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Health Assessment > Week 12 Male/Female Genitalia & Anus/Rectum/Prostate > Flashcards

Week 12 Male/Female Genitalia & Anus/Rectum/Prostate Flashcards

1
Q

What are the current USPTSTF recommendations regarding breast cancer screening?

A

50-74 yrs old - Q 2 years
<50 yrs -patient specific factors
>75years – insufficient evidence

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2
Q

What are the seven characteristics of a breast nodule that should be described?

A

Location – by quadrant/clock, with cm from nipple
Size – cm
Shape – round/cystic; disc-like; or irregular in contour
Consistency – soft, firm, or hard (Hard = cancer)
Delimitation – well circumscribed? (poorly circumscribed = cancer)
Tender –
Mobility – fixed? (fixed to skin = cancer)

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3
Q

What history, exam findings and risk factors are consistent with a fibroadenoma?

AGE
NUMBER
SHAPE
CONSISTENCY
DELIMITATION
MOBILITY
TENDER
RETRACTION SIGNS
A

AGE: puberty -young adult

NUMBER: usually single; maybe multi

SHAPE: round, disc, lobular, 1-2cm (small)

CONSISTENCY: maybe soft, firm

DELIMITATION: well delineated

MOBILITY: very mobile

TENDER: Non tender

RETRACTION SIGNS: Absent

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4
Q

What history, exam findings and risk factors are consistent with a CYST?

AGE
NUMBER
SHAPE
CONSISTENCY
DELIMITATION
MOBILITY
TENDER
RETRACTION SIGNS
A

AGE: 30-50yrs

NUMBER: single or multiple

SHAPE: round

CONSISTENCY: soft/firm/elastic

DELIMITATION: well-delineated

MOBILITY: mobile

TENDERNESS: usually tender

RETRACTION: Absent

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5
Q

What history, exam findings and risk factors are consistent with a CANCER?

AGE
NUMBER
SHAPE
CONSISTENCY
DELIMITATION
MOBILITY
TENDER
RETRACTION SIGNS
A

AGE: 30-90yrs; usually >50yrs

NUMBER: Single

SHAPE: Irregular or stellate (star pattern)

CONSISTENCY: Firm or Hard

DELIMITATION: no clearly delineated from surrounding tissues

MOBILITY: Fixed to skin or tissues

TENDER: nontender

RETRACTION: Present

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6
Q

What are some visible signs of breast cancer? #6

A

Retraction signs:
-Fibrosis causes dimpling, changes in countour, & retraction/deviation from nipple

Abnormal contours:
-variation in convexity

Skin Dimpling:
-pt arm at rest, special positioning, & compressing breast

Nipple Retraction:
-flatted/pulled inward. Nipple deviates towards cancer

Edema of the skin:
-“orange peel” 1st seen in lower portion areola. Caused by lymphatic blockade

Paget Disease of the Nipple:

- scaly, eczema lesion on nipple that weeps/crusts/erodes.  - Suspect Pagets for persistent dermatitis of nipple.
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7
Q

What could milky nipple discharge indicate? Bloody? Clear, serous, green or black?

A

Milky Nipple discharge:

- nonpuerperal galactorrhea
- Cause: hypothyroidism, pituitary prolactinoma, & dopamine antagonists (psychotropics & phenothiazines

Spontaneous unilateral bloody discharge warrants evaluation for intraductal papilloma.

Clear, serous, green, black, or nonbloody & multiductal = benign

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8
Q

What are considered normal findings of the breasts of newborns?

A

M + F breasts enlarged; last several months

“Witches milk” ; 1-2 weeks

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9
Q

What is premature thelarche?

A

Breast development between 6 months – 2 years

No other signs of puberty or hormonal abnormalities

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10
Q

What symptoms and exam findings are consistent with a testicular torsion?

#3
who is this common in?
A

Tender painful scrotal swelling that is retracted upward in the scrotum
Absent cremasteric reflex
Common in infants & adolescents

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11
Q

What is the cremasteric reflex and how is it performed?

