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NUNP 540 (Kelly's flashcards) > Week 8 - Essentials text... > Flashcards

Week 8 - Essentials text... Flashcards

1
Q

What does the acronym NURSE stand for?

A 
Name the emotion
Show Understanding 
Handle the issue with Respect
Show Support 
Ask the patient to Elaborate on the emotion
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2
Q

What does SPIKES stand for?

A

Setting up the interview (sitting, privacy, etc.)
Perception of the patient (open - ended Q’s)
Invitation to disclose info (what would you like to know)
Knowledge giving (warn patient, avoid medical jargon, avoid being too blunt)
Empathizing with the patient’s emotions (NURSE)
Strategize and Summarize

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3
Q

HEADSS

A 
Home and environment 
Education and employment
Activities
Drugs
Sexuality
Suicide/Depression
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4
Q

What are the 5 P’s of sexual history?

A

Partners (number and gender, relationship)
Practices (types of sex, sex work, survival sex, genital piercings, etc)
Protection (barriers, PrEP, PEP, HPV immunization)
Past history (Age of sexual activity, past STIs, hx sexual assault/abuse)
Pregnancy (GTPAL, planning, contraception, menstruation)

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5
Q

How do you assess hepatojugular reflux and what does a positive test indicate?

A

Apply pressure over RUQ/liver for 30 seconds. JVP height should increase transiently. If it remains elevated this indicates heart failure.

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6
Q

What are 1st degree and 2nd degree sensory modalities (Essentials of clinical examination… p. 16)

A

1st degree: pain, temperature, fine tough, vibration, proprioception

2nd: stereognosis, graphestesia, two point discrimination

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7
Q

Reynold’s pentad (cholangitis)

A

Charcot’s triad (jaundice, fever, RUQ pain) + hypotension + altered mental status

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8
Q

6 F’s of protuberant abdomen:

A 
Fat
Fluid
Feces
Fetus
Flatus
Fatal growth
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9
Q

Cullen’s sign

A

Blueish discolouration around umbilicus

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10
Q

Sister Mary Joseph Node

A

palpable node bulging into umbilicus indicating pelvic or abdominal malignancy

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11
Q

Grey-Turner’s sign

A

Bluish discolouration to flanks (retroperitoneal hemorrhage)

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12
Q

What do bulging flanks indicate?

A

Ascites

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13
Q

Caput medusae

A

Superficial veins surrounding umbilicus

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14
Q

What is the normal superficial venous flow in the abdomen?

Give an example of abnormal flow and the cause.

A

Normal flow:
Cephalad (towards to head) above the umbilicus and caudad (towards the feet) below the umbilicus.

Abnormal examples:
Cephalad below umbilicus suggests IVC obstruction

Caudal above the umbilicus suggests SVC obstruction

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15
Q

What is a succession splash?

A

“Whoosh” heard on auscultation of epigastrium while rolling patient side to side. Caused by gastric outlet obstruction.

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16
Q

How do you landmark for vascular bruits?

A

Aorta: 1-2 inches above umbilicus

Renal: 1 Inch either side

Bifurcation of common iliac arteries: halfway between iliac and ASIS (ant. sup. iliac spine

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17
Q

Liver + gallbladder exam:
A bruit may be caused by _______ (2)
A venous hum may indicate _________ (1)

A

Bruit: hepatocellular carcinoma, alcoholic hepatitis

Hum: portal hypertension

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18
Q

Courvoisier sign

A

palpable gallbladder and painless jaundice –> pancreatic or biliary neoplasm until proven otherwise

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19
Q

What are two tests to assess for ascites?

A

Shifting Dullness: determine border of tympany in supine then have pt roll onto their side, the border shouldn’t change. If it moves down = dependent fluid = ascites

Fluid wave: Pt hand midline abdomen, tap lateral side and assess for a fluid “thrill” on the contralateral side. (+) = ascites

20
Q

What is Traube’s space? What is Castell’s sign?

A

Traube: Left ant axillary line, left costal margin, 6th rib…
normal = tympanic/resonant splenomegaly = dull

Castell’s sign: left ant axillary line, lowest ICS, dull on inspiration = splenomegaly

Must be on empty stomach. Food is dull.

21
Q

Carnett’s sign

A

Patient lifts legs with knees extended. Pain = abdominal wall lesion. No pain = abdominal cavity etiology.

22
Q

Schilling test

A

Assess for Vit B12 absorption issues. Measurement of urinary Vit B12 after oral ingestion.

23
Q

MRCP and ERCP

A

MRCP: MRI for evaluation of biliary obstruction (for pt with jaundice and elevated liver fntn tests)

ERCP: endoscopic procedure to examine common bile duct and pancreatic duct.

24
Q

AST:ALT ratio for alcoholic liver disease

A

2:1

25
Q

Signs portal hypertension (3)

A

venous hum, splenomegaly, ascites

26
Q

What is a typical menstrual cycle. Include duration and phases.

