

A

12-20 per min

112
Q

physical exam on respiration note

A

RATE AND EFFORT!

113
Q

most common palpable mass in an infant=

A

enlarged kidney

Clinical Med (7 decks)

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