A

Testis retract upward into the inguinal canal

Stoke upward or downward along medial aspect of the thigh. The side being stroked will move upward

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12
Q

What is the difference between a direct and indirect inguinal hernia?

A

INDIRECT: develop at internal inguinal ring, where spermatic cord exits the abdomen==bulge near internal inguinal ring
AGE: most common; Children,
LOCATION: above inguinal ligament near midpoint
COURSE: occurs in scrotum. Hernia comes down inguinal canal and touches the fingertip

DIRECT: more medial d/t weakness in inguinal canal floor & are associated with heavy lifting/straining. == bulge near external inguinal ring
AGE: men >40 yrs
POINT OF ORIGIN: above inguinal ligament, close to pubic tubercle
COURSE: RARELY in scrotum. Hernia bulges anteriorly and pushes side of finger forward

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13
Q

Indirect inguinal hernia

define
AGE
LOCATION
COURSE

A

Indirect: develop at internal inguinal ring, where spermatic cord exits the abdomen==bulge near internal inguinal ring

AGE: most common; Children,

LOCATION: above inguinal ligament near midpoint

COURSE: occurs in scrotum. Hernia comes down inguinal canal and touches the fingertip

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14
Q

Direct inguinal hernia

define
age
location
course

A

Weakness in inguinal canal floor & associated with heavy lifting/straining. == bulge near the external inguinal ring

AGE: less common; men >40 yrs; rarely women

POINT OF ORIGIN: above inguinal ligament, closest to pubic tubercle

COURSE: RARELY in scrotum. Hernia bulges anteriorly and pushes side of finger forward
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15
Q

What exam findings are consistent with gonococcal urethritis vs. nongonococcal urethritis?

A

Gonococcal urethritis: purulent, cloudy, yellow discharge

Nongonococcal urethritis: scanty white or clear discharge.

Definitive diagnosis requires Gram stain and culture

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16
Q

Hypospadias

A

congenital ventral displacement of the meatus on the penis

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17
Q

Chordee

A

Fixed, downward bowing of the penis and may accompany hypospadias.

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18
Q

What are considered to be normal scrotal findings of the newborn? The premature newborn?

A

Full Term Newborn:
ruggae scrotum;
testes in scrotum most of the time 10x15mm

Premature newborn: smooth scrotum

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19
Q

What exam findings are consistent with a hydrocele?

A

Usually with hernia
More common on R side
Overlie testes & spermatic cord, and can be reducible or non reducible. Can be transilluminated. Resolve by 1.5 years

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20
Q

What exam findings are consistent with a hernia in the newborn/infant?

what usually accompanies it? #2
What side is it more common on?
Characteristics? #3

A

Usually with hydrocele or thickened spermatic cord (silk sign)
More common on R side
Hernias are separate from the testes, reducible, and
DO NOT transilluminate and
DO NOT resolve

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21
Q

How would the FNP classify Tanner Stages (Sexual Maturity Rating) in males

A

Stage 1: preadolescent

Stage 2: HAIR: “downy” PENIS: no enlargement TESTES: testes larger; reddened & altered texture

Stage 3: HAIR darker, coarser, curlier PENIS: longer TESTES: further enlarged

State 4: HAIR: like adult, does not include thighs PENIS: longer & wider w/glans development TESTES: skin darkened

Stage 5: HAIR: includes thighs but not abdomen PENIS: adult size TESTES: adult size

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22
Q

What is the general order of pubertal changes in the male?

A

1st reliable sign is increase in size of testes age 9 to 13.5 yrs

2nd sign = pubic har & penis enlargement

“complete change from preadolescent to adult anatomy requires 3 years OR 1.8 to 5 years”

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23
Q

What is considered delayed puberty in the male?