A

Duration:Normal = Q21 to 35 days (average 28d)

Menses: Day 1 (typically 5 days)

Proliferative phase: begins after menses and ends with LH surge (day 7 to 21)

Secretory phase: LH surge to onset of menses (always 14 days)

27
Q

Kallman’s syndrome

A

GnRH deficiency –> amenorrhea. Tx w/ hormone replacement. Also known as hypothalamic hypogonadism

28
Q

Female athlete triad

A

menstrual dysfunction (amenorrhea)
low energy availability (with or without eating disorder)
decreased mineral density (osteoporosis)

29
Q

Causes of dyspareunia (introital, mid vaginal, deep)

A

Introital: inadequate lubricant, vaginismus, vulvovaginitis
Midvaginal: anatomical (short vagina, vaginal septum), UTI
Deep: endometriosis, PID, uterine retroversion
Other: postpartum, pelvic organ prolapse, postoperative, vulvodynia (sometimes idiopathic)

30
Q 
Define: 
Dysmenorrhea 
Amenorrhea 
Polymenorrhea
Oligomenorrhea
Menorrhagia
Metrorrhagia 
Menometrorrhia
Contact bleeding
A

Dysmenorrhea: painful menses
Amenorrhea: no bleeding (primary or secondary)
Polymenorrhea: increased frequency
Oligomenorrhea: decreased frequency (cycle > 35 days)
Menorrhagia: increased duration OR flow
Metrorrhagia: irregular bleeding
Menometrorrhia: heavy AND irregular bleeding
Contact bleeding: postcoital or other

31
Q

Location of cervix:
Anterior = _____uterus
Posterior = _____uterus

A

Anterior cervix = retroverted uterus

Posterior cervix = anteverted uterus (most common)

32
Q

What types of HPV cause most cervical cancers (70%)?

A

18 and 16

33
Q

What types of HPV cause most genital warts?

A

11 and 6

34
Q

How can you tell if uterus is ante/retro/midposition with bimanual exam? What is a typical size and shape?

A

Place intravaginal fingers in posterior fornix and elevate cervix & uterus to abdominal wall.

If best felt by abdominal hand = anteverted (most common)
If best felt by intravaginal fingers = retroverted
If fundus not felt well by either hand = mid position

Size: fist (larger with multiparous or fibroids)
Shape: pear

35
Q

Normal ovary size and shape?

A

Size: 3X2X1
Shape: ovoid

Normally smooth, firm, mobile, mildly tender with compression

36
Q

Uterine fibroids (what are they and what is another name)

A

fibroids are also called leiyomyomata

Growth of smooth muscle, can be submucosal, intramural, subserosal, or pedunculate.
Bleeding fibroids are usually submucosal.

37
Q

Hydatidiform mole

A

Benign form of gestational trophoblastic neoplasm. Ovum fertilized with 2 sperm, or 1 sperm with duplication… abnormal fertilization.

Risk factors: maternal age > 40, low beta carotene diet, Vitamin A deficiency.

Diagnosis: no fetal heart, abnormally rapid progression/growth in pregnancy, high early B-hCG

Tx: D&C. Watch for thyroid storm post-op.

38
Q

Endometrial cancer (s/s)

A

Most common gynaecological CA

Post-menopause bleeding (always investigate) or abnormal uterine bleeding.

39
Q 
Ovarian CA 
Types
Risk
S/S
Investigations
A

3 types: germ cell, stromal cell, epithelial cell.

Risk factors: white, older age, family history, prolonged intervals of ovulation uninterrupted by pregnancy

Early: usually asymptomatic, vague abdominal symptoms (nausea, bloating, dyspepsia, early satiety), irregular bleeding (rare)

Late: increased abdominal girth, urinary frequency, constipation, ascites

Investigation: bimanual, U/S, lab: CA-125, LFTs, CBC, lytes, Cr.

40
Q

Cervical CA

A

Squamous cell CA (95%)
Early: water d/c –> brown or red, postcoital bleeding
Late: bleeding, pelvic/back pain, bowel/bladder symptoms

41
Q

Vulvular CA

A

Squamous cell CA (90%)
Asymptomatic or localized pruritus, lump, or ass, raised red, white or pigmented plaque, ulcer, bleeding, discharge, pain, dysuria

42
Q

Female infertility definition and Ddx

A

Definition: failure to conceive after 1 year unprotected sex

Ovulatory dysfunction (20-40% cases, PCOS, thyroid disease, hypothalamic pituitary dysfunction, etc)

Tubal factors (20-30% cases, PID, adhesions, tubal ligation, previous gynaecological surgery)

Cervical factors (anti-sperm antibodies, structural abnormalities, acidic mucus)

Uterine factors (polyps, injection, intrauterine adhesions, fibroids, endometriosis)

43
Q

Hematuria Ddx

A 
Cancer (bladder/urothelial, renal cell) 
UTI
BPH
Stone disease
Coagulopathy (anti-coagulants) 
Medical renal disease (proteinuria, urine casts)
44
Q

Urinary Incontinence Ddx

A 
OAB
cauda equina
stress incontinence
neurogenic bladder
weak detrusor muscle (overflow incontinence) 
pharmacologic (anticholinergics, sedatives, sympathetic blockers)
cystitis
prostatitis
45
Q

Peyronie’s disease

A

angulation of penile shaft on erection

46
Q

Testicular torsion

A 
adolescent to young adult males
preceded by trauma or spontaneous 
left side more common 
swollen, tender, high-riding
lifting increases pain (whereas epidydimitis decreases pain = phren/friend sign) 
no cremasteric reflex
47
Q

Prostate CA and PSA testing

A

Men > 75 years should not be tested
Males 50-75 years with life expectancy > 10 years should be informed of risks/benefits
Males at higher risk:
- african-american
- 1st gen relative
- high fat diet
- abnormal feeling prostate (discrete change in texture, fullness or symmetry)

NUNP 540 (Kelly's flashcards) (10 decks)

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