Week 12 Male/Female Genitalia & Anus/Rectum/Prostate Flashcards by Ashlyn Taylor

What are the current USPTSTF recommendations regarding breast cancer screening?

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

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

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

AGE
NUMBER
SHAPE
CONSISTENCY
DELIMITATION
MOBILITY
TENDER
RETRACTION SIGNS

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

AGE
NUMBER
SHAPE
CONSISTENCY
DELIMITATION
MOBILITY
TENDER
RETRACTION SIGNS

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

AGE
NUMBER
SHAPE
CONSISTENCY
DELIMITATION
MOBILITY
TENDER
RETRACTION SIGNS

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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What are some visible signs of breast cancer? #6

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

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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What are considered normal findings of the breasts of newborns?

M + F breasts enlarged; last several months

“Witches milk” ; 1-2 weeks

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What is premature thelarche?

Breast development between 6 months – 2 years

No other signs of puberty or hormonal abnormalities

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

#3
who is this common in?

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

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What is the cremasteric reflex and how is it performed?

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

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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Indirect inguinal hernia

define
AGE
LOCATION
COURSE

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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Direct inguinal hernia

define
age
location
course

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

Gonococcal urethritis: purulent, cloudy, yellow discharge

Nongonococcal urethritis: scanty white or clear discharge.

Definitive diagnosis requires Gram stain and culture

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Hypospadias

congenital ventral displacement of the meatus on the penis

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Chordee

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

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

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

Premature newborn: smooth scrotum

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What exam findings are consistent with a hydrocele?

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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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

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

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

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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What is considered delayed puberty in the male?

What are some common causes? #3

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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Vestibule

Study These Flashcards

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

What are the current cervical cancer screening recommendations?

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.

What is the difference between perimenopause and menopause? at what age does menopause occur?

Menopause: 48-55 years; 12 month cessation menses Perimenopause: erratic cyclical bleeding, hot flashes, flushing, sweating

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

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

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

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

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?

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 ```

What are some tips for a successful pelvic exam?

Avoid intercourse; no douching for 48 hours Empty Bladder Supine, head/shoulders elevated, arms at side HCP Permission/chaperone Explain each step

What are ambiguous genitalia? What are some possible etiologies?

Masculinization of female external genitalia Cause: Congenital adrenal hyperplasia

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

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:

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

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

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

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

What Tanner stage does menarche occur?

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

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

No breast or pubic hair by 12 years CAUSE: - low gonadotropin secretion r/t defective hypothalamic GnRH production - Anorexia - Turner Syndrome

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

Primary: no menarche by age 16; CAUSE: anatomic or genetic Secondary: Cessation of menses; CAUSE: stress, excessive exercise, & eating disorder

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

``` 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 ```

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

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

What are the current recommendations for prostate cancer screening?

55 -69 years old PSA test

What is a normal PSA level?

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

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

round/heart shaped/2.5cm long | -Only posterior surface palpable

What history and exam findings are consistent with a Prostatitis #4 What is the usual cause?

- 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.

What history and exam findings are consistent with a BPH s/s how does it feel?

- S/S: urgency, frequency, nocuturia OR decreased stream, incomplete emptying - Feels symmetric englarged, smooth, firm, elastic

What are the current colorectal screening guidelines?

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

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

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

What history and exam findings would be consistent with External Hemorrhoids? What is it? What makes it painful? What would you see?

(Thrombosed): Dilated hemorrhoidal veins. Symptomatic if thrombosis. Acute pain that increases with defecation & sitting. Tender, swollen, bluish, ovoid mass at anal margin.

What history and exam findings would be consistent with Prolapsed Rectum

Straining w/ BM, mucosa prolapses through anus.

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

45-54 - annual screening | >55 yrs - Q2yrs screening

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

40 years - Screen Q 1 or 2 years recommends clinical breast exams

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

55 years Stop at 69 PSA used as screening tool

What is the American Cancer Society's prostate cancer screening recommendation? average risk high risk how often?

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

What is the American Urological Association's prostate cancer screening recommendation? average risk? high risk? How often?

``` 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 ```

Which primitive reflexes disappear at 4 months? #4

Galant Moro Palmar Rooting

Which primitive reflexes disappear at 3 months?

Asymmetric Tonic Neck Reflex

What does a persistent plantar grasp reflex mean?

Pyramidal tract dysfunction

What primitive reflex disappears at 8 months?

Plantar

What primitive reflex disappears at 6 months?

Landau | Positive Support

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

Severe generalized or CNS disease CN V dysfunction

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

(59 cards)