What are some common causes? #3

A

No pubertal changes by 14 years of age

  • “constitutional delay” = familial condition involving delayed bone & physical maturation but normal hormonal levels
  • Primary or Secondary Hypogonadism
  • GnRH deficiency
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24
Q

Vestibule

A

boat shaped fossa between labia minora that surround opening of the urethra.

25
Q

What are the current cervical cancer screening recommendations?

A

BEGIN at 21 yrs Q 3 years;

END at 65yrs after 3 consecutive negative results or 2 consecutive negative plus HPV testing w/in 10 years before cessation.
Most recent test should be within 5 years.

26
Q

What is the difference between perimenopause and menopause?

at what age does menopause occur?

A

Menopause: 48-55 years; 12 month cessation menses

Perimenopause: erratic cyclical bleeding, hot flashes, flushing, sweating

27
Q

What questions are important to ask when assessing for risk for STIs?

A

Partners, Practices, Protection, Past history of STIs, Pregnancy plans,

28
Q

When considering acute pelvic pain, what are some life-threatening conditions that should be on your differential?

A

Ectopic Pregnancy: r/o first! Urine testing or ultrasound; features: abdominal pain, adnexal tenderness/mass, abnormal uterine bleeding.

Ovarian Torsion

Appendicitis

PID: STIs, recent IUD insertion; features: compression tenderness

29
Q

What are the difference in symptoms, exam findings and wet mounts finding for trichomonal vaginitis, candidial vaginitis, and bacterial vaginosis?

s/s
type of mount preparation?

A

Trichomonal vaginitis:
S/S: profuse, frothy, yellowish-green/gray
MALOROROUS; pruritus, pain w urination & dyspareunia
MOUNT: Saline wet mount

Candida:
S/S: “white and curdy” NO ODOR; purities, vaginal soreness, pain on urination, dyspareunia
MOUNT: KOH preparation for the branching hyphaie of Candida

Bacterial Vaginosis: 
    S/S: thin, MALODOROUS; fishy/musty; 
    MOUNT: - Saline wet mount “clue cells” 
		-KOH “whiff test”
		-Vaginal pH >4.5
30
Q

What are some tips for a successful pelvic exam?

A

Avoid intercourse; no douching for 48 hours
Empty Bladder
Supine, head/shoulders elevated, arms at side

HCP
Permission/chaperone
Explain each step

31
Q

What are ambiguous genitalia? What are some possible etiologies?

A

Masculinization of female external genitalia

Cause: Congenital adrenal hyperplasia

32
Q

What are some normal configurations of the hymen in the prepubertal child? #5

A

Septate hyman: 2 orifices

Crescent shape: border lower part of vaginal orifice

Annular: hole in center

Redundant labial tissue: estrogen effect. Need knee-chest configuration to visualize.

Annular & thickened:

33
Q

How would the FNP classify Tanner Stages (Sexual Maturity Rating) in females?

A

Stage 1: nipple only

Stage 2: “breast bud” ; HAIR “downy” labia only

Stage 3: enlargement of elevation of breast and areola (no separation of contour); HAIR darker over pubic symphysis

Stage 4: Areola projects (2 contours/2nd mound); HAIR similar to adult NOT ON THIGHS

Stage 5: Nipple projection; areola recedes to general breast contour; HAIR = THIGHS

34
Q

What is the general order of pubertal changes in the female?

A

1st easily detectable sign = breast buds and sometime pubic hair appears earlier

35
Q

What Tanner stage does menarche occur?

A

Menarche usually occurs when a girl is in breast stage 3 or 4

36
Q

What is considered delayed puberty in the female? What are some common causes? #3

A

No breast or pubic hair by 12 years

CAUSE:

  • low gonadotropin secretion r/t defective hypothalamic GnRH production
  • Anorexia
  • Turner Syndrome
37
Q

What is primary vs. secondary amenorrhea? What are some possible causes?

A

Primary: no menarche by age 16; CAUSE: anatomic or genetic

Secondary: Cessation of menses; CAUSE: stress, excessive exercise, & eating disorder

38
Q

What are some physical signs of sexual abuse in the pediatric patient?

A 
Lacerations
Ecchymoses
Newly healed scars on hymen
No hymenal tissue (or healed) from 3 to 9 o’clock (in various positions)
Perianal lacerations
Purulent discharge
Herpetic Lesions
39
Q

What are some causes of vaginal discharge in the pediatric patient?

A 
Perineal irritation (bubble baths)
Foreign body – purulent, profuse, malodorous & blood tinged discharge
Candida
Pinworms
STI from sexual abuse
40
Q

What are the current recommendations for prostate cancer screening?

A

55 -69 years old

PSA test

41
Q

What is a normal PSA level?

A

2.5 – 4nb/ml safe for most…risk factors?

>4nb/ml abnormal

42
Q

What history and exam findings are consistent with a normal prostate gland #4

A

round/heart shaped/2.5cm long

-Only posterior surface palpable

43
Q

What history and exam findings are consistent with a Prostatitis #4

What is the usual cause?

A
  • Fever, UTI s/s
    • Feels tender, swollen, “boggy,” warm
    • Usually E. coli
    • 80% report obstructive or irritative symptoms on voiding but no sign of infection.
44
Q

What history and exam findings are consistent with a BPH

s/s
how does it feel?

A
  • S/S: urgency, frequency, nocuturia OR decreased stream, incomplete emptying
  • Feels symmetric englarged, smooth, firm, elastic
45
Q

What are the current colorectal screening guidelines?

A

Adults 50-75years
Stool based test
Direct visualization tests (colonoscopy every 10 years)
CT colonography Q 5 years

46
Q

What history and exam findings would be consistent with internal hemorrhoids?

A

: (Prolapsed) Enlarged vascular cushions. Not palpable. Bright red bleeding during defecation. Reddish, moist, protruding.

47
Q

What history and exam findings would be consistent with External Hemorrhoids?

What is it?
What makes it painful?
What would you see?

A

(Thrombosed): Dilated hemorrhoidal veins. Symptomatic if thrombosis.

Acute pain that increases with defecation & sitting.

Tender, swollen, bluish, ovoid mass at anal margin.

48
Q

What history and exam findings would be consistent with Prolapsed Rectum

A

Straining w/ BM, mucosa prolapses through anus.

49
Q

what are the current American Cancer Society breast cancer screening recommendations?

A

45-54 - annual screening

>55 yrs - Q2yrs screening

50
Q

What are the American College of Obstetricians and Gynecology recommendations for breast cancer screening?

A

40 years - Screen Q 1 or 2 years

recommends clinical breast exams

51
Q

What does the USPSTF recommend for prostate cancer screening?
Start?
stop?

A

55 years
Stop at 69
PSA used as screening tool

52
Q

What is the American Cancer Society’s prostate cancer screening recommendation?

average risk
high risk
how often?

A

Annual PSA or Q2 if PSA <2.5
50 years
40 years for high risk
Stop when life expectancy is <10yrs

53
Q

What is the American Urological Association’s prostate cancer screening recommendation?

average risk?
high risk?
How often?

A 
55 yrs
40yrs high risk
Stop when life expectancy is <10yrs
Q2years PSA
Use psa, imaging and risk calculators to determine if biopsy is needed
54
Q

Which primitive reflexes disappear at 4 months? #4

A

Galant
Moro
Palmar
Rooting

55
Q

Which primitive reflexes disappear at 3 months?

A

Asymmetric Tonic Neck Reflex

56
Q

What does a persistent plantar grasp reflex mean?

A

Pyramidal tract dysfunction

57
Q

What primitive reflex disappears at 8 months?

A

Plantar

58
Q

What primitive reflex disappears at 6 months?

A

Landau

Positive Support

59
Q

What does an absent rooting reflex mean? Which CN dysfunction?

A

Severe generalized or CNS disease

CN V dysfunction

Health Assessment (3 decks)

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